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4. Pediatrics MCQs

Practice Set 10 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 181

Topic: 4. Pediatrics

A 5-year-old child with spastic quadriplegic cerebral palsy is undergoing routine hip surveillance. Radiographs show a migration percentage of 45% with a break in Shenton's line. What is the most appropriate management?

. Observation and repeat radiographs in 1 year
. Botulinum toxin injection to the adductors
. Adductor tenotomy alone
. Varus derotational osteotomy (VDRO) of the proximal femur
. Total hip arthroplasty

Correct Answer & Explanation

. Varus derotational osteotomy (VDRO) of the proximal femur

Explanation

In cerebral palsy, a migration percentage >40% indicates progressive hip subluxation. Bony reconstructive surgery, typically a VDRO with or without pelvic osteotomy, is indicated to prevent painful dislocation.

Question 182

Topic: Pediatric Hip

A 12-year-old obese boy presents with a 3-week history of left groin pain and a limp. On examination, as the left hip is flexed, it obligatorily externally rotates. Radiographs are shown.

What is the most appropriate definitive management?

. Spica cast immobilization
. In situ pinning with a single cannulated screw
. Closed reduction and casting
. Proximal femoral osteotomy
. Core decompression

Correct Answer & Explanation

. In situ pinning with a single cannulated screw

Explanation

The presentation is classic for a Slipped Capital Femoral Epiphysis (SCFE). The gold standard treatment for a stable SCFE is in situ pinning with a single cannulated screw to prevent further slippage.

Question 183

Topic: Pediatric Hip

A 6-year-old boy presents with a painless limp of 2 months' duration. His hip range of motion reveals decreased abduction and internal rotation. A radiograph reveals sclerosis and fragmentation of the proximal femoral epiphysis. What is the most likely diagnosis?

. Transient synovitis
. Septic arthritis
. Legg-Calve-Perthes disease
. Slipped capital femoral epiphysis
. Juvenile idiopathic arthritis

Correct Answer & Explanation

. Legg-Calve-Perthes disease

Explanation

Legg-Calve-Perthes disease typically presents in children aged 4-8 with a painless or mildly painful limp. Radiographs show avascular necrosis of the capital femoral epiphysis.

Question 184

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 185

Topic: Pediatric Hip

A 4-week-old female infant is brought to the clinic for a routine check-up. Barlow and Ortolani maneuvers are positive on the left side. Ultrasound confirms developmental dysplasia of the hip (DDH). What is the initial treatment of choice?

. Pavlik harness
. Rigid abduction orthosis
. Closed reduction and spica casting
. Open reduction and spica casting
. Observation

Correct Answer & Explanation

. Pavlik harness

Explanation

The Pavlik harness is the gold standard initial treatment for DDH in infants under 6 months of age, maintaining the hip in flexion and abduction.

Question 186

Topic: 4. Pediatrics

A 3-year-old child presents with a severe bowleg deformity (varus) that has progressed over the past year. Radiographs show medial beaking and fragmentation of the proximal tibial metaphysis.

What is the most likely diagnosis?

. Physiologic bowing
. Achondroplasia
. Rickets
. Infantile Blount's disease
. Osteogenesis imperfecta

Correct Answer & Explanation

. Infantile Blount's disease

Explanation

Infantile Blount's disease is characterized by a pathologic varus deformity due to disordered growth of the medial proximal tibial physis, displaying a classic metaphyseal beak.

Question 187

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 188

Topic: 4. Pediatrics
A 13-year-old boy sustains an ankle injury. Radiographs show a Salter-Harris III fracture of the anterolateral aspect of the distal tibial epiphysis. What ligament is responsible for the avulsion of this fracture fragment?
. Anterior talofibular ligament
. Calcaneofibular ligament
. Anterior inferior tibiofibular ligament
. Posterior inferior tibiofibular ligament
. Deltoid ligament

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament

Explanation

A Tillaux fracture is a Salter-Harris III fracture of the anterolateral distal tibial epiphysis, avulsed by the anterior inferior tibiofibular ligament (AITFL) due to external rotation.

