Pediatrics 2016 Flashcards
- Figures 3a and 3b are the radiographs of a patient who has a painful right leg without any sign of infection. The original injury to the leg occurred 2 years ago when an external fixator was placed. Treatment should now address the tibia with
- observation.
- surgery and no procedure to the fibula.
- surgery and guided growth of the fibula.
- surgery and osteotomy of the fibula.
- amputation and prosthetic fitting.
- Surgery and osteotomy of the fibula.
- Figures 13a and 13b are the radiographs of a 12-year-old girl who is referred for scoliosis. (26 degree curve) What is the best treatment option?
- Continued observation with follow-up in 4 months for repeat radiographs
- Full-time thoracolumbosacral brace wear at least 13 hours per day
- Full-time serial body casting for 3 months
- Anterior thoracoscopic tethering procedure
- Posterior spinal fusion with instrumentation
- Full-time thoracolumbar brace wear iwth at least 13 hours per day
RECOMMENDED READINGS
Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013 Oct 17;369(16):1512-21. doi: 10.1056/NEJMoa1307337. Epub 2013 Sep 19. PubMed PMID: 24047455.
Sanders JO, Khoury JG, Kishan S, Browne RH, Mooney JF 3rd, Arnold KD, McConnell SJ, Bauman JA, Finegold DN. Predicting scoliosis progression from skeletal maturity: a simplified classification during adolescence. J Bone Joint Surg Am. 2008 Mar;90(3):540-53. doi: 10.2106/JBJS.G.00004. PubMed PMID: 18310704.
- A cast index higher than 0.8 can help to predict which complication following closed reduction and casting of a pediatric distal radius fracture?
- Skin breakdown under the cast
- Neurologic injury
- Growth arrest
- Redisplacement of the fracture in a cast
- Compartment syndrome
- Redisplacement of the fracture in a cast.
RECOMMENDED READINGS
Kamat AS, Pierse N, Devane P, Mutimer J, Horne G. Redefining the cast index: the optimum technique to reduce redisplacement in pediatric distal forearm fractures. J Pediatr Orthop. 2012 Dec;32(8):787-91. doi: 10.1097/BPO.0b013e318272474d. PubMed PMID: 23147621.
McQuinn AG, Jaarsma RL. Risk factors for redisplacement of pediatric distal forearm and distal radius fractures. J Pediatr Orthop. 2012 Oct-Nov;32(7):687-92. doi: 10.1097/BPO.0b013e31824b7525. PubMed PMID: 22955532.
- Figures 29a through 29c are the pelvic and knee radiographs of an 11-year-old girl who has pain on the inner aspect of her thigh. She walks with a limp and has decreased range of motion of the right hip and knee secondary to her pain. Her right knee is stable, and there is no joint line tenderness. What is the best next step?
- Arthroscopy of the right knee
- Rest, ice, and elevation of the right limb
- Injection of the right knee
- Surgery on the right hip
- Nerve block of the right limb
- Surgery on the right hip.
RECOMMENDED READINGS
Hosseinzadeh P, Iwinski HJ, Salava J, Oeffinger D. Delay in the Diagnosis of Stable Slipped Capital Femoral Epiphysis. J Pediatr Orthop. 2015 Oct 21. [Epub ahead of print] PubMed PMID: 26491912.
Aronsson DD, Loder RT, Breur GJ, Weinstein SL. Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg. 2006 Nov;14(12):666-79. Review. PubMed PMID: 17077339.
- A 2-week-old infant has minimal use of the right upper extremity. The child was delivered after a prolonged and difficult labor. Which examination findings are associated with 90% recovery of function?
- Flail extremity, no elbow flexion and ptosis
- Torticollis with no shoulder, elbow, or wrist function
- No shoulder abduction or external rotation, no elbow flexion or supination, intact wrist flexion
and extension, hand intrinsics intact
- No shoulder abduction or external rotation, no elbow flexion or supination, no wrist flexion or
extension, hand intrinsics intact
- No shoulder abduction or external rotation, no elbow flexion or supination, no wrist flexion or
extension, no hand intrinsic function
- No shoulder abduction or external rotation, no elbow flexion or supination, in tact wrist flexion and extensio, hand intrinsics intact.
