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PPS Diplomate Exam > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

_____ describes a deformity involving malalignment of the calcaneotalar-navicular complex.

A

Talipes Equinovarus (Clubfoot)

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2
Q

_____ is a normal foot that has been held in a deformed position in utero and is found to be flexible on examination in the newborn nursery.

A

Positional Clubfoot

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3
Q

Clubfoot is extremely common in patients with _____.

A

Myelodysplasia

Arthrogryposis

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4
Q

Examination of the infant clubfoot demonstrates _____.

A

Forefoot Cavus & Adductus

Hindfoot Varus & Equinus

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5
Q

A common radiographic finding in clubfoot is _____ between lines drawn through the axis of the talus and the calcaneus on the lateral view, indicating _____.

A

parallelism

hindfoot varus

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6
Q

_____ is initiated in all infants with clubfoot and should be started as soon as possible following birth.

A

Nonoperative Treatment

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7
Q

_____ has a definite role in the management of clubfeet, especially congenital clubfeet that have failed nonoperative or minimally invasive methods, and for the neuromuscular and syndromic clubfeet that are characteristically rigid.

A

Surgical Realignment

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8
Q

______ manifests as pain over the tibial tubercle in a growing child.

A

Osgod-Schlatter Disease

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9
Q

The patellar tendon inserts into the _____, which is an extension of the _____.

A

tibial tubercle

proximal tibial epihysis

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10
Q

_____ is likely a traction of the tibial tubercle growth plate an the adjacent patellar tendon.

A

Osgod-Schlatter Disease

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11
Q

Osgod-Schlatter Disease is self-limited in most patients and resolves with _____.

A

skeletal maturity

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12
Q

In Osgod-Schlatter Disease, _____ is the usual complaint, and _____ is often of concern.

A

pain over the tubercle

swelling over the tubercle

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13
Q

_____ refers to a spectrum of pathology in the development of the immature hip joint.

A

Developmental Dysplasia of the Hip (DDH)

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14
Q

Developmental Dysplasia of the Hip is classified into _____.

A

typical

teratologic

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15
Q

_____ DDH occurs in otherwise normal patients or those without defined syndromes or genetic conditions.

A

Typical

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16
Q

_____ DDH usually have identifiable causes such as arthrogryposis or genetic syndrome and occur before birth.

A

Teratologic

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17
Q

The final common pathway in the development of DDH is _____, which fails to maintain a stable femoroacetabular articulation.

A

increased laxity of the hip capsule

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18
Q

Any condition that leads to _____ and, consequently, _____ may be associated with DDH.

A

tighter uterine space

less room for normal fetal motion

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19
Q

The _____ assesses the potential for dislocation of a nondisplaced hip in a neonate.

A

Barlow Maneuver

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20
Q

Barlow Maneuver

A
  • Adduct the flexed hip and gently push the thigh posteriorly (dislocate the femoral head).
  • In a (+) test, the hip is felt to slide out of the acetabulum.
  • As the pressure is released, the hip can be felt slip back into the acetabulum.
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21
Q

The _____ attempts to reduce a dislocated hip.

A

Ortolani Maneuver

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22
Q

Ortolani Maneuver

A
  • While gripping the thighs, lift the greater trocanther while simultaneously abducting the hip.
  • When the test is positive, the femoral head will slip into the socket with a delicate clunk that is palpable.
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23
Q

Shortening of the thigh, the _____, is best appreciated by placing both hips in a 90° flexion and comparing the height of the knees.

A

Galeazzi Sign

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24
Q

The walking child often presents to the physician after the family has noticed a _____.

A

limp
waddling gait
leg-length discrepancy

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25
Q

_____ is the diagnostic modality of choice for DDH before the appearance of the femoral head ossific nucleus (4-6 weeks).

A

Ultrasonography

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26
Q

During the early newborn period (0-4 weeks), _____ is preferred in diagnosing DDH due to high incidence of false-positive sonograms.

A

Physical Examination

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27
Q

_____ are recommended for an infant once the proximal femoral epiphysis ossifies, usually by 4 mos.

A

Radiographs

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28
Q

The goals in the management of DDH are to obtain and maintain a _____ to provide the optimal environment for the normal development of the femoral head and acetabulum.

