Male GU Flashcards
1
Q
T/F men are more likely than women die or get injured at work
A
true
2
Q
T/F men are less likely than women to attempt suicide ubt are more likely to suceed
A
true
3
Q
T/F women over 75 have the highest rate of suicde
A
false, men
4
Q
two categories of questions that concerning male gentalia
A
sexual function and screening for infection
5
Q
sexual function questions of the male GU exam
A
how is your sex life
do you still have an interest in sex
do you have any concerns about getting an erections
do you have issues with the duration of intercourse (too long or too short)
6
Q
infection questions to ask during the male GU exam
A
color, amount, presence of discharge
systemic signs of infection
penile lesions
scrotal lesions
painful erections or orgasm
Hx or risk factors for STI
7
Q
two areas of erectile tissue in the penis
which of thse contain the urethra and form the glans
A
corpus spongiosum and corpus cavernosa
corpus spongiosum
8
Q
prepuce
A
the fold of skin over the uncircumcised penis
9
Q
smegma
A
the secretions that can be trapped in the prepuce
10
Q
T/F the testes should always be smooth, without masses, and hard
A
false, they should be firm but not hard
11
Q
tunica vaginalis
A
the serous membrane the covers the anterior and lateral parts of the testis
12
Q
epididymis
A
the soft, comma shaped structure the functions as a reservior for storage, maturation, and transport of sperm
13
Q
why would a herpes cause burning after urination rather than during
A
because the leasion might be on the meatus
14
Q
hydrocele
A
accumulation of fluid in the tunica vaginalis
15
Q
vas deferens
A
cord that passes through the external inguinal ring, down the spermatic cord, and into the tail of epididymis
16
Q
signs of a vasectomy
A
a knot in the spermatic cord
17
Q
landmarks of the groin
A
anterior superior iliac spine
pubic tubercle
inguinal ligament
18
Q
where is the inguinal canal
what is in it
what is the internal and external opening
A
above and parallel to the inguinal ligament
the vas deferens
external/internal inguinal ring
19
Q
inguinal hernia
A
a loop of bowel that has pushed through the inguinal canal
20
Q
femoral hernia
A
a loop of bowel that pushes through the femoral canal
21
Q
inspection of the penis notes
A
inspect all areas
if there is a discharge ask them to milk it
if there are painful lesions or nodule you will need to palpate them
educate uncircumsized men on hygiene
22
Q
patient presents with a large scrotal mass or visable bulge in the inguinla area that disappears when they lay down
what does ithis indicate
what would you do if the mass remained
A
a hernia
auscultation with a stethoscope hearing bowel sounds = hernia
scrotal mass, shine a light behind the mass, if it glows red it probably not a hernia
23
Q
at what age is testicular cancer most common
what is the prognosis
A
15-35
excellent with early detection
24
Q
if there is a suspected hernia, what must be ruled out
A
an enlarged lymph node
25
two types of inguinal hernias
direct and indirect
26
how will direct inguinal hernias presnet
indirect
direct will rarely present in the scrotum
indirect will usually present in the scrotum
27
on inguinal exam there is a weakness in the inguinal ring during the cough
is that normal
yes
28
STI indicated by...
