DPT Pediatric Physical Therapy 4 — Questions and Answers
Question 1: A toddler with Down syndrome (trisomy 21) demonstrates significant hypotonia and joint hypermobility. Which atlantoaxial instability precaution is essential before initiating PT?
- Screen for cervical instability before any activities loading the cervical spine (Correct answer)
- Avoid all exercise to prevent subluxation
- Refer immediately for surgical stabilization
- Apply cervical traction to improve alignment
Correct answer: Screen for cervical instability before any activities loading the cervical spine
Up to 15% of individuals with Down syndrome have atlantoaxial instability; radiographic clearance is needed before contact sports or cervical loading activities.
Question 2: A child with spina bifida and a neurogenic bladder requires catheterization. Under IDEA, which related service may the PT coordinate with school staff regarding mobility to/from the restroom?
- Accessible route training and mobility support to enable clean intermittent catheterization (Correct answer)
- Direct catheterization as a PT duty
- Exclusion from school until bladder management is independent
- Restriction from participation in gym class
Correct answer: Accessible route training and mobility support to enable clean intermittent catheterization
PT in schools under IDEA addresses educationally relevant mobility needs, including safe, accessible routes to support health-related school routines.
Question 3: When using the Alberta Infant Motor Scale (AIMS), the therapist observes the infant in four positions. Which position is NOT assessed on the AIMS?
- Sitting with support (Correct answer)
- Prone
- Supine
- Standing
Correct answer: Sitting with support
The AIMS assesses prone, supine, sitting (unsupported), and standing — supported sitting is not a distinct AIMS position category.
Question 4: A 5-year-old with hemiplegic CP demonstrates a circumduction gait pattern on the involved side. The primary cause is:
- Inability to advance the leg through hip flexion due to spastic plantarflexors and hip extensors (Correct answer)
- Weakness of the contralateral hip abductors
- Leg length discrepancy on the uninvolved side
- Excessive hip abductor activity on the involved side
Correct answer: Inability to advance the leg through hip flexion due to spastic plantarflexors and hip extensors
Circumduction is a compensatory strategy to advance a stiff, spastic limb that cannot shorten adequately through swing-phase hip and knee flexion.
Question 5: Which standardized tool best measures functional mobility and daily activity performance in children ages 6 months to 7.5 years with disabilities?
- Pediatric Evaluation of Disability Inventory (PEDI) (Correct answer)
- School Function Assessment (SFA)
- Functional Independence Measure for Children (WeeFIM)
- Movement Assessment Battery for Children (MABC-2)
Correct answer: Pediatric Evaluation of Disability Inventory (PEDI)
The PEDI assesses functional skills and caregiver assistance in self-care, mobility, and social function for children 6 months to 7.5 years.
Question 6: A physical therapist is treating a 4-year-old with brachial plexus birth injury (Erb's palsy). The classic 'waiter's tip' posture involves:
- Shoulder adduction, internal rotation, elbow extension, and forearm pronation (Correct answer)
- Shoulder abduction, external rotation, elbow flexion, and forearm supination
- Wrist drop with finger extension weakness
- Total arm paralysis with Horner syndrome
Correct answer: Shoulder adduction, internal rotation, elbow extension, and forearm pronation
Erb's palsy (C5-C6) produces the waiter's tip posture due to paralysis of shoulder abductors/external rotators and elbow flexors, with preserved hand function.
Question 7: A 13-year-old presents with insidious onset of anterior knee pain worsened by stairs and running, with tenderness over the tibial tubercle. The most likely diagnosis is:
- Osgood-Schlatter disease (Correct answer)
- Patellofemoral pain syndrome
- Osteochondritis dissecans of the knee
- Prepatellar bursitis
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease is an apophysitis at the tibial tubercle in adolescents, driven by traction from the patellar tendon during rapid growth.
DPT Pediatric Physical Therapy 4
A toddler with Down syndrome (trisomy 21) demonstrates significant hypotonia and joint hypermobility.
Which atlantoaxial instability precaution is essential before initiating PT?