Peds B Midterm

True/False: Malnutrition from anorexia nervosa can permanently affect bone density if not treated.

a. True

b. False

a. True

True/False: Bulimia nervosa is only dangerous if the person is underweight.

a. True

b. False

b. False

Which of the following is a common physical sign of an eating disorder?

a. Lanugo (fine body hair)

b. Frequent sneezing

c. Coughing at night

d. Increased height

a. Lanugo (fine body hair)

Which professional should be involved in a teen's eating disorder recovery for nutrition guidance?

a. Chiropractor only

b. Registered dietitian

c. Dentist

d. Personal trainer

b. Registered dietitian

A common red flag for immediate medical attention in eating disorders is severe __________ or chest pain. (fill in)

Dizziness

Adolescents with anorexia nervosa may experience delayed __________ due to hormonal changes. (fill in)

Puberty

Which of the following findings is MOST characteristic of Ehlers-Danlos Syndrome in pediatric patients?

a. Joint stiffness with a limited range of motion

b. Joint hypermobility with frequent subluxations

c. Bone fragility with frequent fractures

d. Progressive muscle weakness

b. Joint hypermobility with frequent subluxations

Which of the following is MOST likely to be seen on imaging in a pediatric patient with Ehlers-Danlos Syndrome?

a. Severe joint erosion

b. Normal findings

c. Diffuse osteoporosis

d. Bone tumors

b. Normal findings

Which of the following is used to assess joint hypermobility in patients suspected of Ehlers-Danlos Syndrome?

a. Glasgow Coma Scale

b. Apgar Score

c. Beighton Score

d. Visual Analog Scale

c. Beighton Score

Which of the following activities is MOST appropriate for a pediatric patient with Ehlers-Danlos Syndrome?

a. Gymnastics

b. Contact sports

c. Swimming or cycling

d. Heavy weightlifting

c. Swimming or cycling

Routine laboratory findings are typically abnormal in patients with Ehlers-Danlos Syndrome.

a. True

b. False

b. False

High-velocity, end-range adjustments are not recommended in patients with Ehlers-Danlos Syndrome to improve joint

stability.

a. True

b. False

a. True

Ehlers-Danlos Syndrome affects the body's _________________, which supports joints, skin, muscles, and blood vessels. (Fill in)

Connective tissue

Ehlers-Danlos Syndrome is more commonly diagnosed in _______ patients. (Fill in)

Female

Match the intervention with its rationale:

a. Avoid end-range stretching

b. Use low-force adjusting techniques

c. Closed-chain exercises

d. Activity modification

— Decreases risk of injury during daily or sports activities

— Reduces stress on already unstable joints

— Prevents worsening of joint laxity

— Provide greater joint support during movement

a. Avoid end-range stretching — Prevents worsening of joint laxity

b. Use low-force adjusting techniques — Reduces stress on already unstable joints

c. Closed-chain exercises — Provide greater joint support during movement

d. Activity modification — Decreases risk of injury during daily or sports activities

Match the Goal to the Stage of Management:

a. Rehabilitation/Exercise

b. Lifestyle & Patient Education

c. Symptom Relief

d. Corrective Care

— Improve proprioception and joint stability

— Addressing biomechanical instability and alignment

— Prevent hyperextension and reduce injury risk

— Reduce pain without increasing joint laxity

a. Rehabilitation/Exercise — Improve proprioception and joint stability

b. Lifestyle & Patient Education — Prevent hyperextension and reduce injury risk

c. Symptom Relief — Reduce pain without increasing joint laxity

d. Corrective Care — Addressing biomechanical instability and alignment

T/F: Structural scoliosis is developed from bad posture.

a. True

b. False

b. False

T/F: 5 hours a day of bracing for structural scoliosis in growing children is needed.

a. True

b. False

b. False

Structural scoliosis does not change with _______ where as functional scoliosis does. (fill in)

a. Bracing

b. Surgery

c. Movement

d. All of the above

c. Movement

At ________ degrees of scoliosis curvature is surgical intervention most likely required? (fill in)

a. 0-9 degrees

b. 10-25 degrees

c. 25-39 degrees

d. 45+ degrees

d. 45+ degrees

What is the age peak for scoliosis to progress?

a. 0-5 years

b. 6-10 years

c. 12-16 years

d. 18+ years

c. 12-16 years

Which of the following is an important part of managing scoliosis in children and adolescents?

a. Avoiding all physical activity

b. Emotional support and reassurance

c. Ignoring mild curves completely

d. Bed rest until the spine straightens

b. Emotional support and reassurance

What is the MOST common underlying cause of functional scoliosis?

