OTIE Pediatric Questions T.Y. Getahun J. Jarvis. #9 A 13 year old football player who is scheduled to play summer football reports continued popping of.

OTIE Pediatric Questions

T.Y. Getahun

J. Jarvis

#9 A 13 year old football player who is scheduled to play summer football reports continued popping of the ankle. History reveals that the patient sustained an ankle sprain last season that was managed with taping. A radiograph and MRI are shown. The nest step in management should consist of:

1) An ankle brace2) An incisional biopsy of the talus3) A total bone scan and radiographs directed

at abnormal areas4) A CBC and serum alkaline phosphatase,

calcium and phosphorous levels5) Arthroscopic examination and possible

drilling

1) An ankle brace2) An incisional biopsy of the talus3) A total bone scan and radiographs directed at

abnormal areas4) A CBC and serum alkaline phosphatase, calcium

and phosphorous levels

5) Arthroscopic examination and possible drilling

#16 A 6 year old girl underwent correction of a left clubfoot with serial casting during infancy. Her parents report that she often trips and walks on the lateral border of her foot. Examination reveals dynamic intoeing gait on the left side. Active ROM for the left ankle shows 30 of PF and 10 DF. The hindfoot is well corrected and there is only mild residual forefoot adductus. Management should consist of:

1) Repeat serial casting until symmetric DF is obtained

2) A ground reaction short leg brace3) Opening medial cuneiform and closing cubiod

osteotomies4) Posterior tibialis transfer through the

interosseous membrane with anastomosis to the anterior tibialis and the peroneus brevis tendons

5) Anterior tibialis tendon transfer to lateral cuneiform

1) Repeat serial casting until symmetric DF is obtained2) A ground reaction short leg brace3) Opening medial cuneiform and closing cubiod

osteotomies4) Posterior tibialis transfer through the interosseous

membrane with anastomosis to the anterior tibialis and the peroneus brevis tendons

5) Anterior tibialis tendon transfer to lateral cuneiform

#23 A 14 year old sustained a SH II fracture of the distal femur 6 months ago. Follow up examination reveals that the fracture has healed in good position but it appears that there may be a partial growth plate closure. An MRI shows 60% obliteration of the physis. The next most appropriate step in management should consist of:

1) Physeal bar resection 2) Obtaining a scanogram now and in 6

months to construct a Moseley growth chart

3) Femoral lengthening4) Contralateral distal femoral

epiphyseodesis5) Bilateral distal femoral epiphyseodesis

1) Physeal bar resection 2) Obtaining a scanogram now and in 6

months to construct a Moseley growth chart

3) Femoral lengthening4) Contralateral distal femoral

epiphyseodesis5) Bilateral distal femoral epiphyseodesis

#29 Following figures show radiographs of a male infant. What is the most likely diagnosis?

1) Larsens’s syndrome

2) Fragile X syndrome

3) Marfan syndrome

4) Stickler syndrome (hereditary artho-opthalmopathy)

5) Contractural arachnodactyly

Following figures show radiographs of a male infant. What is the most likely diagnosis?

1) Larsens’s syndrome2) Fragile X syndrome

3) Marfan syndrome

4) Stickler syndrome (hereitary artho-opthalmopathy)

5) Contractural arachnodactyly

#37 A 10 year old girl with chronic glomerulonephritis is a candidate for a renal transplant. She has progressive genu valgum and has begun to have pain in the hips bilaterally. She has an antalgic wide-based and external rotated gait. Hip ROM with internal rotation is painful and markedly limited. Which of the following studies will best define the source of hip pain?

1) Blood urea nitrogen and serum creatinine

2) Serum Ca++, Phosphorus, 1,25 dihydroxyvitamin D levels

3) AP and frog lateral radiographs of the hips

4) Arthrogram of the hips

5) CT scan of the pelvis

1) Blood urea nitrogen and serum creatinine

2) Serum Ca++, Phosphorus, 1,25 dihydroxyvitamin D levels

3) AP and frog lateral radiographs of the hips

4) Arthrogram of the hips

5) CT scan of the pelvis

#43 A 6 month old girl has a congenital right foot deformity that has failed to respond to serial casting. An AP radiograph and T1 MRI scan are shown, management should consist of:

1) Continued serial casting2) An abductor hallucis tenotomy3) Proximal osteotomy of the first through

fifth metatarsals4) Excision of the metatarsal bracket with

placement of interpositions material5) Lengthening of the first metatarsal with

dynamic external fixation

1) Continued serial casting

2) An abductor hallucis tenotomy

3) Proximal osteotomy of the first through fifth metatarsals

4) Excision of the metatarsal bracket with placement of interpositions material

5) Lengthening of the first metatarsal with dynamic external fixation

#49 The parents of a 3 year old girl report that she had a transient episode of diffuse left knee pain and a limp 1 week ago that lasted about 24 hrs. history reveals no antecedent trauma, although the parents describe the child as being very active. She is afebrile and there is no obvious systemic illness. Examination does not elicit any clear locking or effusion. Radiographs of the hips are unremarkable; radiographs of the knee are shown. Management should consist of:

1) Immobilization with knee flexed 45

2) Immobilization with knee in full extension

3) Arthroscopic microfracture technique

4) Fixation with absorbable pins

5) Observation

1) Immobilization with knee flexed 45

2) Immobilization with knee in full extension

3) Arthroscopic microfracture technique

4) Fixation with absorbable pins

5) Observation

#54 A 6-year-old boy sustains a both-bone forearm fracture, and management consists of reduction and cast immobilization. Follow-up radiographs show 25º of angulation of the radius on the AP view and 15º on the lateral view. What is the true angle of the fractured bone?

1. Less than 15º

2. 17º

3. 20º

4. 25º

5. Greater than 25º

1. Less than 15º

2. 17º

3. 20º

4. 25º

5. Greater than 25º

#66 Figures 13a and 13b show the radiographs of an 8-year-old boy who injured his left knee in a fall from his bicycle. A bloody effusion is aspirated, and 10mL of 1% lidocaine is injected into the joint, but on examination the knee will not extend fully. The next most appropriate step in management should consist of:

1. An early referral to physical therapy to restore range of motion

2. Arthroscopy (and possible arthrotomy) for reduction and fixation

3. Arthoscropy (and possible arthrotomy) for removal of the loose fragment

4. MRI of the knee

5. A hinged knee orthosis and early range-of-motion exercises

1. An early referral to physical therapy to restore range of motion

2. Arthroscopy (and possible arthrotomy) for reduction and fixation

3. Arthoscropy (and possible arthrotomy) for removal of the loose fragment

4. MRI of the knee5. A hinged knee orthosis and early range-

of-motion exercises

#71 The parents of a 3-year-old child are concerned about the posture of the child’s toes. They report frequent erythema and tenderness at the dorsum of the third toe and they have difficulty with care of the nail of the fourth toe. Clinical photographs are shown in Figures 16a and 16b. Treatment should consist of:

1. Ablation of the nail of the fourth toe

2. Proximal interphalangeal joint arthrodesis of the fourth toe

3. Distal interphalangeal joint arthrodesis of the third toe

4. Release of the extensors of the third toe

5. Release of the flexors of the fourth toe

1. Ablation of the nail of the fourth toe

2. Proximal interphalangeal joint arthrodesis of the fourth toe

3. Distal interphalangeal joint arthrodesis of the third toe

4. Release of the extensors of the third toe

5. Release of the flexors of the fourth toe

#84 The maximal rate of curve progression in idiopathic scoliosis is best correlated with which of the following parameters in girls?

1. Risser stage 1

2. Peak velocity of growth

3. Chronologic age of 12 years

4. Chronologic age of 13 years

5. Menarche

1. Risser stage 1

2. Peak velocity of growth3. Chronologic age of 12 years

4. Chronologic age of 13 years

5. Menarche

#99 A 14-year-old basketball player has had activity-related low back pain for the past 6 weeks. Plain radiographs are unremarkable. Selected coronal single-photon emission computed tomography scans are shown in Figure 27. The best course of action should be:

1. Bilateral facet blocks

2. Brace immobilization for 3 to 6 months

3. Instrumented posterior spinal fusion

4. A CT-guided needle biopsy

5. An open incisional biopsy

1. Bilateral facet blocks

2. Brace immobilization for 3 to 6 months

3. Instrumented posterior spinal fusion

4. A CT-guided needle biopsy

5. An open incisional biopsy

#111 A 12-year-old boy is referred for evaluation of a spinal deformity. Examination and history reveal that he and one of his two sisters have numerous light brown birthmarks distributed on all areas of the body. The radiograph shown in Figure 32 reveals a curve that measures 70º. The best course of action should be:

