Menu

4. Pediatrics MCQs

Practice Set 222 of 334

This practice set contains high-yield board review questions covering key concepts in 4. Pediatrics. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 4421

Topic: 4. Pediatrics

A 9-year-old boy presents with a pathologic fracture of the proximal humerus after a minor fall. Radiographs reveal a central, lytic, well-circumscribed diaphyseal-metaphyseal lesion with a "fallen leaf" sign. Which of the following is true regarding this condition?

. It contains blood and is lined by multinucleated giant cells
. It is characterized by an USP6 gene translocation
. The lesion typically migrates away from the physis as the child grows
. Malignant transformation occurs in 5% of cases
. Wide surgical resection is the first-line treatment

Correct Answer & Explanation

. The lesion typically migrates away from the physis as the child grows

Explanation

This describes a unicameral (simple) bone cyst (UBC). As the child grows, a "latent" UBC will migrate away from the physis into the diaphysis, whereas an "active" cyst remains adjacent to the physis.

Question 4422

Topic: 4. Pediatrics

A 12-year-old obese male presents with a several-week history of left hip and knee pain, worse with activity and relieved with rest. He walks with an antalgic gait. On examination, there is decreased internal rotation and abduction of the left hip. What is the most appropriate immediate management?

. Physical therapy and NSAIDs
. Non-weight-bearing and urgent orthopedic referral
. Steroid injection
. Open reduction and internal fixation
. MRI of the hip

Correct Answer & Explanation

. Non-weight-bearing and urgent orthopedic referral

Explanation

This clinical picture (obese adolescent male, hip/knee pain, antalgic gait, decreased internal rotation/abduction) is highly suspicious for Slipped Capital Femoral Epiphysis (SCFE). Prompt diagnosis and management are crucial to prevent further slippage and complications like avascular necrosis. Immediate non-weight-bearing (e.g., crutches or wheelchair) is essential to protect the physis from further shear stress, followed by urgent surgical stabilization (in situ pinning). Physical therapy, steroid injections, or simple observation are contraindicated. While an MRI can confirm the diagnosis, the clinical suspicion warrants immediate protection to prevent progression.

Question 4423

Topic: Pediatric Hip

A 4-year-old child presents with an antalgic gait and pain in the right hip. Radiographs show flattening and increased density of the right femoral epiphysis. What is the most appropriate initial management?

. Immediate surgical pinning
. Observation and activity modification with crutches
. Total hip arthroplasty
. Steroid injections
. Casting in abduction

Correct Answer & Explanation

. Observation and activity modification with crutches

Explanation

This presentation is classic for Legg-Calve-Perthes disease (LCPD), an idiopathic avascular necrosis of the femoral head. For a 4-year-old, the primary goal is to maintain containment of the femoral head within the acetabulum to allow for remodeling and prevent deformity. While there are various treatment strategies depending on the extent and stage, in most young children, observation and activity modification (often with protected weight-bearing via crutches) is the initial approach for mild cases or early stages, allowing for revascularization and remodeling. Surgical pinning is for SCFE. Total hip arthroplasty is for end-stage arthritis. Steroid injections are not indicated. Casting in abduction (e.g., Petrie cast) may be used for more severe cases or older children to contain the femoral head, but not as the initial generalized approach for all LCPD.

Question 4424

Topic: Pediatric Hip

Which of the following is a classic radiographic sign of Developmental Dysplasia of the Hip (DDH) in an infant older than 3 months?

. Shenton's line disruption
. Increased acetabular index
. Lester's sign
. Ossification of the femoral head
. Perkins' line intersection

Correct Answer & Explanation

. Shenton's line disruption

Explanation

Shenton's line (a curved line formed by the medial aspect of the femoral neck and the inferior border of the superior pubic ramus) disruption is a classic radiographic sign of hip dislocation or subluxation in DDH. An increased acetabular index (angle formed by the acetabular roof and a horizontal line through the triradiate cartilage) indicates acetabular dysplasia. Lester's sign is not a recognized orthopedic sign. Ossification of the femoral head typically begins around 3-6 months and is not a direct sign of DDH, although delayed ossification can be associated. Perkins' line (vertical line from the lateral aspect of the acetabulum) helps define quadrants for femoral head position, but disruption of Shenton's line is a direct indicator of subluxation/dislocation.

Question 4425

Topic: Pediatric Upper Extremity & Spine

Which of the following conditions is most strongly associated with adolescent idiopathic scoliosis progression?

. Male gender
. Risser sign 5
. Curve magnitude > 20 degrees at presentation
. Age greater than 16 years
. Menarche status (post-menarche)

Correct Answer & Explanation

. Curve magnitude > 20 degrees at presentation

Explanation

The most significant factors for progression of adolescent idiopathic scoliosis are curve magnitude at presentation (curves > 20 degrees are more likely to progress than smaller curves), skeletal immaturity (lower Risser sign), and premenarchal status in females. Female gender is associated with higher progression rates and need for intervention. Risser sign 5 indicates skeletal maturity, at which point progression risk is minimal. Younger age and pre-menarche are risk factors for progression.

