4. Pediatrics MCQs

A 12-year-old obese boy is diagnosed with a slipped capital femoral epiphysis (SCFE). Histologic and biomechanical studies demonstrate that the slippage occurs through a specific zone of the physis. Through which zone of the growth plate does the primary failure occur in SCFE?

When stabilizing a Gartland Type III supracondylar humerus fracture with percutaneous pins, a surgeon debates between placing crossed pins (medial and lateral) versus two lateral divergent pins. What is the primary biomechanical and clinical trade-off of using a crossed-pin configuration?

A 6-week-old female has been treated with a Pavlik harness for 2 weeks for Developmental Dysplasia of the Hip (DDH). Her mother reports that the baby is no longer kicking her right leg. Examination reveals decreased active extension of the right knee, while toe and ankle movements remain normal. What is the most appropriate next step in management?

A 13-year-old boy presents to the emergency department with severe acute hip pain after a minor fall and is completely unable to bear weight. Radiographs confirm a severe, displaced slipped capital femoral epiphysis (SCFE). According to the Loder classification, what is the most significant long-term risk associated with this specific presentation?

A 5-year-old girl sustains a Gartland type III supracondylar humerus fracture. After a successful closed reduction and percutaneous pinning in the operating room, her hand is warm and well-perfused with brisk capillary refill, but the radial pulse remains non-palpable. What is the most appropriate management?

An 11-year-old boy presents with a unilateral stable slipped capital femoral epiphysis (SCFE). His medical history is significant for panhypopituitarism, for which he receives growth hormone replacement. After treating the affected hip, what is the most appropriate management for the asymptomatic contralateral hip?

A 14-month-old girl presents with a painless limp since she began walking. Radiographs demonstrate a dislocated left hip. On the AP pelvis radiograph, displacement of the femoral head lateral to which of the following radiographic lines indicates abnormal lateralization?

An 8-year-old boy is brought to the clinic 2 years after undergoing closed reduction and percutaneous pinning of a Gartland III supracondylar humerus fracture. The parents are concerned about the cosmetic appearance of his arm, which shows a marked cubitus varus deformity. What is the most common cause of this deformity?

A 12-year-old boy with a BMI in the 98th percentile presents with a 3-month history of ill-defined knee pain. The knee examination is unremarkable, but the affected hip exhibits obligate external rotation during passive flexion. Which radiographic finding on the AP pelvis is most characteristic of this condition?

A 2-year-old girl with neglected developmental dysplasia of the hip is scheduled for an open reduction via an anterior (Smith-Petersen) approach. Which of the following structures is NOT considered a primary anatomic obstacle to reduction in this condition?

During preoperative planning for percutaneous pinning of a Gartland type III supracondylar humerus fracture, the biomechanical properties of different pin configurations are reviewed. Compared to two divergent lateral pins, a crossed-pin configuration (one medial, one lateral) provides statistically significant increased resistance to which of the following forces?

A 14-year-old girl is 6 months post-operative from in situ pinning of a stable slipped capital femoral epiphysis (SCFE). She now presents with a stiff, painful hip. Examination reveals significant global restriction of range of motion. Radiographs demonstrate severe joint space narrowing, but the hardware is well-seated without joint penetration. What is the most likely diagnosis?

A 4-week-old female infant, born breech, has a normal clinical hip examination. A screening ultrasound reveals an alpha angle of 45 degrees and a beta angle of 65 degrees. Based on the Graf classification, what is the most appropriate next step in management?

The biomechanical failure that leads to a slipped capital femoral epiphysis (SCFE) occurs predominantly through which specific microscopic zone of the physis?

A 9-month-old infant is undergoing a closed reduction and spica casting for developmental dysplasia of the hip (DDH). Intraoperatively, the surgeon establishes Ramsey's "safe zone" to minimize the risk of complications. This safe zone is defined by the arc of motion between the angle of maximum abduction and the angle of:

A 13-year-old obese boy presents with severe left hip pain and inability to bear weight after a minor fall 2 days ago. Radiographs show a posterior and inferior displacement of the proximal femoral epiphysis. According to the Loder classification, what is the primary determinant of a poor prognosis in this patient?

A 6-week-old female is being treated with a Pavlik harness for a dislocated left hip. During a follow-up visit at 2 weeks, the mother notes the child is no longer kicking the left leg. Examination reveals decreased active knee extension on the left. What is the most appropriate next step in management?

A 6-year-old boy sustains a Gartland type III extension-type supracondylar humerus fracture. On presentation, his hand is pink and warm, but the radial pulse is nonpalpable. After closed reduction and percutaneous pinning, the hand remains pink and warm, but the pulse is still absent. What is the most appropriate next step in management?

A 12-year-old boy with chronic renal failure presents with a stable right slipped capital femoral epiphysis (SCFE). Which of the following is the strongest indication for prophylactic pinning of the contralateral, asymptomatic hip in this patient?

A 14-year-old boy complains of vague right knee pain for 3 months. Hip examination reveals that as the right hip is passively flexed, it obligately moves into external rotation and abduction. This clinical finding is most consistent with which of the following diagnoses?