Pediatric Orthopaedics — MCQs

Q: Epiphyseal enlargement is seen in which of the following conditions?

Juvenile Rheumatoid Arthritis. **Explanation:** The correct answer is **Juvenile Rheumatoid Arthritis (JRA)**. **Why JRA is correct:** In JRA (now more commonly termed Juvenile Idiopathic Arthritis), chronic synovial inflammation leads to **increased blood flow (hyperemia)** to the affected joint. This persistent hyperemia stimulates the adjacent growth plates, resulting in **accelerated osseous maturation** and **epiphyseal enlargement**. This is a classic radiological and clinical feature, often manifesting as "ballooning" of the epiphyses, particularly in the knees or wrists. **Why the other options are incorrect:** * **Rickets:** The hallmark of Rickets is **metaphyseal** changes, specifically widening, fraying, and cupping of the metaphysis due to failure of mineralization. While the joint may appear swollen clinically, the primary pathology is at the metaphysis, not the epiphysis. * **Scurvy:** Scurvy is characterized by subperiosteal hemorrhages and specific metaphyseal signs (e.g., Trummerfeld zone, Wimberger’s ring sign, Pelkan spur). It typically causes **epiphyseal atrophy** or "ground-glass" appearance rather than enlargement. * **Spondyloepiphyseal Dysplasia (SED):** This is a genetic bone dysplasia characterized by **small, flattened, or fragmented epiphyses** (epiphyseal dysgenesis), leading to short stature. It does not cause enlargement. **High-Yield Clinical Pearls for NEET-PG:** * **Epiphyseal Enlargement:** Think JRA, Hemophilia (due to repeated hemarthrosis/hyperemia), and Beckwith-Wiedemann Syndrome. * **Epiphyseal Dysgenesis (Stippled Epiphyses):** Think Hypothyroidism (most common), Conradi-Hünermann syndrome, and Warfarin embryopathy. * **Metaphyseal Widening:** Think Rickets, Scurvy, and Achondroplasia. * **Wimberger’s Sign:** In Scurvy, it refers to a thin sclerotic rim around a lucent epiphysis; in Congenital Syphilis, it refers to erosion of the medial proximal tibial metaphysis.

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