Menu

Pediatric Upper Extremity & Spine MCQs

Practice Set 15 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 281

Topic: Pediatric Upper Extremity & Spine
A 12-year-old premenarchal female with adolescent idiopathic scoliosis (AIS) has a right thoracic curve of 32 degrees and a Risser stage of 1. According to the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST), what is the most significant factor determining the success of brace treatment?
. The specific type of custom brace prescribed
. The number of hours the brace is worn per day
. The flexibility of the curve on lateral bending films
. The concomitant use of physiotherapeutic scoliosis specific exercises
. The specific vertebral levels of the apical segment

Correct Answer & Explanation

. The number of hours the brace is worn per day

Explanation

The BRAIST study conclusively demonstrated a strong dose-response relationship in bracing efficacy for AIS. Wearing the brace for more hours per day significantly increases the success rate in preventing progression to the surgical threshold.

Question 282

Topic: Pediatric Upper Extremity & Spine

A 12-year-old girl presents with adolescent idiopathic scoliosis (AIS). She has a right thoracic curve of 35 degrees. Her Risser stage is 0, and she is pre-menarchal. What is her approximate risk of curve progression to greater than 50 degrees?

. Less than 10%
. 20-30%
. 40-50%
. 60-70%
. Greater than 90%

Correct Answer & Explanation

. Greater than 90%

Explanation

Patients with large curves (greater than 30-35 degrees) before skeletal maturity (Risser 0, pre-menarchal) have a very high risk of progression, often cited as approaching or exceeding 90%. Bracing or surgery is indicated depending on exact curve magnitude and progression.

Question 283

Topic: Pediatric Upper Extremity & Spine
A 6-year-old boy falls from monkey bars and presents with a Gartland type III extension-type supracondylar humerus fracture. Examination reveals an inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which nerve is most likely injured?
. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve
. Posterior interosseous nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN) is the most commonly injured nerve in extension-type supracondylar humerus fractures. It is assessed by asking the patient to make an "OK" sign, which requires FPL and FDP function.

Question 284

Topic: Pediatric Upper Extremity & Spine
A 6-year-old boy falls from the monkey bars and sustains an extension-type Gartland III supracondylar humerus fracture. On presentation, his hand is pink but pulseless. He is unable to flex the interphalangeal joint of his thumb and the distal interphalangeal joint of his index finger. Which of the following nerves is most likely injured?
. Ulnar nerve
. Anterior interosseous nerve
. Radial nerve
. Posterior interosseous nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve

Explanation

The anterior interosseous nerve (AIN) is the most commonly injured nerve in extension-type supracondylar humerus fractures. Injury results in the inability to make an 'A-OK' sign due to weakness of the flexor pollicis longus and flexor digitorum profundus to the index finger.

Question 285

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal female with Risser stage 0 is diagnosed with adolescent idiopathic scoliosis (AIS). She has a right thoracic curve. Which of the following scenarios is the most appropriate indication to initiate treatment with a Thoracolumbosacral Orthosis (TLSO)?

. A 15-degree curve at initial presentation
. A 20-degree curve without documented progression
. A 25-degree curve with documented progression of 6 degrees over 6 months
. A 45-degree curve at initial presentation
. A 50-degree curve with pain

Correct Answer & Explanation

. A 25-degree curve with documented progression of 6 degrees over 6 months

Explanation

Bracing in AIS is indicated for growing children (Risser 0-2) with curves between 25 and 44 degrees that have documented progression (>5 degrees) or those presenting initially with curves of 30 to 39 degrees. Curves >45-50 degrees generally require surgery.

