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Pediatrics Final > Final > Flashcards

Final Flashcards

1
Q

What percentage of children/adolescents have had a headache by the age of 15?

A

70%

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2
Q

What’s the 3rd MC reason for school absenteeism?

A

Headache

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3
Q

Migraines are classified how?

A

Classic and common

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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

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5
Q

Migraines affect what percentage of children?

A

20%

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6
Q

What age group has the highest incidence of migraines?

A

10-14 year old boys

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7
Q

Parental history of migraines are associated with what percentage of cases?

A

90%

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8
Q

What is an aura?

A

A warning sign that a migraine is about to begin.

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9
Q

How long do aura’s typically last?

A

About 20 mins.

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10
Q

Common migraine (w/out aura) have what symptoms?

A 
Sudden onset without warning
Pain similar to classic
No aura
Scalp tenderness
Photophobia
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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

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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
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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

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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
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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

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16
Q

Secondary Chronic progressive HA

A

Get worse & happen more often
Least common (2%)
Examples: Hydrocephalus, hemorrhage, tumor, blood clots, trauma

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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

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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
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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

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20
Q

90% of meningitis cases occur in children between what ages?

A

1 month and 5 years old

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21
Q

What are indications of meningitis in young infants?

A

Irritability
Lethargy
Poor feeding
Restlessness

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22
Q

Classic signs of meningitis

A

Headache
Stiff neck
(+) Brudzinski sign

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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

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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
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25
Q

When to send out for neurological referral?

A

Children <3 year (rarely have primary HA)
Acute HA w/ focal neurologic sx/signs
Chronic-progressive HA

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26
Q

CT/MRI indicated in patients with:

A

Chronic-progressive HA pattern

Abnormal findings in neurological exam

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27
Q

What are common triggers of migraines?

A 
Emotional stress
Ovulation or menstruation
Changes in normal eating patterns
Caffeine 
Weather changes
Medications
Sensitivity to chemicals/preservatives in foods
Changes in regular routine
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28
Q

This is a sudden disruption of the brain’s normal electrical activity accompanied by altered consciousness and/or other neurological and behavioral manifestations.

A

Seizures

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29
Q

What are the 3 classifications of seizures?

A

Epileptic
Febrile
Afebrile

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30
Q

How often do seizures occur in children?

A

1 in 10 children

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31
Q

This type of seizure is focal and generalized.

A

Epileptic

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32
Q

This type of seizure is provoked by body temp, and occurs between 6 months and 4 years old.

A

Febrile (non-epileptic)

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33
Q

This seizure occurs without fever

A

Afebrile

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34
Q

To dx epilepsy what must occur?

A

2 or more unprovoked seizures occurring at intervals more than 24 hours apart

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35
Q

Epilepsy develops due to what?

A

Abnormal brain wiring
Imbalance of nerve signaling
Neurotransmitters
Combination of these factors

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36
Q

What is used to diagnose epilepsy?

A

EEG’s

Brain scans

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37
Q

Modern medicine and surgical techniques control what percentage of epilepsy?

A

80%

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38
Q

What FDA approved technique is used for epileptic pts that medications will not work for?

A

Vagus nerve stimulation

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39
Q

What 2 life-threatening conditions are people with epilepsy at risk for?

A

Status epilepticus

Sudden unexplained death

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40
Q

Febrile seizures are characterized how?

A

Generalized, symmetric, tonic posturing and clonic movements (few mins duration)
Occurs suddenly in children whose developmental progress is normal
Fever (rectal of 102 degrees)

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41
Q

What percentage of children will experience at least 1 febrile seizure?

A

5%

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42
Q

Recurrence rate of Febrile seizures < than 1 yoa; 1 and 3 year; and after 3 years

A

30-50%
25%
12%

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43
Q

What are the M/C type of food allergies?

A

Dairy

Gluten

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44
Q

Diagnosis criteria for Febrile seizures:

A 
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)
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45
Q

DDx for Febrile seizures?

A

Meningitis
Encephalitis
Sub-arachnoid hemorrhage (rarely)

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46
Q

Prolonged daily use of oral anticonvulsants to prevent febrile seizures IS OR IS NOT recommended?

