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pediatric Boards > ortho/sports medicine > Flashcards

ortho/sports medicine Flashcards

0
Q

What is the appropriate immediate treatment for an ankle sprain ?

A

Ice for 20min at a time over the first 48 hours

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1
Q

In defining varus vs valgus, which one refers to when the distal part of the deformity points away from midline ?

A

Valgus

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2
Q

What is the likely diagnosis in a pre-adolescent child with bone pain over the physis who has a normal X-ray?

A

Salter Harris 1 fracture

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3
Q

What is a grade 1 ankle sprain?

A

Minor stretching of ligament with minimal discomfort or loss of function

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4
Q

What is the difference between grade 2 and grade 3 sprain?

A

Grade 2 has partially torn ligaments whereas grade 3 has complete tear

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5
Q

What is the appropriate treatment for a child who sustained an ankle injury after being stepped on…exam shows bruise and swelling with strong pulses and diminished sensation to light touch

A

Obtain compartment pressures

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6
Q

What are the 5 symptoms of compartment syndrome ?

A 
Pain
Paresthesias 
Pallor
Paralysis 
Pulselessness
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7
Q

What diagnosis should you consider in a patient who presents with fracture who is found to have blue sclera? What other condition is associated with this disease?

A

Osteogenesis imperfecta type 1 - conductive and sensorineural hearing loss

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8
Q

What disease presents with an infant born with multiple fractures with a large head who is born either stillborn or died shortly after birth?

A

Osteogenesis imperfecta type 2

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9
Q

What disease presents with an infant who is born with fractures and sustain progressive deformities and has gray sclera, macrocephaly and short stature?

A

Osteogenesis imperfecta type 3

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10
Q

What is the inheritance pattern of achondroplasia ?

A

Autosomal dominant 20%

Spontaneous mutation 80%

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11
Q

What is the most likely cause of sudden death in an infant with achondroplasia ?

A

Cervicomedullary junction compression

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12
Q

What syndrome presents with fusion of cervical vertebrae, short neck,scoliosis, spina bifida, deafness and renal problems?

A

Klippel Feil syndrome

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13
Q

What diagnosis may present with torticollis and upper motor neuron findings such as increased DTRs?

A

Posterior fossa tumor

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14
Q

What other abnormality is associated with congenital torticollis?

A

Hip dysplasia

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15
Q

What is the treatment for congenital torticollis?

A

Daily stretching and PT - if continued after one year, surgical intervention

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16
Q

What is the cause of muscular torticollis?

A

Positioning or trauma

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17
Q

What is the diagnosis in a patient with repeated attacks of torticollis that lasts a few minutes and is accompanied by vomiting, pallor and irritability ?

A

Paroxysmal torticollis

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18
Q

What is the sprengel deformity?

A

Affected side of the neck is broader and shorter and mimics torticollis

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19
Q

What is the cause of sprengel deformity?

A

Poor fetal development and failure of the scapula to descend to the normal position

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20
Q

What are the 4 risk factors for developmental dysplasia of the hip?

A

Breech
Female
First born
Family hx

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21
Q

You are presented with a patient who recently immigrated from a developing country, he presents with painful ankle that is swollen and red. He had similar symptoms in the knee yesterday and now has macular rash. What is the likely diagnosis?

A

Rheumatic fever

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22
Q

What is the treatment of choice for an adolescent with septic joint?

A

Ceftriaxone plus azithromycin (to cover GC)

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23
Q

What organisms are commonly the cause of septic joint in a neonate?

A

GBS, staph and gram negative bacillus

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24
Q

What is legg calve perthes disease?

A

Avascular necrosis of the femoral head

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25
Q

What is the most common etiology of osteomyelitis in the neonatal period and what is the most common complication?

A

E. coli and GBS

Septic joint

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26
Q

What is the likely diagnosis in an adolescent male with chronic knee pain that locks up and swells? How would you diagnose this?

A 
Osteochondritis dissecans (necrosis of the articulate surface)
MRI
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27
Q

What is the appropriate treatment of osteochondritis dissecans?

A

Immobilization and surgical removal of fragments if no improvement

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28
Q

How might a pelvic osteomyelitis present, other than hip or thigh pain ?

A

Abdominal pain

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29
Q

What is the treatment for osgood schlatter disease?

A

Weeks of rest with gradual return to activity

NSAIDs

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30
Q

What is the mechanism behind the pain caused by osgood schlatter disease ?

