Rita's Ortho Questions

Question 1

A 12yo presents with a swelling on the tibial tuberosity. This likely represents:

a) slipped capital femoral epiphysis
b) Osgood Schlatter’s disease
c) Bone tumor

Answer 1

b) Osgood Schlatter’s disease
- -> pain much worse w/activity

slipped capital femoral epiphysis –> externally rotated, usually no effect on knee

bone tumor –> more pain at rest

Question 2

A child presents with his third fracture within the past 2 years. What would be the best management approach?

a) do a skeletal survey
b) refer to ortho for further f/u
c) follow up in 3 months

Answer 2

a) do a skeletal survey

Question 3

A child has a click on hip exam. What maneuver would help you elicit this?

a) Barlow
b) Ortolani
c) Allis sign
d) Galeazzi sign

Answer 3

b) Ortolani
- -> put back in

Barlow: attempt to posteriorly dislocate
Allis/Galeazzi: same; look at knee height differences at 90 degrees

Question 4

What is a serious complication of idiopathic juvenile arthritis?

a) iridocyclitis
b) intermittent fever
c) hepatitis
d) pulmonary fibrosis

Answer 4

a) iridocyclitis

Question 5

At what age is it normal for a child to have gene valgum?

a) 3 years
b) 7 years
c) 10 years
d) 13 years

Answer 5

a) 3 years

valgum: “l” is next to “k” –> knock knees!

Question 6

When do you refer flat feet?

a) whenever you see them
b) when the parent complains
c) when they are painful

Answer 6

c) when they are painful

Question 7

What’s more worrisome for child abuse?

a) a linear skull fracture in a 12 month old who fell off a table or bed
b) a linear skull fracture in a 3 month old
c) a coughing 9 month old with multiple posterior rib fractures

Answer 7

c) a coughing 9 month old with multiple posterior rib fractures

posterior rib fractures: never see except w/shaken baby

Question 8

What is the most suspicious of child abuse?

a) linear skull fracture
b) forearm ecchymosis
c) forehead bruise
d) retinal hemorrhage

Answer 8

d) retinal hemorrhage

Question 9

Why is the PE often normal for sex abuse cases?

a) delayed disclosure and rapid healing of genital tissue
b) elastic vaginal tissue
c) inexperienced examiners

Answer 9

a) delayed disclosure and rapid healing of genital tissue

Question 10

Which of the following would be suspicious of abuse in a young child?

a) genital warts
b) labial adhesions
c) candida infection

Answer 10

a) genital warts

Question 11

A previously healthy 13yo presents with right knee pain of 3 weeks’ duration. He is an athletic adolescent playing basketball and running track. He denies recent trauma. The pain increases with running or jumping. There is mild edema over the tibial tubercle. What is the most likely dx?

a) Slipped Capital femoral epiphysis
b) Legg-Calve-Perthes disease
c) Osgood Schlatter disease
d) fracture of the fibula

Answer 11

c) Osgood Schlatter disease

Question 12

A 3 week old presents to the office with fever of 104, pain on rotation of the hip, and 2 day recent fever. Which of the following would you consider the most likely dx?

a) flu-related arthralgias
b) osteomyelitis
c) legg-calve-perthes disease

Answer 12

b) osteomyelitis

Question 13

An 8yo child is running and feels a snap and then significant pain on the top of the hipbone. What is the most likely dx?

a) a sprain
b) an avulsion fracture
c) hematoma
d) Slipped capital femoral epiphysis

Answer 13

b) an avulsion fracture

Question 14

A 15 month old has redness around the hip, swelling around the femur, decreased ROM, and tenderness with a limp of one-day duration. What is the most likely dx and organism?

a) osteomyelitis, streptococcus pneumoniae
b) transient synovitis, adenovirus
c) osteomyelitis, staph aureus
d) transient synovitis, RSV

Answer 14

c) osteomyelitis, staph aureus

Question 15

Which treatments are appropriate for a male adolescent with mild Osgood Schlatter’s disease?

a) activity modification as needed w/ice application
b) Achilles stretching before activity and a knee brace during activity
c) restriction for 3 months
d) ice and NSAID daily until full growth is achieved

Answer 15

a) activity modification as needed w/ice application

Question 16

A 12yo overweight male has right anterior thigh pain for six weeks. No trauma history but increasing limp is noted. The child lays on the examining table with extreme external rotation and limited hip flexion on exam. What is the most likely dx?

a) Osgood Schlatter’s disease
b) septic arthritis
c) Toxic synovitis of the hip
d) slipped capital femoral epiphysis

Answer 16

d) slipped capital femoral epiphysis

Osgood Schlatter’s disease –> knee!

septic arthritis –> fever!

