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Pediatric Questions > ORTHOPEDICS > Flashcards

ORTHOPEDICS Flashcards

1
Q

First newborn female, breech presentation, positive Barlow

A

Developmental dysplasia of the hip (DDH)

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2
Q

What is the imaging modality of choice in a
2-month-old girl with concern for DDH?

A

Ultrasound (US) of the hips (< 6 months)

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3
Q

What is the imaging modality of choice in a
7-month-old girl with concern for DDH?

A

Pelvis radiograph (> 6 months)

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4
Q

What is the earliest time for US screening for
DDH?

A

6 weeks of age (before 6 weeks, overly sensitive
and can result in overtreatment)

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5
Q

A 1-month-old is diagnosed with DDH. What is
the preferred treatment?

A

Pavlik harness

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6
Q

An 8-year-old boy presents with limping, pain in
the right hip and knee, plain radiograph shows
ossified and collapsed femoral epiphysis

A

Legg–Calve–Perthes disease

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7
Q

Adolescent with obesity presents with limping,
pain in the right hip and knee, plain radiograph
shows displacement of the femoral epiphysis

A

Slipped capital femoral epiphysis

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8
Q

A 5-year-old boy with upper respiratory
symptoms, complaining of left leg pain and
difficulty walking, decreases movement of the left hip. ESR and CRP are within normal ranges

A

Transient synovitis

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9
Q

A 5-year-old boy presents with left hip pain, fever and limping; he appears ill, grimaces with any left hip movement, limited range of motion, ESR and CRP are significantly elevated, hip US shows left hip effusion

A

Septic hip (pyogenic arthritis)

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10
Q

What is the next best step in cases of pyogenic
arthritis?

A

Antimicrobial to cover against Staphylococcus
aureus and streptococcal species, and in young
children, Kingella kingae should also be covered
Urgent orthopedic consultation

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11
Q

A 12-year-old male presents with left knee redness, pain, and swelling. There is a decreased range of motion along with elevated WBC, CRP, and ESR

A

Distal femur osteomyelitis

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12
Q

What is the most sensitive imaging modality to
check for osteomyelitis?

A

MRI

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13
Q

Short umbilical cord, oligohydramnios, pulmonary hypoplasia, joint contractures, micrognathia, absent skin creases

A

Arthrogryposis

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14
Q

Indications for radiographic evaluation of bow leg “genu varum”

A

> 2 years of age, unilateral, progressive after
1 year, thigh leg angle > 20°, suspected rickets
or associated deformities

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15
Q

A 3-year-old African-American girl with obesity
has severe progressive genu varum; plain
radiograph shows proximal metaphyseal beaking

A

Blount disease

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16
Q

Basketball player presents with left knee pain,
recurrent effusion, quadriceps atrophy, and pain with range of motion; plain radiograph shows subchondral fragment with a lucent line separating it from the condyle

A

Osteochondritis dissecans

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17
Q

A 13-year-old female with right knee pain; she
feels that her knee cap is unstable, parapatellar
tenderness, plain radiograph sunrise view shows lateral tilt of patella

A

Recurrent patellar subluxation and dislocation

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18
Q

A 5-year-old has cystic mass in the back of the left knee for 3 months, it is painless, with no
tenderness, normal range of motion

A

Popliteal cyst (Baker cyst)

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19
Q

The best management of Baker cyst

A

Observation for 12 months

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20
Q

Knee pain with prolonged sitting, activity, and
climbing or descending stairs, feeling of knee
instability. Tenderness over the medial patellar
facet, pain with patellar compression, and mild
swelling

A

Patellofemoral pain syndrome (PFPS)

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21
Q

The best management of patellofemoral pain
syndrome

A

Ice, rest, NSAID, quadriceps and hamstring
strengthening

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22
Q

The most common cause of intoeing in children
> 3 years

A

Femoral torsion

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23
Q

A 7-year-old girl, patellae are looking inward
(kissing patellae), running like an egg-beater,
always sitting in W position, internal rotation of
the hip is more than external rotation

A

Femoral anteversion

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24
Q

Management of femoral anteversion

A

Reassurance (spontaneous resolution in more
than 80% of the cases)

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25
Q

The most common cause of intoeing in children
between 18 months and 3 years

A

Tibial torsion

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26
Q

Are shoe wedges, twister cables, night splint, or
discouraging W-sitting effective in cases of
femoral anteversion?