Question 189

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 190

Topic: 4. Pediatrics

A 5-year-old boy presents with anterior bowing of his tibia and a leg length discrepancy. Radiographs reveal a pseudarthrosis of the middle third of the tibia.

This condition is most strongly associated with which of the following systemic disorders?

. Marfan syndrome
. Neurofibromatosis type 1
. Osteogenesis imperfecta
. Achondroplasia
. Down syndrome

Correct Answer & Explanation

. Neurofibromatosis type 1

Explanation

Congenital pseudarthrosis of the tibia (CPT) has a very strong association with Neurofibromatosis type 1 (NF1). Up to 50% of patients with CPT have NF1.

Question 191

Topic: 4. Pediatrics

A 6-month-old infant is diagnosed with an atypical presentation of multiple fractures in various stages of healing, blue sclerae, and dentinogenesis imperfecta. A genetic defect in which of the following is most likely responsible?

. Fibrillin-1
. Type II collagen
. Type I collagen
. Fibroblast growth factor receptor 3
. Dystrophin

Correct Answer & Explanation

. Type I collagen

Explanation

Osteogenesis imperfecta is primarily caused by autosomal dominant mutations in the COL1A1 or COL1A2 genes, which encode Type I collagen, leading to brittle bones and blue sclerae.

Question 192

Topic: 4. Pediatrics

A 14-year-old pitcher presents with progressive shoulder pain during throwing. Radiographs reveal widening of the proximal humeral physis compared to the contralateral side.

What is the best initial treatment?

. Surgical pinning of the physis
. Arthroscopic SLAP repair
. Absolute rest from throwing for 3 months
. Corticosteroid injection into the subacromial space
. Immediate physical therapy for rotator cuff strengthening

Correct Answer & Explanation

. Absolute rest from throwing for 3 months

Explanation

Little League shoulder (proximal humeral epiphysiolysis) is a stress injury to the proximal humeral physis. The primary treatment is complete cessation of throwing to allow the physis to heal.

Question 193

Topic: Pediatric Upper Extremity & Spine

A 12-year-old girl is diagnosed with adolescent idiopathic scoliosis (AIS). She is premenarchal, Risser stage 0, and has a right thoracic curve of 35 degrees. What is the most appropriate management?

. Observation with radiographs every 6 months
. Thoracolumbosacral orthosis (TLSO) bracing
. Posterior spinal fusion
. Anterior tethering procedure
. Physical therapy alone

Correct Answer & Explanation

. Thoracolumbosacral orthosis (TLSO) bracing

Explanation

In a skeletally immature patient (Risser 0, premenarchal) with an AIS curve between 25 and 45 degrees, bracing is indicated to prevent curve progression.

Question 194

Topic: Pediatric Hip
An 8-year-old boy presents with a persistent limp. Radiographs demonstrate a fragmented proximal femoral epiphysis. Which of the following factors is most predictive of the final radiographic outcome in Legg-Calvรฉ-Perthes disease?
. Gender of the patient
. Body mass index
. Age at clinical onset
. Duration of initial symptoms
. Presence of knee pain

Correct Answer & Explanation

. Age at clinical onset

Explanation

Age at clinical onset is the most significant prognostic factor in Legg-Calvรฉ-Perthes disease. Patients presenting before the age of 6 to 8 years generally have a much higher potential for remodeling and a better final radiographic outcome.

Question 195

Topic: 4. Pediatrics
A 14-year-old boy sustains a twisting ankle injury. Radiographs show a classic triplane fracture. Which of the following accurately describes the typical fracture pattern seen on standard anteroposterior (AP) and lateral radiographic views?
. Salter-Harris II on AP and Salter-Harris III on lateral
. Salter-Harris III on AP and Salter-Harris II on lateral
. Salter-Harris I on AP and Salter-Harris IV on lateral
. Salter-Harris IV on both AP and lateral views
. Salter-Harris II on both AP and lateral views

Correct Answer & Explanation

. Salter-Harris III on AP and Salter-Harris II on lateral

Explanation

A triplane fracture is a Salter-Harris IV equivalent injury. Radiographically, it appears as a Salter-Harris III fracture on the AP view (sagittal fracture line) and a Salter-Harris II on the lateral view (coronal fracture line).

