4. Pediatrics MCQs

A 4-month-old female with developmental dysplasia of the hip (DDH) is being treated with a Pavlik harness. At a follow-up visit, the mother notes the child is no longer kicking her left leg. On exam, there is an absent patellar reflex and decreased active knee extension. Which of the following is the most appropriate next step in management?

A 13-year-old obese male presents to the emergency department with acute left groin pain and inability to bear weight. He reports a 3-month history of mild intermittent knee pain. Radiographs reveal a left slipped capital femoral epiphysis (SCFE). Which of the following factors is the strongest predictor of developing avascular necrosis (AVN) in this patient?

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

An 18-month-old female with neglected developmental dysplasia of the hip is scheduled for an open reduction via an anterior Smith-Petersen approach. During the procedure, several anatomical structures must be addressed to allow concentric reduction. Which of the following represents an extra-articular block to reduction?

An 8-year-old boy presents with bilateral slipped capital femoral epiphyses. His height is in the 5th percentile and his weight is in the 90th percentile. Which of the following laboratory studies is most critical in evaluating the underlying etiology of his condition?

In the treatment of developmental dysplasia of the hip with a Pavlik harness or spica cast, maintaining the hip in excessive abduction significantly increases the risk of which of the following complications?

Prophylactic pinning of the contralateral hip is most strongly indicated in which of the following patients presenting with a unilateral slipped capital femoral epiphysis?

A 4-week-old female infant is undergoing treatment for developmental dysplasia of the hip (DDH) with a Pavlik harness. During a follow-up visit, the mother reports that the infant is no longer actively extending her knee on the affected side. Examination confirms absent active knee extension, though patellar reflexes are intact. What is the most appropriate next step in management?

When evaluating coronal ultrasound images for developmental dysplasia of the hip (DDH) in a 6-week-old infant, the alpha angle is routinely measured. Which anatomic structure serves as the primary landmark for determining this angle?

A 12-year-old boy presents with an acute on chronic slipped capital femoral epiphysis (SCFE) of the left hip. Under which of the following circumstances is prophylactic in-situ pinning of the contralateral, asymptomatic hip most strongly indicated?

A 13-year-old boy with a BMI of 35 presents with a 2-day history of severe right hip pain and absolute inability to bear weight, even with crutches. According to the Loder classification, what is his approximate risk of developing avascular necrosis (AVN) following treatment?

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?

A 14-year-old boy is evaluated 6 months after an uncomplicated in-situ percutaneous pinning for a stable SCFE. He now reports worsening hip pain and demonstrates a global loss of range of motion in the affected hip. Joint space narrowing is evident on radiographs. What is the most likely etiology?

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)?

A 6-month-old girl has been treated with a Pavlik harness for 4 weeks due to a completely dislocated left hip (Developmental Dysplasia of the Hip). Serial ultrasounds demonstrate that the hip remains persistently dislocated despite confirmed appropriate strap tension and compliance. What is the most appropriate next step in management?

A 12-year-old boy presents with a unilateral stable Slipped Capital Femoral Epiphysis (SCFE) of the left hip. Which of the following patient factors is the strongest absolute indication for prophylactic in situ pinning of the asymptomatic right hip?

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?

A 2-year-old girl is brought to the clinic for a painless limp. She has a positive Trendelenburg gait. Radiographs show a dislocated right hip with a false acetabulum and hypoplastic femoral nucleus. Which of the following is the most appropriate treatment for this late-presenting developmental dysplasia of the hip (DDH)?

A 13-year-old girl with a high BMI presents to the emergency department with acute right hip pain after a minor slip. She cannot bear weight on the right leg, even with the assistance of crutches. Radiographs confirm a slipped capital femoral epiphysis. Compared to a stable slip, this patient is at significantly higher risk for which of the following complications?

During an open reduction for developmental dysplasia of the hip (DDH) via an anterior approach, several structures are identified that may block concentric reduction. Which of the following is considered an EXTRA-articular obstacle to reduction?