Abstract
Children’s Orthopaedics II Structured SBA Questions
Children’s Orthopaedics II Structured SBA Questions
1. A surgeon is performing in-situ fixation of a slipped upper femoral epiphysis using an unthreaded device over the physis.
Which patient characteristic will benefit the most from the chosen fixation device?
2. An 8-year-old girl presents with pain and swelling in her right ankle. There is no history of trauma. There is a small palpable mass anterior to the medial malleolus. On examination, the patient had a firm to hard swelling on the anteromedial aspect of ankle, bony in consistency. Radiographs are shown in Figure 17.1. CT and MRI scans show a spur-like calcified lesion originating from talus head.
Figure 17.1 (a) Anteroposteior (AP) and (b) lateral radiographs right foot
Which of the following is the most appropriate course of management for this lesion?
3. You are reviewing a 9-year-old boy with left hip Perthes disease in the OPC. AP radiographs show a stage of final healing with an aspherical congruent hip, coxa magna and short femoral neck. He has not had surgical intervention. On counselling the parents regarding further review, you describe potential deformities that may require intervention.
Which of the following is the least likely anticipated surgery?
4. A 6-month-old boy is referred to you by a consultant paediatrician who saw the child for plagiocephaly but also noted he had a torticollis. When questioned, parents reported the presence of head tilt and rotation since birth. The child is otherwise healthy with normal milestones and has had normal delivery. There is a palpable neck mass on the side of the head tilt.
The least appropriate management at this stage would be which of the following?
5. You are undertaking open reduction of a Weiss type III fracture of lateral condyle in a 6-year-old boy. After incision of skin and dissection of subcutaneous tissue, you find there is a rent in the fascia and deeper tissue plane directly to the fracture site.
Below are the steps you can use safely to improve exposure and visualisation to help with fracture reduction, except which of the following?
6. An 11-year-old boy complains of pain in lateral left ankle and it gives way easily. He is otherwise healthy and plays football regularly. You determine that there is flattening of medial longitudinal arch of the foot. Heel is in valgus with limited range of motion. Forefoot is in abduction.
Plain standing foot x-rays are likely to show which of the following?
7. A 6-month-old girl presents with deformity of unilateral posteromedial bowing of the tibia.
Which of the following statements is correct?
8. A 9-year-old boy presents with a 2-day history of right knee pain and swelling. He also complains of pain and swelling in both ankles for the past week, which have now settled. He was healthy prior to these episodes. The parents report noticing a circular red, expanding rash behind the child’s knee after returning from camping 3 months ago, which resolved spontaneously. He is able to mobilise with aid and has fever of 38°C, WCC 11 000/mm3, ESR 40mm/h, CRP 10 mg/L.
What is the mainstay in diagnosis of this condition?
9. A 7-year-old child was admitted the previous day with septic arthritis of the ankle. He has had open washout using an anterolateral approach. Purulent fluid was drained from ankle joint. The child still has a low-grade fever and you ascertain there is a tender swelling on the lateral ankle. Ultrasound image of lateral ankle is shown below (Figure 17.2).
Figure 17.2 U/S ankle. FE – Fibula epiphysis, FM – Fibula metaphysis, SC – subcutaneous tissue
What is the most appropriate next course of action?
10. A health visitor noted left hip clicking in a female baby. She was born at term, cephalic presentation and no family history of developmental hip dysplasia. She is the first child and is now 3 months old. Her left hip ultrasound is shown in Figure 17.3.
Figure 17.3 US hip
What is the next appropriate step of management?
11. You are planning operative intervention for a 4-year-old girl with severe bilateral genu valgum. She is otherwise healthy, and the deformity is worsening.
In regard to treatment options for the deformity at this stage, which of the following techniques is not ideal?
12. A 7-year-old boy with spastic diplegia GMFCS II has been referred to you by the physiotherapist who is concerned about the child’s toe walking. Sagittal plane kinematics show increased hip and knee flexion throughout stance period with normal range of motion at the ankle.
Based on the scenario here, what is the best management for the child’s gait?
13. You are examining a 9-year-old girl with hemiplegic spastic cerebral palsy. She reports frequent tripping on the affected right side. On the right side, she has positive fixed Duncan-Ely test and you notice very little knee flexion during her swing phase.
In regard to her gait on the contralateral (unaffected) side, she is likely to have which compensatory mechanism?
14. A child is admitted with a femur shaft fracture. You are considering using Gallows traction to manage this injury.
Which of the following is a contraindication for your choice?
15. Surgeon A is treating non-operatively an idiopathic congenital clubfoot of a 4-week-old infant. The foot is manipulated by abducting the forefoot against thumb pressure at the lateral side of the foot near the calcaneocuboid joint and everting the calcaneus.
What will this method will result?
16. A neonatologist has referred a newborn male infant with lower limb deformity. He has been born term and healthy. The mother is still recovering from a postpartum haemorrhage. You examined the infant on the ward and found bilateral cavo varus posture of the feet. The midfoot has curved lateral border and moderate medial and posterior creases. Attempt to correct the posture reveals prominent lateral head of talus and ankle dorsiflexion to 90°.
Which of the following is the best information for the parents in regard to the posture?
17. A 9-year-old boy had closed reduction and crossed K-wire fixation of a supracondylar elbow fracture. During your morning round, he is found to have decreased sensation in the ipsilateral ring and little fingers and unable to abduct his fingers.
What is true of the injured nerve?
19. An 8-year-old boy has genu varum. Blood test shows normal calcium, elevated alkaline phosphatase and parathyroid hormone and decreased phosphate and 25(OH)D.
Other findings of the boy are likely to include which of the following?
20. You are assessing the torsional profile of a 10-year-old girl presenting with bilateral in-toeing.
A torsional profile includes all of the following components EXCEPT which?
21. An 18-month-old girl was brought by her parents to a new patient clinic having had a harness programme for her bilateral developmental hip dysplasia in their home country. They have recently migrated to this country and have no documentation of previous treatment. The AP pelvis x-ray shows both the midpoints of the superior margin of the ossified metaphysis to be at the Perkin’s line and inferior to the Hilgenreiner’s line. Acetabular indices are 20° bilaterally.
The most appropriate next course of action is which of the following?
Related posts:
Chapter 6 – Knee II Structured SBA
Chapter 7 – Foot and Ankle Structured SBA
Chapter 20 – Pathology I Structured SBA
Chapter 24 – Prosthetics and Orthotics Structured SBA
Chapter 26 – Clinical Environment, Evidence Management and Quality Improvement Structured SBA
Chapter 15 – Hand II Structured SBA
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
