Deck 38: Musculoskeletal Disorders

Question 1

A school­age child has a fractured wrist with a Salter­Harris Type II fracture, according to the radiologist. What is true about this type of fracture?
A. Growth disturbance of the long bones of the arm is likely.
B. There is a metaphyseal fragment on the compression side of fracture.
C. There is usually a compression or crushing injury to the physis.
D. This will require anatomic reduction using an open approach.

Answer 1

There is a metaphyseal fragment on the compression side of fracture.

Question 2

During a well baby examination of a newborn, the primary care pediatric
nurse practitioner notes adduction of the right forefoot, with normal position of the mid­ and hind­foot, along with a convex­shaped lateral border of the foot. What will the nurse practitioner do to evaluate this deformity?
A. Grasp the heel with one hand and abduct the forefoot with the other hand.
B. Observe both legs for medial and lateral rotations.
C. Order anterior­posterior and lateral radiographs of both feet.
D. Refer the infant immediately to a pediatric orthopedic specialist.

Answer 2

Grasp the heel with one hand and abduct the forefoot with the other hand.

Question 3

A school­age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed?
A. Application of a figure­eight clavicle brace for 6 to 8 weeks
B. Hospitalization for traction of the affected extremity and shoulder
C. Immobilization with a sling to support the affected extremity
D. Referral to an orthopedic specialist for possible surgical reduction

Answer 3

Immobilization with a sling to support the affected extremity

Question 4

A 3­year­old child is brought to the clinic by a parent who reports that the
child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do?
A. Consider maltreatment as a possible cause of injury.
B. Gently attempt a supination and flexion technique.
C. Immobilize the arm with a sling and refer to orthopedics.
D. Obtain a radiograph of the child's right arm and elbow.

Question 5

The primary care pediatric nurse practitioner elicits positive Ortolani and
Barlow signs in a 6­month­old infant not previously noted in the medical record. What is the correct treatment?
A. Pavlik harness
B. Spica cast
C. Surgical intervention
D. Triple diapering

Question 6

A 14­year­old boy who is overweight develops a unilateral limp with pain in
the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition?
A. Place the child on crutches or in a wheelchair to prevent weight­bearing.
B. Provide information about weight loss to minimize further injury.
C. Recommend seeing an orthopedic specialist as soon as possible.
D. Refer the child to physical therapy to improve range of motion.

Question 7

A young adolescent female is observed to have mild unequal scapula
prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do?
A. Discuss posture and exercise and ask about backpacks and books.
B. Obtain radiographic studies of the entire spine and neck.
C. Reassure the child's parent that functional scoliosis will self­resolve.
D. Refer to an orthopedic specialist for evaluation and possible bracing.

Question 8

A young adolescent reports chest pain associated with coughing and lifting.
Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do?
A. Obtain a chest radiograph to evaluate possible causes for these symptoms.
B. Order an electrocardiogram to rule out potential cardiovascular disease.
C. Recommend NSAIDs, stretching exercises, and ice packs to the area.
D. Refer the child to a pediatric orthopedist for evaluation and treatment.

Question 9

A child who plays soccer is in the clinic reporting pain and swelling in both
knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain worsening when asked to extend the knees against resistance. What is the treatment for this condition?
A. Apply ice packs to both knees and avoid activities that cause pain.
B. Begin quadriceps­stretching exercises now to prevent further injury.
C. Obtain radiographic studies to rule out fractures or ligament tears.
D. Refer to a pediatric orthopedic specialist to evaluate the need for surgery.

Question 10

What will the primary care pediatric nurse practitioner elicit when obtaining a
positive Barlow maneuver when screening for developmental dysplasia of the hip?
A. Dislocation of an unstable hip
B. Dropping of the iliac crest with a raised leg
C. Reduction of a dislocated hip
D. Unequal knee heights in a supine child

Question 11

A parent is concerned that a 12­month­old child is "bow­legged." A physical
examination reveals internal tibial torsion bilaterally. A radiograph reveals asymmetric bowing of the legs with an angle greater than 15 degrees. What is the correct action for the primary care pediatric nurse practitioner?
A. Observe the child's condition over time to assess progression.
B. Order physical therapy to prevent progression of symptoms.
C. Reassure the parent that the child will outgrow this deformity.
D. Refer to a pediatric orthopedic specialist for treatment.