Final Flashcards
(262 cards)
1
Q
What percentage of children/adolescents have had a headache by the age of 15?
A
70%
2
Q
What’s the 3rd MC reason for school absenteeism?
A
Headache
3
Q
Migraines are classified how?
A
Classic and common
4
Q
Type of headache that has “band-like” sensation around the head, neck/shoulder pain, can last for days, associated with stressful events.
A
Tension-Type Headache
5
Q
Migraines affect what percentage of children?
A
20%
6
Q
What age group has the highest incidence of migraines?
A
10-14 year old boys
7
Q
Parental history of migraines are associated with what percentage of cases?
A
90%
8
Q
What is an aura?
A
A warning sign that a migraine is about to begin.
9
Q
How long do aura’s typically last?
A
About 20 mins.
10
Q
Common migraine (w/out aura) have what symptoms?
A
Sudden onset without warning Pain similar to classic No aura Scalp tenderness Photophobia
11
Q
Common migraine (w/out aura) Criteria?
A
Last 1-72 hours
Have 2 of the following (bilat. or unilat.; pulsating quality; mod/sev intensity; aggravated by physcial activities)
At least 1 of the following (nausea and/or vomiting; photophobia and/or phonophobia
12
Q
Classic migraine (with aura) symptoms?
A
Aura Nausea/vomiting Pain (one side) Dull/ache then throbbing Worse around eyes, forehead and temples Under 4 yoa may not have pain but other sx Scalp tenderness Photophobia Perspiration, pallor & diarrhea Localized paresthesia, hemiplegia
13
Q
Migraine (with aura) Criteria?
A
Fulfills criteria for Migraine without aura
At least 3 of the following:
Fully reversible aura symptoms
1 aura gradually developing over more than 4 mins or 2 occurring in succession
No aura lasting > 60 mins
Headache follows < 60 mins
14
Q
Characteristics of Tension-type HA
A
Pain & tension along suboccipital & neck muscles Worse during school hours Absent in early morning Family history of tension HA No neurological signs
15
Q
Secondary Acute HA
A
Occur suddenly 1st time with sx which subside after relatively short period of time
MC result in visit to pediatrician or ER
MC cause is respiratory or sinus infection
Usually due to illness, infection, cold or fever
16
Q
Secondary Chronic progressive HA
A
Get worse & happen more often
Least common (2%)
Examples: Hydrocephalus, hemorrhage, tumor, blood clots, trauma
17
Q
Any child with a HA that occurs early in the morning, or wakens the child, must be evaluated accurately for the presence of what?
A
Brain tumor
18
Q
Warning signs of a brain tumor?
A
HA's which are persistent Vomiting Associated w/ change in behavior/personality Awaken child or occur in the morning Increase w/ valsalva's Changes in head circumference Changes in eyes/vision
19
Q
If this is left untreated it is usually rapidly fatal, and delay in tx generally increases the chance of death or poor prognosis.
A
Meningitis
20
Q
90% of meningitis cases occur in children between what ages?
A
1 month and 5 years old
21
Q
What are indications of meningitis in young infants?
A
Irritability
Lethargy
Poor feeding
Restlessness
22
Q
Classic signs of meningitis
A
Headache
Stiff neck
(+) Brudzinski sign
23
Q
Sinusitis have what characteristics?
A
No seen before school age
Due to allergy or infection
Frontal or sinus pain
Usually present when awakening & disappears after rising
May have fever, runny nose, tenderness of sinuses
24
Q
What are key features of intracranial disease on neurological exam?
A
Altered mental status Abnormal eye movements Optic disc distortion Motor or sensory asymmetry Coordination disturbances Abnormal DTR's
25
When to send out for neurological referral?
Children <3 year (rarely have primary HA)
Acute HA w/ focal neurologic sx/signs
Chronic-progressive HA
26
CT/MRI indicated in patients with:
Chronic-progressive HA pattern
| Abnormal findings in neurological exam
27
What are common triggers of migraines?
```
Emotional stress
Ovulation or menstruation
Changes in normal eating patterns
Caffeine
Weather changes
Medications
Sensitivity to chemicals/preservatives in foods
Changes in regular routine
```
28
This is a sudden disruption of the brain's normal electrical activity accompanied by altered consciousness and/or other neurological and behavioral manifestations.
Seizures
29
What are the 3 classifications of seizures?
Epileptic
Febrile
Afebrile
30
How often do seizures occur in children?
1 in 10 children
31
This type of seizure is focal and generalized.
Epileptic
32
This type of seizure is provoked by body temp, and occurs between 6 months and 4 years old.
