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Pediatrics 2015 Flashcards

1
Q
  1. Figure 3 is the radiograph of a 3-year-old boy who has a limb deformity. This condition should be further investigated with
  2. laboratory studies.
  3. skin biopsy.
  4. knee CT scan.
  5. knee MRI.
  6. spine radiographs.
A
  1. laboratory studies.

RECOMMENDED READINGS

Fucentese SF, Neuhaus TJ, Ramseier LE, Ulrich Exner G. Metabolic and orthopedic management of X-linked vitamin D-resistant hypophosphatemic rickets. J Child Orthop. 2008 Aug;2(4):285-91. doi: 10.1007/s11832-008-0118-9. Epub 2008 Jul 26. PubMed PMID: 19308556; PubMed Central PMCID: PMC2656824.

Choi IH, Kim JK, Chung CY, Cho TJ, Lee SH, Suh SW, Whang KS, Park HW, Song KS. Deformity correction of knee and leg lengthening by Ilizarov method in hypophosphatemic rickets: outcomes and significance of serum phosphate level. J Pediatr Orthop. 2002 Sep-Oct;22(5):626-31. PubMed PMID: 12198465.

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2
Q
  1. Video 13 shows axial MR images of a 15-year-old boy who experienced pain in his left hip while playing football 2 days ago. Radiographs of his pelvis did not demonstrate any noticeable abnormalities; however, he has persistent pain and a limp. What is the best next step?
  2. Immediate pelvic CT scan
  3. Open reduction and internal fixation of the injury
  4. Urgent in situ proximal femoral physeal stabilization
  5. Referral to hematology for evaluation of possible occult blood dyscrasia
  6. Activity restriction and partial weight bearing with crutches until symptoms resolve
A
  1. Activity restriction and partial weight bearing with crutches until symptoms resolve

RECOMMENDED READINGS

McKinney BI, Nelson C, Carrion W. Apophyseal avulsion fractures of the hip and pelvis. Orthopedics. 2009 Jan;32(1):42. Review. PubMed PMID: 19226032.

Kocher MS, Tucker R. Pediatric athlete hip disorders. Clin Sports Med. 2006 Apr;25(2):241-53, viii. Review. PubMed PMID: 16638489.

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3
Q
  1. Figures 21a and 21b are the radiographs of a 15-year-old girl who fell on her right elbow and now has pain. Treatment should consist of
  2. splinting for comfort.
  3. ligament reconstruction.
  4. open reduction and internal fixation.
  5. closed reduction and immobilization.
  6. closed reduction and percutaneous pinning.
A
  1. splinting for comfort.

RECOMMENDED READINGS

Cleary JE, Omer GE Jr. Congenital proximal radio-ulnar synostosis. Natural history and functional assessment. J Bone Joint Surg Am. 1985 Apr;67(4):539-45. PubMed PMID: 3980498.

Kozin SH. Congenital differences about the elbow. Hand Clin. 2009 May;25(2):277-91. doi: 10.1016/j. hcl.2008.12.007. Review. PubMed PMID: 19380066.

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4
Q
  1. What is the most common type of neonatal brachial plexus palsy?
  2. Suprascapular
  3. Klumpke palsy
  4. Upper trunk injury
  5. Horner syndrome
  6. Global plexus injury at C6 and T1
A
  1. Upper trunk injury

RECOMMENDED READINGS

Zlotolow DA, Kozin SH. Upper extremity disorders: pediatrics. In: Flynn JM, ed. Orthopaedic Knowledge Update 10. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:697-713.

Lagerkvist AL, Johansson U, Johansson A, Bager B, Uvebrant P. Obstetric brachial plexus palsy: a prospective, population-based study of incidence, recovery, and residual impairment at 18 months of age. Dev Med Child Neurol. 2010 Jun;52(6):529-34. doi: 10.1111/j.1469-8749.2009.03479.x. Epub 2009 Dec 23. PubMed PMID: 20041937.

