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1711 Cards in this Set

  • Front
  • Back
How many human chrmosomes?
46
What percentage of newborns have chromosomal abnormalitites?
0.5%
What are the 2 most frequent numerical chromosomal abnormalities?
trisomy
monsomy
What is trisomy 21?
Down's syndrome
How palmar creases in Downs?
1
Brushfield spots on iris is found in what syndrome?
Down's
Clinodactaly (incurving) of 5th finger occurs in what syndrome?
Down's
Ventral septal defect occurs in what syndrome?
Down's
A 3rd fontanelle occurs in what syndrome?
Down's
hypotonia occurs in what syndrome?
Down's
Increased space between 1st and 2nd toes occurs in what syndrome?
Down's
Upward slant of palpebral fissures occurs in what syndrome?
Down's
Low set auricles occur in what syndrome?
Down's
What syndrome is trisomy 18?
Edward's Syndrome
Intrauterine growth retardation is characteristic of what syndrome?
trisomy18
A small mouth is characteristic of what syndrome?
trisomy 18
Rocker-bottom feet is found in what syndrome?
Edward's
Abnormal overlapping of fingers is found in what syndrome?
Edward's
A prominent occiput is found in what syndrome?
Edward's
Failure to thrive is found in what syndrome?
Edward's
Hypoplastic finger nails is found in what syndrome?
Edward's
What syndrome is Trisomy 13?
Patau's
Intrauterine growth retardation in all three parameters is found in what syndrome?
Trisomy 13
Coloboma of iris (keyhole-shaped pupil) is found in what syndrome?
Trisomy 13
Capillary hemangioma is found in what syndrome?
Trisomy 13
Polydactly is found in what syndrome?
Trisomy 13
Cleft lip and palate is found in what syndrome?
Patau's
Skin defect of skull is found in what syndrome?
Trisomy 13
Hyperconvex nails is found in what syndrome?
Trisomy 13
What is 45,x syndrome?
Turner's syndrome
What is the numeration for Turner's syndrome?
45,X
Short stature is found in what syndrome?
Turner's
Triangle face is found in what syndrome?
Turner's
Abnormal shape of ears and webbed neck is found in what syndrome?
Turner's
Broad "shield" chest is found in what syndrome?
45,X
Wide-set nipples ifs found in what syndrome?
45,X
Congenital lymphedema of hands and feet is found in what syndrome?
45,X (Turner's)
Shortened 4th and 5th metacarpals and metatarsals is found in what syndrome?
Turner's
Cubitus valgus is found in what syndrome?
Turner's
Primary amenorrhea is found in what syndrome?
Turner's
Coarctation of the aorta is found in what syndrome?
Turner's
Normal IQ is found in what syndrome?
Turner's
Infertility is found in what syndrome?
Turner's
What is the numerical designation of Klinefelter's syndrome?
47, XXY
What syndrome is 47,XXY?
Klinefelter's syndrome
Tall stature is found in what syndrome?
Klinefelter's
Post-puberty small testicles is found in what syndrome?
Klinefelter's
Gynecomastia is found in what syndrome?
Klinefelter's syndrome
Eunuchoid build is found in what syndrome?
Klinefelter's
Increased risk for mild mental retardation is found in what syndrome?
Klinefelter's
Infertility can be found in what two syndromes?
Turner's and Klinefelter's
During what week range is amniocentesis done?
14-16 weeks
During what week range is chorionic villi testing done?
9-10 weeks
What teratogenic infectious agents have the mnemonic TORCHES?
Toxoplasmosis
Other (varicella or parvovirus)
Rubella
Cytomegalovirus
HErpes/HIV
Syphilis
What anticonvulsant is known as a teratogen?
valproic acid
What anti-coagulant is known as a teratogen?
warfarin
What vitamin's derivatives are teratogens?
Vitamin A
What is the average growth in the first year?
10''
Birth length doubles, triples, or quadruples by age 13?
triples
Birth weight doubles, triples, or quadruples by end of first year?
triples
How many fonatnelles at birth?
6
What is last fontanelle to close?
anterior
Persistent primitive reflexes are the earliest markers of what?
abnormal neurological maturation
What tone predominates in a newborn?
flexor tone
What age: in prone turns head to side?
newborn
What age: automatic reflex walking?
newborn
What age: rounded spine when held sitting?
newborn
What age: hands fisted?
newborn
What age: grasp reflex?
newborn
What age: ability to fix and follow bright object?
newborn
What age: turning head to rattle or voice?
newborn
What age: cry?
newborn
What age: reflex stage?
newborn
What age: basic trust vs. basic mistrust?
newborn
What age: does not differentiate between self and mother?
newborn
What age head midline?
4 months
What age head held when pulled to sit?
4 months
What age in prone position lifts head to 90 degrees?
4 months
What age turns to supine?
4 months
What age hands mostly open?
4 months
What age hands fisted?
newborn
What age midline hand play?
4 months
What age crude palmar grasp?
4 months
What age fascinated by own face in mirror?
4 months
Whta age recognizes bottle?
4 months
What age turns to voice and bell consistently?
4 months
What age laughs and squeals?
4 months
What age responsive vocalization?
4 months
What age blows bubbles?
4 months
What age shows circular reaction, the interesting result of action motivates its repetition?
4 months
What age developing a basic sense of trust?
4 months
What age maintains sitting?
7 months
What age may lean on arms?
7 months
What age rolls to prone?
7 months
What age bears all weight, bounces when held erect?
7 months
What age cervical lordosis?
7 months
What age intermediate grasp?
7 months
What age transfers cube from hand to hand?
7 months
What age bangs objects?
7 months
What age differentiates between familiar person and stranger?
7 months
What age holds bottle?
7 months
What age looks for dropped object?
7 months
What age talks to mirror image?
7 months
What age uses single-word and double consonant vowel combinations?
7 months
What age begins to differentiate between mother and self-individuation. Sense of belonging to a central person?
5 months
What age creeps on all 4s?
10 months
What age pivots in sitting?
10 months
What age stand momentarily, cruises?
10 months
What age slight bow leg?
10 months
What age increased lumbar lordosis, acute lumbosacral angulation?
10 months
What age pincer grasp, mature thumb to index grasp?
10 months
What age bangs 2 cubes held in hands?
10 months
What age plays peek-a-boo?
10 months
What age finger feeds?
10 months
What age chews with rotary movement?
10 months
What age shouts for attention?
10 months
What age initiates speech sounds?
10 months
What age waves bye-bye?
10 months
What age uses "mama" and "dada" with meaning?
10 months
What age inhibits behavior to "no?"
10 months
What age can retrieve an object hidden from view?
10 months
What age practicing phase of separation-individuation?
10 months
What age walks alone, arms in high guard or mid-guard?
14 months
What age wide-base, excessive knee and hip flexion?
14 months
What age foot contact on entire side?
14 months
What age slight valgus of knees and feet?
14 months
Whta age pelvic tilt and rotation?
14 months
What age piles 2 cubes?
14 months
What age scibbles spontaneously?
14 months
What age holds crayons full length in palm?
14 months
What age casts objects?
14 months
What age uses spoon with over pronation and spilling?
14 months
What age removes a garment?
14 months
What age uses single words and understands simple commands?
14 months
What age differentiates available behaviors patterns for new ends, i.e. pulls rug on which is a toy
14 months
What age is rapprochement phase - individuation and ambivalence to mother?
14 months
What age is stage of autonomy vs. shame and doubt?
14 months
What age is pleasure in control of muscle and sphincter?
14 months
What age arms at low guard?
18 months
What age mature supporting base and heel strike?
18 months
What age seats self in chair?
18 months
What age walks backwards?
18 months
What age emerging hand dominance?
18 months
What age crude release?
18 months
What age holds crayon butt end in palm?
18 months
What age dumps raisin from bottle spontaneously?
18 months
What age initiates housework?
18 months
What age carries, hugs doll?
18 months
What age drinks from cup neatly?
18 months
What age points to named body part?
18 months
What age identifies 1 picture?
18 months
What age says "no"
18 months
What age uses jargon?
