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Pediatric PT Exam 1 > Pediatric Orthopedics Part 1 > Flashcards

Pediatric Orthopedics Part 1 Flashcards

1
Q

What are the general range differences that are increased?

A 
Increased:
Shoulder extension and rotation
Wrist flexion
Hip abduction and rotation
Ankle DF and Inv/Ev
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2
Q

What are the general range differences that are decreased?

A

Decreased hip and knee extension

Decreased ankle PF

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3
Q

General range differences: What is going on at the hip?

A

Anteversion/antetorsion

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4
Q

General range differences: What are we looking for at the knee?

A

Varus/Varum

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5
Q

General range differences: The first baby usually has more _____ _____

A

Range limitations

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6
Q

General range differences: At birth, do we expect to see full ROM for hip extension?

A

No, we have -10 degrees

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7
Q

General range differences: How many degrees PF do we have at birth?

A

10 degrees PF

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8
Q

Anteversion:

Babies have normal increased ______ at birth, which puts the thigh into ____

A

Anteversion

ER

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9
Q

Anteversion:

When the baby stands up to walk, what muscle is not in a position to work, and why?

A

Glute Med

It is too far behind

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10
Q

Anteversion: How will the baby put glut med into position?

A

They will now in-toe

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11
Q

Anteversion: So… an anteverted hip will result in ____ _____

A

In toeing

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12
Q

Anteversion: If the baby doesn’t ___ ____, then anteversion will stay because did not have good, prolonged ____ ____

A

Weight bear

Weight bear

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13
Q

Anteversion: which way is the femoral head facing?

A

Forward

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14
Q

Retroversion: Which way is the femoral head facing?

A

Backward

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15
Q

Version: head of the femur into the _________
Torsion is the twist of the ______
Ante: takes the baby to ____
Then _____ _____ ______, puts it back into alignment
As we stand on it, both correct
Hip comes into less ________ and less ______ ______
Between the two, we have a _____ _______

A 
Acetabulum
Femur
ER
Medial femoral torsion
Anteversion; Medial torsion
Neutral thigh
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16
Q

Developmental progression of varus to valgus:
Babies start off with ____ ____, then weight bear, and start going into an increased ______, then will go to normal levels of ______

A

Genu varum
Valgus
Valgus

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17
Q

Developmental progression of varus to valgus: Bones will start aligning with _____ _____

A

Normal WB

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18
Q

Developmental progression of varus to valgus: If a baby has poor head control, how do you get WB?

A

Put them in standers!

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19
Q

Developmental progression of varus to valgus: Newborn?

A

Moderate genu varum

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20
Q

Developmental progression of varus to valgus: 6 months?

A

Minimal genu varum

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21
Q

Developmental progression of varus to valgus: 1-2 years?

A

Legs straight

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22
Q

Developmental progression of varus to valgus: 2-4 years?

A

Physiologic genu valgum

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23
Q

Developmental progression of varus to valgus: 16 y.o. Female?

A

Slight genu valgum

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24
Q

Developmental progression of varus to valgus: 16 y.o male?

A

Slight genu varum

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25
Q

What is the most common form of episodic musculoskeletal pain?

A

Growing pains

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26
Q

Growing Pains: What age group is this common in?

A

Kids 3-12 years of age

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27
Q

Growing Pains: What are the 4 symptoms?

A
  1. Nonarticular, most often in shins, calves, thighs, popliteal fossa
  2. Almost always B/L
  3. Pain lasts minutes to hours in duration, mild to severe in intensity
  4. Pain free episodes
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28
Q

Growing Pains: Are there signs of inflammation on exam?

A

NO

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29
Q

Growing Pains: What is the treatment if symptomatic?

A

Muscle stretching

Massage

Resolve with time

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30
Q

Growing Pains: What medication can you take?

A

Tylenol

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31
Q

Growing Pains: What is the explanation behind this?

A

BONE grows quickly, but MUSCLE takes time to lengthen out

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32
Q

Peds. Injury: It can be either a ______ _______ or ______ _______

A

Single macrotrauma

Repetitive microtrauma

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33
Q

Peds. Injury: What is an example of single macrotrauma?

