Menu

Pediatric Upper Extremity & Spine MCQs

Practice Set 14 of 33

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

Question 261

Topic: Pediatric Upper Extremity & Spine

A 12-year-old girl is evaluated for adolescent idiopathic scoliosis. Which of the following radiographic parameters indicates the highest risk for curve progression?

. Risser stage 4
. Open triradiate cartilage
. Closed triradiate cartilage
. Sanders maturity stage 7
. Menarche 1 year ago

Correct Answer & Explanation

. Open triradiate cartilage

Explanation

Curve progression risk is highest during the peak height velocity, which correlates closely with an open triradiate cartilage and lower Sanders maturity stages (1-3). Risser 4, closed triradiate cartilage, and post-menarcheal status indicate decreasing growth velocity.

Question 262

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal female is diagnosed with Adolescent Idiopathic Scoliosis (AIS). Radiographs reveal a right thoracic curve of 25 degrees and a Risser stage of 0. Based on the Lonstein and Carlson nomogram, what is her approximate risk of curve progression?

. 10%
. 20%
. 45%
. 68%
. 95%

Correct Answer & Explanation

. 68%

Explanation

According to Lonstein and Carlson, a premenarchal female with a Risser 0 and a curve between 20 and 29 degrees has roughly a 68% risk of curve progression. This high risk warrants initiation of brace treatment.

Question 263

Topic: Pediatric Upper Extremity & Spine

The BrAIST (Bracing in Adolescent Idiopathic Scoliosis Trial) study significantly impacted the management of AIS. Which variable was shown to be most highly correlated with treatment success (prevention of curve progression to surgery)?

. Initial curve magnitude less than 20 degrees
. Total hours of brace wear per day
. Chronological age > 14 years at brace initiation
. Use of a nighttime-only bending brace instead of a rigid TLSO
. Male gender

Correct Answer & Explanation

. Total hours of brace wear per day

Explanation

The BrAIST trial demonstrated a strong dose-response relationship between brace wear and success. Patients who wore the brace for more than 13-18 hours per day had significantly higher success rates in avoiding surgery.

Question 264

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal girl with Adolescent Idiopathic Scoliosis (AIS) is found to have a right thoracic curve of 32 degrees. Her Risser stage is 0. What is the most appropriate management?

. Observation with radiographs every 6 months
. Thoracolumbosacral orthosis (TLSO) bracing for 16-23 hours daily
. Nighttime-only bending brace
. Posterior spinal fusion with pedicle screws
. Anterior tethering procedure

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) bracing for 16-23 hours daily

Explanation

In a skeletally immature patient (Risser 0-2, premenarchal) with a curve between 25 and 45 degrees, full-time TLSO bracing (prescribed for 16-23 hours daily) is indicated to halt curve progression.

Question 265

Topic: Pediatric Upper Extremity & Spine

In a 12-year-old girl with Adolescent Idiopathic Scoliosis (AIS), which of the following radiographic markers indicates that she is currently at or very near the phase of peak height velocity, representing the highest risk for curve progression?

. Risser stage 4
. Closure of the triradiate cartilage
. Appearance of the iliac apophysis
. Risser stage 5
. Fusion of the proximal humeral physis

Correct Answer & Explanation

. Closure of the triradiate cartilage

Explanation

Closure of the triradiate cartilage typically occurs just before or during the period of peak height velocity. An open triradiate cartilage indicates significant remaining growth and a high risk of curve progression.

Question 266

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal female with a Risser stage 0 presents with a right thoracic curve of 32 degrees on standing posteroanterior radiograph. She is prescribed a thoracolumbosacral orthosis (TLSO). What is the primary established goal of this treatment?

. To permanently reduce the curve magnitude by at least 50%
. To prevent curve progression to greater than 50 degrees
. To delay the need for surgery until she reaches skeletal maturity
. To improve pulmonary function tests
. To completely resolve the associated rib hump

Correct Answer & Explanation

. To prevent curve progression to greater than 50 degrees

Explanation

The primary goal of bracing in Adolescent Idiopathic Scoliosis (AIS) is to halt curve progression and prevent it from reaching 50 degrees. Curves greater than 50 degrees often continue to progress in adulthood and typically require surgical intervention.

Question 267

Topic: Pediatric Upper Extremity & Spine

In the Lenke classification system for Adolescent Idiopathic Scoliosis, a minor thoracic curve is defined as structural if it exhibits a Cobb angle of at least what magnitude on supine side-bending radiographs?

. 10 degrees
. 15 degrees
. 20 degrees
. 25 degrees
. 30 degrees

Correct Answer & Explanation

. 25 degrees

Explanation

In the Lenke classification, a minor curve is considered structural if it fails to correct to less than 25 degrees on supine side-bending radiographs. Alternatively, it is structural if there is kyphosis of at least +20 degrees in that region.

