Week 14- Screening in Special Popuulations Flashcards
PART 1: PEDIATRIC/ADOLESCENT PATIENTS
PART 1: PEDIATRIC/ADOLESCENT PATIENTS
What are some things to keep in minds in regards to pediatric/adolescent populations? (3)
- Ask patient and caregiver preference for the presence of caregiver during examination.
- Remember to talk to the patient and not around them.
- Keep modesty in mind.
Pediatric/Adolescent Pathologies. (7)
- Meningitis
- Neoplastic Disorders
- Osteochondritis (Legg-Calve-Perthes, Freiberg’s Panner’s, -Keinbock’s)
- Disorders of Epiphyseal Growth (Slipped Capital Femoral Epiphysis, Adolescent Idiopathic Scoliosis)
- Myositis Ossificans
- Female Athlete Triad
- Heat Illness
Meningitis:
- What is it?
- Most cases are caused by ______ infection.
- 20% of cases occur in individuals ___-___ years of age.
- Inflammation of membranes (meninges) surrounding brain or spinal cord.
- viral infection
- 14-24 years
What are the (3) hallmark symptoms of Meningitis?
- Fever
- HA
- Stiff/painful neck
Meningitis Risk Factors:
-Skipping __________
-
- skipping vaccinations
- <5 years old
- <20 years old
- immune system
Neoplastic Disorder:
- Bone tumors are usually ______ tumors that usually do not cause constant severe pain associated with malignant tumors.
- Can manifest as pathological _______.
- benign
- pathological fracture
Bone Tumors S/Sx. (5)
- Soft tissue swelling
- Tenderness
- Joint pain
- Presence of mass without history of trauma
- Night pain, pain unrelated to position, fever, weight loss, night sweats, fatigue
Osteochondrosis:
- ______ _______ of the ________.
- ___________ disorders seen in the immature skeleton.
- Most common in _____ years of growth (__-__ yo).
- Does it affect boys or girls more?
- Does it affect lower or upper limbs more?
- Present bilaterally ___-___% of the time.
- Avascular necrosis of the epiphysis
- idiopathic
- middle years (3-10)
- boys > girls
- lower limbs > upper limbs
- 10-15%
What are the (4) types of Osteochondritis?
- Legg-Calve-Perthes Disease (LCP disease)
- Freiberg’s Disease
- Panner’s Disease
- Keinbock’s Disease
Legg-Calve-Perthes Disease:
- Most ______/________ of LE osteochondritis diseases.
- Involves pressure epiphysis of proximal _____.
- Is it more common in boys or girls?
- What ethnicity is more at risk?
- Most often occurs between __-__ years old.
- Bilateral __-__% of time.
- What is the cause?
- common/serious
- proximal femur
- boys > girls (5:1)
- caucasian > AA (10:1)
- 4-8 years old
- 10-15%
- unknown cause
Legg-Calve-Perthes Disease S/Sx. (3)
- Limping
- Pain/stiffness in hip, groin, thigh or knee
- Limited ROM of hip joint
Freiberg’s Disease:
- Osteochondritis of pressure epiphysis of ___________.
- Results in ________ pain with _____.
- Is it more common in males or females?
- May occur secondary to what?
- How is it treated?
- metatarsal heads
- forefoot pain with WBing
- females > males
- long 2nd metatarsal or short 1st metatarsal
- shoe modifications to redistribute weight
Panner’s Disease:
- Osteochondritis of capitellum of the _______.
- MUST BE RULED OUT in pts 3-11 years old presenting with what S/Sx?
- How is it treated?
- What is the prognosis?
- capitellum of humerus
- 3-11 yo with S/Sx including PAIN, SWELLING, and LIMITED ROM in elbow joint
- Treated with immobilization in sling.
- Prognosis good giver non-WBing nature of elbow joint.
Keinbock’s Disease:
- Osteochondritis of _______.
- What age group is this most common in?
- Healing is _____ in adults compared to children/adolescents.
- How is it treated?
