Rheum/MSK/Ortho Flashcards
1
Q
- 6 yo girl with diagnosis of JIA and pain in one knee. CRP 58. Sedimentation 25. ANA negative. No uveitis. What is the next step in management
a. NSAIDS
b. Methotrexate
c. Intra-articular corticosteroids
d. Oral steroids
A
NSAIDs
Oligoarthritis
2
Q
- Girl with systemic JIA well-controlled on methotrexate then re-presents with fever, unwell, rash, liver 3 cm below costal margin. What is the most likely diagnosis
a) MAS
b) Sepsis
c) Methotrexate toxicity
d) Autoimmune hepatitis
——————– - Child with systemic JIA. Presents with fever, purpuric rash, hepatosplenomegaly and irritability. What is the MOST likely diagnosis?
a . methotrexate toxicity
b. macrophage activation syndrome
c. sepsis
——————— - 7 year old girl has oligoarticular JIA and has been on methotrexate as maintenance therapy for her disease. She has sudden onset high fever, anemia, thrombocytopenia, and hepatomegaly with elevated liver enzymes. Which of the following is the cause of her current condition?
a) Methotrexate toxicity
b) Macrophage activation
c) syndrome
——————— - Kid with JIA and MAS features, what is it?
a. MAS
b. Sepsis
A
MAS
3
Q
- 6-year-old with clinical and laboratory evidence consistent with systemic JIA develops persistent fever, extensive and fixed rash, thrombocytopenia and hyponatremia. What is most likely to decrease:
a) Triglyceride
b) Fibrinogen
c) LDH
d) Ferritin
A
Fibrinogen
LOW fibrinogen
HIGH ferritin
HIGH TG
4
Q
- You want to start an 11 year old boy with JIA on Infliximab. Which is most important prior to starting this medication?
a) VZV vaccine
b) MMR vaccine
c) Checking for Mycobacterium Tuberculosis
d) ??
A
Checking for mycobacterium tuberculosis
5
Q
- Kid with fevers, salmon rash, HSM (no joint pain).
a) Systemic JIA
b) ALL
A
Systemic JIA
Arthritis Hot - fever daily Rash - evanescent salmon Adenopathy Serositis HSM
Fever and other systemic features may precede arthritis by weeks to months
6
Q
- A 7 year old boy has a history of recurrent fevers, evanescent pink rash, lymphadenopathy, and hepatomegaly. His MSK exam is normal. What’s the diagnosis?
a. Leukemia
b. Scarlet fever
c. Lyme disease
d. Systemic JIA
—————
Evanescent rash, lymphadenopathy, hepatomegaly without joint pain in 6 yo boy. What is your diagnosis?
a. systemic JIA
b. ALL
————— - Child with spiking fevers and evanescent pink rash, lymphadenopathy, hepatomegaly, splenomegaly, and MSK exam normal, for about 3 weeks Diagnosis.
a. Scarlet fever
b. Lyme disease
c. Systemic onset JIA
d. Leukemia
A
Systemic JIA
7
Q
- Child in rhythmic gymnastics. Has back pain that is worse on extension. On exam has exaggerated lumbar lordosis, hamstring tightness. Bone scan is positive. What does she have?
a) Spondylolysis
b) Posterior overuse sydnrome
c) Herniated disc
d) ring apophositis
——————- - 14 year old female gymnasts presents with a 2 months history of lower back pain on extension. She has tight hamstrings, spasm of her paraspinal muscles, normal sensations and motor function. A bone scan lights up her lumbar vertebrae. What is the diagnosis?
