Mod 1 Chapter 31
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Weight and height scales
How do you assess the cranial nerve XI (accessory) in older children?
have the child to attempt to turn the head against resistance
assessment of neck mobility is particularly important when what type of infections are suspected?
Infections of the central nervous system
Determination of visual acuity test which cranial nerve?
Cranial nerve II (optic)
Epicanthal folds may be present in which type of children?
- Asian descent
- children with genetic abnormalities
- those with fetal alcohol spectrum disorder
After what age does absence of pupillary reflexive action indicate blindness.
3 weeks old
How do you check extrocular mus le motility and function of cranial nerves III and IV (oculomotor and abducens).
instruct child to follow light through the six cardinal position of gaze.
How do you check cranial nerve IV (trochlear) in older children?
Ask the child to look downward and inward
hirschberg test is what?
bring penlight to the middle of your face and direct the child to look at it. the small dot of reflected light seen in the iris should be symmetrically placed in each eye.
How do you test the cranial nerve VIII (acoustic)?
What is a tympanometer?
assess mobility of the ear drum
How do you test cranial XII (hypoglossal)?
ask child to touch roof of mouth and then stick out the tongue and move it from side to side
Toddlers should have about 20 teeth by what age?
How do you test cranial nerve IX (glossopharyngeal)?
have child identify taste with posterior portion of tongue
How to check the cranial nerve X (vagus)?
Check for rise of uvula when gag reflex is elicited
What is pectus excavatum?
what is pectus carinatum?
Areas where the sounds of heart valves radiate in children?
- Aortic valve- second intercostal space, just right of sternum.
- Pulmonic valve- second intercostal space, just left of sternum
- Tricuspid valve - fourth intercostal space, just right of sternum
- Mitral valve- fourth intercostal space at left midclavicular line
s1 is usually loudest where?
over mitral and tricuspid areas and increase in intesity with fever, exercise, and anemia
s2 is usually most intense where?
at the aortic and pulmonic areas
S4 is abnormal and usually occurs with ?
S1 should not vary in intensity at a perticular point. If it does this may indicate a cardiac arrhythmia and should be referred.
a systolic murmur occurs in association with S1 which is closure of which valves?
a diastolic murmur in association with S2 is closure of which valves?
An innocent murmur is most often heard where?
- at the second or fourth intercostal space, and its timing is systolic
- usually medium pitched and musical
- can disappear when child changes position
a venous hum that is heard in the supraclavicular area and possibly radiating down the chest is considered to be what type of murmur?
an inocent murmur
a murmur that is barely audible; sometimes heard, sometimes not. Usually heard only with intense concentration is considered to be what grade murmur?
a murmur that is quiet, soft; heard each time the chest is auscultated is what grade?
a murmur that is audible, intermediate intensity is what grade?
a murmur that is audible , with a palpable thrill is what grade?
a murmur that is loud, audible with edge of the stethoscope lifted off the chest is what grade?
a murmur that is very loud, audible with the stethoscope placed near but not touching the chest is what grade?
When assessing the abdomen, in what order do you perform the assessment?
visible peristaltic wave are abnormal and should reported immediately.
the umbilical stump should fall off by what age?
by the end of the second week of life
In order to measure for brain growth, measure head circumference until what age?
Grading strength of reflex responses
- 0 no response
- 1+ diminished or sluggish
- 2+ average
- 3+ brisker than average
- 4+ very brisk, may involve clonus
What is the definition of clonus?
series of involuntary muscular contractions and relaxations. Clonus is a sign of certain neurological conditions, and is particularly associated with upper motor neuron lesions such as in stroke, multiple sclerosis, spinal cord damage and hepatic encephalopathy. Unlike the small, spontaneous twitching known as fasciculations (usually caused by lower motor neuron pathology), clonus causes large motions that are usually initiated by a reflex
What is the normal grade of a newborn's deep tendon reflex?
By 4 months of age, the deep tendon reflex grade decreases to?
Healthy children should have a relfex grade of 2+
Absent , sluggish, or hyperreactive responses usually indicate disease.
