Peds MCQ V2

  1. 20- 5 year-old kid with osteomyelitis of the tibia. Comes from community with high prevalence of MRSA. Best empiric antibiotic?

  2. 35- All are true except regarding congenital pseudarthrosis of the clavicle?

    B) edges of pseudoarthrosis are hyaline cartilage
  3. 37- What is a positive prognostic factor when doing a varus proximal femur osteotomy for containment in LCP?

    • A)
    • the question refers to indications for surgical intervention in LCP
  4. 52- Most common complication of resecting the radial head in congenital radial head dislocation in a skeletally immature patient?

  5. 79- What is true about growth modulation in adolescent Blount’s?


    Risk factors failure 

    • BMI >45 risk factor
    • Age >14 risk factor
  6. 85- All are true about PAO in adults with dysplasia, except?


    Others are true
  7. 86- All true about steroids in Duchenne, except?


    • Positive effects of steroids
    • Improves strenght
    • Slows down weakening
    • Prevents scoliosis
    • Prolongs ambulation
    • Delays deterioraton of pulmonary function
  8. 92- All true regarding neurofibromatosis EXCEPT?

  9. 94- Regarding C1-C2 instability in Down’s, all true except?

  10. 97- Which is best assessment for CP Hip?

  11. 103 – Question about tibial spine fractures in kids. All true except ?


    ACL laxity present 10-20% but not often clinically significant
  12. 109- 12-month old baby with tibial hemimelia, no tibia seen on xray, dysplastic distal femur, extensor mechanism not working. What is the next step?


    Indications for knee disarticulation and prosthetic fitting

    • -Complete absence of the tibia
    • -Absent extensor mechanism
  13. 111- Kid refusing to weight bear, ESR 50, WBC 14, Temp 37.8°. What is the probability of septic hip?


    • Criteria
    • WBC > 12000
    • Unable to weight bear
    • Fever > 38.5
    • ESR> 40


    • 0: 0.2%
    • 1: 3%
    • 2: 40%
    • 3: 93%
    • 4: 99%
  14. 114- Question about congenital vertical talus, what is true?
    a) Cast is an indicated treatment in both idiopathic and syndromic etiologies
    b) You should do staged release

    For stretching of dorsolateral soft tissues
  15. 120- All are seen in Marfan except?

  16. Pediatric gymnast presents with chronic activity related wrist pain. Which of the following would you expect to see


    Repeated impaction leads to damage to distal radius growth plate >>ulnar overgrowth +ve ulnar variance

    Xray finding: +ve ulnar variance and widened distal radius physis
  17. Best predictor for failure of distal BBFF


    Cast index needs to be <0.8
  18. Which congenital anomaly does not have C1-C2 instability? REPEAT


    Achondroplasia have foramen magnum stenosis + short pedicles

    Pseudoachondroplasia also has C1-2 instability
  19. What is a negative prognostic factor when doing a varus proximal femur osteotomy for containment in LCP? Which is not a surgical indication? 

    • E)  
    • if question is who would not benefit from VDRO
  20. Fishtail deformity what is false? (Repeat)


    Fishtail deformity is deepening of the intercondylar groove of distal humerus

    • A: usually seen with condyle fractures commonly but also possible in SCH#
    • B: True > Only middle of trochlea affected
    • D: False > not related o arthritis
  21. In assessing a patient with LLD and a concomitant knee flexion contracture, what is the optimal method to assess the true LLD?


    A: is apparent LLD
  22. Which of the following is true for patients with sickle cell?


    • Low oxygen tension causes sickling
    • c sounds true: diffeentiate using bone scan (abnormal in bone infarct)
    • They have more infections
    • Hemoglobin denatures with low PO2
  23. Which of the following is not a cause of congenital short metacarpal?  Repeat


    • A: short metacarpal in all hypopit situations
    • B: Acrosyndactyly is syndactyly with fenestration proximally to distal fusion site >>> characteristic of constriction ring syndrome
    • C: True
    • D: True due to bone infarct
  24. What is the last bone to ossify? REPEAT

  25. Patient is 11yo and 54 kg and he suffers a femur fracture. What is the optimal fixation method?

  26. What is the mechanism of action of botox REPEAT


    competitive inhibitor of presynaptic cholinergic receptors with a finite lifetime (usually lasts 2-3 months)
  27. What is true regarding paediatric scaphoid fractures? REPEAT

  28. In a patient with a pediatric brachial plexus injury, all of the following are true except: REPEAT


    Surgery at 3-6 months: nerve transfer
  29. Question on arthrogryposis findings, which is not true? REPEAT


    Not progressive
  30. All of the following are true regarding Gadolinium MRI of the spine except? (REPEAT 2010)

  31. What is a possible source of compartment syndrome when fixing pediatric tibial tubercle fractures?  REPEAT
    a) recurrent posterior tibial artery
    b) recurrent anterior tibial artery
  32. You have a patient with spondyloepiphyseal dysplasia who needs an operation, what is an important consideration preop?


