Derm MSK Heme

Question 1

lateral curvature of the spine

Answer 1

scoliosis

Question 2

When is scoliois treated

Answer 2

Cobb angle >20 degrees

Question 3

annular ligament dislocated

Answer 3

nursemaid’s elbow

Question 4

4 y/o F holding wrist with elbow pronated, no swelling or ecchymosis with hx of playing on monkey bars on playground

Answer 4

nursemaids elbow

Question 5

tx nursemaids elbow

Answer 5

fully supinate then flex forearm vs hand shaking technique

Question 6

14 y/o M with chronic intermittent pain over anterior aspect of knee. Participates in track during the fall and basketball in the winter. On exam there is soft tissue swelling over tubercle
dx
tx

Answer 6

Osgood-Schlatter’s disease

tx- rest, temporary activity avoidance, NSAIDS, ICE, PT , flexibility

Question 7

14 y/o obese AAM with hip pain and associated limp

xray shows widineing of physis

Answer 7

SCFE

Question 8

tx SCFE

Answer 8

immediate non-wt bearing

urgent ortho referral- ORIF

Question 9

what is Legg- Calve Perthes Dis

Answer 9

idiopathic ischemia leads to avascular necrosis of the femoral head

Question 10

Insidious onset of hip pain in limp in 7 y/o M. On exam hip has decreased internal rotation.
Xray shows small size ossific nucleus of the femoral head
dx
tx

Answer 10

Legg-Calve-Perthes Disease

Nonwt bearing, ortho consult

Question 11

Oligoarticular JIA

Answer 11

<= 4 joints
often med to large joints
`uveitis

Question 12

Polyarticular JIA

Answer 12

> =5 joints
large and small joints
~low grade fever, fatigue, rheumatoid nodules
more chronic and destructive

Question 13

Systemic JIA

Answer 13

classically high fever 39-40C 1-2 times per day
90% rash when fever present
any # of joints affected

Question 14

Enthesitis JIA

Answer 14

Males >10 MC LE joints

hallmark: inflamm of tendon insertions (tibial or heel)

Question 15

TX JIA

Answer 15

1st line NSAIDs- naproxen, ibruprofen, meloxicam

2nd line- methotrexate low dose

Question 16

RF for congenital hip dysplasia

Answer 16

Fhx, Breech presentation, F>M
W>AA Csection LGA
1st born status ligamentous laxity

Question 17

What test detects a dislocated hip?

Answer 17

Ortolani- hips abducted- feel reducing back into acetabulum

Question 18

What test detects unstable hips?

Answer 18

Barlow- adduction, “pistoning”

Question 19

Tx congenital hip dysplasia

Answer 19

<6m- Pavlik harness
6-12m- manipulation and spica cast
1-2yrs- Open reduction

Question 20

MC joint injury

Answer 20

inversion sprain of ankle
laterla ligament— primarily ATF
-anterior talofibular band

Question 21

M with hx of gastroenteritis now with stomatitis and conjunctivitis. Right knee sore and swollen
dx
tx

Answer 21

aspiration sterile
Reactive Arthritis
TOC: NSAIDs

Question 22

13y/o M with mass and pain in forearm. Xray shows a “sun ray” and triangle

Answer 22

Osteosarcoma

Question 23

12 M with bone pain. xray demonstrating “onion peel”

Answer 23

Ewing sarcoma

Question 24

a burn without pain is atleast what degree?

Answer 24

3rd

Question 25

partial thickness burns are what degree?

