Assessment Final - Head And Neck

Front 1

When does the anterior fontanel close?

Back 1

18-24 months

Front 2

Where is a "3rd fontanelle"? Is it concerning?

Back 2

Defect in parietal bone along sagittal suture; May be a normal variant, sometimes seen in preemies. Also Down syndrome or congenital hypothyroidism

Front 3

Under what condition is the squamosal suture most present?

Back 3

Increased ICP, along with palpable sphenoid and mastoid fontanels

*Also noted in preterm infants with rapid brain growth

Front 4

What are you listening for when auscultating the anterior fontanel? What is it? With what other condition would you want to auscultate the fontanel to assess for this?

Back 4

-Bruit (murmur) --> may be a normal finding and therefore auscultating is optional

-It's an Intracranial arteriovenous malformation/fistula

-Check for one if baby is in cardiac failure

Front 5

Sutures may be split up to _____ cm

Back 5

1 cm, if wider may = increased ICP

Front 6

What are immobile sutures called?

Back 6

Craniosynostosis

Front 7

Brachycephaly

Back 7

-fused CORONAL sutures

-leads to broad skull

-common head shape in downs and back-to-sleep

-usually goes away once they are ~ 6 months old and can sit on own

Front 8

Plagiocephaly

Back 8

"GENERAL TERM" for describing atypical cranial molding

-Further differentiated as synostotic or non synostotic

-Non synostotic: torticollis, infant on back with brachycephalic head shape, preemie "toaster head"

-Synostotic: closure of sutures on one side = asymmetric skull, will see compensatory changes (fullness on opposite side)

Front 9

Dolicocephaly

Back 9

"toaster head"

-Seen in preemies

-Flattening side to side WITHOUT synostosis

Front 10

Scaphocephaly

Back 10

-Fusion of SAGITTAL suture

-limits lateral growth = narrow head

-More common in males

-Must be opened up

Front 11

3 causes of hydrocephalus

Back 11

1. Increased production of CSF

2. Impaired absorption of CSF (IVH/Meningitis)

3. Obstruction of CSF pathway (tumor, IVH, aqueductal stenosis, Dandy walker, arnold-chiari, ventriculities)

Front 12

Each lateral ventricle has a ________

Back 12

foramen

Front 13

Acquired vs Congenital hydrocephalus

Back 13

Acquired - IVH, meningitis

Congenital - X-linked aqueductal stenosis most common, more in males. 50% of these boys have a cortical thumb (cortical thumb can be WNL but should be LOOSE & not all the time)

Front 14

When is hydrocephalus diagnosed?

Back 14

1. In utero - enlarged ventricles

2. Dx at birth - aqueductal stenosis or myelomeningocele with Arnold Chiari malformation

Front 15

Arnold Chiari malformation

Back 15

Downward displacement of cerebellar tonsils through the foramen magnum (herniates through and compresses brain stem)

Front 16

Clinical findings of hydrocephalus (10)

Back 16

-progressive macrocephaly

-full AF with wide sutures

-prominent scalp veins

-abnormal tone

-lethargy

-poor feeding

-vomiting (increased ICP)

-sun set sign

-apnea

-inability to look up

Front 17

Hydrancephaly - what is it; causes; when can it occur; what do you see at birth?

Back 17

Loss of neuronal tissue in one or both hemispheres of the brain

-Cerebral hemispheres are replaced by membranous sacs filled with CSF

-->porencephaly - can be limited to 1 cyst

--> multicystic encephalomalacia - multiple porencephalic cysts

- Causes: infection, ischemia, infarction, hemorrhage, genetic

-Occurs: after an insult like IVH, sepsis, ischemia up to several months of age

-Babies act NORMAL at brith due to brain stem function, but may be irritable/jittery/poor consolability. Can feed well until spasticity develops

Front 18

Holoprosencephaly - what is it; what anomalies are a/c it; large or small head?; when does the defect occur in utero

Back 18

Single-sphered cerebral structure with a common ventricle

-Membrane over 3rd ventricle, absence of olfactory bulbs, hypoplasia of optic nerve, enlarged 3rd ventricle seen as posterior cyst

-Midline facial anomalies - absence of nose, or single nostril, single eye, midline cleft lip/palate

-Microcephaly or hydrocephalus - fluid accumulates in posterior cyst

-Developmental defect occurring by at least 5-6 weeks gestation --> failure of migration and differentiation of mesoderm into forebrain; failure of migration and differentiation of midline facial structures. Telencephalon fails to form hemispheres

-Strong a/c with chromosomal anomalies (tri 13) or familial, early death

Front 19

Craniotabes

Back 19

-Soft bone felt during palpation of skull

-Snappy sensation (ping pong ball)

