Abos Day #38 (5/15 A 1-3)

Front 1

All follwg Tru re: Friedreich's ataxia EXCPT? 1 caused by repeat mutn -> frataxin gene 2 PE ->ataxia, loss of DTR & extensor Babinski respns; 3 neuronopathy ->DRG, (+) loss peripheral (cont)

Back 1

sensory nerve fibrs; 4 progrssive loss- alpha-motor neurons ->anterior horn spinal cord 5 Age of onset is usually between 7 & 15 years; Progrssve loss alpha-motor neurons anterior horn of SC is spinal muscular atrophy, NOT F's A. Ans4

Front 2

Friedreich's ataxia Mnumic
1 defition of condition; 2 genetic defct; 3 zone affect
4 Sx & assoc dz'z or finding; PE-I/P; provc; n/v E; 5 xray findings; 6 Tx

Back 2

TooK 9 CCaNDy GAAAAsh: T-Toes,Hammer; K-Kyphoskoliosis 9-9 chrom; C-Cavus (pesCavus); C-Cardiomyopathy; N-Nystagmus; D-Dysarthria; GAAAA repeat gene

Front 3

9yo B Tx'd for acut hematgns osteo dis tibia w/ IV ABX. After 3 days Tx, fails improv. MRI 1.5x1.5cm abscess-> dis tibia. pt undergoes I & D w/out complcts. F/u , which studies most expeditious methd determine early success tx?

Back 3

1 WBC count; 2 MRI; 3 ESR; 4 CRP 5 XRAYS
-abscess acute hematogenous osteo indication Bx; CRP, normalizes w/ wk. CRP inc & dec signfly fastr >ESR, reflecting effect Tx & predtg recovery >sensitivly >ESR/WBC.Ans-4

Front 4

6 yo B tendrnss @ R heel & avoids puttg wt R LE after steppg nail 2 wks wearg tennis shoes. fever-39.0. Calcaneal osteo caused puncture wound incr'd rate of which comprd hematogns osteo?

Back 4

acute(AHO) & subacute hematogenous (SHO). MC organism is Stapy A in 70% of the cases. tenderness was the MC sign, but fever & dec limb use MC Sx. Ans-4 Pseudomonas infection

Front 5

sequestrum defd as? 1 reactive bone acut osteo 2 reactive bone chrnc osteo 3 necrotic bone providing nidus infn chrnc osteo 4 healthy bone adjacent chrnc osteo 5 healthy bone adjacent acte osteo

Back 5

:is the necrotic bone walled off from blood supply & is a nidus for chrnc osteo. Involucrumlayer of new bone growth outside existing bone seen in osteo Ans:(3)

Front 6

pedi pt dx'd w/ osteo-femur. All risk factors develpnt of DVT EXCEPT? 1 Surg tx osteo; 2 CRP > 6; 3 MRSA
4 Fever > 38.5 deg; 5 Pt age > 8yo; def fever in Celius

Back 6

nl-38 C (100 4); Risk factors develpmt DVT in children w/ osteo: 1 surgical tx, 2 CRP > 6, 3 MRSA, age > 8 years. Ans:
4

Front 7

which pts w/ osteo -tibia is surgical debridet the next best step tx? 1 9yo G w/ new-onset pain & fever; 2 7yo lethargic B w/ WBC 21K after wk nafcln & vanco; 3 7 yo G w/ 3 D-pain, fever, WBC 21K in ER (traffic L ind surg)

Back 7

4 8yo B pain & fever dec > 24 hrs ampi; 5 8yo lethargic G w/ WBC 21K & CRP of 9 after 24 hrs of gent; Surgery indctd: 1 pt has failed respond ABX Tx; 2 aspirn pus bone; subperiosteal abss. Ans2

Front 8

7yo B c/o worseng L knee pain x 2 wks. He unable to WB L-LE x 24 hrs. knee & lwr leg warm & tender. temp-100.9 CRP 11 (nml <1). xray Fig A. aspirtn-> 2 mL's synovial fld CC 2,500 & no organ gms. next step mangt?

Back 8

1 Repeat asprn L knee; 2 Obser w/ repeat xrays in 1 wk; 3 MRI; 4 Begin IV broad-spectrum ABX & obtain ID consult 5 Exploratory surgl arthrotomy; signs infecn, but nl xray& knee aspiration & MRI is the next step. Ans3

Front 9

afebrile 8yo Ethiopian G w/ a limp. 2 yr ago, had mild trauma f/u “bone infection” & tx'd PO AbX. PE small, pus-secrtg wound ant L thigh. wbc nl, but her ESR 48. xray & CT Fig A & B What blue arrow ID?

