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Pediatric Orthopedics > Peds Physical Exam > Flashcards

Peds Physical Exam Flashcards

1
Q

What are the 2 vasospastic disorders

A

Chilblains
Raynaud’s

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2
Q

What is Chilblains

A

Localized erythema with subcutaneous swelling from cold exposure usually involving the hands, feet, ears and face in children

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3
Q

What is Raynaud’s

A

Intermittent B/L attacks of ischemia to extremities brought in by cold due to underlying vasospastic condition in the vasculature

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4
Q

What is the pulse rate for a child less than 1

A

110-160 bpm

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5
Q

What is the pulse rate for a child 2-5 years old

A

95-140 bpm

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6
Q

What is the pulse rate for a child 5-12 years old

A

80-129 bpm

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7
Q

What happens to pulse rate when patient has a fever or is stressed

A

Pedal pulse increases

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8
Q

What is myelinization

A

Maturation of neurological system once the neural tube closes

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9
Q

How does myelinization progress

A
  • head to toe with head lag progression
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10
Q

What is the time line for the head lag progression of myelinization

A

Newborn; 6 weeks; 6 months

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11
Q

When does myelinization start

A

At the second trimester and goes to the 2nd decade

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12
Q

What is the 1st step in neural development

A

Neural plate forms and closes dorsally forming the CNS

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13
Q

What is the 2nd step in neural development

A

Neural Crest cells proliferate and differentiate into dorsal root, sensory and motor nerves autonomic ganglia, Schwann cell making up the PNS

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14
Q

What is the 3rd step in neural development

A

The two areas fuse at the medulla nad progress superiorly until week 7
If this doesn’t happen, anencephaly and myelomeningocele can occur

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15
Q

What happens between weeks 8-16 during neural development

A

Neural proliferation occur (teratogens and infections blocks)

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16
Q

What happens between weeks 12-22 during neural development

A

Cells migrate to specific sites creating nerve tracts

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17
Q

What happens at week 20 during neural development

A

Neurons organize, align and develop
failure can result in metal retardation and Downs Syndrome

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18
Q

When does myelinization of the axons start

A

Second trimester

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19
Q

When does myelinization of the cerebrum and cerebellar hemispheres start

A

After delivery and continues for 1st 2 decades
(Fine motor and sensory control, balance, coordination, reasoning and intelligence)

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20
Q

What type of movements are initiated from the cerebral cortex

A

Voluntary movements
Control of posture and movement

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21
Q

What happens at 6 months during the pediatric neural development

A
  • head control - raising head from bed
  • rolling over
  • sitting - trunk stability
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22
Q

What happens at 7-9 months during pediatric neural development

A
  • crawling - reciprocal limb control
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23
Q

What happens during 12 months during pediatric neural development

A

Standing - center of gravity

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24
Q

What happens during 1yr -18 months during pediatric neural development

A

Independent walking

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25
Q

What happens during 2 years in pediatric neural development

A

Bowel and bladder control

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26
Q

What are some components of the neonatal neuro exam

A
  • observation
  • upright position
  • prone position
  • eye contact
  • increase in muscle tone
  • presence of earl reflexes
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27
Q

What do you expect at 18 months in a pediatric neurological exam

A

Hand dominance
Begin to run, climb

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28
Q

What are some upper limb evaluations on the pediatric neuro exam

A

Assess weakness - palmar drifting
Assess cerebellum - nose touch, eyes open
Assess sensory function - nose touch, eyes closed
Evaluate tone and ROM- equal b/l
Dexterity - 9 hole peg/ring test, gait exam if walking

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29
Q

How do you evaluate lower limb on peds neuro exam

A
  • compare both sides for
  • limb symmetry
    -muscle bulk
  • tone
  • strength and reflexes
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30
Q

Which nerve root for iliopsoas (hip flexors)

A

L1-L3

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31
Q

Which nerve root for gluteal muscles (hip extensors)

A

L4, L5, S1

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32
Q

Which nerve root for quads (knee extensors)

A

L2, L3, L4

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33
Q

Which nerve root for hamstrings (knee flexors)

A

L5, S1, S2

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34
Q

Which nerve root for tib anterior (ankle DFers)