Question 268

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarcheal girl is evaluated for adolescent idiopathic scoliosis (AIS). Upright standing radiographs reveal a right thoracic curve of 32 degrees. Her Risser stage is 0. What is the most appropriate management recommendation?

. Observation with follow-up radiographs in 1 year
. Thoracolumbosacral orthosis (TLSO) bracing
. Posterior spinal fusion with pedicle screws
. Anterior spinal tethering
. Physical therapy focusing on core strengthening only

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) bracing

Explanation

Bracing is indicated in growing children (Risser 0-2, premenarcheal) with idiopathic scoliosis curves between 25 and 45 degrees. A TLSO brace aims to halt curve progression during the period of rapid adolescent growth.

Question 269

Topic: Pediatric Upper Extremity & Spine
A 12-year-old pre-menarcheal girl presents with a right thoracic adolescent idiopathic scoliosis (AIS). Her Risser stage is 0, and her curve measures 32 degrees on a standing PA radiograph. What is the most evidence-based management strategy?
. Observation with serial radiographs every 6 months
. Thoracolumbosacral orthosis (TLSO) bracing for 16-23 hours daily
. Nighttime only bending brace
. Immediate posterior spinal fusion
. Vertebral body tethering (VBT)

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) bracing for 16-23 hours daily

Explanation

The patient is a growing child (Risser 0, pre-menarcheal) with a curve between 25 and 45 degrees. According to the BRAIST trial, full-time bracing (TLSO for 16-23 hours/day) is highly effective in preventing curve progression to surgical thresholds in this population.

Question 270

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal girl (Risser 0) has a right thoracic adolescent idiopathic scoliosis (AIS) curve of 35 degrees. Which of the following is the most appropriate management?

. Observation with radiographs in 6 months
. Physical therapy and Schroth exercises
. Thoracolumbosacral orthosis (TLSO) bracing
. Posterior spinal fusion
. Anterior tethering procedure

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) bracing

Explanation

Bracing is indicated for skeletally immature patients (Risser 0-2) with idiopathic curves between 25 and 45 degrees. A TLSO brace significantly decreases the risk of curve progression to the surgical threshold.

Question 271

Topic: Pediatric Upper Extremity & Spine

Which of the following factors indicates the highest risk for curve progression in a patient with Adolescent Idiopathic Scoliosis (AIS)?

. Male gender
. Risser 4
. Peak height velocity
. Thoracolumbar curve pattern
. Closed triradiate cartilage

Correct Answer & Explanation

. Peak height velocity

Explanation

The highest risk for curve progression in AIS occurs during the period of peak height velocity. Skeletal immaturity (e.g., Risser 0, open triradiate cartilage), female gender, and larger initial curve magnitudes are also significant risk factors.

Question 272

Topic: Pediatric Upper Extremity & Spine

In the Lenke classification for Adolescent Idiopathic Scoliosis, how is a structural minor curve defined on supine side-bending radiographs?

. The Cobb angle fails to reduce to less than 25 degrees
. The Cobb angle reduces to exactly 10 degrees
. Vertebral rotation remains greater than Grade II
. Regional kyphosis exceeds 40 degrees
. The apex of the curve fails to cross the midline

Correct Answer & Explanation

. The Cobb angle fails to reduce to less than 25 degrees

Explanation

A minor curve is considered structural in the Lenke classification if it does not bend out to less than 25 degrees on supine side-bending radiographs. Additionally, regional kyphosis greater than +20 degrees also classifies a curve as structural.

Question 273

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal girl (Risser 0) is diagnosed with Adolescent Idiopathic Scoliosis. Her right thoracic curve measures 32 degrees. What is the most appropriate recommended management?

. Observation with radiographs in 6 months
. Physical therapy and Schroth exercises alone
. Full-time TLSO bracing
. Posterior spinal fusion
. Anterior vertebral body tethering

Correct Answer & Explanation

. Full-time TLSO bracing

Explanation

Bracing is indicated in skeletally immature patients (Risser 0-2, premenarchal) with curve magnitudes between 25 and 45 degrees. A TLSO worn at least 16-18 hours a day has been shown to significantly decrease the risk of curve progression to surgical magnitude.

Question 274

Topic: Pediatric Upper Extremity & Spine

A 13-year-old premenarchal girl presents with a right thoracic adolescent idiopathic scoliosis. Standing AP radiographs demonstrate a Cobb angle of 32 degrees. Her Risser stage is 1. What is the most appropriate management?