Question 286

Topic: Pediatric Upper Extremity & Spine
A 6-year-old boy falls from monkey bars and sustains a Gartland type III supracondylar humerus fracture. On arrival, his hand is pink but the radial pulse is absent. The fracture undergoes immediate closed reduction and percutaneous pinning. Following fixation, the hand remains pink and well-perfused, but the radial pulse remains absent by Doppler. What is the most appropriate next step in management?
. Observe and admit for close neurovascular monitoring
. Immediate open exploration of the brachial artery
. Perform a CT angiogram of the upper extremity
. Remove the pins and attempt open reduction
. Consult vascular surgery for a bypass graft

Correct Answer & Explanation

. Observe and admit for close neurovascular monitoring

Explanation

A pink, pulseless hand following reduction and pinning of a supracondylar fracture indicates adequate collateral circulation. The standard of care is close observation for 24 to 48 hours rather than immediate vascular exploration.

Question 287

Topic: Pediatric Upper Extremity & Spine

The Injury Severity Score (ISS) is a validated anatomical scoring system used globally for polytrauma patients. How is the ISS mathematically derived from the Abbreviated Injury Scale (AIS)?

. Sum of the AIS scores of the three most severely injured body regions
. Sum of the squares of the highest AIS scores in the three most severely injured body regions
. Sum of the squares of all documented AIS scores
. The highest single AIS score multiplied by 3
. The square of the highest overall AIS score

Correct Answer & Explanation

. Sum of the squares of the highest AIS scores in the three most severely injured body regions

Explanation

The Injury Severity Score (ISS) correlates with mortality and is calculated by summing the squares of the highest Abbreviated Injury Scale (AIS) scores in the three most severely injured physiological regions.

Question 288

Topic: Pediatric Upper Extremity & Spine

A 25-year-old man sustains a C6 spinal cord injury. He has no motor function below the level of injury but has preserved pinprick sensation in the perianal area and voluntary anal contraction. How is his injury classified according to the ASIA Impairment Scale (AIS)?

. AIS A
. AIS B
. AIS C
. AIS D
. AIS E

Correct Answer & Explanation

. AIS B

Explanation

An ASIA B (sensory incomplete) injury is characterized by the preservation of sensory function (including sacral segments S4-S5) but no motor function below the neurological level of injury. The presence of perianal sensation and anal contraction confirms sacral sparing.

Question 289

Topic: Pediatric Upper Extremity & Spine

A 14-year-old girl with adolescent idiopathic scoliosis (AIS) has a right main thoracic curve of 55 degrees and a left lumbar curve of 35 degrees. On lateral bending radiographs, the lumbar curve reduces to 15 degrees. According to the Lenke classification, what type of curve pattern is this?

. Lenke 1 (Main Thoracic)
. Lenke 2 (Double Thoracic)
. Lenke 3 (Double Major)
. Lenke 5 (Thoracolumbar/Lumbar)
. Lenke 6 (Thoracolumbar/Lumbar-Main Thoracic)

Correct Answer & Explanation

. Lenke 1 (Main Thoracic)

Explanation

A structural main thoracic curve with a non-structural lumbar curve (which bends out to less than 25 degrees) is classified as a Lenke 1 curve. This typically requires a selective thoracic fusion.

Question 290

Topic: Pediatric Upper Extremity & Spine

A 14-year-old girl with adolescent idiopathic scoliosis has a primary right thoracic curve of 55 degrees and a left lumbar curve of 35 degrees. On lateral bending radiographs, the lumbar curve corrects to 15 degrees. According to the Lenke classification, what type of curve does she have?

. Type 1 (Main Thoracic)
. Type 2 (Double Thoracic)
. Type 3 (Double Major)
. Type 5 (Thoracolumbar/Lumbar)
. Type 6 (Thoracolumbar/Lumbar - Main Thoracic)

Correct Answer & Explanation

. Type 1 (Main Thoracic)

Explanation

This is a Lenke Type 1 (Main Thoracic) curve. The lumbar curve is nonstructural because it corrects to less than 25 degrees on lateral bending radiographs.

