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Podopediatrics > 1) Pediatric H & P > Flashcards

1) Pediatric H & P Flashcards

1
Q

Podopediatrics

A
  • The diagnosis and management of lower extremity disorders in children and adolescents
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2
Q

Top 5 podopediatric complaints

A
  • Pes planus (flat feet)
  • Rotational abnormalities (eg. intoed gait)
  • Digital deformities (curly, webbed toes)
  • Dermatological disorders (eg. tinea pedis, verucae, ingrown nails)
  • Apophysitis / growth-related disorders (eg. Sever’s disease)
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3
Q

Neonate

A
  • First month of life
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4
Q

Infancy: the first two years of life
Juvenile: from infancy to the onset of puberty
Adolescence: from puberty until the cessation of somatic growth

A
  • First two years of life
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5
Q

Juvenile: from infancy to the onset of puberty
Adolescence: from puberty until the cessation of somatic growth

A
  • From infancy to the onset of puberty
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6
Q

Adolescence

A
  • Puberty until the cessation of somatic growth
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7
Q

Lower extremity development

A
  • 4 – 5 weeks IU: Limb buds appear
  • 4 – 6 weeks IU: critical period
  • 12 weeks IU: lower extremity development complete
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8
Q

4 to 5 weeks (embryo)

A
  • Foot inverted

- Metatarsals differentiate, beginning with the first met

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9
Q

6 weeks (embryo)

A
  • Feet are in varus and equinus with forefoot adducted
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10
Q

7-8 weeks (embryo)

A
  • Digits separate
  • Talus is the largest cartilaginous segment
  • Average length of the foot at birth is 3-4 inches
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11
Q

Premature delivery

A
  • Less than 37 weeks
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12
Q

APGAR scoring

A
  • A = neonatal color
  • P = neonatal heart rate
  • G = Neonatal motor reactions (“grimace”)
  • A = neonatal muscle tone
  • R = neonatal respiratory response
  • Passing score = > 7
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13
Q

Sailing test

A
  • Infant blood analyzed during labor and after birth
  • Reflects respiratory and metabolic function of the infant
  • Not subjective; perhaps more accurate
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14
Q

Developmental history

A
  • Reaches / recognizes by 4 months
  • Crawls by 3 – 5 months
  • Rolls over / plays by 6 months
  • Creeping by 7 – 9 months
  • Walking by 9 – 16 months
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15
Q

16 month development

A
  • Infant walks; uses thumb in opposition to grasp objects
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16
Q

2 years development

A
  • Runs without falling
  • Obeys simple commands
  • +/- 50 word vocabulary
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17
Q

3 years development

A
  • Rides tricycle

- Can feed themselves

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18
Q

Average length of full-term newborn

A
  • 20 in.
  • Length (height) increases by 10 in. during the first year
  • Increases 3 in. / yr. during the next 7 yrs.
  • Birth height doubles by 4 yrs.
  • From 8 yrs. to puberty height increases 2 in. / yr
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19
Q

Adult height

A
  • 2x height at age 2-2.5 years

- Foot growth is complete at 14 in females and 16 in males

20
Q

History of present illness

A
  • NLDOCAT
  • Traumatic / insidious onset
  • Falling / tripping
  • Fatigue (“lazy”; prefers to be carried)
  • “Sloppy” gait
  • Limping / toe walking
21
Q

Physical examination

A
  • Vitals
  • Vascular
  • Neurological
  • Dermatological
  • Orthopaedic
  • Biomechanical
  • Gait evaluation
22
Q

Neurological development

A
  • Stepping reflex: disappears by 5 – 6 weeks
  • Moro (“startle”) reflex: disappears by 5 – 6 months
  • Babinski reaction: disappears by 2 – 2.5 years
23
Q

Tetanus

A
  • Sustained contraction of a muscle
24
Q

Clonus

A
  • Repetitive contraction of a muscle
25
Q

Spasticity

A
  • Velocity dependent motion
26
Q

Limping

A
  • Deviation from normal rhythmic gait
27
Q

Open kinetic chain biomechanical evaluation should include

A
  • Hip
  • Knee
  • Malleoli
  • Ankle
  • Subtalar joint
  • Midtarsal
  • First ray
28
Q