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5
Q
  1. A 2-year-old boy sustained the fracture shown in Figures 33a and 33b. Closed reduction was successful, but a crossed pin technique was required to ensure fracture stability. In the recovery room, the boy could not actively cross his fingers or perform a “scissors” movement with his fingers. What is the most likely cause for the dense nerve palsy?
  2. “Tenting” of the ulnar nerve over the medial pin
  3. Penetration of the ulnar nerve by the proximal tip of the lateral pin
  4. Penetration of the radial nerve by the proximal tip of the medial pin
  5. Compression of the anterior interosseous nerve attributable to elbow swelling
  6. Compartment syndrome of the forearm
A
  1. “Tenting” of the ulnar nerve over the medial pin

RECOMMENDED READINGS

Ozçelik A, Tekcan A, Omeroğlu H. Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures. J Pediatr Orthop B. 2006 Jan;15(1):58-61. PubMed PMID: 16280722.

Shim JS, Lee YS. Treatment of completely displaced supracondylar fracture of the humerus in children by cross-fixation with three Kirschner wires. J Pediatr Orthop. 2002 Jan-Feb;22(1):12-6. PubMed PMID: 11744846.

Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001 May;83-A(5):735-40. PubMed PMID: 11379744.

Herring JA. Upper extremity injuries. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics, 3rd ed. Philadelphia, PA: WB Saunders, 2002; 2115-2250.

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6
Q
  1. Figure 38 is the radiograph of a 12-year-old boy who has left foot pain. Examination of the foot will reveal
  2. clawing of the toes.
  3. cavus deformity of the midfoot.
  4. weakness of the intrinsic muscles.
  5. decreased ankle range of motion.
  6. decreased subtalar joint range of motion.
A
  1. decreased subtalar joint range of motion.

RECOMMENDED READINGS

Vincent KA. Tarsal coalition and painful flatfoot. J Am Acad Orthop Surg. 1998 Sep-Oct;6(5):274-81. Review. PubMed PMID: 9753754.

Mubarak SJ, Patel PN, Upasani VV, Moor MA, Wenger DR. Calcaneonavicular coalition: treatment by excision and fat graft. J Pediatr Orthop. 2009 Jul-Aug;29(5):418-26. doi: 10.1097/ BPO.0b013e3181aa24c0. PubMed PMID: 19568010.

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7
Q
  1. Which bacterial organism most commonly causes pediatric septic arthritis?
  2. Kingella kingae (K. kingae)
  3. Escherichia coli (E. coli)
  4. Staphylococcus aureus (S. aureus)
  5. Haemophilus influenzae (H. influenzae)
  6. Borrelia burgdorferi (B. burgdorferi)
A
  1. Staphylococcus aureus (S. aureus)

RECOMMENDED READINGS

Salava JK, Springer BD. Orthopaedic infections. In: Cannada LK, ed. Orthopaedic Knowledge Update 11. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:287-306.

Young TP, Maas L, Thorp AW, Brown L. Etiology of septic arthritis in children: an update for the new millennium. Am J Emerg Med. 2011 Oct;29(8):899-902. doi: 10.1016/j.ajem.2010.04.008. Epub 2010 Aug 1. PubMed PMID: 20674219.

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8
Q
  1. What is the most effective initial treatment to improve an elbow flexion contracture exceeding 40 degrees in a child with underlying brachial plexus palsy?
  2. Serial casting
  3. Biceps brachii tendon transfer
  4. Arthroscopic elbow capsular release
  5. Full-time elbow extension splinting
  6. Nighttime elbow extension splinting
A
  1. Serial casting

RECOMMENDED READINGS

Ho ES, Roy T, Stephens D, Clarke HM. Serial casting and splinting of elbow contractures in children with obstetric brachial plexus palsy. J Hand Surg Am. 2010 Jan;35(1):84-91. doi: 10.1016/j.jhsa.2009.09.014. Epub 2009 Dec 3. PubMed PMID: 19959298.

Sheffler LC, Lattanza L, Hagar Y, Bagley A, James MA. The prevalence, rate of progression, and treatment of elbow flexion contracture in children with brachial plexus birth palsy. J Bone Joint Surg Am. 2012 Mar 7;94(5):403-9. doi: 10.2106/JBJS.J.00750. PubMed PMID: 22398733; PubMed Central PMCID: PMC3284859.

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9
Q
  1. Figure 56 is the lateral radiograph of an 11-year-old boy who has back pain. Based on this radiographic finding, what is the most likely cause of his back pain?
  2. Trauma
  3. Infection
  4. Metabolic disease
  5. Congenital anomaly
  6. Developmental anomaly
A
  1. Infection

RECOMMENDED READINGS

Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br. 2010 Jul;92(7):905-13. doi: 10.1302/0301-620X.92B7.24668. Review. PubMed PMID: 20595106.