Question 4426

Topic: 4. Pediatrics

A 6-month-old infant is diagnosed with congenital muscular torticollis. What is the most appropriate initial management?

. Surgical release of the sternocleidomastoid muscle
. Cervical collar application
. Physical therapy focusing on stretching and strengthening
. Observation with watchful waiting
. Botulinum toxin injection

Correct Answer & Explanation

. Physical therapy focusing on stretching and strengthening

Explanation

Congenital muscular torticollis is typically managed initially with physical therapy, which includes gentle stretching of the affected sternocleidomastoid muscle and strengthening of the contralateral neck muscles. This is highly effective, especially when initiated early. Surgical release is reserved for cases refractory to conservative management after 6-12 months. Cervical collars are not typically used. Observation alone is insufficient. Botulinum toxin injections are rarely used in infants for this condition.

Question 4427

Topic: 4. Pediatrics
Which type of Salter-Harris fracture classification involves a fracture through the physis and metaphysis, but spares the epiphysis?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

Salter-Harris Type II fractures involve a fracture through the physis and extend into the metaphysis, sparing the epiphysis. This is the most common type. Type I is a separation through the physis only. Type III is a fracture through the physis and epiphysis. Type IV is a fracture through the metaphysis, physis, and epiphysis. Type V is a crush injury to the physis.

Question 4428

Topic: 4. Pediatrics
A 6-year-old child presents with a painful limp and swelling over the proximal tibia after a fall. Radiographs show a fracture through the proximal tibial physis, involving the metaphysis and extending laterally into the epiphysis. According to the Salter-Harris classification, what type is this fracture?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type IV

Explanation

This describes a Salter-Harris Type IV fracture, which involves a fracture line extending through the metaphysis, physis, and epiphysis. This type of fracture is intra-articular and can lead to growth arrest or angular deformity if not anatomically reduced, especially due to damage to the germinal cells of the growth plate and disruption of the articular surface. Type II involves physis and metaphysis. Type III involves physis and epiphysis.

Question 4429

Topic: 4. Pediatrics

A 3-year-old child presents with a progressive valgus deformity of the tibia. Radiographs show irregular widening and medial sloping of the proximal tibial physis. What is the most likely diagnosis?

. Physiological genu valgum
. Blount's disease (Tibia vara)
. Rickets
. Osgood-Schlatter disease
. Fibrous dysplasia

Correct Answer & Explanation

. Blount's disease (Tibia vara)

Explanation

The description of a progressive valgus deformity of the tibia with irregular widening and medial sloping of the proximal tibial physis is characteristic of Blount's disease (tibia vara), particularly the infantile form. Blount's disease is a growth disturbance of the medial part of the proximal tibial physis leading to progressive varus deformity. Physiological genu valgum usually resolves spontaneously by age 7-8 and has a symmetric, non-pathological appearance of the physis. Rickets would present with more generalized physeal widening and metaphyseal fraying. Osgood-Schlatter is apophysitis of the tibial tubercle. Fibrous dysplasia has a different radiographic appearance.

Question 4430

Topic: Pediatric Hip

Which type of orthosis is most commonly used to manage developmental dysplasia of the hip (DDH) in an infant up to 6 months of age?

. Hip spica cast
. Pavlik harness
. Abduction brace
. Knee-ankle-foot orthosis (KAFO)
. Scottish Rite brace

Correct Answer & Explanation

. Pavlik harness

Explanation

The Pavlik harness is the most commonly used and effective orthosis for managing developmental dysplasia of the hip (DDH) in infants up to 6 months of age (and sometimes up to 9 months). It holds the hips in flexion and abduction, allowing for gradual reduction and development of the acetabulum. A hip spica cast is typically used for older infants or those who fail Pavlik harness treatment. Abduction braces are used for older children or after cast removal. KAFOs and Scottish Rite braces are for different orthopedic conditions.

Question 4431

Topic: 4. Pediatrics

A 3-month-old infant presents for a well-child check. On examination, a positive Ortolani sign is noted on the right hip. Radiographs show a dislocated right hip with a significantly increased acetabular index. What is the MOST appropriate management at this age?

. Immediate open reduction and internal fixation
. Pavlik harness application
. Closed reduction under anesthesia with spica cast
. Serial abduction bracing
. Ultrasound-guided manipulation

Correct Answer & Explanation

. Pavlik harness application

Explanation

For infants aged 0-6 months with developmental dysplasia of the hip (DDH), a Pavlik harness is the gold standard of treatment. It maintains the hips in a flexed and abducted position, allowing for gradual reduction and development of the acetabulum. Open reduction is reserved for failures of conservative treatment or older children. Closed reduction with spica cast is typically for older infants (6-18 months) or failures of Pavlik. Ultrasound is a diagnostic tool, not a treatment.

