Ob Paeds - Introduction

Front 1

_________________children are victims of substantiated abuse or neglect in United States each year

Back 1

>1 million

Front 2

child abuse is the_______________ most common cause of death in children _________ _________ ________

Back 2

second, behind accidental injury

Front 3

in child abuse, ________ ___________is the most frequent cause of long term physical morbidity in the child

Back 3

head injury

Front 4

child abuse most common in children______years old

Back 4

< 3

Front 5

child abuse social RF ___________, _______________, ____________

Back 5

recent job loss of parent, children with disabilities (cerebral palsy, premature), step children

Front 6

If unreported, _______chance of repeat abuse and ___________ chance of death from abuse

Back 6

30-50%, 5-10%

Front 7

Child abuse red flags (7)

Back 7

1. long bone fxs in infant that is not yet walking
2. multiple bruises
3. multiple fxs in various stages of healing
4. corner fxs
5. posterior rib fractures
6. bucket handle fractures
7. transphyseal separation of the distal humerus

Front 8

corner fxs are through ______________, and are caused by _______________

Back 8

primary spongiosa (metaphyseal), high specificity for child abuse

Front 9

bucket handle fractures are _________ as corner fractures, avulsed bone fragment is seen__________

Back 9

same, en face as a bucket handle

Front 10

child abuse frequency of fractures:
_________ >________ > ____________,

_________ fractures_ times more common than ______

Back 10

humerus>tibia>femur
diaphyseal fractures 4 times more common than metaphyseal

Front 11

child abuse most common presenting lesion

Back 11

skin lesions

Front 12

Child abuse radiography
Initial evaluation should include __________
______________used as an alternative or adjunctive study for patients ________ _________ _________as skeletal surveys not as reliable in older children

Back 12

skeletal survey, bone scan, 5 years of age or older

Front 13

Reporting suspected child abuse is ______________

Back 13

Reporting suspected child abuse is mandatory

Front 14

mortality rate following pediatric polytrauma is __________

Back 14

mortality rate following pediatric polytrauma is 20%

Front 15

Peds trauma
__________ ____________ have highest morbidity/mortality overall

Back 15

CNS injuries have highest morbidity/mortality overall

Front 16

Peds Trauma: ____________ ________ have highest morbidity/mortality among musculoskeletal injuries

Back 16

spine fracture have highest morbidity/mortality among musculoskeletal injuries

Front 17

cervical spine injuries more common in children_____ years-old

Back 17

cervical spine injuries more common in children <8-years-old

Front 18

__________needed in spine board when transporting children _________. Larger head size can ______ unstable cervical spine leading to injury during transport

Back 18

Occipital cut-out, <6 Y/O. Larger head size can flex unstable cervical spine leading to injury during transport

Front 19

Peds trauma: ____________commonly needed due to difficulty obtaining venous access

Back 19

Intraosseous lines commonly needed due to difficulty obtaining venous access

Front 20

Children may remain______ ________ even after significant blood loss

Back 20

Children may remain hemodynamically stable even after significant blood loss

Front 21

Pediatric triad of death: ___________, ____________, ___________

Back 21

acidosis, hypothermia, coagulopathy

Front 22

blood volume for pediatric patients __________

Back 22

75 - 80 mL/kg

Front 23

Peds trauma score:
PTS<0=_____ mortality
PTS of 1-4=_______ mortality
PTS of 5-8=_______ mortality

PTS less than or equal to_______should be sent to designated peds trauma center

Back 23

PTS<0=100% mortality
PTS of 1-4=40% mortality
PTS of 5-8=7% mortality

PTS less than or equal to 8 should be sent to designated peds trauma center

Front 24

__________at presentation and _______72hrs post-injury are both prognostic of long-term neurologic recovery

Back 24

O2 sat at presentation and GCS 72hrs post-injury are both prognostic of long-term neurologic recovery

Front 25

ICP can be elevated by___________. it is possible to decrease ICP by ______________ _________

Back 25

ICP can be elevated by pain. it is possible to decrease ICP by fracture fixation

Front 26

heterotopic ossification is more common following __________ __________ injury

Back 26

heterotopic ossification is more common following traumatic brain injury

Front 27

increase __________ __________ ___________ heralds onset of HO. __________ _________ is indicated in these situations

Back 27

increase serum alkaline phosphatase heralds onset of HO. NSAID prophylaxis is indicated in these situations

Front 28

Pediatric trauma.
Peripheral nerve injuries most common in_______fractures. obtain ________if no return of function __________ after injury

Back 28

Peripheral nerve injuries most common in closed fractures. obtain EMG if no return of function 2-3 months after injury

Front 29

Unique principals in pediatric bone are __________ and __________ __________.

Back 29

Unique principals in pediatric bone are elasticity and remodeling potential.

Front 30

elasticity leads to unique fracture patterns __________ _________and ____________ __________.

Back 30

elasticity leads to unique fracture patterns buckle fractures and greenstick fractures

Front 31

remodeling occurs more rapidly in_______ _____ _________ _________. _______ ___________ in wrist, due to primarily ___________

Back 31

remodeling occurs more rapidly in plane of joint motion sagittal plane in wrist, due to primarily extension/flexion

Front 32

remodeling occurs more at the________ _______ physes, due to _________ _______ and potential for remodeling

Back 32

remodeling occurs more at the most active physes, due to most growth and potential for remodeling

Front 33

most active physes in upper extremity are __________ __________ (_____ longitudinal growth) and ___________ __________

Back 33

most active physes in upper extremity are proximal humerus (80% longitudinal growth) and distal radius

Front 34

most active physes in lower extremity are ________ _________ and _____________ __________

Back 34

most active physes in lower extremity are distal femu and proximal tibia

Front 35

Zones of the physis (5). Physis pheriphery 92)

