Ortho

Question 1

Paget’s Disease of the Bone Presentation

Answer 1

Most patients are asymptomatic but it can present with bone pain, HA, hearing loss (CNVIII entrapment), spinal stenosis, bowing of bones, fractures, and arthritis.

Question 2

Ewing’s Sarcoma

Answer 2

Second most common bone tumor in children. Pelvis or diaphysis of long bones. Localized pain and swelling with B symptoms. Xray shows “Onion skinning” or “Moth-eaten” appearance.

Question 3

Fibrosarcoma

Answer 3

Rare, spindle cell neoplasm that may have a moth-eaten appearance on x-ray. Usually in adults.

Question 4

Giant Cell Tumor of the bone

Answer 4

A benign tumor that presents in the epiphysis of long bones. Young adults, pain, swelling, “soap bubble” appearance on Xray.

Question 5

Osteoid Osteoma

Answer 5

A benign tumor found in young males, pain responds well to NSAIDs. Usually in the proximal femur. Xray shows small, round lucency.

Question 6

Slipped capital femoral epiphysis

Answer 6

Commonly seen in obese adolescent boys
Hip or knee pain that causes limping
Loss of abduction and internal rotation
Imaging: frog leg lateral xray
tx: surgical pinning

Question 7

Langerhan’s Cell Histiocytosis

Answer 7

lytic lesions in jaw, skull, or fever. Skin lesions (purple papules, eczematous rash) lymphedema/HSM, pulmonary cysts/nodules, central diabetes insipidous.

Langerhans cells seen on bone biopsy.

Chemo and desmopressin.

Question 8

Hemophilic Arthropathy

Answer 8

Hemophilia A & B
Repeated hemarthrosis causes hemosiderin deposit and fibrosis within the joint. This causes the destruction of the cartilage and bone.
Tx: factor concentrates

Question 9

Paget’s Dz of Bone Pathogenesis

Answer 9

Osteoclast dysfunction leading to increased bone absorption.

Question 10

Paget’s Dz of Bone Labs, Imaging, and Tx

Answer 10

Elevated Alk Phos and urine Hydroxyproline. Ca and Phos are usually normal.

Xray: Sclerotic bone, fractures, osteolytic lesions
Tx: Bisphosphonates

Question 11

Sequelae of Paget’s Dz of Bone

Answer 11

Osteosarcoma

Question 12

Sequelae of scaphoid fracture

Answer 12

Osteonecrosis

Question 13

Physiologic bowing of the legs

Answer 13

normal under 2 years old

Question 14

Ottowa Ankle Rules

Answer 14

Xray if pain at the malleoli and one of the following:
Pain at the tip of MM or LM
Unable to bear weight for 4 steps

Question 15

Ottowa Foot Rules

Answer 15

Xray if pain at the midfoot plus one of the following:
Tenderness at navicular
tenderness at the base fo 5th metatarsal
unable to bear weight for 4 steps.

Question 16

Midshaft humerus fracture

Answer 16

radial nerve injury