Chapter 10: Peds #2

Front 1

What is the prognosis for metatarsus varus?

Back 1

85% resolve by 3-4 years of age

- flexible = spontaneous resolution
- rigid = splinting

Front 2

What are the 3 components of CLUBBED FOOT?
Prognosis?

Back 2

1. Ankle - EQUINUS (plantarflexion)
2. Hindfoot - VARUS (heel inversion)
3. Forefoot - VARUS (inversion)

50% require surgical correction
*aka "talipes equinovarus"

Front 3

Name 3 neurologic conditions that may present with CAVUS foot

Back 3

1. Charcot Marie Tooth (HMSN I>II)
2. Poliomyelitis
3. Freidrich's Ataxia

Front 4

CAVUS foot is usually associated with what deformity of the toes?

Back 4

CLAW TOE - due to EXTENSOR contractures

MTP - hyperextended
IP - flexed

Front 5

What is BLOUNT's disease?
How do you treat it?

Back 5

TIBIA VARA
- abnormality in proximal tibial growth plate causes tibia to BOW OUTWARDS
- African American, obese children
- suspect if bow legged-ness continues after age TWO
-Tx = osteotomy of prox tib/fib

Front 6

Congenital hip dysplasia is more common in boys or girls?

Back 6

GIRLS

*esp if in BREECH position & if mother has h/o it

Front 7

How do you test for congenital hip dysplays (aka developmental dysplasia of the hip)

Back 7

1. Barlow - posteriorly dislocate hip with thumb
2. Ortolani - anteriorly reduce hip with long finger
3. Galeazzi - assess level of knees with hips flexed

Front 8

How do you treat congenital hip dysplays (aka developmental dysplasia of the hip)?

Back 8

Early dx: PAVLIK harness or hip SPICA cast - maintain reduction in 90-120 deg flexion x3-4 mos

Late dx: surgery

Front 9

Congenital torticollis most often involves which side?

Back 9

75% RIGHT sided

Front 10

What is an "'OLIVE" sign and what does it indicate?

Back 10

soft nontender enlargement in the SCM
- congenital torticollis

Front 11

Describe the position of the head & chin in a LEFT torticollis

Back 11

- HEAD tilted towards LEFT shoulder
- CHIN rotated to the RIGHT

Front 12

Most common cause of congenital torticollis?
What is another cause?

Back 12

fibrosis of SCM
- cervical hemivertebrae is another cause, which requires surgical FUSION

Front 13

If you see a patient with congenital torticollis what else should you check for on physical exam?

Back 13

Congenital HIP DYSPLASIA
- Ortolani & Barlow, Galeazzi

Front 14

In congenital torticollis, failure to regain full cervical range of motion by 1 year of age will lead to persistent _____

Back 14

facial asymmetry

Front 15

When should you recommend surgery for a patient that has congenital torticollis?

Back 15

Failure of stretching and conservative measures after 18-24 months, preferably prior to age 12 for best results

Front 16

What happens in a NURSEMAID's elbow?
How do you treat it?

Back 16

Radial head subluxes below annular ligament
Reduction = SUPINATION + EXTENSION

Front 17

What is Osgood-Schlatter's Disease? Who typically gets it?

Back 17

traction apophysitis of the ANTERIOR TIBIAL TUBERCLE
- adolescent BOYS>girls

Front 18

Tenderness to palpation over the anterior tibial tubercle in an adolescent male athlete = ?
Treatment?

Back 18

OSCGOOD-SCHLATTER
Tx: 4-8 wks strenuous activity restrict (no deep knee bending or repetitive knee flexion)

Front 19

What is the most common cause of limping & hip pain in children?

Back 19

transient TOXIC synovitis of the hip

Front 20

What is LEGG-CALVE-PERTHES disease? Who typically gets it?

Back 20

AVN of the proximal femur
- d/t rapid growth in relation to blood supply
BOYS>girls

Front 21

What is the most common hip disorder of preadolescent and adolescent children?

