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170 Cards in this Set
- Front
- Back
what are the general problems that can alter gait?
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pain, mechanical problems, neuromuscular problemts
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what are the major key history points when assessing gait?
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character of limp; pain; locatlization (referred); frequency and duration of symptoms; mechanism of injury; signifant PMH
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what are the key pain assessments that should be understood from the history?
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acuity; worsening?; constant (tumor or infection); no pain (neuromuscular or metabolic); and the timing
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what can the timing of musculoskeletal pain tell you?
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occurs in morning or inactivity (inflammatory); worse at night (growing or malignancy); after activity (mechanical)
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what should be considered if a patient has acute limb pain lasting longer than 6 weeks?
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lyme disease
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If the child complains of morning stiffness, what may they have?
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JRA
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What gait issue can HIV cause?
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footdrop
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what is the test to conduct for MD?
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CK
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what should you assess specifically when watching the child walk?
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movement of arms in relation to legs; stress gait with penny on nose
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what should you look for when the child is standing?
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spine; trendelenburg; gowers
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what are you looking at in the musculoskeletal assessment when the child is laying?
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asymmetry; resting position of the limb; ROM; percuss patella; leg length
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describe antalgic gait.
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directed by pain the affected limb; single limb support; shortened stance phace in affected painful extremity; cautious gatit wth diskitis
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what are the characteristics of circumduction gait?
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shortens limbo for foot clearance; excessive hip abduction; pelvic roration; hiking; leg length discrepany
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what is the most common reason for toe walking?
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shortened achillis tendon
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what are the characteristics of equinus gait?
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limited ankle dorsifelxion; gastroc soleus weakness; shortened achillis tendon
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describe trendelenburg gait
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hip abductor weakness; stance on involved side leans toward affected side as the contralateral pelvis drops
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what is step page gait?
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ankle dorsiflexor weakness; seen in Charcot-Marie Tooth
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what is cautious gait?
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to avoid jarring of back; gait is slow; due to painful spine or discitis
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what is grotesque limp pattern?
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bizzare gait which is out of the normal range; inconsisten with organic pathology
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what is the first line in radiology for musculoskeletal issues?
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plain films, they are not helpful in early infection; soft tissues changes can be seen in 50%; can take up 10-12 days to see changes
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what are bone scans excellent for?
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increased flow and osteoblastic activity; osteomyelitis; stress fracture; occult fracture; neoplasm; metastases; early bone infection
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what can be seen on US?
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osteomyelitis; inflammatory myositis; hip effusions with nearly 100% sensitivity
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what can CT see in terms of bones?
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imaging cortical bone; osteoid osteoma; tarsal coalition
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what are the characteristics of ESR?
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increased in 24-48 hours; persists for 3 weeks; 90% of osteomyelitis will have elevation
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what is the growth pattern of CRP?
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acute phase protein; increases in 6 hours but normal in 6-10 days
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ToF; WBCs are always raised in osteomyeltis
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false; they can be normal
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what % of the Diff is abnormal in osteomyelitis and septic arthritis?
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65-70%
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ToF: stress fractures tend to wake the person at night
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FALSE
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what tanner stage is common for boys with osgood schlatter?
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tanner 3
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ToF: toxic synovitis goes away on its own
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TRUE
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what is the common age for boys with toxic synovitis?
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5 to 1
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toxic synovitis causes a restriction of movement when the leg is held in the ___ ___
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external rotation
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what is the pathophysiology of osteomyelitis?
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hematogenous spread or by direct invasion of pathogens into the bone; can be precipitated by trauma
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what is the clinical presentation of osteomyelitis?
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fever; pain; erythema; swelling; and pinpoint tenderness of the affected bone with decreased ROM due to muscle splinting; if lower extremities it can present with a limp
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what are the test to do for osteomyelitis?
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MRI; Blood cultures may be positive; xray may be normal for one week
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what is the length of the treatment for osteomyelitis?
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4-6 weeks
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what is the pathophysiology of septic arthritis?
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infection in joint following puncture injury; hematogenous spread of bacteria ino the joint space or continuous spread from cellulitis or osteomyelitis
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what is the most common cause of septic arthritis in neonates?
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hematogenous spread, due to large network of blood vessels that cross from metaphysis and epiphysis
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at one year of age, blood vessels are obliterated by __ ___
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physis formation
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what is the clinical presentation of septic arthritis?
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monoarticular arthritis with erythema, swelling; fever limiation of motion due to pain; intense synovitis
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what are the most common organisms to cause septic arthritis?
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staphylococcus aureus; non group A strep; H flu; salmonella is more common in sickle cell; N gonorrhoeae in sexually active adolescents
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what is the method for definitive diagnosis of septic arthritis?
