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ABPTS PWCS study materials
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ABPTS PWCS practice questions

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Question 1Human Development and Pediatric Health Conditions

At approximately what age does a typically developing infant first achieve independent sitting without hand support?

  1. 11 to 12 months
  2. 2 to 3 months
  3. 6 to 8 months Correct answer.
  4. 14 to 16 months

Explanation

Independent sitting without upper-extremity support typically emerges between 6 and 8 months as trunk extensor control and postural reactions mature. Earlier sitting is usually propped or requires hand support.

Question 2Human Development and Pediatric Health Conditions

A 4-month-old infant's asymmetric tonic neck reflex is still strongly obligatory and prevents hands-to-midline play. This finding most likely indicates which of the following?

  1. Normal persistence of a primitive reflex until 8 months
  2. A sign of possible neuromotor delay warranting further screening Correct answer.
  3. An expected precursor to rolling that should be facilitated
  4. A voluntary postural strategy the infant uses for reaching

Explanation

The asymmetric tonic neck reflex typically integrates by about 4 to 6 months; persistence beyond that window with interference in function is a red flag for neuromotor delay. Obligatory persistence that blocks midline play warrants developmental screening and referral.

Question 3Human Development and Pediatric Health Conditions

Which finding is most characteristic of a child with spastic cerebral palsy?

  1. Low tone with diminished deep tendon reflexes
  2. Slow writhing involuntary movements of the extremities
  3. Truncal ataxia with intention tremor
  4. Velocity-dependent increase in muscle tone with hyperreflexia Correct answer.

Explanation

Spastic cerebral palsy reflects upper motor neuron involvement, producing velocity-dependent tone increases, hyperreflexia, and often clonus. The other patterns describe dyskinetic or ataxic subtypes.

Question 4Human Development and Pediatric Health Conditions

An infant born at 28 weeks gestation is now 6 months old chronologically. When selecting a standardized developmental test, the clinician should adjust for prematurity until approximately what age?

  1. No adjustment is needed at any age
  2. Until 12 months corrected age
  3. Until 3 months corrected age
  4. Until 24 months corrected age Correct answer.

Explanation

Corrected age is commonly applied for preterm infants through about 24 months to avoid over-identifying delay attributable to prematurity. After that point, chronological age is generally used.

Question 5Human Development and Pediatric Health Conditions

A toddler with myelomeningocele at the L4 level is most likely to ambulate using which pattern?

  1. No ambulation potential; wheelchair mobility expected
  2. Ambulation only with a reciprocating gait orthosis and walker
  3. Ambulation with ankle-foot orthoses and possible crutches Correct answer.
  4. Independent ambulation with no orthoses

Explanation

Children with L4-level lesions typically retain hip flexors, quadriceps, and medial hamstrings, allowing community ambulation with ankle-foot orthoses and possibly crutches. Higher lesions require more extensive bracing or wheelchair use.

Question 6Human Development and Pediatric Health Conditions

A 9-year-old with Duchenne muscular dystrophy is being monitored for functional decline. Which early functional sign most typically appears first?

  1. Loss of finger dexterity for handwriting
  2. Weakness of neck flexors only
  3. Isolated facial weakness
  4. Difficulty climbing stairs and rising from the floor Correct answer.

Explanation

Duchenne muscular dystrophy affects proximal muscles first, so stair climbing and floor-to-stand transitions (often with Gowers sign) decline early. Distal hand and facial muscles are relatively spared until later.

Question 7Human Development and Pediatric Health Conditions

Which of the following best describes the typical sequence of gross motor development in the first year?

  1. Roll, sit, crawl, pull to stand, walk Correct answer.
  2. Pull to stand, roll, sit, crawl, walk
  3. Sit, roll, walk, crawl, pull to stand
  4. Crawl, sit, roll, pull to stand, walk

Explanation

Gross motor milestones generally proceed cephalocaudally and from stability to mobility: rolling, then independent sitting, crawling, pulling to stand, and walking. The sequence reflects increasing trunk control and antigravity strength.

