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Paediatric Orthopaedics

Total questions: 30

Worksheet time: 23mins

Name
Class
Date
1.

A 2-year-old child has symmetrical bowing of both legs, no pain, and is otherwise well. What is the most appropriate management?

a)

Prescribe orthotics

b)

X-ray of lower limbs

c)

Urgent orthopaedic referral

d)

Reassure and observe

e)

Check inflammatory markers

2.

Which feature suggests that in-toeing is pathological rather than a normal variant?

a)

Age 3 years

b)

Bilateral involvement

c)

Worse when tired

d)

Family history of in-toeing

e)

Associated pain and limp

3.

Flexible flat feet in a 5-year-old should be managed by:

a)

Rigid orthotics

b)

Foot surgery referral

c)

MRI foot

d)

Physiotherapy

e)

Reassurance only

4.

Toe walking is most concerning when it is associated with:

a)

Bilateral involvement

b)

Age under 3 years

c)

Developmental delay

d)

Ability to heel-strike on command

e)

Family history of toe walking

5.

A 4-year-old presents with an acute limp following a viral URTI. Afebrile, mild hip pain, able to weight bear. Most likely diagnosis?

a)

Osteomyelitis

b)

Perthes disease

c)

Transient synovitis

d)

SCFE

e)

Septic arthritis

6.

Which feature most strongly suggests septic arthritis rather than transient synovitis?

a)

Mild restriction of movement

b)

Age under 5

c)

Raised ESR only

d)

Refusal to weight bear

e)

Hip pain after infection

7.

A child refusing to weight bear should be:

a)

Reviewed in 48 hours

b)

Treated with NSAIDs

c)

Sent for physiotherapy

d)

Given reassurance

e)

Referred urgently

8.

Perthes disease most commonly affects which age group?

a)

Three to ten years

b)

Ten to fourteen years

c)

Under 2 years

d)

Adolescents only

e)

Neonates

9.

Which is the strongest risk factor for DDH?

a)

Breech presentation

b)

Prematurity

c)

Multiple births

d)

Maternal smoking

e)

Male sex

10.

Appropriate imaging for suspected DDH in a 3-month-old infant is:

a)

Bone scan

b)

Hip ultrasound

c)

Pelvic X-ray

d)

CT scan

e)

MRI

11.

The GP’s role in DDH screening primarily involves:

a)

Repeated Barlow manoeuvres

b)

Ordering MRI scans

c)

Measuring leg lengths only

d)

Identifying risk factors and referring

e)

Initiating splinting

12.

A 13-year-old overweight boy presents with knee pain and a limp. Examination shows reduced internal rotation of the hip. What is the diagnosis?

a)

Patellofemoral pain syndrome

b)

SCFE

c)

Perthes disease

d)

Septic arthritis

e)

Osgood–Schlatter disease

13.

Initial management of suspected SCFE includes:

a)

Immediate non-weight bearing and urgent referral

b)

Physiotherapy

c)

NSAIDs and review

d)

Weight bearing as tolerated

e)

Knee X-ray only

14.

A buckle (torus) fracture is best described as:

a)

Growth plate fracture

b)

Compression injury of bone cortex

c)

Complete fracture

d)

Greenstick fracture

e)

Spiral fracture

15.

Which fracture has the highest risk of neurovascular compromise?

a)

Supracondylar fracture

b)

Greenstick fracture

c)

Clavicle fracture

d)

Metacarpal fracture

e)

Buckle fracture

16.

A Salter-Harris type II fracture involves:

a)

Joint surface only

b)

Metaphysis and physis

c)

Diaphysis only

d)

Epiphysis only

e)

Physis only

17.

Sever’s disease is caused by:

a)

Stress fracture

b)

Achilles tendon rupture

c)

Calcaneal apophysitis

d)

Tarsal coalition

e)

Infection of calcaneus

18.

Rigid flat foot with pain should prompt suspicion of:

a)

Tarsal coalition

b)

Poor footwear

c)

Growing pains

d)

Normal variant

e)

Plantar fasciitis

19.

Osgood–Schlatter disease typically presents with:

a)

Knee locking

b)

Hip pain

c)

Night pain

d)

Medial knee pain

e)

Anterior knee pain over tibial tuberosity

20.

Best initial management of Osgood–Schlatter disease is:

a)

NSAIDs, activity modification, reassurance

b)

Knee brace long-term

c)

Complete sports cessation for 1 year

d)

Steroid injection

e)

Surgery

21.

Nursemaid’s elbow most commonly occurs due to:

a)

Sports injury

b)

Fall on outstretched hand

c)

Sudden pulling of the arm

d)

Birth injury

e)

Direct trauma

22.

Following reduction of nursemaid’s elbow, the child usually:

a)

Requires X-ray

b)

Needs splinting

c)

Regains function immediately

d)

Needs orthopaedic referral

e)

Needs analgesia for weeks

23.

Scoliosis is defined as:

a)

Postural imbalance only

b)

Painful spinal curvature

c)

Lateral spinal curvature over ten degrees

d)

Kyphotic deformity

e)

Any spinal asymmetry

24.

Back pain in children is most concerning when associated with:

a)

Heavy school bags

b)

Night pain

c)

Poor posture

d)

Mild stiffness

e)

Sports activity

25.

Which feature is most suggestive of bone malignancy?

a)

Night pain with weight loss

b)

Joint stiffness only

c)

Pain relieved by NSAIDs

d)

Pain after exercise

e)

Bilateral leg pain

26.

Osteomyelitis commonly presents with:

a)

Only limp without pain

b)

No systemic features

c)

Fever and localized bone pain

d)

Chronic symptoms only

e)

Isolated joint swelling

27.

Which finding should raise concern for non-accidental injury?

a)

Clavicle fracture at birth

b)

Spiral fracture in a non-ambulatory child

c)

Single fracture after fall

d)

Greenstick fracture

e)

Buckle fracture

28.

Which is the most appropriate safety-net advice for parents of a limping child sent home?

a)

Return urgently if fever or refusal to walk develops

b)

Come back if still limping in six months

c)

Book routine physiotherapy

d)

Avoid all activity for weeks

e)

It will resolve

29.

Pain in growing children is:

a)

Always normal

b)

Usually benign

c)

Never concerning

d)

Not a normal feature of growth

e)

Always psychological

30.

Most paediatric orthopaedic presentations in general practice require:

a)

Physiotherapy

b)

Surgery

c)

Imaging

d)

Urgent referral

e)

Reassurance and observation

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