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NPTE > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

APGAR Score

A

Used to report the health of a newborn after delivery
Appearance (color)
Pulse rate
Grimace (reflex irritability)
Activity
Respiration
0-2 scale (2 - normal)

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2
Q

Normal APGAR

A

Pink
> 100 bpm
Pulls away, sneeze or cough
Active movement
Vigorous cry

Score of 7-10 is considered normal

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3
Q

Development concept: cephalic to caudal

A

Development occurs from head and UE to trunk and LE

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4
Q

Development concept: gross to fine

A

Gross motor/large muscle movements develop before small muscle/fine skills

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5
Q

Development concept: mass to specific

A

Simple movements are acquired before complex movements

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6
Q

Development concept: proximal to distal

A

Trunk control is acquired prior to distal control (extremities)

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7
Q

Asymmetrical Tonic Neck Reflex (ATNR)

A

Stimulus: head turned to one side
Response: arm and leg on the face side extend, arm and leg on the scalp side flex. Spine is curved with convex toward face side.
Age: birth to 6 mo

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8
Q

ATNR Abnormality may cause:

A

Interferes with:
Feeding
Visual tracking
Midline use of hands
Bilateral hand use
Rolling!
Development of crawling
Skeletal deformities

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9
Q

Symmetrical Tonic Neck Reflex (STNR)

A

Stimulus: flexion or extension of head
Response: when head is flexed, arms are flexed and legs are extended. When head is extended, arms are extended and legs are flexed
Age: 6-12 mo

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10
Q

STNR Abnormality may cause:

A

Interferes with:
Ability to prop on arms in prone
Attaining hands and knees position
Crawling
Sitting balance
Use of hands when looking at object in hands

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11
Q

Tonic Labyrinthine Reflex (TLR)

A

Stimulus: position of labyrinth in inner ear, based on head position
Response: supine - body and extremities are in extension, prone - body and extremities are in flexion
Age: birth-6 mo

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12
Q

TLR Abnormality may cause:

A

Interferes with:
Ability to initiate rolling
Ability to prop on elbows with extended hips when prone
Ability to flex trunk and hips to come to sitting from supine

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13
Q

Galant Reflex

A

Stimulus: touch to skin along spine from shoulder to hip
Response: lateral flexion of trunk to side of stimulus
Age: 30 wks of gestation-2 mo

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14
Q

Galant reflex abnormality may cause:

A

Interferes with:
Development of sitting balance
Scoliosis

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15
Q

Palmar Grasp Reflex

A

Stimulus: pressure in palm
Response: flexion of fingers around stimulus
Age: birth-4 mo

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16
Q

Palmar grasp reflex abnormality

A

Interferes with:
Ability to grasp and release objects voluntarily
WB on open hand

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17
Q

Plantar Grasp Reflex

A

Stimulus: pressure to base of toes
Response: toe flexion
Age: 28 wk gestation-9 mo

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18
Q

Plantar grasp reflex abnormality

A

Interferes with:
Ability to stand with flat feet
Balance reactions, weight shifting in standing

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19
Q

Rooting reflex

A

Stimulus: touch on cheek
Response: head turn to same side with mouth open
Age: 28 wk gestation-3 mo

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20
Q

Rooting reflex abnormality

A

Interferes with:
Oral motor development
Midline head control
Optical righting, visual tracking, social interaction

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21
Q

Moro reflex

A

Stimulus: head dropping into extension
Response: arms abduct with fingers open, then cross midline to adduction, cry
Age: 28 wk gestation-5 mo

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22
Q

Moro reflex abnormality

A

Interferes with:
Balance reactions in sitting
Protective responses in sitting
Hand eye coordination
Visual tracking

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23
Q

Startle reflex

A

Stimulus: loud, sudden noise
Response: similar to moro reflex, elbows flexed and hands closed
Age: 28 wk gestation-5 mo

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24
Q

Startle reflex abnormality

A

Interferes with:
Sitting balance
Protective responses in sitting
Hand eye coordination
Visual tracking
Social interaction, attention

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25
Q

Positive support reflex

A

Stimulus: weight placed on balls of feet when upright
Response: stiffening of legs and trunk into extension
Age: 35 wk gestation-2 mo

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26
Q

Positive support reflex abnormality

A

Interferes with:
Standing and walking
Balance reactions and weight shifting in standing
Possible PF contracture

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27
Q

Walking (stepping) reflex

A

Stimulus: supported upright position with soles of feet on firm surface
Response: reciprocal flexion/extension of legs
Age: 38 wk-2 mo

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28
Q

Walking reflex abnormality

A

Interferes with:
Standing and walking
Balance reactions and weight shifting in standing
Development of smooth coordinated reciprocal movement of LE

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29
Q

Development of 0-1 mo

A

Prone: physiological flexion, brief head lift, head to side

Supine: physiological flexion, partial roll to side

Sitting: head lag in pull to sit

Standing: reflexive walking pattern

Fine motor: objects in direct line of sight, follows to midline, hands fisted, jerky UE, random or purposeful movement

