Test #1 Flashcards
(121 cards)
1
Q
It is recommended that the entire history be taken before beginning what?
A
Physical assessment
2
Q
Why is the birth history important to chiropractors?
A
Helps determine the amount of trauma to the spine or cranium during the birthing process
3
Q
What vital signs are included in a pediatric exam?
A
Temp Heart rate BP Respiratory rate Weight Length Head circumference
4
Q
A child’s length is measure until what age?
A
2yoa (afterwards it’s measured as height)
5
Q
Head circumference is measure until what age?
A
2yoa
6
Q
Rule of thumb for an infant’s heart rate is that it increases by ____ BPM for each ____ deg. of temp Centigrade increase
A
10; 1
7
Q
A variable respiratory rate known as what is commonly seen in neonates? (more than a 20 sec pause is always abnormal)
A
Periodic breathing
8
Q
Cheyne-Stokes breathing is assoc. w/ what type of abnormalities?
A
Brainstem abnormalities
9
Q
Where is the best place to use a thermometer?
A
Rectal or temporal artery are most accurate (armpits least accurate)
10
Q
Which fontanel is the largest?
A
Anterior (4-6cm, closes b/w 4-26months)
11
Q
Characterized by flattening of the occipital skull on one side
A
Plagiocephaly
12
Q
Describes an elongated head w/ flattening of the bones in the temporoparietal regions
A
Scaphocephaly
13
Q
Term applied when there is bleeding over the outer surface of a skull bone elevating the periosteum
A
Cephalhematoma
14
Q
A localized pitting edema in the scalp that may overlie sutures of the skull, usually formed during labor as a result of circular pressure of the cervix on the fetal occiput
A
Caput succedaneum
15
Q
Refers to premature fusion of one or more of the sutures of the cranial bones, & should be considered in any neonate w/ an asymmetric cranium
A
Craniosynostosis
16
Q
A term for softening of the skull bones, w/ pressure the skull may be momentarily indented before springing out again. The major clinical significance is w/ congenital rickets. Pressure to skull makes a sound “crack” like a ping-pong ball
A
Craniotabes
17
Q
This sign is characterized by a “cracked pot” sound when the cranium is percussed w/ the examining finger.
A
Macewen’s sign (may be evident until fontanel closure)
18
Q
A fungal infection of the scalp charac. by a patch of short broken off hairs & the patches of hair loss may be scaly or they may be marked w/ inflammation, bogginess, & pustules called “kerion”
A
Tinea Capitis
19
Q
The common term for infantile seborrheic dermatitis, causes scaly patches on a baby’s scalp. Can cause thick crusting & white or yellow scales. Usually resolves on its own w/i a few months.
A
Cradle cap
20
Q
Well circumscribed areas of complete or almost complete hair loss, the scalp is smooth w/o signs of inflammation. Hair loss usually begins suddenly, & total loss of scalp & body hair may develop
A
Alopecia Areata
21
Q
Squint, lazy eye, turned eye is called what?
A
Strabismus
22
Q
Cheesy white covering after birth
A
Vernix
23
Q
Soft hair; “peach fuzz”
A
Lanugo
24
Q
Yellowing of sclera, “glowing of skin”
A
Jaundice
25
Small white heads on face of newborn
Milia
26
A green, foul smelling ,purulent discharge from only one side of the nose is common with what?
Foreign object in the nose
27
Purulent discharge bilaterally usually indicates what?
Infection
28
Red mucus in the nose indicates what? Blue & boggy? Gray & swollen?
red = acute infection
Blue & boggy = allergy
Gray & swollen = rhinitis
29
A low position of the ears (below the level of the eyes) or small deformed auricles may be an indication of what?
Brain defect or congenital kidney abnormality, especially renal agenesis
30
Inspection of the aurcile & surrounding tissues can be done by checking what 4 D's?
Discharge
Discoloration
Deformity
Displacement
31
If discharge from the ear is accompanied w/ perforation of the tympanic membrane, what should be suspected?
Otitis media
32
Discoloration in the form of ecchymosis over the mastoid area is called what? It is assoc. w/ trauma & should be considered an emergency
Battle sign
33
Gross deformities of the external ear are often assoc. w/ what?
Anomalies of the middle & inner ear structures
34
Cobblestoning of the pos. pharyngeal wall is a sign of what?