18 months
What age capable of insight?
18 months
What age capable of problem solving by mental combinations?
18 months
What age begins running?
2 years
What age walks up and down stairs alone?
2 years
What age jumps on both feet in place?
2 years
What age hand dominance is usual?
2 years
What age build 8-cube tower?
2 years
What age initiates vertical line?
2 years
What age places pencil shaft between thumb and fingers?
2 years
What age draws with arm and wrist action?
2 years
What age pulls on garment?
2 years
What age uses spoon well?
2 years
What age opens door turning knob?
2 years
What age feeds doll with bottle or spoon?
2 years
What age toilet training usually begun?
2 years
What age two-word phrases are common?
2 years
What age uses verbs?
2 years
What age refers to self by name?
2 years
What age uses me, mine?
2 years
What age follows simple directions?
2 years
What age able to evoke and obect or event not present?
2 years
What age object performance established?
2 years
What age comprehends symbols?
2 years
What age runs well?
3 years
What age pedals tricycle?
3 years
What age broad jumps?
3 years
What age walks up stairs alternating feet?
3 years
What age imitates 3-cube bridge?
3 years
What age copies circles?
3 years
What age uses overhand throw with anteroposterior arm and motion?
3 years
What age catches with extended arms hugging against body?
3 years
What age most children toilet trained day and night?
3 years
What age pours from pitcher?
3 years
What age unbutton; washes and dries hands and face?
3 years
What age parallel play?
3 years
What age can take turns?
3 years
What age can be reasoned with?
3 years
What age three word sentences are usual?
3 years
What age uses future tense?
3 years
What age asks who, what, where?
3 years
What age folows prepositional commands?
3 years
What age gives full name?
3 years
What age may stutter, eager?
3 years
What age identifies sex of self?
3 years
What age recognizes 3 colors?
3 years
What age capable of deferred limitation symbolic play?
3 years
What age drawing of graphic images, mental images, and verbal evocation of event?
3 years
What age range is the preoperation period?
2-7 years
What age range stage of initiative vs. guilt?
3-5
What age deals with issue of genital sexuality?
3 years
What age walks down stairs alternating feet?
4 years
What age hops on 1 foot?
4 years
What age plantar arches developing?
4 years
What age sits up from supine without rotating?
4 years
What age handles a pencil by a finger and wrist action, like adults?
4 years
What age copies a cross?
4 years
What age draws a frog-like person with head and extremities?
4 years
What age throws underhand?
4 years
What age cuts with scissors?
4 years
What age cooperative play-sharing and interacting?
4 years
What age imaginative make-believe play?
4 years
What age dresses and undresses with supervision distinguishing front and back of clothing, and buttoning?
4 years
What age buttons clothing?
4 years
What age does simple errands outside of home?
4 years
What age gives connected account of experience?
4 years
What age asks why, when, how?
4 years
What age uses past tense, adjectives, and adverbs?
4 years
What age knows opposite analogies?
4 years
What age repeats 4 digits?
4 years
What age skips, tiptoes?
5 years
What age balances 10-seconds on each foot?
5 years
What age hand dominance expected?
5 years
What age draws man with head, body, and extremities?
5 years
What age throws with diagonal arm and body rotation?
5 years
What age catches with hand?
5 years
What age creative play?
5 years
What age competitive team play?
5 years
What age uses fork for stabbing food?
5 years
What age brushes teeth?
5 years
What age self-sufficient in toileting?
5 years
What age dresses without supervision except tying shoelaces?
5 years
What age fluent speech?
5 years
What age misarticulation of some sounds may persist?
5 years
What age gives name, age, and address?
5 years
What age defines concrete nouns-classification and use?
5 years
What age follows 3 part commands?
5 years
What age number concept to 10?
5 years
What is the age range of industry vs. inferiority?
5-adolescence
What age adjusts to the inorganic laws of the tool world?
5 years
What age rides bicycle?
6 years
What age roller skates?
6 years
What age prints alphabet?
6 years
What age letter reversals still acceptable?
6 years
What age mature catch and throw of ball?
6 years
What age teacher is important authority?
6 years
What age uses fork appropriately?
6 years
What age uses knife for spreading?
6 years
What age uses knife for spreading?
6 years
What age plays table games?
6 years
What age shows mastery of grammar?
6 years
What age uses proper articulation?
6 years
What age eats with fork and knife ?
7 years
What age combs hair?
7 years
What age is responsible for grooming?
7 years
What age range capable of concrete operational thought?
7-adolescence?
What age capable of logical thought?
7 years
During what trimester do congenitial limb deficiencies occur?
1st trimester
On what day of gestation does mesodermal formation of the limb occur?
day 26
What are 2 risk factors for congenital limb deficiency?
thalidomide
maternal diabetes
What is the preferred classification system for pediatric limb deficiencies?
International Society for Prosthetics and Orthotics (ISPO)
ISPO classifies limb deficiencies in what two ways?
transverse or longitudinal
What limb deficiency classification has a distal portion?
longitudinal
What limb deficiency has not distal limb portion?
transverse
Longitudinal deficiencies are named after what?
the bone that is affected
Transverse deficiencies are named after what?
the segment beyond which there is no skeletal portion
What is amelia?
absence of limb
What is absence of limb?
amelia
What is meromelia?
partial absence of limb
What is partial absence of limb?
meromelia
What is hemimelia?
absence of half of a limb
What is absence of half of a limb?
hemimelia
What is phocomelia?
flipper-like appendage attached to trunk
What is a flipper-like appendage attached to trunk?
phocomelia
What is acheiria?
missing hand or foot
What is a missing hand or foot?
acheria
What is adactyly
absent metacarpal or metatarsal
What is an absent metacarpal or metatarsal?
adactyly
What is aphalangia?
absent finger or toe
What is in an absent finger or toe?
aphalangia
What is the name of the classification that descirbes deficiencies as either terminal or intercalary?
Frantz
What is an upper extremity amelia in the ISPO system?
transverse upper arm, total
What is a fibula hemimelia in the ISPO system?
longitutinal fibular deficiency
What is an upper extremtiy phocomelia in the ISPO system?
longitudinal total humerus, ulna; carpal, metacarpal, phalangeal
What is a transverse upper arm, total in the classic classification?
upper extremity amelia
What is a longitudinal fibular deficiency in the classic classification?
fibula hemimelia
What is the incidence of congenital upper extremity deficiency?
4.1 per 10,000 live births
What are the 3 limb deficiencies that do have heriditary implications?
*deficiencies of hand and feet
*central ray deficiencies
*adactyly involving the first 4 digits with the 5th intact
What is the TAR syndrome?
Thrombocytopenia with Absence of Radius
What is Fanconi's syndrome?
UE limb deficiency and anemia and leukopenia developing at 5-6 years of age
What is Holt-Oram Syndrome?
congenital heart disease, tetralogy of Fallot and UE limb deficieny
What syndrome is Thrombocytopenia with Absence of Radius
TAR syndrome
What syndrome is UE limb deficiency and anemia and leukopenia developing at 5-6 years of age?
Fanconi's syndrome
What syndrome is UE limb deficiency, congenital heart disease, ASD, and tetralogy of Fallot?
Holt-Oram Syndrome
What is Baller-Gerold Syndrome?
UE limb deficiency and craniosynostosis
What syndrome is UE limb deficiency and craniosynostosis?
Baller-Gerold Syndrome
What is VACTERL syndrome?
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophogeal fistula
Renal dysplasia
Limb deficiency
What is the most common congential limb deficiency?
left terminal transradial deficiency
At what developmental milestone and approx. month age range is the first fitting for a prosthetic in a child with a left terminal transradial deficiency?
sitting balance
6-7 months
What is the initial prosthesis in a left terminal transradial prosthesis?
passive mit
At what month age range is the child provided with an improved prosthesis for a terminal transradial?
11-13 months
What are the 3 developmental milestones for an improved prosthesis in a terminal transradial?
walking
grasping
5 minute attention span
What are 2 design features of an initial transradial prosthesis?
