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170 Cards in this Set

  • Front
  • Back
what are the general problems that can alter gait?
pain, mechanical problems, neuromuscular problemts
what are the major key history points when assessing gait?
character of limp; pain; locatlization (referred); frequency and duration of symptoms; mechanism of injury; signifant PMH
what are the key pain assessments that should be understood from the history?
acuity; worsening?; constant (tumor or infection); no pain (neuromuscular or metabolic); and the timing
what can the timing of musculoskeletal pain tell you?
occurs in morning or inactivity (inflammatory); worse at night (growing or malignancy); after activity (mechanical)
what should be considered if a patient has acute limb pain lasting longer than 6 weeks?
lyme disease
If the child complains of morning stiffness, what may they have?
JRA
What gait issue can HIV cause?
footdrop
what is the test to conduct for MD?
CK
what should you assess specifically when watching the child walk?
movement of arms in relation to legs; stress gait with penny on nose
what should you look for when the child is standing?
spine; trendelenburg; gowers
what are you looking at in the musculoskeletal assessment when the child is laying?
asymmetry; resting position of the limb; ROM; percuss patella; leg length
describe antalgic gait.
directed by pain the affected limb; single limb support; shortened stance phace in affected painful extremity; cautious gatit wth diskitis
what are the characteristics of circumduction gait?
shortens limbo for foot clearance; excessive hip abduction; pelvic roration; hiking; leg length discrepany
what is the most common reason for toe walking?
shortened achillis tendon
what are the characteristics of equinus gait?
limited ankle dorsifelxion; gastroc soleus weakness; shortened achillis tendon
describe trendelenburg gait
hip abductor weakness; stance on involved side leans toward affected side as the contralateral pelvis drops
what is step page gait?
ankle dorsiflexor weakness; seen in Charcot-Marie Tooth
what is cautious gait?
to avoid jarring of back; gait is slow; due to painful spine or discitis
what is grotesque limp pattern?
bizzare gait which is out of the normal range; inconsisten with organic pathology
what is the first line in radiology for musculoskeletal issues?
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
what are bone scans excellent for?
increased flow and osteoblastic activity; osteomyelitis; stress fracture; occult fracture; neoplasm; metastases; early bone infection
what can be seen on US?
osteomyelitis; inflammatory myositis; hip effusions with nearly 100% sensitivity
what can CT see in terms of bones?
imaging cortical bone; osteoid osteoma; tarsal coalition
what are the characteristics of ESR?
increased in 24-48 hours; persists for 3 weeks; 90% of osteomyelitis will have elevation
what is the growth pattern of CRP?
acute phase protein; increases in 6 hours but normal in 6-10 days
ToF; WBCs are always raised in osteomyeltis
false; they can be normal
what % of the Diff is abnormal in osteomyelitis and septic arthritis?
65-70%
ToF: stress fractures tend to wake the person at night
FALSE
what tanner stage is common for boys with osgood schlatter?
tanner 3
ToF: toxic synovitis goes away on its own
TRUE
what is the common age for boys with toxic synovitis?
5 to 1
toxic synovitis causes a restriction of movement when the leg is held in the ___ ___
external rotation
what is the pathophysiology of osteomyelitis?
hematogenous spread or by direct invasion of pathogens into the bone; can be precipitated by trauma
what is the clinical presentation of osteomyelitis?
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
what are the test to do for osteomyelitis?
MRI; Blood cultures may be positive; xray may be normal for one week
what is the length of the treatment for osteomyelitis?
4-6 weeks
what is the pathophysiology of septic arthritis?
infection in joint following puncture injury; hematogenous spread of bacteria ino the joint space or continuous spread from cellulitis or osteomyelitis
what is the most common cause of septic arthritis in neonates?
hematogenous spread, due to large network of blood vessels that cross from metaphysis and epiphysis
at one year of age, blood vessels are obliterated by __ ___
physis formation
what is the clinical presentation of septic arthritis?
monoarticular arthritis with erythema, swelling; fever limiation of motion due to pain; intense synovitis
what are the most common organisms to cause septic arthritis?
staphylococcus aureus; non group A strep; H flu; salmonella is more common in sickle cell; N gonorrhoeae in sexually active adolescents
what is the method for definitive diagnosis of septic arthritis?
joint aspiration
what will you see in the diagnosis of septic arthritis?
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
what is the treatment for septic arthritis?
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)
what is the pathogen of lyme disease?
borrelia burgdorferi by tick bites
what are the first and second most common presentations of lyme disease?
erythema migrans is first and arthritis is second
in lyme disease ___ arthritis can occur months to years after infection
monoarticular
ToF: in lyme disease there is pain out of proportion to the swelling
false: swelling out of proportion to pain
what are growing pains?
intermittent nonarticular pain in childhood
what is the diagnosis of growing pains?
one of exclusion
when does the pain of growing pains occur?
at night
what is the requirement to be dx with growing pains>
bilateral and relieved by heat, massage and anelgesics
ToF: rheumatic fever can run in families
TRUE
what is the jones criteria for rheumatic fever?
