Week 8 ped differences HEENT

Question 1

infant head

Answer 1

fontanels are open

suture lines palpable until about 6 months

Question 2

infant neck

Answer 2

trachea is more cylindrical

lies deeper and is more flexible

Question 3

child head

Answer 3

fontanels closed by 18-24 months

subtle changes in facial and skull bones

Question 4

child neck

Answer 4

nose and thyroid cartilage enlarge in adolescent

trachea grows

Question 5

infant lymphatic system

Answer 5

same distribution of nodes as in adult
small, mobile nodes may be palpable
unable to produce antibodies

Question 6

child lymphatic system

Answer 6

tonsils may be enlarged

Question 7

infant thyroid

Answer 7

difficult to palpate due to neck size

Question 8

eye formation

Answer 8

during the first 8 weeks of gestation

• lacrimal drainage complete at birth
• • by 2-3 weeks old gland begins producing full volume tears

Question 9

vision development

Answer 9

term infants: hyperopic 20/400
peripheral vision fully developed at birth
- central vision develops later
3-4 months: binocular vision developed
6 months: infant can differentiate colors
4 years: adult visual acuity achieved

Question 10

inner ear

Answer 10

development in 1st trimester

Question 11

external auditory canal

Answer 11

shorter than in adults

Question 12

eustachian tube

Answer 12

wider, shorter, and more horizontal than in adults

Question 13

salvation

Answer 13

increased by 3 month

- more drooling

Question 14

sinuses

Answer 14

maxillary and ethmoid present at birth, but small

frontal and sphenoid sinuses begin to develop around 3 years of age, complete development in late adolescence.

Question 15

teeth

Answer 15

6-24 months: 20 deciduous teeth erupt
permanent teeth begin form in the jaw by 6 months old
- eruption begins around 6 years, completes around 14-15

Question 16

plagiocephaly

Answer 16

head shape uneven on back of head

- cones out to one side

Question 17

brachycephaly

Answer 17

flat back of head

- cones out laterally on both side

Question 18

dolichocephaly

Answer 18

head shape cones out posteriorly

- long sides

Question 19

Trisomy 21 signs

Answer 19

depressed nasal bridge
epicanthal folds
mongoloid slant of eyes
low-set ears
large tongue

Question 20

fetal alcohol syndrome signs

Answer 20

poorly formed philtrum
widespread eyes
inner epicanthal folds
mild ptosis
hirsute forehead
short nose 
thin upper lip

Question 21

Pierre-Robin sequence

Answer 21

triad of

• micrognathia
• glossoptosis
• palatal clefting

Question 22

positional molding

Answer 22

flattening

• contralateral occipital bossing (outward)
• ipsilateral ear displaced anteriorly

Question 23

unilateral lambdoid synostosis

Answer 23

flattening of back of head

• parietal bossing (protrusion)
• ipsilateral occipitomastoid bossing
• ipsilateral ear displaced posteriorly (variable)

Question 24

cholesteatoma

Answer 24

trapped epithelial tissue behind the tympanic membrane that is often the result of untreated or chronic recurrent otitis media

Question 25

thyroglossal duct cyst patho

Answer 25

palpable cystic mass in then neck - remnant of fetal development -- rises from the foramen cecum at junction of anterior 2/3 and posterior 1/3 of tongue. -

Question 26

thyroglossal duct cyst subjective

Answer 26

tenderness, redness, swelling in midline of neck | difficulty swallowing or breathing

Question 27

thyroglossal duct cyst objective

Answer 27

freely moveable cystic mass in neck midline moves upward with tongue protrusion and swallowing may have small opening in skin, with drainage of mucus

Question 28

branchial cleft cyst patho

Answer 28

congenital lesion formed by incomplete involution of brachial cleft - epithelium-lined cyst with or without a sinus tract to overlying skin

Question 29

branchial cleft cyst subjective

Answer 29

painless mass in lateral neck may have intermittent swelling and tenderness discharge if associated with a sinus tract

Question 30

branchial cleft cyst objective

Answer 30

oval, moderately movable smooth, non-tender fluctuant mass along anteromedial border of sternocleidomastoid muscle usually asymptomatic if infected: tenderness and erythema

