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4. Pediatrics MCQs

Practice Set 1 of 334

This practice set contains high-yield board review questions covering key concepts in 4. Pediatrics. 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: 4. Pediatrics

An 11-year-old baseball pitcher presents with proximal arm pain. Radiographs reveal widening of the proximal humeral physis. What is the recommended treatment?

. Open reduction and internal fixation
. Percutaneous pinning
. Absolute rest from throwing for 3 months
. Physical therapy focusing on external rotation strengthening
. Corticosteroid injection into the subacromial space

Correct Answer & Explanation

. Absolute rest from throwing for 3 months

Explanation

Little Leaguer's shoulder is a stress fracture of the proximal humeral physis caused by repetitive rotational torque. Treatment requires absolute rest from throwing, typically for about 3 months, followed by a gradual return-to-throwing program.

Question 3

Topic: Pediatric Upper Extremity & Spine

A 12-year-old elite baseball pitcher presents with chronic medial elbow pain. Radiographs demonstrate widening and fragmentation of the medial epicondyle apophysis. What biomechanical forces are primarily responsible for this condition?

. Valgus overload causing medial tension and lateral compression
. Varus overload causing medial compression and lateral tension
. Hyperextension causing posterior impingement
. Hyperflexion causing anterior capsular strain
. Direct traumatic impact to the medial epicondyle

Correct Answer & Explanation

. Valgus overload causing medial tension and lateral compression

Explanation

Little League elbow encompasses several conditions caused by repetitive valgus overload during throwing. This creates tension forces on the medial structures (causing medial epicondyle apophysitis) and compressive forces on the lateral structures.

Question 4

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 5

Topic: 4. Pediatrics
Which of the following describes a Salter-Harris Type III fracture?
. Fracture through the physis only
. Fracture through the metaphysis and physis
. Fracture through the physis and epiphysis
. Fracture through the metaphysis, physis, and epiphysis
. Crush injury to the physis

Correct Answer & Explanation

. Fracture through the physis and epiphysis

Explanation

A Salter-Harris Type III fracture involves a fracture line extending from the physis into the epiphysis, typically involving the articular surface.

Question 6

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 7

Topic: 4. Pediatrics

Which of the following is a classic clinical finding in developmental dysplasia of the hip (DDH) in infants?

. Positive Trendelenburg sign
. Limited knee extension
. Asymmetrical thigh skin folds
. Genu valgum
. Clubfoot deformity

Correct Answer & Explanation

. Asymmetrical thigh skin folds

Explanation

Asymmetrical thigh skin folds (along with gluteal folds) are a common sign of DDH in infants, though they are not diagnostic. Ortolani and Barlow maneuvers are more definitive clinical tests.

Question 8

Topic: Pediatric Hip
Which condition is characterized by avascular necrosis of the femoral head in children aged 4-8 years?
. Slipped Capital Femoral Epiphysis (SCFE)
. Legg-Calvé-Perthes disease
. Developmental Dysplasia of the Hip (DDH)
. Transient synovitis of the hip
. Septic arthritis of the hip

Correct Answer & Explanation

. Legg-Calvé-Perthes disease

Explanation

Legg-Calvé-Perthes disease is an idiopathic avascular necrosis of the femoral head in children, typically affecting boys between 4 and 8 years of age.

Question 9

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 10

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 11

Topic: 4. Pediatrics

A 13-year-old elite baseball pitcher complains of gradually worsening shoulder pain while throwing. Radiographs demonstrate widening and irregularity of the proximal humeral physis. What is the mainstay of treatment for this condition?

. Corticosteroid injection
. Surgical pinning in situ
. Absolute rest from throwing for 3 months followed by a return-to-throw program
. Continued throwing with modified mechanics
. Arthroscopic debridement

Correct Answer & Explanation

. Absolute rest from throwing for 3 months followed by a return-to-throw program

Explanation

Little League Shoulder (proximal humeral epiphysiolysis) is a pediatric overuse injury. The definitive treatment is absolute rest from throwing until radiographic and clinical resolution, usually followed by a structured return-to-throw program.

Question 12

Topic: 4. Pediatrics

A 13-year-old Little League pitcher presents with shoulder pain. Radiographs reveal widening of the proximal humeral physis compared to the contralateral side. What is the most appropriate initial treatment?

. Corticosteroid injection into the subacromial space
. Arthroscopic labral repair
. Cessation of throwing and physical therapy
. Open reduction and internal fixation
. In situ percutaneous pinning of the physis

Correct Answer & Explanation

. Cessation of throwing and physical therapy

Explanation

This presentation is consistent with 'Little League Shoulder' (proximal humeral epiphysiolysis). The primary treatment is absolute rest from throwing until symptoms resolve and radiographic healing is evident, followed by mechanical rehabilitation.