Back 21

SCFE - slipped capital femoral epyphysis

*obese Black BOYS

Front 22

Adolescent boy presents with a limp d/t pain in the groin that radiates into the ANTERIOR/MEDIAL thigh towards the knee. Also with decreased internal rotation, ext, abduction.

Back 22

Legg-calve-perthes - AVN of proximal femur

*Differential should include: SCFE & toxic synovitis as well

Front 23

What cause of hip pain/limp in adolescents is best treated with surgical pinning?

Back 23

SCFE
- need to prevent further epiphyseal displacement

Front 24

What cause of hip pain/limp in adolescents is usually treated with rest & and ABDUCTION brace?
What other treatment is available?

Back 24

LCP - legg-calve-perthes - AVN
- surgical varus osteotomy is also an option

Front 25

What cause of hip pain/limp in adolescents is usually treated with rest & NSAIDs?

Back 25

Acute Transient/Toxic synovitis of the hip
- resolves spontaneously in 3-5 days
- avoid full activity until pain free

Front 26

Legg-Calve-Perthes generally carries a good prognosis if diagnosed prior to what age?

Back 26

6 years old, <50% involvement of femoral head

*involvement of the LATERAL portion of the femoral head is POOR prognosis

Front 27

What type of scoliosis is reversible? irreversible?

Back 27

FUNCTIONAL = reversible

STRUCTURAL = irreversible

Front 28

Etiology of nearly 80% of all structural scoliosis?

Back 28

IDIOPATHIC - unknown etiology

Front 29

Development of idiopathic scoliosis is most common amongst what age group?

Back 29

Adolescent (>11 yo)

*least common amongst infants (<3 yo)

Front 30

Development of idiopathic scoliosis is most common amongst males or females?

Back 30

Infant = MALE
Juvenile = equal
Adloscent = equal

Front 31

Development of LEFT THORACOLUMBAR idiopathic scoliosis is most common amongst what age group?

Back 31

Infant (<3 yo)

Front 32

Development of RIGHT THORACIC or DOUBLE CURVE idiopathic scoliosis is most common amongst what age group?

Back 32

Juvenile (4-10 yo)

Front 33

Development of RIGHT THORACIC or LEFT LUMBAR idiopathic scoliosis is most common amongst what age group?

Back 33

Adolescent (>11 yo)

Front 34

ALL children with ANY congenital VERTEBRAL anomaly should be tested for what?

Back 34

anomalies of the GENITOURINARY SYSTEM
- RENAL ULTRASOUND

Front 35

Patients with congenital scoliosis are likely to have what other anomalies?

Back 35

- GU (unilateral renal agenesis)
- Spinal cord

Front 36

Acquired NEUROMUSCULAR scoliosis is most often due to what 4 pediatric diseases?

Back 36

1. CP
2. SMA
3. spina bifida
4. muscular DYSTROPHY

*uncommon in those that are able to WALK though

Front 37

When does a chlid with DUCHENNE typically develop scoliosis?

Back 37

When he can no longer walk -is wheelchair bound.

Front 38

Acquired CONNECTIVE TISSUE related scolioisis is most often due to what CT disorders?

Back 38

1. Ehlers-Danlos
2. Marfan's syndrome
3. Chondrodysplasia

Front 39

What test do schools typically use to screen for scoliosis?

Back 39

ADAMS test
- child bends forward wit straight legs as if touching toes
- examiner onbserves line of spine from occiput down
*keep in mind scoliotic deformity is 3D, so there is rotation as well as lateral curvature

Front 40

When performing an Adams Test on a patient you note a LEFT sided posterior prominence, what does this indicate?

Back 40

LEFT scoliosis
*Prominence = conVEX side of curve (APEX side)

Front 41

What measurement is used to quatify the angle of curvature on PA views?

Back 41

COBB angle

Front 42

At what Cobb angle do PFT abnormalities start to appear in thoracic scoliosis?