Chronic allergic disease/post nasal drip
35
What are the 4 grades of tonsils?
1. Normal visualization
2. Tonsils halfway b/w the pillars & uvula
3. Tonsils almost touching the uvula
4. Tonsils touching the uvula
36
Creamy white reticular plaques seen on the oral mucosa?
Thrush (caused by Candida Albicans)
37
Small bluish white dots surrounded by a reddish zone that appear on the mucous membrane of the cheeks & lips before the appearance of skin eruption
Koplik spots (assoc. w/ Measles/rubeola)
38
Asymmetric expansion of the chest may be seen with what?
Pneumothorax
| Diaphragmatic paralysis
39
The point of maximum impulse of the heart is at what intercostal space until age 7?
4th intercostal space
40
An increase in freq. or pitch of bowel sounds may be assoc. w/ what?
Intestinal obstruction or diarrhea
41
Decreased or absent bowel sounds may be assoc. w/ what?
Paralytic ileus or peritonitis
42
What sign is assoc. w/ R shoulder pain w/ RUQ palpation (represents an irritated diaphragm). Is strongly suggestive of liver injury
Danforth's sign
43
What sign is assoc. w/ L shoulder pain w/ LUQ palpation strongly suggestive of splenic injury?
Kehr's sign
44
What sign is assoc. w/ RLQ pain w/ LLQ palpation? Indicates appendicitis
Rovsing's sign
45
Measurement for sexual maturation
Tanner Staging
46
How is true (direct) leg length measured?
ASIS to medial malleolus
47
How is apparent leg length measured?
Umbilicus to medial malleolus
48
A discrepancy in apparent leg length is d/t what?
Instability of the hip that allows the prox. femur to migrate prox. or d/t an adduction or abduction contracture of the hip that causes pelvic obliquity, so that one hip is higher than the other
49
Ortho test that is a reduction test. The baby in a supine position, the hips & knees are flexed to 90deg, the examiner grasps the baby's thigh & lifts while simultaneously abducting, thus reducing the dislocation & a "clunk" will be observed
Ortolani's Test
50
Ortho test that is a provocative test. Baby's thigh is grasped w/ the middle finger, adducted w/ gentle downward pressure. Dislocation is palpable as the femoral head slips out of the acetabulum
Barlow's Test (Reverse Ortolani's)
51
Ortho test used to test for a dislocatable hip & is performed by flexing the child's knees & hips placing the feet on the table. The lower one has a femoral head that lies posterior to the acetabulum
Allis' or Galazzi's Sign
52
Test for a dislocated hip. Shortening of the thigh will bunch up the soft tissue & will accentuate what, causing an asymmetry
Skin folds
53
This is elicited b/c the femoral head isn't contained w/i the acetabulum. W/ the child supine, knees & hips are flexed to 90deg. Femur is pushed down onto the examining table. Femur & leg are then lifted up & away from table. W/ normal hip, little movement occurs but dislocated hip has a lot of relative movement. Excessive movement is called what?
Telescoping
54
Drop of normal hip when child, standing on both feet, elevates unaffected limb & bears weight on affected side, d/t weakness of hip abductors
Trendelenburg's test
55
What is a normal Babinski's reflex in a baby?
Big toe should lift up, while other toes fan out
56
While manually turning baby's head, his eyes will stay fixed, instead of moving w/ the head. While normally vanishing around 1 month of age, if it reappears later, there may be damage to the CNS.
Doll's Eye
57
Primitive reflex caused by lightly stroking face near corner of mouth. Infant should turn head towards the stimulus. Present until 3-4 months.
Rooting reflex
58
When does the sucking reflex disappear by?
End of 1st year
59
When should the palmer grasp disappear?
By 4-6 months
60
When should the plantar grasp disappear?
By 6-12 months
61
Clapping your hands out of visual fields causing the baby to blink or startle is called what?
Acoustic Blink
62
Primitive reflex when the head is rotated to one side & held. Child will extend the arm & leg on the side where head is turned towards & flex arm & leg on opposite. "Fencing Posture" Present in the 1st 3-4 months. Retention indicates an UMNL or a motor postural disability
Tonic Neck (or Asymmetric Tonic Neck Reflex)
63
Primitive reflex when the head is supported then suddenly lower to allow head to fall backwards. Response is ext. of trunk, symmetric extension & abduction of arms w/ ext. of fingers, followed by flex. & abduction of arms. Birth to 4-5 months. Prolonged reflex may be seen in cerebral palsy or UMNL
Moro
64
How long does the Babinski extensor response lasts?
