20- 5 year-old kid with osteomyelitis of the tibia. Comes from community with high prevalence of MRSA. Best empiric antibiotic?
C)
35- All are true except regarding congenital pseudarthrosis of the clavicle?
B) edges of pseudoarthrosis are hyaline cartilage
37- What is a positive prognostic factor when doing a varus proximal femur osteotomy for containment in LCP?
A)
the question refers to indications for surgical intervention in LCP
52- Most common complication of resecting the radial head in congenital radial head dislocation in a skeletally immature patient?
B)
79- What is true about growth modulation in adolescent Blount’s?
D)
Risk factors failure
BMI >45 risk factor
Age >14 risk factor
85- All are true about PAO in adults with dysplasia, except?
C)
Others are true
86- All true about steroids in Duchenne, except?
A)
Positive effects of steroids
Improves strenght
Slows down weakening
Prevents scoliosis
Prolongs ambulation
Delays deterioraton of pulmonary function
92- All true regarding neurofibromatosis EXCEPT?
D)
94- Regarding C1-C2 instability in Down’s, all true except?
B)
97- Which is best assessment for CP Hip?
B)
103 – Question about tibial spine fractures in kids. All true except ?
C)
ACL laxity present 10-20% but not often clinically significant
109- 12-month old baby with tibial hemimelia, no tibia seen on xray, dysplastic distal femur, extensor mechanism not working. What is the next step?
B)
Indications for knee disarticulation and prosthetic fitting
-
Complete absence of the tibia
-Absent extensor mechanism
111- Kid refusing to weight bear, ESR 50, WBC 14, Temp 37.8°. What is the probability of septic hip?
D)
CriteriaWBC > 12000
Unable to weight bear
Fever > 38.5
ESR> 40
Probability
0: 0.2%
1: 3%
2: 40%
3: 93%
4: 99%
114- Question about congenital vertical talus, what is true?
a) Cast is an indicated treatment in both idiopathic and syndromic etiologies
b) You should do staged release
A)
For stretching of dorsolateral soft tissues
120- All are seen in Marfan except?
D)
Pediatric gymnast presents with chronic activity related wrist pain. Which of the following would you expect to see
D)
Repeated impaction leads to damage to distal radius growth plate >>ulnar overgrowth +ve ulnar variance
Xray finding: +ve ulnar variance and widened distal radius physis
Best predictor for failure of distal BBFF
D)
Cast index needs to be <0.8
Which congenital anomaly does not have C1-C2 instability? REPEAT
D)
Achondroplasia have foramen magnum stenosis + short pedicles
Pseudoachondroplasia also has C1-2 instability
What is a negative prognostic factor when doing a varus proximal femur osteotomy for containment in LCP? Which is not a surgical indication?
E)
if question is who would not benefit from VDRO
Fishtail deformity what is false? (Repeat)
E)
Fishtail deformity is deepening of the intercondylar groove of distal humerus
A: usually seen with condyle fractures commonly but also possible in SCH#
B: True > Only middle of trochlea affected
D: False > not related o arthritis
In assessing a patient with LLD and a concomitant knee flexion contracture, what is the optimal method to assess the true LLD?
B)
A: is apparent LLD
Which of the following is true for patients with sickle cell?
A)
Low oxygen tension causes sickling
c sounds true: diffeentiate using bone scan (abnormal in bone infarct)
They have more infections
Hemoglobin denatures with low PO2
Which of the following is not a cause of congenital short metacarpal? Repeat
B)
A: short metacarpal in all hypopit situations
B: Acrosyndactyly is syndactyly with fenestration proximally to distal fusion site >>> characteristic of constriction ring syndrome
C: True
D: True due to bone infarct
What is the last bone to ossify? REPEAT
B)
Patient is 11yo and 54 kg and he suffers a femur fracture. What is the optimal fixation method?
E)
What is the mechanism of action of botox REPEAT
B)
competitive inhibitor of presynaptic cholinergic receptors with a finite lifetime (usually lasts 2-3 months)
What is true regarding paediatric scaphoid fractures? REPEAT
B)
In a patient with a pediatric brachial plexus injury, all of the following are true except: REPEAT
D)
Surgery at 3-6 months: nerve transfer
Question on arthrogryposis findings, which is not true? REPEAT
A)
Not progressive
All of the following are true regarding Gadolinium MRI of the spine except? (REPEAT 2010)
A)
What is a possible source of compartment syndrome when fixing pediatric tibial tubercle fractures? REPEAT
a) recurrent posterior tibial artery
b) recurrent anterior tibial artery
B)
You have a patient with spondyloepiphyseal dysplasia who needs an operation, what is an important consideration preop?
