The Little People: MSK issues Flashcards by Magda Kazmierczak

C/P of kid with Ewing’s Sarcoma

Pain and swelling for wks/months
mc in metaphysis and diaphysis of femur, tibia or humerus
intermittent fevers, leukocytosis, anemia, Increased ESR

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Ewing’s on xray

lamellated or onion skin periosteal reaction
lesion: lystic, central and accompanied by endosteal scalloping
mottled appearance extension into soft tissue

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Osteomyelitis on xray

central cystic bone defect w/ surrounding sclerosis termed Brodie’s abscess

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age of person with fibrosarcoma

30-60 yrs old

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mc place for glomus tumor

subungual-70% of time
other plcases palm and wrist
4th decade of life F>M

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glomus tumor: triad

common vascular benign tumor triad:

intermittent pain, tenderness and sensitivity to touch

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meconium ileus is assoc w/

cystic fibrosis

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asymptomatic kid at birth, initially healthy. 2 months in jaundice and acholic stools

biliary atresia

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Who loves you more than anyone in the entire world? hint: its a bug

me :)

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Maternal estrogen effects in newborns

Breast hypertrophy
swollen labia
physiologic leukorrhea (white vaginal discharge)
uterine withdrawal bleeding

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By age 12 months weight should (1) and height should (2)

triple

2. increase by 50%

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mc Child vaginal foreign body

toilet paper

small toys..objects

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foreign body in vagina C/f

foul-smelling vaginal discharge,
intermittent bleeding or spotting,
occasional urinary complaints

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Rx of foreign body in vagina

examine and removal

use Calcium alginate swab or irrigation w/ warmed fluids

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Erb-Duchenne palsy

Shoulder dystocia: “Waiters tip”

injury to c5-c7

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C5 innervates

deltoid and infraspinatus

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C6 innervates

biceps

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C7 innervates

wrist/finger extensors

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Septic arthritis in kid, what do you do first?

blood and synovial fluid culture PRIOR to administering empiric antibiotics
Must do Arthrocentesis

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Septic arthritis organisms and Rx? birth to 3 months

Organism: Staphylococcus, GBS, gram neg bacilli
Rx: Antistaphyloccocal (nafcillin or vanco) PLUS gentamicin or cefotaxime

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Septic arthritis in kid older than 3 months, organisms and Rx?

Organisms: Staphylococcus, GAS, S.pneumoniae
Rx: nafcillin, clindamycin, cefazolin, or Vanco

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MC bone tumor in kids and young adults

Osteosarcoma

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Frequent location of Osteosarcoma

metaphyses of long bones:

distal femur, prox tibia, proximal humerus

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Characteristic xray findings of osteosarcoma

spiculated "sunburst" pattern
periosteal elevation (codman triangle)

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Rx of osteosarcoma

Tumor excision | Chemotherapy

Second MC bone malignancy

Ewings Sarcoma

Osteoid osteoma

sclerotic cortical lesion with central nidus of lucency

Osteoid osteoma C/F and Rx

Pain worse at night and not related to activity | Rx: NSAIDs

Classic child with limp. age 4-12

Legg-Calve Perthes disease (LCP)

LCP C/F

Mild chronic hip/knee pain of insidious onset w/ antalgic gait idiopathic osteonecrosis of femoral head

If xrays negative. Kid post infection comes in with limp, | Dx?

Transient synovitis | MC follow viral infection

As LCP disease progresses what can happen to the leg

Internal rotation and abduction at the hip joint | proximal thigh atrophy

Kid with SS disease had a painful crisis 3 months ago comes in with hip pain, restricted abduction and Internal Rotation of hip; Dx?

Avascular necrosis

Why kids usually don't get aseptic necrosis of femoral hip?

Have patent blood supply via ascending arteries and foveal artery which lie w/in the ligamentum teres. Obliterates later in life

Dad pulls on daughters hand and now she has pain. She keeps her hand in the extended, pronated position without moving it. Dx?