A

Serious contact/landing

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34
Q

Peds. Injury: What are 4 examples of repetitive microtrauma?

A
  1. Training errors
  2. Musculoskeletal imbalance (growth spurts)
  3. Anatomical alignment
  4. Footwear
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35
Q

Peds. Injury: What is an example of a training error?

A

Repeated over time

Over training/over doing/fatigue

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36
Q

Peds. Injury: What is an example of anatomical alignment?

A

Increased valgus puts body at more risk.

For example a female basketball player is at more risk than a male basketball player.

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37
Q

Peds. Injury: Anatomical Alignment: Turn out should be at _____, not ____ or _____

A

HIP

Not knee or foot!

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38
Q

Peds. Injury: Footwear: need shoes that ____

A

FIT!

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39
Q

Types of injuries:(3)

A

Fractures

Joint Injury

Musculotendonous unit

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40
Q

Types of injuries: Once growth plates are fused, go to the ____ _____

A

Adult pattern

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41
Q

Types of injuries: Kids will only stay up at night if they have ____ or _____

A

A fracture

Cancer

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42
Q

Types of injuries: Fracture: Can be either at the ______ _____ or can be a _____ ____

A

Growth plate

Stress Fracture

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43
Q

Types of injuries: Fracture: Growth plate: open area of bone that helps _____ and gets tall over time.

Opens, fills in, and gets _________

At ____ ends of the bone; one is usually more contributory to _______ of bone

A

Lengthen

Length

Both

Length

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44
Q

Types of injuries: Fracture: Stress fracture in ________ bone seen _____ weeks post onset of pain

A

Cancellous

6-8 weeks

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45
Q

Types of injuries: Fracture: This fracture looks like a splinter…

A

Greenstick fracture

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46
Q

Types of injuries: Joint injury: Can either be a _______ or _______

A

Ligament sprain

Derangement

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47
Q

Types of injuries: Musculotendonous Unit: You will see this before seeing tendinitis

A

Avulsion fx

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48
Q

X-ray information: Never Do aggressive _____ in Peds client

49
Q

X-ray information: Hand: You see ____ _____ at every bone

Ring finger, prox phalanx has a _______ fx
^ The problem is that they can pivot as they heal and ____ the bone. A ______ will not help rotation. Need to ____ and put in full _____

A

Growth plates

Greenstick

Spin

Splint

Align

Cast

50
Q

Sports Screening: Must assess _______ and _____ ______

A

Maturity

Overall fitness

51
Q

Sports Screening: ___ of all musculoskeletal problems ID in screening unknown by primary physician

52
Q

Sports Screening: When looking at specificity of sport, what two things must you look at?

A

Are they prone to particular injuries?

Range requirements

53
Q

Sports Screening: Look at ______ staging

54
Q

Sports Screening: _____ use and _______ abuse

A

Drug

Dietary

55
Q

Sports Screening: We need to STOP these two things….

A

Sports trauma

Overuse

56
Q

Infancy: If hip dislocated, what motion do you lose?

57
Q

Infancy: Congential ________/_________

How many grades are there?

A

Dislocation/dysplasia

5

58
Q

Infancy: The long it takes to find the congenital dislocation/dysplasia, the better, T/F?

A

FALSE

Find it early = less treatment time

59
Q

Infancy: Metatarsus adductus has 3 classes, what are they? And what would each intervention be?

A

Flexible: HEP, watching

Semirigid: HEP, tape, cast, special shoes

Rigid: Surgery

60
Q

Infancy: Clubfoot - Talipes Equinovarus

What 3 things are present in club foot?

A

Metatarsus adductus

Hindfoot varus

Ankle Equinus

61
Q

Infancy: If you have a flexible club foot, when they get up to walking it will….

A

Correct itself

62
Q

Infancy: Club foot: if rigid and too tight, then what do PTs need to do?