Question 291

Topic: Pediatric Upper Extremity & Spine

A 14-year-old girl with adolescent idiopathic scoliosis presents with a right thoracic curve measuring 55 degrees on standing radiographs. Her Risser stage is 0 and she is pre-menarchal. What is the most appropriate management?

. Observation with radiographs every 6 months
. Full-time TLSO bracing
. Nighttime bending brace
. Posterior spinal fusion
. Anterior vertebral body tethering

Correct Answer & Explanation

. Posterior spinal fusion

Explanation

Curves greater than 50 degrees in growing adolescents have a high risk of continued progression into adulthood and typically warrant surgical correction. Posterior spinal fusion is the standard of care for a progressive 55-degree curve in a Risser 0 patient.

Question 292

Topic: Pediatric Upper Extremity & Spine

A 13-year-old premenarchal female (Risser stage 0) presents for evaluation of a spinal deformity. Radiographs confirm adolescent idiopathic scoliosis with a primary right thoracic curve measuring 35 degrees. What is the most appropriate evidence-based management strategy for this patient?

. Observation with serial standing radiographs every 6 months until skeletal maturity
. Treatment with a full-time custom thoracolumbosacral orthosis (TLSO)
. Treatment with a nighttime-only bending brace
. Posterior spinal instrumentation and fusion
. Anterior vertebral body tethering

Correct Answer & Explanation

. Treatment with a full-time custom thoracolumbosacral orthosis (TLSO)

Explanation

For a skeletally immature patient (Risser 0-2, premenarchal) with an adolescent idiopathic scoliosis curve measuring between 25 and 45 degrees, the standard of care to prevent progression to a surgical threshold is full-time bracing (TLSO).

Question 293

Topic: Pediatric Upper Extremity & Spine

A 14-year-old girl is diagnosed with Adolescent Idiopathic Scoliosis (AIS). Her standing radiographs show a right thoracic curve of 55 degrees and a left lumbar curve of 35 degrees. On side-bending radiographs, the lumbar curve corrects to 15 degrees. According to the Lenke classification system, what type of curve pattern does she have?

. Type 1 (Main Thoracic)
. Type 2 (Double Thoracic)
. Type 3 (Double Major)
. Type 5 (Thoracolumbar/Lumbar)
. Type 6 (Thoracolumbar/Lumbar-Main Thoracic)

Correct Answer & Explanation

. Type 1 (Main Thoracic)

Explanation

The patient has a structural main thoracic curve (greater than 25 degrees on bending) and a non-structural lumbar curve (corrects to less than 25 degrees on bending). This classifies as a Lenke Type 1 curve.

Question 294

Topic: Pediatric Upper Extremity & Spine

A 13-year-old girl presents with adolescent idiopathic scoliosis. She has a right thoracic curve of 55 degrees. She is Risser 0 and premenarchal. What is the most appropriate management?

. Observation with clinical follow-up in 6 months
. Part-time bracing (8 hours/day)
. Full-time bracing (18-23 hours/day)
. Posterior spinal fusion
. Anterior tethering surgery

Correct Answer & Explanation

. Posterior spinal fusion

Explanation

Bracing is typically indicated for curves between 25 and 45 degrees in growing children. For a curve of 55 degrees with significant remaining growth potential (Risser 0), surgical correction with posterior spinal fusion is indicated.

Question 295

Topic: Pediatric Upper Extremity & Spine

A 14-year-old girl with adolescent idiopathic scoliosis (AIS) has a right thoracic curve of 55 degrees and a left lumbar curve of 35 degrees. On lateral bending radiographs, the thoracic curve corrects to 30 degrees, while the lumbar curve corrects to 15 degrees. According to the Lenke classification, what is her curve type?

. Type 1 (Main Thoracic)
. Type 2 (Double Thoracic)
. Type 3 (Double Major)
. Type 4 (Triple Major)
. Type 5 (Thoracolumbar/Lumbar)

Correct Answer & Explanation

. Type 1 (Main Thoracic)

Explanation

This is a Lenke Type 1 (Main Thoracic) curve. The lumbar curve is non-structural because it bends out to 25 degrees or less (in this case, 15 degrees) on side-bending radiographs.

