Final Flashcards
(119 cards)
1
Q
T/F
Infant should be able to lift the head and trunk using forearms after 2 months?
A
True
2
Q
T/F
When infant is sitting, kyphosis of the thoracic and lumbar spine is expected until the infant can sit without support?
A
True
3
Q
List the areas on the infant where you should NOT see symmetry.
A
Axillary Crease
Gluteal Crease
Femoral Crease
Popliteal Crease
4
Q
When testing infant muscle strength, hold the infant upright with your hand under the axillae, if the infant maintains the upright position _____ and if the infant begins to slip through your fingers _____
A
Adequate Muscle Strength; Muscle weakness (Arms flop forward)
5
Q
When counting the fingers and toes and you notice and extra digit, what is the term for this?
A
Polydactyly
6
Q
What is the term for webbing of the toes?
A
Syndactyly
7
Q
When palpating an infant, what is the most commonly missed fractures?
A
Clavicle, Long bones
8
Q
What is the term applied for flat-footed (All babies)?
A
Pes Planus
9
Q
What is the term used when the forefoot is adducted, toes-flare inward because of fetal positioning?
A
Metatarsus Adductus
10
Q
What is the term used when there is a slight varus curvature of the tibia because of fetal positioning and is expected to resolve after 6 months of weight bearing.
A
Tibial Torsion
11
Q
When assessing for this condition:
Child prone, knees flexed to 90, align midline of the foot parallel to the femur, using thumb and index finger grasp the medial and lateral malleolus, place other thumb and index finger on either side of the knee. If your thumbs are not parallel what is suspected?
A
Tibial Torsion
12
Q
What is the term used when the foot is “C” shaped, midline of the foot may bisect the 3rd & 4th toes, forefoot should be flexible, if not x-ray it.
A
Metatarsus Adductus
13
Q
What is this exam?…
Infant supine, flex knees to 90
Grasp a leg with each hand, adduct the thighs to the maximum
Apply downward pressure on the femur this is an attempt to disengage the femoral head from the acetabulum.
A
Barlow Exam
14
Q
What is this exam?…
Slowly abduct the thighs while maintaining axial pressure.
Fingertips on greater trochanter, exert a lever movement in the opposite direction, if there’s a “Palpable clunk”- femur slips back into the acetabulum, suspects hip subluxation/dislocation.
A
Ortolani Exam
15
Q
Sign to detect hip dislocation or shortened femur.
Infant is supine, Flex both knees, keep feet flat on table. Femurs aligned with each other, observe height of the knees.
A
Allis sign
16
Q
How do you evaluate congenital hip dysplasia?
A. Asymmetrical thigh and buttock skin folds
B. Decreased abduction
C. Allis’ sign
D. Ortolani/Barlow’s test
A
All of the above
17
Q
What age can a child raise their head?
A
2 months
18
Q
What age does the child roll from prone to supine?
A
4 months
19
Q
What age does the child sit using tripod position?
A
6 months
20
Q
What age does the child begin creeping (cross crawl)?
A
9 months
21
Q
What age does the child stand without support momentarily?
A
12 months
22
Q
This is evaluated while child is standing, distance between knees is 1 inch, is a common finding in toddlers (Up to 18 months) Note any increase on future examination.
A
Genu Varum (Bowleg)
23
Q
Genu Varum may need to be evaluated further if asymmetry of tibiofemoral angle, and the space between the knees is greater than ___ inches
A
2
24
Q
When evaluating the ankles you note a 1 inch space, common in children 2-4 years
A
Genu Valgum, knock knees
25
May need to evaluate genu valgum if: Asymmetry of the tibiofemoral angle and space are greater than ___ inches
2
26
Child rises from a sitting position by placing hands on the legs and pushing the trunk up, "crawl up their legs," indicates muscle weakness. Classic for muscular dystrophy.
Gowers Sign
27
Congenital neural tube defect, incomplete closure of the vertebral column meninges and sometimes spinal cord protrude into a saclike structure. May have tuffs of hair over sacrum.
Spina bifida Myelomeningocele
28
This is most common in girls, progresses during early adolescence, no known cause.
Structural Scoliosis
29
Most cases of scoliosis
Idiopathic
30
This is an autosomal dominant disorder, deficient ossification bones of the cranium, clavicles and pelvis.
