Neuro Section Of Ped's Test

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  • 1/53 Questions

    The most common permanent disability in children.

    • Spina Bifida
    • Cerebral Palsy
    • Glomerlular Disease
    • Asthma
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About This Quiz

This quiz covers key concepts in pediatric neurology, focusing on cerebral palsy, its non-progressive nature, associated risk factors, and clinical presentations.

Neuro Section Of Peds Test - Quiz

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  • 2. 

    Spina bifida is a failure of the spinal bony covering to close.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Spina bifida is a birth defect where the spinal column does not close completely during fetal development. This can result in a range of physical and neurological abnormalities. The statement correctly states that spina bifida is a failure of the spinal bony covering to close, making the answer true.

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  • 3. 

    Neural tube defect has been linked to insufficient folic acid in the maternal diet.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    up to 70% of cases of spina bifida are thought to be preventable if women of childbearing age take 400 mcg of folic acid daily before becoming pregnant.

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  • 4. 

    A priority nursing diagnosis for a child who sits in a wheelchair all day is risk for impaired skin integrity.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Due to decreased sensation, the child with paralysis who sits in a wheelchair is at very high risk for pressure ulcers.

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  • 5. 

    Hydrocephalus is frequently associated with spina bifida/myelomeningocele.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    True 90-95% have hydrocephalus

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  • 6. 

    Encephalocele is herniation of the brain through a skull defect.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Encephalocele is a medical condition where the brain protrudes through a defect in the skull. This can occur due to incomplete closure of the neural tube during fetal development. The herniation of the brain can lead to various neurological symptoms and complications. Therefore, the statement that encephalocele is the herniation of the brain through a skull defect is true.

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  • 7. 

    Tethered Cord is another problem sometimes associated with Spina Bifida where there is pulling and stretching on the fixed spinal cord.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Tethered Cord is indeed another problem that can be associated with Spina Bifida. It occurs when the spinal cord is fixed and experiences pulling and stretching, causing complications. Therefore, the statement is true.

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  • 8. 

    Leading cause of head injury in children under age 5?

    • Nonaccidental trauma

    • Falls at home

    • MVA

    • Trauma caused by sibling

    Correct Answer
    A. Falls at home
    Explanation
    Falls at home are the leading cause of head injury in children under age 5. Young children are more prone to falls due to their developing motor skills and lack of coordination. They may fall from furniture, stairs, or while playing. The home environment poses various hazards such as slippery floors, uneven surfaces, or objects that can be tripped over. Therefore, it is important to ensure a safe and childproofed environment to prevent such accidents and reduce the risk of head injuries in young children.

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  • 9. 

    With the exception of the Babinski reflex which lasts til around age 12 months, most infantile reflexes should be gone at around 4 months.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Clinch fists, tonic neck, tongue thrusts

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  • 10. 

    At 3 months infant should have head control with it being well established by 4 months.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    By 3 months of age, infants should be able to control their head movements to some extent. This means that they can hold their head up without support and have some control over its movements. By 4 months, this head control should be well established, meaning that the infant can hold their head steady and control its movements with more precision. Therefore, the statement is true as it accurately describes the developmental milestones for head control in infants.

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  • 11. 

    Spina Bifida is a neural tube defect.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    a defect(s) in neural tube closure in the first 3-5 weeks of gestation. May involve the entire length of the neural tube or may be restricted to a small area.

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  • 12. 

    A defect in the bony spine invisible to the eye with no manifestations or problems.

    • Spina bifida occulta

    • Meningocele

    • Myelomeningocele

    Correct Answer
    A. Spina bifida occulta
    Explanation
    Spina bifida occulta is a condition where there is a defect in the bony spine that is not visible to the naked eye and does not cause any symptoms or issues. This is different from meningocele and myelomeningocele, which are more severe forms of spina bifida where the spinal cord and its covering are protruding through the defect in the spine. Therefore, the correct answer is spina bifida occulta.

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  • 13. 

    Spinal defect and the sac-like protrusion are present, but only spinal fluid and meninges are present in the sac.  After the sac is repaired no further symptoms are usually seen since spinal nerves are not damaged.

