Orthopedics

Question 1

A clunk or click of the hips (with barlow and ortolani movements) on a newborn exam is a sign of?

Answer 1

Developmental dysplasia of the hips

Question 2

What is DDH more common in female newborns?

Answer 2

estrogen causes increased laxity of the hips

Question 3

How and when do you diagnose DDH?

Answer 3

4-6 weeks with ultrasound of the hips

Question 4

The treatment for DDH?

Answer 4

Pavlik harness

Question 5

A 6-year-old child is in the ER with sudden onset of knee pain and limping. On exam the child is laying with the hip in a adducted and external rotation position. He does not have a fever and his WBC is normal. What is your diagnosis? What should you do to confirm?

Answer 5

Legg-Calve-Perthe Disease

X-ray for confirmation and cast

Question 6

What two populations of children are at the greatest risk for a slipped capital femoral epiphysis?

Answer 6

Obese adolescents or those in the midst of a growth spurt.

Question 7

What condition is associated with SCFE?

Answer 7

hypothyroidism

Question 8

What criteria should you use when evaluating a child with a possible septic hip?

Answer 8

Kocher Criteria:

• non-weight bearing
• ESR >40
• Fever
• WBC >12,000

Question 9

Where is the swelling and pain in Osgood-Schlatter Disease?

Answer 9

Over the tibial tubercle

Question 10

Having an adolescent bend forward to assess their spine for scoliosis is known as?

Answer 10

Adams test

Question 11

A fracture in a child that involves the growth plate will need?

Answer 11

open reduction, internal fixation

Question 12

If a supracondylar humerus fracture occurs a child, proximal to the brachial artery, what is the biggest concern?

Answer 12

Compartment syndrome

Question 13

A 15-year-old comes to your clinic for evaluation of right leg pain and limping. He is complaining of pain in his thigh. Upon further questioning you find that he has also lost ten pounds in the last 3 months. concerned you get an x-ray and blood work. The x-ray is concerning for Ewing Sarcoma. What was most likely on the x-ray?

Answer 13

A lytic bone lesions with an “onion-skinning” periosteal reaction

Question 14

What is the most likely underlying genetic cause of ewing sarcoma?

Answer 14

11;22 translocation

Question 15

A lytic bone lesion with a “sunburst” pattern on x-ray is characteristic of? Where are these lesions usually found?

Answer 15

Osteosarcoma

Metaphyses of long bones

Question 16

What lab abnormality is common in osteosarcoma?

Answer 16

Elevated ALP

Question 17

What other imaging would be necessary in a child with a diagnosis of osteosarcoma?

Answer 17

Chest x-ray for metastasis

Question 18

How can you distinguish between transient synovitis and septic hip?

Answer 18

Septic hip occurs during the febrile illness, where transient synovitis tends to occur after the viral illness