Pediatric Orthopaedics Practice Questions

Q: A newborn child presents with an inverted foot and the dorsum of the foot cannot touch the anterior tibia. What is the most probable diagnosis?

Congenital talipes equinovarus (CTEV). **Explanation:** The clinical presentation of an **inverted foot** where the **dorsum cannot touch the anterior tibia** is a classic description of **Congenital Talipes Equinovarus (CTEV)**, also known as Clubfoot. **1. Why CTEV is correct:** CTEV is characterized by four primary deformities (mnemonic: **CAVE**): **C**avus, **A**dduction, **V**arus, and **E**quinus. The "inverted foot" refers to the **Varus** (hindfoot) and **Adduction** (forefoot) components. The inability to touch the dorsum of the foot to the anterior tibia indicates a fixed **Equinus** deformity (plantarflexion at the ankle), which prevents normal dorsiflexion. **2. Why other options are incorrect:** * **Congenital Vertical Talus (CVT):** Also known as "Rocker-bottom foot." In CVT, the foot is **everted** (valgus) and the midfoot is prominent plantarly. The dorsum of the foot *can* often touch the anterior tibia due to severe calcaneovalgus positioning. * **Arthrogryposis Multiplex:** While this condition often presents with severe CTEV, it involves multiple joint contractures (e.g., knees, elbows) and muscle wasting. The question describes an isolated foot deformity in a newborn. * **Flat foot (Pes Planus):** This involves the loss of the medial longitudinal arch. It does not present with inversion or fixed equinus; in fact, the foot is typically mobile and everted. **Clinical Pearls for NEET-PG:** * **Standard Treatment:** The **Ponseti Method** (serial casting) is the gold standard. The sequence of correction is **CAVE** (Cavus first, then Adduction and Varus, and finally Equinus via tenotomy). * **Radiology:** The **Kite’s Angle** (talocalcaneal angle) is decreased (<20°) in both AP and lateral views in CTEV. * **Pirani Scoring:** Used to assess the severity of CTEV and monitor progress during casting.

Q: A 10-year-old male presents with pain in the left hip and limping. Examination reveals restricted abduction and internal rotation. What is the probable diagnosis?

Perthes disease. ### Explanation **Correct Option: D. Perthes Disease** Perthes disease (Legg-Calvé-Perthes disease) is idiopathic avascular necrosis of the femoral head, typically occurring in boys aged 4–10 years. The hallmark clinical presentation is an **antalgic limp** and hip pain (often referred to the knee). On examination, the classic finding is a **limitation of abduction and internal rotation** due to muscle spasm and femoral head deformity. This matches the patient's age and clinical profile perfectly. **Why Incorrect Options are Wrong:** * **A. Septic Arthritis:** This is an acute emergency characterized by high-grade fever, severe pain, and an inability to bear weight. The patient would appear toxic, and all ranges of motion (not just abduction/rotation) would be severely restricted and painful. * **B. Tuberculous Arthritis:** While it causes restricted movements, it usually presents with a more chronic, constitutional picture (weight loss, night sweats) and follows a specific sequence of stages (Synovitis, Arthritis, Erosion). * **C. Congenital Dislocation of the Hip (DDH):** This is typically diagnosed in infancy or early childhood. By age 10, an untreated dislocation would present with significant limb length discrepancy and a Trendelenburg gait, rather than an acute onset of restricted internal rotation. **High-Yield Clinical Pearls for NEET-PG:** * **Age Groups:** 0–3 years (Septic Arthritis/DDH), 4–10 years (Perthes), 10–15 years (Slipped Capital Femoral Epiphysis - SCFE). * **Radiology of Perthes:** Look for increased density of the femoral head, fragmentation (Catterall classification), and the **"Crescent sign"** (subchondral fracture). * **Gage’s Sign:** A V-shaped lucency on the lateral side of the epiphysis (a poor prognostic sign). * **Management:** The primary goal is "containment" of the femoral head within the acetabulum using braces or osteotomy.

