Meeting The Physical Therapy Needs of Children 1st Edition by Susan K. Effgen – Test Bank

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Chapter 5. Musculoskeletal System: Structure Function and Evaluation

 

Multiple Choice

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

 

____       1.   You are doing an orthopedic evaluation on a 13-month-old child. The parents are concerned that the child isn’t walking. Select the finding that is atypical in a 13-month-old child.

A. The child has no visible longitudinal arch in standing (flat feet).
B. The child has a 3-degree hip flexion contracture.
C. The child has genu valgum.
D. The child has a straight lateral border of the foot.

 

 

____       2.   Select the factor(s) that contributes to neonatal hip instability.

A. Synovial viscosity
B. High neck shaft angle of inclination
C. 30 degrees of retrotorsion
D. Spherical femoral head

 

 

____       3.   When performing the hip prone extension test, you should

A. stabilize the pelvis prior to measuring.
B. allow the “non-testing” foot to rest gently on the floor.
C. position the child with one hip on the edge of the plinth and the other securely on the plinth.
D. test both sides at the same time.

 

 

____       4.   A full-term, typically developing neonate will have which following range of motion?

A. Limitations in hip flexion and elbow flexion and excessive plantar flexion
B. Limitations in hip extension and elbow extension and excessive plantar flexion
C. Limitations in plantar flexion and excessive hip flexion and elbow extension
D. Limitations in hip extension and elbow extension and excessive dorsiflexion

 

 

____       5.   Select the correct definition(s):

A. Antetorsion is a posterior rotation through the long axis of the femur.
B. Retrotorsion results in a posterior rotation of the neck of the femur in relation to the acetabulum.
C. Anteversion refers to the position of the head of the femur relative to its position in the acetabulum.
D. Retroversion places the leg into external rotation.

 

 

____       6.   Measuring a child’s thigh-foot angle gives you an indication of the amount of

A. twisting of the long axis of the tibia (version).
B. hamstring limitation.
C. genu valgum.
D. metatarsus adductus.

 

 

____       7.   It is common to see the most significant genu valgum posture (knock-kneed) in children around __________ year(s) of age.

A. 1
B. 19
C. 4
D. 12

 

 

____       8.   After initial development, bone shape can be changed through a process called

A. metaphysis.
B. calcification.
C. ossification.
D. modeling.

 

 

____       9.   Variability in joint angle or kinematic patterns during gait is most common in

A. young independent walkers.
B. toddlers.
C. adolescents.
D. running.

 

 

____     10.   Cadence is

A. highest in adolescence.
B. very high in 1-year-old walkers.
C. highest in toddlers.
D. stable during maturation of gait.

 

 

____     11.   The clavicle, mandible, and facial and cranial flat bones develop directly in vascularized mesenchyme through a process called

A. endochondral ossification.
B. mesodermal outgrowth.
C. differentiating chondroblasts.
D. intramembranous ossification.

 

 

____     12.   The spine of a newborn infant is initially in a

A. scolotic position.
B. kyphotic position.
C. straight position.
D. lordotic position.

 

 

____     13.   The kinematics of a child’s gait are generally mature by which age?

A. 2 years
B. 4 years
C. 7 years
D. 9 years

 

 

____     14.   Reciprocal arm swing

A. starts to emerge at age 4 years.
B. is correlated with decreased base of support.
C. is common with hand high guard.
D. is common in early walkers.

 

 

True/False

Indicate whether the statement is true or false.

 

____       1.   A flexible flat foot in a typically developing 3 -year-old is a concerning finding and should be referred to an orthopedic physician for further evaluation.

 

____       2.   To estimate the amount of metatarsus adductus present, you should draw a line that bisects the child’s metatarsals and then draw a second line that is perpendicular to this line and bisects the calcaneus.

 

____       3.   A tape measure is a more accurate method to measure an actual leg length discrepancy than the block method.

 

____       4.   Cartilage provides the initial prenatal structure for the development of bone.

 

____       5.   It is typical for a 24-month old to have a hip flexion contracture of about 10 degrees.

 

 

Chapter 5. Musculoskeletal System: Structure Function and Evaluation

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:   C

Rationale: Children at this age have genu valgum.

