Assessment Final - Neuroskeletal System

Front 1

Newborn bones are mostly comprised of ______

Back 1

cartilage - skeleton is flexible and joints are elastic

Front 2

Bones store ____ and produce ____-

Back 2

Store Ca and phos; produce RBCs

Front 3

Flexion

Back 3

bending a limb at a joint

Front 4

Extension

Back 4

straightening a limb at a joint

Front 5

Abduction

Back 5

moving a limb AWAY from the midline

Front 6

Adduction

Back 6

moving a limb TOWARD the midline

Front 7

Pronation vs Supination

Back 7

Pro - facing DOWNward

Sup - facing UPward

Front 8

Dorsiflexion

Back 8

Flexion toward the back, as in flexion of foot so that the forefoot is higher than the ankle

Front 9

Plantar flexion

Back 9

Extension of the foot so that the forefoot is lower than the ankle

Front 10

Rotation

Back 10

turning as in face to the side

Front 11

Valgus

Back 11

Bent outward or twisted away from the midline of the body

Front 12

Varus

Back 12

Turned inward (foot in - goes away with time/stretching)

Front 13

Everted vs Inverted

Back 13

Everted - turning out and away from midline

Inverted - turning inward toward the midline of the body

Front 14

Are tremors with arms and legs with crying normal or not?

Back 14

Normal in 1st 4 days of life

Front 15

Extremity position initially may reflect ____

Back 15

intrauterine position (think breech)

Front 16

Normal position of term infant (3)

Back 16

-Limbs flexed

-Legs partially abducted at hips

-Head turned to one side (usually R)

Front 17

Torticollis

Back 17

Spasmodic, unilateral contraction of neck muscles

-birth trauma/ischemia in utero

-Not seen in immediate nbn period

-Firm, fibrous mass or tightness in the sternocleidomastoid muscles at 2 weeks of age

-1-2 cm mass that's hard, immobile in midportion of SCM muscle

-R side usually more affected

-Head tilted toward shoulder on affected side, chin rotated away from affected shoulder

Front 18

Klippel-Feil Syndrome

Back 18

Defect of cervical vertebrae - reduction in # of vertebrae and fusion of 2 or more vertebrae

-short neck, limited motion

-confirm on x-ray

-mistaken for torticollis

Front 19

Sprengel deformity

Back 19

congenital structural abnormality of shoulder girdle, more common in males

Front 20

Where's the most common fracture? What do you inspect/feel for?

Back 20

CLAVICLES

Inspect & palpate for size, contour, and crepitus

You will NOT see a callus @ birth, you FEEL crepitus

Suspect fx with: difficult delivery, irregularity in contour, crepitus on palpation, tenderness on palpation

Front 21

Failure to move an upper extremity? Think ____ (3)

Back 21

-spinal cord injury

-brachial plexus paralysis

-fracture

Front 22

2nd most common bone fractured during birth?

Back 22

HUMERUS

Front 23

Brachial palsy d/t

Back 23

Traumatic delivery / stretching injury to brachial plexus (c5-8, t1)

30% have complete recovery as edema resolves (don't do lots of stretching until edema gone). If fx doesn't return by 3 months - lookin gat long term sequelae (muscle atrophy, impaired bone growth, osteoarthritis, scapular winging, scoliosis)

Front 24

Erb's vs Klumpke's palsy

Back 24

Erb - upper arm paralysis, arm adducted & internally rotated, NO moro, + grasp

Klumpke - lower arm paralysis, wrist and hand are paralyzed, NO moro, - grasp

Front 25

Horner's syndrome

Back 25

Ptosis of eyelid, iris changes color, smaller pupil

Reflects injury to the sympathetic nerve at the C8-T1 level

Front 26

Phrenic nerve palsy

Back 26

Cyanosis, increased WOB, asymmetrical chest movement

-Usually resolves within in 3 months. If not = surgery

Front 27

Palm creases are developed d/t ____

Back 27

movement in utero, reason DS babies have simian crease

Front 28

Macrodactyly

Back 28

enlargement of finger/toe - may be normal or sign of neurofibromatosis

Front 29

Overlapping 2nd and 3rd fingers may be a sign of

Back 29

Trisomy 18

Front 30

Clinodactyly

Back 30

incurving of little finger - can be normal

Front 31

Syndactyly

Back 31

congenital webbing of fingers or toes - more severe = greater likelihood of bone abnormalities

Tx depends on severity

Fx deteriorates when multiple digits are involved

Front 32

Polydactyly

Back 32

Extra digits - more common in African American

Most common - floppy digit or skin tag on ulnar side of hand

MUST have x-ray to be sure you don't cut bone

On thumb side? more likely a/c syndrome

> 1 mm? Get ortho/plastics involved

Front 33

Tethered cord - how does it affect infant

Back 33

puts traction on spinal column and they lose ability to move or go to the bathroom

Front 34

What is a "simple dimple"

Back 34

One that is located within 2.5 cm of the anus - does NOT require further investigation

higher up the dimple, more worrisome. Be sure you can see the base, no sinuses

Front 35

Myelomeningocele

Back 35

congenital neural tube defect

-caudal end of neural tube fails to close, permitting meninges and sometimes spinal cord to protrude into sac-like structure

-functional defect of lower extremities

-if level of defect is midback, check legs for muscle wasting/tone. Can baby void/stool?

Front 36

meningomyelocele vs meningocele

Back 36

meningomyelocele - cord/nerves involved

meningocele - sac, but no cord involved

Front 37

Developmental dysplasia of the hip (DDH) occurs more often in _____

Back 37

-1st born

-females

-infants in breech regardless of delivery

Front 38

DDH (does / does not) always present in newborn period

Back 38

does NOT - check infant at every health visit for 1st year

get us at 6 weeks and xray at 4 months

Front 39

Are asymmetric gluteal folds always an indicator of hip dysplasia?

Back 39

NO! 25% of infants with normal hips have asymmetric creases

Front 40

Barlow manuever vs Ortolani

Back 40

B - Bone (femoral head) clunks OUT of acetabulum; checks hip dislocation

O - Bone (femoral head) clucks BACK INTO acetabulum; checks hip reduction

Clicks & snap may be felt but are NOT a/c hp pathology. A distinct clunk will be felt for + sign

Front 41

Pavlik harness

Back 41

keeps femoral head in acetabulum - if not, it becomes shallow and head won't go in anymore

Front 42

Arthrogryposis

Back 42

contractures

Front 43

Metatarsus adductus

Back 43

Most common foot anomaly, caused by intrauterine positioning.

Can be structural - if foot cannot be brought past midline, it will not self correct

Front 44

Flat footedness due to fat pad disappears at

Back 44

1 year of age

Front 45

Club foot

Back 45

A/c LGA, smoking in 1st trimester, early amniocentesis

Bony deformity - cast or surgery

best intervention for club feet - start within 24 hr and cast while mothers hormones are on board

Front 46

Sandal toe

Back 46

spacing between big toe and 2nd toe, may normal but up to 45% of downs babies have it