Pediatric Orthopaedics Practice Questions

Q: Commonest deformity in Rickets is

Genu valgum. ***Genu valgum*** - **Genu valgum**, or **knock knees**, is very common in rickets due to the softening of bones. - The softened bones cannot bear weight properly, leading to bowing of the legs where the knees turn inward. *Genu recurvatum* - **Genu recurvatum (back-knee)** involves hyperextension of the knee joint. - While it can occur in some bone and joint disorders, it is not the most common or characteristic deformity of rickets. *Cubitus valgus* - **Cubitus valgus** refers to an increased carrying angle at the elbow, an deformity of the upper limb. - Rickets primarily affects weight-bearing bones and growth plates, leading to lower limb deformities more frequently. *Genu varum* - **Genu varum**, or **bowlegs**, is also a common deformity in rickets, but **genu valgum** is considered more prevalent in many populations. - It involves bowing of the legs outward, with the knees remaining apart when the ankles are touched together.

Q: Omovertebral bone is associated with?

Sprengel's deformity. ***Sprengel's deformity*** - An **omovertebral bone** is the most common associated skeletal anomaly with **Sprengel's deformity**, a congenital elevation of the scapula. - This fibrous, cartilaginous, or osseous bar connects the **superior medial border of the scapula** to the **cervical spine**. *Hemivertebra* - A **hemivertebra** is a congenital malformation where only half of a vertebral body develops, leading to a **wedge-shaped vertebra**. - While it can cause spinal deformities, it is **not directly associated** with an omovertebral bone. *Scoliosis* - **Scoliosis** is a lateral curvature of the spine, which can be congenital, neuromuscular, or idiopathic. - Although it can be secondary to or co-exist with other spinal anomalies, **scoliosis itself is not directly linked** to the presence of an omovertebral bone. *Cervical rib* - A **cervical rib** is a supernumerary rib arising from the seventh cervical vertebra, which can cause symptoms of **thoracic outlet syndrome**. - It is a distinct congenital anomaly and has **no direct association** with an omovertebral bone connecting the scapula to the spine.

Q: All of the following are described surgical procedures for CTE V except -

Salter's osteotomy. ***Salter's osteotomy*** - **Salter's osteotomy** is a procedure primarily used for treating **developmental dysplasia of the hip (DDH)**, aiming to redirect the acetabulum. - It is not a described surgical procedure for the correction of **congenital talipes equinovarus (CTEV)**. *Dwyer's osteotomy* - **Dwyer's osteotomy** is a surgical procedure performed on the **calcaneus** to correct **hindfoot varus**, typically seen in CTEV. - It involves removing a wedge of bone from the lateral aspect of the calcaneus. *Posteromedial soft tissue release* - This is a common and traditional surgical procedure for correcting severe **CTEV** by addressing the contracted soft tissues on the medial and posterior aspects of the foot. - It involves releasing structures such as the **tibial tendon**, **flexor digitorum longus**, **flexor hallucis longus**, and the **posterior ankle joint capsule**. *Triple Arthrodesis* - **Triple arthrodesis** is a salvage procedure that involves fusing three joints in the foot: the **talonavicular**, **calcaneocuboid**, and **subtalar** joints. - It is used in older children or adolescents with severe, rigid, or recurrent CTEV, often after failed conservative or primary surgical treatments.

Q: Spinal injury with no radiological finding is commonly seen in:

Children. ***Children*** - Spinal cord injury without radiographic abnormality (SCIWORA) is most common in children due to their inherent **ligamentous laxity**, underdeveloped facet joints, and more **elastic vertebral columns**. - The flexible spine can allow significant displacement that causes cord injury but then recoils, leaving no visible bony or ligamentous damage on imaging. *Older woman* - Older women are more prone to **osteoporotic fractures** and other structural spinal changes that would typically be visible on imaging. - While they can experience spinal cord injury, it is rarely classified as SCIWORA due to the presence of visible pathological findings. *In middle aged* - Middle-aged individuals tend to have more robust bony structures than children and are less prone to SCIWORA. - Spinal injuries in this age group are often associated with **disc herniation**, **fractures**, or **ligamentous tears** that are usually evident on imaging. *Older men* - Similar to older women, older men are more susceptible to age-related degenerative changes and trauma that result in visible damage on radiological scans. - SCIWORA is not a common presentation in older men, as their spinal columns are typically less elastic than those of children.

