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45 Cards in this Set
- Front
- Back
When does the anterior fontanel close? |
18-24 months |
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Where is a "3rd fontanelle"? Is it concerning? |
Defect in parietal bone along sagittal suture; May be a normal variant, sometimes seen in preemies. Also Down syndrome or congenital hypothyroidism |
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Under what condition is the squamosal suture most present? |
Increased ICP, along with palpable sphenoid and mastoid fontanels *Also noted in preterm infants with rapid brain growth |
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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? |
-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 |
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Sutures may be split up to _____ cm |
1 cm, if wider may = increased ICP |
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What are immobile sutures called? |
Craniosynostosis |
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Brachycephaly |
-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 |
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Plagiocephaly |
"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) |
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Dolicocephaly |
"toaster head" -Seen in preemies -Flattening side to side WITHOUT synostosis |
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Scaphocephaly |
-Fusion of SAGITTAL suture -limits lateral growth = narrow head -More common in males -Must be opened up |
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3 causes of hydrocephalus |
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) |
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Each lateral ventricle has a ________ |
foramen |
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Acquired vs Congenital hydrocephalus |
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) |
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When is hydrocephalus diagnosed? |
1. In utero - enlarged ventricles 2. Dx at birth - aqueductal stenosis or myelomeningocele with Arnold Chiari malformation |
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Arnold Chiari malformation |
Downward displacement of cerebellar tonsils through the foramen magnum (herniates through and compresses brain stem) |
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Clinical findings of hydrocephalus (10) |
-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 |
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Hydrancephaly - what is it; causes; when can it occur; what do you see at birth? |
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 |
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Holoprosencephaly - what is it; what anomalies are a/c it; large or small head?; when does the defect occur in utero |
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 |
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Craniotabes |
-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 |
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Caput succedaneum |
-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 |
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Cephalohematoma |
-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 |
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Subgaleal hematoma |
-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 |
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Cutis aplasia |
-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 |
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Abnormally placed or > 2 hair whorls & unruly hair is an indicator of : |
abnormal brain growth |
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Low hairline, increased quantity, and brittleness may indicate _________ |
congenital anomalies |
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Slope of each hair follicle is associated with ________ |
stretch of skin during brain growth |
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When is the most rapid brain growth? |
16-19 weeks GA --> produces hair whorl, posterior parietal region |
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What might cause a flattened face? |
Can be d/t prolonged intrauterine compression from oligohydramnios |
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What main facial features do you see with fetal alcohol syndrome (5) |
- Short palpebral fissures - Low nasal bridge - Smooth philtrum - Thin upper lip - Small jaw |
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When do you fix a deviated septum? |
1st couple days by ENT |
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What diagnosis are you expecting when you see a baby cyanotic at rest, pink with crying? |
choanal atresia |
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Swelling of lips in absence of birth injury is normal / abnormal? |
ABnormal |
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Microstomia a/c what syndrome ___ Macrostomia a/c what syndrome ____ |
Micro - a/c trisomy 18 Macro - a/c storage diseases (mucopolysaccharidoses; oculo-auriculo-vertebral spectrum) |
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Do you keep or remove natal teeth? |
Depends! They are usually immature caps of enamel and dentine Removal is recommended but be sure they're not actually the primary teeth! |
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What are Bohn's nodules and epstein's pearls filled with? Where are they located? |
Filled with keratin - same as milia! -Bohn's nodules - epithealial cyst on buccal surface of gums/jaw -Epstein's pearls - on palate |
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Beckwith Wiedemann - what major findings do you see |
-Big tongue (macroglossia) - true -"overgrowth" syndrome |
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What size tongues do down syndrome babies and pierre robin babies have? |
NORMAL size tongues, the MOUTH is small making tongue appear large |
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What is a "tongue tie" |
Frenulum attached to underside of tongue to the floor of the mouth. Thick or prominent frenulum - limits movement of tip of tongue "ankyglossia" |
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What are you thinking when you see white patches on the tongue or mucous membranes? |
- residual milk -candidiasis (oral thrush) --> trick is can you wipe it off? |
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How can you assess for esophageal atresia? |
pass an OG tube If present - keep baby prone and keep sac suctioned |
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What do you see on x-ray with esophageal atresia vs esophageal atresia with TEF |
EA - NO air in belly EA with TEF - air in belly because air can pass into stomach |
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What type of oral drainage do you see with esophageal atresia + TEF? |
frothy saliva - bc air mixes with spit |
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micrognathia |
small chin |
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What is subcutaneous emphysema |
can be seen with PIE --> mediastinum --> may lead to subq emph in neck |
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What is the first bone to ossify? |
Clavicles! |