Orthopedics

Question 1

What is a Nursemaid’s Elbow

Answer 1

Dislocation or subluxation of radial head

Question 2

What causes a Nursemaid’s Elbow

Answer 2

Sudden pull on an extended and pronated forearm, swinging a kid

Question 3

Tx for Nursemaid’s Elbow

Answer 3

Reduction by pulling down on proximal radial head and supinating wrist

Question 4

What is Slipped Capital Femoral Epiphysis

Answer 4

Fracture through the growth plate that results in slippage of overlying end of femur (epiphysis)

Question 5

Who is more likely to get SCFE

Answer 5

Obese, Black/Latino Boys 14-16yrs old

Question 6

Sx of SCFE

Answer 6

Hip pain or limping
Referred pain to thigh or knee
Walks with hip abducted and externally rotated
Limited internal rotation

Question 7

Dx of SCFE

Answer 7

Hip Xray in frog leg view
Shows widening of epiphyseal plate
Displacement of femoral head

Question 8

Tx of SCFE

Answer 8

Emergency
No weight bearing
Can lead to avascular necrosis
Spica hip cast for 6-8wks

Question 9

What is Legg-Calve-Perthes Disease

Answer 9

Avascular necrosis of femoral head

Question 10

Who is more likely to get Legg-Calve-Perthes

Answer 10

Bosy 4-8 years old

Question 11

Sx of Legg-Calve-Perthes Disease

Answer 11

Walks with a limp
Leg length discrepancy
Limited hip ROM
Gradual onset of pain

Question 12

Dx of Legg-Calve-Perthes Disease

Answer 12

Hip Xray first, but Hip MRI is preferred

Question 13

Tx of Legg-Calve-Perthes Disease

Answer 13

Orthopedic referral

Question 14

What is Osgood Shlatter Disease

Answer 14

Osteochondritis of patellar tendon at tibial tuberosity from overuse or small avulsion

Question 15

Sx of Osgood Shlatter Disease

Answer 15

Activity related knee pain/swelling

Lump below the knee

Question 16

Dx of Osgood Schlatter Disease

Answer 16

Xray shows prominence or ossification at tibial tuberosity

Question 17

Tx of Osgood Schlatter Disease

Answer 17

RICE, NSAIDS, quads stretching

Surgery only if growth plate is closed

Question 18

What is scoliosis

Answer 18

When the spine has lateral curvature greater than 10 degrees with vertebral rotation

Question 19

When should screening for scoliosis start

Answer 19

6 yrs old with Adam’s forward bending

Measure Cobb Angle via Xray

Question 20

Tx for Scoliosis

Answer 20

Bracing if 20-40 degrees

Observation if 40 degrees

Question 21

What is Congenital Hip Dysplasia

Answer 21

When the femoral head is not properly aligned with the acetabulum

Question 22

How can you screen for congenital hip dysplasia

Answer 22

Barlow Maneuver: Dislocation with posterior pressure on adducted hips
Ortolani Maneuver: Dislocation with anterior pressure on abducted hips

Question 23

What is the risk with Congenital Hip Dysplasia

Answer 23

Can lead to abnormal growth and permanent instability

Question 24

What type of neoplasm is Osteosarcoma

Answer 24

Most common malignant

Question 25

What age does Osteosarcoma peak

Answer 25

2 peaks: before 20yrs, after 50yrs

Question 26

Sx of Osteosarcoma

Answer 26

Pain, joint swelling, palpable soft tissue mass

Question 27

Dx of Osteosarcoma

Answer 27

Xray - Hair on end

Question 28

Tx of Osteosarcoma

Answer 28

Resection or amputation | Chemo as adjuvant

Question 29

What type of neoplasm is Ewing's Sarcoma

Answer 29

Malignant | Giant Cell Tumor

Question 30

Sx of Ewing's Sarcoma

Answer 30

Bone pain, palpable mass, joing swelling, fever

Question 31

Dx of Ewing's Sarcoma

Answer 31

Onion Peel, Lytic lesions

Question 32

Tx of Ewing's Sarcoma

Answer 32

Chemo, surgery, radiation

Question 33

What type of neoplasm is Osteochondroma

Answer 33

Most common benign

Question 34

Dx of Osteochondroma

Answer 34

Xray, pedunculated, grows away from growth plate

Question 35

Tx of Osteochondroma

Answer 35

Observation | Resection if sx

Question 36

What type of neoplasm is Paget's Disease

Answer 36

Benign | Abnormal bone remodeling

Question 37

What is Juvenile Rheumatoid Arthritis

Answer 37

Autoimmune mono or polyarthritis in children under 16yrs

Question 38

What are 3 types of Juvenile Rheumatoid Arthritis

Answer 38

Pauci-Articular: Oligoarticular Systemic: Acute fever, JIA, daily arthritis Salmon colored migratory rash Polyarticular: At least 5 small joints affected, increased risk of iridocyclitis (eyes)

Question 39

Tx for Juvenile Rheumatoid Arthritis

Answer 39

NSAIDS, Corticosteroids, Methotrexate, Eye Exams

Question 40

**How do you tx Scoliosis**

Answer 40

Observation for most Bracing if 20-40 degrees Surgery if >40 degrees

Question 41

**Dx for Avascular Necrosis**

Answer 41

Hip Xray is initial study: results depend on progression of disease Normal joint space widened to stress fracture to epiphyseal fragmentation to bony destruction Hip MRI is preferred