Pediatric Msk Disorders

Front 1

• Most common congential foot deformity
• C-shaped foot deformity
• Flexible Tx at home
• Non-flexible serial casting
• Refer if non-flexible

Back 1

Metatarsus Adductus

Front 2

• Congenital, teratologic or positional
• ♂ more common, 75% congenital
• Polygenic inheritance
• Foot is in plantar flexion, hindfoot in inversion, forefoot is adducted/supinated

Back 2

Talipes Equinovarus (Club foot)

Front 3

Who is Talipes equinovarus most common in? What is treatement?

Back 3

• Males
• Tx: casting w/in 1st week of lift (severe cases - surgery)

Front 4

• Foot is hypermobile & pronated, asymptomatic.
• Usually improves by age 6.
• Due to ligamentous laxity
• What is important to check for?

Back 4

• Pes Planus (flat foot)
• Check for tight achilles tendon: cerebral palsy
• mne: Planus ≈ flat, PP = pronated due to LL (ligamentous laxity)

Front 5

What is the most common osteochondrosis in the foot? Causes heel pain during adolescnt growth spurt. What is the underlying patholgoy?

Back 5

• Sever disease
• Caused by idiopathic avascular necrosis

Front 6

• Common type of intoeing
• Dianosis made if there is IR when pt is prone and leg is flexed at knee (thigh-foot angle in the negative range)
• What is the treatment?

Back 6

• Tibial torsion
• Tx= observation

Front 7

• Type of familial intoeing most common in ♀
• Child often sits in W position
• Peak incidence 3-6 yo
Child is clumsy, intoeing when running, patella rotated inward.
What is the medial hip rotation?

Back 7

• Femoral Anteversion
• Medial Hip rotation > 70º
mne: F*emoral ≈ F*emale ≈ F*amilial, AnteVersion ≈ W position

Front 8

What sign is ALWAYS a significant pediatric problem?

Back 8

A non-traumatic limp (think hip!!!)

Front 9

What is the most common cause of medical liability suits for pediatricians? Which side is more often affected? What demographic?

Back 9

• Developmental Dysplasia of the Hip
• L hip 3x more common
• Females more often affected

Front 10

What are the risk factors for developmental dysplasia?

Back 10

• Breech delivery
• Oligohydraminos
• Twins
• (+) FH
• First born

Front 11

What are the two signs used to dx a developmental dysplasia of the hip? What are there interpretations?

Back 11

• Ortolani sign: (+) if gentle Anterior lifting with ABduction produces a palpable click or clunk
• Barlow sign: (+) if gentle Posterior pressure w/ Adduction produces click/clunk

mne: Ortolani: O is a vowel, (anterior)
• Barlow: b ≈ p, (posterior pressure) double pp, and double dd in adduction

Front 12

What are two signs of developmentaly dysplasia of the hip? What tests can be used?

Back 12

• Limited Abductio nof the hip
• Waddling gait

• Tests: Ultrasound (most accurate b/w 4wk-3mos), Hip X-ray > 6mos

Front 13

In a newborn exam for Developmental Dysplasia of the Hip, if there is a (+) Ortolani or Barlow tests what do you do? If there is just a click and/or some questionable findings what do you do?
At 1-2 weeks if exam is questionable what do you do?
What is the key to Dx?

Back 13

• Clunk --> refer to pediatric ortho
• Questionable findings/click --> reexamine at 1-2 wks
• At 1-2 weeks if exam is questionable ---> do US and refer to pediatric ortho

Key to diagnosis is EARLY dx (< 4mos)

Front 14

What are the Txs available for Developmental dysplasia o the hip?

Back 14

• Pavlik harness (holds hips Flexed & ABducted)
• Spica cast, diagnosis @ ≥ 6mos (for 3-5 mos)
• Surgery(delayed diagnosis)

Front 15

What is the most common cause of limp w/ pain in a child < 10 yo? What is the peak age? Who is it most common in?

Back 15

• Transient Synovitis
• Peak age: 3-8 yo
• Most common in ♂

Front 16

Presentation: 5yo boy with a painful limp. (-) Fever. (+) history of URI. PE: unable to medially rotate the hip or Abduct. Antalgic gait. What is the dx? What is the Tx?

Back 16

• Dx: Transient Synovitis
• Tx: bed rest, NSAIDs, recheck in 1-2 wks. Consider Perthes

Front 17

What pediatric disorder of the hip is a pediatric emergency?

Back 17

• Septic arthritis of the hip

Front 18

What are the labs that are associated with Septic arthritis of the hip? X--rays? Tx?

Back 18

• ↑ WBC & ↑ ESR
• Normal x-ray, HOT bone scan
• Tx: surgical drainage

Front 19

Avascular necrosis of the femoral epiphysis. Most common in ____? What is the presentation? Tx?