    • SED Spine:
    • Atlantoxial instability
    • Kyphoscoliosis
    • Lumbar platyspondyly
    • Excessive lumbar lordosis
    • End plate irregularities
  33. All of the following are true about mucopolysaccaridosis except? (2013 CALGARY REPEAT)


    • Duchenne get pseudohypertophy
    • San filipo and Morquio most common
  34. Peak height velocity is seen with what finding REPEAT

  35. 122. Pediatric patient 3-4 weeks post Salter innominate osteotomy presents with 30° abduction contracture, what is the plan? REPEAT

  36. What is true regarding a paediatric/birth brachial plexus injury?


    • Horners: Lower plexus injury
    • Phrenic nerve palsy: Usually preganglionic
  37. A 16 month old healthy boy presents to your clinic with bowlegs. He ambulates appropriate for age, and is in the 60th percentile for his height and weight. You are shown an x-ray with varus knees, no abnormalities other than perhaps very slight beaking, metaphyseal-diaphyseal angle is measured and given to you at 12 degrees. What should you do?


    • MD angle: <9 no blounts
    • >16: blounts likely needing surgery
  38. Following SCFE fixation, which of the following may be associated with screw impingement on the acetabular rim?


    If startpoint lateral to IT line > unlikely to impinge
  39. Which of the following most closely correlates with peak growth velocity?

  40. What is true regarding unicameral (simple) bone cysts?


    A:methylprednisone superior to bone marrow
  41. All are true regarding Madelung’s deformity EXCEPT?


    Disruption is volar ulnar
  42. All true regarding neurofibromatosis EXCEPT?


    Inheritance is autosomal Dominant
  43. Regarding a Syme amputation, all are true EXCEPT?


    • shoe lift on contralateral side
    • Posterior heel pad migration: common but doesnt affect fct

    Requirement for syme: viable posterior flap and heel pad
  44. Regarding bisphosphonate use in the pediatric population, all are true EXCEPT?

    • D)
    • possible but more in Adults

    The rest are true
  45. All are true regarding tarsal coalitions EXCEPT?


    CT is best for assesing cross sectional size
  46. All are associated with radial clubhand EXCEPT?

    • A)
    • A: associated with TAR(thrombocytopenia absent radius)
    • B:Vacterl
    • C: Rasial longitudinal deficiency
    • D: wrong bc associated with elbow STIFFNESS
  47. All of the following are indicated in the management of a unilateral congenital knee dislocation in a newborn EXCEPT?


    • can do pavlik only once knee flexion improves
    • a: 70-100% dislocated hip
    • b: Initial mgmt
    • d: at age 6 months > open reduction + quad lenghtening
  48. When treating a patient with juvenile idiopathic oligoarthritis, after X-rays, what is the next step in evaluation

    • B)
    • > associated uveitis > poor prognosis

    Pre or: get flex ext + ask to open mouth to ensure TMJ not stiff for intubation
  49. 14 y.o. male with new onset cavus foot, and 1st mt in pronation- corrects with coleman block.  What to do now?

    • A)
    • 1st WT dorsiflexion osteotomy

    Flexible: soft tissue + getting rid of tripod

    d: soft tissue transfer are p longus > previs + Tib post to middle cuneiform
  50. What is best assessment of Peak Height Velocity? Repeat from other years!

  51. DIP closure hand: risser stage?
  52. Appearance of olecranon when triradiate closing
  53. Peak velocity at which risser stage
  54. All are true regarding NF and scoli except

    • A)
    • most are not dystrophic
  55. Which of the following don’t you do in a kid with S2 to S4 Myelomeningocele?

    • A)
    • never do redirectional osteotomy in Neuromuscular cases
  56. Which is true of atraumatic sternoclavicular joint issues


    Freidrichs disease: aseptic necrosis sternal end of clavicle
  57. Atraumatic SC joint dislocation and uveitis: think
    Seronegative spondylarthritis
  58. Young guy with SC joint pain, acne and pustules on palms, what is it? Halifax: 28 year old man with insidious onset pain sternoclavicular pain and prominence. Also noted to have severe acne, pustular lesions on the palm of hands. The most likely diagnosis:

    • A)
    • this is the classic presentation
  59. Young kid with Type III supracondylar fx.  Reduced.  

  60. What is major concern when addressing brach plexus palsy? What should you try to help with first something like that was wording?


    In general should do PT to maintain ROm of all joints
  61. All of the following are false re: obstetrical brach plexus palsy, except? Which one is true regarding peds brachial plexus? Think this was repeat but worded diff?

    • A)
    • 90% resolve

    Most common erbs: C5-6
  62. All of the following osteotomies will cover the femoral head with articular (hyaline) cartilage, except?

  63. All of the following are true re: SCFE, EXCEPT?

  64. All of the following are risk factors for patellar dislocation, except?


    External tibial torsion is the one that is part of miserable malalignment
  65. Which portion of patella most commonly injures after patelar dislocation
    Medial articular facet
  66. List the order of the physis from metaphysis to epiphysis?  

  67. Picture of patient with FD of the Left Hip and whole femur was a Shepard crook deformity.

    What graft do you use to fix this problem?


    Autologous cancellous graft resorbed and replaced by FD

    Also use IM device for FD
  68. Downs syndrome all true except?


