Derm Review; Ped Orthopedics

Front 1

4 layers of epidermis

Back 1

Corneum
Granulosum
Spinosum
Basal

Front 2

langerhan's cell: what line?

Back 2

hematopoietic

Front 3

dendritic cells (antigen-presenting immune cells) of the skin and mucosa

Back 3

langerhans cell

Front 4

melanocytes: what line?

Back 4

neural crest

Front 5

Hair: 3 phases of growth

Back 5

anagen
catagen
telogen

Front 6

Hair spends most time in what phase?

Back 6

anagen - growing phase (the length of this determines length of hair)

Front 7

It takes ____ weeks for a keratinocyte to make it to the corneum. Once there, it remains for ____ weeks.

Back 7

2; 2

Front 8

What should be thought of when a linear lesion is seen?

Back 8

an EXTERNAL cause.

Front 9

Seborrheic dermatitis (dandruff) is due to a hypersensitivity to what?

Back 9

yeast Malassezia

Front 10

T/F KOH test in Seborrheic dermatitis (dandruff) is positive.

Back 10

F. It's due to a HYPERSENSITIVITY, not an overgrowth of the yeast.

Front 11

Koebner phenomenon aka Koebnerization: defn

Back 11

refers to skin lesions appearing on lines of trauma

Front 12

Pityriasis rosea rash can mimic _______

Back 12

syphillis. Must rule out syphillis.

Front 13

T/F KOH test in tinea infections is positive.

Back 13

T

Front 14

acne rosacea: defn

Back 14

chronic condition characterized by facial erythema (redness)
Pimples are sometimes included as part of the definition.[3] Unless it affects the eyes, it is typically a harmless cosmetic condition. Treatment in the form of topical steroids can aggravate the condition.[4]

Front 15

acne rosacea: ethnic associations

Back 15

It primarily affects Caucasians of mainly north western European descent

Front 16

Rhinophyma : defn

Back 16

a descriptive term for a large, bulbous, ruddy appearance of the nose caused by granulomatous infiltration, commonly due to untreated rosacea

Front 17

Characteristic lesions of 2ndary syphilis

Back 17

Copper penny lesion

condyloma lata

Front 18

most common subtype of porphyria

Back 18

Porphyria cutanea tarda

Front 19

One of the most common risk factors observed for Porphyria cutanea tarda

Back 19

infection with the Hepatitis C virus.

Front 20

Porphyria cutanea tarda: sx

Back 20

The disease is characterized by onycholysis and blistering of the skin in areas that receive higher levels of exposure to sunlight.

Front 21

detachment of the nail from the nail bed

Back 21

onycholysis

Front 22

Sarcoidosis: ____% have cutaneous involvement

Back 22

40

Front 23

____ lupus is associated with scarring

Back 23

discoid (chronic cutaneous type)

Front 24

Chronic skin condition of sores with inflammation and scarring favoring the face, ears, and scalp and at times on other body areas. These lesions develop as a red, inflamed patch with a scaling and crusty appearance. The center areas may appear lighter in color with a rim darker than the normal skin.

Back 24

Discoid lupus erythematosus

Front 25

T/F Discoid lupus erythematosus can be divided into localized, generalized and childhood discoid lupus erythematosus

Back 25

T

Front 26

Connective-tissue disease characterized by inflammation of the muscles and the skin.

Back 26

dermatomyositis

Front 27

dermatomyositis: characteristic lesions

Back 27

Heliotrope (eyelid color changes)

Nail fold changes

Front 28

Necrobiosis Lipoidica: associated with what disease?

Back 28

DM

Front 29

Acanthosis nigricans: associated with what disease?

Back 29

Insulin resistance (DM and PCOS)

Front 30

Erythema nodosum: associated with what disease?

Back 30

sarcoidosis

Front 31

inflammation of the fat cells under the skin (panniculitis)[1] characterized by tender red nodules or lumps that are usually seen on both shins.

Back 31

Erythema nodosum

Front 32

Tuberous sclerosis: typical lesion

Back 32

ash leaf depigmentation

Front 33

Most common type of drug rash/eruption

Back 33

morbilliform

Front 34

Highly specific findings for child abuse

Back 34

1) Femur fracture in child <1 yo (non-ambulatory)

2) Humeral shaft fracture in less than 3 yo

3) Sternal fractures

4) Metaphyseal corner fractures

5) Posterior rib fractures

6) Digit fractures in nonambulatory children

Front 35

Workup for suspected child abuse

Back 35

1) Skeletal survey xray series

2) CPS involvement

3) Head CT

4) Ophtho consult

Front 36

In-toeing: 3 causes

Back 36

1) Metatarsal adductus
2) Tibial torsion (most common)
3) Femoral anteversion

Front 37

Metatarsal adductus: tx

Back 37

85% resolve spontaneously.

For the 15%:
Stretching/
observation
casts
reverse last shoes
surgery last resort

Front 38

tibial torsion: tx

Back 38

Improves with growth, usually by 5 years old.