A. Spondylosis
B. Posterior Element Overuse syndrome
C. Disk herniation
D. Vertebral body avulsion fracture
——————- - 12y gymnast presents with 2mo of lower back pain. The pain is worse for 2-3 days after practice. Her sleep is ok. She gets spasms in her paraspinal muscles. On exam, she has tight hamstrings, normal sensation and motor function in her legs with normal anal tone and sensation. A bone scan lights up in her lumbar vertebra over the location of her pain. What is the diagnosis?
a. Spondylolysis
b. Posterior element overuse
c. Disk herniation
d. Vertebral body avulsion fracture
——————- - Low back pain in gymnast. A physical examination shows hyperlordosis, paraspinal muscle spasm and hamstring tightness.
a. Spondylolysis
b. Posterior element overuse
c. Vertebral avulsion fracture
d. Disc herniation
A
Spondylolysis
- stress fracture of pars interarticularis d/t repetitive spinal extension + rotation
- insidious extension*-related back pain
- O/E: hyperlordosis*, paraspinal m spasm + hamstring tightness
- A/P lat Xray: sclerosis of pars interarticularis
Posterior element overuse syndrome
- insidious extension*-related back pain
- focal tenderness of lumbar spine + paraspinal muscles
- IVx normal
Vertebral body apophyseal avulsion fracture
- fractures that posteriorly displace into spinal cord d/t repetitive spinal flexion + extension
- acute onset lumbar flexion* pain. No neuro Sx
Disc herniation
- acute flexion*-related pain
- back muscle spasms, hamstring tightness
Apophysitis
- tenderness along spinous processes to light palpation
- pain with activity or when sitting
8
Q
- Description of a kid with Kawasaki Disease. What is the most common laboratory finding?
a) Neutropenia
b) Hypoalbuminemia
c) High IgA
d) ASOT
- ——————- - 5 year old child with Kawasaki disease. What lab finding would you expect
a. Hypoalbuminemia
b. Thrombocytopenia
c. Low liver enzymes
d. Leukopenia
A
Hypoalbuminemia
Hot: fever >=5d and >=4/5: Conjunctivitis, bilateral, non purulent Rash Edema Adenopathy (>1.5cm) Mucous membranes (dry cracked lips, strawberry tongue)
9
Q
- A kid has had 6 days of fever despite treatment with amoxicillin, with no response. He also has cracked lips, nonpurulent bilateral conjunctivitis, and a polymorphous rash. What would you expect to see on his labs?
a. Neutropenia
b. Hypoalbuminemia
c. Elevated ASOT
d. Elevated EBV titres
———————- - 4 yr old boy with fever of 40 degrees despite amoxcil. Maculopapular rash, bilateral conjunctivitis,dry cracked lips. What is the most likely lab finding?
a. hypoalbuminemia
b. neutropenia
c. EBV monospot +
d. + ASOT
——————-
5 yo with fever 40 degrees x 6days, bilateral conjunctivitis, cervical lymphadenopathy, cracked lips. Has not responded to 3 days of amoxicillin. What finding is most consistent with this diagnosis?
a. Hypoalbuminemia
b. neutropenia
c. positive ASOT
d. positive monospot
—————-
Kid with >=6 day of fever, non purulent conjuctiviits, MP rash. Clinical picture c/w Kawaski’s dx. Most likely lab abnormality?
a. Low albumin
b. Neutropenia
c. Monospot +
d. Positive ASOT
A
Hypoalbuminemia
10
Q
- Young girl with AOM and fever for 9 days, now with conjunctivitis, cracked lips, ect…kawasaki. Which is the most important to test before she leaves?
a) Cardiac ultrasound
A
ECHO
11
Q
- Girl had fever then swollen extremities, cracked lips. Treated with IVIG and ASA then developed anemia and hematuria.
a) Kawasaki IVIG hemolytic reaction
A
IVIG hemolytic reaction
This is why we consider doing CBC, smear, retic, DAT, bili, 5-7d after Tx with IVIG
12
Q
- Boy with lupus. Most likely test consistent with this Dx
a. ANCA+
b. Thrombocytosis
c. HLAB27+
d. positive RPR
A
Positive RPR (false positive)
Immunologic criteria for SLE ANA pos (SP 95-99%, low SN) Anti dsDNA pos (high SP, helps track disease activity) Anti Smith pos (high SP, doesn't track disease activity) Antiphospholipid Ab pos Anticardiolipin pos Lupus anticoagulant pos FALSE POS RPR
Hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia
Low C3, C4, CH50
High ESR CRP
13
Q
Which of the following statements regarding the diagnosis of SEL in .a 15yo girl is correct?
