Pediatric Orthopedics (CTEV, SCFE, Perthes, Congenital Anomalies) MCQs

Orthopedics · 50 free questions with answers & explanations.

1. A 12-year-old obese boy presents with a limp and pain referred to the ipsilateral knee. Hip examination shows painful restriction of internal rotation and obligatory external rotation on flexion. X-ray of the pelvis shows a Klein's line not passing through the femoral head. The diagnosis is:
2. A newborn's left foot is noted to be in equinus, varus, cavus, and forefoot adductus. The foot cannot be passively corrected to a neutral position. The most appropriate initial treatment is:
3. A 12-year-old obese boy presents with limp and referred knee pain for 2 months. Examination shows limited internal rotation of the right hip. X-ray pelvis shows posterior and medial displacement of the right femoral epiphysis relative to the metaphysis. In Slipped Capital Femoral Epiphysis (SCFE), the epiphysis is classified as 'unstable' when:
4. A 5-year-old boy is diagnosed with Perthes disease affecting 60% of the femoral head (Herring lateral pillar Grade C). According to current evidence-based treatment guidelines, what is the appropriate management?
5. In congenital talipes equinovarus (CTEV), the Pirani scoring system is used. The Ponseti method of serial casting corrects deformities in a specific sequence. What is the correct sequence of correction?
6. A newborn is found to have bilateral hip instability (positive Ortolani and Barlow tests) at birth. Ultrasound confirms developmental dysplasia of the hip (DDH) bilaterally in a 3-week-old infant. The first-line treatment is:
7. In Legg-Calvé-Perthes (LCP) disease, the Herring lateral pillar classification determines prognosis. Group C (lateral pillar collapse >50%) is managed by:
8. In Slipped Capital Femoral Epiphysis (SCFE), the 'ice cream falling off the cone' describes the relationship between:
9. In congenital talipes equinovarus (CTEV), the Pirani scoring system assesses hindfoot and midfoot contracture. The component that, if score = 1 (maximum), indicates the MOST severe hindfoot involvement is:
10. In Slipped Capital Femoral Epiphysis (SCFE), the slip occurs through which zone of the physis?
11. A 7-year-old boy with Legg-Calvé-Perthes disease has a lateral pillar classification Group B (50% lateral pillar height maintained). According to the current evidence-based treatment guidelines (Herring 2004 and update), the recommended treatment is:
12. In congenital talipes equinovarus (CTEV), the Pirani scoring system assesses which of the following parameters?
13. A newborn is noted to have bilateral hip dislocations. Ultrasound at 4 weeks of age shows a dislocatable hip with an alpha angle of 49° and a beta angle of 67°. According to Graf classification, this hip is:
14. A 13-year-old obese male with hypothyroidism presents with a 3-week history of left hip pain and a limp. Examination shows restricted internal rotation and obligatory external rotation on hip flexion. X-ray shows a posterior and inferior displacement of the left femoral epiphysis. What is the FIRST priority in management?
15. In Legg-Calvé-Perthes disease, the Catterall group III classification describes which extent of femoral head involvement?
16. A newborn is noted to have a right foot that is fixed in equinus, varus, and adduction with internal tibial torsion. Pirani scoring is 4.5/6. Which is the CURRENT first-line treatment method and what is the weekly casting protocol?
17. In Ponseti management of idiopathic clubfoot, after achieving adequate correction with serial casting, the Achilles tendon tenotomy is performed when dorsiflexion is less than which value in the corrected foot?
18. In slipped capital femoral epiphysis (SCFE), which classification system guides immediate operative urgency and determines prognosis by categorising slips based on the ability of the patient to bear weight?
19. In Herring's lateral pillar classification for Legg-Calvé-Perthes disease, a Group C designation indicates which finding and carries which implication?
20. In slipped capital femoral epiphysis (SCFE), the slippage occurs through which zone of the growth plate?
21. A 7-year-old boy is referred for Perthes disease. The Catterall classification of Perthes disease — in which group does involvement of the ENTIRE femoral head epiphysis fall?
22. In Congenital Talipes Equinovarus (CTEV), the Pirani scoring system assesses 6 clinical signs: 3 hindfoot and 3 midfoot signs. Which of the following is a MIDFOOT Pirani sign?
23. An 11-year-old obese boy complains of left hip and knee pain for 3 weeks. On examination, as he flexes the left hip, obligatory external rotation occurs. X-ray (frog-leg view) shows posteromedial displacement of the left femoral epiphysis. This is SCFE. The Southwick angle is 45°. How is this graded and what treatment is indicated?
24. In Legg–Calvé–Perthes disease, which prognostic classification assesses the lateral pillar of the femoral head on the AP radiograph during the fragmentation stage to predict outcome?
25. A newborn has a right foot with equinus, varus of the heel, adduction of the forefoot, and cavus deformity. This is CTEV. The Pirani scoring system allocates up to 3 points for hindfoot and 3 points for midfoot components. A Pirani score of 5 implies:
26. In developmental dysplasia of the hip (DDH), the Ortolani test demonstrates hip reduction — a 'clunk' as the dislocated femoral head re-enters the acetabulum. In which age group does this test become unreliable?