B)
SED Spine:
Atlantoxial instability
Kyphoscoliosis
Lumbar platyspondyly
Excessive lumbar lordosis
End plate irregularities
All of the following are true about mucopolysaccaridosis except? (2013 CALGARY REPEAT)
C)
Duchenne get pseudohypertophy
San filipo and Morquio most common
Peak height velocity is seen with what finding REPEAT
C)
122. Pediatric patient 3-4 weeks post Salter innominate osteotomy presents with 30° abduction contracture, what is the plan? REPEAT
B)
What is true regarding a paediatric/birth brachial plexus injury?
A)
Horners: Lower plexus injury
Phrenic nerve palsy: Usually preganglionic
A 16 month old healthy boy presents to your clinic with bowlegs. He ambulates appropriate for age, and is in the 60th percentile for his height and weight. You are shown an x-ray with varus knees, no abnormalities other than perhaps very slight beaking, metaphyseal-diaphyseal angle is measured and given to you at 12 degrees. What should you do?
A)
MD angle: <9 no blounts
>16: blounts likely needing surgery
Following SCFE fixation, which of the following may be associated with screw impingement on the acetabular rim?
A)
If startpoint lateral to IT line > unlikely to impinge
Which of the following most closely correlates with peak growth velocity?
B)
What is true regarding unicameral (simple) bone cysts?
A)
A:methylprednisone superior to bone marrow
All are true regarding Madelung’s deformity EXCEPT?
B)
Disruption is volar ulnar
All true regarding neurofibromatosis EXCEPT?
D)
Inheritance is autosomal Dominant
Regarding a Syme amputation, all are true EXCEPT?
B)
shoe lift on contralateral side
Posterior heel pad migration: common but doesnt affect fct
Requirement for syme: viable posterior flap and heel pad
Regarding bisphosphonate use in the pediatric population, all are true EXCEPT?
D)
possible but more in Adults
The rest are true
All are true regarding tarsal coalitions EXCEPT?
B)
CT is best for assesing cross sectional size
All are associated with radial clubhand EXCEPT?
A)
A: associated with TAR(thrombocytopenia absent radius)
B:Vacterl
C: Rasial longitudinal deficiency
D: wrong bc associated with elbow STIFFNESS
All of the following are indicated in the management of a unilateral congenital knee dislocation in a newborn EXCEPT?
A)
can do pavlik only once knee flexion improves
a: 70-100% dislocated hip
b: Initial mgmt
d: at age 6 months > open reduction + quad lenghtening
When treating a patient with juvenile idiopathic oligoarthritis, after X-rays, what is the next step in evaluation
B)
> associated uveitis > poor prognosis
Pre or: get flex ext + ask to open mouth to ensure TMJ not stiff for intubation
14 y.o. male with new onset cavus foot, and 1st mt in pronation- corrects with coleman block. What to do now?
A)
1st WT dorsiflexion osteotomy
Flexible: soft tissue + getting rid of tripod
d: soft tissue transfer are p longus > previs + Tib post to middle cuneiform
What is best assessment of Peak Height Velocity? Repeat from other years!
C)
DIP closure hand: risser stage?
1
Appearance of olecranon when triradiate closing
Quadrangular
Peak velocity at which risser stage
0
All are true regarding NF and scoli except
A)
most are not dystrophic
Which of the following don’t you do in a kid with S2 to S4 Myelomeningocele?
A)
never do redirectional osteotomy in Neuromuscular cases
Which is true of atraumatic sternoclavicular joint issues
D)
Freidrichs disease: aseptic necrosis sternal end of clavicle
Atraumatic SC joint dislocation and uveitis: think
Seronegative spondylarthritis
Young guy with SC joint pain, acne and pustules on palms, what is it? Halifax: 28 year old man with insidious onset pain sternoclavicular pain and prominence. Also noted to have severe acne, pustular lesions on the palm of hands. The most likely diagnosis:
A)
this is the classic presentation
Young kid with Type III supracondylar fx. Reduced.
B)
What is major concern when addressing brach plexus palsy? What should you try to help with first something like that was wording?
D)
In general should do PT to maintain ROm of all joints
All of the following are false re: obstetrical brach plexus palsy, except? Which one is true regarding peds brachial plexus? Think this was repeat but worded diff?
A)
90% resolve
Most common erbs: C5-6
All of the following osteotomies will cover the femoral head with articular (hyaline) cartilage, except?
C)
All of the following are true re: SCFE, EXCEPT?
A)
All of the following are risk factors for patellar dislocation, except?
D)
External tibial torsion is the one that is part of miserable malalignment
Which portion of patella most commonly injures after patelar dislocation
Medial articular facet
List the order of the physis from metaphysis to epiphysis?
B)
Picture of patient with FD of the Left Hip and whole femur was a Shepard crook deformity.
What graft do you use to fix this problem?
C)
Autologous cancellous graft resorbed and replaced by FD
Also use IM device for FD
Downs syndrome all true except?