A

Showed to be ineffective

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27
Q

A 2-year-old with both feet pointing medially,
especially when running, patellae in both legs are pointing anteriorly. The child trips frequently

A

Internal tibial torsion

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28
Q

Management of internal tibial torsion

A

Reassurance (almost all cases resolve
spontaneously)

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29
Q

A 4-month-old with a curved foot; by drawing an
imaginary line bisecting the foot, it passes laterally to the fourth toe

A

Metatarsus adductus

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30
Q

The best management of metatarsus adductus

A

Observation (if persists beyond 6 months and
deformity is rigid, a referral is necessary)

31
Q

Newborn with a deformed foot; the foot can be
everted and dorsiflexed (the foot touches the
anterior tibia)

A

Postural or positional (calcaneovalgus foot) this
is not a clubfoot

32
Q

The best management of calcaneovalgus foot

A

Observation—condition due to the intrauterine
position

33
Q

Best management of clubfoot

A

Serial casting (requires an immediate referral)

33
Q

Newborn male infant with turned inward right foot. The right foot can be passively stretched almost to the midline. The ankle is in equinus (downward), the foot is supinated (varus) and adducted, dorsiflexion beyond 90° is not possible

A

Clubfoot or congenital talipes equinovarus
(TEV)

34
Q

The most common neurological conditions
associated with clubfoot

A

Myelomeningocele and cerebral palsy

35
Q

The most common condition associated with cavus foot

A

Charcot–Marie–Tooth syndrome

36
Q

A mother is concerned that her 6-month-old has a flat foot

A

Reassurance (medial arch of the foot does not
develop until 4 years of age and reaches adult
value by 8 years)

37
Q

A 3-year-old child with tiptoe walking, normal
neurological examination, the best course of action

A

Physical therapy for 6 months for Achilles
tendon stretching; if no improvement, orthopedic referral

38
Q

A 15-year-old presents with progressive back
deformity, plain radiographs of the thoracic spine shows 3 adjacent wedged vertebral bodies of at least 5°

A

Scheuermann kyphosis

39
Q

A 12-year-old female has spinal scoliosis detected by school nurse; the scoliometer measures 7°

A

Adolescent idiopathic scoliosis (AIS)

40
Q

Cases with AIS should be referred to orthopedic if

A

Scoliometer 7° or more, Cobb angle > 20°

41
Q

Management of female adolescent with AIS and
Cobb angle > 25°

A

Bracing (if skeletal growth remaining)

42
Q

Management of female adolescent with AIS and
Cobb angle > 50°

A

Usually, surgery is required

43
Q

The indication for MRI in cases with scoliosis

A

Pain, left thoracic curve, abnormal neurological
exam, infantile and juvenile types

44
Q

Adolescent with low-back pain for a few months. The pain is worse after physical activity or prolonged sitting. O/E: pain is exaggerated with lumbar flexion and bilateral rotation. Tenderness to palpation along the lumbar paraspinal muscles; tightness of the hamstring and calf muscles. Normal neurologic examination. No other symptoms. Normal spine radiograph

A

Mechanical low-back pain

45
Q

What is the best management in the previous case?

A

Physical therapy (lumbar/core strength and
stability exercises)

46
Q

A 10-year-old female does gymnastics; presents
with low-back pain that increases with the
extension of the spine, plain radiograph shows
defect in pars interarticularis, oblique view shows Scotty dog collar sign

A

Spondylolysis

47
Q

A 10-year-old female does gymnastics; presents
with low-back pain that increases with the
extension of the spine, plain radiograph shows
forward slippage in L5 over S1

A

Spondylolisthesis

48
Q

Management of spondylolisthesis

A

Referral to orthopedics

49
Q

Best initial management of spondylolysis

A

NSAID and rest

50
Q

A 15-year-old boxer complaining of dull pain in
radial aspect of the right wrist that is exacerbated by clenching, and tenderness in the anatomic snuffbox; plain radiograph on the right wrist is negative

A

Possible scaphoid fracture. (Radiograph is
usually negative in the first 2 weeks). Treat if
highly suspected

51
Q

The motor manifestation of posterior interosseous nerve injury

A

Finger drop (inability to extend the fingers at the
metacarpophalangeal joint)

