ANSWERS of MCQs PUBLISHED on 12/9/2019 with the title 'PEDIATRIC MCQS: Orthopedic'

ANSWERS of MCQs PUBLISHED on 12/9/2019 with the title 'PEDIATRIC MCQS: Orthopedic'  

MCQ#01

Answer C

Metatarsus adductus is one of the most common causes of an intoeing gait and is typically diagnosed in infancy. It is fairly easily distinguished from clubfoot due to flexibility of the foot, as opposed to clubfoot, which cause a rigid deviation of the foot. DDH is found in 10% of patients with metatarsus adductus and diligence must be paid to evaluating for this abnormality. While clavicular fracture can be found in infancy and has an association with DDH, there is no known association with metatarsus adductus. Pes planus, or flat foot, is ubiquitous in infants, as arch development has not yet occurred. Myelomeningocele, while much rarer in the era of folic acid use prior to pregnancy, is still diagnosed peripartum, but is not related to the presence of metatarsus adductus.

MCQ#02

Answer B

Femoral ante-version is the most common cause of an in-toeing gait in children over the age of 4. It is due to excessive internal rotation at the level of the hip, causing the entire leg to be inwardly deviated. In internal tibial torsion, the internal deviation is at the level of the tibia and therefore the patella are noted to be straight on examination, as opposed to femoral anteversion, where they are internally rotated. Metatarsus adductus is a disorder of infants, causing inward deviation of the forefoot. Slipped capital femoral epiphysis is a cause of an out-toeing gait due to medial displacement of the cap of the femur. While fractures can cause a limp, they do not specifically lead to an intoeing gait.

MCQ#03

Answer C

Babies are born with the maximum amount of varus deformity of the knees. This angular deformity of the knee should improve over time and typically resolves by age 2. Patients whose genu varum persists after this age should be evaluated for other, less typical, cause of varus deformity, including rickets, skeletal dysplasias, or other metabolic bone diseases.

MCQ#04

Answer B

Genu valgus is normal between the ages of 3 and 8 and maximal between the ages of 4 and 6. As long as this patient’s valgus improves over time, there is no further intervention required and the parent can be reassured. If the patient has persistent valgus deformity into adolescence, then a workup for previous fracture or metabolic bone disease may be indicated. Neither orthotics nor physical therapy has been shown to be effective in expediting the resolution of genu valgus.

MCQ#05

Answer C

Developmental dysplasia of the hip is defined as an abnormal relationship between the femur and the acetabulum. Intrauterine conditions that place a strain on the hip and leg, such as breech presentation or oligohydramnios, predispose the fetus to DDH. Torticollis, or wryneck, can also be caused by this type of mechanism and children born with torticollis have a 14% to 20% incidence of DDH.

Patients with metatarsus adductus also have an increased risk of DDH due to the same mechanism; however, this mechanism is not associated with other causes of intoeing, such as tibial torsion or femoral ante-version. Teratologic hip

dislocations can be due to conditions such as arthrogryposis. DDH is not specifically associated with congenital scoliosis, which is due to mal-development of vertebral bodies, or branchial cleft disorders.