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4. Pediatrics MCQs

Practice Set 9 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 161

Topic: 4. Pediatrics

Which of the following parameters provides the greatest potential for remodeling in a pediatric diaphyseal both-bone forearm fracture?

. Midshaft location
. Child age of 14 years
. Angulation in the plane of adjacent joint motion
. Volar apex angulation
. Rotational malalignment

Correct Answer & Explanation

. Midshaft location

Explanation

Remodeling in pediatric fractures is greatest in younger children, near the physis (distal rather than midshaft), and when the angulation is in the plane of motion of the adjacent joint. Rotational malalignment does not remodel.

Question 162

Topic: Pediatric Hip

Which of the following is an absolute contraindication to the use of a Pavlik harness for the treatment of developmental dysplasia of the hip (DDH)?

. Age less than 6 weeks
. Bilateral hip dislocation
. Teratologic hip dislocation
. Reducible Barlow-positive hip
. Ultrasound showing alpha angle of 45 degrees

Correct Answer & Explanation

. Teratologic hip dislocation

Explanation

Teratologic hip dislocations (associated with conditions like arthrogryposis or spina bifida) are rigid and irreducible with a Pavlik harness, representing an absolute contraindication. Pavlik harness treatment in these cases risks prolonged immobilization without success and potential iatrogenic injury.

Question 163

Topic: Pediatric Hip
In the lateral pillar classification of Legg-Calvรฉ-Perthes disease, which radiographic parameter is evaluated to determine the prognosis?
. The extent of medial epiphyseal involvement
. The degree of fragmentation of the central pillar
. The height of the lateral portion of the capital femoral epiphysis
. The severity of metaphyseal cysts
. The alpha angle of the acetabulum

Correct Answer & Explanation

. The height of the lateral portion of the capital femoral epiphysis

Explanation

The Herring lateral pillar classification evaluates the height of the lateral third (lateral pillar) of the capital femoral epiphysis relative to its original height during the fragmentation stage. Preservation of lateral pillar height correlates with a better long-term prognosis.

Question 164

Topic: 4. Pediatrics

A 3-year-old girl is diagnosed with infantile Blount disease (tibia vara). Which of the following radiographic findings is characteristic of this condition?

. Medial metaphyseal beak with an abrupt varus angulation
. Lateral physeal widening of the distal femur
. Posterior medial bowing of the tibia
. Failure of the primary ossification center of the patella
. Symmetrical bowing of both the femur and tibia

Correct Answer & Explanation

. Medial metaphyseal beak with an abrupt varus angulation

Explanation

Infantile Blount disease is characterized by an abrupt varus angulation at the proximal tibia, often with a prominent medial metaphyseal beak and depression of the medial physis. This is due to a growth disturbance of the medial aspect of the proximal tibial physis.

Question 165

Topic: 4. Pediatrics
A 10-year-old falls and sustains a fracture of the distal radius. Radiographs reveal a fracture line extending through the physis and exiting through the metaphysis, leaving a triangular metaphyseal fragment attached to the epiphysis. What is the Salter-Harris classification?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

A Salter-Harris Type II fracture involves the physis and exits through the metaphysis, producing a characteristic Thurston-Holland fragment. It is the most common type of physeal fracture.

Question 166

Topic: 4. Pediatrics
The radiographs of a 13-year-old boy are presented. The radiographs demonstrate characteristics of which of the following conditions?
. Osteoid osteoma
. Tibial hemimelia
. Congenital dysplasia
. Fracture growth arrest
. Osteomyelitis

Correct Answer & Explanation

. Fracture growth arrest

Explanation

The radiographs show characteristics of a growth arrest from a medial distal tibial physeal fracture, either a Salter III or Salter IV. The fracture was not internally fixed, and the residual vertical fracture line and step-off are still visible. A growth plate bar developed and Park-Harris growth lines are seen on the lateral side of the bar. Some of the physis is open medially and, especially, laterally. The fibula has continued to grow.

Question 167

Topic: 4. Pediatrics
An 11.5-year-old boy sustained a Salter IV fracture of the distal tibial physis. The fracture was treated in a cast. Two years later, his radiographs (Slide) are presented. The patient is starting to notice a deformity. Which of the following treatment plans is recommended?
. Medial physeal bar resection
. Right distal fibular epiphyseodesis
. Right distal tibial and fibular epiphyseodesis
. Left distal tibial and fibular epiphyseodesis
. Right distal tibial and fibular osteotomy, and bilateral distal tibial and fibular epiphyseodesis

Correct Answer & Explanation

. Right distal tibial and fibular osteotomy, and bilateral distal tibial and fibular epiphyseodesis

Explanation

This patient has an unacceptable deformity, 2 cm of current shortening, and significant growth remaining. Only right distal tibial and fibular osteotomy, and bilateral distal tibial and fibular epiphyseodesis addresses all of the complications. Bar resection is not uniformly successful and would not correct existing deformity and length inequality, since there is minimal physis medial to the bar that could produce correction.

