1) Pediatric H & P Flashcards
1
Q
Podopediatrics
A
- The diagnosis and management of lower extremity disorders in children and adolescents
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)
3
Q
Neonate
A
- First month of life
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
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
6
Q
Adolescence
A
- Puberty until the cessation of somatic growth
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
8
Q
4 to 5 weeks (embryo)
A
- Foot inverted
- Metatarsals differentiate, beginning with the first met
9
Q
6 weeks (embryo)
A
- Feet are in varus and equinus with forefoot adducted
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
11
Q
Premature delivery
A
- Less than 37 weeks
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
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
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
15
Q
16 month development
A
- Infant walks; uses thumb in opposition to grasp objects
16
Q
2 years development
A
- Runs without falling
- Obeys simple commands
- +/- 50 word vocabulary
17
Q
3 years development
A
- Rides tricycle
- Can feed themselves
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
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
Spasticity
- Velocity dependent motion
26
Limping
- Deviation from normal rhythmic gait
27
Open kinetic chain biomechanical evaluation should include
- Hip
- Knee
- Malleoli
- Ankle
- Subtalar joint
- Midtarsal
- First ray
28
Closed kinetic chain biomechanical evaluation should include
- Angle / base of gait
- Relaxed calcaneal stance position (RCSP)
- Neutral calcaneal stance position (NCSP)
- Frontal plane tibial position
- Limb length measurement
29
Hip examination
- Transverse plane
- Frontal plane
- Saggittal plane
- Normal and symmetrical abduction and external rotation (congruity)
30
hip transverse plane motion
- 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
Frontal plane knee examination
- 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
Ankle joint dorsiflexion with knee extended
- Birth: > 50 degrees
- 3 yrs: > 20 degrees
- 10 yrs: > 15 degrees
- 15 yrs: > 10 degrees
33
Compensated ankle equinus
- Normal heel off with stj / mtj pronation, genu recurvatum or external hip rotation
34
Partially compensated ankle equinus
- Early heel off with / without further compensation
35
Uncompensated ankle equinus
- No heel contact
| - STJ / MTJ supination
36
Tibial torsion (malleolar position)
- Birth: 0 degrees
- 1 yr: 2 – 3 degrees
- 3 yrs: 6 – 8 degrees
- 7 yrs: 13 – 18 degrees external
37
Subtalar joint ROM
- Child: 30 – 45 degrees of total motion
- Adolescent / adult: 30 degrees total
- Inversion / eversion ratio: 2:1
38
Subtalar joint neutral position
- Stj neutral position = Inv + ev / 3 – ev
- Rearfoot valgus
- Rearfoot varus
- Neutral rearfoot
39
Midtarsal joint alignment
- Forefoot to rearfoot relationship
- Inverted (supinatus, varus)
- Everted (valgus, plantarflexed first ray)
- Vertical
40
1st ray ROM
- Begin at level of second ray
| - 1 cm total: 5mm dorsi / plantarflexion
41
Frontal plane forefoot deformities
- Varus, valgus, supinatus
| - Not commonly the etiology of lower extremity pathology (< 10 y.o.)
42
Relaxed calcaneal stance position
- 0 – 5 yrs: flat and everted (“fat, flat and floppy”)
- 7 – age = amount of allowable (normal) everted position
- Calcaneus perpendicular by 7 yrs
43
Neutral calcaneal stance position
- Frontal plane position of tibial with subtalar joint in neutral position
- NCSP = stj neutral position + tibial position
44
Frontal plane tibial position
- Birth – 4 yrs: 5 – 10 degrees varus
| - > 4 yrs: < 5 degrees
45
Gait evaluation components
- Head
- Shoulders
- Arm swing
- Pelvis
- Knees
- Feet (contact, midstance, propulsion)
46
Immature gait
- 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
Staccato gait
- Increased cadence and decreased stride length