Question 296

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal girl presents with a right thoracic curve measuring 32 degrees on standing posteroanterior radiographs. Her Risser stage is 0. What is the most appropriate management?

. Observation with follow-up radiographs in 1 year
. Physical therapy and core strengthening
. Full-time bracing with a thoracolumbosacral orthosis (TLSO)
. Posterior spinal fusion
. Anterior tethering procedure

Correct Answer & Explanation

. Full-time bracing with a thoracolumbosacral orthosis (TLSO)

Explanation

This patient is skeletally immature (premenarchal, Risser 0) and has an adolescent idiopathic scoliosis curve between 25 and 45 degrees. She is at high risk for progression, making her an ideal candidate for full-time TLSO bracing.

Question 297

Topic: Pediatric Upper Extremity & Spine

A patient presents with proximal forearm pain and weakness in flexing the thumb interphalangeal joint. Compression of the median nerve at the ligament of Struthers involves an aberrant anatomical band connecting the medial epicondyle to what structure?

. Supracondylar process
. Coracoid process
. Radial tuberosity
. Olecranon
. Lateral epicondyle

Correct Answer & Explanation

. Supracondylar process

Explanation

The ligament of Struthers is an anomalous band present in about 1% of the population, connecting a bony supracondylar process on the anteromedial humerus to the medial epicondyle. It can compress both the median nerve and the brachial artery.

Question 298

Topic: Pediatric Upper Extremity & Spine

A 6-year-old boy falls from monkey bars and sustains a significantly displaced, extension-type supracondylar humerus fracture. On examination, he is unable to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which nerve is most likely injured?

. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve
. Posterior interosseous nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Radial nerve

Explanation

The anterior interosseous nerve (AIN) is the most commonly injured nerve in extension-type supracondylar humerus fractures. Injury presents as an inability to form the "OK" sign due to weakness of the flexor pollicis longus and flexor digitorum profundus to the index finger.

Question 299

Topic: Pediatric Upper Extremity & Spine

A 14-year-old female presents with a progressive right thoracic scoliotic curve. Radiographs reveal an adolescent idiopathic scoliosis (AIS) curve measuring 55 degrees. Her Risser stage is 0. What is the primary indication for surgical intervention in this patient?

. Presence of an unsegmented congenital bar
. Curve magnitude > 50 degrees with significant remaining growth
. Axial back pain unresponsive to physical therapy
. Preventing progression to a neuromuscular curve
. Associated syrinx on MRI

Correct Answer & Explanation

. Presence of an unsegmented congenital bar

Explanation

In Adolescent Idiopathic Scoliosis, surgical fusion is generally indicated for curves greater than 45-50 degrees, especially in patients with significant remaining growth (Risser 0). This prevents further progression, which inevitably occurs even after skeletal maturity for curves >50 degrees.

Question 300

Topic: Pediatric Upper Extremity & Spine
A 5-year-old girl sustains a Gartland type III supracondylar humerus fracture. Upon evaluation in the emergency department, her hand is pink and warm, but the radial pulse is absent. What is the most appropriate next step in management?
. Immediate exploration of the brachial artery
. Closed reduction and percutaneous pinning, then re-evaluate the pulse
. CT angiogram of the upper extremity
. Application of a hyperflexion long arm cast
. Open reduction and internal fixation with prophylactic fasciotomies

Correct Answer & Explanation

. Closed reduction and percutaneous pinning, then re-evaluate the pulse

Explanation

A "pulseless, pink" hand following a supracondylar humerus fracture indicates adequate collateral perfusion. The standard of care is urgent closed reduction and percutaneous pinning (CRPP), which frequently restores the anatomic alignment and the radial pulse.

Test Yourself

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

On this Page