Febrile (non-epileptic)
33
This seizure occurs without fever
Afebrile
34
To dx epilepsy what must occur?
2 or more unprovoked seizures occurring at intervals more than 24 hours apart
35
Epilepsy develops due to what?
Abnormal brain wiring
Imbalance of nerve signaling
Neurotransmitters
Combination of these factors
36
What is used to diagnose epilepsy?
EEG's
| Brain scans
37
Modern medicine and surgical techniques control what percentage of epilepsy?
80%
38
What FDA approved technique is used for epileptic pts that medications will not work for?
Vagus nerve stimulation
39
What 2 life-threatening conditions are people with epilepsy at risk for?
Status epilepticus
| Sudden unexplained death
40
Febrile seizures are characterized how?
Generalized, symmetric, tonic posturing and clonic movements (few mins duration)
Occurs suddenly in children whose developmental progress is normal
Fever (rectal of 102 degrees)
41
What percentage of children will experience at least 1 febrile seizure?
5%
42
Recurrence rate of Febrile seizures < than 1 yoa; 1 and 3 year; and after 3 years
30-50%
25%
12%
43
What are the M/C type of food allergies?
Dairy
| Gluten
44
Diagnosis criteria for Febrile seizures:
```
Sudden unresponsiveness
Tonic posturing
Generalized rhythmic jerking
Fever source outside nervous system
6 mo to 5 years (MC <3 years)
Normal neurodevelopment
Last 1-2 mins (some as brief as a few seconds)
```
45
DDx for Febrile seizures?
Meningitis
Encephalitis
Sub-arachnoid hemorrhage (rarely)
46
Prolonged daily use of oral anticonvulsants to prevent febrile seizures IS OR IS NOT recommended?
NOT recommended
47
What is the prognosis of febrile seizures?
Vast majority are harmless
No evidence of brain damage
Some face increased risk of developing epilepsy
48
How often do Afebrile seizures occur?
1 out of 250 children
49
What happens if Afebrile seizures become recurrent?
Child is said to have epilepsy
50
Who is affected by type 1 diabetes?
Peak age is middle puberty (boys and girls equal)
Ave age of onset 8 (??)
Less common in children who are breastfed
51
Some symptoms of type 1 diabetes?
```
Polyuria
Enuresis
Polydipsia
Weight loss
Loss of appetite
Yeast infection
Constipation
```
52
What is diabetic ketoacidosis (DKA)?
Ketone levels get too high by burning fat for engery
| Can lead to coma and death
53
Symptoms of Ketoacidosis:
```
Vomiting
Dehydration
Hyperventilation
Acetone odor on breath
Abdominal pain
Lethargy
Shock
Coma
```
54
DDx for type 1 Diabetes:
```
Cushings
Hyperpituitarism
Hyperthryoidism
Congenital pancreatic defects
Infections
Toxins
```
55
Diabetes increases risk of cardiovascular disease by how much?
2 fold
56
Long-term effects of type 1 diabetes?
Thyroid dysfunction, joint hypomobility, growth disturbances
Retinopathy
Nephropathy
57
Between 1935-1996 the incidence of type 2 diabetes has increased by how much?
700%
58
Symptoms of type 2 diabetes:
```
Polyuria
Polydipsia
Polyphagia
Weight loss
Lethargy
Sores/wounds
Dry, itchy skin
Loss of feeling or tingling in hands/feet
Blurry vision
```
59
Type 2 diabetes is diagnosed by the following:
HgA1C of 6.5%
Fasting glucose higher than 126
Random (non-fasting) glucose: > 200
Oral glucose tolerance test: >200 after 2 hours
60
Complications of type 2 DM:
ER: diabetic coma
| Long-term: Retinopathy; Nephropathy; Neuropathy; Peripheral vascular disease; Heart disease
61
Common MSK conditions with type 1 and type 2 DM:
```
Muscle cramps/spasm
Peripheral neuropathy
Complex regional pain syndrome
Carpal tunnel
Calcific tendonitis
Dupuytren's
Flexor tenosynovitis
Loss of DTR
Osteoporosis
```
62
Glucose has a glycemic index of what?
100
63
Foods low on glycemic index:
Beans, seeds, vegetables, most fruits, whole wheat
64
Foods medium on glycemic index:
Grape juice, raisins, prunes, pumpernickel, ice cream, banana, cranberry juice, unpeeled boiled potato
65
Foods high on glycemic index:
White bread, white rice, cereals, pretzels, bagels
66
What are the 3 key features of hypoglycemia (Whipple Triad)?
