Peds Oite 2015

Front 1

Lab tests will reveal what based on this image?

Back 1

Rickets. Abnormalities in calcium and phosphorous, vitamin D.

Front 2

15yo boy has left hip pain while playing football 2 days ago. X rays are normal but MR shows anterior superior iliac spine avulsion fracture. How do you treat?

Back 2

Activity restriction and partial weight bearing with crutches until symptoms resolve.

Front 3

What is the most common type of neonatal brachial plexus palsy?

Back 3

Upper trunk injury known as Erb palsy. Klumpke palsy involves the lower nerve roots and pulling the arm cranially.

Front 4

12 year old boy with left foot pain has the following x rays. What would you expect on physical exam with regard to range of motion?

Back 4

This is a calcaneonavicular tarsal coalition. You would expect limited subtalar range of motion.

Front 5

What organism is the most common cause of pediatric septic arthritis?

Back 5

Staph aureus

Front 6

Borrelia burgdorferi causes

Back 6

Lyme disease

Front 7

staph epidermidis is commonly associated with what type of infection?

Back 7

periprosthetic infection.

Front 8

What is the most effective initial treatment to improve an elbow flexion contracture exceeding 40 degrees in a child with underlying brachial plexus palsy?

Back 8

Serial casting

Front 9

Based on this 11 year old boy's x ray, what do you suspect is the cause?

Back 9

Infection. single level spine fusion with fusion of 2 adjacent vertebral bodies and loss of vertebral height and disc space. No other levels involved to suggest congenital, developmental or metabolic disease and does not look traumatic.

Front 10

What is the name of the posterior aspect of the apical ectodermal ridge that is responsible for
AP axis/ulno-radial development (thumb to small finger, great toe to small toe)

Back 10

Known as the zone of polarizing activity.

Front 11

What embryologic structure/region controls proximal to distal limb growth?

Back 11

Apical ectodermal ridge. Stimulated by FGF 10.

Front 12

In the setting of the condition pictured here in a boy with right hip pain. The right leg will be in obligate ______________

Back 12

Shows SCFE. Right leg will be in obligate external rotation.

Front 13

Immediately after birth following a long labor, the baby's arm looks like this. What is the next step?

Back 13

Emergent fasciotomy for neonatal compartment syndrome.

-very swollen, skin desquamation, hypoperfusion.

Front 14

Marfan's syndrome is cause by a defect in what gene.

Back 14

Fibrillin 1. This is an autosomal dominant inheritance

Front 15

Defect in neurofibromin results in:

Back 15

neurofibromatosis 1

Front 16

Defect in type 1 collagen results in

Back 16

Osteogenesis imperfecta

Front 17

Defect in Type III collagen results in

Back 17

Ehler's Danlos syndrome.

Front 18

Defect in Fibrillin 2 gene results in:

Back 18

congenital contractural arachnodactyly.

Front 19

Upon seeing a child with this pictured deformity, how should you treat?

Back 19

Just observe. This is posteromedial bowing of the tibia and fibula and is not pathologic but is physiologic. It will resolve with time.

Front 20

Anteromedial tibial bowing is consistent with

Back 20

Fibular hemimelia (fibular deficiency). Will also observe absent lateral rays and ball and socket ankle joint. Linked to sonic hedge-hog gene.

Front 21

Anterolateral tibial bowing, which is also concerning for pseudoarthrosis, is consistent with:

Back 21

Neurofibromatosis. NF-1 is found in 50-55% of patients with anterolateral bowing, BUT only 6-10% of patients with NF have anterolateral bowing.

Front 22

The 5 year old child pictured was treated with a Pavlik harness for right hip dislocation. Given his x ray findings, of acetabular index of 31 on the right, and 15 on the left, what is the appropriate treatment?

Back 22

right Pemberton osteotomy due to acetabular dysplasia. In this setting, after age 5, bracing is not effective due to decreased remodeling potential of the acetabulum at this age.

Front 23

2 months old with DDH being treated in a Pavlik can't kick his leg. What do you do?

Back 23

decrease the hip flexion to 90 degrees and monitor with close follow up for return of motor function in the leg. This is due to the femoral nerve being compressed under the inguinal ligament. Incidence of 2.4%

Front 24

10 year old child with heel pain and a limp. No trauma. Based on the x-rays, what lab abnormalities do you expect?