A)
Also have subaxial and occiput-c1 instability
2 indications to do c1-2 fusion in downs
Symptomatic: loss fine motor or change in motor milestones
ADI>10mm
2 y.o. infant idiopathic scoli- all of the following are true EXCEPT?
D) RVAD > 20 likely to PROGRESS (80%)
c: 75% regress
Infantile scoli 2 indications for casting and bracing
Cobb< 25
RVAD <20
Deformity pattern infantile scoli
Left thoracic: 90%
Which of the following dysplasia does not have C1 C2 instability.
A)
Kid with Downs. What is most appropriate?
D)
from consensus
Missed hip dislocation in kid. You see him at 5 years old. What you do?
B)
Which is best assessment for CP Hip?
B)
4yo M with lateral condyle fracture non displaced what is your management?
A)
All muscles are transferred for elbow flexion in arthrogryposis except?
B)
Steinder flexorplasty: transfer muscles from medial epicondyle more proximally to increase elbow flexion
Pec major done in conjunction with tendon allograft
In a pediatic proximal humerus fracture, which of the following structure is most likely to be a block to reduction?
B)
14 year-old girl with proximal humerus fracture. It is 60% translated and 45 degrees angulated. What is the best treatment option?
B)
12 year old male with Duchenne’s presents with thoracolumbar curve of 35 degrees and pelvic obliquity of 15 degrees. His FEV is 55%. He is able to assist with transfer to and from his wheelchair. Which of the following should be included in his care?
C)
What is the Cobb at which you should do surgery on Duchenne’s patients? Why?
20-30 degrees
preserve pulmonary function
Last epiphysis to fuse in human body
D)
Pediatric patient with midshaft femoral fracture. You plan to do retrograde femur elastic nailing. What % of the canal at the isthmus should you fill with your elastic nails?
B)
An 8 year-old girl presents to your clinic 4 months after a BBFF. Still complains of pain in her forearm. You are shown an xray with an atrophic nonunion. What is the most likely finding on physical exam?
C)
neurofibromatosis > Pseudoarthrosis
14 yo boy AIS post posterior spinal fusion and instrumentation. All blood loss meticulously replaced by anesthetist intraop. Has hemovac drains and Foley. Oliguric in PACU and for 24 hours after despite IV at maintenance. What is the cause for this?
D)
SIADH = high ADH > low urine output3
Congenital hallux varus
A)
Caused by firm band like abductor hallucis
9 yo boy presents with hip pain and decreased abduction. His radiographs reveal Herring B LCP. Which option is best for long term outcome?
B)
Since age >8
Indication is harring B or B/C age >8
Worse prognosis for progression in congenital scoliosis? (note: unilateral hemi with contralateral bar was NOT an option)
A)
Tip 4 that lead to progression
unilateral bar + contralateral hemi
Unilateral Bar
Segemented Hemi
Unsegmented Hemi
2 year-old boy presents with thumb hypoplasia, no thenar muscles. The CMC and MCP joints unstable. What is the best treatment at this point?
B)
4 associated syndromes with congenital thumb hypoplasia
TAR
VACTRL
Holt oram: atrial septal defect + absent radius
Fanconi anemia
Thumb hypoplasia classification
1: small thumb
2: Thumb small + MCP unstable
3: Abnormal IP and MCP joint with no motion + MCP stable
3b: add CMC aplasia
4: floating thumb
5 no thumb
Thumb hypoplasia mgmtn: Type 1 normal abd
Type 1 bad abd
Type 2
Type 3 A
Type 3b
Type 4
Observation
Release 1st webspace+ opposition tranfer + MCP fusion
Same as above
Same as above
Polliciztion
Same as above
8 year-old girl comes in complaining of heel pain with activities and at night, relieved by rest and NSAIDS. Investigation that will most likely reveal the etiology of this?
B)
osteoid osteoma
Osteoblastoma > 2 cm
After treating a pediatric patient with a SCFE with an in-situ pinning, which of following radiographic findings will concern you about the screw head impinging on the acetabular rim?
A)
should aim to have screw lateral to IT line
What is a descriptive term for congenital vertical talus?
A)
Cubluxation is oblique talus
All of the following have eye involvement, except?
C)
Marfan has superior lens dislocation
NF lisch nodules
Homocystineuria: inferior lens dislocation
All of the following are seen in NF-1, except?
B)
accoustic neuroma is NF2
HTN from renal disease
You see a 10 y.o. boy in clinic who present ten days after sustaining a SHII distal radius fracture. The radiographs show 50° volar angulation and 5° decrease in radial inclination. What do you do now?
A)
To not further disturb growth plate..key here is presenting after 10 days
But it is not within the acceptable limits for conservative mgmt
>10yo
20 degrees dorsal
6 year-old girl presents to your emergency department with a type III supracondylar fracture of the elbow. She has a cold, blue hand with no pulses. She is also unable to flex her thumb. You do your closed reduction and pinning in the operating room. When you seen her in the PACU, her hand is warm, pink, and has no pulse. She is still unable to flex her thumb. What is the best treatment at this point?