A

L4, L5

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35
Q

Which nerve root for Gastroc (PF)

A

S1, S2

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36
Q

Which nerve root for subtalar inversion

A

L4

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37
Q

Which nerve root for subtalar eversion

A

L5, S1

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38
Q

Which nerve is tested in the ankle jerk reflex

A

S1, S2

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39
Q

Which nerve is tested in the patellar jerk reflex

A

L3, L4

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40
Q

Which nerve is tested in the supination Jerk

A

C6

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41
Q

Which nerve is tested in the Triceps jerk reflex

A

C7

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42
Q

What is he primitive reflexes

A

Spinal reflexes

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43
Q

What age should you get concern when a chilling is walking or not sitting up supported

A
  • 18 months walking
  • 10 months sitting up
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44
Q

At what age is the cortical thumb position developmental reflex

A

4 months

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45
Q

At what age is MORO developmental reflex

A

5 months

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46
Q

At what age is asymmetric tonic neck developmental reflex

A

6 months

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47
Q

At what age is palmer/plantar grasp developmental reflex

A

8-9 months

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48
Q

At what age is stepping response developmental reflex

A

8 months

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49
Q

Differentiate Chaddocks test from Babinski test

A

Chaddocks - lateral malleolus
Babinski - plantar foot

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50
Q

When should you have a positive Babinski response

A

Up to 6 months

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51
Q

When should you see the StePPAGE reflex

A

Present at birth and remains

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52
Q

When should you see tendon jerks (eg patella, ankle)

A

Present at birth and continues

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53
Q

when should you see withdrawal reflex

A

Present at birth; pinprick, normal up to age 2

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54
Q

When should you see Landau’s reflex

A

From 6 mths to 2.5 years

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55
Q

When should you see accoustic blink reaction

A

Replaced by startle reflex at 4 months

56
Q

When should you see tilting reflexes

A

Appears at 6-7 mths

57
Q

Which nerve roots does the cremaster reflex test

A

L1. L2

58
Q

What is the nerve root for the anterior thigh

A

L1, L2, L3

59
Q

What is the nerve root for anteromedial leg

A

L4

60
Q

What is the nerve root for the anterolateral leg

A

L5

61
Q

What is the nerve root for the outer foot and sole

A

S1

62
Q

What is the nerve root for the back of the leg

A

S2

63
Q

What is the nerve root for the buttock

A

S3, S4, S5

64
Q

How do you perform cerebella function tests

A
  • speech - slurring
  • eyes - nystagmus
  • finger nose - coordination
  • rapid movement - hand wrist movement
  • tandem gait - walk the plank
  • heel to shin - fine motor coordination
65
Q

What are movement disorders for UMN lesions

A
  • spasticity, hyper-reflexia, extensor plantar response
  • Weakness of UL extensors
  • Weakness LL flexors
66
Q

Movement disorder of unilateral UMN lesion

A

One arm flexes while one leg extends

67
Q

Movement disorder for B/L UMN lesion

A

cerebral palsy, scissor gait, knees rub, feet PF

68
Q

Movement disorder for basal ganglia lesion

A
  • tremors,
  • rigidity
  • flexed posture
  • slow movement
  • dyskenesias
69
Q

Movement disorder for cerebella lesion

A
  • speech
  • ataxic gait
70
Q

Movement disorders for muscle disorder

A
  • Duchenne, polymyositis
  • Presence of normal reflexes
71
Q

Movement disorder of cerebrum lesion

A
  • hypertonicity and hyperreflexia
  • loss of reflex arc, purposeful movement is affected, abnormal posture leads to contracture, motor landmarks not acquired
72
Q

Movement disorder in the LMN lesion

A
  • muscle wasting
  • hypotonia
  • muscles denerve (loss of anterior horn cells)
  • unstable, no center of gravity
73
Q

Movement disorder for neuromuscular junction lesion

A
  • fatigue: myotonia (inability to relax)
  • myasthenia
74
Q

Movement disorder of the peripheral nervous system and central nervous system lesion

A
  • degeneration
  • motor and sensory dysfunction/neuropathy
  • tuning fork
  • motor weakness and imbalance limit locomotion
75
Q

