MES GROWTH MODULE JUNE 2025 PTLE

THE CATALYST REVIEW

By Marc Andrei Velez Juliano, PTRP

HUMAN GROWTH AND DEVELOPMENT

1. Acquisition and refinement of skills

a. Development
b. Accommodation
c. Growth
d. Assimilation

2. BP of 1 month old child

a. 110/90
b. 75/50
c. 60/45
d. 90/60 – toddler

The normal blood pressure for a 1-month-old infant is typically around:

• Systolic: 70–90 mmHg
• Diastolic: 50–65 mmHg

Infant (1 month):
• BP: ~75/50 mmHg
• Heart rate: 100–160 bpm
• Respiratory rate: 30–60 breaths/min

Reference: Tecklin, J. S. (Ed.). (2015). Pediatric physical therapy (5th ed.). Wolters Kluwer.

3. In terms of cognitive development, the 5-year-old child would be expected to:

a. Believing in magic and wishes affecting things
b. Thinking about ideas that are not real or concrete
c. Understanding that amount stays the same even if shape change
d. Not being able to understand how someone else feels or thinks

PIAGET’S COGNITIVE DEVELOPMENT

STAGE ONSET CHARACTERISTICS
- I___________________________________
Sensorimotor Stage breakfast - (+) circular reactions
- (+) object permanence
- S__________________________________
Pre-Operational Stage To - Active play
- Egocentric
- L__________________________________
Concrete Operational Stage 7 - Concept of Conservation
- Helps/cares others
- A__________________________________
Formal Operational Stage 11
- Problem solving

PSYCHOSEXUAL COGNITIVE DEVELOPMENT by SIGMUND FREUD

- 0-18 mos - 6 y/o – puberty
ORAL - Find pleasure when they put something in LATENCY - Child is busy refining other skills in school
their mouth
- 18-36 mos.
ANAL GENITAL - Importance and function of genitals
- Find pleasure whenever they poop
- 3-6 y/o
- Concept about genitals 0 - 18
- Concept of masturbation 18 - 36
3-6
- OEDIPUS COMPLEX 6 - pub
o Jojowain: _________________ Pub +
PHALLIC o Totropahin: _________________
o (+) CASTRATION ANXIETY

- ELECTRA COMPLEX
o Love Obect:
o (+) PENIS ENVY

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP
4. In what stage is anal sphincter control present?
a. Autonomy vs shame and doubt
b. Initiative vs guilt
c. Industry vs inferiority
d. Identity vs role confusion

5. An 11-year-old consistently compares themselves with classmates and feels inferior despite performing well academically. They
tend to avoid challenges to prevent failure. What psychosocial challenge are they facing according to Erikson’s stages?
a. Industry vs. Inferiority
b. Identity vs. Role Confusion
c. Initiative vs. Guilt
d. Intimacy vs. Isolation

6. A 30-year-old adult feels unfulfilled professionally and personally, showing little interest in mentoring younger colleagues or
contributing to the community. According to Erikson, which stage might they be struggling with?
a. Intimacy vs. Isolation
b. Generativity vs. Stagnation
c. Ego Integrity vs. Despair
d. Identity vs. Role Confusion

PSYCHOSOCIAL COGNITIVE DEVELOPMENT by ERIK ERIKSON

AGE
CONFLICTS AGE GROUP VIRTUE POS. OUTCOME NEG. OUTCOME
RANGE
Faith in
I Trust vs Mistrust 0-1 Infancy Hope Suspicion and fear
environment
Autonomy vs Shame Shame and self-
II 2-3 Early childhood Will Self-control
and Doubt doubt
Initiate own Guilt to be on one’s
III Initiative vs Guilt 4-5 Pre-school Purpose
activities own
IV Industry vs Inferiority 6-12 School age Competence strengths Inferiority
Identity vs Role
V 13-19 Adolescence Fidelity Uniqueness Confusion
Confusion
Inability to form
VI Intimacy vs Isolation 20-34 Young adulthood Love Commitments affectionate
relationship
Generativity vs Concern for next Concern only for
VII 35-64 Mid adulthood Care
Stagnation generation self
Fulfillment and
Dissatisfaction and
VIII Integrity vs Despair >65 Late adulthood Wisdom willingness to face
despair of death
death

7. Unique human activity celebrated throughout life

a. Bipedal walking
b. Palmar prehension
c. Pointing fingers
d. Babbling

• Bipedal locomotion is uniquely human in that it is our primary mode of movement; no other species consistently uses
bipedalism in the same habitual and efficient manner.

• According to Tecklin (6th ed., 2015, Pediatric Physical Therapy), walking is a major motor milestone typically achieved
between 12–18 months. This skill is symbolic of independence and neuromuscular maturation.
• Campbell’s Physical Therapy for Children (5th ed., 2021) emphasizes that independent walking is one of the most
important motor milestones and sets the stage for later gross motor development such as running, jumping, and
climbing.
• Susan K. Effgen and Dale Strickland in Meeting the Physical Therapy Needs of Children (2nd ed., 2017) highlight bipedal
walking as the most celebrated developmental achievement, often marked by photos, videos, and enthusiastic family
reactions.