Cleidocranial dysplasia
31
```
Complete or partial absence of the clavicles
Defective ossification of the cranium
-Large fontanels
-Delayed closure of the sutures
-Symphysis pubis (Waddling gait)
```
Cleidocranial Dysplasia
32
The condition is most commonly brachial plexus injury (C5/C6)
Erb's Palsy
33
The arm is paralyzed held in "waiter's tip" position
| Grasp reflex is present, absent moro, biceps and radial reflex
Erb's Palsy
34
This is rare, results in weakness of intrinsic muscles of the hand, grasp reflex is absent
Klumpke's Palsy (C7-8, T1)
35
Dislocation injury, common in children 1-4 years old, relatively easy cause: tugging on a child's arm (removing clothing), lifting a child by grabbing the hand, jerking the arm upward while the elbow is flexed
Nursemaid's Elbow; Radial head subluxation
36
Child complains of pain in the elbow and wrist, refuses to move the arm, holds arm slightly flexed and pronated. Supination is resisted
Nursemaid's Elbow
37
This is a common congenital defect, affects female more, varying degrees of involvement: Dysplasia, subluxation, dislocation.
Developmental hip displasia
38
This condition is delay of ossification of the acetabulum (Oblique and shallow), femoral head remains in the acetabulum.
Acetabular dysplasia
39
This condition is incomplete dislocation, femoral head remains in contact with the acetabulum joint ligaments and capsule are stretched (displacement of the femoral head)
Subluxation
40
This condition the femoral head loses contact completely with the acetabular capsule, displaced over the fibrocartilaginous rim
Dislocation
41
This condition the femurs twist medially, patella facing inward, increased internal rotation of the hip >70 degrees, decreased external hip rotation. Toe in of the feet increases up to 5-6 years of age, tibia may twist laterally to compensate
MC in Females
Associated with reverse tailor sitting.
Femoral Anteversion
42
This congenital defect of the ankle and foot, inversion of the foot and plantar flexion, affects males, bilateral involvement 30-50% of cases, 10% chance of subsequent child being affected. 1/1000 live births
Talipes Equinovarous
43
This is an exaggerated dorsiflexion (Calcaneous in valgus position and forefoot abducted), up to 1% of live births, probably due to abnormal intrauterine position, most resolve spontaneously (Reduces when weight bearing).
Talipes Calcaneovalgus
44
MC congenital foot deformity, caused by intrauterine positioning, may be fixed or flexible.
Metatarsus Adductus
45
Caused by a vascular insufficency, compression microfractures, necrosis of entire epiphysis may occur.
Epiphyseal osteochondritis
46
Epiphyseal osteochondritis of the hip
2-10 years
Symptoms: limp, school aged, complaining of leg pains (Knee)
Legg-Calve-Perthes Disease
47
Epiphyseal osteochondritis of the knee
9-15 years
Symptoms: Pain, swelling of the tibial tuberosity. Manage this by REST
Osgood-Schlatter disease
48
Group of genetic disorders, gradual degeneration of the muscle fibers
Progressive weakness, muscle atrophy, pseudohypertrophy from fatty infiltrates, GOWER Sign
Muscular Dystrophy
49
CN? Optical Blink Reflex, Dolls Eye maneuver
CN II, III, IV, and VI
50
CN? Rooting Reflex & Sucking Reflex
CN V
51
CN? Evaluating with facial N.
CN VII
52
CN? Acoustic blink
CN VIII
53
CN? Swallowing and Gag Reflex
CN IX and X
54
CN? Suck, Swallow and Tongue midline test
CN XII
55
What reflex is present at birth?
Patellar
56
What two reflexes appear at 6 months?
Achilles and Brachioradial
57
T/F
| Ankle Clonus is common
True
58
Positive-fanning of the toes and dorsiflexion of the great toe, retained until 16-24 months of age, this is normal under age 2
Babinski Sign
59
List Primitive Reflexes present in newborn
```
Yawn, Sneeze
Hiccup
Blink at bright light and loud sounds
Pupillary Constriction w/light
Withdrawal from painful stimuli
```
60
Most disappear by 6 months, replaced with more advanced skills, babinski up to 2 years, fencer's peak at 2-4 months
Automatisms
61
Infants head midline, touch palm of the infants hand from the ulnar side, note strong grasp of your finger, suckling facilitates grasp, strongest b/t 1-2 months, disappears by 3 months.