RECOMMENDED READINGS
Waters PM. Update on management of pediatric brachial plexus palsy. J Pediatr Orthop. 2005 Jan- Feb;25(1):116-26. Review. PubMed PMID: 15614072.
Ho Christine. Disorders of the upper extremity. In: Herring JA ed. Tachdjian’s Pediatric Orthopaedics. Vol 1. 5th ed. Philadelphia, PA: Elsevier-Saunders; 2014:464-471.
- What is the biochemical effect of an intramuscular injection of botulinum toxin A?
- Competitively blocks postsynaptic acetylcholine receptors
- Inhibits synaptic acetylcholinesterase activity
- Inhibits the presynaptic release of acetylcholine
- Decreases the number of neuromuscular junctions
- Disassociates the action of actin and myosin in targeted muscles
- Inhibits the presynaptic release of ACh.
- Figure 43a is a standing lower extremity anteroposterior radiograph of a 2 and a half-year-old boy who has bowed legs. An examination reveals a 6-cm distance between the medial condyles of his knees when his feet are touching and his legs are extended. A gait evaluation reveals a moderate varus thrust while walking. He is slightly overweight. What is the best next step?
- Observation
- Bilateral knee-ankle-foot orthoses
- Bilateral medial tibial hemiepiphysiodesis using 2-hole plate and screws
- Bilateral medial femoral and tibial hemiepiphysiodesis using 2-hole plate and screws
- Bilateral valgus-producing tibial osteotomies
- Observation
RECOMMENDED READINGS
Bowen RE, Dorey FJ, Moseley CF. Relative tibial and femoral varus as a predictor of progression of varus deformities of the lower limbs in young children. J Pediatr Orthop. 2002 Jan-Feb;22(1):105-11. PubMed PMID: 11744864.
Arazi M, Oğün TC, Memik R. Normal development of the tibiofemoral angle in children: a clinical study of 590 normal subjects from 3 to 17 years of age. J Pediatr Orthop. 2001 Mar-Apr;21(2):264-7. PubMed PMID: 11242264.
- Figures 49a through 49f are the MR images of a 12-year-old boy who has severe back and radiating right leg pain after falling from the back of a pickup truck 4 days ago. He can walk only short distances with his hips in extension and his knees flexed. Straight-leg raise and crossed straight-leg raise findings are positive; motor and sensory examination findings are otherwise within normal limits. Radiographs taken in the emergency department are negative for fracture or dislocation. What is the best next step?
- Observation
- Rest, activity modification, and bracing
- L5-S1 diskectomy with foraminotomy
- L5-S1 decompression with instrumented posterior spinal fusion
- Direct L5 pars repair
- Rest, activitiy modification and bracing
RECOMMENDED READINGS
Pizzutillo PD, Hummer CD 3rd. Nonoperative treatment for painful adolescent spondylolysis or spondylolisthesis. J Pediatr Orthop. 1989 Sep-Oct;9(5):538-40. PubMed PMID: 2529267.
Cavalier R, Herman MJ, Cheung EV, Pizzutillo PD. Spondylolysis and spondylolisthesis in children and adolescents: I. Diagnosis, natural history, and nonsurgical management. J Am Acad Orthop Surg. 2006 Jul;14(7):417-24. Review. PubMed PMID: 16822889.
Cheung EV, Herman MJ, Cavalier R, Pizzutillo PD. Spondylolysis and spondylolisthesis in children and adolescents: II. Surgical management. J Am Acad Orthop Surg. 2006 Aug;14(8):488-98. Review. PubMed PMID: 16885480.
- A 12-year-old girl has L3-L4–level myelomeningocele. She is a full community ambulator with ankle-foot orthoses. She has had swelling and erythema of her right proximal tibia for 1 week. Her temperature is 37.7°C. Radiographs show a mild periosteal reaction. Her erythrocyte sedimentation rate (ESR) is 40 mm/h (reference range [rr], 0-20 mm/h), and her C-reactive protein (CRP) level is 0.8 mg/L ([rr], 0.08-3.1 mg/L). What is the best next step?
- Aspiration of the knee to rule out infection
- Empiric antibiotic treatment
- Open incision and drainage of osteomyelitis
- Immobilization in a splint for 3 weeks
- Immobilization in long-leg cast for 12 weeks
- Immobilization in a splint for 3 weeks.