    • Spina bifida occulta

    • Meningocele

    • Myelomeningocele

    Correct Answer
    A. Meningocele
    Explanation
    Meningocele is the correct answer because it refers to a type of spina bifida where the spinal defect and sac-like protrusion are present, but only spinal fluid and meninges (protective coverings of the spinal cord) are contained in the sac. This condition is usually repaired surgically, and since the spinal nerves are not damaged, no further symptoms are typically seen after the repair.

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  • 14. 

    Duchenne Muscular dystrophy (DMD) is the most common form of MD.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Inherited as an x-linked recessive trait, DMD has an onset between 3 and 5 years of age. Life expectancy for DMD reaches into early adulthood.

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  • 15. 

    Most myelomeningoceles involve the lumbar and lumbosacral area.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Myelomeningoceles are a type of neural tube defect where the spinal cord and surrounding structures do not fully develop. They typically occur in the lumbar and lumbosacral area of the spine, which is the lower back region. Therefore, it is true that most myelomeningoceles involve the lumbar and lumbosacral area.

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  • 16. 

    Classification of CP abnormal, involuntary, slow, uncontrollable WRITHING movements of hands, feet, legs, more distally.  Constant worm like WRITHING movements that usually involve all extremities.

    • Hypotoonia

    • Hypertonia (spastic)

    • Athetoid (dyskinetic)

    • Ataxia

    Correct Answer
    A. Athetoid (dyskinetic)
    Explanation
    The given description describes abnormal, involuntary, slow, uncontrollable WRITHING movements that usually involve all extremities. This matches the characteristics of athetoid (dyskinetic) movements, which are commonly seen in individuals with cerebral palsy. Athetoid movements are characterized by slow, writhing movements that affect the hands, feet, legs, and other distal body parts. Hypotonia refers to low muscle tone, hypertonia refers to increased muscle tone (spasticity), and ataxia refers to lack of coordination and balance.

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  • 17. 

    Muscular dystrophy (MD) is a group of inherited disorders with progressive degeneration of symmetric skeletal muscle groups.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    Muscular dystrophy is indeed a group of inherited disorders characterized by the progressive degeneration of symmetric skeletal muscle groups. This means that the condition affects multiple muscle groups in the body and worsens over time. Therefore, the statement "Muscular dystrophy (MD) is a group of inherited disorders with progressive degeneration of symmetric skeletal muscle groups" is true.

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  • 18. 

    CP manifests differently in each child.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    This statement suggests that every child with CP (Cerebral Palsy) may exhibit different symptoms or characteristics. CP is a neurological disorder that affects movement and muscle coordination, and its severity and specific impairments can vary greatly from one individual to another. Therefore, it is true that CP manifests differently in each child.

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  • 19. 

    Cerebral palsy is..

    • Progressive

    • Non-progressive

    • Degenerative

    Correct Answer
    A. Non-progressive
    Explanation
    nonprogressive impairment of motor function control, especially muscle control and coordination.

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  • 20. 

    A 4 year old is in the emergency department for a 2 day old puncture wound that occurred when he stepped on a nail.  Which assessment finding suggests tetanus?

    • Stiffness of the neck and jaw

    • Decreased LOC

    • Abdominal cramping and vomiting

    • Purulent drainage from the puncture site

    Correct Answer
    A. Stiffness of the neck and jaw
    Explanation
    early symptoms of tetanus include progressive stiffness and tenderness in the muscles of the neck and jaw.

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  • 21. 

    A 10 year old is having a tonic clonic seizure at school.  What is the first intervention by the nurse?

    • Loosen restrictive clothing

    • Turn the child to a side lying position

    • Place the child in an upright position

    • Put a tongue blade in the child's mouth

    Correct Answer
    A. Turn the child to a side lying position
    Explanation
    I was surprised by this one too. A tonic clonic seizure is usually accompanied by loss of consciousness and difficulty with excess saliva. The most important action is to protect the airway by turning the child to the side to prevent aspiration. It is not necessary to loosen restrictive clothing.

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  • 22. 