a. Vertebral fracture

b. Tumor growth

c. Muscle imbalance or leg length discrepancy

d. Congenital vertebral anomaly

c. Muscle imbalance or leg length discrepancy

Which finding would MOST likely indicate functional scoliosis rather than structural scoliosis?

a. A rib hump is present on the Adam's forward bend test

b. Fixed curve on X-ray

c. The curve disappears when the patient changes position

d. Vertebral rotation on imaging

c. The curve disappears when the patient changes position

Match the risk factor with its effect:

a. Leg length discrepancy

b. Poor posture

c. Muscle imbalance

d. Asymmetric loading

→ Spinal compensation pattern

→ Asymmetrical spinal pull

→ Uneven stress on spine

→ Pelvic tilt / uneven base

a. Leg length discrepancy → Pelvic tilt / uneven base

b. Poor posture → Spinal compensation pattern

c. Muscle imbalance → Asymmetrical spinal pull

d. Asymmetric loading → Uneven stress on spine

Match the management approach with its purpose:

a. Chiropractic adjustments

b. Physical therapy

c. Ergonomic changes

d. Orthotics referral

→ Correct muscle imbalance & improve posture

→ Address leg length discrepancy.

→ Reduce daily asymmetrical stress.

→ Restore joint motion & pelvic balance.

a. Chiropractic adjustments → Restore joint motion & pelvic balance.

b. Physical therapy → Correct muscle imbalance & improve posture

c. Ergonomic changes → Reduce daily asymmetrical stress.

d. Orthotics referral → Address leg length discrepancy.

Low back pain is common in adolescents

a. True

b. False

a. True

Back pain in children is always harmless.

a. True

b. False

b. False

Which condition is common in young athletes

a. Muscle strain

b. Osteoporosis

c. Spondylolysis

d. Fibromyalgia

c. Spondylolysis

Which test is used for spondylolysis?

a. Babinski

b. Spurling

c. Stork test

d. Romberg

c. Stork test

A common cause of pediatric low back pain is _____________. (Fill in)

Muscle strain

Pain with extension suggests _____________. (fill in)

Spondylolysis

Match the following:

a. Muscle strain

b. Spondylolysis

c. Disc issue

→ Stress fracture

→ Nerve symptoms

→ Overuse

a. Muscle strain → Overuse

b. Spondylolysis → Stress fracture

c. Disc issue → Nerve symptoms

Match the following:

a. Adjustment

b. Core exercises

c. Posture

→ Prevention

→ Improve motion

→ Stability

a. Adjustment → Improve motion

b. Core exercises → Stability

c. Posture → Prevention

True or False. An elevated BMI percentile in pediatric patients is defined as greater than or equal to the 95th percentile.

a. True

b. False

a. True

True or False. Sugary drinks are a minor contributor to caloric intake in pediatric obesity.

a. True

b. False

b. False

Which of the following is a key feature of insulin resistance in pediatric obesity?

a. Decreased blood glucose

b. Increased insulin sensitivity

c. Increased blood glucose levels

d. Decreased fat storage

c. Increased blood glucose levels

Which of the following is considered a lifestyle risk factor for pediatric obesity?

a. Genetics

b. Excess screen time

c. Thyroid dysfunction

d. Cortisol imbalance

b. Excess screen time

Pediatric obesity is caused by an energy ______, leading to fat accumulation. (fill in)

Imbalance

Acanthosis nigricans is associated with ______ resistance. (fill in)

Insulin

Match the lab test with what it assesses:\

a. Fasting Glucose

b. HbA1c

c. Lipid Panel

d. Blood Pressure

→ Long-term glucose control

→ Cholesterol & cardiovascular risk

→ Blood sugar levels

→ Cardiovascular strain

a. Fasting Glucose → Blood sugar levels

b. HbA1c → Long-term glucose control

c. Lipid Panel → Cholesterol & cardiovascular risk

d. Blood Pressure → Cardiovascular strain

Match the management approach with its focus:

a. Nutritional Counseling

b. Exercise Recommendations

c. Lifestyle Modifications

d. Co-Management

→ Increase physical activity

→ Sleep & screen habits

→ Interprofessional care

→ Diet improvement

a. Nutritional Counseling → Diet improvement

b. Exercise Recommendations → Increase physical activity

c. Lifestyle Modifications → Sleep & screen habits

d. Co-Management → Interprofessional care

Which of the following is a physical exam finding associated with pediatric obesity?

a. Hypotension

b. Acanthosis nigricans

c. Bradycardia

d. Muscle wasting

b. Acanthosis nigricans

What is the recommended daily physical activity for children and adolescents?

a. 15 minutes

b. 30 minutes

c. 60 minutes

d. 90 minutes

c. 60 minutes

Match each risk factor with its primary effect on the cervical spine:

a. Prolonged screen time

b. Heavy backpack use

c. Poor posture (forward head posture)

d. Sports participation (contact/repetitive)

— Sustained cervical flexion leading to muscle fatigue

— Repetitive microtrauma or acute injury

— Altered biomechanics and joint stress

— Increased axial loading and strain on cervical musculature

a. Prolonged screen time — Sustained cervical flexion leading to muscle fatigue

b. Heavy backpack use — Increased axial loading and strain on cervical musculature

c. Poor posture (forward head posture) — Altered biomechanics and joint stress

d. Sports participation (contact/repetitive) — Repetitive microtrauma or acute injury

Match each component of chiropractic management with its primary goal:

a. Spinal manipulation (SMT)

b. Soft tissue therapy

c. Postural correction/ergonomic advice

d. Therapeutic exercise

— Improve muscular strength and endurance

— Restore joint mobility and reduce dysfunction

— Reduce muscle tension and improve circulation

— Decrease mechanical stress from daily habits

a. Spinal manipulation (SMT) — Restore joint mobility and reduce dysfunction

b. Soft tissue therapy — Reduce muscle tension and improve circulation

c. Postural correction/ergonomic advice — Decrease mechanical stress from daily habits

d. Therapeutic exercise — Improve muscular strength and endurance

____________ is the most common cause of neck pain in children and adolescents. (fill in)

Mechanical

According to pediatric chiropractic case series date, __________ was the most commonly used intervention. (fill in)

Spinal manipulative therapy (SMT)

Fever and neck stiffness is considered a red flag requiring immediate referral

a. True

b. False

a. True

In a typical chiropractic case series of pediatric neck pain, average care consisted of 8-9 visits over 2-3 weeks

a. True

b. False

b. False

Which of the following is a contraindication to cervical spinal manipulation in children?

a. Mild muscle tightness

b. Poor posture

c. Suspected fracture or instability

d. Limited ROM

c. Suspected fracture or instability

Which condition must be eruled out in a child presenting with torticollis and fever?

a. Retropharyngeal abscess

b. Poor posture

c. Muscle strain

d. Text neck syndrome

a. Retropharyngeal abscess

Which of the following history findings would be MOST concerning in a pediatric patient with neck pain

a. Pain worsens with prolonged screen time

b. Mild soreness after sports activity

c. Night pain accompanied by unexplained weight loss

d. Pain relieved with rest

c. Night pain accompanied by unexplained weight loss

In most cases of pediatric mechanical neck pain, when are X-rays indicated?

a. Immediately for all patients

b. Only if red flags or trauma are present

c. After 1 day of symptoms

d. Only if the patient requests imaging

b. Only if red flags or trauma are present

Patient presents with a headache going on 48 hours now. Patient describes headache as a throbbing pain and has found lying in a dark room relieves the pain. Based off the patient's presentation, what is the most likely diagnosis?

a. Cervicogenic Headache

b. Cluster Headache

c. Migraine

d. Sinus Headache

c. Migraine

Patient presents with a headache localized around the patient's right eye. Mentions headache only lasts 20 minutes or so and complains of a runny nose. Based off the patient's presentation, what is the most likely diagnosis?

a. Cluster Headache

b. Migraine with Aura

c. Stroke

d. Common Migraine

a. Cluster Headache

Patient presents to the office with an acutely severe headache. Patient examination showed blood pressure of 184/98 and patient's skin displays diaphoresis. Based off the patient's presentation, what is the most likely diagnosis?

a. Migraine with Aura

b. Migraine without Aura

c. Decreased extension and left rotation of C3

d. Stroke

d. Stroke

Which of the following is not a risk factor for migraines?

a. Hereditary/Genetics

b. Psychiatric Disorders

c. Poor Diet

d. Exercise

d. Exercise

T or F: Migraines can last beyond 48 hours at a time.

a. True

b. False

a. True

T or F: A headache can only be considered a migraine if the patient complains of "aura" like symptoms.

a. True

b. False

b. False

A migraine with "aura" is also referred to as a _________ migraine. (fill in)

Classic

A migraine without "aura" is also referred to as a _________ migraine. (fill in)

Common

Match the symptom to the condition.

