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Pediatrics Comprehensive Final Exam
Terms in this set (171)
What are the differences between pediatric and adult HIV?
The virus is more aggressive in children leading to AIDS and faster death
For children to be eligible for early intervention in Arizona, they must have ____% in one or more of the areas.
What are the 5 areas required for early intervention in AZ?
2. Physical Development
4. Social or Emotional
What is meant by "Family Centered" therapy?
Having family involved in therapy, as well as the child because family knows child best and can establish their greatest needs
What is meant by a "Natural Environment"?
Settings that are natural or normal for the child's age peers who have no disabilities
What does the acronym IFSP stand for?
Individualized Family Service Plan
How often is an IFSP reviewed?
Every 6 months
What does the acronym IEP stand for?
Individualized Educational Plan
What is the term for the comprehensive plan outlining the specific special educational and related services for a child?
Individualized Educational Plan
If the disability adversely affects the child's education performance, they qualify for what plan?
If the disability limits a child's ability to perform one or more life activities, they qualify for what plan?
What type of orthosis is a shoe insert that extends medially and laterally on calcaneous, but not above subtalar joint, and allows for better control of pronation than a modified insole?
What type of orthosis extends proximal to the sub-talar joint and malleoli, and provides medial/lateral subtalar stability, and reduces excessive supination/pronation?
SMO (Supramalleolar Orthoses)
A Supramalleolar Orthosis is most effective for a problem in what phase of gait?
What type of orthosis is designed to allow the least resistance to subtle movements while providing the max anatomical alignment because the distal portion extends medially, laterally, and along the dorsum of the foot?
What type of orthosis is used for spina bifida, spinal cord injury, and post polio patients and allow the individual to achieve reciprocal gait pattern by extension and rotation of the trunk?
Reciprocating Gait Orthosis (RGO)
What are the 6 types/categories of equipment a child may need?
1. Assistive devices for gait
2. Gait Trainers
5. Bath Items
What are the 7 benefits of standers?
1. Help w/ trunk control
2. Weight bearing for bone/joint growth, bone density
3. Visual exploration
4. Being at peers level
5. Pressure relief
6. Organ Development
What children age group are standers recommended for?
Children older than 14-16 months who are not yet standing independently
What is the recommended frequency for stander use?
60 minutes for 4-5 times per week
What is the purpose of Botox?
Reducing spasticity in muscles
What is the timeline of Botox once taken?
Takes effect in 3 days; 3 weeks reaches max effect; 3 months begins fading
Botox injections work by blocking the release of what substance into the muscle?
The amount of Botox that can be given to a child at one time is determined by what?
What procedure is a surgical excision of select dorsal root fibers at the posterior of the spinal cord?
Selective Dorsal Rhizotomy
What is the purpose of a selective dorsal rhizotomy?
To treat severe spasticity of lower extremities that interferes with mobility or positioning
What are the 2 biggest issues of concern that occur with a selective dorsal rhizotomy?
1. Decreased Strength
2. Decreased Proprioception
What is a Baclofen pump used for?
To deliver Baclofen directly into the spinal cord
Baclofen pumps are refilled every ___ - ___ months.
Baclofen pumps can only be used in what type of cerebral palsy?
A Baclofen Pump is inserted only after what has occurred?
Trial session via lumbar puncture
What are 3 common side effects of the spasticity medication, Diazepam?
Why does oral Baclofen typically cause side effects?
Due to high doses neccessary to reach spinal cord
Cromolyn and Nedrocromil are examples of asthma medications known as?
What is a common stimulant used in children?
What % of children with developmental delay have problems with constipation?
Stimulants, anti-anxiety, anti-depressive, anti-HTN, anti-psychotic and anti-epileptic medications are all used to help manage which condition?
The Strayer and Vulpius techniques are used to lengthen which muscle?
What surgical technique is a method used to decrease the chance of gastrocnemius muscle rupture?
Tongue and Groove Method
Hamstring lengthening is indicated when the popliteal angle is lacking what degree of extension?
Medial and lateral hamstring lengthening places a greater risk of what occurring?
What nerve is at risk of being cut during adductor lengthening surgery?
What surgery is usually done only in combination with other surgeries?
What factor is used to determine the correct dosage for stimulant medication in children?
Child's response to medication
If Obturator nerve is severed during Adductor lengthening surgery, what will the child present with?
What are the 2 lines of treatment for children with ADHD?
What are the 4 types of medications used for asthma?
2. Mast Cell Stabilizers
4. Leukotriene Modifiers
What classification of cerebral palsy is defined as: involvement greater in the lower limbs?
What classification of cerebral palsy is defined as: involvement of upper and lower limbs on one side?