    Also have subaxial and occiput-c1 instability
  69. 2 indications to do c1-2 fusion in downs
    • Symptomatic: loss fine motor or change in motor milestones
    • ADI>10mm
  70. 2 y.o. infant idiopathic scoli- all of the following are true EXCEPT?

    D) RVAD > 20 likely to PROGRESS (80%)

    c: 75% regress
  71. Infantile scoli 2 indications for casting and bracing
    • Cobb< 25
    • RVAD <20
  72. Deformity pattern infantile scoli
    Left thoracic: 90%
  73. Which of the following dysplasia does not have C1 C2 instability.

  74. Kid with Downs.  What is most appropriate?


    from consensus
  75. Missed hip dislocation in kid.  You see him at 5 years old.  What you do?

  76. Which is best assessment for CP Hip?

  77. 4yo M with lateral condyle fracture non displaced what is your management?

  78. All muscles are transferred for elbow flexion in arthrogryposis except?


    Steinder flexorplasty: transfer muscles from medial epicondyle more proximally to increase elbow flexion

    Pec major done in conjunction with tendon allograft
  79. In a pediatic proximal humerus fracture, which of the following structure is most likely to be a block to reduction?

  80. 14 year-old girl with proximal humerus fracture. It is 60% translated and 45 degrees angulated. What is the best treatment option?

  81. 12 year old male with Duchenne’s presents with thoracolumbar curve of 35 degrees and pelvic obliquity of 15 degrees. His FEV is 55%. He is able to assist with transfer to and from his wheelchair. Which of the following should be included in his care?

  82. What is the Cobb at which you should do surgery on Duchenne’s patients? Why?
    • 20-30 degrees
    • preserve pulmonary function
  83. Last epiphysis to fuse in human body

  84. Pediatric patient with midshaft femoral fracture.  You plan to do retrograde femur elastic nailing. What % of the canal at the isthmus should you fill with your elastic nails?

  85. An 8 year-old girl presents to your clinic 4 months after a BBFF. Still complains of pain in her forearm. You are shown an xray with an atrophic nonunion. What is the most likely finding on physical exam?

    • C)
    • neurofibromatosis > Pseudoarthrosis
  86. 14 yo boy AIS post posterior spinal fusion and instrumentation.  All blood loss meticulously replaced by anesthetist intraop.  Has hemovac drains and Foley.  Oliguric in PACU and for 24 hours after despite IV at maintenance.  What is the cause for this?


    SIADH = high ADH > low urine output3
  87. Congenital hallux varus


    Caused by firm band like abductor hallucis
  88. 9 yo boy presents with hip pain and decreased abduction. His radiographs reveal Herring B LCP. Which option is best for long term outcome?


    • Since age >8
    • Indication is harring B or B/C age >8
  89. Worse prognosis for progression in congenital scoliosis? (note: unilateral hemi with contralateral bar was NOT an option)


    Tip 4 that lead to progression

    • unilateral bar + contralateral hemi
    • Unilateral Bar
    • Segemented Hemi
    • Unsegmented Hemi
  90. 2 year-old boy presents with thumb hypoplasia, no thenar muscles. The CMC and MCP joints unstable. What is the best treatment at this point?

  91. 4 associated syndromes with congenital thumb hypoplasia
    • TAR
    • VACTRL
    • Holt oram: atrial septal defect + absent radius
    • Fanconi anemia
  92. Thumb hypoplasia classification
    • 1: small thumb
    • 2: Thumb small + MCP unstable
    • 3: Abnormal IP and MCP joint with no motion + MCP stable
    • 3b: add CMC aplasia
    • 4: floating thumb
    • 5 no thumb
  93. Thumb hypoplasia mgmtn: Type 1 normal abd
    Type 1 bad abd
    Type 2
    Type 3 A
    Type 3b 
    Type 4
    • Observation
    • Release 1st webspace+ opposition tranfer + MCP fusion
    • Same as above
    • Same as above
    • Polliciztion
    • Same as above
  94. 8 year-old girl comes in complaining of heel pain with activities and at night, relieved by rest and NSAIDS. Investigation that will most likely reveal the etiology of this?


    osteoid osteoma

    Osteoblastoma > 2 cm
  95. After treating a pediatric patient with a SCFE with an in-situ pinning, which of following radiographic findings will concern you about the screw head impinging on the acetabular rim?


    should aim to have screw lateral to IT line
  96. What is a descriptive term for congenital vertical talus?


    Cubluxation is oblique talus
  97. All of the following have eye involvement, except?


    • Marfan has superior lens dislocation
    • NF lisch nodules
    • Homocystineuria: inferior lens dislocation
  98. All of the following are seen in NF-1, except?


    accoustic neuroma is NF2

    HTN from renal disease
  99. You see a 10 y.o. boy in clinic who present ten days after sustaining a SHII distal radius fracture.  The radiographs show 50° volar angulation and 5° decrease in radial inclination.  What do you do now?