2 yoa
65
Primitive reflex where the infant is held upright then raised up in air. Response is bilateral flex. of hips & knees. Present until 6 months. If baby scissors legs that's abnormal.
Vertical suspension
66
Pt is supported w/ hands under armpits. Foot is brought into contact w/ edge of exam table. Response is infant will raise foot & step up on table. Disappears b/w 3-6 months. Abnormal response may indicate paresis or hip dislocation.
Placing Response
67
Primitive reflex where infant is held upright over table so the soles of the feet touch the surface. Response is the infant will appear to be taking steps forward. Will persist until it's a voluntary movement.
Stepping/Walking
68
Infant is prone. Stroke back from Csp to iliac crest on 1 side, then repeat on the other side. Response is ext. & lat. flex. of the trunk & head towards side of stimulus. Present from birth until 3-9 months.
Galant's Test
69
Pt placed supine on table & head is rotated 90deg to 1 side & held. Response is child will try to rotate the trunk & pelvis towards the side of rotation. Present 4-6 months to 8-10 months then it becomes voluntary.
Neck Righting Reflex (Symmetric)
70
Child is held in horizontal position & head is pressed down. Response is child will attempt to arch back & hold head up, when head is depressed, feet will go down. Tests head control & motor function. From 3-6 months to 1 year.
Landau
71
Hold infant in midair in horizontal position. Quickly lower child towards the exam table or floor. Response is child will extend arms, hands, & fingers to protect themselves & extend both legs downward. Appears around 6-8 months & fully developed by 1 year.
Parachute
72
Infant is pulled up by the wrists to a sitting position, her head will first fall back, then lift upright & held before it falls forward onto the chest. This is a sign of maturity & muscle tone. Asymmetrical response usually indicates brachial palsy or hemiparesis. Absence of response seen in hypotonia
Traction/Pull up
73
What is one of the M/C CN's injured in the birth process?
CN VII
74
A test for CN XII. Place object in mouth, the infant will try to expel object w/ tongue.
Tongue retrusion reflex
75
One strong indicator of child abuse is what?
Bruises in different stages of healing
76
Bruises that are 1-5 days old are what color?
Purple
77
Bruises that are 5-7 days old are what color?
Green
78
Bruises that are 7-10 days old are what color?
Yellow
79
Bruises that are 10-14 days old are what color?
Brown
80
Failure to provide, by those responsible for the care, custody, & control of the child, the proper or necessary support, education as required by law, nutrition or medical, surgical, or any other care necessary for the child's well-being is called what?
Neglect
81
What are types of neglect?
Physical
Medical
Lack of Supervision
Abandonment
82
Failure to provide the child w/ food, clothing, or shelter necessary to sustain the life or health of the child is what type of neglect?
Physical Neglect
83
Acts or omissions by persons responsible for the care of child that includes failure to use resources to tx a diagnosed medical condition to make child more comfortable, reduce pain & suffering, or correct or substantially diminish a crippling condition from getting worse.
Medical neglect
84
Failure to provide adequate supervision of a child or to remove a child from a situation which requires judgment or actions beyond the child's level of maturity, physical condition or mental abilities that results in injury or likelihood of harm.
Lack of Supervision
85
To desert or cease providing care for child w/o making appropriate provisions for substitute care.
Abandonment
86
Inflicted traumatic brain injury that occurs when a baby is violently shaken or slammed. Significant impact on children under 2 yoa
Abusive Head Trauma (Shaken Baby Syndrome)
87
What is the triad of injuries seen in AHT?
Retinal hemorrhage
Subdural hematoma
Cerebral edema
88
What are the effects of AHT?
```
Irreversible brain damage
Blindness
Mental retardation
Seizures
Death
```
89
Any act, behavior, or omission that impairs or endangers a child's social or intellectual functioning
Emotional Child Abuse
90
Creating a climate of fear or engaging in violent/threatening behavior towards child or others in child's presence is what type of emotional child abuse?
Terrorizing
91
Demonstrating no attachment, failing to provide adequate nurturance, ignoring the child is what type of emotional child abuse?
