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Pediatrics > Final Study Guide > Flashcards

Final Study Guide Flashcards

1
Q

Causes of JIA?

A

Genetic predisposition with external trigger

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2
Q

Systemic JIA

A

4-17%
Male=female
**Fever! 1-2x/day (at least 2 weeks)

Rash

Systemic signs

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3
Q

Polyarticular JIA

A

2-28%
>= 5 joints
-large and small joints

  • symmetrical
  • swollen +warm
  • female > male (rarely red)

Two types RF + and RF -

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4
Q

RF+

A

Onset= 2-4 and 6-12
Nodules on
Elbows, tibial crest and fingers

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5
Q

RF-

A

Late childhood ; adolescence

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6
Q

Most common type of jIA

A

Oligoarticular

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7
Q

Oligoarticular JIA

A

27-56% most common
Less than or equal 4 joints

  • female> male
  • swollen + warm: not always painful
  • systemic signs uncommon
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8
Q

Primary issues of JIA

A

Swelling
Pain
Weakness
Systemic

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9
Q

Secondary issues of JIA

A 
Contracture
Fatigue
Aerobic
Osteopenia
Participation restriction
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10
Q

JIA joint issues in acute

A

Inflammation
effusion
Lig laxity
Instability

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11
Q

Joint issues in JIA in subacute +chronic

A

Synovial hypertrophy
Joint erosion
Loss of alignment

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12
Q

OI Type 1 presentation

A 
Mild-mod bone fragility
Few-several fx before puberty
No bone malformation 
Normal height/weight
Lift avg lifespan: Blue sclera, triangle face, hearing loss (20-30)
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13
Q

OI Type 2 presentation

A 
Perinatal fatal
Extreme fragility
Long bones =crumbled
Small+short
Curved
Deformed
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14
Q

OI Type 3 presentation

A 
Autosomal dominant usually
Short
Progressive deformity
Severe fagility
10s-100s of fx. Blue sclera (lessens with age)
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15
Q

OI Type 4 presentation

A 
Mild- mod deformity
Short (after birth)
Dentiogenesis (teeth)
Variable hearing loss
Ambulation potential =excellent
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16
Q

OI Type 5 presentation

A 
Autosomal dominant
Hypertrophic calcification
Surgical osteotomies
Limited supination+pronation
-$calcification of IM
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17
Q

OI Type 6 presentation

A

Autosomal recessive

  • RARE
  • mod -severe deformity
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18
Q

OI Type 7 presentation

A

Autosomal recessive
—issue =translation of collagen

  • mod-severe fragility
  • humerus+femur short
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19
Q

OI Type 8 presentation

A

Autosomal recessive
—issue =translation of colagen

-flattened long bones

  • skinny ribs
  • small head
  • growth deficiency (teenage survivors)
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20
Q

What should be included in exam of OI?

A
  • Pain: FLACC
  • caregiver handling
  • AROM — never PROM
  • strength - via observation

Gross motor- PDMS-2, PEDI, Bayley

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21
Q

Sitting @10 mo in OI

A

Good predictor for future walking

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22
Q

Contraindication of OI

A 
pROM
Baby walkers
Jumping seats
Pull to sit
Grabbing by arms/legs
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23
Q

PT intervention of OI infants

A 
Education on proper handling/positioning
-avoid forces to long bones
-loose clothing
-bathe in padded plastic bin
-infant carrier for household mobility
-may need car bed
 Aquatic therapy more than or equal 6mo
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24
Q

Pt positioning in OI infants

A 
Sidelying= support with towels
Prone=initiate with infant on caregivers chest
Supine= arms+knees supported
Change position frequently 
—dont restrict natural movement
Prevent contractures +deformity
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25
Q

Pt intervention in OI preschool kids

A

Protected WB. :LE fx more common than UE
-self mobility:scooters, orthotics, walker+padded pommel

  • strengthen: hip extensors, hip abductors. Use bolsters
  • aquatic tx:20-30 min MAx. Heat
  • car: rear-facing seat as LONG as possible
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26
Q

Pt intervention for school aged kids with OI

A

$strengthen mm

  • aerobic
  • protected ambulation
  • enhance lifelong health
  • power or manual w/c for life
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27
Q

What is PFFD?

