Musculoskeletal Disorders
48. Which of the following factors most affects outcomes in patients with LCPD? a. Age of child b. Severity of pain and antalgic gait c. Family history of LCPD d. Bilateral involvement
A: Age, because younger children have more time to remodel compared with older children. Severity of pain, antalgic gait, family history, and bilateral involvement all have less impact on outcome than does age. Legg-Calvé-Perthes disease (LCPD) etiology is multifactorial and may be related to family history, environment, and or trauma
8. ANA seropositivity for antibodies: a. Is a valuable diagnostic marker for JIA b. Is not positive in any childhood diseases c. Is more commonly found in older boys d. Has 100% sensitivity and specificity
A: Antinuclear antibodies (ANA) consists of immunoglobulins directed against structures within the cell. It is found in various autoimmune diseases and even in children who do not have rheumatologic disorders. The presence of ANA is important in juvenile idiopathic arthritis (JIA) to assess the child's risk of developing uveitis (Reuter-Rice & Bolick, 2012, p. 695)
36. Signs and symptoms associated with Duchenne muscular dystrophy are: a. History of delayed developmental milestones b. Visual-motor disturbance, calf hypertrophy c. Delayed motor development, positive Ortolani maneuver d. History of "clumsiness," visual-motor disturbance
A: DMD is a progressive disorder that affects muscles in the lower extremities, chest wall, and heart. There are no visual abnormalities or hip dislocation involved in the disorder
27. Complications of SLE commonly include which of the following? a. Pericarditis, arthritis, nephritis b. Encephalitis, nephritis, pericarditis c. Nephritis, arthritis, rheumatic fever d. Nephritis, hemolytic anemia, contact dermatitis
A: Deposits of immune complexes trigger a generalized inflammatory response that can lead to tissue damage, such as vasculitis and ischemia, and numerous organ system abnormalities (commonly the heart and renal system). There is variety in both the presentation—acute life-threatening episodes or an indolent manner—and how it is manifested over time in an individual (Burns & Dunn, 2012, p. 523)
24. The most definitive feature or features for a diagnosis of "growing pains" includes: a. Exclusion of other causes of lower extremity pain b. Pain, swelling, erythema c. Loss of ambulation d. Decreased ROM
A: Growing pain is a diagnosis of exclusion for (usually intermittent) lower extremity pain. All diagnostic markers are normal
40. Growth in muscle length is related to growth in length of: a. Underlying bone b. Underlying ligament c. Underlying tendon d. Opposing muscle group
A: Growth in muscles is due to the range of motion the muscle is asked to perform as the underlying bone lengthens
7. A characteristic feature of polyarticular JIA disease is: a. The involvement of five or more inflamed joints b. Confinement to lower extremity joints, knees, and ankles c. Asymmetric involvement d. High, daily intermittent spiking fevers
A: JIA is the most common rheumatologic disease with an autoimmune basis and represents a group of conditions with onset of symptoms in children at or younger than 16 years that causes chronic inflammation of at least one synovial joint for 6 weeks or more (Burns & Dunn, 2012, p. 521)
15. In a diagnostic work-up and management plan for a child with osteomyelitis, which of the following is not accurate or recommended? a. Elevated ESR confirms diagnosis. b. Aspiration is usually indicated. c. Antibiotic treatment for identified pathogen 4 to 6 weeks is recommended. d. Surgery is recommended if abscess is present.
A: Laboratory investigations are helpful but lack specificity for osteomyelitis. Leukocytosis and increased erythrocyte sedimentation rate and C-reactive protein levels may be present
51. You have been treating a 14-month-old for torticollis since birth. The condition has not resolved and the child still has limited neck rotation. The appropriate management plan would be to: a. Refer for surgical consultation b. Continue with passive range of motion c. Provide environmental stimulation opposite the contracture d. Apply cervical collar at night
A: Most torticollis resolves by 1 year of age. When there is no response to more conservative treatment interventions such as passive stretching and environmental stimulation, resulting in limited neck range of motion and facial asymmetry, surgery may be the recommended course of action.
