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Pediatric Exam 2 part 1 Flashcards | StudBud
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Pediatric Exam 2 part 1
Pediatric Exam 2 part 1
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Answers
1
What isn’t a list of things that you should incorporate for kids with CP during interventions?
Interventions at critical periods is essential, EI not effective at all
Should practice & discover real world environment, learn when task-oriented
Indep. initiation of mvnt is required to develop spatial cognitive awarenes
Intensity matters, daily HEP a must, saliency matters, use it or lose it
2
Which CP has a jump gait?
Spastic quadriplegia
Spastic hemiplegia
Spastic diplegia
None of the above
3
What is not a list of effective or probably do it treatments for motor activity in children c CP?
Bio-feedback, hippo-therapy, EI
Conductive education, thera-suits, vojita, NDT, Hyperbaric O2, SI
CIMT, Bimanual training
Hydro-therapy, SEMLS, & therapy
4
What CP? Lots of asymmetries & hypertonic patterning, pain, femoral anteversion, windswept pelvic c 1 hip IR & 1 hip ER
Spastic diplegia CP
All of the above
Spastic quadriplegic CP
Spastic hemiplegia CP
5
What isn’t paired correctly?
RDS—> pulmonary immaturity & low surfactant (also Called hyaline membrane)
MAS—> Inhalation of meconium (1st poop is black tare like)
BPD, CLD—> from incomplete or abnormal repair of lung tissue
NEC—> Acute inflammatory disease of bowel (never kills babies)
6
What is a potential secondary impairment as opposed to primary impairements? (MC=motor control)
Spasticity if hypertonia, reduced postural control, reduced selective MC
High, low, mix or fluctuating muscle tone, pain, impaired sensory processin
Muscle hyperextensibility, joint contracture, impaired endurance
Skeletal malalignment, joint sublux/dislocation, osteoporosis/osteopenia
7
What type of setting isn’t paired correctly with when it is allowed to be used?
Early childhood preschool services: 3 years to 5 years old (kindergartner)
School based services: 5 years old to 22 years old
Pediatric medial model: 0-18 years old
Early intervention: Birth to 3
8
CP progression of impairments is: Primary impairments—> compensations/habits—>secondary impairments
True
False
9
What type of CP is described? (LLD, contracture of LE, femoral anteversion, scoliosis, UE>LE deficits but both)
Hypertonia
Spastic diplegia
Spastic hemiplegia
Spastic quadriplegia
10
The approach for school based services should be to focus on medical needs (strength) prior to educational focuses
True
False
11
Diagnoses of CP are made through medical imaging- increased creatine phosphate within the CSF during lumbar puncture
True
False
12
Work in more vertical posture initially for strengthen; incr excursion and improve head control & UE WBing is hypertonic
True
False
13
What isn’t true about mobility in children c CP?
Prone scooter boards help babies learn to propel themselves when appropriat
Adaptive ride cars are helpful for early mobility
Overground training is not effective for gait training for children c CP
The most important aspect is Intensity
14
What is a list of the MOST effective treatment for tone?
Low load long duration stretching
Autotune
Tizanidine, ITB (intrathecal baclofen pump)
Botulinum toxin, SDR, Diazepam
15
What disorder is associated with spastic diplegic?
IVH (Germinal matrix-intraventicular hemorrhage)
CVA (cerebral vascular injury)
PVL (periventricular leukomalacia)
HIE (hypoxic ischemic events)
16
What is not an EFFECTIVE or PROBABLY DO IT treatment for contractures in children c CP?
Orthotics (AFOs), Casting upper limb
Hand surgery, manual stretching, & NDT
SEMLS, Orthotics for the hand
Casting LE (serial cast- PROM, last 5-6 days, 1-2 out of cast, & 4 3-6 wks)
17
To be eligible for adult services (DD waiver) what does the individual need to be delayed in?
Developmental
Muscular
Neuromuscular
Academic
18
SxS of children with CP can change overtime as part of secondary impairments, but not CNS dysfunction changes
False
True
19
What isn’t correct?