A 
Proximal femoral focal  deficiency
-most common LE deficiency
-absence/small proximal femur
— most also have total longitudinal deficiency of fibula
-U/L or B/L
-severe leg length discrepancy
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28
Q

Mild PFFD tx

A

Limb lengthening sx

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29
Q

Severe PFFD tx

A

Amputation

-prosthetics: symes, boyd

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30
Q

Short leg position

A

Flexion
Abduction
ER

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31
Q

Classification of congenital limb deficiencies

A 
Failure of formation
Failure of differentiation
Duplication
Overgrowth
Undergrowth
Skeletal deformities
Congenital constriction band syndrome
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32
Q

Transverse limb dificiency

A

Normal until certain level, then absent

  • usually U/L
  • most common= below elbow BE
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33
Q

Longitudinal limb dificiency

A

Issues along long axis

Skeletal elements exist beyond affected area

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34
Q

What is rotational plasty and who is it used for?

A

For proximal tibis or distal femur
Backwards ankle=knee

  • DF =flexion
  • PF=extension
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35
Q

What conditions influence overuse injuries in kids

A

Rising incidence in pediatrics. Est at >50%of injuries

  • inc sport participation: early specialization, higher complexity,longer duration
  • high stress on growing body
  • lack of appropriate coaching and skill training
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36
Q

Risk factors of overuse injuries

A 
Training error
Muscle-tenson imbalance
Anatomical malalignment
Improper footwear or playing surface
Associated disease states
Growth factors
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37
Q

Hydration needs of kids

A

Pre-hydration of 3 to 12 oz one hour prior to activity

  • 3 to 6 oz just prior to activity
  • 3 to 9oz every 10 to 20 mins

-16 oz for every pound of weight lost in 2 to 4 hours following activity

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38
Q

Stage 1 return to activity post concussion

A

No physical activity. Maximum rest

Progress when: symptom free for a min of 24hrs

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39
Q

Stage 2 return to activity post concussion

A

Light aerobic activity
-10-15 min of light exercise with no resistance. Walking stationary bike, or swimming. Quite play time alone or with parent

Progress when: symptom free for 24 hrs. If symptoms reemerge with this level of exertion. Return to stage 1

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40
Q

Stage 3 return to activity post concussion

A

Sport specific exercise
Running drills for up to 30 mins, nut no contact. Play must be supervised and activities low risk

Progress when: symptom free for 24 hours. If symptoms reemerge with this level of exertion, return to stage 3

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41
Q

Stage 4 post concussion

A

No contact
Complex training
Running jumping
Resistance

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42
Q

Stage 5 return to activity post concussion

A

-full -check ntact practice
Medical clearance. Normal training activities with full exertion. Have parent or adult supervision.

Progress when: symptom free for 24 hrs. If symptoms reemerge with this level of exertion return to stage 4

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43
Q

Stage 6 return to activity post concussion

A

Return to activity. Mormal game play

Next step: no restriction

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44
Q

Erb’s palsy:

A

Most common 52%. Injury to C5 and C6 nerve roots

Shoulder rests in extension IR and AD, elbow extension, forearm pronation and the hand and fingers held in flexion

Paralysis of C5-6 muscles. Rhomboids, levator, serratus, subscap, deltoid, infraspinatus, biceps, brachialis, supinator, brachioradialisand fingerand thumb extensor

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45
Q

Klumpke’s palsy

A

Rare. Breech delivery with the arm overhead
-C7-T1 nerve roots
Shoulder and elbow intacct

-resting position. Forearm supination and elbow flexion.