    To not further disturb growth plate..key here is presenting after 10 days

    But it is not within the acceptable limits for conservative mgmt

    • >10yo
    • 20 degrees dorsal
  100. 6 year-old girl presents to your emergency department with a type III supracondylar fracture of the elbow. She has a cold, blue hand with no pulses. She is also unable to flex her thumb. You do your closed reduction and pinning in the operating room. When you seen her in the PACU, her hand is warm, pink, and has no pulse. She is still unable to flex her thumb. What is the best treatment at this point?


    because there was already a neuro deficit pre op
  101. All of the following are indications for surgical treatment of congenital Coxa Vara EXCEPT:


    A: normal HE (hillgenreiner-epiphyseal angle) angle is 25 treat if over 60

    B: wrong>angle less than 100
  102. All of the following are true with thumb in palm deformity in CP EXCEPT:


    • A: true > this is the cause of the problem
    • B: True weak EPL/EPB part of problem
    • c: usually MCP needs to be fused in treatment

    Deforming force in clasped thumb: FPL
  103. All of the following are associated with radial club-hand EXCEPT:


    usually have stiffness

    • A: holt oram
    • B: TAR
    • C: true
  104. 6 year old F 6/12 following low-energy trauma to forearm.  c/o ongoing dysfx.  XR shows abn radius w/ pseudarthrosis.  What would be associated clin findings?


    NF nd pseudoarthrosis
  105. Trigger Thumb.  What is false?


    congenital clasped hand is problem at MCP

    • trigger thumb is problem at IP
    • B: 25% bilateral
    • Caused by: Mimatch in size of A1 pulley and FPL
  106. NOtta nodule is
    Nodule on FPL in trigger thumb

    never remove it
  107. Recurrent clubfoot s/p Ponseti with a supination and in-toeing deformity


    If not flexible then need mid tarsal osteotomy
  108. CVT (old question)


    • Talus and calc equinus
    • HIndfoot in valgus
    • Tight EXTENSORS

    need tib post lenghtening
  109. Increased risk of AVN in pedatric femoral neck fracture


    • DELBET 1-2 worse
    • Older age worse
  110. Hemiepiphysiodesis/arthrodesis best for


    • A: usually done for hemivertebrae
    • b: best in children <5
    • C: correction usually <15 degrees
    • d: best in curve <40 degrees
  111. What is hemimetameric shift
    Contralateral hemivertebrae separated by one normal vertebrae
  112. What is false about serologic markers and pediatric acute hematogenous osteomyelitis?

  113. Normalized CRP after how long in acute osteo
    7 days
  114. ESR peak after infection
    3-5 days
  115. Contraindication for tendon transfer in athetoid CP (reason athetoid CP kids due poorly with tendon transfers)


    Athetoid cp: dyskinetic purposeless movements

    Astereognosis: inability to recognize objects by handling them

    Athetoid not associated with muscle weakness or poor hand sensation
  116. Calcaneonavicular coalition (Calcaneonavicular bar), best outcome with:


    CN usually interpose EDB or fat or bone wax
  117. All of the following can be causes of snapping hip in adolescents, EXCEPT:

  118. Test for tight IT band
  119. 3-week infant, comes in emergency room with swollen elbow not moving arm and fevers. What bug is most likely from aspiration?


    if in NICU then GBS
  120. What is the most common organism to cause septic arthritis in a 25 y.o. (young adult population)?


    • A if sexually active
    • C if sexually inactive
  121. What are the 3 most common organisms in a 3 y.o. to cause septic arthritis?

  122. Erb’s palsy position, all except:

  123. Pt. with spina bifida at L4 what is the foot position (Dalhousie has L4 myelomenigocele)?
    a) Equinus
    b) Cavus
    c) Calcaneus
    d) normal
    e) Varus
    f)  Valgus
    Answer B and E

    Strong Tib ant > cavovarus

    • L5 myelo gives calcaneovalgus deformity
    • L1-2: equinovarus
  124. What is true in the nonoperative treatment of clubfoot:

  125. A neonate presents shortly after birth with congenital knee dislocation. All the following are appropriate management EXCEPT:

  126. 15 y/o with anterior dislocation of his shoulder, post closed reduction, what is the highest risk (most common sequelae)?

  127. 15 y/o with proximal humerus fracture (through physis?) irreducible what is the primary block?

  128. SC# in ER with cold, pulseless, blue hand. Management:

  129. A patient with a sharp short segment 40 deg curve of the thoracic spine with rib penciling, has Lisch nodules and cafe-au-lait spots on his skin, which is correct


    Kyphosis is common in typ 2 dystrophic
  130. Young girl with hip pain, refusal to walk, cannot ROM (+++ pain), 38C, ESR and WBC up, next step:


    has 4 criteria
  131. Elbow ossification, last is which?

  132. Child with healed type 3 SC fracture. Cubitus varus all caused by, EXCEPT:


    Flexion injury causes vagus deformuty
  133. Kid, 4 yo, assessed for walking problem, intoes in gait, IR 70 and ER 30 bilateral, foot angle is 10 degrees ER, valgus knee of 8 deg, what is problem?