Question 196

Topic: 4. Pediatrics

A 13-year-old boy presents with an isolated juvenile Tillaux fracture of the ankle. Which of the following best explains the specific anatomical pathogenesis of this fracture pattern?

. Closure of the distal tibial physis begins laterally and progresses medially
. Closure of the distal tibial physis begins centrally and medially, leaving the lateral physis open and vulnerable
. The deltoid ligament avulses the medial epiphysis during eversion
. The calcaneofibular ligament causes a lateral compression injury
. It is a purely direct axial loading injury to the central plafond

Correct Answer & Explanation

. Closure of the distal tibial physis begins centrally and medially, leaving the lateral physis open and vulnerable

Explanation

The distal tibial physis closes asymmetrically, beginning centrally, progressing medially, and closing laterally last. The still-open lateral physis is vulnerable to avulsion by the anterior inferior tibiofibular ligament during an external rotation injury.

Question 197

Topic: Pediatric Hip

An 8-month-old girl presents with developmental dysplasia of the hip (DDH) that has failed Pavlik harness treatment. A closed reduction and spica casting is planned. Which of the following is considered the most significant extra-articular block to closed reduction in this age group?

. Inverted limbus
. Iliopsoas tendon
. Pulvinar
. Ligamentum teres
. Transverse acetabular ligament

Correct Answer & Explanation

. Iliopsoas tendon

Explanation

The iliopsoas tendon is typically the most significant extra-articular block to reduction in DDH, often causing an hourglass constriction of the hip capsule. The other listed options are intra-articular blocks.

Question 198

Topic: Pediatric Upper Extremity & Spine

A 6-year-old boy presents with a displaced extension-type supracondylar humerus fracture. After anatomic closed reduction and percutaneous pinning, the radial pulse is absent, but the hand remains warm and pink with brisk capillary refill. What is the most appropriate next step in management?

. Immediate exploration of the brachial artery
. Observation with strict pulse oximetry monitoring
. Immediate removal of all pins and open reduction
. Prophylactic fasciotomy of the forearm
. Immediate CT angiogram of the upper extremity

Correct Answer & Explanation

. Observation with strict pulse oximetry monitoring

Explanation

A 'pulseless, pink' hand following an adequate reduction and pinning of a supracondylar fracture indicates sufficient collateral circulation. Standard management is close observation and monitoring, as the pulse often returns over several days.

Question 199

Topic: 4. Pediatrics

When correcting a severe congenital idiopathic clubfoot using the Ponseti method, what is the correct physiological sequence of deformity correction during serial casting?

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

Correct Answer & Explanation

. Cavus, Adductus, Varus, Equinus

Explanation

The Ponseti method dictates correcting the deformities in the CAVE sequence: Cavus first (by supinating the forefoot), followed simultaneously by Adductus and Varus, and finally Equinus (which frequently requires a percutaneous Achilles tenotomy).

Question 200

Topic: Pediatric Hip

A 12-year-old obese boy presents with right knee pain and an antalgic gait. Hip radiographs

show a stable slipped capital femoral epiphysis (SCFE). He is treated with a single in-situ screw. What is the most common long-term complication of his underlying condition?

. Chondrolysis
. Avascular necrosis of the femoral head
. Femoroacetabular impingement
. Subtrochanteric fracture
. Slipped capital femoral epiphysis of the contralateral hip within 1 week

Correct Answer & Explanation

. Femoroacetabular impingement

Explanation

Even after successful in-situ fixation, the residual metaphyseal prominence of the proximal femur often leads to cam-type femoroacetabular impingement (FAI). Avascular necrosis is a higher risk in unstable SCFE.

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