Orthopedics / Rheumatology

Question 1

Caused from lifting/swinging/pulling a child while forearm is pronated and extended - radial head wedges into the stretched annular ligament

Answer 1

Radial head subluxation (nursemaid’s elbow)

Question 2

Management of radial head subluxation (nursemaid’s elbow)

Answer 2

Reduction - pressure on radial head with supination and flexion

Question 3

Most common in 7-16 y/o african american males

Answer 3

Slipped capital femoral epiphysis

Question 4

Femoral head epiphysis slips _________ and ___________ at growth plate in SCFE

Answer 4

Posterior

Inferior

Question 5

Pt presents with hip, thigh or knee pain with limp, external rotation of affected leg

Answer 5

Slipped capital femoral epiphysis

Question 6

Management of SCFE

Answer 6

Non weight-bearing with crutches

ORIF - risk of avascular necrosis

Question 7

Most common cause of chronic knee pain in active, young adolescents

Answer 7

Osgood-schlatter disease

Question 8

Diagnosis of osgood-schlatter disease

Answer 8

XR shows prominence or heterotrophic ossification at tibial tuberosity

Question 9

Management of osgood-schlatter disease

Answer 9

1. RICE, NSAIDs, quadriceps stretching

2. Surgery only in refractory cases

Question 10

Lateral curvature of spine > 10 degrees

Answer 10

Scoliosis

Question 11

Scoliosis most commonly begins at ages:

Answer 11

8-10 y/o

Question 12

If scoliosis is associated with cafe au lait spots, skin tags and axillary freckles:

Answer 12

Neurofibromatosis type I

Question 13

Diagnosis of scoliosis

Answer 13

Adam’s forward bending test

Cobb’s Angle

Question 14

Management of scoliosis

Answer 14

Observation, +/- bracing

Surgical correction if > 40 degrees

Question 15

Most common in children 4-10 y/o, 4x MC in boys, low incidence in african-americans

Answer 15

Legg-Calve-Perthes Disease

Question 16

Painless limping x weeks - worsens with continued activity especially at the end of the day

Answer 16

Legg-Calve-Perthes Disease

Question 17

Restricted range of motion - loss of abduction and internal rotation with painless limping

Answer 17

Legg-Calve-Perthes disease

Question 18

Diagnosis of Legg-Calve-Perthes disease

Answer 18

XR:
Early - increased density of femoral head
Advanced - crescent sign

Question 19

Management of Legg-Calve-Perthes disease

Answer 19

Observation - activity restriction - non-weight bearing with ortho followup
Physical therapy

Question 20

Autoimmune mono or polyarthritis in < 16 y/o

Answer 20

Juvenile rheumatoid arthritis

Question 21

Juvenile rheumatoid arthritis often resolves by:

Answer 21

Puberty

Question 22

Diagnosis of rheumatoid arthritis

Answer 22

Clinical diagnosis
Increased ESR, CRP
+ ANA in oligo, + rheumatoid only in 15%

Question 23

Management of rheumatoid arthritis

Answer 23

NSAIDs and/or corticosteroids
Methotrexate or leflunomide
Frequent eye exams