Practice Set 229 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.
During the Ponseti method of serial casting for idiopathic clubfoot, what is the correct biomechanical sequence of deformity correction?
. Cavus, Adductus, Varus, Equinus
A 12-year-old obese male presents with left knee pain and an antalgic gait. Exam reveals obligatory external rotation of the hip upon passive flexion. Following in situ pinning of a severe slipped capital femoral epiphysis, the patient develops a rapid loss of joint space and progressive stiffness. What is the most likely diagnosis?
. Chondrolysis
An 8-month-old female with neglected developmental dysplasia of the hip (DDH) undergoes closed reduction and spica casting. Postoperatively, what is the most significant risk associated with casting the hip in excessive abduction (greater than 60 degrees)?
. Avascular necrosis of the femoral head
A 13-year-old obese male presents with an obligatory external rotation of the hip during active flexion. Radiographs confirm a slipped capital femoral epiphysis (SCFE). This physical exam finding is due to the displacement of the femoral neck in which direction relative to the epiphysis?
. Anterior and superior
A 6-week-old female treated with a Pavlik harness for developmental dysplasia of the hip lacks active knee extension on the affected side at a 2-week follow-up. This complication is most likely caused by which positioning error?
. Excessive hip flexion
In a 7-year-old boy diagnosed with Legg-Calve-Perthes disease, which of the following classification systems is considered the most reliable radiographic prognostic indicator when assessed at the time of maximal epiphyseal fragmentation?
. Lateral pillar classification
An infant with developmental dysplasia of the hip (DDH) is treated with a Pavlik harness. During a routine follow-up visit, the infant exhibits decreased spontaneous extension of the knee on the treated side, though hip motion remains unchanged. Which of the following harness positioning errors is most likely responsible for this complication?
. Inadequate hip flexion
A 12-year-old boy presents with a left-sided slipped capital femoral epiphysis (SCFE) and undergoes in situ pinning. Prophylactic pinning of the contralateral, asymptomatic hip is most strongly indicated if the patient has which of the following concurrent conditions?
. Hypothyroidism
A 6-week-old female infant is undergoing treatment with a Pavlik harness for developmental dysplasia of the hip (DDH). A follow-up ultrasound reveals the femoral head remains dislocated posterosuperiorly and is irreducible on dynamic testing. Continued rigid use of the Pavlik harness in this situation places the patient at highest risk for which of the following complications?
. Erosion of the posterior acetabulum (Pavlik disease)
In the evaluation of a 7-year-old boy with Legg-Calve-Perthes disease, the lateral pillar (Herring) classification is utilized to determine prognosis. This classification is primarily based on the height of the lateral pillar of the capital femoral epiphysis during which stage of the disease?
. Fragmentation stage
In the surgical management of an unstable slipped capital femoral epiphysis (SCFE) with single in situ screw fixation, which iatrogenic complication is most strongly associated with screw placement in the anterior-superior quadrant of the femoral head?
. Avascular necrosis
In the assessment of Legg-Calve-Perthes disease, the Lateral Pillar (Herring) classification is widely used for determining prognosis. What specific radiographic feature defines a Lateral Pillar Group B hip on an AP radiograph?
. Greater than 50% maintenance of the lateral pillar height
A 12-year-old obese boy presents with knee pain and an obligatory external rotation of the hip during active flexion. Radiographs confirm a slipped capital femoral epiphysis (SCFE). What is the primary reason for performing an in situ single-screw fixation rather than attempting closed reduction?
. To decrease the risk of avascular necrosis
In the Ponseti method for correcting idiopathic clubfoot, what is the final deformity to be corrected before the application of the last cast and potential Achilles tenotomy?
. Equinus
A 6-year-old boy is diagnosed with Legg-Calve-Perthes disease. According to the Herring lateral pillar classification, which radiographic finding portends the poorest prognosis for future hip joint congruency?
. Greater than 50% loss of lateral pillar height
A 13-year-old obese male presents with acute-on-chronic left hip pain and an inability to bear weight. Radiographs show a severe slipped capital femoral epiphysis (SCFE). He undergoes urgent in-situ pinning. What is the most common devastating complication associated with this specific presentation?
. Osteonecrosis (avascular necrosis) of the femoral head
A 6-year-old boy is diagnosed with Legg-Calve-Perthes disease. According to the Herring lateral pillar classification, a patient with greater than 50% loss of lateral pillar height is placed in which prognostic group?
. Group C
. Chromosomal breakage testing
A newborn is evaluated for bilateral absence of the radius and hypoplastic thumbs (radial longitudinal deficiency). The pediatrician diagnoses Holt-Oram syndrome. Which associated systemic abnormality must be aggressively ruled out or treated in this child?
. Cardiac septal defects
When performing a total hip arthroplasty on a patient with Crowe Type IV developmental dysplasia of the hip (DDH), which of the following surgical strategies is most often required to safely bring the hip center down to the true acetabulum without causing sciatic nerve palsy?
. A subtrochanteric shortening osteotomy