Question 4432

Topic: Pediatric Upper Extremity & Spine

A 7-year-old boy falls off monkey bars and sustains a supracondylar humerus fracture. On presentation, he has a pulseless but warm and pink hand with intact motor function. Radiographs confirm a displaced extension-type supracondylar fracture. What is the MOST appropriate initial management?

. Observation and repeat neurovascular exam
. Closed reduction and percutaneous pinning (CRPP)
. Open reduction and internal fixation (ORIF)
. Splinting in extension and referral to orthopedics
. Immediate surgical exploration of the brachial artery

Correct Answer & Explanation

. Closed reduction and percutaneous pinning (CRPP)

Explanation

A pulseless but perfused hand in the setting of a supracondylar humerus fracture, particularly after a traumatic event, often indicates vascular spasm or kinking rather than a complete transection. The initial management is urgent closed reduction and percutaneous pinning (CRPP) to restore anatomical alignment and decompress the brachial artery. If the pulse does not return after successful reduction and pinning, or if signs of ischemia develop, then surgical exploration of the brachial artery becomes necessary. Observation is inappropriate, and ORIF is typically reserved for irreducible fractures. Splinting in extension could worsen the neurovascular status.

Question 4433

Topic: Pediatric Hip
A 13-year-old obese male presents with a several-week history of left hip pain and a limping gait. He denies any specific trauma. On examination, he holds his left hip in external rotation and has decreased internal rotation and abduction. What is the most likely diagnosis and the immediate management?
. Legg-Calvรฉ-Perthes disease; bed rest and NSAIDs
. Developmental dysplasia of the hip; Pavlik harness
. Transient synovitis; observation
. Slipped capital femoral epiphysis; non-weight bearing and urgent surgical pinning in situ
. Septic arthritis; urgent joint aspiration and antibiotics

Correct Answer & Explanation

. Slipped capital femoral epiphysis; non-weight bearing and urgent surgical pinning in situ

Explanation

This presentation (obese adolescent, hip pain, limping, external rotation, limited internal rotation/abduction) is classic for Slipped Capital Femoral Epiphysis (SCFE). SCFE is an orthopedic emergency because further slippage can occur. Immediate management involves making the patient strictly non-weight bearing on the affected side and urgent surgical pinning in situ to stabilize the growth plate and prevent further displacement. Legg-Calvรฉ-Perthes typically affects younger children (4-8 years). DDH is infantile. Transient synovitis is self-limiting but less likely with these exam findings. Septic arthritis would present with acute, severe pain and fever.

Question 4434

Topic: Pediatric Hip
A 6-year-old boy presents with a painless limp and restricted hip motion, particularly abduction and internal rotation, for several months. Radiographs show fragmentation and flattening of the femoral epiphysis. What is the primary goal of treatment for Legg-Calvรฉ-Perthes disease?
. To relieve pain with NSAIDs
. To prevent femoral head avascular necrosis
. To maintain femoral head sphericity and containment within the acetabulum
. To accelerate revascularization of the femoral head
. To perform an urgent surgical osteotomy

Correct Answer & Explanation

. To maintain femoral head sphericity and containment within the acetabulum

Explanation

The primary goal of treatment for Legg-Calvรฉ-Perthes disease is to maintain the sphericity of the femoral head and achieve containment within the acetabulum. This helps to prevent femoral head collapse and subsequent premature osteoarthritis. While pain relief and revascularization are aspects of care, they are secondary to the overall goal of preserving the joint's shape and function. Urgent osteotomy is reserved for specific indications or failures of conservative management.

Question 4435

Topic: Pediatric Lower Extremity

A newborn is diagnosed with idiopathic clubfoot (talipes equinovarus). What is the gold standard, non-surgical treatment approach?

. Surgical correction with posteromedial release
. Dynamic splinting with ankle-foot orthoses (AFOs)
. Ponseti method of serial manipulation and casting
. Observation and passive stretching exercises
. Kinesio taping and massage therapy

Correct Answer & Explanation

. Ponseti method of serial manipulation and casting

Explanation

The Ponseti method of serial manipulation and casting is the universally accepted gold standard non-surgical treatment for idiopathic clubfoot. It involves a specific sequence of gentle manipulations and plaster cast applications, typically weekly, followed by a percutaneous Achilles tenotomy and then bracing with a foot abduction orthosis. Surgical correction is reserved for failed Ponseti treatment or severe, rigid deformities. Other options are ineffective or not primary treatment.