A. A strongly positive ANA test has a high specificity for the diagnosis of SLE
B. A strongly positive anti-dsDNA antibody test is the most sensitive antibody test for the diagnosis of SLE
C. A strongly positive anti-Sm antibody test is the most sensitive antibody test for the diagnosis of SLE
D. Anti-cardiolipin antibodies have a high specificity for the diagnosis of SLE
E. Both anti-DNA and anti-Sm antibodies are highly specific for the diagnosis of SLE
A
Anti DNA + anti Sm are specific
Positive ANA = sensitive Anti-DNA antibodies* Anti Sm antibodies* *Highly specific for SLE Anti-phospholipid antibodies Anticardiolipin Lupus anticoagulant
Other:
- anti RNP: Raynaud, pulm HTN
- anti Ro (SSA), anti La (SSB): neonatal lupus, may be Sjogren
- antiphospholipid ab (includes anticardiolipin): venous + arterial thrombotic events
- antihistone: drug-induced lupus
14
Q
- Woman with rash, arthritis, nephritis (SLE?). What associated?
a. Pancytopenia
b. ??
A
Pancytopenia
15
Q
- 14 yr old with fevers, polyarthralgia, wt loss. Appears pale. No arthritis on exam. Urine + for protein and blood. Decreased WBC and lymphs. Normal platelets. What is the most likely diagnosis.
a. SLE
b. Systemic JIA
—————-
12 yo girl – fever, malaise, arthralgia for 3 weeks. ESR 50, WBC 3 (leukocytes 10%, neutrophils 90%). Trace proteinuria/hematuria. BUN/Cr normal. What is your diagnosis?
a. lupus
b. systemic JIA
c. PSGN
——————
Child with wt loss anemia, normal plts, low WBC, protein/blood in urine. Dx?
a. SLE
b. RF
c. PSGN
A
SLE
Systemic JIA Fever >=2wks, daily for >=3d Need >=1 of Rash Adenopathy Serositis HSM Not specified
16
Q
- Which ECG change is characteristic of acute rheumatic fever?
a) Peaked T waves
b) Prolonged PR interval
c) Sinus tachycardia
A
Prolonged PR interval
17
Q
- 13 y.o. Girl presents with antalgic gait and pain for 2 weeks. She has difficulty with rotation and adduction of her leg. X-ray was similar to the one below. What is the diagnosis?
a) Septic joint
b) Calve-Perthes
c) SCFE
d) Fracture
e) Post-infectious
A
SCFE - adol, obese. Can weight bear, limp, groin/knee/thigh pain.
Internal rotation, abduction, and flexion Limitation
(FAB IRL)
PIN!
Legg Calve Perthe - 4-8yo. Antalgic limp. Restriction of internal rotation and abduction
18
Q
- If a child has a septic hip, what position do they normally hold their hip in?
a) abducted and internally rotated
b) abducted and externally rotated
c) adducted and internally rotated
d) adducted and externally rotated
- —————————– - What is the position of the septic hip in a patient with septic arthritis?
a. Abducted and internally rotated
b. Abducted and externally rotated
c. Adducted and internally rotated
d. Adducted and externally rotated
A
Held in ABDuction and external rotation (FABER)
Knee usually flexed
Sepsis has an outgoing personality
19
Q
- 3 year old with refusal to walk for 3 days. Temp 38.1C, mildly tachycardic, very irritable when you examine right leg which is held in slight abduction and external rotation. Right hip has decreased ROM and he is in pain when you move his hip. He refuses to walk. Bloodwork shows ESR 48, CRP 20, WBC 14, normal Hgb and platelets. Most likely diagnosis:
a. transient synovitis
b. osteomyelitis
c. septic arthritis
d. Legg-Calve-Perthes disease
————————–
5 year old fever 38.5 degrees, had a recent URTI. Hip was externally rotated and child not weight-bearing. ESR was 40. Diagnosis?
