Pediatric Musculoskeletal Interventions Chapter 6 Test Bank

Chapter 06. Musculoskeletal System: Consideration and Interventions for Specific Pediatric Pathologies

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Select the most accurate statement about exercise and children.
   1. Children with Duchenne muscular dystrophy should participate in intense regular exercise to improve muscle bulk and slow the progression of the disease.
   2. Children with juvenile idiopathic arthritis should only perform non–weight-bearing exercises to avoid increasing joint pain.
   3. Children with cerebral palsy typically have poor aerobic and muscular endurance.
   4. Children with Ehlers-Danlos syndrome should not participate in sports due to risk of joint damage.
2. Select the correct statement regarding Duchenne muscular dystrophy (DMD). Children with DMD:
   1. develop hypertrophy of the gastrocnemius as a method to compensate for progressive weakness.
   2. should avoid resistive activities and eccentric contractions because they can cause further muscle breakdown.
   3. require use of ankle-foot orthoses to maintain walking past 12 years of age.
   4. will not get muscle contractures if parents perform passive stretches weekly.
3. A unilateral limitation in hip abduction could be an indication of all of the following except:
   1. developmental hip dysplasia.
   2. slipped capital femoral epiphysis.
   3. Legg-Calvé-Perthes disease.
   4. spinal muscular atrophy.
4. Children with cerebral palsy
   1. commonly retain neonatal levels of hip retroversion
   2. have atypical muscle composition so strengthening is not advocated
   3. have a higher incidence of scoliosis than the general population
   4. characteristically have intellectual disabilities
5. Select the correct statement regarding congenital muscular torticollis.
   1. It can be associated with developmental dysplasia of the hip.
   2. The muscle tightness will spontaneously resolve by 12 months of age.
   3. It is characterized by tightness of the sternocleidomastoid muscle resulting in decreased lateral flexion and rotation to the same side.
   4. Torticollis is caused by prematurity.
6. Arthrogryposis:
   1. is characterized by an asymmetrical pattern of contractures and joint involvement.
   2. typically has associated cognitive impairments.
   3. may be related to a lack of fetal movement.
   4. is a progressive disorder.
7. Which of the following disorders can cause fractures early in life, and children younger than 3 are typically investigated for child abuse?
   1. Osteogenesis imperfecta
   2. Cerebral palsy
   3. Legg-Calvé-Perthes
   4. Juvenile idiopathic arthritis
8. Children with juvenile idiopathic arthritis in their hips:
   1. exacerbate their symptoms with exercise.
   2. should lie in prone every day.
   3. have lifelong joint inflammation.
   4. should use a wheelchair as their main means of mobility.
9. Which of the following is an unlikely cause of a leg length discrepancy?
   1. Inflammatory hyperemia
   2. Hemimelia
   3. Joint contracture
   4. Stress fracture of bone diaphysis
10. Which of the following conditions is unlikely to present with toe-walking?
    1. Cerebral palsy
    2. Duchenne muscular dystrophy
    3. Idiopathic toe walking
    4. Down syndrome
11. Moderate exercise for children with juvenile idiopathic arthritis usually leads to
    1. increased joint pain.
    2. increased joint inflammation.
    3. improved fitness.
    4. increased joint bleeds.
12. Children with Duchenne muscular dystrophy present with all of the following except:
    1. increased base of support, lateral trunk sway, and toe-walking during the late ambulatory stage.
    2. loss of upper extremity function, scoliosis, and contractures during the late ambulatory stage.
    3. increased lumbar lordosis and weakness in the hip extensors and ankle dorsiflexors.
    4. rapid loss of ambulation ability typically by age 7 years.
13. Why should children with arthrogryposis be evaluated for an early intervention program?
    1. Arthrogryposis is generally associated with intellectual impairment.
    2. Arthrogryposis is a progressive, debilitating condition.
    3. Weakness and contractures at birth may delay motor milestone acquisition and lead to disuse weakness.
    4. Physical therapy intervention can correct the deformities.
14. Young boys having Duchenne muscular dystrophy tend to use the Gower maneuver to rise from the floor because of weakness in:
    1. knee extensors and flexors.
    2. hip extensors and flexors.
    3. distal leg musculature.
    4. upper extremity musculature.
15. Pseudohypertrophy is commonly seen in children with:
    1. Duchenne muscular dystrophy.
    2. Ehlers-Danlos syndrome.
    3. Juvenile idiopathic arthritis.
    4. Blount disease.
16. Methods to promote bone mineralization include all of the following except:
    1. impact exercise.
    2. weight-bearing exercise.
    3. upright standing frames.
    4. running.
    5. swimming.
17. What diagnosis is characterized by abnormal collagen synthesis leading to skin hyperextensibility, ligamentous laxity, tissue fragility, delayed wound healing, atrophic scarring, and easy bruising and bleeding?
    1. Arthrogryposis
    2. Osteogenesis imperfecta
    3. Ehlers-Danlos syndrome
    4. Duchenne muscular dystrophy
18. Recommended recreational activities for children with Ehlers-Danlos syndrome include all of the following except:
    1. swimming.
    2. cycling.
    3. dance.
    4. tennis.
    5. lacrosse.
19. A 6-year-old child presents to therapy with joint pain and swelling in six joints. The family reports the child had a fever for 3 weeks and a faint rash following the fever. After this time, the child was reported to have abdominal pain, anemia, liver enlargement, and swollen glands. What diagnosis might the therapist suspect?
    1. Systemic-onset juvenile idiopathic arthritis
    2. Ehlers-Danlos syndrome
    3. Osteogenesis imperfecta
    4. Oligoarthritis
    5. Polyarticular juvenile idiopathic arthritis
20. Common musculoskeletal comorbidities of JIA include all of the following except:
    1. foot deformities.
    2. muscle hyperextensibility.
    3. leg length discrepancy.
    4. TMJ dysfunction.
    5. muscle wasting.
21. Salter-Harris type II would be classified as:
    1. a fracture that does not completely cross the epiphysis.
    2. a fracture that extends through the epiphyseal border.
    3. a crushing injury to the bone.
    4. a tendon injury with partial separation from the bone.
22. A 12-year-old female patient presents to outpatient therapy with a diagnosis of scoliosis. Her family history indicates that her mother and aunt both also had scoliosis diagnosed at about the same age. Based on this limited information, what classification of scoliosis would this patient present with?
    1. Infantile scoliosis
    2. Juvenile scoliosis
    3. Adolescent scoliosis
    4. Postural scoliosis
23. A 5-year-old child presents to physical therapy due to outward bowing of the lower extremities. The child is obese, and his parents report limited physical activity. Which diagnosis would describe this presentation?
    1. Slipped capital femoral epiphysis
    2. Legg-Calve-Perthes
    3. Blount disease
    4. Congenital talipes equinovarus
24. A therapist is treating a child who presents with idiopathic toe walking in an outpatient clinic. After completing ROM testing, the therapist documents bilateral dorsiflexion range of motion with the knee extended to 5 degrees less than a neutral alignment. Based on this presentation, the therapist should select which treatment strategy?
    1. Serial casting
    2. Night splinting and stretching
    3. Stretching and use of an AFO
    4. Stretching only
25. Erb palsy is characterized as damage to the brachial plexus involving nerve roots for:
    1. C1–C5.
    2. C5–C6.
    3. C5–T1.
    4. C8–T1.
26. Why is systematic JRA considered one of the most debilitating types of JIA?
27. The increased chance of macrophage activation syndrome (MAS)
28. The high number of joints that are involved
29. The short duration of the disease
30. It is the least painful type of JIA
31. Persistent oligoarthritis is prevalent in which distribution?
    1. Less prevalent in males than females
    2. Equally prevalent in males and females
    3. More prevalent in males than in females
    4. More prevalent in males before the age of 6
32. Individuals with JIA may benefit from participating in which activity to best protect their joints from unnecessary stress and still remain active?
    1. Gymnastics
    2. Swimming
    3. Basketball
    4. Bowling
33. Which would be the best option to promote bone mineralization of the lower extremity for a child with cerebral palsy?
    1. Assisted cycling on an exercise bike
    2. Assisted swimming
    3. Standing program, encouraging lower extremity weight-bearing
    4. Bench press activities
34. For an 8-year-old child with GMFCS Level I spastic hemiplegia, which is the best means of providing a stretch in the child’s gastrocnemius musculature?
    1. Wear a night stretching AFO
    2. Wear a night stretching AFO with a knee immobilizer
    3. Daily participation in calf stretches against a wall
    4. PROM by the child’s caregiver

