Week 3

Question 1

What if a “Fracture Blister”?

Answer 1

When the dermis and epidermis separate following a fracture. This is a dermatological emergency!

Question 2

What is a “Greenstick Fracture”?

Answer 2

A fracture which goes through one of the cortex. Just like when you bend a piece of living wood.

Question 3

A Torus fracture involves?

Answer 3

A buckling of the cortex.

Question 4

Where does growth of the bone occur?

What is the weakest part of the growing bone?

Answer 4

The hypertrophic zone.

The hypertrophic zone.

Question 5

What is the Hueter-Volkmann Principle?

Answer 5

Posits that the growth rate of the epiphyseal plate is inhibited by increased pressure, and accelerated with decreased pressure.

Question 6

What is Wolff’s Law?

Answer 6

Posits that bones will remodel to strengthen under stress.

Question 7

A Salter-Harris Class 5 Epiphyseal Fracture involves?

Answer 7

Compression of the growth plate which may cause growth arrest of the bone.

Question 8

Where does the epiphysis typically move in Slipped Capital Femoral Epiphysis? What is the major complication of SCFE? How is it treated?

Answer 8

• Posterior and Inferior
• Avascular Necrosis
• Managed surgically

Question 9

What is more-or-less the younger kid version of SCFE?

Answer 9

Legg-Calve-Perthes Disease

{AKA Perthes Disease}

Question 10

When should you order an X-Ray for an infant.

Answer 10

When they are old enough to have calcified bones! U/S for the little ones, their bones won’t show up well on X-Ray!

Question 11

How do you treat clubbed feet?

Answer 11

Ponseti Casts!

Question 12

How do you treat calcaneovalgus feet?

Answer 12

Get the parents to regularly stretch their kids feet. It will usually correct on its own without any more intervention.

Question 13

What line is used to determine if a kid has SCFE?

Answer 13

Kline’s Line. Drawn parallel the femoral neck it should cross over the border of the epiphysis.

Question 14

Scoliosis is secondary to another condition. Name a few.

Answer 14

Cerebral Palsy, Spina Bifida, and Spine Fractures.

Question 15

If scoliosis has a curve of _______ degrees you need to take an X-Ray every _______ months during growth spurts.

Answer 15

> 20 degrees; 6 months

Question 16

When should you order an MRI for a kid with scoliosis?

Answer 16

• Severe Pain
• Growing Boys Curves > 20
• Headaches, Abnormal Reflexes
• Loss of Bladder Control
• Children < 10 with Curve > 30

Question 17

Roughly outline treatment of scoliosis in regards to the COBB angle.

Answer 17

• 30° - 45° = Brace {Kids}
• 45° - 50° = Surgery {Kids}
• > 60° = Surgery {Kids + Adults}

Question 18

Describe characteristics of white muscle fibres.

Answer 18

• Fast twitch.
• Produce lots of force.
• Tire quickly.
• Little myoglobin.
• Use glycogen.

Question 19

Describe characteristics of red muscle fibres.

Answer 19

• Slow twitch.
• Produce less force.
• High endurance.
• Lots of myoglobin.
• Energy via Krebs Cycle.

Question 20

What happens in Myasthenia Gravis?

Answer 20

The immune system attacks acetylcholine receptors causing muscle weakness. The external ocular muscles are initially affected in 50% of cases, followed by other cranial nerves, then proximal, followed by distal, muscles. Spontaneous remissions may occur.

Question 21

What goes wrong in Duschene Muscular Dystrophy?

Answer 21

Genetic defect located on the X chromosome in which the protein dystrophin is incorrectly made. Muscle weakness starting in the legs. Wheelchair by 12, death in their 30’s.

Question 22

Children affected by arthritis may have bones which grow _______ on the side which is affected.

Answer 22

Longer. Leg length discrepancies in children with arthritis of the knee or hip are due to the affected leg growing longer than the unaffected due to increased vascularization and blood flow.

Question 23

What often presents with juvenile idiopathic arthritis and Enthesitis-Related Arthritis?

Answer 23

Uveitis

Question 24

What are the two types of developmental dysplasia of the hip?

Answer 24

Teratologic {Syndromes and Stiff} and Typical {Ligamentous Laxity, Breech, 1st Born Female, Torticollis}.

Question 25

What are the lab results for transient synovitis like?

Answer 25

Joint Aspirate Cell Count 5 000 - 15 000 25% PMN. ESR, CRP, and WBC counts normal. Effusion on U/S. May look like septic arthritis.

Question 26

What is the most common pathogen to cause osteomyelitis?

What is usually the first radiological sign?

Answer 26

S. Aureus

Evidence of deep localized soft tissue swelling.

Question 27

Kids legs start out _____, then go _____ around 2, and should become normal between 4 - 6.

Answer 27

Varus, Valgus