Exam 2 Flashcards
1
Q
torticollis
A
inability to completely turn the head in both directions
2
Q
Causes of Microcephaly
A
- Genetic defect
- Karyotype
- Intrauterine infections
- Antenatal radiation
- Exposure to drugs/chemicals
- Perinatal insult
3
Q
Causes of Scaphocephaly (aka Dolichocephaly)
A
- positional problems int he premature infant (“Premie head”)
- Saggital craniosynostosis
4
Q
Causes of Plagiocephaly
A
- Common with back head sleep position
- Torticollis
5
Q
Scaphocephaly
A
- Growth is parallel to sagittal suture (anteroposterior elongation, bitemporal narrowing)
- Frontal bossing and prominent occiput
6
Q
Bracycephaly
A
- Bilateral coronal or lambdoidal (11%)
- Broad skull with a short base and a recessed lower forehead
- Caused by premature closure of the coronal suture on both sides of the head (associated with Apert, Crouzon, Pfeiffer syndrome)
- “high-hat” appearance (compared to the long narrow appearance of sagittal craniosynostosis
7
Q
Crouzon’s syndrome
A
- Craniosynostosis most often of the coronal and lambdoid, and occasionally sagittal sutures (brachycephalic)
- Underdeveloped midface with receded cheekbones (midface hypoplasia) or exophthalmos (bulging eyes)
- Esotropia and/or wide-set eyes
- Hypertelorism
- Need to open up these sutures early to allow their brain to grow
8
Q
Apert Syndrome
A
- Very high brachycephalic head
- Severe syndactyly affecting all limbs (“mitten-hand appearance”); syndactyly involves bony fusion
- Hypertelorism, ptosis, downward-slanting palpebral fissures
- Cognitive defects
- Apert is the 2nd most common craniofacial syndrome after Crouzon.
9
Q
Metopic Craniosynostosis
A
- “Trigonocephaly”
- Keel-shaped forehead with hypotelorism
- Upward slanting of the eyelids laterally
- Triangular shape to the forehead and supraorbital ridge
- They get ocular problems (astigmatism & strabismus). It’s not urgent though; it won’t affect their brain growth.
- You’d feel overriding sutures at the forehead tip
10
Q
Oxycephaly
A
- Closure of all sutures except squamosal
- This is an EMERGENCY; she needs urgent surgery done to open up her suture line and allow her brain to grow
11
Q
Positional plagiocephaly
A
- “Parallelogram” shape
- Face will be pushed forward on the affected side
- Frontal bossing due to pressure on the occiput
- The ear on the affected side will be forward i comparison to the unaffected side
- Commonly associated with torticollis, or positional problems (not changing the baby’s position often enough)
12
Q
Lambdoidal craniosynostosis
A
- “Trapezoid” shape
- Affected side no open suture; if there is lambdoidal synostosis, the head cannot expand in the frontal region on the affected side of the head so the growth will be affected on the unaffected side
- Since there is growth restriction on the affected side, there is overgrowth everywhere else
- The face is asymmetrical; one side of the face is coming out more than the other
- Posterior displacement of the ipsilateral ear
13
Q
Waardenburg syndrome
A
- White forelock
- Beaked nose
- Triangular face, pointed chin
- *They develop hearing loss later in life; it’s a genetic disease with variable penetrance, so the amount of hearing loss varies from person-to-person
14
Q
Alopecia areata
A
- Autoimmune disease
- Black dot sign
- Circular pattern of hair loss
15
Q
Midface hypoplasia
A
- associated with sleep apnea and stridor
- dental problems
- may have hearing problems
16
Q
Micrognathia
A
- The mandible has not grown as much as it should resulting in a small mandible and chin.