Toxic synovitis of the hip –> preschoolers and early school-aged

Question 17

A 15 month old presents with mild bilateral intoeing. What is the next best step in the management of the patient?

a) x-ray of both knee
b) reassurance
c) referral to ortho
d) follow up in 6 months

Answer 17

b) reassurance

Question 18

A 3yo has gene valgum. What is the next best step in management of this patient?

a) x-ray of both knees
b) reassurance
c) referral to ortho
d) follow up in 6 months

Answer 18

b) reassurance

Question 19

A 15yo track star presents with knee crepitus with a history of pain on extension. What is the likely dx?

a) patella-femoral syndrome
b) meniscal injury
c) knee joint effusion
d) lateral collateral ligament tear

Answer 19

a) patella-femoral syndrome

Question 20

During the exam of a 2 week old, irritability when lifting, an asymmetrical Moro, and spasm is noted along the right sternocleidomastoid. What is the most likely dx?

a) torticollis
b) Erb’s palsy
c) Fractured clavicle
d) Klippel Feil syndrome

Answer 20

c) Fractured clavicle

- -> see lump over sternocleidomastoid

Question 21

What symptom occurs in a child with growing pains?

a) a mild limp
b) bilateral lower limb pain
c) lower extremity pain during the day
d) lower extremity pain only at night

Answer 21

b) bilateral lower limb pain

- -> also worse at night

Question 22

With of the following findings would help distinguish slipped capital femoral epiphysis from Legg Calves Perthes?

a) painful limp
b) peak incidence at age 7
c) obesity
d) antalgic limp

Answer 22

b) peak incidence at age 7

Legg Calves Perthes: avascular necrosis of femoral head
–> more common in age 6/7

Question 23

A 6yo presents with a 1 week hx of mildly painful limp without fever. The child has a normal CBC. The child resists external left hip rotation. There is no swelling. What is the most likely dx?

a) Legg-calve perches
b) septic arthritis
c) osteomyelitis
d) slipped capital femoral epiphysis

Answer 23

a) Legg-calve perches

- -> peak age= 6-7 yrs old

Question 24

What is the most frequent finding with child abuse?

a) soft tissue injury
b) femur fracture
c) rib fracture
d) skull fracture

Answer 24

a) soft tissue injury

Question 25

A 16 month old presents with a limp, fever of 103, and limitation of motion in the right hip. What is the most likely dx?

a) legg calve perthes
b) osteomyelitis
c) slipped capital femoral epiphysis

Answer 25

b) osteomyelitis

- -> fever!

Question 26

A 1/2 year old cannot move her arm after her mother pulled her up by her arm. The most appropriate step is:

a) Give motrin and reassess
b) supinate and flex the arm
c) order a clavicle x-ray

Answer 26

b) supinate and flex the arm

- -> nursemaid’s

Question 27

What is the approach to tibial torsion in an 18 month old infant?

a) refer to orthopedics
b) reassure
c) Dennis Brown bar

Answer 27

b) reassure

Question 28

An afebrile 3yo who cried with examination of one leg and held leg in extended position most likely has:

a) osteomyelitis
b) spiral fracture
c) transient synovitis

Answer 28

b) spiral fracture

transient synovitis= subtle presentation…just a little limp

Question 29

When should you refer a child with pes planus?

a) if the pes planus is painful
b) if orthotics cause mild discomfort
c) if the pes planus has not resolved by age 8

Answer 29

a) if the pes planus is painful

Question 30

What is the reason that children with Marfan syndrome cannot participate in active sports?

a) joint laxity
b) aortic dilation
c) lens dislocation
d) Mitral valve prolapse

Answer 30

b) aortic dilation

Question 31

What’s the best sport for someone with exercise-induced asthma?

a) swimming
b) baseball
c) track
d) skiing

Answer 31

a) swimming

OR b) baseball ?????

Question 32

Which of the following students should not be cleared for sports?

a) A child with bilateral inguinal hernia
b) A child with myocarditis
c) A child with an umbilical hernia
d) A child with a hx of ankle sprain

Answer 32

b) A child with myocarditis

Question 33

You would advise the mother of a son who had football practice in the sun in August all of the following except:

a) have him take salt replacement tablets after practice
b) have him gradually increase his time spent in the sun every day
c) have him drink 7-10 ounces of fluid frequently during practice
d) start conditioning in July

Answer 33

a) have him take salt replacement tablets after practice

- -> no salt tablets for normal kids!

Question 34

What task best demonstrates joint mobility, coordination, and balance?

a) duck walking
b) jumping
c) hopping
d) running

Answer 34

a) duck walking

Question 35

Which of the following is less likely in a 14yo with acute hip pain?

a) Legs calve perthes
b) Transient synovitis
c) slipped capital femoral epiphysis
d) Osgood Schlatter’s

Answer 35

c) slipped capital femoral epiphysis

- -> can be a v. acute dx!

Question 36

You are seeing an 11yo female in your office. She presents with limping and knee pain on and off for the past month. She denies any new activity, trauma, or injury, recent illness, or fever. Her examination is otherwise normal but she has limited ROM of her hip and pain when weight bearing in the office. What is the most likely dx based on her hx?

a) Blounts disease
b) Growing pains
c) Slipped capital femoral epiphysis
d) stress fracture

Answer 36

c) Slipped capital femoral epiphysis