childhood conditions 1 Flashcards
speech/language don’t develop normally
language disorder
trouble getting meaning across
expressive language disorder
issue understanding other’s meaning
difficulty following directions
receptive language disorder
MC group of dev delayed children, with wk muscles, DTR are WNL, walking 24-30m, good prognosis
benign congenital hypotonia
progressive degen dz, hypotonia dt deg in ant horns of sc and motor nuclei of CNs - no DTRs
spinal muscular atrophy
hand dominance occurs around 2-3. if it occurs prior to 1 yr, suspect:
hemiplegia
test for spastic hemiplegia
crother’s slap test
hypotonic at birth, us delayed onset, 3-6m dev spasticity or rigidity, seizures, drooling, strabismus, etc
spastic quadriplegia
group of gen d/o, gradual degen of muscle fibers, atrophy, pseudohypertrophy from fatty infiltrates
duchene’s muscular dystrophy
pp toe walking, waddling gait, clumsy, gower’s sign, inc L lordosis and calf muscles, trendelenberg
MD
gower sign indicative of
MD
JRA
damage to the left brain will cause ___ for right handers and vv
apasia
trouble using words/sentences
expressive aphasia
trouble understanding others
receptive aphasia
trouble with using and understanding words
global aphasia
motor speech d/o, child knows what to say but can’t neurologically
apraxia
motor speech d/o, weak facial muscles
dysarthria
weak tongue tip muscles, lies too far forward, persistent tongue thrust reflex causes
orofacial myofunctional d/o
MC congenital ant chest wall deformity
pectus excavatum
looser’s zone on an xray along with osteopenia, coarsened trabeculation indicates
osteomalacia
thumb overlaps 5th digit around wrist, marfan
walker wrist sign
thumb hangs out over fist, marfan
steinberg sign
part of brain that controls homeostasis, emotions, survival, threat avoidance, social interaction and learning
limbic system of CNS
part of brain that controls emotional conditioning, social signs of emotion (facial, posture)
amygdala of CNS
part of brain that controls affect (depression, lack of)
prefrontal cortex of CNS
part of brain that controls pain, touch, temp
parietal of CNS
when a baby goes on side, raises head/pelvis and flops leg over, it is called
autistic roll
when a baby uses arms more, an army crawl or drags one arm beside it is called
autistic crawl
to dx ADHD
6 attn or 6 hyperactivity moments before 7yo
several sx before 12yo
several present in 2+ settings
sx interfere with social, school, work fxn
sx dont occur with another psychotic d/o
used for 16-30m and assesses risk for ASD
MCHAT
modified checklist for autism in toddlers
special diet to help sx of autism
feingold diet
ASD’s
autism aspberger's rett's pervasive dev d/o (PDD) childhood disintigrative d/o (CDD)
remove replace re-inculate repair re-test re-introduce
6 R’s for proper _____
Gut function
qs to ask re asthma
age of first attack (in first 5y is dx) how often time of day triggers wheezing exercise exacerbate, limited activity miss school pets/smokers at home, meds, allergy hx
loss of kyphosis around T4-7 indicates struct abn in liver, stomach or pancreas can mean mm contrx of esoph, heart, lungs
pottenger’s saucer
whiplash avulsion frx in adults look for ____ and in kids ____
clay shoveler’s frx (lower c/s C7/T1)
higher c/s (C2-4)
**very stable
after ____ take xray first THEN ortho/neuro
MVA
most severe and unstable injury of the c/s - usually at C2, from hyperflx - hyperxt-sudden hyperflx
tear drop frx
flex or flx with rot that shows with the bow tie sign, disrup of 25-30%
unilateral facet disloc
**get CT
flex or flx with rot, ant disloc of 50%+, unstable
bilateral facet disloc
UNSTABLE
s/s raccoon eyes, battle sign, head trauma causes. rare in peds
basilar skull frx
intracranial hemorrhage bt skull and dura
epidural
-rarely crosses suture line
intracranial hemorrhage bt dura and arachnoid
subdural
intracranial hemorrhage directly into brain tissue
intracerebral
acute ___ hematoma is an ARTERIAL bleed common w temporal frx, onset is min-hours followed by lucid interval, possible death
epidural
acute ___ hematoma is a VENOUS bleed, onset hours to days, fluctuating consciousness
-alcoholics, elderly, blood thinners
subdural
in ______ , bleeding can be arterial or venous and sx is often not helpful, s/s similar to stroke
intracerebral hemorrhage
MC form of hemorrhage assoc with head trauma, located in flax cerebri or tentorium and outer cortical surface
subarachnoid hemorrhage
abn ankle gait with excess hip IR, tight ant hip capsule, tight gastroc, achilles, peroneals
-repeat ankle sprains, pes planus, genetic
overpronated
abn ankle gait with tight ITB, weak peroneals, post trauma to knee/foot/ankle, high arch, toe claw, genetic
oversupinated
gait with inability to actively dorsiflex foot with axaggerated hip/knee flx during swing phase
steppage
pt lurches TOW side of weakness, downward pelvic tilt away from affected hip during swing phase
trendelenburg
trendelenburg gait seen in
CHD
LCP
SCFE
flx of knee, hip and foot in inverted and PF , circumduction with hip elevation to accomodate PF
spastic hemiplegia gait
scissor gait, walks on toes, both feet PF’d, legs rub while walking
spastic diplegia gait
unsteady borad based gait, stands and sways, seen in cerebellar injuries, OM, labyrinthitis
ATAXIC
scoliosis red flags (mc deform of spine)
left sided thoracic curve
signif pn/stiff
abn neuro exam
MC type of scoliosis
idiopathic
MC tumor, may cause scoliosis with pain
osteoid osteoma
for scoliosis curves <10*
follow up every 6m until skeletal maturity
stabilize exercise
for scoliosis curves 10-20*
xray every 3-6m with dec freq if no changes
daily stretch, yog, rehab
ortho ref for brace
for scoliosis curves 20-25%
xray every 3-6m til skeletal maturity
adj, stretch, lengthen
ortho for brace
for scoliosis curves 25-40
can adj, MUST ortho ref
bracing rec’d
stretch/strengthen V IMP
for scoliosis curves 40-50*
IMMED ref in most
can adj, comg, PT?