RECOMMENDED READINGS
Kumar SJ, Cowell HR, Townsend P. Physeal, metaphyseal, and diaphyseal injuries of the lower extremities in children with myelomeningocele. J Pediatr Orthop. 1984 Jan;4(1):25-7. PubMed PMID: 6693564.
Lock TR, Aronson DD. Fractures in patients who have myelomeningocele. J Bone Joint Surg Am. 1989 Sep;71(8):1153-7. PubMed PMID: 2777841.
- A patient has been prepped for surgery; while working in the operating room, a resident notices an alcohol odor while speaking to the attending surgeon. The procedure has not yet begun. What is the assisting resident’s responsibility in this scenario?
- Assume that the odor is from the skin prep
- Ask the surgeon to take a break for 5 minutes
- Report the finding immediately
- Address the issue after the procedure because the patient has been prepped and is ready
- Be prepared to perform the procedure without guidance
- Report the finding immediately
- An 8-year-old boy is struck by a motor vehicle. An examination in the emergency department reveals a closed-head injury, pulmonary contusion with rib fractures, hypotension, and a displaced transverse femur fracture. After initial resuscitation, he is stabilized but has persistent drops in blood pressure. Treatment should consist of
- placement of a traction pin and balanced traction for 4 weeks followed by spica casting.
- immediate spica casting and admission to the pediatric intensive care unit (PICU) for
additional stabilization.
- immediate open reduction and internal fixation of the femur fracture.
- admission to the PICU for hemodynamic resuscitation and fracture fixation within 48 hours.
- admission to the PICU and fracture fixation within 2 weeks of injury.
- Admission to the PICU for hemodynami resuscitation and fixation within 48 hours.
- An 8-year-old child underwent the surgical procedure on the hand as seen in Figure 74. This condition is associated with
- Blount disease.
- Down syndrome.
- achondroplasia.
- Poland syndrome.
- pseudoachondroplasia.
- Poland Syndrome
RECOMMENDED READINGS
Catena N, Divizia MT, Calevo MG, Baban A, Torre M, Ravazzolo R, Lerone M, Sénès FM. Hand and upper limb anomalies in Poland syndrome: a new proposal of classification. J Pediatr Orthop. 2012 Oct- Nov;32(7):727-31. doi: 10.1097/BPO.0b013e318269c898. PubMed PMID: 22955538.
Ireland DC, Takayama N, Flatt AE. Poland’s syndrome. J Bone Joint Surg Am. 1976 Jan;58(1):52-8. PubMed PMID: 175070.
- Figure 81 is the anteroposterior elbow radiograph of a 12-year-old child. What is the best treatment option?
- Long-arm cast for 6 weeks followed by physical therapy
- Sling with early range of motion to prevent stiffness
- Open reduction and internal fixation with plating and immediate range of motion
- Closed reduction and casting accepting residual angulation of 60 degrees
- Percutaneous reduction and immobilization for 3 weeks, followed by protected
range of motion
- Percutaneous reduciton and immobilization for 3 weeks, followed by protetcted range of motion.
RECOMMENDED READINGS
Radomisli TE, Rosen AL. Controversies regarding radial neck fractures in children. Clin Orthop Relat Res. 1998 Aug;(353):30-9. Review. PubMed PMID: 9728157.
D’souza S, Vaishya R, Klenerman L. Management of radial neck fractures in children: a retrospective analysis of one hundred patients. J Pediatr Orthop. 1993 Mar-Apr;13(2):232-8. PubMed PMID: 8459018.
- An increase in which complication(s) has been seen in children with ipsilateral forearm fractures associated with supracondylar humerus fractures?
- Ipsilateral nerve palsy and compartment syndrome
- Open injury and compartment syndrome
- Pulseless extremity and ipsilateral nerve palsy
- Associated rupture of the biceps tendon
- Infection and iatrogenic ulnar nerve injury
- Ipsilateral nerve palsy and compartment syndrome.
- Which femur fracture pattern is most associated with nonaccidental injury?
- Transverse
- Spiral
- Oblique
- Butterfly
- Comminuted
- Transverse