Chapter 10: Peds #1

Front 1

A single palmar crease (simian crease) is indicative of what chromosomal abnormality?

Back 1

Trisomy 21 - Down's syndrome

*also look for hypotonia, congenital heart disease, ventral septal defects

Front 2

Small mouth, small jaw (micrognathia), prominent occiput, rocker bottom feet, & low set abnormally shaped ears are indicative of what chromosomal abnormality?

Back 2

Trisomy 18 - Edward's syndrome

*also IUGR, short palpebral fissure, short sternum, ROCK BOTTOM FEED, CHD, spasticity, overlapping fingers

Front 3

Keyhole shaped pupil (colomba of iris), capillary hemangioma, rocker bottom feet, cleft lip & palate are indicative of what chromosomal abnormality?

Back 3

Trisomy 13 - Patau's syndrome

*also CHD, urinary tract abnorms, hyperconvex nails, IUGR

Front 4

Short stature, webbed neck, SHIELD chest, & CHD are indicative of what chromosomal abnormality?

Back 4

TURNER's syndrome: 45, X

*CHD = coarctation of aorta
*also wide-set nipples, triangular face, congenital lymphedema hands/feet, primary amenorrhea

Front 5

Tall stature, gynecomastia, learning & behavior problems are indicative of what chromosomal abnormality?

Back 5

KLINEFELTER's syndrome: 47, XXY

*also postpubertally small testicles, mental retardation, infertility

Front 6

Name some infectious agents that are known to be teratogenic

Back 6

"TORCHeS"
Toxoplasmosis
Other (varicella, parvo)
Rubella virus
CMV
Herpes/HIV
Syphilis

Front 7

What is considered advanced maternal age?

Back 7

>35

Front 8

In terms of height, what are some major benchmarks in a child's life?

Back 8

Age 4 = should be DOUBLE birth length
Age 13 = should be TRIPLE birth length

Front 9

In terms of weight, what are some major benchmarks in a child's life?

Back 9

4-5 months = should be DOUBLE birth weight
1 year = should be TRIPLE birth weight
2 years = should be QUADRUPLE birth weight

Front 10

When does the anterior fontanelle usually close by?

Back 10

10-14 months

*posterior closes earlier at 4 months

Front 11

What is the first bone to calcify?

Back 11

Clavicle - happens in utero

Front 12

HEAD RIGHTING
Age of emergence?

Back 12

2 months in prone position, 3-4 months for supine

Front 13

Protective extension (sitting: anterior, lateral, posterior)
Age of emergence?

"parachute response"

Back 13

Anterior = 5-7 mos
Lateral = 6-8 mos
Posterior = 7-8 mos

*standing = 12-14 mos

Front 14

MORO reflex
Age of emergence?
Age of integration?

Back 14

E: birth
I: 4-6 mos

*startle reflex

Front 15

ROOTING & SUCKING reflexes
Age of emergence?
Age of integration?

Back 15

E: birth
I: 4 mos

*turn head to side of cheek being touched

Front 16

ATNR reflex
Age of emergence?
Age of integration?

Back 16

E: birth (definitive around 1-2 mos)
I: 4-6 mos

*fencer reflex when head is turned to one side

Front 17

STNR
Age of emergence?
Age of integration?

Back 17

E: 4-6 mos
I: 8-12 mos

*flex neck = hands flex, feet extend
*ext neck = hands ext, feet flex

Front 18

PLANTAR grasp
Age of emergence?
Age of integration?

Back 18

E: birth
I: 9-14 mos (when walking well)

Front 19

AUTOMATIC WALKING (stepping reflex)
Age of emergence?
Age of integration?

Back 19

E: birth
I: 1.5-2 mos

Front 20

PALMAR grasp
Age of emergence?
Age of integration?

Back 20

E: birth
I: 4-6 mos

Front 21

GALANT reflex
Age of emergence?
Age of integration?

Back 21

E: birth
I: 4-6 mos

*stroke skin along one side of back, trunk curls towards that side

Front 22

CROSSED EXTENSION reflex
Age of emergence?
Age of integration?