Q: What is the age of tendon transfer in post polio residual paralysis

>5 years. ***>5 years*** - Tendon transfer surgery is typically delayed until the child is **at least five years old** to ensure maximal spontaneous recovery has occurred and definitive muscle weakness patterns are established. - This age allows for better patient cooperation with **post-operative rehabilitation** and provides sufficient size for effective tendon grafting and fixation. *1 year* - This age is generally too early for tendon transfer, as it does not allow enough time for the **natural recovery process** from polio to conclude. - Performing surgery at this age risks unnecessary intervention if motor function might still spontaneously improve. *2 years* - While some recovery may have occurred, **two years** is still often considered premature for definitive tendon transfer in post-polio paralysis. - The child's growth and neuromuscular maturation are not yet complete, which could impact surgical outcomes and the ability to gauge permanent deficits. *<6 months* - This age is far too early for tendon transfer surgery in post-polio residual paralysis. - Infants require time for initial muscle recovery post-infection and for their skeletal and muscular systems to develop sufficiently for such a procedure.

Q: An 11 year old boy presented with the complaints of pain in the right arm near the shoulder. X-ray examination revealed an expansile lytic lesion in the upper third of humerus. The most likely diagnosis is

Unicameral bone cyst. ***Unicameral bone cyst*** - **Unicameral bone cysts (UBCs)** are common in children and typically present as **expansile lytic lesions** in the metaphysis of long bones, most frequently the **proximal humerus** or femur. - The patient's age (11 years old) and the **radiographic finding** of an expansile lytic lesion in the upper humerus are highly characteristic of a UBC, which often causes pain due to microfractures. *Osteochondroma* - **Osteochondromas** are **benign bone tumors** that appear as **bony outgrowths** or exostoses, usually arising from the metaphysis near the growth plate. - They are typically **pedunculated or sessile** and have a cortical and medullary continuity with the underlying bone, which is different from a lytic lesion. *Parosteal osteosarcoma* - **Parosteal osteosarcoma** is a **low-grade malignant bone tumor** that originates from the outer surface of the bone, rather than being purely intramedullary. - It usually presents as a **densely calcified mass** attached to the cortex of long bones and is more common in adolescents and young adults, but less likely to manifest as a purely lytic expansile lesion. *Giant cell tumor* - **Giant cell tumors (GCTs)** are typically found in the **epiphysis and metaphysis of long bones**, particularly around the knee, and are more common in adults (20-40 years old). - While they can be lytic and expansile, GCTs are **rare in pre-adolescents** like an 11-year-old boy and often demonstrate a characteristic "soap bubble" appearance on X-ray in older patients.

Q: Block vertebrae are seen in

Klippel-Feil syndrome. ***Klippel-Feil syndrome*** - **Block vertebrae** are a hallmark feature of **Klippel-Feil syndrome**, characterized by the **congenital fusion of two or more cervical vertebrae**. - This fusion results from a failure of normal segmentation of the cervical somites during early embryonic development. *Paget's disease* - Characterized by **disorganized bone remodeling**, leading to thickened, enlarged, and often deformed bones. - While it can affect the spine, it causes **osteosclerosis** and **vertebral expansion**, not congenital fusion or block vertebrae. *Leukemia* - A malignancy of white blood cells that can infiltrate bone marrow, leading to **osteopenia**, **lytic lesions**, or **osteosclerosis**. - It does not directly cause the congenital fusion of vertebrae or formation of block vertebrae. *TB* - **Tuberculosis (TB) of the spine**, also known as **Pott's disease**, causes **vertebral destruction**, **collapse**, and **kyphosis**. - Although it can lead to reactive bone formation, it is an infectious process that destroys and sometimes fuses vertebrae secondarily due to healing, not congenital block formation.

