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?

<p>Length symmetry of arms (A)</p> Signup and view all the answers

In assessing the humerus, which symptom suggests a fracture?

<p>Mass or hematoma on palpation (A)</p> Signup and view all the answers

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

<p>Inspection of symmetry (B)</p> Signup and view all the answers

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

<p>Palmar creases and finger length (A)</p> Signup and view all the answers

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

<p>Normal contour of the shoulder (D)</p> Signup and view all the answers

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

<p>Elbow and forearm assessment (D)</p> Signup and view all the answers

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

<p>Skin color (A)</p> Signup and view all the answers

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

<p>Left leg (A)</p> Signup and view all the answers

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

<p>Male gender (D)</p> 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)?

<p>1 in 100 (D)</p> Signup and view all the answers

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

<p>Hairy patch over the midline (D)</p> Signup and view all the answers

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

<p>Abnormal development of the hip socket (C)</p> Signup and view all the answers

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

<p>Innocent sacrococcygeal dimple (D)</p> Signup and view all the answers

What spinal curvature condition should be excluded during inspection?

<p>Kyphosis (B)</p> Signup and view all the answers

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

<p>Being a first-born child (A)</p> Signup and view all the answers

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

<p>Deformities present (D)</p> Signup and view all the answers

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

<p>To identify any hip abnormalities early (A)</p> Signup and view all the answers

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

<p>Delayed identification of fetal sex (C)</p> Signup and view all the answers

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

<p>Dislocatable hips (D)</p> Signup and view all the answers

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

<p>Referral for Hip USS by 4-6 weeks (B)</p> Signup and view all the answers

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

<p>3 to 5 per 1,000 (C)</p> Signup and view all the answers

What is the typical duration for wearing the Pavlik harness?

<p>6 to 12 weeks (C)</p> Signup and view all the answers

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

<p>Clunks back into place (A)</p> Signup and view all the answers

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

<p>Osteoarthritis of the hip and back (B)</p> Signup and view all the answers

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

<p>Sandal gap (B)</p> Signup and view all the answers

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

<p>Positional Talipes (B)</p> 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?

<p>Single crease (simian crease) (A)</p> Signup and view all the answers

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

<p>Syndactyly (D)</p> Signup and view all the answers

What is characterized by the presence of too few toes?

<p>Oligodactyly (C)</p> Signup and view all the answers

What term refers to the condition of having extra digits?

<p>Polydactyly (A)</p> Signup and view all the answers

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

<p>Bunion (B)</p> Signup and view all the answers

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

<p>Trisomy 21 (D)</p> Signup and view all the answers

Flashcards

Clavicle

A bone that connects the shoulder blade to the breastbone (sternum) forming the front part of the shoulder joint.

Upper limbs

The upper arms, from the shoulder to the elbow, including the humerus bone.

Legs

The lower limbs, from the hip to the ankle, including the femur (thigh bone) and tibia/fibula (lower leg bones).

Spine

The bones of the spine, also known as the vertebral column, it runs from the neck to the tailbone.

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Hips

A pair of bones that connect the femur (thigh bone) to the pelvis, forming the hip joint.

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Humerus

A bone found in the upper arm, extending from the shoulder to the elbow.

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Radius

A bone found in the forearm, located on the thumb side of the arm, parallel to the ulna.

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Ulna

A bone found in the forearm, located on the little finger side of the arm, parallel to the radius.

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Newborn leg posture

The lower part of a baby's legs, from the knee to the feet. They are normally slightly bowed inwards (bowed) and bent at the knees.

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Allis sign

A test to see if a baby's hip is developing properly. A positive Allis sign means the hip might not be developing correctly.

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Femur

The thigh bone, located between the hip and knee.

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Tibia and fibula

The two bones in the lower leg, located between the knee and ankle.

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Fractures in the lower limb

This refers to any breaks or fractures in the bones of the lower limb, especially common in babies during difficult births or breech deliveries.

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Amniotic Constriction Band Syndrome (ABS)

A rare condition (1:1,200 births) where fibrous bands from the amnion wrap around the developing fetus, potentially causing limb abnormalities ranging from minor indentations to complete limb absence.

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Dactyly

The condition of having digits.

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Polydactyly

A condition where an individual has extra fingers and/or toes.

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Oligodactyly

A condition where an individual is missing one or more fingers and/or toes.

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Syndactyly

A condition where fingers or toes are fused together, either partially or completely, which can involve skin and/or bone.

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Clinodactyly

A condition where a finger curves inwards, possibly causing overlapping of fingers. It can be a minor issue or a more serious condition.

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Positional Talipes

A condition where a baby's feet turn inwards (invert) at birth, often caused by tightness in the womb.

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Congenital Talipes Equinovarus (CTEV)

The most common type of clubfoot, where a baby's feet turn inwards (invert) and the ankle points downwards.

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Single Plantar Crease (Simian Crease)

A deep groove running lengthwise from the big toe to the second toe on the sole of the foot, often associated with genetic conditions like Down syndrome (trisomy 21).

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Sandal Gap (Hallux Varus)

A wide gap between the big toe and the second toe on the foot, possibly associated with Down syndrome (trisomy 21) or a benign finding.

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Webbing

A condition where there is webbing between toes, sometimes extending up the toe or as excessive folds.

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Absent or Deformed Nails

An abnormal condition affecting the nails on the toes, including missing or deformed nails.

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Clubfoot

A condition where a baby's foot is twisted inwards, making it difficult to straighten.

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Scapulae

The bones of the shoulder blades, normally with a triangular shape and a flat surface.

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Spinal curve abnormality

An abnormally curved spine, which can be too curved forwards, backwards, or have a sideways curve.

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Spina bifida

A condition where the spinal cord doesn't close completely during pregnancy, leading to varying degrees of disability.

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Amniotic Constriction Band Syndrome

A rare birth defect where fibrous bands from the amniotic sac wrap around the developing fetus, potentially causing limb deformities.

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Developmental Dysplasia of the Hip (DDH)

A condition where the hip joint doesn't develop properly, leading to instability and potential dislocation.

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Sacral dimple

A shallow dimple on the back, usually near the tailbone, which is typically harmless.

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Anal patency

A condition where the anus is not fully formed, which can be identified at birth.

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Kyphosis, Lordosis, Scoliosis

An abnormal curvature of the spine, which can be seen in newborns.

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Concerns with back dimples or patches

A condition where a baby has a lump, dimple, or hairy patch on the back, which may indicate a spinal problem.

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Newborn Physical Examination (NIPE)

The examination conducted within 72 hours of birth to check for developmental dysplasia of the hip and other health issues.

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Barlow Maneuver

A maneuver used during NIPE to check for a dislocatable hip by attempting to move the hip out of the joint.

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Ortolani Maneuver

A maneuver used during NIPE to check for a dislocated hip by attempting to move the hip back into place.

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Pavlik Harness

A common treatment for DDH involving a harness worn by the baby to keep the hip in the correct position.

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Breech Presentation

A factor influencing DDH: presentation of the baby with the feet first at or after 36 weeks.

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Risk Factors for DDH

Factors increasing the likelihood of DDH: family history of hip problems and breech presentation during pregnancy.

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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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