A

NOT recommended

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47
Q

What is the prognosis of febrile seizures?

A

Vast majority are harmless
No evidence of brain damage
Some face increased risk of developing epilepsy

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48
Q

How often do Afebrile seizures occur?

A

1 out of 250 children

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49
Q

What happens if Afebrile seizures become recurrent?

A

Child is said to have epilepsy

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50
Q

Who is affected by type 1 diabetes?

A

Peak age is middle puberty (boys and girls equal)
Ave age of onset 8 (??)
Less common in children who are breastfed

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51
Q

Some symptoms of type 1 diabetes?

A 
Polyuria
Enuresis
Polydipsia
Weight loss
Loss of appetite
Yeast infection
Constipation
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52
Q

What is diabetic ketoacidosis (DKA)?

A

Ketone levels get too high by burning fat for engery

Can lead to coma and death

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53
Q

Symptoms of Ketoacidosis:

A 
Vomiting
Dehydration
Hyperventilation
Acetone odor on breath
Abdominal pain
Lethargy
Shock
Coma
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54
Q

DDx for type 1 Diabetes:

A 
Cushings
Hyperpituitarism 
Hyperthryoidism
Congenital pancreatic defects
Infections
Toxins
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55
Q

Diabetes increases risk of cardiovascular disease by how much?

A

2 fold

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56
Q

Long-term effects of type 1 diabetes?

A

Thyroid dysfunction, joint hypomobility, growth disturbances
Retinopathy
Nephropathy

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57
Q

Between 1935-1996 the incidence of type 2 diabetes has increased by how much?

A

700%

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58
Q

Symptoms of type 2 diabetes:

A 
Polyuria
Polydipsia
Polyphagia
Weight loss
Lethargy
Sores/wounds
Dry, itchy skin
Loss of feeling or tingling in hands/feet
Blurry vision
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59
Q

Type 2 diabetes is diagnosed by the following:

A

HgA1C of 6.5%
Fasting glucose higher than 126
Random (non-fasting) glucose: > 200
Oral glucose tolerance test: >200 after 2 hours

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60
Q

Complications of type 2 DM:

A

ER: diabetic coma

Long-term: Retinopathy; Nephropathy; Neuropathy; Peripheral vascular disease; Heart disease

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61
Q

Common MSK conditions with type 1 and type 2 DM:

A 
Muscle cramps/spasm 
Peripheral neuropathy
Complex regional pain syndrome
Carpal tunnel
Calcific tendonitis
Dupuytren's
Flexor tenosynovitis
Loss of DTR
Osteoporosis
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62
Q

Glucose has a glycemic index of what?

A

100

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63
Q

Foods low on glycemic index:

A

Beans, seeds, vegetables, most fruits, whole wheat

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64
Q

Foods medium on glycemic index:

A

Grape juice, raisins, prunes, pumpernickel, ice cream, banana, cranberry juice, unpeeled boiled potato

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65
Q

Foods high on glycemic index:

A

White bread, white rice, cereals, pretzels, bagels

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66
Q

What are the 3 key features of hypoglycemia (Whipple Triad)?

A
  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
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67
Q

What are some holistic tx’s for allergies?

A
  • 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
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68
Q

When should you refer a child w/ allergy problems?

A
  • Wheezing
  • Respiratory distress
  • Serum sickness
  • Past history of anaphylaxis
  • No improvement w/ chiro/holistic care
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69
Q

Glucose below what results in coma?

A

<10 mg/dl

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70
Q

What are s/s of asthma?

A
  • 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
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71
Q

What is chiropractic management for asthma?

A
  • Adjust - full spine, ribs, upper Csp
  • Trigger avoidance
  • Environmental control measures
  • Diet changes
  • Relaxation techniques, stress control/reduction
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72
Q

What are common triggers for asthma?

A
  • 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)
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73
Q

Glucose below what results in subtle reduction of mental efficiency?

A

<65 mg/dl

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74
Q

Glucose below what results in impairment of action and judgment?

