Musculoskeletal

Question 1

Genu varum
African American
Not rickets
Overweight (adolescent)

Medial Metaphyseal angulation (breaking)

Answer 1

Blount’s disease

Question 2

Fracture through physis
Separation of epiphysis and metaphysis

Management

Answer 2

Salter Harris type 1 fracture

Cast x 2-3 weeks

Question 3

Fracture through physis and metaphysis

Management

Answer 3

Salter Harris type 2

Closed reduction casting x 3-6 weeks

Question 4

Fracture physis and epiphysis

Management

Answer 4

Salter Harris type 3

ORIF

Question 5

Fracture though physis, metaphysis, epiphysis

Management

Answer 5

Salter Harris type 4

ORIF

Question 6

Growth plate fracture
Crush injury
Microvascular compromise

Answer 6

Salter Harris type 5

Question 7

FOOSH
fracture on one side of bone and not on other side

Answer 7

Greenstick fracture

Question 8

Mutation in COL1A1 and COL1A2
Fractures
Blue/gray sclera
Triangular face
Macrocephaly
Large anterior fontanelle
Pectus excavatum or carinatum

Answer 8

Osteogenesis imperfecta

Question 9

Osteogenesis imperfecta
Most common type
Autosomal dominant
Preschool
Hearing loss

Answer 9

Type 1

Question 10

Osteogenesis imperfecta
Most severe
Lethal. Stillborn
Germinal
Mosaicism
Multiple fractures (“bag of bones”)

Answer 10

Type 2

Question 11

Osteogenesis imperfecta
Progressive deforming type
Fractures
Wormian bones
Codfish vertebrae

Answer 11

Type 3

Question 12

Osteogenesis imperfecta
White sclera

Answer 12

Type 4

Question 13

Osteogenesis imperfecta
Progressive calcification
No blue sclera

Answer 13

Type 5

Question 14

Mass in sternocleidomastoid muscle
Head tilted

Answer 14

Congenital torticollis

Associated with developmental dysplasia of the hip

Question 15

Fusion of cervical vertebrae
Short neck
Low Occipital hairline
Scoliosis
Spina bifida
Renal problems
Sprengel deformity
Deafness

Answer 15

Klippel-Feil syndrome

Question 16

Failure of scapula to descend to normal position during fetal development

Answer 16

Sprengel deformity

Question 17

Risk factors for developmental dysplasia of hip

Answer 17

Female (#1)
Breech positioning
Family history in first degree relative
Improper swaddling methods

Question 18

Diagnosing developmental dysplasia of hip

Answer 18

< 3 mo - ortalani/barlow
> 3 mo - limitations in hip abduction

< 4 mo (> 6wk) - US
> 4 mo - Xray (frog leg)

Question 19

Treatment for developmental dysplasia of hip

Answer 19

Pavlik harness

Question 20

Weakness/tenderness to muscle
Elevated CK
Recent URI

Answer 20

Viral myositis

Question 21

Recent URI
Hip
Hip pain or limp
Normal ESR

Answer 21

Transient synovitis

Question 22

Fever
Won’t walk or move extremity
Leukocytosis
Elevated ESR
Increased joint space on Xray
Warm, red, swollen joint
Positive gram stain

Answer 22

Septic arthritis

Question 23

Treatment for septic Arthitis

Answer 23

Joint aspiration
IV antibiotics

Question 24

Most common bacteria for septic arthritis

Answer 24

Staph aureus

Question 25

Septic arthritis Sickle cell

Answer 25

Salmonella Cefotaxime

Question 26

Osteomyelitis Sickle cell

Answer 26

Salmonella

Question 27

Osteomyelitis Nail

Answer 27

Pseudomonas

Question 28

Avascular necrosis of femoral head Hip pain Limping 4-10 yo One femoral head smaller than other

Answer 28

Legg-Calve- Perthes disease

Question 29

Hip/knee pain Limp Leg extended and externally rotated Male. Obese

Answer 29

Slipped capital femoral epiphysis

Question 30

Pain below patella Athletic adolescent Excessive activity Pain with knee extension against resistance

Answer 30

Osgood-Schlatter disease (Tibial tuberosity apophysitis)

Question 31

Osgood-Schlatter disease Heel

Answer 31

Sever’s syndrome (Calcaneal apophysitis)

Question 32

Fluid-filled cysts Not precancerous Asymptomatic Diagnosed as pathological fracture

Answer 32

Simple (unicameral) bone cyst

Question 33

Painful bone cyst Associated with underlying tumor Can cause nerve compression if on vertebra

Answer 33

Aneurysmal bone cyst

Question 34

Hypermobile Poor wound healing Easy bruisability

Answer 34

Ehlers-Danlos syndrome

Question 35

Management for idiopathic scoliosis if A) Curvature < 25 deg B)Curvature 25-40 deg + > 2 yr of growth still expected C) curvature > 40 def

Answer 35

A) Observation B) Bracing C) Surgery

Question 36

Fixed kyphosis Puberty Distended abdomen

Answer 36

Scheuermann disease

Question 37

Pulled by the arm Not using arm Arm held close to body Elbow flexed Forearm pronated

Answer 37

Nursemaid’s elbow

Question 38

3 causes of intoeing

Answer 38

Metatarsus adductus in infancy Tibial torsion in toddlerhood Femoral anteversion in early childhood

Question 39

Broad-based mass originating from surface of bone Projective away from joint

Answer 39

Osteochondroma Observation only

Question 40

Scoliosis management

Answer 40

< 20 deg - normal activity 25-45 deg - bracing > 45 deg - spinal fusion or rod

Question 41

Mature peripheral ossification with a distinct margin surrounding a radiolucent center of immature osteoid and primitive mesenchymal tissue.

Answer 41

Heterotopic ossification