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Pediatrics > Exam stuff > Flashcards

Exam stuff Flashcards

1
Q

slide 6 packet 1: principles of development

A

look at slide?

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2
Q

Flexors vs extensors: Tone, antigravity, weight bearing

A

Tone: flexor tone before extensor

Antigravity: Extensor antigravity control before flexor

Weight bearing: Weight bear on flexed extremities before extended

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3
Q

Spiral nature of development mean?

A
  • you revert to more perfected skills under stress
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4
Q

skillful movements should become what?

A

automatic/subcortical

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5
Q

Pre-requisites for skillful movement

A
  • automatic/subcortical
  • need foundational skills before higher level skills
  • appropriate postural set for anticipated moment is present
  • static and dynamic posture
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6
Q

Static posture gives what?

A

stability

start with head control

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7
Q

Dynamic posture gives what?

A

mobility

start with rocking

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8
Q

What are the 3 phases of intrauterine development?

A
  • germinal: conception to 2 weeks
  • embryonic: 3-8 weeks post conception
  • fetal: 8-38 weeks post conception
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9
Q

Why is pregnancy considered to be 40 weeks when fetal ends at 38 weeks post conception?

A

Because pregnancy is considered to start at the last menstrual period. 2 weeks before conception

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10
Q

Why should we study intrauterine development?

A
  • this is where development begins. not at birth
  • quality of postnatal life depends on pre and perinatal events
  • postnatal mvmt is reflection of prenatal patterns
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11
Q

Hookerā€™s study on intrauterine development

A
  • need sensory input for motor output

- at 7.5 weeks gestation have first sensitivity to stim.

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12
Q

According to Hooker, by birth all cutaneous sensitivity is developed except for where? and why is this important

A
  • except for top and back of head.

- protective for birth.

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13
Q

Okapiā€™s studies on intrauterine development

A

challenged Hooker
- said motor responses occur in embryo as early as 4 weeks without afferent input
(study not sure if gestation or conception)

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14
Q

Meiosis

A
  • cell reduction and division; one of each of 23 pairs of chromosomes in each sex cell from each parent unite
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15
Q

Zygote

A

fertilized egg

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16
Q

Mitosis

A

Repeated cell division of zygote (2 cells to 4 to 8 to blastocyst)

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17
Q

Blastocyst

A

Day 5 of gestation (approx. 60 cells)

  • the stage of the embryo during implantation
  • implantation occurs between day 5 and 10
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18
Q

cell differentiation

A
  • cells continue to inc and differentiate into specialized cells
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19
Q

Embryonic landmarks - 5 weeks gestation (3 weeks post conception)

A
  • neural tube is forming
  • recognizable head
  • tail folds
  • optic vesicles
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20
Q

Embryonic landmarks - 6 weeks gestation (4 weeks post conception)

A
  • neural tube closes
  • heartbeat begins
  • recognizable organs
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21
Q

Embryonic landmarks - 7 weeks gestation (5 weeks post conception)

A
  • brain divides into 3 parts
  • peripheral nerves appear
  • arm and leg buds
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22
Q

Embryonic landmarks - 10 weeks gestation (8 weeks post conception)

A
  • facial features (eyes, ears, nose, mouth)
  • digits
  • sensory organs developing
  • begin bone ossification
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23
Q

full term pregnancy is how long and what are the trimesters

A

full term = 37-40 weeks

1st tri= week 1-14 (14)
2nd = week 15-27 (13)
3rd = week 28-38/40 (11-13)

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24
Q

post term = 40-42 weeks. what is the importance?

A

placenta deteriorates at 42 weeks

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25
Q

what is a pre-term baby?

A
  • less than 37 weeks
  • immature lung development cause anoxia and hypoxia that can damage brain first, eyes, gut, liver, kidneys and all other organsā€¦.
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26
Q

How does the fetus get nourishment and expel waste?

A
  • O2 and nutrients from umbilical cord and placenta
  • CO2 and waste carried away by maternal blood