Question 168

Topic: 4. Pediatrics

The radiographs (Slide) indicate which of the following diagnoses:

. Congenital dysplasia of the distal humerus
. Osteogenesis imperfecta
. Supracondylar humeral fracture
. Lateral condylar humeral fracture
. Normal elbow

Correct Answer & Explanation

. Supracondylar humeral fracture

Explanation

The radiographs indicate a supracondylar fracture of the distal humerus. The anterior humeral line should bisect the capitellum on the lateral view. The anterior and posterior fat pads are elevated. The fracture line may be seen on the anteroposterior and the lateral radiographs, although it is subtle. The cortical break of the coronoid fossa is evident. Surgeons must recognizethese fractures so that the patient and family may be given proper activity restrictions and expectations for improvement.

Question 169

Topic: 4. Pediatrics

A 5-year-old boy was imaged after being struck by a car. His radiographs (Slide) indicate which of the following diagnoses:

. Buckle fracture of the proximal humeral metaphysis
. Salter I fracture of the proximal humeral physis
. Salter II fracture of the proximal humeral physis
. Salter IV fracture of the proximal humeral physis
. Normal humerus

Correct Answer & Explanation

. Normal humerus

Explanation

The proximal humeral physis has two planes and two ossification centers (in this way, it is analogous to the proximal femur).When seen in some projections, the more distal extent of the physis may produce a lucent line. The smooth nature and characteristic location of the line should allow surgeons to make the correct interpretation. The two ossification centers of the humeral head may be misinterpreted as a fracture. This patient had a greenstick fracture of the clavicle (not included on this field), which was not noticed, and a humeral fracture was incorrectly diagnosised.

Question 170

Topic: Pediatric Upper Extremity & Spine

Flexion-type supracondylar fractures of the distal humerus in children are characterized by which of the following when compared to extension-type injuries:

. Younger age at presentation
. Higher risk of ulnar nerve injury
. Higher risk of anterior interosseous nerve injury
. Lower risk of needing open reduction
. Greater frequency of occurrence

Correct Answer & Explanation

. Higher risk of ulnar nerve injury

Explanation

Flexion-type supracondylar fractures of the distal humerus in children include the following characteristics: Frequency is less than one-tenth as that of extension-type supracondylar fractures Tend to occur in older children Lower risk of anterior interosseous nerve injury Higher risk of ulnar nerve injury More often require open reduction

Question 171

Topic: Pediatric Hip

Patients who have had a unilateral slipped capital femoral epiphysis (SC FE) are at what odds of a contralateral slip compared to the general population:

. 2 times
. 20 times
. 200 times
. 2,000 times
. 20,000 times

Correct Answer & Explanation

. 2,000 times

Explanation

Patients who have presented with a unilateral SC FE are at approximately 2,000 times the risk of a contralateral slip compared to the general population. The risk of a contralateral slip in a juvenile is approximately 1/10,000, which provides justification for prophylactic pinning of a second side if a surgeon thinks it is warranted.

Question 172

Topic: 4. Pediatrics

A 4-week-old infant is treated with a Pavlik harness for developmental dysplasia of the hip. At a follow-up visit, the infant is noted to have decreased spontaneous movement of the knee and absent knee extension against gravity. What is the most likely iatrogenic cause?

. Femoral nerve palsy due to excessive hyperflexion
. Sciatic nerve palsy due to excessive hyperflexion
. Obturator nerve palsy due to excessive abduction
. Avascular necrosis of the femoral head
. Transient synovitis

Correct Answer & Explanation

. Femoral nerve palsy due to excessive hyperflexion

Explanation

Femoral nerve palsy is a known complication of the Pavlik harness if the hips are hyperflexed. It typically resolves with adjustment of the harness to reduce flexion.

Question 173

Topic: 4. Pediatrics

An obese 12-year-old boy presents with a 3-week history of knee pain and a limp. He sits with his affected leg externally rotated. Radiographs reveal a widened and irregular proximal femoral physis. What is the most appropriate initial management?

. Closed reduction and spica casting
. In situ pinning with a single cannulated screw
. Open reduction and internal fixation
. Proximal femoral osteotomy
. Observation with non-weight bearing

Correct Answer & Explanation

. In situ pinning with a single cannulated screw

Explanation

Stable Slipped Capital Femoral Epiphysis (SCFE) is best treated with in situ pinning using a single, centrally placed cannulated screw to prevent further slippage. Closed reduction increases the risk of avascular necrosis.