Back 22

E: birth
I: 1-2 mos

*hold one leg in extension and apply pressure to sole, opposite leg will flex, adduct, then extend

Front 23

FLEXOR WITHDRAWAL reflex
Age of emergence?
Age of integration?

Back 23

E: birth
I: 2 mos

*withdrawal of foot from noxious stimuli

Front 24

LANDAU reflex
Age of emergence?
Age of integration?

Back 24

E: 3-4 mos
I: 12-24 mos

*hold baby prone in air, will assume "superman" pose

Front 25

TONIC LABYRINTHE reflex (TLR)
Age of emergence?
Age of integration?

Back 25

E: birth
I: 6 mos

*prone position = flexor tone
*supine position = extensor tone

Front 26

At what age should you start to see MIDLINE HAND PLAY?

Back 26

4 mos

Front 27

At what age should you start to see a baby hold their head in neutral when pulled to sit?

Back 27

4 mos

Front 28

At what age should you start to see laughing and squealing?

Back 28

4 mos

Front 29

At what age should you start to see independent sitting?

Back 29

6 mos

Front 30

At what age should you start to see a baby holding its own bottle?

Back 30

7 mos

*can also therefore transfer a cube from one hand to the other

Front 31

At what age should you start to see a baby use single words?

Back 31

7 mos

Front 32

At what age should you start to see a baby cruising?

Back 32

10 mos

Front 33

At what age should you start to see a PINCER grasp?

Back 33

10 mos

Front 34

At what age should you start to see a baby waving bye bye?

Back 34

10 mos

Front 35

At what age should you start to see a baby finger feed?

Back 35

10 mos

Front 36

At what age should you start to see independent walking?

Back 36

Variable but on average it's 14 mos

Front 37

At what age should you start to see stacking of two cubes?

Back 37

14 mos

Front 38

At what age should you start to see walking backwards?

Back 38

18 mos

Front 39

At what age should you start to see pointing to a named body part?

Back 39

18 mos

Front 40

At what age should you start to see running?

Back 40

2 years

Front 41

At what age should you start to see common two word phrases?

Back 41

2 years

Front 42

At what age should you start to see toilet training day and night?

Back 42

3 years

Front 43

At what age should you start to see 3 word phrases?

Back 43

3 years

Front 44

At what age should you start to see expected hand dominance?

Back 44

2-5 years

Front 45

At what age should you start to see social smile?

Back 45

3 mos

Front 46

At what age should you start to see stranger anxiety?

Back 46

6 mos

Front 47

Name two major risk factors for congenital limb deficiency

Back 47

1. THALIDOMIDE
2. maternal diabetes

Front 48

What is the difference between a TRANSVERSE vs LONGITUDINAL congenital limb deficiency?

Back 48

Transverse = no distal remaining portions
Longitudinal = have distal portions

*ISPO classification

Front 49

What is Amelia?
MEROmelia?
HEMImelia?
PHOCOmelia?

Back 49

A = absent
Mero = partial absent
Hemi = half absent
Phoco = flipper-like

Front 50

What other anomalies are associated with congenital limb deficiencies?

Back 50

craniofacial

Front 51

Congenital upper limb deficiency + thrombocytopenia = ?

Back 51

TAR sydrome (thrombocytopenia with Absence of Radius)

Front 52

Congenital upper limb deficiency + anemia/leukopenia = ?

Back 52

Fanconi's syndrome (5-6 yo)

Front 53

Congenital upper limb deficiency + congenital HEART disease = ?

Back 53

Holt-Oram syndrome (esp atrial septal defects & tetralogy of fallot)

Front 54

Congenital upper limb deficiency + craniosynostosis = ?

Back 54

Baller-Gerold Syndrome
*premature fusion of cranial sutures

Front 55

Congenital upper limb deficiency + multi organ symptom involvement = ?

Back 55

VACTERYL (aka VATER)
Vertebral, Anal atresia, Cardiac, Tracheo-Esophageal fistula, Renal dysplasia, Limb deficiency

Front 56

Most common type of congenital limb deficiency?

Back 56

LEFT TRANSRADIAL

Front 57

At what age should you start prosthetic fitting for a unilateral congenital upper limb deficiency?

Back 57

"SIT to fit"
6 mos

*initial prosthesis is a passive mitt

Front 58

At what age should you upgrade a child's prosthesis to a more sophisticated device from a passive mitt?

