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PRM Board Exam > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

What is metatarsus varus?

A

adduction of the forefoot on the hind foot

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2
Q

What is the treatment for metatarsus varus?

A

possible splinting if rigid

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3
Q

What are the four deformities seen on physical exam of a child with clubfoot?

A
  • C: midfoot Cavus
  • A: forefoot Adductus
  • V: hindfoot Varus
  • E: hindfoot Equinus
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4
Q

What is the preferred treatment for clubfoot? What is associated with success?

A

Ponseti method (most successful if started in first month of life)

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5
Q

What is talipes equinovarus?

A

club foot

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6
Q

What is talipes calcaneovalgus?

A

excessive dorsiflexion at the ankle and eversion of the foot due to intrauterine positioning which usually responds to stretching

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7
Q

At what age does genu varum usually resolve?

A

12-18 months

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8
Q

At what age does genus valgus usually resolve?

A

6 to 7 years old

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9
Q

When should Blount’s Disease (tibia vara) best suspected?

A

persistent bowing of knees after 2 years old

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10
Q

What is the treatment for Blount’s Disease?

A

osteotomy of the proximal tibia and fibula

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11
Q

What is the Galeazzi test?

A

Flexing hips and knees to assess knee heights

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12
Q

What is the Barlow test?

A

Trying to dislocate the hip by pushing posteriorly on a flexed and adducted leg

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13
Q

What is the Ortolani test?

A

Trying to relocate a dislocated hip by putting anterior pressure over the greater trochanter in the hip with limited abduction.

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14
Q

What is the most commonly affected side in congenital torticollis?

A

the right side

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15
Q

What 2 conditions should be excluded in a child presenting with congenital torticollis?

A

cervical hemivertebrae, atlantoaxial rotary subluxation

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16
Q

What is the most common cause of congenital torticollis?

A

fibrosis of the SCM

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17
Q

What should also be suspected in a child with congenital torticollis?

A

developmental hip dysplasia

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18
Q

What is the treatment for congenital torticollis?

A

stretching the neck 4-6 times per day (every diaper change)

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19
Q

What determines if facial asymmetry will resolve in a child with congenital torticollis?

A

If normal range of motion is obtained by 1 year old it should resolve

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20
Q

When is surgical intervention considered for congenital torticollis?

A

no improvement by 18-24 months

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21
Q

How is a subluxation of the radial head reduced?

A

with supination and extension or the opposite movement

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22
Q

What causes medial elbow pain in a young baseball pitcher?

A

medial epicondylar apophysitis

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23
Q

What is the most common cause of limping and hip pain in children?

A

transient synovitis of the hip

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24
Q

What age range typically suffers AVN of the proximal femur (Legg-Calve-Perthes)

A

4 - 10 years old

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25
Q

What age range typically suffers SCFE?

A

9 - 15 years old

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26
Q

What hip motion is limited in transient synovitis, ATN, and SCFE?

A

internal rotation

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27
Q

When can full activity resume in a patient with acute transient toxic synovitis?

A

When the hip is pain free

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28
Q

Treatment for ATN of the hip?

A

rest and weight bearing in abduction brace

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29
Q

Most common hip disorder in preadolescents-adolescents?

A

SCFE

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30
Q

When does juvenile scoliosis present?

A

3 - 10 years old

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31
Q

Most common curve in adolescent scoliosis?

A

right thoracic

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32
Q

What diagnostic test should all children with congenital scoliosis have?

A

a renal US

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33
Q

When can surgery be considered for neuromuscular scoliosis?

A

when Cobb angle is over 20 degrees

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34
Q

What is an isthmic spondylolisthesis?

A

slippage due to fracture of the pars

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35
Q

What is the most common level for spondylolisthesis in children?

A

L5-S1

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36
Q

What are two causes of dysplastic spondylolisthesis?

A

pars elongation or facet joint malformation

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37
Q

When is surgical fusion generally recommended for spondylolisthesis?

A

slippage over 50% or progressive neurological deficits

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38
Q

What level scoliosis can a TLSO be used for?

A

Curve apex of T9 or lower

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39
Q

What is Klippel-Feil syndrome

A

congenital fusions of the cervical vertebrae

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40
Q

What is the underlying abnormality in osteogenesis imperfecta?

A

defective collagen synthesis

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41
Q

What is the most severe type of osteogenesis imperfecta?

A

type III

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42
Q

Besides long bone fractures, what are 4 other features of osteogenesis imperfecta?