single painless chancre
single painful chancre
multiple painful chancre
syphilis
HSV
HSV or chancroid
29
EEP with direct inguinal hernia
less common, usualy in men over 40, rare in women
30
EEP indirect hernia
most common with any age, both sexes, and children
31
hypospadias
two urethral openings
32
peyronies disease
painful erections that can be indcated by nodules
33
phimosis
paraphimosis
the inability to pull the foreskin down the penis
the unability to pull the forskin up
34
signs of bowens disease
squamous cell carcinoma in situ that can be found on the penis, often looks benign
35
typical cause of scrotal edema
will it transluminate
trauma or infection
no
36
indcations for a hydrocele
fiungers can get above the mass
it will transluminate
37
cryptochordism
increases risk for
undescended testicle
testicular cancer and infertility
38
acute orichitis causes
what might the patient say they do because of this
infection or trauma
they have to wear tight underwear to support the affected area
39
acute epididymitis causes
infection and trauma
40
T/F epididymal cysts tend to drain and smell bad
true
41
causes of scrotal varicocele
increase portal pressure, venous obstruction
42
two categories of questions concerning the anorectal exam
Lower GU
lowe GI
43
lower GI questions
change in bowel function
change in size, color, consistency of school
blood
44
GU questions
difficulty starting
normal amount of urine or caliber
nocturia
dysuria
blood discharge
trauma
pain or stiffness of the lowerback, hips, thighs
45
health promotion for the anorectal examn
testicle self examn
HPV vaccine
screen for rectal, prostate, colorectal cancer
46
important note for patients who engage in anal sex
top, bottom, or both
47
anal canal
the short segment at the end of the GI tract
48
where does the anal canal change to the rectum
the anorectal junction (pectinate line)
49
blood in the ejactulate is indicative to what
trauma or pathology at the prostate
50
where is the prostate in the rectum
the anterior rectal wall
51
screening for rectal cancer
proctoscopy
52
should the anorectal exam be painful
not unless there is a fissure or ulcer
53
notes for the male anorectal exam
the prostate is rubbery and nontender
try to go above the prostate to feel the seminal vescles
note color of anything on the gloves
54
limitation of the digital prostate exam
you can only palpate the posterior side of the prostate, lesions could be anywhere
55
shape of the prostate
heart shaped with a central sulcus with two lobes
56
what is important to discern when a patient presents with symptoms of prostate enlargement
if the prostate enlargement is normal or pathological
57
thrombosed hemorroid
treatment
a vein with a clot in it
small ones will go away, large ones you lance and express
58
age specific considerations for the neonatal assessment
exam happens in the presence of the patient
swaddle and then undress as necessary to do the exam
dim lights and rock newborn to encourage eye opening
observe feeding when possible
demonstrate calming measures to parents
59
first neonatl exam happens \_\_\_\_\_
comprehensive exam happens \_\_\_\_\_
immediately after birth
within 24 hours
60
neonatal assessment sequence
head and neck
heart and lungs
abdomen and GU
lower extremities
back
ears and mouth
neurologic
hips
eyes
skin
61
apgar test
categories
62
apgar appearance 0-2
63
apgar pulse0-2
64
apgar grimace 0-2
65
apgar activity 0-2
66
apgar scores respiration 0-2
67
1min apgar normal
some nervous system depression
severe depression
8-10
5-7
0-4
68
5 minute apgar normal
high risk for CNS or organ dysfunction
8-10
0-7
69
classification for preterm
late preterm
term
post term
\<34 weks
34-36 wks
37-42 wks
\>42 weeks
70
classification for extremely low birth weight
very low
low
normal
\<1000g
\<1500g
\<2500
\>= 2500
71
increased risk for preterm babies
short term
long term
CV and respiratory issues
neurodevelopment
72
increased risks for late preterm babies
prematurity related complications
73
increased risks for post term babies
perinatal mortality or morbidity such as asphyxia and meconium
74
complications for babies that are small for gestational age
asphyxia
meconium aspiration
hypoglycemia
polycythemia
hypothermia
75
complicatons for babies that are large for gestational age
dystocia
hypoglycemia
congeital anomalies
76
when is the best time to do a comprehensive neonatal exam
why
1-2 hours after a feeding, becuase that is when they should be most alert
77
four things to pay special attention to during the comprehensive neonatal exam
color, size, posture and movement, resipiration
78
how will a normal full term baby lie
a symmetric position with the limbs semiflexed and legs partially abducted at the hips
79
T/F neonates should have spontaneous motor activity
treu
80
T/F flexed finges and slight tremors are abnormal for babies