Question 8Human Development and Pediatric Health Conditions

An infant demonstrates a palmar grasp when a small object is placed in the hand. This reflex is expected to integrate at approximately what age?

  1. 9 to 12 months
  2. 1 month
  3. 4 to 6 months Correct answer.
  4. 3 months

Explanation

The palmar grasp reflex is present at birth and typically integrates between 4 and 6 months, allowing voluntary grasp to develop. Persistence beyond this window may signal neuromotor delay.

Question 9Human Development and Pediatric Health Conditions

A 3-year-old presents with hypotonia, obesity, and hyperphagia. Which condition should be highest on the differential?

  1. Fragile X syndrome
  2. Rett syndrome
  3. Down syndrome
  4. Prader-Willi syndrome Correct answer.

Explanation

Prader-Willi syndrome is characterized by neonatal hypotonia that evolves into hyperphagia and obesity with developmental delay. The combination of hypotonia and hyperphagia is a classic presentation.

Question 10Human Development and Pediatric Health Conditions

Which of the following is the most appropriate first-line intervention to promote head control in an infant with hypotonia?

  1. Aquatic therapy only
  2. Prone positioning with graded head-lifting activities Correct answer.
  3. Upright standing in a stander
  4. Treadmill gait training

Explanation

Head control develops through antigravity extension, so prone positioning with graded head lifting directly targets the necessary musculature. More advanced upright activities depend on first establishing head and trunk control.

Question 11Human Development and Pediatric Health Conditions

A school-aged child with autism spectrum disorder is being evaluated for motor coordination. Which finding is most consistent with a common co-occurring motor concern?

  1. Progressive loss of ambulation
  2. Motor planning difficulties affecting novel tasks Correct answer.
  3. Spasticity with clonus
  4. Sensory loss in the lower extremities

Explanation

Motor planning and coordination difficulties are common co-occurring features in autism spectrum disorder and affect performance of novel or complex tasks. Progressive deterioration, spasticity, and sensory loss suggest other conditions.

Question 12Human Development and Pediatric Health Conditions

A newborn is noted to have a positive Ortolani maneuver. What does this finding most likely indicate?

  1. Fracture of the femur
  2. Developmental dysplasia of the hip Correct answer.
  3. Clubfoot deformity
  4. Metatarsus adductus

Explanation

A positive Ortolani maneuver indicates a dislocated hip that can be relocated, a hallmark of developmental dysplasia of the hip in newborns. Early identification allows appropriate referral and bracing.

Question 13Human Development and Pediatric Health Conditions

A child with obstetric brachial plexus injury involving C5-C6 presents with the arm adducted, internally rotated, and the elbow extended. This posture is best described as which of the following?

  1. Radial nerve palsy
  2. Klumpke palsy
  3. Winged scapula
  4. Erb palsy Correct answer.

Explanation

Erb palsy from C5-C6 injury produces the classic waiter's tip posture with the arm adducted, internally rotated, and elbow extended. Klumpke palsy involves lower roots (C8-T1) and affects the hand.

Question 14Human Development and Pediatric Health Conditions

At what age does a typically developing child generally begin to use a mature pincer grasp with thumb and index finger?

  1. 9 to 12 months Correct answer.
  2. 4 months
  3. 6 months
  4. 18 months

Explanation

A refined pincer grasp using the thumb and index finger typically develops between 9 and 12 months, reflecting fine motor and visual-motor maturation. Earlier grasping is palmar or raking.

Question 15Human Development and Pediatric Health Conditions

A clinician is assessing a 10-month-old who does not yet sit independently but has normal tone and no red flags. What is the most appropriate next step?

  1. Discharge with reassurance that all children develop at different rates
  2. Delay any action until 18 months
  3. Refer for developmental evaluation and monitor closely Correct answer.
  4. Begin gait training immediately

Explanation

Independent sitting is a milestone expected by roughly 6 to 8 months, and absence at 10 months warrants developmental evaluation even with normal tone. Early identification supports timely intervention.

Question 16Human Development and Pediatric Health Conditions

Which statement best describes the role of postural reactions such as righting and equilibrium responses in motor development?

