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80 Cards in this Set
- Front
- Back
A single palmar crease (simian crease) is indicative of what chromosomal abnormality?
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Trisomy 21 - Down's syndrome
*also look for hypotonia, congenital heart disease, ventral septal defects |
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Small mouth, small jaw (micrognathia), prominent occiput, rocker bottom feet, & low set abnormally shaped ears are indicative of what chromosomal abnormality?
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Trisomy 18 - Edward's syndrome
*also IUGR, short palpebral fissure, short sternum, ROCK BOTTOM FEED, CHD, spasticity, overlapping fingers |
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Keyhole shaped pupil (colomba of iris), capillary hemangioma, rocker bottom feet, cleft lip & palate are indicative of what chromosomal abnormality?
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Trisomy 13 - Patau's syndrome
*also CHD, urinary tract abnorms, hyperconvex nails, IUGR |
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Short stature, webbed neck, SHIELD chest, & CHD are indicative of what chromosomal abnormality?
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TURNER's syndrome: 45, X
*CHD = coarctation of aorta *also wide-set nipples, triangular face, congenital lymphedema hands/feet, primary amenorrhea |
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Tall stature, gynecomastia, learning & behavior problems are indicative of what chromosomal abnormality?
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KLINEFELTER's syndrome: 47, XXY
*also postpubertally small testicles, mental retardation, infertility |
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Name some infectious agents that are known to be teratogenic
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"TORCHeS"
Toxoplasmosis Other (varicella, parvo) Rubella virus CMV Herpes/HIV Syphilis |
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What is considered advanced maternal age?
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>35
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In terms of height, what are some major benchmarks in a child's life?
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Age 4 = should be DOUBLE birth length
Age 13 = should be TRIPLE birth length |
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In terms of weight, what are some major benchmarks in a child's life?
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4-5 months = should be DOUBLE birth weight
1 year = should be TRIPLE birth weight 2 years = should be QUADRUPLE birth weight |
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When does the anterior fontanelle usually close by?
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10-14 months
*posterior closes earlier at 4 months |
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What is the first bone to calcify?
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Clavicle - happens in utero
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HEAD RIGHTING
Age of emergence? |
2 months in prone position, 3-4 months for supine
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Protective extension (sitting: anterior, lateral, posterior)
Age of emergence? "parachute response" |
Anterior = 5-7 mos
Lateral = 6-8 mos Posterior = 7-8 mos *standing = 12-14 mos |
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MORO reflex
Age of emergence? Age of integration? |
E: birth
I: 4-6 mos *startle reflex |
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ROOTING & SUCKING reflexes
Age of emergence? Age of integration? |
E: birth
I: 4 mos *turn head to side of cheek being touched |
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ATNR reflex
Age of emergence? Age of integration? |
E: birth (definitive around 1-2 mos)
I: 4-6 mos *fencer reflex when head is turned to one side |
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STNR
Age of emergence? Age of integration? |
E: 4-6 mos
I: 8-12 mos *flex neck = hands flex, feet extend *ext neck = hands ext, feet flex |
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PLANTAR grasp
Age of emergence? Age of integration? |
E: birth
I: 9-14 mos (when walking well) |
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AUTOMATIC WALKING (stepping reflex)
Age of emergence? Age of integration? |
E: birth
I: 1.5-2 mos |
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PALMAR grasp
Age of emergence? Age of integration? |
E: birth
I: 4-6 mos |
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GALANT reflex
Age of emergence? Age of integration? |
E: birth
I: 4-6 mos *stroke skin along one side of back, trunk curls towards that side |
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CROSSED EXTENSION reflex
Age of emergence? Age of integration? |
E: birth
I: 1-2 mos *hold one leg in extension and apply pressure to sole, opposite leg will flex, adduct, then extend |
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FLEXOR WITHDRAWAL reflex
Age of emergence? Age of integration? |
E: birth
I: 2 mos *withdrawal of foot from noxious stimuli |
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LANDAU reflex
Age of emergence? Age of integration? |
E: 3-4 mos
I: 12-24 mos *hold baby prone in air, will assume "superman" pose |
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TONIC LABYRINTHE reflex (TLR)
Age of emergence? Age of integration? |
E: birth
I: 6 mos *prone position = flexor tone *supine position = extensor tone |
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At what age should you start to see MIDLINE HAND PLAY?
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4 mos
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At what age should you start to see a baby hold their head in neutral when pulled to sit?
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4 mos
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At what age should you start to see laughing and squealing?
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4 mos
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At what age should you start to see independent sitting?
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6 mos
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At what age should you start to see a baby holding its own bottle?
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7 mos
*can also therefore transfer a cube from one hand to the other |
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At what age should you start to see a baby use single words?
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7 mos
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At what age should you start to see a baby cruising?
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10 mos
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At what age should you start to see a PINCER grasp?
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10 mos
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At what age should you start to see a baby waving bye bye?
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10 mos
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At what age should you start to see a baby finger feed?
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10 mos
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At what age should you start to see independent walking?
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Variable but on average it's 14 mos
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At what age should you start to see stacking of two cubes?