1. Symptoms known to be caused by hypoglycemia
2. Low glucose at time of symptoms
3. Reversal or improvement of symptoms or problems when glucose is restored to normal
67
What are some holistic tx's for allergies?
- Chiro - upper Csp/Tsp adjustments
- Water/hydration
- Neti pot
- Diet changes
- Elimination of triggers
- Essential oils - chamomile, lavender, lemon, tea tree
- Herbs - echinacea, elderberry, stinging nettles, thyme
68
When should you refer a child w/ allergy problems?
- Wheezing
- Respiratory distress
- Serum sickness
- Past history of anaphylaxis
- No improvement w/ chiro/holistic care
69
Glucose below what results in coma?
<10 mg/dl
70
What are s/s of asthma?
- Coughing
- Whistling or wheezing sound when exhaling
- Shortness of breath
- Chest congestion or tightness
- Trouble sleeping caused by shortness of breath, coughing or wheezing
- coughing/wheezing that get worse w/ cold/flu
- Delayed recovery or bronchitis after a respiratory infection
- Fatigue or trouble breathing during active play or exercise
71
What is chiropractic management for asthma?
- Adjust - full spine, ribs, upper Csp
- Trigger avoidance
- Environmental control measures
- Diet changes
- Relaxation techniques, stress control/reduction
72
What are common triggers for asthma?
- Allergens from dust mites/mold spores
- Animal dander
- Cockroaches
- Pollen
- Indoor/outdoor pollutants
- Irritants from smoking, perfumes, cleaning agents
- Drug triggers (NSAIDS, sulfites)
- Physical triggers (exercise, cold air)
- Physiologic factors (stress, GER, URTI, rhinitis)
73
Glucose below what results in subtle reduction of mental efficiency?
<65 mg/dl
74
Glucose below what results in impairment of action and judgment?
<40 mg/dl
75
Glucose below what results in coma?
<10 mg/dl
76
Causes of Hypoglycemia:
```
Diabetes
Medications
Excessive alcohol consumption
Hepatitis, kidney, anorexia/starvation
Insulin overproduction
Endocrine deficiencies
After meals
```
77
Symptoms of hypoglycemia in children:
```
Irritability
Nervous
Tired
Pale
Confused
Behavioral problems-tantrums
May demand food
Headache
Muscle weakness/paresthesia
```
78
Symptoms of hypoglycemia in infants:
```
Flushing of skin
Sweating
Cyanosis
Limpness
Twitching
Apnea spells
Abnormal neurological signs
```
79
Common characteristics of hypoglycemia:
```
Lack of sleep
Dark circles under eyes
Menstrual cycle not regular
Overwhelmed with life
Feel puffy, stiff and sore
Exhausted
Groggy
Digestion not regular
```
80
What are some environmental control measures for asthma/allergies?
- Remove carpets
- Wash bedding & clothing in hot water (weekly)
- Hypoallergenic mattress & pillow covers
- Remove stuffed animals
- Keep pets outdoors
- Hypoallergenic furnace filters
- Dehumidifier (household humidity <50%)
81
What are some dietary changes to help w/ allergies/asthma?
- Avoid dairy/wheat
- Limit processed sugars
- Avoid food additives & preservatives (MSG)
- Probiotics
- Omega-3 fatty acids
- Calcium & magnesium
- Antioxidants
82
What is the 2nd MC reason after a well baby visit to see the pediatrician's office?
Otitis Media
83
How many children will experience 1 or more ear infections before 2 years?
70%
84
When is the peak prevalence of otitis media (OM)?
6-18 months
85
Boys or girls are more common for OM?
Boys
86
Risk factors for OM?
```
Prematurity
Family history
Alaskan, Native Am, Caucasians
Altered immunity
Cleft palate
Pollutant exposure
Use of pacifier
Prone sleeping
(I didn't put absolutely all of them)
```
87
Developing on basis of (viral) upper respiratory infection with blockage of eustachian tube and effusion in middle ear, when the fluid in middle ear gets additionally infected with bacteria.
Acute Otitis Media (AOM)
88
Collection of fluid that occurs within middle ear space due to negative pressure produced by altered eustachian tube function. Can be viral URI, no pain or bacteria infection
Otitis media with effusion (OME)
89
Perforation in the tympanic membrane and active bacterial infection within the middle ear space for several weeks or more. Hearing impairment often accompanies this disease.
Chronic suppurative otitis media
90
Biological preparation that improves immunity to particular ds. Contains an agent that resembles a ds-causing microorganism & is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins.
Vaccine
91
This virus affects the liver, not considered a common childhood illness (M/C 20-39 yoa) & not contagious.