What is patterned response - cord mediated response

A

Present at birth and involute by 2 months
- flexor withdrawal
- extensor thrust
- crossed extension

76
Q

What is crossed extension in patterned response

A
  • flex the tested limb, then flex the opposite limb; spontaneous extension of the first limb
  • in extension rubbing the medial side of one foot produces abduction in the contralateral limb
77
Q

What is patterned response - brain stem mediated

A

Involuted at 6 months
- static postural reflexes
- asymmetrical tonic reflex - supine
- symmetrical tonic reflex - prone
Flex head ventrally: UL flex LL extend
Extend head dorsally: UL extends LL felx

78
Q

What are patterned responses - midbrain

A

Neck righting reflex
- head rotation and body follow
Disappears at 6 mths

79
Q

If there is a problem with volitional control, what does that mean

A

CND disease, have to retrain and readapt - complete loss of voluntary muscle control

80
Q

What are the detrimental factors of Bleck’s Prediction of Walking Factors

A
  • asymmetrical tonic
  • neck righting
  • Symmetrical tonic
  • MORO
  • Extensor thrust
81
Q

What are the favorable factors on the Bleck’s Prediction of Walking Factors

A
  • foot placement
  • parachute
82
Q

What is the scale for Belcks prediction of walking factors

A

0 = good
1 = guarded
2 = poor prognosis

83
Q

What are 3 specific foot and ankle problems with neurological roots

A
  • equinus - common in CP, Duchennes, doesn’t allow swing phase, stance phase delayed, stance no heel contact, premature heel off
  • hallux varus - contracture of abductor hallucis
  • hallux abducto valgus - muscle and soft tissue imbalance
84
Q

What are some other neurological rooted problems

A
  • osteopenia- disuse atrophy
  • fracture - equinus and calcaneal fracture
  • myelomingenocele - high fracture rate
  • ante torsion and internal and external torsion
85
Q

What is the most common hereditary ataxia

A

Frederich’s ataxia

86
Q

What is the presentation for Frederich’s ataxia

A
  • worsening ataxic gait
  • degenerative changes in cerebellum, worsens
  • absent DTR, loss of vibratory cardiac problems
  • peds cavus, TEV
  • need to support the trunk and lower leg
87
Q

What is Gillian Barre

A
  • post infection demyelinating neuropathy
  • respiratory infection
  • pain with significant motor weakness
  • drop foot - weakness occur distally (PNS)
    Take care of infectious cause support the drop foot
88
Q

What is myasthenia Travis

A
  • atuoimmune
  • stars with fatiguable muscle weakness
    -steroid therapy or removal of thymus
89
Q

What is cerbral palsy

A

CNS lesion
Non progressive
Global: cognitive dysfunction developmental disorder, attention deficit,
- diagnosed b 2 years
- intraventricular hemorrhage, infection, toxin, trauma

90
Q

How common is spastic CP

A

75% of cases

91
Q

Type of spastic CP

A
  • monoplegia (single limb, rare)
  • hemiplegia (both limbs on one side) b/c cerebral dominance occurs early
  • diplegia - most common all four extremities, B/L, equniovalgus
  • quadriplegia (total body CP, primitive reflexes remain)
92
Q

/what can you do for dynamic contractures in CP

A

Botulinum toxin A

93
Q

What can you do for equinovalgus in CP

A

Bracing may be difficult
Calc osteotomyq

94
Q

What can you do for equinovarus in CP

A

Lengthen or advance Achilles tendon
Lengthen TP and TA, transfer to lateral foot

95
Q

What is Type 1 and II HSMN (hereditary motor sensory neurotpathy)

A

Charcot Marie tooth
- feet always affected first
- clumsy presentation
- champagne legs

96
Q

What is Type III HSMN (hereditary motor sensory neurotpathy)

A

Dejerine-Sottas
- uncommon involves the decrease in NCV (nerve conduction velocity), weakness

97
Q

What is Type IV HSMN (hereditary motor sensory neurotpathy)

A

Refsum’s
- hypertrophic neuropathy
- first and second decades of life

98
Q

What is spina bifida

A
  • failure to close neural tube
  • asymptomatic spina bifida occulta
  • myelomeningocele
99
Q