a. Photophobia

b. Headache lasting 4-48 hours

i. Migraine with Aura

ii. Cervicogenic headache

iii. Sinus headache

iv. Migraine without aura

a. Photophobia — i. Migraine with aura

b. Headache lasting 4-48 hours — iv. Migraine without aura

Match the symptom to the condition

a. Nausea/Emesis from Headache

b. Sudden Onset of Excruciating Headache

i. Migraine

ii. Cervicogenic Headache

iii. Stroke

iv. Sinus Headache

a. Nausea/Emesis from Headache - i. Migraine

b. Sudden Onset of Excruciating Headache - iii. stroke

A pediatric case should always begin with:

a. X-rays

b. Neurological examination

c. Written parental consent

d. Laboratory testing

c. Written parental consent

T/F. Two opposing radiographic views are considered the legal standard in pediatric imaging.

a. True

b. False

a. True

The Tanner Scale divides pubertal growth into __________ stages of development.

a. 5

b. 3

c. 6

d. 2

a. 5

Which of the following is considered one of the most characteristic traits of adolescence?

a. Emotional stability

b. Physical inactivity

c. Change

d. Social withdrawal

c. Change

Match the adolescent need with its description:

A. Confidentiality

B. Support for autonomy

C. Nonjudgmental acceptance

D. Consistency and limit setting

- Encouraging increasing independence

- Creating trust during healthcare visits

- Providing structure and boundaries

- Avoiding criticism during patient interaction

A. Confidentiality - Creating trust during healthcare visits

B. Support for autonomy - Encouraging increasing independence

C. Nonjudgmental acceptance - Avoiding criticism during patient interaction

D. Consistency and limit setting - Providing structure and boundaries

Which stress hormone is commonly elevated with chronic bullying-related stress?

a. Dopamine

b. Insulin

c. Serotonin

d. Cortisol

d. Cortisol

Cyberbullying differs from traditional bullying because it:

a. Is always physical

b. Only occurs at school

c. Can persist online indefinitely

d. Never involves anonymity

c. Can persist online indefinitely

Which neurotransmitter is most associated with the brain reward pathway involved in addiction?

a. Acetylcholine

b. GABA

c. Dopamine

d. Histamine

c. Dopamine

T/F. Adolescent substance abuse may interfere with emotional regulation and impulse control because the brain is still developing.

a. True

b. False

a. True

The "4 Rs" trauma-informed care model includes all of the following EXCEPT:

a. Recognize

b. Respond

c. Resist re-traumatization

d. Rehabilitate

d. Rehabilitate

Which of the following is MOST important to ask when obtaining a pediatric chief complaint?

a. Favorite sports team

b. School grades only

c. Effects of the complaint on the child's behavior

d. Vaccination status only

c. Effects of the complaint on the child's behavior

In most states, the age of majority is:

a. 16

b. 17

c. 18

d. 21

c. 18

Which of the following is considered a protective factor in adolescents?

a. Hopelessness

b. Poor academic performance

c. Family involvement

d. Criminal behavior

c. Family involvement

Cyberbullying differs from traditional bullying because it:

a. Only occurs in schools

b. Always involves physical harm

c. Can persist online indefinitely

d. Cannot be anonymous

c. Can persist online indefinitely

Which of the following physical symptoms is commonly associated with chronic bullying stress?

a. Hyperactivity

b. Muscle tension

c. Increased appetite

d. Improved sleep

b. Muscle tension

Which of the following is considered a key characteristic of bullying?

a. Random behavior

b. Mutual disagreement

c. Imbalance of power

d. Single isolated incident

c. Imbalance of power

Bruising in which location is especially suspicious for abuse?

a. Knees

b. Elbows

c. Shins

d. Torso or ears

d. Torso or ears

Approximately what percentage of students report being bullied at school?

a. 5%

b. 10%

c. 20%

d. 50%

c. 20%

Cyberbullying affects approximately what percentage of high school students annually?

a. 5%

b. 16%

c. 35%

d. 60%

b. 16%

Does California have a Romeo and Juliet law?

A. Yes

B. No

B. No

ACE stands for:

a. Adolescent Childhood Evaluation

b. Adverse Childhood Experiences

c. Abuse Counseling Evaluation

d. Adult Childhood Exposure

b. Adverse Childhood Experiences

Which fracture is highly specific for abuse?

a. Spiral tibial fracture

b. Bucket-handle fracture

c. Greenstick fracture

d. Compression fracture

b. Bucket-handle fracture

Posterior rib fractures are suspicious because they are commonly caused by:

a. Running

b. Chest squeezing

c. Sports

d. Falling while walking

b. Chest squeezing