Chunguang Z, Limin L, Rigao C, Yueming S, Hao L, Qingquan K, Quan G, Tao L, Jiancheng Z. Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis. J Pediatr Orthop. 2010 Apr- May;30(3):271-6. doi: 10.1097/BPO.0b013e3181d39899. PubMed PMID: 20357594.

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10
Q
  1. Figures 64a and 64b are the radiographs of a 1-year-old girl who underwent bilateral reconstructive surgery for a similar bilateral hand deformity. During embryogenesis, there was a problem with control of the anteroposterior (AP) axis (thumb to small finger, great toe to small toe) in all of her developing limb buds. The AP axis, which is under the control of an area of tissue in the posterior aspect of the apical ectodermal ridge, is known as the
  2. area for preaxial focus (APF).
  3. area of digital specification (ADS).
  4. zone of polarizing activity (ZPA).
  5. zone of axial determination (ZAD).
  6. sonic hedgehog zone (SHH).
A
  1. zone of polarizing activity (ZPA).

RECOMMENDED READINGS

Herring JA. Disorders of the upper extremity. In: Herring JA, ed. Tachdjian’s Pediatric Orthopaedics, 3rd ed. Philadelphia, PA: WB Saunders; 2002:379-512.

Waters PM. The upper limb. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:921-986.

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11
Q
  1. Figures 70a and 70b are the pelvic radiographs of an 11-year-old boy who has right hip pain. The alignment of the right limb is
  2. flexed.
  3. adducted.
  4. abducted.
  5. internally rotated.
  6. externally rotated.
A
  1. externally rotated.

RECOMMENDED READINGS

Peck K, Herrera-Soto J. Slipped capital femoral epiphysis: what’s new? Orthop Clin North Am. 2014 Jan;45(1):77-86. doi: 10.1016/j.ocl.2013.09.002. Review. PubMed PMID: 24267209.

Schoenecker PL, Gordon JE, Luhmann SJ, Dobbs MB, Keeler KA, Clohisy JC. A treatment algorithm for stable slipped capital femoral epiphysis deformity. J Pediatr Orthop. 2013 Jul-Aug;33 Suppl 1:S103-11. doi: 10.1097/BPO.0b013e31829774d6. PubMed PMID: 23764781

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12
Q
  1. Figures 74a and 74b are the clinical photographs of a newborn infant who has unilateral right arm swelling, hypoperfusion, and skin desquamation after a prolonged labor. It was noted that the right arm was adducted and flexed at the elbow behind the infant’s back during delivery. What is the most appropriate next step?
  2. Neonatal sepsis workup
  3. Hematology evaluation for a bleeding disorder
  4. Elevate and ice the arm with a repeat exam in 2 hours
  5. Emergent fasciotomy for neonatal compartment syndrome
  6. Local wound care and immediate compression dressings for edema control
A
  1. Emergent fasciotomy for neonatal compartment syndrome

RECOMMENDED READINGS

Ragland R 3rd, Moukoko D, Ezaki M, Carter PR, Mills J. Forearm compartment syndrome in the newborn: report of 24 cases. J Hand Surg Am. 2005 Sep;30(5):997-1003. PubMed PMID: 16182057.

Allen LM, Benacci JC, Trane RN 3rd, Driscoll RJ. A case of neonatal compartment syndrome: importance of early diagnosis in a rare and debilitating condition. Am J Perinatol. 2010 Feb;27(2):103-6. doi: 10.1055/ s-0029-1224870. Epub 2009 Jun 5. PubMed PMID: 19504429.

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13
Q
  1. Marfan syndrome is caused by a defect in the gene that encodes for which protein?
  2. Fibrillin-1
  3. Fibrillin-2
  4. Neurofibromin
  5. Type I collagen
  6. Type III collagen
A
  1. Fibrillin-1

RECOMMENDED READINGS

Shirley ED, Sponseller PD. Marfan syndrome. J Am Acad Orthop Surg. 2009 Sep;17(9):572-81. Review. PubMed PMID: 19726741.

Dean JC. Marfan syndrome: clinical diagnosis and management. Eur J Hum Genet. 2007 Jul;15(7):724- 33. Epub 2007 May 9. Review. PubMed PMID: 17487218.

