Orthopedics & Sports Medicine

Question 1

What is the appropriate immediate treatment for an ankle sprain ?

Answer 1

Ice for 20min at a time over the first 48 hours

Question 2

What is the likely diagnosis in a pre-adolescent child with bone pain over the physis who has a normal X-ray?

Answer 2

Salter Harris 1 fracture

Question 3

What is a grade 1 ankle sprain?

Answer 3

Minor stretching of ligament with minimal discomfort or loss of function

Question 4

What is the difference between grade 2 and grade 3 sprain?

Answer 4

Grade 2 has partially torn ligaments whereas grade 3 has complete tear

Question 5

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

Answer 5

Obtain compartment pressures

Question 6

What are the 5 symptoms of compartment syndrome ?

Answer 6

Pain
Paresthesias 
Pallor
Paralysis 
Pulselessness

Question 7

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?

Answer 7

Osteogenesis imperfecta type 1 - conductive and sensorineural hearing loss

Question 8

What disease presents with an infant born with multiple fractures with a large head who is born either stillborn or died shortly after birth?

Answer 8

Osteogenesis imperfecta type 2

Question 9

What disease presents with an infant who is born with fractures and sustain progressive deformities and has gray sclera, macrocephaly and short stature?

Answer 9

Osteogenesis imperfecta type 3

Question 10

What is the inheritance pattern of achondroplasia ?

Answer 10

Autosomal dominant 20%

Spontaneous mutation 80%

Question 11

What is the most likely cause of sudden death in an infant with achondroplasia ?

Answer 11

Cervicomedullary junction compression

Question 12

What syndrome presents with fusion of cervical vertebrae, short neck,scoliosis, spina bifida, deafness and renal problems?

Answer 12

Klippel Feil syndrome

Question 13

What diagnosis may present with torticollis and upper motor neuron findings such as increased DTRs?

Answer 13

Posterior fossa tumor

Question 14

What other abnormality is associated with congenital torticollis?

Answer 14

Hip dysplasia

Question 15

What is the treatment for congenital torticollis?

Answer 15

Daily stretching and PT - if continued after one year, surgical intervention

Question 16

What is the cause of muscular torticollis?

Answer 16

Positioning or trauma

Question 17

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 ?

Answer 17

Paroxysmal torticollis

Question 18

What is the sprengel deformity?

Answer 18

Affected side of the neck is broader and shorter and mimics torticollis

Question 19

What is the cause of sprengel deformity?

Answer 19

Poor fetal development and failure of the scapula to descend to the normal position

Question 20

What are the 4 risk factors for developmental dysplasia of the hip?

Answer 20

Breech
Female
First born
Family hx

Question 21

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?

Answer 21

Rheumatic fever

Question 22

What is the treatment of choice for an adolescent with septic joint?

Answer 22

Ceftriaxone plus azithromycin (to cover GC)

Question 23

What organisms are commonly the cause of septic joint in a neonate?

Answer 23

GBS, staph and gram negative bacillus

Question 24

What is legg calve perthes disease?

Answer 24

Avascular necrosis of the femoral head

Question 25

What is the most common etiology of osteomyelitis in the neonatal period and what is the most common complication?

Answer 25

E. coli and GBS | Septic joint

Question 26

What is the likely diagnosis in an adolescent male with chronic knee pain that locks up and swells? How would you diagnose this?

