History and examination of the child

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QUESTION 1 OF 15

A 9 years old boy is brought to the paediatric orthopaedics clinic for clinical evaluation of tip toe walking.
Which of the following is NOT part of your assessment.

QUESTION ID: 1248

1. Examination of calf muscles looking for calf pseudo-hypertrophy b) Examination of the feet for polydactyly
2. Examination of hip abduction and rotational range of movement
3. Examining the mobility of the calacneo-navicular joint
4. History regarding brain injury perinatally
5. History regarding developmental milestones and behavioural development
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QUESTION 2 OF 15

A young child attends the paediatric clinic complaining of one years history of knee pain. Radiographs are shown below(Figure 1)
Which of the following is correct  

Hussian 1png.png

Figure 1.Anteroposterior(AP) and lateral radiographs tibia

QUESTION ID: 1249

1. If the patient presents with an x ray showing a significant step in the metaphysis with the epiphysis filling the resulting gap then there is no benefit for bracing
2. If this patient is younger than 3 years then a proximal tibial osteotomy is the treatment of choice
3. The aim of corrective osteotomy is to achieve the expected the angle as per the salenius graph
4. The overall period of bracing is between 4 and 6 months
5. This patient is more likely to be a female patient who’s an early walker
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QUESTION 3 OF 15

A 1 year old male was brought to hospital with the x ray shown below, which of the following is correct

Hussian 2 png.png

Figure 1.AP radiograph femur 

QUESTION ID: 1287

1. As this is a transverse fracture which is longitudinally stable the recommended treatment is flexible intramedullary nails
2. At this age you can accept a degree of rotational deformity as it will remodel
3. Leg length discrepancy is not uncommon with shortening of the affected side the most likely outcome
4. The fracture morphology suggests that you should look for rib fractures and scapula fractures
5. This child is unlikely to have a genetic mutation affecting COL 1A genes
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QUESTION 4 OF 15

96.On clinical examination of this 10-year-old boy what feature is he most likely to have?

Answer B- Increased femoral anteversion.jpg

QUESTION ID: 2236

1. Generalised ligamentous laxity
2. Increased femoral anteversion
3. Increased genu valgum
4. Internal tibial torsion
5. Squinting patellae
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QUESTION 5 OF 15

125.An 11-year-old with GMFCS I cerebral palsy presents with a right stiff knee gait failing to achieve adequate flexion.
Which test manoeuvre is best to assess the relevant muscle group tightness:

QUESTION ID: 2250

1. Patient is prone and the knee is gradually flexed and the elevation of the hemipelvis with knee flexion
2. Patient is prone, the knee is flexed and the hip is hyperextended. The Knee is then gradually extended and the movement of the ipsilateral hemipelvis is monitored.
3. Patient supine and hip flexed to 90 degrees, and knee extended and the angle between a vertical line and the tibia is measur
4. The patient is on the left lateral decubitus with the right side up, the knee is flexed, the hip is flexed to 90 and abducted and extended and then allowed to adduct. The angle between the thigh and the table is measur
5. The patient is supine, the hip is flexed to 45 degrees similar to hip flexion in normal gait, and the knee extended and the angle between a vertical line and the tibia is measured
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QUESTION 6 OF 15

127.A child is born with a rocker-bottom deformity of the right foot with a prominent talar head medially.
Which of the following is the most appropriate?

QUESTION ID: 2252

1. An x ray is not useful in the early stages in guiding the treatment as the foot bones are not ossified yet and are difficult to visualise
2. Manipulation and serial casting are usually successful in treating the deformity
3. The patient should be assessed for packaging disorders especially DDH
4. The serial casting aims to achieve plantar flexion and eversion
5. The treatment is a combination of serial casting followed by surgery in the form of soft tissue releases and bony stabilization with K wires and it is imperative to undertake the intervention as early as possible
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QUESTION 7 OF 15

112.You see the following patient in your outpatient clinic. On further review, you note her right leg is bigger than the left(Figure 10). 
This condition is usually not associated with:

111.jpg

QUESTION ID: 3277

1. Clinodactyly.
2. Congenital trigger thumb.
3. Polydactyly.
4. Syndactyly.
5. Toe anomalies.
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QUESTION 8 OF 15