Emotionally abandoning
92
Teaching or rewarding for unlawful, antisocial, or sexually mature behaviors is what type of emotional child abuse?
Corrupting
93
Restoration of neurobiomechanical balance of pelvis w/ a sacral adjustment
Webster Technique
94
Baby position is unstable till what week of pregnancy?
35-36 weeks
95
What are some reasons Webster technique may not work?
Umbilical cord
Scar tissue in mother's abdomen
Uterine anomalies (placenta previa, pelvic tumors/fibroids)
Maternal stress
96
Hormone that increases rapidly in 1st trimester. Manufactured when the egg implants into uterine wall, stimulating an increase in estrogen & progesterone. May be the cause of morning sickness.
hCG
97
Why does hCG decrease by the 2nd trimester?
Placenta takes over production of estrogen & progesterone
98
This hormone helps uterine growth & maintains uterine lining. Also increases blood circulation, regulates other hormone production for pregnancy, growth of breasts, stimulation of mammary glands for milk production & organ/bone development in fetus
Estrogen
99
What are skin sensitivities assoc. estrogen?
Hyperpigmentation
| Increased blue vessel appearance
100
What are the functions of progesterone?
```
Keeps placenta functioning
Keeps uterine lining thick & healthy
Stimulates breast tissue
Decreases function of smooth muscle around uterus to allow relaxation & growth
Softens cartilage & loosens ligs/joints
```
101
What are some negative effects of progesterone?
```
GI discomforts (heartburn, constipation)
Increased sweating & acne
```
102
This hormone loosens ligs/joints, causes GI discomfort, softens & lengthens the cervix, & relaxes the muscles of the uterus
Relaxin
103
This hormone causes uterine contractions, shrinks the uterus after birth, & causes milk letdown
Oxytocin
104
This hormone produces milk after the baby is born. Also causes increased hair growth.
Prolaction
105
What are some acupressure points used in labor?
Web on hand - helps make contractions effective
Trap area - facilitates childbirth, relieves pain, fatigue, irritability
Many points along lumbosacral region
106
What are red flags to adjusting during pregnancy?
- Premature contractions/labor
- Rigorous chiro. procedures to middle/low back throughout pregnancy
- Round lig. pain w/ nausea, diarrhea, fever, bleeding, cramping
- No pelvic adjustments if bleeding or discharge present
- Saddle pain/ B&B dysfunction
- Fainting, vomiting
- "Drop attacks"
107
What is the M/C reason for LBP in pregnancy?
Dysfunction in SI joints
108
High levels of hormones, rapid stretching of uterine muscles, relaxation of muscles in GI tract, excessive acid in stomach can causes what?
Morning sickness
109
Compression of lumbar plexus resulting in pain in pelvis & radiating pain down leg
Sciatic Neuralgia
110
After 28 wks, if these are present w/ HTN & water retention refer back to OB or midwife
Headaches
111
Carpal tunnel syndrome during pregnancy can be caused be what?
Pregnancy-induced edema
112
This mineral can cause constipation
Iron
113
Malabsorption of calcium, electrolyte imbalance, & pressure on blood vessels can cause what?
Leg cramps
114
Swelling of facial nerve d/t hormonal changes & increased fluid retention can cause what?
Bell's palsy
115
When is gestational diabetes usually diagnosed?
Around 24-28 weeks
116
What are risks assoc. w/ gestational diabetes?
```
Overweight baby
Premature birth
Respiratory problems
Jaundice
Increase risk of type II DM later on
```
117
What is normal weight gain for pregnancy for a woman at normal weight? overweight? underweight?
25-35lbs; 15-25lbs; 28-40lbs
118
What are some ways to naturally induce?
```
Walks (30mins or more)
Acupressure
Nipple stimulation
Intercourse
Herbal teas
Adjustments
Evening primrose oil
```
119
What are some risks for the mother involved with epidurals?
```
Increase likelihood of other medical interventions
Hypotension
Prolonged labor
Inability to move freely
Nausea, vomiting, fever
Headache & back pain
Decrease release of oxytocin
```
120
What are epidural risks for baby?
```
Reduced muscle tone
Increased incidence of jaundice
Damage to CNS
Impaired sensory or motor responses
Irritability
Withdrawal symptoms
```
121
This is used to induce labor, stimulate contractions, control bleeding
Pitocin/Oxytocin