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14
Q
  1. Figures 86a and 86b are the radiographs of an infant who has a leg deformity. Treatment for this deformity should include
  2. amputation.
  3. observation.
  4. osteotomy at 1 year of age.
  5. osteotomy at 4 years of age
  6. guided tibia growth at 8 years of age.
A
  1. observation.

RECOMMENDED READINGS

Shah HH, Doddabasappa SN, Joseph B. Congenital posteromedial bowing of the tibia: a retrospective analysis of growth abnormalities in the leg. J Pediatr Orthop B. 2009 May;18(3):120-8. doi: 10.1097/ BPB.0b013e328329dc86. PubMed PMID: 19339901.

Pappas AM. Congenital posteromedial bowing of the tibia and fibula. J Pediatr Orthop. 1984 Sep;4(5):525-31. PubMed PMID: 6490868.

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15
Q
  1. Figures 92a and 92b are the radiographs of a 5-year-old boy who was treated at birth in a Pavlik harness for a right hip dislocation. Since that time, he has developed typically, has had no hip pain, and has a typical gait. The left acetabular index is 15 degrees and the right is 31 degrees. What is the best next step?
  2. Continued observation
  3. Right hip Pemberton osteotomy
  4. Right hip proximal femoral varus derotational osteotomy
  5. Bilateral hip Pemberton osteotomies
  6. Nighttime abduction bracing
A
  1. Right hip Pemberton osteotomy

RECOMMENDED READINGS

Faciszewski T, Kiefer GN, Coleman SS. Pemberton osteotomy for residual acetabular dysplasia in children who have congenital dislocation of the hip. J Bone Joint Surg Am. 1993 May;75(5):643-9. PubMed PMID: 8501078.

Gillingham BL, Sanchez AA, Wenger DR. Pelvic osteotomies for the treatment of hip dysplasia in children and young adults. J Am Acad Orthop Surg. 1999 Sep-Oct;7(5):325-37. Review. PubMed PMID: 10504359.

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16
Q
  1. A 2-month-old infant with developmental dysplasia of the left hip that is being treated with a Pavlik harness is unable to kick his leg. What is the best next step?
  2. Reduce hip flexion to 90 degrees but continue the harness with closer follow-up for return of function of the left lower extremity.
  3. Continue the harness at daytime only and closely follow the infant for return of function of the

left lower extremity.

  1. Discontinue the harness completely and closely follow the infant for return of function of the left lower extremity.
  2. Discontinue the harness and convert to closed reduction and hip spica casting of the affected side.
  3. Order MR images of the spine to assess for potential spinal dysraphism.
A
  1. Discontinue the harness completely and closely follow the infant for return of function of the left lower extremity.

RECOMMENDED READINGS

Schoenecker JG, Podeszwa DA. Pediatric hip disorders. In: Cannada LK, ed. Orthopaedic Knowledge Update 11. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2014:859-873.

Guille JT, Pizzutillo PD, MacEwen GD. Development dysplasia of the hip from birth to six months. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):232-42. Review. PubMed PMID: 10951112.

Murnaghan ML, Browne RH, Sucato DJ, Birch J. Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip. J Bone Joint Surg Am. 2011 Mar 2;93(5):493-9. doi: 10.2106/ JBJS.J.01210. PubMed PMID: 21368082.

17
Q
  1. Figure 104 is the lateral ankle radiograph of a 10-year-old boy who has heel pain and a limp. There is no history of trauma or recent illness. He is afebrile and has tenderness over the calcaneus. Laboratory results should demonstrate
  2. elevated Lyme titers.
  3. elevated rheumatoid factor.
  4. an increased C-reactive protein level (CRP).
  5. an increased white blood cell count (WBC).
  6. normal CRP and WBC values.
A
  1. normal CRP and WBC values.

RECOMMENDED READINGS

Takada J, Hoshi M, Oebisu N, Ieguchi M, Kakehashi A, Wanibuchi H, Nakamura H. A comparative study of clinicopathological features between simple bone cysts of the calcaneus and the long bone. Foot Ankle Int. 2014 Apr;35(4):374-82. doi: 10.1177/1071100713519600. Epub 2014 Jan 9. PubMed PMID: 24406278.