eval every 3m
possible sx
for scoliosis curves >50*
REF IMMED
can adj, comg, PT?
xray every 3m
2 comorbids with wrong way scoliosis
syringomyelia
arnold-chiari
almost ALL hip conditions walk with hip ___ and ____
flexion
external rotation
2 d/o with severe leg bowing
rickets
osteogenesis imperfecta
metatarsus adductus tib torsion femoral torsion EX ilium sublux club foot talipes equinovarus all conditions that present with:
pigeon toed walking
4 conditions with persistent toe walking
club foot
CP
autism
AS occiput
talipes calcaneovalgus MC pes planus pes cavus kohler's dz freiber'gs infarction all conditions that present with this gait
toe out walking
THINK CANCER FIRST, THEN LCP OR SCFE
KNEE PAIN
bow legged aka
genu varum
knock kneed aka
genu valgum
growth d/o of tibia, turns in and slowly progresses - in obesity and early walking
blount’s dz
> 70* IR of hip, assoc with reverse tailor sitting
femoral anteversion/antetorsion
MC bilat pigeon toed assoc with metatarsus varus, genu varum and tibia vara
medial tib torsion
MCC of knee pn in young athletes
osgood schlatter
similar to OG but at inf pole of patella
sindig larsen johansson
unhappy triad
ACL
MCL
med meniscus
ottaway rules for ankle frx xray
tenderness at post medial or lat malleolus
inability to bear wt
T2P at 5th met base/navicular
MC sports injury, and 3 lig affected
inversion/lateral ankle sprain
-ATFL, CFL, PTFL
lig affected with eversion/med ankle sprain
deltoid lig
turf toe is ___ with axial load, and sand toe is ____
hyperextension
hyperflexion
p/t at achille’s insertion while walking, can be surgical
sever dz
-MC in soccer
septic arthritis osteomyelitis frx DDH leg length diff hip sublux
presents with limping MC bt these ages:
birth - 3yo
septic arthritis osteomyelitis toxic synovitis frx LCP (nonpainful) leukemia JRA
ages MC seen with limping:
4-10y
sprain/frx osteomyelitis OG tumor SCFE
presents with limping at this age range:
11-18yo
MCC for limp is
transient synovitis
osteomyelitis, leukemia ankle/mm/knee sprain/dysfx LCP, SCFE hip sublux, bad shoes frx Present with:
painful limp ddx
transient synovitis LCP tumor eosinophilic granuloma Present with
Painless limp
limp with morning stiffness
JRA
limp with back pain
discitis
limp that is better with rest indicates
inflammatory
limp with nocturnal pain
osteoid osteoma, neopaslm
limp with joint pain
local pathology
limp with activity pain 3 ddx
overuse
stress frx
hypermobility
infx of joint, on xray jt effusion, juxtaarticular osteoporosis, erosis, CROSSES joint space
septic arthritis
inflam/swelling of tissues around hip jt, MC unilateral bt 2-15yo
transient synovitis
SCFE, LCP
pyogenic arthritis (via CBC), IVD d/o
SI sublux
are all ddx for
transient synovitis
acute transient synovitis from age 4-8 yo is
LCP
acute transient synovitis from age 12-16 yo is
SCFE
MC hip pathology in adolescents
SCFE
- 15yo M, overweight, hip/knee pn
- kline and shentons line
painful limp, KNEE pain, avn of prox femoral epiphysis, tear drop distance
LCP
measurement of medial hip joint space, distance from lat margin of pelvic tear drop to most medial aspect of femoral head
tear drop distance
9-11mm, >1-2mm dif bt sides = hip jt fluid
-MRI - trauma infx inflam
obturator foramen smaller on painful side of hips dt contrx of obturator internus muscle
obturator sign
myelomeningocele
arthrogyoposis
lumbosacral agenesis
Are all:
Teratologic causes of Dev hip dislocation
- dislocated (fem head outside acetab, can be reduced)
- dislocatable (w/i but easily displaced)
- subluxatable (giving sensation with clunk
Typical developmental hip dislocation types