- Advancement of the mandible and chin surgically
- The correction is done via the intraoral route without any incisions on the face
- preceded by orthodontic treatment to align the teeth prior to proper surgical treatment
17
Q
Prognathic mandible
A
- Lower jaw is too prominent
- Occurs with congenital overgrowth of the lower jaw
- Certain pathologic causes such as gigantism due to pituitary overgrowth and other tumors or congenital deformities
18
Q
Sturge Weber Syndrome
A
- Look for non-elevated purple venous malformation (port wine stain) in the distribution of trigeminal nerve (i.e. forehead and upper eyelid)
- Involves opthalmic division
- High incidence of mental retardation
- Ocular complications (glaucoma) on the affected side
- High incidence of seizures related to deformation of the brain
- Today they can laser away the redness; you’d never know there was anything wrong.
19
Q
Myopia
A
“Nearsightedness”
- Occurs when the anterior-posterior diameter of the eye is too long relative to the refracting power of the cornea and lens
- Lengthening of the eye in such a way is common at the start of puberty; hence why a lot of people start wearing glasses in middle school
20
Q
Hyperopia
A
“Farsightedness”
- Hyperopic eye is too short relative to the refracting power of the eye
- The focal point of the image occurs posterior to the retina and the image that forms on the retina is blurred
- Glasses may not be requried
21
Q
Astigmatism
A
- Type of refractive error that causes blurred vision for objects at both distance and near
- Occurs because the optical system of the eye, particularly the cornea, is not perfectly spherical
22
Q
Strabismus
A
Occurs when the eyes do not move in synchronous pattern
23
Q
Esotropia
A
(type of strabismus)
- (Convergent squint) inward deviation
24
Q
Exotropia
A
(type of strabismus)
- (Divergent squint) outward deviation
25
Latent Strabismus
"PHORIA"
- Becomes apparent only on dissociation of the vision of the eyes (e.g. on covering one eye) and is termed a phoria (exophoria, esophoria, hyperphoria)
- Can be more prominent with fatigue, illness, or with lack of attention
26
Hypertropia
(type of strabismus)
- condition of misalignment of the eyes (strabismus) whereby the visual axis of one eye is higher than the fellow fixating eye
27
Hypotropia
(type of strabismus)
| - condition where the visual axis of one eye is lower than the fellow fixating eye
28
Esophoria
Characterized by tendency toward inward deviation of the eye usually due to extraocular muscle imbalance with good fusion
29
Exophoria
Form of heterophoria in which there is a tendency of the eye to deviate outward
30
Comitant strabismus
- Same deviation in all fields of gaze
- Causes include: Hereditary, Sensory deprivation, Accommodative (kids with frequent excessesive convergence aka esotropia), sometimes unknown cause
31
Incomitant strabismus
- Limited eye movement and size of deviation is different in different fields of gaze
- Occurs most commonly where there is paralysis of one or more extraocular muscles
- Causes include: Neurological, Muscular, Neuromuscular (myasthenia gravis), Congenital conditions
32
Tests for Strabismus
- Hirschberg test (Corneal light reflex)
- Red reflex (Bruckner test)
- Cover test
- Evaluate extraocular movement
- Binocular status; Stereopsis Tests
33
Amblyopia
- Poor vision caused by abnormal visual development secondary to abnormal visual stimulation
- Classified by the presence of associated clinical findings:
(1) Strabismic amblyopia
(2) Anisometropic or refractive amblyopia
(3) Deprivational amblyopia
34
Strabismic amblyopia
- Results from abnormal binocular interaction
- Causes the fovea of the two eyes to be presented with different images
* This is preventable!
