Paediatric physiotherapy

40 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Paediatric physiotherapy, part of Special Populations. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   An infant holds the head tilted to the right and the chin rotated to the left. Which muscle is shortened?

   1. ARight upper trapezius muscle
   2. BLeft splenius capitis muscle
   3. CRight sternocleidomastoid
   4. DLeft sternocleidomastoid muscle

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   Answer: C · Right sternocleidomastoid

   Congenital muscular torticollis involves a short sternocleidomastoid. It tilts the head to the same side and rotates the face to the opposite side. Stretching, positioning and handling treat it.

   • A: Trapezius does not rotate the chin to the opposite side in this way.
   • B: Splenius capitis rotates the head to the same side.
   • D: The left muscle would tilt the head left.

   Remember this

   In torticollis the head tilts to the side of the short sternocleidomastoid and the face turns away.

2. Question 2 · Medium

   A 6-year-old with cerebral palsy walks indoors with a posterior walker and uses a wheelchair for school and community outings. What is the GMFCS level?

   1. ALevel III
   2. BLevel II
   3. CLevel I
   4. DLevel V

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   Answer: A · Level III

   GMFCS level III is walking with a hand-held mobility device indoors and using wheeled mobility for longer distances. Level I walks without limitation, level II walks without a device but is limited on uneven ground, and level V is transported in a manual chair.

   • B: Level II walks without a device.
   • C: Level I means walking without limitations.
   • D: Level V needs transport in a wheelchair with limited self-mobility.

   Remember this

   GMFCS III: walks with a hand-held device indoors and uses wheeled mobility outdoors.

3. Question 3 · Medium

   After casting for clubfoot, which factor most reduces the risk of relapse?

   1. AHeel cord stretching by the child alone at home
   2. BConsistent use of the foot abduction brace
   3. CEarly barefoot running on hard surfaces
   4. DAvoiding any weight-bearing for the first two years

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   Answer: B · Consistent use of the foot abduction brace

   Relapse is common if the brace is not worn as prescribed, full time for about three months and then at night until 4 to 5 years. The brace holds the foot abducted and dorsiflexed after correction. Parents need clear education on wearing it.

   • A: A young child cannot stretch the cord alone.
   • C: Barefoot running does not hold the correction.
   • D: Avoiding weight-bearing causes weakness and is not recommended.

   Remember this

   Brace adherence is the main protection against clubfoot relapse.

4. Question 4 · Medium

   Typically developing children first jump with both feet leaving the ground at about:

   1. A6 years
   2. B9 months
   3. C2 years
   4. D4 years

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   Answer: C · 2 years

   Jumping off the ground with both feet appears at about 2 years, followed by tricycle riding at 3 years and hopping on one foot at about 4 years. At 9 months children crawl and pull up to stand.

   • A: At 6 years skipping and complex skills develop.
   • B: At 9 months children are crawling.
   • D: At 4 years children hop on one foot.

   Remember this

   Jumping with both feet appears about 2 years, tricycle riding about 3, hopping about 4.

5. Question 5 · Easy

   Which description fits congenital talipes equinovarus (clubfoot)?

   1. APlantarflexed ankle, inverted heel and adducted forefoot
   2. BDorsiflexed ankle with an everted heel and a flexible forefoot
   3. CA laterally deviated great toe
   4. DA flattened medial arch with a valgus heel in standing

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   Answer: A · Plantarflexed ankle, inverted heel and adducted forefoot

   Clubfoot has four components remembered as CAVE: cavus, adductus of the forefoot, varus of the hindfoot and equinus. The foot is held plantarflexed, inverted and adducted, and is rigid. Treatment starts in the first weeks of life.

   • B: A dorsiflexed, everted foot describes calcaneovalgus.
   • C: A deviated great toe describes hallux valgus.
   • D: A flat arch with a valgus heel is flexible flat foot.

   Remember this

   Clubfoot is cavus, adductus, varus and equinus.

   Mnemonic: CAVE

6. Question 6 · Medium

   An 8-month-old infant still shows an obligatory asymmetrical tonic neck reflex. Which functional problem is most likely?

   1. ADifficulty tolerating a bottle during feeds
   2. BExcessive crying when placed on the back
   3. CDifficulty rolling and bringing both hands to the midline
   4. DInability to hold the head up in sitting position

   Answer and explanation in LearnFree account

7. Question 7 · Easy

   Duchenne muscular dystrophy is inherited as:

   1. AAn autosomal dominant condition
   2. BA mitochondrial condition passed from the father
   3. CAn autosomal recessive condition
   4. DAn X-linked recessive condition

   Answer and explanation in LearnFree account

8. Question 8 · Easy

   A boy rises from the floor by pushing his hands up along his thighs. This Gowers' sign indicates:

   1. AUpper motor neuron spasticity of the calf muscles
   2. BCerebellar ataxia of the trunk
   3. CProximal pelvic girdle and thigh weakness
   4. DDistal sensory loss in both of the feet

   Answer and explanation in LearnFree account

9. Question 9 · Medium

   Which home advice is the highest priority for the parents of a child with an L3 myelomeningocele lesion?

   1. ACheck the skin daily and teach pressure relief, as sensation is absent
   2. BUse hot water bottles on cold feet at night to keep them warm and comfortable
   3. CCover the feet in tight shoes at all times, including in bed
   4. DAllow the child to crawl on hard floors barefoot all day

   Answer and explanation in LearnFree account

10. Question 10 · Medium

    During a session a child with a ventriculoperitoneal shunt becomes drowsy and starts vomiting, with a new headache. What is the correct action?

