Pediatrics

Question 1

What is this injury and what does it represent?

Answer 1

Pediatric corner fractures of distal femur.

Represents NAT

Question 2

What are fractures highly suspicious for child abuse?

Answer 2

Corner fx
Distal humerus transphyseal fx
Posterior rib fx
Fractures in various stages of healing
Long bone fx in non ambulatory patient

Question 3

What region of the physis do Physeal fractures occur?

Answer 3

Hypertrophic zone (zone of provisional calcification)

Question 4

Indications for Physeal bar excision?

Answer 4

>2cm growth remaining
<50% Physeal involvement

Question 5

What view do you use to measure medial epicondyle displacement?

Answer 5

Humeral axial view

Question 6

Risks of ORIF proximal radius fractures?

Answer 6

Loss ROM
AVN
Synostosis

Try and close reduce if possible, this is needed when >30-45 deg angulation

Question 7

Treatment algorithm for ped femur fracture?

Question 8

Signs of compartment syndrome in kids?

Answer 8

Agitation
Anxiety
Analgesics

Question 9

Complication of tibial tubercle fracture?

Answer 9

Compartment syndrome (injury to recurrent anterior tibial artery)

Question 10

Complications of tibial spine fracture?

Answer 10

Stiffness
Late anterior instability (60%)

*intermeniscal ligament and medial meniscus can get entrapped and often block reduction

Question 11

What is Cozen’s phenomenon?

Answer 11

Late valgus deformity if tibia that occurs ~6 months after proximal tibia fracture. This usually self corrects. But if present beyond 2 years after injury then can consider osteotomy.

Question 12

Pediatric HALO pin configuration?

Answer 12

6-8 pins at 2-4 in-lbs

Question 13

Spine flexion distraction injuries typically involve the ——- region and 50% have this associated injury?

Answer 13

Thoracolumbar

Intra-abdominal injury

* Management is extension bracing for stable bony injuries or operative stabilization if ligamentous injuries

Question 14

Joints with intra-articular metaphysis that are prone to septic joint…

Answer 14

SHEA

Shoulder
Hip
Elbow
Ankle

Question 15

First line test for Lyme disease?

Answer 15

ELISA and then if this is positive next order Western Blot test

Treatment:
- >8 years Doxycycline
- <8 years Amoxicillin

Question 16

MRI finding consistent with cerebral palsy?

Answer 16

Periventricular leukomalacia

Question 17

Mechanism of action for Botox?

Answer 17

Inhibits presynaptic release of acetylcholine

Question 18

Equinovarus foot is caused by…

Answer 18

overpull of posterior tibialis +/- Achilles tendon

Common in spastic hemiplegic CP patients

Question 19

Myelodysplasia serum marker

Answer 19

Maternal serum alpha-fetoprotein

*risk factors: low folic acid, valorous acid, carbamazepine, maternal hyperthermia, maternal insulin dependent diabetes

Question 20

Inheritance pattern of Duchennes muscular dystrophy and Becker muscular dystrophy?

Answer 20

X-linked recessive (males affected)

Question 21

What Cobb angle do you fuse scoliosis in muscular dystrophy ?

Answer 21

When cobb reaches >20-25 deg because risk of loss of pulmonary function

Question 22

Area of the spinal cord affected by polio?

Answer 22

Anterior horn

(Loss of motor but intact sensation)

*treatment is sub exhaustion exercise to prevent further loss of motor cell function

Question 23

Posteromedial tibial bowing

Question 24

Anteromedial tibial bowing is associated with…

Answer 24

Fibular hemimelia/ PFFD/ longitudinal deficiency

Sonic hedge hog gene

Associated with ball and socket ankle and equinovalgis foot

Question 25

Anterolateral tibial bowing is associated with…

Answer 25

Pseudoartbrosis of the tibia (neurofibromatosis)

Question 26

Clubfoot correction order

Answer 26

CAVE Cavus Adductus Varus Equinus *deficient tibialis anterior artery, possible LLD

Question 27

Fibular deficiency is associated with…

Answer 27

Limb length discrepancy Limb malalignment (valgus) ACL absence Ball and socket ankle joint Tarsal coalition

Question 28

Most common segments involved with a brachial plexus injury?

