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NU665
NU665C/ NU 665C E XAM 1: (NEW 2024/
2025 UPDATE) FAMILY PSYCHIATRIC MENTAL
HEALTH | QS & AS| GRADE A| 100%
CORRECT (VERIFIED ANSWERS)- REGIS
Hip examination - ANS ✓1. Galeazzi - can signal conditions that cause leg-length
discrepancies; includes flexing the hips and knees while the infant or child lies
supine, placing the soles of the feet on the table near the buttocks, and then
looking at the knee heights for equality
-Positive if the knee heights are unequal
2. Barlow - assess for dislocation of a nondisplaced hip in an infant during the
first month of life; the infant should be unclothed and supine with knees flexed;
the hip is flexed and the thigh is brought into an adducted position while
applying gentle downward pressure; the hip would slip out of the acetabulum or
can be pushed out of the socket; this is a positive; the dislocation is palpable; the
hip relocates after release
3. Ortolani - reduces a posterior dislocated hip and is performed gently to reduce
a recently dislocated hip; the infant is in a supine position with both knees flexed;
the providers thumb is placed near the lesser trochanter and the pad of the
second finger is position on the bony prominence of the greater trochanter; the
leg is flexed at the hip and then abducted while pushing up
-A palpable clunk as the femoral head is relocated is a positive; a high-pitched hip
click may be audible or felt at the end of abduction
4. Klisic test - an observational sign of hip placement; the PCP places the tip of the
third finger of one hand over the greater trochanter and the index finger of the
same hand on the anterosuperior iliac spine
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-If the hip is dislocated, the trochanter is elevated and the imaginary line points
halfway between the umbilicus and the pubis
5. Trendelenburg sign - can be used to identify conditions that cause weakness in
the hip abductors; by having the child stand and raise one leg off the ground; if
the pelvis drops on the side of the raised leg, the sign is positive and indicates we
Costochondritis - ANS ✓-Common cause of chest pain in children and
adolescents
-Inflammation of one or more of the costochondral cartilages that causes
localized tenderness and pain in the anterior chest wall
-Caused by trauma and unaccustomed physical effort
-Treatment - mild analgesia and NSAIDS to relieve discomfort and avoiding
strenuous activity; cough suppressants if cough is aggravating; stretching
exercises and ice
-Not related to cardiac disease
Scoliosis - ANS ✓-A lateral curvature of the spine; of more than 10 degrees
-Testing - standing AP and lateral radiographs of the entire spine; MRI to find the
cause;
-Interventions - observation for curves less than 20 degrees, bracing, and surgery
if they do not respond to bracing and curves are more than 45-50 degrees
Developmental dysplasia of the hip - ANS ✓-Anatomical abnormalities in
which the femoral head and acetabulum are in improper alignment and/or grow
abnormally
-A hip examination should be done on children as part of their well-child
supervision until the child begins to walk
-Ortolani and Barlow in first month; other tests - Klisic and Galeazzi after;
ultrasound is suspicious
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-In the older infant - 6-18 months - may see limited abduction of the affected hip
and shortening of the thigh and a positive Galeazzi sign
-Other symptoms include asymmetry of inguinal or gluteal folds, unequal leg
lengths
-In the ambulatory child - positive Trendelenburg sign, marked lordosis or toe
walking, painless limping or waddling gait with child leaning to the affected side
-Management - restore the articulation of the femur within the acetabulum; most
resolve spontaneously by 6-8 weeks so close observation is recommended;
-Refer infant to orthopedist if the newborn exam is positive; follow up at 2 weeks
with a thorough hip exam - if positive or inconclusive - refer
-Treatment is a Pavlik harness for subluxation and reducible dislocations worn
24 hours a day except for bathing, the 6-18 month old - closed manipulation or
open reduction and a spica cast
-Annual or biannual radiographs to the point of skeletal maturity is
recommended to evaluate for late asymmetric epiphyseal closure
Tibial torsion - ANS ✓-Twisting of the long bone along its long axis
-Congenital, developmental, or acquired
-Most common cause of in-toeing during the second year of life and is noted
