Pediatric Orthopaedics Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Pediatric Orthopaedics. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Pediatric Orthopaedics Indian Medical PG Question 1: What is the most common bone fractured in children?
- A. Fracture of the distal radius
- B. Fracture of the supracondylar humerus
- C. Fracture of the radius/ulna
- D. Fracture of the clavicle (Correct Answer)
Pediatric Orthopaedics Explanation: ***Fracture of the clavicle***
- The clavicle is the **most commonly fractured bone in children**, especially during falls onto an outstretched hand or direct trauma.
- Its subcutaneous location and an **S-shape** make it prone to injury.
*Fracture of the distal radius*
- While common, especially in older children or adolescents, **distal radius fractures** are not as frequent as clavicle fractures across all pediatric age groups.
- These fractures often result from a **fall onto an outstretched hand** (FOOSH).
*Fracture of the supracondylar humerus*
- **Supracondylar humerus fractures** are common in children, particularly between ages 5 and 7 years, usually due to falls.
- However, they are associated with more potential complications (like **nerve or vascular injury**) but are less common overall than clavicle fractures.
*Fracture of the radius/ulna*
- **Fractures of the midshaft radius and/or ulna** are common in children but often require more significant trauma compared to clavicle fractures.
- These often present as **greenstick or torus fractures** in younger children.
Pediatric Orthopaedics Indian Medical PG Question 2: A 6-year-old boy presents with a painful limp, tenderness in the femoral triangle, and some limitation of hip movements. The X-ray is normal. What is the next investigation?
- A. MRI (Correct Answer)
- B. CT scan
- C. Arthroscopy
- D. Bone scan
Pediatric Orthopaedics Explanation: ***MRI***
- An **MRI** is the most sensitive imaging modality for detecting early changes in bone marrow and soft tissues, such as **avascular necrosis of the femoral head** (Legg-Calvé-Perthes disease), which can present with a painful limp and normal initial X-rays.
- It can visualize bone edema, cartilage irregularities, and effusions that are not apparent on plain radiographs.
*CT scan*
- While useful for detailed bone anatomy, a **CT scan** exposes the child to significant **radiation** and is less effective than MRI for detecting early soft tissue and bone marrow changes in conditions like Perthes disease.
- It is often reserved for complex fracture assessments or when MRI is contraindicated.
*Arthroscopy*
- **Arthroscopy** is an **invasive surgical procedure** used for direct visualization, diagnosis, and treatment of joint problems.
- It is not a primary diagnostic investigation for a painful limp with a normal X-ray, as less invasive imaging like MRI should be performed first.
*Bone scan*
- A **bone scan** (scintigraphy) is sensitive for detecting increased **metabolic activity** in bone, such as in infections or tumors, but it is less specific than MRI for detailed anatomical changes in early Perthes disease.
- It involves radiation exposure and may not provide the detailed soft tissue information needed to differentiate various causes of a painful hip.
Pediatric Orthopaedics Indian Medical PG Question 3: A child presents with painful limp and restricted hip rotation. ESR and CRP are elevated. Initial plain radiograph is normal. What is the next best imaging study?
- A. CT Scan
- B. MRI with contrast (Correct Answer)
- C. Bone Scan
- D. Plain Radiograph
Pediatric Orthopaedics Explanation: ***MRI with contrast***
- An **MRI with contrast** is the most sensitive and specific imaging modality for detecting early changes in **osteomyelitis** or **septic arthritis**, which are serious conditions given the child's symptoms and elevated inflammatory markers.
- It can visualize soft tissue and bone marrow edema, joint effusions, and abscesses, guiding immediate treatment.
*CT Scan*
- While useful for bony detail, a CT scan is **less sensitive than MRI** for detecting early bone marrow changes or soft tissue inflammation in the hip joint.
- It also involves **radiation exposure**, which should be limited in children when other effective modalities are available.
*Bone Scan*
- A bone scan using **technetium-99m** is sensitive for detecting increased bone turnover, but it is **not specific for infection** and cannot differentiate between inflammatory processes, tumors, or fractures.
- It provides less anatomical detail compared to MRI, making precise localization of an infection more challenging.
*Plain Radiograph*
- Plain radiographs are typically the **initial imaging study** for orthopedic complaints but are often **normal in early stages** of septic arthritis or osteomyelitis.
- Significant radiographic changes, such as bone erosion or joint space widening, usually appear much later in the disease process.