8. In normal development, a child will assume the pivot prone position at what age?
a. 0-3 months
b. 3-5 months
c. 4-6 months
d. 6-8 months

Reference: Tecklin, J. S. (2015). Pediatric

physical therapy (5th ed.). Wolters Kluwer Health.

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP

9. An infant is independent in sitting, all protective extension reactions and can pull-to-stand through kneeling, cruise sideways and
stand alone. The infant still demonstrates plantar grasp in standing. The infant’s chronological age is ______ months.
a. 5
b. 10-15
c. 8-9
d. 6

The 8 to 9-month-old will be able to pull-to-stand, stand alone, and cruise sideways, but because he/she is not yet walking, may still
exhibit plantar grasp in the standing position. At 5 months, the infant can roll prone to supine and demonstrates head control in
supported sitting. At 6 months, the infant can sit independently and pull-to- stand. At 10-15 months, the infant typically begins to walk
unassisted.

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP
10. A pediatric physical therapist is assessing a 9-month-old infant. The child sits independently and demonstrates protective extension
forward and laterally but falls backward without protective response. Which of the following BEST describes the child's neuromotor
development?
a. Delayed postural control due to absence of protective extension forward
b. Age-appropriate development; backward protective response is typically absent at this stage
c. Mild delay in equilibrium reactions; backward protective extension should be present by this age
d. Advanced motor development; forward and lateral protective reactions are not expected until after 9 months

11. A physical therapist is assessing the postural reactions of an infant during a developmental screening. The infant demonstrates
protective extension forward when pushed from behind while sitting, lateral protective extension when gently tilted to the side, and
backward protective extension when pushed from the front. Based on the presence of all three protective extension reactions, what
is the MOST LIKELY chronological age of this infant?
a. 4–5 months
b. 6–7 months
c. 8–9 months
d. 12–15 months

12. All protective extension reactions usually develop by this age.

a. 4–5 months
b. 6–7 months
c. 8–9 months
d. 12–15 months

13. At what age does the Landau reflex typically appear, and what is its main purpose in infant development?
a. Appears at birth; helps with grasping objects
b. Appears at 3–4 months; helps develop postural extension
c. Appears at 6–8 months; helps with crawling
d. Appears at 9–12 months; helps with walking balance

It helps the infant develop postural extension of the head, trunk, and limbs, important for later motor skills like sitting and crawling.

14. A newborn is examined at birth using the APGAR test. Based on the following results, the neonatal therapist suspects that
neurological complications are likely with an APGAR of:
a. 3 at 10 minutes
b. 8 at 5 minutes
c. 9 at 1 minute
d. 8 at 1 minute

0 1 2
Appearance Blue baby Pink trunk, blue extremities Pink
Pulse No pulse <100 bpm >100 bpm
Grimace No response Weak grimace, weak cry Good cry
No activity
Activity Some flexion Active flexion
Floppy

15. When does fetal kicking begin in the mother’s belly?

a. 16th week of gestation
b. 20th week of gestation
c. 22nd week of gestation
d. 24th week of gestation

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP
16. The nurse is monitoring the growth and development of an infant and knows that one important milestone in physical growth is the
infant’s birth weight tripling. Based on typical developmental norms, by what age should an infant’s birth weight have approximately
tripled?
a. 9 months
b. 1 year
c. 18 months
d. 2 years

Head Circumference Height Weight

Birth 35 cm Birth 50 cm Birth 2500 – 4000 g
4 mos 41 cm 12 mos 50% BH + BH Low Birth Weight <2500 g
Moderately Low Birth
12 mos 47 cm 4 y/o 100 cm 1500 – 2500 g
Weight
Early School Very Low Birth Weight
Adult 57 cm 5 cm annually <1500 g
Age
Extremely Low Birth
Adolescence 5-8 cm annually <1000 g
Weight
Adult Micro preemies
Center of Gravity Height at 2 y/o x 2
(estimate)
Xiphoid process / Macrosomia
Child
T12
Adult Sl. Anterior to S2 Pes Planus Oz divided by 28.35
Normal 0 – 24 mos
Starts to Estimated Weight at 1 y/o Birth Weight x 3
Head & Trunk Ratio 2 y/o
appear
< 1 y/o Head > Trunk Matures by 4 y/o
= 1 y/o Head = Trunk
< 1 y/o Head < Trunk

Reference:
• Tecklin, J. S. (2015). Pediatric Physical Therapy (6th ed.)
• Santrock, J. W. (2018). Child Development (15th ed.)

