10/15 CorePendium Board Review

A 4-year-old boy presents with a limp for 2 days following a viral upper respiratory infection. He is afebrile, able to bear weight, and has mild limitation of hip internal rotation. Labs: WBC 8,500, ESR 12 mm/hr, CRP 0.7 mg/dL. What is the most likely diagnosis?

• Septic arthritis

• Transient synovitis

• Legg-Calvé-Perthes disease

• Slipped capital femoral epiphysis

A 12-year-old obese boy presents with 3 weeks of knee pain and limp. Exam shows limited internal rotation of the hip. What is the most likely diagnosis?

• Osgood-Schlatter disease

• Slipped capital femoral epiphysis

• Legg-Calvé-Perthes disease

• Septic arthritis

A 3-year-old with a limp after minor trauma has tibial shaft tenderness. X-ray is normal. What is the best next step?

• Discharge without immobilization

• Long leg splint and repeat X-ray in 10 days

• Immediate MRI

• IV antibiotics

Which clinical finding most strongly suggests septic arthritis over transient synovitis?

• History of recent URI

• Refusal to bear weight

• Mildly limited hip ROM

• Normal inflammatory markers

A 7-year-old boy presents with chronic hip pain and limp. Exam shows decreased hip abduction and internal rotation. X-ray reveals increased density and sclerosis of the femoral head. What is the diagnosis?

• Transient synovitis

• Legg-Calvé-Perthes disease

• Slipped capital femoral epiphysis

• Osteosarcoma

A 12-year-old girl presents with ankle pain after a tumbling accident. X-rays reveals fracture of the anterolateral distal tibia through the epiphysis but not the metaphysis. Which fracture does this represent?

• Salter-Harris I fracture

• Salter-Harris II fracture

• Salter-Harris III fracture

• Salter-Harris IV fracture

A 13-year-old boy injures his ankle playing basketball. X-rays show a distal tibial fracture involving epiphysis, physis, and metaphysis with >2 mm displacement. What is the next step?

• Discharge with removable ankle brace

• Closed reduction and outpatient follow-up

• Orthopedic consultation for operative fixation

• Long leg casting alone

Which of the following fracture types is most associated with risk of growth arrest and poor outcomes?

• Torus fracture

• Greenstick fracture

• Salter-Harris I fracture

• Salter-Harris V fracture

A 2-month-old infant presents with bruising on the torso and ears. The caregiver reports the baby “rolled off the couch.” Which of the following best explains the significance of these findings?

• Likely accidental injury in a mobile child

• Sentinel injuries highly suspicious for abuse

• Consistent with birth trauma

• Unlikely to be related to abuse due to caregiver explanation

Which of the following fractures is most specific for child abuse?

• Greenstick fracture of the radius

• Spiral tibial fracture in a 3-year-old

• Posterior rib fracture in an infant

• Simple linear skull fracture