54. A 3-year-old presents with a history of fever for the past several days, pain in his left leg, and refusal to bear weight on the left leg. Ten days ago, he fell from a slide and bruised his leg. His WBC count is slightly elevated. You suspect either toxic synovitis or osteomyelitis. Which finding supports a diagnosis of osteomyelitis more so than toxic synovitis? a. Recent injury b. Leg pain c. Non-weight-bearing d. Elevated WBCs
A: Osteomyelitis is frequently associated with local trauma, whereas toxic synovitis is more commonly associated with a recent upper respiratory illness. The elevated WBCs, fever, and refusal to bear weight can occur in either osteomyelitis or transient (toxic) synovitis.
38. Sports injuries are commonly associated with: a. Improper training b. Higher frequency in females c. Scoliosis d. Low socioeconomic status
A: Poor body mechanics are a common cause of sports injuries that can be lessened by proper training. Sports injuries are more commonly found in males in sports such as football, soccer, and wrestling. Not affected by socioeconomic status or preexisting conditions such as scoliosis
23. Initial treatment of a grade I sprain includes which of the following? a. Rest, ice, compression, elevation, and NSAIDs b. Heat, ROM exercise, compression, elevation, and NSAIDs c. Rest, heat, compression, elevation, and NSAIDs d. Rest, ice, ibuprofen, compression, and NSAIDs
A: Rest, ice, compression, elevation (RICE) for the injured part. Apply ice immediately for 15 to 20 minutes, and then, depending on the severity of the injury, every 2 to 6 hours for the first 24 to 48 hours. Give non-steroidal anti-inflammatory drugs (NSAIDs) with food. Initially, NSAIDs can be used for 7 to 10 days without affecting muscle healing. Grade II and III sprains should be referred to an orthopedic practitioner
25. Systemic-onset JIA is most commonly associated with: a. High, daily intermittent spiking fevers and rash b. Single joint involvement c. Positive RF factor and iridocyclitis d. Painless joint involvement
A: Systemic manifestations include fever, erythematous rashes, leukocytosis, serositis, lymphadenopathy, and rheumatoid nodules
6. A physical finding not usually associated with talipes equinovarus congenita is: a. Contracture of the iliotibial bands b. Deep crease on medial border of foot c. Atrophy of calf muscles d. Small foot with limited dorsiflexion
A: Talipes equinovarus has three elements: the ankle is in equinus (the foot is in a pointed-toe position), the sole of the foot is inverted as a result of hind foot varus or inversion deformity of the heel, and the forefoot has the convex shape of metatarsus adductus (MA) (forefoot adduction). The foot cannot be manually corrected to a neutral position with the heel down. Iliotibial bands are not involved with contracture of the foot (Burns & Dunn, 2012, p. 955)
31. In a newborn, a diagnosis of hip dislocation is suspected when: a. Positive Galeazzi, Barlow, and Ortolani signs b. Wide hip abduction that is symmetric c. Flaccidity of the left leg following extension of both legs with return to flexion d. Tonic neck reflex in which the left leg is flexed
A: The Galeazzi sign can signal conditions that cause leg length discrepancies, the Barlow maneuver dislocates an unstable or dislocatable hip posteriorly, and the Ortolani maneuver reduces a posteriorly dislocated hip. All three will be positive in a dislocatable hip
33. The parents of a 5-year-old recently diagnosed with muscular dystrophy want an explanation about the hereditary nature of the disease. The best explanation is: a. X-linked recessive gene transmitted by unaffected female carriers b. Recessive gene that is known to skip generations between transmission c. Dominant sex-linked gene predominantly in white families from Europe d. Recessive gene that requires both mother and father to be carriers
A: The X-linked dystrophies are the most common, with the most common dystrophy being Duchenne
34. Which of the following is true for idiopathic scoliosis, which occurs primarily in adolescents? a. Mild curves occur equally between the sexes. b. Generally, there is no family history. c. Back pain is usually associated with curves of 35 degrees or greater. d. Bracing is indicated for thoracic curves of 10 to 25 degrees.
