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Pediatric Lower Extremity MCQs

Practice Set 8 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 141

Topic: Pediatric Lower Extremity

According to the Ponseti method for the conservative treatment of congenital talipes equinovarus (clubfoot), what is the correct sequence of deformity correction during serial casting?

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

Correct Answer & Explanation

. Cavus, Varus, Adductus, Equinus

Explanation

The Ponseti method sequentially corrects the components of the clubfoot deformity in the specific order represented by the acronym CAVE: Cavus (corrected by elevating the first ray to supinate the forefoot), Adductus, Varus, and finally Equinus (which often requires a percutaneous Achilles tenotomy for full correction).

Question 142

Topic: Pediatric Lower Extremity

A 2-year-old child presents with bilateral genu varum. Radiographs show medial beaking of the proximal tibial metaphysis. Which of the following radiographic measurements is the most reliable predictor that the deformity will progress (infantile Blount's disease) rather than resolve (physiologic bowing)?

. Tibiofemoral angle > 15 degrees
. Metaphyseal-diaphyseal angle (Drennan angle) > 16 degrees
. Epiphyseal-diaphyseal angle > 10 degrees
. Mechanical axis zone 3 or greater
. Posterior slope of the proximal tibia > 10 degrees

Correct Answer & Explanation

. Metaphyseal-diaphyseal angle (Drennan angle) > 16 degrees

Explanation

The metaphyseal-diaphyseal angle (Drennan angle) is critical in distinguishing physiologic bowing from infantile Blount's disease. An angle > 16 degrees has a high predictive value (up to 95%) that the varus deformity will progress (Blount's disease), warranting intervention such as bracing. Angles < 10 degrees typically indicate physiologic bowing, which resolves spontaneously.

Question 143

Topic: Pediatric Lower Extremity

According to the Ponseti method for the conservative management of idiopathic clubfoot, what is the correct sequence of deformity correction during serial casting?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method corrects the components of clubfoot in a specific sequence, remembered by the mnemonic CAVE: Cavus (corrected first by supinating the forefoot to align with the hindfoot), Adductus, Varus, and finally Equinus (which often requires a percutaneous Achilles tenotomy).

Question 144

Topic: Pediatric Lower Extremity

A 2-week-old infant is brought to the clinic with an idiopathic clubfoot. The treating orthopedic surgeon plans to initiate the Ponseti method of serial casting. According to the principles of the Ponseti method, what is the first step in correcting the complex deformity of the foot?

. Abducting the forefoot to correct the adductus
. Pronating the forefoot to correct the varus
. Plantarflexing the first ray to correct the cavus
. Dorsiflexing the first ray to correct the cavus
. Dorsiflexing the ankle to correct the equinus

Correct Answer & Explanation

. Dorsiflexing the first ray to correct the cavus

Explanation

The Ponseti method addresses clubfoot deformities in a specific sequence summarized by the acronym CAVE: Cavus, Adductus, Varus, Equinus. The very first step is to correct the cavus deformity. This is achieved by supinating the forefoot and elevating (dorsiflexing) the first ray to align the forefoot with the hindfoot.

Question 145

Topic: Pediatric Lower Extremity

When utilizing the Ponseti method for the correction of idiopathic clubfoot, which of the following represents the correct sequence of deformity correction?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method corrects the components of clubfoot in a specific sequence, easily remembered by the acronym CAVE: Cavus, Adductus, Varus, and Equinus. The cavus is corrected first by elevating the first ray to align the forefoot with the hindfoot. Adductus and varus are then corrected simultaneously by abducting the foot around the talar head. Equinus is corrected last, frequently requiring a percutaneous Achilles tenotomy.

Question 146

Topic: Pediatric Lower Extremity

In the Ponseti method for the treatment of idiopathic clubfoot, sequential correction of the deformity components must be strictly followed to avoid creating a 'rocker-bottom' deformity. What is the correct sequence of deformity correction?

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

Correct Answer & Explanation

. Cavus, Adduction, Varus, Equinus

Explanation

The mnemonic CAVE describes the correct sequence of correction in the Ponseti method: Cavus (by supinating the forefoot to align it with the hindfoot), Adduction, Varus, and finally Equinus (often requiring a percutaneous Achilles tenotomy). Premature correction of equinus leads to a rocker-bottom foot.

Question 147

Topic: Pediatric Lower Extremity

A 48-year-old female presents with chronic, progressive midfoot pain and a newly developing planovarus deformity. Radiographs demonstrate comminution, sclerosis, and a 'comma-shaped' deformity of the tarsal navicular. What is the most likely diagnosis?