A

aggressive scoliosis, joint laxity, aortic dilatation, and hearing loss

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43
Q

What are two orthopedic deformities that toe-walkers are at risk for?

A

mid-foot collapse and external tibial torsion

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44
Q

What physical exam finding can differentiate mild diplegia from idiopathic toe walking?

A

ankle clonus (few beats)

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45
Q

Toe-walking after what age may not improve?

A

6

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46
Q

What is the goal range of motion with heel-cord lengthening in a toe walker?

A

10 deg of dorsiflexion with knee extended

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47
Q

When is toe-walking a red flag for a neuromuscular condition?

A

presentation over 3 years old

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48
Q

How does arthrogryposis present in utero?

A

absence of fetal joint movement in setting of polyhydramnios

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49
Q

In what three areas can contractures be seen in arthrogryposis?

A

jaw, spine, extremities

50
Q

What is the survival of those with arthrogryposis?

A

normal

51
Q

How is arthrogryposis defined?

A

two or more joint contractures present at birth

52
Q

What should be ruled out before starting therapy in an infant with arthrogryposis?

A

fracture

53
Q

What is group 1 arthrogryposis?

A

total body involvement (Larsen syndrome) with significant ligament laxity, myelopathy and joint dislocations

54
Q

What is group 2 arthrogryposis?

A

distal involving hands and feet

55
Q

What is group 3 arthrogryposis?

A

involves pterygium syndrome with webbing across flexor creases (axilla, elbow, knee)

56
Q

Why are unilateral hip dislocations in the setting of arthrogryposis often treated surgically?

A

Due to scoliosis risk

57
Q

Why should upper extremity surgery, if appropriate, be done early in arthrogryposis patients?

A

to avoid joint adhesions

58
Q

In Legg-Calve-Perths disease, when is surgery usually required?

A

More than 50% involvement of the capital femoral epiphysis (Catterall III or IV)

59
Q

In Legg-Calve-Perths disease, under what age is management non-surgical (NSAIDS)?

A

6

60
Q

What needs to be excluded in acute transient synovitis?

A

septic arthritis

61
Q

Why are many patients with SCFE initially misdiagnosed?

A

It often presents as knee pain

62
Q

What is Scheuermann’s disease?

A

osteochondrosis of vertebral endplate with 3 or more consecutive segments wedged more than 5 degrees

63
Q

What it the treatment for Scheuermann’s disease?

A

TLSO or Milwaukee brace for up to 3 months

64
Q

What is the most common cause of discitis?

A

staph aureus

65
Q

How does femoral anteversion present on exam?

A

more than 70 degrees internal rotation and less than 20 degrees external rotation

66
Q

At what age does in-toeing generally resolve?

A

8

67
Q

What is the prognosis for infantile scoliosis (under 3 yo)?

A

often spontaneously resolves

68
Q

When is a scoliosis curve unlikely to progress?

A

Less than 40 degrees in a skeletally mature patient

69
Q

Why is the medial meniscus at risk for injury with a MCL tear?

A

Their fibers are contiguous

70
Q

Would you expect joint effusion with an isolated MCL or LCL tear? Why?

A

No, they are extraarticular

71
Q

What is the mechanism for a patellar dislocation?

A

twisting on an extended knee

72
Q

In what direction do most patellar dislocations occur?

A

Greater than 90% are lateral

73
Q

Why is there commonly rapid knee swelling with a patellar dislocation?

A

There is hemarthrosis from tearing of the medial patellofemoral ligament and medial patellar retinaculum

74
Q

What is someone who suffer a quadriceps contusion at risk of developing?

A

myositis ossificans

75
Q

What is turf toe?

A

tearing of the first MTP joint capsule due to hyperextension of the toe

76
Q

What should be suspected in an athlete with mid foot pain with weight-bearing?

A

Lisfranc injury

77
Q

What imaging should be pursued in a suspected Lisfranc injury?

A

bilateral weight bearing x-rays

78
Q

In football, what direction does the shoulder typically dislocate?

A

anterior direction

79
Q

What is a type II AC joint injury?

A

complete AC joint tear, CC joint sprain

80
Q

When should electromyographic evaluation be done after a stinger?

A

If symptoms last greater than 3 weeks

81
Q

What range of motion asymmetry can be seen in the shoulder of baseball players?

A

Glenohumeral internal rotation deficit (GIRD)

82
Q

How does GIRD present on exam?

A

Increased shoulder external rotation coupled with decreased internal rotation in the painful throwing arm

83
Q

What is the provocative test for the labrum. How is it done?