Surgery rarely needed. Bracing is ineffective.

Front 39

femoral anteversion: tx

Back 39

Usually corrects by 8-10.

Bracing ineffective.

Femoral osteotomies if severe.

Front 40

Physiologic Bowing: cause

Back 40

many babies born bowlegged from intrauterine positioning. When limbs form they're slightly inwardly rotated.

Front 41

Physiologic Bowing: when does it resolve?

Back 41

When child starts walking, usually by 2 years old.

Front 42

Blount's disease: defn

Back 42

growth disorder of the shin bone (tibia) in which the lower leg turns inward, resembling a bowleg. Symptoms: One or both of the lower legs turn inward. This is called "bowing."

Front 43

Blount's disease: treatment

Back 43

1) Brace if still worsening at age 2.
2) Surgery if >3.5 years old.
3) MUST be fixed by age 4.

Front 44

Blount's disease: main concerns

Back 44

Must be fixed by age 4 or else it can affect the growth plates, shutting down bone growth.

Front 45

Developmental Dysplasia of the Hip (DDH): defn

Back 45

abnormal development or dislocation of hip
Can be associated with metatarsus adductus and torticollis

Front 46

Developmental Dysplasia of the Hip (DDH): signs and symptoms

Back 46

Asymmetric gluteal folds

Decreased or asymmetric abduction of flexed hips.

Ortolani and Barlow - positive tests

Trendelenburg stance in older kids.

Front 47

Ortolani test: defn

Back 47

Elevation and ABduction of femur relocates a dislocated hip

Front 48

Barlow test: defn

Back 48

Depression and ADduction dislocates a dislocatable hip

Front 49

Developmental Dysplasia of the Hip (DDH): dx

Back 49

ULTRASOUND in <3 months old - bones aren't sufficiently calcified until around 3 months of age.

Front 50

Developmental Dysplasia of the Hip (DDH): tx

Back 50

Pavlik harness for at least 6 weeks, continuously.

Front 51

Pavlik harness: what does it treat?

Back 51

Harness that Most important that makes sure hips are flexed 90-110 degrees and not held in maximal abduction

Front 52

Galeazzi sign: defn

Back 52

Short femur on affected side

Front 53

Slipped Capital Femoral Epiphysis (SCFE): defn and pathophys

Back 53

fracture through the physis (the growth plate) due to weakness of the hypertrophic zone. Results in slippage of the overlying epiphysis.

Front 54

Slipped Capital Femoral Epiphysis (SCFE): what demographic?

Back 54

Adolescent obese black males

Front 55

Slipped Capital Femoral Epiphysis (SCFE): symptoms

Back 55

Limp, external rotation gait, hip or thigh pain OR (referred) knee pain

Front 56

Slipped Capital Femoral Epiphysis (SCFE): most feared complication

Back 56

Avascular necrosis of femoral head - child will need total hip replacement.

Front 57

Slipped Capital Femoral Epiphysis (SCFE): PE findings

Back 57

Decreased internal rotation and pain.

May have obligate external rotation as hip is flexed along with overall decreased flexion.

Front 58

Slipped Capital Femoral Epiphysis (SCFE): stable vs unstable

Back 58

Stable: weight bearing is possible, but need to be treated quickly to avoid becoming unstable.

Unstable - severe pain prevents weight-bearing. 50% risk of AVN.

Front 59

Slipped Capital Femoral Epiphysis (SCFE): treatment

Back 59

Put pins in it just the way it is - no reduction (reduction increases risk of AVN).

Front 60

T/F Stable slips must be treated relatively quickly to avoid it becoming an unstable SCFE and increasing the chance of AVN.

Back 60

T

Front 61

Congenital Talipes Equinovarus is aka

Back 61

Clubfoot

Front 62

What is CAVE?

Back 62

Cavus - fixed plantar flexion

forefoot Adducted

Varus hindfoot - pointed out

Equinus (plantar flexed)

Front 63

Ponseti technique: defn

Back 63

manipulative technique that corrects congenital clubfoot without invasive surgery.

Involves stretching with serial long leg casts for up to 4 years.

Abducts and dorsiflexes the foot.

Front 64

Kocher's criteria for diagnosing a septic joint vs transient synovitis

Back 64

Febrile (>101.5)

Elevated WBC

Elevated ESR

Elevated C-reactive protein

Patient is not weight-bearing on the joint.

Front 65

T/F Pus is chondrolytic

Back 65

T! It destroys cartilage, which is why a joint infection must be drained.

Front 66

Septic joint: tx

Back 66

Incision and drainage

(+ Abx)

Front 67

Clubfoot is associated with what?

Back 67

associated with hand anomalies, diastrophic dwarfism, arthrogryposis, and myelomeningocele (spina bifida)

Front 68

Bacteria causing septic joints

Back 68

Staph

Gonorrhea (especially consider in teens)

Group B Strep (more rare now)