35
Anisometropic amblyopia
- Similar to strabismic amblyopia, the fovea in the anisometropic amblyopia also are presented with different images
- Caused by unequal refractive error
- When you have a 2 line difference below age 8, you will eventually turn off the eye that is the poorer eye
- Picked up with red light reflex assessment
36
Deprivation amblyopia
- Least common and most serious type of amblyopia
- Severe visual deprivation due to occlusion of the visual axis or severe distortion of the foveal image
- *Because when your rods/cones aren't developed, you really can't see at all
37
Tests for Amblyopia
- Vision screen
- Use instrumentation in younger infants
- Optotypes in children starting at age 3 years
38
Hippus
- Normal pupil is in continuous motion dilating in and out by contracting a small amount
- More prominent in pediatric patients exposed to bright light
- You want to document whether the kid has hippus before/after surgery (especially neurosurgery)
39
Anisocoria
- Simple: 0.4mm difference in size of rifght and left pupil (not due to drugs, ocular injury, or ocular inflammation)
- Normal anisocoria is the same and light and dark; may indicate pathology if it's not the same in a lighted room as it is in a dark room
40
Relative Afferent Pupillary Defect
"Marcus Gunn Pupil"
- Most common pupil problems
- An RAPD generally occurs with significant optic nerve or retinal disease, when there is a difference in the disease process between the two eyes
- In Marcus Gunn pupil, the pupil where the light is shined will constrict strongly when light is shining into the eye but as light moves to illuminate the abnormal eye, both pupils dilate (react as though it was dimmer)
- The eye that dilates when the light is shown on it, is the abnormal or Marcus Gunn Pupil
41
Iris coloboma
- Isolated iris coloboma does not interfere with vision
42
Aniridia
- Absence or iris
| - 1/3rd have associated Wilms tumor
43
Ciliary injection
- Injection (reddening) at the limbus
- Lessens as it moves to the palpebral conjunctiva
- Seen in: uveitis (can lead to blindness), Keratitis, Acute angle glaucoma
44
Chemosis
- Swelling of the conjunctiva
| - Found in acute allergic conjunctivitis and in sick children with pharyngoconjunctival fever (adenoviral infection)
45
Uveitis
- inflammation of the middle layer of the eye
| - Ciliary injection, poorly responsive pupil, photophobia are all signs
46
Diagnosis of a corneal abrasion
- Area of corneal epithelial defect stains with fluorescein dye and "lights up" with a blue light
47
Hyphema
- Blood in the anterior chamber (space in between iris and cornea)
- Causes include: trauma (blunt or penetrating), other eye injuries (corneal abrasion, open globe)
48
Blepharitis
- Defined as eyelid inflammation/infection
- Typical cause of blepharitis (combo of) --> Staphylococcal infection at lash bases AND skin oil glands of the eyelid (meibomian glands) being inflamed
49
Chalazion
- Obstructed meibomian gland
- Causes an acute mass in lid (like a pimple)
- Initially tender, then not
- Often associated with blepharitis
50
Phtiriasis palpebra
- One cause of blepharitis
- LICE
- Usually cause is pubic lice, rarely head or body lice
- Way to differentiatie: crust in lashes is RED-BROWN, not white or clear like typical blepharitis (because they fee d on your blood, so their poop is this color)
51
Hypopyon
Pus in the anterior segment
52
Iridocyclitis
Inflammation of the iris
53
Iridodonesis
Quivering of the iris when the patient moves the eye
54
Synechia
Adhesion between the iris and the cornea
55
Waterhammer or Corrigan's pulse
- Pulse that is bounding and forceful, rapidly increasing and subsequently collapsing, as if it were the sound of a waterhammer that was causing the pulse
- PDA
56
Quincke pulse
- With a light held on the pad of the finger, gentle pressure is applied to the distal nail.
- If the pulse pressure is wide, alternating filling and blanching of the capillary bed can be seen
57
Age-specific cardiac auscultation techniques
- Infants: listen during feeding
- 4 mo. - 1 yr: Listen while the baby is being brought to sitting, valsalva while straining to sit up
- Toddler: Play with them once they have confidence in you. Give them time to warm up
58
7 S's of innocent murmurs
1. Systolic
2. Short duration (not holosystolic)
3. Single (no clicks or gallops)
4. Small (do not radiate)
5. Sensitive (tend to change with position or resp. effort; louder supine)
6. Soft
7. Sweet (no harsh sounds)
59
How to distinguish a Split S2 sound (physiological splitting) from a S3 sound?