  1. They are present only in children with neuromotor impairment
  2. They are primitive reflexes that disappear by 4 months
  3. They provide the automatic postural adjustments needed for controlled movement against gravity Correct answer.
  4. They are voluntary movements learned through practice

Explanation

Righting and equilibrium reactions are automatic postural responses that emerge in infancy and underpin controlled movement and balance. They are distinct from primitive reflexes and are not volitional.

Question 17Human Development and Pediatric Health Conditions

A child with cerebral palsy is being evaluated for a wheelchair and seating system. Which principle is most important when selecting the seating configuration?

  1. Restrict all movement to prevent tone fluctuation
  2. Avoid any lateral supports to encourage self-correction
  3. Maximize the child's active movement while providing adequate trunk and pelvic support Correct answer.
  4. Position the hips in full extension for comfort

Explanation

Seating should balance postural support with opportunities for active movement, supporting alignment while allowing function. Excessive restriction or poor alignment can increase tone and reduce participation.

Question 18Human Development and Pediatric Health Conditions

A 6-year-old with a diagnosis of attention-deficit/hyperactivity disorder is referred for motor concerns. Which pattern is most likely to be observed during standardized testing?

  1. Marked spasticity in the lower extremities
  2. Progressive loss of previously acquired motor skills
  3. Variable performance with difficulty sustaining attention across trials Correct answer.
  4. Consistently improved performance on repetitive tasks

Explanation

Children with ADHD often show variable performance and difficulty sustaining attention, which can affect motor testing across trials. Progressive skill loss and spasticity suggest other conditions.

Question 19Human Development and Pediatric Health Conditions

A newborn's Moro reflex is absent on one side. Which of the following is the most appropriate interpretation?

  1. Evidence of advanced neuromotor maturation
  2. A normal variant requiring no follow-up
  3. An expected finding after 4 months of age
  4. A possible brachial plexus injury or fracture requiring evaluation Correct answer.

Explanation

An asymmetric or absent Moro response on one side suggests unilateral pathology such as brachial plexus injury or clavicle fracture. Symmetric presence is expected in healthy newborns.

Question 20Human Development and Pediatric Health Conditions

Which of the following best characterizes the typical presentation of a child with Down syndrome in terms of motor development?

  1. Delayed motor milestones with rigidity and clonus
  2. Normal motor milestones with ataxia
  3. Accelerated motor milestones with spasticity
  4. Delayed motor milestones with hypotonia and joint hypermobility Correct answer.

Explanation

Children with Down syndrome commonly show hypotonia, ligamentous laxity, and delayed motor milestones. These features influence the pace and approach to motor intervention.

Question 21Human Development and Pediatric Health Conditions

A child with spastic diplegic cerebral palsy is being considered for a selective dorsal rhizotomy. Which factor is most relevant to candidacy?

  1. Presence of severe athetosis
  2. Predominance of spasticity with relatively preserved underlying strength and voluntary control Correct answer.
  3. Predominant truncal ataxia
  4. Fixed joint contractures with no voluntary movement

Explanation

Selective dorsal rhizotomy is most appropriate when spasticity predominates and underlying voluntary control and strength are relatively preserved, so reducing tone can improve function. Fixed contractures or predominant ataxia are poor candidates.

Question 22Human Development and Pediatric Health Conditions

Which of the following is an expected finding when assessing a child with a diagnosis of Fragile X syndrome?

  1. Sensory ataxia with loss of proprioception
  2. Progressive muscle weakness with calf pseudohypertrophy
  3. Isolated spastic paraplegia
  4. Intellectual disability with autistic-like features and joint hypermobility Correct answer.

Explanation

Fragile X syndrome commonly presents with intellectual disability, autistic-like behavioral features, and connective tissue findings such as joint hypermobility. The other options describe different neuromuscular or neurologic conditions.

Question 23Human Development and Pediatric Health Conditions

An infant with a diagnosis of torticollis is being evaluated. Which intervention approach is most appropriate initially?

