A young adolescent female is observed to have mild unequal
scapula prominences on gross examination while standing. In
the Adams forward bending position, this inequality disappears.
What will the primary care pediatric nurse practitioner do?
Discuss posture and exercise and ask about
backpacks and books.
The primary care pediatric nurse practitioner elicits positive
Ortolani and Barlow signs in a 6-month-old infant not
previously noted in the medical record. What are two treatments
anticipated to be used for this child's treatment?
Surgical intervention and Spica Cast The 6- to
18-month-old infant with a dislocated hip is
likely to require either closed manipulation or
open reduction. Preoperative traction, adductor
tenotomy, and gentle reduction are especially
helpful in preventing osteonecrosis of the
femoral head. After the closed or open
reduction, a hip spica cast is applied in order to
maintain the hip in more than 90 degrees of
flexion and avoid excessive internal or external
rotation.
A parent is concerned that a 12-month-old child is "bow-
legged." A physical examination reveals internal tibial torsion
bilaterally. A radiograph reveals asymmetric bowing of the legs
with an angle greater than 15 degrees. What is the correct action
for the primary care pediatric nurse practitioner?
Refer to a pediatric orthopedic specialist for
,treatment In Blount disease, the bowing is
asymmetrical; children with this disorder need
immediate referral to an orthopedist.
A child who plays soccer is in the clinic reporting pain and
swelling in both knees. A physical examination reveals swelling
and focal tenderness at the tibial tuberosities, with pain
worsening when asked to extend the knees against resistance.
What is the treatment for this condition?
Apply ice packs to both knees and avoid
activities that cause pain.
A 7-year-old girl presents with wrist pain after a fall from a
swing. The X-ray report states, "involves physeal separation
with fracture through the epiphysis into the joint." After looking
at the x-ray, what type of fracture is present?
Salter Harris III
Salter-Harris classification of fractures:
Type I involves a fracture through the zone of
hypertrophic cells of the physis with no fracture
of the surrounding bone. Type II fractures, the
most common type of growth plate fracture, are
similar to type I except that a metaphyseal
fragment is present on the compression side of
the fracture. Growth disturbance in types I and
II is rare. Type III fracture involves physeal
separation with fracture through the epiphysis
into the joint and requires anatomic reduction,
occasionally through an open approach. Type
IV fracture involves the metaphysis, physis, and
epiphysis. Type V fracture involves a
,compression or crushing injury to the physics.
Type V fractures are rare and are difficult to
diagnose initially due to the lack of radiologic
signs. Types IV and V require anatomic
reduction to prevent articular incongruity and
osseous bridging across the physis. Certain
growth plates are more prone to growth
disturbances. Children should be reevaluated
intermittently for 1 year after healing to assess
possible growth or functional disturbances.
A 4-year-old child presents with right hip pain and no history of
trauma. There is no tenderness to palpation, the ROM in his
lower extremities is normal, and vital signs are normal. The
erythrocyte sedimentation rate (ESR) is <25, and the CBC-d is
normal. What is the most likely cause of this symptom?
Transient synovitis Transient synovitis is the
most common cause of atraumatic hip pain is
children. It usually occurs in children <6 years
old, and the cause is unknown
When examining a 2-week-old infant, your feel a "clunk" with
adduction of the legs while applying downward and leteral
pressure on the knees. This is a positive:
Barlow's sign Barlow's sign is positive when
there is hip dislocation and "clunk".
A 14-year-old competitive swimmer presents with pain in the
right shoulder aggravated by movement. Physical exam is
significant for tenderness on palpation and muscle weakness in
the affected arm. Physeal fracture and apophysitis have been
ruled out. What is the most likely diagnosis?
, Rotator cuff tendonopathy
A 15-year-old girl who competes in basketball and cross-country
presents with left anterior knee pain. She is not limping but
finds that workouts and climbing the stairs at her school worsen
the pain. Her knee feels sore after sitting in one position for an
extended time. There has been no swelling. In the exam there is
no redness or swelling in the left knee. Palpating and
compressing the joint with the knee extended is tender and
painful. What condition is the leading diagnosis in the
differential diagnoses list?
patellofemoral pain syndrome (PFPS). The
patient will present with anterior knee pain that
worsens with activity, going up and down stairs,
and soreness after sitting in one position for an
extended time. There is usually no associated
swelling
A mother brings her 7-year old daughter in for evaluation of a
spider bite. She states her daughter was playing in a backyard
playhouse last evening about 12 hours ago and she felt a burning
sensation on her arm and noticed a brownish spider on her arm.
The mother put antibiotic ointment and ice on the bite, but this
morning the arm is painful and throbbing. On exam, you note a
vesicular lesion surrounded by erythema. Her temperature is
101 F and she is mildly tachycardic. What is your initial step in
treating the patient?