. Muller-Weiss syndrome
. Kohler disease
. Freiberg's infraction
. Charcot neuroarthropathy
. Sever's disease

Correct Answer & Explanation

. Muller-Weiss syndrome

Explanation

Muller-Weiss syndrome is spontaneous adult-onset osteonecrosis of the tarsal navicular, characterized by a comma-shaped navicular and progressive midfoot collapse. Kohler disease is also navicular osteonecrosis but occurs in young children.

Question 148

Topic: Pediatric Lower Extremity

A 28-year-old woman presents with bilateral progressive cavovarus foot deformities. A Coleman block test is performed, which neutralizes the hindfoot varus to neutral. Which of the following muscle imbalances is the primary driver of this patient's forefoot-driven hindfoot varus?

. Overpull of the tibialis anterior relative to the peroneus longus
. Overpull of the peroneus longus relative to the tibialis anterior
. Overpull of the peroneus brevis relative to the tibialis posterior
. Weakness of the gastrocnemius-soleus complex
. Spasticity of the extensor digitorum longus

Correct Answer & Explanation

. Overpull of the peroneus longus relative to the tibialis anterior

Explanation

In Charcot-Marie-Tooth disease, a forefoot-driven cavovarus deformity is typically initiated by an overpull of the peroneus longus relative to a weak tibialis anterior, leading to a rigidly plantarflexed first ray. The Coleman block test confirms the hindfoot varus is flexible and driven by the forefoot.

Question 149

Topic: Pediatric Lower Extremity

When utilizing the Ponseti method for the treatment of idiopathic clubfoot, what is the correct sequential order of deformity correction?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method corrects deformities sequentially using the CAVE acronym: Cavus (by elevating the first ray), Adductus, Varus, and finally Equinus (which often requires a percutaneous Achilles tenotomy).

Question 150

Topic: Pediatric Lower Extremity

When utilizing the Ponseti method for the treatment of idiopathic clubfoot, the sequence of deformity correction is critical. Which of the following represents the correct sequential order of correction?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method follows the CAVE sequence: Cavus is corrected first by elevating the first ray, followed by Adductus and Varus corrected simultaneously, and Equinus is corrected last, often requiring a percutaneous Achilles tenotomy.

Question 151

Topic: Pediatric Lower Extremity

In the Ponseti method of idiopathic clubfoot casting, what is the correct sequence of deformity correction?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method corrects clubfoot deformities in the specific order of the acronym CAVE: Cavus, Adductus, Varus, and finally Equinus. The cavus is corrected first by elevating the first ray to align the forefoot with the hindfoot.

Question 152

Topic: Pediatric Lower Extremity

A 3-week-old infant with idiopathic clubfoot is undergoing serial casting using the Ponseti method. The deformity is corrected in a specific sequence (CAVES). Which aspect of the deformity is corrected last, frequently necessitating a minor surgical procedure?

. Cavus
. Adductus
. Varus
. Equinus
. Supination

Correct Answer & Explanation

. Equinus

Explanation

In the Ponseti method, the sequence of correction is Cavus, Adductus, Varus, and finally Equinus. Equinus correction often requires a percutaneous Achilles tenotomy as the final step before the application of the definitive cast.

Question 153

Topic: Pediatric Lower Extremity

A 45-year-old distance runner undergoes a surgical plantar fascia release for recalcitrant plantar fasciitis after 18 months of failed conservative management. The surgeon completely releases the entire fascial band. What is the most likely biomechanical complication of this procedure?

. Medial column overload
. Lateral column overload and cuboid pain
. Fixed equinus deformity
. Dorsal midfoot exostosis
. Progressive cavovarus deformity

Correct Answer & Explanation

. Lateral column overload and cuboid pain

Explanation

Complete release of the plantar fascia significantly decreases the longitudinal arch height and shifts peak plantar pressures laterally. This frequently results in lateral column overload and iatrogenic cuboid syndrome.

Question 154

Topic: Pediatric Lower Extremity

A 4-week-old infant is undergoing treatment for an idiopathic right clubfoot using the Ponseti method. After four sequential casts, the forefoot is abducted to 60 degrees, and the heel is in valgus. However, the ankle can only be dorsiflexed to neutral. What is the most appropriate next step in management?