Back 42

50-60 degrees
- vital capacity is reduced

Front 43

Treatment for:
Scoliosis of any etiology with 1-20 degrees of curvature

Back 43

OBSERVE

Front 44

Treatment for:
Neruomuscular scoliosis with 20-40 degrees of curvature

Back 44

SURGERY
*sooner if rapidly progressing

Front 45

Treatment for:
Idiopathic scoliosis with 20-40 degrees of curvature

Back 45

BRACE

Front 46

Treatment for:
Idiopathic scoliosis with >40 degrees of curvature

Back 46

Surgery

Front 47

Treatment for:
Scoliosis d/t to CP with >40 degrees of curvature

Back 47

Surgery - may be able to wait until >60 degrees sometimes

Front 48

How do you make the radiologic diagnosis of SCHEUERMANN'S DISEASE?

Back 48

3 OR MORE consecutive vertebrae with...
5 DEGREES OR MORE of wedging

*Schmorl's nodes

Front 49

What are Schmorl's nodes indicative of on xray?

Back 49

Scheurmann's disease
- protusions of disc material into spongiosum of vertebral bodies

Front 50

How do you treat Scheurmann's disease?

Back 50

- Rest, ice, gentle stretching, NSAIDS
- possible TLSO for pain control
- physical exercise prohibited if pain + one or more irregular vertebral bodies on xray

Front 51

What type of spondylolisthesis is most common in children and at what levels does it most frequently occur?

Back 51

ISTHMIC - d/t previous spondylolysis (fx at pars)

L5, L4, L3

Front 52

Spondylolisthesis is more common in which sex?

Back 52

MALES

*females have more severe progression however

Front 53

What causes DYSPLASTIC spondylolisthesis?

Back 53

Lengthening of the LAMINA (without fx)

-associated w/ more severe neurologic signs than isthmic type d/t compression of cauda at L5

Front 54

What is the most common connective tissue disorder in children?

Back 54

JUVENILE RHEUMATOID ARTHRITIS

Front 55

Name the 5 types of JRA

Back 55

1. POLYartic - RF (-)
2. POLYartic - RF (+)
3. PAUCIartic - EARLY
4. PAUCIartic - LATE
5. Systemic (Still's)
*pauci are both RF (-)

Front 56

What is the most common type of JRA?

Back 56

PAUCI- articular (4 or less joints), RF NEGATIVE

Front 57

Which type of PAUCIarticular JRA is most common, Type I (early onset) or Type II (late onset)?

Back 57

TYPE I - EARLY ONSET

Front 58

POLYarticular JRA affects boys or girls more?

Back 58

GIRLS

Front 59

What type of JRA?
Female > 11 yo -symmetric joint involvement

Back 59

POLY-POSITIVE

*also erosive disease, subq nodules

Front 60

What type of JRA?
Complaint of STIFFNESS but not pain, high change of hip involvement

Back 60

POLY-NEGATIVE

Front 61

What type of JRA?
Female <4 yo

Back 61

PAUCI-EARLY onset

*Needs an eye exam to check for IRIDOCYCLITIS

Front 62

What type of JRA?
High risk of IRIDOCYCLTIS

Back 62

PAUCI-EARLY
PAUCI-LATE

Front 63

What type of JRA?
Boy 9-10 yo

Back 63

PAUCI-LATE

Front 64

What type of JRA?
HLA-B27 association in 90%

Back 64

PAUCI-LATE

*50% later develop AS or other seronegative spondyloarthropathies

Front 65

What type of JRA?
Least common

Back 65

STILL's disease = SYSTEMIC onset JRA

Front 66

What type of JRA?
Acute rash, fever, fatigue, myalgia, pericarditis, hepatosplenomegaly

Back 66

SYSTEMIC (Still's) - small joints

Front 67

What type of JRA?
Sacroiliitis

Back 67

PAUCI-LATE

Front 68

What type of JRA?
ANA (+)

Back 68

POLY-POSITIVE
POLY-NEGATIVE
PAUCI-EARLY

Front 69

What type of JRA?
ANA (-)

Back 69

PAUCI-LATE
SYSTEMIC (Still's)