Which nerve roots affected in pt with spina bifida and no major problems

A

S2

100
Q

Which nerve roots affected in pt with spina bifida and peas planus

A

L5-S1

101
Q

Which nerve roots affected in pt with spina bifida and calcaneal deformity

A

L5

102
Q

Which nerve roots affected in pt with spina bifida and varus, insensate foot

A

L4

103
Q

What causes HIV

A

T-cell disturbance

104
Q

What percentage of intrauterine transfer of HIV

A

80%

105
Q

What are symptoms of Duchenne and Becker’s Muscular Dystrophy

A
  • waddle gait, weak pelvic girdle, equinus and hypertrophic calves
  • presents before 5 years
  • delay in walking
  • progressive
  • WC at 12
106
Q

Which is milder between Duchenne and Becker’s

A

Becker

107
Q

Describe idiopathic toe walking

A
  • normal finding in children up to 5
  • prolonged toe walking noted in children with cognitive delays
  • cerebral palsy, muscular dystrophy etc
108
Q

Describe Hypotonia

A

Floppy CNS and connective tissue
Spinal muscular atrophy
Down’s syndrome

109
Q

Describe unilateral foot deformity

A

Size differences
Spinal cord neuro anatomy

110
Q

Describe tethered cord

A

Small and deformed single foot and leg
Gait disturbances
Bladder dysfunction

111
Q

What are the components of a orthopedic peds exam

A

ARM
Attitude at rest
Relationship of component parts
Motion of joints

112
Q

What are the components of he “relationship to component parts”

A
  • thigh and body
  • ankle to knee
  • rearfoot to leg
  • forefoot to rearfoot
113
Q

What is the relationship between thigh and body

A

Femur assume a lateral rotation

114
Q

What is the relationship of ankle to knee

A

Knee face anteriorly, if not, worry about torsion

115
Q

What is the relationship between the rearfoot to leg

A

Grasp the heel and look for abnormality in sagittal and frontal planes

116
Q

What is the relationship between forefoot to rearfoot

A

Look plantarly, met adductus or adductus
Then look at forefoot varus and valgus

117
Q

What are some tests for motion of joints

A

Ortolani’s test - spreading the thigh to elicit “click”
Telescoping the femur - symmetry of the pelvis and thighs

118
Q

What is hip ROM external:internal in kids up to 3 years old

A

2:1
Ex:in
External ROM decreases till 5-6 years then equalizes

119
Q

What is the total ROM of the hip

A

More Han 100 degrees, decreases with age

120
Q

What is the Ryder’s test

A

Test for femoral torsion

121
Q

In a tibia torsional exam, when looking at the thigh-foot angle, if met adductus is present where must we use as a reference

A

Hindfoot

122
Q

How do you check thigh-foot angle

A

Compare trans malleolar axis to coronal plant of the proximal tibia

123
Q

For knee ROM describe frontal plane motion

A

Minimal frontal plane ROM

124
Q

For knee ROM describe transverse plane motion

A

IR = ER

125
Q

Describe hip ROM for up to 3 years

A

ER: IR
2:1

126
Q

How much ankle DF is there at birth

A

60

127
Q

How much ankle DF is there at 3 yrs

A

25 degrees

128
Q

‘How much STJ ROM is there at birth

A

50 deg

129
Q

How much STJ ROM is there at 3 yrs

A

30 deg

130
Q

What are the most common foot abnormalities in peds

A

Calcaneovalgus
Met adductus
Equinus
TEV

131
Q

What is the black grading system for met adductus

A

Normal (midline runs between 2nd and 3rd)
mild midline runs through 3rd
moderate midline between 3rd and 4th
severe midline between 4th and 5th

132
Q

What do expect to see in a shoe of a person with calcaneal gait

A

Excessive heel wear

133
Q

What do expect to see in a shoe of a person with pronation

A

Medial heel wear

134
Q

What do expect to see in a shoe of a person with neurological gait

A

Tip of sole

135
Q

What do expect to see in a shoe of a person with supinating, varus

A

Excessive lateral heel wear

Pediatric Orthopedics (18 decks)

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