Certification QBank Pediatrics 1-30

Question 1

in children with traumatic spinal cord injury, tetraplegia it is more likely than paraplegia
A.  As a result of birth injury
B.  In children under 9 years of age
C.  In children with myelomeningocele
D.  In girls and boys

Answer 1

B. In children under 9 years of age
Due to the large head to body ratio of young children, type of injuries can be classified depending on the age:

0-8 years old:

• Paraplegia 30% ( incomplete 21%; complete 49%)
• Tetraplegia 70% ( incomplete 12%; complete 18%)

9-15 years old:

• Paraplegia 53% ( incomplete 19%; complete 28%)
• Tetraplegia 47% ( complete 29%; complete 24%)

The boy/girl ratio for birth to 3 years is equal, 48 years is 60:40, and 9-15 years is 70:30. 4 children 15 years in order, half the children are paraplegic in about half of them have complete lesions; the boy to girl ratio is 80:20

Question 2

Which of the following is a key feature for a bowel program in those with spina bifida?

a. restricting fluids
b. avoiding osmotic laxatives such as polyethylene glycol
c. a low-fiber diet
d. placing the suppositories on the rectal mucosa

Answer 2

D. Placing the suppositories on the rectal mucosa
Fluids are very important for her bowel program as is consistently using an osmotic laxative. Also important is a high fiber diet and making sure that the suppositories placed on the rectal mucosa

Question 3

clinical symptoms and signs of a tethered cord in a child with spina bifida include:
A.  Flaccid lower extremities
B.  Worsening scoliosis
C.  Abdominal pain
The.  Decline in shoulder strength

Answer 3

B. Worsening scoliosis
The most common clinical signs or symptoms of a tethered cord in a child with spina bifida include spasticity in the lower extremities, decline in lower extremity strength, and worsening scoliosis. Other signs and symptoms are strongly suggest tethering of spinal cord include back pain ( in about 20%), changes in urologic function,changes in gait, and development of lower extremity contractures

Question 4

what screening imaging studiesfor atlantoaxial instability (AAI) should be included in a sports participation physical for an asymptomatic child with Down syndrome?
A. Early lateral cervical spine x-rays
B. Magnetic resonance imaging of cervical spine
C. Initial neutral, flexion, and extension cervical spine x-rays
The. Cervical spine CT in neutral and flexion

Answer 4

C. Initial neutral, flexion, and extension cervical spine x-rays
Initial screening neutral, flexion, and extension cervical spine films are recommended in the United States to assess for AAI since it is common (13-14%) in Downs. An anterior atlantodens interval (ADI) of greater than 3.5 mmrepresents instability and recommendation to avoid sports with potential neck flexion/extension is warranted. Repeating films yearly is not necessary at stability over time has been demonstrated CT or MRI are not needed as screening tools but are utilized to work up t asymptomatic individual

Question 5

what is the most common congenital musculoskeletal deformity associated with myelomeningocele?
A.  Hip contracture
B.  Spinal's kyphosis
C.  Equina varus foot
E.  Acetabular dysplasia

Answer 5

C. Equina varus foot
Musculoskeletal deformity is correlated in general with neurologic level. Kyphosis is generally seen with thoracic level lesions, hip abnormalities with lumbar lesions, and equina varus with nearly all levels

Question 6

1 month old boy exhibits generalized hypotonia and weakness.  Which are the following should be included in the differential diagnosis
A.  Lumbosacral myelomeningocele
B.  Duchenne muscular dystrophy
C.  Spinal muscular atrophy 
D.  Neuroblastoma

Answer 6

2. Spinal muscular atrophy
   Myelomeningocele usually involves weakness of the legs, but not generalized hypotonia. Duchenne muscular dystrophy usually presents after age 2 years with weakness, but attainment of motor milestones is usually normal to mildly delayed. Neuroblastoma may present with leg paralysis but not generalized hypotonia. The differential diagnosis of generalized hypotonia and weakness in an infant should include brain pathology ( severe encephalopathy), proximal spinal cord disorders ( spinal cord injury or spinal muscular atrophy), and myopathy

Question 7

which doing complication is frequently seen with brachial plexus palsy
A. Elbow extension contracture
B. Anterior shoulder subluxation
C. Posterior shoulder subluxation
D. Shoulder external rotation contracture

Answer 7

C. Posterior shoulder subluxation
Glenoid dysplasia with posterior shoulder subluxation is frequently a complication of children after birth brachial plexus palsy-

Question 8

what is the normal bladder capacity 42-year-old?
A.  2 ounces
B.  3 ounces
C.  4 ounces
D.  5 ounces