Front 70

What type of JRA?
Usually good outcome in terms of severity of arthritis

Back 70

PAUCI-EARLY

Front 71

What type of JRA?
SEVERE arthritis in > 50%

Back 71

POLY-POSITIVE

Front 72

Adult or Juvenile RA?
Systemic features are more common

Back 72

JUVENILE

Front 73

Adult or Juvenile RA?
More frequent LARGE joint involvement

Back 73

JUVENILE

Front 74

Adult or Juvenile RA?
EARLY joint destruction

Back 74

ADULT

Front 75

Adult or Juvenile RA?
EARLY synovitis, LATE erosive disease

Back 75

JUVENILE

Front 76

Adult or Juvenile RA?
Rheumatoid nodules are more likely

Back 76

ADULT

Front 77

Adult or Juvenile RA?
CERVICAL spine involvement is more likely

Back 77

JUVENILE

*atlantoaxial joint can sublux

Front 78

Adult or Juvenile RA?
ULNAR deviation at the WRIST with loss of wrist extensors

Back 78

JUVENILE

*in adult ulnar deviation happens at the MCP (fingers)

Front 79

Adult or Juvenile RA?
RADIAL deviation of the MCP joints

Back 79

JUVENILE

*In adult MCP joints display ULNAR deviation

Front 80

What is REYE's SYNDROME?

Back 80

Occurs with use of ASPIRIN in context of
- INFLUENZA
- VARICELLA
*affects mutliple organs esp BRAIN & LIVER

Front 81

In terms of medications, what is the mainstay of treatment for JRA?

Back 81

1. NSAIDS - naproxen, ibuprofen, tolmetin
2. DMARDs - hydroxychloroquine, gold salts, D-penicillamine, sulfasalazine
3. Immunosuppressants (cyclosporine, azathioprine)
4. Steroids

Front 82

Adult or Juvenile RA?
ULNAR deviation of the MCP joints

Back 82

ADULT

*juvenile develops ULNAR deviation at the WRIST & RADIAL deviation at the MCP

Front 83

Adult or Juvenile RA?
Development of hip FLEXION contracture with INternal rotation & ADDuction

Back 83

JUVENILE

*adults have hip flexion contracture with EXternal rotation & ABDuction (kids stay closer, adults go farther away)

Front 84

Adult or Juvenile RA?
Development of hip FLEXION contracture with EXternal rotation & ABDuction

Back 84

ADULT

*juvnile has hip flexion contracture with INternal rotation & ADDuction (kids stay closer, adults go farther away)

Front 85

What are some negative prognostic factors for JRA?

Back 85

RF POSITIVE
HIP involvement
OLDER age at onset
Longer duration of disease (esp if >7 years)
Multiple SMALL joints involved
EARLY EROSION

Front 86

What triad of symptoms characterizes REITER'S SYNDROME?

Back 86

1. ASYMMETRIC arthritis
2. conjunctivitis
3. urethritis/gastroenteritis

*joints, eyes, GU/GI

Front 87

Which joints are most commonly affected in REITER'S?

Back 87

1. Knee
2. Ankle

*oligoarthritis

Front 88

Joint aches, nail pitting, hyperkeratosis & anterior uveitis in a 13 yo girl

Back 88

Juvenile onset PSORIATIC ARTHRITIS

Front 89

What type of serological profile might you see in someone with SLE?

Back 89

1. anti-DNA Ab
2. anti-Sm Ab
3. ANA(+)
4. False positive syphilis

Front 90

What type of arthritis is characteristic of SLE?

Back 90

NON-EROSIVE

Front 91

Pathologic organism responsible for LYME DISEASE?

Back 91

spirochete = borrelia burgdorferi
deer tick = ixodes dammini

Front 92

Tx for Lyme disease?

Back 92

- doxycycline
- amoxicillin
- erythromycin

Front 93

boys or girls >4 yo, pain/swelling arthritis in large joints, CARDITIS, fever, rash, w/ history of prior Streptococcal infection

Back 93

Rhemuatic fever

- Dx using JONES criteria
*also chorea, subq nodules, elevated ESR/CRP

Front 94

Most common cause of septic arthritis in newborns?

Back 94

Staph aureus

Front 95

Most common cause of septic arthritis in children 2 months to 2 yo?

Back 95

H. Influenza

Front 96

Most common cause of septic arthritis in children >2 yo?