Back 24

This is a unicameral bone cyst, you expect no abnormal lab values.

Front 25

After closed reduction of a 14 month old's left dislocated hip, the post op CT in spica cast is as follows: What is the next best step?

Back 25

The left femoral head is smaller because it was previously dislocated. Now, both hips are adequately reduced. No intervention necessary.

Front 26

2 year old boy with worsening genu varum since he started walking. metaphyseal-diaphyseal angles are 18 degrees bilaterally. What should you do?

Back 26

This is infantile Blount. Should do valgus-inducing knee-ankle-foot orthotic bracing as a metaphyseal-diaphyseal angle > 16 degrees is predictive of varus deformity progression. Consider valgus-producing osteotomy in a child younger than 4 years of age, but at 2 years, bracing can be effective.

Front 27

17 year old GMFCS V with x-rays shown. How do you treat?

Back 27

The femoral head and acetabulum have degenerative changes. Best procedure is femoral head excision and realignment of the proximal femur.

Front 28

The proximal humeral growth plate contributes what percentage of overall humeral length?

Back 28

80%. The fact that so much growth comes from the proximal end also allows for the increased remodeling potential in proximal humerus fractures.

Front 29

The 2 year old child pictured walks with a limp on the left side, left side is shorter than right and has less hip range of motion on the left. This should be treated with:

Back 29

Must treat with open reduction of hip with likely acetabular and/or femoral osteotomies. This is because this child has been walking and closed reduction will most likely be unsuccessful.

Front 30

17 year old boy is being seen of scoliosis. Left upper thoracic curve Cobb angle is 28 degrees and right main thoracic curve Cobb angle is 29 degrees.

Back 30

Only moderate curve in a skeletally mature child (age and Risser 5). Just observe.

Front 31

5 year old boy who fell and then has x ray findings shown. What is the diagnosis and what further work up should be done?

Back 31

Pathologic fracture due to unicameral bone cyst. No further work up is required.

Front 32

6 year old boy with 2 weeks history of left foot pain and antalgic gait and diffuse foot swelling. No trauma. How do you treat?

Back 32

This shows avascular necrosis of the navicular, known as Kohler's disease. Treat with foot immobilization and symptoms will resolve.

Front 33

6 year old girl with Morquio syndrome is schedule for surgery for her deformity. Pre surgical work up should include:

Back 33

This is a mucopolysaccharidosis (malfunctioning lysosomal enzymes which breakdown glycosaminoglycans). Associated with C1- C2 instability due to odontoid hypoplastia, genu valgum, abnormal epiphyses. Need to get a Cervical spine x ray due to likely instability of the neck at C1 - C2 prior to neck manipulation for intubation. In Morquio, there is proportionate dwarfism, no MR and there is keratan sulfate in urine. Also have corneal clouding, complex sugars in urine.

Front 34

What do you do about this painful lesion in a 14 year old postmenarchal girl with prominence over her right hip.

Back 34

This is a large, but benign osteochondroma. Treat with excision.

Front 35

For this 3.5 year old with painless limb on the left and lateral thrust during stance phase, what is the best treatment option?

Back 35

This is infantile Blounts disease (unilateral). Since she is < 4 years old, tibial and fibular valgus producing osteotomies are indicated.

Front 36

7 months old girl has the ultrasound of the right and left hip as shown. How do you treat?

Back 36

Bilateral closed reduction and spica casting. Pavlik is only indicated up to 6 months. Open reduction would only be performed after trying closed reduction.

Front 37

what is the typical age range for a child to walk without assistance?

Back 37

12 - 18 months.

Front 38

12 year old girl with bilateral hand, wrist and ankle joint swelling along with inflamed eyes. ANA is elevated and ESR is elevated. What is the likely diagnosis?

Back 38

Juvenile idiopathic arthritis.

-Lupus would not typically present at this early of an age

-Gonoccal also occurs in older children and is monoarticular.

Front 39

After closed reduction and percutaneous pinning of a supracondylar humerus fracture, at what time point do you remove the pins?

Back 39

3 weeks. Leaving in place for longer than 4 weeks poses risk for infection and loss of motion.