True/False

Identify whether the statement is true or false.

1. For children with spasticity, stretching to increase range of motion and reduce spasticity should be complete 2 to 3 times per day for 3 repetitions with 30-second holds for each muscle group.
2. Most children with mild osteogenesis imperfecta walk by the age of 2 years.
3. In 90% of the surviving children with arthrogryposis multiplex congenita, all four extremities are involved with symmetrical distribution of multiple joints.
4. The incidence of congenital muscular torticollis in infants is greater than that of congenital hip dysplasia.
5. Literature varies on the incidence of familial toe walking, with estimates of a genetic component ranging between 30% and 42% of children with idiopathic toe walking.

Short Answer

1. Name two pediatric diagnoses where limitation in range of motion is a common characteristic.
2. Name two diagnoses where heightened reaction to trauma is common.
3. Which type of juvenile idiopathic arthritis involves the most joints and is the most debilitating?
4. Identify two special tests that assist with diagnosing developmental hip dysplasia.

Check All That Apply

Select all answers that are correct.

1. Recommended treatment considerations for infants with hip dysplasia include:
   1. avoidance of positions of extreme or forceful extension.
   2. promotion of swaddling.
   3. periodic monitoring using ultrasound or radiograph.
2. For infants with congenital muscular torticollis, the following are important focus areas of these evaluations. Choose all that apply.
   1. Neck passive and active range of motion
   2. Symmetrical movement development
   3. Environmental adaptations, caregiver education
   4. Differential diagnoses including Sandifer syndrome, DDH, GERD, eye muscle weakness, neurological conditions such as brachial plexus, and so on
3. Clinical features of all three types of SMA include:
   1. Limb and trunk weakness
   2. Muscle atrophy being more pronounced proximally and in the lower extremities
   3. Hypertonia
   4. Soft tissue contractures
   5. Hip subluxation
   6. Scoliosis

Chapter 06