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30
Q

Development of 2-3 mo

A

Prone: lifts head to 90 deg briefly, chest up position with some WB through forearms, rolls prone to supine

Supine: ATNR, reciprocal leg kicking, prefers head to side

Sitting: head upright with bobbing, variable head lag in pull to sit, req full assistance to sit

Standing: poor WB, hip flexion with hips behind shoulders

Fine motor: can see further distances, tracks 180 deg, hands opening, reflexive grasp (palmar grasp)

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31
Q

Development of 4-5 mo

A

Prone: bears weight on extended arms, pivots to grab objects

Supine: rolls supine to SL, feet in mouth

Sitting: steady head, turns head, can sit alone briefly

Standing: full WB with support

Fine motor: grasp and release, ulnar-palmar grasp

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32
Q

Development of 6-7 mo

A

Prone: supine to prone roll, reaches for toys

Supine: lifts head

Sitting: can get to sitting independently, can sit independently, lifts head

Mobility: backward crawl

Fine: radial-palmar grasp, approaches object with one hand in neutral position, voluntary object release

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33
Q

Development of 8-9 mo

A

Prone: hands and knees position

Supine: does not tolerate

Sitting: moves from sitting to prone, sits without hands, pivots

Standing: pulls to stand with furniture, stands at furniture, lowers to sitting

Mobility: crawls forward, cruises along furniture

Fine: radial-digital grasp, points/pokes, takes objects out of container

34
Q

Development of 10-11 mo

A

Standing: stands briefly without support, pull to stand with half kneel intermediate position, picks objects up while standing

Mobility: walks with 1-2 hand hold, bear crawl/creep

Fine motor: fine pincer grip, puts objects into container, grasps crayon adaptively

35
Q

Development of 12-15 mo

A

Walks without support
Fast walking
Walks sideways
Bends over to look between legs
Creeps upstairs
Throws ball in sitting
Builds tower with minimal cubes
Turns over small container to obtain contents

36
Q

Development of 16-24 mo

A

Squats in play
Walks backward
Walks up and down stairs with one hand held, using both feet on step
Propels ride on toys
Kicks and throws ball
Picks up toy without falling
Folds paper
Stacks more cubes
Holds crayon with thumb and fingers

37
Q

Development of 2 yo

A

Rides tricycle
Walks on tiptoes
Runs on toes
Walks downstairs with alternating feet
Catches large ball
Hops on one foot
Turns knob
Opens/closes jar
Button large buttons
Folds paper/clothes

38
Q

Preschool age development (3-4 yo)

A

Throws ball 10 feet
Walks on line 10 feet
Hops 2-10x on one foot
Jumps distances
Jumps over obstacles
Runs fast and avoids obstacles
Cuts with scissors
Hand preference

39
Q

Early school age development (5-8 yo)

A

Skips
Gallops
Jump rope
Bounce large ball
Kick ball with control
Writes well
Able to button small buttons

40
Q

Later school age development (9-12 yo)

A

Mature movement patterns
Competition increases
Improved balance, coordination, endurance

41
Q

Adolescent development (13+ yo)

A

Rapid growth in size and strength
Puberty
Balance, coordination, hand eye coordination plateau during growth spurt
Improved dexterity

42
Q

Pediatric positioning: supine

A

30-90 deg hip flexion
10-20 deg hip abduction
Slight cervical flexion
Knees in flexion
Feet at 90 deg

43
Q

Pediatric positioning: prone

A

Hips in extension
10-20 deg hip abduction
Slight cervical flexion
Flexion of elbows and shoulders
Knees extended
Feet at 90 deg

44
Q

Pediatric positioning: sidelying

A

Hips in flexion
10-20 deg abduction
Slight cervical flexion
0-40 deg of IR of upper arm
Knees in flexion
Feet at 90 deg
Pillow between knees

45
Q

Pediatric positioning: sitting

A

90 deg hip flexion
10-20 deg hip abduction
Shoulders over hips
Elbows in flexion
0-45 deg of IR at shoulders
Knees and ankles at 90 deg

46
Q

Arthrogryposis Multiplex Congenita (AMC)

A

Non-progressive NM disorder, occurs during 1st trimester in utero
Causes fibrosis of muscles and joint structures
May be caused by poor movement during early development due to myopathic, neuropathic, or joint abnormalities

“Multiple joint curvatures present at birth”

47
Q

Signs and symptoms of arthrogryposis multiplex congenita

A

Cylinder like extremities with minimal definition
Significant contractures
Dislocation of joints
Muscle atrophy

48
Q

Arthrogryposis multiplex congenita treatment

A

Positioning
Stretching
Strengthening
Splinting
Adaptive equipment
Possible surgery

49
Q

Autism Spectrum Disorder (ASD)

A

Group of development disorders that are characterized by difficulties with social interaction, communication, and repetitive behaviors

50
Q

Signs and symptoms of ASD

A

Approx 2-3 yo
Non-purposeful (or absence of) speech
Inability to understand non-verbal cues
Limited interest or awkwardness in social interaction
Lack of empathy
Defensiveness towards sensory stimulation
Perseverations
Preoccupation with routine and rituals
Decreased coordination