A

<40 mg/dl

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75
Q

Glucose below what results in coma?

A

<10 mg/dl

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76
Q

Causes of Hypoglycemia:

A 
Diabetes
Medications
Excessive alcohol consumption
Hepatitis, kidney, anorexia/starvation
Insulin overproduction
Endocrine deficiencies
After meals
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77
Q

Symptoms of hypoglycemia in children:

A 
Irritability
Nervous
Tired
Pale
Confused
Behavioral problems-tantrums
May demand food
Headache
Muscle weakness/paresthesia
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78
Q

Symptoms of hypoglycemia in infants:

A 
Flushing of skin
Sweating
Cyanosis
Limpness
Twitching
Apnea spells
Abnormal neurological signs
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79
Q

Common characteristics of hypoglycemia:

A 
Lack of sleep
Dark circles under eyes
Menstrual cycle not regular
Overwhelmed with life
Feel puffy, stiff and sore
Exhausted
Groggy
Digestion not regular
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80
Q

What are some environmental control measures for asthma/allergies?

A
  • 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%)
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81
Q

What are some dietary changes to help w/ allergies/asthma?

A
  • Avoid dairy/wheat
  • Limit processed sugars
  • Avoid food additives & preservatives (MSG)
  • Probiotics
  • Omega-3 fatty acids
  • Calcium & magnesium
  • Antioxidants
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82
Q

What is the 2nd MC reason after a well baby visit to see the pediatrician’s office?

A

Otitis Media

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83
Q

How many children will experience 1 or more ear infections before 2 years?

A

70%

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84
Q

When is the peak prevalence of otitis media (OM)?

A

6-18 months

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85
Q

Boys or girls are more common for OM?

A

Boys

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86
Q

Risk factors for OM?

A 
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)
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87
Q

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.

A

Acute Otitis Media (AOM)

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88
Q

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

A

Otitis media with effusion (OME)

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89
Q

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.

A

Chronic suppurative otitis media

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90
Q

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.

A

Vaccine

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91
Q

This virus affects the liver, not considered a common childhood illness (M/C 20-39 yoa) & not contagious.

A

Hepatitis B

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92
Q

Cells produced in the body by the immune system in response to antigen being identified & recognized

A

Antibodies

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93
Q

Temporary immune protection from antibodies passed from mother to baby from placenta during pregnancy & breastfeeding. Can last 6-12 months

A

Passive immunity

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94
Q

Ability of body to recognize & respond to germs to protect from the virus or bacteria. “Natural immunity”

A

Innate/Adaptive immunity

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95
Q

What is the body’s first line of defense?

A

Skin & mucous membranes

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96
Q

What is the goal of vaccines?

A

Protect children from many ds’s w/o having the actual illness first

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97
Q

What are some common ingredients in vaccines?

A
  • Thimerosal (trace amounts in DTap, HIB, flu, Hep. B)
  • Human & animal tissue
  • Aluminum
  • Formaldehyde
  • MSG
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98
Q

What is the max daily aluminum dose recommended by the FDA to prevent accumulation & toxicity?

A

4-5mcg/kg/day

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99
Q

When is Hep B vaccine currently given?

A

Birth
1-2 months
6-18 months

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100
Q

What other ds’s is Hep B vaccine linked to?

A

Guillain-Barre syndrome
Diabetes
MS
Arthritis

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101
Q

This causes a meningitis bacterial infection. Its contagious & spreads from person-to-person through coughing, sneezing, & other respiratory or secretions from mouth

A

Hib -Haemophilius Influenza Type B

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102
Q

When is the Hib vaccine given?

A

2, 4, 6, & 12-15 months

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103
Q

What ds’s does the DTaP vaccine prevent?

A

Diphtheria
Tetanus
Pertussis

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104
Q

When is the DTaP vaccine given?

A

2, 4, 6, 15-18 months

4-6 years

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105
Q

The most severe reactions (encephalitis, convulsions, death) to the DTaP vaccine are to which part?

A

Pertussis

106
Q

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

A

Diphtheria

107
Q

Bacterial infection that causes lockjaw. Not contagious, found in soil. Symptoms usually begin around the 8th day.

