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Pediatric Lower Extremity MCQs

Practice Set 1 of 18

This practice set contains high-yield board review questions covering key concepts in Pediatric Lower Extremity. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1

Topic: Pediatric Lower Extremity

A 10-year-old boy presents with posterior heel pain that worsens after playing soccer. Examination reveals point tenderness over the calcaneal apophysis and a negative squeeze test of the calcaneal body. Radiographs show sclerosis of the apophysis. What is the recommended initial management?

. Below-knee cast immobilization for 6 weeks
. Surgical excision of the apophysis
. Local corticosteroid injection
. Heel cord stretching, heel lifts, and activity modification
. Non-steroidal anti-inflammatory drugs (NSAIDs) for 3 months

Correct Answer & Explanation

. Heel cord stretching, heel lifts, and activity modification

Explanation

Sever's disease (calcaneal apophysitis) is a common cause of heel pain in growing children. It is a self-limiting condition best managed initially with activity modification, heel lifts to reduce Achilles tension, and stretching exercises.

Question 2

Topic: Pediatric Lower Extremity

An 11-year-old male gymnast complains of anterior knee pain that is exacerbated by jumping. Physical examination reveals focal tenderness exclusively at the inferior pole of the patella. Radiographs demonstrate calcification and fragmentation at this exact site. What is the most likely diagnosis?

. Osgood-Schlatter disease
. Sinding-Larsen-Johansson syndrome
. Patellar sleeve fracture
. Bipartite patella
. Patellar tendinitis

Correct Answer & Explanation

. Sinding-Larsen-Johansson syndrome

Explanation

Sinding-Larsen-Johansson syndrome is a traction apophysitis (osteochondrosis) at the inferior pole of the patella. It differs from Osgood-Schlatter disease, which presents with tenderness and prominence at the tibial tubercle.

Question 3

Topic: Pediatric Lower Extremity

What is the common term for degeneration of the patellar tendon due to overuse?

. ACL tear
. Meniscus tear
. Osgood-Schlatter disease
. Chondromalacia patellae
. Jumper's knee

Correct Answer & Explanation

. Jumper's knee

Explanation

Jumper's knee, or patellar tendinopathy, is a condition characterized by pain at the inferior pole of the patella, resulting from overuse and degenerative changes in the patellar tendon.

Question 4

Topic: Pediatric Lower Extremity

A 35-year-old man presents with chronic medial knee pain months after a valgus injury. Radiographs reveal a linear calcification adjacent to the medial femoral condyle. What is the eponymous name for this radiographic sign?

. Segond fracture
. Pellegrini-Stieda lesion
. Osgood-Schlatter disease
. Sinding-Larsen-Johansson syndrome
. Hoffa's disease

Correct Answer & Explanation

. Pellegrini-Stieda lesion

Explanation

A Pellegrini-Stieda lesion is a calcification at the medial femoral condyle at the origin of the medial collateral ligament (MCL). It typically occurs secondary to a previous chronic MCL injury.

Question 5

Topic: Pediatric Lower Extremity

A 45-year-old female presents with chronic medial knee pain. Radiographs reveal a calcification near the medial femoral epicondyle.

What is the eponymous name for this radiographic finding?

. Segond fracture
. Arcuate sign
. Pellegrini-Stieda lesion
. Osgood-Schlatter disease
. Sinding-Larsen-Johansson lesion

Correct Answer & Explanation

. Pellegrini-Stieda lesion

Explanation

A Pellegrini-Stieda lesion is a calcification at the medial femoral epicondyle, which typically results from a chronic, healed avulsion or injury to the proximal Medial Collateral Ligament (MCL).

Question 6

Topic: Pediatric Lower Extremity

A 55-year-old patient presents with anterior knee pain, a palpable gap above the patella, and an inability to perform a straight leg raise after a fall. Lateral radiographs demonstrate patella baja. What is the most likely diagnosis?

. Patellar tendon rupture
. Quadriceps tendon rupture
. Osgood-Schlatter disease
. Bipartite patella fracture
. Tibial tubercle avulsion

Correct Answer & Explanation

. Quadriceps tendon rupture

Explanation

A quadriceps tendon rupture causes loss of active knee extension and results in patella baja (low-riding patella) due to the unopposed pull of the intact patellar tendon.

Question 7

Topic: Pediatric Lower Extremity

A 12-year-old boy presents with anterior knee pain heavily aggravated by jumping activities. Examination reveals point tenderness directly over the inferior pole of the patella. Radiographs show localized fragmentation at the patellar apex. What is the most likely diagnosis?