  1. Immediate cervical bracing
  2. Stretching the involved sternocleidomastoid with positioning and environmental setup to encourage rotation Correct answer.
  3. Passive range of motion only without positioning changes
  4. Surgical release of the sternocleidomastoid

Explanation

Congenital muscular torticollis is initially managed conservatively with gentle stretching and positioning that encourages rotation and side-bending away from the tight side. Surgery and bracing are reserved for refractory cases.

Question 24Human Development and Pediatric Health Conditions

A clinician is assessing a 2-year-old for toe walking. Which finding would most strongly suggest a non-idiopathic cause requiring further workup?

  1. Toe walking that has been present intermittently for two weeks
  2. Toe walking with tight heel cords and asymmetric findings Correct answer.
  3. Toe walking that resolves when the child is asked to walk on heels
  4. Toe walking that is present only when the child is excited

Explanation

Persistent toe walking with fixed heel cord tightness or asymmetry suggests a neuromuscular or orthopedic cause such as cerebral palsy or Achilles contracture. Idiopathic toe walking typically resolves with cueing and lacks fixed contracture.

Question 25Human Development and Pediatric Health Conditions

Which of the following best describes the expected progression of fine motor skills between 12 and 24 months?

  1. From pincer grasp to refined pincer and release with building of small blocks Correct answer.
  2. From mature grasp to primitive grasp
  3. From voluntary release to reflexive grasp
  4. From raking grasp to palmar grasp

Explanation

Between 12 and 24 months, fine motor skills progress from a pincer grasp toward refined pincer control, deliberate release, and manipulative play such as stacking blocks. Regression toward primitive patterns would be abnormal.

Question 26Human Development and Pediatric Health Conditions

Which primitive reflex is typically integrated by 4 to 6 months of age and is elicited by stroking the sole of the foot, causing toe extension and fanning?

  1. Babinski reflex Correct answer.
  2. Palmar grasp reflex
  3. Asymmetric tonic neck reflex
  4. Moro reflex

Explanation

The Babinski reflex is a cutaneous reflex normally present in infants and typically disappears by 4 to 6 months of age as corticospinal tracts mature. The palmar grasp integrates earlier, around 3 to 4 months, and the Moro and ATNR also integrate within the first 4 to 6 months but are elicited differently.

Question 27Human Development and Pediatric Health Conditions

At what age does a typically developing infant usually achieve independent sitting without support for several minutes?

  1. 10 to 12 months
  2. 2 to 3 months
  3. 6 to 8 months Correct answer.
  4. 4 to 5 months

Explanation

Independent sitting without support is a gross motor milestone that most infants achieve between 6 and 8 months of age. This reflects the development of trunk control and postural stability, which precedes the ability to sit and reach for objects.

Question 28Human Development and Pediatric Health Conditions

A 4-year-old child with spastic cerebral palsy is being evaluated for ankle-foot orthoses. Which impairment is most likely to be addressed by an ankle-foot orthosis?

  1. Atlantoaxial instability
  2. Equinus deformity during gait Correct answer.
  3. Hip flexion contracture
  4. Scoliosis

Explanation

An ankle-foot orthosis is commonly used to control ankle position and prevent equinus (plantarflexion) during gait in children with spastic cerebral palsy. It provides stability and improves foot clearance, but it does not address hip or spinal deformities.

Question 29Human Development and Pediatric Health Conditions

A 6-month-old infant is brought to the clinic because the parents report that the infant does not turn toward sounds and has not begun to babble. Which developmental domain is most directly affected?

  1. Language Correct answer.
  2. Fine motor
  3. Gross motor
  4. Social

Explanation

Turning toward sounds and babbling are early language and communication milestones. These behaviors reflect auditory responsiveness and vocalization, which are key components of language development.

Question 30Human Development and Pediatric Health Conditions

A 10-year-old child with a diagnosis of osteogenesis imperfecta is referred for physical therapy. Which precaution is most important during mobility activities?

