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Musculoskeletal System > 2 - Ortho: Pediatrics > Flashcards

2 - Ortho: Pediatrics Flashcards

1
Q

What should kids be doing by 3 months old?

A

Lift Head

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2
Q

What should kids be doing by 6 months old?

A

Sit independently

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3
Q

What should kids be doing by 9 months old?

A

Pull to standing

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4
Q

What should kids be doing by 10 months old?

A

Cruising furniture

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5
Q

What should kids be doing by 10-14 months old/

A

WALKING

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6
Q

At which date after birth should a parent be referring their child for evaluation if they aren’t workign?

A

24 months is significant developmental delay

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7
Q

When do kids usually start smiling to their name?

A

2 months

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8
Q

What should the physician be thinking if a child shows strong signs of handedness by age 2?

A

Possible pathology in the apparent non-dominant hand

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9
Q

What is congenital trigger thumb?

A

IP joint cannot fully extend because an enlargement of the flexor tendon?

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10
Q

Explain the primitive reflex involved with the subcortical nuclei.

A

Hand Grasp upon stimulation of the palm (reflex distinguishes~2-4months)

Looks for birth brachial plexus trauma

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11
Q

What should be suspected if the grasp reflex persists after 2-4 months?

A

Cerebral Palsy

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12
Q

Describe the plantar grasp reflex

A

Stimulation of the plantar foot will cause tonic flexion and adduction of toes

Dissapears by the end of the first year

Persists in children wiht birth injury or delayed development

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13
Q

Describe the Moro Reflex

A

Startling the child causes an extension of all limbs/digits

Looking for symmetrical response - lack of symmetry indicates Periph nerve palsy or cerebral palsy

Persistence of this relfex after 6 months = cerebral palsy

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14
Q

Describe the stepping reflex

A

holding child with feet on table will cause simulated stepping

disappears at 1-2 months

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15
Q

Describe the placing reaction reflex

When does it disappear

A

Infant supported upright and anterior tibia or dorsal foot touch edges of table, infant will lift foot onto the table via flexion at hip and knee

Absence indicates brain damage

Persists til 12 months

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16
Q

Describe the crossed extension reflex

When does it disappear

A

Pressure applied to inguinal area, the opposite leg adducts then extends + toes fan

Disappears after 1 month

Persistence after indicates a partial spinal lesion

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17
Q

Describe the asymmetric tonic neck reflex (fencer’s pose)

When does it disappear

A

Kid supine head rotated to the side, arm and leg on the chin side extend

Arm and leg on the occiput side flex

Disappears @ 4-6months,
Persistence indicates cerebral palsy

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18
Q

Describe the parachute reaction

When does it emerge

A

child held at waist in prone and directed head first at table or floor

child extends hands and arms to break fall

Emerges at 6 months and persists throughout

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19
Q

Describe the superficial abdominal reflex

A

stimulation of the paraumbilical area with handle of reflex hammer

may be absent (unremarkable?)

presence of asymmetry is pathologic

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20
Q

Which nerve levels are tested with a superficial abdominal reflex test in the upper quadrants?

Lower quadrants?

A

T7-T10

T-10-L1

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21
Q

At which angle is a coronal spinal curve denoted as a scoliosis?

A

> 10 deg

22
Q

What is the name of the measurement that measures the superior end-plate at the top of the curve and the inferior end-plate at the bottom of the curve of a stuctural scoliosis?

A

Cobb angle measurement

23
Q

What is the curve location of a scoliosis described by?

A

The apex of the curve

24
Q

Importance of the level of a scoliotic curve?

A

The level has a large impact on the severity of symptoms, higher level ^ towards cervical has a larger degree of negative implications because of lack of room for compensation

25
Q

Describe Adolescent Idiopathic Scoliosis

A

A structural scoliosis of the spine occuring at or near the onset of puberty, for which no cause can be established (3.6:1, girls:boys), Overall prevalence = 2-3%

26
Q

Describe the likelihood of scoliotic progression (greater/lesser) tendency to progress.

