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OSCE > PAEDS > Flashcards

PAEDS Flashcards

1
Q

6 customs outcome measures

A
  1. balance
  2. MSK movement related functions
  3. Neuromovement related func
  4. pain
  5. sensory func
  6. Skin func
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2
Q

Growing pains how would you differentiate?

A

Nature of pain
Inclusion: intermittent
Exclusion: persistent

Onset of pain
Inclusion: evening, bilateral
Exclusion: unilateral, pain, still present next morning

Examination
Inclusion: normal
Exclusion: swelling, erythema, tenderness

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3
Q

TEV known as

A

Talipes Equinovarus (club foot)

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4
Q

Age of skill acquisition + red flags

A
  1. sitting alone (3-9m) >10m
  2. Crawling (5-13)
  3. Walking (8-17) >20m
  4. Running (12-24) >24m
  5. jumping(24-36) >36m
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5
Q

function assessment

A

squatting: time of walking
- not achieved, non symmetrical

skipping: achieved by 6yrs
- not achieved, unilateral skip, loses balance

Hopping: 4yrs

Single leg stance, 3yrs =10s, 5yrs= 10s, 8yrs= 15s

Stairs= unaided stair climb by 4yrs
- looking for symmetry + quality of movement- use of hands to stabilise

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6
Q

gower’s signs

A

mild= prolonged or rise using single hand action

mod= forming prone crawl pos, using one or two hands on thigh

sever= more than 2 thigh manoeuvres w aid or unable to rise

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7
Q

hyporeflexia and cause

A

lower motor neurone deficiency
cause: injury. or disease
i.e. CMT, polio, muscular dystrophy

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8
Q

hypereflexia

A

upper motor neuron deficiency
cause= congenital or acquired
MS, hyperthyroidism

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9
Q

growing pain rx

A

muscle stretching, and shoe wedging (Evans 2008)
- stretching: quadriceps hamstrings, triceps surae daily 2x 20- 30 sec holds

evans and sluter found that wedges for PRO foot type result in dec incidence of aching legs

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10
Q

stretch reflex response grading

A

0 absent
1 hypoactive
2 normal
3 brisk w/o clonus
4 hyperactive w unsustained clonus
5 hyperactive w sustained clonus

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11
Q

motor strength

A

0 no movement
1 flicker
2 moves with gravity eliminated
3 moves against gravity by not resistance
4 - mod movement against resistance
4+ sub maximal movement against resistance
5 normal movement

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12
Q

cerebral palsy

A

chronic, static, non progressive disorder of motor control due to injury of nervous system. resulting in abnormalities of posture, muscle tone and motor control

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13
Q

TEV casting

A

manipulation consists of ABD of foot beneath stabilised talar head.
Reduce cavus pos Ffoot in align w Rfoot
casting: heel not touched, allow calc to abduct w foot
apply padding

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14
Q

CALCANEAL APOPHYSITIS

A
  • Pain at posterior aspect of heel
  • May present in children b/w 8 to 15 yrs during the years of skeletal development where the apophysis of the heel is open
  • Child often reports pain to be worse during and post activity, and severity of pain may cause limp or avoidance of heel contact
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15
Q

CALCANEAL APOPHYSITIS Dx

A
  • Diagnosis not by imaging but clinical assessment via squeeze test (med and lat compression of heel) and exclusion of other ddx
  • 2 forces crossing growth plate- push and pull force- Achilles pulls where it attaches on growth plate at back of heel upward traction on growth plate
  • Push and pull effect on growth plate causes an intense inflammation leading to pain at site
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16
Q

CALCANEAL APOPHYSITIS aetiology

A
  • Trauma takes place through movement of apophasis to diaphysis through either passive tension of insertion of gatroc/ soleus complex or through compression or impact forces
  • Overuse trauma caused by active contraction of gastroc/ soleus complex and may be influenced by abnormal foot posture- some authors argue having a pronated foot posture inc generated forces required by gastroc/ soleus thus accentutating the force being transferred through the apophysis- why some prescribe orthoses
    Aetiology
  • High levels of athletic activity, obesity
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17
Q