*self suspending
*supracondylar socket
By what age range can a child operate all types of prosthetic components and controls?
4-5 years old
What are the two indications for the krukenberg procedure?
absent hand
visual impairment
What procedure separates the ulna and radius in the forearm in a child with a missing hand?
Krukenberg procedure
The Krukenberg procedure is used primarily for unilateral or bilateral missing hands?
bilateral
What are the 2 possible suspensions for a transhumeral deficiency?
harness
silicone suction
What is the developmental milestone for addition of active terminal devices in a transhumeral deficiency?
walking
At what age range can a child use a body-powered hook?
2-3 years old
What what age range can a child use a body-powered elbow?
4-5 years
An infant will have greater difficulty rolling over with a transradial or transhumeral prosthesis?
transhumeral
Amputation revision is required in what percentage of UE limb deficiencies?
10%
What procedure attaches a toe to the residual limb?
Vilke procedure
What is the most common lower extremity deficiency?
fibular longitudinal deficiency (fibular hemimelia)
What is the percentage of fibular longitudinal deficiency that is bilateral?
25%
What amputation is performed with a severe leg-length discrepency caused by a unilateral fibular longitudinal deficiency?
Syme's amputation (ankle disarticulation with attachement of the distal heal pad to the end of the tibia)
What is the incidence of longitudinal deficiency of the tibia?
1 in 1,000,000 births
What is the treatment of choice for a longitudinal deficiency of the tibia?
knee disarticulation
What is the inheritance pattern of a partial tibial deficiency?
autosomal dominant
What percentage of partial tibial deficiency is herditary?
30%
What proceudure is done if there is a long tibial segment remaining in a partial tibial deficiency?
synostosis with the fibular and amputation of the foot
What is PFFD?
partial proximal femoral focal deficiency
What is the incidence of PFFD?
1 in 50,000 births
What is the postion the PFFD is held in ?
flexion, external rotation, and abduction
What is the Van Ness rotation?
rotating the foot 180 degress so ankle motion can control the prosthesis
What condition is an indication for the Van Ness Rotation?
Partial proximal femoral focal deficiency
At what developmental milestone is a child fitted with a LE prosthesis? month age range?
pull up to standing; 9-10 months
What age is normal heel-to-toe gait?
2 years old
At what developmental milestone can a child attain prosthetic heel-strike to toe-off gait? approx age?
one-legged standing; 5 years old
At what age (months) is a knee joint added to a prosthesis in a child with partial proximal femoral focal deficiency?
18 months
What is the most commonly prescribed foot for the child amputee?
solid ankle cushion heel
For what age group is a fluid controlled knee reserved?
adolescents
What two knees are used for childhood prosthetics?
single axis
polycentric
At what age is a suction socket prescribed?
5 years old
What a complication of a patellar tendon-bearing prosthesis in a child?
dislocated patella
What type of prosthesis and cuff are used for a child BKA?
patellar tendon-bearing prosthesis with a supracondylar cuff
What is a sign of an ill-fitting prosthesis in a child?
gait deviation
How often is a prosthesis replaced ages 1-5?
annually
How often is a prosthesis replaced in ages 5-12?
every 2 years
What is the most common cause of pediatric amputations?
trauma
What percentage of pediatric amputations are lower limb?
60%
What is the most frequent cause of disease-related amputation in children?
tumors
What are the two most common tumors causing amputation in children?
*Ewing's sarcoma
*osteogenic sarcoma
What complication of fracture non-union can cause pediatric amputations?
neurofibromatosis
Why is a joint disarticulation preferred over a trans-metaphyseal or a trans-diaphyseal ampution?
to preserve the epiphyseal growth plate
What is the most common complication after amputation in the immature child?
terminal overgrowth at the transected end
Terminal overgrowth as a complication after pediatric amputation occurs most frequently on what 4 bones in order of frequency?
humerus, fibula, tibia, femur
How do amputees preserve their energy expenditure?
decreasing walking speed
What is the youngest age to use a power wheelchair?
3 years old
What is the traditional age range for use of a power wheel chair?
5-6 years old
Do congenital limb-deficient children develop phantom pain or sensation?
no
Do children with congenital limb deficiencies who undergo conversion to surgical amputation of the limb experience phantom pain or sensation?
no
What condition is characterized by adduction of the forefoot on the hindfoot, with the heel in normal position or slightly valgus?
metatarsus varus
What is metatarus varus?
What condition is characterized by adduction of the forefoot on the hindfoot, with the heel in normal position or slightly valgus
What is the cause of metatarsus varus?
uterine positioning
By what age range have most cases of metatarsus varus resolved?
3-4
What are the 3 associated deformities of club foot?
*plantar flexion
*heel varus
*forefoot varus
What is the incidence of club foot?
1 per 1,000
What is talipes equinovarus?
club foot
What is the treatment of a rigid metatarsus varus?
splinting
What is the deformity of talipes calcaneovalgus?
foot eversion
ankle dorsiflexion
Is flat foot normal in infants?
yes
Cavus foot is associated with what 3 neurologic conditions?
poliomyelitis
Charcot-Marie-Tooth
Friederich's ataxia
Poliomyelitis, Charcot-Marie-Tooth, and Friederich's ataxia are associated with foot condition?
cavus foot
What is cavus foot?
high longitudinal arch
What condition is usually seen in disorders of motor weakness such as CMT or pes cavus foot deformity?
claw toes
What is bow leg?
genu varum
What is the postion of claw toes?
metatarsophalangeal joints are hyperextended and interphalangeal joints are flexed
Infants generally have genu varus or genu valgus?
genu varum (bow leg)
By 12-18 months infants are genu varus or genu valgus?
genu valgus
What is Blount's disease?
tibia vara
Where is the abnormality causing tibia vara?
medial portion of the proximal tibial growth plate
What is tibia vara called?
Blount's disease
What is the most common cause of leg bowing in the young child?
Blount's disease (tibia vara)
In what subset of children is tibia vara most common?
obese children who walk at 9-10 months
What is the most common racial group for tibia vara?
African-American
What is the treatment of Blount's disease?
osteotomy of proximal tibia and fibula
What are the 3 conditions of developmental dysplasia of the hip?
hip subluxation
hip dislocation
acetabular dysplasia
When is hip dislocation diagnosed?
birth
Hip dislocation is more common in what type of delivery?
breech
What is the incidence of hip dislocation?
1 per 1,000 birth
Hip dislocation is more common in males or females?
females
If the mother had a history of dislocated hip, the risk to the baby is increased to what ratio if breech?
1 in 15
If the mother had a history of dislocated hip, the risk to the baby is increased to what ratio if nonbreech?
1 in 25
What two conditions have an increased incidence of hip dysplasia at birth?
metatarsus adductus
torticollis
Metatarsus adductus and torticollis predispose to what other congenital disorder?
hip dysplasia
What are the 2 names of the test for hip dysplasia at birth?
Galeazzi or Allis test
With knees and hips flexed a lower level of the flexed knee indicates what condition?
hip dysplasia
With knees and hips flexed a lower level of the flexed knee indicates what condition much less common than hip dysplasia?
congenital short femur
What two tests are conducted for congenital instability of the hips?
Barlow and Ortolani tests
What imaging study is now done in conjunction with the Barlow or Ortolani test for congenital hip instability?
ultrasound
What test is used to determine if a dislocated hip can be readily dislocated?
Barlow test
What is the purpose of the Barlow test?
To determine if a dislocated hip can be readily dislocated
What is the purpose of the Ortolani test?
To determine if a dislocated hip can be readily reduced
If a hip remains dislocated for several weeks what hip ROM may become limited on the affected side?
hip abduction
What is the sign of a positive Ortolani test?
palpable "clunk" as the hip reduces
What are the 2 treatments for hip instability?
Pavlik harness or hip spica cast
The Pavlik harness or hip spica cast maintain hip reduction in what degree range of flexion?
90-120 degrees of hip flexion
What position and degree range does the pavlik harness or hip spica cast maintain the hip in?
90-120 degrees of flexion
How long are the pavlik harness or hip spica cast used to treat hip instabiility?
