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OB/Peds > Pediatric Chiro Eval > Flashcards

Pediatric Chiro Eval Flashcards

1
Q

What is a reverse fencer?

A

Invert infant - relax tension on one leg and watch child’s head turn to that side

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2
Q

What is a positive fencer?

A

Infant considered restricted or twitches turning to one side compared to other

Suggests subluxation between atlas-axis or atlas-occ on that side

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3
Q

If an infant arches backwards during a fencer what may this be a sign of?

A

Meningeal tension

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4
Q

What MUST you check before performing the fencer on an infant?

A

Hip stability (orthani’s)

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5
Q

True or false; if the landau’s response is present in an infant reverse fencer is no longer a viable test

A

true (landau is when infant is suspended prone when head looks up so do the feet - if the head looks down the feet go down)

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6
Q

What is the acetabular pump part of the reverse fencer? How do you interpret findings?

A

Infant supine - apply pressure along shaft of femur - the “spongy” side consider side of atlas laterality (if they’re even consider occ)

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7
Q

True or false; infants have a normal flexed tone and legs are commonly in “frog leg” position

A

true

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8
Q

What is KISS? What are the 2 types?

A

KISS = Kinematic imbalances due to suboccipital stress

KISS 1: Fixed lateroflexion

KISS 2: Fixed retroversion (hyperextension during sleep)

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9
Q

Signs & symptoms of KISS

A

Torticollis, scoliosis, plagiocephaly (flat spot on baby’s head)

Frequent vomitting, dysphagia, colic with excessive crying

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10
Q

What is KISS induced Dyspraxia and Dysgnosia (KIDD)?

A

Syndrome related to KISS that has been associated with:

Slow development of fine and gross motor skills
Poor posture and equilibrium
Delayed language development
Restless ADHD

Essentially neurological complications related to KISS

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11
Q

What is the normal “evolution” from bowlegs to knock-knees to normal valgus knees

A

2 years = bowleg
3 years = Knock knees (extreme valgus)
5 years = normal valgus

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12
Q

True or false; typical causes of Toe-out during a prone leg check would include: EX ilium, tibial torsion, femoral anteversion, weak psoas or glute max, cerebral palsy

A

false; all of those would cause Toe-IN

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13
Q

Common causes of toe-out during prone leg check

A

IN ilium

Hypertonicity of psoas or glut. max

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14
Q

True or false; placing patient prone during instrumentation can be helpful with infants and children

A

true

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15
Q

How many degrees F does it take for an atlas reading to be considered significant clinically

A

> 0.5 asymmetrically

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16
Q

True or false; during lateral bend at C1-Occ area small children differ from adults or older children in that their atlas moves up toward your finger - contrast adults or older children atlas moves under occiput during lateral flexion

A

true

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17
Q

What motion should be assessed first from C2-L5 on infants

A

P-A motion (segments not always rotated)

18
Q

True or false; when infants lay prone and turn head ipsilateral SI motion may appear restricted

A

true

19
Q

When would you use a reverse fencer?

A

Infants under 6 months

20
Q

Restricted occ. glide bilaterally; both condyles are restricted in flexion are motion findings with what listing?

A

AS occ

21
Q

Restricted occ glide, and lateral flexion with pain over ipsilateral nuchal line, “High ear” are findings with what listing?

A

Occ PS-RS

22
Q

True or false; you should palpate atlas laterality in a seated or upright position

A

true

23
Q

Where do infants tend to hold their head relative to atlas subluxation

A

Opposite (example: ASR would hold head to left)

Note: Breastfed infants may be irritable/feed poorly on breast that requires them to lie with subluxated side down

24
Q

What response can be triggered by a C1 adjustment

A

Moro (commonly causes infant to cry)

25
Q

True or false; extension will be restricted at C2 on P, PLS/PRS, or ESL/ESR listings

A

true all have restricted extension (note ESL/ESR not toggle listing - with no uncinates yet they segment can move that way relative to C3)

26
Q

True or false; during a PLS/PRS listing at C2 pain will be felt on ipsilateral articular pillar

A

False; pain will be felt both at lateral inferior tip of spinous and OPPOSITE articular pillar (side of body rotation)

27
Q

Pain will be felt at the lateral/inferior tip of spinous on ESL/ESR listings at C2. Where else would infant feel pain?

A

Ipsilateral articular pillar (contrast opposite articular pillar in PLS/PRS)

28
Q

In a P listing at C2 where would pain be felt in an infant

A

over spinous and both lamina

29
Q

When do unicnates typically begin to develop?

A

6-9 years

30
Q

For C2-C7 what should your contact be? How much rotation? Should you limit it?

A

Tip of index

25-30 degrees; yes you should - no uncinates so need to be cautious with rotation component

31
Q

True or false; anterior adjusting is recommended on infants

A

false; not recommended under 3 years

32
Q

What is the preferred technique for thoracic adjusting in infants

A

DTH (either side of spinous)

33
Q

What is the preferred technique for infants when adjusting L1-L3

A

DTH (contact mammillary processes)

34
Q

Explain infant adjusting technique for L4-L5

A

Contact spinous on side of spinous laterality with thumb (#9) contact

Apply light pressure over contralateral mammillary process for stabilization

35
Q

Explain gluteal cleft deviation in infants?

A

Pinch gluteal cheeks; cleft should be midline

IF deviates may indicate side of PI ilium OR side of AI sacrum

36
Q

True or false; some recommend that side posture be reserved for patients >1 year

A

true

37
Q

What technique do most use on infants for SI misalignment

A

Prone

38
Q

How long do infants typically have horizontal facets?

A

~ age 10

39
Q

What is Swischuk’s line? What is it checking for?

A

Line connecting anterior cortices of spinous’ C1-C3

Line should intersect or lie within 1 mm anterior to anterior cortex of SP of C2

IF C2 is >2mm off line = true injury

40
Q

True or false; pseudosubluxation is a normal variant occuring MC at C2/C3

A

True

Detected by Swischuk’s line

41
Q

DDx pseudosubluxatoin v. Hangman’s fx

A

Pseudo = C2 may appear anterior relative to C3 by as much as 5mm

Hangman’s = Fx of arch C2 - Vertebral body moves anterior while arch and spinous move posterior

42
Q

True or false; if you see lateral masses hanging over C2 in infant automatic diagnoses of burst fx

A

false; normal variant up to 6mm common

OB/Peds (3 decks)

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