Hepatitis B
92
Cells produced in the body by the immune system in response to antigen being identified & recognized
Antibodies
93
Temporary immune protection from antibodies passed from mother to baby from placenta during pregnancy & breastfeeding. Can last 6-12 months
Passive immunity
94
Ability of body to recognize & respond to germs to protect from the virus or bacteria. "Natural immunity"
Innate/Adaptive immunity
95
What is the body's first line of defense?
Skin & mucous membranes
96
What is the goal of vaccines?
Protect children from many ds's w/o having the actual illness first
97
What are some common ingredients in vaccines?
- Thimerosal (trace amounts in DTap, HIB, flu, Hep. B)
- Human & animal tissue
- Aluminum
- Formaldehyde
- MSG
98
What is the max daily aluminum dose recommended by the FDA to prevent accumulation & toxicity?
4-5mcg/kg/day
99
When is Hep B vaccine currently given?
Birth
1-2 months
6-18 months
100
What other ds's is Hep B vaccine linked to?
Guillain-Barre syndrome
Diabetes
MS
Arthritis
101
This causes a meningitis bacterial infection. Its contagious & spreads from person-to-person through coughing, sneezing, & other respiratory or secretions from mouth
Hib -Haemophilius Influenza Type B
102
When is the Hib vaccine given?
2, 4, 6, & 12-15 months
103
What ds's does the DTaP vaccine prevent?
Diphtheria
Tetanus
Pertussis
104
When is the DTaP vaccine given?
2, 4, 6, 15-18 months
| 4-6 years
105
The most severe reactions (encephalitis, convulsions, death) to the DTaP vaccine are to which part?
Pertussis
106
This is a bacterial infection that is contagious w/ an incubation period of 2-5 days. Found in poor & densely populated areas. Forms a membrane on throat & tonsils
Diphtheria
107
Bacterial infection that causes lockjaw. Not contagious, found in soil. Symptoms usually begin around the 8th day.
Tetanus
108
This used to be called "100 day cough". Can lead to pneumonia, lead to ear infection, dehydration, convulsions, brain damage (rare) or death (rare).
Pertussis (Whooping Cough)
109
This leads to many cases of pneumonia, meningitis, & blood infections as well as ear & sinus infections.
Pneumococcal (PCV)
110
When is the PCV vaccine given?
2, 3, 6, & 12-15 months
111
This virus causes acute viral gastroenteritis. Leading cause of diarrhea.
Rotavirus
112
When is the Rotavirus given?
2, 4, & 6 months
113
What complication could Rotatvius vaccine (RotaTeq) be linked to?
Intussusception
114
This occurs when a thin retracted ear drum becomes sucked into the middle ear space and stuck to the ossicles and other bone of middle ear.
Adhesive otitis media
115
Signs and symptoms of AOM
```
Otalgia (ear pain)
Child pulling on ear
Fever
Irritability
Anorexia
Vomiting
Otorrhea (discharge from ear)
TM inflammation on otoscopic exam
```
116
OME often follows AOM. Symptoms include:
Hearing loss
Tinnitus
Vertigo
Otalgia
117
Causative microorganisms for OM:
Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
118
Why are children with a cleft palate more likely to have OM?
Muscles that move the palate also open the Eustachian tube
119
What are the 4 TM characteristics of OM?
1. Color: yellow- effusion; red- AOM
2. Position: AOM- retracted; OME- bulging
3. Mobility: impaired
4. Perforation: single is MC
120
How long does "watchful waiting" last before antibiotic treatment is given?
24-48 hours
121
What procedure makes an incision in the eardrum membrane to remove fluid?
Myringotomy
122
What procedure inserts ear ventilation in eardrum for prolonged time to prevent accumulation of fluid?
Tympanostomy tubes
123
When to refer for ear pain:
>24-48 hours
Drainage from ear
Child still sick >24-48 hours with home remedies and chiro care
124
This is avascular necrosis of the epiphysis of the femoral head.
Legg-Calve-Perthes Disease (LCPD)
125
How long does avascular necrosis of the hip considered LCPD? And who is it MC in?
<12 year old
| Boys (5:1)
126
What ethnicities are MC to develop LCPD?
Japanese, Mongoloid, Eskimo and central European
127
These babies are more likely to develop LCPD:
Breech, transverse presentation and low birth weight babies
128
What is the clinical presentation of LCPD?
```
Pain (often knee pain)
Effusion/Edema
Limp
Movement limitation
Myospasm
Short stature
May have small feet (weird....)