Radial head subluxation | nursemaids elbow

How nursemaids elbow happens

axial traction on forearm with elbow extended | radial head pulled through annular ligament around it

Rx radial head subluxation

Hyperpronation of forearm or | Supination of forearm and flexion of elbow

chronic inflammatory papulosquamous disease; yellow papules and occasional scaling plaques; mc around eyebrows, nasolabial folds, eyelashes, paranasal skin

Seborrheic dermatitis

Rx of Seborrheic dermatitis

``` moisturizers topical antifungals, anti-dandruff shampoos topical steroids If severe--> underlying ID ```

Red, Sharply demarcated, scaling lesions that may coalesce to form round or oval plaques

Psoriasis | onset: 20-50s

Infant: Itchy, red, scaly crusted lesions on extensor surfaces, trunk, cheeks and scalp Child adult: lichenified plaques in flexor creases

Atopic dermatitis | Eczema

Rx: eczema

Topical emollients +/- steroid ointment

Complications of atopic dermatitis

Eczema herpeticum Cellulitis/abscess discomfort interfering w/ daily activities and sleep

Foot deformity: aduction of anterior aspect of ft w/ convex lateral border and concave medial border; active mt of ft overcorrects the deformity into abduction; Dx?

Metatarsus adductus type 1

Type 1 metatarsus adductus

ft that overcorrect both passively and actively into abduction

Type II metatarsus adductus

ft correct to neutral position w/ passive and active mvts

Type III metatarsus adductus

rigid ft and do not correct

Rx of metatarsus adductus

Type 1: reassurance Type 2: orthosis or corrective shoes, sometimes cast type 3: serial casts

obese boy with pain in hip, 10-16 years, altered gait; Dx?

Slipped capital femoral epiphysis (SCFE)

kids with SCFE hold leg in

affected hip in passive external rotation and exhibit decreased internal rotation, abduction and flexion

Rx SCFE

stat surgical screw fixation to avoid avascular necrosis

femoral neck stress Fx c/f

runners or athletes in training hip pain, esp w/ actiity pain w/ passive ROM esp internal and external rotation

Legg Calve Perthes disease

AVN of hip common in boys age 5-7

Vit D deficiency Labs

``` Ca: N/Decreased Phosphorus: N/Decreased ALP: INCreased PTH: Increased 25-OH Vit D: Decreased ```

eczema herpeticum is what

form of primary HSV infection that is assoc w/ atopic dermatitis

eczema herpeticum apperance

numerous umbilicated vesicles over the area of healing atopic dermatitis are typical

Rx of eczema herpeticum

STAT acyclovir

osteomyelitis in SS kids, mC organisma

Salmonella | S. Aureus

Growing pains

Occur at night and resolve by morning Affect LE usually bilateral Normal PE and activity

Rx growing pains

Parental education & reassurance | Massage, stretching exercises, heat and analgesics

subperiosteal hemorrhage, limited to the surface of one cranial bone

Cephalohematoma | spontaneously heal w/in 2 wks to 3 months

diffuse, sometimes ecchymotic, swelling of scalp, extends across suture lines

caput succedaneum

back pain, neuro dysfunction (Urinary incontince, anal sensation), palpable "step off" at L-S area..... Dx?

Spondylolisthesis

Compartment syndrome C/f

``` Severe pain (w/ increase meds not helping) pallor poiklothermia paresthesias late findings: pulselessness/paralysis ```

Single lytic bone lesion on xray, overlying tender swelling and pain; labs show hypercalcemia, dx?

Langerhans cell histriocytosis

Precocious puberty, cafe au lait spots multiple bone defects endorcine disorder: Hyperthyroid, prolactin, GH tumor, adrenal hypercortilism; DX?

McCune Albright Syndrome

McCune Albright syndrome defect?

defect in the G protein cAMP-kinase function: autonomous activity of that tissue

3 ps of Mccune albright

Precocious puberty pigmentation: cafe au lait polyostotic fibrous dysplasia

Osteogenesis imperfect inherited defect

AD mutation of COL1A1

Patient with OI present w/

``` Osteopenia blue sclerae Recurrent Fx, bruising, hypotonia Hearing loss Dentigenesis imperfecta ```

Albright hereditary osteodystrophy (AHOD) chemical findings

low Ca, High PO4 High PTH (resistance to PTH)

Phenotype of AHOD

``` Short statue: delayed BA MR Increased bone density throughout body (skull) brachydactyly Obesity: round face Short neck Subscapular cataracts Cutaneous/subcutaneous/ perivascular calcification of Basal ganglia ```

what can develop with prolonged immobilization, Fx? labs,,,

hypercalcemia | hypercalciuria

vit d resistant rickets labs

low PO4 | Normal Ca

Common presentation of JRA

1-4 y/o blue-eyed, blonde female with arthritis of knee/ankle. High risk for uveitis

The Little People: MSK issues Flashcards

(75 cards)