Pediatric Orthopaedics Indian Medical PG Question 4: A 10-year-old boy presenting with cubitus varus deformity and a history of trauma 3 months prior, on clinical examination, has preserved the normal relationship of the three bony points of the elbow. What is the most probable diagnosis?
- A. Old unreduced elbow dislocation
- B. Malunited intercondylar fracture of the humerus
- C. Malunited supracondylar fracture of the humerus (Correct Answer)
- D. Non-union of lateral condylar fracture of the humerus
Pediatric Orthopaedics Explanation: ***Malunited supracondylar fracture of the humerus***
- A malunited **supracondylar fracture** is the most common cause of **cubitus varus** deformity, also known as gunstock deformity, in children, which results from the medial displacement and internal rotation of the distal fragment.
- The **normal relationship of the three bony points** (medial epicondyle, lateral epicondyle, and olecranon) is preserved because the fracture is usually extra-articular and the trochlea and capitellum maintain their normal relationship with the ulna and radius.
*Old unreduced elbow dislocation*
- An **elbow dislocation** would disrupt the normal anatomical relationship between the radius, ulna, and humerus, leading to an **abnormal relationship of the three bony points** of the elbow.
- While it can cause deformity, it typically presents with obvious joint incongruity and significant functional limitations that would be evident on examination.
*Malunited intercondylar fracture of the humerus*
- An **intercondylar fracture** involves the articular surface of the humerus, suggesting an intra-articular injury.
- Such a fracture, even if malunited, would likely disrupt the **normal alignment of the trochlea and capitellum** with the olecranon and radial head, thus altering the relationship of the three bony points.
*Non-union of lateral condylar fracture of the humerus*
- A **non-union of a lateral condylar fracture** can lead to progressive valgus deformity (cubitus valgus) or instability, not typically cubitus varus.
- While it affects the elbow joint, the primary issue is joint instability and changes in the carrying angle, not the varus deformity described with preserved bony point relationships.
Pediatric Orthopaedics Indian Medical PG Question 5: A 2-year- old boy presents with progressive clumsiness and difficulty walking. On physical examination, the child has
large calves. He has difficulty walking on his toes and has a waddling gait as shown. Which of the following is the most likely diagnosis?
- A. Myotonic dystrophy
- B. Facioscapulo humeral dystrophy
- C. Becker muscular dystrophy
- D. Duchenne muscular dystrophy (Correct Answer)
- E. Limb-girdle muscular dystrophy
Pediatric Orthopaedics Explanation: ***Duchenne muscular dystrophy***
- This X-linked recessive disorder is characterized by **progressive muscle weakness** and **atrophy**, typically presenting in early childhood with symptoms like **clumsiness, difficulty walking, and a waddling gait**.
- **Pseudohypertrophy of the calves**, due to fat and connective tissue infiltration, and walking on toes are classic signs, along with a **Gowers' sign** (using hands to push off the floor to stand).
*Myotonic dystrophy*
- This autosomal dominant disorder is frequently characterized by **myotonia** (delayed muscle relaxation), which is not described.
- Clinical features usually include **distal muscle weakness**, **facial weakness**, **cataracts**, and **cardiac conduction abnormalities**, and symptoms typically begin in adolescence or adulthood, though congenital forms exist with more severe weakness.
*Facioscapulohumeral dystrophy*
- This genetic disorder has a primary presentation involving weakness of the **facial muscles**, **shoulder girdle**, and **upper arm**, which is not the predominant symptom set.
- Onset is typically in adolescence or adulthood, with initial symptoms rarely affecting lower limb ambulation as severely in early childhood.
*Becker muscular dystrophy*
- While also an X-linked recessive disorder caused by a dystrophin gene mutation, **Becker muscular dystrophy** typically has a **later onset** and a **milder, slower progression** compared to Duchenne muscular dystrophy.
- Symptoms usually appear in adolescence or early adulthood, and patients often retain the ability to walk into adulthood, unlike the rapid progression seen in this 2-year-old.
*Limb-girdle muscular dystrophy*
- This heterogeneous group of disorders primarily affects **proximal muscles** of the pelvic and shoulder girdles.
- While it can present with proximal weakness, onset is typically **later in childhood or adolescence**, and **calf pseudohypertrophy** is less prominent than in Duchenne muscular dystrophy.
- The age of presentation (2 years) and classic features make Duchenne more likely.
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