Term
| MC finding seen in a victim of child abuse |
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Definition
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|
Term
| inflicted injuries usually involve |
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Definition
| more than one plane of an extremity, the torso, and or head, and are often found in places that are unusual sites for accidental injury |
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|
Term
| ___________ are among the most common forms of inflicated burns. What is the typical pattern? |
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Definition
| immersion burns, stocking glove distribution with a sharp line of demarcation. |
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Term
| what type of fx is abuse until proven otherwise? |
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Definition
|
|
Term
| dorsal (colles) fx of the wrist is most likely |
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Definition
|
|
Term
| ventral (Smith) wrist fractures are most likely |
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Definition
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Term
| what test should you order for children who have multple fxs of extremities and ribs |
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Definition
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Term
| children younger than 2-3yo (sometimes 5) should undergo what type of injury assessment |
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Definition
| skeletal survey (radiographic) because some fxs are occult |
|
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Term
| what test should you order when the child has multiple bruises but no signs of fx? |
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Definition
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Term
| fx due to forcefully grabbign a child's arm and twisting it |
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Definition
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Term
| this type of fx can also be the result of torsional forces or of a slowly applied bending force |
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Definition
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Term
| ths fx is the result of mid-moderate compression forces delivered in a direction parallel or nearly parallel to the axis of a long bone. |
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Definition
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Term
| type of fx that results from a "karate chop" or "night stick" injury |
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Definition
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Term
| what test is best for detecting skull fxs? |
|
Definition
| routine skull radiographs |
|
|
Term
| what test is good for a shaken baby? |
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Definition
| CT, good at detecting interhemispheric subdural hematomas |
|
|
Term
| what test is good at detecting cerebral edema? |
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Definition
|
|
Term
| for what injuries is MRI superior to CT/xrays? |
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Definition
small subdural hematomas over the convexities.
subtle contusions
small parenchymal hemorrhages
diffuse axonal injury
abnl of the post. fossa structures
brainstem and spinal cervical cord
prior/old injuries |
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|
Term
| parental risk factors for child abuse |
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Definition
past hx of being abused
poor socialization
emotional/social isolation
limited ability to deal wiht stress
alcoholism/substance abuse
mental illness
domestic violence
membership in certain cults/sects |
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|
Term
| child risk factors for child abuse |
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Definition
age < 3 yo
being separated from the Mom at birth (high risk for attachment issues)
product of unplanned/unwanted pregnancy
SGA, congenital abnormalities, chronic illness
percieved as difficult/different
havinG ADHD or ODD
foster children/adopted children |
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|
Term
| typical oral patterns associated with child abuse? |
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Definition
| bruising of the mucosa of the upper lip or maxillary gingiva associated with tearing of the frenulum |
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|
Term
| victim of child abuse with a septal hematoma is at increased risk of developing? |
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Definition
| septal abscess due to delayed presentation |
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Term
| if the story doesn't match the injuries always suspect |
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Definition
|
|
Term
| xray findings that can be consitent with child abuse |
|
Definition
medullary sclerosis
callous formation
subperiosteal new bone |
|
|
Term
| symmetrical thin rims of subperiosteal new bone (<2cm in width) can be a normal finding in the long bones of who? |
|
Definition
| infants younger than 3-6m of age |
|
|
Term
| metaphyseal and rib fx in toddlers and infants are often associated with |
|
Definition
| head injuries, all of which are suspicious for child abuse |
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|
Term
| common findings in shaken baby syndrome (4) |
|
Definition
retinal hemorrhages
metaphyseal fractures
rib fractures (posterior)
subdural hematomas |
|
|
Term
|
Definition
idiopathic
congenital - underlying NM disorder
neuromuscular - CP, DMD, spinal muscular atrophy, myelodysplasia.