Answer 26

``` Osteochondritis dissecans (necrosis of the articulate surface) MRI ```

Question 27

What is the appropriate treatment of osteochondritis dissecans?

Answer 27

Immobilization and surgical removal of fragments if no improvement

Question 28

How might a pelvic osteomyelitis present, other than hip or thigh pain ?

Answer 28

Abdominal pain

Question 29

What is the treatment for osgood schlatter disease?

Answer 29

Weeks of rest with gradual return to activity | NSAIDs

Question 30

What is the mechanism behind the pain caused by osgood schlatter disease ?

Answer 30

Excessive activity at the insertion of the patellar tendon at the anterior tibial tubercle (apophysis)

Question 31

At what curvature does scoliosis require surgery?

Answer 31

Curvature >40 degrees

Question 32

At what curvature may you simply observe a child with scoliosis?

Answer 32

<25

Question 33

What determines when to brace a child with scoliosis curvatures 25-40 degrees?

Answer 33

Bracing required if there is more than 2 more years of growth expected

Question 34

What should you do if a child with scoliosis has >1 degree per month of increased curvature during the growth spurt ?

Answer 34

MRI to rule out a cause other than idiopathic scoliosis

Question 35

What is the cause of congenital scoliosis? What can this be associated with?

Answer 35

Failed segmentation or formation of spinal elements - can be associated with fused ribs or spinal cord anomalies

Question 36

What is idiopathic scoliosis and what is the normal progression?

Answer 36

Isolated scoliosis with no cause - worsens by 1 degree per month during the growth spurt

Question 37

What diagnosis should you consider in a patient with rapidly progressive scoliosis and neurological deficits?

Answer 37

Neurofibromatosis

Question 38

What type of screening is warranted in patients with congenital scoliosis? (3 answers)

Answer 38

Renal ultrasound and ECHO as well as spinal MRI

Question 39

What is the normal range of thoracic kyphosis and at what degree is intervention indicated ? What is the first study to perform in these cases?

Answer 39

Normal range: 20-40 | PFTs if >60 degrees

Question 40

What is the likely diagnosis in a teenager who can't stand up straight and has chronic upper back pain? What is the treatment?

Answer 40

Scheuermann disease - NSAIDs and physical therapy

Question 41

What is the diagnosis in an infant with swelling of the bones and progressive cortical thickening on X-ray?

Answer 41

Caffey disease (infantile cortical hyperostosis)

Question 42

How can caffey disease be distinguished from non accidental trauma?

Answer 42

Abuse involves the periosteum but caffey disease involves only the cortex

Question 43

What is the difference between unicameral and aneurysmal bone cysts? (Comment on location, symptoms and complications)

Answer 43

Unicameral - found on proximal humerus or femur. Asymptomatic and not precancerous. Aneurysmal - found on tibia or femur. Present with pain and associated with bone tumors

Question 44

What is the diagnosis for a patient with pain over the distal clavicle with area of prominence ?

Answer 44

Acromioclavicular Injury

Question 45

What diagnosis presents as shoulder pain with elevation of the arm, but no deformity ?

Answer 45

Rotator cuff injury

Question 46

When is intervention needed for genu varus (bow legged) ?

Answer 46

If unilateral, worsening after age 1 or unresolved by age 2

Question 47

What are the two major concerns if genu varus is present after age 2?

Answer 47

Rickets or Blounts disease

Question 48

What is the cause of adolescent Blount disease? What is the treatment ?

Answer 48

Overweight adolescent develops distortion of proximal tibial physis and epiphysis Bracing or surgery is needed

Question 49

What is the treatment for infantile Blounts disease?

Answer 49

No treatment indicated

Question 50

What type of fracture presents as a separation of the epiphysis and metaphysis? What is the treatment?

Answer 50

Salter Harris type 1 - casting 2-3 weeks

Question 51

What type of fracture goes through the growth plate and extends through the epiphysis? What is the treatment ?

Answer 51

Salter Harris type 3 - open reduction needed

Question 52

What type of fracture involves a splitting of the metaphysis and physis? What is the treatment?

Answer 52

Salter Harris type 2 - closed reduction with casting 3-6 weeks

Question 53

What is the cause of an anterior and posterior fat pad on X-ray of the elbow?

Answer 53

Anterior - normal | Posterior - fracture

Question 54

What is the diagnosis in a patient with pain over the anatomical snuffbox (even with a negative X-ray)?

Answer 54

Scaphoid bone fracture

Question 55

What type of fracture does through the metaphysis/physis/epiphysis? What is the treatment ?

Answer 55

Salter Harris type 4 - open reduction

Question 56

What is the likely diagnosis in a patient who heard a pop after twisting of the knee and pain over the lateral patella ? What is the treatment?

Answer 56

Patella subluxation - maintain quadriceps and hamstring strength and flexibility

Question 57

What diagnosis would you consider in an obese teenager with left knee pain?

Answer 57

SCFE (hip pain commonly presents as knee pain)

Question 58

What is the appropriate treatment for tibial torsion and femoral anteversion?

Answer 58

Nothing!!! Resolves spontaneously

Question 59