CALCANEAL APOPHYSITIS rx

A
  • Heel raises- address trauma caused by passive tension of gastroc/ soleus complex caused by relative lengthening of tibia during rapid growth
    o Reduce ROM and dec activity of gastroc- complex
    o During 1-2 months intially
  • Physical activity modification or restriction
  • Orthoses
  • Footwear modification or replacement- supportive or cushioned footwear dec trauma at apophysis by absorbing ground reaction force
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18
Q

FPI

A

FPI measures foot pos, provides norm values for pop
- FPI dec as age inc
- 85% of children will have PRO foot type
- 4% will have a SUP type
- Only a guide
- Nil dynamic measurement

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19
Q

effectiveness of foot orthoses for paeds pes planus

A
  • Pes planus- lowered medial longitudinal arch
  • Rigid (arch height does not change) + flexible
  • No diagnostic technique- rearfoot angle, heel position (varus/ valgus), navicular height and arch formation
  • FO’s pos impact on pain, foot posture, gait function
  • Current evidence lacks diagnostic criteria
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20
Q

ossification vs ossified

A

ossification= bone begins to soldify
ossified= fuses (stops growing)

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21
Q

WHO MILESTONES

A
  1. standing w/o support 6m
  2. standing w assistance 7.5m
  3. hands + knee crawling- 8.5m
  4. walking w assistance - 9m
  5. standing alone- 10m
  6. walking alone 12-18m
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22
Q

wolf law

A

form alters func
move or alt pos

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23
Q

hip development (newborn)

A

flexion 130
extension 0
ABD 80
ADD 20
MR 80
LR 90

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24
Q

developmental dysplasia of hip (DDH)

A

condition in which femoral head has abnormal relationship to acetabulum
ax Barlow, ortolani

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25
Q

femoral anteversion

A

NOF + HOF turned or tilted further towards ant asp of body (FP)
medially rotated thigh

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26
Q

femoral retroversion

A

NOF + HOF turned or tilted away from ant asp of body
retroversion- laterally rotated leg

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27
Q

hips at birth

A

antetorsion= 30 internal
anteversion- 60 external
overall, laterally rotated pos

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28
Q

**RYDERS TEST (assumptions)

A

bring greater trochanter to prom pos assume you brought femur to centre of thigh
when greater trochanter at most prom pos we assume ‘normal’ amount of ante version (15-20)

29
Q

RYDERS TEST EQUATION

A

femoral torsion= Ryders findings +/- assumed amount fo anterversion
Assumed anteversion= 15- 20

30
Q

paed Ryders test

A

results= 20 medially
20 + (15-20)= 35- 40 of femoral ante torsion

If antetorsion more excessive than anteversion, leg will be medially rotated

31
Q

knee pos (SP)
new born
6-12m
3-4 yrs
6-11yrs

A

new born = 15-20 varum
6-12m = peak genu varum
3-4 yrs= 8 varum (peak genu valgum
6-11yrs= reducing valgum

at 4yrs popliteal angle suddenly inc

32
Q

MEDIAL GENICULAR BIAS

A

rotation at extension
KJ infants= 20- 30 ROM
rotation at flexed KJ <3yrs = 1.1 or 1.2

MGB exists if more medial R > lateral rotation
test in both. HJ flexed and extended to check for tight medial hamstrings

33
Q

5 determinants of mature gait

A
  1. duration of single limb stance
  2. walking velocity
  3. step lneght
  4. ratio of pelvic span to ankle span
  5. cadence
34
Q

Toe walking

A

absence of heel to toe . Assoc w. congenital talipes equines, cerebral palsy
- internal FPA during gait
- IR profile in NWB
rectus foot in NWB + degree of pes planus WB