compensatory - leg length discrepancy |
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|
Term
| waht type of spinal curves have an increased risk of intraspinal pathology? what test should you do? |
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Definition
| left thoracic curves, do an MRI |
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Term
|
Definition
|
|
Term
| what is the most common scoliosis pattern? |
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Definition
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|
Term
| MC idiopathic type of scoliosis |
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Definition
|
|
Term
| tx of idiopathic scoliosis |
|
Definition
| PT, ortho referral, orthosis/bracing, surgery (>45 degrees) |
|
|
Term
| what is warranted with congenital scoliosis? |
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Definition
|
|
Term
| when is rapid progression expected with congenital scoliosis? |
|
Definition
| before age 2yo or after age 10yo |
|
|
Term
| MC treatment for congential scoliosis |
|
Definition
| spinal fusion without instrumentation because curves are rigid and bracing offers little benefit |
|
|
Term
| MC renal abnormality associated with congential scoliosis |
|
Definition
| unilateral renal agenesis |
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|
Term
| tx of neuromuscular scoliosis |
|
Definition
bracing is not usually effective, surgery is usually required.
some pts are nonambulatory due to the long, sweeping curves |
|
|
Term
| what is it important to distinguish between in compensatory scoliosis? |
|
Definition
| structural and compensatory spinal deformity |
|
|
Term
| how are a pelvic obliquity and spinal curve usually related? |
|
Definition
| the spinal curve goes in the same direction as the pelvic obliquity |
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|
Term
| who should you MRI in regards to congenital scoliosis? |
|
Definition
| pts < 10yo and those with "opposite" curves |
|
|
Term
| increased angulation in the thoracic or the thoracolumbar spine in the sagittal plane |
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Definition
|
|
Term
|
Definition
| scheuermann disease, congenital kyphosis |
|
|
Term
| complication of congenital kyphosis |
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Definition
|
|
Term
|
Definition
|
|
Term
| can pt's with Scheuermann's disease correct the kyphosis? |
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Definition
| no, not standing or prone |
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|
Term
| what do xrays of Scheuermann's disease look like? |
|
Definition
narrowed disk space
loss of normal anterior height
wedging of 5 degrees in 3+ vertebrae
irregularities of end plates
schmorl nodes |
|
|
Term
| tx of Scheuermann's disease |
|
Definition
similar to scoliosis
corrective plaster cast
orthosis
surgery is rare |
|
|
Term
| impairment of the blood supply to the developing femoral head results in avascular necrosis |
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Definition
|
|
Term
| when does Legg-Calve-Perthes manifest? |
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Definition
|
|
Term
| painless limp, + trendelenberg sign, flexion contracture of the affected hip, pt bears less weight, delayed skeletal maturation and small for their age, M>F |
|
Definition
|
|
Term
|
Definition
self limited, lasts 1-2 yrs
synovitis = anti inflammatory meds
permanent degenerative change = surgery |
|
|
Term
| microfracture of the patellar tendon insertion |
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Definition
|
|
Term
| who is Osgood Schlatter MC in? |
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Definition
|
|
Term
| swelling, tenderness, and increased prominence of the tibial tubercle |
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Definition
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|
Term
|
Definition
rest, restriction of activities, and occasionally a knee immobilizer combined with isometric exercise program.
anti-inflammatory meds are usually not beneficial.