a. transient synovitis
b. JIA
c. septic arthritis
A
Kocher criteria
1) Failure to wt bear
2) FEver > 38.5%
3) WBC > 12
4) ESR >40 or CRP>20
If 4/4: 99.6% chance of septic arthritis
20
Q
- Septic joint next step?
a) Aspirate
b) Urgent consult to Ortho
c) Admit and start IV antibiotics
A
If hip or shoulder, surgical emergency, urgent consult to ortho
If not hip or shoulder, aspirate for definitive diagnosis
21
Q
- 8y boy had URTI two weeks ago; now presents with fever >40, unable to weight bear on right leg. WBC is 18, ESR 40 (? I think) and CRP 80. What is next step in management?
a) Admit and start IV abx
b) Nsaids
c) Urgent orthopedic consultation
A
Urgent orthopedic consult
1) Refusal to wt bear
2) fever >38.5
3) WBC >12
4) ESR >40 or CPR >20
0/4: 0.2% 1/4: 3% 2/4: 40% 3/4: 93% 4/4: 99.6% septic arthritis
22
Q
- Toddler comes to the ED refusing to weight bear. Xray of leg shows non-displaced spiral fracture of left tibia. Which is most likely?
a) NAI
b) Ricketts
c) Toddler’s fracture
d) Osteogenesis Imperfecta
A
Toddler’s fracture
- ambulatory, 1-4yo
- often after seemingly harmless twist/fall
- refusal to bear wt
- AP/lat tib-fib Xray: non-displaced spiral #
- May need oblique view
- above knee cast x3wk
23
Q
- A 2 year old boy with 2 days fever, now irritable, elevated inflammatory markers, and refusing to move right leg. Tender area over right tibia. Which of the following investigations will most likely make the diagnosis?
a. x ray tibia
b. x ray hip
c. bone scan
d. blood culture
A
Bone scan
MRI if this was an option
Worry about osteomyelitis
24
Q
- 5yo M with intermittent abdominal pain and purpuric rash on thighs. He has joint pains and hematuria. Which of the following lab abnormalities would likely be present?
a) Thrombocytopenia
b) Schistocytes
c) Elevated IgA
A
Elevated IgA
HSP
- IgA vasculitis
1. Skin (all): palpable purpura. Usually symmetric, gravity-dpdt (legs) or pressure pts (butt). Usu normal plt + coags.
2. MSK (75%): arthritis + arthragias, LE, resolves in 2wks
3. GI (80%): abdo pain, V/D, paralytic ileus, melena. Rare intussusception, perforation, mesenteric ischemia
4. Renal (50%); microscopic hematuria, proteinuria, HTN, frank nephritis, nephrotic syndrome, ARF or CRF
25
Q
- 4yo F with one very inflamed joint for over 1 month, ANA negative, no uveitis. What is the first line treatment for her condition?
a) Methotrexate
b) Systemic steroids
c) NSAIDs
d) IVIg
A
NSAIDs
Need to be 6wks to diagnose oligo
26
Q
- A teen girl presents with a 3 week history of arthritis, thrombocytopenia, hemolytic anemia, and decreased C3/C4 after attending camp. What test of most specific?
a) Borrelia burgdorferi serology
b) ANA
c) Anti-ds DNA
A
anti-ds DNA
ANA is most sensitive
Relevance of camp: UV light can be flare for lupus flare
27
Q
- 6y girl presents with arthritis of 3-4 joints at a time. Her ANA is positive. Which is the most likely associated finding?
