Systemic paediatrics: nursemaid elbow: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Systemic paediatrics: nursemaid elbow

Sample item

A 2-year-old stops using her right arm after her father pulled her up by the hand. She holds the arm extended and pronated, cries on moving the elbow and has no swelling or bruising. What is the best management?

ASurgical fixationBReduction by supination and flexion of the elbowCImmobilisation in a cast for 6 weeksDAspiration of the elbow joint

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Reduction by supination and flexion of the elbow

Pulling on the extended arm causes radial head subluxation (pulled elbow), where the annular ligament slips over the radial head. Hyperpronation or supination with flexion reduces it and the child usually uses the arm again within minutes. No radiograph is needed if the history is typical.

Option by option

A. Surgical fixation
Surgery is not required for a simple radial head subluxation.
B. Reduction by supination and flexion of the elbow (correct)
Correct. Supination with flexion, or hyperpronation, reduces the radial head.
C. Immobilisation in a cast for 6 weeks
A cast is unnecessary for a subluxation that reduces with manipulation.
D. Aspiration of the elbow joint
Aspiration treats septic arthritis, which causes fever and swelling.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is B, Reduction by supination and flexion of the elbow. Pulling on the extended arm causes radial head subluxation (pulled elbow), where the annular ligament slips over the radial head.

Why is "Surgical fixation" not the answer?

Surgery is not required for a simple radial head subluxation.

Why is "Immobilisation in a cast for 6 weeks" not the answer?

A cast is unnecessary for a subluxation that reduces with manipulation.

Why is "Aspiration of the elbow joint" not the answer?

Aspiration treats septic arthritis, which causes fever and swelling.

What concept does this question test?

It tests Systemic paediatrics: nursemaid elbow in Pediatrics. Hyperpronation or supination with flexion reduces it and the child usually uses the arm again within minutes. No radiograph is needed if the history is typical.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic paediatrics: nursemaid elbow?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.