 

PTS:    1

 

  1. ANS:   B

Rationale: Neonates have a high neck shaft angle of inclination. This angle reduces over time, putting the head of the femur deeper and more securely in the acetabulum.

 

PTS:    1

 

  1. ANS:   A

Rationale: Stabilizing the pelvis is essential to ensure that the pelvis doesn’t rotate and give you additional false range of motion.

 

PTS:    1

 

  1. ANS:   D

Rationale: Babies are born with physiological flexion, which limits hip and elbow extension. Babies are also born with more than normal dorsiflexion range and less than normal plantar flexion. These situations occur due to the compression of the fetus in the uterus.

 

PTS:    1

 

  1. ANS:   C

Rationale: Version refers to the position of the head of femur relative to the acetabulum; torsion refers to a twisting of the long axis of the femur. Anteversion and retrotorsion both place the leg in external rotation. Retroversion and antetorsion place the leg in internal rotation.

 

PTS:    1

 

  1. ANS:   A

Rationale: Thigh-foot angle measures the difference between the thigh and foot axis. This is an indication of tibial version.

 

PTS:    1

 

  1. ANS:   C

Rationale: Knee posture starts in genu varum at birth, moves into genu valgum around age 4, and then moves into a more neutral alignment.

 

PTS:    1

 

  1. ANS:   D

Rationale: After initial development, bone shape can be changed through a process called modeling, which includes bone formation and resorption.

 

PTS:    1

 

  1. ANS:   A

Rationale: Variability in joint angle or kinematic patterns is the highest in the youngest independent walkers and decreases rapidly with gait maturation (Ivanenko, Dominici,&  Lacquaniti, 2007).

 

PTS:    1

 

  1. ANS:   B

Rationale: Cadence is the number of steps per min. Cadence is very high in 1-year-old walkers and decreases with age; the most rapid decrease is between 1 and 2 years. It continues to decrease over time into adulthood (Sutherland et al., 1988).

 

PTS:    1

 

  1. ANS:   D

Rationale: The clavicle, mandible, and facial and cranial flat bones develop directly in vascularized mesenchyme through a process called intramembranous ossification. Intramembranous ossification begins near the end of the second month of gestation. The remaining bones of the body develop through endochondral ossification, or the deposition of bone on a cartilaginous model.

 

PTS:    1

 

  1. ANS:   B

Rationale: The infant’s spine is initially in a kyphotic position, but as the infant begins to hold his head up and prop on his forearms in prone position, cervical and lumbar lordosis begin to develop.

 

PTS:    1

 

  1. ANS:   C

Rationale: The kinematics, or joint angles, of children mature and change over time. These changes generally mature by age 7 years (Sutherland et al., 1988).

 

PTS:    1

 

  1. ANS:   B

Rationale: Sutherland (1988) indicated that by age 1 years, the arms begin to come down and reciprocal arm swing begins to emerge. By age 3 to 4 years, it is seen in all children. It has been suggested that the high guard pattern assists the child with balance and stability during upright forward locomotion. Additionally, the emergence of a reciprocal arm swing though walking experience is correlated with the decrease in the base of support, indicating improvement in balance (Ledebt, 2000).

 

PTS:    1

 

TRUE/FALSE

 

  1. ANS:   F

Rationale: Children typically do not develop a visible longitudinal arch until after age 4 years.

 

PTS:    1

 

  1. ANS:   F

Rationale: To estimate metatarsus adductus, you draw a line that bisects the heel and then follows the long axis of the foot.

 

PTS:    1

 

  1. ANS:   T

Rationale: Studies have compared tape measure measurements to x-rays to confirm its accuracy. A study of the block method showed that accuracy was very poor.

 

PTS:    1

 

  1. ANS:   T

Rationale: Cartilage provides the initial prenatal structure for bone development. Cartilage is a gel-like substance with fine collagen fibrils distributed in the gel to add tensile strength.

