Ortho Issues

Question 1

presents w/ clavicular crepitus or callus, ↑risk w/ LGA infants and breech deliveries;
dx and tx

Answer 1

clavicualr fracture

reassurance > figure 8 splint

Question 2

what is the MC fracture in kids

Answer 2

supracondylar frx

Question 3

next step when suspect supracondylar frx

Answer 3

check brachial artery!!

Question 4

kid holding arm in pronator posistion + treatment

Answer 4

nursemain elbow = subluxation of radial head from annular ligament

tx= manual reduction/supinate motion

Question 5

falling on outstreched arm injury

Answer 5

radial epiphyseal seperation (seperation of radius at epiphyseal plate)

Question 6

treatment for spiral fx of tibia

Answer 6

splint immobilization

Question 7

when do bow legs need intervention

Answer 7

> 2 yo

Question 8

type I vs II vs III metatarsus adductus

Answer 8

I = overcorrects with passive and active movement
tx = reassurance

II = corrects into position with passive and active movement
tx = corrective shoes

III = doesnt correct into position
tx = surgical correction

Question 9

congenital foot deformity with inward and outward pointing feet + increased risk of spina bifida
tx?

Answer 9

club foot

tx =stretching, serial casts (< 3mos), surgery (> 3 mos)

Question 10

presents as painless limp in a boy <10 y/o vs painful limp in a fat boy

Answer 10

painless = avascular recorsis (legg-calve-perthes dz)

painful = slipped capital femoral epiphysis

Question 11

veruse injury of quads and patellar tendon → traction apophysitis of tibial tuberosity → localized
pain/swelling;

Tx?

Answer 11

osgood-schlatter dz

Tx = RICE and NSAIDs

Question 12

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

Dx? How to make/ confirm Dx? Tx?

Answer 12

congenital hip dysplasia

get US (not calcified enough to see on xray)

tx = splinting

Question 13

fever + localized bone pain

dx? how to make dx? tx

Answer 13

osteomyelitis

bone scan (xray can be false neg for first 3 days)

Tx: IV abx

Question 14

tc for eptic arthritis

Answer 14

IV nafcillin

Question 15

defect in OI

Answer 15

AD defect in type 1 collagen

**hearing loss, dental probs

Question 16

presents w/ localized bone pain and swelling; Dx X-ray shows Codman’s triangle and “sunburst appearance” vs Dx X-ray shows “onion skin” appearance

Answer 16

sunburst = osteosarcoma

onion = ewing

Question 17

deep aching pain in leg muscles w/o any “red flags” (fever, swelling, systemic sx); Tx reassurance

Answer 17

growing pains

Question 18

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

Answer 18

patellofemoral syndrome