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QUESTION 1 OF 3

The following 14-year child was brought in by his mum because he walks with both feet pointing inward (in-toeing) (Figure 1) .
Examine the clinical photograph carefully, the most likely cause of his in-toeing is:

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Figure 1.Clinical photograph gait 

QUESTION ID: 1300

1. Dynamic caused by biceps femoris muscle
2. Femoral torsion
3. Hallux varus
4. Metatarsus adductus
5. Tibial in-torsion

QUESTION 2 OF 3

Zoe is a 9-year-old girl whose parents noted a swelling behind her knee. She has no symptoms what so ever. She is fit and healthy otherwise. Her older sister died of lymphoma which presented with swellings in her neck, groin and behind the knees. Parents are worried this might be the same condition and requested a biopsy. MRI scan confirmed the cystic nature of the cyst but radiologist was reluctant to commit to whether it is benign or malignant.
The most appropriate next step is:

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QUESTION ID: 1302

1. Aspirate the cyst and send fluid for cytology
2. Excise the cyst and send for histopathology
3. Perform CT guided biopsy to rule our lymphoma
4. Reassure parents and arrange a follow up in 6 months
5. Refer for a haematologist with an interest in lymphoma

QUESTION 3 OF 3

Mo is a 4-year-old boy who is born with congenital pseudoarthrosis of the tibia and fibula. He was treated in a cast for nearly 4 months but did not unite. He has been in a brace for 3 years and his skin started breaking down from the pressure affect. He is fit and healthy child. He is very active and love playing football with his cousins. He often removes the brace when play football as it has become very comfortable. He was investigated for Neurofibromatosis and it was negative.

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The best option for this child is:

QUESTION ID: 1303

1. Advise parents to encourage him on different sport (swimming and cycling)
2. Change the brace for a well-padded carbon fibre brace
3. Intramedullary rod stabilisation is essential part of treatment
4. Open reduction and internal fixation using compression locking plate
5. The best results have been reported with circular frame and bone graft