A)
because there was already a neuro deficit pre op
All of the following are indications for surgical treatment of congenital Coxa Vara EXCEPT:
B)
A: normal HE (hillgenreiner-epiphyseal angle) angle is 25 treat if over 60
B: wrong>angle less than 100
All of the following are true with thumb in palm deformity in CP EXCEPT:
D)
A: true > this is the cause of the problem
B: True weak EPL/EPB part of problem
c: usually MCP needs to be fused in treatment
Deforming force in clasped thumb: FPL
All of the following are associated with radial club-hand EXCEPT:
B)
usually have stiffness
A: holt oram
B: TAR
C: true
6 year old F 6/12 following low-energy trauma to forearm. c/o ongoing dysfx. XR shows abn radius w/ pseudarthrosis. What would be associated clin findings?
A)
NF nd pseudoarthrosis
Trigger Thumb. What is false?
B)
congenital clasped hand is problem at MCP
trigger thumb is problem at IP
B: 25% bilateral
Caused by: Mimatch in size of A1 pulley and FPL
NOtta nodule is
Nodule on FPL in trigger thumb
never remove it
Recurrent clubfoot s/p Ponseti with a supination and in-toeing deformity
C)
If not flexible then need mid tarsal osteotomy
CVT (old question)
D)
Talus and calc equinus
HIndfoot in valgus
Tight EXTENSORS
need tib post lenghtening
Increased risk of AVN in pedatric femoral neck fracture
A)
DELBET 1-2 worse
Older age worse
Hemiepiphysiodesis/arthrodesis best for
D)
A: usually done for hemivertebrae
b: best in children <5
C: correction usually <15 degrees
d: best in curve <40 degrees
What is hemimetameric shift
Contralateral hemivertebrae separated by one normal vertebrae
What is false about serologic markers and pediatric acute hematogenous osteomyelitis?
D)
Normalized CRP after how long in acute osteo
7 days
ESR peak after infection
3-5 days
Contraindication for tendon transfer in athetoid CP (reason athetoid CP kids due poorly with tendon transfers)
C)
Athetoid cp: dyskinetic purposeless movements
Astereognosis: inability to recognize objects by handling them
Athetoid not associated with muscle weakness or poor hand sensation
Calcaneonavicular coalition (Calcaneonavicular bar), best outcome with:
C)
CN usually interpose EDB or fat or bone wax
All of the following can be causes of snapping hip in adolescents, EXCEPT:
D)
Test for tight IT band
Ober
3-week infant, comes in emergency room with swollen elbow not moving arm and fevers. What bug is most likely from aspiration?
E)
if in NICU then GBS
What is the most common organism to cause septic arthritis in a 25 y.o. (young adult population)?
C)
A if sexually active
C if sexually inactive
What are the 3 most common organisms in a 3 y.o. to cause septic arthritis?
B)
Erb’s palsy position, all except:
B)
Pt. with spina bifida at L4 what is the foot position (Dalhousie has L4 myelomenigocele)?
a) Equinus
b) Cavus
c) Calcaneus
d) normal
e) Varus
f) Valgus
Answer B and E
Strong Tib ant > cavovarus
L5 myelo gives calcaneovalgus deformity
L1-2: equinovarus
What is true in the nonoperative treatment of clubfoot:
B)
A neonate presents shortly after birth with congenital knee dislocation. All the following are appropriate management EXCEPT:
A)
15 y/o with anterior dislocation of his shoulder, post closed reduction, what is the highest risk (most common sequelae)?
B)
15 y/o with proximal humerus fracture (through physis?) irreducible what is the primary block?
A)
SC# in ER with cold, pulseless, blue hand. Management:
A)
A patient with a sharp short segment 40 deg curve of the thoracic spine with rib penciling, has Lisch nodules and cafe-au-lait spots on his skin, which is correct
C)
Kyphosis is common in typ 2 dystrophic
Young girl with hip pain, refusal to walk, cannot ROM (+++ pain), 38C, ESR and WBC up, next step:
C)
has 4 criteria
Elbow ossification, last is which?
B)
Child with healed type 3 SC fracture. Cubitus varus all caused by, EXCEPT:
B)
Flexion injury causes vagus deformuty
Kid, 4 yo, assessed for walking problem, intoes in gait, IR 70 and ER 30 bilateral, foot angle is 10 degrees ER, valgus knee of 8 deg, what is problem?
C)
>70 IR and <30 ER
Thigh foot angle <10 internal
Young kid with anterolateral bowing on exam, as well as scoliosis, what is problem? Ottawa: Child noted to have short leg with normal foot and ankle. Non-tender. Also noted to have scoliosis. Xray shows painless anterolateral bow. What is the most likely diagnosis?
