MSK

Question 1

Age of presentation SUFE ve Perthe’s disease

Answer 1

SUFE: 10-16 yrs

Perthe’s disease: 3-11 yrs

Question 2

Presentation of Perthe’s disease + pathophys

Answer 2

Path: avascular necrosis of the femoral head

Pain in hip or knee + limp

Question 3

What nerve roots are in Erb’s palsy?

Answer 3

C5-C6

Note: Klumpks is C8-T1

Question 4

Damage to what nerve causes foot drop?

Answer 4

Common peroneal nerve (L5, S1)

Question 5

Obligate external rotation is characteristic of what?

Answer 5

SUFE

Note: this means when the hip is flexed, external rotation of the limb occurs

Question 6

Mgmt of SCFE

Answer 6

Urgent fixation w/pinning (epiphysiodesis)

Question 7

How often is SCFE bilateral?

Answer 7

20-25%

Question 8

In the management of an open fracture it is important to probe it in the ER T/F

Answer 8

F - it should not be probed as this may dislodge debris further into the wound and introduce infection

Note: should check neuromuscular status and then immobilise, check tetanus status, ref to ortho and start IV antibiotics

Question 9

In a pt with suspected Duchenne MD what is the 1st appropriate investigation?

Answer 9

Serum CK

Question 10

Inguinal hernia in children are usually direct or indirect ?

Answer 10

Indirect

Direct hernias are very rare in the absence of a connective tissues disorder

Question 11

Inguinal hernia in premature males have a high recurrence rate T/F

Answer 11

T - about 5% recur post op

Question 12

When would it be expected for achondroplasia and hypochondroplasia to present?

Answer 12

Achondroplasia: usually in the neonatal period, growth in utero is normal until 22 weeks hence unless patient was getting a late scan for some reason.

Hypochondroplasia: presents later with short stature

Question 13

How does achondroplasia usually present clinically?

Answer 13

Proximal (rhizomelic) limb shortening, esp in the upper limbs and normal head circumference

Question 14

Telephone handle femurs on X-ray what pathology?

Answer 14

Thanatophoric dwarfism

Question 15

Which ligament is injured in nursemaid elbow?

Answer 15

Annular

Question 16

Teenage athlete presents with pain, swelling and locking of knee after sports, arthroscopy showing 3 loose bodies in synovial cavity. What pathology

Answer 16

Oestochondritis dissescans

Due to underlying necrosis of articular cartilage and its underlying bone. Cause of this is unknown

Note: if only one body was seen another differential would be a chip (avulsion) fracture

Question 17

> 50 loose bodies in a joint cavity on arthroscopy, what disease?

Answer 17

Synovial chondromatosis

Question 18

Metaphyseal fracture (AKA corner or bucket handle fracture) of lower limb is specifically associated with NAT T/F

Answer 18

T

Question 19

Trethowan’s sign is indicative of what pathology

Answer 19

SUFE

Note: in this sign line of Klein passes above the femoral head.

Question 20

What is the treatment of a toddlers fracture?

Answer 20

Long leg cast

Note: healing is rapid, 4-5 weeks

Question 21

What is the most common elbow fracture?

Answer 21

Supracondylar fracture of the distal humerus

Question 22

Complications of supracondylar fracture of the distal humerus?

Answer 22

• radial or median nerve damage
• brachial artery damage
• compartment syndrome
• Volkmann contracture
• improper reduction can lead to cubits varus

Question 23

What is Blount disease? What is mgmt?

Answer 23

Developmental deformity resulting from abnormal endochondral ossification of the medial aspect of the proximal tibial physis leading to varus deformity and internal rotation of tibia

Mgmt: if diagnosis before three knee brace. If >3 at diagnosis or failure of knee brace ortho referral for surgery

Question 24

Hyperkyphosis and X-ray showing wedging of > 5 degrees in at least 3 consecutive vertebrae bodies. What pathology and mgmt?

Answer 24

Scheuermann disease (AKA juvenile kyphosis)

Mgmt: bracing if < 70 degrees. > 70 degrees requires surgery

Note: usually minimal pain and normal neuro exam

Question 25

Traumatic myositis ossificans is a bony mass, always slightly separated from the bone

Answer 25

T More common in adolescent athletes. Painless On xray round mass with mature peripheral ossification and a more radiolucent centre of mature osteoid. This tends to be a reverse of tumour appearance

Question 26

Most common cause of intoeing in less than 2 yrs old and its management?

Answer 26

Internal tibial torsion Mgmt: reassurance, usually resolves without intervention. Refer to surgeon if persists > 8 yrs of age, interferes with activity or has poor cosmetic appearance

Question 27

At what age is genu vagum normal?

Answer 27

2-4 yrs (knock knee) Note: birth - 2 yrs varus (bowing) is normal

Question 28

Intermittent knee pain that worsens with activity. Sometimes knee "locks up/gives way". Full extension of knee limited. Most likely pathology?

Answer 28

Osteochondritis dissecans Note: most commonly affected is the medial condyl of femur; sometimes a boney fragment will be seen in joint space

Question 29

When does polydactyly occur in utero? What race is it more common?

Answer 29

6 - 7 weeks | African American

Question 30

A positive McMurrary test is characteristic of what injury?

Answer 30

Meniscal

Question 31

Peripheral oedema, hyperglycaemia, HTN and arthralgia are side effects of what performance enhancing drug?

Answer 31

Growth hormone Note: can also cause cardiomegaly

Question 32

Tennis elbow vs golfers elbow locations?

Answer 32

Tennis: lateral epicondylitis Golfer: medial epicondylitis Note: little league elbow is also medial pain

Question 33

SUFE is associated with hypothyroidism and T1 DM T/F

Answer 33

F - not associated with DM but is associated with hypothyroidism Also associated with growth hormone therapy, renal osteodystrophy and obese males with hypogonadal conditions

Question 34

Forward slippage of upper vertebra in relation to the vertebra below, spondylolesthesis or spondylolysis?

Answer 34

Spondylolesthesis Note: 85% of spondylolesthesis is due to spondylolysis (bone defect in pars interarticularis of the vertebra)

Question 35

Mgmt of spondylolesthesis vs spondylolysis

Answer 35

Spondylolysis: NSAIDs and can return to sport once pain free. Surg referral only if not improvement in pain Spondylolesthesis: ortho referral. Surgical treatment is usually needed for high slip (> 50%). No contact sports if the slippage is more than 50% of the vertebral width

Question 36

Mechanism of action associated with ACL or PCL tear?

Answer 36

ACL - sudden declaration and pivoting of knee | PCL - direct blow to anterior knee with knee flexed (often knee hits dashboard)

Question 37

Mechanism of action of medial meniscus tear?

Answer 37

Twisting motion of planted leg

Question 38

Mgmt of scoliosis

Answer 38

Mild < 20 degrees: no activity restrictions Mod (25-45) : considering bracing Severe (> 45): spinal fusion/Harrington rod