35
Q

flat foot

A

lowered media longitudinal arch w foot eversion
acquired joint disorder= values foot deformity
types: congenital, rigid or spastic

36
Q

rigid + skew foot (flat foot)

A

congenital varus talus, skewfoot
stiff, flattened arch on and off WB

37
Q

flexible pes planus

A

structural abnormalities e.g. ankle valves, tibia vacuum, genu valgum, tibial torsion, femoral anteversion
flat foot aetiology: root theory- abnormally deviated STJ

normal arch durning non wb
flattening arch on WB

38
Q

expected foot pos

newborn
child
adult

A

newborn: natural STJ pos= 22 varus
Total STJ ROM= 45
Ffoot varus= 12-15
met primus adductus

child: <7 yrs RCSP= eversion
1yr= 10 eversion

adult
ideal rcsp
30 STJ 2:1

39
Q

new walker

A

wide base of gait
inc knee and ankle flexion
hips externally rotated in swing phase
avg 12 months to start to walk

40
Q

growing pains

A

non specific leg pain which affects heathy children. inclusion: intermittent pains in muscles, not joints of both legs which occur at night time

aetiology: genu valgum, flat feet
rx: stretching,
ddx: bone tumour,
exclusion: inc intensity, pain still present in morning, swelling, infection

41
Q

TARSAL OSSIFICATION

A

cuboid 40 wks
mets + phalanges 20 m
medial cuneiform 2yrs
intermediate cuneiform 3 yrs
navicular 2-5 yrs

42
Q

TEV casting

A

stabilize talus ltaterally
abduct foot while in supination hold with gentle pressure for 60 s

43
Q

APGAR SCORES

A

heart rate
respiratory effort
muscle tone
reflexes
colour
assessed at 1 min and 5mins post birth

44
Q

HIP JOINT ROM

A

flexion: 150, 120
extension 30, 30
abd 55,45
add 30, 30
IR 55,45
ER, 45, 45

up to 2yrs, ER > IR
by 3yrs, acetabular deepens and angles downward due to WB- pushed HOF into acetabulum

45
Q

Issues with toe walking

A
  • Calcaneus often very narrow due to lack of WB,changes to foot posture
  • Falls
  • Knee instability
  • Inc frequency of injury
46
Q

Why is Intoeing a concern?

A
  • Parental dissatisfaction with the aesthetics of child’s gait
  • Abnormal shoe wear to lateral toe tips (shoe scuffing)
  • Fatigue
  • Recurrent tripping and clumsiness
  • Parental concern re – future hip, knee problems
  • Parental concern re – sporting prowess
47
Q

What is expected?

A
  • Gait – FPA abducted – parallel
  • Hips – equal lat:med rotation + nil hip flexor or adductor restrictions
  • Femur – femoral torsion 15-20o
  • Knee – lat:med rotation 2:1 or equal, nil soft tissue contractures posteriorly
  • Tibia – torsion developing from nil to 20o
  • Foot – rectus foot NWB + various degrees of pes planus in WB
  • Conditions or syndromes – screening, tone, contractions
48
Q

Intoeing assessment

A
  • Gait- FPA + hip + knee in swing phase
  • Hips- ROM, adductors, hip flexors
  • Femur- Femoral torsion
  • Knee- ROM, genicular bias, soft tissue contractures post
  • Tibia- torsion
  • Foot- metatarsus adductus+ postural met.add+skew foot for abnormal presentations
49
Q

Other reasons why children toe walk?
Common conditions with neurological changes

A
  • Autism spectrum disorders
    • Autism, Asperger’s, Rett’s
    • Proposed to be from:
    o Hyperarousal from stimulus in environment
    o Cerebellum dysfunction
  • Cerebral Palsy: injury to brain resulting in CNS def
  • Persistence of primitive reflexes, delay in walking and milestones
    • 2-2.5/1000 births
  • Development delay
    • 25% in >/= two skill domains
    • Congenital, musculoskeletal or environmental
50
Q