D)
because of the associated scoliosis
Some dude has Proteus syndrome, which will he have?
B)
5 features of proteus syndrome
MAcrodactyly
Vertebral anomalies
Hyperostosis
Vascular malfomations
Abnormal adipose tissue distribution
26 month old kid with high femoral-tibia angle (Blounts), treatment? Ottawa: 26 mo old with metadiaphys angle of 19 degrees. Physes look normal, What is treatment?
e)Intra-articular osteotomy
B)
indication for surgery
-Angle >16 and >3 y.o
-Failed conservative
-Satge V-VI: with bony bar
3 week old kid, Galleazzi normal, no LLD, Ortolani negative, Barlow positive, what to do?
A)
The best predictor of poor outcome following clubfoot surgery in the long term is which:
D)
problem with gastroc weakness and ankle rigidity(OA) in the long term
SCIWORA in kids, is all except:
E)
most common in c spine
50% delayed presentation
Odontoid # in kids, all true EXCEPT:
C)
A+B true
Low non union rate: treat with minerva brace or halo
Ottawa: Another halo question that i can’t remember.
A)
Kid with Bado 2 Monteggia, treatment:
B)
bado 2=posterior subluxation
Bado 1: cast in flexion
10 year old girl sustains a Monteggia fracture with radial head dislocated posteriorly. With regards to treatment, which of the following statements is true?
C)
bado 2 posterior displacement radial head
CP hemiplegia with FCU to ECRB transfer, this will help how?
D)
A: wrong
C: Improved gross motor function (grip strenght) if FCU to EDC transfer
d: hemiplegia not wheelchair bound
Risk Factors for progession in Scoliosis are EXCEPT:
A)
Female is a risk factor for progression
Thoracic curve higher risk to progress than lumbar
Peak growth velocity occurs when what is going on?
C)
Kids with OI and are treated with bisphosphonates can expect all EXCEPT?
D)
congenital scoliosis, what is true?
a) R>L curve
b) associated with tetherd cord
B)
Kids C Spine, what is true about pseudosubluxation?
B)
Most common in C1-2: caused by hprizontal facet joints
Pseudosubluxation will reduce in extension
Amniotic band syndrome: associated with
Olygohydramnios and packaging disorders
A child with back pain and fever, x-ray shows decreased disc space and endplate erosion. Rx:
C)
What is true about isthmic spondylolisthesis?
C)
incidence is 5%
Progress if dx before growth spur or >50% slip
Congenital torticollis, what is true?
B)
A: head tilted towards affected side not looks
c: 5-20% have ddh
d: Packaging disorder
What is not associated with thoracic congenital scoliosis? Calgary: All of the following are associated w/ congenital thoracic scoliosis except:
E)
SC# on floor 6 hours after pinning, pulseless, painfull and full on compartment syndrome, next? UBC and Ottawa: Twelve hours after reducing a supracondylar fracture, child develops pain six hours ago, with mottling and coolness to the extremity. Median nerve anaesthesia present. Unable to move fingers and passive stretch is extremely painful. What do you do?
D)
13 yo with painful rigid pes planus. CT shows talocalcaneal coalition. What is a contraindication to bar resection?
D)
if>50% then fuse
Surgeon resects the diseased fascia in palm of a Dupuytren’s contracture and at closure notices there is a gap that can’t be closed without significant tension on the skin. What is the best method of treatment?
A)
if skin deficit need full thickness graft if not > fibrosis
What happens in OCD of elbow (capitellum)?
B)
Treatment of CP kid all except:
C)
Scoliosis with curve from T6 to T11, 11 yo, no menses, 23 degrees, tx? UBC: 11-year old girl comes in with a 1.5 cm bump on the right, with a T6-11 right thoracic curve measuring 23 degrees. After 4 months of physiotherapy the curve does not improve. What is your next step in management?
a) Boston (TLSO)
b) Milwaukee (CTLSO)
c) Observe and follow up in 4 months
d) PSF
A or C
Brace if >30 initial presentation or progression 5 degrees and greater than 20 degrees
What is an indicator of progression of developmental coxa vara? McGill: Risk of Coxa Vara when you should operate is?
a) Hilgenreiner-epiphyseal angle > 60
b) Neck shaft angle <100
c) Femoral head subluxation
d) Age at presentation , 6 years of age
A and B
indications are
HE >60
Neck shaft angle<110
Proximal tibia fracture in kid in metaphysis, the expected angular deformity is which?
D)
Cozen deformity: tends to resolve spontaneously after 24 months
Leukemia vs JRA, what will make you tell the difference?
C)
Severe pain out of proportion to swelling differentiates leukemia from JIA (from JAAOS article
A 8-year-old girl with a SH 2 distal radius. She presents 16 days of following her injury with 35° of dorsal angulation. What is the best treatment? McGill: 11 yo with DR #, 2 weeks ago, now dorsally angulated and too much, what you do?