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joint aspiration
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what will you see in the diagnosis of septic arthritis?
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WBC elevated with left shift; marker of inflammtion elevated; US detect joint effusions; xray lag for 10 days; MRI, CT, bone scan can be more helpful
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what is the treatment for septic arthritis?
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Admission for Abx;
once improved, give 3 weeks of oral Abx; neonate (cloxacillin and gent) 1-3 months: (cefuroxime; cefotaxime); children (cefazolin); adolescents (ceftriaxone or cefixime + azith) |
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what is the pathogen of lyme disease?
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borrelia burgdorferi by tick bites
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what are the first and second most common presentations of lyme disease?
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erythema migrans is first and arthritis is second
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in lyme disease ___ arthritis can occur months to years after infection
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monoarticular
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ToF: in lyme disease there is pain out of proportion to the swelling
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false: swelling out of proportion to pain
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what are growing pains?
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intermittent nonarticular pain in childhood
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what is the diagnosis of growing pains?
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one of exclusion
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when does the pain of growing pains occur?
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at night
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what is the requirement to be dx with growing pains>
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bilateral and relieved by heat, massage and anelgesics
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ToF: rheumatic fever can run in families
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TRUE
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what is the jones criteria for rheumatic fever?
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must have 1 required, 2 major and 0 minor;
or 1 major and 2 minor. Required: evidence of strep infection (increases titer ASO, throat culture or recent scarlet fever); |
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what are the major criteria for scarlet fever by jones?
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carditis; polyarthritis; chorea; erythema maginatum; subcutaneoud nodules
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what are the minor jones criteria for rheumatic fever
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fever; arthralgia; previous ruehmatic fever; elevated CRP or ESR; prolonged PR interval
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what does erythema marginatum look like?
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snakes on the skin
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what strain is the cause of rheumatic fever?
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M strain of GAS
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what is the simplest overuse syndrome of the musculoskeletal system?
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stress fractures
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what causes stress fracture?
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repetitive load of relatively rigid tissue needs leads work hardening. Bone is brittle and eventually breaks
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stress fractures of the hip are __ and they can disrupt the blood supply leading to __ __ of the femoral head
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rare; avascular necrosis
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what kids are at risk for stress fractures?
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long distance runners
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what are the disorders caused by overuse of the bone?
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stress fracture; osgood schlatter; sinding-larsen johansson disease; severs disease
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what is sinding-larsen johansson disease?
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inferior pole of he patella; pateall periosteum can creaste same stress of apophysis of tibial tubercle; xray irregular calcification at the end of the patella
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what are the charaterisitics of severs disease?
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calcaneal apophysitis; apophyseal insertion of the achillis tend into the calcaneus;
9-14 peak 10-11; tends to be bilateral; shoe inserts; ICE NSAIDS; and activity modification |
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what is the pathophys of osgood schlatter?
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traction apophysitis of the tibial tubercle; chronci avulsion of secondary ossification center; repetitive strain of quadriceps produce cartilage to be pulled away leading ossification and enlargement
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what is the clinical presentation of osgood schlatter?
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pain over anterior tibial tuberosity;
pain exacerbated by activity; c hronic nature lasting 12-24 months |
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what is the treatment for osgood schlatter?
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RICE; NSAID; stretch hamstrings; quad strengthening exercise;
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why is casting not really sued in osgoood schlatter?
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quadricep wasting
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what must you be careful to assess for if you think you have a soft tissue injury?
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salter harris type 1 fracture
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what is the cause of soft tissue injury?
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acute trauma. Ankle sparin (lateral contralateral ligaments) and Anterior curciate ligament ACL
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which group has higher rates of ACL tears?
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girls
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ToF: SCFE is an inflammatory process
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FALSE
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what is SCFE?
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femoral head is displaced from the femoral neck and the limb becomes flexed and externally rotated
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who gets SCFE the most?
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overweight boys 10-14
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what does a possible SCFE need?
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ortho referral stat
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ToF: SCFE can have passive internal rotation of the hip
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TRUE
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why does SCFE occur?
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salter harris type !
Through the physeal palte of the proximal femur resulting in displacement |
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SCFE is __ as common in males than females
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twice
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which race has highest SCFE?
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aftican american
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when does SCFE tend to occur?
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during the growth spurt
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what is the most common hip disorder in adolecents?
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SCFE
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what are the predisposing factors for SCFE?
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obestiy;
renal osteodystrophy; endocrine disorders including hypothyroid and hypopit; bilateral involvement of the bhips can be seen in 20-30% of patients |
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what will the hx of SCFE involve?
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acute, chronic, subacute;
limp and pain in hip, groin thigh or knee; symptoms for greater than 2 weeks; progressive external rotation and limb shortening; gait natalgia is worse |
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what is seen on exam with SCFE?