a. Eye pain
b. Photophobia
c. Unequal pupil
A
Unequal pupil
Oligoarthritis, ANA pos
Oligo JIA or SLE
Point is that ant uveitis in oligo JIA is aSx and painless, so without screening, would present with synechiae
- Ant uveitis: typically painless + aSx. Can have pain, photophobia, hyperemia (ciliary flush), lacrimation, keratic precipitates
Sx usually with ERD assoc’d uveitis - Chronic uveitis presents with band keratopathy (degenerative changes to cornea), cataract, glaucoma, impaired vision
- Synechiae (adhesion of iris to lens) is complication of unrecognized uveitis
28
Q
- A 10 yr old girl presents with 10 days of fever and a migratory arthritis. On exam, she has a swollen left wrist. Her WBC is 18 and her ESR is 75. Diagnosis:
a. SLE
b. JRA
c. Rheumatic fever
d. Septic arthritis
A
Rheumatic fever
29
Q
- Boy with proximal muscle weakness, difficulty climbing stairs, easily fatigable and scaly rash on dorsum of hands. What is the diagnosis:
a. JIA
b. SLE
c. JDM
d. Myesthenia gravis
—————
Rash over backs of hands, muscle pain, being teased at school for weakness.
a. DMD
b. JDM
c. SLE
A
JDM
30
Q
- Girl with JDM, what is the best diagnostic test
a) EMG
b) CK
- ——————————————– - JDM question, what most likely to make dx.
a. CK
b. EMG
A
EMG
CK may be normal
31
Q
- Picture of a 7y boy with completely erythematous face. He’s on fluticasone and phenytoin. What is the most likely diagnosis?
a. Drug hypersensitivity
b. SLE
c. JDM
d. JIA
—————————— - marked facial erythema pic ? dx
a. Drug hypersensitivity
b. Dermatomyositis
c. SLE
——————————
Picture of a boy who was taking phenytoin, shows erythematous rash over cheeks and nose
a. Acute drug hypersensitivity syndrome
b. Lupus
——————————
(Picture of a kid with a malar rash). Has fever, joint pain, diffuse rash. Only meds are fluticasone and phenytoin for a seizure disorder. What is the most likely?
a. drug hypersensitivity reaction
b. Juvenile dermatomyositis
c. Systemic lupus erythematosus
d. Juvenile idiopathic arthritis
A
Drug hypersensitivity
Drug-induced lupus
- phenytoin, minocycline, hydralazine, isoniazid
- improve after withdrawal of med
Phenytoin
- reduces influx of sodium ions across cell membranes of motor cortex
- ADR
> conc’n dpdt: ataxia, nystagmus, dizziness, H/A, sedation, visual blurring, diploplia
> Idiosyncratic: blood dyscrasias, rash
> chronic: gingival hyperplasia, folate deficiency
> rare: dress, SLE-like
32
Q
- 13 yo boy presents with intermittent and recurrent hip and heel pain. What is likely to be found on review of family history?
a. psoriasis
b. ankylosing spondylitis
c. SCFE
————– - Teenager presents with left sided hip pain and decreased range of motion, and right sided heel pain; what question on family hx would most likely be positive?
a. Rheumatoid arthritis
b. Ankylosing spondylitis
c. Psoriasis
d. LCP disease
————–
Hip pain and posterior heel pain. What FHx would most fit diagnosis?
a. Ank spon
b. Psoriasis
c. RA
————–
Boy comes in to your office with left hip pain for 8 months, decreased and painful range of motion, with pain in the left heel. What disease is most likely in his family medical history:
a. rheumatoid arthritis
b. ankylosing spondylitis
c. psoriasis
d. inflammatory bowel disease - ?
A
Ankylosing spondylitis
ERA JIA
FDR with
1) ank spond
2) ERA
3) IBD with sacroilitis
4) acute (symptomatic) anterior uveitis
33
Q
- A 3 year old girl presents with 7 day history of fever. She has bony pain but no arthritis on exam, but she has HSM and diffuse generalized lymphadenopathy. Her blood work shows WBC 18, Plt 110 and anemia. What is the next best step?
a) Bone Marrow Aspirate
b) EBV Serology
c) Work up for systemic JIA
A
BMA
Bony pain!
Generalized lymphadenopathy!
Pancytopenia!