- lunate
- late adolescence to young adulthood
- slower
- Treated by excision of lunate before degenerative changes develop in surrounding carpals.
Keinbock’s Disease S/Sx. (3)
- Aching in wrist
- Tenderness over lunate
- Swelling secondary to repetitive microtrauma
Correctly identify the following pathologies:
- )Most common/serious LE osteochondritis involving pressure epiphysis of proximal femur.
- ) Osteochondritis of capitellum of the humeris.
- ) Osteochondritis of the lunate.
- ) Osteochondritis of pressure epiphysis of metatarsal heads.
- ) Legg-Calve-Perthes Disease
- ) Panner’s Disease
- ) Keinbock’s Disease
- ) Freiberg’s Disease
What are the (2) main disorders of epiphyseal growth?
- Slipped Capital Femoral Epiphysis (SCFE)
- Adolescent Idiopathic Scoliosis
Slipped Capital Femoral Epiphysis:
- Most common hip disorder seen in ___________.
- _____ (__-__ yo) 2-5x more likely than _______ (__-__ yo).
- What are (3) risk factors for SCFE?
- adolescents
- Males (13-16 yo) 2-5x more likely than Females (11-14 yo)
- obesity, AA, endocrine abnormalities
SCFE S/Sx. (4)
- Limping that increases with fatigue
- Pain in distal thigh/knee
- May have mild hip pain
- Prefer hip flexion, ER, and abduction
Adolescent Idiopathic Scoliosis:
- Develops during pediatric years and typical onset is _______.
- Most common form of scoliosis.
- ______ curvature of the spine.
- Is it more common in males or females?
- What test is used as a screening tool?
- Surgical correction necessary for progressive curves >__-__ degrees
- puberty
- lateral curvature
- females
- Adam’s forward bending test
- > 45-50 degrees
Myositis Ossificans:
- What is it?
- Results as a complication of severe or poorly managed ________.
- Common sites include which muscles?
- Watch for __________ at the site of injury SEVERAL DAYS POST INJURY.
- Formation of heterotrophic bone within the muscle.
- contusion
- quadriceps and biceps brachii
- palpable mass
What are some warning signs of myositis ossificans? (4)
- Marked decrease in ROM
- Significant pain
- Joint effusion
- Decreased function
Female Athlete Triad:
- Refers to the relationship between what (3) things?
- What (3) things does this result in?
- energy availability, menstrual function, and BMD
- energy deficiencies, functional hypothalamic amenorrhea, and osteoporosis
What are some cues to screen for Female Athlete Triad? (3)
- Low body weight
- Current or past stress fractures
- Participation in sport that favors lean body size or that have weight classes
Heat Illness:
- Do children acclimate to heat as well as adults? When does ability to dissipate heat improve?
- What are (2) things that can be done to prevent heat illness?
- No, improves in adolescences
- Limit time platin in hot and humid conditions, ensure adequate fluid intake
Heat stroke is defined as a temp >____.
105 degrees
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PART 2: OBSTETRIC PATIENTS
PART 2: OBSTETRIC PATIENTS
What are some things we should avoid when examining and treating obstetric patients? (7)
- Avoid flat prone lying in mid-late pregnancy.
- Avoid supine position for longer than a few minutes after 4th month of pregnancy (monitor for NAUSEA, BRADYCARDIA, and SYNCOPE)
- Avoid activities that strain the pelvic floor/abdominal muscles.
- Avoid positions that involve rapid uncontrolled bouncing or swinging.
- Avoid overaggressive stretching of hip adductors.
- Avoid overheating.
- Avoid deep heat modalities or electrical stimulation over the trunk.
What is Supine Hypotension Syndrome?
Caused when the gravid uterus compresses the inferior vena cava when a pregnant woman is in a supine position, leading to decreased venous return centrally.
With Supine Hypotension Syndrome, what (3) things do we need to monitor for?
- Nausea
- Bradycardia
- Syncope
What is the suggested positioning for Supine Hypotension Syndrome?
Rotate 30 degrees to left supported with pillows under R side to shift uterus to L and relieve caval occlusion.