A

Stretch it out

63
Q

Clubfoot: also presents with _____ and _____ and the ankle

If severe, they will _____ at ankle. Why is this not a good thing?

A

PF and inversion

Fuse

Because balance reactions come from this angle!

64
Q

Developmental Muscular Torticollis: What is this a result of from the mother?

A

Tight uterine package

65
Q

Developmental Muscular Torticollis: What is the position of the neck; and what muscles are tight?

A

Rotation to opposite side, lateral flexion to same side

SCM is tight

66
Q

Developmental Muscular Torticollis: What are the causes? (6)

A 
Tumors- 1/3
Trauma
Pseudotumors
Fetal malposition
Uterine compression
Inflammatory conditions

May occur with other conditions (check out hips)

67
Q

Developmental Muscular Torticollis: Impairments: Asymmetrical pressure on ____ of head

68
Q

Developmental Muscular Torticollis: Impairments: SCM tightness (lateral flexion to tight side, rotation to opp. Side)

What other neck muscles can be affected?

A

UT

Scalenes

Hyoids

Tongue and facial muscles

69
Q

Developmental Muscular Torticollis: Impairments: May have secondary ______ asymmetry, _______, and ________

A

Facial

Plagiocephaly

Scoliosis

70
Q

Developmental Muscular Torticollis: Impairments: In plagiocephaly, one side of the face moves _____ and other moves ______

A

Back

Forward

71
Q

Developmental Muscular Torticollis: Functional limitations?

Usually only affects ______ _______
With increasing severity can affect ability to WB on _____ ____

A

Righting reactions

I/L UE

72
Q

Torticollis: What additional history do you want to look at?

A

How much time is child spending in equipment?

What is the sleeping position? Need to spend time on bellies!

73
Q

Torticollis: Examination:

ROM including _____ ____ ______ —> discharge when ____ _____

A

Resting head tilt

Neural head

74
Q

Torticollis: Examination:

_____ and _____ symmetry —> helmets mold their head

A

Facial and skull

75
Q

Torticollis: Examination:

Palpation of ______ (note: size, physical characteristics, location)q

76
Q

Torticollis: Examination: ____ and ____ Motor Development

A

Gross

Fine

77
Q

Torticollis: Intervention: Better Px if treatment starts early, ___ ____ 1 year of age

78
Q

Torticollis: Intervention: Gentle stretching with slight ____ ____

A

Cervical traction

79
Q

Torticollis: Intervention: Strengthening including: (2)

A

Visual tracking

Righting reactions —> use this to drive head tilt

80
Q

Torticollis: Intervention: Positioning to provide ____ _____

At least _____ positioning of head

A

Prolonged stretch

Midline

81
Q

Torticollis: Intervention: Handling/carrying —> change _____ of the room

A

Orientation

82
Q

Torticollis: Intervention: Orthotics. Must have some ____ and _____

A

PROM and AROM

83
Q

National Guideline Prevention and Management of Positional Skull Deformities: Prevention includes what 2 things?

A

Parent education

Prone play time when awake and observed

84
Q

National Guideline Prevention and Management of Positional Skull Deformities: Diagnosis is based on what two things?

A

Physical exam

Head shape for diff Dx between deformational plagiocephaly and craniosynostosis

85
Q

National Guideline Prevention and Management of Positional Skull Deformities: What is craniosynostosis?

A

Skull stops expanding, but brain is still growing

If sutures fuse, there is cranial pressure

Sometimes prominent ridge —> emergency

86
Q

National Guideline Prevention and Management of Positional Skull Deformities: Management includes:

Preventive \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_ adjustments (repositioning) and \_\_\_\_\_\_\_
Skull molding \_\_\_\_\_\_ (if conservative management does not work for mild/mod plagiocephaly)
A

Counseling

Mechanical, and exercises

Helmets

87
Q

National Guideline Prevention and Management of Positional Skull Deformities: What is the term when the head is a trapezoid shape?

A

Plagiocephaly

88
Q

National Guideline Prevention and Management of Positional Skull Deformities: What is the term when the baby’s head is a long oval vertically?