A)
do not attempt late reduction
Open tibia in 16 yo, 10 cm wound, unable to recall last tetanus but thinks it was more than 10 years ago, what to do EXCEPT?
D)
Kid with shoe gets nail through it, no signs infection, no puss, management?
A)
need abx
Ceftriaxone bc foot injury and high incidence of pseudomonas
3 yo kid 4 month s/p open reduction and innominate osteotomy (Salter), now 30 deg ABD contracture, do what now?
A)
When is it ok to lengthen the longer leg?
B)
Kid in trauma, got blood, needs fluid bolus, what is amount?
C)
20cc for fluid
10cc for blood
80cc/kg is circulating volume
A 14 yo girl with proximal hum fracture that is 60% displaced and 45 angulated. What should be the management.
A)
What is the most common cause of a cavovarus foot in a pediatric patient.
C)
A 6 yo child presents 18-month post femur fracture. There is a 2 cm LLD. What do you tell the mother about the LLD?
C)
because already 18 months out
Overgrowth in the first 1-2 years only
What is the most common level for a dislocated hip in a pt with myelodysplasia.
C)
iliopsoas and adductors active + inactive abductors and extesnros
at L4 quads can fct> household ambulator
What volume of crystalloid fluid do you bolus in a paediatric trauma.
A)
A 3 year old with valgus post proximal tibial fracture present to your clinic 6 mths later with a healed # but a 15o valgus deformity. What to tell his mother?
C)
cozen phenomema
if >10 yo hen consider surgery of >15 degrees
With regards to triplane fractures in children, EXCEPT?
C)
What is the order of elbow ossification centers:
A)
CRITOE
Which is LAST Ossification center to fuse in elbow?
Medial epicondyle
CITEROI
A kid steps on nail at cottage, what is your treatment.
B)
Since nail take pseudomonas covering ABx: 3rd gen cephalosporin
Rib anomalies associated with congenital scoliosis?
C)
From jbjs article
Anomalies not associated with size or rate of progreession
With regards to medial epicondyle # all are true EXCEPT
C)
most are treated non operatively
Reduction of high grade spondylolisthesis with a high slip angle is becoming popular. All are true except?
C)
reduction increases neuro risk
20% incidence L5 nerve root injury: transient
A 3 yo presents with a 3 wk hx of back pain, fever and unable to ambulate. His CRP and WBC are elevated. You are consulted by his pediatrician. Radiographs reveal narrow disc space and endplate erosions. What should you do next?
B)
but really need blood cx first
A patient suffers a supracondylar fracture, and is treated by closed reduced in flexion. That evening you are called to floor and the kid has cool bluish hand with forearm pain on passive stretch. After cast removal, what do you do?
C)
first step then fasciotomy
A widely displaced suprcondylar Type III is treated in the OR with multiple attempts of closed reduction. The surgeon is unable to reduce the fracture, and during each reduction the hand goes white and has no pulse (which was present pre-op). What is going on?
a) Brachial artery spasm
b) Brachial artery caught in the fracture site
B)
What is the most common cause of a flat top talus:
B)
caused by excessive dorsiflexion before correcting abduction
Kid comes in with varus after supracondylar III, all except could cause it
A)
flexion gives valgus
Pavlik harness in left DDH
B)
posterior strap control abduction: should be left loose if not its forcing abducion > AVN
Risk of Contralateral SCFE in healthy 13 boy:
A)
10 year old girl risser 0, with 27 curve and no menses:
C)
Brace if curve >25 and risser 0,1,2
Predictor of bad prognosis in perthes (except):
E)
Risk factors
Age
female
Decreased ROM
Lateral pillar
6 months post SCFE pinning, 12 yo pt's hip is still stiff, no IR and painful (fixation on X-ray is fine, no evidence of AVN):
C)
observe up to 2 years
rule out AVN
24 year old with Monteggia type I, comminuted ulnar fracture, no radial head fracture, just dislocated, best treatment
a) CR ulna, IM nail, CR radial headCR
b) ulna and radial head, long arm cast
c) ORIF ulnar, CR radial head
d) ORIF radial head
C if ulna is lenght unstable
B if ulna is lenght stable
AVN of radial head
C)
Symptoms 23 months after trauma
Kid comes in with varus after supracondylar III, all except could cause it
D)
flexion is valgus
15 year old patient with flat femoral head and with smooth joint, short neck, greater troch above level of acetabulum. Abductor weakness with trendelenburg
D)
Most likely association with discitis in early grade school age kid
A)
Children <3: limp or refusal to WB
Child 3-8: Vague back or abdo pain
>8: back pain
OI iliac crest biopsy – all are true EXCEPT
D)
Brachial plexus injury in pediatric 9 month old kid followed for brachial plexus. Now you notice a deep anterior crease in proximal shoulder and decreased ER
D)
Torticollis in 4 month kid with frontal bossing, facial asymmetry, Tx (options for torticollis only – no mention about work-up for dysmorphism)
B)
2 week old presents with elbow septic arthritis. What is bug?