A

Tetanus

108
Q

This used to be called “100 day cough”. Can lead to pneumonia, lead to ear infection, dehydration, convulsions, brain damage (rare) or death (rare).

A

Pertussis (Whooping Cough)

109
Q

This leads to many cases of pneumonia, meningitis, & blood infections as well as ear & sinus infections.

A

Pneumococcal (PCV)

110
Q

When is the PCV vaccine given?

A

2, 3, 6, & 12-15 months

111
Q

This virus causes acute viral gastroenteritis. Leading cause of diarrhea.

A

Rotavirus

112
Q

When is the Rotavirus given?

A

2, 4, & 6 months

113
Q

What complication could Rotatvius vaccine (RotaTeq) be linked to?

A

Intussusception

114
Q

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.

A

Adhesive otitis media

115
Q

Signs and symptoms of AOM

A 
Otalgia (ear pain)
Child pulling on ear
Fever
Irritability
Anorexia
Vomiting
Otorrhea (discharge from ear)
TM inflammation on otoscopic exam
116
Q

OME often follows AOM. Symptoms include:

A

Hearing loss
Tinnitus
Vertigo
Otalgia

117
Q

Causative microorganisms for OM:

A

Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

118
Q

Why are children with a cleft palate more likely to have OM?

A

Muscles that move the palate also open the Eustachian tube

119
Q

What are the 4 TM characteristics of OM?

A
  1. Color: yellow- effusion; red- AOM
  2. Position: AOM- retracted; OME- bulging
  3. Mobility: impaired
  4. Perforation: single is MC
120
Q

How long does “watchful waiting” last before antibiotic treatment is given?

A

24-48 hours

121
Q

What procedure makes an incision in the eardrum membrane to remove fluid?

A

Myringotomy

122
Q

What procedure inserts ear ventilation in eardrum for prolonged time to prevent accumulation of fluid?

A

Tympanostomy tubes

123
Q

When to refer for ear pain:

A

> 24-48 hours
Drainage from ear
Child still sick >24-48 hours with home remedies and chiro care

124
Q

This is avascular necrosis of the epiphysis of the femoral head.

A

Legg-Calve-Perthes Disease (LCPD)

125
Q

How long does avascular necrosis of the hip considered LCPD? And who is it MC in?

A

<12 year old

Boys (5:1)

126
Q

What ethnicities are MC to develop LCPD?

A

Japanese, Mongoloid, Eskimo and central European

127
Q

These babies are more likely to develop LCPD:

A

Breech, transverse presentation and low birth weight babies

128
Q

What is the clinical presentation of LCPD?

A 
Pain (often knee pain)
Effusion/Edema
Limp
Movement limitation
Myospasm
Short stature
May have small feet (weird....)
129
Q

LCPD diagnosis:

A 
Internal rotation limit
Decreased abduction
Patrick FABRE
Thomas' Sign
(+) Trendelenburg test
Decreased circumference of upper thigh
(+) Roll test
130
Q

What are the 4 stages of LCPD?

A
  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
Q

What are the 4 surgeries for LCPD?

A
  1. Contracture release: lengthen tight muscles
  2. Loose body removal: bone or torn cartilage
  3. Hardware implants
  4. Joint realignment
132
Q

This defines a range of hip pathology from dislocation to instability:

A

Developmental Dysplasia of Hip (DDH)

133
Q

What percentage of children affected by DDH will recover normal hip function?

A

96%

134
Q

How many DDH cases resolve by 1 week how many resolve by 2 months?

A

50%

90%

135
Q

Who is more likely to get DDH and why?

A

Female infants may be more sensitive to maternal hormone such as estrogen and relaxin

136
Q

DDH effects left hip how often and right hip how often and bilaterally?

A

Left: 60%
Right: 20%
Bilateral: 20%

137
Q

DDH Diagnosis:

A 
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
Q

DDH Treatment:

A 
Immediate referral to pediatric orthopedist
Triple diapers
Frejka pillow
Craig or Illfeld splint
Von Rosen splint
Pavlik harness
Surgery
139
Q

What shape should the hips and legs be in when swaddling or in carrier?

