4.1- Peds 1

Question 0

Starts with egg being fertilized-after fertilization the cell divides until a sphere of cells is formed. During implememtation into the uterus, that inner layer of cells beomes the embryonic disc.

Answer 0

Preembrionic stage

Question 1

Conception to 2 weeks

Answer 1

Preembrionic stage

Question 2

14 days - 8 weeks

Answer 2

embryonic stage

Question 3

Embryonic stage:

1. Edges of the ______fold towards each other forming the ________ _________
2. The folds of the _______ __________ grow toward eachother finally touching around day 21 to make the ________ __________.
3. Neural tube closure can be affected by ________/_________, lack of ______ ______etc. before a woman knows shes pregnant.

Answer 3

1. disc, neural groove
2. neural groove, nerual tube
3. alcohol/drugs, folic acid

Question 4

The neural tube closes first in the cervical region and from the top to bottom like a zipper leaving open ends called?

Answer 4

neuropores

Question 5

This part of the neuropore closes by day 27

Answer 5

superior neuropore

Question 6

This neuropore closes about 3 days later, any later will cause abnormalities

Answer 6

inferior neuropore

Question 7

The folds of the neural groove grow toward each other finally touching around day 21 to make what structure?

Answer 7

Neural tube

Question 8

What forms the neural groove?

Answer 8

Edges of the embryonic disc

Question 9

This occurs when the cranial end of the neural tube does not close. Brain stem forms but not the Cerebral or Cerebellar hemispheres. Skull does not form over incomplete brain leaving it exposed-fatal

Answer 9

Anencephaly

Question 10

Partial failure to close cranial end of the tube causing malformation of teh cerebellum and brain stem. the structure wedge in the foramen magnum causing problems with the circulation of CSF.

Answer 10

Arnold-Chiari malformation

Question 11

Increased pressure causes enlarged ventricles and increased pressure on the brain stem

Answer 11

hydrocephalus

Question 12

Not as severe, symptoms often do not start until early adulthood. Causes severe headache, vomiting and lethargy

Answer 12

Type 1-arnold-chiari malformation

Question 13

Obvious at birth due to enlarged cranium (result of enlarged ventricles) and the fontanel bulges.

Answer 13

Type 2-Arnold-Chiari malformation

Question 14

Surgically a shunt is run from ventricle to abdomen to relieve pressure. Must watch for signs of shunt blockage.

Answer 14

Type 2-Arnold-Chiari malformation

Question 15

Signs for shunt blockage:

young child:
Older child:

Answer 15

younger child: bulge of fontanels, thin skin/sparse hair over skull
older child: lethargy, vomiting, confusion, dizziness

Question 16

Regardless of the type of Arnold-Chiari malformation, we must avoid what?

Answer 16

prolonged head down position

Question 17

What is spina bifida?

Answer 17

occurs when inferior neural tube does not close

Question 18

Posterior arch does not close

Answer 18

Bifida vertebrae

Question 19

What are the 2 types of spina bifida?

Answer 19

1. Spina bifida occulta

2. spina bifida cystica

Question 20

Bony defect, but neural tissue does not protrude-no neural signs-sc works normally. May have tuft of hair over

Answer 20

Spina bifida occulta

Question 21

Generally lower lumbar, but can affect T-spine, no rx required

Answer 21

spina bifida occulta

Question 22

Visible cyst protruding from the bony defect that may be covered by skin or meninges

Answer 22

spina bifida cystica

Question 23

What are the 2 types of spina bifida cystica?

Answer 23

1. Meningocele

2. Myelomeningocele

Question 24

Cyst has only CSF and meninges, may have very mild changes in sensation or motor tone below lesion, but not significant

Answer 24

Meningocele

Question 25

SC is involved in the cyst

Answer 25

myelomeningocele

Question 26

Myelomeningocele:

1. problems depend on the level of damage: neural deficits below the lesion may include:
   a. ________ paralysis–if nerve roots are damaged
   b. _________ paralysis–if part of the SC below the lesion is intact

Answer 26

a. Flacid

b. Spastic

Question 27

What other problems are associated with myelomeningocele?

Hint: there are 6

Answer 27

1. osteoporosis-b/c no muscular force on the bone
2. scoliosis-either caused by skeletal deformity or muscle imbalance
3. foot deformity-most common club foot
4. sensory loss-can’t feel for pressure relief
5. bowel and bladder incontinence
6. latex allergy

Question 28

What is the most common foot deformity caused by myelomeningocele?

Answer 28

club foot

Question 29

Caused by scarring of surgical repair-ancors cord to surgical site and as column grows, increasing neuro symptoms. Immediate report any deterioration to MD

Answer 29

Tethered cord syndrome

Question 30

PT intervention: Prevent secondary problems from occurring during growth and development

1. _____ to avoid deformities
2. _________
3. _________
4. Cover ______ when learning to crawl/creep
5. ________ 2-3x/day
6. _______ and _______ control

Answer 30

1. position
2. handling
3. orthoses
4. feet
5. ROM
6. head/neck

Question 31

position to avoid ________

Answer 31

deformities

Question 32

Position off any _______ scars initially

Answer 32

surgical

Question 33

What position is important to prevent hip deformations,knee flexion contractures

Answer 33

Prone

Question 34

What position also helps develop head and neck control?

Answer 34

prone

Question 35

Teach family/caregivers appropriate handling techniques to allow proper ________ and _________ interaction with environment

Answer 35

alignment and sensory

Question 36

Support ______ until control developes

Answer 36

head

Question 37

What should be used PRN to prevent contractures?

Answer 37

orthoses

Question 38

May need ________ pillow to avoid ______ dislocations. Night splints to prevent ________
contractures.
Watch _______ with any device

Answer 38

adduction, hip, PF, skin

Question 39

The structures wedge in the foramen magnum causing problems with the circulation is what defect?

Answer 39

Arnold-Chiari malformation