Answer 28

C5-6 (Erb Palsy - waiter tip deformity)

Question 29

Birth brachial plexopathy can result in these changes of the glenohumeral joint due to persistent muscular imbalances?

Answer 29

Posterior humeral subluxation Glenoid retroversion humeral head flattening Glenohumeral joint incongruity

Question 30

What is the curve pattern in adolescent idiopathic scoliosis?

Answer 30

Right thoracic scoliosis with hypokyphosis

Question 31

Diagnosing physiologic knee varus, blount’s disease, and rickets (both diet and hypophosphotemic rickets)…

Question 32

AIS Bracing with open triradiate cartilage is effective if the brace is worn a minimum of ___ hours per day

Answer 32

18

Question 33

Risk factors for hip dysplasia?

Answer 33

First born Female sex Breach Family history DDH

Question 34

Risk factors for failure of Pavlik harness treatment for DDH?

Answer 34

Femoral nerve palsy during treatment Irreducibility (ortalolani negative) Treatment after 7 weeks of age Right sided dislocation Graf type IV grade at presentation

Question 35

Infantile scoliosis is more likely to progress when it meets these criteria?

Answer 35

RVAD >20 deg Cobb angle >25

Question 36

For Pediatric hip dislocations what is the best treatment and post reduction imaging modality?

Answer 36

Closed gentle reduction in the OR with paralysis. Postreduction MRI to ensure to entrapped cartilage (CT not helpful because much of hip is not yet ossified)

Question 37

Intra-articular tibial tubercle fractures are at risking if entrapping this structure?

Answer 37

Lateral mensiscus

Question 38

Direction of physeal closure of the tibial tubercle?

Answer 38

Posterior to anterior and medial to lateral

Question 39

Blocks to reduction for displaced pediatric tibial spine fractures?

Answer 39

Intermeniscal ligament Medial meniscus

Question 40

For distal tibia phsyeal fractures, the Risk of growth arrest in kids increases if…

Answer 40

The postreduction gap is >3mm

Question 41

Pattern of distal tibia phsyeal closure

Answer 41

central > medial > lateral

Question 42

Halo pins used in Peds Number Lbs

Answer 42

6-8 pins at 2-4 in-lbs

Question 43

Kocher criteria? Which of the criteria is the best predictor of infection?

Answer 43

NWB Fever >38.5 ESR >40 WBC >12K Fever am

Question 44

Brain MRI finding for cerebral palsy?

Answer 44

Periventricular leukomalacia

Question 45

Duchenne and Becker muscular dystrophy have this inheritance pattern?

Answer 45

X linked recessive

Question 46

Scoliosis is primarily a ____ deformity

Answer 46

Rotational

Question 47

AIS etiology?

Answer 47

Multifactorial

Question 48

This reading on a scoliometer warrants referral?

Answer 48

7 deg or more (equates to 21 deg Cobb)

Question 49

Typical AIS curve pattern?

Answer 49

RIGHT thoracic curve with hypokyphosis

Question 50

Factors affecting AIS curve progression?

Answer 50

Age Skeletal maturity Risser 0-1 Sanders Peak growth velocity Occurs prior to menarche Occurs prior to Risser 1 Curve >20 deg

Question 51

MRI indications for scoliosis in presumed AIS?

Answer 51

Left thoracic curve Pain Rapidly progressing scoliosis Atypical kyphosis of thoracic curve Juvenile onset (before age 10) Neurologic signs or symptoms Congenital abnormalities

Question 52

When do you prophylacticallynpin the contralateral hip for SCFE?

Answer 52

Endocrine abnormalities Open triradiate cartilage

Question 53

Familial Vit D resistant hypophosphotemia is associated with these lab findings?

Answer 53

Low serum phosphate Elevated urinary phosphate