3-4 months
What is a complication of forced hip abduction in the brace or pavlik harness?
avascular necrosis of the hip
What is a ROM precaution of the pavlik harness or hip spica cast?
no forced abduction
What other range of motion is limited by the pavlik harness or hip spica cast?
adduction
What is the incidence of congenital tortecollis?
1 in 250
What side, right or left, comprises 75% of congenital torticollis?
right side
What is the olive sign?
a soft nontender enlargement in the sternocleidomastoid
What does the "olive" sign represent?
congenital torticollis
At what month range does congenital torticollis subside?
4-6 months
What is plagicephaly?
orbital assymetry
What 4 secondary deformities can occur with congenital torticollis?
*flattening of the ipsilateral face
*contralateral occipital flattening
*orbital asymmetry
*ipsilateral hip dysplasia
What are 3 differential diagnoses for congenital torticollis?
*muscular fibrosis
*cervical hemivertebra
*atlantoaxial rotary subluxation
In right torticollis what direction is the head tilted?
right shoulder
In right torticollis what direction is the chin rotated to?
left
In left torticollis what direction is the head tilted?
left shoulder
In left torticollis what direction is the chin rotated to?
right
What is the most common cause of congenital torticollis?
sternocleidomastoid fibrosis
Sternocleidomastoid fibroisis is the most common cause of what congenital disorder?
congenital torticollis
The SCM is enlarged or smaller on the side toward which the head is laterally tilted?
enlarged on the side toward which the head is tilted
What condition can result from a cervical hemivertabrae?
congenital cervical scoliosis
X-rays of congential torticollis reveal rotation of what two vertabrae?
C1-C2
What is the mainstay treatment of congenital torticollis?
stretching
On what side of the crib is a mobile put for an infant with right torticollis?
right of the crib
On what side of the crib is a mobile put for an infant with left torticollis?
left of the crib
Failure to regain full cervical ROM in congenital torticollis will lead to what complication?
persistent facial assymetry
Surgery is performed most successfully in congenital torticollis if the child is less than what age?
12
What is the finding in subluxation of the radial head (nursemaid's elbow)?
the radial head and neck are displaced distal to the annular ligament
What two motions reduces a subluxation of the radial head?
supination and extension of the forearm
Is the xray normal in subluxation of the radial head?
yes
What is little leaguer's elbow?
medial epicondylitis
What is the cause of medial epicondylitis?
repetitive stress on the apophysis of the medial humeral epicondyle ossification center
What is the stress vector causing medial epicondylitis?
valgus stress on the elbow
What is Osgood-Schatter's disease?
traction apophysitis of the anterior tibial tubercle
What is a traction apophysitis of the anterior tibial tubercle?
Osgood Schlatter's disease
Where is the knee pain in Osgood-Schlatter's, anterior or posterior knee?
anterior knee
What is the pathology of Osgood-Schlatter's disease?
inflammation/microfractures of the apophyseal cartilage between the tibial tubercle and the secondary ossification center of the tibial tuberosity where the patella tendon attaches
Where is the tenderness in Osgood-Schlatter's disease?
directly over the tibial tubercle
What are the 2 activity restrictions for Osgood-Schlatter's disease?
no deep knee bending
no knee flexion
What is the most common cause of limping and pain in the hip of children?
transient toxic synovitis of the hip
What are two other causes of nontraumatic hip pain in children?
*Avascular necrosis of the proximal femur (Legg-Calve-Perthes disease)
*Epiphyiolysis (slipped captial femoral epiphyisis (SCFE)
What is the most common hip disorder of preadolescent and adolescent children?
Slipped Capital Femoral Epiphysis (SCFE)
What is a risk factor for SCFE?
obesity
In what gender is SCFE more common?
boys
In what gender is Legg-Calve-Perthes more common?
boys
What is the incidence of nontraumatic hip pain in children?
1 in 750
What ROM is limited in acute transient toxic synovitis?
limited hip internal rotation
How long does acute transient toxic synovitis take to resolve?
3-5 days
What is the xray finding in acute transient toxic synovitis?
normal
What is the age range for acute transient toxic synovitis?
3-6 years old
What gender is affected more frequently in acute transient toxic synovitis?
boys
Where is the pain in Legg Calves Perthes?
groin with radiation to anterior thigh
What 3 hip ROMs are limited in Legg Calves Perthes?
internal rotation
extension
abduction
What are 2 xray finding in Legg Calves Perthes?
*small ossified femoral head
*widening of hip joint space
What are 2 risk factors of SCFE?
*obesity
*delayed secondary sex characteristics
What is the resting position of the hip apparent in SCFE?
external rotation
What are 2 hip ROM limitations in SCFE?
internal rotation
abduction
What are 2 xray findings in SCFE?
*growth plate wider and irregular
*narrow epiphysis
What is the preferred treatment for SCFE?
surgical pinning
What is the age range for SCFE?
9-15 years old
In what what racial group is SCFE more common?
blacs
In what gender is SCFE more common?
boys
What is the prognosis in SCFE?
variable
What are two criteria for a good prognosis in Legg Calve Perthes disease?
*< 6 years old
< 50% femoral head involvement
Involvement of what part of the femoral head indicates a poorer prognosis in Legg Calve Perthes?
lateral femoral head
What percent of children have a second episode of acute transient toxic synovitis?
<10%
What is the inheritence pattern of idiopathic scoliosis?
autosomal dominant
When is the most common onset of idiopathic scoliosis?
adolescence
What is the curve pattern in idiopathic infantile scoliosis?
left thoracolumbar
What is the curve pattern in idiopathic juvenile scoliosis?
right thoracic or double curve
What is the curve pattern in idiopathic adolescent scoliosis?
right thoracic
What is the male:female ratio in adolescent scoliosis?
1:1
Whose scoliosis worsens more commonly, males or females?
females, 8-10x more frequently
30% of infants with congenital scoliosis may have one of what 2 other congenital deformities?
*unilateral renal agenisis
*spinal cord abnormality
Congenital scoliosis is an additional finding in what acronym syndrome?
VATER
Acquired scoliosis is most commonly seen in what 4 congenital disorders?
cerebral palsy
spinal bifida
muscular dystrophy
spinal muscular atrophy
Scoliosis is uncommon in children with who are able to do what activity?
walk
In what form of cerebral palsy is acquired scoliosis most common?
spastic quadreplegia
What two activities is a spastic quadraplegic CP patient with acquired scoliosis unable to perform?
stand or walk
At what progression milestone in Duchenne's muscular dystophy is acquired scoliosis more common?
When the child becomes wheelchair bound
Acquired scoliosis is very common in children with spina bifida who do not have neurologic function below what level?
Thoracolumbar level
What is the Adams's test? What is a positive test?
a forward bending test; positive if there is a prominence on the posterior trunk corresponding to the convex side
What xray view is used to measure a cobb angle?
PA
To measure the cobb angle a straight line is drawn along the superior endplate of what vertabrae?
most tilted cephalad vertabrae
To measure the cobb angle a straight line is drawn along the inferior endplate of what vertabrae?
most tilted inferior caudal vertabrae
At what degree of angulation curve range do pulmonary function test abnormalities appear in scoliosis?
50-60%
What is the most common pulmonary function test abnormality in scoliosis?
decreased vital capacity
There is a decreased sized hemithorax on the concave or convex side of scoliosis?
convex side
What idiopathic scoliosis degree range requires bracing?
20-40 degrees
What neuromuscular scoliosis degree range requires surgery?
20-40 degrees
Surgery is indicated in cerebral palsy scoliosis at what degree?
60 degrees
What is the radiographic criterion for Scheurmann's disease?
3 consecutive vertabrae are wedged >5 degrees
Whta is the preferrred brace for Scheurmann's disease?
TLSO
What are two other x-ray findings in Scheurmann's disease?
*Schmorl's nodes
*irregular endplates
What is the presenting symptom in spondylolisthesis?
painful lumbar flexion
What form of spondylolisthesis is most common in adults?
degenerative
What is the most common level for pediatric spondylolisthesis?