A

O’Brien’s test. Shoulder is put in 90 deg flexion and 10 deg adduction. Arm is internally rotated with the thumb down. Patient resists downward pressure. Positive test is pain in first position received when the arm is supinated.

84
Q

What is Little Leaguer’s shoulder?

A

proximal humeral physes stress injury

85
Q

How do stress injuries to growth plates present on X-ray?

A

asymmetric widening of the physis

86
Q

What is the treatment for Little Leaguer’s shoulder?

A

discontinuation of overhead throwing for at least 6 weeks followed by rehab

87
Q

What should be suspected in a pitcher with pain during the acceleration phase of throwing?

A

UCL sprain

88
Q

What diagnosis should not be missed when a throwing athlete presents with lateral elbow pain?

A

OCD of the capitellum

89
Q

What can cause ulnar sided wrist pain and reduced grip strength in a baseball player?

A

hamate fracture

90
Q

What is Osgood-Schlatter disease?

A

traction apophysitis of the tibial tuberosity

91
Q

What is Sinding-Larsen-Johansson syndrome?

A

traction apophysitis of the inferior patellar pole

92
Q

What commonly causes anterior knee pain in a runner?

A

patellofemoral stress syndrome (PFSS)

93
Q

What 5 anatomic varients contribute to the miserable malalignment syndrome that contributes to PFSS?

A

widened Q-angle, femoral anteversion, genu valgum, external tibial torsion, overpronation

94
Q

What age range does OCD of the knee present?

A

10 to 20

95
Q

Where does OCD of the knee most commonly present?

A

lateral aspect of the medial femoral condyle

96
Q

How does presentation of a tibial stress fracture differ from tibial stress syndrome?

A

a stress fracture presents with pain at a focal site on the tibia and pain at rest

97
Q

Who commonly gets Sever’s disease?

A

Boys aged 8 to 13 during period of rapid growth

98
Q

When do the sesamoids fully ossify?

A

7 to 10 years old

99
Q

What causes pain at the plantar aspect of the first MTP joint of the foot during toe-off?

A

sesamoiditis

100
Q

What is Gymnast’s wrist?

A

distal radius physis stress injury

101
Q

What is the primary stabilizer of the distal radioulnar joint?

A

triangular fibrocartilage complex (TFCC)

102
Q

When should surgery be considered in spondylolisthesis?

A

More than 50% slippage

103
Q

Tenderness at which 4 sites warrant an X-ray in an ankle injury?

A

medial malleolus, lateral malleolus, navicular, base of 5th metatarsal

104
Q

What are the two sites where the ITB can get impinged?

A

lateral femoral epicondyle, greater trochanter

105
Q

What presents with gradual onset of pain over the forefoot that worsens with activity?

A

metatarsal stress fracture

106
Q

What is internal snapping hip?

A

iliopsosas tendon sliding over the pectineal eminence

107
Q

What is external snapping hip?

A

ITB or gluteus medius sliding over the greater trochanter

108
Q

What is dancer’s fracture?

A

avulsion fracture of the base of the 5th metatarsal

109
Q

What is a Jones fracture?

A

Fracture of the 5th metatarsal at the metaphyseal-diaphyseal junction

110
Q

What should a Jones fracture not be missed?

A

they are at risk for poor healing due to tenuous blood supply

111
Q

What provocative test is positive in femoracetabular impingement?

A

FADIR

112
Q

What is a Stener lesion?

A

entrapment of the 1st digit UCL at the adductor policies aponeurosis

113
Q

What is the most common fracture of childhood?

A

clavical

114
Q

What should not be missed in the skeletally immature athlete with lateral ankle pain?

A

Salter-Harris I fracture of the distal fibula

115
Q

Indication for surgery in brachial plexus palsy?

A

lack of antigravity biceps function at 6 to 9 months

116
Q

3 risk factors for brachial plexus palsy?

A

breach, shoulder dystocia, large birth weight

117
Q

2 protective factors for brachial plexus palsy?

A

C-section, multiple gestation

118
Q

About what percentage of brachial plexus palsy occurs with Horner’s syndrome?

A

15%

119
Q

Femoral anteversion angle at birth?

A

40 degrees

120
Q

When is cervical fusion recommend in Downs syndrome?

A

Alantodens interval (ADI) above 7mm

121
Q

What are 4 pediatric conditions in which a cavus foot can be seen?

A

MMC, CMT, Friedreich’s ataxia, or spinal tumor

122
Q

What pediatric orthopedic condition presents with a rocker bottom and laterally deviated forefoot?

A

congenital vertical talus

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