NOooooooOO
34
Q
- A 6 year old Greek girl presents with a high fever, tachypnea, and RUQ pain. On exam, there is no guarding in the abdomen. What is the most likely diagnosis?
a) Bacterial pneumonia
b) Pleurodynia
c) FMF
A
Bacterial pneumonia
35
Q
- Child with recurrent fever, cervical adenitis, aphthous ulcers, pharyngitis. Normal immune work-up. Best treatment
a) oral colchicine x 5 days
b) oral prednisone x 1 day
A
PFAPA
Prednisone x1-2 doses for episodic resolution
(May shorten interval between attacks)
If requiring >2mg/kg of prednisone per month, then consider
- Cimetidine ppx
- colchicine ppx
- tonsillectomy
36
Q
- Kid with FMF, what to give?
a. Colchicine
A
Colchicine for ppx in all FMF pts regardless of frequency + intensity
Try to prevent amyloidosis (d/t chronic low-grade inflammation that can occur during aSx intervals)
For protracted febrile myalgia: prednisone x 1-2wk with taper after for Sx relief
37
Q
- A mother comes to you with her 2.5 year old son who she says is intoeing. On exam, you find evidence of metatarsus adductus. What do you suggest?
a) Reassure
b) Avoid W sitting
c) Refer to orthopedics
A
Avoid W sitting
Metatarsus adductus
- intrauterine positioning deformity (packing problem)
- Look at heel bisector line. See if can bring back to normal (2-3 interspace)
- Has transverse midline crease on plantar surface
- spont corrects, esp with wt bearing
38
Q
- Which is the most sensitive test for early detection of Legg-Calve-Perthes?
a. Bone scan
b. Bone densitometry
c. Ultrasound
d. AP and frog leg Xrays
A
Bone scan (if Xray normal + MRI not available. Scintigraphy precedes Xray findings by ~3mo)
MRI better
39
Q
- Hip XR, what do we do? ??SCFE
a) Pin it?
A
Pin it
40
Q
- Ankle injury. Indication for xray:
a. posterior malleolus tenderness
b. can’t wt bear immediately
c. anterior medial malleolus
————— - Patient with ankle injury. Can wt bear in er. Reason to x-ray?
a. swollen ankle
b. tenderness anterior to medial malleolus
c. tenderness posterior to lateral malleolus
d. inability to wt bear immediately after injury
—————–
Ankle injury with weight bearing in ER. When to xray?
a. pain to posterior edge of lateral malleolus
b. pain to anterior edge of medial malleolus
c. cannot weight bear in ER
d. swelling
—————
A 10 year boy hurts his ankle while playing soccer. He is able to weight bear in the emergency with significant pain. Which of the following would make you more inclined to do an ankle x-ray?
a. Inability to weight bear immediately after the injury
b. Pain at the anterior edge of the lateral malleolus
c. Pain at the posterior edge of the medial malleolus
d. Swelling
A
Tenderness to posterior lateral or medial malleolus
Ottawa ankle rules
Pain in malleolar zone AND any of:
A. Bone tenderness 6cm along posterior edge from tip of medial malleolus
B. Bone tenderness 6cm along posterior edge from tip of medial malleolus
C. Cannot weight bear immediately AND in ED
41
Q
- Kid w knee pain
a. Patellofemoral syndrome
- —————– - 12 year old athletic girl complains of knee pain that she notices when walking down the stairs. On exam you note pain on palpation behind her patella. What is her most likely diagnosis
a. Osgoode Schlatter
b. Patella fracture
c. Patellofemoral syndrome
A
Patellofemoral syndrome
- pain walking up/down stairs
- pain behind or under patella. Reproducible on exam
- PT is mainstay
- Resolves spontaneously
42
Q
- Teen boy with pain to the right knee, above the joint. No effusion. No trauma. X-ray shows mottling in bone, and periosteal reaction. The likely diagnosis:
a. osteosarcoma
b. osteoid osteoma
c. osteochondroma
d. Ewings sarcoma
————–
14-year old female presents with pain above the right knee which is worse at night and with activity. On exam there is no fever, but there is tenderness to palpation above the knee. X-ray shows periosteal elevation and mottling of the distal femur. The most likely diagnosis is:
a. osteomyelitis
b. osteosarcoma
c. osteoid osteoma
d. aneurismal bone cyst
—————
17 year old male with left calf pain for 3 weeks, thought he hurt it playing basketball, now pain is waking him at night. X ray shows periosteal elevation and mottling of distal femur. Most likely diagnosis:
osteosarcoma
A
Osteosarcoma
Osteosarcoma - most common malignant bone tumour in children - adolescent - Distal femur; metaphysis of long bones - pain at night - mets to lungs + bones Xray - Sunburst, sclerotic destruction Tx - chemo - surgery (only for periosteal osteosarcoma) - resect lung mets
Sun and night, teens have weird hours of sleep. Circle of O around knee.
