4. Pediatrics MCQs

A 7-year-old boy presents with a severely displaced supracondylar humerus fracture. The overlying skin on the anterior distal arm exhibits a distinct dimple or "pucker" sign. This finding strongly suggests interposition of which of the following structures?

In the radiographic evaluation of an infant treated for developmental dysplasia of the hip (DDH), the acetabular index is monitored sequentially. By what age should the acetabular index typically normalize to less than 20 degrees in a successfully treated child?

A 15-year-old boy is evaluated for worsening hip stiffness and pain 6 months after in situ pinning of a slipped capital femoral epiphysis (SCFE). Radiographs reveal concentric narrowing of the hip joint space to less than 3 mm and subchondral sclerosis. What is the most likely cause of these findings?

A newborn girl with arthrogryposis multiplex congenita is found to have bilateral rigid, high-riding hip dislocations. Unlike typical developmental dysplasia of the hip (DDH), what is the most appropriate initial management for her hip pathology?

A 12-year-old boy presents with an acute, unstable slipped capital femoral epiphysis (SCFE). The surgeon is planning surgical fixation. Which of the following maneuvers is strictly contraindicated during the surgical positioning and fixation of this patient?

During a closed reduction of a developmental dysplasia of the hip (DDH) under general anesthesia, an arthrogram is performed. The hip reduces in flexion and abduction but re-dislocates when adducted past 40 degrees of abduction. The hip cannot be safely abducted past 55 degrees due to significant adductor tension. Which of the following best describes this situation?

A 6-week-old female infant is currently being treated with a Pavlik harness for Developmental Dysplasia of the Hip (DDH). At her 2-week follow-up, the ultrasound reveals that the left hip remains dislocated. During the physical examination, you note that she has an absent patellar reflex on the left side and decreased spontaneous extension of the left knee. What is the most appropriate next step in management?

A 6-year-old boy sustains a completely displaced Gartland type III extension-type supracondylar humerus fracture. On initial presentation, his hand is pink but the radial pulse is not palpable. Following urgent closed reduction and percutaneous pinning, the fracture is anatomically aligned, but the hand remains pink and pulseless. Capillary refill is less than 2 seconds. What is the most appropriate management?

A 14-year-old boy presents with an ankle injury after an external rotation force during football. Radiographs and a subsequent CT scan reveal a Salter-Harris type III fracture of the anterolateral aspect of the distal tibial epiphysis, with 3.5 mm of displacement. What anatomic structure is responsible for the avulsion of this specific fracture fragment?

During an open reduction of a late-presenting Developmental Dysplasia of the Hip (DDH) via a medial (Ludloff) approach, several anatomical structures blocking reduction can be accessed. Which of the following pathological obstacles to reduction CANNOT be adequately addressed through this approach?

In the evaluation of Adolescent Idiopathic Scoliosis using the Lenke classification, specific radiographic criteria are used to determine if a minor curve is structural. Which of the following findings correctly defines a proximal thoracic minor curve as structural?

A 4-week-old female infant with a breech presentation history is referred for a developmental dysplasia of the hip (DDH) ultrasound. When obtaining a standard Graf coronal view, the sonographer must ensure a standard plane is captured. Which bony landmark must be clearly visualized to confirm a true standard coronal view?

A 3-month-old female infant is being treated with a Pavlik harness for developmental dysplasia of the hip (DDH). During her 2-week follow-up, the parents report she has stopped kicking her left leg. On examination, there is an absence of active knee extension on the left, but she flexes the hip and moves the toes spontaneously. What is the most appropriate next step in management?

A 24-month-old girl presents with a painless limp. Examination demonstrates a positive Trendelenburg sign on the left.

Radiographs confirm a dislocated left hip with a false acetabulum and severe acetabular dysplasia. What is the most appropriate initial treatment?

A 13-year-old girl twists her ankle. Radiographs reveal a Salter-Harris III fracture of the anterolateral aspect of the distal tibia. This specific fracture pattern (Juvenile Tillaux fracture) is primarily due to which of the following anatomical factors?

A 12-year-old premenarchal girl has a right thoracic curve of 32 degrees on standing posteroanterior radiographs. Her Risser stage is 0. What is the most appropriate management?

In an ultrasound evaluation of a 4-week-old infant's hip for developmental dysplasia,

what specific anatomic feature is quantified by the alpha angle?

A 10-year-old boy presents with a stable slipped capital femoral epiphysis (SCFE) of the right hip. Under which of the following conditions is prophylactic pinning of the contralateral, asymptomatic hip most strongly indicated?

A 14-year-old boy sustains a triplane fracture of the distal tibia following a fall. By definition, this fracture complex involves fracture lines propagating through three distinct planes. Which of the following accurately describes these planes?

When treating developmental dysplasia of the hip (DDH) with closed reduction and spica casting, maintaining the hip in forced, extreme abduction ('frog-leg' position) significantly increases the risk of which of the following complications?