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external rotation and adduction; gait is painful; hipp externally rotated; thigh muscle atrophies
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what are the classifications of SCFE?
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minimal: less than 1/3 of the upper metaphyseal width of femoral neck; moderate: 1/3- 1/2; severe: > 1/2
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what are the required positions for imaging of SCFE>?
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frog leg lateral
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what does SCFE look like on xray?>
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ice cream falling of the cone
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on frogleg views, a line drawn tangential to the lateral cortex of the meaphysis should bistes a portion of ___ bone
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ossified
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the femoral head of SCFE can be __ and __
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mottled and flat
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how is SCFE treated?
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surgically with pin fixation
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what are the potential complications of SCFE?
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avascular necrosis and chondrolysis
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what are the benign bone tumors?
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osteochondroma (exostosis);
endochondroma; chondroblastoma; chondromayxoid fibromal; osteoid osteomal; osteoblastoma |
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what are the malignant bones tumors
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ewings; osteosarcoma; chondrosarcoma;l malignant fibrous histiocytoma; small cell osteosarcoma; adamantinoma
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ToF: pain is more common with malignatn lesions, usually present at rest or at night and are responsive to NSAIDS and weak narcotics
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false: not responseive to NSAID
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what are the radiologic findings of ewings?
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onion skinning sun burst lesions, and a primary lytic lesion
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what bone cancer favors whites?
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ewings
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what are the ccommon site of origin for osteosarcoma and ewings?
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O: metaphysis of long bones (distal femur) ;
E: long bones (femur>ilium) and the metadiaphysis |
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ToF: an atheletic injury may be inplicated as the cause of pain and can delay a dx of ewings
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TRUE
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what are the systemic symptoms of ewings?
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fever; elevated ESR, WBC, LDH; malaise; weight loss
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what are the radiographic findings of osteosarcoma?
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sclerotic destruction with bone forming lesion; occasional mineralization often extending into the surrounding soft tissues, described as a classic sunburst appearance
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what are the lab findings for osteosarcoma?
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elevated LDH; elevated Alk phos; ESR elevations
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where is osteosarcoma found?
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areas of active skeletal growth: humerus; distal femur; proximal tibia;
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what age groups is most common for osteosarcoma?
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10 to 25
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osteosarcoma is more common in __ children than white chidren
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black
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what is the most common primary bone malignancy in pediatrics?
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osteosarcoma
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where do osteosarcomas arise from?
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the medullary cavity or the boney cortex
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what are the radiographic findings of osteosarcoma?
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alrge aggressive, eccentric lesion (sclerotic, lucent or both);
usually don't cross the physis; moth-eaten appearance with sunburst periosteal reaction or calssic codman triangle; pathologic fractures; large soft tissue component |
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what are the tx for osteosarcoma?
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surgery and chemo
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where does osteosarcoma metastasize?
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lungs and other bones
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50% of patients with leukemia present with ___ pain
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bone
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what is the bone pain like of leukemia>
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generalized and nonspecific
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25 % of patients with leukemia will have faint lineks that look like growth arrest lines and are called __ __
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leukemic lines
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what should you do if you suspect leukemic lines?
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CBC with diff and a smear
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what are the caharacteristics of arthropathy with leukemia?
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severe pain;
anemia; keukopenia; thrombocyt; blasts; xray show lucent metaphyseal bands with sclerotic densities |
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____ are locally aggressive intrameduallry lesions that are treated by removal
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chondrosarcomas
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ToF: primary b cell tumors are common
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FALSE
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what are malignant fibrous histiocytomas?
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high grade malignant pleomorphic bone tumors, occur over age 40
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what are adamantinomas?
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low grade, slowing progressive lesions;
exclusively in the diaphysis of the tibia; metastisize to the lungs lymph nodes, and bones with 20% risk of recurrences |
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what are the clinical presentation of osteoid osteoma?
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pain: acute, intense, unremitting, of sudden onset;
not associated with exercise or trauma, worse at night and at rest; |
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ToF: the pain of osteoid osteoma is not responsive to NSAIDs
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false, it is
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what are the common sites for osteoid osteoma?
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femur and tibia
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what is seen on plain radiograph of osteoid osteoma?
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stalk or projection from the bone surface; < 2cm
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what is the management of osteoid osteoma?
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are not removed (curettage/resection) unless the lesions cause pain or risk joint destruction;
orthopedist annually |
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list the 4 diagnostic features of osteoid osteoma?
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1. sharp round or oval lesions
2. less than 2 cm 3. hasn a homogenous dense center 4. 1-2mm peripheral radiolucent zone |
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what are the characteristics of multiple heredtiary exostosis?