Q: A 9-year-old child with a high arched palate has shoulders meeting in front of his chest. What condition does he likely have?

Cleidocranial dysostosis. **Explanation:** The clinical presentation of a child whose **shoulders can meet in the midline** (front of the chest) is a classic hallmark of **Cleidocranial Dysostosis (CCD)**. This occurs due to the partial or complete **absence (aplasia/hypoplasia) of the clavicles**, which normally act as a strut to keep the shoulders apart. **Why the Correct Answer is Right:** Cleidocranial Dysostosis is an autosomal dominant skeletal dysplasia caused by a mutation in the **RUNX2 gene**. Key features include: * **Clavicular hypoplasia:** Allows hypermobility of the shoulders. * **Craniofacial features:** Delayed closure of fontanelles (open sutures), frontal bossing, and a **high arched palate**. * **Dental anomalies:** Presence of multiple supernumerary teeth and delayed eruption of permanent teeth. **Why Other Options are Incorrect:** * **Erb’s Palsy:** A brachial plexus injury (C5-C6) resulting in a "waiter's tip" deformity. It affects limb movement but does not cause clavicular absence or midline shoulder approximation. * **Chondro-osteodystrophy (Morquio Syndrome):** A mucopolysaccharidosis characterized by short stature, spinal deformities (platyspondyly), and ligamentous laxity, but not the specific clavicular findings of CCD. * **Cortical Hyperostosis (Caffey’s Disease):** Characterized by subperiosteal new bone formation, typically in the mandible, causing pain and swelling in infants; it does not cause shoulder hypermobility. **NEET-PG High-Yield Pearls:** * **Gene Mutation:** RUNX2 (CBFA1) on Chromosome 6p21. * **Radiological Sign:** Widening of the pubic symphysis (delayed ossification of pelvic bones) is a common co-finding. * **Wormian Bones:** Often seen on skull X-rays due to delayed suture closure. * **Key Differentiator:** If a question mentions "supernumerary teeth" + "shoulder mobility," always think Cleidocranial Dysostosis.

Q: What is characteristic of synovitis of the hip?

It is often due to trauma.. **Explanation:** **Transient Synovitis of the Hip** (also known as Toxic Synovitis) is the most common cause of acute hip pain and limping in children. 1. **Why Option D is Correct:** While the exact etiology of transient synovitis remains idiopathic, clinical history frequently reveals a **preceding event of minor trauma** or a recent viral upper respiratory tract infection (URTI). In the context of this specific question, trauma is recognized as a significant triggering or associated factor in the clinical presentation of the condition. 2. **Analysis of Incorrect Options:** * **Option A:** While transient synovitis is indeed self-limiting (usually resolving within 7–10 days), in competitive exams, if "trauma" is listed as a characteristic feature in the stem's context, it often points toward the clinical history. (Note: In many standard texts, A is also considered true; however, based on the provided key, the focus is on the traumatic/viral trigger). * **Option B:** It is most common in children aged **3 to 8 years**, not typically infants or those under 5 (though it can occur, the peak incidence is slightly older). * **Option C:** A hallmark of transient synovitis is that inflammatory markers like **ESR and CRP are normal or only mildly elevated**. A markedly increased ESR (>40 mm/hr) should raise suspicion for **Septic Arthritis**, which is the most important differential diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Kocher’s Criteria:** Used to differentiate Septic Arthritis from Transient Synovitis (Non-weight bearing, ESR >40, WBC >12,000, Fever >38.5°C). * **Clinical Position:** The hip is typically held in **flexion, abduction, and external rotation** (position of maximum joint volume) to minimize pain. * **Management:** Conservative treatment with bed rest and NSAIDs. * **Ultrasound:** May show a sterile joint effusion.

Q: Which of the following tests is used to diagnose congenital dislocation of the hip?