Back 58

when they're starting to WALK
11-13 mos
- also performing grasp and release activites
- attention span >5 minutes
*self suspending suprcondylar socket & a hand

Front 59

At what age should a child be able to operate all types of prosthetic components & controls?

Back 59

4-5 years old

Front 60

What is a Krukenberg procedure?

Back 60

For those with transradial congenital limb deficiency (esp when bilateral) - ulna & radius are surgically separated, converting forearm into a PINCER via the PRONATOR TERES.

Front 61

At what age should a child with a transhumeral congenital limb deficiency have body-powered HOOKS prescribed?

Back 61

2-3 years
- child is strong enough & has cognitive ability to operate this type of terminal device

Front 62

At what age should a child with a transhumeral congenital limb deficiency have body-powered ELBOW prescribed?

Back 62

4-5 years old

Front 63

What is a VILKKE procedure?

Back 63

Attachment of a toe to the residual limb

Front 64

What is the most common congenital LOWER LIMB deficiency?

Back 64

Fibula HEMImelia (half absent) - this is a LONGITUDINAL deficiency, followed by transTIBIAL

*problem w/ leg length discrepancy, may need to correct surgically with Syme's amputation/prosthesis

Front 65

Treatment of choice for a LONGITUDINAL congenital tibia deficiency?

Back 65

KNEE DISARTIC

Front 66

What is a VAN NESS procedure?

Back 66

Foot is rotated 180 degrees at the end of congenitally deficient limb in order to simulate knee motion via the ankle joint.

*aka rotationplasty

Front 67

At what age should you start prosthetic fitting for a unilateral congenital lower limb deficiency?

Back 67

When the child is ready to pull up from standing
9-10 mos

*start with JOINTLESS above knee prosthesis
*add joint starting at 1.5 years old

Front 68

At what age should you start to see normal HEEL-TO-TOE gait established?

Back 68

2 years old

Front 69

At what age should you start to see a child develop prosthetic heel-strike to toe-off gait?

Back 69

5 years old (or when they can stand on one leg for a sustained period of time)

Front 70

At what age is it appropriate to prescribe a suction socket to a child?

Back 70

5 years old
- they can assist in donning the prosthesis, until then a pelvic belt is an acceptable suspension system

Front 71

How often should a prosthesis be replaced for a growing child?

Back 71

At least every 15-18 mos

Front 72

At what age is it appropriate to prescribe a FLUID controlled knee in the pediatric population?

Back 72

ADOLESCENCE
- because they are heavy and large

Front 73

Leading cause of acquired amputations in pediatric population?
- Upper vs Lower?
- Boys vs. Girls?

Back 73

TRAUMA
LOWER
BOYS
*unilateral>bilateral

Front 74

Leading cause of disease-related amputations in pediatric population?

Back 74

TUMORS
- Osteogenic SARCOMA
- EWING's sarcoma

Front 75

Why is a knee disartic preferred over a trans-meta/diaphyseal amputation in the pediatric population?

Back 75

EPIPHYSEAL GROWTH PLATE is at the distal femur
- loss of this can result in significantly shorter residual limb
*also better wt bearing, more mechanical advantage d/t longer lever arm, helps avoid terminal boney overgrowth

Front 76

What is the most common complication after amputation in the immature child?

Back 76

Terminal overgrowth at transected end of a long bone
- can actually pierce the skin & cause ulceration

Front 77

What are the advantages of an INTRA-OPERATIVE lower limb prosthetic fitting for a pediatric patient?

Back 77

- waling soon after surgery
- decreased edema & calf pain

*young adults/teens are best candidates -they can be compliant with weight bearing restrictions

Front 78

At what age would a child be able to safely operate a POWER WHEELCHAIR?

Back 78

3 years old

- traditionally not used until 5 or 6 yo though

Front 79

Phantom pain in a child that has undergone an amputation is more likely if the procedure is performed after what age?

Back 79

10 years old

Front 80

UP-GOING toe (BABINSKI sign)
Age of emergence?
Age of integration?

Back 80

E: birth
I: 1-2 yo

*Definitely abnormal above 2 yo