Protective reflexes include which reflexes?
- Righting reflex
- Parachute reactions
Definition of the righting reflex?
reflex that occurs when the body of an animal becomes inverted. It causes the body to turn around so that the animal is on its feet. The reflex may occur in the cerebral cortex, via visual cues, or in the midbrain via the labyrinthine or proprioception cues. The reflex can be affected by alcohol consumption
Definition of the parachute reaction?
- Protective abduction of arms, extension of elbows and wrists and spreading of fingers, a normal defence reflex, elicited when an infant is held in ventral suspension and is tilted abruptly forward toward the floor, seen in the 8th–12th month of age, a response that is asymmetrical in infants with hemiparesis and is an early sign of cerebral palsy
Lightly touching a child's cheek with a cotton ball to elicit rooting is testing which cranial nerve?
Cranial nerve V (trigeminal)
Cerebellar function tests include:
- Heel to shin
- Rapid alternating movements
- Finger to Finger
- Finger to nose
Describe the Romberg test.
Ask the school age or older child to stand still with eyes closed and arms down by the sides. Ovserve the child for leaning. This is considered a positive Romberg test, indicating cerebellar dysfuntion.
Describe Heel to Shin test.
have the child lie in a supine position, place one heel on the opposite knee, and run it down the shin.
Describe the Rapid alternating movement test.
The child pats the thighs with the hands, lifts them, turns them over, pats the thighs with the back of the hands, and repeats the process multiple times. An alternate test is for the child to touch the thumb to each finger of the same hand starting at the index finger, then reverse the direction and repeat.
Describe the finger to finger test.
the child's eyes are open. The child touches the examiner's outstretched finger with the index finger, then touches his or her own nose. The examiner moves the finger to a different spot and the child repeats this process several times.
Describe the finger to nose test.
The child's eyes are closed. The child stretches the arm with the index finger extended, then touches his or her nose with that finger, keeping the eyes closed.
Balance and coordination are controlled by which part of the brain?
Inability to staighten the foot to midline may indicate what?
Slight tremors may be noticed in the infant's extremities until what age?
1 month old
Definition of polydactyly
increased number of digits
What is the definition of syndactyly?
Webbing of digits
What is the definition of genu varum?
What is the definition of genu valgum?
Genu Valgum is usually present until what age?
7 years old
Screen infants younger than 6 months for the developmental dysplasia of the hip by performing which manuevers?
Ortolani and Barlow Maneuvers
What is dyplasia of the hip?
abnormal development of the hip
Describe the Ortolani and Barlow maneuvers.
- It is performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner's index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting the infant's legs using the examiner's thumbs.
- A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum:
- Specifically, this tests for posterior dislocation of the hip.
- Ortolani - This is part of the standard infant exam performed preferably in early infancy; it usually becomes negative after 2 months of age.
- It is performed with the Barlow maneuver and inspection of the hip joint and legs.
- Barlow - The maneuver is easily performed by adducting the hip (bringing the thigh towards the midline) while applying light pressure on the knee, directing the force posteriorly. If the hip is dislocatable - that is, if the hip can be popped out of socket with this maneuver - the test is considered positive. The Ortolani maneuver is then used, to confirm the positive finding (i.e., that the hip actually dislocated
The newborn's spine has a single C-shaped curve and remains rounded until about what age?
At what age does the lumbar curve develop?
Between 12 to 18 months.
Adolescents often demonstrate what in their spine as the skeletion and muscles are both growing rapidly?
In the newborn, tenderness or crepitus in the clavicles reveals what?
Fracture sustained at birth
In the older infant or child, a bump indicates callus formation with clavicle fracture.
Requesting that a child shrug the shoulders while you apply downward pressure test which cranial nerve?
Cranial nerve XI
What position by the boy can reduce cremasteric reflex that retracts the testicles during palpation?
Sitting cross legged
What is the definition of the cremasteric reflex?
This reflex is elicited by lightly stroking the superior and medial (inner) part of the thigh. The normal response is a contraction of the cremaster muscle that pulls up the scrotum and testis on the side stroked.
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