A

‘M’ shaped

140
Q

Complications of DDH:

A

Limp
Premature OA
Low back and hip pain
Recurrent dislocation

141
Q

When is the polio vaccine given?

A

2, 4, 6-18 months

Booster at 4-6 yrs old

142
Q

MMR vaccine should not be given to children allergic to what?

A

Gelatin
Eggs
Neomycin

143
Q

When is MMR given?

A

1 year & 4-6 yrs old

144
Q

Virus transmitted through fecal-oral route. Can be spread through diaper changes at day care.

A

Hep A

145
Q

When is Hep A vaccine given?

A

1-1.5 year & 6-12 months after 1st dose.

146
Q

When is Varicella vaccine given?

A

12-15 months & then 4-6 yrs old

147
Q

This ds is more common in those w/ weakened immune systems, no spleen, or crowded living conditions (college)

A

Meningitis

148
Q

What are the 3 vaccines for meningitis?

A

HIB
Pneumococcus
Meningococcus

149
Q

When is HPV vaccine given?

A

11-12 yr old girls (3 doses w/i 1 yr)

“Catch up” through 26 yrs

150
Q

What are the clinical presentations of osgood-schlatters?

A

Localized swelling and tenderness
Pain aggravated by direct pressure
Ext of knee against resistance and palp are painful

151
Q

What are the 4 types of vaccine exemptions?

A

Religious
Philosophical
Medical
Proof of Immunity

152
Q

Scoliosis when measured on X-ray is a curve greater than how many degree?

A

10 degrees

153
Q

The ball at the upper end of the femur slips off in a backward direction (due to weakness of growth plate)

A

Slipped Capital Femoral Epiphysis (SCFE)

154
Q

What are possible etiologies of SCFE?

A

Unknown
Endocrine based
Low or high levels of sex hormones
Mechanical factors

155
Q

Who is most likely to develop SCFE?

A

MC boys- 10-17 years old

156
Q

SCFE clinical presentation:

A

Limp
Pain and loss of hip motion
Unilateral and bilateral involvement
Outward turning leg

157
Q

Treatment for shin splints:

A

Rest, Ice, anti-inflammatory
Calve stretches
Stop running completely

158
Q

What is one of the MC causes of knee pain in young athletes?

A

Osgood-Schlatter Disease

159
Q

Who is most likely to develop osgood-schlatters?

A

Boys having a growth spurt and most likely engaged in vigorous activities

160
Q

How is osgood-schlatters believe to occur?

A

Pull of quads caused by excessive biomechanical force on tibial tendon at insertion point on tibial tuberosity

161
Q

When does osgood-schlatters occur?

A

Late childhood or early adolescence

162
Q

Treatment for osgood-schlatters?

A 
Bracing or sleeve cast
Ice
Restricted activity
Anti-inflammatories
Surgery (after conservative care fails)
163
Q

Softening and damage to articular hyaline cartilage to undersurface of patella.

A

Chondromalacia patella

164
Q

What are contributing factors for chondromalacia patella and who is most affected?

A

Weakness and tightness in quads (vast med), abnormalities of lower limp alignment
Young women more likely to develop

165
Q

Treatment of chondromalacia patella?

A 
Decrease activity
Brace/tape
Anti-inflammatory 
MFR
Adjust, etc
166
Q

DDx for shin splints:

A

Tibialis anterior syndrome
Posterior compartment syndrome
Periostitis

167
Q

Shin splints are related to what?

A

Over training in school-aged athletes

Distance running

168
Q

Most children have an asymmetric posture with what characteristics?

A
  • Slight right scoliosis/ right rib
  • Short left leg
  • Left Lsp hump/ right Tsp rib hump
169
Q

The apex of the scoliosis is located where?

A

At the vertebra having the greatest lat. deviation from the mid-line viewed on an A-P x-ray

170
Q

What is the M/C presentation of scoliosis?

