Final Flashcards
T/F
Infant should be able to lift the head and trunk using forearms after 2 months?
True
T/F
When infant is sitting, kyphosis of the thoracic and lumbar spine is expected until the infant can sit without support?
True
List the areas on the infant where you should NOT see symmetry.
Axillary Crease
Gluteal Crease
Femoral Crease
Popliteal Crease
When testing infant muscle strength, hold the infant upright with your hand under the axillae, if the infant maintains the upright position _____ and if the infant begins to slip through your fingers _____
Adequate Muscle Strength; Muscle weakness (Arms flop forward)
When counting the fingers and toes and you notice and extra digit, what is the term for this?
Polydactyly
What is the term for webbing of the toes?
Syndactyly
When palpating an infant, what is the most commonly missed fractures?
Clavicle, Long bones
What is the term applied for flat-footed (All babies)?
Pes Planus
What is the term used when the forefoot is adducted, toes-flare inward because of fetal positioning?
Metatarsus Adductus
What is the term used when there is a slight varus curvature of the tibia because of fetal positioning and is expected to resolve after 6 months of weight bearing.
Tibial Torsion
When assessing for this condition:
Child prone, knees flexed to 90, align midline of the foot parallel to the femur, using thumb and index finger grasp the medial and lateral malleolus, place other thumb and index finger on either side of the knee. If your thumbs are not parallel what is suspected?
Tibial Torsion
What is the term used when the foot is “C” shaped, midline of the foot may bisect the 3rd & 4th toes, forefoot should be flexible, if not x-ray it.
Metatarsus Adductus
What is this exam?…
Infant supine, flex knees to 90
Grasp a leg with each hand, adduct the thighs to the maximum
Apply downward pressure on the femur this is an attempt to disengage the femoral head from the acetabulum.
Barlow Exam
What is this exam?…
Slowly abduct the thighs while maintaining axial pressure.
Fingertips on greater trochanter, exert a lever movement in the opposite direction, if there’s a “Palpable clunk”- femur slips back into the acetabulum, suspects hip subluxation/dislocation.
Ortolani Exam
Sign to detect hip dislocation or shortened femur.
Infant is supine, Flex both knees, keep feet flat on table. Femurs aligned with each other, observe height of the knees.
Allis sign
How do you evaluate congenital hip dysplasia?
A. Asymmetrical thigh and buttock skin folds
B. Decreased abduction
C. Allis’ sign
D. Ortolani/Barlow’s test
All of the above
What age can a child raise their head?
2 months
What age does the child roll from prone to supine?
4 months
What age does the child sit using tripod position?
6 months
What age does the child begin creeping (cross crawl)?
9 months
What age does the child stand without support momentarily?
12 months
This is evaluated while child is standing, distance between knees is 1 inch, is a common finding in toddlers (Up to 18 months) Note any increase on future examination.
Genu Varum (Bowleg)
Genu Varum may need to be evaluated further if asymmetry of tibiofemoral angle, and the space between the knees is greater than ___ inches
2
When evaluating the ankles you note a 1 inch space, common in children 2-4 years
Genu Valgum, knock knees
May need to evaluate genu valgum if: Asymmetry of the tibiofemoral angle and space are greater than ___ inches
2
Child rises from a sitting position by placing hands on the legs and pushing the trunk up, “crawl up their legs,” indicates muscle weakness. Classic for muscular dystrophy.
Gowers Sign
Congenital neural tube defect, incomplete closure of the vertebral column meninges and sometimes spinal cord protrude into a saclike structure. May have tuffs of hair over sacrum.
Spina bifida Myelomeningocele
This is most common in girls, progresses during early adolescence, no known cause.
Structural Scoliosis
Most cases of scoliosis
Idiopathic
This is an autosomal dominant disorder, deficient ossification bones of the cranium, clavicles and pelvis.