Answer 8

C. 4 ounces
Bladder capacity in children is based on the Berger equation –age in years +2 equals bladder capacity in ounces up until around age 12 years when the bladder capacity equals an adult size. If the detrusor muscle is all reactive and can overcome the pressure of the external sphincter, then you likely have a small capacity bladder. If the external sphincter is open, you also likely have a small capacity bladder less you have a flaccid bladder

Question 9

2 siblings, ages 13 and 11, come to clinic after recent diagnosis of limb girdle muscular dystrophy, although the subtype has not been clarified. As part of initial evaluation and management, you recommend:
A. Eccentric strength training to improve strength
B. Cardiac and pulmonary evaluation
C. Initiation of gene therapy
D. Muscle biopsy to confirm subtype

Answer 9

B. Eccentric strength training may be counterproductive or even dangerous if it triggers rhabdomyolysis. Jean and myeloblast transfer therapy or in research only and not considered treatments. Subtype is confirmed with genetic testing and muscle biopsy is generally not necessary

Question 10

what other requirements to obtain a driver's license for an individual with cerebral palsy?
A.  On an adaptive vehicle
B.  Be seizure free for 15 months
C.  Complete a driving evaluation
D.  Meade federal driving requirements

Answer 10

C. complete a driving evaluation

Seizure control varies from state to state from 3-12 months. There are no federal requirements.

Question 11

what supplement can reduce risk of myelomeningocele
A.  Creatine
B.  Folate
C.  Iron
D.  Vitamin B1

Answer 11

B. Folate

Fortification of flowers with folate has helped bring down the incidence of myelomeningocele over the last 20 years

Question 12

a 12-year-old with severe brain injury is admitted as a result of a car versus bicycle collision. Which of the following statement is true regarding prognosis?
A. Longer length of coma is a negative predictor of outcome
B. Time until able to follow commands does not predict general functional outcome
C. The number of lesions on MRI does not correlate with severity and functional outcome
D. Emergence of agitation predicts poor prognosis for recovery

Answer 12

A. Longer length of coma is a negative predictor of outcome
the longer a child remains in coma, the worse the prognosis. Similarly, the sooner the child can follow commands, the better the outlook. Number and volume of MRI lesions does correlate with severity and a worse outcome. Agitation is often a sign of progression to the Rancho Los Amigos scale

Question 13

3-year-old male presents with toe walking and elevated transaminases. What additional physical exam findings is most likely?
A. Calf pseudohypertrophy
B. Stork-like appearance of legs and high arched feet
C. Dysmorphic facial features with absent philtrum
D. Hypertonicity, abnormal involuntary movement and cognitive

Answer 13

A. Calf pseudohypertrophy
Elevated transaminases are frequently found incidentally in boys with Duchenne muscular dystrophy, and should lead to check of CK and complete functional and physical evaluation. Stork-like appearance of legs and high arches are consistent with Charcot-Marie-Tooth disease. Dysmorphic facial features with absent philtrum is suggestive of fetal alcohol syndrome. Hypertonicity and involuntary movements or features of cerebral palsy which generally does not present with laboratory abnormalities

Question 14

strength and circuit training studies of children with cerebral palsy have demonstrated
A. No long-lasting benefits
B. Increase strength by 20% to 70%
C. Walking distance is improved
D. Aerobic power similar to typically developing children

Answer 14

B. Increase strength by 20-70%
1 study of children with cerebral palsy showed that weekly training resulted in an increase of 35% and peak aerobic power. Other studies of strength and circuit training in children with CP have shown that by weekly training improves muscle imbalances, increase his strength 20-70%, and leads to increase in walking speed, and that the results are long-lasting. GMFCS I and II subjects were shown to have aerobic measurements significantly below those of their typically developing peers

Question 15

a 6-month-old boy with right Erb's palsy comes for follow-up.  His right upper extremity passive range of motion is within normal limits.  The right hand is slightly smaller than his left.  He is not able to bring his right hand to his mouth and also has weak wrist extension.  Based on exam, you recommend which the following treatment plans?
A.  Occupational therapy
B.  Wrist hand orthosis
C.  Home stretching exercise
D.  Surgical referral

Answer 15

D. Surgical referral
Patients with Erb’s palsy who had surgery at 6 months to better than those who spontaneously recovered elbow flexion at 5 months. Surgical intervention is commonly recommended for those having less than antigravity strength in elbow flexion at 6 months of age

Question 16

an 8-year-old on the inpatient rehab service is undergoing chemotherapy for medulloblastoma. Which statement regarding this patient’s care is true?
A. They should not engage in therapy if the count is under 100,000
B. Spasticity medications are best given systemically rather than by local injection
C. School support should be put on hold until the child is near to discharge
D. It is best to avoid ultrasound and heat modalities in proximity to the tumor or an diffuse metastatic disease