false
81
T/F neonatal development is faster than at any other time
false, infancy is fastest
82
growth milestones for the infant
weight shuld have tripled, heigh should have increasd by 50% within the first year
83
describe the progression of neurlogical development in an infant
head before trunk
arms and legs before hands and fingers
84
congitive assessment of an infant
infants should know cause and effect
object permanence
use of tools
stronger anxiety
85
language assessment of the infant
infants should transition to cooing to squealing to babbling to saying 1-3 words by 1 yr old
86
what is the ballad score used for
to determine gestational age when te mom doesn't know when the babies was concieved
87
social and emotional development of the infant
social tasks such as bonding, trust should be present
88
how does the structure of the PE differ in an infant
general
skin
head
thorax, lungs
heart
neck
breasts
abdomen
GU
musculoskeletal
nervous system
eyes
ears
mouth
nose
rectal
89
why are the Eyes, Ears, Mouth & Pharynx, Nose & Sinuses, Rectal done last in an infant PE
because you don't want to make them mad earily
90
vital signs for infant exam
BP, pulse, respiration, temp, length, weight, head circumference
91
T/F weight should be taken with dirty diaper
false, it should be clean
92
normal BP at birth
1 month
6 months
70
85
90 systolic
93
normal RR infants
birth to 2 month (\>60)
2-12 (\>50)
94
implications of sustained infant HTN
renal artery disease
congenital renal disease
coarctation of the aorta
95
what indicates tachycardia in pulse
SVT
250bpm
\>180 bpm
96
T/F fever can increase RR as much as 10resp/min/degree of fever
true
97
what might beindicated by very rapid, shallow breathing
cyanotic heart disease, right to left shunting, metabolic
98
tachypnea or increased respiratory effort indicateds what
pneumonia or bronchiolitis
99
nonpathological caues of fever
what constituites a fever in a neonate
swaddleing
anxiery
\>100.4
100
testing for jaundice
press the skin, look for a yellowish tint indicative of jaundice
101
when a rectal exam be done on a neonate/infant
to check for imperforate anus
to assess rectal bleeding
102
erythema toxicum
a common condition usually statying 3-5 days after birth with small pustules on erythematous bases that usually resolves withinf 1-2 weeks
103
chronic conditions neurological, renal, cardiac, endocrine often manifest how
failure to thrive
104
how will failure to thrive presents as it progresses
height will slow, then weight, then head circumference
105
milliria rubra
treatment
blocked sweat glands in the face, scalp, diaper area
light clothing and decreased humidity
106
pulsular melanosis
small fragile pustules that leave freckles behind
107
milia
small white papules concentrated on nose, cheeks, forehead, chin that usually resilve within 1-2months
108
benign birthmarks
eyelid patch
salmon patch
cafe aulait spots
mongolian spots
109
biggest considerations for infant head assessment
symmetry, sutures, fontanelles
110
symmetric abnormalities in infant head assessment
cephalohematoma (dones't cross suture line)
caput succedaneum (crosses the stures line)
plagiocephaly
111
how long does cephalohematoma take to resolved
caput
3 weeks
1-2 days
112
what might cause plagiocephaly
something that causes the bbay lay their head to one side (injury to scm, lack of stimulation)
113
describe the course of normal jaundice
appears days 2-3
peaks day 5
disappears within the first week
114
what causes molding of the infant skull
overlapping cranial bones as a result from being passed through the birth canal
115
what level of bilirubin requires treatment
14-15 by day2 or 3
116
depression of the anterior fontanelle suggests what
what about bulging
dehydration
hydrocephalus, increased ICP, neoplastic disease
117
risk factors for early closing fontanelles
microcephaly
craniosynotosis
118
conditions associated with delayed closing fontanelles
hypothyroid
megalocephaly
increased ICP
rickets
119
an enlarged posterior fontanelle is indicative of what
congenital hypothyroidism
120
which fontanelle is larger
which closes first
posterior is smaller and closes first
121
craniossynotosis
when one of the sutures of the skull that fuses too early and causes the skull to shaped oddly
122
considerations for the eye exam of an infant
newborns keep their eyes closed
attempting to open them makes them close they tighter
bright lights make them blink
use small, colorful toys
123
T/F during the first 10 days an infants eys might be fixed
true
124
T/F some infants will intermittently cross their eyes
true
125
what to look for in the infant eye assessment
pupillary reactions
normal irises, conjuctiva
optic blink reflex
126
opthalmoscopic exam for an infant
look for red reflex
optic disk should be lighter