Ishikawa SN. Conditions of the calcaneus in skeletally immature patients. Foot Ankle Clin. 2005 Sep;10(3):503-13, vi. Review. PubMed PMID: 16081017.

18
Q
  1. Figure 113 is the postreduction CT scan of a 14-month-old girl with a left dislocated hip who underwent closed reduction after adductor tenotomy. What is the best next step?
  2. Acetabuloplasty
  3. Maintainence of the left hip in a hip spica cast
  4. Open reduction of the left hip
  5. Closed reduction of the left hip
  6. Varus femoral derotational osteotomy
A
  1. Maintainence of the left hip in a hip spica cast

RECOMMENDED READINGS

Cooper A, Evans O, Ali F, Flowers M. A novel method for assessing postoperative femoral head reduction in developmental dysplasia of the hip. J Child Orthop. 2014 Aug;8(4):319-24. doi: 10.1007/s11832-014- 0600-5. Epub 2014 Jul 4. PubMed PMID: 24993902; PubMed Central PMCID: PMC4128942.

Madhu TS, Akula M, Scott BW, Templeton PA. Treatment of developmental dislocation of hip: does changing the hip abduction angle in the hip spica affect the rate of avascular necrosis of the femoral head? J Pediatr Orthop B. 2013 May;22(3):184-8. doi: 10.1097/BPB.0b013e32835ec690. PubMed PMID: 23407430.

19
Q
  1. Figure 122 is the bilateral standing alignment radiograph of a 2-year-old boy who has bowed legs. His mother states that he was born with bowed legs, and the deformity seems to have worsened since he started walking at 11 months of age. The metaphyseal-diaphyseal angles are 18 degrees bilaterally. What is the best treatment option?
  2. Observation
  3. Valgus-inducing knee-ankle-foot orthotic bracing
  4. Bilateral proximal tibia and fibula epiphysiodesis
  5. Immediate bilateral tibia and fibular valgus osteotomies with gradual correction with

external fixators

  1. Immediate bilateral tibia and fibular valgus osteotomies with acute correction and

internal fixation

A
  1. Valgus-inducing knee-ankle-foot orthotic bracing

RECOMMENDED READINGS

Levine AM, Drennan JC. Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities. J Bone Joint Surg Am. 1982 Oct;64(8):1158-63. PubMed PMID: 7130229.

Birch JG. Blount disease. J Am Acad Orthop Surg. 2013 Jul;21(7):408-18. doi: 10.5435/ JAAOS-21-07-408. Review. PubMed PMID: 23818028.

20
Q
  1. Figure 129 is the pelvic radiograph of a 17-year-old boy who has cerebral palsy and Level V functioning as measured by the Gross Motor Function Classification System. He has pain and decreased range of motion of the right hip. Treatment should consist of
  2. total hip arthroplasty.
  3. arthroscopic repair of the labrum.
  4. open reduction of the hip with osteotomies.
  5. closed reduction of the hip with osteotomies.
  6. femoral head resection and proximal femoral osteotomy.
A
  1. femoral head resection and proximal femoral osteotomy.

RECOMMENDED READINGS

K Graham H, Narayanan UG. Salvage hip surgery in severe cerebral palsy: some answers, more questions? Bone Joint J. 2014 May;96-B(5):567-8. doi: 10.1302/0301-620X.96B5.34119. PubMed PMID: 24788487.

Larnert P, Risto O, Hägglund G, Wagner P. Hip displacement in relation to age and gross motor function in children with cerebral palsy. J Child Orthop. 2014 Mar;8(2):129-34. doi: 10.1007/s11832-014-0570-7. Epub 2014 Mar 5. PubMed PMID: 24595560; PubMed Central PMCID: PMC3965763.

21
Q
  1. Which percentage best describes the relative contribution of the proximal humeral growth plate to overall humeral length?
  2. 20%
  3. 40%
  4. 60%
  5. 80%
  6. 100%
A
  1. 80%

RECOMMENDED READINGS

Wattenbarger JM, Frick SL. Shoulder, upper arm, and elbow trauma: pediatrics. In: Flynn JM, ed. Orthopaedic Knowledge Update 10. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:675-686.

Hensinger RL. Standards in Pediatric Orthopaedics: Tables, Charts, and Graphs Illustrating Growth. New York, NY: Raven Press; 1986:142.

