Pediatrics and Research BOARD REVIEW. Question. On examination, a 3-month-old girl still has a Moro reflex, asymmetric tonic neck reflex, and plantar grasp reflex. She does not have any protective extension. You advise her parents that (a) further diagnostic evaluation is indicated.
(d) Children with cerebral palsy often have weakness as part of their disorder. Treatments such as bracing, tendon lengthening or transfers, and medications such as botulinum toxin or intrathecal baclofen add to this weakness. Strengthening programs or functional training programs can help to strengthen weak muscles.
The most useful clinical criterion to distinguish Becker muscular dystrophy from Duchenne
muscular dystrophy is ?
The leading cause of childhood disability is
The most common complication after amputation in the immature child is
A parent of an 18-month-old child reports that the child babbled as an infant but became much quieter after about 8 months of age. She has no true words, though she will wave bye-bye. She follows no verbal commands but will follow occasional pantomime commands. Her gross and fine motor skills have been normal. The most likely diagnosis is ?
The most severe form of mental retardation in cerebral palsy occurs in association with
A 7-year-old boy is referred for evaluation and management of gradually progressive pain located in the right medial thigh and knee, a limp, and limited painful hip motion. There was a similar episode 3 months before which resolved spontaneously. Of the following conditions, the most likely diagnosis is
In evaluating a hypotonic infant with electromyography you find low-amplitude, short-duration motor units with early recruitment. Based on these findings, the LEAST likely diagnosis would be
Which reflex is typically NOT seen in a normal 4-month-old infant?
Which statement is true regarding spinal cord injury without obvious radiologic abnormality in children?
Acquired subluxation or dislocation of the hips in spastic cerebral palsy is usually due to muscular imbalance and pull of the
Your 15-year-old patient with Duchenne muscular dystrophy complains of new onset morning headaches. What is the most likely cause?
Which insult is the most likely cause of spastic diplegic cerebral palsy?
A 6-month-old child presents in your office for rehabilitation assessment. She was born at full term. There was mild transient respiratory distress at birth. The patient was noted to be diffusely hypotonic at birth except for normal cranial nerves. There were no feeding issues once the respiratory distress resolved within 24 hours. The baby has remained relatively hypotonic since birth. However, she has become very socially alert and aware and attempts to use her arms to reach for toys and pick up lightweight objects. She doesn’t roll. She cannot sit except very briefly when propped and bearing weight through both arms with elbows extended. On examination, head circumference is normal, length is normal, as is weight. There is a pronounced head lag. Arms, while in the supine position, maintain a “jug-handle” posture. Reflexes are present but dimished There is no spasticity. The cranial nerves are normal except for fine fasciculations of the tongue.The most likely diagnosis is
What is the most common cause of traumatic brain injury in a child under the age of 1 year?
Secondary injury in pediatric brain trauma is caused by
To prevent contractures, which position is the correct placement for children with major burns?
Bracing for curves developing after age 3, but before puberty onset (juvenile idiopathic scoliosis) should commence when the curve reaches approximately how many degrees?
In children with spastic cerebral palsy, which intervention strengthens weak muscles?
One of your 4-year-old patients exhibits the following characteristics: distress over minor changes in environment, echolalia, lack of awareness of the existence of feelings in others, nonparticipation in simple games. The most likely diagnosis is
symptomatology roughly correlates with scan findings. Virtually all patients in whom a substantial portion of the brain is radiated complain of memory loss and attentional deficits.
A 17-year-old boy from India presents with a longstanding history of areflexia and asymmetric muscular atrophy after a febrile illness as a child. The likeliest site of neurologic pathology is
Which finding is normal in newborn infants?
Which measure is the first sign of respiratory muscle dysfunction in boys with Duchenne muscular dystrophy?
A 10-year-old child with L4-5 myelodysplasia and shunted hydrocephalus develops spasticity in her legs. The most likely cause of this spasticity is
Juvenile rheumatoid arthritis (JRA) differs from adult onset rheumatoid arthritis: in JRA
Children with which physical disorder tend to have higher verbal skills compared to overall cognitive ability?
A 5-year-old boy is brought to your office with pain in his left groin for the last 2 months. He has an antalgic gait and favors his left leg. He has been unable to play with his siblings because of pain and reports increased severity of the pain at night. There is no history of trauma. Passive range of motion of the left hip is extremely painful. Which of the following is most likely?
What condition casues the typical “myopathic gait” seen in a young boy with Duchenne muscular dystrophy with accentuated lumbar lordosis and toe walking?
The most common spinal problem seen with achondroplasia during childhood is
What is the pathophysiology of Duchenne muscular dystrophy?
Your 6-month-old patient had burns to his head and both arms in a house fire. What approximate percent of his total body surface area (TBSA) was burned?
Which joints are most commonly involved in juvenile rheumatoid arthritis?
temporomandibular and hip 50% each. The shoulder is involved about 8% of the time in early JRA and about 33% later.
You are asked to evaluate an 8-month-old child with developmental delay. On exam you find low tone, but brisk deep tendon reflexes at the knees and biceps, full passive range of motion, and poor head and trunk control. This child’s diagnosis is likely
Which endocrine abnormality is most likely to occur 5 years after severe traumatic brain injury in a 2-year-old girl?
What percentage of American children with myelomeningocele requires a shunt to manage hydrocephalus?
A 16-year-old with Duchenne muscular dystrophy presents to your office with a 3-month history of worsening shortness of breath and pressure-like chest pain. His pulmonary function testing has not changed significantly. The most likely cause for his complaints is
A normal 6-month-old infant may demonstrate which reflex?
Which statement is TRUE about swallowing in infants?
You are performing a consult on an 8-year-old child who has sustained a traumatic brain injury. The child has hyperthermia, hypertension, tachycardia, and rigidity. The best management for this child would be
The Education for All Handicapped Children Act (EHA, PL 94-142), passed in 1976, and the Individuals with Disabilities Education Act (IDEA, PL 105-17), passed in 1997, guarantee that children with disabilities have
catheterization) but do not require medical care be provided.
Randomized controlled trials examining intrathecal baclofen (ITB) use in children with cerebral palsy show that children who receive ITB have
The most common congenital limb deficiency is a
46. You are covering for your partner who is a pediatric physiatrist. Today, you are admitting a 2-year old girl who sustained a burn. You suspect that this girl is a victim of a non-accidental injury (ie,child abuse) because you see
A 6-month-old infant presents to you with hypotonia. You perform an electrodiagnostic study which shows normal motor conduction velocity, normal sensory conduction velocity and amplitude, normal motor units, and occasional fibrillations and positive waves. The most likely cause of these findings is