Palmer Grasp (Birth)
62
Touch the plantar surface of the infants feet at the base of the toesm toes should curl downward, strong up to 8 months
Plantar Grasp (Birth)
63
Infant supported in semi-sitting position, allow head and trunk to drop back to a 30 degree angle, observe symmetric abduction and extension of the arms, the arms then adduct in an embracing motion, followed by relaxed flexion, legs follow a similar pattern, diminishes in strength by 3-4 months
Moro Reflex (Birth)
64
Hold the infant upright under arms, touch the dorsum of the foot to the edge of a flat surface, observe flexion of the hips and knees and lifting of the foot (As if stepping up), age of disappearance varies.
Placing Reflex (4 days)
65
Hold the infant upright under arms, allow the soles of the feet to touch the surface of the table, observe for alternate flexion and extension of the legs (Walking) disappears before voluntary walking.
Stepping Reflex (birth-8 weeks)
66
Infant supine, turn head to one side, observe for ipsilateral extension & contralateral flexion of the arms and legs, repeat-turing head to other side. Diminishes around 3-4 months and disappears by 6 months.
Asymmetric Tonic Neck (2-3 months)
| aka Fencer's
67
Suspend the infant prone over your hand, stroke paraspinally from shoulders to the buttock, trunk should curve toward the side stroked.
Galant (Birth to 4 months)
68
Suspend infant prone over your hand, stroke over the spinous processes from sacrum to occiput, infant extends head and brings knees to chest. Urinates.
Perez (& Pee) Reflex
69
Suspend infant over both hands, observe the infants ability to lift its head and extend its spine on horizontal plane, diminishes by 18 months, disappears by 3 years
Landau Reflex
70
Hold infant suspended (Prone), slowly lower headfirst toward a surface, observe the infant extend its arms and legs (protecting itself), this reflex should not disappear.
Parachute (4-6 months)
71
T/F exercise for PHD: Supervised "Tummy time" on firm surfaces when the infant is awake and being observed, if torticollis is present parents should be taught specific neck motion exercises (head rotation and lateral bend) this should be done at diper changes.
Hold for 5 sec and 2 repetitions
False, Hold for 10 seconds and 3 repetitions.
72
Neurologic disorder that is categorized under the umbrella of pervasive development disorders, is characterized by severe and pervasive impairment in several areas of development.
Autism
73
What are the causes of autism
No single cause, but suspected causes are:
- heredity; genetic
- pregnancy complications
- viral infection & metabolic imbalances
- exposure to environmental toxins, vaccines. (MMR)
74
T/F Prevalence of Autism, 2-6 individuals per 1000 have an autism spectrum disorder.
True (1/166)
75
T/F
| Autism is 4x more prevalent in females
False, Males.
76
Common traits of Autism
Insistence on sameness, resistance to change
Difficulty in expressing needs
Using gestures or pointing instead of words
Repeating words, instead of normal language
Prefers alone time
Tantrums
Not wanting to cuddle or be cuddled
Little to no eye contact
77
One aspect that differs Asperger's from Autism is?
Language development
78
T/F
| Children with Aspergers syndrome often grasp language quite quickly, sometimes advanced development for their age group.
True
79
T/F
Children with Aspergers syndrome tend to talk exclusively at great length about their favorite topics, such as dead presidents, meteorology, star wars, bambi, and may develop an impressive vocab.
True
80
The sudden death of an infant under 1 years old, which remains unexplained after thorough case investigation.
SIDS
81
Infant supine, turn head to the side, observe the infant turn its whole body in the direction of the head is turned. (3 Months after tonic neck disappears)
Neck Righting Reflex
82
T/F
| Deep tendon reflexes use the same technique as adults, response should be the same.
True, may use fingers instead of reflex hammer
83
These are nonfocal, functional neurologic findings; they provide subtle cues to an underlying diseases.
Neurological Soft Signs
84
Children with multiple soft signs are often to have what?
Learning Problems
85
A few examples of soft signs include:
```
Walking
running gait
heel walking
tip-toe walking
tandem gait
one foot standing
hopping in place
motor stance
visual tracking
rapid thumb to thumb
finger-nose
right left discrimination
2 pt discrimination
Graphesthesia
Sterognosis
```
86
```
This is episodic, sudden involuntary contractions of a group of muscles. Excessive discharge of cerebral neurons, may be caused by systemic disease, head trauma, toxins, stroke, hypoxic syndrome.