Neurological Disorders

A
  • Neurological disorders may show clinically as:
    • Delay in milestones
    • Head size abnormalities (increased/decreased size)
    • Activity, reflexes or movement abnormalities
    • Lack of coordination
    • Changes in level of consciousness or mood
    • Muscle changes: i.e. spasms, hypotonicity, spastic tremors
    • Headaches, vision changes (especially in older children)
51
Q

Ankle Joint Equinus

A
  • Assessment of the involved structures
  • Gastrocnemius equinus
  • Soleal equinus
  • Gastroc-soleal equinus
  • ROM, Quality of motion, direction of motion, end-feel, symmetry
  • Normative data available?
  • Catch and clonus?
    • Catch  End ROM and muscle catches (e.g. cerebral palsy), neurological sign
    • Clonus  End ROM and it starts to shake (neurological sign)
    • Shouldn’t want to feel either of these two
52
Q

Curly or Raised digits

A
  • Overlapping or underlapping digit(s)
  • May resolve on weight bearing
  • Treatable early 0 taping of digit into desire position periodically
  • Surgery may be indicated if conservative management fails to achieve results
53
Q

growing pain aetiology

A
  • 3 main theories:
    1. Anatomical theory  orthopaedic factors (e.g. genu valgum, flat feet), increased leg muscle work
    2. Fatigue theory  Overuse response in leg muscles of active children
    3. Psychological and emotional theory  wider pain sphere
54
Q

Osgood-Schlatter’s

A
  • Traction apophysitis affecting tibial tubercle
  • Presents as pain, tenderness and inflammation
  • Symptomatic with exercise, relieved with rest
  • AGE:
    • Boys 12 – 15
    • Girls 10 – 12
    • BOYS > GIRLS
  • Contributing factors: Strenuous activity, sports involving running and jumping, muscle imbalances
  • Dx: warmth, swelling, tenderness over tibial tuberosity, leg extension against resistance painful
  • Tx: Activity mod, NSAID’s, stretch and strengthen, surgical excision as last resort
  • Px: Mainly self-limiting, may continue into adulthood
  • DDx: Osteogenic sarcoma, osteochondritis dissecans, RA, meniscus injury
55
Q

Calcaneal Apophysitis (Server’s)

A
  • Traction apophysitis of insertion of Achilles tendon into the calcaneus
  • Presents as heel pain, limp, worse barefoot and in morning, bilateral (60% of the time)
  • Contributing factors: tight triceps surae, poor/negative heel footwear, growth, poor training techniques, flat foot, start of the sporting season
  • AGE:
    • Boys 7 and 15
    • Girls 5 and 13
    • Between 10 – 12 years
    • Boys > Girls
  • Pain localised to heel around ossification centre, diagnosed with squeeze test
  • Tx: activity mod, shoe wear, heel lifts, stretches only once issues resolve
  • Px: self-limiting
  • DDx: Retrocalcaneal bursitis, Achilles tendinopathy, bone tumour, medial calcaneal nerve entrapment, tarsal tunnel syndrome, RA
56
Q

Frieberg’s Lesion

A
  • Avascular necrosis of metatarsal head presenting as pain through forefoot on weight-bearing
    • 70% cases = 2nd met
    • 30% = 3rd met head (can affect any)
  • Factors: Longer 2nd met, dancers
  • AGE: 12- 15 (Girls > Boys)
  • Dx: clinically, X-ray, bone scan and MRI (more sensitive)
  • Tx: Activity mod, off-loading, shoe wear, short leg casting, surgery, aspirin
  • Px: Self-limiting but high prevalence of OA
  • DDx: Stress #, March #, synovitis, neuroma, RA
  • STAGES:
    1. Fissure of subchondral epiphysis
    2. Collapse of dorsal and central portion of met head with evidence of flattening articular surface
    3. Advanced flattening of met head and further collapsing of articular surface
    4. Loose body formation
    5. Development of degenerative arthrosis
57
Q