    Depending on the severity of the disability, the child may not be diagnosed with CP until up to 3 years of age, even if brain injury occurs before or at the time of birth.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The statement suggests that the diagnosis of cerebral palsy (CP) in a child may not occur until they are up to 3 years old, regardless of whether the brain injury that causes CP occurs before or at birth. This is because the severity of the disability may not be immediately apparent or may take time to manifest fully. Therefore, it is true that a child may not be diagnosed with CP until they are 3 years old, even if the brain injury occurred earlier.

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  • 23. 

    The term spina bifida is usually used to refer to this condition.  There is a visible defect in the spine with a sacklike protrusion at any level of the spinal column at the midline of the bac.  The sac contains meninges, spinal fluid , and nerves

    • Spina bifida occulta

    • Meningocele

    • Myelomeningocele

    Correct Answer
    A. Myelomeningocele
    Explanation
    Myelomeningocele is the correct answer because it refers to a type of spina bifida where there is a visible defect in the spine with a sacklike protrusion at any level of the spinal column at the midline of the back. This sac contains meninges, spinal fluid, and nerves. Spina bifida occulta refers to a less severe form of spina bifida where the spinal cord and nerves are usually not involved. Meningocele refers to a type of spina bifida where the sac contains meninges and spinal fluid, but not nerves.

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  • 24. 

    A 6-year old child with spina bifida (myelomeningocele) is not yet toilet trained for either bowel or bladder.  Nursing interventions of this child are based on the knowledge that the child with spina bifida:

    • Has intellectual delays that may delay the ability to toilet train her.

    • Cannot be toilet trained because she is in a wheelchair and has difficulty usint the toilet.

    • Has decreased enervation to bowel and bladdeer and requires special strategies to manage bowel and bladder function.

    • Has difficulty with toilet training due to the inability to coordinate the use of arms and legs.

    Correct Answer
    A. Has decreased enervation to bowel and bladdeer and requires special strategies to manage bowel and bladder function.
    Explanation
    Decreased enervation,caused by damage to the spinal cord above the area that affects bowel and bladder control (lower sacral area), is present in all children with spina bifida. The child will require special strategies to manage bowel and bladder control, Intellectual delays occur in some children with spina bifida, but theses are not the cause of toilet training problems. Being in a wheelchair or having coordingation problems are not the cause of the child's bowel and bladder difficulties.

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  • 25. 

    Muscular Dystrophy is a curable disease.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    There is no cure.

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  • 26. 

    Which of the following statements are true regarding CP?  (choose all that apply)

    • Early recognition is the key to obtaining optimal development.

    • It is a permanent disorder.

    • Anoxia plays the most significant role in the pathology of associated brain damage

    • It is a progressive disorder

    Correct Answer(s)
    A. Early recognition is the key to obtaining optimal development.
    A. It is a permanent disorder.
    A. Anoxia plays the most significant role in the pathology of associated brain damage
    Explanation
    It is a non-progressive disorder

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  • 27. 

    Classification of CP that may involve one or both sides of body, tense muscles, uncoordinated impaired fine gross and gross motor activity that is rigid and spastic, scissoring

    • Hypotonia

    • Hypertonia (spastic)

    • Athetoid (dyskinetic)

    • Ataxia

    Correct Answer
    A. Hypertonia (spastic)
    Explanation
    The given symptoms, such as tense muscles, uncoordinated impaired fine gross and gross motor activity, rigidity, and scissoring, are indicative of hypertonia (spastic) in cerebral palsy classification. Hypertonia refers to increased muscle tone and stiffness, leading to difficulties in movement and coordination. The symptoms mentioned align with the characteristics of spasticity, which involves increased muscle tone and exaggerated reflexes. Therefore, the correct answer is hypertonia (spastic).

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  • 28. 

    Duchenne's Muscular dystrophy is inherited by X-linked recessive trait.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    An x-linked recessive trait means the mother of the child is the carrier of the disease.

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  • 29. 