17. The Bayley Scales of Infant and Toddler Development is a standardized tool used to assess which of the following?
a. Deviation from normal development
b. Mental and motor development across multiple domains
c. Neurological maturity and developmental age
d. Simple milestone achievement
e. None of the above

Deviation from typical developmental patterns

Denver Developmental Screening Test
(DDST)
Purpose: to check if a child is developing on time
Separates score into mental developmental index and psychomotor development
Bayley Scale of Infant Development index.
(Bayley-II)
Purpose: checks how well a child is developing now
Assess a child’s developmental age in relation to their chronologic age
Gessel Developmental Schedule
Purpose: check child’s developmental age

18. At what age does an infant typically achieve the milestone of sitting steadily without support, demonstrating sufficient trunk control
and balance to maintain an upright seated position independently?
a. 4
b. 5
c. 8
d. 15

19. At what is the earliest age range during which an infant is expected to achieve independent walking, demonstrating the ability to
stand and take steps without assistance?
a. 8 to 10
b. 12 to 15
c. 15 to 18
d. 18 to 21

20. During a routine developmental screening, the you are assessing the gross motor milestones of a healthy 5-month-old infant.
Which of the following motor skills would be most appropriate for this age?
a. Roll from abdomen to back.
b. Roll from back to abdomen.
c. Sit erect without support.
d. Move from prone to sitting position.
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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP

21. Parents may notice changes in their infant's social behavior as they grow. At what age do most infants typically begin to show fear
or anxiety around unfamiliar people, also known as stranger anxiety?
a. 2 months
b. 4 months
c. 6 months
d. 12 months

NEWBORN
Gross Motor Fine Motor Personal/Social Speech & Language
flexor tone
predominates hands fisted habituation and some control of cry
turns head to side in prone state (mabilis mawala interest State-dependent
Palmar grasp reflex pag paulit-ulit stimulus) quieting
automatic reflex walking
state dependent ability to fix and
rounded spine when held follow bright object State dependent head turning to rattle
sitting and voice

4 MONTHS
Gross Motor Fine Motor Personal/Social Language
turns to voice and bell
head midline hands mostly open consistently
head held when pulled to sit Cooing, chuckles. laughs,
midline hand play squeals
in prone, lifts head to 90°
and lifts chest slightly responsive vocalization
recognizes bottle blows bubbles,
Rolls prone à supine crude palmar grasp “raspberries”

7 MONTHS
Gross Motor Fine Motor Personal/Social Language

maintains sitting, may lean differentiates between use single and double
on arms intermediate grasp familiar person and stranger consonant-vowel
combinations
transfers cube from hand to
rolls supine à prone hand holds bottle
bears all weight;
bounces when held looks for dropped object
erect 1 syllable
bangs objects “talks” to his mirror image
cervical lordosis
Sitting w/ supp = 6 mos Stranger anxiety
Sitting w/o supp = 8 mos Separation anxiety
Pull-to-sit = 5 mos
Pull-to-stand = 10 mos

10 MONTHS
Gross Motor Fine Motor Personal/Social Language

Pincer grasp (mature thumb

creeps on all 4s to index finger grasp) plays peek-a-boo shouts for attention

pivots in sitting finger feeds imitates speech sounds

stand momentarily bangs 2 cubes held in hands chews with rotary waves “bye-bye” à
movement 2 syllables
uses “mama” & “dada”
Cruises, creeps, crawls Love affair w/ the world w meaning
slight bow leg; increased
lumbar lordosis; acute
lumbo- sacral angulation inhibits behavior to “no”

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP
14 MONTHS
Gross Motor Fine Motor Personal/Social Language

uses spoon with

walks alone, arms in high piles 2 cubes overpronation and uses single words = 1
guard or mid guard spilling word

wide BOS, excessive hip scribbles spontaneously

and knee flexion
foot contact on entire sole holds crayon full length in palm

slight valgus knees and feet removes garment understands simple

command
pelvic tilt and rotation casts objects

18 MONTHS
Gross Motor Fine Motor Personal/Social Language
emerging hand points to named body
arms at low guard dominance imitates housework part
mature supporting base and
heel strike crude release carries, hugs doll identifies one picture
holds crayon butt end in palm
seats self in chair says “no”
drinks from cup neatly
dumps raisin from bottle
walks backwards spontaneously Sits on a chair properly jargons

2 YEARS
Gross Motor Fine Motor Personal/Social Language
2-word phrases are
begins running hand dominance pulls on garment common
walks up and down
stairs alone builds 8 cube tower uses spoon well uses verbs
aligns cubes
horizontally opens door turning knob refers to self by name
feeds doll with bottle or
imitates vertical line spoon uses “me”, “mine”
places pencil shaft between
jumps on both feet in
thumb and fingers
place
toilet training usually follows simple
draws with arm and wrist begun directions
action

3 YEARS

Gross Motor Fine Motor Personal/Social Language

most children toilet trained 3 word sentences are
runs well imitates 3 cube bridge day and night usual
pedals tricycle copies circle pours from pitcher uses future tense
uses overhand throw with
broad jumps anteroposterior arm and trunk unbuttons; washes and dries asks “what”, “who”,
motion hands and face “where”
follows prepositional
walks upstairs parallel play commands (under,
alternating feet between, behind)
can take turns gives full name
may stutter in
catches with extended arms
eagerness
hugging against body
can be reasoned with identifies self as boy or
Unstable tandem walking girl
Overhead throw and catch recognizes 3 colors

