Peadiatrics

Question 1

What factors are associated with outcomes of a distal femoral fracture

Answer 1

SH classification
presence of displacement
open fracture
presence of hardware across the physis

direction of displacement is not associated with outcome

Question 2

Findings of osteopetrosis

Answer 2

Inability to acidify the howship lacunae
AR not compatible with life
AD compatible with life

Rugger jersey spine
multiple fractures
coxa vera (stress fractures)
deafness
blindness 
anemia
frequent infections

Question 3

Radiographic indicators of both bone forearm fractures following reduction

Answer 3

On AP biceps and radial styloid are 180 degrees apart

On Lateral ulnar styloid and coronoid are 180 degrees apart

Question 4

Complications and concerns following transphyseal distal humerus injury

Answer 4

posteromedial displacement
child abuse

closed reduction and splinting
pin if very displaced

Varus
medial condyle AVN
(no risk of tardy ulnar nerve palsy)

Question 5

Phenotype of diastropic dysplasia

Answer 5

defect in sulphate transporter affecting cartilage

cauliflower ear
hitchikers thumb
symphangalisism
kyphosis c-spine

Question 6

Fracture associated with highest morbidity and mortality

Answer 6

spine

Question 7

Acceptable angulation of a radial neck fracture

Answer 7

30 degrees
begin ROM early to prevent stiffness

Percutaneous pinning
Open reduction - associated with stiffness and increased risk of AVN

Question 8

Reduction technique for radial neck fracture

Answer 8

Patterson - extension and supnation
Isralei - flexion and pronation
Compression bandage

K-wire joystick
Metaizeau - retrograde nail across fracture

Question 9

complications of radial neck fracture

Answer 9

stiffness (loss of pronation)
radial head ON
synostosis (open, delayed)
radial head overgrowth (40%)

Question 10

Multifocal mycobacterial infection

Answer 10

Polyarthrosis swelling
elevated ESR
from foreign place

spine (50%), large joints, long bones
subchondral erosions with diffuse osetopenia

treatement with Abx
Surgery for residual constitutional sx

Question 11

Best predictors of septic hip

Answer 11

Fever
CRP
ESR
Refusal to bear weight
WBC

In that order

Question 12

Bones with intra-articular metaphyses

Answer 12

shoulder
elbow
hip
ankle

Question 13

Indications for surgical treatment of proximal humerus fracture

Answer 13

usually can be treated nonoperativley because of ability to heal and remodel

open
NV
> 45 degrees

Question 14

Drop in BP intraop myelomeningocele

Answer 14

latex allergy

IGE mediated

Question 15

Risk factors for spina bifida

Answer 15

DM2
maternal hyperthermia
valproic acid
folate deficiency

10% have chromosomal abnormality

Question 16

Level of myelomeningocele at risk for hip dislocation

Answer 16

L3-4
(level is the lowest functioning level)
usually confined to wheelchair

L5 is more normal functioning

Question 17

Procedure to correct calcaneus heel in L5 level

Answer 17

posterior transfer of tib ant

Question 18

Larsen syndrome

Answer 18

hyperlaxity, presents with multiple dislocations

at risk for cervical kyphosis

Question 19

Scoliosis with no curve and assymetric abdominal reflex

Answer 19

syrinx

Question 20

most common cause of malignant back pain

Answer 20

leukemia

Question 21

lower extremity growth

Answer 21

Proximal femur - 3mm
Distal Femur - 9mm
Proximal tibia - 6mm

Question 22

what is the teardrop comprised of

Answer 22

quadrilateral surface
cotyloid fossa

normal hip at 18 months
usually not there in untreated DDH

Question 23

Side of congential pseudoarthrosis

Answer 23

Right middle

Cosmesis or function at 3-6 years old
Iliac crest graft with ORIF

Question 24

Factor most associated with loss of reduction of forearm fractures

Answer 24

Cast index > 0.85

Question 25

Acceptable reduction forearm fracture

Answer 25

9yo - 10 deg, 30 deg rotation, 1 cm bayonette

Question 26

What is the most common cause of physical disability in child abuse

Answer 26

head injury

Question 27

most common age of child abuse

Question 28

acceptable alignment of distal radius fracture

Answer 28

> 10 yo - 20 deg ang, 30 deg rotation closed reduction initially if inadequate or reduction lost then do closed reduction with pinning

Question 29

Disease associated with olecranon fracture

Answer 29

OI

Question 30

What is the most common complication requiring intervention following hip spica treatment for femoral shaft fractures

Answer 30

loss of reduction

Question 31

Treatment of anterolateral bowing associated with neurofibromatosis

Answer 31

bracing If fracture then IM device (growing rod)

Question 32

Gauchers mutations

Answer 32

glucocerbridase

Question 33

fibrous dysplasia mutation

Answer 33

cAMP

Question 34

SLC6A2A sulphate transporter

Answer 34

diatrophic dysplasia

Question 35

Morqoio

Answer 35

keratin sulphate proportionate dwarfism normal intellegence odontoid hypoplasia

Question 36

Hurlers

Answer 36

C1-2 instability

Question 37

Hunters

Answer 37

X-linked recessive metal retardation clear corneas

Question 38

diatrophic dysplasia

Answer 38

cervical kyphosis cauliflower ears hitchhikers thumb

Question 39

indications for physeal bar resection

Answer 39

20% will require osteotomy as they are unlikley to correct

Question 40

superior lens dislocation

Answer 40

marfans

Question 41

inferior lens dislocation

Answer 41

homocystinuria

Question 42

dolichostenomelia

Answer 42

long limbs associated with marfans

Question 43

SCFE associations

Answer 43

left hip males hip pain (not knee pain)

Question 44

best radiograph for lateral epicondyle

Answer 44

internal oblique

Question 45

long term consequences of brachial plexus palsy

Answer 45

glenohumeral dysplasia - due to internal rotation contracture (70%) elbow contracture - due to overdrive of the biceps

Question 46

prognosis of brachial plexus palsy

Answer 46

90% recover with early PT Good - erbs, biceps activity ``` Poor: lack of biceps by 3 months preganglionic injuries (elevated hemi, rhomboid dys) horners C5-7 klupkes ```

Question 47

Erbs

Answer 47

C5-6 - most common waiter's tip Axillary/SS - absent deltoid, teres minor, SS, IS MC - biceps, BR intact wrist and hand

Question 48

Klumpke

Answer 48

C8-T1 - poor prognosis Median and ulnar nerve - claw hand often associated with horners

Question 49

Early brachial plexus treatment

Answer 49

Nerve graft - flail arm at 1 month - horners at 1 month - no biceps by 3 months Nerve transfer - root avulsion at 3 months

Question 50

Late surgery for brachial plexus

Answer 50

Glenohumeral dislocation - ORIF with capsuloraphy - proximal humerus osteotomy (no glenoid) Glenohumeral dysplasia - lat dorsi transfer - persistant ER with mild dyplasia - pec major - 5yo

Question 51

SMN-1

Answer 51

spinal motor dystrophy

Question 52

PMP 22

Answer 52

CMT

Question 53

myelomeningocele hip dislocation

Answer 53

observe | highest risk in L3

Question 54

most common foot deformity with spina bifida

Answer 54

clubfoot