ortho/rheum (5%)

Question 1

what is the anatomic term for nursemaids elbow

Answer 1

radial head subluxation w annular ligament stretching

Question 2

what age is nursemaids elbow MC

Answer 2

2-5yo

Question 3

what is the MOI of nursemaids elbow

Answer 3

pulling of arm while it is pronated + extended

Question 4

presentation of nursemaids elbow

Answer 4

slightly flexed, usu no swelling

TTP of radial head

Question 5

tx of nursemaids elbow

Answer 5

reduce

Question 6

what happens in SCFE

Answer 6

femoral head slips posterior + inferior at growth plate

Question 7

what populations are most likely to have SCFE

Answer 7

obese
AA
puberty-age
growth-spurt

Question 8

what way is leg usu rotated in SCFE

Answer 8

external

Question 9

tx of SCFE

Answer 9

non-wt bearing crutches –> ORIF

Question 10

if pt gets SCFE before puberty, what should you check for

Answer 10

hormonal/systemic disorders

e.g. hypothyroidism

Question 11

what is osgood-schlatter disease

Answer 11

osteochondritis of patellar tendon @ tibial tuberosity

Question 12

what causes osgood-schlatter

Answer 12

overuse or small avulsions

Question 13

who MC gets osgood-schlatter

Answer 13

males
10-15yo
athletes w growth spurt

Question 14

presentation of osgood-schlatter

Answer 14

activity-related knee pain/swelling

painful lump below knee

Question 15

tx of osgood schlatter

Answer 15

RICE, NSAIDs, stretch quads

surgery if refractory

Question 16

in what population is scoliosis MC

Answer 16

8-10yo girls

Question 17

what is the definition of scoliosis

Answer 17

lateral curvature >10 degrees

Question 18

most sensitive test for scoliosis

Answer 18

adams forward bending test

Question 19

what is cobb’s angle

Answer 19

measured on AP/lateral films to dx scoliosis

Question 20

when should you brace scoliosis? surgery?

Answer 20

> 20, >40

Question 21

what is legg-calve-perthes dz

Answer 21

AVN of the proximal femur

Question 22

in what population is legg-calve-perthes MC

Answer 22

kids 4-10yo

boys

Question 23

presentation of legg-calve-perthes

Answer 23

painless limping for weeks that is worse w continued activity (end of day)
loss of abduction + internal rotation

Question 24

what do you see on XR in pt w legg-calve-perthes

Answer 24

early- inc density of femoral head, widening of cartilage space
advanced- deformity, crescent sign (microfxs w collapse of bone)

Question 25

tx of legg-calves-perthes

Answer 25

observe- self-limiting w revascularization w.i 2yrs | restrict activity- NWB w ortho follow up

Question 26

what is the MC bone malignancy

Answer 26

osteosarcoma

Question 27

what is the MC benign bone tumor

Answer 27

osteochondroma

Question 28

what populations are most affected by osteosarcoma

Answer 28

adolescents

Question 29

what are the most common met sites of osteosarcoma

Answer 29

lungs

Question 30

sx of osteosarcoma

Answer 30

bone pain, joint swelling, palpable soft tissue mass

Question 31

what do you see on XR of osteosarcoma

Answer 31

hair on end or sun ray/burst appearance on soft tissue mass mixed sclerotic lesions periosteal bone runs codmans triangle

Question 32

what is codmans triangle

Answer 32

ossification of raised periosteum

Question 33

what is tx for osteosarcoma

Answer 33

resect, radial amputation if neovascular, chemo PRN

Question 34

what type of tumor is ewing sarcoma

Answer 34

giant cell tumor

Question 35

who MC gets ewing sarcoma

Answer 35

males 5-25yo

Question 36

what are the MC sites of ewing sarcoma

Answer 36

femur + pelvis

Question 37

what is the MC site of mets of ewing sarcoma

Answer 37

bone

Question 38

presentation of ewing sarcoma

Answer 38

bone pain +/- palpable mass joint swelling fever

Question 39

what does ewing sarcoma look like on XR

Answer 39

lytic lesion, layered periosteal rxn (onion skin) | +/- codmans triangle

Question 40

tx of ewing sarcoma

Answer 40

chemo, surg, radiation

Question 41

what population MC gets osteochondroma

Answer 41

10-20yo males

Question 42

progression of osteochondroma

Answer 42

begins in childhood + grows to skeletal maturity

Question 43

what do you see on XR of osteochondroma

Answer 43

pedunculated, grows away from growth plate + involves medullary tissue

Question 44

tx of osteochondroma

Answer 44

observe, resect if painful or pelvis

Question 45

tx of juvenile rheumatoid arthritis

Answer 45

NSAIDs, corticosteroids methotrexate or leflunomide freq eye exams usu resolves by puberty

Question 46

how many joints are involved in pauci-articular JRA

Answer 46

<5 joints (MC large)

Question 47

what are the 2 types of pauci-articular JRA

Answer 47

type I: iridocyclitis (Anterior uveitis)- often asx but may cause blindness if not tx type II: inc incidence of ankylosing spondylitis

Question 48

how does systemic/acute febrile JRA present and what is the other name for it

Answer 48

stills disease arthritis (small + large), diurnal high fever salmon/pink migratory rash hepatosplenomegaly, hepatitis LAD, serositis (pleural + pericardial effusions)

Question 49

how does polyarticular JRA present

Answer 49

5+ small joints, iridocyclitis +/- low grade fever

Question 50

which type of JRA is most like adult RA

Answer 50

polyarticular