Ortho, Rheum, Etc

Question 1

Proximal medial tibia fracture or odd appearance, bowing

Answer 1

Blount disease

- Usually diagnosed by 4 yo, but can occur in infants or adolescents

Question 2

Subtle medial slippage of epiphysis of femoral head

Answer 2

Slipped capital femoral epiphysis (SCFE)

• Obese adolescent with knee pain (referred)
• Dx: Get AP frog leg view
• Tx: Immobilize and avoid weight bearing. Surgery

Question 3

Irregular shaped and jagged femoral head

Answer 3

Legg-Calve-Perthes Disease

• idiopathic avascular necrosis or osteochondrosis of the femoral head
• Usually diagnosed by 8 yo, usually painless limp but can have hip pain

Question 4

Breakdown of the tibia at the point of insertion of the patellar tendon, prominence at the tibial tuberosity

Answer 4

Osgood Schlatter Disease
Aka Tibial tuberosity apophysitis
- Active adolescent or child in growth spurt, with pain below the knee
- Traction at the tibial tubercle
- Dx: Get lateral X-ray

Question 5

Salter Harris fracture

Answer 5

SMACK mnemonic
• S: slipped (type I)
• M: metaphyseal (type II)
• A: articular-epiphyseal (type III)
• C: complete-metaphysis and epiphysis (type IV)
• K: krushed! (type V) X-ray might look normal or have posterior fat pad

Type III and IV usually require open reduction.
Type V has worse prognosis

Question 6

Dislocated shoulder

Answer 6

usually ANTERIOR (posterior is rare) and >10yo
Dx:  Axillary view X-ray

Question 7

Valgus deformity

Answer 7

Outward angulation of the distal part of the bone/joint

Ex. “Knock knees”

Question 8

Varus deformity

Answer 8

Inward angulation of the distal part of the bone/joint
Ex. “Bow legs”
Ex. Talipes equinovarus deformity, aka “club foot”

Question 9

Protuberance on one side of the bone with no fracture or deformity on the other side of the bone, usually at the diaphysis

Answer 9

Torus fracture (aka Buckle fracture)

• Compression of bone from longitudinal force
• Does NOT go through growth plate

Question 10

Genu varum

Answer 10

Bowed legs

• Normal in <1yo
• Pathologic if: gets worse after 1yo, persists after 2yo, or presents after 2yo

Question 11

Intoeing

Answer 11

• Tibial torsion: Toddlers (Two years old)
• Femoral anteversion: pathologic if persists after 8yo
• Metatarsus adductus

Question 12

Scoliosis - treatment

Answer 12

<25 degrees: Observe
25-40 degrees: Brace while child is growing
>40 degrees: Surgery

Question 13

Strain vs sprain

Answer 13

Strain = Muscle injury/tear (“sTruscle injury”)
Sprain = ligament injury/tear. (“Sprigment injury”)
Tx: Rest-Ice-Compression-Elevate

Question 14

ACL tear

Answer 14

(+) anterior drawer sign
Dx: MRI
Tx: Surgery

Question 15

Arthrocentesis

Answer 15

Joint aspiration
Indicated for any concern for septic arthritis
-Normal: Yellow fluid,  WBC<200 
-Traumatic tap:  WBC<2000
-Inflammatory or infectious:  WBC >2000
-SLE:  WBC>5000 and normal viscosity
-Rheumatic fever:  WBC>5000 and LOW viscosity
-JRA: WBC ~15,000 and LOW viscosity
-Septic arthritis:  WBC>50,000

Question 16

Juvenile Rheumatoid Arthritis

Answer 16

aka Juvenile Idiopathic Arthritis
<16yo, symptoms >6 weeks, LARGE joints
-Rheumatoid nodules are rare
-Rh factor is not diagnostic but indicates poorer prognosis
-Tx: NSAIDs -> Steroids
-Oligoarticular/pauciarticular=4 or fewer joints, assoc with chronic uveitis
-Polyarticular=5 or more joints, few systemic sx
-Systemic (aka Still’s disease)=Evanescent rash, serum WBC>30, fever, LAD, HSM, Koebner phenomenon, pleurisy, pericarditis. Serum markers NEGATIVE

Question 17

Systemic lupus erythematosus

Answer 17

• Sx: at least 4 of: arthralgias/arthritis, fatigue, malar rash, photosensitive, discoid lesions, oral/nasal ulcers, fever, wt loss, hematologic abnormalities, nephritis (low C3 and C4)
• Dx: ANA (sensitive), anti-DNA (sensitive), anti-Smith (specific)
• Tx: NSAIDs, steroids, hydroxychloroquine, methotrexate
• Neonatal SLE: maternal antibodies. Causes third degree AV heart block. Check anti-Ro/La (aka SS-A, SS-B)
• Drug-induced SLE: AEDs, sulfa meds, lithium, hydralazine, quinidine. Reversible.

Question 18

Juvenile Reiter syndrome

Answer 18

Seroneg spondyloarthropathy
“can’t see, can’t pee, can’t climb a tree”
-Uveitis/iritis
-Urethritis
-Arthritis
Often preceded by infection with Salmonella, Shigella, Yersinia, Chlamydia

Question 19

Behcet syndrome

Answer 19

Aphthous and genital ulcers
Uveitis
Arthritis
GI symptoms (distinguishing feature)

Question 20

Sjogren syndrome

Answer 20

Can have renal tubular acidosis
Next step: Schirmer’s test (paper to eye)
To confirm: Biopsy lip or salivary gland

Question 21

Wegener’s granulomatosis

Answer 21

(+) C-ANCA

Sinuses, lungs, and kidneys