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Questions and Answers

What is the primary focus of the article by Kristin Bird and Gerald Moore?

  • Management of back pain
  • Evaluation of joint disorders
  • Conducting an office-based musculoskeletal exam (correct)
  • Assessment of skeletal injuries

    • Which of the following would most likely be considered a red flag of low back pain?

  • Localized muscle soreness
  • Improvement with rest
  • Recent change in mobility (correct)
  • Decreased range of motion

    • In the context of musculoskeletal complaints, what is the importance of conducting a thorough history?

  • To assess familial tendencies in joint diseases
  • To determine the effectiveness of previous treatments
  • To rule out all possible causes of pain
  • To identify potential underlying conditions (correct)

    • What aspect should NOT be overlooked when assessing back pain in a patient?

    <p>The layout of the examination room</p> Signup and view all the answers

    What does the presence of bidirectional or vertical nystagmus suggest?

    <p>It suggests a central cause of vertigo.</p> Signup and view all the answers

    Which symptom could complicate the assessment of low back pain?

    <p>Presence of joint swelling</p> Signup and view all the answers

    When evaluating nystagmus, what should be observed when asking the patient to look to the sides?

    <p>Slight changes in direction of eye movement.</p> Signup and view all the answers

    Which type of nystagmus is considered more reassuring during evaluation?

    <p>Unidirectional nystagmus.</p> Signup and view all the answers

    In the context of nystagmus evaluation, which statement accurately describes what is sought after?

    <p>Changes in eye direction indicating potential underlying issues.</p> Signup and view all the answers

    If a patient exhibits unidirectional nystagmus during evaluation, what is the likely implication?

    <p>It indicates a benign cause of vertigo.</p> Signup and view all the answers

    What is a key distinction between breath-holding spells and epileptic seizures?

    <p>Epileptic seizures typically involve a loss of consciousness.</p> Signup and view all the answers

    Which of the following differentiates between stereotypies and tics?

    <p>Tics are often preceded by an urge to move.</p> Signup and view all the answers

    In pediatric neurology, what defines paroxysmal non-epileptic disorders?

    <p>They can be differentiated by the age of onset.</p> Signup and view all the answers

    What characterizes upper motor neuron (UMN) dysfunction compared to lower motor neuron (LMN) dysfunction?

    <p>UMN dysfunction typically preserves deep tendon reflexes.</p> Signup and view all the answers

    Which statement about neurologic disorders is true?

    <p>Pseudoseizures are typically not associated with electrical discharges in the brain.</p> Signup and view all the answers

    What metabolic risk factors co-occur for both Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD)?

    <p>Abdominal obesity, hyperglycemia, dyslipidemia, and hypertension.</p> Signup and view all the answers

    What is the recommended duration for aerobic physical activity to achieve significant systolic blood pressure reduction?

    <p>30 minutes most days of the week.</p> Signup and view all the answers

    Which dietary pattern is specifically mentioned as part of a healthy eating plan?

    <p>DASH diet.</p> Signup and view all the answers

    What is one of the key considerations in providing person-centered and culturally effective care?

    <p>Respectful communication and building trust.</p> Signup and view all the answers

    Which of the following is NOT a component of the 5 'A's framework for obesity management?

    <p>Advocate.</p> Signup and view all the answers

    Which of these screening methods is commonly used in assessing the risk for atherosclerotic cardiovascular disease?

    <p>ASCVD Risk Calculator.</p> Signup and view all the answers

    In evaluating metabolic syndrome, which condition is usually assessed?

    <p>Hypertension.</p> Signup and view all the answers

    What is the focus of the physical activity recommendations for managing metabolic syndrome?

    <p>Aerobic activity for overall health.</p> Signup and view all the answers

    What is the primary method of treatment for clubfoot?

    <p>Ponseti method of serial casting</p> Signup and view all the answers

    Which screening method is recommended for detecting developmental dysplasia of the hip in high-risk infants?

    <p>Ortolani/Barlow tests</p> Signup and view all the answers

    What is a common complication associated with Slipped Capital Femoral Epiphysis (SCFE)?

    <p>Avascular necrosis</p> Signup and view all the answers

    At what angle of curvature is scoliosis considered significant and diagnosed?

    <p>10°</p> Signup and view all the answers

    For which age group is ultrasound screening for hip dysplasia recommended?

    <p>4-6 weeks</p> Signup and view all the answers

    What is the typical incidence rate of clubfoot in live births?

    <p>1-2 per 1000 live births</p> Signup and view all the answers

    Which of the following is NOT a characteristic of clubfoot?

    <p>Deduction of the forefoot</p> Signup and view all the answers

    Which treatment option is commonly used for non-operative management of scoliosis curves between 25° and 40°?

    <p>Bracing</p> Signup and view all the answers

    What is a key physical exam finding for SCFE?

    <p>Decreased internal rotation</p> Signup and view all the answers

    When is referral to orthopedics necessary for developmental dysplasia of the hip?

    <p>For abnormal physical exam or imaging</p> Signup and view all the answers

    Which treatment is indicated for hip dislocation in DDH?

    <p>Pavlik harness</p> Signup and view all the answers

    Scoliosis screening is commonly performed using which method?