complete resolution of sxs through complete healing takes 12-24 months |
|
|
Term
| onset during puberty, M>F, displacement of the femoral head from the femoral neck through the epiphyseal plate |
|
Definition
| slipped capital femoral epiphysis (SCFE) |
|
|
Term
painful limp without trauma (hip, thigh, knee)
LE is ER, shortened, with flexion contracture
antalgic gait with abductor lurchgait |
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Definition
|
|
Term
|
Definition
min/mod = in situ pin fixation
severe = pin fixation but may have complication of avascular necrosis |
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|
Term
|
Definition
|
|
Term
| when does genu varum usually correct? |
|
Definition
| after 6-12 months of independent ambulation (about 2 yrs old) |
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|
Term
|
Definition
|
|
Term
| when is genu valgum usually seen? usually resolve? |
|
Definition
seen = 3-4 yo
resolves = 5-8 yo |
|
|
Term
| when do DDH hip dislocation usually occur? |
|
Definition
|
|
Term
|
Definition
typical = neuro normal
teratologic = underlying NM disorder that occured in utero |
|
|
Term
|
Definition
| females, 60% = first borns |
|
|
Term
| what birth position is most associated with DDH? |
|
Definition
| frank breech = hips flexed, knees extended (butt first) |
|
|
Term
|
Definition
1 = no tx, conservative management
2-4 = spinal fusion |
|
|
Term
| when do you refer scoliosis to orthopedics? |
|
Definition
skeltally immature > 20 degrees
skeletally mature > 40 degrees
presence of suspicious pain or neuro sxs |
|
|
Term
| when should an ankle sprain be referred to ortho? |
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Definition
|
|
Term
| fracture forces produce more than two separate fragments |
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Definition
|
|
Term
| bone bends to the point of plastic deformation without fracturing |
|
Definition
|
|
Term
| fx is complete except for the portion of the cortex on the compression side of the fx, which is only plastically deformed |
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Definition
|
|
Term
| fx is parallel to the axis of a long bone |
|
Definition
|
|
Term
| fx line takes a curvilinear course around the axis of the bone |
|
Definition
|
|
Term
| bone ends are crushed together, producing an indistinct fx line |
|
Definition
|
|
Term
|
Definition
1 = epiphyseal separation through the physis
2 = fx through a portion of the physis and exiting across the metaphysis
3 = fx through the physis exiting across the epiphysis of the joint
4 = fx line extending across the metaphysis, physis, and epiphysis
5 = crush injury to the physis |
|
|
Term
|
Definition
age < 16
arthritis in 1+ joint
duration > 6 wks
exclusion of other forms of juvenile arthritis |
|
|
Term
|
Definition
polyarteritis = 5+ inflammed joints
oligoarthritis = < 5 inflammed joints
systemic = arthritis + fever |
|
|
Term
|
Definition
morning stiffness
gelling
joint pain and swelling later in the day
oligoarthritis
predominantly affects the LE joints (knees and ankles) |
|
|
Term
nonthrombocytopenic palpable purpura, arthritis, bowel angina, and renal abnormalities.
S&S = rash, abd pain, and arthritis |
|
Definition
|
|
Term
|
Definition
clotting factors = WNL
platelets = WNL or elevated
IgA found in glomeruli, skin and serum |
|
|
Term
| 90% of cases of HSP occur in who? who has a milder case? |
|
Definition
90% of cases in children < 10yo
milder cases < 2 yo |
|
|
Term
| who is MC affected by Kawasaki disease? |
|
Definition
|
|
Term
| most serious complication of Kawasaki disease? |
|
Definition
| coronary artery aneurysms |
|
|
Term
| 2 phases of Kawasaki disease |
|
Definition
subacute (10-25d) = peeling of the hands, fingers, toes, coronary artery aneurysms (refer to cardio), thrombocytosis.
Convalescent (21-60d) = low risk for developing aneurysms, risk fo coronary artery vasculitis |
|
|
Term
| diagnostic criteria for Kawasaki disease |
|
Definition
fever for 5 days +
conjunctivitis
lymphadenopathy
rash
cahnges in mucous membranes
injected pharynx/lips
dry, fissured lips |
|
|
Term
| changes of the peripheral extremities associated with Kawasaki disease |
|
Definition
hand and foot edema
hand and foot erythema
fingertip desquamation |
|
|
Term
| who is spondylosis and spondylolisthesis most common in? |
|
Definition
| kids in gymnastics due to hyperextension stresses |
|
|
Term
| presence of what requires an ortho consult? |
|
Definition
| supsicious pain or neuro symptoms |
|
|
Term
| what is the most important maneuver in examining the newborn hip? |
|
Definition
|
|
Term
| how successful is the pavlic harness in treating dysplastic or subluxed hips vs true dislocation |
|
Definition
dysplastic/subluxed = 95% successful
true dislocation = 80% successful |
|
|
Term
short stature
macrocephaly
severe angular scoliosis
congenital bowing and thinning or the corticies of long bones and pseudoarthrosis of the tibia, fibular, femur
axillary/inguinal freckling = less common
pheochromocytoma
learning disabilities/behavioral problems |
|
Definition
|
|
Term
more CNS tumors of meningeal/glial origin
cutaneous manifestations such as cafe au lait, neurofibromas
lisch nodules = NOT typical |
|
Definition
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|