ROP: From abnormality of blood vessels with scarring in retina
GERD: Problem for premature infants, because they don’t have any sphincters
PVL: Ischemic lesion from reduction in cerebral BF; PVL cysts
IVH: Comes before birth
20
What type of CP is described? (Fluctuated tone, initially athetosis c hypotonia, emotional swings, sociable)
Spastic hemiplegic CP
Ataxic CP
Spastic diplegia
Dyskinetic CP
21
What CP? (Teach them to manage tone, LE dissociation, prevent 2nd deformities—> long duration, low-load stretch)
Hypertonic CP
Dyskinetic CP
Ataxic CP
All are correct
22
Too much extension is a big problem with children in the NICU and promoting flexion and midline is treatment
False
True
23
What GMFCS level would a pt. Who can walk using hand-held mobility device in most indoor settings. Can climb stairs c CS
Level II
Level I
Level IV
Level III
24
CVA, head trauma, infection, brain trauma are postnatal RF for CP
True
False
25
To decrease hypertonicity: use vibration, spinal rotation, flexion, LE dissociation, proprioception input, traction
True
False
26
What isn’t true about the benefits of spasticity in CP?
Spasticity May help maintain MM and prevent bone demineralization
Increase voluntary movements, improve sleeping, improve standing or gait
Extensor tone may help the pt. Stand, may decrease edema and risk of DVT
Hyperactive stretch reflexes increase isometric and eccentric contraction
27
What isn’t true about positioning techniques for a newborn baby in the NICU?
Supine: Semiflezed, midline alignment using blanket 4 swaddling containment
Prone & sidelying: chin tuck, trunk flex, shoulder pro PPT, flex legs symme
Prone & sidelying: Vert. under thorax, hori. roll under hip, neck flexed
All positions have extremity extension
28
Child walks in most settings, experience difficulty c long distances and balancing on uneven grounds what GMFCS level?
Level II
Level III
Level I
Level V
29
What is a positive effect of the intrathecal baclofen pump (IBP)?
It is in the SC, so avoid most side effects
No risk of respiratory failure
Can just stop whenever the pt wants that sameday
Decreases risk of infections
30
What is not a list of effective or probably do it treatment for function & self care in children c CP?
Seating, treadmill training, botulinum toxin
Orthotic hand, ITB, sensory processing, massage, NDT
Assistive technology, SDR
Goal-directed training, HEP
31
IDEA part B: outlines special education and related services (including PT) & part C: Provides EI for infants 2 toddlers
True
False
32
What is the BEST ANSWER for where the setting of early intervention should be?
The Natural setting
The park near their grandparents
The school
The home
33
What isn’t true about ataxic CP?
Ataxia and broad based gait
Dysmetria c reaching
Truncal stability & high tone
Cerebellar lesions
34
In the school setting transitions plans need to be started at 16 years old, & in early interventions right away
False
True
35
What isn’t true about spastic CP?
Decreased deep tendon reflex
Decreased muscle tone in involved limbs
Lesion in motor portion of cerebral cortex or pyramidal tract
Stereotyped movement patterns
36
What isn’t a list of perinatal RF of CP?
Placenta abruption, asphyxia
Premature birth, low birth weight, severe jaundice
CVA, Head trauma, infection, brain tumor
Multiple births, breech delivery, Prolapsed umbilical cord
37
What isn’t true about strapping, fabrifoam, dynamic trunk orthoses, and compression suits?
Goal: biomechanical alignment, improve patient posture & function
Goal: Enhance sensory input (especially proprioeption)
Works best if child needs maximum assistance for posture or mvnt
Works best if child needs minimal assist for posture or mvnt
38
In CVAs they are similar to strokes, and occur before birth in uterine in full term infants
False
True
39
What CP? (Interventions: CIMT, Bimanual training, splinting (splinting (only in UE if it improves function) and in LE)
Spastic quadriplegia
Spastic diplegia
All of the above
Spastic hemiplegia
40
What isn’t true about the intensity of practice?
Focus on what will give you the most reward for the most effort in priority
Ask these carer how and when implementation would work for them each day
Most families can handle 11-13 things a day for HEP
Goal-directed training in natural environment, training implement by carer
41
Most surgeries are delayed until a child is at least 6 years old what is the only thing that surgeons will do earlier?
Lack of dorsiflexion
Static knee valgus
Femoral anteversion
Hip subluxation
42
What isn’t true about the motor growth curves?
