4. Pediatrics MCQs

A 3-year-old girl is brought to the clinic due to noticeable anterolateral bowing of her left tibia. On physical exam, you note multiple cafe-au-lait spots and axillary freckling. What genetic mutation is most likely responsible for her condition?

In the surgical management of an unstable slipped capital femoral epiphysis (SCFE) using a single cannulated screw, which complication is most directly related to unrecognized intra-articular hardware penetration?

A 4-month-old female infant is evaluated for asymmetric thigh folds. Ultrasound reveals a dysplastic left hip with an alpha angle of 50 degrees and a beta angle of 80 degrees. What is the most appropriate initial management?

A 6-year-old boy presents with a painless limp. Radiographs show sclerosis and flattening of the capital femoral epiphysis. According to the Herring lateral pillar classification, greater than 50% loss of lateral pillar height categorizes the hip into which group?

You are asked to review a 28-year-old man who is thought to originate from Afghanistan who has presented to an immigration centre claiming asylum. He has been diagnosed with HIV for which HAART has been commenced. There is a past history of tuberculosis as a child for which he was successfully treated with triple anti-bacterial therapy. Over the past few days, he has developed a severe cough, productive of bloody sputum. On examination, he is pyrexial 37.8 °C, his BP is 105/70 mmHg, and pulse is 80 bpm and regular. There are scattered coarse crackles on auscultation of the chest. Investigations: Hb 11.0 g/dl, WCC 7.9 × 10^9/l, PLT 194 × 10^9/l, Na+ 137 mmol/l, K+ 4.2 mmol/l, Creatinine 115 μmol/l, CXR: Bilateral pleural effusions, widespread nodular consolidation. Which of the following is the most likely diagnosis?

A 6-month-old infant is diagnosed with developmental dysplasia of the hip (DDH) after failing 6 weeks of treatment in a Pavlik harness. Ultrasound confirms persistent dislocation. What is the most appropriate next step in management?

A 13-year-old obese boy presents with a 3-week history of right groin pain and a limp. On examination, he walks with an antalgic gait, and his right hip goes into obligate external rotation when flexed. Radiographs confirm a slipped capital femoral epiphysis (SCFE). What is the standard surgical treatment?

A 6-year-old girl falls onto her outstretched hand and sustains a Gartland type III supracondylar humerus fracture. On evaluation, the hand is well-perfused and warm with brisk capillary refill, but the radial pulse is absent. What is the most appropriate initial management?

During closed reduction and percutaneous pinning of a supracondylar humerus fracture, a healthy 6-year-old boy suddenly develops tachycardia, masseter muscle rigidity, and a rapidly rising end-tidal CO2. The anesthesiologist administers the definitive antidote. What is the mechanism of action of this life-saving drug?

An obese 12-year-old boy presents with a 3-week history of right groin and knee pain, walking with an externally rotated limp. Radiographs demonstrate widening of the capital femoral physis with the epiphysis displaced posteriorly and inferiorly. Which of the following is the most feared complication directly associated with attempted forceful closed reduction of this condition?

When managing an infant with congenital idiopathic clubfoot using the Ponseti method, what is the correct sequence of deformity correction?

An obese 12-year-old boy presents with an inability to bear weight on his left leg and severe left hip pain. Radiographs show a posterior and inferior slip of the proximal femoral epiphysis. He is diagnosed with an unstable slipped capital femoral epiphysis (SCFE). Which complication is most highly associated with this specific presentation?

A 6-year-old boy sustains a severe extension-type supracondylar humerus fracture. Upon arrival, his hand is warm and pink, but the radial pulse is absent. After successful closed reduction and percutaneous pinning, the hand remains warm and pink with capillary refill less than 2 seconds, but the radial pulse remains unpalpable. What is the best next step?

A 6-year-old child presents with a pulseless, pale, and poorly perfused hand following a displaced extension-type supracondylar humerus fracture. After anatomical closed reduction and percutaneous pinning, the hand remains pulseless and poorly perfused. What is the next most appropriate step in management?

An 18-month-old child is diagnosed with untreated developmental dysplasia of the hip (DDH) on the right side. Which of the following is the most appropriate initial surgical management?

A 13-year-old obese male presents with right thigh pain and a limp. Examination reveals obligate external rotation of the right hip during passive flexion. Radiographs confirm a severe, stable slipped capital femoral epiphysis (SCFE). What is the most appropriate definitive management?

A 9-year-old boy presents with a 3-week history of right groin pain and an antalgic limp. His BMI is in the 25th percentile for his age. Radiographs confirm a mild stable slipped capital femoral epiphysis (SCFE). Given the patient's age and weight, which of the following is the most appropriate initial laboratory workup?

An obese 13-year-old boy presents with an obligatory external rotation of his right hip when it is passively flexed. Radiographs reveal a slipped capital femoral epiphysis (SCFE). Which of the following is the most likely direction of epiphyseal displacement relative to the femoral neck?

A 6-month-old infant is treated with a Pavlik harness for developmental dysplasia of the hip (DDH). Two weeks later, the baby exhibits decreased active extension of the left knee. What is the most likely complication?

A 2-year-old child presents with bowed legs, costochondral junction enlargement, and delayed closure of the fontanelles. Radiographs show widened, cupped, and frayed metaphyses. Which zone of the physis is massively expanded in this condition?