Infant Examination & Injuries Quiz

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Questions and Answers

What could a positive Allis sign indicate?

Legg-Calve-Perthes disease (correct)

Normal hip development

Hip dysplasia (correct)

Slipped capital femoral epiphysis

What is Amniotic Band Syndrome (ABS)?

A condition where digits are fused together

A type of infection

A genetic disorder

A syndrome affecting the development of the limbs (correct)

What is one possible indicator of a brachial plexus injury in infants?

Increased reflexes

Reduced mobility in the shoulder (correct)

Swelling in the wrist

Extended arm posture

Which sign would NOT typically indicate a clavicle fracture in an infant?

Length symmetry of arms Signup and view all the answers

In assessing the humerus, which symptom suggests a fracture?

Mass or hematoma on palpation Signup and view all the answers

What observation technique is essential for evaluating an infant's spine?

Inspection of symmetry Signup and view all the answers

What is typically assessed in the hands during an infant examination?

Palmar creases and finger length Signup and view all the answers

Which of the following is NOT a sign of dislocated shoulder in an infant?

Normal contour of the shoulder Signup and view all the answers

What aspect of joint examination focuses on the number of bones present?

Elbow and forearm assessment Signup and view all the answers

Which observation is NOT typically considered when assessing the legs of an infant?

Skin color Signup and view all the answers

What is the most common leg affected by developmental dysplasia of the hip (DDH)?

Left leg Signup and view all the answers

Which of the following is NOT a risk factor for developmental dysplasia of the hip (DDH)?

Male gender Signup and view all the answers

In terms of prevalence, what is the occurrence rate of dislocatable hip instability in developmental dysplasia of the hip (DDH)?

1 in 100 Signup and view all the answers

Which of the following signs on inspection may suggest a spinal neural tube disorder?

Hairy patch over the midline Signup and view all the answers

What characterizes development dysplasia of the hip (DDH) in infants?

Abnormal development of the hip socket Signup and view all the answers

What does the presence of a spinal or dermal dimple usually indicate?

Innocent sacrococcygeal dimple Signup and view all the answers

What spinal curvature condition should be excluded during inspection?

Kyphosis Signup and view all the answers

What risk factor increases the likelihood of developmental dysplasia of the hip (DDH) the most?

Being a first-born child Signup and view all the answers

Which feature is not typically associated with a normal spinal examination?

Deformities present Signup and view all the answers

What is the purpose of the NIPE examination within 72 hours of birth?

To identify any hip abnormalities early Signup and view all the answers

Which of the following factors is NOT a national risk factor for DDH during the NIPE screening?

Delayed identification of fetal sex Signup and view all the answers

What does the Barlow manoeuvre screen for during the NIPE examination?

Dislocatable hips Signup and view all the answers

What is the recommended action if a baby screens positive for DDH?

Referral for Hip USS by 4-6 weeks Signup and view all the answers

What is the range of live births that may require a Pavlik harness for DDH treatment?

3 to 5 per 1,000 Signup and view all the answers

What is the typical duration for wearing the Pavlik harness?

6 to 12 weeks Signup and view all the answers

Which of the following is a characteristic of a dislocated hip identified through the Ortolani manoeuvre?

Clunks back into place Signup and view all the answers

What could be a long-term complication of untreated DDH?

Osteoarthritis of the hip and back Signup and view all the answers

Which term describes the condition where there is a wide space between the first and big toe?

Sandal gap Signup and view all the answers

What is the most common type of talipes that results from constriction in utero?

Positional Talipes Signup and view all the answers

Which condition is characterized by a deeply grooved plantar crease running longitudinally from between the big and second toe?

Single crease (simian crease) Signup and view all the answers

What condition involves the presence of webbing that may limit movement of the toes?

Syndactyly Signup and view all the answers

What is characterized by the presence of too few toes?

Oligodactyly Signup and view all the answers

What term refers to the condition of having extra digits?

Polydactyly Signup and view all the answers

Which of the following is NOT an abnormality associated with toes?

Bunion Signup and view all the answers

What is commonly associated with the presence of a single crease on the foot?

Trisomy 21 Signup and view all the answers

Study Notes

Examination of the Newborn

Areas examined include the skull, clavicle, upper limbs, legs, spine, and hips.

Observation

Symmetry and posture are assessed.
Signs of discomfort are noted.
Range of joint motion is evaluated.