51
Q

ASD Treatment

A

Multidisciplinary
Improving social communication
Decreasing non-purposeful movements and vocalizations
Sensory integration therapy

52
Q

Cerebral Palsy (CP)

A

Movement disorders due to brain damage, non-progressive and acquired in utero, during birth, or infancy.
Caused by:
-Lack of oxygen
-Maternal infections
-Drug or alcohol abuse
-Placental abnormalities
-Toxemia
-Prolonged labor
-Prematurity

53
Q

CP Signs and symptoms

A

Abnormal muscle tone
Impaired modulation of movement
Presence of abnormal reflexes
Impaired mobility

54
Q

Spastic CP

A

Lesion to the motor cortex
UMN damage
Jerky movement, muscle tightness, joint stiffness

55
Q

Athetoid CP

A

Lesion in the basal ganglia
Writhing movements

56
Q

Monoplegia CP

A

Involves one extremity

57
Q

Diplegia CP

A

Involves bilateral LE

58
Q

Hemiplegia CP

A

Involves unilateral upper and lower extremities

59
Q

Quadriplegia CP

A

Involves the entire body

60
Q

CP Treatment

A

Normalization of tone
Stretching
Strengthening
Motor learning and developmental milestones
Positioning
Weight bearing activities
Mobility skills
Splinting, AD, specialized seating
Surgical intervention for spasticity

61
Q

Down Syndrome

A

Genetic abnormality, addition of an extra chromosome (21)

62
Q

Down syndrome signs and symptoms

A

Intellectual disability
Hypotonia
Joint hypermobility
Flattened nasal bridge
Narrow eyelids
Small mouth
Feeding impairments
Flat feet
Scoliosis
Congenital heart disease
Visual and hearing loss

63
Q

Down syndrome treatment

A

Emphasize exercise and fitness
Stability
Respiratory function

64
Q

Duchenne Muscular Dystrophy (DMD)

A

Progressive disorder due to absence of the dystrophin and nebulin production genes, causing impaired muscle contractility and destruction of myofibrils.
Fat and connective tissue infiltration in muscle
Death due to cardiopulmonary failure prior to 25 yo
X linked recessive trait (mother is silent carrier, only male children manifest)

65
Q

DMD Signs and symptoms

A

2-5 yo
Progressive weakness (proximal to distal)
Disinterest in running
Falling
Toe walking
Pseudohypertrophy of calves
Gower signs

66
Q

DMD Treatment

A

Avoid strength training!
Respiratory function
Submaximal exercise
Mobility skills
Splinting, orthotics, adaptive equipment
Medical: immunosuppressants, steroids, surgery

67
Q

Prader Willi Syndrome

A

Genetic condition caused by partial deletion of chromosome 15

68
Q

Prader Willi Syndrome Signs and symptoms

A

Small hands, feet, and sex organs
Hypotonia
Almond shaped eyes
Obesity
Constant desire for food
Coordination impairments
Intellectual disability

69
Q

Prader Willi Syndrome Treatment

A

Postural control
Exercise and fitness
Gross and fine motor skills training

70
Q

Spina Bifida

A

Developmental abnormality due to insufficient closure of neural tube. Occurs in low thoracic, lumbar, or sacral regions and impacts the CNS, MSK, and urinary systems.

71
Q

Spina Bifida Occulta

A

Impairment and non-fusion of the spinous processes of a vertebra, with intact meninges and spinal cord. No disability associated.

72
Q

Spina Bifida Cystica

A

Cyst like protrusion through the non-fused vertebrae, causing impairment.

73
Q

Meningocele (Spina Bifida)

A

Herniation of the meninges and CSF into a sac that protrudes through the vertebral defect. Spinal cord remains in canal.

74
Q

Myelomeningocele (Spina Bifida)

A

Severe form
Herniation of the meninges, CSF, and spinal cord through the vertebral defect. May or may not be covered by skin.

75
Q

Spina Bifida Signs and symptoms

A

Specific to myelomeningocele:
Motor loss below the level of the defect
Sensory deficits
Hydrocephalus
Arnold Chiari Type II malformation
Osteoporosis
Club foot
Scoliosis
Tethered cord syndrome
Latex allergy
Bowel and bladder dysfunction
Learning disabilities

76
Q

Spinal Muscle Atrophy (SMA)

A

Progressive degeneration of the anterior horn cell. Autosomal recessive genetic inheritance

77
Q

Acute infantile SMA

A

Between birth-2 mo
Motor degeneration progresses quickly
< 1 yr life expectancy

78
Q

Chronic childhood SMA

A

Between 6 mo-1 yr
Slower progression, steady impairments
Can survive into adulthood

79
Q

Juvenile SMA

A

4-17 yo
Survive into adulthood

80
Q

SMA signs and symptoms

A

Progressive muscle weakness and atrophy
Diminished or absent DTRs
Normal intelligence
Intact sensation
End stage respiratory compromise

81
Q

SMA Treatment

A

Positioning
Vestibular and visual stimulation
Access to play
Mobility training
AD and adaptive equipment

NPTE (6 decks)

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