Musculoskeletal and Orthopaedics – Prometric Style Questions, Set 2

What this deck covers

Musculoskeletal and Orthopaedics – Prometric Style Questions, Set 2 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Still after a difficult birth
2. Moving the shoulder at four weeks
3. Bent at the tip, and stuck
4. Sore in the snuffbox
5. Aching only when he throws
6. Morphine, and still crying
7. The pulse feels fine
8. Three extra doses overnight
9. It stopped hurting, then smelled
10. Pressures already measured
11. On his toes since he started
12. Bulky calves, late to walk
13. Only the left foot
14. Less time on one leg
15. Better once the knee bends
16. Palms flat on the floor
17. Aching by the evening
18. An uncle who collapsed
19. Papery scars on both knees
20. Bendier than her friends
21. Same length, different levels
22. Standing, not on the couch
23. Found at a school check
24. The broken leg is longer
25. Deciding when to operate
26. A short forearm, no thumb
27. A thread on the ward
28. Three webs on one hand
29. A groove round the leg
30. An arm ending below the elbow
31. Ibuprofen fixes it in minutes
32. Spotted after a sprain
33. A fragment lying at the bottom
34. A hard lump above the knee
35. An indistinct border on the film
36. Hips normal as a baby
37. Some walk, some do not
38. A number they follow
39. He has never complained
40. Two years of x-rays
41. A smooth line near the joint
42. The other ankle as well
43. Worried about the x-rays
44. Small fragments round the joint
45. A normal film at four weeks
46. Clumsy with a tilted head
47. Tall with long fingers
48. Short limbs and loud snoring
49. Hands that will not open
50. A bend in one shin

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: C8 and T1, Immobilise and re-image in two weeks, That the diagnosis is unlikely, Urgent fasciotomy, A habit copied from a sibling, Juvenile idiopathic arthritis, Repeated scratching, By comparing the heights of the knees, The growth remaining, from the bone age, None until school age, Chronic osteomyelitis, It will stop growing when he does, The age at diagnosis, The steady rise across the three films.

Clinical pearls from this deck

• Read the posture, then check the hand. A normal grasp is what tells you the lower roots escaped, and it changes the prognosis entirely.
• Most recover is true and dangerous. Test elbow flexion against gravity at a month, because that is the sign that separates the babies who will not.
• Feel the palm, not the joint. A painless nodule at the base of the thumb explains a tip that will not straighten.
• A normal scaphoid film means nothing in the first fortnight. Treat the snuffbox, not the report, or you meet the same wrist again as a non-union.
• In a growing athlete the growth plate gives way before the ligament does. Ask what changed in training this season, because the answer is usually volume.
• The five Ps are a list of things that arrive too late. Pain on passive stretch and a rising morphine requirement are the two that arrive in time.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all Musculoskeletal and Orthopaedics case decks · pediatric reference values.