Ortho
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| What might subdural or retinal hemorrhaging suggest in a child? | possible abuse from shaking
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| What fractures indicate possible abuse? (5) | posterior rib, scapula, posterior process of spine, sternum, corner fractures of long bone metaphysis
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| Pt (child) presents w/ posterior heel pain and a limp. Pain inc w/ activity. | clacanel apophysitis aka Sever's dz
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| what age/gender is assoc w/ sever's dz | male 8-11 y/o
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| tx for calcaneal apophysitis (sever's dz) | activity restriction, heel lift, achilles tendon stretching, casting 4-6 wks, NO SURGERY OR INJECTION
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| associated w/ ligamentous laxity in hip and detectable at birth. assymptomatic in neonates and sometimes picked up when child starts to walk. | Developmental dysplasia of the hip
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| Dx Develop. Dysplasia of the hip | PE. Barlow test. Ortolani maneuver for relocatability. hip limiter abduction. US. Geleazzi sign for leg length
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| What are the adverse outcomes of Dev. Dysplasia of the hip | longer the hip is dislocated the harder to reduce AND possible early DJD
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| Tx Develop. dysplasia of the hip | <3 mos - PAVLIK HARNESS3-9 mos try harnesslater - closed or open reduction
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| congenital deformity, autosomal dominant, mild scoliosis, moderate limb deformity, mild limb shortening. BLUE SCLERAE | osteogenesis imperfecta
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| adverse outcomes of growth plate damage? | limb length discrepancy or angulation
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| congenital dislocaton of the radial head | subluxation of radial head
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| what is the most common childhood dislocation? | elbow dislocation
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| Are most elbow dislocations anterior or posterior? | 80% posterior
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| tibia becomes laterally deviated from midline as it progresses distally | Valgum
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| "knock knees" | valgum
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| "bow legged" | varus
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| how do you dx valgum | measure height and plot on nomogram; measure tibiofemoral angle or intermalleolar dist
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| tx for valgum | None: usually corrects itself
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| deformity w/ tibia medially deviated more as it progresses distally | genu varum
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| tx varum | ITV-bracing; tibial osteotomy 30-60 mos
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| what can cause mild intoeing? | mild CP
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| after what age is an osteotomy used to treat in toeing/out toeing | 7-8 yrs
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| What age should is in/out toeing considered severe at? | severe beyond age 4 and watch until age 8
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| what age is metatarsus adductus severe beyond | 6 mos
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| idiopathic osteonecrosis of femoral head in children 2-12 y/o | legg-calve-perthes dz
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| is legg-calve-perthes dz more common in males or females | males 4:1
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| what leads to a worse prognosis for legg-calve-perthes dz | advanced age and involvement; also bone death w/ collapse may lead to deformity and DJD
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| pt presents w/ limping x 3-6 weeks, pain increasing w/ activity and aching in groin or thigh | legg-calve-perthes dz
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| dx legg-calve-perthes dz | limited abduciton; AP and frog-lateral views of hips; inc density of FH, CRESCENT SIGN of shear fracture in subchondral bone; poss MRI
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| CRESENT SIGN on and xray indicates... | legg-calve-perthes dz
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| tx legg-calve-perthes dz | observation for children w/mild involvement:bracing in abduction (marginally effective), bed rest and traction, osteotomy for older pts
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| displacement of femoral head through an immature physis typically during adolescent growth spurt | slipped capital femaoral epiphysis
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| what directions does SCFE usually slip | posterior and medial
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| what factore predispose SCFE | obesity, male, sports activities
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| What age range for female and males w/ SCFE | F: 12y/o M: 13y/o
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| pt w/ proximal anterior thigh or groin pian possibly radiating to distal thigh. pain inc w/ activity. loss of hip internal rotation w/flexion. abduction and extension dec. shortening of affected extremity | SCFE
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| Dx SCFE | AP and frog-lateral pelvic films
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| "ice cream slipping off ice cream cone" | SCFE
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| Adverse outcomes of SCFE | progressive arthritis, chondrolysis, osteonecrosis, DJD
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| tx SCFE | in situ stabilization, reduction and emergent stabilization, realignment osteotomy, PINNING IN SITU IS STANDARD OF CARE
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| After what age do you worry about toe walking? | 18 mos
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| antibiotic used to treat animal bites | Augmentin
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| organism involved in cat/dog bites | pasturella multocida
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| when do you close a cat bite? | NEVER!!!!
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| swelling or stenosis of the tendon sheath, pain swelling, triggering at base of thumb. Swelling and tenderness over first dorsal compartment | DeQuervain's tenosynovitis
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| + finkelstein test | DeQuervain's tenosynovitis
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| tx DeQuervain's tenosynovitis | thumb spica splint, NSAID, injection surgery
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| nodular thickening and contracture of the palmar fascia. usually men >50 | Dupuytren contracture
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