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP
4 YEARS
Gross Motor Fine Motor Personal/Social Language
handles a pencil by finger and gives connected
walks down stairs with wrist action, like an adult cooperative play, sharing and account of recent
alternating feet interacting experiences
imaginative make believe asks “why”, “when”,
hops on one foot copies a cross play “how”
dresses and undresses
plantar arches draws a frog-like person with with supervision, uses past tense,
developing head and extremities distinguishing front and adjectives, adverbs
back of clothes
knows opposite
sits up from supine position Throws and catches underhand does simple errands analogies
without rotating outside home
Walks on heels, Squats Uses and cuts with scissors repeats 4 digits number

5 YEARS
Gross Motor Fine Motor Personal/Social Language

skips hand dominance is creative play Very fluent speech

expected
misarticulations of
tip toes draws man with head, body competitive team play some sounds may
and extremities persist
throws and catches with uses fork for stabbing gives name, address,
balances 10 sec on each diagonal arm and body food age
foot rotation
defines concrete nouns by
Stable tandem walking brushes teeth composition, classification
or use

catches with hands

follows 3 part
Draws Triangle self sufficient in toileting command
dresses without supervision
Kicks ball except tying shoelaces has number concepts up
to 10

6 YEARS
Gross Motor Fine Motor Personal/Social Language
prints alphabets (letter teacher is important shows mastery of
rides bicycle reversal still acceptable) authority to child grammar
uses fork appropriately
uses knife for spreading
roller skates mature catch and throw of ball uses proper
articulation
ties shoelaces
Draws fat diamond
plays table games

7 YEARS
Gross Motor Fine Motor Personal/Social Language
eats with fork and knife
Draws thin diamond
continuing refinement of combs hair
skills
responsible for grooming

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP
PEDIATRIC CONDITIONS, ASSESSMENT, AND REHABILITAITON
22. Premature baby
a. 28-37 weeks
b. 20-37 weeks
c. 24-37 weeks
d. 32-37 weeks

23. A therapist presents an educational seminar on cerebral palsy, where he discusses its numerous etiologies. The following are
congenital etiology of cerebral palsy, EXCEPT:
a. Meningitis
b. Rubella
c. Syphilis
d. Toxoplasmosis

PRENATAL PERINATAL
Prematurity Prolonged labor
Rh Incompatibility Asphyxia d/t cord coiling
Hyperbilirubinemia Placenta complications
Vasculopathies AbN presentation:
Fetal anoxia - _________________________
Maternal infection
- S POSTNATAL
- T Trauma
- O Hemorrhage
- R Infection (fetal)
- C Coagulopathy
- H

24. Vibration is often used to facilitate muscle tone in children with Down syndrome. The muscle groups MOST in need of facilitation
are ________;
a. Neck and back flexors and extensors, elbow extensors and knee flexors and extensors
b. Back extensors, elbow flexors and extensors, hip adductors and knee extensors
c. Neck flexors and extensors, trunk flexors, hip adductors, and knee extensors
d. Neck and back extensors, elbow extensors, hip abductors, and knee extensors

Children with Down syndrome commonly present with generalized hypotonia, which affects postural stability and movement control.
To support functional movement and posture, facilitation techniques like vibration are often used on specific antigravity and postural
muscles that tend to be weak or underactive.

The muscle groups most in need of facilitation include:

• Neck and back extensors – for postural control, head and trunk alignment
• Elbow extensors – to support weight bearing during prone and quadruped positions
• Hip abductors – to stabilize the pelvis during standing and walking
• Knee extensors – to maintain upright posture and support standing/walking

These are crucial in achieving developmental milestones such as sitting, crawling, standing, and walking.

References:
• Tecklin, J. S. (Ed.). (2015). Pediatric physical therapy (5th ed.). Wolters Kluwer.
• Molnar, G. E., & Alexander, M. A. (2017). Pediatric rehabilitation (6th ed.). Demos Medical Publishing.
• Levitt, S. (2018). Treatment of cerebral palsy and motor delay (6th ed.). Wiley-Blackwell.

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP

25. Before 2 years of age, a gait abnormality commonly observed in a child with hemiplegic cerebral palsy is:
a. Festinating
b. Circumduction & limited arm swing
c. Toe walking
d. Ataxic

According to Tecklin, during early ambulation (around 12–24 months), children with spastic hemiplegic CP may begin walking
with:
• Asymmetry in the lower limbs
• Early toe walking on the affected side, due to increased plantarflexor tone and spasticity
• This can present as unilateral toe walking as one of the first observable gait differences

Even though circumduction and limited arm

swing (Choice B) is more classically associated
with hemiplegic CP in older children, toe walking
on the affected side can be one of the earliest
gait abnormalities seen just after independent
walking begins — typically before age 2.

