Podcast
Questions and Answers
What is the primary focus of the article by Kristin Bird and Gerald Moore?
What is the primary focus of the article by Kristin Bird and Gerald Moore?
- Management of back pain
- Evaluation of joint disorders
- Conducting an office-based musculoskeletal exam (correct)
- Assessment of skeletal injuries
Which of the following would most likely be considered a red flag of low back pain?
Which of the following would most likely be considered a red flag of low back pain?
- Localized muscle soreness
- Improvement with rest
- Recent change in mobility (correct)
- Decreased range of motion
In the context of musculoskeletal complaints, what is the importance of conducting a thorough history?
In the context of musculoskeletal complaints, what is the importance of conducting a thorough history?
- To assess familial tendencies in joint diseases
- To determine the effectiveness of previous treatments
- To rule out all possible causes of pain
- To identify potential underlying conditions (correct)
What aspect should NOT be overlooked when assessing back pain in a patient?
What aspect should NOT be overlooked when assessing back pain in a patient?
What does the presence of bidirectional or vertical nystagmus suggest?
What does the presence of bidirectional or vertical nystagmus suggest?
Which symptom could complicate the assessment of low back pain?
Which symptom could complicate the assessment of low back pain?
When evaluating nystagmus, what should be observed when asking the patient to look to the sides?
When evaluating nystagmus, what should be observed when asking the patient to look to the sides?
Which type of nystagmus is considered more reassuring during evaluation?
Which type of nystagmus is considered more reassuring during evaluation?
In the context of nystagmus evaluation, which statement accurately describes what is sought after?
In the context of nystagmus evaluation, which statement accurately describes what is sought after?
If a patient exhibits unidirectional nystagmus during evaluation, what is the likely implication?
If a patient exhibits unidirectional nystagmus during evaluation, what is the likely implication?
What is a key distinction between breath-holding spells and epileptic seizures?
What is a key distinction between breath-holding spells and epileptic seizures?
Which of the following differentiates between stereotypies and tics?
Which of the following differentiates between stereotypies and tics?
In pediatric neurology, what defines paroxysmal non-epileptic disorders?
In pediatric neurology, what defines paroxysmal non-epileptic disorders?
What characterizes upper motor neuron (UMN) dysfunction compared to lower motor neuron (LMN) dysfunction?
What characterizes upper motor neuron (UMN) dysfunction compared to lower motor neuron (LMN) dysfunction?
Which statement about neurologic disorders is true?
Which statement about neurologic disorders is true?
What metabolic risk factors co-occur for both Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD)?
What metabolic risk factors co-occur for both Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD)?
What is the recommended duration for aerobic physical activity to achieve significant systolic blood pressure reduction?
What is the recommended duration for aerobic physical activity to achieve significant systolic blood pressure reduction?
Which dietary pattern is specifically mentioned as part of a healthy eating plan?
Which dietary pattern is specifically mentioned as part of a healthy eating plan?
What is one of the key considerations in providing person-centered and culturally effective care?
What is one of the key considerations in providing person-centered and culturally effective care?
Which of the following is NOT a component of the 5 'A's framework for obesity management?
Which of the following is NOT a component of the 5 'A's framework for obesity management?
Which of these screening methods is commonly used in assessing the risk for atherosclerotic cardiovascular disease?
Which of these screening methods is commonly used in assessing the risk for atherosclerotic cardiovascular disease?
In evaluating metabolic syndrome, which condition is usually assessed?
In evaluating metabolic syndrome, which condition is usually assessed?
What is the focus of the physical activity recommendations for managing metabolic syndrome?
What is the focus of the physical activity recommendations for managing metabolic syndrome?
What is the primary method of treatment for clubfoot?
What is the primary method of treatment for clubfoot?
Which screening method is recommended for detecting developmental dysplasia of the hip in high-risk infants?
Which screening method is recommended for detecting developmental dysplasia of the hip in high-risk infants?
What is a common complication associated with Slipped Capital Femoral Epiphysis (SCFE)?
What is a common complication associated with Slipped Capital Femoral Epiphysis (SCFE)?
At what angle of curvature is scoliosis considered significant and diagnosed?
At what angle of curvature is scoliosis considered significant and diagnosed?
For which age group is ultrasound screening for hip dysplasia recommended?
For which age group is ultrasound screening for hip dysplasia recommended?
What is the typical incidence rate of clubfoot in live births?
What is the typical incidence rate of clubfoot in live births?
Which of the following is NOT a characteristic of clubfoot?
Which of the following is NOT a characteristic of clubfoot?
Which treatment option is commonly used for non-operative management of scoliosis curves between 25° and 40°?
Which treatment option is commonly used for non-operative management of scoliosis curves between 25° and 40°?
What is a key physical exam finding for SCFE?
What is a key physical exam finding for SCFE?
When is referral to orthopedics necessary for developmental dysplasia of the hip?
When is referral to orthopedics necessary for developmental dysplasia of the hip?
Which treatment is indicated for hip dislocation in DDH?