A

Thoracic dextroscoliosis from about T5-T11 w/ apex at T8

171
Q

What are some problems (parental concerns/ signs after age 8) that could indicate scoliosis?

A
  • 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
Q

What type of scoliosis will reduce or disappear on forward bending & at bending to the side of the convexity?

A

Non-structural/functional

173
Q

What are different types/classifications scoliosis?

A
  • Non-structural/functional

- Structural (osteopathic, neuropathic, idiopathic)

174
Q

A structural scoliosis may begin as what?

A

A functional curve

175
Q

A partial unilateral failure of vertebral formation is what?

A

wedge vertebra

176
Q

A complete unilateral failure of vertebral formation is what?

A

Hemivertebra

177
Q

A unilateral failure of vertebral segmentation is what?

A

Congenital Bar

178
Q

A bilateral failure of vertebral segmentation is what?

A

Block Vertebra

179
Q

What is the M/C type of scoliosis?

A

Idiopathic scoliosis

180
Q

What factors determine the outcome/prognosis of a scoliosis?

A
  • Severity of curve
  • Location of apex
  • Skeletal maturity
  • Age of menses
181
Q

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

A

Infantile Idiopathic Scoliosis

182
Q

Type of scoliosis that makes up 10-15% of idiopathic scoliosis?

A

Juvenile Scoliosis (most likely to progress & often left-sided)

183
Q

Juvenile curves that reach what degree tend to continue to worsen w/o tx?

A

30 deg

184
Q

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?

A

95%

185
Q

What is the M/C type of Idiopathic scoliosis?

A

Adolescent

186
Q

Adolescent Scoliosis that curves >20 deg occur more often in males or females?

A

Females

187
Q

Are adolescent curves for the most part progressive or not progressive?

A

Not progressive

188
Q

What is the chest cage expansion measurement seen in scoliosis?

A

.75cm - 2.2cm (normal = 1.6cm - 2.7cm)

189
Q

This instrument measures the angle of trunk rotation in scoliosis?

A

Scoliometer (7deg or greater refer to orthopedist)

190
Q

What is the standard method of measuring a scoliosis?

A

Cobb angle

191
Q

This sign determines skeletal maturity

A

Risser Sign (little growth occurs after +4)

192
Q

What factors determine tx choice for scoliosis?

A
  • Skeletal maturity

- Curve angle

193
Q

Chiro care is effective for scoliosis curves that measure less than what?

A

20 degrees

194
Q

Bracing is most effective for scoliosis curves that measure in what range?

A

20-40 degrees

195
Q

What are goals of chiropractic when treating a scoliosis?

A
  • Maintain spinal flexibility & reduce VSC
  • Correct compensations to spine
  • Help reduce muscle spasm & pain related to soft tissues
  • Level pelvis
196
Q

This is a congenital fusion of 2 or more c-sp vert.

A

Klippel-Feil Syndrome

197
Q

When does the fusion of Klippel-Feil occur?

A

3rd-8th week of embryonic development

Unknown etiology

198
Q

What other anomalies are present with Klippel-Feil?

A

Sprengel’s deformity; spina bifida; cleft palate; hearing impairment; GU; cardiopulmonary and nervous system problems

199
Q

How does Klippel-Feil syndrome present?

A

Short neck
Hairline may appear low
C-sp ROM restricted
Webbed neck

200
Q

Complications of Klippel-Feil?

A

Scoliosis or kyphosis (60%)
Urinary tract abnormalities (33%)
Congenital heart disease (14%)
Deafness (30%)

201
Q

What is the management/treatment of Klippel-Feil?

A

Flexion/distraction is helpful
Adjust other spinal compensations of spine
Manage other conditions associated-scoliosis
Avoid HVLA in c-sp

202
Q

Congenital elevation of the scapula- failure of scapula to descend to normal thoracic position during fetal development. Unknown etiology.

A

Sprengel’s deformity

203
Q

70% of sprengel’s deformity is associated with what other anomalies:

A

Klippel-Feil
Renal problems
Scoliosis, fused ribs, spina bifida

204
Q

What is the management of Sprengel’s Deformity?

