Paeds

Question 1

Describe the APGAR assessment

Answer 1

Neonatal Ax
Appearance, pulse, grimace, activity, respiration 
Each scored 0-2 
Score of 0-3 = sig distress
4-6 = mild distress

Question 2

Asymmetrical Tonic Neck Reflex

Answer 2

0-4 mo

Head turned to one side with ipsi arm extended and contra flexed

Question 3

Moro Reflex

Answer 3

When feeling like falling will open arms and bring them back to chest

Question 4

Grasping Reflex

Answer 4

0-4mo

Grasp when pressure is out on palm, will relax if stroke back of hand

Question 5

Stepping Reflex

Answer 5

Body weight shift and will make stepping motions (first 2 mo)

Question 6

Symmetrical Tonic Neck Reflex

Answer 6

3mo
Neck flexion causes UE flex and ext LE
Neck extension causes UE ext and LE flex

Question 7

Plantar Grasp Reflex

Answer 7

28wks -9-10mo

Pressure to base of toe = toe flexion

Question 8

Rooting Reflex

Answer 8

Up to 3 mo

Stroke side of cheek and will open mouth and turn towards side of stim

Question 9

Describe the 3 postural reactions

Answer 9

Righting - head will orient to upright position
Equilibrium - related to trunk stability
Protective - extending arms with sudden displacement so not to fall

Question 10

Development - Birth to 3 mo

Answer 10

Able to turn head to side, brief head righting, random kicks in supine, maintain head midline, reflex grasp

Question 11

Development - 4-5 mo

Answer 11

Able to prop with extended elbows, head control, rolls, supported sitting (good head control, turns head), WB in standing when supported, grasp/hold small toys, inc frequency of reaching

Question 12

Development - 5 mo

Answer 12

Head control in sitting

Question 13

Development - 6 mo

Answer 13

Sitting independent, use hands for play, stands with support, straight reaching path, radial-palmar grasp

Question 14

Development - 7 mo

Answer 14

Anticipate and orient hand for reach and grasp, commando crawling

Question 15

Development - 8-9 mo

Answer 15

4 point kneel, moves from sit to prone, pivots in sitting, may pull to stand, points and pokes, pincer grip

Question 16

Development - 10-11 mo

Answer 16

Transfer from sit to stand, picks up objects from floor , stands hands free briefly; mobility (cruising, crawls, walking with hands held)

Question 17

Development - 12-18 mo

Answer 17

Walks independently, squats, stairs with rail/hands, throws ball, walks backwards and sideways

Question 18

Development - 2-2.5yrs

Answer 18

Propels or steers push toys, walk on tiptoes, jumps, stands on one foot, ascend and descend stairs

Question 19

Development - 3-5yrs

Answer 19

Climb stairs independently, run faster and more controlled, walk straight line, dress and eat independent, skip

Question 20

Prader-Willi Syndrome (s/s)

Answer 20

Related to disturbance in hypothalamus, genetic deletion (chromosome 15 usually)
S/S: hypotonia, intellectual impairment, short stature, hyperphagia (extreme obesity, behaviour problems)

Question 21

Neonatal Respiratory Distress Syndrome (+ s/s)

Answer 21

<37 weeks gestation due to lack of surfactant

S/S: tachypnea, indrawing, cyanosis, occurs soon after birth

Question 22

Arthrogryposis Multiplex Congenital (+s/s)

Answer 22

Rare non progressive neuromuscular syndrome (unknown etiology)
S/S: joint contractures, muscle weakness, poor muscle development
Fibrosis - can lead to scoliosis, heart defects, resp problems

Question 23

Salter Harris #

Answer 23

Affects growth plate in children

Question 24

Pagets Disease (+s/s)

Answer 24

Localized disorder of bone remodelling (excessive resorption followed by increase in bone formation) = structurally disorganized mosaic of bone = weaker, larger, less compact, more vascular, more susceptible to #
S/S: usually asymptomatic, bone pain, secondary OA, deformity, excess warmth, neuro complications

Question 25

Acromegaly (+ complications)

Answer 25

Pituitary gland produces excess growth hormone during adulthood = increased bone size (in children = gigantism)
Complications: HTN, OA, cardiomyopathy, DM, precancerous growths on lining of colon, sleep apnea, carpal tunnel, uterine fibroids, hypopituitarism

Question 26

Osgood-Schlatter Syndrome

Answer 26

Activity related pain and swelling of insertion of patellar tendon on tib tub = self limiting
Caused by minor degree of separation of tib tub, associated with patella alta
Usually 10-15yrs (boys more)

Question 27

Osteochondritis Dissecans

Answer 27

Lesion of subchondral bone and articular surface (distal femur most common)
Due to ischemic necrosis

Question 28

Torticollis (+ causes, presentations)

Answer 28

Rotational deformity of Csp with secondary head tilting (lat tilt and contra rotation)
Types:
Congenital Muscular - uni shortening of SCM at birth (causes: birth trauma, intrauterine malposition, perinatal compartment syndrome, genetics, more time on back)
Presentations:
SCM ‘tumor’ - palpable mass
Muscular - thickening of SCM
Postural - clinical features but no mass or shortening

Question 29

Describe 4 possible outcome measures.

Answer 29

Functional Mobility Scale - want high score, questions not observation, used to figure out devices - rates walking at 5, 50, 500m
GMFCS - 5 levels (1 = high; 5 = limited), based on self initiated motion
GMFM - standard test for gross motor for CP, all items a 5yo would do
COPM - identifies goals in self care, productivity, leisure