    <p>Forward bend test</p> Signup and view all the answers

    What is the follow-up care after applying the Ponseti method for clubfoot?

    <p>Use of a foot abduction orthosis</p> Signup and view all the answers

    Study Notes

    Nystagmus Evaluation

    • When evaluating nystagmus, ask the patient to look slightly left and then right. Notice slight changes in direction.
    • Bidirectional or vertical nystagmus suggests a central cause of vertigo, like a stroke.
    • Unidirectional nystagmus is reassuring and may not be indicative of a serious condition.

    Common Problems Pediatric Neurology - Paroxysmal Non-Epileptiform Disorders

    • Paroxysmal non-epileptiform disorders can be classified based on the age of onset.
    • There are differences between breath-holding spells and epileptic seizures, as well as between stereotypies and tics.
    • Important to differentiate between non-epileptic seizures (pseudoseizures) and true epileptic seizures.

    Upper Motor Neuron (UMN) Dysfunction vs. Lower Motor Neuron (LMN) Dysfunction - Cranial Nerve 7

    • UMNs are part of the Central Nervous System (CNS), with cell bodies located in the brain or spinal cord.

    Orthopedic Conditions in Children

    Clubfoot

    • Clubfoot is a complex deformity characterized by a high arch, adducted forefoot, varus hindfoot, and equinus.
    • Incidence is around 1-2 per 1000 live births.
    • Can be idiopathic or associated with neuromuscular conditions or syndromes.
    • Treatment involves the Ponseti method of serial casting and possible Achilles tenotomy.
    • After casting, patients wear foot abduction orthosis full-time for 3 months, then part-time until age 4.
    • Recurrence is common and may require additional casting or surgery.
    • Referral to an orthopedic specialist familiar with the Ponseti method is recommended.
    • Chronic pain is a common complication.

    Developmental Dysplasia of the Hip (DDH)

    • DDH is a spectrum of disorders ranging from mild acetabular dysplasia to complete hip dislocation.
    • Key risk factors include breech presentation and family history.
    • Screening is done with a physical exam (Ortolani/Barlow tests) in infancy.
    • Ultrasound screening is recommended at 4-6 weeks for high-risk infants.
    • X-rays are used for screening after 4-6 months of age.
    • Treatment depends on age and severity and may include Pavlik harness, closed reduction, or open reduction.
    • The goal is to maintain concentric hip reduction to allow normal development.
    • Referral to an orthopedic specialist is needed for abnormal physical exams or imaging findings.

    Slipped Capital Femoral Epiphysis (SCFE)

    • SCFE is a displacement of the femoral metaphysis anteriorly/laterally on the epiphysis.
    • Typically occurs in adolescents, often obese.
    • Can present with hip, knee, or thigh pain.
    • Physical exam shows decreased internal rotation and abduction of the hip; persistent hip pain.
    • Diagnosis is made with AP and frog-leg lateral x-rays of the pelvis.
    • Treatment is urgent surgical fixation.
    • Complications include avascular necrosis and future arthritis.
    • Urgent referral to an orthopedic specialist or the ED is needed when suspected.

    Scoliosis

    • Scoliosis is defined as a spinal curve greater than 10° on x-ray, showing lateral curvature.
    • Most common type is adolescent idiopathic scoliosis.
    • Screening is done with the forward bend test and scoliometer.
    • X-rays are indicated for a scoliometer reading greater than 7°.
    • Curves between 10-25° are monitored.
    • Curves between 25-40° are often treated with bracing.
    • Curves greater than 50° usually require surgical fusion.
    • MRI is indicated for atypical curves or early-onset scoliosis.
    • Referral to an orthopedic specialist is recommended for curves greater than 20-25°.

    Stanford Low Back Exam

    Orthopedic Videos

    • Hoffman sign: Tests for impingement
    • Impingement sign:
    • Rotator cuff:
    • Thomas Test: Tests for hip flexion
    • Milking effusion in the knee:
    • Medial Collateral Ligament (MCL):
    • Lateral Collateral Ligament (LCL):
    • McMurray:
    • Lachman's:
    • Anterior Drawer:
    • Posterior Drawer:

    Musculoskeletal Class Slides

    Conditions Requiring Urgent Attention

    Respiratory Assessment

    • Perform direct or indirect percussion on the chest, and compare each side for:

    • Auscultate the chest with the stethoscope diaphragm, comparing sides for:

    Metabolic Syndrome

    • Metabolic Syndrome: Co-occurrence of metabolic risk factors for both type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD): abdominal obesity, hyperglycemia, dyslipidemia, and hypertension.

    Diabesity

        -   -   -   -   -   -   -   -   -

    DASH Diet Eating Plan

    Physical Activity Recommendations

    • 4-9mmHg systolic blood pressure (SBP) reduction with aerobic physical activity for 30 minutes most days of the week.

    Type 2 Diabetes Mellitus (T2DM) Screening

    ASCVD Risk Calculator

    USPSTF Statin Use Recommendations

    Person-Centered / Culturally Effective Care

    OARS

    SDOH with Screening

    Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes - 2021

    Assessing and Managing the Metabolic Syndrome in Children and Adults

    The 5 As Framework for Obesity Management

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