A

Excessive activity at the insertion of the patellar tendon at the anterior tibial tubercle (apophysis)

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31
Q

At what curvature does scoliosis require surgery?

A

Curvature >40 degrees

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32
Q

At what curvature may you simply observe a child with scoliosis?

A

<25

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33
Q

What determines when to brace a child with scoliosis curvatures 25-40 degrees?

A

Bracing required if there is more than 2 more years of growth expected

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34
Q

What should you do if a child with scoliosis has >1 degree per month of increased curvature during the growth spurt ?

A

MRI to rule out a cause other than idiopathic scoliosis

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35
Q

What is the cause of congenital scoliosis? What can this be associated with?

A

Failed segmentation or formation of spinal elements - can be associated with fused ribs or spinal cord anomalies

36
Q

What is idiopathic scoliosis and what is the normal progression?

A

Isolated scoliosis with no cause - worsens by 1 degree per month during the growth spurt

37
Q

What diagnosis should you consider in a patient with rapidly progressive scoliosis and neurological deficits?

A

Neurofibromatosis

38
Q

What type of screening is warranted in patients with congenital scoliosis? (3 answers)

A

Renal ultrasound and ECHO as well as spinal MRI

39
Q

What is the normal range of thoracic kyphosis and at what degree is intervention indicated ? What is the first study to perform in these cases?

A

Normal range: 20-40

PFTs if >60 degrees

40
Q

What is the likely diagnosis in a teenager who can’t stand up straight and has chronic upper back pain? What is the treatment?

A

Scheuermann disease - NSAIDs and physical therapy

41
Q

What is the diagnosis in an infant with swelling of the bones and progressive cortical thickening on X-ray?

A

Caffey disease (infantile cortical hyperostosis)

42
Q

How can caffey disease be distinguished from non accidental trauma?

A

Abuse involves the periosteum but caffey disease involves only the cortex

43
Q

What is the difference between unicameral and aneurysmal bone cysts? (Comment on location, symptoms and complications)

A

Unicameral - found on proximal humerus or femur. Asymptomatic and not precancerous.
Aneurysmal - found on tibia or femur. Present with pain and associated with bone tumors

44
Q

What is the diagnosis for a patient with pain over the distal clavicle with area of prominence ?

A

Acromioclavicular Injury

45
Q

What diagnosis presents as shoulder pain with elevation of the arm, but no deformity ?

A

Rotator cuff injury

46
Q

When is intervention needed for genu varus (bow legged) ?

A

If unilateral, worsening after age 1 or unresolved by age 2

47
Q

What are the two major concerns if genu varus is present after age 2?

A

Rickets or Blounts disease

48
Q

What is the cause of adolescent Blount disease? What is the treatment ?

A

Overweight adolescent develops distortion of proximal tibial physis and epiphysis
Bracing or surgery is needed

49
Q

What is the treatment for infantile Blounts disease?

A

No treatment indicated

50
Q

What type of fracture presents as a separation of the epiphysis and metaphysis? What is the treatment?

A

Salter Harris type 1 - casting 2-3 weeks

51
Q

What type of fracture goes through the growth plate and extends through the epiphysis? What is the treatment ?

A

Salter Harris type 3 - open reduction needed

52
Q

What type of fracture involves a splitting of the metaphysis and physis? What is the treatment?

A

Salter Harris type 2 - closed reduction with casting 3-6 weeks

53
Q

What is the cause of an anterior and posterior fat pad on X-ray of the elbow?

A

Anterior - normal

Posterior - fracture

54
Q

What is the diagnosis in a patient with pain over the anatomical snuffbox (even with a negative X-ray)?

A

Scaphoid bone fracture

55
Q

What type of fracture does through the metaphysis/physis/epiphysis? What is the treatment ?

A

Salter Harris type 4 - open reduction

56
Q

What is the likely diagnosis in a patient who heard a pop after twisting of the knee and pain over the lateral patella ? What is the treatment?

A

Patella subluxation - maintain quadriceps and hamstring strength and flexibility

57
Q

What diagnosis would you consider in an obese teenager with left knee pain?

A

SCFE (hip pain commonly presents as knee pain)

58
Q

What is the appropriate treatment for tibial torsion and femoral anteversion?

A

Nothing!!! Resolves spontaneously

59
Q

What are 3 situations where acute illness makes a child ineligible for participation in sports?

A

Fever
Carditis
Hepatosplenomegaly

60
Q

What is the definition of heat exhaustion?

