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63 Cards in this Set

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• Most common congential foot deformity
• C-shaped foot deformity
• Flexible Tx at home
• Non-flexible serial casting
• Refer if non-flexible
Metatarsus Adductus
• Congenital, teratologic or positional
• ♂ more common, 75% congenital
• Polygenic inheritance
• Foot is in plantar flexion, hindfoot in inversion, forefoot is adducted/supinated
Talipes Equinovarus (Club foot)
Who is Talipes equinovarus most common in? What is treatement?
• Males
• Tx: casting w/in 1st week of lift (severe cases - surgery)
• Foot is hypermobile & pronated, asymptomatic.
• Usually improves by age 6.
• Due to ligamentous laxity
• What is important to check for?
• Pes Planus (flat foot)
• Check for tight achilles tendon: cerebral palsy
• mne: Planus ≈ flat, PP = pronated due to LL (ligamentous laxity)
What is the most common osteochondrosis in the foot? Causes heel pain during adolescnt growth spurt. What is the underlying patholgoy?
• Sever disease
• Caused by idiopathic avascular necrosis
• 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?
• Tibial torsion
• Tx= observation
• 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?
• Femoral Anteversion
• Medial Hip rotation > 70º
mne: F*emoral ≈ F*emale ≈ F*amilial, AnteVersion ≈ W position
What sign is ALWAYS a significant pediatric problem?
A non-traumatic limp (think hip!!!)
What is the most common cause of medical liability suits for pediatricians? Which side is more often affected? What demographic?
• Developmental Dysplasia of the Hip
• L hip 3x more common
• Females more often affected
What are the risk factors for developmental dysplasia?
• Breech delivery
• Oligohydraminos
• Twins
• (+) FH
• First born
What are the two signs used to dx a developmental dysplasia of the hip? What are there interpretations?
• 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
What are two signs of developmentaly dysplasia of the hip? What tests can be used?
• Limited Abductio nof the hip
• Waddling gait

• Tests: Ultrasound (most accurate b/w 4wk-3mos), Hip X-ray > 6mos
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?
• 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)
What are the Txs available for Developmental dysplasia o the hip?
• Pavlik harness (holds hips Flexed & ABducted)
• Spica cast, diagnosis @ ≥ 6mos (for 3-5 mos)
• Surgery(delayed diagnosis)
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?
• Transient Synovitis
• Peak age: 3-8 yo
• Most common in ♂
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?
• Dx: Transient Synovitis
• Tx: bed rest, NSAIDs, recheck in 1-2 wks. Consider Perthes
What pediatric disorder of the hip is a pediatric emergency?
• Septic arthritis of the hip
What are the labs that are associated with Septic arthritis of the hip? X--rays? Tx?
• ↑ WBC & ↑ ESR
• Normal x-ray, HOT bone scan
• Tx: surgical drainage
Avascular necrosis of the femoral epiphysis. Most common in ____? What is the presentation? Tx?
• 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)
What hip disorder most commonly presents in adolescent, obses, black ♂s ?
Slipped Capital Femoral Epiphysis
mne: lots of Blacks in DC (the capital)
What is the presentation of Slipped Capital Femoral Epiphysis? What is the Tx?
• Chronic hip/knee pain w/ limp. Obese, hypogonadal, adolescent black ♂
• Tx: Ortho referral ASAP for internal in-situ screw fixation
Posterior-medial, painless, non-pulsatile soft mass, prominent w/ extension
Popliteal cyst (Baker cyst)
• 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?
Osgood-Schlatter's disease
Tx: symptomatic
Wrist synovial fluid dilled cyst
• Most common in the radiocarpal joint.
What is the Tx?
Ganglion cyst
• Observation or surgery
Subluxation of the annular ligament
• Presents w/ elbow flexed, palm-down position
• What must you always check?
• Dislocation of the Radial head
• ALWAYS check clavicle
What is the most vulnerable joint in throwing injuries?
Elbow
What is the most common cause of scoliosis? Who does it present in most often? When is there the greatest risk?
• Idiopathic
• ♀s. Adolescent form most common.
• Greatest risk during pds of rapid growth
What is the Cobb angle used for? What is the procedure for <20º, > 20º, 30º-45º and > 45º?
• Cobb andle is used for the dx of scoliosis
• < 20º observe
• > 20º refer
• 30º-45º orthotic therapy (braces)
• > 45º surgery
What are the complications sene w/ congenital scoliosis?
• 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)
What test can be conducted for scoliosis? What else should you check for?
• Adam's forward bend test
• Check for café-au-lait spots, midline hair tufts
What are red-flags associated with Scoliosis?
• Pain
• Abnormal neuro exam
• Midline cutaneous abnormalities
• High arches (congenital)
When does the neural plate develop? What does it give rise to? When does the neural tube develop?
• Neural plate: 18 days gestation
• Gives rise to neural tube & neural crest cels
• Neural tube: 22 days

mne: pl8 and 22 2be (tube)
Spinal dysraphism is?
Neural tube defects
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
Spinal dysraphism