```
129
LCPD diagnosis:
```
Internal rotation limit
Decreased abduction
Patrick FABRE
Thomas' Sign
(+) Trendelenburg test
Decreased circumference of upper thigh
(+) Roll test
```
130
What are the 4 stages of LCPD?
1. Avascular Necrosis: bone cells die
2. Resorptive Stage: dead cells removed
3. Re-ossification: new bone starts
4. Healed: all bone built back
131
What are the 4 surgeries for LCPD?
1. Contracture release: lengthen tight muscles
2. Loose body removal: bone or torn cartilage
3. Hardware implants
4. Joint realignment
132
This defines a range of hip pathology from dislocation to instability:
Developmental Dysplasia of Hip (DDH)
133
What percentage of children affected by DDH will recover normal hip function?
96%
134
How many DDH cases resolve by 1 week how many resolve by 2 months?
50%
| 90%
135
Who is more likely to get DDH and why?
Female infants may be more sensitive to maternal hormone such as estrogen and relaxin
136
DDH effects left hip how often and right hip how often and bilaterally?
Left: 60%
Right: 20%
Bilateral: 20%
137
DDH Diagnosis:
```
Breech presentation
Female with asymmetric skin folds
Hip abduction limits
(+) Galeazzi's sign
(+) Ortolani's and Barlow's
Shortened limb
Limp and toe walking
US for initial eval
X-Rays for >3 months old
```
138
DDH Treatment:
```
Immediate referral to pediatric orthopedist
Triple diapers
Frejka pillow
Craig or Illfeld splint
Von Rosen splint
Pavlik harness
Surgery
```
139
What shape should the hips and legs be in when swaddling or in carrier?
'M' shaped
140
Complications of DDH:
Limp
Premature OA
Low back and hip pain
Recurrent dislocation
141
When is the polio vaccine given?
2, 4, 6-18 months
| Booster at 4-6 yrs old
142
MMR vaccine should not be given to children allergic to what?
Gelatin
Eggs
Neomycin
143
When is MMR given?
1 year & 4-6 yrs old
144
Virus transmitted through fecal-oral route. Can be spread through diaper changes at day care.
Hep A
145
When is Hep A vaccine given?
1-1.5 year & 6-12 months after 1st dose.
146
When is Varicella vaccine given?
12-15 months & then 4-6 yrs old
147
This ds is more common in those w/ weakened immune systems, no spleen, or crowded living conditions (college)
Meningitis
148
What are the 3 vaccines for meningitis?
HIB
Pneumococcus
Meningococcus
149
When is HPV vaccine given?
11-12 yr old girls (3 doses w/i 1 yr)
| "Catch up" through 26 yrs
150
What are the clinical presentations of osgood-schlatters?
Localized swelling and tenderness
Pain aggravated by direct pressure
Ext of knee against resistance and palp are painful
151
What are the 4 types of vaccine exemptions?
Religious
Philosophical
Medical
Proof of Immunity
152
Scoliosis when measured on X-ray is a curve greater than how many degree?
10 degrees
153
The ball at the upper end of the femur slips off in a backward direction (due to weakness of growth plate)
Slipped Capital Femoral Epiphysis (SCFE)
154
What are possible etiologies of SCFE?
Unknown
Endocrine based
Low or high levels of sex hormones
Mechanical factors
155
Who is most likely to develop SCFE?
MC boys- 10-17 years old
156
SCFE clinical presentation:
Limp
Pain and loss of hip motion
Unilateral and bilateral involvement
Outward turning leg
157
Treatment for shin splints:
Rest, Ice, anti-inflammatory
Calve stretches
Stop running completely
158
What is one of the MC causes of knee pain in young athletes?
Osgood-Schlatter Disease
159
Who is most likely to develop osgood-schlatters?
Boys having a growth spurt and most likely engaged in vigorous activities
160
How is osgood-schlatters believe to occur?
Pull of quads caused by excessive biomechanical force on tibial tendon at insertion point on tibial tuberosity
161
When does osgood-schlatters occur?
Late childhood or early adolescence
162
Treatment for osgood-schlatters?
```
Bracing or sleeve cast
Ice
Restricted activity
Anti-inflammatories
Surgery (after conservative care fails)
```
163
Softening and damage to articular hyaline cartilage to undersurface of patella.
Chondromalacia patella
164
What are contributing factors for chondromalacia patella and who is most affected?
Weakness and tightness in quads (vast med), abnormalities of lower limp alignment
Young women more likely to develop
165
Treatment of chondromalacia patella?