A: The female-to-male ratio increases with increasing curve magnitude. Small curves are equivalent between females and males. For curves less than 20 degrees, the risk for progression of the curve is low; these curves generally just need to be observed. However, for curves between 20 and 45 degrees, the risk for progression is high during growth, and early intervention is of paramount importance (Burns & Dunn, 2012, p. 940)
35. In Legg-Calvé-Perthes disease, which of the following signs and symptoms are seen? a. Insidious onset of limp with knee and groin pain b. Sudden onset of limp and pain in lateral hip c. Fever and insidious onset of limp d. Afebrile and sudden onset of limp
A: The patient with LCPD is generally afebrile, and the disorder arises from the avascular necrosis of the femoral head. The pain is referred to the knee or groin area
10. For a newborn, the correct management of hip dislocation should include: a. Use of a flexion-abduction device such as a Pavlik harness to stabilize hip b. Following and observing closely for 3 to 4 weeks, and then referring to an orthopedist c. Surgical reduction d. Traction for 6 weeks
A: The treatment of choice for subluxation and reducible dislocations identified in the early phase is a Pavlik harness. The harness is applied with hips having greater than 90 degrees of flexion and with adduction of the hip limited to a neutral position (Burns & Dunn, 2012, p. 944)
22. A 14-year-old diagnosed with JIA is not up-to-date on his immunizations and is currently on methotrexate. Which of the following vaccinations would be cautioned in this case? a. Varicella b. Influenza c. Inactive polio d. Tdap
A: There is risk of developing serious complications of varicella-zoster infection (VZI) in juvenile idiopathic arthritis (JIA) patients receiving disease-modifying antirheumatic drugs (DMARDs), including methotrexate and biologic agents. Varicella zoster (VZ) immune status should therefore be checked in all children before starting such therapy. Seronegative children mostly receive varicella zoster vaccine (VZV)
57. A macular, salmon to red-colored rash with irregular borders and central clearing is typical of which of the following? a. Systemic juvenile arthritis b. Lyme disease c. Systemic lupus erythematosus d. Rheumatic fever
A: This is the characteristic rash associated with systemic juvenile arthritis that occurs in 25% to 50% of children. Lyme disease rash is characteristic of erythema at the site of the tick bite with central clearing like a bull's eye. Systemic lupus erythematosus typically has a "butterfly rash" that is most often seen over the cheeks and bridge of the nose and gets worse in sunlight. Rheumatic fever often is associated with erythema marginatum, a nonpruritic, light pink macular rash that is usually on the trunk
30. Subluxation of the radial head is referred to as "nursemaid's elbow." If the risk for fracture is low or absent, which of the following is recommended? a. Supination and flexion of forearm maneuver b. Extension and supination c. Use of finger traps with weight on the humerus d. The hypopronation and extension maneuver
A: Two techniques can be used to reduce the radial head: supination and flexion or pronation and flexion
42. Tracy, who is 9 years old, complains that she does not like to wear shorts because her knees look funny. Upon examination, you note a genu valgum angle of greater than 15 degrees. You should: a a. Reevaluate in 1 year if still present b. Consult with an orthopedic specialist c. Instruct her to avoid the "W" sitting position d. Encourage exercise to strengthen quadriceps
A: Valgus up to 15 degrees is common up through the age of 8 or 9 years, but persistence beyond that may lead to problems and degenerative changes and warrants referral
21. Which of the following diagnoses is associated with contracture of one of the sternocleidomastoid muscles? a. Lordosis b. Torticollis c. Scoliosis d. Kyphosis
B: Asymmetric shortening of the sternocleidomastoid muscle results in preferential turning of the head to one side
39. An injury at which of the following sites will most likely result in a bone length discrepancy? a. Diaphysis b. Epiphysis c. Medullary cavity d. Metaphysis
B: Bone length occurs at the epiphyseal plates, which is also where the blood supply enters. If the blood supply is compromised growth may be jeopardized
45. A child with growing pains is most likely to experience: a. A mild limp b. Bilateral lower extremity pain c. Lower extremity pain primarily during the day d. Lower extremity pain associated with decreased range of motion
B: Growing pains tend to occur during rapid growth, increasing in prevalence after 5 years of age. The pain is a muscular pain located bilaterally in the legs and thighs
17. Which of the following statements is true about acute osteomyelitis? a. It occurs more frequently in females than in males. b. Peak ages are infancy (younger than 1 year) and preadolescence (9 to 11 years). c. Most common sites are radius and ulna. d. It is a self-limiting disorder.