22
Q
  1. Figure 143 is the pelvic radiograph of a 2-year-old girl who has a limp on her left side. Her left leg is shorter than her right leg, and her left hip has less range of motion than her right hip. Treatment should consist of
  2. observation.
  3. abduction bracing.
  4. closed reduction of the hip.
  5. closed reduction of the hip with adductor tenotomy.
  6. open reduction of the hip with osteotomies.
A
  1. open reduction of the hip with osteotomies

RECOMMENDED READINGS

Wenger DR. Surgical treatment of developmental dysplasia of the hip. Instr Course Lect. 2014;63:313-23. PubMed PMID: 24720317.

Gholve PA, Flynn JM, Garner MR, Millis MB, Kim YJ. Predictors for secondary procedures in walking DDH. J Pediatr Orthop. 2012 Apr-May;32(3):282-9. doi: 10.1097/BPO.0b013e31824b21a6. PubMed PMID: 22411335.

23
Q
  1. Figures 152a and 152b are the spine radiographs of a 17-year-old boy who has scoliosis that was noticed during his well-child pediatric evaluation 2 months ago. He has no back pain or other symptoms and does not notice any impairment related to his spinal deformity. The Cobb angle of the left upper thoracic curve is 28 degrees, and the Cobb angle of the right main thoracic curve is 29 degrees. What is the best treatment option?
  2. Observation
  3. Boston brace treatment
  4. Anterior spinal fusion of both curves
  5. Posterior spinal fusion of both curves
  6. Selective posterior spinal fusion of the main thoracic curve only
A
  1. Observation

RECOMMENDED READINGS

Dolan LA, Wright JG, Weinstein SL. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2014 Feb 13;370(7):681. doi: 10.1056/NEJMc1314229. PubMed PMID: 24521128.

Schlenzka D, Yrjönen T. Bracing in adolescent idiopathic scoliosis. J Child Orthop. 2013 Feb;7(1):51- 5. doi: 10.1007/s11832-012-0464-5. Epub 2012 Nov 30. Review. PubMed PMID: 24432059; PubMed Central PMCID: PMC3566257.

24
Q
  1. Figure 162 is the right shoulder radiograph of a 5-year-old boy who fell and now has right shoulder pain. Prior to the fall he had no history of symptoms. What is the best next step?
  2. Bone scan
  3. Chest radiograph
  4. No further testing
  5. Assessment of calcium and vitamin D levels
  6. Skin biopsy to check for collagen abnormalities
A
  1. No further testing

RECOMMENDED READINGS

Pretell-Mazzini J, Murphy RF, Kushare I, Dormans JP. Unicameral bone cysts: general characteristics and management controversies. J Am Acad Orthop Surg. 2014 May;22(5):295-303. doi: 10.5435/ JAAOS-22-05-295. Review. PubMed PMID: 24788445.

Donaldson S, Wright JG. Simple bone cysts: better with age? J Pediatr Orthop. 2015 Jan;35(1):108-14. doi: 10.1097/BPO.0000000000000336. PubMed PMID: 25436480.

25
Q
  1. Figure 169 is the lateral radiograph of a 6-year-old boy who has a 2-week history of left foot pain without trauma. Examination reveals an antalgic gait with diffuse foot swelling. Treatment should consist of
  2. foot immobilization.
  3. midfoot biopsy.
  4. midfoot irrigation and debridement.
  5. open reduction and internal fixation.
  6. closed reduction and internal fixation.
A
  1. foot immobilization.

RECOMMENDED READINGS

DiGiovanni CW, Patel A, Calfee R, Nickisch F. Osteonecrosis in the foot. J Am Acad Orthop Surg. 2007 Apr;15(4):208-17. Review. PubMed PMID: 17426292.

Aiyer A, Hennrikus W. Foot pain in the child and adolescent. Pediatr Clin North Am 2014 Dec; 61(6): 1185-1205. PMID: 25439019.

26
Q
  1. Figures 174a and 174b are the anteroposterior and lateral tibia/fibula radiographs of a 6-year-old girl who has a leg-length discrepancy with a short right leg. She has 4 toes on her right side. Her knee and ankle examination is stable and she walks on her toes on her right leg. What is the most likely diagnosis?
  2. Tibial deficiency
  3. Fibular deficiency
  4. Perthes disease
  5. Gorham disease
  6. Osteosarcoma of the fibula
A
  1. Fibular deficiency

RECOMMENDED READINGS

Oberc A, Sułko J. Fibular hemimelia - diagnostic management, principles, and results of treatment. J Pediatr Orthop B. 2013 Sep;22(5):450-6. doi: 10.1097/BPB.0b013e32836330dd. PubMed PMID: 23807497.

