PEDS Core Test-2016

35 Questions | Total Attempts: 36

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PEDS Core Test-2016

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Questions and Answers
  • 1. 
    What is the sequence of ossification of growth centers about the elbow in a child?
    • A. 

      Radial head, olecranon, capitellum, medial, lateral, trochlea

    • B. 

      Capitellum, olecranon, radial head, trochlea, medial, lateral

    • C. 

      Capitellum, radial head, medial, trochlea, olecranon, lateral

    • D. 

      Radial head, capitellum, olecranon, medial, lateral, trochlea

  • 2. 
    What is the normal mLDFA (mechanical lateral proximal femoral angle)?
    • A. 

      82 degrees

    • B. 

      87 degrees

    • C. 

      93 degrees

    • D. 

      97 degrees

  • 3. 
    Which of the following is true about a pulseless supracondylar humerus fracture? 
    • A. 

      When there is a concomitant nerve injury, the rate of nerve recovery is quite low unless open reduction is performed

    • B. 

      70% of the time, closed reduction is all that is required to restore pulse

    • C. 

      Emergent angiogram should be considered when a patient presents with a dysvascular supracondylar humerus fracture

    • D. 

      If the pulse is dopplerable, there is no concern for brachial artery injury

  • 4. 
    An external fixator will have more stability if: 
    • A. 

      Half pins are all close together with similar angle, you use larger rings, and thin wires are close to the frame

    • B. 

      Thin wires are far from the frame, rings are close to the bone and half pins have wide spread with various angles

    • C. 

      Half pins are close together with similar angle, you use smaller rings, and thin wires are close to the frame

    • D. 

      Rings are closer to the bone, half pins are wide spread with various angles, and thin wires are close to the frame

  • 5. 
    Which of the following is true about medial epicondyle fractures?
    • A. 

      This fracture most commonly happens in younger school age children

    • B. 

      Treatment should not be influenced by which sports a child plays

    • C. 

      X-rays should be assessed for intraarticular fragments

    • D. 

      The fracture fragment is usually displaced posteriorly/inferiorly

  • 6. 
    Radial neck fractures
    • A. 

      Need to be reduced if the angulation is over 20 degrees

    • B. 

      Have a low rate of failure of closed reduction

    • C. 

      Have a high concern for problematic growth arrest

    • D. 

      Have worse outcomes if open reduction is necessary

  • 7. 
    Which of the following statements is true about reducing a pediatric both bone forearm fracture:
    • A. 

      The radial styloid should be 90 degrees from the radial tuberosity

    • B. 

      The ideal cast index is >0.7

    • C. 

      Angulation of 45 degrees is ok for a young child

    • D. 

      20 degrees of malrotation may be well tolerated

  • 8. 
    Which physis contributes the most to height yearly (and how much does it grow/year)?
    • A. 

      Proximal tibia at 10mm/year

    • B. 

      Distal femur at 9mm/year

    • C. 

      Distal tibia at 6mm/year

    • D. 

      Proximal femur at 7mm/year

  • 9. 
    At what final projected leg length discrepancy is it appropriate to consider contralateral epiphysiodesis?
    • A. 

      Over 1cm

    • B. 

      2-5cm

    • C. 

      3-7cm

    • D. 

      Any discrepancy under 6cm

  • 10. 
    What is the natural progression of lower extremity limb alignment over time?
    • A. 

      Babies are born with neutral femoral-tibial angle that becomes progressively valgus with time

    • B. 

      Babies are born with valgus femoral-tibial angle which becomes progressively varus with time and then becomes neutral

    • C. 

      Babies are born with varus femoral-tibial angle which becomes progressively valgus with time and then decreases to slight valgus

    • D. 

      Babies are born with neutral femoral-tibial angle which becomes varus and then becomes progressively valgus

  • 11. 
    A 7-year-old boy with spastic dysplasia, Gross Motor Function Classification System (GMFCS) level 3, has progressive hip subluxation on the right. Examination reveals a scissored gait, tight spastic adductors, limited hip abduction, and increased femoral anteversion. An anteroposterior pelvic radiograph reveals coxa valga and a right dysplastic acetabulum with a Reimer’s migration index of 80%. The surgeon plans a reconstructive procedure on the right hip. The most appropriate procedure would consist of an adductor tenotomy, a varus derotational osteotomy, and a
    • A. 