B: Males are twice as likely as females to be affected. Any bone may be affected, but the femur and tibia are the most common sites. One in 5000 children younger than the age of 13 will develop osteomyelitis, with 50% of those infections occurring in the first 5 years of life (Reuter-Rice & Bollick, 2012, p. 883)
12. Most children with Duchenne muscular dystrophy become wheelchair dependent by what age? a. 4 to 6 years of age b. 10 to 12 years of age c. 14 to 16 years of age d. Highly variable depending on response to treatment
B: Many children with DMD begin using a wheelchair sometime between ages 7 and 12 years. Transition to a wheelchair usually is a gradual process; at first, the chair may be required only to conserve the child's energy when covering long distances (Muscular Dystrophy Association, 2014)
55. Which of the following suggests internal tibial torsion rather than internal femoral torsion in a 2-year-old child presenting with an in-toeing gait? a. Sitting in "W" position b. Knees face forward when walking c. Generalized ligament laxity d. Limited external rotation of hip
B: Observing the patella can be very helpful in differentiating internal tibial torsion from internal femoral torsion. The patella will rotate inward if the problem is above the knee. There is also general ligamentous laxity in other areas (fingers, elbows) associated with internal tibial torsion.
50. The appropriate management of Osgood-Schlatter disease includes: a. Local injection of soluble corticosteroid b. Decreasing activity, applying ice, and taking prescribing NSAIDs c. Program of strengthening and stretching for quadriceps d. Casting in adduction for 6 weeks
B: Osgood-Schlatter disease is a benign condition resulting from overuse and is best treated with rest and supportive therapy.
37. Which of the following is an appropriate goal for a child being treated for osteomyelitis? a. Prohibiting activities b. Complete course of antibiotic therapy c. Encouraging a low-fat diet d. Restricting visitors
B: Osteomyelitis is an inflammation of the bone that requires long-term antibiotic therapy (4-6 weeks). Diet, activity, and rest are supportive care as indicated
1. Which of the following disorders is usually associated with adduction of the forefoot? a. Internal femoral torsion b. Talipes equinovarus congenita c. Genu valgum d. Internal tibial torsion
B: Talipes equinovarus congenita is a congenital birth disorder in which the forefoot is in adducted supination, the hind foot is inverted, and the foot remains in plantar flexion
19. Genu varum is considered an abnormal condition when: a. Extreme knock-knees continues after 7 years of age b. Extreme tibial bowing continues after 2 years of age c. Parents are concerned about their child's appearance d. Tibial bowing is evident before 2 years of age
B: The typical pattern of normal bowing seen in children is a symmetric lateral bowing of both tibias in the first year followed by bowlegs in the second year. Asymmetric tibial bowing after 18 months is often associated with Blount's or tibia vara
47. Which of the following represents appropriate anticipatory guidance for a child diagnosed with slipped capital femoral epiphysis? a. Avoid contact sports until pain has resolved b. Use crutches to facilitate mobility during acute phase c. Apply ice to affected area d. Perform range-of-motion and strengthening exercises
B: Treatment of slipped capital femoral epiphysis is aimed at preventing further slippage. Since the goal is no weight bearing and avoiding flexion of the hip, no sports are recommended. Ice would not change the problem in the femoral head, and ROM and exercise are contraindicated
44. During examination of 2-week-old J. P., you note irritability when lifted, asymmetrical Moro reflex, and spasm along the right sternocleidomastoid. What does this suggest? a. Torticollis b. Sprengel deformity c. Fractured clavicle d. Klippel-Feil syndrome
C: A fractured clavicle is not an uncommon finding following birth, especially in large babies. The spasm of the sternocleidomastoid and asymmetrical Moro reflex are classic signs of this problem
52. While completing the hip examination on a newborn infant, you are able to dislocate the infant's right hip. The appropriate management plan would be to: a. Triple diaper and reevaluate in 2 weeks b. Recommend positioning prone while awake c. Refer to orthopedic specialist d. Order tight swaddling of the infant
C: Although still recommended in some sources, triple diapering is not thought to be effective because the musculoskeletal forces are greater than those exerted by diapers. Swaddling and the prone position are contraindicated and may increase the risk of dislocation. The appropriate treatment would be an evaluation by an orthopedic specialist and most likely a Pavlik harness.
