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CCOC III > Dag 1 > Flashcards

Dag 1 Flashcards

1
Q

The patho-anatomy in congenital scoliosis is determinative for the risk of curve progression. Which of the following anomalies has the highest risk?

  1. Block vertebrae
  2. Unilateral bar
  3. Hemivertebra
  4. Unilateral bar with contralateral hemivertebra
  5. All of the above
A
  1. Unilateral bar with contralateral hemivertebra
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2
Q

A 10 year old girl has been referred for lower back pain. Pain is present since 6 weeks and decreases in rest, extension is painful at the lower lumbar region. Physical examination shows localized tenderness and no neurological signs. After physical examination you suspect spondylolysis. Radiographs of the lumbar spine however don’t reveal spondylolysis. Which next step is indicated?

  1. Order an erythrocyte sedimentation rate (ESR)
  2. Treat with thoraco-lumbosacral orthosis (TLSO)
  3. Continue work-up with MRI/CT or bone scintigraphy
  4. Comfort the patient and parents and end treatment
  5. Start with NSAIDS and schedule for follow-up consultation
A
  1. Continue work-up with MRI/CT or bone scintigraphy
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3
Q

Septic arthritis peaks in the first few years of life. One particular bacteria is in most cases the cause of the infection in children. Which of the following bacteria is this?

  1. Group B Streptococcus
  2. H Influenzae
  3. Meningococcusi
  4. Salmonella
  5. Staph Aureus
A
  1. Staph Aureus
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4
Q

Certain fractures do occur in children. Sometimes such a fracture is a feature of osteogenesis imperfecta (IO). In which of the following fractures is screening for OI indicated?

  1. Anterior iliac spine avulsion fracture
  2. Burst type thoracal spine fracture
  3. Olecranon apophyseal avulsion fracture
  4. Subcapital humeral fracture
  5. Supracondylar humeral fracture
A
  1. Olecranon apophyseal avulsion fracture
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5
Q

Which remark is not true in relation to coxa vara?

  1. Pain is common
  2. Boys and girls are equally affected
  3. Surgery is indicated if Hilgenreiner-epiphyseal angle is more than 60 degrees
  4. The congenital type is characterized by a primary cartilaginous defect in the femoral neck
  5. The arrows in the figure point towards the inverted Y-sign. This is pathognomonic for coxa vara
A
  1. Pain is common
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6
Q

The following remarks are all about Legg-Calvé-Perthes’ disease (LCPD). Which of these remarks is incorrect?

  1. Treatment is controversial in LCPD
  2. Re-ossification is the third radiographic stage in LCPD
  3. LCPD occurs in children with a range, 2 years to late teens
  4. ROM testing will often reveal decreased abduction and internal rotation
  5. LCPD is caused by a mutation in the gene encoding galactosamine-6-sulfatase and is located at 16Q24,3
A
  1. LCPD is caused by a mutation in the gene encoding galactosamine-6-sulfatase and is located at 16Q24,3
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7
Q

Five statements about fractures.

  1. A Salter Harris 3 fracture will inevitably lead to a deformation at later age
  2. A Salter Harris 5 fracture needs to be operated to prevent a growth arrest
  3. An adult can’t have a buckle fracture
  4. The younger the child who sustains a fracture, the shorter the plaster immobilization period can be
  5. A residual dorsal angulation of a healed distal radial fracture will correct not as quickly as a residual radial deviation

Which statement is or which statements are true?

  1. 1 and 3
  2. 1, 2 and 5
  3. 2, 4 and 5
  4. 3 and 4
  5. 3 and 5
A
  1. 3 and 4
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8
Q

In what order do the ossification centers of the elbow appear on a radiograph?

  1. Capitellum - medial epicondyle - proximal radius - trochlea - olecranon - lateral epicondyle
  2. Capitellum - proximal radius - medial epicondyle - trochlea - olecranon - lateral epicondyle
  3. Capitellum - proximal radius - trochlea - medial epicondyle - lateral epicondyle - olecranon
  4. Trochlea - capitellum - proximal radius - medial epicondyle - olecranon - lateral epicondyle
  5. Trochlea - medial epicondyle - lateral epicondyle - proximal radius - capitellum - olecranon
A
  1. Capitellum - proximal radius - medial epicondyle - trochlea - olecranon - lateral epicondyle
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9
Q

What is the incidence of hip dysplasia or subluxation in a caucasian population?

  1. 0.5 in 1000 newborns (0.05%)
  2. 1 in 1000 newborns (0.1%)
  3. 5 in 1000 newborns (0.5%)
  4. 10 in 1000 newborns (1%)
  5. 50 in 1000 newborns (5%)
A
  1. 10 in 1000 newborns (1%)
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10
Q

Ultrasonography of the infant hip is useful in confirming a diagnosis of developmental dysplasia of the hip. Reference parameters are the alpha angle and the beta angle. What is true about these parameters?

  1. At age 4 to 6 weeks, a normal alpha angle is >60°; a normal beta angle is <55°
  2. At age 4 to 6 weeks, a normal alpha angle is >55°; a normal beta angle is <60°
  3. At age 6 to 12 weeks, a normal alpha angle is >60°; a normal beta angle is <55°
  4. At age 6 to 12 weeks, a normal alpha angle is >55°; a normal beta angle is <60°
  5. At age > 12 weeks, a normal alpha angle is >60°; a normal beta angle is <55°
A
  1. At age 4 to 6 weeks, a normal alpha angle is >60°; a normal beta angle is <55°
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11
Q

Which statement about tarsal coalitions of the foot is true?