```
Decrease activity
Brace/tape
Anti-inflammatory
MFR
Adjust, etc
```
166
DDx for shin splints:
Tibialis anterior syndrome
Posterior compartment syndrome
Periostitis
167
Shin splints are related to what?
Over training in school-aged athletes
| Distance running
168
Most children have an asymmetric posture with what characteristics?
- Slight right scoliosis/ right rib
- Short left leg
- Left Lsp hump/ right Tsp rib hump
169
The apex of the scoliosis is located where?
At the vertebra having the greatest lat. deviation from the mid-line viewed on an A-P x-ray
170
What is the M/C presentation of scoliosis?
Thoracic dextroscoliosis from about T5-T11 w/ apex at T8
171
What are some problems (parental concerns/ signs after age 8) that could indicate scoliosis?
- Uneven shoulders
- Prominent shoulder blade
- Uneven waist
- Elevated hips
- Leaning to one side
- Hem line of pant is different on each side/pant wears more on one side
172
What type of scoliosis will reduce or disappear on forward bending & at bending to the side of the convexity?
Non-structural/functional
173
What are different types/classifications scoliosis?
- Non-structural/functional
| - Structural (osteopathic, neuropathic, idiopathic)
174
A structural scoliosis may begin as what?
A functional curve
175
A partial unilateral failure of vertebral formation is what?
wedge vertebra
176
A complete unilateral failure of vertebral formation is what?
Hemivertebra
177
A unilateral failure of vertebral segmentation is what?
Congenital Bar
178
A bilateral failure of vertebral segmentation is what?
Block Vertebra
179
What is the M/C type of scoliosis?
Idiopathic scoliosis
180
What factors determine the outcome/prognosis of a scoliosis?
- Severity of curve
- Location of apex
- Skeletal maturity
- Age of menses
181
This type of scoliosis occurs during the 1st 3 years of life, is M/C in males & the curve is most often in the Tsp & is usually convex to the left. Correlated w/ in-utero constraint, low birth weight, prematurity, mental retardation, & delayed muscle development
Infantile Idiopathic Scoliosis
182
Type of scoliosis that makes up 10-15% of idiopathic scoliosis?
Juvenile Scoliosis (most likely to progress & often left-sided)
183
Juvenile curves that reach what degree tend to continue to worsen w/o tx?
30 deg
184
Bracing is often used to managed curves >30 deg but nearly what % of children in the juvenile age range go on to require surgical tx?
95%
185
What is the M/C type of Idiopathic scoliosis?
Adolescent
186
Adolescent Scoliosis that curves >20 deg occur more often in males or females?
Females
187
Are adolescent curves for the most part progressive or not progressive?
Not progressive
188
What is the chest cage expansion measurement seen in scoliosis?
.75cm - 2.2cm (normal = 1.6cm - 2.7cm)
189
This instrument measures the angle of trunk rotation in scoliosis?
Scoliometer (7deg or greater refer to orthopedist)
190
What is the standard method of measuring a scoliosis?
Cobb angle
191
This sign determines skeletal maturity
Risser Sign (little growth occurs after +4)
192
What factors determine tx choice for scoliosis?
- Skeletal maturity
| - Curve angle
193
Chiro care is effective for scoliosis curves that measure less than what?
20 degrees
194
Bracing is most effective for scoliosis curves that measure in what range?
20-40 degrees
195
What are goals of chiropractic when treating a scoliosis?
- Maintain spinal flexibility & reduce VSC
- Correct compensations to spine
- Help reduce muscle spasm & pain related to soft tissues
- Level pelvis
196
This is a congenital fusion of 2 or more c-sp vert.
Klippel-Feil Syndrome
197
When does the fusion of Klippel-Feil occur?
3rd-8th week of embryonic development
| Unknown etiology
198
What other anomalies are present with Klippel-Feil?
Sprengel's deformity; spina bifida; cleft palate; hearing impairment; GU; cardiopulmonary and nervous system problems
199
How does Klippel-Feil syndrome present?
Short neck
Hairline may appear low
C-sp ROM restricted
Webbed neck
200
Complications of Klippel-Feil?
Scoliosis or kyphosis (60%)
Urinary tract abnormalities (33%)
Congenital heart disease (14%)
Deafness (30%)
201
What is the management/treatment of Klippel-Feil?
Flexion/distraction is helpful
Adjust other spinal compensations of spine
Manage other conditions associated-scoliosis
Avoid HVLA in c-sp
202
Congenital elevation of the scapula- failure of scapula to descend to normal thoracic position during fetal development. Unknown etiology.
Sprengel's deformity
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70% of sprengel's deformity is associated with what other anomalies:
Klippel-Feil
Renal problems
Scoliosis, fused ribs, spina bifida
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What is the management of Sprengel's Deformity?
Surgery to reduce
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This is a dislocation of the proximal head of radius
Nursemaid's Elbow
206
How does the child with nursemaid's elbow present?
Child will resist flexion due to pain- may create pseudoparalysis
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Common birth injuries:
Erb's palsy
Klumpke's Paralysis
Clavicle and humerus fx
Cerebral palsy
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How often do injuries at birth occur?
6-8/1000 births
209
What are risk factors for birth injuries?
```
Breech
Large baby (>9.5 lbs)
Quick second stage of labor
Maternal forces
Instrument deliveries (forceps or vacuum)
```
210
What is Erb's palsy?
Injury to C5/6 upper brachial plexus
| MC form of brachial plexus palsy
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How does Erb's palsy present?
Adduction/internal rotation of shoulder, extension of elbow and pronation of forearm ("Waiter's tip" deformity)
Sensory normal
Palmar grasp normal
Biceps reflex is absent
212
What advanced imaging should be done with Erb's palsy?
MRI
| EMG and nerve conduction studies
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When is a consult needed for Erb's palsy?
Paralysis persists for more than 3-6 months
214
Recovery/Complications for Erb's Palsy?
Usually spontaneous recovery
Nerve laceration may result in a permanent palsy
Long term: progressive bony deformity; muscle atrophy; joint contractures; possible impaired growth of limb; weakness of shoulder girdle
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What is Klumpke Paralysis?
Injury to C7/8 and T1 lower brachial plexus (Rare)
216
How does Klumpke paralysis present?
Hand paralysis/weakness of muscles (grasp reflex is absent)
| Possible ptosis, miosis, anhidrosis (Horner's)
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How is Klumpke Paralysis caused?
Pulling of arm above head
| Common with breech birth-elbow maintained in flexed position
218
What is cerebral palsy?
Non-progressive motor disorder from damage in-utero or during birth that causes CNS damage
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This condition is characterized by asymmetrical distortion of the skull. Flat spot on the back or one side of head
Plagiocephaly ("Flat Head Syndrome")
220
Etiology of plagiocephaly:
```
In utero constraints, birth injuries
Craniosynostosis
Torticollis
Sleeping on back
Subluxation
```
221
This type of plagiocephaly effects an entire quadrant
Anterior ear shift on same side
Ipsilateral forehead bossing
Contralateral forehead
Moderate Plagiocephaly
222
Type of plagiocephaly involves:
Significant asymmetries to forehead, ears and facial features
Asymmetry crosses midline
Severe Plagiocephaly
223
DDx of plagiocephaly
Positional Head Deformity
| Craniosynostosis
224
Management for plagiocephaly
```
Preventive counseling
Mechanical adjustments
Exercises
Skull molding helmets
Surgery
(if parents follow the first 3, will clear up 2-3 months)
```
225
Types of Torticollis:
Congenital
| Acquired
226
When is torticollis usually discovered?
6-8 weeks
227
What percentage of children have congenital muscular torticollis and congenital hip dysplasia?
20% (weird questions, but I could kinda see her asking it)
228
What is the onset of acquired torticollis?
Sudden- usually following strenuous activity, mild trauma or sudden change in neck position
229
Medical management for torticollis?
Surgery done 18-24 months
230
What are secondary effects of untreated torticollis?
Plagiocephaly
Facial hypoplasia
Musculoskeletal effects
231
What are risk factors for back pain in children?
```
>12 years
Females MC
Extended TV watching
Sports participation
Previous back injury
Sitting at school
Carrying back packs
Familial tendency
```
232
What are the 7 warning signs for Pediatric back pain?
1. Child is 4 weeks
2. Back pain causes a functional disability
3. Duration >4 wks
4. Fever is present
5. Antalgic posture
6. Neurologic abnormality
7. Limitation of motion due to pain
233
Surgery should be considered for scoliosis curves that measure over what?
40 degrees (can have cardiopulmonary/neurologic consequences)
234
What are causes of constipation?
- Dietary
- Food allergy
- Dehydration
- Environmental Stress/Tension
- Mechanical
- Medications
- Potty training
- Lack of exercise
235
What are holistic/chiro tx for constipation?
- Alter diet
- Probiotic
- Abdominal massage (clockwise)
- Adj upper Csp & Lsp regions
- Warm bath
- Exercise
- Potty training modification
- Hydrate
- Proper diapering
236
When do you refer for constipation?