11. Duchenne muscular dystrophy is characterized by which of the following signs and symptoms? a. At birth, affected infants are notably hypotonic, "floppy" babies. b. Earliest symptom is often refusal to bear weight. c. Abnormalities of gait and posture become evident during preschool years and during gross motor development. d. Children are unable to keep up with peers when running by school age.
C: DMD typically presents with delayed walking, slower movements, rolling gait, waddle, large calves, and a positive Gower sign (pushing off thighs when changing positions from being seated to standing)
29. Antonio is a newborn, and the PNP notes on physical assessment that both feet turn in with the hind and midfoot in normal neutral position. When attempting range of motion of the forefoot, the PNP finds that both feet move relatively freely past midline in all directions consistent with: a. Clubfoot b. Syndactyly c. Metatarsus adductus d. Fracture in his feet
C: In flexible MA, the forefoot can be abducted past midline
2. The most common rheumatoid disease of childhood is: a. Systemic lupus erythematosus b. Kawasaki disease c. Juvenile idiopathic arthritis d. Legg-Calvé-Perthes disease
C: JIA is the most common rheumatologic disease with an autoimmune basis and represents a group of conditions with onset of symptoms in children at or younger than 16 years that causes chronic inflammation of at least one synovial joint for 6 weeks or more (Burns & Dunn, 2012, p. 521)
3. Radiographic findings of disease progression and sphericity of the femoral head is helpful in the diagnosis and follow-up of: a. Transient synovitis of the hip b. Osgood-Schlatter disease c. Legg-Calvé-Perthes disease d. Slipped capital femoral epiphysis
C: Legg-Calvé-Perthes develops from an infarction of the bony epiphysis of the femoral head and often presents as avascular necrosis of the femoral head. Radiographs depict stages of progression and remodeling and are important in diagnosis and management
58. A baseball coach asks for advice on how to prevent Little League elbow in his 8- and 9-year-old players. Which of the following would be incorrect advice? a. Have each child pitch only three innings. b. Limit or eliminate curve balls. c. Use ice massage before and after pitching. d. Conduct slow warm-ups.
C: Little League elbow, or epicondylitis, is a result of repetitive forearm supination and pronation. Therefore, the goal is to prevent the injury by reducing the repetitive motion. Ice falsely reassures parent or coach that the injury can be prevented by applying before and after pitching
56. A full-term infant in the newborn nursery is noted to have a deformity in her left foot consisting of a convex lateral border and forefoot, which can be abducted past an imaginary line extending from the middle of the heel through the second toe. Which of the following management strategies is most appropriate? a. Reverse-last shoes b. Out-flare shoes c. Stretching exercises d. Orthopedic referral
C: Metatarsus adductus is a flexural deformity of the foot related most commonly to intrauterine positioning. Flexible deformities able to be moved past the midline can be managed with stretching exercises.