. Observation and repeat radiograph in 6 months
. Physical therapy and core strengthening
. Night-time only bending brace
. Full-time TLSO bracing
. Posterior spinal fusion

Correct Answer & Explanation

. Full-time TLSO bracing

Explanation

Full-time TLSO bracing is indicated for growing children (premenarchal, Risser 0-2) with a Cobb angle between 25 and 45 degrees. Clinical trials have proven that full-time bracing significantly decreases the risk of curve progression to the surgical threshold.

Question 275

Topic: Pediatric Upper Extremity & Spine

In the Lenke classification for Adolescent Idiopathic Scoliosis, what radiographic criterion defines a "structural" minor curve that must be included in the operative fusion construct?

. The curve measures > 10 degrees on a standing AP radiograph
. The curve measures > 20 degrees on a standing AP radiograph
. The curve fails to correct to < 25 degrees on lateral bending radiographs
. The curve fails to correct to < 10 degrees on lateral bending radiographs
. The curve is associated with a kyphosis > 10 degrees

Correct Answer & Explanation

. The curve fails to correct to < 25 degrees on lateral bending radiographs

Explanation

The Lenke classification defines a minor curve as structural if it does not correct to less than 25 degrees on side-bending radiographs (or if there is a regional kyphosis of at least 20 degrees). Structural curves generally must be included in the fusion.

Question 276

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal female presents for a routine evaluation. Radiographs reveal a right thoracic adolescent idiopathic scoliosis (AIS) curve measuring 35 degrees. Her Risser stage is 0. What is the most appropriate management?

. Observation and follow-up in 6 months
. Physical therapy focusing on core strengthening
. Thoracolumbosacral orthosis (TLSO) bracing
. Vertebral body tethering
. Posterior spinal fusion

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) bracing

Explanation

This patient has significant remaining growth (premenarchal, Risser 0) and a progressive curve between 25 and 45 degrees. TLSO bracing is indicated to halt progression and decrease the likelihood of requiring surgical intervention.

Question 277

Topic: Pediatric Upper Extremity & Spine

A 15-year-old girl is diagnosed with adolescent idiopathic scoliosis (Lenke Type 1). Her main thoracic curve measures 58 degrees and is flexible on side-bending. Her pulmonary function tests are normal. What is the standard of care for this patient?

. Anterior spinal fusion
. Posterior spinal fusion
. Observation
. Thoracolumbosacral orthosis (TLSO)
. Vertebral body tethering

Correct Answer & Explanation

. Posterior spinal fusion

Explanation

In a skeletally mature or nearly mature patient with a thoracic AIS curve exceeding 50 degrees, posterior spinal fusion with segmental instrumentation is the standard surgical treatment to halt progression and correct deformity.

Question 278

Topic: Pediatric Upper Extremity & Spine

A 12-year-old girl presents with adolescent idiopathic scoliosis (AIS). Her radiographs demonstrate a right thoracic curve of 35 degrees. She is premenarchal and Risser 0. Which of the following is the most appropriate management?

. Observation with repeat radiographs in 6 months
. Physical therapy and core strengthening
. Full-time TLSO bracing
. Posterior spinal fusion
. Anterior spinal tethering

Correct Answer & Explanation

. Full-time TLSO bracing

Explanation

In a premenarchal, Risser 0 patient with an AIS curve between 25 and 40 degrees, the risk of progression is very high (often >60%). Full-time bracing (e.g., TLSO) is indicated to alter the natural history and prevent progression to the surgical range.

Question 279

Topic: Pediatric Upper Extremity & Spine

A 13-year-old female presents with adolescent idiopathic scoliosis. She is pre-menarchal and Risser 0. Her right thoracic curve measures 32 degrees on standing PA radiographs. What is the most appropriate management?

. Observation and follow-up in 6 months
. Physical therapy and core strengthening
. Thoracolumbosacral orthosis (TLSO) bracing
. Posterior spinal fusion
. Vertical Expandable Prosthetic Titanium Rib (VEPTR) insertion

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) bracing

Explanation

TLSO bracing is indicated for growing children (Risser 0-2, pre-menarchal) with curves between 25 and 45 degrees to prevent curve progression.

Question 280

Topic: Pediatric Upper Extremity & Spine

A 13-year-old girl with adolescent idiopathic scoliosis (AIS) presents for follow-up. She is pre-menarchal and Risser stage 0. Standing radiographs reveal a progressive right thoracic curve measuring 32 degrees. Based on the BrAIST trial, what is the most appropriate recommendation?

. Observation with radiographs in 6 months
. Nighttime-only bending brace
. Full-time TLSO bracing for at least 18 hours per day
. Immediate posterior spinal fusion
. Vertebral body tethering

Correct Answer & Explanation

. Full-time TLSO bracing for at least 18 hours per day

Explanation

The BrAIST trial established that full-time bracing (at least 18 hours daily) significantly decreases the rate of curve progression to the surgical threshold in skeletally immature patients with curves between 25 and 40 degrees.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page