1. MRI of the entire spine

2. Brace treatment with a thoracolumbosacral orthosis

3. Posterior spinal fusion and observation for possible crankshaft progression of the curve

4. A period of observation to determine whether the curve may progress

5. A renal ultrasound and echocardiogram

1. MRI of the entire spine2. Brace treatment with a

thoracolumbosacral orthosis

3. Posterior spinal fusion and observation for possible crankshaft progression of the curve

4. A period of observation to determine whether the curve may progress

5. A renal ultrasound and echocardiogram

#118 The mother of a 1-month-old infant reports that he seems to sniff and snort persistently and his temperature has been very labile. Examination reveals a depressed nasal bridge, mild jaundice, and hepatosplenomegaly. Radiographs are shown in Figures 35a and 35b. To help confirm the diagnosis, the best course of action would be:

1. A rapid plasma reagin (RPR) test

2. A technetium Tc 99m total body bone scan

3. CT of the skull and upper cervical spine

4. Needle aspiration of both tibiae

5. Bilateral hip ultrasound studies

1. A rapid plasma reagin (RPR) test2. A technetium Tc 99m total body bone

scan

3. CT of the skull and upper cervical spine

4. Needle aspiration of both tibiae

5. Bilateral hip ultrasound studies

#125An 11-year-old soccer player has had left lateral pain for the past 6 months. Examination shows increased heel valgus and decreased subtalar motion on the left side. Ankle range of motion and stability are symmetric. Radiographs of the foot and ankle are normal. The next most appropriate step in management should consist of:

1. Observation with follow-up in 6 months2. A full shoe orthosis with medial heel

posting left3. Left sinus tarsi injections with local

anesthetic4. Comparative stress radiographs of both

ankles5. CT of the left foot

1. Observation with follow-up in 6 months

2. A full shoe orthosis with medial heel posting left

3. Left sinus tarsi injections with local anesthetic

4. Comparative stress radiographs of both ankles

5. CT of the left foot

#128 What is the most common soft-tissue tumor in children?

1. Ganglion

2. Hemangioma

3. Fibroma

4. Lipoma

5. Sarcoma

1. Ganglion

2. Hemangioma3. Fibroma

4. Lipoma

5. Sarcoma

#136 A woman who is in the 20th week of her pregnancy seeks an orthopedic consultation after undergoing an ultrasound. The findings reveal that the fetus has bilateral clubfeet and both femurs measure less than two standard deviations below normal. What is the most likely diagnosis?

1. Myelomeningocele

2. Bilateral proximal focal femoral deficiency

3. Diastrophic dysplasia

4. Achondroplasia

5. Spondylometaphyseal dysplasia

1. Myelomeningocele

2. Bilateral proximal focal femoral deficiency

3. Diastrophic dysplasia4. Achondroplasia

5. Spondylometaphyseal dysplasia

#140 An asymptomatic 10-year-old boy is referred for evaluation of a limb-length discrepancy that measures less than 2cm. Examination reveals that the most lateral ray of the ipsilateral foot is absent, and the ipsilateral knee is unstable to Lachman and anterior drawer tests. Figure 43 shows an AP radiograph of the ankle. Management of the knee should consist of:

1. Anterior cruciate ligament reconstruction using a quadruple hamstring technique

2. Anterior cruciate ligament reconstruction using an allograft in the over-the-top position

3. Observation4. An aggressive physical therapy program

that emphasizes open chain techniques5. Functional knee bracing until skeletal

maturity, followed by anterior cruciate ligament reconstruction

1. Anterior cruciate ligament reconstruction using a quadruple hamstring technique

2. Anterior cruciate ligament reconstruction using an allograft in the over-the-top position

3. Observation4. An aggressive physical therapy program that

emphasizes open chain techniques

5. Functional knee bracing until skeletal maturity, followed by anterior cruciate ligament reconstruction

#151 A 6-month-old boy with L1 myelomeningocele has bilateral dislocated hips. Examination reveals that the hips are clinically reducible, and there are no significant hip or knee joint contractures. The best course of action for both hips should consist of:

1. Observation

2. Application of a Pavlik harness

3. Application of a rigid hip abduction orthosis

4. Closed reduction with a hip spica cast

5. Open reduction via an adductor approach

1. Observation2. Application of a Pavlik harness

3. Application of a rigid hip abduction orthosis

4. Closed reduction with a hip spica cast

5. Open reduction via an adductor approach

#160 A patient with developmental dysplasia of the hip is undergoing open reduction. Which of the following is considered an advantage of using a medial approach compared with an anterior approach?

