Rourke Baby Record- Physical examination- misc

Question 1

Who should be screened for snoring

Answer 1

all children/adolescents

Question 2

What are next steps if child/adolescents is snoring and has signs/symptoms of OSA

Answer 2

polysomnography

Question 3

What is first line treatment for patients with adenotonsillar hypertrophy

Answer 3

adentonsillectomy

Intranasal corticosteroids are an option for children with mild OSA in whom adenotonsillectomy is contraindicated or for mild postoperative OSAS.

Question 4

How do you assess muscle tone in infants?

3

Answer 4

• observe if baby is stiff (hypertonia) or floppy (hypotonia)
• do they hold head appropriately for age
• do they favor one side or fail to move one side

Observe and palpate the muscles for:

Hypertonia: Increased resistance to passive movement.
Hypotonia: Floppy muscles, decreased resistance to passive movement.

Question 5

When checking deep tendon reflexs of an infant what does hyperreflexia and hyporeflexia indicate

Answer 5

hyperreflexia - upper motor neuron disorders like CP
hyporeflexia - peripheral nerve or lower motor neuron disorders

Question 6

What are primitive reflexes

Answer 6

automatic, involuntary movements present at birth that disappear as the nervous system matures

Question 7

What is the Moro reflex

Answer 7

the startle reflex that is a primitive reflex where babay throws arms out and then brings them back in response to sudden drop or noise

Question 8

What is the asymmetric tonic neck reflex

Answer 8

Primitive reflex when the head turns to one side, the arm on that side extends and the opposite arm flexes (fencing posture)

Question 9

What is the palmar grasp reflex

Answer 9

primitive reflex where baby grips object placed in palm

Question 10

When do primitive reflexs disappear

Answer 10

by 5-6 months of age

Question 11

What does the persistence of primitive reflexes beyond 6 months indicate

Answer 11

delayed or abnormal brain development

can be early sign of CP, neuromotor disorder, CNS dysfunctions

Question 12

Why is routine hip examination necessary for infants

Answer 12

Screening for developmental dysplasia of the hip (DDH)

Question 13

What is developmental dysplasia of the hip

Answer 13

abnormal development or dislocation of the hip joint

–> can lead to long-term complications such as gait abnormalities or early-onset arthritis if untreated

Early detection allows for effective treatment, such as bracing or surgery, to prevent permanent joint damage.

Question 14

Is there routine imaging needed to screen for hip dysplasia

Answer 14

no- just routine examinations

Question 15

How long should infants be examined for hip dysplasia

Answer 15

until 1 year old or child is walking

Question 16

What 2 physical exams are needed when assessing for DDH

Answer 16

• limb length discrepancy
• asymmetric thigh or gluteal creases

Question 17

What are you looking for when checking limb length for DDH

Answer 17

• compare height of keeps when infant is supine with hips and knees flexed (called Galeazzi test)
• difference in knee height suggests femoral shortening or dislocation

Question 18

What are you looking for when checking for asymmetric thigh or gluteal creases

Answer 18

• Inspect the skin folds on the thighs and buttocks for asymmetry
• Asymmetric creases may indicate hip dysplasia but can also be normal, so other findings should confirm the diagnosis.

Question 19

What manoeuvre is done for exams from 0-3 months to check for DDH

Answer 19

Ortolani manoeuvre detects dislocated but reducible hip

Question 20

How do you perform a ortolani manoeuvre

Answer 20

• Place the infant supine with the hips flexed at 90° and knees bent.
• Gently abduct (move outward) the thighs while applying slight anterior pressure on the greater trochanters.
• Positive Ortolani: A “clunk” as the femoral head reduces into the acetabulum, indicating an unstable or dislocated hip.

Note: This manoeuvre is most reliable in the first few months of life, as hip laxity decreases with age.

Question 21

What manoeuvre is done at 3-12 months old to check for DDH

Answer 21

Hip abduction to detect restricted hip mobility

Question 22

How do you perform hip abduction to look for DDH

Answer 22

• Flex the hips and knees to 90°
• Abduct the thighs fully (move outward) and compare the range of motion bilaterally

Positive finding: Limited or asymmetric abduction suggests hip dislocation or dysplasia.

Question 23

What are the 3 cases where infants should have imaging to check for DDH

Answer 23

• infants with normal hip exam but were breech
• family history
• infants with positive findings on physical exam

Question 24

What are sentinel injuries in children

Answer 24

early often subtle injuries that may indicate a risk of child maltreatment (abuse) or a medical condition

These injuries serve as warning signs for healthcare providers to perform a more thorough investigation to rule out abuse or other underlying medical issues.

Sentinel injuries are especially critical in the context of young children, particularly infants and toddlers, as they cannot communicate the cause of their injuries. When a healthcare provider identifies one of these injuries, it can prompt further evaluation to ensure the child’s safety and well-being.

Question 25

Whare are 3 common sentinel injuries

Answer 25

• bruising on face, neck. torso, arms esp under 6 months of age
• subconjunctival hemorrhages ( small blood vessels that break in the white part of the eye, causing redness) - can be from vigorous crying, forceful impact, or shaking like shaken baby syndrome
• intra-oral trauma (Injury to the frenulum (the tissue connecting the lip to the gum), lips, oral mucosa, gingiva, or tongue can be an important signal of abuse. These injuries are often associated with forceful or repetitive trauma (e.g., biting, slapping, or punishing).)