A

Scaphocephaly

Squished horizontally, too much S/L

89
Q

National Guideline Prevention and Management of Positional Skull Deformities: What population of babies would you see scaphocephaly?

A

S/L a lot, so premature babies; too much on side, head will compress bc gravity

90
Q

National Guideline Prevention and Management of Positional Skull Deformities: What term is it called when babies have a long horizontal head?

A

Brachycephaly

Will have bald spot on back of head

91
Q

Molding helmets: How many points of pressure?

Must be _____ frequently, must allow baby’s head to _____

Wear until good _____

A

3

Redone

Grow

Shaping

92
Q

Childhood: Legg-Calve Perthes:
What is the ratio for M:F?
What is the age range?

A

4:1

5-10 years old

93
Q

Childhood: Legg-Calve Perthes: What happens to femoral head?

94
Q

Childhood: Legg-Calve Perthes: Where does one feel pain?

A

Groin
Hip
Knee

95
Q

Childhood: Legg-Calve Perthes: How will one walk?

A

With a limb and + Trendelenberg secondary to pain and decreased strength

96
Q

Childhood: Legg-Calve Perthes: What ranges are limited?

A

IR (early sign)

Abduction

97
Q

Childhood: Legg-Calve Perthes: If this is not picked up, what will happen as an adult?

A

Early onset arthritis

98
Q

Childhood: Legg-Calve Perthes: AVN is more likely to happen if you have an ______ to hip

99
Q

Childhood: Legg-Calve Perthes: Knee pain is ____

A

BAD!

Must check hip right away

100
Q

Childhood: Legg-Calve Perthes: Shuts off What muscle?

101
Q

SCFE: What is the ratio for M:F

What is the age?

A

2-3:1

7-15 years old

102
Q

SCFE: What is the first sign?

103
Q

SCFE: Initially you will have an _____ _____/_____

Then chronic ______ lurch, and ____ toeing

A

Antalgic gait/limp

Abductor

Out

104
Q

Osgood Schlatter’s:
F>M
True or false?

A

False, M>F

105
Q

Osgood Schlatter’s: What are the ages?

A

10-15 years old

106
Q

Osgood Schlatter’s: What is it?

A

Separation of tibial tubercle.

You end up having a large tib tub, and avulsion fracture is possible

107
Q

Osgood Schlatter’s: Where do you feel pain?

A

Over the tubercle

108
Q

Osgood Schlatter’s: Development of ______

109
Q

Osgood Schlatter’s: What are the treatments?

A

Rest
Ice
Decreasing activity
Avoid jumping and squatting

110
Q

Sever Disease: What are the age groups?

A

7-10 and also 10-14 (rapid growth spurts)

111
Q

Sever Disease: What is it?

A

Fracture and avulsion at ACHILLES TENDON attachment

112
Q

Sever Disease: Where you feel pain, and when do you feel pain?

A

Pain in heel

Especially after activity

113
Q

Sever Disease: Where will you feel tenderness?

A

Posterior aspect of heel

114
Q

Sever Disease: Development of _____

115
Q

Sever Disease: What is the treatment?

A

Rest
Heel cups/lift
Reduced activity
Heel cord stretching

116
Q

X-ray: Need to keep kids into _________ by putting them in a ________.

Some signs and then you get total compression of femoral head, then splintering of it (ossification centers/spotty)

A

Abduction

Brace

117
Q

X-ray: If the SCFE is greater than ____% off, then you need surgery

118
Q 
Management for: LCPD, SCFE, Osgoods, Sever:
Alleviate \_\_\_\_\_
Improve/maintain \_\_\_\_\_\_\_
Improve \_\_\_\_\_\_\_
Improve \_\_\_\_\_\_ \_\_\_\_\_\_\_
A

Pain
Range
Strength
Functional skills

119
Q

Management for: LCPD, SCFE, Osgoods, Sever: What functional skills should yo be looking at?

A

Gait pattern

Gait speed (think of keeping up with peers)

Sports specific activities if appropriate

Pediatric PT Exam 1 (14 decks)

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