Only valid with GMFM-88
Children <6 years assessed every 6 months
Older children assessed every 9-12 months
Only valid with GMFM-66
43
Eligibility of >30% cognitive delay, must qualify for spec ed; there can be exception, not often is for what service?
Adult services
Early intervention
School based services
Medical model
44
The earliest age that a baby can have the Ballard physical and neurological signs assessed is 20 weeks of gestation
False
True
45
What does not make someone a good candidate for SDR?
Fixed deformities that are corrected prior or after, supportive family
Ability to follow through c intensive therapy and HEP
GMFCS II-V, any cognitive level, spastic hemiplegia, 0-4 years old
GMFCS level II-IV, good cognitive function, spastic diplegia, 4-7 years old
46
What CP? (Treatment: Positioning, adaptive equipment, assistive technology, BW supported gait training)
Spastic diplegia
Spastic Hemiplegia
Spastic Quadriplegia
None of the above
47
During the 6 evaluation of the baby’s neuromuscular system are performed what isn’t tested?
Scarf sign, heel to ear
Eyes and ears, plantar creases
Arm recoil, popliteal angle
Posture, square window
48
If a child isn’t sitting independently by what age would you most likely expect them not learn to walk?
2 years old
1 year old
4 years old
3 years old
49
What isn’t true about dyskinetic CP (athetosis, dystonia, and/or mixed)?
Dystonia-variable tone or rigidity, abnormal positioning trunk & extremitie
Athetosis- involuntary mvnt distal, UE>LE, facial grimace & oral difficulty
Abnormality of extrapyramidal tracts, c controlled movements
Mixed- most common in spastic diplegia c athetosis
50
Which type of CP is paired incorrectly?
Diplegia= all four extremities could be involved but at once arms or legs
Triplegia= hemiplegia+ one extremity on the contralateral side
Hemiplegia= bilateral UE or bilateral LE
Quadriplegia= head, trunk, and all 4 extremities involved (UE>/=LE)
51
What type of CP is described? (Decreased contralateral stride length, undergrowth of one side, impaired sensory on half)
Spastic quadriplegia
Spastic hemiplegia CP
Spastic triplegia
Spastic diplegia CP
52
What CP? (Independent locomotor skills, mobilize trunk and rib cage, head control and UE WBing for play)
Hypertonic CP
Triplegia CP
Dyskinetic CP
Ataxic CP
53
What type of goal should be written for school based services and how often?
IFSP every 6 months
IFSP every year
IEP every 6 months
IEP every year
54
What isn’t true about HIE?
Cooling reduces ATP, which dec. adverse metabolic effect and inflammation
Watershed areas are effected
Can cause spastic quadriplegia, dyskinetic, hypotonia CP
Can cause ataxic CP if basal ganglion is effected
55
What isn’t true about hypotonic CP?
Underlying low tone if trunk and neck even in children c spastic CP
Poor antigravity mvnt
High muscle tone and muscle strength increase
Transient stage of athetoid/ataxic CP
56
What isn’t one of the four aspects of the CP definition?
Non-progressive brain injury (but longer time progressive MSK changes)
Disorder of movement
Occurring early in development- prenatal or early postnatal UMN lesion.
Activity limitation- c massive severity
57
What score is considered normal for the APGAR in new mexico (Activity, Pulse, Grimace, Appearance, Respiration)
5,6
10
7,8,9
0
58
What are good treatments for strengthening in children c CP?
Whole body vibration
Strength training LE & UE, & ES
Vojta
All are good ideas (the more the better throw the kitchen sink at them)
59
What isn’t a test or measures that is helpful for children c CP?
Lumbar puncture, MMT, Psychological testing
Gross motor function measure (GMFM), motor assessment (Bayley), ROM
Developmental milestone, gait/posture, pain scale, PEDI-CAT, CP-QOL, PODCI
Muscle tone assessment, selective control SCALE assessment, Reflexes
60
What isn’t another issue that CP can present with?
Gastrointestinal issues (90-100%)
Seizure disorders 25-35% of patients
Impairment of sensation (hearing 25%, vision 40-50%)
Cognitive impairments (50-75%)
61
What isn’t a way to medically or PT management of spasticity?
