Pestana2 Ortho (Peds, Back pain)

Question 1

Two most common primary malignant bone tumors in pediatric patients

Answer 1

• Osteogenic sarcoma (mc)

- Ewing’s sarcoma

Question 2

Osteogenic sarcoma (age, location, xray)

Answer 2

• 10-25yo
• Around knee (lower femur/upper tibia)
• “Sunburst” pattern

Question 3

Ewing sarcoma (age, location, xray)

Answer 3

• 5-15yo
• Diaphyses of long bones
• “Onion skinning”

Question 4

Common sx w/ primary malignant bone tumor

Answer 4

Persistent low-grade pain

Question 5

Two types of fractures in pediatric pts that can cause problems

Answer 5

• Supracondylar fractures of the humerus

- Fractures that involve the growth plate

Question 6

Bone remodeling after frx in pediatric pts (2 advantages)

Answer 6

• Wider degree of acceptable angulations after reduction

- Faster healing

Question 7

Supracondylar frx’s of humerus (injury)

Answer 7

Hyperextension of elbow 2/2 fall on hand w/ outstretched arm

Question 8

Supracondylar frx’s of humerus (complication x2)

Answer 8

• Vascular/nerve injury (can lead to Volkmann contracture)

- Compartment syndrome

Question 9

Supracondylar frx’s of humerus (mgmt)

Answer 9

Casting/traction

Question 10

Fractures that involve the growth plate (mgmt x2 based on mechanism)

Answer 10

• Closed reduction: epiphysis+growth plate are in the same piece; frx doesn’t cross epiphysis or growth plate; frx doesn’t involve joint
• Open reduction, internal fixation: growth plate is in 2 pieces

Question 11

Soliosis (demographic and abnormality)

Answer 11

• Adolescent girls

- Thoracic spine curves to the right

Question 12

Scoliosis (dx and tx)

Answer 12

• Inspect from behind as she bends down: hump over r.thorax

- Bracing; surgery

Question 13

Club foot (aka, demographic)

Answer 13

• Talipes equinovarus

- At birth

Question 14

Club foot (abnormalities x5)

Answer 14

• Both feet turned inward
• Plantar flexion of ankle
• Inversion of foot
• Adduction of forefoot
• Internal rotation of tibia

Question 15

Club foot (mgmt)

Answer 15

• Serial plaster casts from neonatal period (50%)

- Surgery: > 6-8mo, <1-2yrs (50%)

Question 16

Osgood-Schlatter disease (aka, demographic)

Answer 16

• Osteochondrosis of the tibial tubercle

- Teenagers

Question 17

Osgood-Schlatter disease (sx)

Answer 17

• Pain over tibial tubercle, aggravated by quadricep contraction
• No swelling

Question 18

Osgood-Schlatter disease (mgmt)

Answer 18

• Conservative (ice, rest, compression, elevation), then:
• Immobilization of the knee in an extension, or
• Cylinder casts for 4-6wks

Question 19

Genu x2 by age

Answer 19

• Genu varum (bow-legs): NL up to 3yo

- Genu valgus (knock-knee): NL 4-8yo

Question 20

Persistent varus (dx)

Answer 20

• After age 3

- Blount disease (disturbance of medial proximal tibial growth plate)

Question 21

Acute hematogenous osteomyelitis (sxs 2, dx, tx)

Answer 21

• Fever; Severe localized pain
• MRI
• ABXs

Question 22

Hip pathology (sx localization)

Answer 22

Pain maybe in hip or knee

Question 23

Hip disorders (x4)

Answer 23

• Developmental dysplasia of the hip
• Legg-Perthes disease
• Slipped capital femoral epiphysis
• Septic hip

Question 24

Developmental dysplasia of the hip (demographic, sxs 2)

Answer 24

• Dx’d at birth
• Uneven gluteal folds
• Hips easily dislocated posteriorly with a “click” and returned with a “snap”

Question 25

Developmental dysplasia of the hip (dx)

Answer 25

Sono

Question 26

Developmental dysplasia of the hip (mgmt)

Answer 26

Abduction splinting w/ Pavlik harness (6mo)

Question 27

Legg-Perthes disease (aka, demographic)

Answer 27

- AVN of the capital femoral epiphysis) | - 6yo

Question 28

Legg-Perthes disease (sxs 5)

Answer 28

- Hip/knee pain - Limping - Antalgic gait - Decreased hip motion - Guarded passive motion of hip

Question 29

Legg-Perthes disease (dx)

Answer 29

AP/lateral XRAY

Question 30

Legg-Perthes disease (tx)

Answer 30

Contain femoral head w/in acetabulum by casting and crutches

Question 31

Slipped capital femoral epiphysis (demographic)

Answer 31

-Chubby 13yo boy

Question 32

Slipped capital femoral epiphysis (sxs 5)

Answer 32

- Groin/knee pain - Limping - Sole of dangling affected foot points toward other foot - Limited hip motion - As hip is flexed, thigh goes into external rotation+cannot be internally rotated

Question 33

Slipped capital femoral epiphysis (dx, tx)

Answer 33

- XRAY | - Pins

Question 34

Septic hip (demographic)

Answer 34

-Toddlers

Question 35

Septic hip (sxs)

Answer 35

- Fever - Decreased hip motion - Hip flexed in slight abduction and external rotation - Guarded passive motion

Question 36

Septic hip (dx 2)

Answer 36

- Elevated ESR | - Dx: Aspiration of hip

Question 37

Disk herniation (mc locations)

Answer 37

L4-L5 | L5-S1

Question 38

Disk herniations (types of pain)

Answer 38

Discogenic pain followed by neurogenic pain

Question 39

Discogenic vs. Neurogenic Pain

Answer 39

- Discogenic: vague, aching pain (ant.spinal ligament) | - Neurogenic: extremely severe, electric pain, exacerbated by coughing, sneezing, or defecating

Question 40

Disk herniations (sxs 3)

Answer 40

- positive straight leg-raising test - cannot ambulate - hold affected leg flexed

Question 41

Disk herniations (dx)

Answer 41

MRI

Question 42

Disk herniations (mgmt)

Answer 42

- Pain control, bed rest - Surgical w/ progressive neurological deficits: weakness - Immediate decompression w/ cauda equina syndrome

Question 43

Cuada equina syndrome

Answer 43

- Bladder incontinence - Flaccid rectal sphincter - Perineal saddle anesthesia

Question 44

Ankylosing spondylitis (demographic)

Answer 44

- Young men in their 30s, 40s | - HLA-B27

Question 45

Ankylosing spondylitis (presentation x2)

Answer 45

- Chronic back pain w/ morning stiffness | - Worse at rest, improves w/ activity

Question 46

Ankylosing spondylitis (dx)

Answer 46

XRAY: bamboo spine

Question 47

Ankylosing spondylitis (mgmt)

Answer 47

- Anti-inflammatory agents | - PT

Question 48

Metastatic malignancy to vertebrae (demographic)

Answer 48

Elderly

Question 49

Metastatic malignancy to vertebrae (presentation x4)

Answer 49

- Progressive back pain - Worse at nt - Unrelieved by rest or positional changes - Wt loss

Question 50

Metastatic malignancy to vertebrae (dx)

Answer 50

XRAY: lytic breast cancer (women); blastic prostate cancer (men) MRI: best dx'c tool