D)
kid with a displaced supracondylar elbow fracture NV intact pre-op but after you pin with cross pinning he develops ulnar palsy. Your treatment consists of all of the following EXCEPT:
D)
kid 12 hours post pinning supracondylar elbow fracture with 6 hours of increasing pain and cool pale mottled hand with median parasthesia what to do:
A)
first step
2 months old baby initially at birth had subluxed hip on US with positive Barlow treated since birth with pavlik harness. Now at two months US shows persistent post lateral subluxation of hip what to do?
D)
2 weeks old neonate with decreased motion of right arm. They tell you x-rays show a clavicle fracture with abundant callus and a spiral humeral fracture with no callus on the same side. What is most likely cause?
A)
Brachial plexus palsy questions - prognostic sign
Return of biceps at 3 months
ALso worse if horner's present
most common bug in septic arthritis - kid ( about 5 year old)
Staph aureus
torticollis – which
a) the head tilt toward the affected side and head turn away
b) the head tilt toward the other side and head turn towards
A)
casued by SCM contracture: head tilted same side but rotated to opposite side
foot at birth that is dorsiflexed against the tibia but plantarflexes to 5 deg plantar to neutral. Dx:
D)
CVT: rigid, convex plantar surface, midfoot is DF and abducted on the hindfoot and cannot be PF (rocker-bottom or Persian slipper foot)
Positional calaceovalgus: marked DF of foot with mild and flexible eversion of subtalar jt, tissues on dorsolateral aspects of foot are contacted and limited but rarely prevent PF and inversion. Tx is physio, generally resolves on it’s own
Tibial Hemimelia: equinovarus-supinated foot
Fibular Hemimelia: valgus foot, anterior bowing of the tibia with a dimple over the apex and valgus of the knee
Grisel’s syndrome: diagnostic test
B)
Grisel is: atlantoaxial rotatory subluxation casued by neck inflammation
Question on how to place the graft in the Grice Bone block arthrodesis for CP equinovalgus foot (note don’t do this procedure on the exam)
a) lay the graft in line with the foot
b) vertically in the sinus tarsi
B)
4 year old girl with LCP, Herring stage B. Clinically has decreased abduction. What is best tx?
C)
Age <8, Herring B or B/C – Maintain ROM, no Sx
Age >8, Herring B or B/C – Maintain ROM, Sx containment during fragmentation stage improves outcomes – pelvic osteotomy or shelf +/- femoral varus osteotomy (containment)
Herring C – Sx does not improve outcomes, individualize salvage procedures after re-ossification (shelf, extension-valgus osteotomy for abduction hinge)
12 year old with knee pain after wiping out off his bike. You notice that he walks with ER gait. Knee x-rays normal. What is the best next investigation
D)
rule out SCFE
Chondrolysis in SCFE in associated with all of these except one
B)
five factors associated with chondrolysis in SCFE
Unrecognized pin penetration
hip spica
Intertroch osteotomy
Advanced SCFE
African american
Spina bifida – what is the highest level that gives hip dislocation
B)
Clavicle fracture in young patient – what makes you operate
C)
4 year old girl with LCP, Herring stage B. Clinically has decreased abduction. What is best tx?
B)
Chondrolysis in SCFE in associated with all of these except one
a) Repeated reduction attempts
b) Hip spica cast
c) Corrective osteotomies
d) Caucasian race
African American is risk factor
JRA, all false except…
D)
Pauci articular: 4 or less joints involved
most common joint: knee
MOst aggressive: seropositive (less common)
FOr seropositive hands and wrists most affected
8 month old brat with bilateral club feet. Treatment has consisted of Ponseti serial casting, perc Achilles tenotomy, post-tenotomy casting, Denis Brown bar. Comes back now with non-correctable recurrence of equines and varus. Why recurrence?
B)
Most common residual defect in clubfoot correction
D)
Secondary to overactive tub ant
Position of calcaneus in vertical talus
A)
Medial condyle fracture – what is not a complication
D)
Overgrowth leads to cubitus valgus
X-ray of adult foot showing rocker bottom foot with flat-top talus and 1st metatarsal varus. What is most likely cause of this presentation
D)
15 yo male grade 2 spondylolisthesis failed physiotherapy and one year ongoing back pain only, no neurologic symptoms. Rx:
D)
Rx of Undisplaced paediatric lateral condyle elbow fracture
B)
Elbow fishtail deformity cauded by
AVN trochlea from Lat condyle
Type 3 supracondylar # elbow with no pulse, but perfused hand. Which of the following is the most appropriate answer
B)
Osteomyelitis in kid. All of the following are TRUE, Except?