Orthoses/casting, pharmacotherapy, local/nerve blocks, surgery (SDR)
Facilitation techniques to move out of ab synergistic patterns, positioning
Standing for 30-45 min/day, orthoses, adaptive equipment
Never use a intrathecal balcofen pump
62
What isn’t a detrimental effect of spasticity on CP?
Improved function and participation, increased DVT and edema
Impaired positioning, impaired sleep, impaired standing or gait
Slow velocity mvnt, skin shear, limited AROM, pain from spasms
Increased risk of contractures (sub/dislocat), impaired perineal hygiene
63
90% of motor potential is reached by age 3-5 years of age for the GMFM
False
True
64
What isn’t true about the grading of IVH (germinal matrix-intraventicular hemorrhage)
1: Germinal matrix hemorrhage
2: Extension into the lateral ventricle c hemorrhage filling less than 500%
3: extensive hemorrhage c distention or dilation of lateral ventricles
4: Ventricular rupture c bleeding into parenchtmal involvement
65
What type of CP? (Use hard firm surfaces, not movable ones, rotation to unlock postural stability, immediate feedback ML
Dyskinetic CP
Hypertonic CP
athetosis CP
Ataxic CP
66
What type of CP is described? (Use inhibition techniques, active extremities WBing in midranges, Intermittent compress)
Spastic hemiplegic CP
Hypertonic CP
Ataxic CP
Dyskinetic CP
67
What isn’t an outcome desire for children c CP?
Optimize gross motor function, participation, and independence c ADLs
Promote early independent mobility exclusively through walking
Reduce/prevent primary impairments
Reduce/prevent secondary impairments
68
Why is positioning and handling important?
Maintain ROM
To promote extension
Optimize development of motor abilities, including flexed midline position
To promote health and state organization
69
What age is a child considered very premature?
<34 weeks
37 weeks
<32 weeks
35 weeks
70
What isn’t true about HINES and GMA?
If no fidgety mvnt & have cramped synchronized mvnt doesn’t indicate CP
Are highly sensitive to detecting neuromotor impairments as early as 14 wks
The HINES are for infants 2-24 months
GMA assesses writhering mvnt patterns in infants ideally 3 months
71
What is paired incorrectly?
SGA: small for gestational age (less than 10%)
LGA: Large for gestational age (greater than 90%)- mom c diabetes
SSGA: symmetrically small for gestational age (small head (small brain))
Full-term 38 weeks
72
What isn’t a list of prenatal RF of CP?
Premature birth, low birth weight, severe jaundice, multiple birth
Infections of mother or fetus, lack of GF, blood type or Rh incompatibility
Inability of placenta to give O2 & nutrient, cerebral hypoxia, diabetes
Hypothyroidism, chromosomal abnormalities, maternal malnutrition
73
Within the 1st 2 hours of birth what isn’t a physical maturity thing assessed?
Skin, Lanugo (the soft downy hair on a baby’s body), plantar creases
Genital female, genital male
Breast, eyes and ears
Posture, popliteal angle
74
What CP? (Proximal stability for distal mobility, use firm touch & deep pressure, weighted vest, light arm weights)
Hypertonic CP
Ataxic CP
Dyskinetic CP
Triplegia CP
75
What isn’t true about the PT role in the NICU?
PT & OT assess development, feeding/oral motor ability, neurobehavior state
PT is a member of health care team, focus on FAMILY-CENTERED CARE
To identify any impairments that contribute to activity & participation res
Don’t help c skilled positioning & handling, and environmental adaptations
76
What type of CP? (Low tone base, graded control in midrange, weighted AD for midrange, hard, firm surfaces)
Dyskinetic CP
Spastic hemiplegic CP
Hypertonic CP
Ataxic CP
77
What CP? Crouch or equinus posture, Decreased SLS time, decreased stride length, flat foot strike, intoeing
Spastic Diplegia
Spastic quadriplegia
None of the above
Spastic hemiplegia
78
What CP? (Mix of low & high tone in trunk & high tone in extremities—> leads to contractures & spasticity (2 joint m.)
Spastic hemiplegic CP
Spastic quadriplegia CP
Ataxic CP
Hypertonic CP
79
Hyperactive DTR, babinski, ankle clonus, reduced ROM, cocontraction and weakness can accompany hypertonia & spasticity.