L5-S1
What are the two most frequent types of spondylolisthesis in children?
dysplastic
isthmic
What is the most common type of pediatric spondylolisthesis?
isthmic
Isthmic spondylolisthesis occurs at the site of a previous what?
pars spondylolysis
What type of spondylolisthesis is associated with severe neurologic deficits?
dysplastic
What is the defect in dysplastic spondylolisthesis?
lengthening of lamina
Spondylolisthesis is more common in males or females?
males
Spondylolisthesis progresses more commonly in males or females?
females
How much more common (multiple range) is spondylolisthesis is males than females?
2-4x
In children with spondylolisthesis what percentage slippage requires fusion?
>50%
What type of spondylolisthesis is more likely to cause compression on the cauda equina?
dysplastic
What is the most common type of connective tissue disease in children?"
juvenile rheumatoid arthritis
What are the two diagnostic criteria of juvenile rheumatoid arthritis?
arthritis >6 weeks
onset<16 years old
What are the 5 types of juvenile arthritis?
*polyarticular RF negative
*polyarticular RF positive
*pauciarticular Type 1
*pauciarticular Type 2
*Systemic onset juvenile arthritis
What is the most common subtype of juvenile arthritis?
pauciarticular type 1 (early onset) 30% of all children with JRA
What are the two diagnostic criteria for polyarticular JRA?
5 or more joints involved in
first 6 months
What percentage of all JRA is polyarticular RF negative?
25%
Polyarticular JRA is more common in boys or girls?
girls
What is the main complaint in polyarticular RF negative?
stiffness
What joint is involved in 50% of children with polyarticular JRA?
hip
Hip involvement is common in what subtype of polyarticular JRA?
RF negative
What is the hip pathology causing late disability in children with polyarticular RF negative?
erosion of the femoral head
Polyarticular RF positive is symmetric or asymmetric?
symmetric
What is the minimum age of onset for polyarticular RF positive?
11 years old
What are two findings other than symmetric involvement in RF positive polyarticular RF positive?
subcutaneous nodules
erosions
What is the most common type of JRA?
pauciarticular
What is the maximum number of joints affected in pauciarticular JRA?
4
What are the two subtypes of pauciarticular JRA?
Type 1 early onset
Type 2 late onset
Pauciarticular Type 1 is more common in boys or girls?
girls
What is the maximum age of onset for pauciarticular type 1?
4 years old
Pauciarticular type 1 accounts for what percentage of all children with JRA?
30%
What is the primary ocular complication in pauciarticular type 1?
iridocyclitis
What is the demographic (gender and age range) of pauciarticular JRA type 2?
boys 9-10 years old
With what haplotype is pauciarticular type 2 associated in 90% of cases?
HLA-B27
What is a late complication of pauciarticular type 2 with HLA-B27 positive?
ankylosing spondylitis
What is Still's disease?
systemic-onset JRA
What is the least common form of JRA?
systemic-onset JRA
Large or small joints are most often involved with Still's disease?
small joints
What are 3 constitutional symtoms of Still's disease?
*spiking fevers
*rash
*hepatosplenomegaly
What is a cardiac complication of Still's disease
pericarditis
In systemic-onset JRA what symptoms can precede arthritis?
systemic symptoms i.e.
acute spiking fevers
hepatosplenomegaly
lymphadenopathy
myalgia
fatigue
pericarditis
What JRA involves the SI joint?
pauciarticular type II (i.e. HLA-B27)
What percentage of Iridocyclitis in pauciarticular type 1 is chronic?
50% chronic
What percentage range of Iridocyclitis in pauciarticular type 2 is acute?
10-20% acute
What is the only JRA that is RA positive?
polyarticular RF positive
What 2 JRAs are ANA negative?
pauciarticular type 2 and systemic-onset (Still's Disease)
Whta 3 JRA can have a positive ANA?
polyarticular RF neg
polyarticular RF pos
pauciarticular type 1
What JRA has the highest likelihood of ANA positive?
polyarticular RF pos
What JRA has the highest likelihood of an ultimate morbidity of severe arthritis?
polyarticular RF pos
What is the HLA of polyarticular RF pos?
HLA DR4
What JRA has a risk of vision loss?
pauciarticular type 1
Systemic features of RA are more common in adults or children?
children
What is the only JRA that is predominately males?
pauciarticular type 2
Large joint are invovled more frequently with children of adults with RA?
children
What is the wrist deviation of children with JRA?
ulnar deviation at the wrist
What wrist loss of ROM is present with JRA?
loss of wrist extension
What is the finger deviation of of children with JRA?
radial deviation of the fingers
At what joint does radial deviation of the fingers occur in children with JRA?
MCP
What is finger deformity in children with JRA?
finger flexion
What is more common in children with RA, bursitis or tenosynovitis?
tensynovitis
Rheumatoid nodule occur more frequently in adults or children with RA?
adults
The cervical spine is involved more frequently in adults or children with RA?
children
Periarticular bone demineralization is seen radiographically once what percentage of demineralazation occurs?
50%
What percentage of children improve with NSAID therapy?
50%
What are the 3 NSAIDs approved for use in children?
naproxen
ibuprofen
tolmentin
What percentage range of children receiving gold salts showed improvement?
60-70%
What are 3 side effects of gold salts?
rash
proteinuria
bone marrow suppression
What is more efficacious oral or IM gold?
IM
What anti-malarial drug is most commonly used for JRA?
hydroxychloroquine
What is the JRA remission percentage range with D-penicillamine?
60-70%
What are the two mechanisms of action of cyclosporine?
*blocks production of interleukin-2
*blocks synovial T-cells
What med is used for children with refractory JRA disease?
azothioprine
What med can reduce the use of steroids?
azothioprine
Do systemic steroids reduce symptoms or cause remission, or both?
only reduce symptoms
Reye's syndrome is more of risk with aspirin use for JRA when there is also an infection with what two viral agents?
varicella
influenza
What is a CNS complication of ibuprofen?
asceptic meningitis
What is a skin complication of naproxen?
cutanea tarda
What is a cognitive complication of indomethacin?
poor attention span
What is an ocular side effect of hydroxycholoquine?
macular degeneration
What is an immune side effect of d-penicillamine?
bone marrow suppression
Use of what medication class should be avoided with methotrexate use?
NSAIDs
NSAIDs should not be used with methotrexate because of an increased risk of what side effect?
bone marrow suppression
What is the cause of joint pain?
stretching of the joint capsule
What pediatric pain questionnaire takes into account the child's cognitive level of development?
Varni/Thompson
What is the ideal water temperature range for JRA heat treatments?
90-100 degrees F
What is the depth of heat penetration using a hot pack?
1 cm
What is the degree range and bias (flexion or extension) of wrist splinting in children with wrist RA?
15-20 degrees extension
Subluxation of the atlantoaxial joint can occur in RA with the erosion of what ligament?
transverse ligament
The erosion of the cervical spine transverse ligament can lead to the subluxation of what joint in children with RA?
atlanto-axial joint
The TMJ is involved in what percentage of children with JRA?
50%
What 2 shoulder ROMs are limited in children with JRA?
abduction and internal rotation
What shoulder ROM is limited in adults with RA?
external rotation
What percentage of the normal elbow flexion ROM is required for ADLs?
>90%
What wrist ROM is lost early in JRA?
wrist extension
What bias wrist contracture develops in children with JRA?
flexion contracture
Hyperextension (swan-neck deformity) of the PIP is more common in adults or children with RA?
adults
What deformity is the PIP hyperextension?
swan-neck
What is the Swan Neck deformity?
PIP hyperextension
What deformity is flexion at the PIP and hyperextension at the DIP?
Boutannaire's deformity
What is Boutannaire's deformity?
flexion at the PIP and hyperextension at the DIP
At what joint does radial deviation of the fingers occur?
MCP
What are the two ROM biases for hip flexion contracture in children with JRA?
internal rotation and adduction
What are the two ROM biases for hip flexion contracture in adults with RA?
external rotation and abduction
What joint is involved in 50% of children with polyarticular RF neg JRA?
hip
What degree of knee flexion minimizes intra-articular pressure?