Closed kinetic chain biomechanical evaluation should include

A
  • Angle / base of gait
  • Relaxed calcaneal stance position (RCSP)
  • Neutral calcaneal stance position (NCSP)
  • Frontal plane tibial position
  • Limb length measurement
29
Q

Hip examination

A
  • Transverse plane
  • Frontal plane
  • Saggittal plane
  • Normal and symmetrical abduction and external rotation (congruity)
30
Q

hip transverse plane motion

A
  • Total motion: 80 – 120 degrees
  • External > internal 2:1 until age 6 yrs
    > 6 yrs: 1:1 / 2:1
  • Examine with hips flexed and extended
  • Internal > external never normal (femoral anteversion)
31
Q

Frontal plane knee examination

A
  • 0-2 yrs: genu varum
  • 2-4 yrs: straight
  • 4-12 yrs: genu valgum
  • 12-14 yrs: straight (males)
  • > 15 yrs: genu valgum / straight (females), straight (males)
32
Q

Ankle joint dorsiflexion with knee extended

A
  • Birth: > 50 degrees
  • 3 yrs: > 20 degrees
  • 10 yrs: > 15 degrees
  • 15 yrs: > 10 degrees
33
Q

Compensated ankle equinus

A
  • Normal heel off with stj / mtj pronation, genu recurvatum or external hip rotation
34
Q

Partially compensated ankle equinus

A
  • Early heel off with / without further compensation
35
Q

Uncompensated ankle equinus

A
  • No heel contact

- STJ / MTJ supination

36
Q

Tibial torsion (malleolar position)

A
  • Birth: 0 degrees
  • 1 yr: 2 – 3 degrees
  • 3 yrs: 6 – 8 degrees
  • 7 yrs: 13 – 18 degrees external
37
Q

Subtalar joint ROM

A
  • Child: 30 – 45 degrees of total motion
  • Adolescent / adult: 30 degrees total
  • Inversion / eversion ratio: 2:1
38
Q

Subtalar joint neutral position

A
  • Stj neutral position = Inv + ev / 3 – ev
  • Rearfoot valgus
  • Rearfoot varus
  • Neutral rearfoot
39
Q

Midtarsal joint alignment

A
  • Forefoot to rearfoot relationship
  • Inverted (supinatus, varus)
  • Everted (valgus, plantarflexed first ray)
  • Vertical
40
Q

1st ray ROM

A
  • Begin at level of second ray

- 1 cm total: 5mm dorsi / plantarflexion

41
Q

Frontal plane forefoot deformities

A
  • Varus, valgus, supinatus

- Not commonly the etiology of lower extremity pathology (< 10 y.o.)

42
Q

Relaxed calcaneal stance position

A
  • 0 – 5 yrs: flat and everted (“fat, flat and floppy”)
  • 7 – age = amount of allowable (normal) everted position
  • Calcaneus perpendicular by 7 yrs
43
Q

Neutral calcaneal stance position

A
  • Frontal plane position of tibial with subtalar joint in neutral position
  • NCSP = stj neutral position + tibial position
44
Q

Frontal plane tibial position

A
  • Birth – 4 yrs: 5 – 10 degrees varus

- > 4 yrs: < 5 degrees

45
Q

Gait evaluation components

A
  • Head
  • Shoulders
  • Arm swing
  • Pelvis
  • Knees
  • Feet (contact, midstance, propulsion)
46
Q

Immature gait

A
  • High arm guard position (1-2 yrs)
  • Staccato gait
  • Wide base of gait (stability)
  • Asynchronous movement of arms/legs
  • No heel contact type of gait initially (develops by 1.5 – 5 yrs)
  • Genu and tibial varum
  • Excessive stj pronation (up to 7 yrs)
47
Q

Staccato gait

A
  • Increased cadence and decreased stride length

Podopediatrics (6 decks)

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