Ewings - <10yo - small round cell tumour - t(11;22) - Ribs, pelvis, spine; diaphyses of long bones, flat bones or axial - systemic Sx - soft tissue mass - mets to lungs, bones, BM Xray - ELMO: Ewing - Lytic, Moth eaten, Onion-skinning Tx - Chemo - Radiotherapy (radiosensitive but risk fo second malig) - Surgery
G Ewing when young. He was weird (weird locations - ribs, pelvis). Young kids like ELMO. Your shirt with Xray = radiation.
43
Q
- What is the most common childhood wrist fracture?
a. Colles fracture
b. Greenstick
c. Buckle fracture
d. Salter Harris
A
Buckle fracture
- most common wrist #: buckle (torus) > greenstick
- FOOSH mechanism
44
Q
14 yo girl with scoliosis. Measurements of Cobb angle = 50 degrees. What is management of choice? a. spinal fusion b. electrical muscular stimulation c. molded brace ------------ 14 yr old who hasn’t been to see you in 2 yrs. She has scoliosis with Cobb angle of 50 degrees. What is the most appropriate management? a. observe b. refer for brace/ orthosis c. refer for posterior spinal fusion d. electrical muscle stimulation
A
Spinal fusion
45
Q
- 6 days post scoliosis surgery. Presents with bilious vx. Etiology?
a. SMA
b. Small bowel adhesions
c. Pancreatitis
A
SMA
Lots of S
Scoliosis, Spinal Surgery, Superior Mesenteric Artery Syndrome
46
Q
- A 3 yo child develops left hip pain following URTI. What is the best way to rule out osteomyelitis?
a. Lack of fever
b. Normal WBC
c. Negative blood culture
d. Bone scan
A
Bone scan
MRI is better
47
Q
- Child with 6 wk history of severe ankle pain. Unable to weight bear. Unable to do physiotherapy. The foot is swollen, red, and warm. What is the most likely cause? (1 or 2 depending on stem)
a. Reflex sympathetic dystrophy
b. Osteomyelitis
c. Munchausen
A
Osteomyelitis
If unable to wt bear, r/o infection (consider septic arthritis also)
Reflex sympathetic dystrophy = CRPS1: usually cool, cyanotic, sweaty, swollen
48
Q
- 8 year old girl tripped over a curb two weeks ago. She now complains of left leg pain. On exam the leg is cool and pale and she complains of pain even with light touch. Her X-ray is normal. What is the likely diagnosis?
a. Fracture
b. Conversion disorder
c. Reflex sympathetic dystrophy
A
Reflex sympathetic dystrophy = CRPS1. No evidence of nerve injury
49
Q
28 weeker is intubated for RDS. The following physical exam finding is noted. (club foot). What is the next best step in management? (Sick Kids Review)
a) Call Ortho STAT for serial casting
b) Consult Ortho now for further management
c) Consult Ortho after the baby is extubated for further management
d) Observe the baby
A
Consult Ortho after the baby is extubated for further management
Stabilize first
50
Q
Which of the following is assoc’d with spinal cord anomalies in a newborn? (Sick kids review)
a) anorectal anomalies
b) arthrogryposis
c) malrotation
d) dislocated hips
A
Apparently dislocated hips as per UTD