** quality of fetal nourishment is dependent on motherā€™s behavior

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27
Q

Fetal landmarks at 12 weeks gestation

A
  • sex recognizable
  • large head, small body
  • brain configuration near completion
  • bone marrow producing blood
  • startle, suck, swallow reflex
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28
Q

fetal landmarks at 16 weeks gestation

A
  • motor behavior
  • hair on head
  • heart developed
  • sensory organs formed
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29
Q

fetal landmarks at 20 weeks gestation

A
  • legs longer
  • myelination of spinal cord beginning
  • auditory system response
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30
Q

at 24 weeks gestation

A
  • ** limits of viability (ability to survive outside uterus)
  • beginning movements similar to respiration
  • layers in cerebral cortex
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31
Q

at 28 weeks gestation

A
  • fat tissue increases
  • retina light receptive
  • forceful eye blinking with startle
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32
Q

at 32 weeks gestation

A
  • weight increasing faster than length

- taste

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33
Q

at 36 weeks gestation

A
  • body more rounded

- distal femur begins to ossify

34
Q

at 40 weeks gestation

A
  • prox tibial ossification
  • beginning brain myelination
  • pulmonary branching 2/3 complete
35
Q

teratogens

A
  • any agent that can disturb normal development of fetus
  • greatest vulnerability during first 16 weeks of gestation.
  • i.e., alcohol, nicotine, cocaine, and other recreational or prescription drugs
36
Q

Extrinsic factors that can influence fetus (besides teratogens)

A
  • excess pressure on fetus
  • temperature extremes
  • environmental pollutants
  • radiation
37
Q

**what 2 brain structures are most sensitive to prenatal alcohol exposure?

A
  • corpus callosum (responsible for communication between right and left side)
  • cerebellum (processes input from other areas to coordinate motor and cognitive skills)
38
Q

What hormone is released by motherā€™s hypothalamus around birth? and what is exogenous form?

A

oxytocin

-exogenous = pitocin

39
Q

What is the ideal position for a baby during birth?

A

head down, face down

  • (vertex presentation, occipito-anterior )
40
Q

Why is a vaginal delivery ideal?

A
  • exposes to natural flora in birth canal
  • pressure of birth helps expel fluid in lungs
  • there are risks associated with forceps and vacuum as well as C-section.
41
Q

neonate definition

A
  • first 28 days

- full term infant

42
Q

Characteristics of full term infants

A
  • physiologic flexion
  • no anti-grav control
  • auditory and olfactory recognition
  • ability to seek out maternal contact
  • demonstrates intelligence and memory associated with prenatal experience
  • long sleep states with inc alertness
  • rhythmical crying that is consolable
43
Q

Physiological flexion

A
  • symmetrical flexor tone in all postures

- flexor tone develops before extensor

44
Q

Preterm neonate

A
  • born lacking physiologic flexion. will never develop.
    (no dominant tone at rest. the more premature, the less flexor tone shown)

-no anti-gravity control

45
Q

Characteristics of neonate: Prone and supine

A
  • flexion
  • head to side (influence ATNR, and protection against suffocation)

Prone = hips and knees flexed so buttocks in air

Supine = hips and knees flexed so feet are not touching surface

46
Q

Characteristics of neonate: pull-to-sitting

A
  • physiological flexion keeps head up in plane with body so it appears to have head control
  • as tone goes away, will have head lag
47
Q

Characteristics of neonate: supported sitting

A
  • no head control
  • no anti-grav extension
  • back rounded in an immature ā€œCā€ curve
  • pelvis is perpendicular to surface
48
Q

when do you start to lose physiological flexion?

A

gradually by 6 weeks of age (definitely gone by 8 weeks)

49
Q

Developing head control in prone

A
  • around 2 months = begins lifting head
  • by 3 months = lift head and upper chest to prop on forearms (POE)
  • at 3 months head = at 45 degrees
  • at 4 months head = at 90 degrees
  • at 6 months = stable POE and face at 90 degrees with chin tuck
50
Q

first proprioceptive weight bearing position for child

A
  • prone on elbows

- important for learning weight shifting

51
Q

How does development progress

A

cepalocaudal direction, proximal to distal direction, gross movement to fine movement

52
Q

weight shifting in prone

A
  • at first weight shift towards face side (side looking at)
  • not functional for development of visually directed reaching
  • need to learn to shift and reach
53
Q

Pelvic mobility in prone

A
  • rock back and forth (post and ant tilting)
  • vestibular stimulation
  • POE -> Laundau (pivot prone/superman) -> POE
    (post tile) -> (ant tilt) -> (post tilt)
54
Q

Laundau position stabilizes what?

A
  • lower trap
55
Q

POE works on what stabilizers?

A

rhomboids

56
Q

Prone on extended arms

A
  • typically achieved by 5 months
  • SA and pec major
  • able to then push into 4 point
57
Q

quadruped/4 point

A
  • typically achieved by 6-8 months (stationary)

- development of hip and shoulder stability in closed chain.

