NMS Q&A Family Medicine

chap ter 27Musculoskeletal Problemsin ChildrenExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 You are caring for an adolescent whose routine chestx-ray shows a curvature in the thoracic spine. Whichof the following is not consistent with probably idiopathicscoliosis.(A) Right dorsal thoracic ribcage is more prominentthan the left(B) Female patient(C) Family history of idiopathic scoliosis(D) Right thoracic curve(E) Left thoracic curve2 A 5-month-old boy is brought to the family doctorby the parents who complain of the baby constantlylying with the head turned onto the left side, that is,the head turning right in his crib when lying facedown or turned onto the right asleep on his back.Each of the following is a true statement regardingthis condition except for which one?(A) The condition likely a result of rightsternocleidomastoid (SCM) pathology.(B) There may be congenital deformity of the cervicalspine.(C) There may be a palpable nodular prominence ofthe left SCM muscle.(D) Failure to treat will result in facial distortion.(E) There may be associated hip congenital hipdysplasia.3 A 7-year-old boy is brought to your office by his parentswith complaint of pain in the right knee whoseonset was gradual over the past 3 weeks. It is worsenedby athletic play and by kneeling on a hard surface.On examination, there is seen to be a tenderswelling inferior to the patella. Which of the followingstatements is true regarding this condition?(A) Quadriceps exercises are a mainstay oftreatment during the acute phase.(B) There usually is associated knee joint effusion.(C) This condition is an expression of juvenilerheumatoid arthritis (JRA).(D) The condition usually remits after fusion of thetibial tubercle with the diaphysis.(E) The condition is caused by premature closure ofthe tibial tuberosity with the diaphysis.4 A 6-year-old boy has developed a limp over a periodof 5 days. He appears to be ill and has had a fever withtemperatures rising to 102 ° F. During examination,eversion of the left hip elicits pain. Which of the followingis the least logical next step in the dispositionin this case?(A) Open surgical exploration(B) Determination of complete blood cell (CBC)count and sedimentation rate(C) Needle aspiration of the left hip joint(D) Plain x-rays of the left hip(E) Arthroscopy5 A 7-year-old boy began limping after exercise severalmonths ago. The parents questioned him at first andhe denied pain. Later the boy began complaining ofpain in the right hip and at times the right thigh andknee. Over the past week, the pain has been disabling.Vital signs are normal; on examination, the boy isunable to actively abduct and internally rotate as aresult of muscle spasm. A CBC count is normal. Aplain x-ray shows a “moth eaten” appearance of thefemoral epiphysis, flattening of the head, and irregularcontours of the acetabulum. Which of the followingis the likely diagnosis?(A) Slipped femoral capital epiphysis(B) Legg–Calvé–Perthes disease(C) Septic arthritis of the right hip(D) Toxic synovitis(E) Osteomyelitis of the right femur6 A 14-year-old boy, who is in the early stages of sexualdevelopment, complains of left knee pain, developingover a course of 2 weeks. He walks with a limp. Onexamination his weight is 184 lb (83.4 kg) at a height169