PPH - PAEDS Flashcards

Question

What are the fetal position at birth

Answer 1

1. **Cephalic presentation** is Ideal: left occiput anterior with chin tucked - baby facing Lt. side so to turn facing head to spine. 2. The left side of the maternal pelvis 3. Fetal occiput anterior: face first - leads to truma and emergency c-section

Answer 2

Breech: * Frank * Complete * Footling * Shoulder

Answer 3

* Exercise * Moving around (walk, stand, leaning * Squat * Kneeling * Wall press-up * Gravity helps the baby move

Answer 4

* Heat - cold * Massage * Bath * Tens machine * acupressure * Intradermal water injections

Answer 5

* Gas (nitrous oxide) * Pethidine (makes baby sleepy) * Epidural (helps woman relax) * spinal block

Answer 6

1. Artificial rupture of membranes 2. Oxytocin 3. Prostaglandin 4. Cervical balloon catheter

Answer 7

1. Vacuum 2. Forceps

Answer 8

Cut into perineum and posterior vaginal wall

Answer 9

1. Post partum bleeding (lochia) stops after 2-4w 2. C-section recovers 6-8w 3. Stitches tear: * 1st degree: skin deep * 2nd degree: mm. and skin * 3rd degree: mm., skin, perineum, sphincter * 4th degree: Extends to rectum

Answer 10

Separation of linea Alba * Hormonal change * wight gain * Abb mm. weakness

Answer 11

* Knees of patient bent, place hand above navel pointing towards feet Patient raise heat and shoulders up, feel for gap or dip * Normal – 1 finger space or less * Diastasis recti – 2 or more finger spaces

Answer 12

* Deep abdominal muscle exercises * No sit-ups!! * Abdominal support belts/shorts * Avoid lifting anything heavy

Answer 13

Affect 10-15% - refer to GP for blood tests * Feeling depressed or miserable * Increased crying * Reduced interest in things normally enjoyed * Not able to sleep or sleeping more than usual * Reduced appetite or overeating * Preoccupation with morbid thoughts * Excessive feelings of guilt and/or failure * Feeling disconnected with baby or that they don’t have a bond with the baby

Answer 14

* Any birth complications / interventions * Any signs of feeding difficulties Unsettled, * reflux * Tongue-tie * Plagiocephaly (flat head syndrome)

Answer 15

First pregnancy? Conception? Illnesses, interventions, mothers overall health. Any complications?

Answer 16

1. Gestational age? 2. Induced? 3. Vaginal or caesarian delivery? 4. How long were stages of labour? 5. Apgar scores? (initial activity after birth)

Answer 17

First check of babies health at 1min 5min 10min after birth * Appearance, * Pulse, * Grimace, * Activity, * Respiration

Answer 18

Make sure the baby is on the same line of weight or above

Answer 19

1. Weight increase 2. Feeding (formula, breast, frequency, amount, vomit, reflux) 3. Sleeping (routine, position) (cry while supine?) 4. Pattern of unsettled 5. Systems screen (bowel movement, consistency, constipation, urination, burping) 6. Meds & vaccines 7. Accidents, surgery, illness?

Answer 20

* Observation * General obs * skin colour, * skin spots, * location of hair spots, * palmar creases, * alertness * Head shape * Any flattening on one occiput, * bulging in forehead or eyes, * ear levels Mouth, palate, gums, tongue, frenulum * Abdominal examination * Palpation, * listening with a stethoscope if necessary for bowel movements, symmetry, umbilicus * Neuro exam * Cranial nerves, * Romberg's, * Babinski's * Primitive reflexes

Answer 21

1. Palmar grasp 2. Plantar grasp 3. Rooting reflex (tongue) 4. Startle reflex 5. Asymmetric tonic neck reflex 6. Trunk bend stimulus 7. Pacing and stepping reflex

Answer 22

**Hips** * Ortolani and Barlows maneuvers (hip dislocation) * Leg length, * fat fold symmetry * Club foot (inversion and supination of foot ) **Shoulders and arms** * Torticollis * Clavicle fracture (birth injury) * Brachial plexus injury

Answer 23

**New born cranium:** * 2 frontal bones, * 2 parietal bones, * 1 occipital bone **Sutures** * _Metopic suture_: form top of head to middle of forehead. 2 frontal bones meet * _Coronal suture_: extends from ear to ear. Frontal bones meet w/ parietal bones Sagittal suture: middle of the top of head. 2 parietal bones meet * _Lambdoid suture:_ extends across back of head. Parietal bones meet with the occipital bone

