Ortho

Question 1

what 3 things should you think about if you think someone has AVN

Answer 1

trauma, steroid use, or sickle cell

Question 2

AVN in kids is called

Answer 2

Legg-Calve’ Perthes disease

Question 3

sx Legg-calve perthes

Answer 3

acute or insidious onset of hip pain and/or limp which is worse w activity

Question 4

PE for Legg-calve perthes

Answer 4

decreased abduction & internal rotation

Question 5

what will radiographs show for Legg-calve perthes

Answer 5

early - increased density and smaller appearance of the femoral epiphysis

advanced - deformity, positive crescentic sign

Question 6

tx Legg-calve perthes

Answer 6

observation - activity restriction - self-limiting within 2 years

pelvic osteotomy if > 8

Question 7

when is exam of the hip in newborn performed

Answer 7

at every well visit until 9 months

Question 8

biggest RF for dysplasia of the hip

Answer 8

breech presentation

Question 9

what two maneuvers can you do to assess for hip dysplasia

Answer 9

ortolani - abduction and elevation - reduces the hip

Barlow - gentle adduction without downward pressure – dislocates the hip

galeazzi test - flex hip and knees so that ankles are near buttocks; test is positive if knees are at different heights

Question 10

tx dysplasia of the hip

Answer 10

< 6 mos - pavlik harness
6mos - 2 years: closed reduction

Question 11

how old do you have to be to be diagnosed wit juvenile idiopathic rheumatoid arthritis

Answer 11

< 16

Question 12

how long do sx have to last to be diagnosed with juvenile rheumatoid arthritis

Answer 12

> 6 weeks

Question 13

3 types of juvenile idiopathic rheumatoid arthritis

Answer 13

systemic (still’s disease)

oligo (pauci) articular

polyarticular

Question 14

what is systemic (still’s disease) for JRA

Answer 14

daily or diurnal high fever
salmon-colored pink migratory rash on trunk and extremities

Question 15

what is oligo (pauci) articular for JRA

Answer 15

< 5 joints involved
idiocyclitis (anterior uveitis)

Question 16

what is polyarticular for JRA

Answer 16

5 or more small joints
most similar with adult RA (usually have morning stiffness)
iridocyclitis (anterior uveitis)

Question 17

dx JRA

Answer 17

clinical
elevated ESR and CRP

Question 18

tx JRA

Answer 18

NSAIDs

Question 19

what is the MC primary bone malignancy in kids and young adults

Answer 19

osteosarcoma

Question 20

where does osteosarcoma MC metastasize to

Answer 20

lungs

Question 21

sx osteosarcoma

Answer 21

bone pain worse at night

Question 22

tx osteosarcoma

Answer 22

radiographs - hair on end or sunburst appearance

biopsy - definitive

labs - increased alkaline phosphatase

CT to evaluate lungs

Question 23

tx osteosarcoma

Answer 23

neovascular - chemo + surgical removal w amputation

not neovascular - limb-sparing resection

Question 24

what is the second MC primary bone malignancy in kids and young adults

Answer 24

Ewing sarcoma

Question 25

where is Ewing sarcoma MC located

Answer 25

50% found in the diaphysis of the long bones - femur MC then pelvis

Question 26

sx Ewing sarcoma

Answer 26

localized bone pain and swelling

Question 27

dx Ewing sarcoma

Answer 27

radiographs - multilayers periostea reaction with an onion skin/peel appearance or a moth-eaten appearance

Question 28

what lab carries prognostic significance for Ewing sarcoma

Answer 28

LDH

Question 29

tx Ewing sarcoma

Answer 29

chemo following by limb-sparing resection when possible

Question 30

MC benign bone tumor

Answer 30

osteochondroma

Question 31

dx osteochondroma

Answer 31

XR - pedunculated -- grows away from the growth plate

Question 32

tx osteochondroma

Answer 32

observation

Question 33

nursemaid's elbow is also called

Answer 33

radial head subluxation

Question 34

when is nursemaid's elbow MC

Answer 34

kids 2-5 yo

Question 35

mechanism for radial head subluxation

Answer 35

lifting, swinging or pulling a child while forearm is pronated and extended

Question 36

dx nursemaid's elbow

Answer 36

radiographs

Question 37

tx nursemaid's elbow

Answer 37

closed reduction via hyperpronation or supination/flexion method can repeat two times

Question 38

osgood schlatter disease is also called

Answer 38

tibial tuberosity avulsion

Question 39

osgood-schlatter disease is due to

Answer 39

inflammation of the patellar tendon at the insertion of the tibial tubercle due to overuse or small avulsions from repetitive knee extension and quad contraction

Question 40

sx osgood-schlatter disease

Answer 40

activity-related anterior knee pain and swelling relieved with rest may have bony prominence, swelling, and tenderness to the anterior tibial tubercle

Question 41

tx osgood-schlatter

Answer 41

conservation - rest, ice, elevation, NSAIDs, stretching etc

Question 42

kyphosis vs lordosis

Answer 42

kyphosis - humpback lordosis - sway back

Question 43

screening for scoliosis

Answer 43

Adams forward bend test

Question 44

what is used to measure the ankle of trunk rotation if asymmetry is noted on Adams test

Answer 44

scoliometer; positive for scoliosis if a >/= 7 degree curve is measured

Question 45

Cobb angle on XR for scoliosis

Answer 45

Cobb's angle >/= 10 degrees

Question 46

tx scoliosis

Answer 46

Cobb angle < 25 - observation bracing to stop the progression if 20-49 degrees surgery if > 40 degrees

Question 47

what is slipped capital femoral epiphyses

Answer 47

displacement of the femoral head from the femoral neck through the growth plate

Question 48

sx scfe

Answer 48

pain and altered gait - dull, achy hip, groin thigh or knee pain w a painful limp worse w activity

Question 49

PE for SCFE

Answer 49

externally rotated leg + limited internal rotation

Question 50

dx SCFE

Answer 50

XR - posterior displacement of femoral epiphysis, similar to ice cream slipping off a cone

Question 51

tx SCFE

Answer 51

strict non-weight bearing crutches to prevent further slippage -- operative stabilization (internal fixation with a screw)