A

Surgery to reduce

205
Q

This is a dislocation of the proximal head of radius

A

Nursemaid’s Elbow

206
Q

How does the child with nursemaid’s elbow present?

A

Child will resist flexion due to pain- may create pseudoparalysis

207
Q

Common birth injuries:

A

Erb’s palsy
Klumpke’s Paralysis
Clavicle and humerus fx
Cerebral palsy

208
Q

How often do injuries at birth occur?

A

6-8/1000 births

209
Q

What are risk factors for birth injuries?

A 
Breech
Large baby (>9.5 lbs)
Quick second stage of labor
Maternal forces
Instrument deliveries (forceps or vacuum)
210
Q

What is Erb’s palsy?

A

Injury to C5/6 upper brachial plexus

MC form of brachial plexus palsy

211
Q

How does Erb’s palsy present?

A

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
Q

What advanced imaging should be done with Erb’s palsy?

A

MRI

EMG and nerve conduction studies

213
Q

When is a consult needed for Erb’s palsy?

A

Paralysis persists for more than 3-6 months

214
Q

Recovery/Complications for Erb’s Palsy?

A

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

215
Q

What is Klumpke Paralysis?

A

Injury to C7/8 and T1 lower brachial plexus (Rare)

216
Q

How does Klumpke paralysis present?

A

Hand paralysis/weakness of muscles (grasp reflex is absent)

Possible ptosis, miosis, anhidrosis (Horner’s)

217
Q

How is Klumpke Paralysis caused?

A

Pulling of arm above head

Common with breech birth-elbow maintained in flexed position

218
Q

What is cerebral palsy?

A

Non-progressive motor disorder from damage in-utero or during birth that causes CNS damage

219
Q

This condition is characterized by asymmetrical distortion of the skull. Flat spot on the back or one side of head

A

Plagiocephaly (“Flat Head Syndrome”)

220
Q

Etiology of plagiocephaly:

A 
In utero constraints, birth injuries
Craniosynostosis
Torticollis
Sleeping on back
Subluxation
221
Q

This type of plagiocephaly effects an entire quadrant
Anterior ear shift on same side
Ipsilateral forehead bossing
Contralateral forehead

A

Moderate Plagiocephaly

222
Q

Type of plagiocephaly involves:
Significant asymmetries to forehead, ears and facial features
Asymmetry crosses midline

A

Severe Plagiocephaly

223
Q

DDx of plagiocephaly

A

Positional Head Deformity

Craniosynostosis

224
Q

Management for plagiocephaly

A 
Preventive counseling
Mechanical adjustments
Exercises
Skull molding helmets
Surgery
(if parents follow the first 3, will clear up 2-3 months)
225
Q

Types of Torticollis:

A

Congenital

Acquired

226
Q

When is torticollis usually discovered?

A

6-8 weeks

227
Q

What percentage of children have congenital muscular torticollis and congenital hip dysplasia?

A

20% (weird questions, but I could kinda see her asking it)

228
Q

What is the onset of acquired torticollis?

A

Sudden- usually following strenuous activity, mild trauma or sudden change in neck position

229
Q

Medical management for torticollis?

A

Surgery done 18-24 months

230
Q

What are secondary effects of untreated torticollis?

A

Plagiocephaly
Facial hypoplasia
Musculoskeletal effects

231
Q

What are risk factors for back pain in children?

A 
>12 years
Females MC
Extended TV watching
Sports participation 
Previous back injury
Sitting at school
Carrying back packs
Familial tendency
232
Q

What are the 7 warning signs for Pediatric back pain?

A
  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
Q

Surgery should be considered for scoliosis curves that measure over what?

A

40 degrees (can have cardiopulmonary/neurologic consequences)

234
Q

What are causes of constipation?

A
  • Dietary
  • Food allergy
  • Dehydration
  • Environmental Stress/Tension
  • Mechanical
  • Medications
  • Potty training
  • Lack of exercise
235
Q

What are holistic/chiro tx for constipation?