Pain control, ice application, elevation,
urinalysis, and lab evaluation
scapula prominences on gross examination while standing. In
the Adams forward bending position, this inequality disappears.
What will the primary care pediatric nurse practitioner do?
Discuss posture and exercise and ask about
backpacks and books.
The primary care pediatric nurse practitioner elicits positive
Ortolani and Barlow signs in a 6-month-old infant not
previously noted in the medical record. What are two treatments
anticipated to be used for this child's treatment?
Surgical intervention and Spica Cast The 6- to
18-month-old infant with a dislocated hip is
likely to require either closed manipulation or
open reduction. Preoperative traction, adductor
tenotomy, and gentle reduction are especially
helpful in preventing osteonecrosis of the
femoral head. After the closed or open
reduction, a hip spica cast is applied in order to
maintain the hip in more than 90 degrees of
flexion and avoid excessive internal or external
rotation.
A parent is concerned that a 12-month-old child is "bow-
legged." A physical examination reveals internal tibial torsion
bilaterally. A radiograph reveals asymmetric bowing of the legs
with an angle greater than 15 degrees. What is the correct action
for the primary care pediatric nurse practitioner?
Refer to a pediatric orthopedic specialist for
,treatment In Blount disease, the bowing is
asymmetrical; children with this disorder need
immediate referral to an orthopedist.
A child who plays soccer is in the clinic reporting pain and
swelling in both knees. A physical examination reveals swelling
and focal tenderness at the tibial tuberosities, with pain
worsening when asked to extend the knees against resistance.
What is the treatment for this condition?
Apply ice packs to both knees and avoid
activities that cause pain.
A 7-year-old girl presents with wrist pain after a fall from a
swing. The X-ray report states, "involves physeal separation
with fracture through the epiphysis into the joint." After looking
at the x-ray, what type of fracture is present?
Salter Harris III
Salter-Harris classification of fractures:
Type I involves a fracture through the zone of
hypertrophic cells of the physis with no fracture
of the surrounding bone. Type II fractures, the
most common type of growth plate fracture, are
similar to type I except that a metaphyseal
fragment is present on the compression side of
the fracture. Growth disturbance in types I and
II is rare. Type III fracture involves physeal
separation with fracture through the epiphysis
into the joint and requires anatomic reduction,
occasionally through an open approach. Type
IV fracture involves the metaphysis, physis, and
epiphysis. Type V fracture involves a
,compression or crushing injury to the physics.
Type V fractures are rare and are difficult to
diagnose initially due to the lack of radiologic
signs. Types IV and V require anatomic
reduction to prevent articular incongruity and
osseous bridging across the physis. Certain
growth plates are more prone to growth
disturbances. Children should be reevaluated
intermittently for 1 year after healing to assess
possible growth or functional disturbances.
A 4-year-old child presents with right hip pain and no history of
trauma. There is no tenderness to palpation, the ROM in his
lower extremities is normal, and vital signs are normal. The
erythrocyte sedimentation rate (ESR) is <25, and the CBC-d is
normal. What is the most likely cause of this symptom?
Transient synovitis Transient synovitis is the
most common cause of atraumatic hip pain is
children. It usually occurs in children <6 years
old, and the cause is unknown
When examining a 2-week-old infant, your feel a "clunk" with
adduction of the legs while applying downward and leteral
pressure on the knees. This is a positive:
Barlow's sign Barlow's sign is positive when
there is hip dislocation and "clunk".
A 14-year-old competitive swimmer presents with pain in the
right shoulder aggravated by movement. Physical exam is
significant for tenderness on palpation and muscle weakness in
the affected arm. Physeal fracture and apophysitis have been
ruled out. What is the most likely diagnosis?
, Rotator cuff tendonopathy
A 15-year-old girl who competes in basketball and cross-country
presents with left anterior knee pain. She is not limping but
finds that workouts and climbing the stairs at her school worsen
the pain. Her knee feels sore after sitting in one position for an
extended time. There has been no swelling. In the exam there is
no redness or swelling in the left knee. Palpating and
compressing the joint with the knee extended is tender and
painful. What condition is the leading diagnosis in the
differential diagnoses list?
patellofemoral pain syndrome (PFPS). The
patient will present with anterior knee pain that
worsens with activity, going up and down stairs,
and soreness after sitting in one position for an
extended time. There is usually no associated
swelling
A mother brings her 7-year old daughter in for evaluation of a
spider bite. She states her daughter was playing in a backyard
playhouse last evening about 12 hours ago and she felt a burning
sensation on her arm and noticed a brownish spider on her arm.
The mother put antibiotic ointment and ice on the bite, but this
morning the arm is painful and throbbing. On exam, you note a
vesicular lesion surrounded by erythema. Her temperature is
101 F and she is mildly tachycardic. What is your initial step in
treating the patient?
Pain control, ice application, elevation,
urinalysis, and lab evaluation
