MSK - Peds

Question 1

What does thalidomide consumption by the mother lead to in a fetus? How?

Answer 1

Phocomelia

interrupts blood flow, causes limb not to grow

Question 2

What is the difference between aplasia and hypoplasia?

Answer 2

Aplaisa - limb/fingers/toe does not form

Hypoplasia - smaller limb

Question 3

What is congenital amputation?

Answer 3

Loss of limb/no growth of limb, usually due to lack of blood supply

Question 4

What is Streeter’s dysplasia?

Answer 4

Constricting bands in utero sac cause amputations of fetal limbs

Question 5

What is Sprengle’s deformity? What extra bone may develop as a result? When is surgery performed?

Answer 5

Congenital elevation of scapula
Omovetebral bone
3-8 years old

Question 6

What congenital absence can cause hypermobility of shoulders?

Answer 6

Absence of clavicle

Question 7

What results from congenital radial-ulnar synostosis? What actions are restricted?

Answer 7

Failure of radius and ulna to separate

Inability to supinate/pronate

Question 8

What deformity of the elbow is caused by congenital dislocation of the radial head?

Answer 8

Varus deformity

Question 9

What upper extremity fracture is most common in children?

Answer 9

Clavicle

Question 10

How many pitches per game and season are recommended for 9-10, 11-12, and 13-14

Answer 10

9-10: 50 per game, 2000 per year
11-12: 75 per game, 3000 per year (100 per week)
13-14: 75 per game, 3000 per year (125 per week)

Question 11

What is nurse maid’s elbow? What ligament is involved? How do children present? How is it reduced?

Answer 11

Subluxation of radial head
Annular ligament
Pronated, slightly flexed
Supinate and flex elbow

Question 12

How are non-displaced supracondylar humerus fractures treated? How are displaced supracondylar humerus fractures treated? What is a major complication of untreated supracondylar fractures?

Answer 12

Posterior splint, check hourly for 24 hours
Closed reduction with percutanous pinning or ORIF
Volkmann’s contracture

Question 13

Are sprains common in children?

Answer 13

No

Question 14

What is the weakest area of the physis?

Answer 14

Hypertrophic zone

Question 15

What is the tibial eminence? What are 4 types of fractures? How are they treated?

Answer 15

Bony attachment of ACL
Type 1 - non-displaced - immobilize in extension
Type 2 - intact posterior hinge - reduce, immobilize
Type 3 - completely displaced - ORIF
Type 4 - Completely displaced, rotated, comminuted - ORIF

Question 16

How are femur fractures treated in children <6 months, >6 months, or >11 years?

Answer 16

<6 months - Pavlik harness
6months-5years - spica casting
>11 years - flexible IM nails, antegrade nail, or ex-fix

Question 17

What are patella sleeve fractures? How are non-displaced treated? Displaced?

Answer 17

Cartilage sleeve separated from patella
Non-displaced - cast
Displaced - ORIF

Question 18

What lower leg fractures are common from bumper injuries? Children on slide with parents? How are they treated?

Answer 18

Tibia/fibula shaft fracture
Non-displaced spiral toddler fracture
Cast usually

Question 19

What type of Salter-Harris fracture is a triplane fracture? After x-rays, what must be ordered to evaluate it? How is it treated if displacement is greater than 2mm?

Answer 19

Salter-Harris IV
CT
ORIF if greater than 2mm displacement

Question 20

What area of long bones is most susceptible to osteomyelitis in children? What does it spread through? What is ordered to evaluate it?

Answer 20

Metaphysis of long bones
Spreads through Haversian canals
MRI w/ contrast

Question 21

What is the Kocher Criteria? What is it used to evaluate?

Answer 21

WBC >12000
Inability to bear weight
Fever > 101.3
ESR >40mm/h
Septic Hip in children

Question 22

What mimics septic hip in children? What is it related to? What lab value is different? Are children able to bear weight? How is it treated

Answer 22

Transient synovitis of hip
Related to viral infections
CRP<20
Able to bear weight, restricted abduction
NSAIDs and observation

Question 23

What three factors put you at greatest risk for development dysplasia of hip?

Answer 23

First-born, female, breech

Question 24

What is Hilgenreiner’s line? What is perkin’s line? What should be seen in the inferomedial quadrant? If not, what is this an indication for?

Answer 24

H - Through triradiate cartilage
P - Perpendicular to H at lateral edge of acetabulum
Epiphysis shoulder be seen in inferomedial quadrant
Developmental Dysplasia of hip

Question 25

What are the 5 timelines for treatment of development dysplasia?

Answer 25

<6 months - Pavlik harness 23 hrs per day 6-18 months - Closed reduction, spica casting 18months - 2 years - open reduction and spica casting 2-4 years - open reduction, femoral osteotomy 4+ years - open reduction, pelvic osteotomy

Question 26

What is Shenton's line? What is an abnormal finding? Indicative of?

Answer 26

Arc along medial femoral neck and superior margin of obturator foramen Discontinuous arc Developmental dysplasia of hip

Question 27

What is Legg-Calve-Perthe disease? How is usually treated? What is it associated with? If it is collapsed, how is it treated?

Answer 27

AVE of proximal femoral epiphysis Self-limiting Coagulopathy Operative

Question 28

What is the most common disorder affecting adolescent hips? Where is pain usually seen? What zone does it occur in? How does Klein's line help assess it? How is it treated?

Answer 28

Slipped Capital Femoral Epiphysis (SCFE) Knee Hypertrophic zone Tangent line of greater trochanter should go through epiphyseal head Percutaneous screw (in situ - w/o reduction)

Question 29

What tumor is Hemihypertrophy associated with? How is it monitored

Answer 29

Wilm's tumor - renal neuroblastoma (nephroblastoma) | Serial ultrasounds will 7

Question 30

Where is a popliteal cyst usually found?

Answer 30

Between semimembranosis and medial head of gastroc

Question 31

Is bipartite patella normal? How is it treated? If painful?

Answer 31

Yes Observation Excision

Question 32

What is Blout's disease? Who is at risk? How is it treated under 3 years? Over 3 years? What angle is used to assess severity?

Answer 32

Progressive genu varum - proximal tibial bowing Early walkers Bracing if under 3 years Surgery if over 3 years Drennan angle - >16 degrees - 95% change of progression, <10 degrees 95% chance of resolution

Question 33

What is the most common birth defect?

Answer 33

Club foot

Question 34

What is the Coleman block test? What is it used to evaluate?

Answer 34

Block under lateral foot will correct hindfoot varus if flexible Cavovarus (elevated arch)

Question 35

What is the difference between Kohler's, Iselin's, and Sever's disease? How are they treated?

Answer 35

Kohler's - AVN of navicular Iselin's - traction apophysitis of 5th metatarsal Sever's disease - overuse injury to calcaneal apophysitis Non-op, rest, NSAIDs

Question 36

What are the treatments for tarsal coalition and flexible pes planovalgus?

Answer 36

Tarsal coalition - observation, immobilization with casing, potential surgery Flexible pes planovalgus - non-op initially, surgery (achillese lengthening or calcaneal osteotomy) for causes that don't resolve

Question 37

What is the difference between Kohler's, Iselin's, and Sever's disease? How are they treated?

Answer 37

Kohler's - AVN of navicular

Question 38

Where is syndactyly of toes most common?

Answer 38

Between 2nd and 3rd toes

Question 39

What is the non-progressive upper motor neuron disease, onset prior to age 2?

Answer 39

Cerebral palsy