Head and Neck

Question 1

What should you think of when you see a white pupillary reflex?

Answer 1

Leukocoria; chorioretinitis, retinopathy of prematurity or retinoblastoma

Question 2

What eye findings are seen with Horner syndrome?

Answer 2

Congenital ptosis

Horner syndrome - lower brachial plexua injury that includes the 1st thoracic nerve. Presents as anhidrosis, ptosis, and miosis.

Question 3

What causes inclusion blennorrhea?

Answer 3

Chlamydia trachomatis, occurs at 5-14 days of life. Most common cause of conjunctivitis in 1st month of life.

Question 4

In addition to many different syndromes, what is associated with malformed or low-set ears?

Answer 4

Underlying urogenital malformations

Question 5

What can cause nasal stuffiness in the neonatal period?

Answer 5

Trauma, mucus still in nostrils, sign of opiate withdrawal

Hemorrhagic, thick, purulent nasal discharge (“snuffles”) is seen in congenital syphilis

Question 6

Differentiate epithelial pearls, Epstein pearls, and ranula.

Answer 6

Epithelial pearls - common and shiny, white masses (retention cysts) on the gums

Epstein pearls - accumulation of epithelial cells found midline, roof of mouth, and junction of hard and soft palates

Ranula - benign mass on the floor of the mouth, sublingual dilatation of a salivary gland.

Question 7

An infant presents with a protruding tongue, small mouth, and cleft palate. What is a likely diagnosis?

Answer 7

Pierre-Robin Sequence/syndrome

Micrognathia with posterior displacement of the tongue and respiratory compromise

Question 8

In which anatomic location do thyroglossal duct cysts occur?

Answer 8

Located in ventral midline and can extend to the base of the tongue and move vertically with swallowing and tongue protrusion.

Question 9

Describe Erb palsy.

Answer 9

Significant lateral traction during delivery –> damage to the upper part of the brachial plexus; 5th and 6th cervical roots.

Arm is held alongside the body in internal rotation (“waiter’s tip”).

Question 10

What bony abnormality should you look for in Erb palsy?

Answer 10

Ipsilateral clavicular fractures are relatively common in brachial plexus injuries.

Question 11

Describe Klumpke palsy.

Answer 11

7th and 8th cervical roots and the 1st thoracic component of the brachial plexus –> clawlike posturing of the hand

Commonly seen in breech deliveries

Question 12

What causes Horner syndrome?

Answer 12

Injury to the sympathetic fibers of the 1st thoracic nerve

Presents as ptosis, miosis, and anhidrosis, in addition to delayed pigmentation of the iris.