1. A lower incidence of osteonecrosis

2. Access for performance of capsulorrhaphy

3. Access to the transverse acetabular ligament

4. Better ability to reduce an inverted labrum

5. Better visualization of the lateral femoral cutaneous nerve

1. A lower incidence of osteonecrosis

2. Access for performance of capsulorrhaphy

3. Access to the transverse acetabular ligament

4. Better ability to reduce an inverted labrum

5. Better visualization of the lateral femoral cutaneous nerve

#168 In the absence of a visible fracture on radiographs, the presence of a positive posterior fat pad sign following trauma of the elbow in a 5-year-old child most like represents:

1. A normal radiographic finding

2. A soft-tissue contusion

3. Nursemaid’s elbow

4. An occult fracture

5. Synovial hypertrophy

1. A normal radiographic finding

2. A soft-tissue contusion

3. Nursemaid’s elbow

4. An occult fracture5. Synovial hypertrophy

#170 The parents of a 6-month-old infant report that she has been unwilling to move her left upper extremity for the past 5 hours. An AP radiograph and an MRI scan are shown in Figures 54a and 54b. Based on these findings and after initial treatment, a consultation should be arranged with:

1. Child protection services

2. A geneticist

3. A nephrologist

4. A rheumatologist

5. An infectious disease specialist

1. Child protection services2. A geneticist

3. A nephrologist

4. A rheumatologist

5. An infectious disease specialist

#178 Which of the following systemic conditions is associated with a genetic defect in skeletal formation that does not involve abnormal collagen?

1. Osteogenesis imperfecta

2. Spondyloepiphyseal dysplasia congenita

3. Achondroplasia

4. Multiple epiphyseal dysplasia

5. Kneist dysplasia

1. Osteogenesis imperfecta

2. Spondyloepiphyseal dysplasia congenita

3. Achondroplasia4. Multiple epiphyseal dysplasia

5. Kneist dysplasia

#185 A 6 year old girl has a right genu varum that has progressed over the last 6 months. Plain radiographs of the knee reveal a sloping medial joint line with obvious bony bar at the medial proximal tibial physis. A CT scan shows that this bar involves about 20% of the physis. Treatment at this time should include:

1) Epiphyseodesis of the proximal tibial physis

2) Corrective osteotomy of the tibia and fibula

3) Corrective osteotomy of the tibia and epiphyseodesis of the left proximal tibial physis

4) Proximal tibial physeal bar resection and corrective osteotomy of the tibia and fibula

5) Elevating osteotomy of the proximal tibial medial plateau

1) Epiphyseodesis of the proximal tibial physis

2) Corrective osteotomy of the tibia and fibula

3) Corrective osteotomy of the tibia and epiphyseodesis of the left proximal tibial physis

4) Proximal tibial physeal bar resection and corrective osteotomy of the tibia and fibula

5) Elevating osteotomy of the proximal tibial medial plateau

#188 The following figures show the radiographs of an 8 year old boy who has atraumatic recurrent lateral dislocations of the left patella. Exam reveals no fixed genu varum or valgum and lower extremity lengths are equal. The Q angle is 25. The extended hips show internal rotation of 40 and external rotation of 60 with a neutral thigh-foot angle. There is no generalized ligamentous laxity. Treatment should consist of:

1) Femoral rotational osteotomy

2) Tibial rotational osteotomy

3) Tibial tuberosity transfer ( Fulkerson, Elmslie-Trillat or Hauser)

4) Tenodesis of the semitendinosus to the patella

5) Patellectomy and vastus medialis advancement

1) Femoral rotational osteotomy

2) Tibial rotational osteotomy

3) Tibial tuberosity transfer ( Fulkerson, Elmslie-Trillat or Hauser)

4) Tenodesis of the semitendinosus to the patella

5) Patellectomy and vastus medialis advancement

#194 The lateral crista of the trochlea develops from what secondary ossification center?

1) Medial condylar epiphysis

2) Lateral condylar epiphysis

3) Medial epicondylar apophysis

4) Lateral epicondylar apophysis

5) Olecranon apophysis

1) Medial condylar epiphysis

2) Lateral condylar epiphysis3) Medial epicondylar apophysis

4) Lateral epicondylar apophysis

5) Olecranon apophysis

#208 Which of the following conditions will most likely cause disability at some point in the life of a patient with achondroplasia?

1) Degenerative joint disease of the knees

2) Cervical instability with myelopathy

3) Scoliosis of the thoracic or lumber spine

4) Spinal stenosis

5) Progressive contractures of the limbs

1) Degenerative joint disease of the knees

2) Cervical instability with myelopathy

3) Scoliosis of the thoracic or lumber spine

4) Spinal stenosis5) Progressive contractures of the limbs

#219 Which of the following conditions is most commonly associated with congenital fibular hemimelia?

