4. Pediatrics MCQs

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the patient's forearm. The anteroposterior radiograph is shown (Slide). The next step is to order a:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. An immediate appointment for magnetic resonance imaging (MRI) and computed tomography (CT) scan are not available, and a genetic evaluation has been carried out previously. As you await the report from the geneticist's office, you decide to get a skeletal radiograph series on the patient. The radiograph of the opposite forearm (Slide 1) and right leg are shown (Slide 2). You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 3). Your suspected diagnosis is:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The child's skeletal radiograph survey is also presented (Slide 2 and Slide 3). The genetic pattern seen in patients with this type of presentation is:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The child's skeletal radiograph survey is also presented (Slide 2 and Slide 3). The chance of hand involvement in this child is:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The child's skeletal radiograph survey is also presented (Slide 2 and Slide 3). The difference between Madelung's deformity and this boy's condition is:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy's forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well. The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelung's deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The child's skeletal radiograph survey is also presented (Slide 2 and Slide 3). All of the following are acceptable options, either alone or in combination, for management of this child's condition, except:

An infant with Developmental Dysplasia of the Hip (DDH) is being treated with a Pavlik harness. If the anterior straps are adjusted to place the hips in excessive hyperflexion (greater than 120 degrees), the child is at highest risk for developing which of the following complications?

In a child diagnosed with Legg-Calvé-Perthes disease (idiopathic avascular necrosis of the proximal femoral epiphysis), what is the single most significant independent prognostic factor for developing premature hip osteoarthritis in adulthood?

A newborn presents with radial longitudinal deficiency (radial club hand). If Holt-Oram syndrome is suspected as the underlying genetic etiology, what is the most common associated congenital cardiac anomaly?

A 4-month-old infant is undergoing closed reduction for developmental dysplasia of the hip (DDH). The intraoperative arthrogram demonstrates medial pooling of dye and a failure to achieve concentric reduction. Which anatomic structure most commonly blocks closed reduction extracapsularly?

A 13-year-old obese boy presents with left thigh pain and an obligatory external rotation of the hip during active flexion. A diagnosis of Slipped Capital Femoral Epiphysis (SCFE) is made. What is the most devastating complication associated with forceful closed reduction of a displaced SCFE?

A newborn presents with an absent radius and an absent thumb. Which of the following tests is most appropriate to rule out a life-threatening associated condition?

A 13-year-old obese boy presents with a 3-week history of left thigh pain and a limp.

On physical examination, his left hip obligatorily externally rotates when flexed. What is the most appropriate definitive treatment?

A 12-year-old obese male presents with a stable slipped capital femoral epiphysis (SCFE) and undergoes in situ pinning. Six months later, he develops severe hip stiffness and a flexion contracture. Radiographs show significant uniform loss of the joint space. What is the most likely diagnosis?

A 4-month-old infant is being treated with a Pavlik harness for developmental dysplasia of the hip (DDH). During a follow-up visit, the infant is noted to have absent spontaneous extension of the knee on the treated side. Which nerve is most likely compressed due to improper harness positioning?

Prophylactic in situ pinning of the contralateral asymptomatic hip in Slipped Capital Femoral Epiphysis (SCFE) is most strongly indicated in a patient with which of the following underlying conditions?

A 3-month-old infant is being treated for developmental dysplasia of the hip (DDH) with a Pavlik harness. Hyperflexion of the hips in the harness places the child at highest risk for which of the following complications?

A 13-year-old obese male presents with acute-on-chronic left hip pain and inability to bear weight. Radiographs confirm a severe, unstable slipped capital femoral epiphysis (SCFE). Which of the following factors is most strongly associated with the development of avascular necrosis (AVN) in this patient?

A 4-month-old infant is diagnosed with developmental dysplasia of the hip (DDH) after an ultrasound demonstrates a dislocated left hip with an alpha angle of 40 degrees. A Pavlik harness is prescribed. Which complication is most likely if the hip is positioned in excessive flexion?

A 12-year-old obese male undergoes in situ pinning for a stable slipped capital femoral epiphysis (SCFE). Post-operatively, it is discovered that the screw penetrated the anterosuperior quadrant of the femoral head into the joint unrecognized. What is the most likely complication?