Pediatric Board Review - Musculoskeletal

Front 1

What does physeal mean?

Back 1

Growth plate

Front 2

What does metaphyseal mean?

Back 2

The end of the long bone

Front 3

What does Varus mean?

Back 3

When the distal part of the deformity points inward

Front 4

What does Valgus mean?

Back 4

When the distal part of the deformity points away from the midline.

A "gust" of wind blows everything away.

Front 5

What is Genu Valgum?

Back 5

It is where the knees are stuck together and the feet are outward.

The gum holds the knees together so you have knock-knees

Front 6

What is the immediate treatment of an ankle sprain?

Back 6

Ice for 20 minute intervals for 36-48 hours.

Front 7

A child recovers from an ankle injury and then suffers another, more severe injury in the same ankle. What is the most likely cause?

Back 7

Reinjury because the child returned to competitive play too soon.

Front 8

A 10yo boy had a traumatic injury during football, He has pain over his knee, but his x-ray is normal. What is his diagnosis?

Back 8

Salter Harris I fracture

Front 9

A child has a traumatic injury playing basketball where his opponent stepped on the boy's ankle and lateral leg. You note only a bruise and swelling. There is a good dorsal pulse and some diminished sensation to pinprick and light touch. What is your next step?

Back 9

Obtain compartment pressures.

Front 10

What are the signs and symptoms of compartment syndrome?

Back 10

Pain
Pulselessness
Paralysis
Pallor
Paresthesias

Front 11

For the following features related to osteogenisis imperfecta, indicate whether it is Type 1, 2, 3, or 4.

A. Appear as bag of bones at birth
B. Autosomal dominant
C. Hearing Loss
D. Progressive deforming type
E. Born with fractures
F. Born without fractures
G. Blue sclera
H. Gray sclera
I. White sclera
J. Macrocphaly
K. Short stature
L. Don't live past the postnatal period

Back 11

A. Appear as bag of bones at birth = Type 2
B. Autosomal dominant = Type 1
C. Hearing Loss = Type 1
D. Progressive deforming type = Type 3
E. Born with fractures = Type 2 and 3
F. Born without fractures = Type 1
G. Blue sclera = Type 1
H. Gray sclera = Type 3
I. White sclera = Type 4
J. Macrocphaly = Type 3
K. Short stature = Type 3
L. Don't live past the postnatal period = Type 2

Front 12

A child was born with blue sclera and hearing loss. She develops multiple pathologic fractures and has bad teeth by the time she is in preschool. What is the diagnosis? What is the genetic inheritence pattern?

Back 12

OI 1 Type B. Autosomal dominant
Remember, bad teeth on a blue moon that comes 1 in a lifetime and dominates the sky

Front 13

A 6 month old infant is new to your practice. On exam you note macrocephaly, frontal bossing, midface hypoplasia, and proximal shortening of the limbs. You correctly diagnose achondroplasia. What is the inheritence pattern and what is the most likely cause of death?

Back 13

It is autosomal dominant! Short people rule!
And they die of cervicomedullary junction compression.

Front 14

A 9 month old comes to your office for the first time. You note a mass in the sternocleidomastoid muscle and facial asymmetry. What is the diagnosis and treatment?

Back 14

Congenital torticollis requires daily stretching and

Front 15

True or False
Congenital torticollis can be associated with hip dysplasia

Back 15

True

Front 16

How do you distinguish muscular torticollis, paroxysmal torticollis and posterior fossa tumor.

Back 16

Muscular torticollis results from positioning or bleeding during birth.

Paroxysmal torticollis is like infant migraine. They are intermittent neck tilting episodes associated the vomiting, irritability and pallor.

Posterior fossa tumor will have increased DTR.

Front 17

What is klippel feil syndrome?

Back 17

It is where there is fusion of the cervical vertebrae. These kids have short neck and low occipital hairline.

Imagine "clippers," instead of cervical vertebrae, that cut the hair.

Front 18

A mother brings in her son thinking that his back is not straight. His spinal curve is 40 degrees convex. What is his diagnosis?

Back 18

This is normal. Hunchback is kyphosis which is > 40 convex curvature. While concave curvature is lordosis.

Front 19

A 15yo boy is brought in by his mom, because he "can never stand up straight." The boy complains of chronic back pain and you not kyphosis. What is your diagnosis?
A) Scheuermann disease
B) Chronic poor posture
C) Scoliosis
D) Spinal tumor
E) Osteomyelitis

Back 19

A. This is the triad of bad posture + kyphosis + back pain.

Front 20

What is the treatment for Scheuermann disease?

Back 20

NSAIDs, physical therapy and observation over time.

Front 21

What is the sprengel's deformity?

Back 21

It is where one scapula does not "spring" back into place so the two scapulas are uneven from birth.

Front 22

Which of the following regarding hip dysplasia is false?
A) It is more frequent in males
B) It is more commonly on the left
C) Asymmetric gluteal folds
D) Barlow is the part of the exam where abduction is done using downward pressure
E) Ortolani is the attempt at relocating the dislocated femoral head
F) Treatment is with a pavlik harness

Back 22

D. Barlow is done in adduction with downward pressure.

Front 23

Which of the following is not a risk factor for DDH?
A) Breech
B) Family history of DDH
C) Preemie
D) Female
E) First born

Back 23

C

Front 24

A 5yo presents with knee pain after a recent URI. The ESR is normal, his temp is 37.8 and he has a negative gram stain. What is the diagnosis and treatment?

Back 24

Toxic synovitis. Give supportive care

Front 25

A 2yo has stopped standing on his leg. He cries every time you touch his left leg. He is febrile with a temp of 39 and his hip is warm to touch. On x-ray there is increased joint space and there is an elevated ESR. What is your next step?
A) Aspiration of the joint and Antibiotics
B) Steroids
C) CT
D) MRI
E) Ultrasound

Back 25

A.