27. A 12-year-old obese boy presents with right hip pain and limp for 4 weeks. He walks with an antalgic gait, and internal rotation of the hip is restricted and painful. On 'log roll' testing, the hip automatically externally rotates. X-ray shows posterior and inferior displacement of the femoral epiphysis on the right. This is a slipped capital femoral epiphysis (SCFE). Which imaging view is MOST sensitive for detecting early SCFE?
28. In Perthes disease (Legg-Calvé-Perthes), the lateral pillar classification (Herring classification) is the most widely used prognostic system. Which lateral pillar group is associated with the WORST prognosis for femoral head shape at skeletal maturity?
29. In Legg-Calvé-Perthes disease, Herring lateral pillar classification is used to predict outcome. In which lateral pillar group does more than 50% lateral pillar height collapse predict a poor outcome with residual femoral head deformity at skeletal maturity?
30. A 12-year-old obese boy presents with right hip pain and limp. X-ray shows posterior-inferior displacement of the femoral epiphysis on the metaphysis. This is slipped capital femoral epiphysis (SCFE). The steel angle (epiphyseal-shaft angle) is 40°. This is classified as:
31. A 12-year-old obese boy presents with groin pain and a limp. Examination shows the affected leg lies in external rotation at rest and internal rotation is markedly restricted. X-ray shows a 'line of Klein' that does not transect the femoral head. What is the diagnosis and appropriate management?
32. In Perthes disease, the Herring lateral pillar classification is used to guide prognosis and treatment. What does lateral pillar group C indicate?
33. During the Ponseti treatment of congenital talipes equinovarus (CTEV), the most common component that CANNOT be corrected by casting alone and usually requires surgical release is:
34. A 12-year-old obese boy presents with right hip pain radiating to the knee and a limp for 3 weeks. On examination, when the hip is flexed, it also goes into external rotation and cannot be internally rotated. X-ray shows widening of the physis and posterior-inferior displacement of the capital epiphysis. The diagnosis is:
35. In Perthes disease, the Catterall Group IV classification indicates:
36. In congenital talipes equinovarus (CTEV, clubfoot), the Pirani score is used to guide treatment. In the Ponseti method, casting is continued until the Pirani score reaches what value before tenotomy is considered?
37. A 12-year-old obese boy presents with right groin pain and a limp. His right hip is externally rotated at rest, and internal rotation is painful and restricted. X-ray shows widening of the physis with posterior-inferior displacement of the femoral head on the frog-leg lateral view. The FIRST step in management is:
38. In Legg-Calve-Perthes disease, the Catterall Group III hip is characterized by:
39. The Pirani scoring system is used to:
40. A 13-year-old obese boy presents with left hip pain radiating to the knee, a limp, and limited internal rotation with obligate external rotation on hip flexion. X-ray shows posterior inferior displacement of the femoral epiphysis. This is SCFE. The most important immediate management is:
41. In the Ponseti method for clubfoot (CTEV) correction, casting is performed weekly. The sequence of correction follows the mnemonic CAVE. What does each letter represent and in which order are the deformities corrected?
42. An 11-year-old obese boy presents with right hip pain and limp for 2 weeks. On examination, passive internal rotation is restricted and pain is referred to the medial knee. Plain radiograph shows Klein's line not intersecting the femoral head epiphysis and a 'ice cream falling off the cone' appearance. The FIRST step in management is:
43. A 4-year-old boy is diagnosed with Legg-Calvé-Perthes (LCP) disease involving the entire femoral head (Catterall Group IV). According to the concept of 'containment', the surgical treatment that best reduces lateral extrusion of the femoral head is:
44. In Perthes disease, a 9-year-old boy has Herring lateral pillar Grade C involvement. According to the current evidence, which treatment is associated with better radiographic outcomes at skeletal maturity?
45. In slipped capital femoral epiphysis (SCFE), the Southwick slip angle is used to grade severity. An unstable SCFE is defined as:
46. A 12-year-old obese boy presents with right hip pain referred to the knee, with limited internal rotation on examination. Plain radiograph shows epiphyseal displacement with a positive Klein's line sign. Emergency surgical management consists of:
47. In Perthes disease, the severity of involvement determines prognosis. According to the lateral pillar classification (Herring), which class carries the worst prognosis and highest risk of femoral head deformity?
48. In Perthes disease (Legg-Calvé-Perthes), the Herring lateral pillar classification is used to prognosticate outcomes. A child aged 9 years with Herring group C (lateral pillar height <50% of the contralateral side at the fragmentation stage) has the worst prognosis. The primary treatment principle for this group is:
49. A 13-year-old obese boy complains of left groin pain radiating to the knee for 3 months; left hip X-ray (AP and frog-leg lateral) shows a posterior-inferior displacement of the left femoral epiphysis relative to the neck (SCFE). The right hip is currently asymptomatic. The most appropriate management approach is:
50. A 12-year-old obese boy presents with a 3-week history of right hip pain radiating to the knee and a limp. He is afebrile. On examination, right hip external rotation is noted with flexion, and passive internal rotation is restricted and painful. X-ray (AP and frog-leg lateral) shows posterior inferior displacement of the femoral head epiphysis. Loder classification of this injury is important. An 'unstable' SCFE is defined as: