Exam II Flashcards
When can the infant raise their head prone?
2 months
When can the infant roll from prone to supine?
4 months
When can the infant sit using tripod position?
6 months
When can the infant crawl?
9 months
When can the infant stand without support?
12 months
What is a concern with early walkers?
more stress on bone causing genu varus
What is the Gower sign?
when a child rises from sitting to standing by placing hands on legs and pushing the trunk up
What does the gower sign indicate?
muscular dystrophy
What other issue is commonly seen with developmental hip dysplasia?
torticollis
What increases the risk of developmental hip dysplasia?
breech
intrauterine constraint
What characterizes a subluxation in acetabular dysplasia?
femur head remains in contact with acetabulum, but joint ligaments and capsule are stretched
What is the most common exam finding with developmental hip dysplasia?
decreased hip abduction
What are two orthopedic tests done to assess developmental hip dysplasia?
Barlow’s
Ortolani’s
What does Allis sign detect?
shortened femur
dDx: hip dislocation
What is the MC kind of scoliosis in girls?
idiopathic structural scoliosis
Which nerves are involved in Erb’s Palsy?
C5/C6
What are some impaired findings in an infant with Erb’s Palsy?
asymmetrical moro, biceps and radial reflexes
What is the MC foot problem in infants?
metatarsus adductus
Which two foot problems are due to intrauterine constraint?
- tibial torsion
- metatarsus adductus
Is “pes planus” normal in an infant?
yes, the longitudinal arch is obscured by a fat pad until 3yrs
Which part of the foot is involved in metatarsus adductus?
the forefood
heel and ankle are not involved
Which sitting position places stress on the joints and may cause intoeing & femoral anteversion?
reverse tailor position
What are some clinical findings for femoral anteversion?
- inc. internal hip rotation (>70)
- femurs twist medially
- patella faces inward
What are the 3 things you need to ask yourself when assessing and infant/child?
- outside normal range
- appropriate for their age
- is it symmetric
What is the measurement for genu varum?
1 inch between knees
When should you evaluate a genu varum further?
- asymmetry of tibiofemoral angle
- space between knees >1.5 inches
What is the measurement for genu valgum?
1 inch between medial maleoli
When is genu valgum common?
2-4 years
When should you evaluate a genu valgum further?
- asymmetry of tibiofemoral angle
- space between knees >2 inches
What are some characteristics of Talipes Equinovarus?
- congenital defect of ankle and foot
- inversion of foot at the ankle
- plantar flexion
- bilateral involvement 30-50% of cases
What is the treatment for Talipes Equinovarus?
Ponseti Method
What is the Ponseti Method?
- series of manipulation and casting
- tenotomy (achiles)
- food abduction brace (Denis Browne Bar)
What are some characteristics of Talipes Calcaneovalgus?
- exaggerated dorsiflexion
- from uterine positioning
- resolves spontaneously
What is another name for radial head subluxation and what is the etiology?
- Nursemaid’s Elbow
- jerking the arm upward while elbow is extended
Where is the pain located with a Nursemaid’s Elbow injury?
pain in the elbow and the wrist (both articulations)
What is Legg-Calve-Perthes?
AVN of the humeral head
When is Legg-Calve-Perthes MC seen?
in boys 2-10 years old
What is the referred pain patter in Legg-Calve-Perthes?
medial thigh, knee or groin
When is SCFE MC seen and what is the referred pain pattern?
- boys 8-16 yoa
- knee pain
Until what age does the brain keep growing?
12-15 years
What is the pattern of motor maturation?
cephalocaudally
Doll’s eye maneuver involves which cranial nerve?
CN VIII
Which reflexes test CN V?
- rooting reflex
- sucking reflex (also CN XI,X, XII)
Which DTR is present at birth?
patellar reflex
Which DTRs appear around 6 months?
achilles and brachioradialis reflexes
When are primitive reflexes present until?
birth to 6 months
Until when is the Babinski sign present?
16-24 months
What facilitates the palmar grasp?
suckling
disappears by 3 months
When does the plantar grasp disappear?
8 months
When does the moro refelx diminish?
3-4 months
What is the Placing reflex?
touch the dorsum of the foot and observe flexion of hips and knees
How is the Galant reflex performed?
with infant prone over hand, run finger along paraspinals on one side, infant should curve toward that side
How is the Perez relfex performed?
stroke finger over spinous processes from sacrum to occiput
What is the response to Perez?
infant extends head and brings knees to chest; urinates
When does Fencer’s appear/disappear?
2-3 months
6 months
What is the Neck Righting reflex?
infant turns its whole body in the direction the head is turned
When does the Neck Righting reflex appear?
around 3 months
after fencer’s disappears
What type of touch is not typically tested in kids?
superficial pain
What are nuerological soft signs?
nonfocal, functional neurologic findings
-provide subtle cues to an underlying CNS deficit
What is the soft finding associated with walking/running gait?
stiff-legged w/ foot slapping, unusual arm posture
What is the soft finding associated with motor-stance?
difficulty maintaining stance
- extended arms
- feet together
- eyes closed
What is the soft finding associated with one-foot standing?
unable to remain stance longer than 5-10 sec
What is the soft finding associated with heel/toe walking?
unable to do for 10ft
What is a common finding in traumatic brain injuries?
fever
-nervous system unable to control temp.
Which meningitis symptom symptom is not present in infants?
nuchal rigidity
until 6-9 months
What should you automatically think of when an infant has a fever?
meningitis
What are some characteristics of Spastic CP?
- hypertonicity
- tremors
- scissor gait
- toe walking
What are some characteristics of Dyskinetic CP?
- involuntary slow writhing movements of extremities
- tremors may be present
What are some characteristics of Ataxic CP?
abnormalities of movement involving balance and position of trunk and extremities
What is the incidence of Generalized Seizure Disorder in children?
75% new cases develop during childhood and adolescence
What is the peak age of incidence of SOLs/intracranial tumors?
3-12 years
50-70 years
What is the MC cause of congenital torticollis?
birth trauma w/ resultant hematoma formation
-breech or difficult forceps deleivery
What is another issue present in infants with congenital muscular torticollis?
20% have congenital hip dysplasia
What is standard management for torticollis?
- passive stretching
- increase tummy time
What are some secondary effects of untreated torticollis?
- plagiocephaly
- facial hypoplasia
- musculoskeletal effects
For severe head deformity, during what age would be the best use of a helmet?
from 4-12 months
What is commonly seen in the birth history in infants with colic?
- long/difficult labor
- epidural & pitocin
What does the “rule of three” pertain to regarding colic?
-crying for > 3 hours per week
-for > 3 days per week
-for > 3 weeks
in an infant that is well fed and otherwise healthy
When does colic normally appear and disappear?
begins by 2 weeks and resolves by 4 months
What’s the total package for colic?
- chiropractic adjustments
- modification of maternal diet
- switch to goat’s milk
- probiotics
- teas
- screen for food intolerances, allergies etc.
What are some causes for an occiput posterior presentation?
- pendulous abdomen
- small pelvic size
- flat sacrum
- anterior wall placenta
What are symptoms associated with occiput posterior?
-back labor caused by fetal head pressing on the sacrum putting pressure on the sacral plexus
What effects can on occiput posterior have on the infant head?
- abnormal cranial molding
- cone head
- caput succedaneum
What is another name for occiput posterior?
sunny side up
What happens to the umbilical cord when exposed to air for a prolonged period of time?
it begins to constrict cutting off blood flow
What are some risk factors for face presentation?
- lax uterus
- flat pelvis
- multiple fetuses
- anencephaly
- neck spasm (fetus)
What are some risk factors for parietal presentation?
- flat/platypelloid pelvis
- pitocin & epidural
What is a common injury with parietal presentation?
- traction and/or compression of brachial plexus
- cephalhematoma
What is the MC compound presentation?
nuchal arm: arm alongside of head
What are some risk factors for a compound presentation?
- malposition
- malpresentation
- small infant
- mulitparous (lax uterus)
What are some consequences of a forceps delivery?
- depression fractures
- birth marks
- iatrogenic torticollis
- brachial plexus damage
- subluxation
What are some consequences of a vacuum delivery?
- cone head
- caput succedaneum
- subluxation of parietal bones
What is dystocia?
difficult labor caused by inadequate uterine function, pelvic contraction, and baby malpresentation
What are some variables that may distort Webster’s during knee flexion?
- knee subluxation
- collateral/cruciate tears
- knee edema
- scar tissue
- quad splinting
- lumbar subluxation
What do you contact on sacrum when using Webster’s?
sacral notch (NOT ala) ==>lateral and inferior to 2nd sacral tubercle
What is the preferred mode of adjusting for Webster’s?
low force, P-A drop technique
What is the DS in Webster’s?
stand on side of resistance
What does a negative Derifield suggest?
anterior inferior sacrum
What are some findings found with a -D?
SI, pubic bone, ischial tuberosity, medial aspect of knee tenderness and thick achilles tendon on the side of involvment
For sacral leg checks, the higher leg indicates ___?
side of apex deviation
SAR or SAL
What are some conditions that may prevent the fetus from turning?
- multiple babies
- oligohydramnios
- placenta previa
- short umbilical cord
- uterine abnormalities
When are ECVs typically done?
37 weeks
What is the MC type of HA in children?
migraines
What is the MC type of migraine?
basilar type
