Bone and Joint

Question 1

malialignment of calcaneotalar-navicular complex

Answer 1

Talipes equinovarus (clubfoot)

Question 2

normal foot that has been held in deformed position in utero and found to be flexible on examination

Answer 2

positional clubfoot

Question 3

clubfoot is extremely common in patients with myelodysplasia and arthrogryphosis

Answer 3

Clubfoot

Question 4

examination findings in infants with clubfoot

Answer 4

forefoot cavus and adductus

hindfoot varus and equinus

Question 5

common radiographic finding in clubfoot

Answer 5

“parallelism” between lines drawn through axis of the talus and calcaneus on the lateral radiograph indicating hindfoot varus

Question 6

pain over tibial tubercle in a growing child

Answer 6

Osgood-Schlatter disease

• traction of the tibial tubercle growth plate and adjacent patellar tendon
• self-limited in most patients and resolves with skeletal maturity

Question 7

two groups of Developmental Dysplasia of Hip

Answer 7

typical

teratologic

Question 8

occurs in otherwise normal patients or those with defined syndromes or genetic conditions

Answer 8

Typical DDH

Question 9

have identifiable cause such as arthrogryposis or genetic syndrome and occur before birth

Answer 9

Teratologic DDH

Question 10

what is Barlow maneuver

Answer 10

assess the potential dislocation of a nondisplaced hip in a neonate

• examiner adducts the flexed hip and gently pushes the thigh posteriorly
• (+) test: hip is felt to slide out of acetabulum

Question 11

What is Ortolani maneuver?

Answer 11

examiner attempts to reduce a dislocated hip

• examiner grasps the child’s thigh between thumb and index finger and with 4th and 5th fingers lifts the greater trochanter while simultaneously abducting the hip
• (+) test: femoral head will slip into the socket with delicate chunk that is palpable not audible

Question 12

shortening of the thigh is best appreciated by placing both hips in 90 degrees of flexion and comparing height of knees, looking for asymmetry in infants

Answer 12

Galeazzi sign

Question 13

what is the modality of choice in DDH?

Answer 13

Ultrasonography

• before appearance of femoral head ossific nucleus
• early newborn period (0-4 weeks): PE preferred over UTZ
• radiographs once femoral epiphysis ossifies

Question 14

management of patients Barlow and Ortolani positive

Answer 14

Pavlik harness

Question 15

most important complication of DDH

Answer 15

avascular necrosis of femoral epiphysis

Question 16

hip disorder of unknown etiology that results from temporary interruption of the blood supply to the proximal femoral epiphysis –> osteronecrosis and femoral head deformity

Answer 16

Legg-Calve-Perthes Disease

Question 17

Stages of Legg-Calve-Perthes Disease

Answer 17

1. initial: lasts months; synovitis, joint irritability and early necrosis of femoral head
   2 fragmentation: lasts 8 months; femoral epiphysis begin to collapse usually laterally and begins to extrude from acetabulum
2. healing stage: lasts 4 years begins with new bone formation in the subchondral region
3. residual stage: begins when entire head has reossified

Question 18

most common presenting sign of Legg-Calve-Perthes Disease

Answer 18

limp

*routine plain radiograph

Question 19

management of Legg-Calve-Perthes Disease

Answer 19

activity limitation, protected weight bearing, NSAIDs and physical therapy

*most common surgical containment procedure is varus osteotomy of proximal femur

Question 20

tilting head to the right or left side in combination of head to the opposite side

Answer 20

Torticollis

Question 21

most common etiology of Torticollis

Answer 21

congenital muscular torticollis

Question 22

treatment for congenital muscular torticollis

Answer 22

stretching, stimulation and positioning measures

Question 23

torticollis associated with GER

Answer 23

Sandifer syndrome

Question 24

result from strabismus (weakness of 4th cranial nerve) or superior oblique muscle palsy

Answer 24

Ocular torticollis

Question 25

most common infecting organism in Osteomyelitis

Answer 25

Staphylococcus aureus

Question 26

frequently affected bones in osteomyelitis

Answer 26

femur and tibia equally affected

Question 27

imaging of choice in osteomyelitis

Answer 27

MRI is more sensitive than CT

*Brodie abscess

Question 28

In neonates with osteomyelitis, what is the treatment of choice?

Answer 28

Nafcillin or Oxacillin and broad spectrum cephalosporin such as Cefotaxime

Question 29

gold standard agent for treating invasive MRSA infections of osteomyelitis

Answer 29

Vancomycin

Question 30

parenteral treatment of osteomyelitis caused by Methicilin sensitive S. aureus

Answer 30

Cefazolin

Question 31

minimal duration of antibiotics for osteomyelitis

Answer 31

21-28 days

Question 32

most common cause of septic arthritis

Answer 32

Staphylococcus aureus

Question 33

important cause of septic arthritis in neonates

Answer 33

Group B streptococcus

Question 34

In neonates with septic arthritis, what is the treatment?

Answer 34

Nafcillin or oxacillin and broad spectrum cephalosporin Cefotaxime

Question 35

most common genetic cause of osteoporosis

Answer 35

Osteogenesis imperfecta

Question 36

triad of Osteogenesis imperfecta

Answer 36

fragile bones
blue sclerae
early deafness

Question 37

most severe nonlethal form of Osteogenesis imperfecta

Answer 37

Osteogenesis imperfecta type III

*results in significant physical disability

Question 38

morbidity and mortality of Osteogenesis imperfecta

Answer 38

cardipulmonary

Question 39

treatment for Osteogenesis imperfecta

Answer 39

Bisphosphonates decreases bone resorption by osteoclast

limit treatment duration to 2-3 years