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?

Accepted Answer

A Salter-Harris Type II fracture involves a metaphyseal fragment on the compression side of the fracture. Option A is incorrect because growth disturbance is a potential complication of Salter-Harris Type V fractures, not Type II. Option C is incorrect because there is usually a shearing injury to the physis, not a compression or crushing injury. Option D is incorrect because the majority of Salter-Harris Type II fractures can be treated with closed reduction, without the need for surgery.

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?

Accepted Answer

This description is indicative of metatarsus adductus, a common foot deformity in newborns where the forefoot is adducted. The appropriate initial evaluation involves manually manipulating the foot, specifically by grasping the heel and abducting the forefoot, to assess the flexibility of the deformity and potential for self-correction.

Question 3

A school­age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed?

Accepted Answer

A closed fracture of the clavicle can usually be managed with immobilization using a sling to support the affected arm. A figure-eight clavicle brace may also be used in some cases, but hospitalization for traction or referral to an orthopedic specialist for surgery is reserved for more severe cases with displacement or multiple fractures.

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?

Accepted Answer

Given the reported mechanism of injury, it is possible that the child has a nursemaid's elbow (subluxation of the radial head). Gentle reduction maneuvers are often successful and can be attempted in the primary care setting. Immobilization and referral to orthopedics or obtaining radiographs are not necessary unless reduction attempts are unsuccessful, there are signs of more significant injury or the child is experiencing significant pain or discomfort. Maltreatment should not be immediately suspected without further assessment or contextual information.

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?

Accepted Answer

The answer of The primary care pediatric nurse practitioner elicits...

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?

Accepted Answer

The answer of A 14­year­old boy who is overweight develops...

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?

Accepted Answer

The mild unequal scapula prominences that disappear in the Adams forward bending position suggest a functional scoliosis rather than a structural scoliosis. The primary care pediatric nurse practitioner should discuss posture and exercise with the adolescent, and ask about backpacks and books. Bracing and radiographic studies are not needed for functional scoliosis, which will self-resolve with correction of underlying postural issues.

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?

Accepted Answer

The symptoms and physical examination findings are consistent with musculoskeletal pain, likely due to a rib strain or injury. NSAIDs, stretching exercises, and ice packs can help alleviate pain and promote healing. Ordering a chest radiograph or an electrocardiogram is not necessary based on the clinical presentation. Referral to a pediatric orthopedist may be warranted if the child's symptoms do not improve with conservative therapy, but it is not the first-line management for uncomplicated musculoskeletal pain.

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?

Accepted Answer

The child is most likely suffering from Osgood-Schlatter disease, a common condition in growing children who participate in sports that involve running, jumping or other activities that repeatedly strain the knee joint. Treatment for this condition includes rest, ice packs and avoiding activities that cause pain. In most cases, the condition resolves on its own as the child grows and matures. Quadriceps-stretching exercises or referral to a specialist are not necessary for this condition. Radiographic studies may be helpful in ruling out other injuries, but are not necessary for diagnosing Osgood-Schlatter disease.

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?

Accepted Answer

A positive Barlow maneuver indicates dislocation of an unstable hip.

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?

Accepted Answer

The child's condition requires referral to a pediatric orthopedic specialist for treatment. The angle of bowing is greater than 15 degrees and will likely require intervention to correct the deformity. Observe and reassurance are not appropriate in this case, and physical therapy alone may not be enough to prevent progression of symptoms.

Quiz 38: Musculoskeletal Disorders

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?

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 schoolage child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed?

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 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 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?

What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip?

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?