Question 31

torticollis patho

Answer 31

shortening or excessive contraction of the sternocleidomastoid muscle - often result of birth trauma or inter-uterine malposition Acquired: tumor, trauma, CN IV palsy, muscle spasms, infection, drug ingestion

Question 32

torticollis subjective

Answer 32

stiff neck, dec. ROM in neck | possible vision problem

Question 33

torticollis objective

Answer 33

head tilted and twisted toward affected muscle with chin elevated and turned toward opposite side hematoma may be palpated shortly after birth, and within 2-3 weeks firm, fibrous mass may be felt in muscle

Question 34

encephalocele patho

Answer 34

neural tube defect with protrusion of brain and membranes that cover it through openings in the skull - failure of the neural tube to close completely during fetal development - can occur anywhere on scalp - genetic component: FHX of spina bifida or anencephaly

Question 35

encephalocele subjective

Answer 35

before birth are visible only by intrauterine US or seen immediately after birth

Question 36

encephalocele objective

Answer 36

visible sac of tissue protruding through skull craniofacial abnormalities or other brain malformations - hydrocephalus

Question 37

hydrocephalus patho

Answer 37

problem in the formation, flow, or absorption of CSF that leads to an increase in volume of the CSF - congenital malformation, infections - acquired: intracranial mass, intracranial hemorrhage, meningitis, trauma

Question 38

hydrocephalus subjective

Answer 38

poor feeding irritability dec. activity vomiting

Question 39

hydrocephalus objective

Answer 39

``` head enlargement separation of cranial sutures dilated scalp veins tense anterior fontanelle sunsetting sign inc. muscle tone: spasticity macewen sign ```

Question 40

microcephaly patho

Answer 40

circumference of head is smaller than normal because the brain has not developed properly or has stopped growing - present at birth, may develop in first few years of life Congenital: infections, neuroanatomic abnormalities

Question 41

microcephaly subjective

Answer 41

intellectual disability

Question 42

microcephaly objective

Answer 42

head circumference is 2-3 SD below mean for age

Question 43

Craniosynostosis patho

Answer 43

premature closure of one or more cranial sutures before brain growth completes - leads to misshapen skull

Question 44

craniosynostosis subjective

Answer 44

abnormally shaped skull, usually not accompanied by intellectual disability

Question 45

craniosynostosis objective

Answer 45

skull growth restricted perpendicular to fused suture | if multiple sutures fuse while brain is still growing, intracranial pressure can increase.

Question 46

retinoblastoma patho

Answer 46

embryonic malignant tumor arising from the retina - develops during first 2 years of life - autosomal dominant trait or chromosomal mutation (RB1 gene on chromosome 13)

Question 47

retinoblastoma subjective

Answer 47

FHX of retinoblastoma | white reflex on photographs

Question 48

retinoblastoma objective

Answer 48

leukocoria, a white reflex ill-defined mass arising from retina on funduscopic examination - chalky white areas of calcification

Question 49

retinopathy of prematurity patho

Answer 49

disruption of normal progression of retinal vascular development in preterm infant - abnml proliferation of blood vessels

Question 50

retinopathy of prematurity subective

Answer 50

``` low birth weight preterm other associated factors - anemia - poor wt gain - blood transfusion - resp. distress - breathing difficulties ```

Question 51

retinopathy of prematurity objective

Answer 51

straight, temporally diverted blood vessels on funduscopic examination - can be mild with no visual defects, or refractive error, amblyopia, or progress to retinal detachment and blindness

Question 52

retinal hemorrhages in infancy patho

Answer 52

abnml bleeding of the blood vessels in the retina - shaken baby syndrome - HTN - bleedin problems/leukemia - meningitis/sepsis/endocarditis - vasculitis - retinal disease - anema - hypoxia

Question 53

retinal hemorrhages in infancy subjective

Answer 53

altered responsiveness without good explanation | - suspicion of physical abuse

Question 54

retinal hemorrhages in infancy objective

Answer 54

dilated funduscopic examination shows retinal hemorrhages