may not see a fovea light reflex
look for retinal hemorrhages
127
what might be indicated if an infant that doesn;t follow your face during alert periods
visual impairment
128
whatmight be inidicated by an infant that cant open eyes
congential ptosis
129
T/F subconjunctival hemorrhages are uncommon
false, they are common in neonates born vaginally
130
T/F nystagmus is normal in the infant eye exam
true, but it should be gone by a few days or it may indicate CNS disease or poor vision
131
alternating convergent and divergent strabismus beyond three months indicated what
ocular motor weakness
132
visual milestones for infancy
birth
1 month
1.5-2 months
3 months
12 months
blinks, looks at face
fixes on objects
coordinating eye movement
eye converge
acuity around 20/50
133
coloboma
defect in the iris
134
brushfield's spots
ring of white specks in the iris indicative of down syndrome but cna be normal
135
dark light reflex is caused by what
white light reflex is caused by what
dark: cataracts, retinopathy
white: cataract, retinal detachment, chorioretinitis, retinoblastoma
136
causes of retinal hemorrhages
severe anoxia
subdural hemotoma
subarachnoid hemorrhage
trauma
137
what is the criteria for low set ears
if the auricle and pinna ears are below an imaginary line drawn from the inner and outer canthus of the eyes, the ears are low swt
138
what prevents full otoscopic exam in a neonate
vernix in the ears
139
acoustic blink relfex
babies will blink in response to a loud sound
140
small, deformed, low set ears are indicative of what
congeital disease, specifically renal disease
141
perinatal risk factors for hearing defects
\<1500g weight at birth
anoxia
ototoxic meds
congenital infection
hyperbilirubinemia
meningitis
142
assesment of the nose in an infant
test for patency
inspect septum
143
choanal atresia
a simple fix
when the posterior openings of the nose aren't open
pass a feeding tube through the nostril to the pposterior pharynx
144
describe infant oral mucosa
edentulous, alveolar mucosa is smooth with finely serrated borders
145
epsteins pearls
white or yellow rounded retention cysts located on the hard palate
146
signs of thrush
white patches that are hard to wipe away and have a erythmoous base
147
two conditions that will have a prominent protruding tongue
congenital hypothyroid
downs
148
macroglossia is indicative of what
severe systemic conditions
149
pattern of tooth eruption
1 tooth each month between 6 and 26 months up to 20 primary teeth
150
infant neck assessment
palpate lymph nodes lying down for younger kids
assess for adiitional masses
check position of thyroid cartilage and trachea
check clavicles for newborns
151
assessment of the thorax in an infant
expect a rounded thorax
note work of breathhing
should have very audilbe breath sounds
tactile fremitus
152
T/F an infant should have similar breath sounds from the nose and stethoscope
true
153
upper air way auscultation of an infant should beharsh and loud and symmetrc
true
154
infant breath sounds should be louder higher and usually inspiratory should be louder
yes to bth
155
apnea in an infant
might indicate what
cessation of breathin for 20 seconds often accompanied with tachycardia
respiratory, CNS, cardiopulmonary disease, high risk for sids
156
nasal flaring indicates what
effort from URI or pneumoia
157
causes of acute stridor in an infant
laryngotracheobronchitis, epiglottis, bacterial trachiatis, foreign bodies, hemangioma
158
assymetrical chest movement indicates what
diminished breath sounds indicates what
space occupying lesion
congenital diaphragmatic hernia
159
wheezes = \_\_\_\_
crackles = \_\_\_\_
asthma or bronchiolitis
pneumonia or bronchiolitis
160
abnormal respiratory effort and ausculataion iindicates what
pneumonia
161
T/F tachypnea is commonly found in pneumonia
true
162
hoover's sign
paradoxical seesaw movement between the chest and abdomen commn with LRI (bronchiolitis, pneumonia)
163
T/F URIs are no typically serious in infants
true
164
assesment of the heart in an infant
inspection for cyanosis, pulse ox
palpate for PMI, abnormal precordial movement, peripheral puses
auscultation
165
T/F S1 and S2 are commonly dull in an infant
false, they are normally crisp and normally separate
166
notable findings on infant auscultation
sinus arrhytmia
skipped beats
murmurs
extra heart sounds
167
what causes enlarged breasts in males and females
maternal estrogen
168
infant abdominal assessment
inspect the umbilical cord
auscultation
percussion of the liver and spleen
169
increased frequency or pitch of bowel sounds indicates what
gastroenteritis
170
small mass in the right upper quadrant or epigastrum indicates
pyloric stenosis
171
enlarged heart or tender liver in an infant indicates
heart failure or storage disese
172
abdominal masses common to infants
hydropnephrosis