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);
what are the major criteria for scarlet fever by jones?
carditis; polyarthritis; chorea; erythema maginatum; subcutaneoud nodules
what are the minor jones criteria for rheumatic fever
fever; arthralgia; previous ruehmatic fever; elevated CRP or ESR; prolonged PR interval
what does erythema marginatum look like?
snakes on the skin
what strain is the cause of rheumatic fever?
M strain of GAS
what is the simplest overuse syndrome of the musculoskeletal system?
stress fractures
what causes stress fracture?
repetitive load of relatively rigid tissue needs leads work hardening. Bone is brittle and eventually breaks
stress fractures of the hip are __ and they can disrupt the blood supply leading to __ __ of the femoral head
rare; avascular necrosis
what kids are at risk for stress fractures?
long distance runners
what are the disorders caused by overuse of the bone?
stress fracture; osgood schlatter; sinding-larsen johansson disease; severs disease
what is sinding-larsen johansson disease?
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
what are the charaterisitics of severs disease?
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
what is the pathophys of osgood schlatter?
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
what is the clinical presentation of osgood schlatter?
pain over anterior tibial tuberosity;
pain exacerbated by activity; c
hronic nature lasting 12-24 months
what is the treatment for osgood schlatter?
RICE; NSAID; stretch hamstrings; quad strengthening exercise;
why is casting not really sued in osgoood schlatter?
quadricep wasting
what must you be careful to assess for if you think you have a soft tissue injury?
salter harris type 1 fracture
what is the cause of soft tissue injury?
acute trauma. Ankle sparin (lateral contralateral ligaments) and Anterior curciate ligament ACL
which group has higher rates of ACL tears?
girls
ToF: SCFE is an inflammatory process
FALSE
what is SCFE?
femoral head is displaced from the femoral neck and the limb becomes flexed and externally rotated
who gets SCFE the most?
overweight boys 10-14
what does a possible SCFE need?
ortho referral stat
ToF: SCFE can have passive internal rotation of the hip
TRUE
why does SCFE occur?
salter harris type !
Through the physeal palte of the proximal femur resulting in displacement
SCFE is __ as common in males than females
twice
which race has highest SCFE?
aftican american
when does SCFE tend to occur?
during the growth spurt
what is the most common hip disorder in adolecents?
SCFE
what are the predisposing factors for SCFE?
obestiy;
renal osteodystrophy;
endocrine disorders including hypothyroid and hypopit; bilateral involvement of the bhips can be seen in 20-30% of patients
what will the hx of SCFE involve?
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
what is seen on exam with SCFE?
external rotation and adduction; gait is painful; hipp externally rotated; thigh muscle atrophies
what are the classifications of SCFE?
minimal: less than 1/3 of the upper metaphyseal width of femoral neck; moderate: 1/3- 1/2; severe: > 1/2
what are the required positions for imaging of SCFE>?
frog leg lateral
what does SCFE look like on xray?>
ice cream falling of the cone
on frogleg views, a line drawn tangential to the lateral cortex of the meaphysis should bistes a portion of ___ bone
ossified
the femoral head of SCFE can be __ and __
mottled and flat
how is SCFE treated?
surgically with pin fixation
what are the potential complications of SCFE?
avascular necrosis and chondrolysis
what are the benign bone tumors?
osteochondroma (exostosis);
endochondroma;
chondroblastoma;
chondromayxoid fibromal;
osteoid osteomal;
osteoblastoma
what are the malignant bones tumors
ewings; osteosarcoma; chondrosarcoma;l malignant fibrous histiocytoma; small cell osteosarcoma; adamantinoma
ToF: pain is more common with malignatn lesions, usually present at rest or at night and are responsive to NSAIDS and weak narcotics
false: not responseive to NSAID
what are the radiologic findings of ewings?
onion skinning sun burst lesions, and a primary lytic lesion
what bone cancer favors whites?
ewings
what are the ccommon site of origin for osteosarcoma and ewings?
O: metaphysis of long bones (distal femur) ;

E: long bones (femur>ilium) and the metadiaphysis
ToF: an atheletic injury may be inplicated as the cause of pain and can delay a dx of ewings
TRUE
what are the systemic symptoms of ewings?
fever; elevated ESR, WBC, LDH; malaise; weight loss
what are the radiographic findings of osteosarcoma?
sclerotic destruction with bone forming lesion; occasional mineralization often extending into the surrounding soft tissues, described as a classic sunburst appearance
what are the lab findings for osteosarcoma?
elevated LDH; elevated Alk phos; ESR elevations
where is osteosarcoma found?
areas of active skeletal growth: humerus; distal femur; proximal tibia;
what age groups is most common for osteosarcoma?
10 to 25
osteosarcoma is more common in __ children than white chidren
black
what is the most common primary bone malignancy in pediatrics?
osteosarcoma
where do osteosarcomas arise from?
the medullary cavity or the boney cortex
what are the radiographic findings of osteosarcoma?