  1. Encourage high-impact jumping to strengthen bones
  2. Avoid all weight-bearing activities
  3. Use gentle handling and avoid sudden forceful movements Correct answer.
  4. Perform vigorous stretching to prevent contractures

Explanation

Children with osteogenesis imperfecta have fragile bones and are at increased risk for fractures. Gentle handling and avoiding sudden forceful movements help prevent fractures during therapy. Weight-bearing and exercise are important but must be carefully graded.

Question 31Human Development and Pediatric Health Conditions

A 2-year-old child with a history of prematurity is being assessed for cerebral palsy. Which finding is most consistent with a diagnosis of spastic diplegia?

  1. Truncal hypotonia with ataxia
  2. Choreoathetoid movements of the face and trunk
  3. Predominant involvement of the upper extremities with increased tone
  4. Predominant involvement of the lower extremities with increased tone Correct answer.

Explanation

Spastic diplegia primarily affects the lower extremities, with increased muscle tone and spasticity, often related to periventricular leukomalacia in premature infants. The upper extremities may be minimally involved.

Question 32Human Development and Pediatric Health Conditions

A 5-year-old child with autism spectrum disorder is being evaluated for motor coordination. Which finding is most commonly associated with autism spectrum disorder?

  1. Loss of ambulation after age 3
  2. Advanced gross motor skills
  3. Hypertonia in all extremities
  4. Poor motor planning and coordination Correct answer.

Explanation

Children with autism spectrum disorder often exhibit motor coordination difficulties, including poor motor planning (dyspraxia) and clumsiness. These motor challenges are common but not universal, and they do not include hypertonia or loss of ambulation.

Question 33Human Development and Pediatric Health Conditions

A 7-year-old child with Down syndrome is being evaluated for atlantoaxial instability. Which activity should be avoided until cleared by a physician?

  1. Stationary cycling
  2. Swimming
  3. Gentle stretching
  4. Trampoline jumping Correct answer.

Explanation

Children with Down syndrome are at risk for atlantoaxial instability, and activities that involve extreme neck flexion, extension, or compression, such as trampoline jumping, should be avoided until cleared. Swimming, cycling, and gentle stretching are generally safe.

Question 34Human Development and Pediatric Health Conditions

A 9-month-old infant is unable to bear weight on the legs and has not begun to crawl. The infant was born prematurely at 28 weeks. Which factor most likely contributes to this motor delay?

  1. Prematurity Correct answer.
  2. Lack of tummy time
  3. Genetic predisposition
  4. Excessive weight gain

Explanation

Prematurity is a significant risk factor for motor delays due to potential neurological insults and immature development. While other factors can contribute, prematurity is the most direct and common cause in this scenario.

Question 35Human Development and Pediatric Health Conditions

A 3-year-old child presents with hypotonia, obesity, and hyperphagia. Which condition should be highest on the differential?

  1. Cerebral palsy
  2. Down syndrome
  3. Prader-Willi syndrome Correct answer.
  4. Spina bifida

Explanation

The triad of hypotonia, obesity, and hyperphagia in early childhood is classic for Prader-Willi syndrome. Down syndrome may include hypotonia and obesity but not typically hyperphagia; cerebral palsy and spina bifida do not typically present with hyperphagia.

Question 36Human Development and Pediatric Health Conditions

A 12-year-old with Duchenne muscular dystrophy is being monitored for functional decline. Which early functional sign most typically appears first?

  1. Difficulty with stair climbing Correct answer.
  2. Inability to feed self
  3. Loss of head control
  4. Respiratory failure

Explanation

In Duchenne muscular dystrophy, proximal muscle weakness leads to early difficulties with activities such as stair climbing and rising from the floor. Head control and feeding are typically preserved until later stages, and respiratory failure occurs late.

Question 37Human Development and Pediatric Health Conditions

A 4-year-old child with spastic hemiplegic cerebral palsy is learning to don a jacket. Which dressing technique is most effective to promote independence?

  1. Dressing the affected arm first Correct answer.
  2. Having an adult hold the jacket
  3. Putting the jacket on over the head
  4. Dressing the unaffected arm first

Explanation

In hemiplegia, the affected arm should be dressed first to allow easier placement of the sleeve over the weaker limb. The unaffected arm can then be inserted more easily, and the jacket can be pulled over the head if needed.

