High Yield OSCE Flashcards
Measuring OFC?
feel for occiput
bring tape measure to the front above the ears in midline of forehead (midline between eyebrows and hairline)
measure 3 times and take the largest
What is microcephaly?
head circumference that is two standard deviations below the mean
i.e., below the 2nd centile
Causes of microcephaly?
genetic:
familial
inborn errors of metabolism (PKU)
craniosynostosis
Trisomy 13
Trisomy 21
cri-du-chat syndrome
non-genetic:
intra-uterine infections (TORCH, CMV, Zika)
maternal smoking or drug use
radiation
brain injuries at birth (CP)
CNS insults (encephalitis, meningitis, HSV)
Investigations for microcephaly?
Hx:
antenatal history
in-utero insults
birth history
admission to NICU/SCBU
CNS infections?
heel-prick test?
FHx of microcephaly
familial head circumference
Exam:
cranial nerve
cerebellar
neurological
developmental
Imaging:
craniosynostosis
genetic testing
What is macrocephaly?
defined as head circumference greater than 2 standard deviations above the mean
i.e., above the 98th centile
Causes of macrocephaly?
familial (common in Ireland)
raised ICP (haematoma, tumour, neurofibromatosis, hydrocephalus)
CNS storage disorders (mucopolysaccharidosis, Hunter’s syndrome)
cerebral gigantism (Soto’s syndrome)
Investigating for macrocephaly?
Hx:
antenatal
developmentally appropriate
raised ICP symptoms
FHx of macrocephaly
FHx of NF, mucopolysaccharidosis
measure parent’s heads
Exam:
neuro
CN
cerebellar
developmental
signs of raised ICP
Imaging
Signs of raised ICP?
infants:
irritability, poor feeding, bulging fontanelle, vomiting, papilledema, sunsetting of eyes if due to hydrocephalus
child:
headaches, vomiting, drowsiness, sunsetting of eyes if due to hydrocephalus
Mx of hydrocephalus?
surgical management
refer to Temple Street
extra-ventricular drain insertion
ventriculo-peritoneal shunt
Causes of hydrocephalus?
overproduction of CSF or obstruction with drainage or absorption
aqueductal stenosis
Arnold-Chiari malformation
congenital malformations or agenesis
metabolic disorders
IVH
Causes of short stature?
familial
constitutional delay of growth and puberty
genetic disorders (T21, Turner’s, Noonan)
malnutrition
malabsorption (coeliac, IBD, CF)
chronic illnesses (CHD, JIA, CKD)
endocrine (hypothyroidism, GH deficiency, I-GF1 deficiency)
medications (steroids, methylphenidate)
skeletal abnormalities (achondroplasia, scoliosis)
Investigation short stature?
take mid-parental height
Hx:
pregnancy
birth Hx
feeding Hx
meds
FHx
exam:
secondary signs of puberty
nutritional status
dysmorphic features
investigations:
FBC, U&E
TFTs
coeliac bloods
karyotype and microarray
IgF-1
X-ray of hand
What is failure to thrive?
falling down weight centiles
one or more if BW < 9th
two or more if BW < 91st
three or more if BW >91st
Causes of failure to thrive?
inadequate nutritional intake
difficulty feeding (CP, cleft lip or palate)
malabsorption (coeliac, CF, CMPA)
incr. energy requirements (hyperthyroid, malignancy, chronic disease, chronic infections)
inborn errors of metabolism
T1DM
toddlers drinking excessive milk and not getting nutrients from elsewhere is common
Investigating failure to thrive?
antenatal, birth and developmental Hx
feeding Hx
observe feeding
observe parent-child interactions
Exam
coeliac screen
FBC
TFTs
U&Es, LFTs