52
Q

The best management of scaphoid fracture

A

Thumb spica splint and repeat radiograph in
2 weeks

53
Q

The motor manifestation of radial nerve injury

A

Wrist drop and finger drop

54
Q

The motor manifestation of ulnar nerve injury

A

Partial claw hand

55
Q

The motor manifestation of median nerve injury

A

Inability to flex the index finger

56
Q

The most common sports injury in the knee, e.g., female playing soccer

A

Anterior cruciate ligament (ACL) injury

57
Q

A 14-year-old complains of right shoulder pain
after a fall, arm held in abduction, and externally rotated, the shoulder is boxlike. Patient resists adduction and internal rotation, plain radiograph shows a subcoracoid position of the humeral head in the AP view and humeral head lies anterior to the “Y” in an axillary view

A

Anterior shoulder dislocation

58
Q

A 14-year-old complains of right shoulder pain
after an electric shock, the arm is held in adduction and internal rotation, patient resists external rotation and abduction. Plain AP radiograph shows a humeral head that resembles an ice cream cone. The scapular “Y” view reveals the humeral head behind the glenoid (the center of the “Y”)

A

Posterior shoulder dislocation

59
Q

Child with anterior shoulder dislocation loses the pinprick sensation in the deltoid

A

Axillary nerve injury (check axillary nerve
sensation before and after reduction)

60
Q

Right shoulder pain after a fall during basketball
practice, prominent clavicle with loss of the
normal contour of the shoulder, shoulder
radiographs show separation between the clavicle and acromion

A

Acromioclavicular joint disruption

61
Q

Right shoulder pain after a fall during basketball
practice directly onto the lateral aspect of the right shoulder, pain when adducting the arm across the chest, there is mild swelling and tenderness at the distal end of the clavicle, shoulder radiographs are normal

A

Acromioclavicular joint sprain

62
Q

The most common ligaments affected in ankle
sprain

A

Lateral ligaments of the ankle (anterior
talofibular most common, calcaneofibular, and
posterior talofibular ligaments)

63
Q

When can a patient with an ankle sprain go back to sports?

A

If no pain and painless range of motion

64
Q

The best way to differentiate between an ankle
sprain and fracture

A

Bony tenderness is usually a fracture

65
Q

A 2-year-old boy fell 2 h ago; now he is refusing to walk. He appears to have tenderness over the distal third of the left tibia. Radiographs of lower extremities are normal. What is the next best step?

A

Apply a cast on the left lower extremity and
repeat radiography in 2 weeks (possible toddler
fracture)

66
Q

A 12-year-old boy had a fracture of right tibia,
fixed with an above-knee cast. He continues to
have pain afterward, the pain keeps getting worse despite the maximum dose of prescribed pain medicine, any movement of the toes causes him excruciating pain, also he has numbness between the first 2 toes

A

Compartment syndrome. Presence of pain
despite fracture immobilization and pain
medication is a red flag for compartment
syndrome

67
Q

What is the next best step in the previous case of compartment syndrome?

A

Report immediately to the nearest ER
(immediate removal of cast and orthopedic
consultation)

68
Q

The most common orthopedic complication of
snake bite in the extremities

A

Compartment syndrome

69
Q

A 12-year-old with right knee trauma. Knee
radiograph showed no fracture but incidentally
found a small, well-defined radiolucent cortical
lesion with a surrounding rim of sclerosis in the
upper tibia. The longitudinal axis of the lesion is
parallel to the axis of the tibia

A

Fibrous cortical defect (non-ossifying fibromas),
Most cases are accidentally discovered in
radiographs taken for other reasons. No
treatment is required in most cases

70
Q

A 12-year-old with severe pain in the upper part of the right tibia at night improved dramatically with ibuprofen; radiograph showed 1.5 cm sharp round lesion (nidus) surrounded by a rim of radiodensity

A

Osteoid osteoma

71
Q

A 2-year-old child suddenly stops moving his right arm after his brother forcibly pulled his hand

A

Nursemaid elbow

72
Q

Short, webbed neck decreased the range of motion in the cervical spine, low hairline. Fusion of cervical vertebrae on radiograph

A

Klippel–Feil syndrome

73
Q

Common associations with Klippel–Feil syndrome

A

Sprengel’s deformity (elevation of the scapula),
thoracolumbar anomalies, renal and cardiac
anomalies

Pediatric Questions (31 decks)

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