Inspection and Palpation - Upper Limbs

Shoulders are examined for reduced mobility, reflexes, birth trauma (brachial plexus injury, Erb's palsy, Klumpke's palsy), and dislocation (rare).
Clavicles are assessed for size, contour, crepitus, bruising, puffiness, and pain. Fractures are considered.
Humerus length and contour are observed to detect masses (hematomas) and pain on palpation (fractures).
Elbows, forearms, and wrists are checked for size, shape, number of bones, range of motion, and tumors/masses.
Hands are examined regarding shape, size, posture, and palmar creases.
Fingers are checked for number, shape, length, flexion, and nail condition.

Amniotic Constriction Band/Amniotic Band Syndrome (ABS)

Rare condition, occurring in approximately 1 in 1,200 births.
Fibrous bands from the amnion wrap around the developing fetus, inhibiting growth and potentially leading to limb deformation.

Fingers - Dactyly

Polydactyly: Extra digits.
Oligodactyly: Missing digits.
Syndactyly: Fused fingers/toes, can be inherited or sporadic (1 in 2,000 births). May include skin or bone fusion.
Clinodactyly: Curving fingers, potentially causing overlapping.

Inspection and Palpation - Lower Limbs and Feet

Legs typically appear slightly anterior, bowed, and flexed at rest.
Femur length, shape, symmetry, and movement (full range of motion) are checked. Fractures, especially with birth trauma/breech, are considered.
Allis sign (positive sign) can indicate developmental hip displacement.
Tibia and fibula are evaluated for length, shape, symmetry, and movement (full range of motion). Fractures, especially from birth trauma/breech, are considered.

Feet and Toes

Feet: Shape, size, posture, and the positioning of both feet (normal position when at rest).
Toes: Number, position, spacing, presence of webbing, and the shape/appearance of nails are checked.
Abnormalities: Can mirror hand abnormalities (absent/deformed nails, clinodactyly, oligodactyly, polydactyly, syndactyly, webbing, sandal gap (hallux varus), and presence of a single crease (simian crease) among others.

Talipes

Positional Talipes: Most common, with feet turned inward (inversion).
Congenital Talipes Equinovarus (CTEV): Clubfoot.

Inspection and Palpation - Back and Spine

Scapulae (shoulder blades): Roughly triangular, flat surface, horizontal upper border below clavicle height with usual shoulder movements.
Spinal curve: Convex, straight alignment is expected. Exclude kyphosis, lordosis, or scoliosis (abnormal curves).
Spine integrity: Skin inspection from the skull to the coccyx, checking for changes in color, birthmarks, masses, and deformities, dimples, and the shape of the spine.
Sacral dimple: Shallow; normal-depth (innocent).
Anal patency: Anus is normally situated and patent.

Spinal Neural Tube Disorders

Concerns: Lump, dimple, hairy patch, or naevus over midline require further investigation.
Spina bifida occulta (SBO): Hidden defect.
Spina bifida cystica (SBC): Visible sac .
Spinal/dermal dimple: Innocent sacrococcygeal dimple, particularly if over the coccyx.

Developmental Dysplasia of the Hip (DDH)

Definition: Abnormal development of the hip socket 'ball and socket' joint.
Incidence: 1 in 100 (instability) to 1 in 1000 (dislocated hips).
Risk factors: Family history, firstborn, breech deliveries (after 36 weeks, females affected more often); oligohydramnios; multiple pregnancies.
Why? Lax ligaments, bad positioning, impaired hip development due to maternal/fetal laxity, genetics, intrauterine and post-natal positioning.

Diagnosing DDH

Performed during the NIPE examination: Within 72 hours of birth.
Minimises long-term complications.
NIPE risk factors: First-degree family history, breech presentation after week 28 gestation.
Observation and manipulation: Leg Length, Allis sign, and restricted abduction of hip flexion.
Ortolani & Barlow maneuvers: Detects dislocatable and dislocated hips.

Treatment of DDH

Pavlik harness: Used for 6-12 weeks. Constant wear, adjusted during follow-up.
Surgery: 1 in 1-2 per 1000 births, if the pavlik harness is ineffective or diagnosed late (after 6 months).

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Description

Test your knowledge on important indicators and assessment techniques related to infant examinations. This quiz covers topics such as signs of fractures, dislocations, and syndromes like Amniotic Band Syndrome. Perfect for healthcare professionals and students specializing in pediatrics.