26. A 14-year-old has pain in the knee. The pain increases with activity and is relieved with rest. The PNP diagnoses Osgood-Schlatter disease and orders: a. An x-ray examination, application of hot packs to the knee, and rest b. Application of hot packs to the knee, aspirin, and rest c. A reduction in activity, application of ice to the knee, and ibuprofen d. Application of ice to the knee and continued participation in sports
C: Osgood-Schlatter disease is a self-limiting condition with symptom management that includes avoiding or modifying activities that cause pain until the inflammation subsides, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
28. Which of the following children need an orthopedic referral? a. A 6-year-old with mild bowing of the lower legs b. A 6-month-old with internal tibial torsion c. A 3-week-old with equinovarus of feet d. A newborn with a positive Pavlik sign
C: Refer to an orthopedist as early as possible, ideally in the newborn nursery, because the joints are most flexible in the first hours and days of life
9. Dislocation in the hip of a child 6 months or older may typically present with: a. Asymmetry of skin folds b. Atrophied hip muscles c. Positive Galeazzi sign d. Negative Trendelenburg sign
C: The Galeazzi maneuver can depict a leg length discrepancy. The exam is reliable in children with dislocatable, but not dislocated, hips or in children with bilateral hip dislocation
41. Varus between the tibia and femur of up to 15 degrees followed by a progression to a neutral angle, which then progresses to valgus between 7 degrees and 9 degrees, is associated with which of the following? a. Blount disease b. Internal tibial torsion c. Normal developmental growth pattern d. Abnormal tibiofemoral growth pattern
C: The normal growth pattern is one of slight varus (bowleg), which progresses to a neutral angle, and then slight valgus (knock-knee). Persistence of any phase beyond what is expected warrants further investigation
5. Which of the following would be the most appropriate initial management of a newborn diagnosed with developmental dysplasia of the hip? a. Observe and reexamine at 2-week well-child visit b. Triple diapering in nursery c. Pavlik harness d. Surgical reduction
C: The treatment of choice for subluxation and reducible dislocations identified in the early phase is a Pavlik harness. The harness is applied with hips having greater than 90 degrees of flexion and with adduction of the hip limited to a neutral position (Burns & Dunn, 2012, p. 944)
20. Tibial torsion is commonly associated and can be treated with: a. Pain, analgesics b. Restricted ROM, braces c. Internal rotation of lower extremities, observation d. In adolescents 13 to 16 years of age, increasing dietary calcium
C: Tibial torsion involves the twisting of the long bone along its long axis, resulting in increased internal rotation. Treatment of tibial version (the normal variation in tibial rotation) is observation and monitoring
53. Which of the following would not be an appropriate indicator for developmental dysplasia of the hip in a 6-month-old child? a. Allis sign b. Skinfold symmetry c. Galeazzi sign d. Ortolani maneuver
D: After the age of 6 months, the Ortolani maneuver is less reliable due to diminished laxity in the hip. After 2 months of age, soft tissue contractures may develop, making this test unreliable.
49. During physical examination of Jason, a 2.5-year-old, you note large, muscular-looking calves and observe his difficulty rising from a sitting position. The Denver A developmental screening examination reveals delays in the gross motor area. Which of the following laboratory tests would be most beneficial? a. Serum calcium b. Serum magnesium c. Serum phosphorus d. Serum creatine kinase
D: Creatinine is formed in healthy muscle tissue from creatine at a steady rate. When muscle wasting occurs, as in muscular dystrophy, creatine excretion is dramatically increased. Deficiencies in serum calcium, phosphorus, and magnesium may result in muscle cramping and spasms but do not represent the clinical picture described
43. What is the appropriate treatment for genu varum in a 15-month-old child? a. Passive exercise with each diaper change b. Denis Browne splint at night c. Blount brace at night d. No treatment is warranted
D: Genu varum, or bowed leg, is normal until approximately 18 months
16. A healthy 6-year-old child presents with a limp and knee pain. The PNP finds limited passive internal rotation and abduction of the hip joint on physical examination. The most likely diagnosis is: a. Slipped capital femoral epiphysis b. Osgood-Schlatter disease c. Transient synovitis of the hip d. Legg-Calvé-Perthes disease