    Cerebral Palsy is associated with cerebral damage; especially during: (choose all that apply)

    • The perinatal period

    • The prenatal period

    • Adolescence

    Correct Answer(s)
    A. The perinatal period
    A. The prenatal period
    Explanation
    Cerebral Palsy is a condition that is characterized by damage to the brain, which affects a person's muscle control and movement. The perinatal period refers to the time immediately before and after birth, while the prenatal period refers to the time during pregnancy. Both of these periods are critical for brain development and any damage that occurs during these times can lead to the development of cerebral palsy. Therefore, it is associated with cerebral damage during the perinatal and prenatal periods. Adolescence is not mentioned as a period associated with cerebral damage in this context.

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  • 30. 

    Which factor accounts for the fact that a young child's response to head injury differs from that of an adolescent or an adult?

    • Proportionally larger head size

    • Thicker brain tissue

    • Large subdural spaces

    • Smaller volume of blood in the brain

    Correct Answer
    A. Proportionally larger head size
    Explanation
    young child has larger head, greater volume of blood in brain, smaller subdural spaces and thinner softer brain tissue.

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  • 31. 

    The nurse should teach the parents of an infant with cerebral palsy to:

    • Maintain immobility of limbs with splints

    • Focus on cognitive rather than motor skills

    • Preserve muscle tone to prevent contractures

    • Continue to offer the special formula to limit gagging

    Correct Answer
    A. Preserve muscle tone to prevent contractures
    Explanation
    Children with CP are especially prone to muscle tone disorders, including spasticity, which can lead to contractures.

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  • 32. 

    With regards to CP,  _______________plays the most significant role in the pathology of brain damage.

    • Genetics

    • Fetal alcohol syndrome

    • Anoxia

    • Premature birth

    Correct Answer
    A. Anoxia
    Explanation
    Anoxia refers to a complete lack of oxygen supply to the brain, which can lead to severe brain damage. Lack of oxygen deprives brain cells of the energy they need to function properly, causing them to become damaged or die. This can have a significant impact on brain function and can result in various neurological impairments. Therefore, anoxia plays the most significant role in the pathology of brain damage in relation to CP.

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  • 33. 

    An 8 month old is admitted with head injuries after falling from his high chair.  The nurse closely monitors for signs of increased intracranial pressure.  She should expect an 8-month old with increased ICP to have:

    • Diplopia

    • Headache

    • Behavior changes

    • A bulging fontanel.

    Correct Answer
    A. A bulging fontanel.
    Explanation
    Because the anterior fontanel hasn't closed by age 8 months, an infant's head can increase in size as ICP increases. Assessing for diplopia (double vision), or headache in an infant is difficult. Behavior changes may occur, but they would be subtler than increased head size.

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  • 34. 

    A nurse is assessing a 3 year old who has had surgery for ventriculoperitoneal shunt placement to treat hydrocephalus.  Which symptom indicates that the child has increased ICP?

    • Bulging Fontanel

    • Vomiting

    • Nuchal rigidity

    • Sunset eyes

    Correct Answer
    A. Vomiting
    Explanation
    vomiting is an indication that a child who has a ventriculoperitoneal shunt in place is experiencing increased ICP. A 3 year old has closed fontanels, so they wouldn't bulge. Nuchal rigidity is a sign of meningitis. Sunset eyes (both eyes forced downdward, revealing an area of the sclera above the iris? are a sign of long term increased ICP, not postoperative increased ICP. They're usually associated with unresolved, long-term hydrocephalus or tumor.

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  • 35. 

    This classification of CP presents as Floppy with diminished reflex response, as well as positive parachute reflex beyond 6 months.

    • Hypotonia

    • Hypertonia (spastic)

    • Athetoid (dyskinetic

    • Atxaxia

    Correct Answer
    A. Hypotonia
    Explanation
    This classification of CP presents as floppy with diminished reflex response, as well as positive parachute reflex beyond 6 months. Hypotonia refers to low muscle tone, which can cause floppy movements and reduced reflexes. The presence of a positive parachute reflex beyond 6 months suggests a delay in motor development, further supporting the diagnosis of hypotonia in this case.

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  • 36. 