urethral obstrucion
intussussception
turmors
173
potential causes of hepatomegaly in a new born
hepatitis
storage diseaes
vasucular congestion
biliary obstructuin
174
cuaes of splenomegaly in newborns
infection
hemolytic anemia
inflammatory autoimmune diseases
portal HTN
175
infant male GU assessment
penis should be straight
testes should be palpable in teh scrotum
scrotum should have rugae by 40 weeks
scrotal edema may be present due to maternal estrogen
176
hypospadias
urtherla orfice on the ventral surface of the glans or the shft of the pens
177
cryptorchidsm
undescended testicle
178
what indcates an infant hydrocele
nonreducible, transluminated mass that overlies the spermatic cord and testes that usually resolves in 18 months
179
inguinal hernia indications
reducible, non-translumiunable mass separate from the testes
180
T/F maternal estrogen will make female infant genitalia prominent
true
181
notable inspection points for the infant female GU exam
size of the clitoris
color and size of labia
lesions on genitalia
assess hymen
look for labial adhesions
182
important features of the MS exam on an infant from hands to hips
clenched hands (palmar reflex)
check for clavical fractures
check for patches or pits indicative of spina bifida
ortolani, barlow for hipdysplasia
183
important infant MS features in the legs and feet
legs should be bowlegged and be equal legnth
toe in/out shiuld correct in the second year
feet turned in at birth
feet seem flat due to plantar fat pad
184
what is the most common severe congenital deformity
club foot (talipes equinovarus
185
important features of the neuro exam on infants
mental status (crys, responds to pain)
gross and fine motor function meeting milestones
muscle tone
cry
DTRs
primitive reflex (suck, root, grasp)
186
CN II assesment for infants
CNIII
face tracking
check for optic blink reflex
187
CN III, IV, VI assesment for infants
CN V
CN VII
face tracking
root/suck
facial expressions
188
CN VIII assessment for infants
CN IX, X
XI
XIII
acoustic blink
swallowing
symettry of shoulders
coordination of sucking
189
physical develpment slows by how much after infancy
1/2 the previous rate
190
gross motor skills 1-4 years
walk by 15 months
run well by 2
ride tricycle by 3
jump 3-4
191
fine motor milestones between 1-4
18 month scribbles freely
2yrs imitates lines
3yrs draws and copies circles
192
language milestones between 1-4
18 months 10-20 words
2 yrs 2-3 word sentances
3 yrs has convesations, asks why, sings songs
4 yrs complex sentances but lack of logical thought
193
social and emotional development 104 yrs
strive for independence
temper tantrums
don't ask them if they want to do something
194
child development 5-10 years general
goal directed exploration of the world
increases physical and cognitive abilities (trial and error)
195
child development 5-10 years physical
grow at a steady, slower rate
strength and coorindation increases
children with disabilities will find their limitations
196
child development 5-10 years cognitive and language development
more able to used logic
little understanding of consequences
learning done mainly from environment
language becomes more complex
197
child development 5-10 years social and emotional development
progressively more independent
critical time for self esteem
moral and value systems mature but remain relatively simply
198
important respiratory ROS for middle childhood
otitis media
recurrent UTIs
bronchitis
cough
croup
pneumonia
wheezing
199
important CV ROS for middle childhood
fatiguabilty or syncope
200
important GU ROS for middle childhood
UTIs
hematuria
dysuria
frequency
oliguria
unexplained fever
201
important CNS ROS for middle childhood
seizures
tics
202
important GI ROS for middle childhood
diarrhea/constipation
food intolerances
203
three stages of adolescents
early, middle, late
204
when does adolescent physical development start for girls
boys
when does it stop
10 for girls, 11 for boys
stops 14 for girls, 16 for boys
205
congitive development in adolescence
progression from formal reasoning to logical and abstraction
increased morality
206
social and emotionald development during adolescents
increase influence of friends and peers
struggles for identity
207
what is the goal of providing confidentiality to an adolescent patient
to encourage them to talk to their parents not keep their secrets
208
important points for early childhood
avoid physcial struggle
be aware of stranger anxiety
209
middle childhood exam considerations
usually modest so give provacy
generally cooperative
get to know the kid
210
tips for examining young children
get at the childs eye level
examine patient teddy bear first then the child
let the child do some of the exam
have the child hold your hand and help you
211
tipps for examining young children
use a reassuring voice