Cleidocranial dysplasia
Complete or partial absence of the clavicles Defective ossification of the cranium -Large fontanels -Delayed closure of the sutures -Symphysis pubis (Waddling gait)
Cleidocranial Dysplasia
The condition is most commonly brachial plexus injury (C5/C6)
Erb’s Palsy
The arm is paralyzed held in “waiter’s tip” position
Grasp reflex is present, absent moro, biceps and radial reflex
Erb’s Palsy
This is rare, results in weakness of intrinsic muscles of the hand, grasp reflex is absent
Klumpke’s Palsy (C7-8, T1)
Dislocation injury, common in children 1-4 years old, relatively easy cause: tugging on a child’s arm (removing clothing), lifting a child by grabbing the hand, jerking the arm upward while the elbow is flexed
Nursemaid’s Elbow; Radial head subluxation
Child complains of pain in the elbow and wrist, refuses to move the arm, holds arm slightly flexed and pronated. Supination is resisted
Nursemaid’s Elbow
This is a common congenital defect, affects female more, varying degrees of involvement: Dysplasia, subluxation, dislocation.
Developmental hip displasia
This condition is delay of ossification of the acetabulum (Oblique and shallow), femoral head remains in the acetabulum.
Acetabular dysplasia
This condition is incomplete dislocation, femoral head remains in contact with the acetabulum joint ligaments and capsule are stretched (displacement of the femoral head)
Subluxation
This condition the femoral head loses contact completely with the acetabular capsule, displaced over the fibrocartilaginous rim
Dislocation
This condition the femurs twist medially, patella facing inward, increased internal rotation of the hip >70 degrees, decreased external hip rotation. Toe in of the feet increases up to 5-6 years of age, tibia may twist laterally to compensate
MC in Females
Associated with reverse tailor sitting.
Femoral Anteversion
This congenital defect of the ankle and foot, inversion of the foot and plantar flexion, affects males, bilateral involvement 30-50% of cases, 10% chance of subsequent child being affected. 1/1000 live births
Talipes Equinovarous
This is an exaggerated dorsiflexion (Calcaneous in valgus position and forefoot abducted), up to 1% of live births, probably due to abnormal intrauterine position, most resolve spontaneously (Reduces when weight bearing).
Talipes Calcaneovalgus
MC congenital foot deformity, caused by intrauterine positioning, may be fixed or flexible.
Metatarsus Adductus
Caused by a vascular insufficency, compression microfractures, necrosis of entire epiphysis may occur.
Epiphyseal osteochondritis
Epiphyseal osteochondritis of the hip
2-10 years
Symptoms: limp, school aged, complaining of leg pains (Knee)
Legg-Calve-Perthes Disease
Epiphyseal osteochondritis of the knee
9-15 years
Symptoms: Pain, swelling of the tibial tuberosity. Manage this by REST
Osgood-Schlatter disease
Group of genetic disorders, gradual degeneration of the muscle fibers
Progressive weakness, muscle atrophy, pseudohypertrophy from fatty infiltrates, GOWER Sign
Muscular Dystrophy
CN? Optical Blink Reflex, Dolls Eye maneuver
CN II, III, IV, and VI
CN? Rooting Reflex & Sucking Reflex
CN V
CN? Evaluating with facial N.
CN VII
CN? Acoustic blink
CN VIII
CN? Swallowing and Gag Reflex
CN IX and X
CN? Suck, Swallow and Tongue midline test
CN XII
What reflex is present at birth?
Patellar
What two reflexes appear at 6 months?
Achilles and Brachioradial
T/F
Ankle Clonus is common
True
Positive-fanning of the toes and dorsiflexion of the great toe, retained until 16-24 months of age, this is normal under age 2
Babinski Sign
List Primitive Reflexes present in newborn
Yawn, Sneeze Hiccup Blink at bright light and loud sounds Pupillary Constriction w/light Withdrawal from painful stimuli
Most disappear by 6 months, replaced with more advanced skills, babinski up to 2 years, fencer’s peak at 2-4 months
Automatisms
Infants head midline, touch palm of the infants hand from the ulnar side, note strong grasp of your finger, suckling facilitates grasp, strongest b/t 1-2 months, disappears by 3 months.
Palmer Grasp (Birth)
Touch the plantar surface of the infants feet at the base of the toesm toes should curl downward, strong up to 8 months
Plantar Grasp (Birth)
Infant supported in semi-sitting position, allow head and trunk to drop back to a 30 degree angle, observe symmetric abduction and extension of the arms, the arms then adduct in an embracing motion, followed by relaxed flexion, legs follow a similar pattern, diminishes in strength by 3-4 months
Moro Reflex (Birth)
Hold the infant upright under arms, touch the dorsum of the foot to the edge of a flat surface, observe flexion of the hips and knees and lifting of the foot (As if stepping up), age of disappearance varies.