Answer 16

D. Avoid ultrasound near the tumor
All therapy should be held when platelets dip below 20,000.local injections are preferred over the potentially sedative effects of systemic medication for spasticity. School and educational supports to begin as early as possible

Question 17

compared to Duchenne muscular dystrophy, patients with spinal muscular atrophy type 1 have:
A.  Earlier onset scoliosis
B.  Fewer hip issues
C.  Greater benefit from steroid therapy
D.  Lower intellectual ability

Answer 17

A. Earlier onset scoliosis
Children with SMA are more likely to develop scoliosis at a younger age. They are also more likely to have hip problems in patients with Duchenne muscular dystrophy. There is no role for steroids in the treatment of SMA. Patients with Duchenne often have intellectual disability along with challenges and social pragmatics whereas patients with SMA typically have above average IQ

Question 18

what factor directly influences a teen with spina bifida, who ambulated as a child, to discontinue walking?
A.  Reduced upper extremity strength
B.  Metabolic syndrome
C. peer pressure
D.  Fatigue

Answer 18

D. Fatigue
When energy costs of daily activities for children with and without spina bifida are compared, ambulator’s with spina bifida consume more energy per task and tend towards early fatigue. the metabolic syndrome as well described for children with spina bifida but is not the reason children discontinue walking. Cessation of gait may contribute to the metabolic syndrome

Question 19

how should the hand of a child with juvenile rheumatoid arthritis he positioned?
A. Wrist in 0° extension, MCP joints and 25° of flexion, thumb in opposition
B. Wrist in 0° extension, MCP joint in neutral, thumb in 10° of extension
C. Wrist in 15° of extension, MCP joints in neutral, thumb in neutral position
D. Wrist in 15° of extension, MCP joints and 25° of flexion, thumb in opposition

Answer 19

D. Wrist in 15° of extension, MCP 25° of flexion, thumb in opposition
This provides support for weakend structures and helps to reduce contractures

Question 20

which reflex is helpful to assess a 2 week old baby with suspected Erb’s palsy?
A. Fingers flexed when the palm is touched
B. Shoulder abduction followed by elbows flexion when the neck is suddenly extended
C. Infant extending his arms when he is held in a sitting position
D. Infant outstretches arms and legs symmetrically when his body is moved abruptly headfirst in downward direction

Answer 20

B. Moro reflex shows shoulder abduction and elbow flexion. It is a valuable aid in assessing those active movements for patients with upper plexus involvement. Grasp reflex (a) is not affected and upper plexus lesions. Propping (c) and parachute (d) reflexes do not appear at 2 weeks of age

Question 21

Which statement is true regarding clubfoot (also known as talipes equinovarus)?
A. Is 1 of the most common and treatable birth defects
B. It is birth defect and leads to sensory deficits in adulthood
C. It is difficult to diagnose in utero by ultrasound
D. It is characterized by foot that is generally in hindfoot valgus

Answer 21

A.
clubfoot is 1 of the most common and treatable birth defects that can often lead to near normal athletic activities later in life. Persistent deformity into adulthood can result in unstable ankles, lateral sprains, and difficulty with weightbearing and other gross motor tasks. The foot is generally in equinus, with forefoot and hindfoot varus and severe adduction

Question 22

in children with spina bifida, what is the primary goal of neurogenic bladder management?
A. Preserved the kidneys and renal function
B. Treat all bacteriuria
C. Maintain stable bladder size throughout development
D. Have a post void residual of 0

Answer 22

A. Preserved kidneys and renal function

Post-void residual of 10-20% is acceptable

Question 23

a 5-year-old with spastic diplegic cerebral palsy presents with asymmetric gait, positive Galleazzi sign with limb shortening, decreased hip abduction and decreased knee extension on the left or to the right.  what is the cause of these abnormalities?
A.  Worsening scoliosis
B.  Hamstring tightness
C.  Hip subluxation
D.  Ankle contracture

Answer 23

C. Hip Subluxation
The Galleazzi sign refers to the comparison of knee height. Asymmetric knee heights with the hips flexed imply hip subluxation on the apparently shorter side. Subluxation is common in cerebral palsy and is often suspected on examination when there is to abduction and shorter knee height. Diagnosis is made with radiographs in children and by ultrasound in infants under the age of 6 months

Question 24

what is the primary goal of treatment with orthotic bracing for scoliosis from neuromuscular disease?
A. Improve sitting posture in wheelchair
B. Rest spinal curve progression
C. Improved respiratory function
D. Decreased falls and ambulatory patients

