Ortho/rhem/msk Flashcards
59 (4). What is the most common childhood wrist fracture? a. Colles fracture
b. Greenstick
c. Buckle fracture
d. Salter Harris
buckle
14 year old adolescent girl who you haven’t seen in the last 2 years comes in for routine check-up. When she bends forward, you note a large thoracic asymmetry. Spine X-ray shows a Cobb angle of 50 degrees. What do you do next?
a. Repeat X-ray in 3 months
b. Custom thoracolumbar spine brace c. Spinal fusion
d. Electro-something stimulation
Consensus: C spinal fusion Answer: C
● Not B - angle too much
● Clearly not D
● Unlikely A but technically as per nelson >50 spinal fusion or 45-50 and progressive = fusion, do we need to repeat x-ray to check for progression?
● Braces are offered for treatment of skeletally immature patients with curves >30 degrees at the first visit, or in patients who are being followed and have developed progression of their curvature beyond 25 degrees. Bracing is ineffective in curvatures >45 degrees.
● Surgical treatment involves spinal arthrodesis or fusion and is usually recommended for skeletally immature patients with progressive curves >45 degrees and skeletally mature patients with curves >50 degrees.
4. Picture above - 4 yo child was eating normal diet, BMI at 75th percentile (did not mention anything about supplements or dietary restrictions). 1 - Tibia Vara 2 - Rickets 3 - Genu Varum 4 - Achondroplasia Consensus:
A Tibia Vara Answer: 2?
**2017, Question 5; In-Toeing 2yo, Reassurance or Advise Against W Position?
Reassurance ?
49 (51). A 6y girl presents with arthritis of 3-4 joints at a time. Her ANA is positive. Which is the most likely associated finding?
a. Eye pain
b. Photophobia
c. Unequal pupil
Consensus: C
From Lecture: Unequal pupil means synechia, which is a complication of untreated uveitis which is asymptomatic in oligoJIA. Synechia are adhesions of the iris secondary to inflammation
60 (6). A 7 year old boy has a history of recurrent fevers, evanescent pink rash, lymphadenopathy, and hepatomegaly. His MSK exam is normal. What’s the diagnosis? a. Leukemia
b. Scarlet fever
c. Lyme disease
d. Systemic JIA
Consensus: D/A systemic JIA
From Lecture: evanescent rash is highly specific for sJIA. If the question is asking what is the most likely diagnosis - sJIA. If it is asking what is the most important diagnosis to assess for or rule out: leukemia
rpr - is best for sle ?
Answer: A (rapid plasma reagent - detects antibodies against syphillis)
Apparently RPR testing for syphilis can be false positive in lupus (https://www.hopkinslupus.org/lupus-tests/antiphospholipid-antibodies/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1535952/). Positive HLAB27 you would expect in JIA/ank spon (rheum guide). Thrombocytosis is the opposite of what you would expect in SLE (bicytopenias). ANCAs is supportive of the diagnosis but not maybe the MOST supportive of the diagnosis. Although maybe up for debate?
. 6 year old Greek girl presents with a high fever, tachypnea, and RUQ pain. On exam, there is no guarding in the abdomen. What is the most likely diagnosis?
a. Bacterial pneumonia b. Pleurodynia
c. FMF
c. FMF
Consensus: A Pneumonia
Discussed at end of Rheum lecture, either bacterial pneumonia given tachypnea and fever, with referred pain. OR FMF because she’s greek, but usually they have guarding as they have serositis. Dr. R said she would pick FMF because of Greek girl
Why does acrodermatitis enteropathica occur with switch from breast to cow’s milk?
From Talia’s Research: Human milk contains adequate amount of zinc for infants up to 7mo, after which additional sources are required
From lecture - has to do with zinc being absorbed in the breastmilk better than in the bottle
Dermatology Questions
9. Hemangioma on left upper lip and jaw measuring 2-3cm^2. Other than regular surveillance of growth and development at regular appointments, what else to do?
a. Ophtho
b. MRI
c. No additional testing d. Cbc in 6 months
Consensus: C
Per Miriam Weinstein’s lecture
3. Boy on carbamazepine develops rash - what do you do? a. Change anti-epileptic
b. Reassure
c. Urgent dermatology consult d. See in clinic that day Consensus: D
Answer: D - rash could be anything (maybe urticaria in which case not concerned for SJS), reasonable to see the child first and if concerning send to ED for derm to see
14. 6 month old Baby with severe diaper dermatitis and bluish crusted lesions, resistant to routine treatment for candida for 6 month (not sure of duration). Noted to have petechiae and brownish lesions at periphery.
What are the 3 DDx?
What’s the most important test to order?
1
- Hemangioma on left upper lip and jaw measuring 2-3cm^2. Other than regular surveillance of growth and development at regular appointments, what else to do?
a. Ophtho
b. MRI
c. No additional testing d. Cbc in 6 months
c
- a Kid w hemangioma covering eye, what to do? a. Refer to surgery for resection
b. Reassess in few months
c. Start propranolol
Answer: start propranolol
would also refer to optho
Head lice - which one is least likely to increase resistance? *****a. permethrin 1%
b. R&C
c. lindane
d. Resultz shampoo
Consensus: D Resultz
Permethrin if resistance only in the area, Resultz if the actual strain is resistant
- Boy involved in MVA intubated. Pedestrian killed. EtOH smell. Police asked you for alcohol levels report
a) give it to them
b) ask for a warrant
c) Call CMPA
d) Call CAS
Answer: B (or C?) Consensus: B
2) 2001-2010, question 13 and 28: Which of the following statements regarding autonomy is true in pediatrics:
a. The wishes of the parents supersede the wishes of the child
b. If there is a psychiatric problem, the wishes of the parent and child are not valid
c. CAS authority can supersede the wishes of the parent and the child
d. The right to autonomy can be used to force the MD to take medical action that they feel is inappropriate
e. If conflict exists, the physicians opinion takes precedence over that of the parent of child
→ some debate on the consensus key, but I think C is most correct; B seems too conditional and the statement is really broad as if it applies to every situation
D can also be correct in some situations
Consensus: C
3) 2001-2010, question 14: A 15-month-old child presents with diarrhea and FTT. The mother has a history of IV drug use. She doesn’t know who the father of the child is. You suspect HIV as a cause of the child’s presentation. You would do all of the following EXCEPT:
a. Discuss the benefits and harms of knowing about one’s HIV status b. Discuss the issues and services available for those with HIV
c. Discuss the confidentiality of the test
d. Explore the risk factors
e. Explain that you will follow-up by telephone as soon as the test results are available → this would NOT be done because it should be an in-person discussion?
Consensus: E