. Osgood-Schlatter disease
. Sinding-Larsen-Johansson syndrome
. Patellar tendinopathy
. Bipartite patella
. Osteochondritis dissecans of the patella

Correct Answer & Explanation

. Sinding-Larsen-Johansson syndrome

Explanation

Sinding-Larsen-Johansson syndrome is a traction osteochondrosis of the inferior pole of the patella seen in active adolescents. It is clinically distinct from Osgood-Schlatter disease, which causes apophysitis at the tibial tubercle.

Question 8

Topic: Pediatric Lower Extremity

When treating an infant with a severe rigid clubfoot (talipes equinovarus) using the Ponseti method, the very first step in the serial casting process targets which component of the deformity?

. Equinus of the ankle
. Varus of the hindfoot
. Cavus by elevating the first ray
. Adductus of the forefoot
. Internal tibial torsion

Correct Answer & Explanation

. Cavus by elevating the first ray

Explanation

The Ponseti method systematically addresses the CAVE deformities (Cavus, Adductus, Varus, Equinus). The critical first step is to correct the cavus by elevating the first metatarsal, which aligns the forefoot properly with the hindfoot.

Question 9

Topic: Pediatric Lower Extremity

In the Ponseti method for the treatment of idiopathic clubfoot, the sequence of correction is paramount to achieve a successful plantigrade foot. Which of the following represents the correct sequential order for correcting the deformities?

. Cavus, Adductus, Varus, Equinus
. Equinus, Varus, Adductus, Cavus
. Adductus, Varus, Cavus, Equinus
. Varus, Cavus, Adductus, Equinus
. Cavus, Varus, Adductus, Equinus

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method sequentially corrects the components of clubfoot deformity using the mnemonic CAVE: Cavus, Adductus, Varus, and Equinus. The cavus is corrected first by elevating the first ray to align the forefoot with the hindfoot.

Question 10

Topic: Pediatric Lower Extremity

A 55-year-old male with end-stage renal disease presents with acute knee pain and an inability to actively extend his knee after a fall. Lateral radiographs demonstrate significant patella baja. Which of the following is the most likely diagnosis?

. Patellar tendon rupture
. Quadriceps tendon rupture
. Osgood-Schlatter disease
. Sinding-Larsen-Johansson syndrome
. Tibial tubercle avulsion

Correct Answer & Explanation

. Quadriceps tendon rupture

Explanation

A quadriceps tendon rupture leaves the patellar tendon intact, allowing the patella to migrate inferiorly (patella baja). Conversely, a patellar tendon rupture results in patella alta.

Question 11

Topic: Pediatric Lower Extremity

When treating an idiopathic clubfoot using the Ponseti method, what is the correct sequence of deformity correction?

. Cavus, Adductus, Varus, Equinus
. Equinus, Varus, Adductus, Cavus
. Adductus, Cavus, Varus, Equinus
. Varus, Equinus, Cavus, Adductus
. Cavus, Varus, Adductus, Equinus

Correct Answer & Explanation

. Cavus, Varus, Adductus, Equinus

Explanation

The Ponseti method corrects deformities sequentially using the CAVE acronym: Cavus (by supinating forefoot), Adductus, Varus, and finally Equinus (usually requiring a percutaneous Achilles tenotomy).

Question 12

Topic: Pediatric Lower Extremity

When correcting an idiopathic clubfoot deformity using the Ponseti method, what is the proper sequence of deformity correction?

. Cavus, Adduction, Varus, Equinus
. Equinus, Varus, Adduction, Cavus
. Cavus, Varus, Adduction, Equinus
. Adduction, Varus, Cavus, Equinus
. Varus, Cavus, Adduction, Equinus

Correct Answer & Explanation

. Cavus, Adduction, Varus, Equinus

Explanation

The acronym CAVE dictates the correct sequence of manipulation and casting: Cavus, Adduction, Varus, then Equinus. Equinus is the final deformity corrected, which typically requires a percutaneous Achilles tenotomy.

Question 13

Topic: Pediatric Lower Extremity

During the Ponseti serial casting technique for idiopathic clubfoot, which component of the deformity is corrected last?

. Cavus
. Adductus
. Varus
. Equinus
. Forefoot supination

Correct Answer & Explanation

. Equinus

Explanation

The Ponseti method dictates sequential correction following the CAVE acronym: Cavus, Adductus, Varus, and lastly Equinus. The equinus deformity is often corrected by a percutaneous Achilles tenotomy prior to applying the final cast.