1: Meningocele
2: Spina bifida occulta
3. Myelomeningocele
What is Cushing triad? What does it mean?
• ↑ BP, ↓ Pulse, Irregular respirations
• Signifies critically ↑ ICP (shown by abnormal pupils)
What are some of the signs & symptoms of ↑ ICP?
• HA (morning), vomiting (morning), CN VI palsy, papilledema, hulging fontanel, sunsetting of the eyes.
• Critically ↑ ICP is shown by Cushing triad.
What can distension of the 3rd venticle in hydrocephalus caues?
• Endocrine disfxn (compession of hypothalamic regions)
• Visual dysfxn (compression of optic nerves/chiasm/tracts)
Benign process, usually in obese ♀ of childbearing age
• Not critically ill
Sx: HA, diplopia, CN VI palsy, PAPILLEDEMA
• Brain imaging normal
Psuedotumor Cerebri
What is the Tx of psuedotumor cerebri?
• Acetazolamide, repeated LPs, corticosteroids, surgery
What is the Tx for ↑ ICP?
• Elevate head of the bed
• Mannitol
• Corticosteroids
• Acetazolamide & furosemide
• Hyperventilateion
• Ventricular catheter
• Phenobarbital induced coma
• Frequent Autosomal recessive disease
• Progressive degeneraltion of anterior horn cells
• Progressive proximal muscle weakness
• Flaccid quadriplegia, respiratory failure & death
• Werdnig-Hoffman or Spinal Muscular Atrophy

Idiopathic periopheral neuropathy
• Often occurs after a respiratory or GI infxn
• Areflexia, flaccidity, symmetric ascneding weakness
What is the Tx?
• Guillain-Barre Syndrome
• Often resolves spontaneously
• Sex linked recessive trait
• Calf-psuedo-hypertrophy
• Proximal musce weakness
• Gower sign
• Hyperlorgotic & waddling gait
Duchenne's Musculodystrophy
What are the lab findings in Duchenne's Musclodystrophy? What is the underlying pathology? What is the difference b/w Duchenne's & Beckers?
• Labs: ↑ serum creatine phophokinase
• Pathology due to absence of dystrophin
• Becker's has ABNORMAL dystrophy (Duchenne's has none)
• AD disease
• Due to a triplet CTG repeat (shows anticipation)
• At birth ther eis severe generalized weakness
• Expressionless face
Myotonic Dystrophy
• AD disease
• Harmartomas on organs: brain, eye, skin, kidney, & heart
• Facial angiofibromas, mental retardation, severe epilepsy
• Shagreen patches, ash-leaf spots (hypopigmented macule)
• Tuberous Sclerosis
• 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
• Neurofibramatosis Type-1
• Mutation of the NF-1 gene (chromosome 17q)
What is required for the Dx of Neurofibramatosis Type I?
≥ 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
• AD
Loss of tumor suppressor gene on chromosome 22
• multiple intracranial & spinal tumors
• Bilateral vestibular schwannomas by age 30 yo
Cataracts
• Neurofibramatosis Type II
What is required for the Dx of Neurofibramatosis Type II?
• Bilateral vestibular schwannomas
• FH of NF2
• Any two of the following:
• Glioma
• Meningioma
• Schwannoma
• Juvenile posterior subcapsular/lenticular opacity (or juvenile coritcal cataracts)
• 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
Sturge-Weber syndrome
What is the Tx for Sturge-Weber syndrome?
• Anticonvulsants (to prevent seizure due to ischemic injury to the brain underlying the meningeal angiomas)
• hemispherectomy
• Laser surgery (for facial nevus)
What causes "tram track" on brain imaging in Sturge Weber syndrome?
• Calcium deteceted in the gyri of the brain underlying angioma
What causes seizures in Sturge Weber syndrome?
Due to ischemic inury to the brain underlying meningeal angiomas
• Joint disease that occurs in children16 yo
• More comon in♀
• RF is usually absent
Juvenile rheumatoid arthritis
• Arthritis in children < 16 yo
• limited to a few joints
• Uveitis w/ potential for blindness
• Pauciarticular Juvenile Rheumatoid arthritis
• Disabling juvenile arthritis that affects many joints
• Polyarticular Juvenile Rheumatoid arthritis
• Necrotizing medium-sized vessel vasculitis involing the coronary arteries (thrombosis, aneurysm)
Kawasaki disease
What are the demographics of Kawasaki disease?
• ♂ < 5 yo
• Children of asian decenst higher incidence
Disease presents as: fever, erythema, edema of hands/feet, desquamatated rash, cervical adenopathy, oral erythema & cracking of lips, Abnormal ECG
Kawasaki disease
What is the biggest risk associated with Kawasaki disease? What is the Tx?
• Risk of coronary complications (aneurysms)
• Tx: IV IgG and Aspirin
What disease is being shown? What process?
Kawasaki disease
Desquamation of the skin of the toes
What disease is pictured?
Ganglion cyst