4. Pediatrics MCQs

An 8-year-old boy is diagnosed with Legg-Calvé-Perthes disease. Radiographs reveal that he is in the fragmentation stage. According to the Herring Lateral Pillar classification, which of the following radiographic findings places this patient in Lateral Pillar Group C, portending a poorer prognosis?

A 2-year-old girl is referred for anterolateral bowing of her left lower leg. The mother reports a recent minor fall, after which the child refused to bear weight. Radiographs show a fracture through a dysplastic, sclerotic mid-diaphyseal segment of the tibia that has failed to heal after 4 months of casting. This presentation of congenital pseudarthrosis of the tibia (CPT) is most strongly associated with which of the following underlying conditions?

A 13-year-old boy undergoes in situ pinning of a stable slipped capital femoral epiphysis (SCFE) of the right hip. Six months postoperatively, he presents with worsening right hip pain, a significant limp, and severely restricted range of motion in flexion and abduction. Radiographs demonstrate severe diffuse joint space narrowing, generalized osteopenia around the joint, but no evidence of segmental collapse or sclerosis of the femoral head. What is the most likely diagnosis?

A 5-year-old boy with spastic quadriplegic cerebral palsy (GMFCS level IV) presents for routine hip surveillance.

His parents report no pain, but the physical examination reveals hip abduction of 20 degrees bilaterally. An AP pelvis radiograph demonstrates a Reimers migration percentage of 45% bilaterally with early acetabular dysplasia. What is the most appropriate management?

A 3-year-old boy, initially treated with the Ponseti method for idiopathic right clubfoot, presents with a relapse.

His parents report that he walks on the outside border of his right foot. Gait analysis shows dynamic supination of the foot during the swing phase. Passive range of motion indicates the deformity is fully correctable. What is the most appropriate next step in management?

A 14-year-old boy presents to the emergency department after a twisting injury to his ankle while playing soccer.

Radiographs and a CT scan reveal a Salter-Harris III fracture of the anterolateral aspect of the distal tibial epiphysis, displaced by 3 mm. What is the pathomechanical etiology of this specific fracture pattern?

A 4-year-old boy is brought to the clinic for progressive, severe bilateral leg bowing. Standing radiographs reveal a metaphyseal-diaphyseal angle (MDA) of 20 degrees bilaterally with profound medial physeal beaking (Langenskiöld stage III). He has previously worn KAFO braces for 1 year without improvement. What is the most appropriate management?

An 8-year-old boy is diagnosed with Legg-Calvé-Perthes disease.

Which of the following radiographic findings is considered one of Catterall's 'head at risk' signs, indicating a potentially poorer prognosis and an increased likelihood of epiphyseal extrusion?

A 5-year-old boy sustains a severe, completely displaced extension-type supracondylar fracture of the humerus. On presentation, the hand is pink and warm, but the radial pulse is absent. He has normal capillary refill and intact median, ulnar, and radial nerve motor and sensory function. Following an urgent closed reduction and percutaneous pinning, the hand remains pink and warm, and the radial pulse remains absent. What is the most appropriate next step in management?

A 3-year-old child who was successfully treated with the Ponseti method for idiopathic clubfoot now presents with dynamic supination of the foot during the swing phase of gait. On examination, the foot is fully correctable passively with no fixed structural deformity. What is the most appropriate next step in management?

A 6-month-old infant with developmental dysplasia of the hip (DDH) was treated with a Pavlik harness starting at age 4 weeks. After 4 weeks of harness wear, the hip remained dislocated, and the harness was discontinued. Currently, ultrasound confirms persistent dislocation. What is the most appropriate next step in management?

A 6-year-old boy sustains a completely displaced extension-type supracondylar humerus fracture. On initial examination, the hand is pink, but the radial pulse is absent. He is taken to the operating room for closed reduction and percutaneous pinning. Post-reduction, the hand remains pink and warm with a capillary refill of less than 2 seconds, but the radial pulse remains unpalpable. Doppler ultrasound confirms flow in the palmar arch. What is the most appropriate next step?

A 12-year-old boy with a BMI of 32 presents with knee pain. He walks with a limp and his foot is externally rotated. Examination shows obligatory external rotation with hip flexion. AP and frog-leg lateral radiographs of the pelvis show a mild left slipped capital femoral epiphysis (SCFE) and a normal right hip. What is the most appropriate management?

A 14-year-old girl sustains an ankle injury. Radiographs show a Salter-Harris III fracture of the anterolateral aspect of the distal tibial epiphysis. Which structure is responsible for the avulsion of this fracture fragment?

A 6-month-old infant is evaluated for frequent fractures and is found to have blue sclerae and dentinogenesis imperfecta. A diagnosis of osteogenesis imperfecta is made. This condition is primarily associated with a defect in the synthesis of which of the following?

An 8-year-old boy presents with a limp. Radiographs confirm Legg-Calvé-Perthes disease with fragmentation of the femoral head and more than 50% collapse of the lateral pillar. According to the Herring lateral pillar classification, which of the following best describes his prognosis and indicated management?

An 11-year-old obese boy presents with right hip pain and a limp. Radiographs confirm a unilateral right slipped capital femoral epiphysis (SCFE), which is treated with in situ single-screw fixation. The parents ask about the risk of the left hip developing the same condition. Which of the following radiographic findings is the strongest predictor for a subsequent contralateral slip and most justifies prophylactic pinning of the asymptomatic left hip?

A 6-year-old girl is brought to the emergency department after falling from monkey bars. She sustains a severely displaced Gartland type III supracondylar humerus fracture. On initial examination, her hand is pink and well-perfused, but the radial pulse is absent. She is taken to the operating room for urgent closed reduction and percutaneous pinning. Following stable anatomic reduction and pinning, the hand remains pink with brisk capillary refill (< 2 seconds), but the radial pulse remains nonpalpable by Doppler. What is the most appropriate next step in management?

A 5-week-old infant is being treated with a Pavlik harness for developmental dysplasia of the left hip. During the 2-week follow-up visit, the parents report that the infant has stopped kicking the left leg. On physical examination, the infant exhibits an absence of active knee extension on the left side, though hip flexion and ankle movements are preserved. Ultrasound confirms the hip is well-reduced. What is the most appropriate management of this complication?

A 17-year-old non-ambulatory male (GMFCS Level V) with spastic quadriplegic cerebral palsy presents with severe right hip pain that interferes with seating, perineal care, and sleep. Radiographs demonstrate a chronically dislocated right hip with severe degenerative changes and a deformed femoral head. He has failed extensive non-operative management, including optimizing medical therapy and seating modifications. Which of the following surgical interventions is most appropriate to alleviate his pain and improve nursing care?