1. General Principles & Basic Science MCQs

A 2-week-old neonate presents with pseudoparalysis of the right leg. Ultrasound shows a large hip effusion, and aspiration yields frank pus.

What is the most appropriate surgical approach for emergency drainage of this joint?

A 10-year-old girl is evaluated for a broad skull, delayed fontanelle closure, and the unusual ability to touch her shoulders together anteriorly. Which gene mutation is responsible for her condition?

A 9-year-old girl presents with multiple recurrent episodes of bone pain and swelling in her clavicle and distal tibia. Labs show a mildly elevated ESR but normal WBC count. Multiple biopsies reveal sterile, non-infectious inflammation. What is the first-line treatment for this condition?

A 3-week-old neonate presents with a swollen, erythematous right thigh and pseudoparalysis. An ultrasound confirms a hip effusion, and radiographs show early destructive changes in the proximal femur.

What anatomic factor strongly predisposes neonates to concurrent osteomyelitis and septic arthritis of the hip?

A 10-year-old girl is evaluated for short stature and delayed primary tooth eruption. On examination, she is able to bring her shoulders together anteriorly. Radiographs reveal absent clavicles and delayed skull ossification. Which transcription factor is mutated in this condition?

A 9-year-old girl presents with recurrent episodes of bone pain and swelling involving the clavicles and distal tibias. Blood cultures are repeatedly negative, and a bone biopsy reveals sterile, non-specific chronic inflammation. She also has palmoplantar pustulosis. What is the first-line treatment for this condition?

A 3-week-old neonate presents with fever, irritability, and decreased movement of the left lower extremity. Imaging demonstrates a hip effusion.

What is the most appropriate empiric intravenous antibiotic regimen after obtaining aspirates?

A 9-year-old girl has had intermittent clavicle and distal tibial pain for 6 months. Inflammatory markers are mildly elevated. Multiple bone biopsies yield no bacterial growth and show chronic non-suppurative inflammation. What is the most appropriate first-line treatment?

A 10-year-old boy is brought in for an abnormal shoulder appearance. He has excessive shoulder mobility and can touch his shoulders together anteriorly. Radiographs show complete absence of the clavicles. Which gene is primarily mutated in this condition?

A 3-week-old premature neonate presents with asymmetric hip creases, irritability, and decreased spontaneous movement of the right lower extremity. Ultrasound reveals a large right hip effusion.

Following diagnostic aspiration that yields purulent fluid, which of the following empiric antibiotic regimens is most appropriate for this patient?

A 6-year-old girl with blue sclerae, dentinogenesis imperfecta, and a history of multiple low-energy long bone fractures is diagnosed with Osteogenesis Imperfecta (OI). She is started on an intravenous bisphosphonate protocol. What is the primary cellular mechanism of action of this medication in the treatment of her condition?

A 10-year-old girl presents with a 6-month history of intermittent, multifocal bone pain involving the medial clavicle and bilateral proximal tibias. Laboratory studies show a mildly elevated ESR, but multiple bone biopsies show sterile, non-suppurative inflammation. Radiographs reveal mixed lytic and sclerotic metaphyseal lesions. Which of the following is the most appropriate first-line treatment for this condition?

A 9-year-old boy is evaluated for unusual shoulder mobility. On examination, he is able to approximate his shoulders in the midline anteriorly. Physical exam also reveals a broad skull, delayed fontanelle closure, and multiple retained deciduous teeth. A mutation in which of the following genes is responsible for this patient's condition?

A 4-week-old female is treated for culture-proven septic arthritis of the right hip.

Which unique anatomical factor makes the neonatal hip highly susceptible to permanent avascular necrosis and physeal destruction from this condition?

A 7-year-old boy presents with high fever, chills, and an inability to bear weight on his left leg. Examination reveals severe focal tenderness over the distal femur. Which region of the bone is the initial nidus for bacterial seeding in acute hematogenous osteomyelitis in this age group?

A 6-year-old girl from Connecticut presents with a massive, painless effusion of the right knee. She had an uncharacterized rash several months prior. Joint aspiration yields 40,000 WBCs with predominantly mononuclear cells. What is the recommended initial serological test to confirm the suspected diagnosis?

A 35-year-old male presents with a painless burn on his right hand. Neurological examination reveals a loss of pain and temperature sensation in a cape-like distribution over his shoulders and upper extremities, while light touch and proprioception remain intact.

Which of the following neuroanatomical structures is primarily affected in the early stages of this condition?

A 5-year-old girl is diagnosed with oligoarticular Juvenile Idiopathic Arthritis primarily affecting her right knee. She has an antinuclear antibody (ANA) positive titer. In addition to monitoring for leg length discrepancies, what mandatory screening must be instituted?