Answer 24

* **Anterior** (soft spot): junction for 2 frontal and 2 parietal bones. Has pulse (Gentle palpation) * **Posterior**: junction of 2 parietal bones and occipital bone * **Sphenoidal** fontanelle * **Mastoid** fontanelle

Answer 25

fit most of the areola in the mouth, chin should be under the areola

Answer 26

* Sidelying * Football hold * Laidback * cradle position * Cross cradle position \*\*\*dont hold baby up let pillows carry the weight

Answer 27

* Express breastmilk * Use donor milk * Use formula * Use a combination of both \*\*9/10 women breastfeed but only 4 will continue after 4months

Answer 28

Structural abnormality of the lingual frenulum it has an adverse effect on feeding and speech

Answer 29

the procedure used to treat tongue, lip or buccal tie they use water laser to snip the membrane Mandatory stretching every 4h to help with post-surgery to avoid re-attachment

Answer 30

when they have been over-exerting in latching, the baby bounds up through front and tongue so releasing the anterior body and upper thoracics will comfortably let them lie on their back

Answer 31

reflux without content reflux can lead to good ceases after 4 months

Answer 32

type of vomit if it shows mucous = stomach content uncomfortable lying on their back irritable discomfort while feeding

Answer 33

* increase frequency decrease amount of feed * Burp more often during feed * put crib at an angle * Meds under advice from GP

Answer 34

* Blood * fever * GORD * refuse to feed * regurgitate * Chronic respiratory infections

Answer 35

* **Pyloric stenosis:** * enlarged muscles around pyloris * surgical repair * lots of vomit * **Intussusception** * Abdominal emergency * Bowel telescope up on itself * Intense abdominal pain * knees to chest * **Hip Dysplasia** * femur separated from the acetabulum * Bridged position at birth * Girls 4\>1 Boys

Answer 36

Symmetric but and legs folds even hip abduction Knee height difference After 8 weeks - Barlow: Hip adduction + compression "clunk" After 8 weeks - Ortolani: abduction and traction and feel

Answer 37

The motor skills children are expected to develop at a certain age

Answer 38

**Gross Motor skills** * 3/12- lying supine head midline * 3/12-no head lag when pulled from supine to sitting * 3/12- lift head when on tummy **Fine Motor skills** * 3/12- plays with hands, hands in mouth * 3/12- will hold things but unaware they are holding it

Answer 39

Gross motor skills * 5/12- rolling * 7-8/12- sitting by themselves Fine Motor skills * 6/12 – reaching and grasping objects and putting into mouth * 6/12 – transferring objects from one hand to another * 6-12 months poking and pointing with index finger

Answer 40

Gross motor skills * 10-12/12- crawling * 1 year- cruising on furniture * 19/12- walking

Answer 41

seeing near and far. Birth- can see, pupils react to light, will follow face 1⁄4 circle 3/12- very alert, follow face 1⁄2 circles

Answer 42

hear information, listen and interpret Birth- startled by a sudden noise 3/12- may be distressed by a sudden noise

Answer 43

understand and learn a language 6/52- starting to make ‘coo’ noises 3/12- quite vocal 9-10/12- using words

Answer 44

eating, communication, relationships 6/52- smile 3/12- loves to be talked to and played with

Answer 45

1. Baby not responding to sounds 2. Appears baby cannot see things of has white or cloudy eyes Squints a lot after 3/12, eyes not focusing 3. If baby is not interested in what is going on around them Cannot hold head up on tummy by 3-4/12 4. Persistent and excessive crying after 3-4/12 5. No babbling by 6/12 6. If baby doesn’t use or move both arms and both legs 7. Baby not sitting by themselves by 10/12 8. Not weight bearing by 1 year

Answer 46

4 Months 1. Moro (startle): over sensitive and reactive to sensory stimulus 2. Rooting (suckling): difficulty with solid foods, poor articulation 3. Palmer: difficulty with fine motor skills, messy hand writing 6 Months 1. Asymetrical tonic reflex: poor hand-eye coordination, poor visual tracking while learning to read and write 2. Spinal Galant reflex: may affect posture, coordination, attention, ability to sit still, wet the bed

Answer 47

fatigue reflex – generally do something that over stimulates reflex until it starts to go away Frequency of exercises is more important than intensity

Answer 48

Misshapen baby head after 6/12 most common on supine sleeping

Answer 49

* tummy time * move cot around * use toys to get rotation - helmet 23h/24 a day - before 1yr. **Osteo** **treatment for Cx, Tx, upper ribs, cervical musculature, jaw**

Answer 50

* Improve development of neck, back, shoulder mm. * 0-3m = couple minutes several times * 3+ more than 1h tummy time