Answer 24

A. Improve sitting posture in wheelchair

Scoliosis in neuromuscular disease is very common and can begin early and progress quickly. Neuromuscular curve progression is really slowed by bracing. Orthoses may be beneficial because they can stabilize a week trunk, and improve sitting posture in those using wheelchairs. Bracing may cause instability for ambulatory patients however, increasing the risk for falls. Rigid spinal bracing has a negative effect on vital passively

Question 25

an adolescent soccer player is seen 3 days effort concussion with persistent but improving headache and poor activity tolerance. The neurologic exam is normal except for mild balance derangement. What is the next best step in care?
A. Order brain MRI
B. Referral for vestibular testing
C. Prescribed oxycodone for headache and sleep
D. Reassurance and return to play and learning protocols

Answer 25

D.
Most children (~80%) with concussion are back to baseline within 2-3 weeks.  Common symptoms include headache, poor activity tolerance, fatigue, and disrupted balance.  A trajectory of early improvement with a nearly normal neurologic exam is to be expected, and further imaging and referrals are not necessary at this time.  Use of opiate medications is relatively contraindicated in concussion for teenagers with mild traumatic brain injury

Question 26

to reduce the risk for neural tube defects such as spina bifida, daily folic acid supplementation
A. Should begin after positive urine pregnancy test
B. Is recommended for all women of childbearing age
C. Is adequately supplied by eating a low carbohydrate, organic diet
D. Should be given at doublethe recommended dose for high risk women

Answer 26

B. Is recommended for all women of childbearing age
Up to 50% of pregnancies are unplanned.neural tube closure occurs during the first 4 weeks of gestation. High risk mom’s ( personal or family history of neural tube defects or seizure meds) should be given 10x dosing (4-8 mg/day). Folate deficiency is associated with a low carbohydrate diet. organic diets are not regulatedin terms of folic acid fortification

Question 27

a 16-year-old boy presents with isolated right hand weakness.  4 months ago, he sustained a laceration to his right forearm that required subsequent suture repair.  Physical exam reveals normal wrist and finger flexion and normal sensation.  With wrist extension he demonstrates obligatory radial deviation weakness on strength testing.  He is also unable to extend his fourth and fifth digits.  Froment's test is negative.  A lesion of which nerve is most likely?
A.  Ulnar nerve injury at the forearm
B.  Posterior interosseous nerve injury
C.  Anterior interosseous nerve injury
D.  Superficial radial nerve

Answer 27

B. Posterior interosseous nerve injury

Posterior interosseous nerve innervates supinator, extensor digitorum communis, extensor digiti minimi, abductor pollicis longus, extensor pollicis longus and brevis, and extensor indicis propius. The right hand displays wrist extension with radial deviation because the extensor carpi ulnaris muscle is absent. Partial paralysis of the posterior interosseous nerve may produce a pseudo-clawhand with decreased ability to extend the fourth and fifth digit. Preservation of sensation indicates sparing superficial radial, ulnar, and median sensory nerves. No weakness of thumb and finger flexion can rule out anterior interosseous nerve injury.

Question 28

select the risk factor that is associated with development of venous thromboembolism (VTE) in a child with TBI
A. TBI due to nonaccidental trauma
B. Presence of an intracranial pressure monitor
C. Prepuberal status, age less than 10
D. Need for inpatient rehabilitation

Answer 28

A. TBI due to non-accident
VTE is about 4 times more likely and hospitalized pediatric patients with TBI versus medical. Increased risk associated with older age, venous catheterization, mechanical ventilation, tracheostomy, nonaccidental trauma, increase length of stay, orthopedic surgery, and cranial surgery

Question 29

which intervention has a direct effect on osteoblast and osteoclast activity to reduce bone mineral density?
A.  Phenytoin
B.  Phenobarbital
C.  Carbamazepine
D.  Gabapentin

Answer 29

8. Phenytoin
   Liver induction with increased breakdown of vitamin D, impaired calcium release from bone, but decreased intestinal absorption caused by vitamin D deficiency may contribute. Medications such as phenobarbital and carbamazepine may upregulated liver enzymes being to vitamin D deficiency. Osteoporosis may be caused by a direct effect on phenytoin on osteclasts and osteoblasts. A ketogenic diet may decrease bone mineral density by leaching calcium from bone

Question 30

successful transition from adolescent to adult health care for persons with disability generally requires:
A. Predetermined age of transition
B. Insurance independent of parents
C. Communication between health care providers
D. Moving to a community group home

Answer 30

C. Communication