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
what are the tx for osteosarcoma?
surgery and chemo
where does osteosarcoma metastasize?
lungs and other bones
50% of patients with leukemia present with ___ pain
bone
what is the bone pain like of leukemia>
generalized and nonspecific
25 % of patients with leukemia will have faint lineks that look like growth arrest lines and are called __ __
leukemic lines
what should you do if you suspect leukemic lines?
CBC with diff and a smear
what are the caharacteristics of arthropathy with leukemia?
severe pain;
anemia;
keukopenia;
thrombocyt;
blasts;
xray show lucent metaphyseal bands with sclerotic densities
____ are locally aggressive intrameduallry lesions that are treated by removal
chondrosarcomas
ToF: primary b cell tumors are common
FALSE
what are malignant fibrous histiocytomas?
high grade malignant pleomorphic bone tumors, occur over age 40
what are adamantinomas?
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
what are the clinical presentation of osteoid osteoma?
pain: acute, intense, unremitting, of sudden onset;
not associated with exercise or trauma, worse at night and at rest;
ToF: the pain of osteoid osteoma is not responsive to NSAIDs
false, it is
what are the common sites for osteoid osteoma?
femur and tibia
what is seen on plain radiograph of osteoid osteoma?
stalk or projection from the bone surface; < 2cm
what is the management of osteoid osteoma?
are not removed (curettage/resection) unless the lesions cause pain or risk joint destruction;
orthopedist annually
list the 4 diagnostic features of osteoid osteoma?
1. sharp round or oval lesions
2. less than 2 cm
3. hasn a homogenous dense center
4. 1-2mm peripheral radiolucent zone
what are the characteristics of multiple heredtiary exostosis?
autosomal dominant; increased risk of joint deformity; limitation in ROM; increased risk of malignancy
describe osteochondromatosis.
autosomal dominant disease characteristized by mutliple, usually sessile, osteochondromas;

in the knee, ankle and shoulder are simultaneously affected
what are the triad of features of Mccune albright syndrome?
1. polyostotic, usually unilateral, firbrous dysplasia
2. endorcien abnormalities (precocoius puberty, hyperthyroidism)
3. caufe au lait spots
solitary ___ is a developmental abnormality of bone
osteochondroma
when does osteochondroma occur?
when part of the growth plate forms an outgrwoth on the surface of the bone
describe the outgrowth of osteochondromas.
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
ToF: osteochondromas are mobile lesions
FALSE
ToF: osteochondroma often undergo malignant degeneration to become osteosarcoma
FALSE
what is the management of benign bone lesions?
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
what is JRA?
arthritis in one joint for at least 6 weeks, age of onset less 16 years
what are the symptoms of JRA?
pain, limitation of ROM or increased warmth
what must be ruled out for a dx of JRA?
lyme disease
what are the lab testing forJRA?
lupus testing, ANA and Anti-CPP
if a child become incontinent and stool changes what tests must be done?
reflexes and an anal wink
what is the pathophysiology of transverse myelitis?
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
what are the history findings for transvere myelitis?
viral infection with fever; associated with multiple sclerosis
what is the clinical presentation of transverse myelitis?
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
what is idiopathic avascular necrosis of the femoral head?
leg calve perthes
which gender gets LCP more?
boys 5:1
what age group gets LCP?
5 to 1
what happens if LCP occurs by age 6?
restoration of the spherical femoral head is likely and degenerative osetoarthritis can be avoided
what can be said for girls with LCP?
more extensive disease
what is the etiology of LCP?
impaired blood supply to femoral head
in LCP, ___ occurs from increased joint pressure during synovitis
tamponade
Patients with LCP that have a mutation in factor __ __ gene which results in resistance to activated protein ___
V Leiden; C
clinical __ could be triggered off in the individuals with coagulopathies by thrombotic insults such as passive smoking, can lead to LCP
thrombosis
what is the history of LCP?
gradual limp, pain in groin, thigh or knee
What is felt on PE with LCP?
tenderness of anterior hip or decreased internal rotation or abduction
what is seen on plain film with LCP?
widening of joint space
What is seen on US in LCP?
joint effusion
what is the treatment of LCP?
bedrest; crutches; traction, 40% require surgery; natural progression 18-24 months
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
roughly 25-30% of all physeal fractures occur in the __
wrist
what are toddler's fractures?
non-displaced oblique or spiral fracturs of the midshaft of the tibia
which children get toddlers fractures
those that have first start to walk
how do children with toddler's fractures present?
refusing to bear weight or walk on the involved extremity
how are toddlers' fractures best viewed ?
on oblique angle
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
tarsal coalition will often manifest itself as __ __ __
chronic foot pain
when do most patients present with tarsal coalition?
adolescence
benign cortical defects are seen in up to __% of all children at some time in tehri development
40
when are benign cortical defects most seen?
4-6 years old
for benign cortical defects, the term ___ __ ___ is used for lesions > 2cm?
non-ossifying fibroma
where are benign cortical defect found emanating from?
the cortex of long bone metaphyses
what is the most common location of the benign cortical defects?
distal femur