Ortho + Endo

Question 1

MC fx in kids, due to trauma to humerus

Answer 1

Supracondylar fx

**check radial pulse since brachial artery can be injured

Question 2

Toddler fx:

Answer 2

nondisplaced spiral fx of distal tibia in infants; (Tx splint immobilization)

Question 3

Nursemaid elbow:

Answer 3

pulling on hand → subluxation of radial head from annular ligament → kid holds arm in a pronated position
(reduce with supination motion)

Question 4

Called Blount disease if kid >2 y/o

Answer 4

genu varum (bowlegs)
**ortho consult

Question 5

Metatarsus adductus =

tx?

Answer 5

forefoot pointing inwards

t1 = reassurance
t2 = orthosis or correctuve shoes
t3= surgical (doesn't correct w mvmt)

Question 6

Clubfoot = increased risk of associated…

Answer 6

spina bifida

Question 7

avascular necrosis of femoral head =

presentation?

Answer 7

Legg-Calve-Perthes disease

painless limp in a boy <10 y/o (requires ortho c/s)

Question 8

painful limp in a fat boy?

Answer 8

slipped capital femoral epiphysis

*dx with XR

Question 9

Osgood-Schlatter disease =

Answer 9

overuse injury of quads and patellar tendon → traction apophysitis of tibial tuberosity ( = localized pain/swelling)

*tx = RICE + NSAIDs

Question 10

uneven gluteal folds and “snapping hips” during physical exam in a newborn

Answer 10

congenital hip dysplasia

*dx via US

Question 11

dx of osteomyelitis?

Answer 11

bone scan (X-ray can be false-neg for 3
days)

Question 12

fever + localized joint pain + limited ROM =

dx/tx?

Answer 12

septic arthritis

dx= aspiration
tx = drainage + IV nafcillin

Question 13

Osteogenesis imperfecta:
inheritance?
abnormality?

Answer 13

AD

type 1 collagen

Question 14

Osteosarcoma XR shows…

Ewing sarcoma XR shows…

Answer 14

Codman’s triangle and sunburst appearance

“onion skin”

Question 15

Patellofemoral syndrome =

tx?

Answer 15

chronic anterior knee pain, worse w/ exercise or prolonged sitting

Tx strengthening exercises

Question 16

Sick euthyroid syndrome: pathophys?

Answer 16

↑bodily stress (trauma, starvation, etc.) causes ↑cortisol, which blocks TSH →

• ↓T4/T3
• normal TSH
• ↑rT3 (deiodinase 3 activated by stress)

Question 17

Cushing syndrome: dx?

Answer 17

ACTH/cortisol levels + dexamethasone suppression test (pituitary Cushing can be suppressed)

Question 18

Hyperaldosteronism lab abn?

Answer 18

↑Na, ↓K, ↓H (HTN, metabolic alkalosis)

Question 19

Addison syndrome:
hormone abn?
presenttion?
tx?

Answer 19

↓cortisol/↓aldosterone

fatigue, hypoglycemia, HTN, hyperpigmentation, weight loss

Tx prednisone + fludrocortisone replacement

Question 20

Congenital adrenal hyperplasia: 
abn hormones?
presentation?
dx?
tx?

Answer 20

∆21α-hydroxylase → ↓aldosterone/↓sex hormones

↓Na, ↑K, ↑H (metabolic acidosis), hirsutism, virilization

Dx ↑17-OHP

tx hydrocortisone + fludrocortisone replacement

Question 21

Tx Nephrogenic DI vs Central DI?

Answer 21

nephrogenic = DDAVP

central = hctz

Question 22

Hypercalcemia sx: s

Answer 22

• stones (kidney, GB)
• bones (pain, osteitis fibrosa cystica)
• groans (PUD, pancreatitis)
• psychic overtones

Question 23

Hypocalcemia sx: n

Answer 23

euromuscular irritability (tingling, tetany)
prolonged QT
arrhythmias

Question 24

Hypercalcemia s/p fracture is due to…
dx?
tx?

Answer 24

extensive bone resorption

Dx urine calcium:creatinine ratio >0.2

Tx hydration, calcitonin if severe

Question 25

Nutritional rickets: electrolyte abn?

Answer 25

normal Ca, ↓P → decreased bone mineralization

Question 26

X-linked hypophosphatemic rickets:
genetic abn?
lab abn?
presentation?

Answer 26

XD ∆PHEX (renal phosphate resorption gene)

↑urinary P, ↓serum P

decreased bone mineralization resistant to vitamin D supplements

Question 27

Pseudohypoparathyroidism:
cause?
electrolyte abn?
presentation?

Answer 27

renal tubules unresponsive to PTH →
↓Ca, ↑P, ↑PTH

hypOcalcemia sx + 4th/5th finger bradydactyly (knuckle-knuckle-dimple-dimple sign)

Question 28

Hypoparathyroidism: electrolyte abn?

Answer 28

lack of PTH → ↓Ca, ↑P, ↓PTH

hypOcalcemia sx

Question 29

1° hyperparathyroidism: electrolyte abn?

Answer 29

excessive PTH → ↑Ca, ↓P, ↑PTH (hypercalcemia sx)