Paralysis: of C7-T1 muscles. Wrist flexors and extensors hand intrinsics

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46
Q

Erb-klumpke palsy:

A

Combo of C5-6 and C7-T1

Total arm paralysis and loss of sensation

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47
Q

Horners syndrome

A 
Avulsion of T1 roots
Deficient sweating(anhydrosis)
Recssion of the eyeball
Miosis
Ptosis
Irises of different colors

-70% of full recovery. Some have spont recovery within a few weeks. Recovery in shoulder ER. Accurately predict full recovery

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48
Q

OBPI initial intervention after birth

A

Initial rest period 7-10 days after birth
NoROM
Limb is positioned across the abdomen. Avoid lying on limb

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49
Q

OBPI PT intervention after rest period

A

HEP with ROM
Parent education on risk of dislocation and sensory loss issues

-strengthening activities through play

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50
Q

OBPI PT intervention for active movement

A

$faciliatate normal movement patterns. Inhibit substitutions during reaching and WB. Watch scapula. Can manually support and align

  • use functional tasks. Hand to mouth, transferring objects, weight shift or propped UE and creeping
  • sidelyng on uninvolved arm. Free involved arm to work on reaching

-pushing up to sitting from involved side
$bilateral activities

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51
Q

OBPI Pt intervention ROM

A

Avoid over stretching unstable joint

  • does not pick child up under axilla
  • stretch scapulohumeral muscles. Scapula can be stabilized in first 30 deg of abduction. Beyond 30 deg, scapula must rotate. Avoid impingement

-improve elbow extension. Botox and casting. Requires more research

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52
Q

OBPI PT intervention for sensory awareness

A

Can lead to neglect self-mutilation

  • find way to make imapired arm seem purposeful and part of self
  • incorporate variety and creativity
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53
Q

OBPI PT intervention for positioning and splinting

A

Sleeping: Abd, ER, elbow flexion,supination

Wrist splints. Prevent contractures.

Constrain uninvolved arms for short periods of time

E-stim requires more research

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54
Q

OBPI pathophysiology

A
  • forceful traction injury during birthing process

- damage to any rootlets, roots, ,trunks, divisions, cords, peripheral nerve

55
Q

risk factors for brachial plexus injury

A
  • > 3500
  • long labor
  • difficulty w/deliver
  • maternal DM
  • sedated/hypotonic infant
  • breech
56
Q

neurapraxia

A
  • least severe

- temporary nerve block

57
Q

axonotmesis

A
  • disruption of axon

- sheath is intact

58
Q

neurotemesis

A
  • most severe

- complete rupture

59
Q

nerve regrowth

A
  • -4-6 mo in upper arm (up to 2 years)
  • 7-9 mo in lower arm (up to 4 years)

** distal takes longer than proximal

60
Q

what are the types of CP? and associated lesions

A
  • spastic= motor cortex
  • Dyskinesia= BG
  • ataxic= cerebellum
  • mixed = MC +BG COmbo of spastic and dykinesia
61
Q

How is CP diagnosed?

A
  • clinical diagnosis
    • abnormal muscle tone
  • abnormal movement patterns
    • useful tests:
  • —-best sensitivity +specificity for EARLY mo. GM
  • —best sensitivity +specificity for OLDER infants. AIMS, NSMDA
62
Q

in CP what early skills are predictive for future ambulation?

A
  • Best predictor for amb 15m by 8 yr
  • ** independent sitting by 24 mo
  • -if not by age 3 likelihood of functional walking very low
63
Q

CP quadriplegia

A
  • all four limbs are involved “tetraplegia”
64
Q

CP diplegia

A
  • all four limbs are involved. both legs are more severely affected than the arms
65
Q

CP hemiplegia

A

-one side of the body is affected. the arm is usually more involved than the leg.

66
Q

CP triplegia

A
  • three limbs are involved, usually both arms and a leg
67
Q

CP monoplegia

A
  • only one limb is affected, usually an arm
68
Q

GMFCS level in general

A
  • Level 1: walks w/o limitation
  • Level 2: walks with limiattaion
  • Level 3: walks using a hand-held mobility device
  • Level 4: self-mobility with limitations, may use powered mobility
  • Level 5: transported in a manual wheelchair
69
Q

CP common impairments

A
  • hypertonia and hypoextensibility
  • contrcatures
  • diminished strength. weak distal >proximal , concentric > eccentric, fast >slow
70
Q