Metatarsus Adductus

A
  • Adduction or medial deviation of forefoot at tarsometatarsal joints
  • 1 in 1000 births
  • M= F
  • Bilateral= unilateral
  • 59% first born children
  • High correlation with medial tibial torsion
  • Relationship with acetabular dysplasia
    Aetiology
  • Tight/ malinsertion of abductor hallucis/ tibialis anterior
  • Tight tibialis anterior secondary to weak peroneals
  • Abnormal insertion of tibialis posterior
58
Q

Correction of club foot

A
  • When correcting club foot we do not force correction around the imaginary 45 degree axis as this will rotate talus in ankle mortice
  • Gradual lateral shift of the navicular, cuboid, calcaneus
  • Achieved by abducting the foot while held in supination
  • Final correction of equinas may require with lengthening of achilles
59
Q

Met adducts types

A

Postural metatarsus adductus
- Hallux only in adduction
- During stimulated WB
Simple metatarsus Adductus
- Transverse plane deformity at Lisfranc joint
Complex Metatarsus adductus
- Transverse and frontal plane deformity (adduction and varus)
Skewfoot
- Usually acquiredor iatrogenic
- Forefoot adduction and varus with rearfoot eversion and abduction

60
Q

rx for genu valgum

A

Use xray if unilateral, history of trauma or metabolic bone disease. Treat if pain with gait, cosmetic concerns or KJ pain. May be pathologic due to metaphyseal dysplasias, renal osteodystrophy.
Normal RSCP for a child under 7 is eversion. Can calculate by minusing their age from 7, plus or minus two. First time walker (1year) = 10 degrees eversion. In an adult 30 degrees STJ motion, 2:1 inv to ev.

61
Q

• Define growing pains

A

Growing pains are defined as non-specific leg pain which affects otherwise healthy children, characterized by intermittent pains in the muscles (not joints) which occur at night. Its inclusion’s are bilateral pain and commonly anterior thigh, calf and posterior knee.

62
Q

growing pains
- What are some DDx how would you differentiate

A

Differential diagnoses are juvenile arthritis: articular, unilateral, morning stiffness. Bone tumor: unilateral pain not only at night, restless legs: family history.

63
Q

Growing pains how would you rx
How would you treat?

A

Highest evidence treatment is stretching, followed by wedging. Non rating includes paracetamol, heat and massage.

64
Q

New Walker

A

wide base of gait, increased knee and ankle flexion, arms in abduction, hips externally rotated in swing, no contralateral arm swing, flat foot pattern and only way to go faster is to increase cadence.

65
Q

2 year old

A

base of gait narrows, step length increases as heel strike may occur, diminished pelvic tilt and external rotation, reciprocal arm swing emerges.

66
Q

3 year old

A

adult walking pattern on way to being achieved, narrower base of support, more obvious heel strike, hips less externally rotated and movements much more smooth. Still have shorter stride length and high cadence.

67
Q

4 to 7

A

increasing lumbar lordosis due to anterior pelvic tilting, hip medial and lateral rotation equalize, genu valgum resolving and ankle joint DF 10-20 degrees. Increased stride length in 7 year old. Both rear and forefoot varus reduce: RCSP between 2 degrees inverted or everted.

68
Q

toe walking

A

heel contact exlcuded
may be idiopathic, developmental or assoc w conditions such as muscular dystrophy.
normal under 2-3 yrs.
By 2 yrs have consistent heel- to - toe pattern,
foot slap indicates inadequate extensor function to control 1st rocker

69
Q

toe walking subjective and obj info

A

-family history
- prem birth
- diagnosis of autism, cerebral palsy
- falls >5
AJ ROM
able to squat

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