Back 35

1. Reserve zone
2. Proliferative zone
3. Hypertrophic zone
4. Primary spongiosa
5. Secondary spongiosa

1. Groove of Ranvier
2. Perichondrial fibrous ring of La Croix

Front 36

Gaucher's zone

Back 36

Reserve zone

Front 37

Diastrophic Dysplasia zone

Back 37

Reserve zone

Front 38

Kneist Zone

Back 38

Reserve zone and Hypertrophic zone

Front 39

Pseudoachondroplasia zone

Back 39

Reserve zone

Front 40

Achondroplasia zone

Back 40

Proliferative zone

Front 41

Giagantism Zone

Back 41

Proliferative zone

Front 42

MHE Zone

Back 42

Proliferative zone

Front 43

SCFE Zone

Back 43

Hypertrophic zone

Front 44

Rickets Zone

Back 44

Hypertrophic zone

Front 45

Enchondroma Zone

Back 45

Hypertrophic zone

Front 46

Mucopolysacharide disease Zone

Back 46

Hypertrophic zone

Front 47

SED Zone

Back 47

Hypertrophic zone

Front 48

MED Zone

Back 48

Hypertrophic zone

Front 49

Schmids Zone

Back 49

Hypertrophic zone

Front 50

Transphyseal fractures Zone

Back 50

Hypertrophic zone

Front 51

Metaphyseal "corner fracture" Zone

Back 51

Primary spongiosa

Front 52

Scurvy Zone

Back 52

Primary spongiosa

Front 53

Renal SCFE Zone

Back 53

Secondary spongiosa

Front 54

OStechondroma Zone

Back 54

Groove of Ranvier

Front 55

Reserve zone Cells store __________,_____________,________ aggregates for later ________ _____ ________ ___________. _______oxygen tension.

Back 55

Reserve zone Cells store lipids, glycogen, and proteoglycan aggregates for later growth and matrix production. Low oxygen tension.

Front 56

Proliferative zone chondrocytes with________ growth and __________of chondrocytes. ________rate of extracellular matrix production. __________oxygen tension in surroundings __________ calcification

Back 56

Proliferative zone chondrocytes with longitudinal growth and stacking of chondrocytes. Highest rate of extracellular matrix production. Increased oxygen tension in surroundings inhibits calcification

Front 57

3 phases of the hypertrophic zone.

Back 57

1. Maturation zone
2. Degenerative zone
3. Provisional calcification zone

Front 58

Maturation zone: preparation of __________ ______ _______, __________ growth

Back 58

Maturation zone: preparation of matrix for calcification, chondrocyte growth

Front 59

Degenerative zone chondrocyte ________________

Back 59

Degenerative zone chondrocyte growth in size (5x)

Front 60

Provisional calcification zone: chondrocyte________ allows calcium release, allowing calcification of matrix

Back 60

Provisional calcification zone: chondrocyte death allows calcium release, allowing calcification of matrix

Front 61

Chondrocyte maturation regulated by local growth factors (_________ _________ ________, expression regulated by __________ __________ gene)

Back 61

Chondrocyte maturation regulated by local growth factors (parathyroid related peptides, expression regulated by Indian hedgehog gene)

Front 62

_______ ___ ________ produced by hypertrophic chondrocytes important for mineralization

Back 62

Type X collagen

Front 63

Primary spongiosa. Vascular _________ and resorption of ___________ ___________. ___________ align on cartilage bars produced by physeal expansion. Primary spongiosa ___________ to form __________ _________and then __________ to become secondary spongiosa

Back 63

Primary spongiosa. Vascular invasion and resorption of transverse septa. Osteoblasts align on cartilage bars produced by physeal expansion. Primary spongiosa mineralized to form woven bone and then remodels to become secondary spongiosa

Front 64

Secondary spongiosa:___________ remodeling (removal of _________ ________, replacement of_________ bone with lamellar bone) _________ remodeling (____________)

Back 64

Secondary spongiosa: internal remodeling (removal of cartilage bars, replacement of fiber bone with lamellar bone) External remodeling (funnelization)

Front 65

Groove of Ranvier during the________year of life, the zone spreads over the adjacent ________ to form a fibrous circumferential ring bridging from the __________ to the _________.

Back 65

Groove of Ranvier During the first year of life, the zone spreads over the adjacent metaphysis to form a fibrous circumferential ring bridging from the epiphysis to the diaphysis.

Front 66

Groove of Ranvier _________ the mechanical strength of the physis and is responsible for __________ bone growths and supplies __________to periphery

Back 66

Groove of Ranvier increases the mechanical strength of the physis and is responsible for appositional bone growths and supplies chondrocytes to periphery

Front 67

Perichondrial fibrous ring of La Croix _________ ________ _________that is the primary limiting membrane that anchors and supports the physis through_________ __________

Back 67

Perichondrial fibrous ring of La Croix Dense fibrous tissue that is the primary limiting membrane that anchors and supports the physis through peripheral stability

Front 68

________ ________ major source of nutrition to physis

Back 68

Perichondrial artery major source of nutrition to physis

Front 69

Growth arrest treatment options: _______ ________ with __________ or ___________ ___________ ____ ________

Back 69

Growth arrest treatment options: bar resection with interposition, ipsilateral completion of arrest

Front 70

bar resection with interposition indications______ physeal involvement, _____ years or ____________ growth remaining

Back 70

bar resection with interposition indications < 50% physeal involvement, > 2 years or 2cm growth remaining

Front 71

ipsilateral completion of arrest indications: ___ physeal involvement. can combine with contralateral __________ and/or ipsilateral ________

Back 71

ipsilateral completion of arrest indications: > 50% physeal involvement. can combine with contralateral epipysiodesis and/or ipsilateral lengthening