Peds Flashcards
% children with myelo who have hydrocephalus at birth
What percentage of myelomeningoceles (MMCs) are associated with hydrocephalus at birth?
sexual development of females with MMC
Between 12% and 15% of girls with MMC show precocious puberty; 95% have menses.
Which is the major cause of calcaneal deformity in myelomeningocele (MMC)?
unopposed ankle dorsiflexors
Milestones
Palmar grasp involves picking up an object with the whole hand. Scissor grasp is achieved at 8 months and uses all four fingers and the side of the thumb. Pincer grasp uses the thumb and index finger. Fine pincer grasp is achieved at 12 months and uses the thumb and DIP of the index finger.
Myotonic muscular dystrophy
Myotonic muscular dystrophy affects skeletal muscle, smooth muscle, myocardium, brain, and ocular structures. Associated findings include frontal pattern baldness, gonadal atrophy (in males), cataracts, insulin insensitivity, and cardiac dysrhythmias.
AIDP
Although all of the answer choices can be seen, motor involvement predominates. Campylobacter jejuni, Mycoplasma pneumoniae, cytomegalovirus, and Epstein-Barr virus are common known causes.
MMC incidence
1 per 1,000 births
monophasic, single quantum version of a biphasic end-plate action potential of summated quanta, both of which can be found in either children or adults.
Miniature end-plate potentials
Milestones
Palmar grasp involves picking up an object with the whole hand. Scissor grasp is achieved at 8 months and uses all four fingers and the side of the thumb. Pincer grasp uses the thumb and index finger. Fine pincer grasp is achieved at 12 months and uses the thumb and DIP of the index finger.
A child should be able to pivot circles while prone at 5 months of age. They can maintain their heads in the midline position at 2 months of age. By 3 months, they should be able to prone prop on extended elbows. At 4 months, they can roll prone to supine.
You observe a child who is able to crawl on his or her hands and knees (“creeps”). At what age should this milestone be met? 9 months
Neural tube defects occur between
The nervous system is derived from ectoderm. The anterior neuropore closes around 23rd day of intrauterine life. The posterior neuropore closes at 26 and 27 days of intrauterine life. (18 to 30 days)
The most common identifiable risk factor for childhood ischemic stroke is:
congenital heart disease
Poor outcome in JIA
Indicators of poor outcome of juvenile idiopathic arthritis include greater severity or extension of arthritis at onset, symmetrical disease, early wrist or hip involvement, presence of rheumatoid factor, persistent active disease, and early radiographic changes,unremitting polyarticular disease, early hip or wrist involvement
Which dislocation common after birth brachial plexus injury
Glenoid dysplasia with posterior shoulder subluxation is frequently a complication of children after birth brachial plexus palsy.
Surgical referral for Erb’s palsy in infants
Patients with Erb’s palsy who had surgery at 6 months did better than those who spontaneously recovered elbow flexion at 5 months. Surgical intervention is commonly recommended for those having less-than-antigravity strength in elbow flexion at 6 months of age.
Elevated transaminases and toe walking can be found in
DMD
What is the most common congenital musculoskeletal deformity associated with myelomeningocele?
Equinovarus foot (downward and inward) . The foot is generally in equinus, with forefoot and hindfoot varus and severe adduction.
Glycogen phosphorylase deficienc
associated with McArdle’s disease.
Glycogen phosphorylase deficiency
associated with McArdle’s disease.
The bladder capacity in children is based on the Berger equation –
age in years plus 2 equals bladder capacity in ounces up until around age 12 years when the bladder capacity equals an adult size….
2 year old is 4 oz
risk factor that is associated with development of a venous thromboembolism (VTE) in a child with traumatic brain injury (TBI).
TBI due to non-accidental trauma
Purpose of orthosis in neuromuscular scoliosis
Neuromuscular curve progression is rarely slowed by bracing. Orthoses may be beneficial because they can stabilize a weak trunk, and improve sitting posture in those using wheelchairs.
splinting position for wrist in JRA
The correct position for splinting an involved hand in a child with juvenile rheumatoid arthritis is with the wrist in 15° of extension, the metacarpophalangeal joints in 25° of flexion, and the thumb in opposition. This position provides support for weakened structures and helps to reduce contractures.