Reference: Tecklin, J. S. (Ed.). (2015). Pediatric physical therapy (5th ed.). Wolters Kluwer.

26. The basal ganglia play a crucial role in the regulation of movement and muscle tone. When damage occurs to this specific area of
the brain, it results in a distinct type of cerebral palsy characterized by involuntary movements, fluctuating muscle tone, and
difficulty controlling motor functions. What type of cerebral palsy is typically caused by damage to the basal ganglia?
a. Diplegic
b. Quadriplegic
c. Hemiplegic
d. Athetoid

27. Among the various types of cerebral palsy (CP), seizures are a common associated complication. Considering the typical clinical
presentations and prevalence, which type of cerebral palsy is most frequently associated with the occurrence of seizures in
affected children?
a. Spastic diplegia
b. Spastic Hemiplegia
c. Spastic
d. Quadriplegia

28. The most severe type of cerebral palsy caused by periventricular leukomalacia:
a. Spastic diplegia
b. Spastic quadriplegia
c. Spastic hemiplegia
d. CP athetoid type

29. Cerebral Palsy associated with hyperbilirubinemia and asphyxia

a. Athetoid
b. Diplegia
c. Ataxic
d. Dyskinetic

SPASTIC DIPLEGIA SPASTIC QUADRIPLEGIA SPASTIC HEMIPLEGIA

Most common type Worst prognosis & Most Severe Good prognosis
M/C Cause: M/C Cause: M/C
___________________________ __________________________ Cause:____________________________
Affected: Affected: Affected:
_____________________________ _____________________________ ______________________________

(+) scissoring gait = spasticity of (+) Mental retardation (+) Typical arm posture
___________ (+) Seizures (+) Sialorrhea
(+) Bunny hopping (+) Speech, visual, and hearing deficits (+) Cortical thumb
(+) Frog leg positioning (+) chewing, sucking, and swallowing (+) Circumducting gait
Hip dislocation or subluxation possible difficulties (+) Equinus
Near normal-to-normal intelligence (+) Combat crawling (+) Limb asymmetry
(+) Straphanger deformity (+) Hip disclocation
(+) Bird wing deformity (+) Sensory deficit
(+) Scoliosis (+) Toe walking
(+) Typical arm posture Normal intelligence
(+) Sialorrhea
(+) Cortical thumb **if there is hand preference prior to 18
mos., there is increased risk for CP SH

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP

30. A patient with spina bifida presents in the clinic with a history of early hip dislocation. This presentation is most consistent with what
specific segment of affectation?
a. L4-L5
b. L1-L3
c. S1-S2
d. NOTA

Kyphoscoliosis
T6-T12 (+) Frog leg position (hip ABER) In the tune of:
Complete paralysis of LE Love Moves in Mysterious Ways by Nina
(MYMP)
Severe (early) hip dislocation d/t paralysis of
muscles supporting hip
T6 – T12 Kyphoscoliosis
L1-3 (+) contracture of hip FAD
L1, L2, L3 – Severe hip, severe hip dislocation
(+) Scoliosis and Lordosis
(+) Equinus foot L4, L5 – Mild hip dislocation with
calcaneovarus
L4-5 Mild (late) hip dislocation w/ calcaneovarus
S1 ay calcaneocanvus
S1 Cavus foot
S2 claw toes
S2 Claw toes
S3, S4 – sphincter control problem
S3-4 Sphincter control problem

31. Prevention of neural tube defects such as myelomeningocele requires intake of which of the following vitamins?
a. Vit B12
b. Vit B9
c. Vit B3
d. Vit B5

• Folic Acid - (found in green leafy vegetables) is essential for the spinal cord to develop properly
• Iron - (found in beef, chicken, beans, spinach, and tofu) is necessary to make additional hemoglobin, which carries oxygen
to the body’s cells
• Calcium - (found in milk, yogurt, and cheese) is required to develop strong teeth and bones as well as a healthy heart,
muscles, and nerves.

Women of childbearing age 400 μg or 0.4 mg/day.

Women who have spina bifida 4,000 μg or 4 mg/day
OR
Female with previous NTD pregnancy 1 to 3 months prior to conception and through the fi rst
trimester.
High-risk pregnancies (mother taking valproic acid or has 4 mg/day
maternal diabetes)

32. Arnold-chiari malformation manifestation:

a. Ataxia
b. Aphasia
c. Diplopia
d. Low IQ

Reference: Goodman, C. C., &

Fuller, K. S. (2015). Pathology
Implications for the Physical
Therapist (4th ed.). Saunders.

Reference: Spearing, E. M.,

Pelletier, E. S., & Drnach, M.
(2021). Tecklin’s Pediatric
Physical Therapy. Lippincott
Williams & Wilkins.