- Split S2 is of equal intensity and quality
| - Heard at base (splitting at the base is absent in certain congenital diseases like tetralogy)
60
Holosystolic murmur
- Even, sustained sound between S1 and S2
| - Classic for VSD
61
5 Innocent murmurs of childhood
1. Still's murmur
2. Pulmonary ejection flow murmur
3. Peripheral pulmonic branch stenosis murmur
4. Supraclavicular bruit
5. Venous hum
62
Still's murmur
- Most common innocent murmur (age 3-7)
- Caused by uniform periodic vibration of the some left heart structure
- First heard during sick visit in preschooler and usually disappears by puberty
- Short, systolic
- Vibratory, buzzing hocking (twang of a guitar)
- LOWER LEFT STERNAL BORDER
- Louder when supine
- Decreases significantly or disappears with Valsalva
63
Pulmonary ejection (flow) murmur
- Probably from mildly turbulent flow in right side of heart
- Short, systolic ejection
- Upper left sternal (transmit to back)
- All ages (rare in infants); Much more common in late childhood and early adolescents
- Louder with expiration
- Normal S2 split
- Thin body habitus
- Increased with fever, anemia
- Best heard in supine position with exhalation
- Intensifies with exercise
64
Peripheral pulmonic Branch stenosis
- Turbulence arising in the acute angle at which the relatively small branch pulmonary arteries take off from the main pulmonary artery
- Systolic, ejection which disappears by 6 MONTHS
- If it does not disappear by 6 months, severe branch pulmonary artery stenosis is associated with William's syndrome and congenital rubella
- Heard in the chest and axillae (often loudest in axillary)
- Newborn infants and early well child check
65
Supraclavicular carotid bruit
- Caused by turbulence at the take off area of the brachiocephalic and carotid arteries from the aortic arch
- Systolic and ejection, high pitched, harsh
- Best heard in supraclavicular fossa on the RIGHT more than left
- Does not radiate far
- Supraclavicular region and neck (not heard below clavicle; not affected by sitting/lying; decreased by hyperextension of shoulder)
66
Venous hum
- Cause: The flow of blood can cause the vein walls to vibrate creating a humming noise which can be heard by the subject
- Continous (louder in diastole)
- Supraclavicular
- RIGHT more than left
- Disappears with change in head position, digital pressure, lying supine
- Loudest when sitting or standing
67
ASD hallmark sign
Widely split S2
68
Conductive hearing loss
Refers to impairment of the outer and/or middle ear conductive mechanism only
69
Sensory hearing loss
Refers to damage to the cochlea (outer hair cells or outer and inner hair cells)
70
Mixed hearing loss
Refers to the presence of both conductive and sensory impairment
71
Neural hearing loss
- Refers to damage to the auditory neurons (spiral ganglia) and/or the auditory branch of the 8th Cranial nerve
- Auditory neuropathy and dis-synchrony are examples of neural hearing loss
72
Central hearing loss (aka 'Auditory Processing')
Refers to damage to auditory structures in the brainstem, thalamo-cortex and/or cortex.
73
External otitis - Physical Exam findings
- Pain on movement of the auricle (pain with jiggling of the tragus)
- Canal may be red, friable, and full of pus
- Inspect the entire TM looking at landmarks, color, contour, and perforations
- Infections of the external ear canal related to changes in the pH of the canal; any organism (fungal, viral, bacteria, yeast). Pseudomonas is common.