Birch JG, Lincoln TL, Mack PW, Birch CM. Congenital fibular deficiency: a review of thirty years’ experience at one institution and a proposed classification system based on clinical deformity. J Bone Joint Surg Am. 2011 Jun 15;93(12):1144-51. doi: 10.2106/JBJS.J.00683. PubMed PMID: 21776551.

27
Q
  1. Figure 183 is the radiograph of a 6-year-old girl who has Morquio syndrome. She is scheduled for lower extremity surgery to address the deformity. Presurgical testing should include
  2. urinalysis.
  3. cervical spine radiographs.
  4. a chest radiograph.
  5. an abdominal ultrasound.
  6. electrolyte laboratory studies.
A
  1. cervical spine radiographs

RECOMMENDED READINGS

White KK, Jester A, Bache CE, Harmatz PR, Shediac R, Thacker MM, Mackenzie WG.Orthopedic management of the extremities in patients with Morquio A syndrome. J Child Orthop. 2014 Aug;8(4):295- 304. doi: 10.1007/s11832-014-0601-4. Epub 2014 Jul 8. PubMed PMID: 25001525; PubMed Central PMCID: PMC4128951.

Baratela WA, Bober MB, Thacker MM, Belthur MV, Oto M, Rogers KJ, Mackenzie WG. Cervicothoracic myelopathy in children with Morquio syndrome A: a report of 4 cases. J Pediatr Orthop. 2014 Mar;34(2):223-8. doi: 10.1097/BPO.0000000000000074.PubMed PMID: 24096444.

28
Q
  1. A 4-year-old boy has been limping on his left leg for 4 days. His parents say he was fine until he began limping. They report no fevers, but the boy had an upper respiratory infection about 2 weeks ago. His white blood cell count is 8 109/L (reference range [rr], 4.5-11 109/L), his erythrocyte sedimentation rate is 30 mm/h (rr, 0-20 mm/h), and his C-reactive protein level is within defined limits. Pelvic radiographs are unremarkable. What is the best next step?
  2. Spica cast
  3. MR image of the pelvis
  4. Nonsteroidal anti-inflammatory drugs (NSAIDs) and observation
  5. Irrigation and debridement of the left hip
  6. Broad-spectrum antibiotics and observation
A
  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) and observation

RECOMMENDED READINGS

Nouri A, Walmsley D, Pruszczynski B, Synder M. Transient synovitis of the hip: a comprehensive review. J Pediatr Orthop B. 2014 Jan;23(1):32-6. doi: 10.1097/BPB.0b013e328363b5a3. Review. PubMed PMID: 23812087.

Singhal R, Perry DC, Khan FN, Cohen D, Stevenson HL, James LA, Sampath JS, Bruce CE. The use of CRP within a clinical prediction algorithm for the differentiation of septic arthritis and transient synovitis in children. J Bone Joint Surg Br. 2011 Nov;93(11):1556-61. doi: 10.1302/0301-620X.93B11.26857. PubMed PMID: 22058311.

29
Q
  1. Figures 195a and 195b are the radiographs of a 14-year-old postmenarchal girl who has a prominence over her right hip. She has pain with walking and running. The prominence is mildly tender without any overlying skin changes. There is full hip range of motion. What is the best next step?
  2. Excision
  3. Radiotherapy
  4. Chemotherapy
  5. Hemipelvectomy alone
  6. Hemipelvectomy with adjuvant chemotherapy
A
  1. Excision

RECOMMENDED READINGS

Wodajo FM. Top five lesions that do not need referral to orthopedic oncology. Orthop Clin North Am. 2015 Apr;46(2):303-14. doi: 10.1016/j.ocl.2014.11.012. Review. PubMed PMID: 25771324.

Nystrom LM, DeYoung BR, Morcuende JA. Secondary chondrosarcoma of the pelvis arising from a solitary exostosis in an 11-year-old patient: a case report with 5-year follow-up. Iowa Orthop J. 2013;33:213-6. PubMed PMID: 24027486; PubMed Central PMCID: PMC3748883.