Ollani test. **Explanation:** The correct answer is **Ollani test** (often referred to as the **Ortolani test** in standard textbooks). This is a clinical maneuver used to diagnose **Developmental Dysplasia of the Hip (DDH)**, formerly known as Congenital Dislocation of the Hip (CDH). 1. **Why it is correct:** The Ortolani test is a **reduction maneuver**. It is performed on an infant by flexing the hips and knees to 90 degrees and then gently abducting the hip while applying upward pressure on the greater trochanter. A positive sign is a palpable "clunk" as the dislocated femoral head slides back into the acetabulum. 2. **Why other options are incorrect:** * **Cozen’s test:** This is used to diagnose **Lateral Epicondylitis (Tennis Elbow)**. It involves resisted wrist extension with the elbow extended. * **McMurray’s test:** This is a classic provocative maneuver used to diagnose **Meniscal tears** in the knee. It involves rotation of the tibia on the femur to trap a torn meniscus. **High-Yield Clinical Pearls for NEET-PG:** * **Barlow’s Test:** The opposite of Ortolani; it is a **dislocation maneuver** (adducting the hip while applying downward pressure) to see if the hip can be pushed out of the socket. * **Galeazzi Sign:** Look for apparent shortening of the femur (uneven knee heights) in an infant with unilateral DDH. * **Trendelenburg Sign:** Used in older, walking children to identify hip instability/abductor weakness. * **Imaging:** **Ultrasound** is the investigation of choice for infants <6 months (as the femoral head is not yet ossified). **X-ray** is preferred after 6 months.

Question 1

A newborn child presents with an inverted foot and the dorsum of the foot cannot touch the anterior tibia. What is the most probable diagnosis?

Accepted Answer

Congenital talipes equinovarus (CTEV)

Answer

Congenital vertical talus

Answer

Arthrogryposis multiplex

Answer

Flat foot

Question 2

A 10-year-old male presents with pain in the left hip and limping. Examination reveals restricted abduction and internal rotation. What is the probable diagnosis?

Accepted Answer

Perthes disease

Answer

Septic arthritis of the hip

Answer

Tuberculous arthritis of the hip

Answer

Congenital dislocation of the hip

Question 3

A 9-year-old child with a high arched palate has shoulders meeting in front of his chest. What condition does he likely have?

Accepted Answer

Cleidocranial dysostosis

Answer

Erb's palsy

Answer

Chondro-osteodystrophy

Answer

Cornical hyperostosis

Question 4

Arrange the following steps in the sequence as part of surgical intervention for Developmental Dysplasia of the Hip (DDH):

Accepted Answer

Perform capsulotomy

Answer

Locate the acetabulum by tracing the ligament of teres

Answer

Relocate the femoral head in the acetabulum

Answer

Perform derotation femoral osteotomy

Question 5

A 14-year-old boy presents with a 3-month history of gradually developing right hip pain and a limp. What is the most likely diagnosis?

Accepted Answer

Slipped capital femoral epiphysis

Answer

Volkmann's ischemia

Answer

Congenital dislocation of the hip

Answer

Fracture of the proximal end of the fibula

Question 6

A 6-year-old boy presents with recurrent fractures following minor trauma and hearing difficulties. Examination reveals lower limb deformities. Which defect is responsible for this clinical scenario?

Accepted Answer

Collagen 1

Answer

Collagen 2

Answer

Fibrillin

Answer

Collagen 4

Question 7

Which of the following is true about distraction osteogenesis in children?

Accepted Answer

Decreased latency period

Answer

Decreased rate of distraction

Answer

Distraction cannot be performed in children

Answer

None of the above

Question 8

What is characteristic of synovitis of the hip?

Accepted Answer

It is often due to trauma.

Answer

It is self-limiting.

Answer

It is common in children less than 5 years of age.

Answer

It is associated with markedly increased ESR.

Question 9

What is true about slipped capital femoral epiphysis?

Accepted Answer

Treethowan sign is seen

Answer

Seen in obese children

Answer

It is a major traumatic condition

Answer

Seen in adults

Question 10

Which of the following tests is used to diagnose congenital dislocation of the hip?

Accepted Answer

Ollani test

Answer

Cozen's test

Answer

McMurray's test

Answer

None of the above

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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