    Scenario:  A child was diagnosed with Duchenne's muscular dystrophy 2 years ago.  He is now confined to a wheelchair and often needs supplemental oxygen to maintain adequate oxygenation.  He is admitted to the pediatric unit with bilateral bacterial pneumonia and is receiving intravenous antibiotics.  What comfort measures need to be provided for this child?  Choose all that apply:

    • Support joints and extremities

    • Turn frequently

    • Ice swollen joints

    • Provide diversional activities appropriate for the child's age

    Correct Answer(s)
    A. Support joints and extremities
    A. Turn frequently
    A. Provide diversional activities appropriate for the child's age
    Explanation
    There isn't joint swelling.

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  • 37. 

    A child returns from surgery with a ventriculoperitoneal shunt for treatment of hydrocephalus.  The first intervention is to :

    • Check the child's IV line

    • Take the childs vital signs

    • Check the head and abdominal dressings

    • Place the child on the nonoperative side

    Correct Answer
    A. Check the head and abdominal dressings
    Explanation
    When a child has surgery, the first action is to assess the surgical dressings. Head and abdominal dressings can be assessed without turning the child to either side.

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  • 38. 

    A 6-year old is admitted to the ER after falling from a tree.  Which question helps to assess level of consciousness (LOC)?

    • What is your name?

    • Do you have a headache?

    • What day is it?

    • What happened after you fell out of the tree?

    Correct Answer
    A. What is your name?
    Explanation
    Ask simple age appropriate questions such as What is your name? to assess LOC. Headache is a symptom of increased ICP, but a 6 year old may not be able to distinguish whether his headache results from the fall.

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  • 39. 

    Microcephaly is usually associated with mental retardation.  Which finding indicates that an infant has microcephaly?

    • Premature closure of single or multiple sutures of the cranial vault

    • Head circumference more than two standard devieations above average on growth charts.

    • Head circumference more that two standard deviations below average on growth charts.

    • Premature closure of the coronal sutures, causing the skull to become shortened.

    Correct Answer
    A. Head circumference more that two standard deviations below average on growth charts.
    Explanation
    Microcephaly is dx when the infant's head circumference is more than two standard deviations below average on growth charts. Head circumferenc more than two standard deviations above the growth charts indicates hydrocephalus.

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  • 40. 

    A woman who is pregnant is undergoing an amniocentesis.  During the test, elevated lefels of AFP are found.  What further diagnostic tests will be performed?  Check all that apply

    • MRI

    • CT Scan

    • Radiograph

    • Kernig's

    Correct Answer(s)
    A. MRI
    A. CT Scan
    A. Radiograph
    Explanation
    If alpha-fetoprotein levels are elevated in amniotic fluid, the primary care provider will order and MRI, CT scan, radiograph, or other test to determine what type of neural tube defect the fetus might have.

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  • 41. 

    Ancephaly is an interchangeable term with microcephaly.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    Anacephaly is the absence of the brain with exposed vascular mass with no bony covering. May use transillumination for diagnosis.

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  • 42. 

    An infant was diagnosed with phenylketonuria (PKU) at age 6 weeks.  At follow-up home visits, the nurse should assess for:

    • Hemolytic disease

    • Delayed development

    • Erythroblastosis fetalis

    • Hyaline membrane disease

    Correct Answer
    A. Delayed development
    Explanation
    Delayed development because the enzyme phenylalanine hydroxylase is lacking, phenylalanine accumulates in the bloodstream of children with PKU. This affects the brain and Central nervous system and can cause impaired cognitive development, slow language devlopment, and learning disorders.

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  • 43. 

    A nurse is assessing an infant after repair of a myelomeningocele.  What complication is the most common with this defect?

    • Sepsis

    • Meningitis

    • Hydrocephalus

    • Central cyanosis

    Correct Answer
    A. Hydrocephalus
    Explanation
    Myelomeningocele. Just remember hydrocephalus is the most common complication.

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  • 44. 

    A 3 month old infant has a ventriculoperitoneal shunt inserted.  The nurse should pland to :

    • Keep the infant in the prone position

    • Apply sterile, moist dressings to the incision

    • Observe for signs of leakage of cerebrospinal fluid

    • Teach the parents the signs of increased intracranial pressure

    Correct Answer
    A. Teach the parents the signs of increased intracranial pressure
    Explanation
    The parents must be taught to identify signs of increased intracranial pressure because this can develop if shunt malfunction occurs.