CP progressive resistance training

A
  • 4-12 week duration
  • 3x/day
  • 80-90% max load
71
Q

IDEA Part C

-EI

A
  • Age 0-3
  • eligible: disability or medical diagnosis high probability of developmental delay
  • –FM/GM, speech , adaptive, cognitive, social/emotional.
72
Q

EI— agency

A
  • CA= regional center
  • 0-36 mo… 33% delay
  • one low incidence condition. blind, death, orthopedically handicapped
  • must use private insurance first

-child find: referral system

73
Q

EI–Purpose

A
  • meet developmental needs of infant
  • resources to family
  • provide child everyday learning opportunities
  • natural environment
74
Q

tests for IDEA Part C EI

A
  • Bayler
  • DAYC-2
  • PDMS- 2
75
Q

IDEA Part B

eligibility catgeories

A
  • school district: Age 3-21
  • autism
  • deaf
  • ID
  • orthopedic CP
  • speech/language
  • TBI
76
Q

IDEA Part B

-individualized education Plan HEP

A
  • academic and functional performance
  • initial eval w/in 60 days
  • re-eval at least every 3 years, and max 1/year
77
Q

IDEA Part B test

A
  • PDMS-2
  • BOT
  • GMFM
78
Q

how can a child obtain PT services through the school if they do not require special education?

A
  • section 504
  • -general school funding (does not NOT receive govt funding) Does not need IEP

–substantial physical/mental impairments

79
Q

How is cystic fibrosis inherited?

A
  • chromosome 7
  • > 15000 mutations found that cause CF
  • Problem = exocrine gland ion transport NaCl
  • ** CFTR protein
  • viscous secretions build up outside of cell
  • impaired secretion clearance
  • autosomal recessive- Both parents must be carriers
  • most common inherited life-shortening illness in white population
80
Q

What organs does CF affect? in respiration

A
  • Lungs

- -chronic cough +sputum, incr risk of infection, less O2 –> cyanosis +hypoxia

81
Q

What organs does CF affect

- digestive

A
  • Pancreas: issues with fats +proteins. signs of malnutrition
  • meconium ileus: unable to poop 1st few days after birth
82
Q

what organs does CF affect? in reproductive system

A
  • MALE only
  • 98% = infertile
  • -vas deferens blocked
83
Q

What is clinical manifestation of cystic fibrosis?

A
  • muscle pain
  • decr bone mineral density
  • hypetrophic pulmonary OA: causes clubbing of fingers +toes. increases with age
84
Q

CF intervention in infancy

A
  • emphasis on prevention of respiratory impairments
  • imporves adherence with tx
  • tx:
  • -postural drainage
  • -precussion
  • -manual vibration
  • -positive expiratory pressure (preferred)
  • breathing games
    • developmental milestones yp improve chest wall mobility, LE strengthening, endurance
85
Q

CF intervention in pre-school and school age kids main goals

A
  • improve exercise tolerance
  • secretion clearance
  • posture
  • self- efficacy +independence
  • promote adherence
86
Q

CF intervention in preschool and school age LEAST adhered to…

A
  • percussion
  • vibration
  • postural drainage
87
Q

CF intervention HFCWO

A
  • vest tat helps with secretion clearance
88
Q

CF intervention for adolescence

A
  • PEP
  • active cycle of breathing
  • ex program +strengthening
  • diet
  • autogenic drainage
  • ball therapy
  • posture (breathing mechnaics, hyperinflated lungs)
89
Q

autogenic drainage

A
  • 1st= unstick in distal
  • 2nd= collect in middle
  • 3rd= evacuate from central airways
  • -PROS: no equipment can do in sitting
  • -CONS: hard to teach/learn
90
Q

COmmon signs of child abuse and neglect

A
  • enuresis
  • nightmares
  • academic decline
  • helpless behaviors
  • secretiveness
  • bruising
91
Q

What is a PT role as a mandatory reporter?

A
  • ADA: must report suspected abuse

- Physical or sexual abuse and neglect

92
Q

Common extrinsic asthma triggers?

A
  • extrinsic= allergic
  • pollen
  • mold
  • pet dander
  • dust mites
  • chemicals/pollutants
  • strong odors
  • smoke
93
Q

strategies to prevent acute attack with exercise induced asthma?

