Orthopedics/MSK

Question 1

How does osteosarcoma commonly present?

What will be seen on x-ray?

Answer 1

The most common presenting symptom is dull pain. As the tumor progresses, there is swelling and palpable mass.

Sunburst appearance or Codman’s triangle

Codman’s triangle is a the characteristic triangular lifting of the periosteum

Question 2

During a routine examination of a newborn, the pediatrician notes that the left leg appears slightly shorter than the right. When performing the Ortolani maneuver, there is a palpable clunk. What is the most likely diagnosis, and what is the initial management?

A. The newborn likely has a femur fracture; immediate orthopedic consultation is required.
B. The infant may have slipped capital femoral epiphysis; schedule an X-ray of the hip.
C. The infant likely has developmental dysplasia of the hip; initiate treatment with a Pavlik harness.
D. The newborn might have muscular dystrophy; refer to a neurologist.

Answer 2

The infant likely has developmental dysplasia of the hip; initiate treatment with a Pavlik harness.

Question 3

Which of the following is a common risk factor for developing congenital hip dysplasia?

A. Male sex
B. Vaginal delivery
C. Breech position at delivery
D. Low birth weight

Answer 3

Breech position at delivery

Question 4

A 2-week-old infant is brought to the clinic for a routine check-up. Which physical exam test should be performed to screen for congenital hip dysplasia?

Answer 4

Barlow-Ortalani

Question 5

What is the first-line imaging study for a 6-month-old suspected of having developmental dysplasia of the hip?

A. Ultrasound of the hip
B. X-ray of the hip
C. MRI of the hip
D. CT scan of the hip

Answer 5

X-ray of the hip

Ultrasound is used to assess in infants < 6 months of age. Radiographs are unreliable until the patient is at least four months old because of radiolucency of the femoral head. Past 6 months x-ray is preferred.

Question 6

Which of the following findings on ultrasound is indicative of developmental dysplasia of the hip in infants younger than 6 months?

A. Increased alpha angle
B. Decreased beta angle
C. Shallow acetabular roof
D. Deep acetabular notch

Answer 6

Shallow acetabular roof

a “shallow acetabular roof” observed on an ultrasound in infants is a direct sign of inadequate hip joint development, pointing towards DDH. This specific finding is important because it directly relates to the structural integrity and function of the hip joint, which is critical in the early diagnosis and management of DDH to prevent long-term disabilities.

Question 7

What is the most appropriate initial treatment for a 3-month-old diagnosed with developmental dysplasia of the hip?

A. Surgical reduction and fixation
B. Observation and re-evaluation in 1 month
C. Application of a Pavlik harness
D. Physical therapy and exercises

Answer 7

Application of a Pavlik harness

Question 8

In children, what is the name for avascular necrosis of the proximal femur?

What is the study of choice to diagnose AVN in children?

Answer 8

In children, AVN is known as Legg-Calve’ Perthes disease - will present with persistent pain and a limp. Ages 2-11 years old with a peak incidence of 4-8 years of age

MRI

Question 9

Which of the following is a typical clinical presentation of avascular necrosis of the proximal femur in children?

A. Acute onset of severe, bilateral hip pain
B. Intermittent pain in the groin, thigh, or knee
C. Continuous, non-radiating lower back pain
D. Sudden swelling and redness of both hips

AVN in children is most commonly diagnosed in which age group?

Answer 9

Intermittent pain in the groin, thigh, or knee

School aged (6-10 years old)

Question 10

Which factor is considered a risk for developing avascular necrosis of the proximal femur in pediatric patients?

A. High body mass index (BMI)
B. Frequent use of corticosteroids
C. Vigorous physical activity
D. Genetic predisposition

Answer 10

Frequent use of corticosteroids

Question 11

True/False: Avascular necrosis can occur as a complication following the treatment of developmental dysplasia of the hip.

Answer 11

True

Question 12

Which of the following is the most common subtype of juvenile idiopathic arthritis?

A. Systemic JIA
B. Oligoarticular JIA
C. Polyarticular JIA, rheumatoid factor positive
D. Enthesitis-related JIA

Answer 12

Oligoarticular JIA

Question 13

Which of the following laboratory findings is commonly found in children with systemic JIA?

A. Elevated rheumatoid factor
B. Positive ANA
C. Elevated ESR and CRP
D. Low white blood cell count

Answer 13

Elevated ESR and CRP

Question 14

What is the initial treatment of choice for a child diagnosed with oligoarticular juvenile idiopathic arthritis?

A. High-dose corticosteroids
B. NSAIDs
C. Methotrexate
D. Biologic agents

Answer 14

NSAIDs

Question 15

A child with polyarticular JIA is not responding to NSAIDs. What is the next best step in management?

A. Physical therapy only
B. Immediate surgical intervention
C. Start methotrexate
D. Increase NSAID dosage

Answer 15

Start methotrexate

Question 16

An 8-year-old boy has been complaining of pain in both wrists and several fingers for the past two months. He experiences morning stiffness that lasts for more than an hour. His mother also reports occasional low-grade fevers. An examination shows swelling in the affected joints. Laboratory tests reveal a negative rheumatoid factor and elevated inflammatory markers. What is the most likely diagnosis, and what should be the initial treatment approach?

A. Systemic lupus erythematosus; start hydroxychloroquine.
B. Polyarticular juvenile idiopathic arthritis, rheumatoid factor negative; initiate treatment with NSAIDs and consider early introduction of methotrexate.
C. Rheumatic fever; administer penicillin.
D. Osteoarthritis; provide symptomatic relief with acetaminophen.

Answer 16

Polyarticular juvenile idiopathic arthritis, rheumatoid factor negative; initiate treatment with NSAIDs and consider early introduction of methotrexate.

Question 17

What are the Salter Harris Fracture classifications?

Answer 17