What are 3 situations where acute illness makes a child ineligible for participation in sports?

Answer 59

Fever Carditis Hepatosplenomegaly

Question 60

What is the definition of heat exhaustion?

Answer 60

Mild dehydration with core temp <104

Question 61

When is power lifting safe for pre-adolescents ?

Answer 61

Low resistance weight training is permitted but power lifting is not safe for preadolescents

Question 62

What should be done for a patient participating in sporting events who presents with headache, nausea or confusion and is sweating on physical exam?

Answer 62

Stop exercising and drink fluids

Question 63

What are the 4 criteria for heat stroke ?

Answer 63

Temp >105 Hot dry skin (not sweating) CNS depression Severe dehydration

Question 64

What is the risk involved in heat stroke and why?

Answer 64

End organ damage due to release it endotoxins and cytokines

Question 65

What should be done in a patient who presents with diagnosis of heat stroke?

Answer 65

Decrease core body temperature (down to 102, avoid hypothermia) Rehydrate with IVF only Vasopressors if needed

Question 66

What is the diagnosis in a patient who sustains eye trauma and develops a collection of blood between the cornea and iris?

Answer 66

Hyphema

Question 67

What is the appropriate treatment for hyphema?

Answer 67

Referral to ophthalmology | Bed rest and HOB at 30 degrees to decrease intraocular pressure (should not patch the eye)

Question 68

What diagnosis should you consider in a patient with blunt eye trauma who presents with double vision when looking to one side and disconjugate gaze but intact pupillary reflexes ?

Answer 68

Blowout fracture of orbital wall

Question 69

What diagnosis would you consider in a patient who sustains eye injury and presents with pain and tearing but no Diplopia or dysconjugate gaze? What would confirm this diagnosis ?

Answer 69

Corneal abrasion | Focal uptake of fluorescein

Question 70

What diagnosis presents as a visual deficit in the peripheral fields but no dysconjugate gaze?

Answer 70

Detached retina

Question 71

What diagnosis should you consider in a patient who wears contacts and presents with redness and irritation of the eye, normal pupil exam and diffuse uptake of fluorescein stain? What is the appropriate treatment?

Answer 71

Gram negative infection or ulcer of corneal epithelium - urgent management by ophthalmology

Question 72

What diagnosis presents as anterior knee pain over the patella and visible swelling? What is the treatment ?

Answer 72

Prepatellar bursitis - NSAIDs and padding during sports

Question 73

What is the most likely diagnosis in a patient who presents with large area of swelling on anterior thigh after blunt trauma ? How would you treat?

Answer 73

Hematoma of soft tissue - NSAIDs, Ice and rest

Question 74

What is the most likely diagnosis in a patient with pain over the dorsum of the hand near the base of the thumb?

Answer 74

Scaphoid fracture

Question 75

What is the most likely diagnosis in a 12y/o gymnast with left wrist pain x 3 months without any significant trauma and normal physical exam with tenderness only at distal radius? How would you treat?

Answer 75

Distal radial epiphyseal injury - rest and splint until wrist is healed to avoid growth plate disruption

Question 76

Hep would you treat a non displaced mid shaft clavicle fracture ?

Answer 76

Sling (no reduction needed)

Question 77

What is the appropriate treatment for a patient with medial clavicle fracture?

Answer 77

CT scan may be needed to rule out complications

Question 78

What diagnosis should you consider In a patient with distal clavicle pain after trauma injury who has negative clavicle X-ray ?

Answer 78

AC separation

Question 79

What is the next step in a patient with hemophilia who sustains hand injury and presents with numbness of the hand?

Answer 79

Measure compartment pressure

Question 80

What should be done to secure an airway in a patient who sustains a neck injury while playing football?

Answer 80

Never remove helmet or should pads - may remove face guard only!

Question 81

What are potential risks involved in anabolic steroid use in females?

Answer 81

Hirsutism and early closure of growth plates

Question 82

What are 6 potential side effects of Anabolic steroid use in males?

Answer 82

``` Acne Gynecomastia High pitched voice Hypogonadism Aggression HTN ```

Question 83

Until what age are children required to wear a face guard when batting during baseball games?

Answer 83

Up to age 14

Question 84

What are 4 common lab findings consistent with anabolic steroid use?

Answer 84

Elevated LFTs Low HDL High LDL Oligospermia

Question 85

How long are anabolic steroids detected after PO vs IM use?

Answer 85

PO steroids remain in urine up to a few weeks | iV steroids remain in the system >6 months

Question 86

What would you do in an athlete who presents for sports clearance and is found to have LVH?

Answer 86

No sports restriction as this is normal in athletes

Question 87

What is part of sports clearance in a patient with Down syndrome?

Answer 87

Plan neck X-ray to rule out AA instability

Question 88

What should diabetic patients do in preparation for exercise?

Answer 88

Increased caloric intake or decreased insulin to avoid hypoglycemia

Question 89

In defining varus vs valgus, which one refers to when the distal part of the deformity points away from midline ?

Answer 89

Valgus