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Peds > Chpt. 3 Immune and lymphatics, head and neck > Flashcards

Chpt. 3 Immune and lymphatics, head and neck Flashcards

1
Q

Lymph nodes in the neonate react quickly or slowly to mild stimulus?

A

quick

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2
Q

What is the theory for the mild sensitivity of lymph nodes in neonates?

A

To compensate for lack of antibodies by increased filtration and phagocytosis

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3
Q

Which lymph nodes react especially quick to mild stimulus?

A
  1. cervical

2. postauricular chains

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4
Q

Which tonsils are much larger during early childhood than after puberty?

A

palatine tonsils

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5
Q

Do enlarged palatine tonsils in children necessarily mean there is a problem?

A

No but they may obstruct the nasopharynx (sleep apnea)

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6
Q

What would you suspect a child has if they snore loudly, have restless sleep, daytime sleepiness, and morning headaches?

A

obstructive sleep apnea

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7
Q

Developmental delay and frequent infection are signs of what?

A

obstructive sleep apnea

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8
Q

What should normal lymph nodes look and feel like?

A

Firm, discrete, moveable, <5mm, upu to 1cm in cervical or inguinal regions

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9
Q

What findings when evaluating lymph nodes would cause for further investigation?

A
  1. growing rapidly or suspiciously large (>2-3cm)

2. fixed and immovable

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10
Q

What lymph nodes are expected regions of enlargement for children under the age of 1 and 2?

A

Postauricular and occipital

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11
Q

What lymph nodes are expected regions of enlargement for children over the age of 2?

A

Cervical and submandibular

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12
Q

It is NEVER normal for what lymph nodes to be enlarged?

A

Supraclavicular

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13
Q

What virus is infectious mononucleiosis?

A

Epstein-Barr Virus

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14
Q

Infectious mononucleosis ma occur at any age but what age is MC?

A

teens

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15
Q

What are the initial symptoms of Infectious mononucleosis?

A
  1. Pharyngitis
  2. fever
  3. fatigue
  4. malise
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16
Q

What are the exam findings fro infectious mononucleosis?

A
  1. Enlarged anterior and posterior cervical chains
  2. Splenomegaly
  3. hepatomegaly
  4. Rash
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17
Q

What are symptoms of strep pharyngitis?

A
  1. sore throat
  2. runny nose
  3. headaches
  4. fatigue
  5. abdominal pain
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18
Q

What are the exam findings of Strep pharyngitis?

A
  1. palatal petchiae

2. Enlarged anterior cervical nodes

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19
Q

What is needed to confirm strep pharyngitis?

A

Throat culture

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20
Q

What is the Mclsaac modification score?

A

A sign and symptoms score to give a likelyhood of pt. having strep. (-1 through 4/5)

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21
Q 
What is the percent likelyhood of a pt. having strep if they have a mclsaac modification strep score of:
-1/0 = ?
1 = ?
2 + ?
3 = ?
4 = ?
A 
-1 = 1%
1 = 10%
2 = 17%
3 = 35%
4 = 51%
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22
Q

What is cranial molding?

A

During vaginal birth cranial bones shift and overlap but will resume a normal shape and size

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23
Q

How long should you expect the skull to resume normal shape after a vaginal birth?

A

1 week

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24
Q

What is the condition Caput succedaneum?

A

subcutaneous edema

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25
Q

Does Caput succedaneum (subcutanous edema) cross suture lines?

A

Yes

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26
Q

What is the MC are to have Subcutaneous edema (caput succedaneum)?

A

occiput

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27
Q

Are the margins of caput succedaneum (subcutaneous edema) firm and well defined or soft and poorly defined?

A

soft and poorly defined

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28
Q

What is cephalhematoma?

A

Subperiosteal bleed

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29
Q

Does a cephalhematoma (subperiosteal bleed) cross sutures?

A

No

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30
Q

What is the MC location of a cephalhematoma (subperiosteal bleed)?

A

Parietal bone

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31
Q

Are the margins of Cephalhematoma (subperiostial bleed) firm and well defined or soft and poorly defined?

A

firm and well-defined ages

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32
Q

What is craniosynostosis?

A

Irregular or premature closing of cranial suture lines

33
Q

Unusual contour of the cranium in preterm infants can be due to what?

A

Soft cranial bones flattening with positioning and weight of head

34
Q

Is craniosynostosis accompanied by mental retardation?

A

No

35
Q

What are visual cues of craniosynostosis?

A
  1. small head circumference (microcephaly)
  2. Rigid sutures
  3. Misshapen skull
36
Q

What is plagiocephaly?

A

Flattening of the head

37
Q

Does positional head deformity (plagiocephaly) have ridging?

A

NO

38
Q

The ear on the flat side of the head migrates in what direction with positional head deformity (plagiocephaly)?

A

Ear on flat side migrates forward

39
Q

What side does the forehead prodrude with positional head deformity (plagiocephaly)?

A

Same side as occipital flattening

40
Q

Where is the bald spot with Positional head deformities?

