module 21 peds MS

Question 1

Inspection

Answer 1

inspect skeleton and extremities and compare sides

• alignment
• contour and symmetry
• size
• gross deformity

Question 2

inspection over muscles and joints

Answer 2

color
number of skin folds
swelling
masses

Question 3

fetal development

Answer 3

skeletal system emerges from embryologic CT to form cartilage that calcifies to become bone

• Long bones: increase in diameter by growth of new bone tissue around bone shaft. Length results from proliferation of cartilage at growth plates.
• Small bones: cartilage ossifies

Question 4

children ligaments

Answer 4

ligaments are stronger than bone till adolescence

- injuries to long bones and joints more likely to result in fractures than in sprains.

Question 5

rapid growth in puberty leads to

Answer 5

dec. strength in epiphysis

- increased risk for injury

Question 6

Bone growth complete

Answer 6

around age 20

- peak at age 35

Question 7

Family Hx

Answer 7

congenital abnormalities of hip and foot
scoliosis and back problems 
arthritis 
genetic disorders
- osteogenesis imperfecta
- skeletal dysplasia
- rickets
- hypophosphatemia
- hypercalciuria

Question 8

birth hx

Answer 8

presentation 
Large or small for gestation age 
birth injuries ( fx or nerve damage)
type of delivery
use of tools
premature
resuscitation 
ventilatior support

Question 9

quality of movement

Answer 9

spasticity
flaccidity
cog wheel rigidity

Question 10

back inspection on infants

Answer 10

hair tufts and dimples
discolorations
cysts or masses near spine
curvature of spine 
Extremities
- symmetry
- movement
- equality
- deformity

Question 11

infant palpation of bones

Answer 11

fractures of dislocations
crepitus
masses
tenderness 
SPINE
- shape
- formation
- splitting

Question 12

infant palpation of muscles and joints

Answer 12

tone
mobility
subluxation or dislocation

Question 13

Infants look for

Answer 13

motor development: fine and gross
ROM
muscle strength
tibial torsion

Question 14

Barlow maneuver

Answer 14

detects hip dislocation or subluxation

• position yourself at supine infants feet, flex the hip and knee to 90 degrees
• thumb on inside of thigh, base of thumb on knee, fingers gripping outer thigh, finger tips on greater trochanter
• adduct the thigh and gently apply downward pressure on femur in attempt to disengage femoral head
• – Positive sign: clunk or sensation is felt as femoral head exits

Question 15

Ortolani maneuver

Answer 15

detects hip dislocation of subluxation

• at supine infants feet, flex the hip and knee to 90 degrees
• thumb on inside of thigh, fingers on outer thigh, tips at the greater trochanter
• slowly abduct the thigh while maintaining axial pressure
• fingertips exert a lever movement in the opposite direction, press the head of the femur back toward the acetabulum
• • if head of femur slips back into acetabulum with palpable clunk with pressure: suspect subluxation or dislocation

Question 16

genu valgum

Answer 16

knock-knees

- common between 2-4 years of age

Question 17

Genu varum

Answer 17

bowlegs

- common until 18 months of age

Question 18

talipes equinovarus (club foot) 3 features

Answer 18

equinus or plantar flexion of the foot at the ankle joint
varus or inversion deformity of the heel
forefoot varus

Question 19

tibial torsion

Answer 19

abnormal bowing (internal or external rotation) of tibia

• toeing appearance of child’s legs when walking/running
• not painful, trip and fall often
• can note internal rotation of affected leg, flat feet, increased lumbar lordosis

Question 20

developmental dysplasia of the hip

Answer 20

abnormal development or dislocation of hips

• 1st born, breech, girl: risk factors
• oligohydramnios

Question 21

Talipes equinovarus patho

Answer 21

fixed congenital defect of the ankle and foot

• genetic and external influences in the final trimester
• • intrauterine compression

Question 22

talipes equinovarus subjective

Answer 22

dx usually obvious at birth with classic deformity

Question 23

talipes equinovarus objective

Answer 23

most common combo includes inversion of the foot at the ankle, plantar flexion, with the toes lower than the heel.

Question 24

metatarsus adductus (metatarsus varus) patho

Answer 24

most common congenital foot deformity

• can be fixed or flexible
• caused by intrauterine positioning
• medial adduction of toes and forefoot results from angulation at the tarsometatarsal joint

Question 25

metatarsus adductus subjective

Answer 25

dx is usually obvious at birth

heel and ankle uninvolved

Question 26

metatarsus adductus objective

Answer 26

lateral border of the foot is convex
transverse crease is sometimes apparent on the medial border of the foot
- 10% of cases will also have hip dysplasia

Question 27

legg-calve-perthes disease patho

Answer 27

avascular necrosis of the femoral head

Question 28

legg-calve-perthes disease subjective

Answer 28

most common in boys between 3 and 11 years old
pain os often referred to the medial thigh, knee, or groin
bilateral involvement in 10% of cases

Question 29

legg-calve-perthes disease objective

Answer 29

limp with or without pain
loss of internal rotation, abduction and decreased ROM
muscle weakness of the upper leg may be present if s/s have been present for a prolonged period

Question 30

osgood-schlatter disease patho

Answer 30

traction apophysitis (inflammation of a bony outgrowth) of the anterior aspect of the tibial tubercle from repetitive stresses. (athletes)

• associated with inflammation of the anterior patellar tendon
• self limiting
• most common in boys between 9 and 15 years
• • rapid growth spurts

Question 31

osgood-schlatter disease subjective

Answer 31

walking with a limp

knee pain, especially with activity

Question 32

osgood-schlatter disease objective

Answer 32

knee swelling that is aggravated by strenuous activity
pain especially prominent with activity involving the quad
pain with palpation over the tibial tuberosity

Question 33

slipped capital femoral epiphysis patho

Answer 33

disorder in which the capital femoral epiphysis slips over the neck of the femur

• Spontaneous dislocation of femoral head both downward and backward secondary to disruption of epiphyseal plate
• most common between 8 and 16 years of age`

Question 34

slipped capital femoral epiphysis subjective

Answer 34

child or adolescent with knee pain and limp

Question 35

slipped capital femoral epiphysis objective

Answer 35

leg weakness and reduced internal hip rotation

XR: slippage of femoral head

Question 36

muscular dystrophy patho

Answer 36

group of genetic disorders involving gradual degeneration of the muscle fibers
- progressive symmetric weakness and muscle atrophy or pseudohypertrophy from fatty infiltrates

Question 37

muscular dystrophy subjective

Answer 37

clumsiness
difficulty climbing stairs
frequent falls

Question 38

muscular dystrophy objective

Answer 38

muscle atrophy and weakness with a waddling gait
positive gower sign
progressive loss of function, including ability to walk

Question 39

scoliosis patho

Answer 39

physical deformity of the spine

- curvature of the vertebral bodies: spine looks more like and S or C than a straight line from posterior view

Question 40

scoliosis subjective

Answer 40

may lead to back discomfort and is often associated with a leg length discrepancy

Question 41

scoliosis objective

Answer 41

lateral curvature of the spine, rib hump as the child flexes forward to touch toes
severe: uneven shoulder and hip levels, may have crease on one side at waist
Physiologic alterations occur in spine, chest, and pelvis

Question 42

radial head subluxation (nursemaid elbow) patho

Answer 42

dislocation injury

- caused by jerking the arm upward while elbow is extended

Question 43

radial head subluxation subjective

Answer 43

common in children 1-4 years old
pain in the elbow and wrist
refuses to move arm

Question 44

Gower sign

Answer 44

child rises from a sitting position by placing hands on the legs and pushing the trunk up.