 

PTS:    1

 

  1. ANS:   F

Rationale: In a study of 86 typical healthy infants, the hip flexion contracture diminished from a mean of 10 degrees (SD = 2.6 degrees) at 9 months to 9 degrees (SD = 4.8 degrees) at 12 months, 4 degrees (SD = 3.2 degrees) at 18 months, and 3 degrees (SD = 3.0 degrees) at 24 months (Phelps, Smith, & Hallum, 1985).

 

PTS:    1

 

 

 

Chapter 15. The Neonatal Intensive Care Unit

 

Multiple Choice

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

 

____       1.   Which of the following can be a complication of premature birth that is often found in premature infants who have cerebral palsy?

A. Intraventicular hemorrhage
B. Periventricular leukomalacia
C. Microcephaly
D. Retinopathy of prematurity

 

 

____       2.   Infants needing intensive care are very sensitive to stimulation. The NICU environment is an overwhelming setting for the infant. Which following recommendation can assist in helping the infant cope with the NICU environment?

A. Place the infant under a bright light during the daytime hours
B. Keep light and noise levels as low as possible and minimize the frequency of handling the infant
C. Group quiet infants next to each other and more active infants next to each other
D. Provide a certain level of noise often to help the infant adapt to the noise level

 

 

____       3.   Developmentally supportive care is individualized caregiving and is based on

A. the general routine in each specific NICU.
B. using specific methods to speed up the infant’s tolerance to care-giving procedures.
C. the infant’s physiological reactions, behavioral cues, and signs of stress in response to the immediate environment.
D. providing an individual caregiver for the infant so the infant may adapt to that person’s approach.

 

 

____       4.   Physical therapy examination and evaluation of the infant in the NICU is an ongoing process and provides which of the following information?

A. The infant’s physiological and behavioral responses to stress
B. The infant’s active movements, strength, and muscle tone
C. The infant’s ability to maintain a flexed position
D. Indications for specialty follow-up care after the infant is discharged from the NICU
E. All of the above

 

 

____       5.   Positioning recommendations are an important part of physical therapy treatment in the NICU. Which of the following general recommendations apply to most infants in the NICU?

A. The supine position is encouraged because prone is not a recommended sleep position in healthy infants
B. Hands and knees should not touch because it may lead to skin breakdown
C. The hands should be positioned away from the face to avoid scratching of the face
D. The infant should be positioned in flexion with the arms and legs close to the body

 

 

____       6.   When making recommendations about the infant’s active movement, the physical therapist should generally recommend

A. encouraging the infant to have several periods of active movement during the day to build body strength and endurance.
B. allowing active movement when the infant is awake and quietly alert, but helping the infant to avoid excessive, frequent movements.
C. avoiding all active movement to conserve energy, including using restraints if needed.
D. encouraging any active movement as long as the infant is not crying.

 

 

____       7.   Full-term infants are born

A. between 37 and 42 weeks gestation.
B. at 9 months gestation.
C. at 40 weeks gestation.
D. between 35 and 40 weeks gestation.

 

 

____       8.   Infants that are small for gestational age

A. are premature.
B. are born after 40 weeks gestation.
C. weigh less than the 10th percentile.
D. weigh 1,000 g.

 

 

____       9.   Physiological signs of stress in a neonate include

A. increased heart rate and skin color changes.
B. gaze aversion and leg extension.
C. increased respiration and oxygen saturation.
D. facial grimace and finger splays.

 

 

____     10.   Behavioral signs of stress in a neonate include

A. hyperalertness and apnea.
B. finger splays and gaze aversion.
C. decreased respiratory rate and bradycardia.
D. leg extension and increased blood pressure.

 

 

True/False

Indicate whether the statement is true or false.

 

____       1.   Infants born preterm and weighing less than 1,000 g at birth are at the greatest risk for cerebral palsy and other motor, cognitive, and behavioral disorders.

