Certification QBank Pediatrics 31-60 Flashcards
a 6-year-old boy with Down syndrome presents for evaluation of torticollis. Mother reports that he often tilts his head to the right, and it is especially notable when he is watching TV. He denies pain. What is your main concern about etiology of his head tilting before starting therapy?
A. Congenital shortening of the right sternocleidomastoid
B. Atlantoaxial rotatory fixation
C. Ocular superior oblique muscle palsy
D. Arnold-Chiari malformation
B. Atlantoaxial rotatory fixation (AARF)
AARF associates with syndromes like trisomy 21, Klippel-Feil, Marfan, Larsen and Morquio. Bony abnormalities such as AARF can be the etiology for torticollis in Down syndrome patients, and in this case occupational therapy will be contraindicated. Cervical radiographs (AP-L views) his first-line tests. Add open mouth odontoid view if AARF is suspected. Dynamic CT is useful in assessing C1-2 rotation in different positions of neck rotation. If cervical CT is positive, do a cervical MRI/MRA to check for spinal cord, ligamentous and vascular injuries
according to the American disabilities act of 1990, a person with a disability who applies for a job as typically have access to the employer which of the following question?
A. Employment coaching
B. Low cost health insurance
C. Worker’s Compensation
D. Adaptive transportation
C. Worker’s Compensation
The American with disabilities act of 1990, and mended 2008, states that it covered entity she will not discriminated against a qualified individual with a disability. This applies to job application procedures, hiring, advancement and discharged employees, Worker’s Compensation, and job training and other terms, conditions and privileges of employment. This gives similar protections against discrimination to individuals with disability as though stipulated in the civil rights at 1964, which may discrimination based on race, religion, sex, national origin and other characteristics of legal. Benefits such as insurance or transportation to work, need to be consistent with the company’s policy is for all employees and in accordance with state law. Public transportation does need to accommodate people with disabilities.
what is the mode of inheritance of spinal muscular atrophy?
A. Autosomal dominant
B. Autosomal recessive
C. sex-linked
D. Mitochondrial
B. autosomal recessive
spinal muscular atrophy (SMA) is an autosomal recessive disease characterized by degeneration of anterior horn cells of the spinal cord and brainstem motor nuclei with resultant muscle atrophy and progressive weakness. SMA has traditionally been classified into 3 categories by age of onset and highest level of motor function achieved. SMA is an autosomal recessive disorder, with ileal on chromosome 5q13, although his phenotypic variability results in part from the number of repeats of the SMN2 gene
which joint is most commonly affected in patients with juvenile idiopathic arthritis (JIA?)
A. Hip
B. Cervical spine
C. Knee
D. Wrist
C. Knee
Cervical spine involvement occurs more often in children with JIA in adults, but in the is the most commonly affected JIA.
bracing is recommended for adolescent scoliosis with curves between
A. 5-10°
B. 20-40°
C. 50-70°
D. 70-75
B. 20-40°
More than 90% adolescent scoliosis can be controlled effectively with bracing for curves between 20 and 40°. Bracing is recommended for curves over 20° in a skeletally immature patient in whom only 5-10° of progression has been noted over 6 month period. Brace wears discontinued in lieu of surgical intervention generally the curve exceeds 40° or more rapid reaction is noted. In neuromuscular scoliosis, while orthoses may improve trunk control in sitting posture, the less often slow curve progression and do not prevent the need
a 20-year-old male with Duchenne muscular dystrophy has an FEV1 of 20% predicted and end tidal CO2 of 58 mmHg, complains of breathlessness when speaking, daily headache and fatigue. What treatment would you recommend?
A. Flu and pneumonia vaccines, aggressive pulmonary toilet and improved positioning
B. Nocturnal BiPAP with CoughAssist during the day
C. Tracheostomy and ventilator
D. Daytime BiPAP/sip and puff withcough
D. Per DMD care guidelines, and daytime ventilation is indicated for:
- self extension of the nocturnal ventilation into waking hours
- Abnormal deglutition due to dyspnea, which is relieved by ventilatory assistance
- Inability to speak a full sentence without breathlessness and/or
- Symptoms of hypoventilation when awake, resting on SpO2 <95% and/or large were end tidal CO2 > 45 mmHg whenweek
a patient with myelomeningocele presents with low back pain, decreased lower limb strength, and increased spasticity. What is most likely diagnosis?
A. Urinary tract infection
B. Intracranial hemorrhage
C. Vertebral compression fracture
D. Tethered cord
D. Tethered cord
Tethered cord often occurs during growth spurts of adolescence, and presents with pain, weakness, change in bladder habits, and is in spasticity. Evaluation includes MRI and neurosurgical intracranial hemorrhage is not a commoncombination of MMC, although shunt malfunction can be. UTI should not cause decreased strength
What lower limb deformity in children with L4 spina bifida most likely to happen?