30 degrees
What is the gait of a child with JRA with foot/ankle involvement?
flat foot gait
What part of the gait cycle is affected by MTP involvement?
push off
What joint in the foot is most commonly affected by JRA?
MTP
What ACR class has limited ability to perform ADLs?
Class IV
What fraction of children with JRA go into remission?
2/3rds
What is the percentage range of death from JRA in children?
2-4%
Involvement of what joint indicates a poor outcome?
hip
Involvement of small or large joints indicates a poor outcome?
small joints
Early or late age onset of disease in JRA indicates a poor outcome?
late
RF-positive or negative indicates a poor outcome in JRA?
RF positive
Timely or delay in treatment indicates a poor outcome in JRA?
delay in treatment
Juvenile onset seronegative spondyloarthropathies are more common in boys or girls?
boys
What are the 4 seronegative spondyloarthropathies?
*anklyosing spondylitis
*reactive arthritis (Reiter's)
*arthritis with IBS
*psoriatic arthritis
What is the haplotype associated with seronegative spondyloarthropathies?
HLA-B27
Above what age is anklyosing spondylities more common?
8 years old
What pecentage of white patients with AS are HLA-B27 positive?
90%
What percent children with AS have peripheral joint involvement?
82%
What peripheral joints are most commonly invovled in juvenile AS?
lower extremities, especially the hip
What feature of AS occurs more commons in children than adults?
enthesitis
What is enthesitis?
pain at the insertion of tendon to bone
What is pain at the insertion of tendon to bone?
enthesitis
What are 3 types of symptoms of seronegative spondyloarthropathies?
arthritis
enthesitis
tenosynovitis
What joint involvement is necessary for a diagnosis of juvenile AS?
x-ray evidence bilateral SI joint involvement
What is an indicator of poor outcome in juvenile AS?
hip involvement
What is the triad of reactive arthritis (Reiter's syndrome)?
assymetric arthritis
urethritis
conjunctivitis
Is the arthritis is Reiter's syndrome symmetric or assymetric?
assymetric
What two joint are most commonly involved in reactive (Reiter's) arthritis?
knee or ankle
What is the most common gender and age for reactive arthritis?
boys greater than 8 years old
What 5 organisms most commonly are involved with reactive arthritis?
chlamydia
salmonella
shigella
yersinia
What percentage range of children with UC or Crohn's suffer from arthritis?
10-20%
Is psoriatic arthritis symmetric or assymetric?
assymetric
What are 3 associated symptoms of psoriatic arthritis?
nail pitting
hyperkeratosis
anterior uveitis
What is associated with a poor functional outoome in psoriatic arthritis?
positive ANA
What percent of SLE begins in childhood?
20%
What is the male:female ratio of SLE?
4.5:1
How many of the 11 diagnostic criteria must be present for a diagnosis of SLE?
at least 4
What 2 rashes are diagnositic criteria of SLE?
discoid rash
malar rash
What 4 positive immunoserology tests are diagnositic criteria of SLE?
LE cells
antinative DAN antibodies
anti-SM antibodies
false positive test for syphilis
What 4 "itis"es are diagnostic criteria of SLE?
nephritis
pericarditis or pleuritis
non-erosive arthritis
encephalitis
Is the arthritis of SLE erosive or nonerosive?
nonerosive
Is positive or negative ANA a diagnoistic criterion of SLE?
positive ANA
What ulceration is a diagnostic criterion of SLE?
oral or nasal mucocutaneous ulceration
What eye condition is a diagnostic criterion of SLE?
photosensitivty
What blood disorder is a diagnostic criterion of SLE?
cytopenia
List all 11 diagnostic criteria of SLE?
discoid rash
malar rash
cytopenia
positive ANA
pericarditis or pleuritis
encephalopathy
nephritis
arthritis
positive immonserology (LE cells, false positive test for syphlis
photosensitivity
oral of nasal mucocutaneous ulceration
What fraction of children have a malar rash?
1/3
What is a malar rash?
erythematous rash over the bridge of the nose and cheeks
What is the most important of the SLE diagnostic criteria in determining outcome in children?
nephritis
What percentage of children with SLE have nephritis?
75%
Can joint deformities develop in children with SLE?
yes, nonerosive joint deformities
What 6 conditions of SLE are associated with a poor outcome?
*hematuria
*proteinura
*hypertension
*pulmonary hypertension
*chronic active disease
*biopsy-proven proliferative glomerulonephritis
What three structures are involved in juvenile dermatomyositis?
muscle
skin
subcutaneous tissues
What are 3 clinical features of juvenile dermatomyositis?
*vasculitis
*calcinosis
*no association with malignancy in childhood
What is the most common age range for juvenile dermatomyositis?
5-14 years old
What gender is more commonly affected with juvenile dermatomyositis?
girls
Weakness in juvenile dermatomyositis is proximal or distal?
proximal
What is the classic rash of juvenile dermatomyositis?
periorbital heliotropic rash
What is the EMG finding in juvenile dermatomyositis?
inflammatory myopathy
What enzymes are elevated in juvenile dermatomyositis?
muscle enzymes
What are 8 common constitutional symptoms associated with juvenile dermatomyositis?
fever
malaise
muscle tenderness
weight loss
arthritis
dyspnea
dyspahgia
EKG changes
What is the mainstay treatment of juvenile dermatomyositis?
steroids
Over what time frame is the steroid taper in juvenile dermatomyositis?
2 years
What is the purpose of physical therapy in juvenile dermatomyositis?
to prevent contractures
What is the pathological hallmark of scleroderma?
fibrosis
What is the average age of onset range for scleroderma?
8-10 years old
What is the localized from of scleroderma?
mophea
Mophea is only present in what tissue?
skin
What is CREST syndrome?
Calcinosis
Raynaud's
Esophogeal dysfunction
Sclerodactyly
Telangiectasia
What is the organism causing Lyme disease?
borrelia burgdorferi
What class of microbe is borrelia burgdorferi?
spirochete
What tick transmits borrelia burgdorferi?
deer tick
What is the name of the deer tick that transmits borrelia burgdorferi?
ixodes dammini
Erythema migrans is characeristic of what condition?
lyme disease
What is the appearance eythema migrans?
round red skin lesion with central clearing
What are 5 initial constitutional symptoms of lyme's disease?
fever, fatigue, headache, myalgia, and stiff neck
What are 3 late phase conditions of lyme's disease?
arthritis, cardiac, and neuorlogical disease
What is the cardiac condition in lyme's disease?
heart block
What percent of children develop a chronic inflammatory arthritis in lyme's disease?
10%
What are 3 antibiotics used to treat lyme's disease?
doxycylcine
amoxicillin
erythromycin
What antibiotic (and delivery method IV or p.o.) is used to treat late-stage Lyme's disease?
IV ceftriaxone
What is the age of onset of rheumatic fever?
>4 years old
What is the male:female ratio of rheumatic fever?
1:1
What 4 joints are most commonly in rheumatic fever?
knees, elbows, wrists, ankles
What are 5 associated findings in rheumatic fever/
carditis
fever
rash
chorea
nodules
Rheumatic fever is often preceded by what infection?
streptococcal infection
Diagnoisis of rheumatic fever is made by what criteria?
Jones criteria
What is the EKG change in rheumatic fever?
prolonged PR interval
What 5 conditions are considered the "major" in the Jones criteria?
carditis
polyarthritis
chorea
erythema marginatum
subcutaneous nodules
Prognosis in rheumatic fever is based on what organ involvement?
cardiac involvement
What two meds are the mainstays of rheumatic fever treatment?
salicylates
corticosteriods
Septic arthritis occurs in children under what age?
2 years old
What gender is affected more by septic arthritis?
boys
What joint is affected by the transient synovitis of 3-10 year old boys?
hip
Where is the referred pain in the transient synovitis of 3-10 year old boys?
thigh or knee
Bacterial septic arthritis accounts for what percentage of all childhood arthritis?