Question 14

Topic: Pediatric Lower Extremity

During the Ponseti method for correcting congenital talipes equinovarus (clubfoot), which deformity is corrected LAST?

. Cavus
. Adductus
. Varus
. Equinus
. Tibial torsion

Correct Answer & Explanation

. Cavus

Explanation

The Ponseti method corrects clubfoot deformities in a specific sequence (CAVE): Cavus, Adductus, Varus, and finally Equinus. The equinus is often corrected last with a percutaneous Achilles tenotomy.

Question 15

Topic: Pediatric Lower Extremity

A 14-year-old boy presents with anterior knee pain exacerbating with jumping. Examination reveals tenderness over the tibial tubercle. Radiographs demonstrate fragmentation of the tibial apophysis.

Which of the following is the most appropriate initial management?

. Surgical excision of the ossicle
. Corticosteroid injection
. Activity modification, NSAIDs, and physical therapy
. Long leg cast for 6 weeks
. Core decompression

Correct Answer & Explanation

. Activity modification, NSAIDs, and physical therapy

Explanation

Osgood-Schlatter disease is a traction apophysitis of the tibial tubercle. It is self-limiting and best managed conservatively with activity modification, stretching, and NSAIDs.

Question 16

Topic: Pediatric Lower Extremity

An infant is born with a rigid equinovarus deformity of the right foot. When applying the Ponseti method of serial casting, which component of the deformity is corrected first?

. Equinus
. Varus
. Adduction
. Cavus
. Internal rotation

Correct Answer & Explanation

. Cavus

Explanation

The Ponseti method corrects the clubfoot deformity in the sequence of CAVE: Cavus, Adductus, Varus, and Equinus. The cavus is corrected first by elevating the first metatarsal.

Question 17

Topic: Pediatric Lower Extremity

A 15-year-old male complains of a painful, stiff flatfoot. Symptoms are worse when walking on uneven ground. Radiographs reveal a "C sign" on the lateral view. What is the most likely diagnosis?

. Calcaneonavicular coalition
. Talocalcaneal coalition
. Accessory navicular
. Posterior tibial tendon dysfunction
. Sever's disease

Correct Answer & Explanation

. Talocalcaneal coalition

Explanation

The "C sign" on a lateral radiograph is formed by the medial outline of the talar dome and the posterior outline of the sustentaculum tali, pathognomonic for a talocalcaneal coalition.

Question 18

Topic: Pediatric Lower Extremity

A newborn is diagnosed with severe idiopathic clubfoot. The pediatric orthopedic surgeon begins treatment using the Ponseti method. According to this protocol, which deformity must be corrected first?

. Equinus
. Varus
. Adductus
. Cavus
. Supination

Correct Answer & Explanation

. Cavus

Explanation

In the Ponseti method, the sequence of correction follows the mnemonic CAVE (Cavus, Adductus, Varus, Equinus). Cavus is corrected first by supinating the forefoot and elevating the first ray to align it with the hindfoot.

Question 19

Topic: Pediatric Lower Extremity

A child is born with a severely shortened right thigh held in flexion, abduction, and external rotation. Radiographs show absence of the proximal femur. According to the Aitken classification, a Type C Proximal Focal Femoral Deficiency (PFFD) is characterized by which of the following?

. Normal acetabulum with a short femur and bony connection to the femoral head
. Severe shortening with no acetabulum and no femoral head
. Dysplastic acetabulum, absent femoral head, and no bony connection
. Normal acetabulum and femoral head with a subtrochanteric pseudarthrosis
. Normal hip joint with isolated shortening of the femoral shaft

Correct Answer & Explanation

. Dysplastic acetabulum, absent femoral head, and no bony connection

Explanation

In Aitken Type C PFFD, the acetabulum is severely dysplastic, the femoral head is absent, and there is no connection between the shaft and the pelvis. Type D is the most severe, with no acetabulum or femoral head.

Question 20

Topic: Pediatric Lower Extremity

A newborn is evaluated for a markedly shortened thigh and flexed, abducted, and externally rotated hip. Radiographs reveal absence of the proximal femur but a normal acetabulum. Which of the following conditions is most likely to be present ipsilaterally?

. Tibial hemimelia
. Fibular hemimelia
. Developmental dysplasia of the hip
. Blount disease
. Clubfoot

Correct Answer & Explanation

. Fibular hemimelia

Explanation

Proximal focal femoral deficiency (PFFD) is commonly associated with ipsilateral fibular hemimelia in up to 50-70% of cases. The acetabulum can range from normal to severely dysplastic depending on the Aitken classification.

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