Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics Indian Medical PG Practice Questions and MCQs

Question 311: Charlie Chaplin gait is seen in?

A. DDH
B. Tibial torsion (Correct Answer)
C. Genu valgus
D. Congenital coxa vara

Explanation: ***Tibial torsion*** - **Tibial torsion** typically causes an out-toeing gait, where the feet are externally rotated, mimicking the classic Charlie Chaplin gait. - This condition involves a rotational deformity of the **tibial bone**, leading to an altered foot progression angle during walking. *DDH* - **Developmental dysplasia of the hip (DDH)** usually presents with a **Trendelenburg gait** if unilateral, or a waddling gait if bilateral, due to hip instability. - It involves abnormal development of the **hip joint**, leading to dislocation or subluxation, rather than an out-toeing pattern. *Genu valgus* - **Genu valgus** (knock-knees) causes the knees to touch or come very close together while the ankles remain apart. - This condition generally leads to an ungainly gait with the feet often wide apart to maintain balance, not an out-toeing characteristic. *Congenital coxa vara* - **Congenital coxa vara** is characterized by a decreased angle between the femoral neck and shaft, leading to a shortened leg and often a **Trendelenburg gait**. - It can result in a functionally shorter limb and a characteristic limp, but not typically the exaggerated out-toeing seen in Charlie Chaplin gait.

Question 312: Commonest deformity in Rickets is

A. Genu recurvatum
B. Cubitus valgus
C. Genu varum
D. Genu valgum (Correct Answer)

Explanation: ***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.

Question 313: Omovertebral bone is associated with?

A. Sprengel's deformity (Correct Answer)
B. Hemivertebra
C. Scoliosis
D. Cervical rib

Explanation: ***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.

Question 314: All of the following statements regarding bone remodeling are TRUE EXCEPT

A. young children have a greater capacity for remodeling than adults
B. Remodeling is related to the degree of angulation
C. angulation in the natural plane of the joint motion will remodel more successfully than angulation outside the plane of joint motion
D. Injuries involving the epiphyseal plate are more likely to remodel successfully (Correct Answer)

Explanation: ***Injuries involving the epiphyseal plate are more likely to remodel successfully*** - This statement is **FALSE**. Injuries involving the **epiphyseal plate** in children can disrupt normal growth and are **less likely to remodel successfully** compared to metaphyseal fractures, often leading to growth disturbances or angular deformities. - Damage to the growth plate interferes with the physiological process of bone elongation and shaping, making complete restoration of bone architecture via remodeling less probable. *young children have a greater capacity for remodeling than adults* - Young children have a **greater capacity for bone remodeling** due to their active growth plates and higher metabolic bone turnover rates. - This enhanced remodeling allows for significant correction of fracture deformities through growth. *Remodeling is related to the degree of angulation* - The success and extent of bone remodeling in fractures are **directly related to the degree of initial angulation**. Less severe angulation generally remodels more completely than severe angulation. - Significant angulation beyond certain limits may not fully remodel, potentially leading to persistent deformity. *angulation in the natural plane of the joint motion will remodel more successfully than angulation outside the plane of joint motion* - Fractures with **angulation in the plane of joint motion** (e.g., knee angulation in the sagittal plane) tend to remodel more effectively and functionally, as the forces through the joint continue to align the bone. - Angulation **outside the plane of joint motion** (e.g., varus/valgus deformity at the knee) imposes abnormal mechanical stresses and is less likely to remodel to a functional alignment.

Question 315: All of the following are described surgical procedures for CTE V except -

A. Dwyer's osteotomy
B. Salter's osteotomy (Correct Answer)
C. Posteromedial soft tissue release
D. Triple Arthrodesis

Explanation: ***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.

Question 316: Spinal injury with no radiological finding is commonly seen in:

A. Older woman
B. Children (Correct Answer)
C. In middle aged
D. Older men

Explanation: ***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.

Question 317: What is the age of tendon transfer in post polio residual paralysis

A. 1 year
B. 2 years
C. >5 years (Correct Answer)
D. <6 months

Explanation: ***>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.

Question 318: 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

A. Osteochondroma
B. Unicameral bone cyst (Correct Answer)
C. Parosteal osteosarcoma
D. Giant cell tumor

Explanation: ***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.

Question 319: Block vertebrae are seen in

A. Pagets disease
B. Leukemia
C. TB
D. Klippel-Feil syndrome (Correct Answer)

Explanation: ***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.

Question 320: All of the following are the classical presentation of Craniovertrebral junction anomalies except

A. Pupillary asymmetry (Correct Answer)
B. Short neck
C. Low hairline
D. Pyramidal signs

Explanation: ***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.

Practice by Chapter

Developmental Dysplasia of Hip

Practice Questions

Clubfoot

Practice Questions

Pediatric Fractures

Practice Questions

Growth Plate Injuries

Practice Questions

Legg-Calvé-Perthes Disease

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Slipped Capital Femoral Epiphysis

Practice Questions

Pediatric Spine Deformities

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Cerebral Palsy: Orthopaedic Aspects

Practice Questions

Neuromuscular Disorders in Children

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Pediatric Bone and Joint Infections

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Limb Length Discrepancies

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Orthopedic Manifestations of Genetic Disorders

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