ortho/sports medicine Flashcards
What is the appropriate immediate treatment for an ankle sprain ?
Ice for 20min at a time over the first 48 hours
What is the likely diagnosis in a pre-adolescent child with bone pain over the physis who has a normal X-ray?
Salter Harris 1 fracture
What is a grade 1 ankle sprain?
Minor stretching of ligament with minimal discomfort or loss of function
What is the difference between grade 2 and grade 3 sprain?
Grade 2 has partially torn ligaments whereas grade 3 has complete tear
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
Obtain compartment pressures
What are the 5 symptoms of compartment syndrome ?
Pain Paresthesias Pallor Paralysis Pulselessness
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?
Osteogenesis imperfecta type 1 - conductive and sensorineural hearing loss
What disease presents with an infant born with multiple fractures with a large head who is born either stillborn or died shortly after birth?
Osteogenesis imperfecta type 2
What disease presents with an infant who is born with fractures and sustain progressive deformities and has gray sclera, macrocephaly and short stature?
Osteogenesis imperfecta type 3
What is the inheritance pattern of achondroplasia ?
Autosomal dominant 20%
Spontaneous mutation 80%
What is the most likely cause of sudden death in an infant with achondroplasia ?
Cervicomedullary junction compression
What syndrome presents with fusion of cervical vertebrae, short neck,scoliosis, spina bifida, deafness and renal problems?
Klippel Feil syndrome
What diagnosis may present with torticollis and upper motor neuron findings such as increased DTRs?
Posterior fossa tumor
What other abnormality is associated with congenital torticollis?
Hip dysplasia
What is the treatment for congenital torticollis?
Daily stretching and PT - if continued after one year, surgical intervention
What is the cause of muscular torticollis?
Positioning or trauma
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 ?
Paroxysmal torticollis
What is the sprengel deformity?
Affected side of the neck is broader and shorter and mimics torticollis
What is the cause of sprengel deformity?
Poor fetal development and failure of the scapula to descend to the normal position
What are the 4 risk factors for developmental dysplasia of the hip?
Breech
Female
First born
Family hx
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?
Rheumatic fever
What is the treatment of choice for an adolescent with septic joint?
Ceftriaxone plus azithromycin (to cover GC)
What organisms are commonly the cause of septic joint in a neonate?
GBS, staph and gram negative bacillus
What is legg calve perthes disease?
Avascular necrosis of the femoral head
What is the most common etiology of osteomyelitis in the neonatal period and what is the most common complication?
E. coli and GBS
Septic joint
What is the likely diagnosis in an adolescent male with chronic knee pain that locks up and swells? How would you diagnose this?
Osteochondritis dissecans (necrosis of the articulate surface) MRI
What is the appropriate treatment of osteochondritis dissecans?
Immobilization and surgical removal of fragments if no improvement
How might a pelvic osteomyelitis present, other than hip or thigh pain ?
Abdominal pain
What is the treatment for osgood schlatter disease?
Weeks of rest with gradual return to activity
NSAIDs
What is the mechanism behind the pain caused by osgood schlatter disease ?
Excessive activity at the insertion of the patellar tendon at the anterior tibial tubercle (apophysis)
At what curvature does scoliosis require surgery?
Curvature >40 degrees
At what curvature may you simply observe a child with scoliosis?
<25
What determines when to brace a child with scoliosis curvatures 25-40 degrees?
Bracing required if there is more than 2 more years of growth expected
What should you do if a child with scoliosis has >1 degree per month of increased curvature during the growth spurt ?
MRI to rule out a cause other than idiopathic scoliosis
What is the cause of congenital scoliosis? What can this be associated with?
Failed segmentation or formation of spinal elements - can be associated with fused ribs or spinal cord anomalies