Exam #5: Pediatric Neuromuscular Exam

Question 1

What is the first thing you do when preforming the neuromuscular exam on the newborn?

Answer 1

Observation of tone

Question 2

What should you see when examining the newborn (muscle tone)?

Answer 2

Flexion at elbows, hips, and knees

Question 3

What are you concerned about if there is an absence of flexion i.e. one arm if flexed but the other isn’t?

Answer 3

1) Clavicle fracture

2) Brachial plexus injury

Question 4

How do clavicle fractures appear?

Answer 4

Swelling at the fracture site

Question 5

Following observation, how do you continue tone assessment?

Answer 5

Pull the patient toward you by the arms or legs and see what degree of flexion returns, then:

1) Pull test i.e. pick the baby up by both arms to see what the head does (head should try to come up)
2) Ventral suspension–place the baby prone in your hand
3) Vertical suspension–hold the baby upright with two hands around the chest

Question 6

What are the two tests for the hip exam to rule out developmental displasia of the hip (DDH)?

Answer 6

Barlow’s maneuver

• Grab leg with thumb inside & fingers around outer thigh
• ADduct thigh & apply downward pressure on femur
• **Positive sign is CLUNK when femoral head exits acetabulum

Ortolani’s maneuver

• ABduct the thigh
• Use fingers as a LEVER to push femoral head into trochanter
• ***If there is a CLUNK suspect hip dislocation

Question 7

What are the risk factors for displasia of the hip?

Answer 7

• Female
• First born
• Breech

Question 8

What is the difference between the Barlow’s Maneuver and the Ortolani’s Maneuver?

Answer 8

Levering up in Ortolani’s

Question 9

What is the Allis sign?

Answer 9

Flex the knees of the newborn and determine if the knee’s are at the same level

Question 10

What is the treatment for DDH?

Answer 10

1) Soft positioning device, called a Pavlik harness
2) Possible splint/ cast
3) Surgery

Question 11

What is talipes equinovarus?

Answer 11

Clubfoot

*Note that this is a FIXED deformity, you can’t move the feet back to neutral

Question 12

What is metatarsus adductus?

Answer 12

• Turning in of the midfoot
• Maxes a c-shape
• Midfoot

*Note that this is a FIXED deformity, you can’t move the feet back to neutral

Question 13

What are the three major primitive reflexes that you should do with every baby?

Answer 13

1) Suck
2) Plantar & palmar grasp reflexes
3) Moro

Question 14

What is the suck reflex?

Answer 14

Baby should be sucking–examine with your finger (put in baby’s mouth) or by report i.e. observe feeding or report of good feeding

Question 15

What are the plantar and palmar grasp reflexes?

Answer 15

• Place your finger in the babies hand, it should grab
• Normal for 4-6 months
• Should happen equally on both sides

Question 16

What is the moro reflex?

Answer 16

Place baby on his or her back & release arms–should grab at the air

Question 17

Generally, how are cranial nerves evaluated in infants?

Answer 17

Observation

Question 18

What physical skills are expected of the toddler?

Answer 18

• Walks alone
• Pulls toys behind when walking
• Begins to run
• Stands on tiptoe
• Kicks a ball

Question 19

How old is a “toddler?”

Answer 19

1-3 years

Question 20

What is the general progression of development?

Answer 20

Cephalocaudal i.e. from the head down

- Motor control of the head an neck happens before control of the trunk

Question 21

What is Gower’s sign?

Answer 21

This describes a patient that has to use his hands and arms to “walk” up his own body from a squatting position due to lack of hip and thigh muscle strength.

Question 22

What is Gower’s sign indicative of?

Answer 22

DMD i.e. Duchenne’s Muscular Dystrophy