MSK

Question 1

Traumatic clavicular fractures in older children (not neonates) are treated how?

Answer 1

Nondisplaced: Figure-of-8 splint

Displaced: surgically reduced

Question 2

What is important to ask for monoarticular arthritis?

Answer 2

Rashes - indicative of several pathologies, including:
Lyme
Juvenile arthritis (evanescent, macular, salmon-colored rash)
Serum sickness (pruritic rash)

Question 3

What are oligoarticular and polyarticular juvenile idiopathic arthritis both characterized by?

Answer 3

May be complicated by uveitis
Sex ratio F > M

Question 4

What is a typical sign of oligoarticular JIA?

Answer 4

Pain worse in the morning in a toddler (age <5), with joint swelling most commonly of large joints

Question 5

What muscle weakness does Trendelenburg sign indicate?

Answer 5

Gluteal muscle of the contralateral side to hip drop

Question 6

Slipped capital femoral epiphysis results in what position of leg?

Answer 6

Externally rotated foot - due to decreased abduction and internal rotation

Quadriceps and gluteus muscle disuse –> atrophy

Question 7

Which direction is the femoral head in SCFE?

Answer 7

Femoral head (epiphysis) posteriorly displaced from metaphysis

Question 8

Where is pain in patellar tendinitis?

Answer 8

Inferior pole of patella

Question 9

How does patellofemoral pain feel?

Answer 9

Patella - sensation of instability or buckling at the knee
Overuse injury from running, squatting

Question 10

Where is pain of Osgood-Schlatter disease? How is it diagnosed and treated?

Answer 10

Apophysitis of tibial tubercle
Traction apophysitis from quadriceps muscle pulling –> elevation and chronic avulsion of tibial tubercle
Pain is reproduced by knee extension against resistance or squatting
Diagnosis is clinical, treatment is supportive

Question 11

Why does hypothyroidism predispose to SCFE?

Answer 11

Thyroid hormone normally promotes ossification of growth plate
These kids would have SCFE at earlier age (<10) and more likely bilateral

Question 12

What is diagnostic for SCFE?

Answer 12

Frog-leg lateral hip x-ray

Question 13

What is transient synovitis?

Answer 13

Inflammatory hip condition in children age 3-8 yo with hip pain and limp following viral illness

Question 14

Legg-Calve-Perthes disease treatment

Answer 14

Conservative - bracing/splinting
Surgery - if femoral head is not well contained within acetabulum

Question 15

Transient synovitis hip is held in which position to relieve pain?

Answer 15

Flexed and everted to maximize the joint space
US may show small, unilateral or bilateral hip effusions

Question 16

Myositis ossificans cause and location

Answer 16

Trauma or neurologic events (TBI, stroke)
Quadriceps, brachialis

Question 17

Myositis ossificans labs and imaging

Answer 17

Alk phos and inflammatory markers
Eggshell calcification representing heterotopic ossification

Question 18

What are the prenatal positioning disorders related to intrauterine crowding?

Answer 18

Congenital muscular torticollis
Developmental dysplasia of the hip
Metatarsus adductus
Clubfoot

Question 19

X-linked hypophosphatemic rickets presents with what on x-ray?

Answer 19

Metaphyseal fraying with widened physes
Beaking of the proximal tibial metaphyses

Question 20

What does a metaphyseal corner fracture suggest?

Answer 20

Child abuse - forcible pulling or twisting of an extremity

Question 21

What is Blount disease? What are signs/symptoms?

Answer 21

Pathologic cause of bowlegs due to abnormal cartilage growth

Leg length discrepancy, asymmetrical bowing, lateral thrust with ambulation

Question 22

How would developmental dysplasia of hip affect skin fold?

Answer 22

Asymmetric; extra skin fold on affected side

Question 23

Down syndrome atlantoaxial instability diagnosis and treatment

Answer 23

Diagnosis - lateral cervical x-rays showing compression of spinal cord due to increased mobility between C1 (atlas) and C2 (axis) (due to excessive laxity in posterior transverse ligament)

Treatment - surgical fusion of C1 to C2

Question 24

Treatment for osteoid osteoma

Answer 24

NSAIDs

Question 25

Spondylolysis pain worsens with what movement?