    >70 IR and <30 ER

    Thigh foot angle <10 internal
  134. Young kid with anterolateral bowing on exam, as well as scoliosis, what is problem? Ottawa: Child noted to have short leg with normal foot and ankle. Non-tender. Also noted to have scoliosis. Xray shows painless anterolateral bow. What is the most likely diagnosis?

    • D)
    • because of the associated scoliosis
  135. Some dude has Proteus syndrome, which will he have?

  136. 5 features of proteus syndrome
    • MAcrodactyly
    • Vertebral anomalies
    • Hyperostosis
    • Vascular malfomations
    • Abnormal adipose tissue distribution
  137. 26 month old kid with high femoral-tibia angle (Blounts), treatment? Ottawa: 26 mo old with metadiaphys angle of 19 degrees. Physes look normal, What is treatment?

    e)Intra-articular osteotomy

    indication for surgery

    • -Angle >16 and >3 y.o
    • -Failed conservative
    • -Satge V-VI: with bony bar
  138. 3 week old kid, Galleazzi normal, no LLD, Ortolani negative, Barlow positive, what to do?

  139. The best predictor of poor outcome following clubfoot surgery in the long term is which:


    problem with gastroc weakness and ankle rigidity(OA) in the long term
  140. SCIWORA in kids, is all except:


    most common in c spine

    50% delayed presentation
  141. Odontoid # in kids, all true EXCEPT:


    • A+B true
    • Low non union rate: treat with minerva brace or halo
  142. Ottawa: Another halo question that i can’t remember. 

  143. Kid with Bado 2 Monteggia, treatment:


    bado 2=posterior subluxation

    Bado 1: cast in flexion
  144. 10 year old girl sustains a Monteggia fracture with radial head dislocated posteriorly.  With regards to treatment, which of the following statements is true?


    bado 2 posterior displacement radial head
  145. CP hemiplegia with FCU to ECRB transfer, this will help how?


    • A: wrong
    • C: Improved gross motor function (grip strenght) if FCU to EDC transfer
    • d: hemiplegia not wheelchair bound
  146. Risk Factors for progession in Scoliosis are EXCEPT:


    Female is a risk factor for progression

    Thoracic curve higher risk to progress than lumbar
  147. Peak growth velocity occurs when what is going on?

  148. Kids with OI and are treated with bisphosphonates can expect all EXCEPT?

  149. congenital scoliosis, what is true?
    a) R>L curve
    b) associated with tetherd cord
  150. Kids C Spine, what is true about pseudosubluxation?


    Most common in C1-2: caused by hprizontal facet joints

    Pseudosubluxation will reduce in extension
  151. Amniotic band syndrome: associated with
    Olygohydramnios and packaging disorders
  152. A child with back pain and fever, x-ray shows decreased disc space and endplate erosion. Rx:

  153. What is true about isthmic spondylolisthesis?


    incidence is 5%

    Progress if dx before growth spur or >50% slip
  154. Congenital torticollis, what is true?


    • A: head tilted towards affected side not looks
    • c: 5-20% have ddh
    • d: Packaging disorder
  155. What is not associated with thoracic congenital scoliosis? Calgary: All of the following are associated w/ congenital thoracic scoliosis except:

  156. SC# on floor 6 hours after pinning, pulseless, painfull and full on compartment syndrome, next? UBC and Ottawa: Twelve hours after reducing a supracondylar fracture, child develops pain six hours ago, with mottling and coolness to the extremity.  Median nerve anaesthesia present.  Unable to move fingers and passive stretch is extremely painful.  What do you do?

  157. 13 yo with painful rigid pes planus. CT shows talocalcaneal coalition. What is a contraindication to bar resection?


    if>50% then fuse
  158. Surgeon resects the diseased fascia in palm of a Dupuytren’s contracture and at closure notices there is a gap that can’t be closed without significant tension on the skin.  What is the best method of treatment?


    if skin deficit need full thickness graft if not > fibrosis
  159. What happens in OCD of elbow (capitellum)?

  160. Treatment of CP kid all except:

  161. Scoliosis with curve from T6 to T11, 11 yo, no menses, 23 degrees, tx? UBC: 11-year old girl comes in with a 1.5 cm bump on the right, with a T6-11 right thoracic curve measuring 23 degrees.  After 4 months of physiotherapy the curve does not improve. What is your next step in management?
    a) Boston (TLSO)
    b) Milwaukee (CTLSO)
    c) Observe and follow up in 4 months
    d) PSF
    A or C

    Brace if >30 initial presentation or progression 5 degrees and greater than 20 degrees
  162. What is an indicator of progression of developmental coxa vara? McGill: Risk of Coxa Vara when you should operate is?
    a) Hilgenreiner-epiphyseal angle > 60
    b) Neck shaft angle <100
    c) Femoral head subluxation
    d) Age at presentation , 6 years of age
    A and B

    • indications are
    • HE >60
    • Neck shaft angle<110
  163. Proximal tibia fracture in kid in metaphysis, the expected angular deformity is which?


    Cozen deformity: tends to resolve spontaneously after 24 months
  164. Leukemia vs JRA, what will make you tell the difference?


