Ortho

Question 1

erb’s palsy

Answer 1

upper brachial plexus inury C5,6.

P: flaccid arm asylum moro reflex. internally rated with elbow extended. fingers flexed= waiter’s tip

Question 2

klumpke’s palsy

Answer 2

lower brachial plexus C7,8.

P: claw hand. unopposed finger flexion and decr ability to extend elbow and flex wrist. horner’s if SNS damaged

Question 3

brachial plexus injury

Answer 3

erb’s palsy, klumpke’s palsy

dx: CMG.
tx: oberserve and RoM physical therapy to prevent contractors. improve in 48hr. surgery if it doesn’t

Question 4

nursemaid’s elbow

Answer 4

subluxation of radial head. pulling toddler upward by hand.
P: sudden pain, hard to localize. elbow flexed. no swelling. don’t want to use arm though hand func is nl.
dx: P.

Question 5

congenital torticollis

Answer 5

uterine constraint or birth trauma that cause contracture of SCM
P: head filtered toward affected site. chin pt away from contractor. stiff. mass in SCM may be bleeding into M. asm of head/ears if no tx
dx: PE.
tx: stretching exercise. helmet to correct shape
C: skull deformity.

Question 6

acquired torticollis

Answer 6

cervical adenitis. peritonsillar or retropharyngeal abscess, cervical diskitis, osteomyelitis, neoplasm

Question 7

atlantoaxial instability

Answer 7

unstbale J btw occiput and 1st cervical vertebrae
P: normal. asx. suspect in down’s, skeletal dysplasia. minor trauma can cause spine injury
dx: lateral flexion extension radiograph of C spine
tx: fuse C1/2
C: paralysis death

Question 8

scoliosis

Answer 8

lateral curvature of spine.
80% idiopathic, due to leg length discrepancy, NMD, CTD
P: asxm shoulder ht, scapular position and wasitline. bend over- hump = posterior displacement of curved spine. no pain.
dx: PE, PA and lateral spine sray.
tx: bracing prevent progression during growth.
tx: surgery if cobb’s angle >50 post puberty, >40 prepuberty

Question 9

spondylolysis

Answer 9

stress fracture in pars interarticularis. due to repetitive hyperextension of spine - gymnastics, tennis, diving. incr pain with hyperextension
dx: lumbar spine SCPECT or bone films
tx: analgesics. cast if persist
C: sponylolithesis- subluxation of vertebra- surgery if N impingement, pain, progression

Question 10

diskitis

Answer 10

infection (aureus), or inflame of intervertebral disk.
P: sx of URI or minor trauma. then tenderness over disk. fever. decr mobility
dx: ESR incr. MRI
tx: bed. antistaylcoccal antibiotics

Question 11

developmental dysplasia of hip

Answer 11

acetabulum is abnormally flat cause easy dislocation.
dx; barlow and ortolani, galeazzi. asx abduction of hips and thigh or buttock folds
dx: PE. US in infants bc femoral head doesn’t ossify until 4-6mo. AP radiograph if >6mo
tx: earlier= less likely need surgery. pavlik harness- stimulate formation of normal cup shape.
C: avascular necrosis, limb discrepancy, painful gait, osteroarthritis

Question 12

limp dd

Answer 12

septic arthritis, transient synovitis, leg calve perches, SCFE

Question 13

septic arthritis

Answer 13

orthopedic emergency
peak 1-3yo. hip in younger, knee in older. s aureus or strep progenies
P: fever, irritability, can’t walk, pain with mV, flexed, abducted, external rotation. erythema, swelling, asm soft tissue fold.
dx: high WBC, ESR CRP. blood culture psi in 1/2. US see fluid in J capsule.
tx: surgical decompression. emperic IV antibiotics to coger gram pos 4-6wks
C: avascular necrosis and cartilaginous damage

Question 14

transient synovitis

Answer 14

toxic synovitis. self limtited post infectious response of hip J. URI or diarrhea prodrome. dx of exclusion.
EPi: most common cause of painful limp in toddler. peak 2-7yo.
P low grade fever, limp, appear well. hip pain acute of insidious.position ~ septic J.
Dx: Hx and PE, WBC and ESR nl or slightly high. effusion at hip- aspirate to r/o septic arthritis.
tx: NSAID.