Back 9

1.Bn infarct; 2 Sequstrm; 3 Involucrum; 4 Osarcoma 5 Hematoma;xrays-> chrnc osteo; involucrum- new Bn growth periosteum walls off seqestrm ->hlthy Bn. sequstrm necro Bn avasclr & isolated hlthy BnAns3

Front 10

10yo B c/o2 Ds worsg R knee pn. unable ambulate since AM. denies recnt TR. PE (+) tend disl fem w/out fluid collctn. ESR 68 (nl <15) & CRP 14 (nl <1). T-101.2 Xrays Fig A&B. aspirn knee 1700 nucltd cells & no organ grm stn. most apprt mangmnt?

Back 10

1 MRI; 2 Observation f/u ESR, CRP, repeat aspiration 2 ds
3 PO cephalosporin & f/u 10 Ds; 4 Sugi arthrotomy, I&D
5 Chest, abdn, pelvis CT; consistent w/ acute infection, not septic arthritis MRI confirm dx & assist plang bn, bx, cx ABX Ans1

Front 11

14 yo B 6 mth after spraing R ankle. xrays Fige A. He returns persistent R ankle pain. pt denies fevers, ESR 35 (nl 20). CRP & WBC nl. xray & MRI Fig B, C, D. What is the next step in mangnt?

Back 11

1 SLC & obsrvtn; 2 CT tibia; 3 PO abx, w/ op f/u x 6 wks; 4 bx & cx tibial lesion; 5 Urgent ankle arthrotomy; subacute osteo, w/ Brodie's abscess, initially, most important txg children is ruling out tumors. Ans4

Front 12

7yo B R elbow & L wrist swelling x 3 mths. photos elbow & wrist Fig A&B, xrays Fig C&D. (+) night sweats & loss appetite, PE b/l axillary adenopathy. WBC nl, ESR elevated. bx Fig E. What is dx?

Back 12

1 Multicentric giant cell tumor; 2 Letterer-Siwe dz; 3 Polyostotic mycobacterial infn; 4 Hand-Schuller-Christian dz; 5 Metastatic rhabdomyosarcoma; sx nite sweats, bx multiple giant cells w/ caseous necrs.Ans3

Front 13

Septic arthritis pedi pts 2^ direct intra-articular spread metaphyseal osteo. This can occur in all the following joints EXCEPT? 1 Hip; 2 Ankle; 3. Shoulder; 4 Elbow 5 Knee

Back 13

intra-articular metaphyses: prox humerus, proxradius, prox femur, dist fibula/tibia. 2^ direct metaphyseal spead osteo. metaphysis knee extra-articular proxl tibial distal femur osteo NOT spread knee. Ans5

Front 14

8 yo B, R leg while playg soccer 6 Ds ago. Initial xray neg, pt into KI. Despite NWB pain worsn, bone scan MRI Fig B & C. PE no knee effsn but tendr prox tib. WBC & ESR nl, CRP is up. initial step mangmnt?

Back 14

1 LLC continued NWB; 2 Chest CT scan & referral ortho oncologist; 3 Neoadjuvant chemo f/u surgical resection
4 Percut bx cx & 5 Percutaneous pin'g physeal fx & LLC; next step bx w/ cx/ABX;Ans4

Front 15

13-yo G L ankle pn after fallg playing soccer 3 wks. pain initially imprvd, but x 10 D inc pain. dec appetite. T 38.9 WBC nl. ESR & CRP elevd & blood cx pendg. ankle xrays nl MRI Fig A & B. next step Tx?

Back 15

1 d/c home NSAID & SLC NWB; 2 d/c home PO ABX w/ serial ESR&CRP outpt settg; 3 Admit do cx & IV ABX w/ serial ESR&CRP; 4 Admit do bx referral ortho oncologist; 5 Admit I&D & IV ABX w/serial ESR & CRP.Ans3

Front 16

Which conditions characterized failure of scapula to migrate caudally during fetal develpt? 1 Poland's syndrm; 2 Sprengel's deformity, 3 Erb's palsy 4 Parsonage-Turner syndm 5 amniotic band syndrm

Back 16

Sprengel's deformity failure shoulder descend caudally durg fetal devel, leads elevation & medial rotation inferior border scapula. assw/ Klippel-Feil syndrm, congnl scoli, fused ribs, omovertebral Bn & myelomeningocele.Ans2

Front 17

4yo B w/ Klippel-Feil syndm elevation L scapula since birth. Spine xray no evidence scoli. What shoulder motion is likely to be most limited? 1 add 2 abd 3 IR 4 ER 5 extension

Back 17

MC congnl shoulder abn. Ass conditions w/ Sprengel's deformity: Klippel-Feil syndrome, congenital scoliosis, and torticollis. Surgery considered restriction abduction or cosmetic reasons.Ans2