Bone and joints

Question 1

deformity involving malalignment of the calcaneotalar-navicular complex

Answer 1

Talipes equinovarus (Clubfoot)

Question 2

Clubfoot extremely common in patients with

Answer 2

myelodysplasia and arthrogyposis

Question 3

examination of infant clubfoot demonstrates

Answer 3

forefoot cavus and adductus

hindfoot varus and equinus

Question 4

common radiographic finding in clubfoot

Answer 4

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

Question 5

management of clubfeet

Answer 5

surgical realignment

Question 6

pain over tibial tubercle in a growing child

Answer 6

Osgood-Schlatter disease

*patellar tendon inserts into the tibia tubercle which is an extension of proximal tibial epiphysis

Question 7

treatment for Osgood-Schlatter

Answer 7

self-limited in most patients and resolves with skeletal maturity

Question 8

spectrum of pathology in the development of immature hip joint

Answer 8

Developmental dysplasia of the hip

Question 9

2 major groups of DDH

Answer 9

typical and teratologic

• typical: occurs in otherwise normal patients or those without defined syndromes or genetic conditions
• teratologic: have identifiable causes such as arthrogryphosis or genetic syndrome and occur before birth

Question 10

final common pathway in development of DDH

Answer 10

increased laxity of hip capsule which fails to maintain a stable femoroacetabular articulation

Question 11

Barlow maneuver

Answer 11

provocative maneuver to assess the potential for dislocation of a nondisplaced hip in a neonate

• examiner adducts the flexed hip and gently pushes the thigh posteriorly in an effort to dislocate the femoral head
• In a positive test, hip is felt to slide out of the acetabulum
• as the examiner relaxes the proximal push, the hip can be felt to sip back into the acetabulum

Question 12

Ortolani test

Answer 12

reverse of Barlow; examiner attempts to reduce a dislocated hip

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

Question 13

Galeazzi sign

Answer 13

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

Question 14

diagnostic modality of choice for DDH before the appearance of femoral head ossific nucleus (4-6mo)

Answer 14

Ultrasonography

Question 15

preferred examination during early newborn period (0-4 weeks)

Answer 15

physical examination

Question 16

what is the treatment for newborn hips positive for Barlow or Ortolani

Answer 16

Pavlik harness as soon as diagnosis is made

Question 17

most important complication of DDH

Answer 17

avascular necrosis of femoral epiphysis

Question 18

hip disorder that results from temporary interruption of the blood supply to the proximal femoral epiphysis leading to osteronecrosis and femoral head deformity

Answer 18

Legg-Calve-Perthes Disease

Question 19

stages of Legg-Calve-Perthes Disease

Answer 19

initial stage: often lasts for months, characterized by synovitis, joint irritability, early necrosis of the femoral head

fragmentation stage: lasts 8 months where femoral epiphysis begins to collapse usually laterally and begins to extrude from acetabulum

healing stage: lasts approximately 4 year begins with new bone formation in the subchondral region

Final stage (residual stage): begins after the entire head has reossified

Question 20

most common presenting symptom of Legg-Calve-Perthes

Answer 20

limp of varying duration

Question 21

primary diagnostic tool for LCPD

Answer 21

routine plain radiographs

Question 22

most common surgical procedure for LCPD

Answer 22

varus osteotomy of the proximal femur

Question 23

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

Answer 23

Torticollis

Question 24

contracture of left sternocleidomastoid muscle results

Answer 24

in tilt of the head to the left and vice versa

Question 25

treatment of muscular torticollis

Answer 25

stretching, stimulation and positioning measures, often supervised by physical therapist

Question 26

Ocular torticollis result from

Answer 26

strabismus (weakness of 4th cranial nerve) or a superior oblique

Question 27

most common infecting organism in all age groups with osteomyelitis

Answer 27

Staphylococcus aureus

Question 28

focal tenderness over a long bone

Answer 28

osteomyelitis

Question 29

most sensitive imaging for osteomylelitis

Answer 29

MRI

Question 30

gold standard for treating osteomyelitis invasive MRSA infections especially when child is critically ill

Answer 30

Vancomycin

Question 31

agent of choice for parenteral treatment of osetomyelitis caused by methicillin-susceptible S aureus

Answer 31

Cefazolin

duration of antibiotics: 21-28 days provided that patient shows resolution of signs and symptoms (within 5-7days) and CRP and ESR have normalized

Question 32

most common genetic cause of osteoporosis; generalized disorder of connective tissue

Answer 32

Osteogenesis imperfecta

Question 33

causes full spectrum of OI

Answer 33

structural or quantitative defects in Type I collagen

*primary component of the extracellular matrix of bone and skin

Question 34

What is the triad of Osteogenesis imperfecta

Answer 34

fragile bones, blue sclerae, early deafness

Question 35

most severe nonlethal form of OI

Answer 35

Type III

results in significant physical disability

Question 36

clinical manifestations of OI Type 4

Answer 36

fractures or bowing of lower long bones but fracture rates decreased after puberty

Question 37

morbidity and mortality in OI

Answer 37

cardiopulmonary

Question 38

treatment for OI

Answer 38

bisphosphonates

Question 39

Presence of genu varum beyond this age is considered pathologic

Answer 39

2 years

Question 40

Injuries in this part of bone may lead to potential deformity due to involvement of growth plate

Answer 40

Epiphysis