58
Q

Plantigrade

A
  • typically achieved at 10-12 months
  • on hands and feet
  • transition posture for getting from floor to upright standing
  • weight bearing on extended uppers and lowers
59
Q

Locomotion in prone

A
  • scooting and wiggling 0-4 months
  • pivot prone (superman, typically 5-6 months)
  • prone mobility = push backward first, crawling -belly on surface, typically 6-8 months
60
Q

Quadruped locomotion

A
  • creeping (belly off surface)
  • reciprocal moment of uppers and lowers
  • contralateral pattern requires intra axial counter rotation
  • typically develop 8-10 months
61
Q

what are the 2 greatest limiting factor for delayed creeping?

A

-abdominal and adductor strength

62
Q

lifting head in supine/head control

A
  • typically develops ~5 months

- ATNR must be integrated

63
Q

hands to feet/feet to mouth

A
  • develops at 5 months
  • activation of abs
  • development of feet (DF, supination)
  • midline orientation development
  • development of body awareness
  • development of pelvic mobility
  • preparing for prop sitting (also ~5 months)
64
Q

antigravity reaching in supine

A

3 month = each away form body to grasp

4 months = visually direct reach well enough to grasp toy

5 month = hands to midline trunk, knees, feet; crossing midline

6 month = reaching up to parent face

65
Q

development of sitting

A
  • no head control = head bob forward
  • immature C curve of back
  • pelvis perpendicular to surface (if not they are sacral sitting = bad)
66
Q

Head erect and midline in sitting by how many months?

A

4 months. ATNR is integrated and replaced by AG extensor control

67
Q

Posture of back in sitting

A
  • initially immature C curve
  • increasing cephalocaudally, extension develops through trunk
  • by 6-7 months full ext of back
68
Q

Propped sitting

A
  • 5 months
  • infant props with own uppers in forward tripod position
  • independent of external support
  • stability increases with inc in back extension
  • flexion is at hips to maintain this position
69
Q

Independent ring sitting

A
  • 6 months
  • after propped sitting
  • hips flexed and abducted with wide BOS
  • initial position of UE is high guard*
70
Q

What happens after ring sitting becomes stable?

A
  • wt shifting in sitting
  • lean away and recover
  • reach and rotation
  • allows side sitting
71
Q

What is side sitting?

A
  • when ring sitting becomes stable,

- intra-axial rotation to transition in and out of sitting

72
Q

What is hitching?

A
  • locomotion in sitting

- one foot digs into surface to scoot butt forward

73
Q

Transitions in/out of sitting: sitting to prone/quadruped

A
  • IR on hip into side sit
  • WB on UE opposite IR hip
  • cross midline with UE opposite WB UE
  • ext hips = prone
  • raise to quadruped with co-contraction and/add, flex/ext, core stability
74
Q

Transitions in/out of sitting: quadruped to sitting

A
  • ER one hip
  • Flex opposite hip to bring foot in front, use hip/knee ext to push into sitting
  • intra-axial rotation to return to ring sit
  • ** if no rotation, results in W sit
75
Q

W sitting

A
  • IR hips
  • bad. can become habitual
  • can be pathological
76
Q

Development of rolling

A
  • Non-segmental rolling (AKA log rolling)
    - rolling from prone to supine, supine to side lying (not supine to prone)
  • Segmental rolling
    - prone to supine ~5 months
    - supine to prone ~ 6 months
77
Q

Development of erect standing and bipedal locomotion

A
  • early response to being help in standing (0-2 months)
    - positive supporting reaction
    - automatic stepping reflex
    - plantar grasp reflex
    - narrow BOS
    - bears wt on supinated feet (body righting acting on head reaction at initial contact maybe)

-astasia and abasia (months 3 and 4)

  • body takes weight on LE again ~ 5 months
    (begin wt shifting)
  • body takes full wt by 7 months
  • pull to stand ~9-10 months
  • cruising ~ 10 months
  • plantigrade transition ~ 12 months
  • walking independent of support 10-14 months. 12 month common
78
Q

Astasia and abasia

A
  • astasia = takes no weight (3-4 months)

- abasia = takes no steps

79
Q

Develop erect standing

A
  • 5 month body takes weight on LE
  • 7 months = full weight on LE
  • 9-10 = pull to stand
  • 10 months = cruising
  • 10-14 months = walking independent
  • some plantigrade around 12 months
80
Q

can walk up and down stairs at what age?

A

at 2 yrs

81
Q

running vs fast walk time

A

running = 2-3 years

fast walk = 18 months

82
Q

knee change from young age to a little older

A
  • varus
  • to valgus
  • back to normal

Pediatrics (4 decks)

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