May see disturbances in:
-Consciousness
-Behavior
-Sensation
-Autonomic function
```
Generalized Seizure Disorder
87
Inflammatory process in the meninges, S&S fever, chills, nuchal rigidity, headache, seizures, vomiting, altered level of consciousness
Infant: Very irritable and inconsolable, fever, diarrhea, poor appetite, toxic appearance
Meningitis
88
Inflammation of the brain and Cord. Quiescent stage of often precedes the disturbances in CNS function (headache, drowsiness, confusion) progression to stupor and coma. Motor functions may be impaired, severe paralysis and ataxia.
Encephalitis
89
Abnormal growth of the neural & non-neural tissue within the cranium, peak age of incidence: 3-12 years and 50-70 years. Threaten function by compression or destruction of tissue.
SOL/Intracranial tumor
90
Non-progressive neuromuscular disorder, results from insult to the cerebellum, basal ganglia, or motor cortex, disability depends on the extent of damage.
Signs: Delayed Motor development, altered muscle tone/performance/reflexes , abnormal posture.
Cerebral Palsy
91
Progressive encephalopathy associated with AIDS, Impaired brain growth.
Signs and Symptoms:
Progressive motor dysf.
Regression of develp. milestones
Generalized weakness. Signs of UMN lesion
HIV Encephalopathy
92
Progressive encephalopathy, unknown cause, girls b/t 6-18 months of age.
Signs and symptoms:
-loss of voluntary hand movement, loss of hand skills
hand wringing movements
Gradual development of ataxia & Rigidity, growth retardation, seizures, Loss of facial expression deceleration of head growth.
Rett Syndrome
93
Hold infant upside down, making sure to have a solid grip on their ankles, release one foot slowly watch child turn head to that side, repeat.
Reverse fencer Part 1 (Heel swing)
94
Reverse fencer part 1, compare bilaterally, what 2 things are you looking for?
Restriction or twitching
95
If child arches back during Reverse fencers part 1
Meningeal tension and adjust C spine, occiput, sacrum
96
Infant supine, apply pressure along shaft of femur into acetabular fossa, compare bilat. the spongy side is said to be what?
Atlas laterality, during part 2 of Reverse fencer
97
Negative heel swing response indicates what?
Subluxation b/t Atlas-Axis or Atlas-Occip.
98
T/F
| Supine leg check, long leg is said to be the side of atlas laterality?
True
99
Cold side or hot side is said to be side of atlas laterality
Cold side
100
Atlas fossa: R 85 L 86, no other findings in C spine, what is the issue?
Sacrum
101
EX ilium is toe out or in
Toe in
102
Inward tibial or femoral torsion, toe out or in?
Toe in
103
Weak psoas or Glute max and CP bilaterally, toe out or in?
Toe in
104
IN ilium, toe out or in?
Toe out
105
Psoas, piriformis, or glute max spasm, toe out or in?
Toe out
106
T/F
If you see gluteal cleft deviation, may either be to the side of posterior-inferior SI sublux or the side of Anterior-inferior sacral movement at the Lumbosacral jx.
True
107
Sacral Dimples have asymmetry, this suggests?
Pelvic Misalignment
108
Infant's occiput is significantly fixed, the infant is irritable even with you do what?
Light Palpation
109
If the infant has an AS occiput, when adjusted the infant becomes relaxed and may even do what?
Fall Asleep
110
Premature fusion of the sagittal suture, MC craniosynostosis (>50%) head is elongated in AP diameter and short in the biparietal diameter, ridging of sagittal suture is palpable.
Scaphocephaly
111
Premature fusion of both coronal sutures, increased biparietal diameter, shorter AP.
Brachycephaly
112
Premature fusion of metopic sutures, results in pointed forehead, usually mild and requires on surgical intervention.
Trigonocephaly
113
There are 2 causes of this:
1. craniosynostosis of the lambdoid sutures
2. Positional molding
Posterior Plagiocephaly
114
T/F
| In-utero or intrapartum molding, and cranio synostosis are differentials included if plagiocephaly is present at birth.
True
115
T/F
| if plagiocephaly develops later, then torticollis, subluxation.
True
116
```
Term for this:
Palpable ridge
Ear on flat side, more posterior
Forehead does not protrude
No bald spot
```
Craniosynostosis
117
Term for this:
- Palpable ridge
- Ear on flat side, more anterior
- Forehead protruding on occipital flattening
- Parallelogram shape
PHD, Positional head deformity
118
Management of PHD?
```
Preventative counseling for parents
Mechanical adjustments
Exercises
Skill molding helmets
Surgery
```
119
T/F
Mechanical adjustment for PHD:Position the infant so that the rounded side of the head is placed dependent against mattress
True