D: LCPD often presents with an intermittent limp (abductor lurch) especially after exertion, with mild or intermittent pain in the anterior part of the thigh. Some children may present with limited range of motion of the affected extremity. The most common symptom is persistent pain that may be referred to the medial aspect of the ipsilateral knee or to the lateral thigh (Burns & Dunn, 2012, p. 945). Slipped capital femoral epiphysis (SCFE) often occurs after age 8 and predominantly in boys who are overweight. Osgood Schlatter does not occur until early adolescence and is often associated with sports. Transient synovitis typically occurs between ages 3 and 8 years, and the child often refuses to bear weight and has a low-grade fever
46. C. W., a 20-month-old, presents in the emergency room with a greenstick fracture of his left femur. Physical examination also reveals an enlarged anterior fontanelle and enlarged costochondral junction. What do these clinical findings suggest? a. Child abuse b. Osteogenesis imperfecta c. Osteoporosis d. Rickets
D: Rickets develops after several months of vitamin D deficiency and is characterized by craniotabes and enlarged anterior fontanelle with delayed closing. The enlarged costochondral junction, or rachitic rosary, is a classic sign
13. An obese 13-year-old male with 2 days of right knee pain without trauma or illness has an exam of significant pain upon right hip motion, and he maintains his leg in external rotation and adduction. Based on these findings, the most likely diagnosis is: a. Osgood-Schlatter disease b. Chondromalacia c. Spondylolysis d. Slipped capital femoral epiphysis
D: SCFE typically occurs just after the onset of puberty, often in overweight and slightly skeletally immature boys. Pain is typically reported in affected groin, hip, or knee, and there is often a limp
14. Management of scoliosis depends on the severity of curve as well as the age of the child. Which of the following would require surgical intervention? a. Curves of 15 degrees in a child who is still growing b. Thoracic and/or lumbar curve greater than 25 degrees, even if growth is complete c. Thoracic curve greater than 30 degrees or lumbar curve greater than 40 degrees that has not progressed while in brace d. Thoracic curve greater than 50 degrees or lumbar curve greater than 40 degrees
D: Surgery may be required in children with structural problems that cause kyphosis and in adolescents with curvature of the back that exceeds 50 to 60 degrees. Surgery is indicated for children who have progressive spinal deformity that cannot be controlled by nonoperative means, such as bracing, and where there is significant spinal growth remaining For Cobb angle less than 15 degrees: Observation at 6- to 12-month intervals For Cobb angle 15 to 20 degrees: Outpatient therapy with a combination of therapist-guided sessions and home exercise program For Cobb angle 21 to 25 degrees: Outpatient physiotherapy, scoliosis intensive rehabilitation (SIR) program where available. A brace may be indicated For Cobb angle greater than 25 degrees: Outpatient physical therapy, SIR program, and brace wear. Rationale for surgical intervention (Burns & Dunn, 2012, p. 942)
18. Which of the following statements is not true of slipped capital femoral epiphysis? a. It is thought to be precipitated by hormone changes during puberty. b. Unilateral involvement is more common than bilateral. c. It is more common among males and African Americans. d. It is thought to be caused by repetitive stresses in young athletes prior to growth spurt.
D: The etiology of SCFE is unknown but thought to be related to stresses on the physis from rapid growth
32. Which of the following statements is true regarding slipped capital femoral epiphysis? a. It is more common in females who are underweight. b. It generally occurs following severe sudden trauma. c. Incidence is more common in athletes. d. The goal of treatment is to stabilize or improve the position of the femoral head.
D: The goal of treatment in SCFE is to prevent further slippage and to stabilize the epiphysis via surgical intervention
4. A 4-year-old boy is brought in by his mother, who is concerned about the sudden onset of a painful limp in his right leg 2 days ago. Today he has a low-grade fever. Which of the following diagnoses is most likely? a. Osgood-Schlatter b. Juvenile idiopathic arthritis c. Osteomyelitis d. Transient synovitis of the hip
D: Transient synovitis, also referred to as toxic synovitis, is an inflammatory process that often affects large joint spaces—primarily, the hip. Children ages 3 to 8 are often affected. The typical presentation consists of pain in the affected joint, antalgic gait, refusal to bear weight, and low-grade fever