L4 vs L5 muscle contractures in spina bifida
The knee extensors (quadriceps) are innervated at the L3-4 level, while the knee flexors (hamstrings) are innervated at the L5-S1 level. A child with L4 preserved level would have quadriceps muscles that work, while hamstrings will either be weak or absent. Foot muscles are innervated at the L5-S2 levels. Equinus and cavus feet result from asymmetric pull of foot muscles, which would be seen in levels of spina bifida L5 and distally.
For patients with peripheral vascular disease, the best method of assessing their walking endurance is:
Constant load treadmill test
only clear benefits for creatine for increasing performance in exercise have been found in
short duration, high intensity activity.
Massage techniques
Petrissage is a method of compression massage that is used to break up tissue and muscle adhesions.
effleurage massage the practitioner uses a stroking motion that is beneficial for vascular and lymphatic drainage.
Friction massage is a method of massage that uses circular motions to small areas of tissue to help with tendonitis and fasciitis.
Acupressure is a massage method in which pressure is applied on specific body points to help reduce pain.
MET activity
Lying quietly is 1.0 MET. Climbing stairs is equivalent to 3-4 METs, and heavy gardening is equivalent to 4-5 METs.
Muscle fiber types
Type 1 muscle fibers are slow-twitch with oxidative metabolic pathways. Type 2 muscle fibers are fast-twitch fibers. The type 2 fibers can then be further divided into fast-twitch with both oxidative and glycolytic metabolism (type 2a) and fast-twitch glycolytic (type 2b).
Energy transfer types
Conduction is a process of transferring thermal energy between 2 entities placed in direct contact with each other, for example cold packs on skin. Convection is a process of using a medium to transfer energy. Examples of convection include the use of husks with fluidotherapy, and the use of water with whirlpool therapy. Vapocoolant sprays are an example of evaporation, not conduction.
Scheuermann kypohsis surgery if
curve >75 deg, refractory pain, or neuro deficit…less than 50 deg conservative, 50-75 deg TLSO and conservative NSAID, PT, Ice
Scoliosis
idiopathic- infantile (left thoracolumbar), juvenile (right thoracic or double curve), adolescent (most common) >11 yrs old, M=F, right thoracic, right thoracic/left lumbar
congenital
acquired
prominence of posterior trunk correlates to the convex side of curve, restrictive lung, decr TVC, the higher the curve the more the lung is compressed on the convex side, observe if less than 20 deg, brace is 20-40 unless neurmuscular etiology than sooner….surgery generally if curve over 40, but in CP may wait even longer.
syndromes associated with limb deficiencies (5)
thrombocytopenia with absense of radius (TAR) syndrome (thrombocytopenia)
Fanconi syndrome (anemia, leukopenia)
Hold oram syndrome (heart)
Baller-Gerold synd (craniosynostosis)
VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo esophag fistula, renal dysplasia, limb deficiency
upward slant palpebral fissues, brushfield spots, third fontanelle, protruding tongue, low set ears, excess nuchal skin, single palmar crease, CHD (endocardial cushion defect), VSD
trisomy 21
Intrauterine growth retardation, short palpebral fissues, small mouth, micrognathia, low set ears, prominent occiput, short sternum, hypolastic fingrenails, rocker bottom feet, CHD
trisomy 18 (edward)
IUGR, coloboma of iris *keyhold pupil”, capillary hemangioma, skil defect of skull, polydactyly, rocker bottom feet, cleft palate, CHD, urinary tract abnormalities
trisomy 13 patau syndrome (survival less than 3 days)
short stature, triangular face, webbed neck, shield/broad chest, wide set nipples, amenorrhea, coarctation of aorta
turner synd 45,x
tall statur, small testicles, gynecomastia, incr risk for mitral regurg, learning problems, infertility
klinefelter’s syndrome 47 x,x,y
height in kid *** by 4 years
weight end of first year
doubles
triples
head midline head held when pulled to sit in prone lifts head and chest slightly turns to supine hands midline open crude palmar grasp
4 months
maintains sitting, rolls to prone, transfers cube from hand to hand, intermediate grasp, single word
7 months
stands momentarily, cruises, pincer grasp, peek a boo, finger feeds, waves bye bye, uses mama and dada with meaning, can retrieve an object hidden from view
10 months
walks alone, piles two cubes, scribbles, uses spoon with spilling
14 months
heel strike, mature supporting base, arms lower while walking, points to named body part
18 months
begins running, walking up and down stairs, jumps on both feet in place, builds 8 cube tower
2 years
triccyle, runs well, copies circle, three word sentence
3 years
hops on 1 foot, walks down stairs with alternating feet, copies a cross
4 years
