Pediatric rehab 2001-2009

9. The most useful clinical criterion to distinguish Becker muscular dystrophy from Duchenne
muscular dystrophy is(a) creatine kinase values at the time of diagnosis.(b) walking ability
during the teen-age years.(c) Gowers sign and calf enlargement.(d) age at onset of diagnosis
9. (b) The most useful clinical criterion to distinguish Becker muscular dystrophy (BMD) from
Duchenne muscular dystrophy (DMD) is the continued ability of the patient to walk into late
teen-age years
.Persons with BMD will typically remain ambulatory beyond 16 years. Outlier DMD cases
generally stop ambulating between 13 and 16 years of age. Creatine kinase values cannot be used
to differentiate DMD from BMD. Calf enlargement and the presence of Gowers’ sign are
anonspecific findings. Studies have shown significant overlap in the observed age at onset
betweenDMD and BMD.
169. In which type of cerebral palsy is a seizure disordermost commonly seen?(a) Tetraplegia(b)
Diplegia(c) Athetosis(d) Hemiplegia
169. (d)Approx. 70% of children with hemiplegia have seizures.About 50% of children with
tetraplegic cerebral palsy haveseizures.Seizures are rare in children with diplegia or athetosis.
Remember:

Cerebral palsies
•
Intrauterine stroke --> hemiplegic
•
Intraventricular hemorrhage --> spastic diplegic
•
Neonatal hyperbilirubinemia --> athetosis
•
Birth asphyxia --> spastic quadriplegic

179. A 1-year-old child with a midlength transfemoral limb deficiency presents for prosthetic
management. Which component should be in the prosthetic prescription?(a) Socket with a
growth liner(b) Single action knee joint(c) Vertical shock pylon(d) Dynamic foot
179. (a)The 1-year-old child should be fit with a simple prosthesis which suspends securely and
allows for growth. The knee joint should be added between 3 and 5 years. The SACH foot is
most commonly prescribed because of its simple design and durability. SACH = solid ankle
cushion heel All prostheses for growing children should incorporate a removable growth liner in
the socket
99. A normal 6-month-old infant may demonstrate which reflex?(a) Rooting(b) Automatic
walking(c) Plantar grasp(d) Posterior protective extension
99. A normal 6-month-old infant may demonstrate which reflex?(a) Rooting(b) Automatic
walking(c) Plantar grasp(d) Posterior protective extension
Sunday, January 17, 2010

99. (c) Rooting andautomatic walking reflexes are present at birth, and areintegrated by 4 months
of age. Posterior protective extension does not appear until 7 to 8 months of age. Plantar grasp is
present at birth and not integrated until after independent walkingoccurs at approximately 12
months of age.
Reflex Age of Emergence Age of Suppression (or Integration)
Moro Birth 4–6 monthsRooting Birth 4 monthsAsymmetric tonic neckreflex (ATNR) 1–3
months 6–7 monthsPlantar grasp Birth 12–14 months–ie, when walking wellAutomatic walking
Birth 3–4 monthsPosterior protectiveExtension 7–8 months

109. Which statement is TRUE about swallowing in infants?(a) Sucking and swallowing are
well-coordinated for oral intake by 34weeks of gestation.(b) The infant’s larynx is low, about the
level of the sixth cervical vertebra.(c) The infantʼs tongue fills less of the oral cavity than the adult
ʼs tongue.(d) Oral breathing occurs at birth and may interfere with sucking.
109. (a) Sucking and swallowing are well-coordinated at 34 weeksʼ gestation.Because the infant
ʼs tongue is more anterior than the adultʼs, the tongue fillsmore of the oral cavity than in the
adult.The larynx in the infant is high, about at the C2–3 level.Newborn infants are obligate nose
breathers and oral breathing is notobserved until 3 to 4 months of age.

109. Disorders of executive functioning are common in children after severetraumatic brain
injury.Which sign indicates problems of executive function?(a) Low intelligence quotient(b)
Attention and memory problems(c) Aphasia(d) Agitation

129. What is a reasonable long-term rehabilitation goal for a 6-year-oldchild with a C6 ASIA class Aspinal cord
injury?(a) Independent lower extremity dressing(b) Bed mobility(c) Independent bathing(d)
Independent feeding

129. (d) A child with C6 ASIA class A spinal cord injury would beexpected ultimately to
independentlyself-feed, but not bathe, do lower extremity dressing, or perform bedmobility.
Note:
A C6 pt would have forearm extensors (C6) for tenodesis action to graspa utensil, and
biceps/deltoid fxn to bring the food to the mouth.
79.(a)The lack of coughing in a patient with neurologic impairment whenpresented with food may
mean a normal swallow, but is more likely tomean silent aspiration. A normal videofluoroscopic
swallowing study isunlikely in a patient with a TBI who is drooling and hoarse. Hoarsenessmay
be a sign of reflux, but in a child with a TBI is more likely to meanvocal cord abnormality

139. A 3-year-old child has a high thoracic spinal cord injury. At age 10,which of the following is the most
likely complication?(a) Severe lordosis without scoliosis(b) Scoliosis requiring surgical
treatment(c) Deep venous thrombosis(d) Heterotopic ossification
139.(b)Children who sustain cervical or high thoracic spinal cord injuries at anearly age are at
high risk of developing progressive scoliosis thatrequires surgical management.

149. The most common congenital limb deficiency is(a) right transtibial limb deletion.(b) right
transradial limb deletion.(c) left transtibial limb deletion.(d) left transradial limb deletion.