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 MES GROWTH MODULE JUNE 2025 PTLE
THE CATALYST REVIEW
By Marc Andrei Velez Juliano, PTRP
33. Most important role of pediatric rehabilitation during critical injury and illness.
a. Ease pain and discomfort
b. Minimize anxiety and trauma
c. Improve muscle strength
d. Prevent joint contractures

• During critical injury and illness, children are vulnerable not only physically but
also psychologically.
• Pediatric rehabilitation aims to reduce anxiety and trauma which can
negatively affect recovery and long-term outcomes.
• While pain management, muscle strengthening, and preventing joint
contractures are important goals, minimizing anxiety and trauma is
foundational during the acute phase to promote cooperation, reduce
psychological harm, and improve overall rehabilitation success.
• Early psychological support helps foster trust, reduce fear, and encourage active
participation in rehab.

34. Duchenne muscular dystrophy (DMD), also referred to as pseudohypertrophic or progressive muscular dystrophy, is a common and
severely disabling neuromuscular disorder in children. It is caused by a mutation at Xp21 that affects which protein?
a. Dysferlin
b. Calpain-3
c. Telethonin
d. Dystrophin

PATAU SYNDROME EDWARD’S SYNDROME DOWN SYNDROME

Trisomy 13 Trisomy 18 Trisomy 21
Trigonocephaly AbN shaped head Dysplastic
Hearing impairment Small mouth & jaw Occiput is flat
Microphthalmia Internal organ problem Weak
Cleft palate Syndactyly Neck is shirt
Heart problem Severe MR 1st and 2nd toe webspace are increased
Clenched fist Most fatal 4 Short
Dies within 1st day or first week Simian crease
Slanting eyes
Subluxation

TURNER SYNDROME KLINEFELTER SYNDROME CRI-DU-CHAT SYNDROME

XO XXY Xp5
Webbed neck Narrowed shoulder High pitch
Short Wide pelvis Laryngeal problem
Cubitus valgus Gynecomastia Wide setting eye
Amenorrhea Tall Microcephaly
Absent ovaries Undescended testes Severe MR

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PRADER WILLI SYNDROME ANGELMAN SYNDROME
Xq15 (Paternal gene) Xq15 (Maternal Gene)
Increased appetite Sunken nasal bridge
Type 2 DM Small widely spaced tooth
Obesity Small chin
Insatiable appettite Ear-to-ear smile
(+) MR
Seizure
Large tongue

35. A therapist observes a child with DMD pick up an object from the table but is unable to raise his hands to his mouth. What score
should the therapist give this patient?
a. 3
b. 4
c. 5
d. 6

36. Clinically, what criterion can be used to differentiate between Duchenne muscular dystrophy (DMD) and Becker muscular
dystrophy (BMD)?
a. Utilization of gower’s maneuver
b. The ability to ambulate past the late teenage years
c. Pseudohypertrophy of the calf muscles
d. Onset of muscle weakness before 3 years of age

The key clinical difference is in the severity and progression of the disease:
• DMD typically leads to loss of ambulation by early teens (around 12 years).
• BMD progresses more slowly; patients often retain the ability to walk into their late teens or adulthood.

References:
Tecklin, J. S. (2015). Pediatric Physical Therapy (6th ed.).
Emery, A. E. H. (2002). The muscular dystrophies.

37. Most common cause of death in patients with DMD?

a. Respiratory failure
b. Multiple organ failure
c. Renal failure
d. Cardiac failure

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38. In children with Duchenne Muscular Dystrophy (DMD), certain muscle groups are more prone to developing tightness and
contractures due to progressive muscle weakness and compensatory postural changes. All of the following muscles are commonly
tight in patients with DMD, EXCEPT:
a. Iliopsoas
b. Gastrocnemius
c. Quadriceps
d. Hamstrings

DMD BMD
Xp21 Affectation Xp21
absent Dystrophin Defective
3-5 y/o Onset 10-15 y/o
Impaired Intellect Normal
Cardiorespiratory failure Cause of Death Cardiorespiratory failure
(+) Gower Sign S/Sx Same as DMD but less severe
Pseudohypertrophy and less progressive
Waddling gait
Dystrophic gair
Scoliosis
Equinovarus foot
Genu recurvatum

CONTRACTURE WEAK
Hip Flexor Hip extensor
Knee flexor Knee extensor
Elbow flexor Neck extensor
TFL
Triceps Surae

39. A patient with Fascioscapulohumeral dystrophy has affectation of the following muscles: orbicularis oris, zygomaticus, orbicularis
oculi. She will have difficulty in the following activities, EXCEPT:
a. Frowning when angry
b. Whistling to call her dog
c. Pursing the lips while putting on lipstick
d. Drinking from a straw

Reference: Frontera, W. R. (Ed.). (2020). DeLisa's physical medicine & rehabilitation: Principles and practice (6th ed.). Wolters
Kluwer.