let the child touch and see the exam tools
examine child in the parents lap
let them take a break
make a game of it
don't ask permission
212
when do you stop measuring head circumference
after 2
213
T/F BP should increase through out child hood
treu
214
what are common causes for high blood pressure in children
improper BP cuff
primary HTN, renal disease, dug use
215
major factors effecting pulse
illness, emotion, exercise
216
what constitutes tachypnea in a child
\>1yr \>40breaths/minute
217
things to look for on the head exam for older kids
shape, symmetry, abnormal facies
218
eye exam for older kids
red reflex
disconjugate gaze/eom
visual acuity
219
T/F adolescents should get a visual acuity test annually
true
220
why are ears difficult to evaluate in older kids
because they aren't very sensitive
221
when would acoustic screening be warranted for a kid older than 4
those who have failed screening or have delayed speech
222
common diagnosis of the ear in kids
acute otitis media
middle ear effusion
otitis externa
223
mucous membranes in allergic rhinitis
pale and boggy
224
causes of purulent rhinitis in kids
viral infections, sinusitis
225
foul smelling purulent unilateral discharge inducates what
foreign body in the nose
226
signs of sinusitis in kids
purulent rhinorrhea that is generally unilateral and includes headache, sore throat, sinus pain
227
development of sinuses
maxillary age 4
sphenoid age 6
frontal age 6-7
228
mouth exam for kkids
make it a game
check teeth for decay and carries
malcocclusion(overbite)
tongue
position, size, symmetry of tonsils
halitosis
229
typical causes of swollen lymph nodes in kids
viral or bacterial infections
230
how does croup sound on auscultation
prolonged inspiration accompanied with stridor, cough, rhonchi
231
auscultation of asthma in kids
prolonged expiration with coughing, wheezing, increased work of breathing
232
how to check for coarctation of the aorta
measure BP in both arms or one leg at a time
233
stills murmur
a benign murmur usually found between 2 and 8 increased with supine position, fever, anemia
234
what causes venous hum in kids
turbulence in the jugular veins
235
three benign murmurs found in childhood
stills
venous hum
carotid bruitis
236
pathological murmurs found in childhood
Aortic stenosis, mitral valve disease
237
what does stills murmur sound like
where is it found
grade I or II, musical, vibratory, early and midsystolic murmur
mid to lower left sternal border frequently carotid bruits
238
how does venous hum sound
where it is usualyl heard
soft, hollow, continuous
uunderclavicke
239
how does a carotid bruit sound in kids
where is it heard
early or midsystolic whoosh
usually louder on the left, made btter by carotic compressuion
240
describre a pulmonary heart murmur
where is it heard
grade I-II/VI soft, non harsh, ejection in timiming
Upper left sternal border
241
notes for the abdominal exam in kids
toddlers have a protuberant abdomen
check for apendicitis if there is acute abdominal pain
palpate liver, spleen, kidneys
percussion is more tympanic
242
male GU exam for kids
check for descended testes
inguinal canal for hernia
243
painful testicle in kids indicates what
epididymitis
orchitis
torsion
244
female GU for kids
vaginal discharge
adhesions
rashes
abrasions
trauma
lesions
hymenal variations
vaginal bleeding
245
first sign of female puberty
other signs
breast buds
hymen changes secondary to estrogen
wider hips
beginning of height spurt
246
delayed pubery might indicate what
turners
anorexia
chronic disease
247
what is the first reliable sign of puberty in males
increased size of testes, more pubic hair, larger penis
248
causes of delayed puberty in boys (no sign of puberty before 14)
constitutional delay
249
MS exam for kids
observe child walking, standing, touch toes, rise from a chair, run, pick up objects, duckwalk, squat, jump
250
nursmaids elbow
subluxation of the raidal head due to a tugging injury
251
lower extremity conditions for the MS exam in kids
bowleggedness (usually disappears by 18 months)
knock knees 3-4 years to 9-10
toe in walk may incrase up to age 4 and disappear around 10
assess for leg length
trendelenburg for hip disease
252
T/F most scoliosis is idiopathic
trye
253
adams test
bend foward with knees straight, looks for scoliosis
254
T/F scoliosis in young children is abnormal, older children is not uncommon
true
255
plumb line test for scoliosis
attach a string to C7 and see if the line extends to the gluteal crease
256
neuro exam for kids
primitive reflexes should be gone
check cranial nerves
257
gait, strength, coordination assesment during the kids neuroexam
look for asymmetries, weakness, undue tripping, heel to toe walk, hopping and jumping
hand preference usualyl determined by 2
differentiate ortho from neuro gait abnormailities