Answer 25

Lumbar extension of lower back

Question 26

What inheritance is Duchenne muscular dystrophy? What is the mutation?

Answer 26

X-linked recessive - markedly reduced or absent dystrophin in muscle fibers

Question 27

What is congenital myotonic dystrophy?

Answer 27

CTG repeat in myotonia dystrophy protein kinase (DMPK) Big sign is sustained muscle contraction with inability to relax (myotonia)

Question 28

Myotonic dystrophy signs if presenting in childhood (by age 10); shows earlier than muscular signs

Answer 28

Cognitive (intellectual impairment) Behavioral (ADHD, mood disorder) Sleep disturbances (excessive daytime sleepiness)

Question 29

Which neoplasm is in epiphysis, lytic area with "soap bubble" appearance?

Answer 29

Giant cell tumor of bone - benign

Question 30

What is a unicameral bone cyst?

Answer 30

Proximal femur/humerus fluid-filled lesion with well-defined margins Presents as pathologic fracture most commonly

Question 31

Describe clubfoot. What to do?

Answer 31

Forefoot adduction + internal rotation Fixed plantarflexion Underdeveloped calf Serial molding cast application to feet to gently manipulate and stretch, followed by long-term bracing Surgical correction for refractory or recurrent cases

Question 32

Achondroplasia signs

Answer 32

Limb shortening, tibial bowing, frontal bossing Gross motor delay

Question 33

Rickets - what signs at metaphysis?

Answer 33

Concavity (cupping) Indistinct margins (fraying) Excess non-mineralized osteoid alters diameters, stability, and organization of physis and metaphysis

Question 34

Palpable click with manipulation of the hip

Answer 34

Iliopsoas bursitis

Question 35

Where is a branchial cleft cyst located?

Answer 35

Anterior to sternocleidomastoid muscle Tract may extend to tonsillar fossa (2nd branchial arch) or pyriform recess (3rd branchial arch)

Question 36

Klumpke palsy is associated with what syndrome?

Answer 36

Horner syndrome (ptosis, miosis)

Question 37

What are the two benign neonatal rashes that can be treated if severe?

Answer 37

Miliaria rubra - not present at birth - erythematous, papular rash on occluded and intertriginous areas - topical steroids if severe Neonatal cephalic pustulosis - age 3 weeks - erythematous papules and pustules on face/scalp only - topical steroids or ketoconazole if severe

Question 38

Systemic JIA vs polyarticular/oligoarticular

Answer 38

Systemic JIA has macular rash with quotidian fever (daily fever) Oligo often ANA+ Polyarticular RF- but sometimes RF+ Systemic has no ANA or RF

Question 39

Scheuermann kyphosis

Answer 39

Due to abnormal anterior vertebral wedging Diagnose with lateral x-rays showing >40 degree curvature and >5 degree anterior wedging in at least 3 vertebrae Pain worse with flexion, activity; better after rest

Question 40

Constitutional growth delay vs familial short stature

Answer 40

Delayed bone age (vs normal bone age) until 11 girls or 13 boys, after which ideal height is achieved

Question 41

Ewing sarcoma translocation

Answer 41

t(11;22)

Question 42

Osteosarcoma vs Ewing - which more likely to have systemic symptoms?

Answer 42

Ewing - fever, anorexia, fatigue

Question 43

Duchenne vs Becker muscular dystrophy

Answer 43

Becker is qualitative dystrophin protein abnormality, later age of onset and better life expectancy, CK only 5x normal (vs 10-20x)

Question 44

Developmental dysplasia of hip - treatment based on age

Answer 44

<6 mo: rigid brace, Pavlik harness splint 6-18 mo: spica cast >18 mo: open reduction followed by spica cast

Question 45

Legg-Calve-Perthes vs SCFE

Answer 45

LCP is painless, SCFE is painful LCP may resolve on own or can consider bracing/cast/osteotomy if extensive necrosis or decreased ROM; SCFE should have immediate surgical screw fixation and no weight-bearing until stabilized