1) Congential absence of the patella

2) Congential absence of the first ray

3) Genu varum

4) Equinovarus ankle

5) Talocalcaneal coalition

1) Congential absence of the patella

2) Congential absence of the first ray

3) Genu varum

4) Equinovarus ankle

5) Talocalcaneal coalition

#224 An 11 year old girl has had progressive medial midfoot pain bilaterally for the past 6 months. Her mother states that the child’s feet appeared normal until the pain started, and she is concerned about the development of flatfeet. What is the most likely diagnosis?

1) Physiologic pes planus

2) Charcot foot

3) Posterior tibial tendon insufficiency

4) Congential vertical talus

5) Accessory navicular

1) Physiologic pes planus

2) Charcot foot

3) Posterior tibial tendon insufficiency

4) Congential vertical talus

5) Accessory navicular

#229 A 16 year old boy who is 5 ft 4 in tall reports pain in the knees and ankles. Exam reveals that his knees are in 15 of valgus. The articular surfaces of the knees and ankles are irregular and the femoral heads are slightly flattened. A lateral radiograph shows that the patellae have a double layer. What is the most likely diagnosis?

1) Kneist syndrome

2) Spondyloepiphyseal dysplasia congentia

3) Multiple epiphyseal dysplasia

4) Achondroplasia

5) dyschondrosteosis

1) Kneist syndrome

2) Spondyloepiphyseal dysplasia congentia

3) Multiple epiphyseal dysplasia4) Achondroplasia

5) dyschondrosteosis

#231 A 14 year old has been limping and has had pain with weight bearing on the right lower leg for the past 48 hrs. She has a temp of 37.7. She prefers a prone position with the right hip and knee extended. Pain is produced by placing the hip in flexion, abduction and external rotation. Which of the following studies will best confirm the diagnosis?

1) Hip aspiration

2) AP radiograph of the pelvis

3) Oblique radiograph of the lumber spine

4) CT of the abdomen

5) MRI of the pelvis

1) Hip aspiration

2) AP radiograph of the pelvis

3) Oblique radiograph of the lumber spine

4) CT of the abdomen

5) MRI of the pelvis

#238 A 13 year old boy has nonrigid Scheuermann’s kyphosis. Weight-bearing radiographs show a kyphosis of 70 form T7 to L1, with a scoliosis that measures 10 at Risser 2 maturity. Management should consist of:

1) Postural exercises and analgesics

2) A Charleston bending brace

3) An extension-type spinal orthosis

4) Posterior spinal fusion with instrumentation

5) Anterior spinal release and posterior spinal instrumentation

1) Postural exercises and analgesics

2) A Charleston bending brace

3) An extension-type spinal orthosis4) Posterior spinal fusion with

instrumentation

5) Anterior spinal release and posterior spinal instrumentation

#245 A child with recurrent multifocal osteomyelits has painful swelling and tenderness in the right medial clavicle with no fluctuance. She has a temp of 37.2. The palms and soles show pustular lesions. Radiographs reveal periosteal new bone formation in the medial clavicle. Management should consist for:

1) A steroid injection into the medial clavicle

2) Oral NSAIDs

3) IV administration of oxacillin for 4 weeks

4) IV administration of gamma globulin

5) Incision and drainage of the medial clavicle

1) A steroid injection into the medial clavicle

2) Oral NSAIDs3) IV administration of oxacillin for 4 weeks

4) IV administration of gamma globulin

5) Incision and drainage of the medial clavicle

#256 Which of the following conditions is considered a common clinical manifestation of multiple hereditary exostoses?

1) Radial bowing

2) Scoliosis

3) Acetabular dysplasia

4) Genu varum

5) Dwarfism

1) Radial bowing2) Scoliosis

3) Acetabular dysplasia

4) Genu varum

5) Dwarfism

#263 A 13 year old girl with scoliosis has mild intermittent back pain. A bone scan, CT scan and MRI would most likely reveal which of the following conditions?

1) Spondylolsis

2) Spondylolisthesis

3) Scheuermann’s

4) Slipped vertebral apophysis

5) No other condition

1) Spondylolsis

2) Spondylolisthesis

3) Scheuermann’s

4) Slipped vertebral apophysis

5) No other condition

#269 The likelihood of a contralateral slip occurring in a boy with a unilateral SCFE is greatest when combined with which of the following risk factors?

1) An unstable slip

2) A chronic slip

3) A grade III slip

4) Patient age of 11years

5) Patient age of 13 years

1) An unstable slip

2) A chronic slip

3) A grade III slip

4) Patient age of 11years5) Patient age of 13 years