      Salter osteotomy

    • B. 

      Dega osteotomy

    • C. 

      Bernese periacetabular osteotomy

    • D. 

      Hip fusion

  • 12. 
    A 12-year-old male who is skeletally immature presents to the office with a swollen right knee after a football injury. The patient describes a valgus blow to his knee, and feeling a “pop.”  The patient was unable to continue sporting activity after his injury.  The patient has a positive Lachman’s test, a positive pivot shift test, and lateral joint line pain. Radiographs demonstrate a joint effusion but no fractures or dislocations. The parents should be counseled that not treating this injury can lead to:
    • A. 

      arthrofibrosis

    • B. 

      Increased rate of intra-articular damage

    • C. 

      Growth disturbance

    • D. 

      Return to a normal activity level

  • 13. 
    . A 2-month-old girl is diagnosed with left developmental hip dislocation with a positive Ortolani sign. She is initially treated in a Pavlik harness with the hips flexed to 100 degrees and hips allowed to fall into abduction. A repeat ultrasound taken after one month in the Pavlik harness reveals persistent hip subluxation. What is the most appropriate next step in treatment? 
    • A. 

      Tighten the flexion straps on the Pavlik

    • B. 

      Tighten the abduction straps on the Pavlik

    • C. 

      Continued Pavlik use and repeat ultrasound in another month

    • D. 

      Discontinue the Pavlik

  • 14. 
     A 2 month in a Pavlik harness is not extending her leg at one week follow-up. What is the etiology of this?
    • A. 

      Compression of femoral nerve

    • B. 

      Dislocated hip

    • C. 

      Subluxed hip

    • D. 

      This is normal

    • E. 

      Compression of sciatic nerve

  • 15. 
     A 36 month old patient presents with a unilateral dislocated hip. What is the next most appropriate step in management?
    • A. 

      Open reduction with femoral and pelvic osteotomies

    • B. 

      Closed reduction

    • C. 

      Pavlik harness

    • D. 

      Open reduction alone

  • 16. 
    A 2-year-old boy is examined for flat feet.  Examination reveals bilateral flat feet, with the left side affected more than the right.  The arch on his right foot is restored when he stands on his toes or is sitting. The left foot remains flat when standing on his toes or sitting.  AP, lateral, and plantar flexion lateral radiographs of the left foot are. Treatment of the left foot should consist of
    • A. 

      Triple arthrodesis

    • B. 

      Serial casting followed by application of a foot abduction orthosis

    • C. 

      A supramalleolar orthosis

    • D. 

      Serial casting followed by surgical correction of the midfoot and heel cord lengthening

    • E. 

      Talectomy

  • 17. 
    The parents of a 5-year-old boy report that he had a right clubfoot corrected using the Ponseti method shortly after birth. They now note that he has been walking on the outside of his foot. Examination reveals the forefoot and hindfoot are well corrected.  The ankle can be dorsiflexed 15°. When he walks, the foot supinates during swing phase and comes down on the lateral border during stance phase.  What is the preferred management of this patient? 
    • A. 

      Reverse last shoes

    • B. 

      Split posterior tibial tendon transfer

    • C. 

      Full-time use of the Denis-Browne bar for 3 months

    • D. 

      Anterior tibial tendon transfer to the lateral cuneiform

    • E. 

      Percutaneous heel cord tenotomy and plantar fasciotomy

  • 18. 
    At long-term follow-up (more than 25 years after the initial procedure), infants with clubfoot who were treated with extensive soft-tissue release demonstrate
    • A. 

      Joint stiffness only at the subtalar joint.

    • B. 

      Good long-term function if treated before age 1 year.

    • C. 

      Outcomes unrelated to the extent of the soft-tissue release.

    • D. 

      Muscle weakness primarily in the peroneal muscles

    • E. 