Answer 51

Duration of Symptoms Trauma Preceding illness (a simple viral infection can preced transient synovitis or reactive arthritis) Fever or systemic symptoms Pain levels and measures taken to reduce pain Daily pattern – worse in Am/PM only with activity? Previous injuries

Answer 52

* **Always do scoliosis** * AROM - All joints – knee pain can come from hip, thigh pain from the spine * Internal rotn hip loss: Legg-Perthes disease, slipped capital femoral epiphysis Trendelenburg * Galeazzi (knee heights) * Faber * Pelvic compression * Psoas sign

Answer 53

In most children limping is caused by a mild, self-limiting event like a sprain, strain or contusion change inactivity Always investigate can be life-threatening (osteomyelitis??) Woodling not normal after 3

Answer 54

* Trauma (eg fracture, sprain etc) * Overuse syndromes * Infections (osteomyelitis, septic arthritis) Malignancy * Rheumatological disorders and reactive arthritis Intra-abdominal pathology (appendicitis) Inguinoscrotal disorders (eg testicular torsion) Transient synovitis of the hip * **Non-accidental or inflicted injury (abuse) ??**

Answer 55

If in doubt refer Imaging: Xrays – Perthes, tumours, dysplasia of hips Ultrasound – septic hip Bone scan – osteomyelitis, Perthes, occult fracture CT/MRI usually only done after orthopedic consultation

Answer 56

* Fever, systemic upset (malaise, weight loss, night sweats) * Lymphadenopathy, hepatosplenomegaly Bone pain * Pain described as deep, not localised and not associated with trauma * Persistent night waking * Incongruence between history and presentation/pattern of physical findings * **Regression - ALERT - can't do the same as before sign of underline pathology**

Answer 57

Cancer * Osteosarcoma * Ewings sarcoma * Acute lymphoblastic leukemia * Rhabdomyosarcoma Infection * Osteomyelitis * Septic Arthritis

Answer 58

* Forms from osteoblasts. Usually at the ends of long bones * Most common in 10-25 years old * Pain and swelling over bone or joint, most commonly affects the knee * Bone that breaks for no reason

Answer 59

* Forms in bone marrow, tends to be extensive in the bone shaft * Peak incidence between 10 and 25 years old * Pain or swelling, pain worse at night * Lump that feels soft and warm in legs, arms, chest or hips * Fever, tiredness, weight loss

Answer 60

* Overproduction of immature white blood cells * Most common type of childhood leukemia and most common childhood cancer More common in children aged 0-14 * Slow healing, infections, unexplained bleeding or bruising * Anaemia: tired, dizzy, pale, shortness of breath

Answer 61

* Can occur anywhere, but head and neck, trunk, extremities and genitourinary system most common * **Lump or** swelling that keeps getting bigger Bulging eye, headache * Difficulty urinating or with bowel motions

Answer 62

* subacute onset of limp * refusal to use limb * localized pain on movement * renderness * soft tissue redness and swelling * fever +/-

Answer 63

* Refusal to use limb * acute onset limp * pain on movement or rest * limited ROM * soft tissue tenderness and redness * fever

Answer 64

diagnosis of exclusion * Most common reason for a limp in children aged 3-8 * "irritable hip”, involves inflammation of the synovium of the hip joint * Recent history of viral URTI * Usually able to walk but with pain. * Pain usually felt in the groin, sometimes in the front of the thigh or knee * Child otherwise afebrile and well * Decreased ROM in hip especially internal rotation

Answer 65

* Avascular necrosis of bone, breaks more easily and heals poorly * Usually occurs in children aged 4-10 years old and more common in boys * Insidious onset, but may occur after injury to hip * Usually unilateral * Symptoms: * gradual onset of pain in the hip and sometimes the knee. * Limping, slow joint movements, sometimes wasting of thigh mms

Answer 66

* Epiphyseal plate on femur slips down and backwards * Can happen spontaneously and not associated with injury * More common in boys, and obesity is a significant risk factor * Symptoms develop slowly, * may seem like a pulled muscle in groin, hip, thigh or knee * On examination show shortening of one leg * Usually a progressive condition, most children need operation to resolve

Answer 67

* Umbrella term used to describe the many autoimmune and inflammatory conditions that can develop in children under 16 * No known cause, possible genetic predisposition * No cure, early diagnosis and treatment are essential. Remission is possible * Common symptoms are joint pain and swelling, but some types affect the musculoskeletal system while others involve eyes, skin, muscles and gastrointestinal tract

Answer 68

Cause is unknown, no evidence that growth is painful. Doesn’t happen only when growth is occurring _Cramping, aching or throbbing pain_s of the thigh, shin and calf; typically at **evening or night** Moving the legs does not make the pain better or worse Pain does not cause a limp May awaken child at night, disappears by morning No pain with activity

