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Pediatrics > Torticollis/Genetics/Spine > Flashcards

Torticollis/Genetics/Spine Flashcards

1
Q

Risk factors for torticollis. What are the most common?

A
  • large birth weight
  • male
  • multiple births
  • primiparous mother (1st pregnancy and 1st birth)
  • use of vacuum or forceps assist
  • nuchal cord
  • maternal uterine abnormalities

Most common

  • difficult labor and delivery
  • breech position
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2
Q

torticollis is associate with what

A
  • hip dysplasia
  • clubfoot
  • CBPI
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3
Q

Torticollis is an initial sign in __________ tumors.

- What are symptoms?

A

posterior fossa

- symptoms of headache, nausea, and vomiting

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4
Q

What are the 4 subtypes of torticollis?

A
  • SCM tumor
  • Muscular torticollis
  • Postural torticollis
  • Postnatal torticollis
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5
Q

SCM Tumor torticollis characteristics

A
  • discrete mass palpable on SCM
  • normal x-ray
  • tissue changes - fibrosis, hyperplasia, and atropthy
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6
Q

Muscular torticollis characteristics

A
  • tightness but no palpable mass
  • normal x ray
  • head tilt, ROM limitations, cervical muscle imbalance
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7
Q

Postural torticollis characteristics

A
  • no mass, no tightness of SCM
  • normal x ray
  • head tilt, no PROM limitations, AROM limitations, cervical muscle imbalance
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8
Q

What are possible causes of congenital muscular torticollis?

A
  • benign paroxysmal torticollis
  • congenital absence of cervical muscle(s) or transverse ligament
  • contracture of other neck muscles
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9
Q

Postnatal Muscular torticollis characteristics

A
  • environmental induced (laying on same side)
  • plagiocephaly induced (asymmetrical head)
  • positional preference induced
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10
Q

Which subtype of torticollis will have A/PROM limitations and which subtype will only have AROM limitations?

A

A/PROM limitations - muscular torticollis

AROM limitations only - Postural torticollis

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11
Q

What is the sign for plagiocephaly?

A

Anterior progression of the ear on the same side as the flattened occiput

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12
Q

Brachycephaly

A

a condition where the head is disproportionately wide

- Baby who spends a lot of time on their back

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13
Q

Scaphocephaly or dolichophaly. What population is this common in?

A

a condition where the head is disproportionately long and narrow

Common in babies born prematurely

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14
Q

craniosynostosis. What can this result in?

A

early fusion of the suture of the bones of the skull

- may result in increased cranial pressure

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15
Q

shape of lamboid craniosynostosis head

A

skull takes on trapezoid shape (wider in front, narrower in back)

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16
Q

What are the associated changes in body structure with torticollis?

A
  • decreased ipsilateral cervical rotation
  • decreased cervical lateral flexion

favor extension

  • Will lack flexion and midline control
  • May favor ATNR to side they are facing and may neglect other side
  • Will not like tummy time
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17
Q

Red Flags in Initial Presentation of Torticollis in Children (9)

A
  • age of presentation greater than 6 months
  • pain
  • neurologic findings
  • associated syndromes (down, skeletal dysplasia)
  • trauma
  • inflammatory or infectious history
  • alternating sides
  • atypical position
  • late onset
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18
Q

Motor Characteristics of Children with Torticollis

A
  • supine - trouble centering head to midline
  • bias towards extension and asymmetry
  • visual gaze toward side of head turning
  • prone - altered forearm weight bearing
  • cascade - abdominals, trunk and extremity righting
19
Q

normal PROM neck rotation and lateral flexion for babies

A

neck rotation - 110

lateral flexion - 70

20
Q

What is the muscle function scale?

A
  • used to assess torticollis - football hold baby
    1-6 scale with 1 (head held significantly below horizontal line/most severe) to 6 (head held significantly higher above horizontal line/least severe)
21
Q

indications for a TOT collar

A
  • 4 months or older
  • constant tilt of 5 deg or greater for more than 80% of awake time
  • perform all movement and motor skills w/ tilt
  • adequate ROM and head tilting reactions
22
Q

discharge guidelines for torticollis

A
  • full PROM and AROM
  • maintain midline 95% of time
  • no compensatory pattern
  • = and age appropriate head righting
23
Q

contraindications for cranial orthoses

A
  • craniosynostosis
  • unshunted hydrocephalus
  • children beyond 18 months of corrected age
  • babies under 3 months of age
24
Q

Monogenic, polygenic, cytogenetic

A

mono - single gene involved

poly - many genes involved

cyto - large-scale changes in chromosomes

25
Q

What are the 4 categories of genetic disorders?

A
  • chromosomal - not hereditary
  • single gene
  • multifactorial
  • mitochondrial
26
Q

chromosomal disorder

A

deletions, inversions, duplications, translocations

- not hereditary

27
Q

signs of down syndrome

A

cloudy eyes

horizontal line across palm

28
Q

_________ is most common health problem with 40% having malformations in down syndrome

A

coronary heart disease

- cardiovascular issues

29
Q

What is Turner and Klinefelter?

A

sex chromosome disorders

  • Turner (1 X chromosome - female)
  • Klinefelter (2 X and 1 Y chromosome - male)
30
Q

Marfan’s syndrome has what type of issues?

A

CV issues

31
Q

Cri-du-Chat

A

cat like cry as infants

- low birth weight, hypotonia, cognitive impairments, clumsiness

32
Q

Prader Willi

A
  • excessive eating by 2 years of age

- behavior issues

33
Q

occulta spina bifida

A
  • failure of vertebral arches to meet & fuse in 3rd month
  • Overlying skin may be marked by dimple, pigmentation, or patch of hair
  • no neurological or MSK dysfunction
34
Q

meningocele or myelocele

A
  • spinal cord vertebral canal but may be abnormal
35
Q

myelomeningocele

A

extensive spinal cord abnormalities

- spinal cord and meninges out of vertebral canal

36
Q

anencephaly

A

cranial end of neural tube does not fuse

37
Q

bulging fontanelle and sunset sign are signs of what

A

shunt malfunctioning in infants

38
Q

What is arnold chiari malformation? What are symptoms?

A

brainstem and cerebellum herniate through foramen magnum

- respiration, paralysis of vocal cords, apnea, swallowing, abnormal gag, UE weakness

39
Q

What is hydromyelia? What are symptoms?

A

dilation of the center canal of spinal cord

- rapidly progressive scoliosis, UE weakness, spasticity, ascending motor loss in LE

40
Q

What is tethered cord? What are symptoms?

A

pathological fixation of the spinal cord in an abnormal caudal location
- decreased strength, LE spasticity, back pain at sit of sac closure, change in urological function

41
Q

What can flaccid LE or frog leg position cause?

A

hip abduction tightness which can limit movement from sitting to quaddrapped

42
Q

what muscles are strong in high lumbar kids? What does this put them at risk for?

A

strong hip flexors and adductors

- increased risk for dislocations

43
Q

What muscles are strong in low lumbar spinal injury kids?

A
  • strong hip flexors and adductors
  • some hip abduction
  • strong quads and medial hamstrings
  • anterior tib and some foot intrinsics
44
Q

What muscles may be weak with sacral level spinal injuries? What may this cause?

A

gastroc weakness - need AFO for gait

- can lead to crouched gait and increased weight gain

Pediatrics (5 decks)

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