Musk

Question 1

When would intervention be required for genu Varus (bow leg)

Answer 1

When unilateral, worsens after age 1, does not resolve by 2 yrs of age

Ddx includes rickets and Blount disease

Question 2

Salter Harris type 1 presentation and tx

Answer 2

Fracture through the physis

Cast 2-3 wks

Question 3

Salter Harris type 2 presentation and tx

Answer 3

Fracture through the metaphysis and physis

Closed reduction casting 3-6 wks

Question 4

Salter Harris type 3 presentation and tx

Answer 4

Fracture through the growth plate extending to the epiphysis into the joint space

Open reduction may be needed

(Type 3 is worse!)

Question 5

Salter Harris type 4 presentation and tx

Answer 5

Fracture through all layers

Requires reduction in OR

Question 6

OI type I

Answer 6

Autosomal dominant

Blue sclerae, fractures during preschool years
Hearing loss by the time they are adults

Question 7

OI type 2

Answer 7

Usually lethal, most severe

Dominant new mutation or germinal mosaicism

Born with multiple fractures
Rarely live past postnatal period

Question 8

OI type 3

Answer 8

Born with fractures and deformities are progressive

Gray sclera at birth and lighten over time

Microcephaly and short stature

Question 9

OI type 4

Answer 9

Fractures in preschool years not before

WHITE sclera (not blue)

Question 10

What other condition can congenital torticolis be associated with

Answer 10

Hip dysplasia

Question 11

What is klippel-feil syndrome

Answer 11

Fusion of the cervical vertebrae

Presents as congenital torticollis, short neck and low occipital hairline

Question 12

Associated findings with klippel-feil syndrome

Answer 12

Scoliosis, Spina bífida, renal problems, sprengel deformity, deafness

Question 13

Risk factors for DDH

Answer 13

Breech, family Hx of DDH, female, first born, oligohydramnios

Question 14

How do you assess for DDH after 3 months of age

Answer 14

Limitations in hip abduction
Unequal knee height (galeazzi)
Asymmetric gluteal folds

Question 15

Common pathogens for septic arthritis in neonates, infants/children, adolescents

Answer 15

Most common is staph aureus

Neonates - group b strep and ecoli

Infants/kids - strep pneumonia, group a beta hemolytic strep, h. Flu

Teens - n. Gonorrhea

Question 16

Tx for septic arthritis based on age

Answer 16

Neonates - cloxacillin/gent

Infants to 3 mo- cefuroxime or cefotaxime

Kids - cefazolin (ancef)

Adolescents - ceftriaxone or cefixime (Suprax) and need to add azithromycin to cover GC

If MRSA - vancomycin

If sickle cell - cefotaxime (claf) to cover salmonella

Question 17

Screening workup for congenital scoliosis

Answer 17

Renal ultrasound and cardiac echo

Spinal MRI

Question 18

Tx for scoliosis based on curvature

Answer 18

<25 degrees - observation
25-40 degrees- bracing
>40 - surgery

Question 19

What is scheuermann disease

Answer 19

Fixed kyphosis which presents at puberty. Round back and back pain

Kyphosis is abnormal when above 60 degrees

Question 20

When is toe walking a problem

Answer 20

Persists after age 2-3 yrs and when unable to put the heel down at rest

Question 21

What conditions do you think of in kids that initially walk normally and then later develop toe walking

Answer 21

Muscular dystrophy, Charcot Marie tooth l, hereditary neuropathies

Question 22

What is sprengel deformity

Answer 22

Failure of the scapula to descend to its normal position during fetal development

Question 23

If a pt with JIA has a positive rheumatoid factor what is this associated with

Answer 23

Bone erosions

Question 24

If a patient with JIA has a positive ANA this is asociares with a higher risk of what

Answer 24

Uveitis (iridocyclitis)