around 6-12 months
-In most causes it resolves by 8 years of age
-Signs - in toeing
-Refer to orthopedist if the problem is significant (TFA > 20 degrees by 3 years of
age); stretching exercises or external rotational splints; surgery for severe cases
that persist into late childhood and cause functional problems
Talipes Equinovarus (clubfoot) - ANS ✓-The ankle is in equinus (foot in a
pointed toe position), the sole of the foot is inverted as a result of hindfoot varus
or inversion deformity of the heel, and the forefoot has the convex shape of
forefoot adduction
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-From environment and genetics
-AP and lateral radiographs are recommended with the foot held in a normal
position
-Refer to an orthopedist upon diagnosis, ideally shortly after the infant is born,
because the joints are most flexible in the first hours and days of life
-Nonoperative treatment should begin ASAP after birth
-Tapping and strapping; manipulation; and serial casting
-Ponseti method - manipulation and serial casting - weekly cast changes with up
to 5-10 casts; full time bracing for three months and then night time bracing for
3-5 years
Annular ligament displacement injury - ANS ✓-Nursemaids elbow
-A frequent injury that occurs in children 6 months to 5 years of age
-Occurs when traction is applied to the arm of a young child, which is most often
the result of pulling a child by the hand or grasping a child's hand to prevent a fall
-The annular ligament slides over the head of the radius, where it becomes
entrapped in the radiohumeral joint when the distal traction is released
-The child refuses to use the arm, pain when moved, particularly the elbow;
swelling and ecchymosis are not always present
-Can do supination and flexion or pronation; do not attempt with epitrochlear
tenderness
-A palpable or audible click usually signals successful reduction; the child will
reach for objects again with the arm within 15 minutes; if this is done - no further
treatment is necessary
-Several attempts may be needed; if normal use does not follow reduction
attempts - immobilization with a sling with prompt orthopedic follow-up is
indicated
-More prone to to get this once you've had it
NU665C/
NU665
NU665C/ NU 665C E XAM 1: (NEW 2024/
2025 UPDATE) FAMILY PSYCHIATRIC MENTAL
HEALTH | QS & AS| GRADE A| 100%
CORRECT (VERIFIED ANSWERS)- REGIS
Hip examination - ANS ✓1. Galeazzi - can signal conditions that cause leg-length
discrepancies; includes flexing the hips and knees while the infant or child lies
supine, placing the soles of the feet on the table near the buttocks, and then
looking at the knee heights for equality
-Positive if the knee heights are unequal
2. Barlow - assess for dislocation of a nondisplaced hip in an infant during the
first month of life; the infant should be unclothed and supine with knees flexed;
the hip is flexed and the thigh is brought into an adducted position while
applying gentle downward pressure; the hip would slip out of the acetabulum or
can be pushed out of the socket; this is a positive; the dislocation is palpable; the
hip relocates after release
3. Ortolani - reduces a posterior dislocated hip and is performed gently to reduce
a recently dislocated hip; the infant is in a supine position with both knees flexed;
the providers thumb is placed near the lesser trochanter and the pad of the
second finger is position on the bony prominence of the greater trochanter; the
leg is flexed at the hip and then abducted while pushing up
-A palpable clunk as the femoral head is relocated is a positive; a high-pitched hip
click may be audible or felt at the end of abduction
4. Klisic test - an observational sign of hip placement; the PCP places the tip of the
third finger of one hand over the greater trochanter and the index finger of the
same hand on the anterosuperior iliac spine
NU665C/
, 2
NU665
-If the hip is dislocated, the trochanter is elevated and the imaginary line points
halfway between the umbilicus and the pubis
5. Trendelenburg sign - can be used to identify conditions that cause weakness in
the hip abductors; by having the child stand and raise one leg off the ground; if
the pelvis drops on the side of the raised leg, the sign is positive and indicates we
Costochondritis - ANS ✓-Common cause of chest pain in children and
adolescents
-Inflammation of one or more of the costochondral cartilages that causes