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autosomal dominant; increased risk of joint deformity; limitation in ROM; increased risk of malignancy
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describe osteochondromatosis.
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autosomal dominant disease characteristized by mutliple, usually sessile, osteochondromas;
in the knee, ankle and shoulder are simultaneously affected |
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what are the triad of features of Mccune albright syndrome?
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1. polyostotic, usually unilateral, firbrous dysplasia
2. endorcien abnormalities (precocoius puberty, hyperthyroidism) 3. caufe au lait spots |
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solitary ___ is a developmental abnormality of bone
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osteochondroma
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when does osteochondroma occur?
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when part of the growth plate forms an outgrwoth on the surface of the bone
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describe the outgrowth of osteochondromas.
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may or may not have a stalk;
when a stalk is present, the structure is called pedunculated; when no stalk is present, it is called sessile |
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ToF: osteochondromas are mobile lesions
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FALSE
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ToF: osteochondroma often undergo malignant degeneration to become osteosarcoma
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FALSE
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what is the management of benign bone lesions?
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observation;
surgical management ofcurettage and excision may be needed for (large lesions, lesions proximal to a joint, lesions with premalignatn lesions, lesions invovling more than 50% of the bone diamter may require curettage and bone gratfing due to the risk of pathologic fracture |
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what is JRA?
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arthritis in one joint for at least 6 weeks, age of onset less 16 years
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what are the symptoms of JRA?
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pain, limitation of ROM or increased warmth
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what must be ruled out for a dx of JRA?
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lyme disease
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what are the lab testing forJRA?
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lupus testing, ANA and Anti-CPP
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if a child become incontinent and stool changes what tests must be done?
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reflexes and an anal wink
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what is the pathophysiology of transverse myelitis?
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segmental spinal injury casued by acute inflammation;
may be cell mediated immune response to viral infection, a direct viral of the spinal cord, or autoimmune vasculitis |
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what are the history findings for transvere myelitis?
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viral infection with fever; associated with multiple sclerosis
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what is the clinical presentation of transverse myelitis?
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acute onset of weakness with sensory deficits;
usually lower extremities; 1-5 cases a year; associated with HIV and may be intital presenation of AIDs |
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what is idiopathic avascular necrosis of the femoral head?
|
leg calve perthes
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which gender gets LCP more?
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boys 5:1
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what age group gets LCP?
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5 to 1
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what happens if LCP occurs by age 6?
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restoration of the spherical femoral head is likely and degenerative osetoarthritis can be avoided
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what can be said for girls with LCP?
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more extensive disease
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what is the etiology of LCP?
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impaired blood supply to femoral head
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in LCP, ___ occurs from increased joint pressure during synovitis
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tamponade
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Patients with LCP that have a mutation in factor __ __ gene which results in resistance to activated protein ___
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V Leiden; C
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clinical __ could be triggered off in the individuals with coagulopathies by thrombotic insults such as passive smoking, can lead to LCP
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thrombosis
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what is the history of LCP?
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gradual limp, pain in groin, thigh or knee
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What is felt on PE with LCP?
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tenderness of anterior hip or decreased internal rotation or abduction
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what is seen on plain film with LCP?
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widening of joint space
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What is seen on US in LCP?
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joint effusion
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what is the treatment of LCP?
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bedrest; crutches; traction, 40% require surgery; natural progression 18-24 months
|
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what is the most commonly encountered injury to the wrist and elbow?
|
a buckle fracture or transverse of the distal raidal metaphysis with or wihtout involvement of the distal ulnar metaphysis. Fall on an outsretched hand
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roughly 25-30% of all physeal fractures occur in the __
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wrist
|
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what are toddler's fractures?
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non-displaced oblique or spiral fracturs of the midshaft of the tibia
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which children get toddlers fractures
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those that have first start to walk
|
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how do children with toddler's fractures present?
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refusing to bear weight or walk on the involved extremity
|
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how are toddlers' fractures best viewed ?
|
on oblique angle
|
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what is tarsal coalition?
|
congenital fusion of two of the tarsal bones of the foot; the union can be either a complete or parital bony fusion or a cartiaginous fibrous fusion
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tarsal coalition will often manifest itself as __ __ __
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chronic foot pain
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when do most patients present with tarsal coalition?
|
adolescence
|
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benign cortical defects are seen in up to __% of all children at some time in tehri development
|
40
|
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when are benign cortical defects most seen?
|
4-6 years old
|
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for benign cortical defects, the term ___ __ ___ is used for lesions > 2cm?
|
non-ossifying fibroma
|
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where are benign cortical defect found emanating from?
|
the cortex of long bone metaphyses
|
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what is the most common location of the benign cortical defects?
|
distal femur
|