False
True
80
What isn’t true about state recommendations for standing for children c CP?
Hip abduction of 15-30 degrees
60 minutes but can be broken into two 30 minute sessions
Needs to be done 5 days a week
Helps reduce leg spasticity, increase BMD, improve ROM of LE
81
What is true about hip health?
Needs to be started by 90 months of age
Surgery is necessary if 4% of the femoral head is uncovered “no return”
Daily positioning in hip add for pt. C spasticity or weakness
Surveillance is important every 6 months
82
Transitioning for early intervention to adult services is incredibly hard due to long waitlists
True
False
83
IF someone scores the 30th percentile on the GMFM-66 what GMFCS score who’d they be when they are 2?
Level II
Level IV
Level V
Level III
84
Use power mobility in most settings, may walk short distances at home c physical assistance
Level V
Level I
Level IV
Level II
85
Why would you use the GMFM-66 vs. GMFM-88?
Motor growth curves are valid with it
Only 66 items not administered all of the items
Easy to score on pen and paper
Reliable and valid measurement of change over time in children c CP and DS
86
To prioritize impairments and chose interventions you go with all the dogs that are barking
True
False
87
50% of CP diagnosis are made in survivors of prematurity
True
False
88
What leads to CP?
Asphyxia
Prematurity
All of the above
Low birth weight
89
What GMFCS level is a child who is transported in manual W/C in all settings. Can’t maintain antigravity head and trunk
Level V
Level I
Level II
Level IV
90
What doesn’t lead to HIE (hypoxic ischemic events)?
Focal hypoxia-ischema reperfusion
Global hypoxia-ischemia/reperfusion
Insults can include arterio-oclusive insults and veno-occlusive results
MCA (R>L)—> hemiparesis
91
By Dec 1st ___ will sit for 10 mins s falling backward & play c toys bilaterally and call mom at end. What type of goal?
IEP in school settings
IFSP in early intervention
IEP in early intervention
IFSP in school settings
92
What isn’t an essential thing to ask when doing a subjective history for children c CP?
Interests, parent or patient concerns/wishes
All are essential to ask
Mom’s pregnancy, birth hx, postnatal hx, medical hx
Developmental hx, cormorbidities, prior or current intervention, abilities
93
What is true about PT intervention for bone health in children c CP?
Active muscle tension pulling in vertical direction
Ideally is done through weight bearing
Passive muscle tension pulling with different forces in varying directions
Active muscle tension pulling with different forces in varying directions
94
What is a potential negative outcome of a lengthening surgery of soft tissue especially of gastrocnemius?
Gastroc can cause crouch gait and hamstrings can cause knee hyperextension
Gastroc can cause stiff gait and hamstring can cause crouched gait
Can lead to lack of ROM
Can lead to circumduction of contralateral hip
95
Night splints are contraindicated in children c CP
False
True
96
What isn’t a general PT intervention typically utilized for children with CP?
5 hours of constraint induced therapy, unimanual therapy
Education, positioning, adaptive equipment and assistive technology
Functional skill, strengthening, stretching, balance, mobility training
Motor learning strategies, facilitation of developmental milestones
97
What is not true of spasticity, but is actually true of muscle tone?
Usually accompanies hypertonia
Disorder of muscle tone c a CNS etiology, Velocity-dependent increase MT
Increased resistance to passive limb motion
Degree of muscle tension to slow stretch, can have high or low levels
98
Which child is happy?
Increased or decreased RR/apnea, pallor skin, increase muscle tone
Increased HR, HR variability, increased BP, decreased O2 sat, dilated pupil
Crying, gaze aversion, finger splaying, facial grimace, limb withdrawal
Smiling, no differences in eye size, slow mvnt
99
What is “>25% delay or established condition or bio/medical risk of dev delay or environmental delay” eligibility of?
Early intervention
School based services
Adult services
Medical model
100
What is paired incorrectly?
AGA: appropriate for gestational ge
ELBW: Birth weight <1000 g (<2 lbs 3 oz)
VLBW: birth weight of 1000-1500 g (<3 lb 5 oz)
SSGA: small for gestational age (less than 10%)