A

Curves under 30 deg. unlikely to progress

Curves >50 deg. most likely to progress

27
Q

At what degree of curvature does the likelihood of cor pulmonale increase?

A

> 100 degrees

and lesser curves with significant hypokyphosis may have more pulmonary loss

28
Q

Can scoliosis appear de novo in adulthood?

A

Yes, but not associated with AIS, most commonly associated with degeneration

29
Q

Does scoliosis increase/cause problems with pregnancy?

A

No

30
Q

Can you send a kid for x-rays if you suspect scoliosis

A

yes but make sure the department has a scoliosis grid capability

31
Q

What is a possible complication associated with straightening out a scoliotic curve?

A

Superior Mesentaric Artery compression, bowels shut down = Bad

32
Q

What is the significance of risser signs?

A

It measures the level of skeletal maturity,

A grade of 5 indicates almost full maturity - less time for progression (least risk of progression)

A grade of 1 indicates early in maturation - lots of time for progression (greatest risk of progression)

33
Q

Explain the criteria for bracing.

A

Risser 2 or less + cobb angle >25 or 20 w/ 5 deg progression

Bottom line, patients with significant room for growth and who would greatly benefit from prevention of progression.

Not tolerated very well

34
Q

Describe the criteria for Dx of idiopathic infantile scoliosis

A

Use mehta Rib vertebral angle to predict progression aka RAD (rib angle difference) ?
Measurement of rib vs endplate pitch
>20 degree difference indicates an 80% chance of progression

35
Q

Describe Juvenile Idiopathic Scoliosis

A

4-10 years old
RAD >10 degrees indicates risk of progression
High incidence of neuroaxis abnormalities

36
Q

What is a diastemotomyelia?

A

Boney or fibrous defect that splits the spinal cord!

As the child grows and the spine elongates traction causes cord tethering (cabovarus foot may present with age)

37
Q

What is diployelia?

A

Split cord, can be caused by diastemotomyelia

38
Q

Explain what myelomeningocele is

A

Neural tube defect causing spina bifida
Widened interpedicular distance
Missing posterior elements
Causing neuromuscular scoliosis

39
Q

What are some common worries about meylomeningocele

A

Worry about the severity of curve - arnold kiari malformation that can comress the spinal cord or cerebellum

Also can present with hydrocephalus following treatment, needs shunting

40
Q

Describe hydrosyrinx and some complications

A

Expansion of spinal cord with CSF, with central cavities of degeneration
If syrinx is treated, scoliosis can resolve on its own.

41
Q

What is spinal dysraphism?

A

Many causes, all associated with causing a tethered cord

42
Q

What is the most common form of torticollis?

Best treatment?

A

Congenital Tight muscles

OMT!!!!!!!!!!!!

43
Q

Describe the sprengel deformity

A

asymmetry of the shoulders caused by poor migration of the scapulas, can be caused by a tether of some sort (bone or ligament that shouldnt be there)

44
Q

What is the importance of sprengel deformity?

A

High association with klippel feil syndrome if you see it you should rule out.

45
Q

Describe klippel feil syndrome

A

Failure of segmentation of the cervical vertebra causing blocked vertebrae, which causes hypermobility of the vertebrae above and below

Risk of neurological problems, sometimes need fusion to treat hypermobility causing the symptoms

46
Q

Describe the spinal implications involved with Down’s syndrome

A

Ligamentous laxity

Cervical instability in general that could cause problems/danger, in those who are active

47
Q

Describe Larson syndrome

A

congenital laxity of joints and connective tissue malformations

48
Q

What is scheuerman disease?

A

Inflammation of growth plates of vertebral bodies, increased kyphosis is the most painful, vertebral body wedging can be seen. (>5 = criteria)
Possible schmorls nodes

49
Q

How many children die each day from child abuse?

A

4.6 proven, actual incidence is suspected to be 3x greater

50
Q

Who are the most likely perpetrators of abuse?

A

90% biological parents!

51
Q

Which children are more likely to have injury from abuse? Which are more likely to die?

A

Adolescents

<2 years

Musculoskeletal System (21 decks)

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