Question 4436

Topic: Pediatric Upper Extremity & Spine

A 14-year-old girl is diagnosed with adolescent idiopathic scoliosis with a 35-degree thoracic curve (Cobb angle). She is still skeletally immature (Risser 0). What is the MOST appropriate initial management?

. Observation with serial radiographs every 6 months
. Milwaukee brace application
. Spinal fusion surgery
. Physical therapy and core strengthening exercises
. Chiropractic adjustments

Correct Answer & Explanation

. Milwaukee brace application

Explanation

For adolescent idiopathic scoliosis, the management depends on the curve magnitude and skeletal maturity. For curves between 25-40 degrees in a skeletally immature patient (Risser 0-2), bracing (e.g., Boston brace or TLSO) is the most appropriate initial treatment to prevent progression. Observation is for smaller curves (<25 degrees) or skeletally mature patients. Spinal fusion is typically reserved for curves >45-50 degrees or progressive curves despite bracing. Milwaukee brace is generally outdated compared to modern TLSOs.

Question 4437

Topic: Pediatric Lower Extremity

A 14-year-old boy, active in sports, presents with anterior knee pain and tenderness over the tibial tubercle, exacerbated by jumping and kneeling. There is a palpable bump at the site. What is the MOST likely diagnosis?

. Patellofemoral pain syndrome
. Patellar tendonitis
. Sinding-Larsen-Johansson disease
. Osgood-Schlatter disease
. Osteochondritis dissecans

Correct Answer & Explanation

. Osgood-Schlatter disease

Explanation

The classic presentation of Osgood-Schlatter disease is anterior knee pain, localized tenderness, and a palpable bump over the tibial tubercle in an active adolescent, particularly during growth spurts. It is an apophysitis caused by repetitive traction of the patellar tendon on the tibial tubercle. Patellofemoral pain is diffuse anterior knee pain. Patellar tendonitis is pain at the inferior pole of the patella. Sinding-Larsen-Johansson is similar but affects the inferior pole of the patella. Osteochondritis dissecans involves articular cartilage and subchondral bone, usually in the femoral condyle.

Question 4438

Topic: Pediatric Hip
A 4-year-old child presents with a sudden onset of hip pain and a limp. He has a low-grade fever but is otherwise well. Labs show mild elevation of ESR/CRP. Hip range of motion is mildly restricted, but he is able to bear some weight. What is the most likely diagnosis?
. Septic arthritis
. Legg-Calvรฉ-Perthes disease
. Slipped capital femoral epiphysis (SCFE)
. Transient synovitis of the hip
. Juvenile idiopathic arthritis

Correct Answer & Explanation

. Transient synovitis of the hip

Explanation

This presentation (sudden onset limp and hip pain, low-grade fever, mild lab elevations, ability to bear some weight) is classic for transient synovitis of the hip, which is a benign, self-limiting inflammatory condition. Septic arthritis would present with much more severe pain, inability to bear weight, and higher inflammatory markers. Perthes and SCFE have more insidious onset and different age groups (Perthes 4-8, SCFE adolescent). JIA is a chronic condition.

Question 4439

Topic: Pediatric Hip

A 6-month-old infant is diagnosed with a dislocated hip due to Developmental Dysplasia of the Hip (DDH). After successful closed reduction, what is the MOST appropriate next step in management?

. Immediate full weight-bearing and physical therapy
. Long-term hip abduction bracing for 6-12 months
. Open reduction and internal fixation to secure reduction
. Spica cast immobilization for 6-12 weeks
. Observation with monthly clinical exams

Correct Answer & Explanation

. Spica cast immobilization for 6-12 weeks

Explanation

After successful closed reduction of a dislocated hip in DDH (typically for infants aged 6-18 months, or older infants where Pavlik harness failed), the hip is immobilized in a spica cast for typically 6-12 weeks to maintain the reduction and allow for acetabular remodeling. This is crucial for long-term stability. Long-term bracing might follow the cast, but cast immobilization is the immediate next step post-reduction. Open reduction is for irreducible dislocations.

Question 4440

Topic: 4. Pediatrics

Which of the following is a common complication specific to the surgical management of congenital muscular torticollis?

. Facial nerve palsy
. Brachial plexus injury
. Recurrence of the deformity
. Vascular injury to the carotid artery
. Phrenic nerve injury

Correct Answer & Explanation

. Recurrence of the deformity

Explanation

The most common specific complication following surgical correction (e.g., sternocleidomastoid release) for congenital muscular torticollis is recurrence of the deformity, particularly if not adequately addressed or if postoperative stretching/physical therapy is not maintained. While other surgical complications are possible, recurrence is directly related to the condition and its treatment. Facial nerve palsy is not typically associated. Brachial plexus or phrenic nerve injuries are rare and usually associated with more extensive neck dissections or prolonged retraction.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page