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40. Dandy-Walker Malformation is described as a cystic malformation that occurs during embryonic development. Infants with this
condition usually present with motor difficulties such as crawling and walking. Which of the following does not describe this
condition?
a. Enlargement of the fourth ventricle which usually leads to hydrocephalus
b. Typically occurs sporadically and is the most common anterior fossa malformation
c. Can present with malformation of heart, face, limbs, as well as macrocephaly
d. Most cases result from chromosomal aneuploidy, congenital rubella, and fetal alcohol exposure

41. Key feature of Dandy Walker Syndrome?

a. Most patients typically manifest with hydrocephalus in their first year of life
b. Hypoplasia of the vermis of the cerebellum thus cerebellar symptoms are typically a common finding
c. Cystic dilation of the fourth and lateral ventricle
d. Expansion of the posterior fossa with hydrocephalus as an obligatory finding

Dandy-Walker complex (DWC), also known as the Dandy-Walker syndrome (DWS), defines a group of developmental anomalies of
posterior fossa and includes Dandy-Walker malformation (DWM), Dandy-Walker variant (DWV), mega cisterna magna, and posterior
fossa arachnoid cyst (1,2,3). DWM was first defined by Dandy and Blackfan (4) in 1914 and was named as Dandy-Walker by Benda
(5) in 1954. Although it is known with the classical triad of hypoplasia of cerebellar vermis, cystic dilatation of the fourth ventricle and
hydrocephalus, different definitions were also suggested as a result of studies till date (6) (Table 1). Although Hirsch et al. (7)
mentioned hydrocephalus as a frequent complication of DWM, they suggested that it is not necessary for the diagnosis.

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42. Causes of GDD, except:
a. Genetic
b. CNS malformation
c. Trauma
d. Amputation

GDD refers to a delay in reaching developmental milestones in children under the age of 5. It is a broad term, and it means the
child is performing at a level significantly below age expectations in at least two of the following domains:
• Gross motor skills (e.g., crawling, walking)
• Fine motor skills (e.g., using hands for tasks like drawing or feeding)
• Speech and language skills (e.g., understanding language, speaking)
• Cognitive abilities (e.g., memory, problem-solving)
• Social/emotional skills (e.g., interacting with peers, managing emotions)

Amputation, especially when isolated and not due to a broader neurological or genetic condition, does not affect cognitive,
language, or overall brain development.
- It may cause physical or functional limitations (e.g., in gross motor milestones), but it doesn't cause global
delays across multiple domains unless accompanied by another underlying disorder.

43. It is important that physiotherapists can teach a pelvic floor contraction, particularly when they do not have the opportunity to
examine a woman to check her technique (e.g. antenatal classes). It has been suggested that imagery may help women contract
correctly, except:
a. Closing the doors of a lift/elevator and moving up
b. Eating spaghetti
c. Action of a vacuum cleaner
d. None of the above

Reference: Kisner, C., Fair, M., & Colby, L. A. (2020). Tidy’s physiotherapy (15th ed.). Elsevier.

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By Marc Andrei Velez Juliano, PTRP
GERIATRICS
44. A 70-year-old female who recently underwent total knee replacement was referred to PT. The referring physician stated in the chart
that the patient has stage 1 Alzheimer's disease. The PT will therefore not expect to find:
a. Profound communication deficits
b. Memory loss
c. Anxiety and irritability
d. Cannot concentrate

Profound communication deficits (inability to speak),

global deterioration of mental functions (delusions,
hallucinations, fragmented memory), agitation, and
pacing (sundowning – agitation occurring late
afternoon or at night) are all characteristic of later
stages of AD.

Mild AD is characterized by memory loss,

absentmindedness, anxiety and irritability, difficulty
concentrating, and occasional word-finding problems.
(Physical Therapy Applications)

Reference: Kreutzer, J.S., DeLuca, J., & Caplan, B. (2011): Encyclopedia of Clinical Neuropsychology. Springer Science + Business
Media, LLC.

45. Hereditary gene for Alzheimer’s Disease

a. APP
b. ANA
c. ALG-7
d. ALD

THREE DIFFERENT GENE MUTATIONS

- Causing early-onset fAD (familial AD)
1. Amyloid Precursor Protein (APP) on Chromosome 21
2. Presenilin-1 (PSENI) on Chromosome 14
3. Presenelin-2 (PSEN2) on Chromosome 1

ANA (Antinuclear Antibody) is not a gene—it refers to autoantibodies directed against contents of the cell nucleus.

ALG-7 is not found in major genetic studies of Alzheimer’s and has no known link to neurodegenerative processes.

ALD (Adrenoleukodystrophy) presents with neurological deterioration, but it is a separate condition from Alzheimer’s and
follows a different pathological process.