      Poor long-term foot function, with the degree of impairment related to the extent of the soft-tissue release.

  • 19. 
    Figure 40 shows the lateral radiograph of an 8-month –old infant’s foot taken in maximum dorsiflexion. What is the most likely diagnosis?
    • A. 

      Clubfoot

    • B. 

      Metatarsus abductus

    • C. 

      Congenital vertical talus

    • D. 

      Calcaneal valgus

    • E. 

      Cavovarus foot

  • 20. 
    The Ponseti method of clubfood treatment involves which of the following concepts?
    • A. 

      1. Short leg casts for 6 to 8 weeks, followed by percutaneous heel cord tenotomy

    • B. 

      2. Comprehensive posterior, medial, and lateral subtalar release performed at age 3 months

    • C. 

      3. Supination of the food during initial cast correction

    • D. 

      4. Abduction of the foot with counterpressure at the calcaneocuboid joint.

    • E. 

      5. Correction of equinus prior to correction of supination

  • 21. 
    A 9 yo girl reports the immediate onset of severe groin pain and the inability to walk after tripping on a curb. Exam reveals marked hip pain with PROM.  Regardless of treatment, what is the most common complication following this injury?
    • A. 

      Chondrolysis

    • B. 

      OCD of the femoral head

    • C. 

      AVN of the femoral head

    • D. 

      NonunionCoxa magna

  • 22. 
    A 2 yo child has refused to bear weight on his leg for the past 2 days. His parents report that he will crawl, has no fever, and has painless full ROM of his hip and knee. Exam reveals no deformity or bruising, but there is mild swelling and tenderness over the anterior tibia. CRP, CBC, ESR are normal. Radiographs are negative. What is the best course of action?
    • A. 

      Application of a long leg cast

    • B. 

      Aspiration of the tibial metaphysis

    • C. 

      Bone scan

    • D. 

      MRI

    • E. 

      Observation

  • 23. 
    A 4 yo child sustains a spiral fracture to the tibia in an unwitnessed fall. History reveals three other long bone fractures, each of which the parents are vague about the etiology. There is no family history of bone disease. The parents ask if the child has OI; however, there are no clinical or radiographic indications of this diagnosis. In addition to the acute fracture care, the next most appropriate management should be:
    • A. 

      Notification of child protective services and hospital admission

    • B. 

      A punch biopsy of skin for collagen analysis

    • C. 

      DNA testing for OI

    • D. 

      Ca, Phos, alk phos studies

    • E. 

      Placement of IM rods to prevent further fractures

  • 24. 
    An 8 yo boy sustains nondisplaced midshaft fractures of the tibia and fibula after being struck by a car while he was riding his bicycle. No other injuries are noted, the patient reports pain with passive motion of his toes and after immobilization he continues to have severe pain. His neurovascular exam is otherwise normal. What is the best course of action?
    • A. 

      Hospital admission with a referral to social services for evaluation for child neglect

    • B. 

      Long leg casting and follow up 7 days

    • C. 

      Short leg cast and re-evaluate in 24 hours

    • D. 

      Electrical studies of nerve function in 3 to 6 weeks if there is no improvement

    • E. 

      Compartment pressure monitoring with inpatient admission

  • 25. 
    A 6 yo 35kg boy sustains injuries to his head, abdomen, and left lower extremity after being struck by a truck. In the ED, his mental status deteriorates and he is intubated after assessment reveals a GCS of 3; the score subsequently improves to 10. A CT scan reveals a right parietal intracranial hemorrhage, and an abdominal ultrasound reveals free fluid. Prior to an emergency laparotomy, the swollen left thigh is evaluated. Radiographs reveal a transverse fracture of the mid-diaphysis. He is stabilized and cleared for the operating room by the Trauma service.  Management of the fracture should consist of:
    • A. 

      Immediate application of a hip spica cast

    • B. 

      Insertion of a distal femoral traction pin and placement into 90-90 traction

    • C. 

      Closed reduction and stabilization using retrograde flexible IM nails

    • D. 

      Insertion of an antegrade piriformis start reamed IM nail

    • E. 