A
  • long warm-up
  • timing of medication
  • hydration
  • breathing control techniques
  • neuromuscular: facilitate DSS for improved stabilization+ breathing patterns
  • musculoskeletal: rib cage mobilization, stretching , strnegthening
94
Q

Type I SMA

- primary impairment

A
  • acute childhood SMA
  • loss on anterior horn cells
  • muscle weakness at birth. abdominal weakness = respiratory issues. POE= not usually attained
  • supported sitting only for short periods b/c fatigue

-avg life span: 6 mo range= 1-21 mo

  • contrcatures.
  • CN involvement variable
95
Q

Type I SMA

-secondary impairments

A
  • contrcatures

- scoliosis

96
Q

Type II SMA

-primary imapirments

A
  • chronic childhood SMA
  • proximal muscle weakness. poor sitting posture. pulmonary compromise. fatigue easily. hip dislocations +contrcatures
  • **intelligence RARELY affected
97
Q

Type II SMA- severe

A
  • never able to sit independently

- sig reduced respiratory capacity

98
Q

Type II SMA- intermediate

A
  • able to sit independently
  • will never walk
  • FVC down to 45% by 10 y.o
99
Q

Type II SMA- mild

A
  • able to walk independently

- BUT 50% lose ability by 10.yo

100
Q

Type III SMA

- primary and secondary impairments

A
  • juvenile onset SMA
  • onset = end of 1st decade
  • primary: proximal LE weakness
  • secondary: postura; compensations- L/S lordosis, trendelenberg gait. contractures PF= common, scoliosis
101
Q

Presentation of angelman syndrome?

A
  • SEVERE learning difficulties
  • ataxia
  • jerky movements
  • puppet-like gait
  • seizures
  • sleep issues
  • expressive speech = RARE
  • inappropriately timed laughter
102
Q

facial characteristics of Cri-duchat?

A
  • microcephaly
  • small jaw
  • wide-set eyes
  • downward slopin palpebral fissures
  • epicanthal folds
  • strabismus
  • low-set ears
  • broad nasal bridge
103
Q

facial characteristics of Prader-willi

A
  • decreased pigmentation of eyes+ skin

- often overweight b/c no sense to stop eating

104
Q

facial characteristics of angelman syndrome

A
  • SUBTLE
  • wide smiley mouth
  • small maxilla +prominent chin
  • pale blue, deep-set eyes
105
Q

facial characteristics Fragile X

A
  • long face
  • large ears
  • prominent mandible
106
Q

facial characteristics rett syndrome

A
  • microcephaly
107
Q

down syndrome MSK characteristics

A
  • diastasis recti
  • hypoplasia of middle phalanx
  • hypermobility
  • hypotone
  • shallow acetabular angle
  • atlantoaxial instability
  • wide toe gap between 1 and 2
  • single palmar crease
108
Q

DS cardiovascular

A
  • ventricular septal defect
  • patent ductus arteriosus
  • tetralogy of fallot: pulmonary valve stenosis, VSD, malposition of aorta, R ventricle hypertrophy
109
Q

DS GI characteristics

A
  • duodenal stenosis
  • imperforate anus
  • hirschsprung’s disease
110
Q

DS immunologic characteristics

A
  • leukemia
  • chronic rhinitis
  • chronic conjunctivitis
  • fluid in middle ear
111
Q

DS neurologic characteristics

A
  • mild microcephaly
  • hypotonia
  • intellectual disability
  • developmental delay
  • early onset Alzheimer’s ~35yo
  • small cerebellum/brainstem
112
Q

DS gait pattern characteristics

A
  • small step length
  • increased knee flexion at IC
  • hyperextension in stance- secondary to weakness
  • decr single limb support
  • incr hip flexion posture
113
Q

DS interventions

A
  • Monitor delays
  • Promote WB
  • facilitate antigravity muscles: trunk extensors
  • midline orientation
  • righting response
  • cognition, kanguage, socialization
114
Q