A

on the side of flattening

41
Q

Does Craniosynostosis have a palpable ridge?

A

YES

42
Q

What is seen with the ears of a pt. with craniosynstosis?

A

Ears appear even or ear on flat side appear to be more posterioir

43
Q

Does the forehead protrude with craniosynostosis?

A

NO

44
Q

Is there a bald spot with craniosynostosis?

A

NO

45
Q

With positional plagiocephaly what shape does the top of the head represent?

A

parallelogram

46
Q

With Synostosis plagiocephaly what shape does the top of the head resemble?

A

trapezoid

47
Q

What is the rarest type of craniosynostosis?

A

Lambdoid synostosis (2-4% of cases)

48
Q

What characteristics are seen with a pt. that has lambdoid synostosis?

A
  1. flat back of head on affected side
  2. compensatory growth of mastoid process on same side
  3. Tilt of cranial base
  4. Ear on affected side is deviated back and toward fused suture
49
Q

what differentiates positional/deformational plagiocephaly from lambdoid synostosis?

A

Lambdoid synostosis has a cranial base tilt

50
Q

When palpating the head you will feel slight grooves along the sutures up to what age?

A

6 months

51
Q

When do the post. and ant. fontanels close?

A

Post. fontanel = ~2 months

Ant. fontanel = 24 months

52
Q

What can be the cause of fontanel bulging?

A
  1. infx

2. increased intracrainial pressure

53
Q

What could be the cause of a depressed fontanel?

A

Dehydration

54
Q

What measurement should the anterior fontanel not exceed?

A

4-5 cm

55
Q

How do you measure the anterior fontanel?

A

Anteroposterior + transverse diameters divided by 2

56
Q

How do you perform transillumination of the skull?

A

Transluminaor firm against scalp, begin at midline frontal region and inch over entire head, NOT any asymmetry in the ring of illumination

57
Q

What is the normal size of the translumination ring on all regions of the head?

A

Occiput = <1 cm

Everywhere else = <2 cm

58
Q

If illumination is greater than <1 in the occiput and <2 anywhere else what is suggested?

A
  1. excess fluid

2. decreased brain tissue in skull

59
Q

When should transllumination be done?

A

on every infant and on an older child with a suspected intracranial lesion or rapidly increasing head circumference

60
Q

How do you inspect a newborns neck?

A

Place infant supine and elevate the upper back and let the head fall back into extension

61
Q

What is the result of an intrauterine deprivation of thyroid hormone and may cause respiratory distress?

A

Goiter

62
Q

What is another name for torticollis?

A

wry neck

63
Q

What are possible causes of torticollis as a result of a birth injury?

A

Hematoma palpable shortly after birth or a fibrous mass 2-3 weeks later

64
Q

What are some causes of torticollis in older children

A
  1. trauma
  2. muscle spasme
  3. viral infx
  4. drug ingestion
  5. Subluxation
65
Q

what do you first think of when managing torticollis?

A
  1. cause? spinal cord tumor, congenital anomoly, birth trauma, or sublux
66
Q

What are four ways to care for torticollis?

A
  1. chiropractic care
  2. mechanical adjustments
  3. increased “tummy time”
  4. Exercises/stretches
67
Q

What is Microcephaly related to?

A

Related to craniostenosis and cerebral dysgenesis

68
Q

What is microcephaly associated with (symptoms)?

A

associated with mental retardation and failure of brain to develop normally

69
Q

What is Hydrocephalus?

A

enlarged head, bossing of the skull, widening of sutures and fontanels

70
Q

What are some signs of hydrocephalus other than an enlarged head?

A
  1. lethargy, irritability, weakness
  2. craniotabes
  3. ** sclera visible above the iris “Setting Sun Sign”
71
Q

How do you detect the “setting sun sign” seen in hydrocephalus?

A

Rapidly lower the infant from uupright to supine position and look for the scelera above the iris (ddx = brainstem lesion)

72
Q

What is craniotabes?

A

softening of the skull

73
Q

When pressing the bone along the suture line if it pops in and out what does the pt. have?

A

craniotabes

74
Q

What is craniotabes associated with?

A
  1. rickets and hydrocephalus

2. can be a normal finding in 1/3 infant newborns

75
Q

Who is MC to have craniotabes?

A

premature infants

76
Q

What are the asymmetric facial features of bells palsy (facial palsy)

A
  1. Eyelid wont close completely
  2. Drooping corner of mouth
  3. Loss of labonasial fold
77
Q

What are some signs of down syndrome?

A
  1. depressed nasal bridge
  2. epicanthal folds
  3. mongolian slant of eyes
  4. low set ears
  5. large tongue
78
Q

What are some signs that a pt. has fetal alcohol syndrome?

A
  1. smoothe philtrum
  2. widespread eyes
    - inner epicanthal folds
    - mild ptosis
  3. Hirsute forhead
  4. short nose
  5. thin upper lip

Peds (4 decks)

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