. Apply a fifth cast in maximal dorsiflexion and observe
. Perform an open tendo-Achilles lengthening
. Perform a percutaneous Achilles tenotomy followed by casting
. Perform a tibialis anterior tendon transfer
. Transition to a Denis Browne bar and shoes immediately

Correct Answer & Explanation

. Apply a fifth cast in maximal dorsiflexion and observe

Explanation

In the Ponseti method, serial casting corrects cavus, adductus, and varus deformities first. Once the forefoot is abducted to roughly 60 degrees and the hindfoot varus is corrected to valgus, the equinus is addressed. If there is less than 15 degrees of ankle dorsiflexion at this stage (which occurs in about 80% of patients), a percutaneous Achilles tenotomy is indicated, followed by a final cast in hyperdorsiflexion and abduction for 3 weeks.

Question 155

Topic: Pediatric Lower Extremity

When treating a rigid idiopathic clubfoot using the Ponseti method of serial casting, what is the correct order of deformity correction?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method follows a strict sequence of correcting the deformities associated with clubfoot, remembered by the acronym CAVE: Cavus, Adductus, Varus, and Equinus. The cavus is corrected first by supinating the forefoot and elevating the first ray to align it with the hindfoot. Following this, the foot is abducted to correct the adductus and varus simultaneously, pivoting around the head of the talus. Finally, the equinus is corrected, often requiring a percutaneous Achilles tenotomy.

Question 156

Topic: Pediatric Lower Extremity

During the Ponseti casting technique for the treatment of idiopathic clubfoot, the foot is sequentially manipulated to correct the complex deformity. Which of the following describes the correct sequential order of deformity correction?

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

Correct Answer & Explanation

. Equinus, Varus, Adductus, Cavus

Explanation

The Ponseti method utilizes a specific sequence to correct clubfoot deformity, remembered by the acronym CAVE: Cavus, Adductus, Varus, and Equinus. The cavus is corrected first by supinating the forefoot and elevating the first ray to align it with the hindfoot. Then, the adductus and varus are corrected simultaneously by abducting the foot around the head of the talus. Finally, the equinus is corrected, often requiring a percutaneous Achilles tenotomy.

Question 157

Topic: Pediatric Lower Extremity

A newborn male is evaluated for bilateral idiopathic clubfeet (talipes equinovarus). The treating orthopedic surgeon initiates the Ponseti method of serial casting. What is the correct physiological sequence in which the components of the deformity are systematically corrected?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method addresses the components of the clubfoot deformity in a specific sequence, easily remembered by the mnemonic CAVE: Cavus, Adductus, Varus, Equinus. The first cast corrects the cavus by supinating the forefoot to align it with the hindfoot. Subsequent casts correct the adductus and varus by gradually abducting the foot around the head of the talus. Finally, the equinus is corrected, which often requires a percutaneous Achilles tenotomy before the final cast is applied.

Question 158

Topic: Pediatric Lower Extremity

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

. Cavus, adduction, varus, equinus
. Cavus, varus, adduction, equinus
. Adduction, varus, cavus, equinus
. Equinus, cavus, adduction, varus
. Varus, cavus, adduction, equinus

Correct Answer & Explanation

. Cavus, adduction, varus, equinus

Explanation

The Ponseti method for the treatment of idiopathic clubfoot relies on a specific sequence of deformity correction summarized by the acronym CAVE: Cavus, Adduction, Varus, and Equinus. First, the cavus is corrected by elevating the first ray to align the forefoot with the hindfoot. Then, the forefoot is abducted to correct the adduction and varus simultaneously while counter-pressure is applied to the lateral aspect of the talar head. Finally, the equinus is corrected, most often requiring a percutaneous Achilles tenotomy.

Question 159

Topic: Pediatric Lower Extremity

When correcting an infant's idiopathic clubfoot deformity using the Ponseti casting technique, the deformities must be sequentially addressed. What is the correct chronological order of correction?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method dictates a specific sequence for the correction of the clubfoot deformity, easily remembered by the acronym CAVE: Cavus, Adductus, Varus, Equinus. The cavus is corrected first by elevating the first ray to align the forefoot with the hindfoot. Then, the adductus and varus are corrected simultaneously by abducting the midfoot around the fixed head of the talus. Finally, the equinus is corrected, often requiring a percutaneous Achilles tenotomy.

Question 160

Topic: Pediatric Lower Extremity

A 14-year-old boy presents with recurrent ankle sprains, a rigid flatfoot, and peroneal muscle spasm. Suspecting the most common type of tarsal coalition, which radiographic view is most likely to demonstrate the pathology?

. Weight-bearing AP radiograph
. Weight-bearing lateral radiograph
. 45-degree internal oblique radiograph
. Harris axial radiograph
. Canale view radiograph

Correct Answer & Explanation

. Weight-bearing AP radiograph

Explanation

Calcaneonavicular coalition is the most common tarsal coalition and is best visualized on a 45-degree internal oblique radiograph, often presenting as the "anteater nose" sign.

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