Answer 25

2nd

Question 26

Drugs commonly associated with TEN/SJS

Answer 26

``` Sulfa Alloprunol Tetracyclines Anticonvulsants NSAIDs ``` +PCN, cephalosporins, quinolones

Question 27

Difference between SJS and TEN

Answer 27

SJS 30 BSA

Question 28

cause of erysipelas

Answer 28

GABHS

Question 29

Golden honey crusted lesions around nose and mouth dx tx

Answer 29

Impetigo Bacitracin ointment most require PO abs- Cephalexin, Doxy

Question 30

Sudden onset fever, HA, and myalgia with sore throat with petechia and papules on soft palate that ulcerate

Answer 30

Herpangina | -coxsackie virus

Question 31

stomatitis with a vesicular rash on hands and feet

Answer 31

Hand, Foot, & Mouth | -coxsackie virus

Question 32

3y/o F with fever, rhinitis, and malaise that presents with irreg "table salt crystals" on her mucous membranes and a brick red maculopapular rash that began on her face and proceeded downward and outward. Affects palms and soles

Answer 32

Measles | aka- Rubeola

Question 33

"slapped cheek"

Answer 33

Erythema Infectiosum | parvo virus B19

Question 34

1-5 days prodrome fever, malaise, HA, sore throat | now with irreg pink papules on face that spread in a centrifugal distribution to trunk and arms

Answer 34

Rubella virus | aka German measles, Third Disease

Question 35

roseola caused by

Answer 35

HHV6

Question 36

4 days of abrupt onset fever in otherwise mildly ill child. Fever ceases and rash abruptly appears. Morbiliform rose lesions most prominent on neck and truck

Answer 36

Roseola Infantum

Question 37

dome shaped waxy papules that are umbilicated

Answer 37

molluscum contagiosum | -poxvirus

Question 38

herald patch and Christmas tree distribution

Answer 38

pityriasis rosea

Question 39

17yo F with purple polygonal papules on lumbar region and scalp. Mildly pruritic. dx tx

Answer 39

Lichen Planus | topical or intralesional steroids- triamocinolone ointment

Question 40

Pruritic erythematous papules that coalesce into plaques with scaling

Answer 40

atopic dermatitis= eczema

Question 41

atopic dermatitis MC where on PEDs?

Answer 41

cheeks, forehead, extensor surfaces

Question 42

TOC eczema

Answer 42

topical steroids- bethamethasone

Question 43

scaly greasy looking non-pruritic rash along scalp and beard

Answer 43

seborrheic dermatitis | tx antidandruff shampoo and hydrocortisone cream

Question 44

tx cradle cap

Answer 44

1% ketoconazole shampoo and emollients

Question 45

tapioca vesicles on thenar eminences and sides of fingers

Answer 45

dyshidrotic eczema/ vesiculobullous hand eczema | tx keep dry, white cotton gloves, topical glucocorticoid

Question 46

male tx for androgenetic alopecia

Answer 46

finasteride or topical mioxidil

Question 47

female tx for androgenetic alopecia

Answer 47

spironolactone

Question 48

yellowing and thickening of nail bed

Answer 48

onychomycosis- tinea unguium | PO friseofulvin or terbinatine

Question 49

lice tx

Answer 49

OTC 1% permethrin | Rx malathion

Question 50

Tx scabies

Answer 50

``` Permethrin cream 5% PO ivermectin (not FDA approved) ```

Question 51

tx RMSF

Answer 51

doxycycline

Question 52

what labs point to hemolytic anemia

Answer 52

HCT >3% decrease per week reticulocytosis ~ Increased serum LD

Question 53

reddish brown urine in a.m | sxs thrombosis

Answer 53

Paroxysmal nocturnal hemoglobinuria

Question 54

Heinz bodies

Answer 54

G6PDD

Question 55

hyperchromic microcytic anemia | with reticulocytosis and spherocytes on peripheral

Answer 55

hereditary spherocytosis

Question 56

pruritius following warm shower

Answer 56

polycythemia vera

Question 57

how to confirm polycythemia vera

Answer 57

JAK2 mutation screening

Question 58

TTP dx

Answer 58

ADAMST13

Question 59

TMA pentad

Answer 59

``` microangiopathic hemolytic anemia thrombocytopenia fever renal insuff neuro abnl ```

Question 60

Philadelphia chromosome

Answer 60

CML

Question 61

isolated lymphocytosis and smudge cells

Answer 61

CLL

Question 62

auer rods | hypercellular with blasts

Answer 62

AML

Question 63

cells expressing terminal deoxynuceleotidly transferase

Answer 63

ALL

Question 64

painless LAN with Bsymptoms

Answer 64

MC non-Hodgkin

Question 65

painless LAN following EtOH | Reed Sternberg cells

Answer 65

Hodgkin Lymphoma

Question 66

Bence jones proteins in urine

Answer 66

multiple myeloma

Question 67

pathologic fx with punched out lytic lesions

Answer 67

multiple myeloma