113.This is a clinical picture of a 12-year-old boy who complains of clumsiness and lateral foot pain(Figure 11).
This condition

BC 2 Small.jpeg

QUESTION ID: 3278

1. Is associated with an intact myelin nerve sheath but Wallerian axonal degeneration.
2. Is hereditary motor sensory neuropathy 2 (HMSN2).
3. Peroneus brevis is the driving force of the first ray plantarflexion.
4. The chromosome affected encodes peripheral myelin protein 22 (PMP22).
5. This is an autosomal recessive condition but can be associated with sporadic duplications of chromosome 17.
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QUESTION 9 OF 15

114. You see an 8-year-old boy in clinic who presents with asymmetrical scapulae and stiff neck(Figure 1).

BC 3.jpeg

QUESTION ID: 3279

1. It can be associated with Arnold-Chiari malformation, diastematomyelia and renal aplasia.
2. It is paramount to obtain a full spinal x-ray and MRI to rule out scoliosis and tethering of the cord distally.
3. The patient should abstain from contact sports if C2 is involved or if long fusions are present.
4. This condition can occur due to incarcerated, block or bony bar cervical spine vertebrae.
5. This condition is known as Klippel-Weber syndrome and is associated with a Sprengel deformity, as seen here.
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QUESTION 10 OF 15

115.You are asked to see a child in the ED with a painful, swollen sole of their foot.  They jumped on something sharp 5 days ago. They had socks and trainers on at the time.
Concerning the injury

QUESTION ID: 3280

1. I would expect the bacterial load from any infection to be less, given the protection offered by the socks and trainers.
2. I would have a low threshold to wash the wound out given the risk of pseudomonas.
3. If the injury occurred outside there is a risk of eikinella corrodens infection.
4. Start the patient on broad spectrum antibiotics and arrange OPC appointment for a week.
5. The infection could have been cause by an encapsulated, Gram-positive, strict anaerobic, Rod-shaped bacterium.
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QUESTION 11 OF 15

116.You attend the join genetics, paediatrics and orthopaedic specialist clinic.
You see a patient with rhizomelic dwarfism, lumbar stenosis and frontal bossing.  

 

QUESTION ID: 3281

1. It is caused by the absence of FGFR3 gene.
2. The abnormal mutation encodes for fibrin growth factor receptor 3 gene.
3. This disorder effects the proliferative zone of the physis.
4. This disorder effects the reserve zone of the physis.
5. This most common skeletal dysplasia is autosomal recessive but can be x-linked autosomal dominant.
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QUESTION 12 OF 15

115.You attend the join genetics, paediatrics and orthopaedic specialist clinic.
You see a patient with rhizomelic dwarfism, lumbar stenosis and frontal bossing.  

QUESTION ID: 3282

QUESTION 13 OF 15

129.If the hip movements in this child is normal what is the most likely diagnosis?

fibula.jpg

QUESTION ID: 3287

1. Congenital tibial pseudarthrosis.
2. Fibular hemimelia.
3. CTEV.
4. Proximal focal femoral deficiency.
5. Tibial dysplasia.
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QUESTION 14 OF 15

128. A 12-year-old girl presents with recurrent ankle sprains and a lateral view x ray shows a C sign looking at the hindfoot, which of the following is most appropriate:

QUESTION ID: 3288

1. A ball and socket ankle deformity can develop due to the mechanical impact of the underlying pathology.
2. MRI is the investigation of choice to look for ATFL and calcaneo-fibular ligaments.
3. Surgical intervention entails elevation of the extensor digitorum brevis to access the structures deep to it.
4. The choice of surgical treatment is significantly impacted by the Meary’s angle.
5. The choice of what surgical treatment is most appropriate is significantly impacted by the amount of movement in the talonavicular joint.
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QUESTION 15 OF 15

90.If the hip movements in this child is normal what is the most likely diagnosis?

fibula.jpg

QUESTION ID: 3317

1. Congenital tibial pseudarthrosis.
2. CTEV.
3. Fibular hemimelia.
4. Proximal focal femoral deficiency.
5. Tibial dysplasia.
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