A. Equinas but
B. Cavus foot
C. Knee flexion contractures
D. Knee extension Contractures
D. Knee extension contracture
the knee extensors (quadriceps) are innervated at the L3-4 level, while the knee flexors (hamstrings)are innervated at the L5-S1 level. A child with L4 preserved level would have quadriceps muscles that work while hamstrings will either be weak or absent. Foot muscles are innervated at the L5 S2 levels. Equinas and cavus feet results from asymmetric pull of foot muscles which would be seen in levels of spina bifida L5 and distally
a 6-month-old with L5 spina bifida and shunted hydrocephalus presents to your clinic. On examination, you find that he is all hip flexion against gravity and his knee extension strength is at least 4 out of 5. The infant has ankle dorsiflexion but not plantar flexion. His feet are in neutral position. Hip examination is symmetric. What will most likely be this child’s primary means of mobility as he grows older?
A. Community ambulation without assistive device
B. Short distance household ambulation with a cane
C. Use of bilateral crutches for all mobility
D. Independent manual wheelchair mobility
A. Community ambulation without assistive device
This child has a strong quadriceps muscle and no deformities noted at 6 months of age. He is reported to be healthy. Sitting balance and neurologic level were good predictors of ambulation potential the best early predictor of ambulation children with spina bifida is a strong quadriceps muscle. Negative predictors are spine and lower extremity deformities and obesity. Children do not typically learn to use crutches until 3-5 years of age or older
in the newborn with severe pan-brachial plexopathy, wears a lesion located the results in Horner syndrome?
A. C5–6 nerve roots
B. Brainstem
C. C7 nerve root
D. C8–T1 nerve roots
D. C8–T1 nerve roots
Horner syndrome is associated with injury of the C8-T1nerve roots with injury of the superior cervical sympathetic ganglion. Horner syndrome is associated with more severe root avulsion injuries in a poor prognosis for spontaneous recovery
which Maternal factors associated with an increased risk of spina bifida?
A. Anticonvulsant medications in pregnancy
B. Upper socioeconomic class
C. Asian descent
D. Folic acid 4 mg a day prior to and during pregnancy
A. Anticonvulsant medications in pregnancy
The etiology of spina bifida is multifactorial. Both polygenic inheritance and environmental influences contribute. Several studies have shown that the incidence of spina bifida is reduced if food is fortified with folic acid or if mother take folic acid prior to conception and during pregnancy. Recommended doses of folic acid are 0.4 mg per dayin women who are not at high risk and 4 mg per day in women at high risk (eg, those with family history of spina bifida). Some studies have also implicated lower socioeconomic class and in utero exposure to anticonvulsant medication is being risk factors. Fetal alcohol syndrome has an association with increased risk for abnormal CNS development, including NTDs. NTDs very and prevalence, depending on race and ethnicity, with women of African-American and Asian descent having the lowest while the highest is noted among women of Hispanic ethnicity
which the following sports is most commonly associated with pediatric SCI?
A. Basketball
B. Soccer
C. American football
D. Ice skating
C. American football
the sports most commonly associated with SCI R American football, ice hockey, wrestling, diving, skiing, snowboarding, rugby, and cheerleading
as compared to children with severe traumatic brain injuries, children with severe anoxic encephalopathy are more likely to:
A. Regain consciousness
B. Have a longer survival time
C. Develop profound rigidity
D. Recover language skills
C. Develop profound rigidity
Compared to children with severe traumatic brain injury, children with severe anoxic encephalopathy demonstrate a worse outcome. They are less likely to regain consciousness, become ambulatory and also have shorter survival time and often have profound rigidity
a 5-year-old girl has spasticity in her legs and decreased fine motor coordination. She is ambulatory with orthosis and crutches. What would be the most likely finding on a magnetic resonance scan of her brain?
A. Periventricular leukomalacia
B. Parasagittal cerebral necrosis
C. Multifocal brain necrosis
D. Basal ganglia leukomalacia
A. Periventricular leukomalacia
PVL is commonly seen following intraventricular hemorrhage and preterm infants. It is characterized by bilateral White Matter necrosis adjacent to the lateral ventricles. This lesion causes the clinical picture of spastic diplegic cerebral palsythat is described question. Parasagittal cerebral injury and multifocal brain necrosis usually cause spastic tetraplegic CP. Neuronal injury within the basal ganglia results in choreoathetosis.
an 11-year-old boy with autism and speech impairment is referred to you for evaluation of limping for 2 months. You observe he is overweight and has Trendelenburg gait. He suspects he has slipped capital femoral epiphysis (SCFE). Which findings may be present in your clinical exam
A. Increased hip internal rotation
B. Increased hip flexion
C. Outgoing gait
D. Weakness at the hip extensors
C. Outgoing gait
SCFE quickly occurs in boys between age 12-16 years. The 2 most common features of presentation are pain and altered gait. External rotation of the leg is common with some shortening and antalgic, Trendelenburg gait. Physical examination demonstrates a loss of internal rotation, diminished flexion, shortening of the leg, and atrophy of the thigh if the symptoms have been long-standing.