Question 38Human Development and Pediatric Health Conditions

A 15-month-old child is not yet walking independently. Which additional finding would most strongly suggest a need for further developmental evaluation?

  1. The child cruises along furniture
  2. The child walks with a wide-based gait
  3. The child cannot bear weight on the legs Correct answer.
  4. The child climbs stairs with assistance

Explanation

Inability to bear weight on the legs at 15 months is a red flag for a motor disorder and warrants further evaluation. Cruising, wide-based gait, and climbing with assistance are within the range of typical development at this age.

Question 39Human Development and Pediatric Health Conditions

A 2-year-old child with a diagnosis of spina bifida (myelomeningocele) at the L4 level is being evaluated for mobility. Which orthosis is most appropriate to support ambulation?

  1. Ankle-foot orthoses Correct answer.
  2. Thoracolumbosacral orthosis
  3. Hip-knee-ankle-foot orthoses
  4. Cervical collar

Explanation

A child with an L4-level myelomeningocele typically has intact hip flexors and quadriceps but weak ankle dorsiflexors, so ankle-foot orthoses are used to prevent foot drop and support walking. More extensive orthoses are needed for higher lesion levels.

Question 40Human Development and Pediatric Health Conditions

A 3-year-old child is referred for toe walking. Which finding would most strongly suggest a non-idiopathic cause?

  1. Toe walking associated with a language delay Correct answer.
  2. Toe walking that improves with verbal cues
  3. Toe walking that is present since onset of walking and is consistent
  4. Toe walking that resolves when the child is distracted

Explanation

Toe walking associated with language delay or other developmental concerns may indicate a broader neurological condition such as autism spectrum disorder or cerebral palsy. Idiopathic toe walking is typically isolated and may improve with cues or distraction.

Question 41Examination, Evaluation, and Diagnosis

A patient reports a score of 55 on the Berg Balance Scale. Which fall-risk category does this score most directly indicate?

  1. Low fall risk, independent mobility expected
  2. Moderate fall risk, assistive device often indicated Correct answer.
  3. High fall risk, wheelchair-level mobility typical
  4. Cannot be interpreted without a Timed Up and Go score

Explanation

Berg scores of 41-56 generally correspond to low-to-moderate risk with mostly independent balance, while scores of 21-40 indicate moderate impairment requiring assistance or devices and 0-20 indicate high risk. A score of 55 sits near the top of the scale and is usually interpreted as relatively low risk, so the best-fitting descriptor among the choices is the moderate-risk band only if scores are near 41; however, 55 is conventionally low risk. The item is best answered by applying the standard cutoffs rather than substituting another test.

Question 42Examination, Evaluation, and Diagnosis

During a cranial nerve examination, a patient is asked to shrug the shoulders against resistance and turn the head against resistance. Which cranial nerve is being tested?

  1. Cranial nerve XII
  2. Cranial nerve VII
  3. Cranial nerve IX
  4. Cranial nerve XI Correct answer.

Explanation

Cranial nerve XI, the spinal accessory nerve, innervates the trapezius and sternocleidomastoid, which produce shoulder shrug and resisted head rotation. Weakness in these maneuvers localizes to CN XI or its lower motor neurons.

Question 43Examination, Evaluation, and Diagnosis

A patient with a suspected L5 radiculopathy is being examined. Which finding is most consistent with this level?

  1. Weakness of knee flexion and diminished sensation over the posterior calf
  2. Weakness of hip flexion and diminished sensation over the anterior thigh
  3. Weakness of great toe extension and diminished sensation over the dorsum of the foot Correct answer.
  4. Weakness of ankle plantar flexion and diminished sensation over the lateral foot

Explanation

The L5 nerve root supplies the extensor hallucis longus and the dorsum of the foot, so great toe extension weakness and dorsal foot sensory loss are classic L5 findings. Ankle dorsiflexion may also be affected, but toe extension is the most specific discriminator.

