Lecture Three (Pediatric Physical diagnosis-DR.M)-Exam 1

Question 1

What is the head circumference for a newborn man and female?

Answer 1

Occipital frontal circumference:
* Newborn Male 50%= 35.8cm
* Newborn Female 50%= 34.7cm

Question 2

Sutures:
1. What do they allow?
2. What do they act like?
3. What is the result?
4. What do some sutures do?
5. What does one suture so?

Answer 2

1. Allow the bones to move during the birth process.
2. They act like an expansion joint. This allows the bone to enlarge evenly as the brain grows and the skull expands.
3. The result is a symmetrically shaped head.
4. Some sutures extend to the forehead, while others extend to the sides and back of the skull.
5. One suture in the middle of the skull extends from the front of the head to the back.

Question 3

How many sutures do we have and how many fontanelles?

Answer 3

Question 4

What are fontanelles?

Answer 4

The space between the bones of an infant’s skull where the sutures intersect that are covered by tough membranes that protect the underlying soft tissues and brain

Cannot have closed head for growth

Question 5

• What is the anterior fontanelle (soft spot)?
• When does it close?

Answer 5

• This is the junction where the 2 frontal and 2 parietal bones meet.
• The anterior fontanelle remains soft until about 12 months to 2 years of age.

Question 6

• What is the posterior fontanelle?
• When does it closed?

Answer 6

• This is the junction of the 2 parietal bones and the occipital bone.
• The posterior fontanelle usually closes first between 2-3 months after birth.

Question 7

What is super important and the reason why we palpate the fontanelle?

Answer 7

Look for size:
* Decreased: dehydration
* Increased (bulging): Infection, meningitis and hypdroceph.

Question 8

What is this?

Answer 8

• MOLDING: Newborn head molding is an abnormal head shape that results from pressure on the baby’s head during childbirth.
• Yellow arrow: coronal suture-> feel the bump after birht d/t the fontelles overlaping

Not for C-section babies

Question 9

What is this?

Answer 9

Breech molding: Newborn head molding that is flat on the top and elongated in the anteroposterior diameter. Usually improve significantly within the first week.

Question 10

What is this?

Answer 10

Caput succedaneum: An edematous swelling caused by the pressure of the presenting part against the dilating cervix, overlies the periosteum with poorly defined margins and extends across the midline and over suture lines. Usually resolves over the first few days.

Cross over the midline (side to slide)
From pushing down in cerivical a.

Question 11

What is this?

Answer 11

CEPHALOHEMATOMA: Collection of blood secondary to rupture of blood vessels under the periosteum of a skull bone that does not cross suture lines.

• Firm and bulging
• One sided-> does not cross medline
• More prone to get jandice
• Have it for months d/t having it for a long time

Question 12

What is this?

Answer 12

Left: Caput succedaneum
Right: Cephalohematoma

Question 13

What is plagiocephaly?What is the txt?

Answer 13

Question 14

What are normal newborn eyes?

Answer 14

Normal greyish blue iris and the clear pupil. True color is not determined until the age of 6 months

Question 15

What is this?

Answer 15

SUBCONJUNCTIVAL HEMORRHAGE: Breakage of small vessels during the pressure of delivery. The red area may be large or small but is always confined to the limits of the sclera. It is asymptomatic, does not affect vision, and spontaneously resolves in several days

yellow first then heal

Question 16

What is the visual acuity level of a one month old and 6 month old

Answer 16

• 1-month-old 20/300
• 6-month-old 20/20

Question 17

What is the red reflex?

Answer 17

• Definition: a luminous red appearance seen upon the retina
• To be considered normal, the red reflex of the 2 eyes should be symmetrical

Question 18

What do these examples show and explain?

Answer 18

• Dark spots in the red reflex, a blunted red reflex on 1 side, lack of a red reflex, or the presence of a white reflex (leukocoria) are all indications for referral to an ophthalmologist
• White or none: can be catracts or retinoblastoma

Question 19

What is this? How common is it?

Answer 19

ESOTROPIA: Inward deviation (turn) of one or both eyes that occurs in 1.2% of children by 7 years of age and occurs equally in males and females.

Question 20

What is this? How common?

Answer 20

Exotropia: Outward deviation (turn) of one or both eyes that occurs more commonly between 1 - 4 yrs old, accounting for up to 25 % of all ocular misalignment in early childhood

Question 21

What is unique about exotropia and esotropia?

Answer 21

It is a muscular issue, not nerves
* Eye patching does not work-> need surgery

Question 22

What is a normal ear?

Answer 22

The normal ear is one is which all the structures (helix, antiehelix, tragus, antitragus, scaphoid/triangular fossa, and external auditory canal) are all present and well formed.

Question 23

• What is ear tag and ear pit?
• How common is this?
• What are they more likely to have?

Answer 23

• Ear tag: Cartilage bump in front of the ear often inherited as a familial trait
• Ear Pit (preauricular pit): Located at the superior attachment of the pinna to the face and may be unilateral or bilateral.
• Both occur with a frequency of 5 to 6 per 1000 live births
• 5X more likely to have hearing issues

Question 24

What needs to be checked if the ear or canal is misformed?

Answer 24

KIDNEYS

Question 25

How do you determine nasal patency?

Answer 25

Stethoscope under the nose and hear | IMP because if cannot breath, cannot eat properly

Question 26

What is ankyloglossia?

Answer 26

Tongue tied: Short, thick lingual frenulum, which is a membrane connecting the underside of the tongue to the floor of the mouth. This occurs in approximately 4% of newborns ## Footnote Hard for breast feeding Trouble with speaking later on so surgery can be useful

Question 27

What is an epstein peral?

Answer 27

Small white papules on the palate caused by epithelial tissue that becomes trapped during the palatal fusion. Occur in >60% of all newborns and spontaneously resolve in a few weeks to months.

Question 28

What is a natal teeth? How common?

Answer 28

* They are usually part of the primary dentition of the child, so they should not be removed unless they are mobile, presenting an aspiration risk. * Usually occur in the mandibular gum in 1:2000 - 1:3500 newborns.

Question 29

What is this?

Answer 29

Thrush: Caused by Candida albicans, it is the most common oral fungal infection in infants and children ## Footnote Breast feed babies give it to mom-> need to treat mom

Question 30

What is a cleft lip? What is it due to?

Answer 30

* Opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. Does not affect the palate. * Due to the failure of fusion of the maxillary prominence and medial nasal processes (formation of the primary palate).

Question 31

What is cleft palate? What happened?

Answer 31

* Opening in the palate (roof of mouth)that are often associated with feeding problems, speech problems, hearing problems, and frequent ear infections. * The two plates of the skull that form the hard palate (roof of the mouth) are not completely joined.

Question 32

What is the commonality of cleft lip and/or palate?

Answer 32

Question 33

What is a geographic tongue?

Answer 33

Smooth, red, irregularly shaped patches (lesions) on the top or side of tongue, sometimes causing discomfort, can continue for days, months or years. The problem often resolves on its own but may recur.

Question 34

What are the different tonsil sizes and which ones are most common?

Answer 34

Question 35

What are these?

Answer 35

* Left: normal tonsils (+2) * Right: tonsil hypertrophy (+3)

Question 36

What is this?

Answer 36

Question 37

What is this?

Answer 37

Tonsillectomy