DS precautions

A
  • ligament laxity: trauma, joint protection AA- avoid extremes of ROM
115
Q

CMT first sign

A
  • mild preference for rotation/ tilt
  • named for the side of the tilt
  • reinforced by positioning
116
Q

CMT presentation of SCM

A
  • unilateral fibrosis of SCM

- 2/3 have palpable tumor

117
Q

Possible causes of CMT in utero/birthing process

A
  • ischemic injury
  • positioning/ constraint
  • multiple births
  • BAby A position (lower baby)
118
Q

CMT facial deformities

A
  • unlevel ears
  • plagiocephaly
  • ear cupping
  • asymmetric cheeks, eyes, neck creases
119
Q

CMT tx GOal

A
  • ind w/ HEP
  • full cervical AROM/PROM
  • age appropriate postural control and motor milestones. midline control of head, neck and body
  • symmetrical movement pattern
  • monitor for regression!!
120
Q

CMT intervention

A
  • stretching (HEP)
  • can desensitize first with heat or massage
  • teach parents to be gentle yet firm
  • -infants will not like stretching. teach play/distraction techniques
  • positioning, stretching, handling
  • postural control, motor milestones. improve prone skills with tummy time
121
Q

CMT failure to treat

A
  • persistent neck tilt and contracture. SCM and surrounding soft tissues may not grow w/ child.
  • plagiocephaly (flattened cranium). most common cranial deformity

-delayed and/or asymmetrical motor skills. R CMT -> R sided preference. Lead transitions w/ ext not flex

  • scoliosis
  • decr midline postural stability. disorganized postural responses. esp post displacement

-craniofacial deformities. asymmetrical orbital fissures. mandibular asymmetry. muscle growth asymmetry

122
Q

SI sign of under registration

A
  • pay little attention or fail to notice things
  • toys , people, sounds
  • falling or bumping into objects. do not appear to feel pain unless intense
123
Q

SI sign of over registration

A
  • unable to tune out
  • cont or steady sounds
  • overly sensitive to textures
  • respond well to deep pressure
124
Q

SI intervention for gravitational insecurity

A
  • excessive emotional response to vestibular movement

- extremely cautious: manipulates environment to avoid distress. seen as bossy/obstinate

125
Q

SI intervention tactile defensiveness

A
  • negative and emotional response to touch. fidgeting due to clothing. avoid glue, sand, paint food…
  • may avoid or seek out comfortable stimuli. blanket, stuffed animals
  • needs more touch. but cannot modulate it.
  • deep pressure can modulate
126
Q

SI underactive vestibular disorder

A
  • may not become dizzy w/ spinning
  • typical movements do NOT provide enough stimulation
  • will seek out input
127
Q

SI bilateral vestibular disorder

A
  • may be undiagnosed if subtle. appears to have dyslexia/attention problems
  • difficulty w/ postural responses
  • poor integration of R and L
128
Q

SI overactive vestibular disorder

A
  • gravitational/postural insecurity. excessive emotional response to vestibular movement. extremely cautious.
  • manipulates environement to avoid distress
  • easily car motion sick
  • long post rotary nystagmus
129
Q

diagnostic criteria of autism

A
  • Asperger’s
  • childhood disintegrative disorder
  • PDD-NOS: pervasive developmental disorders
  • not otherwise specified
  • symptoms MUST be present from early childhood!.
  • deficits in childhood
  • deficits social interactions
130
Q

early signs of autism

A
  • no babbling by 1 year
  • no words by 16 mo
  • no 2-word phrases by 2 years
  • no response to name
  • loss of previously acquired language
  • poor eye contact
  • no smiling
  • poor social responsiveness
  • excessive lining up objects
131
Q

autism motor function

A
  • motor delay in 2nd + 3rd years. delayed onset of walking. abnormal movement patterns
  • poor coordination. usually B/L, UEs, LEs
132
Q

gait characteristics of autism

A
  • instability
  • reduced ankle ROM
  • incr wariable stride length
  • postural asymmetry
  • abnormal muscle tone
133
Q

Now do

A

Cp
Dcd
Assessments
Milestones

Pediatrics (19 decks)

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