46. An 80-year-old patient diagnosed with Alzheimer's type of dementia was referred for balance and coordination training. In
preparing a plan of care, it is essential to know that the patient is _________________?
a. Usually trusted to be responsible for own daily care needs
b. Usually trusted with transfers with appropriate positioning of the wheelchair
c. Likely not open to activity training if unfamiliar activities are used
d. Is more likely to remember recent experiences than past ones
Answer: C
Activity training is most likely to be successful if done with familiar activities. A patient with Alzheimer’s type dementia cannot be trusted
to safely perform IADLs or functional mobility skills (wheelchair transfers). Memory for past events may be retained initially but
eventually, all memory becomes impaired. (Physical Therapy Applications)

47. Risk for falls with a TUG score of 30

a. High
b. Very High
c. Moderate
d. Low
Answer: A

Reference: S. O’Sullivan & R. Siegelman, National Physical Therapy Examination Review and Study Guide, 2018

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AIDS & CANCER
48. A malignant neoplasm of glandular epithelium is
a. Adenoma
b. Adenocarcinoma
c. Papilloma
d. Basal cell carcinoma

49. A change from columnar epithelium to squamous epithelium may occur in chronic inflammations or vitamin A deficiency; this is
called:
a. Metaplasia
b. Anaplasia
c. Neoplasia
d. Hyperplasia

• A reversible change in which one differentiated cell type (e.g., columnar epithelium) is replaced by another (e.g.,
squamous epithelium).
• Often occurs as an adaptive response to chronic irritation, inflammation, or vitamin A deficiency.
• Example: In chronic smokers, bronchial columnar epithelium can transform into squamous epithelium.

50. A suspicious skin lesion requiring medical evaluation has:

a. Round, symmetric borders
b. Notched edges
c. Matching halves when a line is drawn down the middle
d. A single color of brown or tan

A ASYMMETRY Uneven; a line drawn through the middle does not produce matching halves
B BORDER Irregular and poorly defined edges; uneven, fuzzy, scalloped edges
C COLOR Black, shades of brown, red, white, blue, or other colors present at the same time
D DIAMETER Larger than the width of a pencil eraser
Mole or skin lesion that looks different from the rest or is changing in size. Shape,
E EVOLVING CHANGE
or color; bleeding, itching, crusting

51. Which among the following choices does not correctly defines Ollier’s Disease?
a. Also known as Enchondromatosis, is uncommon and results from excessive cellular proliferation of cartilage cells in the
epiphyseal plates
b. Considered as one of the most common intraosseous cartilage tumors, usually diagnosed among individuals 20 to 50
years of age predisposed genetically
c. Abnormal and irregularly shaped cartilage masses are present within the metaphyses
d. Typically appears as solitary metaphyseal lesions of tubular bones of the hands and feet
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52. A 6-year-old child was born with no physical deformities but suddenly started to have multiple deformities such as shortening of
right lower limb, valgus of left knee, and enlargement of hand and foot. Radiograph reveals multiple radiolucent lesions in the
bones due to excessive proliferation of cartilages. He was later diagnosed with:
a. Mafucci’s syndrome
b. Angelman
c. Ollier’s disease
d. Paget’s disease

Chondromas are benign tumors of hyaline cartilage that usually occur in bones of
enchondral origin. Enchondromas are the most common of the intraosseous cartilage
tumors and are usually diagnosed in individuals 20 to 50 years of age. Typically, they
appear as solitary metaphyseal lesions of tubular bones of the hands and feet.

Enchondromatosis is an uncommon affection of the skeleton characterized by

disorderly and excessive proliferation of cartilage cells at many of the epiphyseal
plates, At birth it may: be present but not apparent on clinical examination. No genetic
basis for enchondromatosis has been demonstrated. The disease has been confused
in the literature with multiple exostoses but differs from it in many respects. An
obvious difference is that in enchondromatosis, the abnormal cartilage masses are
within the metaphysis, whereas the lesions of multiple exostoses project from the
surface of the metaphysis.

Pathology. Irregularly shaped masses of cartilage, whose cells vary from young forms
to mature chondrocytes, are found in the metaphyseal region.

Prader-Willi syndrome is characterized by mental retardation, short stature, hypotonia, profound hyperphagia, obesity,
small hands and feet, and hypogonadism.

Patients with Angelman syndrome are also mentally retarded, but in addition they present with ataxic gait, seizures, and
inappropriate laughter. Because of their laughter and ataxia, they have been referred to as “happy puppets.”

53. You are working with a 2-year-old child who has a tumor in the posterior fossa. She demonstrates a significant right torticollis.
Which intervention is most likely contraindicated?
a. Facilitated active range of motion
b. Gentle anterior-posterior glides in the upper cervical region
c. Home positioning program
d. Upper trapezius strengthening

A posterior fossa tumor in a 2-year-old child is a serious condition often affecting the brainstem and cerebellum, with potential
neurological and cranial nerve involvement. In such cases, manual techniques involving cervical mobilization, especially
anterior-posterior glides in the upper cervical spine, are contraindicated because:
• The upper cervical region is in close proximity to the brainstem and spinal cord.
• A tumor in the posterior fossa could compromise the structural integrity or increase intracranial pressure.
• Passive manual therapy poses a risk of further neurological compromise or vascular injury, especially in children with
altered neurology or intracranial pathology

“For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give
you hope and a future.”
Jeremiah 29:11 (NIV)

JUNE 2025 PTRP!!!

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