Back 96

Staph aureus

Front 97

Most common cause of septic arthritis in adolescents?

Back 97

Gonoccoal disease (if sexually active)

Front 98

A pediatric patient with HEMARTHROSIS should make you include what in your differential?

Back 98

HEMOPHILIA

Front 99

Deficiency of factor VIII

Back 99

hemophilia A

Front 100

Deficiency of factor IX

Back 100

hemophilia B

Front 101

Deficiency of factor XI

Back 101

hemophilia C

Front 102

Kawasaki's disease is more common in boys or girls?

Back 102

BOYS
usually YOUNGER than FOUR YEARS OLD

Front 103

Strawberry tongue, red/chapped lips, conjunctival injection, hand/foot edema, erythema of palms/soles, rash, in a 3 yo boy

Back 103

KAWASAKI's disease (infantile polyarteritis)

Front 104

Burn injuries in the pediatric population tend to happen more to girls or boys?
By what mechanism?

Back 104

BOYS - usually SCALDING

Front 105

How do you calculate the RULE OF 9's in an ADULT?

Back 105

Head = 9
Arm = 9
Chest = 18
Back = 18
Leg = 18
Groin = 1

Front 106

How do you calculate the RULE OF 9's in a CHILD?

Back 106

Head = 18 (double that of adult)
Arm = 9
Chest = 18
Back = 18
Leg = 13.5
Groin = 1
*take 4.5 away from each leg and give it to the head

Front 107

How deep is a PARTIAL thickness burn (2nd degree)?

Back 107

- through epidermis
- part of dermis

*can be more superficial - red/wet/blister/pain
*can be deeper - white/dry/hyposensitive

Front 108

How deep is a FULL thickness burn (3rd degree)?

Back 108

- through epidermis
- through dermis
- visible SUBCUTANEOUS tissue

*dry, white, leathery, anesthetic -nerve endings are in the dermis

Front 109

What is the "5-10-20" rule?

Back 109

Criteria for hospitalization d/t burns:
5% FULL THICKNESS
10% TBSA if child or elderly
20% TBSA

*also eyes/ears/face/hands/feet/genitals, inhalation, electrical, comorbidities, cotrauma

Front 110

Proper positioning of a pediatric burn patient:
forearm supination or pronation?

Back 110

SUPINATION

Front 111

Proper positioning of a pediatric burn patient:
neck flexion or extension?

Back 111

EXTENSION (hyperextension initially)
***NO PILLOWS!!!***
***Check occiput often for pressure ulcers!!!***

Front 112

Proper positioning of a pediatric burn patient:
Burn to dorsum of hand

Back 112

MCP: 70-90 flexion
IP: full extension

Front 113

Proper positioning of a pediatric burn patient:
Burn to volar (palmar) surface of hand

Back 113

- all joints fully extended (including MCP)
- fingers ABducted
- thumb in radial abduction (as opposed to palmar)

Front 114

Proper positioning of a pediatric burn patient:
Hip burns

Back 114

EXTENSION
ABDuction (10 degrees)
neutral rotation

Front 115

Proper positioning of a pediatric burn patient:
Burn to SOLE of foot

Back 115

90 degrees DORSIflexion at ankle
- toes neutral

Front 116

Why should you be extra cautious when considering the use of Ultrasound in a pediatric burn patient to help soften connective tissue?

Back 116

US can cause premature closing of the epiphyseal growth plate

Front 117

What 4 areas of burns require special attention?

Back 117

1. Neck
2. Axilla
3. Hands
4. Feet

Front 118

What is an airplane splint used for?

Back 118

To prevent AXILLA contractures
- holds arm in 90 degrees ABduction, neutral rotation

Front 119

What is the most commonly involved area of burned related contractures in the pediatric population?

Back 119

Axilla

Front 120

What should be done immediately in the acute phase of a hand or foot burn in a child?

Back 120

Wrap digits individually to maintain average spacing

Front 121

Proper positioning of a pediatric burn patient:
Burn to DORSUM of foot

Back 121

PLANTARflexed ankle & toes