    Severe pain out of proportion to swelling differentiates leukemia from JIA (from JAAOS article
  165. A 8-year-old girl with a SH 2 distal radius.  She presents 16 days of following her injury with 35° of dorsal angulation.  What is the best treatment? McGill: 11 yo with DR #, 2 weeks ago, now dorsally angulated and too much, what you do?


    do not attempt late reduction
  166. Open tibia in 16 yo, 10 cm wound, unable to recall last tetanus but thinks it was more than 10 years ago, what to do EXCEPT?

  167. Kid with shoe gets nail through it, no signs infection, no puss, management?


    need abx

    Ceftriaxone bc foot injury and high incidence of pseudomonas
  168. 3 yo kid 4 month s/p open reduction and innominate osteotomy (Salter), now 30 deg ABD contracture, do what now?

  169. When is it ok to lengthen the longer leg?

  170. Kid in trauma, got blood, needs fluid bolus, what is amount?


    • 20cc for fluid
    • 10cc for blood
    • 80cc/kg is circulating volume
  171. A 14 yo girl with proximal hum fracture that is 60% displaced and 45 angulated. What should be the management.

  172. What is the most common cause of a cavovarus foot in a pediatric patient.

  173. A 6 yo child presents 18-month post femur fracture. There is a 2 cm LLD. What do you tell the mother about the LLD?


    because already 18 months out

    Overgrowth in the first 1-2 years only
  174. What is the most common level for a dislocated hip in a pt with myelodysplasia.


    iliopsoas and adductors active + inactive abductors and extesnros

    at L4 quads can fct> household ambulator
  175. What volume of crystalloid fluid do you bolus in a paediatric trauma.

  176. A 3 year old with valgus post proximal tibial fracture present to your clinic 6 mths later with a healed # but a 15o valgus deformity.  What to tell his mother?


    cozen phenomema

    if >10 yo hen consider surgery of >15 degrees
  177. With regards to triplane fractures in children, EXCEPT?

  178. What is the order of elbow ossification centers:


  179. Which is LAST Ossification center to fuse in elbow?
    Medial epicondyle

  180. A kid steps on nail at cottage, what is your treatment.


    Since nail take pseudomonas covering ABx: 3rd gen cephalosporin
  181. Rib anomalies associated with congenital scoliosis?


    From jbjs article

    Anomalies not associated with size or rate of progreession
  182. With regards to medial epicondyle # all are true EXCEPT


    most are treated non operatively
  183. Reduction of high grade spondylolisthesis with a high slip angle is becoming popular. All are true except?

    • C)
    •   reduction increases neuro risk

    20% incidence L5 nerve root injury: transient
  184. A 3 yo presents with a 3 wk hx of back pain, fever and unable to ambulate. His CRP and WBC are elevated. You are consulted by his pediatrician. Radiographs reveal narrow disc space and endplate erosions. What should you do next?


    but really need blood cx first
  185. A patient suffers a supracondylar fracture, and is treated by closed reduced in flexion. That evening you are called to floor and the kid has cool bluish hand with forearm pain on passive stretch. After cast removal, what do you do?


    first step then fasciotomy
  186. A widely displaced suprcondylar Type III is treated in the OR with multiple attempts of closed reduction. The surgeon is unable to reduce the fracture, and during each reduction the hand goes white and has no pulse (which was present pre-op).  What is going on?
    a) Brachial artery spasm
    b) Brachial artery caught in the fracture site
  187. What is the most common cause of a flat top talus:


    caused by excessive dorsiflexion before correcting abduction
  188. Kid comes in with varus after supracondylar III, all except could cause it


    flexion gives valgus
  189. Pavlik harness in left DDH


    posterior strap control abduction: should be left loose if not its forcing abducion > AVN
  190. Risk of Contralateral SCFE in healthy 13 boy:

  191. 10 year old girl risser 0, with 27 curve and no menses:


    Brace if curve >25 and risser 0,1,2
  192. Predictor of bad prognosis in perthes (except):


    • Risk factors
    • Age
    • female
    • Decreased ROM
    • Lateral pillar
  193. 6 months post SCFE pinning, 12 yo pt's hip is still stiff, no IR and painful (fixation on X-ray is fine, no evidence of AVN):


    observe up to 2 years

    rule out AVN
  194. 24 year old with Monteggia type I, comminuted ulnar fracture, no radial head fracture, just dislocated, best treatment
    a) CR ulna, IM nail, CR radial headCR
    b) ulna and radial head, long arm cast
    c) ORIF ulnar, CR radial head
    d) ORIF radial head
    • C if ulna is lenght unstable
    • B if ulna is lenght stable
  195. AVN of radial head


    Symptoms 23 months after trauma
  196. Kid comes in with varus after supracondylar III, all except could cause it


    flexion is valgus
  197. 15 year old patient with flat femoral head and with smooth joint, short neck, greater troch above level of acetabulum. Abductor weakness with trendelenburg

  198. Most likely association with discitis in early grade school age kid


    • Children <3: limp or refusal to WB
    • Child 3-8: Vague back or abdo pain
    • >8: back pain
  199. OI iliac crest biopsy – all are true EXCEPT

  200. Brachial plexus injury in pediatric 9 month old kid followed for brachial plexus. Now you notice a deep anterior crease in proximal shoulder and decreased ER

  201. Torticollis in 4 month kid with frontal bossing, facial asymmetry, Tx (options for torticollis only – no mention about work-up for dysmorphism)

  202. 2 week old presents with elbow septic arthritis. What is bug?