Back 19

• Legg-Perthes disease
• Most common in 4-8 yo ♂
• Presentation: painless limp
• Tx: Ortho referral.
mne: Think Ryan!! Legg-Perthes sounds like a white name (uncommon in blacks)

Front 20

What hip disorder most commonly presents in adolescent, obses, black ♂s ?

Back 20

Slipped Capital Femoral Epiphysis
mne: lots of Blacks in DC (the capital)

Front 21

What is the presentation of Slipped Capital Femoral Epiphysis? What is the Tx?

Back 21

• Chronic hip/knee pain w/ limp. Obese, hypogonadal, adolescent black ♂
• Tx: Ortho referral ASAP for internal in-situ screw fixation

Front 22

Posterior-medial, painless, non-pulsatile soft mass, prominent w/ extension

Back 22

Popliteal cyst (Baker cyst)

Front 23

• Very common. Increase in athletic, 8-12 yo ♂
• Overuse syndrome/traction apophysitis
• Patellar ligament insertion into the tibial tuberosity
• Presents w/ chronic knee pain
Tx?

Back 23

Osgood-Schlatter's disease
Tx: symptomatic

Front 24

Wrist synovial fluid dilled cyst
• Most common in the radiocarpal joint.
What is the Tx?

Back 24

Ganglion cyst
• Observation or surgery

Front 25

Subluxation of the annular ligament
• Presents w/ elbow flexed, palm-down position
• What must you always check?

Back 25

• Dislocation of the Radial head
• ALWAYS check clavicle

Front 26

What is the most vulnerable joint in throwing injuries?

Back 26

Elbow

Front 27

What is the most common cause of scoliosis? Who does it present in most often? When is there the greatest risk?

Back 27

• Idiopathic
• ♀s. Adolescent form most common.
• Greatest risk during pds of rapid growth

Front 28

What is the Cobb angle used for? What is the procedure for <20º, > 20º, 30º-45º and > 45º?

Back 28

• Cobb andle is used for the dx of scoliosis
• < 20º observe
• > 20º refer
• 30º-45º orthotic therapy (braces)
• > 45º surgery

Front 29

What are the complications sene w/ congenital scoliosis?

Back 29

• Congenital is very uncommon (Idiopathic is MOST common)
• GU anomalies, CHD, Spinal dysraphism, Extravertebral anomalies, VATER syndrome (Vertebra, Anal atresioa, Tracheal-Esophageal fistula, Renal agenesis)

Front 30

What test can be conducted for scoliosis? What else should you check for?

Back 30

• Adam's forward bend test
• Check for café-au-lait spots, midline hair tufts

Front 31

What are red-flags associated with Scoliosis?

Back 31

• Pain
• Abnormal neuro exam
• Midline cutaneous abnormalities
• High arches (congenital)

Front 32

When does the neural plate develop? What does it give rise to? When does the neural tube develop?

Back 32

• Neural plate: 18 days gestation
• Gives rise to neural tube & neural crest cels
• Neural tube: 22 days

mne: pl8 and 22 2be (tube)

Front 33

Spinal dysraphism is?

Back 33

Neural tube defects

Front 34

Defects of the L5 or S1 vertebral arches:
1. Sac filled w/ CSF due to protrusion is called ___
2. defects of the underlying bone or canal (tugts of hair, sacral dimple)
3. spinal canal & meninges are exposed

Back 34

Spinal dysraphism
•
1: Meningocele
2: Spina bifida occulta
3. Myelomeningocele

Front 35

What is Cushing triad? What does it mean?

Back 35

• ↑ BP, ↓ Pulse, Irregular respirations
• Signifies critically ↑ ICP (shown by abnormal pupils)

Front 36

What are some of the signs & symptoms of ↑ ICP?

Back 36

• HA (morning), vomiting (morning), CN VI palsy, papilledema, hulging fontanel, sunsetting of the eyes.
• Critically ↑ ICP is shown by Cushing triad.

Front 37

What can distension of the 3rd venticle in hydrocephalus caues?

Back 37

• Endocrine disfxn (compession of hypothalamic regions)
• Visual dysfxn (compression of optic nerves/chiasm/tracts)

Front 38

Benign process, usually in obese ♀ of childbearing age
• Not critically ill
Sx: HA, diplopia, CN VI palsy, PAPILLEDEMA
• Brain imaging normal

Back 38

Psuedotumor Cerebri

Front 39

What is the Tx of psuedotumor cerebri?

Back 39

• Acetazolamide, repeated LPs, corticosteroids, surgery

Front 40

What is the Tx for ↑ ICP?

Back 40

• Elevate head of the bed
• Mannitol
• Corticosteroids
• Acetazolamide & furosemide
• Hyperventilateion
• Ventricular catheter
• Phenobarbital induced coma

Front 41

• Frequent Autosomal recessive disease
• Progressive degeneraltion of anterior horn cells
• Progressive proximal muscle weakness
• Flaccid quadriplegia, respiratory failure & death

Back 41

• Werdnig-Hoffman or Spinal Muscular Atrophy

Front 42

Idiopathic periopheral neuropathy
• Often occurs after a respiratory or GI infxn
• Areflexia, flaccidity, symmetric ascneding weakness
What is the Tx?