    1. AGive extra oral fluids and resume the session in 20 minutes
    2. BContinue with a lower intensity of exercise and watch for further vomiting
    3. CStop the session and arrange urgent medical review for a shunt blockage
    4. DEncourage the child to rest and review the symptoms again next week

    Answer and explanation in LearnFree account

11. Question 11 · Medium

    A 19-month-old toddler is not yet walking independently, although she is otherwise healthy. What is the most appropriate step?

    1. AReassure the family that walking commonly begins after age three
    2. BWait until she reaches five years
    3. CStart high-load strengthening of the legs
    4. DRefer for a developmental assessment

    Answer and explanation in LearnFree account

12. Question 12 · Easy

    At what age do most typically developing infants begin to sit without support?

    1. AAbout 3 months
    2. BAbout 14 months
    3. CAbout 6 to 7 months
    4. DAbout 10 to 11 months

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    A teenager with Duchenne muscular dystrophy has a weak cough and recurrent chest infections. Which technique best supports secretion clearance?

    1. AMechanical insufflation-exsufflation with assisted cough
    2. BHead-down tilting for long periods in the prone position
    3. CVigorous chest percussion with suppression of the cough reflex
    4. DUnaided breath-holding with strong coughing efforts alone

    Answer and explanation in LearnFree account

14. Question 14 · Medium

    In a newborn, the examiner flexes and adducts the hip and pushes posteriorly, and feels the femoral head slip out of the socket. What does this show?

    1. AA normal stable hip
    2. BA previously dislocated hip that reduces (Ortolani)
    3. CA dislocatable hip (positive Barlow)
    4. DA fixed, irreducible dislocation

    Answer and explanation in LearnFree account

15. Question 15 · Easy

    Which pattern of spastic cerebral palsy, with the legs more affected than the arms, is classically linked to preterm birth?

    1. ADyskinetic cerebral palsy
    2. BSpastic diplegia
    3. CAtaxic cerebral palsy
    4. DSpastic hemiplegia

    Answer and explanation in LearnFree account

16. Question 16 · Hard

    A dislocated hip is found for the first time in an infant at 8 months of age. Which management is most appropriate?

    1. AReferral for closed or open reduction and spica casting
    2. BPavlik harness worn full time for six weeks and then reviewed
    3. CStrengthening exercises of the hip abductors and extensors
    4. DObservation with a repeat scan at 2 years of age

    Answer and explanation in LearnFree account

17. Question 17 · Medium

    In the Ponseti method for clubfoot, which component is corrected last, usually with a percutaneous Achilles tenotomy?

    1. AAdductus of the forefoot
    2. BCavus of the midfoot
    3. CEquinus of the ankle
    4. DVarus of the heel

    Answer and explanation in LearnFree account

18. Question 18 · Hard

    An infant with clubfoot is scored using the Pirani system. Curved lateral border 1, medial crease 0.5, talar head coverage 1, posterior crease 1, rigid equinus 1, empty heel 0.5. What is the total score?

    1. A6
    2. B5.5
    3. C4.5
    4. D5

    Answer and explanation in LearnFree account

19. Question 19 · Medium

    What causes calf pseudohypertrophy in Duchenne muscular dystrophy?

    1. AReplacement of muscle fibres by fat and connective tissue
    2. BFluid retention from kidney disease
    3. CTrue growth of the muscle fibres in response to repeated overuse and overwork
    4. DVenous insufficiency

    Answer and explanation in LearnFree account

20. Question 20 · Medium

    A child with spastic diplegia walks with the knees pressed together and crossing. Which impairment mainly causes this scissoring gait?

    1. AWeak hip abductors from L5 root injury
    2. BQuadriceps contracture
    3. CHip adductor spasticity with internal rotation
    4. DHamstring weakness from a lower motor neuron lesion

    Answer and explanation in LearnFree account

21. Question 21 · Medium

    Which radiographic measure is used to monitor hip displacement in children with cerebral palsy?

    1. ACobb angle of the lumbar spine
    2. BQuadriceps angle of the knee
    3. CReimers' migration percentage
    4. DBohler angle of the calcaneus

    Answer and explanation in LearnFree account

22. Question 22 · Hard

    A child with myelomeningocele has strong hip flexion and adduction and knee extension, but no hip abduction and no ankle dorsiflexion. At which functional level is the lesion?

    1. AL3
    2. BL5
    3. CS1
    4. DL1

    Answer and explanation in LearnFree account

23. Question 23 · Medium

    A child with hemiplegic cerebral palsy has the unaffected hand restrained for part of the day while practising tasks with the affected hand. What is this approach?

    1. ANeurodevelopmental treatment
    2. BProprioceptive neuromuscular facilitation
    3. CConstraint-induced movement therapy
    4. DMirror therapy

    Answer and explanation in LearnFree account

24. Question 24 · Medium

    A newborn lies with the right arm adducted, internally rotated, elbow extended and forearm pronated after a difficult delivery. Which injury is most likely?

    1. AKlumpke's palsy affecting C8-T1
    2. BErb's palsy affecting C5-C6
    3. CCerebral palsy
    4. DRadial nerve palsy

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25. Question 25 · Medium

    A child with Down syndrome wants to join sports that involve forced neck flexion, such as tumbling. Which pre-participation step is recommended?

    1. AAssessment of hip flexor length at rest
    2. BScreening for scoliosis only
    3. CA bone density scan of the hips
    4. DClinical screening for signs of atlantoaxial instability

    Answer and explanation in LearnFree account