A

concentric reduction of the femoral head within the acetabulum

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29
Q

Newborn hips that are Barlow (+) or Ortolani (+) should be treated with a _____.

A

Pavlik Harness

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30
Q

The pruncupal goals in the treatment of ate-diagnosed dysplasia are to obtain and maintain _____.

A

reduction of the hip without damaging the femoral head

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31
Q

The most important complication of DDH is _____.

A

avascular necrosis of the femoral epiphysis

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32
Q

_____ is a hip disorder of unknown etiology that results from temporary interruption of the blood supply to the proximal femoral epiphysis, leading to osteonecrosis and femoral head deformity.

A

Legg-Calve-Perthes Disease (LCPD)

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33
Q

The initial stage of LCPD, which often lasts months, is characterized by_____.

A

synovitis
joint irritability
early necrosis of the femoral head

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34
Q

The 2nd stage of LCPD is the ____, which lasts 8 mos., where the femoral epiphysis begins to collapse, usually laterally, and begins to extrude from the acetabulum.

A

Fragmentation Stage

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35
Q

The _____ of LCPD, which lasts ~ 4 yrs., begins with new bone formation in the subchondral region.

A

Healing Stage

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36
Q

The final stage of LCPD is the _____, which begins after the entire head has ossified.

A

Residual Stage

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37
Q

The most common presenting symptom of LCPD is a _____ of varying duration.

A

limp

38
Q

_____ is the primary diagnostic tool for LCPD.

A

Radiography

39
Q

The goal of treatment of LCPD is _____.

A
  • preservation of a spherical, well-covered femoral head

- maintenance of hip range of motion

40
Q

Nonoperative treatment of LCPD consists of _____.

A

activity limitation
protected wright bearing
NSAIDs
physical therapy

41
Q

A _____ of the proximal femur is the most common surgical containment procedure for LCPD.

A

Varus Osteotomy

42
Q

_____ describes the clinical findings of tilting of the head to the right or left side in combination with rotation of the head of the opposite side.

A

Torticollis

43
Q

_____ is the most common etiology of torticollis.

A

Congenital Muscular Torticollis (CMT)

44
Q

Treatment of congenital muscular torticollis involves _____.

A

stretching
stimulation
positioning

45
Q

For the patients with a late diagnosis of congenital muscular torticollis or those in whom the stretching program has failed to correct the deformity, _____ is considered.

A

surgical release of the sternocleidomastoid

46
Q

_____ torticollis can result from strabismus (weakness of the 4th cranial nerve) or a superior oblique muscle palsy.

A

Ocular torticollis

47
Q

_____ describes torticollis in association with GER.

A

Sandifer’s Syndrome

48
Q

_____ are the most common pathogens in acute skeletal infections.

A

Bacteria

49
Q

In osteomylitis, _____ is the most common infecting organism in all groups, including newborns.

A

Staphylococcus aureus

50
Q

_____ may be the 2nd mot common cause of osteomyelitis in children < 5 y.o. in some parts of the world.

A

Kingella kingae

51
Q

Neonates with osteomyelitis might exhibit _____ or pain with the movement of the affected extremity (ex. diaper changes).

A

pseudoparalysis

52
Q

_____ are principally involved in osteomyelitis.

A

Long Bones

53
Q

The _____ and _____ are equally affected and together constitute almost 1/2 of all cases of osteomyelitis.

A

femur

tibia

54
Q

The bones of the _____ account for 1/4 of all cases of osteomyelitis.

A

upper extremities

55
Q

There is usually a single site of the bone or joint involvement except in _____ in whom ≥ 2 bones are involved in almost 1/2 the cases.

A

neonates

56
Q

Children with subacute symptoms of osteomyelitis and a focal finding in the metaphysial area might have a _____, with radiographic lucency and surrounding reactive bone.

A

Brodie Abscess

57
Q

_____ is the best radiographic imaging technique for identifying anscesses and for differantiating between bone and soft tissue infection.

A

MRI

58
Q

In neonates, osteomyelitis treatment must cover for _____.

A

S. aureus
Group B Streptococcus
G (-) Bacilli

59
Q

In neonates, osteomyelitis is treated with _____.