A

Mild dehydration with core temp <104

61
Q

When is power lifting safe for pre-adolescents ?

A

Low resistance weight training is permitted but power lifting is not safe for preadolescents

62
Q

What should be done for a patient participating in sporting events who presents with headache, nausea or confusion and is sweating on physical exam?

A

Stop exercising and drink fluids

63
Q

What are the 4 criteria for heat stroke ?

A

Temp >105
Hot dry skin (not sweating)
CNS depression
Severe dehydration

64
Q

What is the risk involved in heat stroke and why?

A

End organ damage due to release it endotoxins and cytokines

65
Q

What should be done in a patient who presents with diagnosis of heat stroke?

A

Decrease core body temperature (down to 102, avoid hypothermia)
Rehydrate with IVF only
Vasopressors if needed

66
Q

What is the diagnosis in a patient who sustains eye trauma and develops a collection of blood between the cornea and iris?

A

Hyphema

67
Q

What is the appropriate treatment for hyphema?

A

Referral to ophthalmology

Bed rest and HOB at 30 degrees to decrease intraocular pressure (should not patch the eye)

68
Q

What diagnosis should you consider in a patient with blunt eye trauma who presents with double vision when looking to one side and disconjugate gaze but intact pupillary reflexes ?

A

Blowout fracture of orbital wall

69
Q

What diagnosis would you consider in a patient who sustains eye injury and presents with pain and tearing but no Diplopia or dysconjugate gaze? What would confirm this diagnosis ?

A

Corneal abrasion

Focal uptake of fluorescein

70
Q

What diagnosis presents as a visual deficit in the peripheral fields but no dysconjugate gaze?

A

Detached retina

71
Q

What diagnosis should you consider in a patient who wears contacts and presents with redness and irritation of the eye, normal pupil exam and diffuse uptake of fluorescein stain? What is the appropriate treatment?

A

Gram negative infection or ulcer of corneal epithelium - urgent management by ophthalmology

72
Q

What diagnosis presents as anterior knee pain over the patella and visible swelling? What is the treatment ?

A

Prepatellar bursitis - NSAIDs and padding during sports

73
Q

What is the most likely diagnosis in a patient who presents with large area of swelling on anterior thigh after blunt trauma ? How would you treat?

A

Hematoma of soft tissue - NSAIDs, Ice and rest

74
Q

What is the most likely diagnosis in a patient with pain over the dorsum of the hand near the base of the thumb?

A

Scaphoid fracture

75
Q

What is the most likely diagnosis in a 12y/o gymnast with left wrist pain x 3 months without any significant trauma and normal physical exam with tenderness only at distal radius? How would you treat?

A

Distal radial epiphyseal injury - rest and splint until wrist is healed to avoid growth plate disruption

76
Q

Hep would you treat a non displaced mid shaft clavicle fracture ?

A

Sling (no reduction needed)

77
Q

What is the appropriate treatment for a patient with medial clavicle fracture?

A

CT scan may be needed to rule out complications

78
Q

What diagnosis should you consider In a patient with distal clavicle pain after trauma injury who has negative clavicle X-ray ?

A

AC separation

79
Q

What is the next step in a patient with hemophilia who sustains hand injury and presents with numbness of the hand?

A

Measure compartment pressure

80
Q

What should be done to secure an airway in a patient who sustains a neck injury while playing football?

A

Never remove helmet or should pads - may remove face guard only!

81
Q

What are potential risks involved in anabolic steroid use in females?

A

Hirsutism and early closure of growth plates

82
Q

What are 6 potential side effects of Anabolic steroid use in males?

A 
Acne
Gynecomastia
High pitched voice 
Hypogonadism 
Aggression 
HTN
83
Q

Until what age are children required to wear a face guard when batting during baseball games?

A

Up to age 14

84
Q

What are 4 common lab findings consistent with anabolic steroid use?

A

Elevated LFTs
Low HDL
High LDL
Oligospermia

85
Q

How long are anabolic steroids detected after PO vs IM use?

A

PO steroids remain in urine up to a few weeks

iV steroids remain in the system >6 months

86
Q

What would you do in an athlete who presents for sports clearance and is found to have LVH?

A

No sports restriction as this is normal in athletes

87
Q

What is part of sports clearance in a patient with Down syndrome?

A

Plan neck X-ray to rule out AA instability

88
Q

What should diabetic patients do in preparation for exercise?

A

Increased caloric intake or decreased insulin to avoid hypoglycemia

pediatric Boards (23 decks)

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