Question 174

Topic: 4. Pediatrics

A 9-year-old boy sustained a distal femoral physeal fracture 1 year ago. He now presents with a valgus deformity.

Based on the likelihood of a localized physeal bar, what percentage of physeal involvement is generally considered the upper limit for successful bar resection?

. 10%
. 25%
. 50%
. 75%
. 90%

Correct Answer & Explanation

. 50%

Explanation

Physeal bar resection is generally indicated if the bar involves less than 50% of the cross-sectional area of the physis. Additionally, the patient should have at least 2 years of remaining growth.

Question 175

Topic: Pediatric Hip

A 6-year-old boy presents with a painless limp. Radiographs demonstrate sclerosis and fragmentation of the proximal femoral epiphysis. Which of the following factors carries the worst prognosis for this condition?

. Age of onset less than 6 years
. Loss of internal rotation
. Lateral pillar C classification
. Male sex
. Catterall group I

Correct Answer & Explanation

. Lateral pillar C classification

Explanation

In Legg-Calve-Perthes disease, the Lateral Pillar classification is strongly prognostic. Lateral Pillar C (greater than 50% loss of lateral pillar height) has the worst prognosis.

Question 176

Topic: Pediatric Upper Extremity & Spine
A newborn is noted to have a foreshortened right forearm with the hand deviated radially and an absent thumb. Which of the following systemic conditions is NOT typically associated with this deformity?
. TAR syndrome
. Holt-Oram syndrome
. VACTERL association
. Fanconi anemia
. Neurofibromatosis type 1

Correct Answer & Explanation

. Neurofibromatosis type 1

Explanation

Radial clubhand (radial longitudinal deficiency) is associated with TAR, Holt-Oram, VACTERL, and Fanconi anemia. Neurofibromatosis type 1 is classically associated with anterolateral tibial bowing, not radial clubhand.

Question 177

Topic: 4. Pediatrics

When correcting a congenital idiopathic clubfoot using the Ponseti method, what is the correct sequence of deformity correction?

. Equinus, Varus, Adduction, Cavus
. Cavus, Adduction, Varus, Equinus
. Adduction, Varus, Cavus, Equinus
. Cavus, Equinus, Varus, Adduction
. Varus, Cavus, Adduction, Equinus

Correct Answer & Explanation

. Cavus, Adduction, Varus, Equinus

Explanation

The Ponseti method corrects deformities in the mnemonic CAVE sequence. Cavus is corrected first by elevating the first ray, followed by Adduction, Varus, and finally Equinus.

Question 178

Topic: 4. Pediatrics
A 10-year-old boy falls from a tree. Radiographs reveal a fracture extending through the physis and exiting through the metaphysis of the distal radius. What is the Salter-Harris classification of this fracture?
. Type I
. Type II
. Type III
. Type IV
. Type V

Correct Answer & Explanation

. Type II

Explanation

A Salter-Harris Type II fracture involves the physis and exits through the metaphysis. It is the most common type of physeal fracture and typically carries a good prognosis.

Question 179

Topic: Pediatric Upper Extremity & Spine

A 12-year-old premenarchal female (Risser 0) is diagnosed with adolescent idiopathic scoliosis. Her right thoracic curve measures 32 degrees. What is the most appropriate management?

. Observation with radiographs every 12 months
. Physical therapy for core strengthening
. Full-time TLSO bracing
. Posterior spinal fusion
. Anterior tethering procedure

Correct Answer & Explanation

. Full-time TLSO bracing

Explanation

Bracing is indicated for growing children (Risser 0-2, premenarchal) with curves between 25 and 40 degrees. It is also indicated for documented progression of >5 degrees in curves of 20-25 degrees.

Question 180

Topic: 4. Pediatrics
A 14-year-old boy sustains an ankle injury. Radiographs and CT demonstrate a Salter-Harris III fracture of the anterolateral distal tibial epiphysis. What is the anatomic reason for this specific fracture pattern?
. The anterior tibiofibular ligament avulses the fragment
. The medial aspect of the physis closes last
. The lateral aspect of the physis closes first
. The deltoid ligament avulses the fragment
. It is caused by an axial load combined with extreme dorsiflexion

Correct Answer & Explanation

. The anterior tibiofibular ligament avulses the fragment

Explanation

A juvenile Tillaux fracture occurs due to avulsion by the anterior inferior tibiofibular ligament (AITFL). It happens because the distal tibial physis closes from central to medial to lateral, leaving the anterolateral physis vulnerable.

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