A
  • Alter diet
  • Probiotic
  • Abdominal massage (clockwise)
  • Adj upper Csp & Lsp regions
  • Warm bath
  • Exercise
  • Potty training modification
  • Hydrate
  • Proper diapering
236
Q

When do you refer for constipation?

A
  • No stool for 5 days
  • Crying, pain, discomfort
  • Distended, painful abdomen
  • Vomiting & diarrhea
  • Blood in stool
  • Previous abdominal surgery
  • Chronic constipation
237
Q

What are the different levels of diarrhea?

A

Mild: 2-4 loose stools in 24 hrs
Moderate: 4-8 in 24 hrs
Severe: 10 or more, watery, foul-smelling,child acts sick

238
Q

What are causes of diarrhea?

A
  • Infection (GI, extra-intestinal)
  • Poor digestion (food allergy/sensitivity, emotions, environment)
  • Medicine (antibiotics)
  • Systemic illness
239
Q

What is a major concern w/ children & diarrhea?

A

Dehydration

240
Q

What are tx’s for diarrhea?

A
  • Address underlying cause
  • Improve digestion
  • Rest
  • Decrease stress
  • Probiotics
  • Abdominal massage (counterclockwise)
  • Adj. lower Tsp & upper Lsp
241
Q

When do you refer for diarrhea?

A
  • 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
Q

What are some causes of GER(D)?

A
  • Lower esophageal spincter relaxation
  • Lower esophageal hypotonia
  • Hiatal hernia
243
Q

What are some uncommon s/s of GER(D)?

A
  • Arching back
  • Vomiting at any time (not just after eating)
  • May have some respiratory problems d/t aspiration of refluxed material
244
Q

What are some tx’s for GER(D)?

A
  • 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
Q

What are 3 medications used to tx children w/ GERD?

A
  • Prilosec
  • Prevacid
  • Zantac
246
Q

What is the “Rule of Three” related to colic?

A

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
Q

When does colic typically begin?

A

2 weeks of age & usually resolves by 4 months

248
Q

What are s/s of colic?

A
  • 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
Q

What are some possible explanations for colic? (Actual cause is unknown)

A
  • 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
Q

What are ways to manage colic?

A
  • Low allergen diet
  • Hypoallergenic formulas
  • Soy formulas (soy allergy?)
  • herbal tea
  • reduce infant stimulation
  • probiotics
  • white noise
  • “Gripe water”
251
Q

What are the 5 “S’s” assoc. w/ colic?

A
  • Swaddling
  • Side/stomach position
  • Shushing
  • Swinging
  • Sucking
252
Q

What are two special charac. of the pediatric spine you need to consider when choosing an appropriate adjustive technique?

A

Bone strength

Lig. laxity

253
Q

Depth of thrust applied to the pediatric spine needs to be reduced to an amplitude of what?

A

No greater than a half inch

254
Q

Spinal adjusting in peds needs to be performed at what point in their passive range of motion?

A

At a point somewhat before the end of passive range is reached

255
Q

What are 2 reasons the D,C. needs to use precise palpatory techniques for peds?

A
  1. To identify the specific spinal structures

2. To detect any palpable anomalies present

256
Q

What are some anatomical differences among in children?

A
  • Underdeveloped cervical lordosis
  • Low vertebral height
  • Horizontal facets (until age 10)
  • Undeveloped uncinates (until age 7)
257
Q

How long can you use inversion as an evaluation technique in a pediatric pt?

A

Up to 6 months or until Landau Reflex is present

258
Q

What is considered normal when performing a heel swing test during inversion?

A

Infant turns head towards side of heel is released

259
Q

What motion is usually the most restricted in infants from C2 to L5.

A

P-A motion

260
Q

Why is it important to put an infant’s head in neutral while palpating the SI joint?

A

Whichever side the head is turned will cause the SI to appear more pos. or resisted

261
Q

A lower or deeper gluteal fold or more folds on one thigh may indicate what about the ilium?

A

PI ilium on that same side

262
Q

What are some other techniques beside diversified/MPI that you can use for spinal analysis of a peds pt?

A
  • Cervical stair step (SOT)

- Thompson leg checks

Pediatrics Final (1 decks)

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