What classification of cerebral palsy is defined as: involvement of all limbs, upper limb involvement equal to lower limb involvement?
What classification of cerebral palsy includes spasticity and decreased extensibility of muscles?
What classification of cerebral palsy includes continuous writhing movements?
What classification of cerebral palsy includes poor coordination and grading of movement?
What classification of cerebral palsy presents with decreased muscle tone, joint hypermobility, and has difficulty moving against gravity?
What level of the CMFCS for Cerebral Palsy is: walks without limitations?
What level of the CMFCS for Cerebral Palsy is: walks with limitations?
What level of the CMFCS for Cerebral Palsy is: walks using a hand-help mobility device?
What level of the CMFCS for Cerebral Palsy is: self-mobility with limitations, and may use powered mobility?
What level of the CMFCS for Cerebral Palsy is: transported in a manual wheelchair?
What are the 8 major areas that should be considered when looking at factors affecting activity limitations?
1. Posture & Alignment
2. Movement of Body/Balance
3. Movement of Body Parts/Patterns
4. Physical Impairments
6. Cognition/Motor Learning/Planning
7. Environmental & Task Factors
8. Personal Factors
What condition is when a build up of fluid in the cavities deep within the brain occurs, and is typically treated with a shunt to drain excess fluid?
What method used for measuring the degree of scoliosis utilizes extended lines from the most cephalad vertebra of the curve and the most caudal vertebra?
How is the direction of a scoliotic curve determined?
By the side of the convexity of the curve
What form of scoliosis occurs with a lateral curvature of the spine of unknown cause?
What is the most common form of scoliosis in children?
What are the 3 types of idiopathic scoliosis?
What age range is affected by infantile idiopathic scoliosis?
Children younger than 3 y.o.
What age range is affected by juvenile idiopathic scoliosis?
3-9 years old
What age range is affected by adolescent idiopathic scoliosis?
What scoliotic term is defined as a sustained increase in scoliotic curvature of 5 degrees or more on two consecutive examinations at 4 to 6 months intervals?
What type of scoliotic curves are caused by anomalous vertebral development in utero?
Orthotic use for scoliotic curves depends on what 3 things?
1. Curve Type
Orthotics are typically prescribed for children with idiopathic scoliosis with a curve from ____ to ____ degrees.
25 to 45 degrees
What is a major indication for surgical intervention for a scoliotic curve?
Cobb Angle that reaches 45 degrees or greater in immature spine
What spinal condition is a rigid form of postural kyphosis, develops during childhood/adolescence, is usually ascribed to poor posture, and is typically seen with wedging of vertebrae?
What spinal condition is the forward translatory displacement of one vertebra on another, usually occurring at the 5th lumbar vertebra?
Internal Rotation measuring between ____ -____ degrees is evidence of femoral torsion.
If the femoral head lies anterior to the frontal plane, what is this called?
If the femoral head lies less than 10-12 degrees anterior to the frontal plane, what is this called?
If forefoot is curved medially, hindfoot is in the normal slight valgus position, and full dorsiflexion ROM is noted, what is this called?
What foot condition occurs with forefoot adductus, hindfoot varus, and ankle equinus?
What hip test is performed by flexing and abducting the hip, then gradually adducted and pressure exerted in a posterior direction, and tests for hip instability?
What hip test is performed by flexing the hips and knees of a supine infant to 90 degrees, then using the index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting the infant's legs using the examiner's thumbs?
What is the protocol for a child from birth-9 months with Developmental Dysplasia of the Hip?
What is the protocol for a child from 9 months and older with Developmental Dysplasia of the Hip?
What is the protocol for a child 2 years old with Developmental Dysplasia of the Hip?
What is the protocol for a child 3 years old with Developmental Dysplasia of the Hip?
Femoral Shortening or Acetabular Reshaping Osteotomy
What condition occurs when blood supply is temporarily interrupted to the ball part (femoral head) of the hip joint and without sufficient blood flow, the bone begins to die,and breaks more easily and heals poorly?
What is the prinicipal artery affected in Legg-Calve-Perthe's Disease?
Medial Femoral Circumflex Artery
What condition occurs when the growth plate of the proximal femoral physis is weak and becomes displaced from its normal position, and symptoms include groin to thigh and knee pain, antalgic gait, limited IR and flexion?
Slipped Capital Femoral Epiphysis
What is meant by "idiopathic toe-walking"?
How is idiopathic toe-walking treated?
Stretch gastroc/soleus while strengthening ankle DF
What medical problem contributes to the hearing loss in the Down Syndrome population?
Why are children with Down Syndrome at risk for atlanto-axial dislocation?
Laxity of the Transverse Odontoid Ligament causes excess motion of C1 & C2
What are 4 early symptoms of Atlanto-Axial Dislocation?