  1. Calcaneo-talar coalitions are the most common
  2. Operative treatment is always indicated
  3. A lateral oblique x-ray view of the foot is helpful in the diagnosis
  4. Operative treatment in a calcaneo-navicular coalition uses the M Flexor digitorum as interposition graft
  5. A pre-operative CT scan is not useful in ruling out multiple coalitions
A
  1. A lateral oblique x-ray view of the foot is helpful in the diagnosis
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12
Q

In the Ponseti treatment of clubfeet different steps are taken. Which of the following steps is not part of this treatment?

  1. Long leg casts
  2. Pronation of the foot during casting
  3. Achilles tenotomy before the final cast
  4. Lateral pressure on the head of the talus
  5. Consequent bracing following the casting period
A
  1. Pronation of the foot during casting
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13
Q

Which of the following position of the lower extremity is certainly abnormal?

  1. Bow legs with an intercondylar distance of 4 cm in a 2 year old child
  2. Bow legs with an intercondylar distance of 10 cm in a 3 year old child
  3. Bow legs with an intercondylar distance of 6 cm in a 1.5 year old child
  4. Knock knees with an intramalleolar distance of 5 cm in a 3 year old child
  5. Knock knees with an intramalleolar distance of 4 cm in a 8 year old child
A
  1. Bow legs with an intercondylar distance of 10 cm in a 3 year old child
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14
Q

This 7 year old boy has had a marrow transplantation at the age of 1 year and developed a thoracolumbar kyphosis of 50 degrees. What is the most likely diagnosis?

  1. Achondroplasie
  2. Cleidocranial dysostosis
  3. Diastrophic dysplasie
  4. Mucopolysaccharidose I (Hunter’s disease)
  5. Spondylepiphyseal dysplasia
A
  1. Mucopolysaccharidose I (Hunter’s disease)
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15
Q

“Rule of thumb” can be used to determine the time of epipfysiodesis of the long leg. Six statements about this rule of thumb are:

  1. Growth stops at the lower legs in girls around 12 year.
  2. Growth stops at the lower legs in boys around 14 year.
  3. Growth stops at the lower legs in girls around 14 year.
  4. Growth stops at the lower legs in boys around 16 year.
  5. Growth stops at the lower legs in girls around 16 year.
  6. Growth stops at the lower legs in boys around 12

year.

  1. 1 + 2
  2. 1 + 4
  3. 3 + 4
  4. 2 + 3
  5. 5 + 6
A
  1. 3 + 4
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16
Q

At the outpatient clinic you see a boy of 10 years old with an expected leg length discrepancy of 4 cm disadvantage of the right leg at the end of growth. Lower and upper leg are equally short. What is the correct age fot epiphysiodesis around the knee?

  1. Epiphysiodesis around the age of 11 and an half year of the left leg.
  2. Epiphysiodesis around the age of 13 and an half year of the right leg.
  3. Epiphysiodesis around the age of 11 and an half year of the right leg.
  4. Epiphysiodesis around the age of 13 and an half year of the left leg.
  5. There is not enough growth potential to encounter the whole 4 cm difference.
A
  1. Epiphysiodesis around the age of 13 and an half year of the left leg.
17
Q

You are an orthopaedic surgeon. A boy of 6 months old with an anterolateral bowing of his lower leg visits your out-patient clinic. The paedetrician explained to the parents that it would grow straight , but the parents are worried. Which step should be taken next.

  1. Order bloodtests
  2. Inspection of the whole child
  3. Order a radiograph of the whole spine
  4. Order a MRI of the affected lower limb
  5. Order a consultation from genetics immediately
A
  1. Inspection of the whole child
18
Q

Children with a functional paresis can show growth disturbances in that limb. What is the most likely cause?

  1. Asymmetric growth at the growth plate
  2. Asymmetric load deforms the bone (Wolf’s Law)
  3. Asymmetric load deforms the bone (Hueter-Volkman’s Law)
  4. Asymmetry of the muscle tone develops an asymmetric blood distribution of that limb
  5. Functionality of a limb is always directed one way and the bone will adjust towards this
A
  1. Asymmetric growth at the growth plate
19
Q

The mother of a 3 year old girl consults you because she has noticed that the thumb of her daughter is flexed and cannot extend completely. She does not complain of pain. On examination the thumb is flexed in the IP joint, flexion is possible but complete extension not. A painless swelling can be palpated over the volar side of the MCP1 joint. What is the most probable diagnosis?

  1. Clinodactylie of the thumb
  2. Early onset juvenile arthritis
  3. Kirner deformity
  4. Thumb hypopasia (mildest Buck Gramko type)
  5. Trigger thumb
A
  1. Trigger thumb
20
Q

A 6 month infant with a brachial plexus birth palsy (BPBP) has no biceps function and a weak but functioning triceps with antigravity action. What is the preferred advice?

  1. Neurosurgical reconstruction
  2. Bracing of the elbow in flexion
  3. Besides FT start elektrostimulation
  4. Muscle transfer of triceps to biceps
  5. Fysiotherapy to prevent contractures
A
  1. Neurosurgical reconstruction

CCOC III (6 decks)

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