4. Pediatrics MCQs

A 14-year-old boy underwent in situ pinning for a stable SCFE 6 months ago. He now presents with progressive hip stiffness. Examination shows severe restriction of all hip motions. Radiographs show a 2 mm joint space symmetrically but no evidence of AVN. What is the most likely diagnosis?

A 2-year-old boy is being followed after closed reduction and spica casting for DDH at age 8 months. Which radiographic finding is considered the earliest indicator of avascular necrosis of the femoral head in this patient?

Slipped capital femoral epiphysis (SCFE) represents a mechanical failure through which specific histologic layer of the physis?

An infant is born with bilateral dislocated hips and rigid extension contractures of the knees. Genetic testing confirms arthrogryposis multiplex congenita. What is the expected success rate of Pavlik harness treatment in this patient?

When evaluating a 5-month-old with suspected DDH, an AP pelvis radiograph is obtained. Which of the following describes a normal spatial relationship on this imaging?

A 10-year-old girl with primary hypothyroidism presents with bilateral vague knee pain. Frog-leg lateral radiographs of the pelvis demonstrate widening of the bilateral proximal femoral physes without obvious slippage. What is the most appropriate next step in management?

During an anterior open reduction for a developmental dislocation of the hip in a 14-month-old, the surgeon notes an hour-glass constriction of the joint capsule. Which structure is directly responsible for creating this specific capsular constriction?

A 6-week-old infant with developmental dysplasia of the hip (DDH) is being treated with a Pavlik harness. During a follow-up visit, the parents report that the child has stopped kicking the left leg. On examination, there is an absence of active knee extension on the left side, but withdrawal to painful stimuli on the plantar foot is intact. What is the most appropriate next step in management?

A 13-year-old boy with a BMI in the 98th percentile presents to the emergency department unable to bear weight on his right leg after tripping over a rug. Radiographs confirm a slipped capital femoral epiphysis (SCFE). According to the Loder classification, which of the following is the most significant consequence of his inability to bear weight?

A 4-week-old female infant born in breech presentation undergoes a screening hip ultrasound. The coronal view demonstrates a shallow acetabulum with an alpha angle of 45 degrees and a beta angle of 80 degrees. According to the Graf classification, what is the most appropriate management?

An 8-year-old boy presents with bilateral groin pain and an altered gait. Radiographs demonstrate bilateral stable slipped capital femoral epiphyses (SCFE). His height is in the 5th percentile, and his weight is in the 90th percentile. Which of the following laboratory evaluations is most critical in determining the etiology of his condition?

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?

In which of the following patients presenting with a unilateral slipped capital femoral epiphysis (SCFE) is prophylactic in situ pinning of the contralateral hip most strongly indicated?

Following a closed reduction of developmental dysplasia of the hip (DDH) in a 6-month-old, the child is placed in a hip spica cast. To minimize the risk of developing iatrogenic avascular necrosis (AVN), which of the following joint positions must be strictly avoided during casting?

When evaluating an anteroposterior pelvis radiograph of a 12-month-old child suspected of having residual developmental dysplasia of the hip (DDH), the acetabular index is measured. What is generally considered the upper limit of normal for the acetabular index at this age?

A 4-week-old female is treated with a Pavlik harness for developmental dysplasia of the hip (DDH). At the 2-week follow-up, she exhibits decreased spontaneous extension of the right knee and an absent patellar reflex. What is the most appropriate next step in management?

A 13-year-old boy presents with severe left hip pain and an inability to bear weight following a minor fall. Radiographs confirm a slipped capital femoral epiphysis (SCFE). Which of the following is the most likely severe complication directly associated with this specific presentation?

An infant undergoes screening ultrasound for developmental dysplasia of the hip (DDH). The report notes an alpha angle of 45 degrees. Which of the following anatomic structures form the lines used to measure the alpha angle?

A 7-year-old boy, whose weight is in the 30th percentile, presents with a stable slipped capital femoral epiphysis (SCFE). Which of the following laboratory studies is most highly indicated for this patient?