Peds Mini Series

Question 1

injury to the upper and lower brachial plexus during difficult vaginal delivery

Answer 1

obstetric brachial plexus injury

Question 2

How does obstetric brachial plexus injury occur?

Answer 2

forceful traction or rotation of the head and shoulders (breech delivery)
fracture to the clavicle or humerus

Question 3

how will a baby present with a diagnosis obstetric brachial plexus injuries?

Answer 3

made at birth
arm appears flaccid or moves only slightly

Question 4

What is the condition called if obstetric brachial plexus injury does not improve?

Answer 4

erb’s palsy

Question 5

A baby with erbs palsy (injury to c5-c6) how will they present with a resting posture?

Answer 5

rhomboids, levator, serratus, subscap, supraspinatus, infraspinatus
biceps, supinator affected

baby sits in internal rotation and adduction flaccid shoulder

baby will sit with a “waiters tip” position

Question 6

If a baby sits with an arm in a waiters tip position what injury would you think?

Answer 6

obstetric brachial plexus injury
erbs palsy (C5-C6)

Question 7

With Obstetric brachial plexus injury would a stretch or a rupture heal faster?

Answer 7

stretch

Question 8

what percentage of OBPI babies recover in 3 months?

Answer 8

80-90%

Question 9

what is a cookie test?

Answer 9

if a baby can bring their hand to their mouth

Question 10

If a baby is unable to bring their hand to their mouth at_____ months they have a poor recovery for OBI

Answer 10

> 6 months

Question 11

A pt should focus on ___ and _____ activities to promote recovery in OBPI?

Answer 11

developmental and functional

Question 12

Current evidence suggest conservative treatment is an _______ intervention for most BPI at this time

Answer 12

effective

Question 13

nonprogressive, congenital neuromuscular syndrome

Clinical picture:
severe joint contracture
muscle weakness
muscle fibrosis
absence of muscles

Answer 13

Arthrogryposis Multiplex Congenita

Question 14

What causes arthrogyposis multiplex congenita

Answer 14

etiology unknown

Question 15

What are the primary impairments of arthrogyposis multiplex congenita

Answer 15

severe joint contracture
muscle weakness

Question 16

Do children with arthrogyposis multiplex congenita have impaired congnition?

Answer 16

no normal cognition and speech

Question 17

Can arthrogyposis multiplex congenita be diagnosed in utero?

Answer 17

no definitive test but ultrasound may be suggestive

Question 18

What are some interventions for decreased ROM for AMC?

Answer 18

stretching
positioning
splinting/bracing
casting

Question 19

By 5 years old what percentage of those with AMC are independent with ADLs and mobility?

Answer 19

85%

Question 20

Will indvidiuals with AMC have pain with aging, increased muscle weakness

Answer 20

yes

Question 21

will individuals with AMC have a compromised lifespan?

Answer 21

no but increased secondary impairments

Question 22

Brittle bone disease; sneezing could cause bones to break
defect in structure of synthesis of type 1 collagen

Answer 22

osteogenesis imperfecta

Question 23

Which type of OI is most severe and most rare; frequently fatal in infancy?

Answer 23

type 2

Question 24

Do mild or moderate forms of OI affect life expectancy?

Answer 24

No

Question 25

Signs and symptoms of OI

Answer 25

brittle bones short small bones loose joints curved spine blue sclera of the eye brittle teeth hearing loss

Question 26

What are 3 good interventions for an individual with OI

Answer 26

1. early intervention/positioning handling 2. strengthening/ aerobic conditioning/ aquatic therapy 3. protected ambulation

Question 27

are there any congitive declines with OI?

Answer 27

no most are ambitious productive 1/2 adults choose to marry

Question 28

Do most individuals with OI use for community mobility?

Answer 28

wheel chair

Question 29

is calcaneiovalgus the same as club foot?

Answer 29

no its a condition that more than 30% of babies have excessive dorsiflexion that corrects spontaneously

Question 30

what is the presentation of clubfoot- talipes equinovarus

Answer 30

forefoot curved medially small calcaneus, hindfoot varus ankle plantarflexion

Question 31

Is there good outcomes with conservative treatment of talipes equinovarus (clubfoot)

Answer 31

yes

Question 32

What condition do you use ponseti casting method?

Answer 32

talipes equinovarus Club foot

Question 33

Do pt need to be trained in the ponseti method?

Answer 33

yes

Question 34

What are 3 risk factors for development dysplasia of the hip?

Answer 34

1. female 2. twins 3. breached

Question 35

What are 4 conditions from tight packaging?

Answer 35

1. CMT 2. plagiocephaly 3. metatarsus adductus 4. calcaneovalgus

Question 36

What is the barlow test?

Answer 36

hip is flexed and abducted gradually adducted with pressure posterior

Question 37

what does a positive Barlow test determine

Answer 37

unstable hip

Question 38

What is an ortolani test?

Answer 38

in the positive hip the hip is dislocated gentle flexion and abduction and slight anterior traction reduces the hip

Question 39

At what age can you stop using barlow ortolani test

Answer 39

3 months

Question 40

Who uses a pavlik harness

Answer 40

newborns

Question 41

who uses a hip spica

Answer 41

8 months old

Question 42

a disease of the growth or ossification centers in children which begins as a degeneration or necrosis followed by regeneration or recalcification

Answer 42

Osteochondrosis

Question 43

self limiting disease of hip produced by ischemia varying degrees of avascular necrosis of femoral head and spontaneous regeneration

Answer 43

legg calve perthes disease

Question 44

Legg calve perthes disease is most common in boys or girls

Answer 44

boys

Question 45

what are the impairments associated with legg calve perthes disease?

Answer 45

pain often in knee, groin or hip limited ROM: abduction, internal rotation

Question 46

Herring lateral pillar classification is a measure of what in legg calve perthes disease

Answer 46

amount of collapsed area

Question 47

approximately 50% of individuals with legg calve perthes will have _____by the 5th decade?

Answer 47

degenerative hip disease

Question 48

Displacement of femoral head on femoral neck: head inferior and posterior in relation to the femoral neck

Answer 48

slipped capital femoral epiphysis (SCFE)

Question 49

true/false tend to be obese skeletally immature males around time of puberty/growth spurts

Answer 49

true

Question 50

What are the 5 common impairments associated with SCFE

Answer 50

1. ROM limited hip flexion and lateral rotation 2. rest in hip lateral rotation 3. limp 4. pain 5. shortening of affected limb

Question 51

true/false surgical intervention for unstable acute SCFE most return to normal function within 3-6 months

Answer 51

true

Question 52

What are the 3 main questions for clinical decision making children with a limp

Answer 52

1. history of trauma 2. normal neurological examination 3. fever

Question 53

surgical shortening of long leg

Answer 53

epiphysiodesis

Question 54

surgical limb lengthening on affected short leg

Answer 54

wagner or illizarov