  203. kid with a displaced supracondylar elbow fracture  NV intact pre-op but after you pin with cross pinning he develops ulnar palsy.  Your treatment consists of all of the following EXCEPT:

  204. kid 12 hours post pinning supracondylar elbow fracture with 6 hours of increasing pain and cool pale mottled hand with median parasthesia what to do:


    first step
  205. 2 months old baby initially at birth had subluxed hip on US with positive Barlow treated since birth with pavlik harness. Now at two months US shows persistent post lateral subluxation of hip what to do?

  206. 2 weeks old neonate with decreased motion of right arm. They tell you x-rays show a clavicle fracture with abundant callus and a spiral humeral fracture with no callus on the same side. What is most likely cause?

  207. Brachial plexus palsy questions -  prognostic sign
    Return of biceps at 3 months

    ALso worse if horner's present
  208. most common bug in septic arthritis  - kid ( about 5 year old)
    Staph aureus
  209. torticollis – which
    a) the head tilt  toward the affected side and head turn away
    b) the head tilt  toward the other side  and head turn towards

    casued by SCM contracture: head tilted same side but rotated to opposite side
  210. foot at birth that is dorsiflexed against the tibia but plantarflexes to 5 deg plantar to neutral. Dx:


    CVT: rigid, convex plantar surface, midfoot is DF and abducted on the hindfoot and cannot be PF (rocker-bottom or Persian slipper foot)

    Positional calaceovalgus: marked DF of foot with mild and flexible eversion of subtalar jt, tissues on dorsolateral aspects of foot are contacted and limited but rarely prevent PF and inversion.  Tx is physio, generally resolves on it’s own

    Tibial Hemimelia: equinovarus-supinated foot

    Fibular Hemimelia: valgus foot, anterior bowing of the tibia with a dimple over the apex and valgus of the knee
  211. Grisel’s syndrome:  diagnostic test


    Grisel is: atlantoaxial rotatory subluxation casued by neck inflammation
  212. Question on how to place the graft in the Grice Bone block arthrodesis for CP equinovalgus foot (note don’t do this procedure on the exam)
    a) lay the graft in line with the foot
    b) vertically in the sinus tarsi
  213. 4 year old girl with LCP, Herring stage B. Clinically has decreased abduction. What is best tx?

    • C)
    • Age <8, Herring B or B/C – Maintain ROM, no Sx
    • Age >8, Herring B or B/C – Maintain ROM, Sx containment during fragmentation stage improves outcomes – pelvic osteotomy or shelf +/- femoral varus osteotomy (containment)

    Herring C – Sx does not improve outcomes, individualize salvage procedures after re-ossification (shelf, extension-valgus osteotomy for abduction hinge)
  214. 12 year old with knee pain after wiping out off his bike. You notice that he walks with ER gait. Knee x-rays normal. What is the best next investigation


    rule out SCFE
  215. Chondrolysis in SCFE in associated with all of these except one


    five factors associated with chondrolysis in SCFE

    • Unrecognized pin penetration
    • hip spica
    • Intertroch osteotomy
    • Advanced SCFE
    • African american
  216. Spina bifida – what is the highest level that gives hip dislocation

  217. Clavicle fracture in young patient – what makes you operate

  218. 4 year old girl with LCP, Herring stage B. Clinically has decreased abduction. What is best tx?

  219. Chondrolysis in SCFE in associated with all of these except one
    a) Repeated reduction attempts
    b) Hip spica cast
    c) Corrective osteotomies
    d) Caucasian race
    African American is risk factor
  220. JRA, all false except…


    Pauci articular: 4 or less joints involved 

    • most common joint: knee
    • MOst aggressive: seropositive (less common)
    • FOr seropositive hands and wrists most affected
  221. 8 month old brat with bilateral club feet. Treatment has consisted of Ponseti serial casting, perc Achilles tenotomy, post-tenotomy casting, Denis Brown bar. Comes back now with non-correctable recurrence of equines and varus. Why recurrence?

  222. Most common residual defect in clubfoot correction


    Secondary to overactive tub ant
  223. Position of calcaneus in vertical talus

  224. Medial condyle fracture – what is not a complication


    Overgrowth leads to cubitus valgus
  225. X-ray of adult foot showing rocker bottom foot with flat-top talus and 1st metatarsal varus. What is most likely cause of this presentation

  226. 15 yo male grade 2 spondylolisthesis failed physiotherapy and one year ongoing back pain only, no neurologic symptoms.  Rx:

  227. Rx of Undisplaced paediatric lateral condyle elbow fracture

  228. Elbow fishtail deformity cauded by
    AVN trochlea from Lat condyle
  229. Type 3 supracondylar # elbow with no pulse, but perfused hand. Which of the following is the most appropriate answer