      Closed reduction and transcutaneous pin fixation supplemented by a long-leg cast

  • 26. 
    Figures below show the radiographs of a child with dwarfism.  The skeletal dysplasia is a result of a genetic defect in:
    • A. 

      Bone morphogenetic protein-2

    • B. 

      Bone morphogenetic protein-6

    • C. 

      Insulin-like growth factor

    • D. 

      Fibroblast growth factor receptor-3

    • E. 

      Indian hedgehog

  • 27. 
    This 8 yo boy has bilateral Trendelenburg limp and limited ROM of his hips but no pain. His work-up should include:
    • A. 

      A skeletal survey

    • B. 

      Genetic evaluation

    • C. 

      Cardiac evaluation

    • D. 

      Coagulation studies

    • E. 

      MRI of the hips

  • 28. 
    A 6-yr old girl has sustained numerous long bone fractures in the past.  Her parents report that there is no family history of any similar problems.  Examination reveals normal-appearing sclera and brownish opalescent teeth.  A radiograph of her lower extremities is shown below.  The patient’s disorder is the result of:
    • A. 

      Parental abuse

    • B. 

      Abnormal osteoclast function

    • C. 

      Vitamin D deficienc

    • D. 

      Defective N-Ac-Gal-6 sulfate sulfatase enzyme

    • E. 

      Qualitative defect of type I collagen synthesis

  • 29. 
    What long bones are affected with rhizomelic shortening?
    • A. 

      Facial bone

    • B. 

      Vertebral column

    • C. 

      Humerus & Femur

    • D. 

      Radius/Ulna & Tibia/Fibula

    • E. 

      Hands & Feet

  • 30. 
    What skeletal dysplasia is the finding of iliac horns a pathognomonic sign?
    • A. 

      Achondroplasia

    • B. 

      Diastrophic dysplasia

    • C. 

      Multiple epiphyseal dysplasia

    • D. 

      Nail-Patella Syndrome

    • E. 

      Down Syndrome

  • 31. 
    Figure 1 is the radiograph of a child who has pain in his left thigh. Extensive pigmentation with a jagged border is seen on the left trunk. This child is at risk for? 
    • A. 

      Patellar instability and nail abnormalities

    • B. 

      Involvement of other bones and precocious puberty

    • C. 

      Cardiac abnormalities and hearing loss

    • D. 

      Syndactyly and fibular hypoplasia

  • 32. 
    What gene is implicated in spinal muscular atrophy? 
    • A. 

      Survival motor neuron I (SMN-I)

    • B. 

      Peripheral myelin protein 22 (PMP22)

    • C. 

      Dystrophin

    • D. 

      Androgen receptor

  • 33. 
    Figure 36 is the sitting radiograph of a 123- year old boy with Duchenne muscular dystrophy who has a 38-degree scoliosis and pulmonary function test showing a forced vital capacity of 50% of the predicted percentage. His cardiac status is stable. When is the best time to perform spinal fusion surgery? 
    • A. 

      When his purlmonary function test decline to 35% of predicted value

    • B. 

      When his cardiac status start to decline

    • C. 

      When his scoliosis reached 50 degrees

    • D. 

      As soon as possible

  • 34. 
    A 3- year old girl was evaluated for toe walking. Her history for prematurity with know intracranial hemorrhage. Her recent neurologic workup included a brain MRI scan showing periventricular leukomalacia. She walked at age 2. Gait examination revealed a crouched gait on tiptoe with knees and hips flexed. Passive range-of-motion testing revealed hip flexion contracture of 5 degrees on popliteal angle testing, and ankles dorsiflex to neutral in knee extension and 15 degrees above neutral in knee flexion. Initial treatment should consist of. 
    • A. 

      Percutaneous Achilles lengthening

    • B. 

      Open Achilles tendon lengthening

    • C. 

      Ankle bracing and therapy

    • D. 

      Steroid therapy

  • 35. 
    Children develop hand dominancy by approximately what age?
    • A. 

      6 months to 9 months

    • B. 

      12 months to 18 months

    • C. 

      2 years to 3 years

    • D. 

      4 years to 5 years