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A well-educated nurse is seeking a third opinion regarding her 4-year-old daughter with right ankle pain. She states her daughter has sprained her ankle 15 to 20 times over the past year. She insists her daughter has a diagnosis of tarsal coalition that requires immediate surgery. She is also due to see a neurologist for a second opinion regarding unwitnessed seizure activity, despite reassurance from the last subspecialist that the child is healthy. The examination of the right ankle was normal. Radiographs of the foot and ankle are seen in Figures A and B. What would be the next best step in treatment?
CT scan right ankle
Early multidisciplinary evaluation of the patient
Non-weight bearing and prolonged casting
Tarsal coalition excision and adipose tissue interposition
Referral to a foot and ankle surgeon for another opinion
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All of the following decrease the risk of burn from a cast saw EXCEPT:
Using a vacuum
Using fiberglass cast material
Casting with a decreased cast thickness
Using an "up and down" saw technique
Checking the blade frequently
All of the following are social indicators of increased risk of child abuse EXCEPT:
Parent recently losing job
A child with cerebral palsy
A step child
A child with no siblings
A premature child
Which of the following statements regarding child abuse is correct?
It is the 2nd most common cause of death in children over 1 year of age
Fractures in child abuse occur more often children greater than 5 years of age
Burns are the most frequent cause of long-term physical morbidity
Fractures are the most common presenting injury
Metaphyseal fractures four-times more common than diaphyseal fractures
A 12-year-old basketball player is seen for a routine physical. During the physical, he is reluctant to partake in the full physical exam. Upon further questioning, he states that a member of the coaching staff has touched him inappropriately on repeated occasions. Which of the following best outlines your legal responsibility as a physician?
Inform the parents
Inform the school board
Inform the athletic director
Inform the child health and protective services
Inform the school counselor
A 10-month-old child is brought to the emergency room with left elbow swelling and an intact neurovascular exam. The parents report no history of trauma. A radiograph demonstrates a minimally displaced distal humerus physeal separation with abundant callus formation. The next step in managament should include?
Closed reduction and percutaneous pinning
A skeletal survey and contacting the appropriate authorities
Open reduction and internal fixation
Which of the following must be done whenever a non-ambulatory infant presents to the ER with a diaphyseal long bone fracture?
Immediate consultation with child protective services and possible admission to the hospital
Order serum vitamin D levels
Order serum calcium and phosphorus levels
MRI of the cervical spine
Perform genetic testing for COL1-A1 and COL1-A2
A 2-year-old male is brought to the emergency room complaining of pain in the left elbow. Radiographs are shown in Figures A and B. This injury pattern should raise concern for which of the following?
Child abuse should be suspected in an isolated spiral femur fracture of a child in which of the following situations?
Child greater than 3 years old
Child is smaller than predicted growth charts
Child has a single parent
Child has multiple siblings
Child had not yet achieved walking age
What are the two most common lesions seen in abused children?
Skin lesions and head injuries
Skin lesions and fractures
Visceral injuries and fractures
Visceral injuries and head injuries
Skin lesions and visceral injuries
Which of the following is NOT a common fracture pattern seen in abused children?
Metaphyseal corner fractures
Spiral long bone fractures
Multiple fractures in different stages of healing
Anterior translation of the femoral neck relative to the femoral epiphysis
Posterior rib fractures
A 6-month-old child is seen in the emergency department with a spiral fracture of the tibia. The parents are vague about the etiology of the injury. There is no family history of a bone disease. In addition to casting of the fracture, initial management should include
a skeletal survey to rule out other fractures.
a punch biopsy of the skin for collagen analysis to rule out osteogenesis imperfecta.
DNA testing for osteogenesis imperfecta.
blood studies for calcium, phosphorus, and alkaline phosphate levels.
blood studies for parathyroid hormone levels.
A 6-month-old boy is brought to the emergency department by his mother because he has been irritable for the last week. Initially the mother reports no history of trauma, but later she says that he may have fallen from a changing table. Radiographs of the knee demonstrate metaphyseal corner lesions of the distal femur and proximal tibia. White blood cell count and erythrocyte sedimentation rate values are normal. What is the most appropriate next step in treatment?
vitamin D & calcium levels
MRI of the knee
aspiration of the hip
admission and activation of child abuse work-up
hip spica cast
What is the second most common presenting sign of child abuse?
What is the most common presenting sign of child abuse?
skin cuts or bruises
A 10-month-old male is diagnosed with a femoral shaft fracture as seen in Figure A. The parents can not clearly explain the cause of the injury and the child has several other bruises on the right arm. In addition to femur x-rays, what radiologic study is most appropriate?
whole body SPECT scan
MRI of the brain and spine
CT of the chest, abdomen and pelvis
right forearm x-ray
All of the following injuries are highly suggestive of child abuse EXCEPT:
femoral shaft fracture in a nonambulatory infant
posterior rib fracture
multiple fractures in various stages of healing
non-displaced spiral tibial shaft fracture in a toddler
metaphyseal corner fractures
A single mother is in the emergency room with her 6-month-old infant stating he fell and sustained the injury seen in Figure A. The mother reports her oldest son has a confirmed diagnosis of a bone disorder. Laboratory studies are normal. Further imaging is obtained as seen in Figures B-D. Based on this information what is the most likely diagnosis?
A 12-month-old girl is brought to the emergency room by her father. He states that she has not been moving her arm and has been more irritable than usual. A radiograph of the elbow is depicted in Figure A. On examination of her lower extermities, she has mild tenderness and prominence over her left thigh but does not have any bony instability. A radiograph of her left thigh is shown in Figure B. In addition to a complete history and physical, management should include which of the following?
Long arm cast with the elbow in neutral position
Bone scan and liver enzymes
Notification of hospital child protective services and a skeletal survey
Genetic testing to evaluate for chromosomal translocation
Sling and discharge home with follow-up in one week