PCS Pediatric Orthopedic and Musculoskeletal Conditions 1 — Questions and Answers
Question 1: A 10-year-old presents with anterior knee pain that worsens with jumping and running, and tenderness over the tibial tuberosity. Which condition is most likely?
- Osgood-Schlatter disease (Correct answer)
- Patellofemoral pain syndrome
- Sinding-Larsen-Johansson syndrome
- Jumper's knee (patellar tendinopathy)
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease causes traction apophysitis at the tibial tuberosity, presenting with tenderness and swelling at that site in active adolescents.
Question 2: When assessing an infant for developmental dysplasia of the hip (DDH), which clinical test involves abduction of the flexed hip to detect a dislocated femoral head relocating into the acetabulum?
- Ortolani test (Correct answer)
- Barlow test
- FABER test
- Trendelenburg test
Correct answer: Ortolani test
The Ortolani test involves abducting the flexed hip; a 'clunk' indicates reduction of a dislocated femoral head back into the acetabulum.
Question 3: A pediatric physical therapist evaluates a 13-year-old with scoliosis. Which Cobb angle measurement is typically the threshold for recommending bracing in a skeletally immature patient?
- 25–40 degrees (Correct answer)
- 10–15 degrees
- 45–50 degrees
- 5–10 degrees
Correct answer: 25–40 degrees
Bracing is generally recommended for curves between 25 and 40 degrees in skeletally immature patients to prevent progression.
Question 4: Which gait deviation is most characteristic of a child with bilateral hip flexion contractures?
- Increased lumbar lordosis with anterior pelvic tilt (Correct answer)
- Trendelenburg gait
- Scissor gait
- Steppage gait
Correct answer: Increased lumbar lordosis with anterior pelvic tilt
Bilateral hip flexion contractures cause the pelvis to tilt anteriorly and the lumbar spine to hyperextend to maintain an upright posture during gait.
Question 5: In a child diagnosed with Legg-Calvé-Perthes disease, which stage is characterized by revascularization and new bone formation in the femoral head?
- Fragmentation stage
- Initial/necrotic stage
- Reossification stage (Correct answer)
- Residual stage
Correct answer: Reossification stage
The reossification (healing) stage is when revascularization occurs and new bone replaces the necrotic femoral head tissue.
Question 6: A pediatric physical therapist notes that a 6-year-old child walks with bilateral in-toeing. Which of the following is the MOST common cause of in-toeing in children this age?
- Femoral anteversion (Correct answer)
- Metatarsus adductus
- Internal tibial torsion
- Clubfoot
Correct answer: Femoral anteversion
Femoral anteversion is the most common cause of in-toeing in children aged 3–8 years, as the femur remains in excessive internal rotation relative to the acetabulum.
Question 7: Which imaging modality is considered the gold standard for confirming developmental dysplasia of the hip (DDH) in infants younger than 4 months?
- Ultrasound (Correct answer)
- Plain radiograph (X-ray)
- MRI
- CT scan
Correct answer: Ultrasound
Ultrasound is the gold standard for DDH diagnosis in infants under 4 months because the femoral head is largely cartilaginous and not visible on X-ray.
PCS Pediatric Orthopedic and Musculoskeletal Conditions 1
A 10-year-old presents with anterior knee pain that worsens with jumping and running, and tenderness over the tibial tuberosity.
Which condition is most likely?