 

Short Answer

 

  1. Name three neonatal methods of self-calming.

 

  1. Describe the behavioral state of “quiet alertness.”

 

 

Chapter 15. The Neonatal Intensive Care Unit

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:   B

Rationale: Periventricular leukomalacia is an ischemic infarction of the white matter adjacent to the lateral ventricles. It is diagnosed by MRI usually when the infant is 6 months adjusted age or older. It is commonly found in premature infants who have cerebral palsy.

 

PTS:    1

 

  1. ANS:   B

Rationale: Infants need a calm and quiet environment to assist them in achieving optimal rest and recovery. The NICU should keep light and noise levels as low as possible to adjust the NICU environment to the needs of the infants. Handling should be done at a low frequency with care procedures clustered together to allow for needed sleep and rest of the infant.

 

PTS:    1

 

  1. ANS:   C

Rationale: Developmentally supportive care is individualized caregiving that is guided by the infant’s responses. This allows caregivers to provide optimal care for each infant and to appropriately adjust the care as the infant develops and recovers.

 

PTS:    1

 

  1. ANS:   E

Rationale: The physical therapy examination and evaluation of the infant in the NICU is comprehensive and provides information on the infant’s development each time the infant is handled by the physical therapist. All of the above areas of information are noted and influence the result of the examination, reflecting the infant’s motor and developmental abilities at the time of the examination.

 

PTS:    1

 

  1. ANS:   D

Rationale: The general recommendation is to position the infant in flexion with the arms and legs close to the body. Flexion is a position of comfort for the infant and assists the infant in self-calming behaviors, such as bringing the hands together and bringing the hands to the face or mouth. Infants in the NICU often need assistance maintaining a flexed position, and the physical therapist recommends use of buntings, blanket rolls, and methods of holding to help the infant achieve and maintain flexion.

 

PTS:    1

 

  1. ANS:   B

Rationale: Active movement is seen at different extremes in infants in the NICU. Some active movement is seen when the infant is quietly alert after the infant develops and learns to cope with the surrounding environment. Moving frequently, however, is not optimal for infants in the NICU because doing so expends the energy that is needed for growth, development, and recovery. Infants who show excessive and frequent movement should be assisted in maintaining a quiet and calm position.

 

PTS:    1

 

  1. ANS:   A

Rationale: Full-term infants are those infants born between 37 and 42 weeks gestation. Infants who are born less than 37 weeks gestation are considered premature (Darcy, 2009; Engle et al, 2007; Vergara & Bigsby, 2004).

 

PTS:    1

 

  1. ANS:   C

Rationale: Infants are classified based on size for gestational age. If an infant’s weight falls in less than the 10th percentile, they are considered small for gestational age (SGA). An infant whose weight is lower than what is expected for gestational age, would be classified as SGA (Vergara & Bigsby, 2004). It is not the exact weight that matters; it is the weight relative to gestation age that matters.

 

PTS:    1

 

  1. ANS:   A

Rationale: Physiological signs of stress include increased heart rate, decreased heart rate, decreased respiratory rate, increased blood pressure, decreased oxygen saturation, apnea, bradycardia, and skin color changes (review Table 15.4).

 

PTS:    1

 

  1. ANS:   B

Rationale: Behavioral signs of stress include gaze aversion, finger splays, trunk extension, facial grimace, leg extension, turning out/drowsiness, hyperalertness, and arm salute (review Table 15.4.).

 

PTS:    1

 

TRUE/FALSE

 

  1. ANS:   T

Rationale: Infants born preterm and weighing less than 1,000 g at birth are at the greatest risk for cerebral palsy and other motor, cognitive, and behavioral disorders (Foulder-Hughes & Cooke, 2003; Laptook, et al, 2005; Walden et al, 2007).

 

PTS:    1

 

SHORT ANSWER

 

  1. ANS:

Hand to face or mouth; sucking on hand, fingers, thumb, or pacifier; maintaining flexed posture; hands or feet to midline; closing eyes; gaze aversion; drowsy state to control stimulation.

 

PTS:    1

 

  1. ANS:

Eyes open and eye contact made, relaxed face and facial expressions, movements smooth,  and ready for interaction.

 

PTS:    1

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