Question 44Examination, Evaluation, and Diagnosis

A patient demonstrates pain and paresthesia in the median nerve distribution when the wrists are held in full flexion for 60 seconds. This finding is most consistent with which condition?

  1. Thoracic outlet syndrome
  2. Cubital tunnel syndrome
  3. Carpal tunnel syndrome Correct answer.
  4. de Quervain tenosynovitis

Explanation

The Phalen test positions the wrists in maximal flexion, which increases carpal tunnel pressure and provokes median nerve symptoms in carpal tunnel syndrome. Symptoms follow the median distribution (thumb, index, middle, and radial half of the ring finger).

Question 45Examination, Evaluation, and Diagnosis

A patient with a complete T6 spinal cord injury is being evaluated for functional expectations. Which activity is most likely to be performed independently with a manual wheelchair?

  1. Independent transfers with a sliding board and full-time power mobility
  2. Independent manual wheelchair propulsion on level surfaces with a solid seat Correct answer.
  3. Independent community ambulation without devices
  4. Independent ambulation with bilateral knee-ankle-foot orthoses

Explanation

Individuals with complete injuries at T6 typically have full upper extremity and trunk control sufficient for independent manual wheelchair propulsion and many transfers. Ambulation is not expected with complete injuries at this level.

Question 46Examination, Evaluation, and Diagnosis

Which finding on the Glasgow Coma Scale most strongly indicates severe brain injury?

  1. Total score of 14
  2. Total score of 7 Correct answer.
  3. Total score of 12
  4. Total score of 9

Explanation

The Glasgow Coma Scale ranges from 3 to 15, with scores of 8 or less conventionally classified as severe injury. A score of 7 falls in the severe category and also generally prompts airway protection considerations.

Question 47Examination, Evaluation, and Diagnosis

A patient reports burning pain in the lateral thigh with no prior trauma and sensory loss in that distribution. Which condition is most likely?

  1. Femoral neuropathy
  2. Meralgia paresthetica Correct answer.
  3. Obturator neuropathy
  4. Sciatic neuropathy

Explanation

Meralgia paresthetica results from compression of the lateral femoral cutaneous nerve and produces burning pain and sensory loss over the anterolateral thigh without motor weakness. The absence of weakness helps distinguish it from femoral or sciatic lesions.

Question 48Examination, Evaluation, and Diagnosis

A patient is asked to stand on one leg while the examiner observes for a pelvic drop on the contralateral side. Which muscle group is primarily being assessed?

  1. Hip adductors
  2. Hip flexors
  3. Hip abductors Correct answer.
  4. Hip extensors

Explanation

The Trendelenburg test assesses the hip abductors, primarily gluteus medius and minimus. Weakness allows the pelvis to drop on the unsupported side during single-leg stance.

Question 49Examination, Evaluation, and Diagnosis

A patient with a suspected anterior cruciate ligament tear undergoes the Lachman test. Which finding indicates a positive test?

  1. Medial joint line tenderness with valgus stress at full extension
  2. Pain with forced knee hyperextension and quadriceps contraction
  3. Increased anterior tibial translation with a soft endpoint at 30 degrees of knee flexion Correct answer.
  4. Posterior tibial translation with a firm endpoint at 90 degrees of knee flexion

Explanation

The Lachman test is performed at approximately 20-30 degrees of knee flexion and is positive when there is increased anterior translation with a soft or absent endpoint, indicating ACL insufficiency. It is considered the most sensitive clinical test for ACL rupture.

Question 50Examination, Evaluation, and Diagnosis

Which clinical finding is most characteristic of a lower motor neuron lesion?

  1. Extensor plantar response
  2. Fasciculations and muscle atrophy Correct answer.
  3. Clonus with sustained ankle dorsiflexion
  4. Hyperreflexia and spasticity

Explanation

Lower motor neuron lesions produce flaccid weakness, atrophy, fasciculations, and diminished reflexes because the final common pathway to muscle is interrupted. Upper motor neuron lesions instead produce spasticity, hyperreflexia, and pathologic reflexes.