Answer 69

* _Traction apophysitis_ of the tuberosity of the fifth met, due to peroneus brevis tendon * Most seen between 8 – 13 year old **History:** * Pain in lateral aspect of foot * Worse with activity, better with rest * Not always history of trauma to the foot **Phys exam:** * Tenderness over base of 5th met * Pain with resisted eversion and extreme plantar flexion **Treatment:** * REST * Analgesics * Ice pack after activity * Slow, guided return to sports / aggravating activities * Manual therapy to help improve flexibility and function of leg * Very severe symptoms may require case immobilization or controlled ankle motion walker (CAM boot) * If conservative management fails and results in nonunion of the bone, surgical excision

Answer 70

_Traction apophysitis at calcaneus_ Active children aged 9 – 13, especially those who do running or jumping **History:** * Pain over posterior heel * Pain worse with activity or impact **Phys exam:** * squeeze test - positive * Hypertonic Achilles tendon Positive squeeze test * Pain over calcaneal apophysis **Treatment:** * REST * Analgestics * Ice to the area after activity * Slow, guided return to sports/ aggravating activities * Stretching or massaging Achilles tendon, gastrocs, plantar fascia etc * Use a heel cup or heel pad Taping * Immobilization if pain is severe, ongoing or persistent

Answer 71

_OSD traction apophysitis at tibial tubercle_. Bilateral 20-30% of the time More common in boys. Boys 12-15, girls 8-12y. More common in jumpers or sprinters **History:** * Pain on anterior aspect of knee * Aggravated with running, jumping, squatting, kneeling **Phys exam** Enlarged tibal tuberosity Tenderness over tibial tubercle Pain on resisted knee extension **Treatment:** *

Answer 72

_Eccentric contraction of a muscle causes avulsion_ Most often in ages 14-17, more in males. Occurs mostly in sports involving kicking **History** ‘pop’ feeling in pelvic Pain and weakness on affected side **Phys exam** * Antalgic gain * Anterior hip/pelvis pain * Pain at mm origin with active resisted **Treatment**: * Bed rest * Ice after activity Activity modification * Rehab aimed to increase flexibility and improve range of motion

Answer 73

_Splitting of osteochodrosis, small area of avascular subchondral bone_ Most often on convex articular joint surface (knee, elbow, ankle, hip, talus) **History** * Pain that is vague and poorly localized Ongoing swelling in joint **Phys exam** * Localised tenderness Stiffness and swelling * Wilsons test for knee – pain w/ int rotn and extn of knee, rel of pain w/ external rotn **Treatment:** * Stable lesions: * Restricted weight wearing/load bearing of joint * Bracing * Instability, expanding lesions, conservative management failure * Arthroscope * Fixation * Chondral resurfacing

Answer 74

F\>M Idiopathic * Infintile: 2 * JuvenileL 2-10 * Adolescent: 12+ most common Congenital Neuromuscular Paralytic

Answer 75

Left thoracic curves – convex left / concave right * Spinal cord tumors Neuromuscular disorders * Arnold-Chiari malformations or occult syrinx * Severe pain * Neurological * Neurological deficits * Midline hairy patches Café au lait spots

Answer 76

**Less than 60 degrees kyphosis** * Stretching, lifestyle modification, physical therapy * No significant long term sequelae **Kyphosis 60 – 80 degrees and/or symptomaticBracing for 12-24 months** * Most effective in skeletally immature patients * Does not improve curve, but impedes progression **Kyphosis more than 75degrees with unacceptable deformity, pain and/or neurological deficit** * Surgery

Answer 77

Headache is one of the main reasons children are taken to emergency departments Most are benign and have common triggers – missed meals, dehydration, tiredness etc Discerning between primary and secondary HA is essential, to ensure any serious conditions are not missed

Answer 78

Changing quality of headache from usual * HA that occurs in awakening or awakens child from sleep Declining school performance * Functional changes (vision, gait, coordination, behavior)

Answer 79

Initial questions: Onset, duration, temporal pattern, frequency, location, quality, severity Back ground factors: Medication use, systemic illness, fever, vomiting, visual symptoms, seizures, trauma, family history

Answer 80

* Lifestyle factors – regular meals and hydration, avoiding trigger foods Regular sleeping routine * Balance between school, sports, TV, computer games * Relaxation and meditation * Headache diary – record times, places, events, foods, sleep etc every day to try determine any patterns or triggers * Consider referral to dentist for assessment of TMJ, teeth, grinding etc Musculoskeletal treatment as per HA type * Also need to consider co-occurring psychological problems and psychosocial factors