4. Pediatrics MCQs

A 3-week-old female infant is evaluated for a suspected hip abnormality. Examination reveals a palpable clunk when her hips are abducted with anteriorly directed pressure on the greater trochanter. What is the most appropriate initial management?

A 7-month-old infant is referred for evaluation of a developmental dysplasia of the hip (DDH) that was missed at birth. Ultrasound confirms a completely dislocated right hip. What is the most appropriate initial management?

A 6-year-old boy sustains a completely displaced supracondylar humerus fracture. Upon arrival, his hand is pink but the radial pulse is absent. Following closed reduction and percutaneous pinning, the hand remains pink but the pulse is still not palpable. What is the next best step in management?

A 3-year-old child is found to have congenital scoliosis due to a fully segmented hemivertebra at T8. Which of the following imaging modalities is most essential to evaluate for the most common associated non-spinal anomalies?

During attempted closed reduction of a dysplastic hip in a 1-year-old child, the surgeon notes that the hip reduces but is highly unstable in extension. What is the most common extra-articular anatomical block to concentric reduction that may necessitate an open approach?

A 13-year-old boy presents with right knee pain and a noticeable limp for 3 weeks. Radiographs reveal an unstable slipped capital femoral epiphysis (SCFE) of the right hip. He is unable to bear weight, even with crutches. What is the most severe potential complication associated with this condition and its surgical fixation?

A newborn girl with a positive Ortolani sign on the left hip is fitted with a Pavlik harness. Which of the following complications is most likely to occur if the anterior straps of the harness are adjusted to place the hips in excessive flexion (>120 degrees)?

A 2-year-old boy undergoes open reduction for a late-presenting DDH. During a medial approach, which structure must be carefully protected as it passes posterior to the iliopsoas tendon to avoid vascular compromise to the femoral head?

A 13-year-old boy presents with an ankle fracture characterized by a sagittal fracture through the epiphysis, a transverse fracture through the physis, and a coronal fracture through the posterior metaphysis. What is the primary anatomical mechanism responsible for this specific fracture pattern?

According to the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST), a rigid thoracolumbosacral orthosis is most effective at preventing curve progression to surgical thresholds when worn for a minimum of how many hours per day?

A 6-week-old female infant born breech presents for evaluation. Ultrasound demonstrates an alpha angle of 43 degrees and a beta angle of 78 degrees on the left hip. The right hip is normal. What is the most appropriate initial management?

A 12-month-old child undergoes closed reduction and spica casting for developmental dysplasia of the hip. Which of the following positions during casting is the most significant risk factor for the development of iatrogenic avascular necrosis of the femoral head?

A 12-year-old obese boy presents with sudden inability to bear weight on his left leg. He reports a 2-month history of vague left knee pain. Radiographs reveal a severe, posterior translation of the proximal femoral epiphysis. He cannot bear weight even with crutches. What intervention best minimizes the risk of osteonecrosis?

A 5-year-old girl falls from monkey bars and sustains a widely displaced, extension-type supracondylar humerus fracture. On examination, the hand is pink and well-perfused, but the radial pulse is absent. What is the most appropriate next step in management?

A 13-year-old premenarcheal female presents for scoliosis screening. Radiographs demonstrate a 32-degree right thoracic curve. Her Risser stage is 0. What is the most appropriate management?

A 7-year-old boy is diagnosed with Legg-Calve-Perthes disease. Which of the following is considered the most important prognostic factor for long-term hip joint congruency?

A 13-year-old boy sustains an ankle injury while playing soccer. Radiographs reveal a distal tibia fracture that appears as a Salter-Harris III pattern on the AP view and a Salter-Harris II pattern on the lateral view. What is the classic mechanism of injury for this fracture?

A 5-month-old infant with developmental dysplasia of the hip has been treated in a Pavlik harness for 4 weeks. Serial ultrasounds show that the hip remains persistently dislocated and cannot be reduced in the harness. What is the most appropriate next step?

A 14-year-old boy sustains a Salter-Harris II fracture of the distal femur with 30% posterior translation. Which of the following best describes the preferred definitive management and rationale?

A 14-year-old girl sustains a juvenile Tillaux fracture. Which ligament is responsible for the avulsion of the anterolateral fragment of the distal tibial epiphysis?