Which treatment is indicated for hip dislocation in DDH?
Scoliosis screening is commonly performed using which method?
Scoliosis screening is commonly performed using which method?
What is the follow-up care after applying the Ponseti method for clubfoot?
What is the follow-up care after applying the Ponseti method for clubfoot?
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Study Notes
Nystagmus Evaluation
- When evaluating nystagmus, ask the patient to look slightly left and then right. Notice slight changes in direction.
- Bidirectional or vertical nystagmus suggests a central cause of vertigo, like a stroke.
- Unidirectional nystagmus is reassuring and may not be indicative of a serious condition.
Common Problems Pediatric Neurology - Paroxysmal Non-Epileptiform Disorders
- Paroxysmal non-epileptiform disorders can be classified based on the age of onset.
- There are differences between breath-holding spells and epileptic seizures, as well as between stereotypies and tics.
- Important to differentiate between non-epileptic seizures (pseudoseizures) and true epileptic seizures.
Upper Motor Neuron (UMN) Dysfunction vs. Lower Motor Neuron (LMN) Dysfunction - Cranial Nerve 7
- UMNs are part of the Central Nervous System (CNS), with cell bodies located in the brain or spinal cord.
Orthopedic Conditions in Children
Clubfoot
- Clubfoot is a complex deformity characterized by a high arch, adducted forefoot, varus hindfoot, and equinus.
- Incidence is around 1-2 per 1000 live births.
- Can be idiopathic or associated with neuromuscular conditions or syndromes.
- Treatment involves the Ponseti method of serial casting and possible Achilles tenotomy.
- After casting, patients wear foot abduction orthosis full-time for 3 months, then part-time until age 4.
- Recurrence is common and may require additional casting or surgery.
- Referral to an orthopedic specialist familiar with the Ponseti method is recommended.
- Chronic pain is a common complication.
Developmental Dysplasia of the Hip (DDH)
- DDH is a spectrum of disorders ranging from mild acetabular dysplasia to complete hip dislocation.
- Key risk factors include breech presentation and family history.
- Screening is done with a physical exam (Ortolani/Barlow tests) in infancy.
- Ultrasound screening is recommended at 4-6 weeks for high-risk infants.
- X-rays are used for screening after 4-6 months of age.
- Treatment depends on age and severity and may include Pavlik harness, closed reduction, or open reduction.
- The goal is to maintain concentric hip reduction to allow normal development.
- Referral to an orthopedic specialist is needed for abnormal physical exams or imaging findings.
Slipped Capital Femoral Epiphysis (SCFE)
- SCFE is a displacement of the femoral metaphysis anteriorly/laterally on the epiphysis.
- Typically occurs in adolescents, often obese.
- Can present with hip, knee, or thigh pain.
- Physical exam shows decreased internal rotation and abduction of the hip; persistent hip pain.
- Diagnosis is made with AP and frog-leg lateral x-rays of the pelvis.
- Treatment is urgent surgical fixation.
- Complications include avascular necrosis and future arthritis.
- Urgent referral to an orthopedic specialist or the ED is needed when suspected.
Scoliosis
- Scoliosis is defined as a spinal curve greater than 10° on x-ray, showing lateral curvature.
- Most common type is adolescent idiopathic scoliosis.
- Screening is done with the forward bend test and scoliometer.
- X-rays are indicated for a scoliometer reading greater than 7°.
- Curves between 10-25° are monitored.
- Curves between 25-40° are often treated with bracing.
- Curves greater than 50° usually require surgical fusion.
- MRI is indicated for atypical curves or early-onset scoliosis.
- Referral to an orthopedic specialist is recommended for curves greater than 20-25°.
Stanford Low Back Exam
Orthopedic Videos
- Hoffman sign: Tests for impingement
- Impingement sign:
- Rotator cuff:
- Thomas Test: Tests for hip flexion
- Milking effusion in the knee:
- Medial Collateral Ligament (MCL):
- Lateral Collateral Ligament (LCL):
- McMurray:
- Lachman's:
- Anterior Drawer:
- Posterior Drawer:
Musculoskeletal Class Slides
Conditions Requiring Urgent Attention
Respiratory Assessment
-
Perform direct or indirect percussion on the chest, and compare each side for:
-
-
Auscultate the chest with the stethoscope diaphragm, comparing sides for:
Metabolic Syndrome
- Metabolic Syndrome: Co-occurrence of metabolic risk factors for both type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD): abdominal obesity, hyperglycemia, dyslipidemia, and hypertension.
Diabesity
- - - - - - - - -
DASH Diet Eating Plan
Physical Activity Recommendations
- 4-9mmHg systolic blood pressure (SBP) reduction with aerobic physical activity for 30 minutes most days of the week.
Type 2 Diabetes Mellitus (T2DM) Screening
ASCVD Risk Calculator
USPSTF Statin Use Recommendations
Person-Centered / Culturally Effective Care
OARS
SDOH with Screening
Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2021
Assessing and Managing the Metabolic Syndrome in Children and Adults
The 5 As Framework for Obesity Management
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