localized tenderness and pain in the anterior chest wall
-Caused by trauma and unaccustomed physical effort
-Treatment - mild analgesia and NSAIDS to relieve discomfort and avoiding
strenuous activity; cough suppressants if cough is aggravating; stretching
exercises and ice
-Not related to cardiac disease
Scoliosis - ANS ✓-A lateral curvature of the spine; of more than 10 degrees
-Testing - standing AP and lateral radiographs of the entire spine; MRI to find the
cause;
-Interventions - observation for curves less than 20 degrees, bracing, and surgery
if they do not respond to bracing and curves are more than 45-50 degrees
Developmental dysplasia of the hip - ANS ✓-Anatomical abnormalities in
which the femoral head and acetabulum are in improper alignment and/or grow
abnormally
-A hip examination should be done on children as part of their well-child
supervision until the child begins to walk
-Ortolani and Barlow in first month; other tests - Klisic and Galeazzi after;
ultrasound is suspicious
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, 3
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-In the older infant - 6-18 months - may see limited abduction of the affected hip
and shortening of the thigh and a positive Galeazzi sign
-Other symptoms include asymmetry of inguinal or gluteal folds, unequal leg
lengths
-In the ambulatory child - positive Trendelenburg sign, marked lordosis or toe
walking, painless limping or waddling gait with child leaning to the affected side
-Management - restore the articulation of the femur within the acetabulum; most
resolve spontaneously by 6-8 weeks so close observation is recommended;
-Refer infant to orthopedist if the newborn exam is positive; follow up at 2 weeks
with a thorough hip exam - if positive or inconclusive - refer
-Treatment is a Pavlik harness for subluxation and reducible dislocations worn
24 hours a day except for bathing, the 6-18 month old - closed manipulation or
open reduction and a spica cast
-Annual or biannual radiographs to the point of skeletal maturity is
recommended to evaluate for late asymmetric epiphyseal closure
Tibial torsion - ANS ✓-Twisting of the long bone along its long axis
-Congenital, developmental, or acquired
-Most common cause of in-toeing during the second year of life and is noted
around 6-12 months
-In most causes it resolves by 8 years of age
-Signs - in toeing
-Refer to orthopedist if the problem is significant (TFA > 20 degrees by 3 years of
age); stretching exercises or external rotational splints; surgery for severe cases
that persist into late childhood and cause functional problems
Talipes Equinovarus (clubfoot) - ANS ✓-The ankle is in equinus (foot in a
pointed toe position), the sole of the foot is inverted as a result of hindfoot varus
or inversion deformity of the heel, and the forefoot has the convex shape of
forefoot adduction
NU665C/
, 4
NU665
-From environment and genetics
-AP and lateral radiographs are recommended with the foot held in a normal
position
-Refer to an orthopedist upon diagnosis, ideally shortly after the infant is born,
because the joints are most flexible in the first hours and days of life
-Nonoperative treatment should begin ASAP after birth
-Tapping and strapping; manipulation; and serial casting
-Ponseti method - manipulation and serial casting - weekly cast changes with up
to 5-10 casts; full time bracing for three months and then night time bracing for
3-5 years
Annular ligament displacement injury - ANS ✓-Nursemaids elbow
-A frequent injury that occurs in children 6 months to 5 years of age
-Occurs when traction is applied to the arm of a young child, which is most often
the result of pulling a child by the hand or grasping a child's hand to prevent a fall
-The annular ligament slides over the head of the radius, where it becomes
entrapped in the radiohumeral joint when the distal traction is released
-The child refuses to use the arm, pain when moved, particularly the elbow;
swelling and ecchymosis are not always present
-Can do supination and flexion or pronation; do not attempt with epitrochlear
tenderness
-A palpable or audible click usually signals successful reduction; the child will
reach for objects again with the arm within 15 minutes; if this is done - no further
treatment is necessary
-Several attempts may be needed; if normal use does not follow reduction
attempts - immobilization with a sling with prompt orthopedic follow-up is
indicated
-More prone to to get this once you've had it
NU665C/
