Paediatric Musculoskeletal Disorders, Skeletal Dysplasias, and Non-Accidental Trauma — WACS Viva & Clinical Scenarios (Paediatric Radiology)

Exam-style paediatric musculoskeletal disorders, skeletal dysplasias, and non-accidental trauma viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: Film-Viewing and Image-Interpretation Station: A 6-week-old female infant born in breech presentation presents with an asymmetrical thigh crease and a positive Ortolani click on the left side. Candidates are provided with coronal ultrasound views of both hips and subsequent 6-month follow-up plain pelvis radiographs. Candidates must describe the morphological ultrasound landmarks, classify the hip according to Graf criteria, explain the reference lines on plain radiographs, and outline the imaging surveillance protocol.
• SCENARIO 2: Viva Voce / Reporting Station: A 4-month-old male infant presents to the emergency department with irritability, swelling over the left distal femur, and a faint linear bruising pattern across the posterior thorax. Skeletal survey radiographs are presented showing multiple skeletal abnormalities. Candidates must systematically analyse the skeletal survey, identify pathognomonic fracture patterns, articulate the radiographic indicators differentiating non-accidental trauma from metabolic or congenital bone disorders, and state the mandatory imaging protocol for suspected child abuse.
• SCENARIO 3: Single Best Answer / Case-Based Vignette Station: A neonate is delivered with severe rhizomelic micromelia, a narrow thorax, and a prominent forehead with midface hypoplasia. Plain babygram and cranial ultrasound images are displayed demonstrating severe platyspondyly, curved femurs resembling telephone receivers, and a cloverleaf skull deformity. Candidates must differentiate lethal from non-lethal chondrodysplasias, identify specific spine and pelvic radiographic hallmarks, and define the diagnostic imaging pathway.
• SCENARIO 4: Film-Viewing and OSCE Station: A 2-year-old child from a low-resource setting presents with progressive lower limb bowing, delayed walking, and wrist enlargement. Wrist, knee, and chest radiographs are provided. Candidates must identify the classical radiographic features of paediatric rickets, differentiate nutritional rickets from renal osteodystrophy and scurvy, and specify the imaging signs of healing following treatment.
• SCENARIO 5: Acute Clinical Viva Station: An 18-month-old toddler presents with acute refusal to bear weight on the right leg, low-grade pyrexia, and elevated inflammatory markers. Ultrasound of the right hip and plain radiographs of the pelvis and right femur are presented. Candidates must systematically describe the ultrasound technique for evaluating paediatric joint effusions, differentiate septic arthritis from transient synovitis, identify early radiographic and MRI signs of acute haematogenous osteomyelitis, and explain the anatomical basis for transphyseal spread in infants.