1. Gait Changes
2. Urinary Retention
4. Reluctance to Move
The degree of __________________ is a significant factor in children with Down Syndrome.
What evaluation tool is suggest for examining qualitative aspects of movement in infants with Down Syndrome?
Movement Assessment of Infants (MAI)
What measure was designed as an individualized measure of performance and satisfaction in self-care, productivity, and leisure?
Canadian Occupational Performance Measure (COPM)
What condition occurs when the posture of the head and neck from unilateral shortening of the SCM causing head to tilt toward and rotate away from the affected SCM muscle?
Congenital Muscular Torticollis
Children with Congenital Muscular Torticollis are at a high risk of developing what other condition?
What are 7 risk factors for Congenital Muscular Torticollis and Plagiocephaly?
1. Difficult labor/delivery
2. Breech positioning
3. Presence of Nucal Cord
4. Male Gender
5. Vacuum or Forceps Delivery
6. Uterine Abnormalities
7. Multiple Births
What treatment is a proactive dynamic approach to treat deformational plagiocephaly in infants up to 24 months of age, and redirects growth and improves craniofacial symmetry?
DOC Band (Dynamic Orthotic Cranioplasty)
How long does a DOC band need to be worn in order to be effective?
23 out of every 24 hours
Axon regrowth recovery usually takes ___to___ months in the upper arm.
Axon regrowth recovery usually takes ___to___ months in the lower arm.
Continued axon regrowth recovery can take up to ___ years in the upper arm.
Continued axon regrowth recovery can take up to ___ years in the lower arm.
What type of BPI is described as: affects upper roots (C5/C6), paralysis of major muscles, and arm held in "waiter's tip" position?
What type of BPI is described as: affects lower roots (C7-T1), resting position in forearm supination, paralysis of wrist flexors/extensors, intrinsic wrist/hand muscles?
What type of BPI is described as: affects upper and lower roots (C5-T1), initial total arm paralysis, and total paralysis limited mostly to upper roots?
What NICU condition is caused by a combination of immature lungs and low surfactant production?
Respiratory Distress Syndrome (RDS)
What chronic pulmonary conditions are caused by incomplete or abnormal repair of lung tissue, or "rigid" lungs?
Bronchopulmonary Dysplasia (BPD)
What condition is the most frequent form of brain injury and leading cause of CP diagnosis in premature infants, and is the ischemic lesions along cerebral arteries?
Periventricular Leukomalacia (PVL)
What condition occurs when blood vessels within the brain rupture and bleed into the ventricles?
Intraventricular Hemorrhage (IVH)
What condition is an acute inflammatory disease of the bowels and involves impaired blood flow to the intestines?
Necrotizing Enterocolitis (NEC)
What condition is when vascular constriction and hypoxia of the retina occurs with subsequent proliferation of capillaries?
Retinopathy of Prematurity (ROP)
What is the term for an infant who is below the 10th percentile of the norm for the gestational age?
Small for Gestational Age (SGA)
What condition is the lack of oxygen delivery to the brain due to a number of potential causes?
Hypoxic-Ischemic Encephalopathy (HIE)
What are the 12 time-out signs in the NICU?
2. Finger Splaying
8. Gaze Aversion
9. Eye Shielding
10. Muscular/Tonal Changes
11. Shutting Down
What condition is a non-progressive neuromuscular syndrome that presents with severe joint contractures, muscle weakness, and fibrosis, and is defined by a presence of contractures in more than 2 body areas?
Arthrogryposis Multiplex Congenita (AMC)
What type of Arthrogryposis Multiplex Congenita presents with flexed and dislocated hips, extended knees, club feet, internally rotated shoulders, flexed elbows, and flexed and ulnarly deviated wrists?
Type I AMC
What will parents of Type I AMC children describe their child's legs as?
What type of Arthrogryposis Multiplex Congenita presents with abducted and externally rotated hips, flexed knees, clubfeet, IR shoulders, extended elbows, and flexed and ulnarly deviated wrists?
Type II AMC
What will parents of Type II AMC children describe their child's legs as?
What 2 intervention strategies are used during the first 3 months infancy in children with AMC?
1. Stretch hip flexors
2. Prone positioning
Standing the children should begin at ____ months for treatment in children with AMC.
What regimen is recommended with a stretching program in children with AMC?
Stretch everyday, 3-5 sets, 3-5 repetitions w/ 20-30 sec holds
What disease is an inherited connective tissue disorder also known as brittle bone disease, and presents with lax joints, weak muscles, and diffuse osteoporosis?
T/F: Passive range of motion is used in infants with Osteogenesis Imperfecta.