74
Treatment of Otitis Externa
- Debridement of ear canal
- Topical antibiotics (concentration are 100-1000x greater than with systemic therapy)
- Expandable methylcellulose Oto-Wick or sponge (ear wick); change wick every 2 days
- Fungal infection: Acetic drops or antifungal drops
75
5 components of charting the Tympanic Membrane
1. Color
2. Texture
3. Landmarks
4. Light reflex
5. Mobility
76
Mastoiditis
- Infection of the mastoid air cells
- Accumulation of the purulent exudate in the middle ear does not drain through ET or perforated TM but spread to mastoid bone
- Air cells are destroyed and progresses to coalescent phase
- ENT referral
77
Cholesteatoma
- Lesion of the eardrum
| - Can appear as a white cystic mass behind or involving the eardrum
78
Management of Epistaxis
- Digital pressure for 10-15 mins
- Silver nitrate cautery
- Topical vasoconstrictors (Neo-synephrine, nasal sponge [must be removed in 48 hours], Antibiotic Rx, Nosebleed QR)
- Treatment is use of Bactroban tid for one week
- If posterior bleed must have ENT consult
79
Nasal Polyps
- These patients will complain of feeling like they can't breathe through their nose
- Seen in kids with allergies
- ALSO SEEN IN KIDS WITH CYSTIC FIBROSIS! Do a sweat test to rule out CF.
80
Angular cheilitis vs. Cheilosis
- Angluar cheilitis: fissures that occur after exposure to wind, sun
- Cheilosis: Occurs with nutritional deficiency
81
Stomatitis
Coxsackie virus is #1 cause of oral ulcers in kids.
82
Streptococcal Tonsillitis: Clinical presentation
- Nausea and fever may bet he only presenting symptom of strep throat
- Always examine the throat of a child with abdominal pain especially on the right side since you can get lymphoid tenderness in the right lower quadrant pain
- Epigastric tenderness and headache is another sign of strep
83
Pastia's lines
Clinical sign in which pink or red lines formed of confluent petechiae are found in skin creases. It occurs in patients with SCARLET FEVER prior to the appearance of the rash and persists as pigmented lines after desquamation.
84
Peritonsillar abscess: Clinical Evaluation of the oral cavity
- Most common deep infection of neck
- Typical complication of tonsillitis
- Extension of infection from tonsil
- Abscess form between tonsil capsule and superior constructor muscle
- Obstruction and infection of weber gland
85
Cystic Hyrgroma
[Congenital neck mass]
- Discrete, soft, mobile, nontender masses in posterior triangle of neck
- Multiloculated cystic lymphatic malformation; collection of lymphatic sacs that contain clear, colorless lymph
- Usually found by 2nd year; sometimes in newborn period because large lesions are noted on prenatal ultrasonography
- Tends to be on the LEFT SIDE
86
Second Branchial Cleft Cyst
[Congenital neck mass]
- Smooth, nontender, fluctuant masses which occur along the lower third of the anteromedial border of the sternocleidomastoid muscle between the muscle and the overlying skin
- Most common congenital neck mass (2-3% of pop)
- Present in late childhood and early adulthood when acutely infected
- Small cartilaginous horn in lower anterior border of SCM (feels like a small pencil point underneath a layer of clothing)
87
Thyroglossal Duct Cyst
[Congenital neck mass]
- Usually found below the level of hyoid bone in midline or off center. Feels soft, filled with fluid (compared to an enlarged thyroid)
- Seen best when neck is hyperextended
- Cyst may rise with tongue protrusion and swallowing since it's connected to base of tongue
- Can occur anywhere from base of tongue to diaphragm; these patients become HYPOthyroid when they have it removed because it's thyroid tissue they're taking out
- High incidence of carcinoma in adulthood and recurring infections, so it needs to be removed ASAP.
88
Wilson disease
(Hepatolenticular degeneration)
- Presentation: Severe liver cirrhosis, Kayser-Fleishcer rings (deposition of copper in the cornea)
- Accompanied by neurological disorder
- Age of onset is between 8 years - mid 50's
89
Goldenhar syndrome
- Look for facial asymmetry and microtia
- Unilateral or bilateral Hemifacial Microsomia (HFM)
- Microtia: Literally meaning "small ear"
- Aural atresia: Absence of the auditory canal
- Other problems: cleft lip/palate, hearing loss, epibulbar dermoids, vertebral anomalies and organ abnormalities including kidney and heart anomalies