B)
X ray findings(soft tissue by 48hrs
X ray bone change sonly at 5-7 days: periosteal formation
X ray osteolysis: 10-14 days: need 30-50% lysis
repeat: most common cause of flat top talus in clubfoot
Overly forcefull dorsiflexion of clubfoot
Congenital vertical talus direction of navicular
Displaced dorsally on talus: irreducible
Duchenne’s, all the following are true except
A)
Duchennes: inheritance
labs
biopsy
First affected
x linked recessive
CPK >5000
Absent dystrophin protein
Hip extensors: glut max
Steroids in Duchenne’s (except)
C)
Also decrease scoliosis + delayed pulm complications
Steindler flexorplasty, all the following are true except :
4 yo clubfoot recurrence, walking on lateral border of foot
C)
If flexible: Split tib ant transfer to cunneiform
If rigid: Posteromedial release + lateral column shortening
6 yo child 18 months post femur fracture with 2 cm LLD, what do you tell the mom?
B)
8 yo kid with midshaft tibia fracture?
A)
only 5 degrees rotation acceptable
Overgroth usually 5 cm
Thumb hypoplasia. Thenar muscle atrophy. Unstable MCP and CMC
C)
becasue of unstable mcp and CMC cannot fuse
Child with Diastomatomyelia and calcaneous + cavus foot. Management include all the following except:
C)
no role for conservative mgmt
DO not do plantar fascia release: only for cavovarus
if >12 with calcaneocavus: triple arthrodesis
Child with congenital Kyphosis with thoracic curve measuring 40 degrees:
B)
type 2 and 3 should be operated before the age of 5 and curve >50
Type 1: worst prognosis
12 years old girl with progressive low back pain aggravated with sports. Now has severe pain. Most appropriate investigation:
D)
Start with x ray then move on to advanced imaging
bone scan for spondy
0Child with CP has 40 degrees of elbow flexion contracture. Which of the following is not an appropriate treatment option:
A)
since contracture would want to release not advance flexor mass
Picture of ball and socket ankle. Likely associated condition:
Tarsal coalition most common
Fibular hemimelia
Picture of an adult AP and lateral foot shows navicular dislocated dorsally on talus. Patient has pes planus and complaining of pain. He describes as have undergone treatment for his condition as a child with serial casting and some surgery. Likely diagnosis:
a) Vertical talus
b) Talipes equinovarus
B)
because of the serial casting part
CVT is associated with what?
A)
X-ray of flat-top talus, crappy lateral, with dorsal subluxation of navicular on talus. What is the most common cause of a flat top talus:
B)
because of the flat top talus
ll are risk factors for progression in scoliosis, EXCEPT
C)
pencilling is for NF
SCFE, All true except?
B)
age 10-16
SCFE has limited internal & external rotation after fixation. What should you do now?
C)
Observation up to 2 years: femoral neck can remodel
Achondroplasia - EXCEPT
D)
Autosomal dominant
Forearm Xray given of child, with nonunion seen diaphysis. Rx conservatively with marked pseudoarthrosis developed after 6 months
A)
Xray of ball and socket ankle What is associated?
a) Tarsal coalition
b) Marfan’s
A)
Child abuse EXCEPT
B)
different stages of healing is key
Repeat Perthes question what is NOT prognostic/ involved:
A)
Sprengel’s deformity, you would do a woodward procedure, which is true
A)
clavicular osteotomy to prevent plexus issues
Woodward: omovertebral bone/fibrous tissue resection + transfer of trap, rhomboids inferiorly to help pull down scapula
Congenital kyphosis
D)
Operate after 5
type 1 worse
X-ray repeat showing isthmic spondy
B)
Described dystrophic curve Neurofibromatosis Scoliosis. What’s different from adolescent idiopathic
Increased rate of pseudoarthrosis
26 yr-old with foot pain. History of some childhood foot deformity treated with serial casting and minor surgical procedure. You are given an X-ray showing a flat-topped talus with dorsal subluxation of the navicular on the talus. tilted down with the navicular subluxed superiorly on it. What was this guy’s foot deformity?
C)
Spastic hemi CP kid what don’t you do
D)
stendler is proximal advancement of flexor mass
Child with hemiplegic CP and intrinsic tightness. What would be the deformity positions?
A)
12 y.o. Female with bilateral camptodactyly of 25 degrees. What is most appropriate treatment?
D)
It is congenital flexion at PIP of small finger
SPlinting is treatment if <30 degrees
7 y.o. male undergoing surgery for a shoulder dislocation associated with an obstetrical brachial plexus palsy. What is the most appropriate surgery for this patient?
A)
Since older kid there is already problems with glwnoid morphology so need to correct humerus version to maintain joint reduced
