CPEN CPEN Orthopedic and Musculoskeletal Emergencies 2

Question 1

Which assessment finding indicates vascular compromise in a child with a lower extremity fracture?

Accepted Answer

Absent or diminished distal pulses with pallor and coolness

Answer

Absent or diminished distal pulses combined with pallor and cool skin distal to a fracture indicates arterial injury requiring immediate intervention.

Question 2

A 12-year-old male presents with knee pain and a visible bump just below the knee. He is an avid basketball player. What is the most likely diagnosis?

Accepted Answer

Osgood-Schlatter disease

Answer

Osgood-Schlatter disease is caused by traction apophysitis at the tibial tubercle insertion of the patellar tendon, common in active adolescents during growth spurts.

Question 3

What is the purpose of a long arm splint versus a circumferential cast in the acute management of a pediatric fracture?

Accepted Answer

A splint allows for swelling while reducing compartment syndrome risk

Answer

Splints are preferred acutely because they accommodate post-injury swelling and reduce the risk of iatrogenic compartment syndrome from a circumferential cast.

Question 4

A 7-year-old presents with acute limp and hip pain. Which condition requires urgent orthopedic evaluation due to risk of avascular necrosis?

Accepted Answer

Septic arthritis of the hip

Answer

Septic arthritis of the hip is a surgical emergency because elevated intra-articular pressure and bacterial enzymes can rapidly destroy the femoral head vascularity, causing avascular necrosis.

Question 5

Which Kocher criteria combination most strongly predicts septic arthritis versus transient synovitis in a child with a painful hip?

Accepted Answer

Fever, non-weight-bearing, elevated ESR, and elevated WBC

Answer

The Kocher criteria (fever, non-weight-bearing, ESR >40, WBC >12,000) predict septic arthritis; all four positive criteria carry >99% probability of septic arthritis.

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN CPEN Orthopedic and Musculoskeletal Emergencies 2