Back 42

• Guillain-Barre Syndrome
• Often resolves spontaneously

Front 43

• Sex linked recessive trait
• Calf-psuedo-hypertrophy
• Proximal musce weakness
• Gower sign
• Hyperlorgotic & waddling gait

Back 43

Duchenne's Musculodystrophy

Front 44

What are the lab findings in Duchenne's Musclodystrophy? What is the underlying pathology? What is the difference b/w Duchenne's & Beckers?

Back 44

• Labs: ↑ serum creatine phophokinase
• Pathology due to absence of dystrophin
• Becker's has ABNORMAL dystrophy (Duchenne's has none)

Front 45

• AD disease
• Due to a triplet CTG repeat (shows anticipation)
• At birth ther eis severe generalized weakness
• Expressionless face

Back 45

Myotonic Dystrophy

Front 46

• AD disease
• Harmartomas on organs: brain, eye, skin, kidney, & heart
• Facial angiofibromas, mental retardation, severe epilepsy
• Shagreen patches, ash-leaf spots (hypopigmented macule)

Back 46

• Tuberous Sclerosis

Front 47

• AD disease
• Mutation in the tumor suppressor gene ______
• Tumors of peripheral nerves

Comon sx:
• Café au-lait spots
• freckling in the area of the armpit
• Lisch nodules

Back 47

• Neurofibramatosis Type-1
• Mutation of the NF-1 gene (chromosome 17q)

Front 48

What is required for the Dx of Neurofibramatosis Type I?

Back 48

≥ 2 of:
• ≥ 6 café-au-lait spots
• ≥ neurofibromas
≥ Freckling in the area of the armpit or groin
≥ 2 Lisch nodules or iris harmartomas
• Optic nerve glioma
• Scoliosis, abnormal sphenoid or tibia
• FH+ for NF1

Front 49

• AD
Loss of tumor suppressor gene on chromosome 22
• multiple intracranial & spinal tumors
• Bilateral vestibular schwannomas by age 30 yo
Cataracts

Back 49

• Neurofibramatosis Type II

Front 50

What is required for the Dx of Neurofibramatosis Type II?

Back 50

• Bilateral vestibular schwannomas
• FH of NF2
• Any two of the following:
• Glioma
• Meningioma
• Schwannoma
• Juvenile posterior subcapsular/lenticular opacity (or juvenile coritcal cataracts)

Front 51

• Sporadic disease
• Angiomas of the letomeninges
• Ipsilateral port-wine nevus
• possible glaucoma
**Seizures due to ischemic injury to the brain underlying the meningeal angiomas**
• Ca++ in gyri of brain

Back 51

Sturge-Weber syndrome

Front 52

What is the Tx for Sturge-Weber syndrome?

Back 52

• Anticonvulsants (to prevent seizure due to ischemic injury to the brain underlying the meningeal angiomas)
• hemispherectomy
• Laser surgery (for facial nevus)

Front 53

What causes "tram track" on brain imaging in Sturge Weber syndrome?

Back 53

• Calcium deteceted in the gyri of the brain underlying angioma

Front 54

What causes seizures in Sturge Weber syndrome?

Back 54

Due to ischemic inury to the brain underlying meningeal angiomas

Front 55

• Joint disease that occurs in children16 yo
• More comon in♀
• RF is usually absent

Back 55

Juvenile rheumatoid arthritis

Front 56

• Arthritis in children < 16 yo
• limited to a few joints
• Uveitis w/ potential for blindness

Back 56

• Pauciarticular Juvenile Rheumatoid arthritis

Front 57

• Disabling juvenile arthritis that affects many joints

Back 57

• Polyarticular Juvenile Rheumatoid arthritis

Front 58

• Necrotizing medium-sized vessel vasculitis involing the coronary arteries (thrombosis, aneurysm)

Back 58

Kawasaki disease

Front 59

What are the demographics of Kawasaki disease?

Back 59

• ♂ < 5 yo
• Children of asian decenst higher incidence

Front 60

Disease presents as: fever, erythema, edema of hands/feet, desquamatated rash, cervical adenopathy, oral erythema & cracking of lips, Abnormal ECG

Back 60

Kawasaki disease

Front 61

What is the biggest risk associated with Kawasaki disease? What is the Tx?

Back 61

• Risk of coronary complications (aneurysms)
• Tx: IV IgG and Aspirin

Front 62

What disease is being shown? What process?

Back 62

Kawasaki disease
Desquamation of the skin of the toes

Front 63

What disease is pictured?

Back 63

Ganglion cyst