Ortho/rheum

Question 1

Avascular necrosis of the proximal femur epi

Answer 1

2-11 yo Legg–Calvé–Perthes (LCP) disease

Peak at 4-8 yo

Question 2

Avascular necrosis of the proximal femur presentation

Answer 2

Dull ache, throbbing pain localized to groin, alteral hip or buttocks

Pain w// weight bearing activity releived w/ rest

↓ rotation or abduction

Pain, limp, loss of motion

Question 3

Avascular necrosis of the proximal femur tx

Answer 3

Protected weight beating for early stage

Alendronate to prevent early collapse

Cast

Question 4

Avascular necrosis of the proximal femur w/u

Answer 4

MRI * TOC for early etection

Radiography→ crescent sign

Question 5

Congenital hip dysplasia age

Answer 5

4-6 Wk

Question 6

Congenital hip dysplasia presentation

Answer 6

Clicky hip

Barlow and Ortolani

Question 7

Congenital hip dysplasia w/u

Answer 7

U/S

Question 8

Congenital hip dysplasia tx

Answer 8

harness

Question 9

barlow

Answer 9

infant fully relaxed, attempt to dislocate the hip via posterior pressure, adduct the fully flexed hips while pushing the thighs posteriorly

If during this maneuver the femoral head is felt to dislocate or leave the acetabulum → positive

Question 10

ortolani

Answer 10

ID hip that s dislocated,grasp medial aspect of flexed knee w/ thumb fand fully abduct hip → feel for spasm or clunk (not click)

Question 11

Nursemaid elbow age

Answer 11

1-4 yo

Question 12

Nursemaid elbow mechanism

Answer 12

Axial traction on a pronated forearm with elbow in extension→ annular ligament slips over head of radius & becomes trapped in radiohumeral joint

Question 13

Nursemaid elbow presentation

Answer 13

Not using arm, g consistent w/ mech, holding arm close to ody w/ fully extended or slightly flexed elbow and pronated forearm

Pain w/ active supination

No swlling, bony tenderness or deformity

Question 14

Nursemaid elbow tx

Answer 14

Thumb on Osgood-Schlatter disease of radial head and apply gentle traction, supinate forearm and flex elbow

Question 15

Osgood-Schlatter disease epi

Answer 15

Teenage athletes

MC boys

11 yo girls, 13-14 yo boys

Question 16

Osgood-Schlatter disease presentation

Answer 16

Painful knee w/ swelling ver tibial tubercle

Question 17

Osgood-Schlatter disease tx

Answer 17

Stop exercising (curative) or play through it which may cause a palpable nodule

Rest, NSAIDs, ice

Benign course (may last 1-2 yrs)

Question 18

Scoliosis epi

Answer 18

Adolescent (>11 yo) *MC

F>M

Question 19

Scoliosis presentation

Answer 19

Lateral curvature of spine

Truncal asymmetry, school screening or incidental finding

Question 20

Scoliosis tx

Answer 20

Brace if 20-40 deg

Spinal fusion surg if >40 deg

Question 21

Slipped capital femoral epiphysis epi

Answer 21

10-16 yo

M>F

↑ incidence in AA, athletes and obese

Question 22

Slipped capital femoral epiphysis etiology

Answer 22

Weakening of epiphyseal plate of femur → displacement of femoral head

Question 23

Slipped capital femoral epiphysis presentation

Answer 23

Hx of insidious hip, thigh or knee pain associated w/ painful limp

Question 24

Slipped capital femoral epiphysis w/u

Answer 24

Frog leg view**

Lateral radiograph→ post and med displacement of epiphysis

Question 25

Slipped capital femoral epiphysis tx

Answer 25

Pinning in situ Crutches, avoid weight bearing before and after surgery

Question 26

Juvenile Rheumatoid Arthritis epi

Answer 26

F>M (2:1) Females onset 1-3 yo Males onset 8-12 yo

Question 27

Juvenile Rheumatoid Arthritis presentation

Answer 27

Must be <16 yo and lasts for >6 wk Chronic synovitis + extra-articular manifestations (fever, rash, weight loss)

Question 28

Juvenile Rheumatoid Arthritis Systemic

Answer 28

AKA Still's Disease spiking fevers, myalgias, polyarthralgias, hepatosplenomeg, lymphadenopathy, leukocytosis, oericarditis, myocarditis

Question 29

Juvenile Rheumatoid Arthritis Pauciarticular

Answer 29

4 or less medium to large joints involved, at risk for asymptomatic uveitis

Question 30

Juvenile Rheumatoid Arthritis Polyarticular

Answer 30

resembles adult RA w/ symmetric involvement and involved 5 or more of small and large joints, low-grade fever, fatigue, rheumatoid nodules and anemia

Question 31

Juvenile Rheumatoid Arthritis w/u

Answer 31

10-15% of pts have + RF or anti-CCP Ab ESR and CRP ↑ or nrml ANA may be ↑ for pauciarticular type and indicates risk for uveitis imaging studies

Question 32

Juvenile Rheumatoid Arthritis tx

Answer 32

NSAIDs and physical and occupational therapy are most beneficial Methotrexate or leflunomideas secon line early on if no improvement with NSAIDs Monitor for growth abnormalities, nutritional deficiencies and school/social impairment

Question 33

Osteosarcoma presentation

Answer 33

distal femur pain (or prox tib pain) xray sunburst

Question 34

Osteosarcoma tx

Answer 34

resection

Question 35

Best radiographic test for bone tumors

Answer 35

MRI

Question 36

best diagnostic test for bone tumors

Answer 36

Bx

Question 37

Ewing's Sarcoma presentation

Answer 37

mid-shaft pain x-ray shows onion skin

Question 38

Ewing's Sarcoma tx

Answer 38

resection