6.5%
Bacterial septic arthritis in children in usually monoarticular or polyarticular?
monoarticular
What are the two most common pathogens in bacterial septic arthritis?
haemopholis influenzae
staph aureus
What is the most common organism in newborn septic arthritis?
staph aureus
What is the most common organism in 2 months-2 years old septic arthrtis?
h. influenzae
What is the most common organism in the older than 2 years septic arthritis?
staph aureus
What is the most common organism causing septic arthritis in sexually active adolescents?
gonococcal disease
Hemophilias are associated with defecienies of what three factors?
factors VIII, IX, or XI (8,9,11)
On what chromosome are factors 8,9, and 11 carried?
X chromosome
Hemophilia A is a deficiency of what factor?
factor VIII
Hemophilia B is also call what?
Christmas hemophilia
Hemophilia B is a deficiency of what factor?
factor IX
Hemophilia C is a deficiency of what factor?
factor XI
Deficiency of factor VIII is what hemophilia?
A (classic)
Deficiency of factor IX is what hemophilia?
B (christmas)
Deficiency of factor XI is what hemophilia?
C
What is the hallmark sign of hemophilia?
hemarthrosis
Can hemarthrosis in hemophilia occur spontaneously?
yes
What are three symptoms of hemarthrosis?
pain, swelling, and decreased ROM
What are three joint changes associated with repeated hemarthroses?
osteoporosis
muscle atrophy
fixed, non-functional joint
What is the mainstay treatment of hemophilia A during bleeding episodes?
Factor VIII replacement
What are two local treatment during a hemophilia bleeding episode?
cold and pressure
Early treatment with factor VIII can prevent what two poor joint outcomes?
disability and deformity
Severe hemophilia is defined as factor activity less than what percentage?
<1%
Moderate hemophilia is defined as factor acitivity greater than what percentage?
>1%
Mild hemophilia is defined as factor activity greater than what percentage?
>5%
What percentage of hemophiliacs are currently infected with HIV from factor transfusions?
30%
What forms of hepatitis are transmissilble by clotting factor concentrate?
hepatitis B and C
What is Kawasaki's disease?
systemic vasculitis
What is the most common age range for Kawasaki's disease?
<4 years old
What are the 9 diagnostic criteria of Kawasaki's disease?
high fever>5 days
strawberry tongue
red, chapped lips
pharyngeal erythema
conjunctival injection
edema of hands or feet
erythema of palms or soles
truncal rash
cervical lymphadenopathy
Where are the 5 erythemas of Kawasaki's disease?
eyes (conjunctiva)
lips
tongue
throat
palms, soles
Where is the edema in Kawasaki's?
hands or feet
Greater than how long (days) must the fever last in the diagnositic criteria of Kawasaki's?
>5 days
What is the #1 cause of nonmotor vehicle deaths in children ages 1 through 4?
burns
What is the #2 cause of nonmotor vehicle death in children ages 4-14?
burns
Children younger than 4 have a higher risk of death in burns independent of what factor?
burn size
What type of injury is an important predictor of burn mortality?
inhalation injury
What type of burns is the single most common type of pediatric burn injury?
scald burn
With scald burn there is increased suspicion of what?
child abuse or neglect
What percentage of burns are a result of abuse?
8%
What is the rule of "9"s for children?
9% is taken from the legs and added to the head of a child<1 year old. For each subsequent year 1% is returned to the legs unitil age 9.
What is a partial thickness burn?
epidermis plus partial elements of the dermis
What is a full-thickness burn?
all epidermal and dermal elements
Name 2 characteristics of a full-thickness burn
anesthetic, avascular
What color is a full-thickness burn?
white
What color is a partial-thickness burn?
red (shallower) or white (deeper), depending on depth
What total body surface area is an indication for a burn hospitalization?
20%
What total body surface area in children or the elderly is an indication for burn hospitalization?
10%
What percentage full-thickness is an indication for burn hospitalization?
5%
Burns to any of what 6 areas is an indication for a burn hospitalization?
eyes, face, hands, feet, genitalia
What type of pulmonary burn is an indication for hospitalization?
inhalation
What cause of burn is an indication for hosptilization?
elecrical
Comfortable positions for burn patients promote what poor outcome?
contractures
What is the contracture preventing position for neck burns?
extension
What is the contracture preventing position for anterior axilla burns?
90 degress abduction, neutral rotation
What is the contracture preventing position for posterior axilla burns?
shoulder flexion
What is the contracture preventing position for elbow/forearm burns?
elbows extended, forearm supinated
What is the contracture preventing position for wrist burns?
15-20 degrees extension
What is the contracture preventing position for MCP burns?
70-90 degrees flexion
What is the contracture preventing position for IP burns?
full-extension
What is the contracture preventing position for palmar burns?
all joints full extension, thumb radially abducted
What is the contracture preventing position for chest burns?
straight, no lateral or anterior flexion
What is the contracture preventing position for hip burns?
extension, 10 degrees abduction, neutral rotation
What is the contracture preventing position for knee burns?
extension
What is the contracture preventing position for ankle burns?
90 degrees dorsiflexion
When is splinting initiated in the pediatric burn patient?
skin tightening
Do small children tend to lose strength or joint mobility with extended joint immobilization?
no
What type of ROM PT is recommended for children with burns, passive, active, or active assisted ROM?
active or active assisted
What burn-treatment modality can cause premature closure of epiphyseal plates?
ultrasound
What 2 modalities are used as additions to scar therapy?
fluidotherapy
paraffin
What should not be used by neck burn patients while lying supine?
pillows
Where is the most common location for decubiti in children with neck burns?
occiput
What is the most common burn-related contracture in pediatric burn patients?
axilla
What splint is used for successfully in pediatric axilla burns?
airplane splint
What is the correct splint position for dorsal hand burns?
MCP flexion 70-90 degrees, IP extension, radial abduction of thumb
What is the correct splint position for volar hand burns?
MCP/IP full extension, fingers abducted, palmar abduction of thumb
What is the correct splint position for dorsal foot burns?
ankle and toes plantar flexion
What is the correct position for sole or foot burns?
ankle dorsiflexion, toes neutral
Cancer is what number cause of death in the US?
#2
What is the most common type of cancer in children?
leukemia
In what brain fossa do 50% of pediatric brain cancers develop?
posterior
What is the second most common type of childhood cancer?
brain tumors
What location pediatric brain tumor presents with increased ICP and seizures?
supratentorial
Supratentorial brain tumors present with what 2 symptoms?
increased ICP and seizures
What location tumors present with increased ICP and cerebellar signs?
cerebellar and 4th ventricle tumors
Cerebellar and 4th ventricle tumors present with what 2 signs?
increased ICP and cerebellar signs
What are 3 symptoms of brain stem tumors?
ataxia
CN palsies
hemiparesis
In what decade is the peak incidence of Hodgkin's disease?
3 decade
What is the most common presentation of Hodgkin's disease in children?
painless cervical adenopathy
What virus MAY cause Burkitt's lymphoma?
Epstein-Barr
What 2 bones are usually affected by Burkitt's lymphoma?
facial bones
mandible
What type of cells massively proliferate in Burkitt's lymphoma?
lymphoid cells
From what 2 cell types does neuroblastoma develop?
sympathetic ganglia
adrenal medulla
What is the third most common pediatric neoplasm in children <5years old?
neuroblastoma
What age is the peak incidence of neuroblastoma?
2 years old
Presentation of a neuroblastoma in what area is associated with a poor prognosis?
abdominal area
Neuroblastoma is the third most common pediatric neoplasm in what age group?
< 5 years old
What are the 3 most common etiologies of abdominal masses in early childhood?
hydronephrosis
neuroblastoma
Wilm's tumor
Where does a Wilm's tumor orginate?
kidney
What is the most common malignant soft tissue tumor in children?
rhabdomyosarcoma
With what condition is rhabdomyosarcoma associated?
neurofibromatosis
In what two areas is rhabdomyosarcoma commonly found?
head and neck
How is rhabdomyosarcoma diagnosed?
biopsy
Metastasis to what structure is uncommon in children?
bone
What are the 2 most common bone tumors in children?