- No stool for 5 days
- Crying, pain, discomfort
- Distended, painful abdomen
- Vomiting & diarrhea
- Blood in stool
- Previous abdominal surgery
- Chronic constipation
237
What are the different levels of diarrhea?
Mild: 2-4 loose stools in 24 hrs
Moderate: 4-8 in 24 hrs
Severe: 10 or more, watery, foul-smelling,child acts sick
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What are causes of diarrhea?
- Infection (GI, extra-intestinal)
- Poor digestion (food allergy/sensitivity, emotions, environment)
- Medicine (antibiotics)
- Systemic illness
239
What is a major concern w/ children & diarrhea?
Dehydration
240
What are tx's for diarrhea?
- Address underlying cause
- Improve digestion
- Rest
- Decrease stress
- Probiotics
- Abdominal massage (counterclockwise)
- Adj. lower Tsp & upper Lsp
241
When do you refer for diarrhea?
- Moderate to severe diarrhea
- Fever
- Abdominal pain
- Blood in stool
- Child doesn't look well
- Diarrhea more than a week
- s/s of other illness
242
What are some causes of GER(D)?
- Lower esophageal spincter relaxation
- Lower esophageal hypotonia
- Hiatal hernia
243
What are some uncommon s/s of GER(D)?
- Arching back
- Vomiting at any time (not just after eating)
- May have some respiratory problems d/t aspiration of refluxed material
244
What are some tx's for GER(D)?
- Adj upper Csp & sometimes mid-Tsp
- Probiotic
- Chamomile tea
- Small, frequent meals
- Thickening of formula
- Frequent burping
- Position changes during/after feeding
- Diet modification if mother is breastfeeding
- Abdominal massage
- Elevate head of crib/pack-n-play/co-sleeper
- Change diaper before feeding
- Avoid tight clothing around tummy
- Carry/hold baby w/ straight spine
245
What are 3 medications used to tx children w/ GERD?
- Prilosec
- Prevacid
- Zantac
246
What is the "Rule of Three" related to colic?
Crying for more than 3 hours per day, for more than 3 days per week, for longer than 3 weeks in an infant who is well fed & otherwise healthy
247
When does colic typically begin?
2 weeks of age & usually resolves by 4 months
248
What are s/s of colic?
- Attacks of screaming in late afternoon & evening
- Flushed face, furrowed brow, clenched fists
- Legs pulled up to abdomen
- Piercing, high-pitched screams
- Prolonged bouts
- Unpredictable, spontaneous
- Can't be soothed, even by feeding
249
What are some possible explanations for colic? (Actual cause is unknown)
- Milk allergies/intolerance
- Immature digestive system & strong intestinal contractions
- Reflux
- Increased intestinal gas
- Hormone changes in baby
- Baby's temperament
- Maternal anxiety
- Postpartum depression
- Changes in way baby is fed/comforted
250
What are ways to manage colic?
- Low allergen diet
- Hypoallergenic formulas
- Soy formulas (soy allergy?)
- herbal tea
- reduce infant stimulation
- probiotics
- white noise
- "Gripe water"
251
What are the 5 "S's" assoc. w/ colic?
- Swaddling
- Side/stomach position
- Shushing
- Swinging
- Sucking
252
What are two special charac. of the pediatric spine you need to consider when choosing an appropriate adjustive technique?
Bone strength
| Lig. laxity
253
Depth of thrust applied to the pediatric spine needs to be reduced to an amplitude of what?
No greater than a half inch
254
Spinal adjusting in peds needs to be performed at what point in their passive range of motion?
At a point somewhat before the end of passive range is reached
255
What are 2 reasons the D,C. needs to use precise palpatory techniques for peds?
1. To identify the specific spinal structures
| 2. To detect any palpable anomalies present
256
What are some anatomical differences among in children?
- Underdeveloped cervical lordosis
- Low vertebral height
- Horizontal facets (until age 10)
- Undeveloped uncinates (until age 7)
257
How long can you use inversion as an evaluation technique in a pediatric pt?
Up to 6 months or until Landau Reflex is present
258
What is considered normal when performing a heel swing test during inversion?
Infant turns head towards side of heel is released
259
What motion is usually the most restricted in infants from C2 to L5.
P-A motion
260
Why is it important to put an infant's head in neutral while palpating the SI joint?
Whichever side the head is turned will cause the SI to appear more pos. or resisted
261
A lower or deeper gluteal fold or more folds on one thigh may indicate what about the ilium?
PI ilium on that same side
262
What are some other techniques beside diversified/MPI that you can use for spinal analysis of a peds pt?
- Cervical stair step (SOT)
| - Thompson leg checks