  230. Osteomyelitis in kid. All of the following are TRUE, Except?


    • X ray findings(soft tissue by 48hrs
    • X ray bone change sonly at 5-7 days: periosteal formation
    • X ray osteolysis: 10-14 days: need 30-50% lysis
  231. repeat: most common cause of flat top talus in clubfoot
    Overly forcefull dorsiflexion of clubfoot
  232. Congenital vertical talus direction of navicular
    Displaced dorsally on talus: irreducible
  233. Duchenne’s, all the following are true except

  234. Duchennes: inheritance
    First affected
    • x linked recessive
    • CPK >5000
    • Absent dystrophin protein
    • Hip extensors: glut max
  235. Steroids in Duchenne’s (except)


    Also decrease scoliosis + delayed pulm complications
  236. Steindler flexorplasty, all the following are true except :


    • Used for brachial plexus (MSK nerve)
    • Procedure: proximal advancement (5 cm) of PT + FCR + PL + FDS + FCU >>>>more elbow flexion

    Leads to pronation deformity
  237. 4 yo clubfoot recurrence, walking on lateral border of foot


    If flexible: Split tib ant transfer to cunneiform

    If rigid: Posteromedial release + lateral column shortening
  238. 6 yo child 18 months post femur fracture with 2 cm LLD, what do you tell the mom?

  239. 8 yo kid with midshaft tibia fracture?


    • only 5 degrees rotation acceptable
    • Overgroth usually 5 cm
  240. Thumb hypoplasia. Thenar muscle atrophy. Unstable MCP and CMC


    becasue of unstable mcp and CMC cannot fuse
  241. Child with Diastomatomyelia and calcaneous + cavus foot. Management include all the following except:


    no role for conservative mgmt

    DO not do plantar fascia release: only for cavovarus

    if >12 with calcaneocavus: triple arthrodesis
  242. Child with congenital Kyphosis with thoracic curve measuring 40 degrees:


    type 2 and 3 should be operated before the age of 5 and curve >50

    Type 1: worst prognosis
  243. 12 years old girl with progressive low back pain aggravated with sports. Now has severe pain. Most appropriate investigation:


    Start with x ray then move on to advanced imaging

    bone scan for spondy
  244. 0Child with CP has 40 degrees of elbow flexion contracture. Which of the following is not an appropriate treatment option:


    since contracture would want to release not advance flexor mass
  245. Picture of ball and socket ankle. Likely associated condition:
    Tarsal coalition most common

    Fibular hemimelia
  246. Picture of an adult AP and lateral foot shows navicular dislocated dorsally on talus. Patient has pes planus and complaining of pain. He describes as have undergone treatment for his condition as a child with serial casting and some surgery. Likely diagnosis:
    a) Vertical talus
    b) Talipes equinovarus

    because of the serial casting part
  247. CVT is associated with what?

  248. X-ray of flat-top talus, crappy lateral, with dorsal subluxation of navicular on talus. What is the most common cause of a flat top talus:


    because of the flat top talus
  249. ll are risk factors for progression in scoliosis, EXCEPT


    pencilling is for NF
  250. SCFE, All true except?


    age 10-16
  251. SCFE has limited internal & external rotation after fixation. What should you do now?


    Observation up to 2 years: femoral neck can remodel
  252. Achondroplasia - EXCEPT


    Autosomal dominant
  253. Forearm Xray given of child, with nonunion seen diaphysis. Rx conservatively with marked pseudoarthrosis developed after 6 months

  254. Xray of ball and socket ankle What is associated?
    a) Tarsal coalition
    b) Marfan’s
  255. Child abuse EXCEPT


    different stages of healing is key
  256. Repeat Perthes question what is NOT prognostic/ involved:

  257. Sprengel’s deformity, you would do a woodward procedure, which is true


    clavicular osteotomy to prevent plexus issues

    Woodward: omovertebral bone/fibrous tissue resection  + transfer of trap, rhomboids inferiorly to help pull down scapula
  258. Congenital kyphosis


    Operate after 5

    type 1 worse
  259. X-ray repeat showing isthmic spondy

  260. Described dystrophic curve Neurofibromatosis Scoliosis. What’s different from adolescent idiopathic
    Increased rate of pseudoarthrosis
  261. 26 yr-old with foot pain.  History of some childhood foot deformity treated with serial casting and minor surgical procedure.  You are given an X-ray showing a flat-topped talus with dorsal subluxation of the navicular on the talus.  tilted down with the navicular subluxed superiorly on it.  What was this guy’s foot deformity?

  262. Spastic hemi CP kid what don’t you do


    stendler is proximal advancement of flexor mass
  263. Child with hemiplegic CP and intrinsic tightness.  What would be the deformity positions?

  264. 12 y.o. Female with bilateral camptodactyly of 25 degrees.  What is most appropriate treatment?


    It is congenital flexion at PIP of small finger

    SPlinting is treatment if <30 degrees
  265. 7 y.o. male undergoing surgery for a shoulder dislocation associated with an obstetrical brachial plexus palsy.  What is the most appropriate surgery for this patient?


    Since older kid there is already problems with glwnoid morphology so need to correct humerus version to maintain joint reduced

    If young can do open reduction and capsulorraphy
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