Rheum/Ortho SAQ Flashcards
1
Q
- 18 month old with missed developmental dysplasia of the hip:
A. Name two clinical features of this diagnosis (not sure exact wording)
B. Name one physical exam finding.
A
A.
- Infant:
- limited hip abduction
- Asymmetric gluteal or thigh folds
- Walking child
- limp with toe-walking on affected side
- leg-length discrepancy
- excessive lordosis
B.
- Positive Barlow/Ortolani (most SN before 4-6mo)
- Decreased hip abduction (most SN after 4-6mo)
- Positive Galeazzi sign (apparent shortening of thigh)
2
Q
- Photo of gottron’s papules and heliotrope rash. Child has recent difficulty walking up the stairs.
A. What is the diagnosis (1)
B. What are two investigations required for diagnosis (2)
A
A. Juvenile dermatomyositis
B.
- EMG
- Muscle biopsy
Clinical criteria for JDM
- Classic rash
- Heliotrope
- Gottron papules
- Photosensitivity - shawl sign
- Mechanic hands
- AND 3 of
- Proximal symmetric weakness (stairs, hair, Gower)
- Elevated muscle enzymes (>=1): CK, AST, LDH, aldolase
- EMG changes (denervation + myopathy)
- Muscle Bx: inflammation, necrosis
3
Q
- A term baby is born to a mother with maternal lupus. He is noted to have congenital heart block.
a) Name the 2 most common antibodies in congenital heart block.
b) Name 3 other manifestations of neonatal lupus.
A
a) Anti-Ro (SSA), anti La (SSB)
b)
- Cytopenias
- Hepatitis
- Rash (annular or macular on face, trunk, scalp)
4
Q
- A 12 year old girl comes into your office with her mother. She has thoracic scoliosis (this was bolded on the real exam) and her mother is interested in surgical interventions.
Name 4 indications for surgical management.
A
- If skeletally immature and cobb’s angle >45
- If skeletally mature and cobb’s angle >50
- If having symptoms or signs of restrictive lung disease
- If fails to improve or progressive despite bracing
- Limiting activities, causing significant pain
5
Q
- 4 yo girl diagnosed with JIA.
A. Which type of JIA is most associated with uveitis?
B. What blood test would we do to see if a patient is at increased risk?
C. How often do we screen these patients with an eye appointment?
A
A. Oligoarthritis
B. ANA positive
C. Q3mo
- ANA pos
- If <6yo:
- <4y of disease duration, then Q3mo
- >4y of disease, then Q6mo
- >7y of disease, then Q12mo
- If >6yo:
- <4y of disease duration, then Q6mo
- >4y of disease duration, then Q12mo
- If <6yo:
- ANA neg
- Q6mo if <6yo and <4Y disease duration
- Q12mo if <6yo and >4Y disease duration OR >6yo
6
Q
- 15 yo gymnast with hyperlordosis and insidious back pain.
A. Name the condition
B. What investigation
C. 2 management steps for this child.
A
A. Spondylolysis
B. AP+Lateral spine Xray (If pain persistent, abN Xray, red flags: MRI or SPECT bone scan)
C. Mgmt
- Activity modification. Avoid acitivities leading to pain with exension.
- PT for core strengthening + stretching of hip flexors + hamstrings
- Nonnarcotic analgesics
7
Q
- Description of teenage girl with MAS.
A. 2 noninfectious acquired causes
B. Name 3 management
A
A.
- SLE
- systemic JIA
B.
- High dose methylprednisone
- Anakinra
- Cyclosporin
- Supportive management
8
Q
- Name 5 risk factors for DDH
A
- FHx!
- First born
- Female
- Breech (regardless of delivery method)
- left hip
- Oligohydramnios
9
Q
- 4 years old girl with sudden onset of inability to turn head to one side; no history of trauma; name 5 causes (5 causes of acquired torticollis)
A
- Retropharyngeal abscess
- Lemierre syndrome = IJV thrombophlebitis, fusobacterium
- Inflammation of SCM (viral myositis)
- Atlantoaxial rotary subluxation
- Dystonic reaction
- Benign paroxysmal torticollis
- CNS tumour
- Cervical spine injury
10
Q
- Name 3 major criteria for skeletal manifestations of Marfans.
A
- Arachnodactyly
- Scoliosis
- Protrusion acetabuli
- Pes planus
- Pectus excavatum or carinatum
- Reduced elbow extension
- Hindfoot deformity
11
Q
- Kid with rheum condition (JIA or SLE). Then develops pancytopenia, heptosplenomegaly and is unwell. Associated condition.
A
MAS
12
Q
- Picture seen below (foot). State what is the most likely associated diagnosis.
A
Rocker bottom foot
T18
Eighteen = Edward
- E - elongated skull
- D - digits overlapping (clenched fist)
- W - Wide spread nipples, VSD
- A - apnea (cause of death)
- R - rocker bottom feet
- D - dysplastic ears
13
Q
- Babe with clubfoot - name ONE part of the treatment. (1 point)
A
- Ponseti method to correct deformities in order:
- Forefoot Cavus
- Midfoot Adductus
- Heel Varus
- Hindfoot Equinus
- Tenotomy of heel cord 3. Bracing
14
Q
- An 8 year old boy is referred to you for persistent hip and knee pain for 2 months duration. No history of trauma. Walks into office with an antalgic gait. You note decreased abduction and internal rotation on exam. Xray done (picture showed left hip with small femoral head, scalloped edges). Diagnosis?
A
Legg-Calve-Perthes
15
Q
- A 3 year old child comes into emergency. Mom says not using the right arm. There is no history of falls or trauma. The child is holding the arm slightly flexed and pronated. Refusing to move the arm.
A. What is the likely diagnosis?
B. How do you manage?
A
A. Radial head subluxation
- Pulled elbow or nursemaid’s elbow (e.g. holding kid and swinging between parents)
- most common 1-4yo
- Annular ligament interposed between radial head + capitellum
B. Closed reduction
- Supination technique: use thumb to apply pressure over radial head, maximally flex supinated elbow. Often hear palpable click with reduction of radial head
- Hyperpronation technique: hyperpronate forearm in flexed position
- Ensure no fracture before doing this
- Should be able to move arm within minutes after
17
Q
- Baby fell off change table and not using arm. Xray with corner fracture? What is diagnosis?
A
Non-accidental injury b/c metaphyseal corner fracture (bucket handle fracture)
Fractures suggestive of inflicted injury
- Femur # in nonambulatory children
- Distal femoral metaphyseal corner #
- Posterior rib #s
- Scapular spinous process #s
- Proximal humeral #s