Question 13

Topic: 4. Pediatrics

A 14-year-old baseball pitcher presents with generalized shoulder pain. Radiographs reveal widening of the proximal humeral physis. What is the most appropriate initial management?

. Immediate surgical pinning in situ
. Corticosteroid injection into the subacromial space
. Absolute rest from throwing for 2 to 3 months
. Aggressive physical therapy emphasizing internal rotation
. Diagnostic MRI arthrogram

Correct Answer & Explanation

. Absolute rest from throwing for 2 to 3 months

Explanation

Little League Shoulder (proximal humeral epiphysiolysis) is an overuse injury. Absolute rest from throwing for 2 to 3 months is the standard of care until symptoms resolve and radiographs normalize.

Question 14

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 15

Topic: Pediatric Hip
A 45-year-old female presents with anterior hip pain. Radiographs demonstrate a crossover sign and a lateral center-edge angle of 45 degrees, consistent with global acetabular overcoverage. Which condition is most strongly associated with this morphology?
. Cam impingement
. Pincer impingement
. Slipped capital femoral epiphysis
. Legg-Calvé-Perthes disease
. Femoral retroversion

Correct Answer & Explanation

. Pincer impingement

Explanation

A crossover sign and an increased lateral center-edge angle (>40 degrees) indicate acetabular retroversion or overcoverage. These are the classic radiographic hallmarks of Pincer-type femoroacetabular impingement.

Question 16

Topic: 4. Pediatrics

A 14-year-old elite baseball pitcher presents with vague, progressive shoulder pain during the acceleration phase of throwing. Radiographs demonstrate widening of the proximal humeral physis. What is the most appropriate initial management?

. Corticosteroid injection into the subacromial space
. Arthroscopic superior labral repair
. Complete rest from throwing for 3 months followed by a gradual return
. Immobilization in a sling for 6 weeks
. Open reduction and internal fixation across the physis

Correct Answer & Explanation

. Complete rest from throwing for 3 months followed by a gradual return

Explanation

Little League Shoulder is a stress fracture of the proximal humeral physis caused by repetitive rotational and distraction stresses. The standard treatment is cessation of throwing for at least 3 months to allow physeal healing, followed by a structured throwing program.

Question 17

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 18

Topic: Pediatric Hip

A 19-year-old female dancer complains of a deep groin pain and a "clicking" sensation in her hip. Radiographs show a lateral center-edge angle of 15 degrees. What is the most likely underlying structural pathology?

. Femoroacetabular impingement (Cam type)
. Femoroacetabular impingement (Pincer type)
. Developmental dysplasia of the hip
. Slipped capital femoral epiphysis
. Legg-Calve-Perthes disease

Correct Answer & Explanation

. Developmental dysplasia of the hip

Explanation

A lateral center-edge angle of less than 20 degrees is diagnostic for developmental dysplasia of the hip (DDH). The clicking and pain are likely due to secondary labral pathology and capsular overload.

Question 19

Topic: Pediatric Hip

An 8-year-old boy presents with an atraumatic limp and left groin pain. Radiographs reveal a slipped capital femoral epiphysis (SCFE). His weight is in the 45th percentile for his age. Which of the following tests is most appropriate as part of his initial evaluation?

. Thyroid-stimulating hormone (TSH) and free T4
. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
. Rheumatoid factor and Antinuclear antibodies (ANA)
. Bone marrow aspiration
. Genetic testing for COL1A1

Correct Answer & Explanation

. Thyroid-stimulating hormone (TSH) and free T4

Explanation

A patient presenting with SCFE before the age of 10 or with atypical physical features (weight less than 50th percentile) requires a thorough endocrine workup. Hypothyroidism and renal osteodystrophy are among the most common associated endocrine disorders.

Question 20

Topic: Pediatric Upper Extremity & Spine

A 6-year-old girl falls from the monkey bars and sustains an extension-type supracondylar humerus fracture. After closed reduction and percutaneous pinning, she is unable to flex the interphalangeal joint of her thumb and the distal interphalangeal joint of her index finger. Which nerve is most likely injured?

. Ulnar nerve
. Radial nerve
. Anterior interosseous nerve (AIN)
. Posterior interosseous nerve (PIN)
. Musculocutaneous nerve

Correct Answer & Explanation

. Anterior interosseous nerve (AIN)

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 'OK' sign due to weakness of the flexor pollicis longus and the flexor digitorum profundus to the index finger.

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