Peds

Question 1

Developmental dysplasia of the hip

Answer 1

found at newborn exam by Ortolani and Barlow maneuvers, ‘clicks’; come back at 4wks and if still there, get US and see dysplasia; treat with harness

Question 2

Legg-Calve-Perthes disease

Answer 2

~6(4-10)yo; avascular necrosis of hip, insidious onset; cast it or surgery

Question 3

Slipped capital femoral epiphysis

Answer 3

13yo growth spurt or fat; non-traumatic joint pain. Get frog leg xray and do surgery

Question 4

Septic joint

Answer 4

can be in any age kid who presents septic, do arthrocentesis and see >50k WBC, drain + abx

Question 5

Transient synovitis

Answer 5

hip pain after viral illness (not reactive arthritis but similar), can be so bad they can’t bear weight
supportive care and anti-inflammatories, should resolve in 2d

Question 6

Kocher criteria

Answer 6

fever, leukocytosis, inc ESR, inc CRP, no weight bearing

The more are met, the more likely infectious –> arthro

Question 7

Osgood Schlatters disease

Answer 7

aka osteochondrosis; presents in teen athlete as knee pain and tibial swelling, +/- pinpoint pain on tibia
Tx: stop sports, or get palpable nodule on tibia

Question 8

Scoliosis

Answer 8

presents as teen girl, usually bends to the right; if severe may present with dyspnea; get Xray.
Bracing will slow progression, surgery with rods with reverse disease

Question 9

Ewings vs Osteosarcoma

Answer 9

Ewings = t(11,22), mid-shaft, onion skin

Osteo = RB gene, distal femur, sunburst pattern

Both present with focal atraumatic bone pain, get XR then FU MRI; bx –> then resection

Question 10

Fractures - cast vs surgery?

Answer 10

Surgery if: open, comminuted, or involves growth plate

Cast: ok if none of the above

Question 11

Salter-Harris classifications

Answer 11

I - S: straight across GP
II - A: above GP
III - L: lower than GP
IV - T: through/two-sided GP
V - R: cRushed GP

Question 12

What to do about a boy with gynecomastia?

Answer 12

First do physical exam, esp. looking for hypogonadism.
If NL PE:
– if during puberty - nothing; likely resolve w/in 1yr
– outside puberty - lab evaluation of liver, thyroid, and kidneys
*Only progressive enlargement gets sex hormone work-up

Question 13

Clinical picture of pyloric stenosis

Answer 13

baby with vomiting and weight loss which presents within first 7wks; may or may not have the palpable olive-mass but will have distended abdomen

Question 14

CGD

Answer 14

Chronic granulomatous disease (XLR): problem with NT function

• recurrent skin and pulm infections, esp catalase+ bugs like Serratia, Burkholderia, S. aureus
• dx with dihydrorhodamine or nitroblue tetrazolium test

Question 15

Types of bone cancer in children

Answer 15

Osteoid osteoma: improves with pain meds, sunburst pattern

Ewing sarcoma: pain and deformity for weeks, onion skinning layers of subperiosteal bone formation

Osteosarcoma: chronic localized pain with a palpable mass, Codman triangle

Question 16

Baby with BL cataracts, FTT, jaundice, and hypoglycemia probably has…

Answer 16

galactosemia, which is a deficiency of galactose-1-phosphate uridyl transferase
*Galactokinase deficiency presents with cataracts ONLY