Placing Reflex (4 days)
Hold the infant upright under arms, allow the soles of the feet to touch the surface of the table, observe for alternate flexion and extension of the legs (Walking) disappears before voluntary walking.
Stepping Reflex (birth-8 weeks)
Infant supine, turn head to one side, observe for ipsilateral extension & contralateral flexion of the arms and legs, repeat-turing head to other side. Diminishes around 3-4 months and disappears by 6 months.
Asymmetric Tonic Neck (2-3 months)
aka Fencer’s
Suspend the infant prone over your hand, stroke paraspinally from shoulders to the buttock, trunk should curve toward the side stroked.
Galant (Birth to 4 months)
Suspend infant prone over your hand, stroke over the spinous processes from sacrum to occiput, infant extends head and brings knees to chest. Urinates.
Perez (& Pee) Reflex
Suspend infant over both hands, observe the infants ability to lift its head and extend its spine on horizontal plane, diminishes by 18 months, disappears by 3 years
Landau Reflex
Hold infant suspended (Prone), slowly lower headfirst toward a surface, observe the infant extend its arms and legs (protecting itself), this reflex should not disappear.
Parachute (4-6 months)
T/F exercise for PHD: Supervised “Tummy time” on firm surfaces when the infant is awake and being observed, if torticollis is present parents should be taught specific neck motion exercises (head rotation and lateral bend) this should be done at diper changes.
Hold for 5 sec and 2 repetitions
False, Hold for 10 seconds and 3 repetitions.
Neurologic disorder that is categorized under the umbrella of pervasive development disorders, is characterized by severe and pervasive impairment in several areas of development.
Autism
What are the causes of autism
No single cause, but suspected causes are:
- heredity; genetic
- pregnancy complications
- viral infection & metabolic imbalances
- exposure to environmental toxins, vaccines. (MMR)
T/F Prevalence of Autism, 2-6 individuals per 1000 have an autism spectrum disorder.
True (1/166)
T/F
Autism is 4x more prevalent in females
False, Males.
Common traits of Autism
Insistence on sameness, resistance to change
Difficulty in expressing needs
Using gestures or pointing instead of words
Repeating words, instead of normal language
Prefers alone time
Tantrums
Not wanting to cuddle or be cuddled
Little to no eye contact
One aspect that differs Asperger’s from Autism is?
Language development
T/F
Children with Aspergers syndrome often grasp language quite quickly, sometimes advanced development for their age group.
True
T/F
Children with Aspergers syndrome tend to talk exclusively at great length about their favorite topics, such as dead presidents, meteorology, star wars, bambi, and may develop an impressive vocab.
True
The sudden death of an infant under 1 years old, which remains unexplained after thorough case investigation.
SIDS
Infant supine, turn head to the side, observe the infant turn its whole body in the direction of the head is turned. (3 Months after tonic neck disappears)
Neck Righting Reflex
T/F
Deep tendon reflexes use the same technique as adults, response should be the same.
True, may use fingers instead of reflex hammer
These are nonfocal, functional neurologic findings; they provide subtle cues to an underlying diseases.
Neurological Soft Signs
Children with multiple soft signs are often to have what?
Learning Problems
A few examples of soft signs include:
Walking running gait heel walking tip-toe walking tandem gait one foot standing hopping in place motor stance visual tracking rapid thumb to thumb finger-nose right left discrimination 2 pt discrimination Graphesthesia Sterognosis
This is episodic, sudden involuntary contractions of a group of muscles. Excessive discharge of cerebral neurons, may be caused by systemic disease, head trauma, toxins, stroke, hypoxic syndrome. May see disturbances in: -Consciousness -Behavior -Sensation -Autonomic function
Generalized Seizure Disorder
Inflammatory process in the meninges, S&S fever, chills, nuchal rigidity, headache, seizures, vomiting, altered level of consciousness
Infant: Very irritable and inconsolable, fever, diarrhea, poor appetite, toxic appearance
Meningitis
Inflammation of the brain and Cord. Quiescent stage of often precedes the disturbances in CNS function (headache, drowsiness, confusion) progression to stupor and coma. Motor functions may be impaired, severe paralysis and ataxia.