-Seen with: engagement in vertex position for long time, delayed ossification of bone (pressure of skull against maternal pelvis), NOT GENETIC - therefore does NOT indicate rickets

-Resolves spontaneously

Front 20

Caput succedaneum

Back 20

-CROSSES SUTURE LINES

-Edema of presenting part of skull d/t pressure that restricts the return of venous and lymph flow during birth

-Vacuum assisted delivery

-edema pits with pressure

-poorly defined edges

-resolves in a few days

Front 21

Cephalohematoma

Back 21

-MAY NOT BE OBVIOUS AT BIRTH (esp if baby also has caput)

-DOES NOT CROSS SUTURE LINES

-Blood between periosteum and skull

-clearly demarcated edges

-firm, but softer after 48 hrs

-generally seen on a parietal bone

-2 weeks-3 months to resolve, but in 1% leaves residual calcifications

Front 22

Subgaleal hematoma

Back 22

-Bleeding below epicranial aponeurosis, a fascial sheath connecting frontal and occipital parts of occipito-frontales muscle

-UNCONFINED - spreads to neck / forehead

-Crepitant sensation or fluid waves felt

-Seen soon after birth, resolves 2-3 weeks

-CHECK hct or hgb; MAY BLEED TO DEATH

Front 23

Cutis aplasia

Back 23

-Open scalp defect seen in tri 13 OR normal variant

-absence of several skin layers

-alopecia

-if over AF, removal of eschar may cause hemorrhage from ruptured sagittal sinus

Front 24

Abnormally placed or > 2 hair whorls & unruly hair is an indicator of :

Back 24

abnormal brain growth

Front 25

Low hairline, increased quantity, and brittleness may indicate _________

Back 25

congenital anomalies

Front 26

Slope of each hair follicle is associated with ________

Back 26

stretch of skin during brain growth

Front 27

When is the most rapid brain growth?

Back 27

16-19 weeks GA --> produces hair whorl, posterior parietal region

Front 28

What might cause a flattened face?

Back 28

Can be d/t prolonged intrauterine compression from oligohydramnios

Front 29

What main facial features do you see with fetal alcohol syndrome (5)

Back 29

- Short palpebral fissures

- Low nasal bridge

- Smooth philtrum

- Thin upper lip

- Small jaw

Front 30

When do you fix a deviated septum?

Back 30

1st couple days by ENT

Front 31

What diagnosis are you expecting when you see a baby cyanotic at rest, pink with crying?

Back 31

choanal atresia

Front 32

Swelling of lips in absence of birth injury is normal / abnormal?

Back 32

ABnormal

Front 33

Microstomia a/c what syndrome ___

Macrostomia a/c what syndrome ____

Back 33

Micro - a/c trisomy 18

Macro - a/c storage diseases (mucopolysaccharidoses; oculo-auriculo-vertebral spectrum)

Front 34

Do you keep or remove natal teeth?

Back 34

Depends! They are usually immature caps of enamel and dentine

Removal is recommended but be sure they're not actually the primary teeth!

Front 35

What are Bohn's nodules and epstein's pearls filled with? Where are they located?

Back 35

Filled with keratin - same as milia!

-Bohn's nodules - epithealial cyst on buccal surface of gums/jaw

-Epstein's pearls - on palate

Front 36

Beckwith Wiedemann - what major findings do you see

Back 36

-Big tongue (macroglossia) - true

-"overgrowth" syndrome

Front 37

What size tongues do down syndrome babies and pierre robin babies have?

Back 37

NORMAL size tongues, the MOUTH is small making tongue appear large

Front 38

What is a "tongue tie"

Back 38

Frenulum attached to underside of tongue to the floor of the mouth. Thick or prominent frenulum - limits movement of tip of tongue

"ankyglossia"

Front 39

What are you thinking when you see white patches on the tongue or mucous membranes?

Back 39

- residual milk

-candidiasis (oral thrush)

--> trick is can you wipe it off?

Front 40

How can you assess for esophageal atresia?

Back 40

pass an OG tube

If present - keep baby prone and keep sac suctioned

Front 41

What do you see on x-ray with esophageal atresia vs esophageal atresia with TEF

Back 41

EA - NO air in belly

EA with TEF - air in belly because air can pass into stomach

Front 42

What type of oral drainage do you see with esophageal atresia + TEF?

Back 42

frothy saliva - bc air mixes with spit

Front 43

micrognathia

Back 43

small chin

Front 44

What is subcutaneous emphysema

Back 44

can be seen with PIE --> mediastinum --> may lead to subq emph in neck

Front 45

What is the first bone to ossify?

Back 45

Clavicles!