#1 osteosarcoma
#2 Ewing's sarcoma
What is the most common age range for osteosarcoma or Ewing's?
> 10 years old
What is the most common site of osteosarcoma?
distal femur
What are the 2nd and 3rd most common sites for osteosarcoma?
proximal tibia
proximal humerus
What part of long bones is the most common site for osteosarcoma?
metaphysis
Ewing's sarcoma most common occurs in what part of the bone?
diaphysis
What is the most common malignant ocular tumor?
retinoblastoma
What is the age range for >90% of retinoblastomas?
< 5 years old
What is the most common type of pediatric leukemia?
actue lymphoblastic leukemia
What is the peak age range for pediatric leukemia?
2-5 years old
What are 2 risk factors for childhood leukemia?
chromosomal abnormalities
immune deficiency
What two tumors occur commonly in the epihysis?
chondoblastoma
giant cell tumor
What 5 tumors (malignant and benign) occur in the metaphysis?
osteosarcoma
aneurysmal bone cyst
chondromyxoid fibroma
osteochondroma
unicameral bone cyst
What 2 tumors (malignant and benign) occur in the diaphysis?
Ewing's sarcoma
eosinophilic granuloma
What is the leading cause of death in childrn > 1 year old in the US?
TBI
What is the annual incidence of TBI in children (per 100,000)?
185/100,000
What is the death rate of children (per 100,000) from TBI?
10/100,000
What is the second leading cause of death in children in US?
leukemia
What is the leading and second leading cause of TBI in children?
#1 MVA
# 2 falls
After direct impact, what force is the cause of brain injury?
initial deceleration or shearing forces
Shearing forces cause what 2 types of brain injury?
diffuse axonal injury
multiple punctate hemorrhages
What injury is NOT indicative of the severity of brain injury?
skull fracture
What is a contrecoup injury?
cerebral contusion distant from point of impact
What neurological developmental issue in children may result is a greater risk of shearing injury?
incomplete myelination
Brain injury secondary to increased rotational forces is a result of what fact of the pediatric population?
relatively large head
What percentage of children who sustain a TBI also suffer other injuries?
50%
What percentage range of TBI children also have a SCI?
5-10%
What are the 2 most common etiologies of pediatric brachial plexus injuries?
trauma
obstetrical complications
What nerve roots are damaged in an upper trunk brachial plexopathy?
C5 C6
What is the mechanism of injury in an upper trunk brachial plexopathy?
sudden traction to the neck
What is an upper trunk brachial plexopathy also called?
Erb-Duchenne palsy
What is a lower trunk brachial plexopathy also called?
Klumpke paralysis
What is the mechanism of injury in Klumpke's paralysis?
violent upward pull of shoulder
What 2 nerve roots are damaged in Klumpke's paralysis?
C8 and T1
What is the most common cause of Klumpke's paralysis?
fall onto hyperabducted shoulder
What syndrome is associated with Klumpke's paralysis?
Horner's syndrome
What ganglion may be damageed in Klumpke's paralysis?
superior cervical sympathetic ganglion
What mechanism of injury is rare in Klumpke's paralysis?
obstetric
What are 2 signs of Klumpke's paralysis?
small hand muscle atrophy
claw hand deformity
In Erb's palsy shoulder adduction is caused by weakness in what two muscles?
deltoid and suprapinatus weakness
In Erb's palsy shoulder internal rotation is caused by weakness in what 2 muscles?
teres minor and infraspinatus weakness
In Erb's palsy elbow extension is caused by weakness in what 2 muscles?
bicep and brachioradialis weakness
In Erb's palsy forearm pronation is caused by weakness in what 2 muscles?
supinator and brachioradialis weakness
In Erb's palsy wrist flexion is cuased by weakness in what 2 muscles?
extensor carpi radialis longus and extensor carpi radialis brevis weakness
What is the position of the arm in Erb's palsy?
Waiter's tip
What is the position of the shoulder in Erb's palsy?
adducted and internally rotated
What is the position of the elbow in Erb's palsy?
extended
What is the position of the forearm in Erb's palsy?
prontated
What is the position of the wrist in Erb's palsy?
flexed
A GCS of what range is considered severe and the patient is comotose?
3-8
What is the GCS for a mild injury?
13-15
What is the GCS for a moderate injury?
9-12
What is a higher (less severe injury) in GCS? extension or flexion to pain stimulus?
flexion
What is the GCS for spontaneous eye opening?
4
What is the GCS for eye opening to speech?
3
What is the GCS for eye opening to pain?
2
What is the GCS for no eye opening?
1
What is the GCS for verbal response oriented?
5
What is the GCS for verbal response confused conversation (irritable cry)?
4
What is the GCS verbal response inappropriate words (cries to pain)?
3
What is the GCS verbal response incomprehensible speech (moans to pain)?
2
What is the GCS verbal response none?
1
What is the best upper limb motor response obeys commands?
6
What is the best upper limb motor response localizes pain (withdraws to touch)?
5
What is the GCS best upper limb motor response withdraws to pain?
4
What is the GCS best upper motor response flexion to pain?
3
What is the GCS best upper motor response extension to pain?
2
What is the GCS best upper motor response none?
1
What is the infant modification for GCS oriented?
coos, babbles
What is the infant modification for GCS confused conversation?
irritable cry, consolable
What is the infant modification for GCS inappropriate words?
cries to pain
What is the infant modification for GCS incomprehensible sounds?
moans to pain
What is the infant modification best upper limb motor response for obeys commands?
normal movements
What is the infant modification best upper limb motor response for localizes pain?
withdraws to touch
What deficit is more common in children than adults post TBI?
dystonia
Damage to olfactory bulb and tracts, temporal lobes, or subfrontal areas can results in what sensory deficit?
anosmia
Basilar skull fracture is associated with what CN injury?
CN VIII (vestibulocochlear)
CN VIII can be injury in what location skull fracture?
basilar skull fracture
Deficits in what 2 areas are the largest cause of disability in pediatric TBI?
cognitive and communication
Children with what psychomotor condition are more likely to suffer TBI?
hyperactive
Agitation may result from damage to what 2 brain areas?
frontal lobes
subcortical areas
Damage to frontal lobes or subcortical areas may result in what symptom?
agitation
In what timeframe (months) does the majority of improvement in IQ take place after TBI?
first 4 months
Deficits in impulse control and disinhibition can result from damage to what area?
frontal lobe
Where is ADH produced?
hypothalamus
What are 3 signs of SIADH?
decreased urinary output
hyponatremia
decreased serum osmolarity
What condition overwhelmingly affects more girls than boys post TBI?
precocious puberty
Cerebral salt wasting syndrome directly affects what function?
renal tubular function
What condition directly affects renal tubular function?
cerebral salt-wasting syndrome
Diabetes insipidus is marked by excessive or deficient production of ADH?
deficiency of ADH
Diabetes insipidus is marked by excessive or deficient water loss?
excessive water loss (hypovolemia)
What are 3 complications of prolonged intubation in pediatric TBI?
*tracheal stenosis
*tracheomalacia
*vocal cord injury
What is central autonomic dysfunction?
unexplained hyperthermia, HTN, diaphoresis, rigidity, decerebrate posturing, and tachypnea after TBI
What percent of children with TBI are affected by central autonomic dysfunction?
14%
Dysfunction of what 2 brain areas are thought to play are role in central autonomic dysfunction?
hypothalmus
brainstem
What 2 outcomes are worse in patients with central autonomic dysfunction after TBI?
cognitive and motor
Heterotopic ossification is more common after TBI in children older than what age?
11
What are three risk factors for pediatric post-TBI heterotopic ossification?
>11 years old
more severe injury
two or more extremity fractures
What joints are most commonly affected by HO post TBI?
hips, knees
Is HO associated with a good or poor outcome in pediatric TBI?
poor
What is the definition of post-traumatic epilepsy in pediatric TBI?
two or more late (1-2 weeks post injury) seizures after TBI
Is prophylaxis with anti-epileptic drugs indicated in pediatric TBI?