Encephalitis
Abnormal growth of the neural & non-neural tissue within the cranium, peak age of incidence: 3-12 years and 50-70 years. Threaten function by compression or destruction of tissue.
SOL/Intracranial tumor
Non-progressive neuromuscular disorder, results from insult to the cerebellum, basal ganglia, or motor cortex, disability depends on the extent of damage.
Signs: Delayed Motor development, altered muscle tone/performance/reflexes , abnormal posture.
Cerebral Palsy
Progressive encephalopathy associated with AIDS, Impaired brain growth.
Signs and Symptoms:
Progressive motor dysf.
Regression of develp. milestones
Generalized weakness. Signs of UMN lesion
HIV Encephalopathy
Progressive encephalopathy, unknown cause, girls b/t 6-18 months of age.
Signs and symptoms:
-loss of voluntary hand movement, loss of hand skills
hand wringing movements
Gradual development of ataxia & Rigidity, growth retardation, seizures, Loss of facial expression deceleration of head growth.
Rett Syndrome
Hold infant upside down, making sure to have a solid grip on their ankles, release one foot slowly watch child turn head to that side, repeat.
Reverse fencer Part 1 (Heel swing)
Reverse fencer part 1, compare bilaterally, what 2 things are you looking for?
Restriction or twitching
If child arches back during Reverse fencers part 1
Meningeal tension and adjust C spine, occiput, sacrum
Infant supine, apply pressure along shaft of femur into acetabular fossa, compare bilat. the spongy side is said to be what?
Atlas laterality, during part 2 of Reverse fencer
Negative heel swing response indicates what?
Subluxation b/t Atlas-Axis or Atlas-Occip.
T/F
Supine leg check, long leg is said to be the side of atlas laterality?
True
Cold side or hot side is said to be side of atlas laterality
Cold side
Atlas fossa: R 85 L 86, no other findings in C spine, what is the issue?
Sacrum
EX ilium is toe out or in
Toe in
Inward tibial or femoral torsion, toe out or in?
Toe in
Weak psoas or Glute max and CP bilaterally, toe out or in?
Toe in
IN ilium, toe out or in?
Toe out
Psoas, piriformis, or glute max spasm, toe out or in?
Toe out
T/F
If you see gluteal cleft deviation, may either be to the side of posterior-inferior SI sublux or the side of Anterior-inferior sacral movement at the Lumbosacral jx.
True
Sacral Dimples have asymmetry, this suggests?
Pelvic Misalignment
Infant’s occiput is significantly fixed, the infant is irritable even with you do what?
Light Palpation
If the infant has an AS occiput, when adjusted the infant becomes relaxed and may even do what?
Fall Asleep
Premature fusion of the sagittal suture, MC craniosynostosis (>50%) head is elongated in AP diameter and short in the biparietal diameter, ridging of sagittal suture is palpable.
Scaphocephaly
Premature fusion of both coronal sutures, increased biparietal diameter, shorter AP.
Brachycephaly
Premature fusion of metopic sutures, results in pointed forehead, usually mild and requires on surgical intervention.
Trigonocephaly
There are 2 causes of this:
- craniosynostosis of the lambdoid sutures
- Positional molding
Posterior Plagiocephaly
T/F
In-utero or intrapartum molding, and cranio synostosis are differentials included if plagiocephaly is present at birth.
True
T/F
if plagiocephaly develops later, then torticollis, subluxation.
True
Term for this: Palpable ridge Ear on flat side, more posterior Forehead does not protrude No bald spot
Craniosynostosis
Term for this:
- Palpable ridge
- Ear on flat side, more anterior
- Forehead protruding on occipital flattening
- Parallelogram shape
PHD, Positional head deformity
Management of PHD?
Preventative counseling for parents Mechanical adjustments Exercises Skill molding helmets Surgery
T/F
Mechanical adjustment for PHD:Position the infant so that the rounded side of the head is placed dependent against mattress
True