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  • 45. 

    While caring for a 6 year old with a basilar skull fracture, the nurse notices that the child has developed fever and is becoming drowsy.  The nurse should suspect which condition?

    • Meningitis

    • Hemorrhage

    • Herniation

    • Edema

    Correct Answer
    A. Meningitis
    Explanation
    Fever, head injury, drowsiness. . .hello! lol

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  • 46. 

    An infant is born with a myelomeningocele at the high lumbar level.  What nursing assessments and interventions should the nurse prepare for after the child is born and before the infant's initial surgery to repair the defect?  Choose all that apply:

    • Protect the sac over the infant's spinal cord with a clear sterile dressing and avoid pressure to the area.

    • Place the infant in supine position until surgery is performed.

    • Observe for signs of hydrocephalus by monitoring for bulging fontanels and measuring serial head circumference.

    • Monitor the infant's skin integrity and prevent pressure sores, observe the infant's ability to move extremities, and take the infant's temperature (may indicate infection)

    Correct Answer(s)
    A. Protect the sac over the infant's spinal cord with a clear sterile dressing and avoid pressure to the area.
    A. Observe for signs of hydrocephalus by monitoring for bulging fontanels and measuring serial head circumference.
    A. Monitor the infant's skin integrity and prevent pressure sores, observe the infant's ability to move extremities, and take the infant's temperature (may indicate infection)
    Explanation
    infant should be placed PRONE and in frog leg position until surgery is performed.

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  • 47. 

    Classification of CP that affects the child's balance and depth perception, causing poor and irregular muscle coordination and an unsteady WIDE GAIT.

    • Hypotonia

    • Hypertonia (spastic)

    • Athetoid (dyskinetic)

    • Ataxia

    Correct Answer
    A. Ataxia
    Explanation
    Ataxia is the correct answer because it is a classification of cerebral palsy that affects the child's balance and depth perception, causing poor and irregular muscle coordination and an unsteady wide gait. Ataxia is characterized by difficulties in controlling movements and maintaining balance, leading to a lack of coordination and stability in walking. This aligns with the description provided in the question, making Ataxia the most suitable answer.

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  • 48. 

    Scenario:  A child was diagnosed with Duchenne's muscular dystrophy 2 years ago.  He is now confined to a wheelchair and often needs supplemental oxygen to maintain adequate oxygenation.  He is admitted to the pediatric unit with bilateral bacterial pneumonia and is receiving intravenous antibiotics.What assessments will be needed daily for this child?  Select all that apply.Assess:

    • Respiratory and cardiac status

    • LOC

    • Mobility

    • Fluid and electrolyte status

    • Skin integrity

    Correct Answer(s)
    A. Respiratory and cardiac status
    A. Mobility
    A. Fluid and electrolyte status
    A. Skin integrity
    Explanation
    The child with Duchenne's muscular dystrophy is at a higher risk for respiratory and cardiac complications due to the progressive muscle weakness. Therefore, it is essential to assess their respiratory and cardiac status daily to monitor for any signs of respiratory distress or cardiac abnormalities. Additionally, since the child is confined to a wheelchair, assessing their mobility is important to ensure they are comfortable and properly positioned to prevent complications such as pressure ulcers. Monitoring their fluid and electrolyte status is crucial to maintain hydration and prevent imbalances. Lastly, assessing their skin integrity is necessary to identify any areas of breakdown or potential pressure ulcers due to their limited mobility.

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  • 49. 

    Duchene muscular dystrophy is the most sever an the most common form.  Onset appears during the third year of life and may include the following signs and symptoms.  (check all that apply)

    • Waddling gait

    • Vision deficits

    • Gower sign

    • Lordosis

    Correct Answer(s)
    A. Waddling gait
    A. Gower sign
    A. Lordosis
    Explanation
    Remember that the Gower sign is when a patient has to use his hands and arms to "walk" up his own body from a squatting position due to lack of hip and thigh muscle strength.

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  • Feb 20, 2024
    Quiz Edited by
    ProProfs Editorial Team
  • Oct 24, 2016
    Quiz Created by
    Monrojen
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