PCS Pediatric Orthopedic and Musculoskeletal Conditions 2 — Questions and Answers
Question 1: A 2-year-old child presents with a limp and inability to bear weight after falling from a couch. X-ray reveals a spiral fracture of the tibia with no signs of other injuries. What is the MOST likely diagnosis?
- Toddler's fracture (Correct answer)
- Stress fracture
- Greenstick fracture
- Buckle (torus) fracture
Correct answer: Toddler's fracture
A toddler's fracture is a spiral tibial fracture common in young ambulatory children resulting from low-energy torsional forces during normal activity.
Question 2: Which clinical finding is MOST consistent with a diagnosis of slipped capital femoral epiphysis (SCFE) in an obese adolescent male?
- Obligate external rotation of the hip with flexion (Correct answer)
- Pain localized to the tibial tuberosity
- Leg-length discrepancy with hip abductor weakness
- Positive FABER test with groin pain
Correct answer: Obligate external rotation of the hip with flexion
In SCFE, the femoral head slips posteriorly and medially; as the hip is flexed, the leg externally rotates obligatorily due to the altered head-neck relationship.
Question 3: In evaluating a child with juvenile idiopathic arthritis (JIA), which type is most associated with the development of uveitis and requires regular ophthalmologic screening?
- Oligoarticular JIA (Correct answer)
- Polyarticular RF-positive JIA
- Systemic JIA
- Psoriatic JIA
Correct answer: Oligoarticular JIA
Oligoarticular JIA carries the highest risk of asymptomatic uveitis, especially in ANA-positive females, requiring regular slit-lamp ophthalmologic examination.
Question 4: A pediatric patient with osteogenesis imperfecta (OI) is referred for physical therapy. Which intervention is MOST appropriate to improve bone density and function while minimizing fracture risk?
- Low-impact aerobic exercise and aquatic therapy (Correct answer)
- High-resistance weight training
- Passive stretching with joint mobilization
- Avoidance of all weight-bearing activities
Correct answer: Low-impact aerobic exercise and aquatic therapy
Low-impact aerobic exercise and aquatic therapy improve bone density and muscle strength while minimizing the mechanical stress that could cause fractures in OI.
Question 5: Which clinical sign indicates tibial torsion is present in a child, as measured during a prone physical therapy examination?
- Thigh-foot angle outside the normal range of 0–30 degrees external rotation (Correct answer)
- Negative Galeazzi sign
- Hip internal rotation greater than 70 degrees
- Foot progression angle greater than 20 degrees
Correct answer: Thigh-foot angle outside the normal range of 0–30 degrees external rotation
The thigh-foot angle measures tibial torsion; values outside 0–30 degrees external rotation indicate abnormal internal or external tibial torsion.
Question 6: A 15-year-old soccer player presents with lateral ankle pain after an inversion sprain. Which ligament is MOST commonly injured?
- Anterior talofibular ligament (ATFL) (Correct answer)
- Calcaneofibular ligament (CFL)
- Posterior talofibular ligament (PTFL)
- Deltoid ligament
Correct answer: Anterior talofibular ligament (ATFL)
The anterior talofibular ligament (ATFL) is the weakest lateral ankle ligament and is most commonly injured in inversion sprains.
Question 7: A child with Duchenne muscular dystrophy (DMD) begins to develop plantar flexion contractures. Which intervention is MOST effective in delaying progression of these contractures?
- Night splinting and daily passive stretching of the gastrocnemius-soleus complex (Correct answer)
- Active strengthening of dorsiflexors
- Rigid ankle-foot orthoses worn 24 hours a day
- Surgical release of the Achilles tendon as first-line treatment
Correct answer: Night splinting and daily passive stretching of the gastrocnemius-soleus complex
Consistent night splinting and daily passive stretching are the primary conservative interventions to delay plantar flexion contracture progression in DMD.
PCS Pediatric Orthopedic and Musculoskeletal Conditions 2
A 2-year-old child presents with a limp and inability to bear weight after falling from a couch.
X-ray reveals a spiral fracture of the tibia with no signs of other injuries.
What is the MOST likely diagnosis?