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14 mos
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At what age should you start to see walking backwards?
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18 mos
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At what age should you start to see pointing to a named body part?
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18 mos
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At what age should you start to see running?
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2 years
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At what age should you start to see common two word phrases?
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2 years
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At what age should you start to see toilet training day and night?
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3 years
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At what age should you start to see 3 word phrases?
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3 years
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At what age should you start to see expected hand dominance?
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2-5 years
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At what age should you start to see social smile?
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3 mos
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At what age should you start to see stranger anxiety?
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6 mos
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Name two major risk factors for congenital limb deficiency
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1. THALIDOMIDE
2. maternal diabetes |
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What is the difference between a TRANSVERSE vs LONGITUDINAL congenital limb deficiency?
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Transverse = no distal remaining portions
Longitudinal = have distal portions *ISPO classification |
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What is Amelia?
MEROmelia? HEMImelia? PHOCOmelia? |
A = absent
Mero = partial absent Hemi = half absent Phoco = flipper-like |
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What other anomalies are associated with congenital limb deficiencies?
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craniofacial
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Congenital upper limb deficiency + thrombocytopenia = ?
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TAR sydrome (thrombocytopenia with Absence of Radius)
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Congenital upper limb deficiency + anemia/leukopenia = ?
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Fanconi's syndrome (5-6 yo)
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Congenital upper limb deficiency + congenital HEART disease = ?
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Holt-Oram syndrome (esp atrial septal defects & tetralogy of fallot)
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Congenital upper limb deficiency + craniosynostosis = ?
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Baller-Gerold Syndrome
*premature fusion of cranial sutures |
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Congenital upper limb deficiency + multi organ symptom involvement = ?
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VACTERYL (aka VATER)
Vertebral, Anal atresia, Cardiac, Tracheo-Esophageal fistula, Renal dysplasia, Limb deficiency |
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Most common type of congenital limb deficiency?
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LEFT TRANSRADIAL
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At what age should you start prosthetic fitting for a unilateral congenital upper limb deficiency?
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"SIT to fit"
6 mos *initial prosthesis is a passive mitt |
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At what age should you upgrade a child's prosthesis to a more sophisticated device from a passive mitt?
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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 |
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At what age should a child be able to operate all types of prosthetic components & controls?
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4-5 years old
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What is a Krukenberg procedure?
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For those with transradial congenital limb deficiency (esp when bilateral) - ulna & radius are surgically separated, converting forearm into a PINCER via the PRONATOR TERES.
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At what age should a child with a transhumeral congenital limb deficiency have body-powered HOOKS prescribed?
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2-3 years
- child is strong enough & has cognitive ability to operate this type of terminal device |
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At what age should a child with a transhumeral congenital limb deficiency have body-powered ELBOW prescribed?
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4-5 years old
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What is a VILKKE procedure?
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Attachment of a toe to the residual limb
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What is the most common congenital LOWER LIMB deficiency?
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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 |
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Treatment of choice for a LONGITUDINAL congenital tibia deficiency?
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KNEE DISARTIC
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What is a VAN NESS procedure?
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Foot is rotated 180 degrees at the end of congenitally deficient limb in order to simulate knee motion via the ankle joint.
*aka rotationplasty |
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At what age should you start prosthetic fitting for a unilateral congenital lower limb deficiency?
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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 |
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At what age should you start to see normal HEEL-TO-TOE gait established?
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2 years old
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At what age should you start to see a child develop prosthetic heel-strike to toe-off gait?
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5 years old (or when they can stand on one leg for a sustained period of time)
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At what age is it appropriate to prescribe a suction socket to a child?
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5 years old
- they can assist in donning the prosthesis, until then a pelvic belt is an acceptable suspension system |
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How often should a prosthesis be replaced for a growing child?
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At least every 15-18 mos
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At what age is it appropriate to prescribe a FLUID controlled knee in the pediatric population?
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ADOLESCENCE
- because they are heavy and large |
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Leading cause of acquired amputations in pediatric population?
- Upper vs Lower? - Boys vs. Girls? |
TRAUMA
LOWER BOYS *unilateral>bilateral |
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Leading cause of disease-related amputations in pediatric population?
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TUMORS
- Osteogenic SARCOMA - EWING's sarcoma |
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Why is a knee disartic preferred over a trans-meta/diaphyseal amputation in the pediatric population?
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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 |
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What is the most common complication after amputation in the immature child?
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Terminal overgrowth at transected end of a long bone
- can actually pierce the skin & cause ulceration |
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What are the advantages of an INTRA-OPERATIVE lower limb prosthetic fitting for a pediatric patient?
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- waling soon after surgery
- decreased edema & calf pain *young adults/teens are best candidates -they can be compliant with weight bearing restrictions |
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At what age would a child be able to safely operate a POWER WHEELCHAIR?
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3 years old
- traditionally not used until 5 or 6 yo though |
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Phantom pain in a child that has undergone an amputation is more likely if the procedure is performed after what age?
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10 years old
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UP-GOING toe (BABINSKI sign)
Age of emergence? Age of integration? |
E: birth
I: 1-2 yo *Definitely abnormal above 2 yo |