False, it is contraindicated
What disease is an x-linked disorder that causes abnormal muscle cell destruction, specifically the myofibrils?
Duchenne's Muscular Dystrophy
What is the typical age of diagnosis for Duchenne Muscular Dystrophy?
Around age 5 in families w/o genetic history
What are the impairments usually seen in a 4 to 5 year old child with DMD?
Primary muscle weakness and enlarged calves due to fatty and connective tissue infiltration (pseudohypertrophy)
What sign is when the child uses their arms to push off of thighs in order to stand up after repeated attempts?
Why is use of a dynamometer recommended in children with MD?
More reliable information on the progression of weakness in key muscle groups
What are the 2 key muscle groups to include in an initial ROM program for a patient with DMD?
What is the pathology of Spinal Muscular Atrophy?
Abnormality in the large anterior horn cells in the spinal cord
What is the primary impairment in Spinal Muscular Atrophy?
Muscle weakness secondary to progressive anterior horn cell loss in the spinal cord
What term does legislation define as: "any item, piece of equipment, or product system that increases, maintains, or improves an individual's functional status"?
Assistive Technology Device
What are the 4 factors related to abandonment of assistive technology devices?
1. Lack of consideration of user's opinion
2. Ease of procurement
3. Poor device performance
4. Priorities; Change in user's need
What are the 7 outlined steps to be followed in the prescription of devices?
7. Follow-up and Reevaluation
What term is the bleeding into joints, which is a significant problem in patients with hemophilia?
What disease is a hereditary autosomal recessive disorder affecting the exocrine gland, respiratory system, pancrease, reproductive organs, and sweat glands?
How is a Cystic Fibrosis diagnosis confirmed?
What is the agent of most burns in children under 4-5 years old?
What 3 factors is the extent of a burn injury related to?
1. Heat intensity
2. Duration of exposure
3. Tissue Conductance
What is the purpose of a UCBL orthotic?
Control of pronation
What are the 2 pros of wearing a UCBL orthotic?
1. Fits inside shoe
2. Does not limit ankle motion
What are the 2 cons of wearing a UCBL orthotic?
1. Limited control of structures
2. Need proper heel cord length
What is the purpose of a SMO?
Reduce excessive supination or pronation
What orthosis should be prescribed for a patient with toe-walking, gastroc-soleus tightness or spasticity?
RGO's are used in what 3 conditions?
1. Spina Bifida
2. Spinal Cord Injuries
3. Post Polio
What type of orthosis should be used for a patient with excessive dorsiflexion and knee flexion in stance?
Crouch Control Orthosis
SWASH stands for what?
What is Botox short for?
Botulinum Toxin Type A
The SynchroMed Infusion System is an example of what medication?
Intrathecal Baclofen (ITB Therapy or Pump)
What are the 9 common side effects of stimulant medications?**
1. Decreased appetite
3. Stomach Ache
4. Mild Insomnia
5. Growth Suppression
6. Vocal/Motor Tics
7. Increased BP/HR
9. Marked Agitation/Aggression
What are the 3 common side effects of anti-anxiety medications?
2. Fatigue Disinhibition
What are the 3 common side effects of anti-hypertensive medication?
1. Sedative effect
2. Aggravation of asthmatic symptoms
3. Lightheadness or fainting due to low BP
What are the 4 common side effects of anti-psychotic medications?
2. Weight Gain
3. Tardive dyskinesia
What are the 6 common side effects of anti-epileptic medications?**
4. Weight Gain
5. Elevated liver enzymes
6. Menstrual irregularities
What asthma medication relax constricted muscles in the airways by allowing the user to breathe and cough up mucus more easily?
What asthma medication reduces inflammation in airways, making it easier to breathe and lowering change of a severe asthma attack?
Mast Cell Stabilizers
What asthma medication reduces swelling in nasal passages during an asthmatic reaction, reducing symptoms?
What asthma medication prevents inflammation in airways, by halting the process that often leads to asthma attack?
What are the 5 common side effects for GI medication?**
5. Constipation or Diarrhea
Beta-agonists and Anticholinergics are examples of what type of medication?
Who are the 4 members of the team for deciding on appropriate orthotics for a child?
1. Physician (Orthopedic Surgeon/Pediatrician)
3. Physical Therapist
What developmental disorder presents with patient being very talkative, speech is dissociated, jumps from one topic to another, and is also referred to as Williams Syndrome?
Cocktail Party Personality
What term is associated to the regions that lack sensation within a given dermatome and do not correlate with motor levels?
Infantile Idiopathic Scoliosis curves are mostly observed in which direction?
Juvenile Idiopathic Scoliosis curves are mostly observed in the thoracic vertebrae in which direction?
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