Question 15

legg calve perthes

Answer 15

idioapthic necrosis of femoral head.
4-9yo. M>F. active thin boys small for age
P: painful limp decr internal rotation, abduction of hip. log rolling leg internally. pain refer to knee and groin
dx: AP and frog leg lateral radiograph. incr density in afferected femoral head or screaentic subchondral fracutre in femoral head= crescent sign
tx: containemnt, -faciliate molding and reossifying. physical therapy. surgery if >50% damage to femoral head
prog- better if young. resolve in 2y. older kids dev OA in hips as adults

Question 16

SCFE

Answer 16

obese adolescent boy
P: painful limp in groin hip or knee, internal rotaiton, flexion and abduction. 30% b/l, higher in hypothyroid pt.
dx: AP and frog leg lateral film. klein line. - doesn’t cross epiphysis
tx: pinning epiphysis to prevent further slippage.
C: avascular necrosis, chondrolysis, limb dif, OA

Question 17

osteomyelitis

Answer 17

onset

Question 18

LE torsional abn

Answer 18

in toeing (most correct with growth): metatarsus adductus, talipes equinovarus, internal tibial torsion
out-toeing:
angulation of the knee: bowed legs, blond’s disease, know knee

Question 19

metatarsus adductus

Answer 19

medial curvature of mid-ft. in

Question 20

talipes equinovarus

Answer 20

aka club foot. fixed foot inversion with no flexibility. bl in 50%
genetic. associate with DDH, myotonic dystrophy
P: ankle in plantar flexion and inversion, little RoM
dx: PE
tx: casting or surgical
good prog

Question 21

internal tibial torsion

Answer 21

medial rotation of tibia that cause ft to pt inward

epi: most common cause of intoning in u/l.
tx: observe be resolve by 5yo

Question 22

femoral anteversion

Answer 22

medial femoral torsion. epi: most common cause of in toeing in >2yo. ft and patella pt medially. hips can internally rotate more than nl. sit in W position. observe bc resolve by 8yo

Question 23

out-toeing

Answer 23

mostly due to calcaneovalgus foot. flexible ft held in lateral position. due to uterine constraint.
P flantar flexion restricted. tx: stretch foot. rare cast. self limited

Question 24

Painful limp STARTSS HOTT

Answer 24

septic arthritis, transient synovitis, acute rheumatic fever, rheumatoid arthritis, trauma (fracture strain or sprain, Sickle cell disease, SCFE, Henoch schonlein purport, osteomyelitis, TB, tumor (osteosarcoma, leukemia)

Question 25

bowed legs

Answer 25

genu varum. nl

Question 26

blount’s disease

Answer 26

tibia vara. grogressive angulation at proximal tibia.
obese AA boys who are early walkers= overload injury to medial tibia growth plate causing only inhibited growth on medial side
P: bowed legs. lateral thrust with gait.
dx- bowing after 2yo.
tx: bracing, surgical osteotomy if >4yo or severe
OA common if not corrected

Question 27

knock knees

Answer 27

menu valgum. idioapthic angulation toward midline
3-5yo. most due to overcorrection of gene vacuum
P: sep ankles when standing with knees together. swinging legs laterally when walking
tx: observe. surgery if >10yo or pain
can cause OA

Question 28

aussogt schlatter disease

Answer 28

inflm or micro fracture of tibial tuberosity due to overuse
epi: apophysitis - inflm of tuberosity. onset 10-17yo
P: swelling of tibial tuberosity and knee with pt tenderness over tubercle. pain with extension against restistance. worse with running
dx: PE and hx
tx: rest, stretching, analgesics

Question 29

patellofemoral syndrome

Answer 29

sligh alignment of patella causing knee pain.
worse with activity
sunrise view radiograph
tx: rest, stretching, stengthen medial quadriceps

Question 30

supracondylar fracture

Answer 30

FOOSH. risk if

Question 31

forearm fracture

Answer 31

colles- distal radius. monteggia- proximal ulna with dislocation of radial head. galeazzi- radius F with distal radioulnar J dislocation
dx: open or closed reduction + splinting. cast in 4-7d after swelling resolves. heal 6-8wks

Question 32

femur fracture

Answer 32

dx: AP and lateral sray. look at J above and below injury. cast 8wks.

Question 33

toddler’s fracture=

Answer 33

spiral fracture of tibia.
mild or no trauma. figural intact
9mo-3yo. trips and falls when playing.
P: can’t bear wt, erythema, swelling, mild pt tenderness.
oblique view of tibia show fracture line,
tx: long leg cast 3-4wks

Question 34

child abuse fractures

Answer 34

metaphyseal fractures, 1st rib fracutres, somplex skull fracture, scapular, sternal and vertebral spinous process fracture