Front 26

A 5yo has just immigrated from Mexico. He presents with a sore ankle that is painful to both passive and active mevement, red, and swollen. Yesterday he had similar symptoms in his knee, but that has since resolved. There is also a diffuse macular rash. What is the diagnosis?
A) meningococcemia
B) Septic arthritis
C) Post viral synovitis
D) Rheumatic fever

Back 26

D. It is in migrating and in the large joint and has a rash.

Front 27

A 5yo boy complains of marked right knee pain. On x-ray, the right femoral head is noted to be smaller than the left femoral head. What is his diagnosis?

Back 27

Legg Calve Perthes. This is avascular necrosis of the femoral head.

Young Forrest Gump had this.

Front 28

What is/are the most sensitive and specific test(s) in diagnosing osteomyelitis?

Back 28

MRI (sensitive) and Bone Scan (specific)

Front 29

True or False.
Osteomyelitis begins as a localized cellulitis.

Back 29

False. It begins with bacteremia, spreads hematogeously and spreads by local extension.

Front 30

What is diagnostic step in determining etiology of osteomyelitis?

Back 30

Direct aspiration then culture of the metaphysis

Front 31

When would you see the x-ray findings in osteomyelitis?

Back 31

10-14.

Front 32

What are the requirements before you can give po antibiotics for osteomyelitis?

Back 32

Must know sensitivities
Must have responded to IV antibiotics
Must have good parent compliance
Must have po trial in hospital

Front 33

A 14yo presents with chronic right knee pain that locks and swells. What is your diagnostic step, diagnosis and treatment?

Back 33

Do an MRI, Diagnosis is Osteochondritis Dissecans and Treatment is immobilization.

Front 34

A 16yo soccer player complains of constant pain just below the knee. What does he have and what is the treatment?

Back 34

He has Osgood-Schlatter Disease. It is a result of overuse and stress at the site werhe the quadriceps muscle, via the patellar tendon,joins the tibial tubercle. Treat with rest and NSAIDs

Front 35

For the following scenarios what is the treatment?
1. Scoliosis with curvature < 25 degrees
2. Curvature between 25-40 degrees and child > 2yo and still growing
3. Curvature > 40 degrees

Back 35

1. Observe less than 25
2. Brace 25-40
3. Surgery over 40

Front 36

How do you distinguish caffey disease from infant child abuse?

Back 36

Caffey involves only the cortical bone with progressive cortical thickening. "Bones are swollen"

In abuse the periosteum is swollen and bones are broken.

Front 37

A 3yo is brought in by his teenage stepsister who is hysterical because she thinks she broke her brother's arm while holding him back from chasing a ball into the street. What is your next step?
Do you need an x-ray?

Back 37

Check for other injuries and then reduce this subluxed radial head. No x-ray needed.

Front 38

True or False
Club foot is internal rotation of the foot with Achilles tendon extension

Back 38

False. It is internal foot rotation and achilles tendon contraction

Front 39

What is the treatment for clubbed foot?

Back 39

Stretching, casting and surgical release before age 1yo

Front 40

Which of the following does not require further intervention?
A) A 9 month old who has bilateral bow-leggedness
B) A 30 month old who has had bow leggedness since age 8mos.
C) A 2yo who is first noted to have bow leggedness.
D) An overweight 14yo who is noted to be bow-legged.
E) A 18 month old who is bow legged and anorexic.

Back 40

A) Does not need treatment
B) Needs treatment because it worsened
C) Needs treatment because it was diagnosed after age 2.
D) Needs treatment because this is adolescent Blount's disease
E) Needs treatment because this is rickets

Front 41

True or False.
Blount's disease is more common in African American kids.

Back 41

True

Front 42

Which 3 diseases have little or no radius?

Back 42

TAR - thrombocytopenia absent radius
Fanconi's Anemia - cut off thumb and radius
VATER - absent radius

Front 43

Which two diseases are associated with high arches?

Back 43

Friedreich (Fried Arch) and Hurlers syndrome (you need high arches to hurl)

Front 44

True or False.
Flat feet does not need any inserts.

Back 44

True

Front 45

A 9yo comes in with tenderness near his distal humerus. X ray is negative. What type of Salter Harris is this?

Back 45

Type 1

Front 46

What is this?

Back 46

Salter Harris Type 2. A piece of metaphysis splits together with some physis

Front 47

What are these two x-rays

Back 47

Salter-Harris fractures of the ankle. A is a Salter type I fracture is seen with marked lateral displacement of the epiphysis relative to the tibial metaphysis. B is a Salter type III fracture of the lateral tibial epiphysis.

Front 48

What are the 5 Salter Harris Fractures?

Back 48

S: Type 1 is straight through the physis, separated
A: Type 2 is above the growth plate. Part of the metaphysis splits with physis
L: Lower portion is affected. Goes through epiphysis and joint space.
T: Totally through metaphysis, growth plate and epiphysis
R: Crush. Might not show up right away

Front 49

What is this?

Back 49

A normal elbow

Front 50

What is this?

Back 50

Fractured elbow. Elevation of the periarticular fat pads due to haemarthrosis of the elbow. Note the lucencies anterior and posterior to the distal humeral shaft, representing elevation of the periarticular fat pads of the elbow (arrows). The normal anterior fat pad is rounded; the posterior fat pad is not normally visualized.

Front 51

An overweight 15yo boy complains of chronic knee pain. You remember that knee pain in a teen means hip pathology. This is his x-ray. What is your diagnosis and treatment?

Back 51

SCFE Slipped capital femoral Epiphysis. Treat with immobilization, stabilization, pins and/or bone grafts