Q: All of the following are the classical presentation of Craniovertrebral junction anomalies except

Pupillary asymmetry. ***Pupillary asymmetry*** - While some neurological findings can be associated with craniovertebral junction anomalies, **pupillary asymmetry** is not considered a classical presentation. - It usually suggests pathology affecting the **oculomotor nerve** or **sympathetic/parasympathetic pathways** to the eye, which is less directly linked to the structural abnormalities at the craniovertebral junction itself. *Short neck* - A **short neck** is a common external dysmorphic feature associated with various craniovertebral junction anomalies, such as **Klippel-Feil syndrome**, due to vertebral fusion. - This anatomical alteration can limit neck mobility and is often an early indicator of underlying structural issues. *Low hairline* - A **low posterior hairline** is another frequent physical finding in patients with craniovertebral junction abnormalities, particularly in conditions involving cervical vertebral fusions or abnormalities. - It is a visible sign reflecting the altered anatomy and development of the neck and skull base. *Pyramidal signs* - **Pyramidal signs** (e.g., hyperreflexia, spasticity, positive Babinski sign) are crucial neurological indicators of **spinal cord compression** or dysfunction at the craniovertebral junction. - These signs result from compromise of the **corticospinal tracts** due to impingement, commonly seen in conditions like **Chiari malformations** or basilar invagination.

Q: Which of the following is least likely to be associated with progressive congenital scoliosis?

Wedge vertebra. ***Wedge vertebra*** - A **wedge vertebra** is a less severe form of vertebral anomaly compared to a hemivertebra, characterized by incomplete formation of the vertebral body on one side. - While it can cause scoliosis, it is significantly **less likely to progress** rapidly or severely compared to anomalies that involve complete lack of formation or fusion. *Hemivertebra* - A **hemivertebra** is a fully unsegmented vertebral body fused to one side of the adjacent segments, leading to a profound congenital deformity and a powerful growth plate on the opposite side. - This imbalance causes a **high likelihood of progression** in congenital scoliosis due to differential growth. *Unilateral unsegmented vertebra with bar* - This anomaly involves a **failure of segmentation** on one side of a vertebral body, creating a "bar" that inhibits growth on that side, while the other side grows normally. - The unrestricted growth on one side coupled with restricted growth on the other creates a significant imbalance, leading to a **high potential for progressive scoliosis**. *Block vertebra* - A **block vertebra** results from a complete failure of segmentation between two or more vertebral bodies along both sides. - While it causes a reduction in vertebral height and potentially some stiffness, it generally leads to **little or no progressive scoliosis** because the growth inhibition is symmetric and balanced on both sides of the spine.

Question 1

Commonest deformity in Rickets is

Accepted Answer

Genu valgum

Answer

Genu recurvatum

Answer

Cubitus valgus

Answer

Genu varum

Question 2

Omovertebral bone is associated with?

Accepted Answer

Sprengel's deformity

Answer

Hemivertebra

Answer

Scoliosis

Answer

Cervical rib

Question 3

All of the following statements regarding bone remodeling are TRUE EXCEPT

Accepted Answer

Injuries involving the epiphyseal plate are more likely to remodel successfully

Answer

young children have a greater capacity for remodeling than adults

Answer

Remodeling is related to the degree of angulation

Answer

angulation in the natural plane of the joint motion will remodel more successfully than angulation outside the plane of joint motion

Question 4

All of the following are described surgical procedures for CTE V except -

Accepted Answer

Salter's osteotomy

Answer

Dwyer's osteotomy

Answer

Posteromedial soft tissue release

Answer

Triple Arthrodesis

Question 5

Spinal injury with no radiological finding is commonly seen in:

Accepted Answer

Children

Answer

Older woman

Answer

In middle aged

Answer

Older men

Question 6

What is the age of tendon transfer in post polio residual paralysis

Accepted Answer

>5 years

Answer

1 year

Answer

2 years

Answer

<6 months

Question 7

An 11 year old boy presented with the complaints of pain in the right arm near the shoulder. X-ray examination revealed an expansile lytic lesion in the upper third of humerus. The most likely diagnosis is

Accepted Answer

Unicameral bone cyst

Answer

Osteochondroma

Answer

Parosteal osteosarcoma

Answer

Giant cell tumor

Question 8

Block vertebrae are seen in

Accepted Answer

Klippel-Feil syndrome

Answer

Pagets disease

Answer

Leukemia

Answer

TB

Question 9

All of the following are the classical presentation of Craniovertrebral junction anomalies except

Accepted Answer

Pupillary asymmetry

Answer

Short neck

Answer

Low hairline

Answer

Pyramidal signs

Question 10

Which of the following is least likely to be associated with progressive congenital scoliosis?

Accepted Answer

Wedge vertebra

Answer

Hemivertebra

Answer

Unilateral unsegmented vertebra with bar

Answer

Block vertebra

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

On this page

Practice by Chapter

Want unlimited practice?