30
Q
  1. Figure 210 is the standing alignment image of a 3•••-year-old girl. She has a painless limp on her left side and a small lateral thrust on the left side during the stance phase. What is the best treatment option?
  2. Observation
  3. Tibia and fibular valgus-producing osteotomy
  4. Varus thrust knee-ankle-foot orthosis at night
  5. Varus thrust knee-ankle-foot orthosis at all times
  6. Varus thrust knee-ankle-foot orthosis during the day only
A
  1. Tibia and fibular valgus-producing osteotomy

RECOMMENDED READINGS

Birch JG. Blount disease. J Am Acad Orthop Surg. 2013 Jul;21(7):408-18. doi: 10.5435/ JAAOS-21-07-408. Review. PubMed PMID: 23818028.

Shinohara Y, Kamegaya M, Kuniyoshi K, Moriya H. Natural history of infantile tibia vara. J Bone Joint Surg Br. 2002 Mar;84(2):263-8. PubMed PMID: 11922370.

31
Q
  1. These coronal ultrasound images show the right (Figure 223a) and left (Figure 223b) hips of a 7-month-old girl who is seen for hip dysplasia. What is the best next step?
  2. Bilateral Salter innominate osteotomies
  3. Bilateral closed reduction and spica casting
  4. Observation for 6 weeks with repeat ultrasound
  5. Immediate Pavlik harness application
  6. Immediate open reduction of both hips through medial approaches
A
  1. Bilateral closed reduction and spica casting

RECOMMENDED READINGS

Vitale MG, Skaggs DL. Developmental dysplasia of the hip from six months to four years of age. J Am Acad Orthop Surg. 2001 Nov-Dec;9(6):401-11. Review. PubMed PMID: 11730331.

Murray T, Cooperman DR, Thompson GH, Ballock T. Closed reduction for treatment of development dysplasia of the hip in children. Am J Orthop (Belle Mead NJ).2007 Feb;36(2):82-4. PubMed PMID: 17676175.

32
Q
  1. The deformity shown in Figure 229 is classified as
  2. central.
  3. terminal.
  4. preaxial.
  5. postaxial.
  6. intercalary.
A
  1. preaxial.

RECOMMENDED READINGS

Guo B, Lee SK, Paksima N. Polydactyly: a review. Bull Hosp Jt Dis (2013).2013;71(1):17-23. Review. PubMed PMID: 24032579.

Al-Qattan MM. Preaxial polydactyly of the upper limb viewed as a spectrum of severity of embryonic events. Ann Plast Surg. 2013 Jul;71(1):118-24. doi: 10.1097/SAP.0b013e318248b67f. Review. PubMed PMID: 23364674.

33
Q
  1. What is the typical age range for a child to walk without assistance?
  2. 3 to 6 months
  3. 6 to 12 months
  4. 12 to 18 months
  5. 18 to 24 months
  6. 24 to 30 months
A
  1. 12 to 18 months

RECOMMENDED READINGS

Burnett CN, Johnson EW. Development of gait in childhood. II. Dev Med Child Neurol. 1971 Apr;13(2):207-15. PubMed PMID: 5562863.

Sutherland DH, Olshen R, Cooper L, Woo SL. The development of mature gait. J Bone Joint Surg Am. 1980 Apr;62(3):336-53. PubMed PMID: 7364807.

34
Q
A
35
Q
  1. After closed reduction for a displaced pediatric supracondylar humeral fracture, pin removal is typically recommended during which postsurgical time period?
  2. 1 week
  3. 3 weeks
  4. 6 weeks
  5. 9 weeks
  6. 12 weeks
A
  1. 3 weeks

RECOMMENDED READINGS

Wattenbarger JM, Frick SL. Shoulder, upper arm, & elbow trauma: pediatrics. In: Flynn J, ed. Orthopaedic Knowledge Update 10. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2011:675-86.

Green DW, Widmann RF, Frank JS, Gardner MJ. Low incidence of ulnar nerve injury with crossed pin placement for pediatric supracondylar humerus fractures using a mini-open technique. J Orthop Trauma. 2005 Mar;19(3):158-63. Review. PubMed PMID: 15758668.

36
Q
A

5. OITE (41 decks)

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