A 
Antistaphylococcal Penicillins (Nafcillin, Oxacillin)
Broad-Spectrum Cephalosporin (Cefotaxime)
60
Q

_____ is the gold standard agent for treateing invasive MRSA osteomyelitis.

A

Vancomycin

61
Q

_____ is the agent of choice for parenteral treatment caused by methicillin-susceptible S. aureus.

A

Cefazolin

62
Q

For most cases of osteomyelitis, the minimal duration of antibiotics is _____, provided that the patient shows prompt resolution of signs and symptoms (5-7 days) and the ESR & CRP have normalized.

A

21-28 days

63
Q

Treatment of chronic osteomyelitis consists of _____.

A

surgical removal of sinus tracts and sequestrum

64
Q

_____ has emerged as the most common cause of septic arthritis in all age groups.

A

Staphylococcus aureus

65
Q

In sexually active adolescents, _____ is a common cause of septic arthritis and tenosnovitis, usually of small joint or as a monoarticular infection of a large joint (knee).

A

Gonococcus

66
Q

_____ is an imprtant cause of septic arthritis in neonates.

A

Group B Streptococcus

67
Q

Erythema and edema of the skin and soft tissue overlying the site of infection are seen earlier in septic arthritis than in osteomyelitis because _____.

A

the bulging infected synovium is usually more superficial

68
Q

Joints of the _____ constitute 75% of all cases of septic arthritis.

A

lower extremities

69
Q

Aspiration of _____ provides the best specimen for culture of septic arthritis.

A

joint pus

70
Q

_____, compared to radiographs, is more sensitive in providing evidence of the diagnosis of septic arthritis.

A

Radionuclide Imaging

71
Q

In neonates, septic arthritis treatment must cover for _____.

A

S. aureus
Group B Streptococcus
G (-) Bacilli

72
Q

In neonates, septic arthritis is treated with _____.

A 
Antistaphylococcal Penicillins (Nafcillin, Oxacillin)
Broad-Spectrum Cephalosporin (Cefotaxime)
73
Q

_____ are alternatives when treating CA-MRSA septic arthritis.

A

Clindamycin

Vancomycin

74
Q

Antibiotic Duration for S. pneumonia and K. kingae Septic Arthritis

A

10-14 days

75
Q

Infection of the _____ is a surgical emergency because of the vulnerability of the blood supply to the head of the femur.

A

hip

76
Q

_____, the most common genetic cause of osteoporisis, is a generalized disorder of connective tissue.

A

Osteogenesis Imperfecta (OI)

77
Q

Structural or quantitative defects in _____ cause the full clinical spectrum of OI.

A

Type I Collagen

78
Q

_____ is the primary component of the extracellular matrix of bone and skin.

A

Type I Collagen

79
Q

OI has the triad of _____.

A

fragile bones
blue sclerae
early deafness

80
Q

OI Type _____ is sufficiently mild that it is often found in large pedigrees.

A

OI Type I

81
Q

Infants with OI Type _____ may be stillborn or die in the 1st yr. of life.

A

OI Type II

82
Q

OI Type _____ is the most severe nonlethal form of OI and results in significant physical disability.

A

OI Type III

83
Q

OI Type _____ can present at birth with in utero fractures or bowing of the lower long bones, but fracture rates decrease after puberty.

A

OI Type IV

84
Q

Type _____ OI patients clinically have OI Type IV, but have distinct finding on bone histology.

A

OI Type V (Hyperplastic Callus)

OI Type VI (Mineralization Defect)

85
Q

OI Type _____ patients have null mutations.

A

OI Type VII (P3H1)

OI Type VIII (CRTAP)

86
Q

The diagnosis of types I-IV and VII/VIII is confirmed by _____.

A

collagen biochemical studies using cultured dermal fibroblasts

87
Q

The morbidity and mortality of OI are _____.

A

cardiopulmonary

88
Q

Recurrent pneumonia and declining pulmonary function occur in _____ OI patients.

A

pediatric

89
Q

Cor pulmonale occurs in _____ OI patients.

A

adult

90
Q

A several-year course of treatment of children with OI with _____ confers some benefits.

A

Bisphosphonates

91
Q

MoA of Bisphosphonates

A

decrease bone resorption by osteoclasts

92
Q

Bisphosphonate treatment should be limited to _____ to maximize benefits and minimize detriment to cortical material properties.

A

2-3 yrs. in mid-childhood

PPS Diplomate Exam (38 decks)

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