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Physical Assessment > Head, Eyes, Ears, Nose, Mouth & Neck > Flashcards

Head, Eyes, Ears, Nose, Mouth & Neck Flashcards

1
Q

What is required for a complete exam of the head and neck?

A

visual inspection, obtaining measurements, palpation, ophthalmoscope, auscultation and transillumination

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2
Q

What state is optimal for assessment?

A

to facilitate an optimal assessment with minimal discomfort, a quiet alert state allows for examination of the eyes and a crying state allows for examination of the oropharynx

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3
Q

What is included in general initial observation?

A

infant’s state; race-specific variations; color of the skin and mucous membranes; size and symmetry of the head and face; obvious deformations, malformations or evidence of birth trauma

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4
Q

What percentage of all anomalies seen at birth occur in the region of the head and neck?

A

90%; minor anomalies of the head and neck are common

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5
Q

What is the first step in the assessment of head size?

A

measurement of the occipital-frontal circumference (OFC)

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6
Q

How is an OFC measurement properly obtained?

A

by measuring 3 times and recording the largest value obtained; encircling the head at the widest occiput prominence and anteriorly 1-2 cm above the glabellar space at the largest frontal prominence

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7
Q

What is the average OFC measurement of a 40 week term infant?

A

35 cm, ranging from 33-37cm between the 10th and 90th percentile

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8
Q

Prior to the closure of the fontanels, the OFC is an indirect measurement of what?

A

intracranial contents including the brain, cerebrospinal fluid, cerebral blood volume and bone

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9
Q

How can an OFC measurement after birth be possibly misleading?

A

r/t cranial molding, scalp edema or hemorrhage under the periosteum; subsequent measurements should be taken for several days after birth

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10
Q

What is required to diagnose symmetric v asymmetric growth restriction and micro- v macrocephaly?

A

the percentile of OFC, weight and length respective to gestational age

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11
Q

What qualifies as microcephaly?

A

OFC <10% for GA

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12
Q

What causes microcephaly?

A

poor brain growth

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13
Q

How are cranial sutures affected by microcephaly?

A

cranial sutures become prematurely fused because the expansive force of brain growth that enlarges the cranial vault is lacking

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14
Q

Is microcephaly an isolated finding?

A

Sometimes, or it may be associated with a genetic syndrome or congenital infx

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15
Q

Under what circumstances might an OFC measurement be less than expected?

A

prematurity; discrepancies may be d/t inaccurate dating and/or pathologic restriction of growth; non-caucasian infants have a smaller OFC as a normal race variation

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16
Q

Which occurs more frequently: growth restriction or growth acceleration?

A

growth restriction

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17
Q

What qualifies as macrocephaly?

A

OFC >90% despite appropriate weight and length for GA

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18
Q

Why might macrocephaly present?

A

may be a familial characteristic or caused by hydrocephalus or a/w dwarfism or OI

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19
Q

What is the typical presentation of familial macrocephaly?

A

more often presents as macrencephaly (large brain volume) without hydrocephalic features

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20
Q

How is familial macrocephaly confirmed?

A

confirmation requires obtaining measurements of the parents’ heads and plotting them on a Weaver curve

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21
Q

When is cranial transillumination indicated?

A

When the infant’s head has an unusual shape or size or the neurological exam is abnormal

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22
Q

What is implied by a ring of light >2cm larger than the light source when performing a cranial transillumination?

A

increased fluid volume or decreased brain tissue in the cranium

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23
Q

Under what circumstances might an examiner obtain a “false positive” when performing a cranial transillumination?

A

when the infant has a large caput because the scalp edema will transmit a halo of light

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24
Q

In the infant presenting with a high level of suspicion for hydrocephalus, transillumination is often replaced by what other more definitive studies?

A

cranial ultrasound, CT scan or MRI

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25
Q

The relative shape of an infant’s head typically relates to what?

A

molding of the skull during delivery

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26
Q

What is the typical shape of an infant’s head delivered via CSX?

A

well rounded

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27
Q

What is the typical shape of an infant’s head delivered in breech position?

A

molded posteriorly into an egg shape with a prominent occiput

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28
Q

What is the typical shape of an infant’s head delivered following prolonged diagonal pressure?

A

“out of round” or asynclitic when viewed from above

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29
Q

What can be expected of distorted skull shape due to positional, external pressures in utero or during labor?

A

to spontaneous resolve; molding usually resolves within a few weeks following birth

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30
Q

What is a suture?

A

fibrous bands of tissue that separate bones

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31
Q

What is a fontanel?

A

occur at the intersection of sutures

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32
Q

Where is the metopic suture located?

A

the metopic suture extends midline down the forehead between the two frontal bones and intersects with the coronal suture

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33
Q

Where is the coronal suture located?

A

the coronal suture is situated anterolaterally across the cranium separating the frontal and parietal bones

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34
Q

What is formed at the intersection of the metopic, coronal and sagittal sutures?

A

the anterior fontanel (AF)

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35
Q

What is the typical size of the AF?

A

the size of the AF varies from 0.6-3.6cm across; in African American infants, it is commonly larger (1.4-4.7cm)

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36
Q

How are fontanels measured?

A

diagonally from bone to bone rather than from suture to suture

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37
Q

What can fontanel measurement provide?

A

because there is a wide variation of fontanel size at birth, the measurement may serve only as a baseline for serial comparison. Individual measurements have no clinical significance and limited reproducibility

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38
Q

How is the AF typically described?

A

flat and soft is assessed with the infant in a quiet state with the infant held in the sitting position

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39
Q

What might a tense or bulging fontanel indicate?

A

increased ICP or may occur with a crying infant

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40
Q

What might a sunken fontanel indicate?

A

severe dehydration and is rarely seen in the newborn nursery; may indicate excessive or acute decompression by an EVD

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41
Q

What might a very large AF indicate?

A

congenital hypothyroidism

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42
Q

When is the AF expected to close?

A

between 6-24mo of age

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43
Q

Where is auscultation performed?

A

over the fontanels and lateral skull bones

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44
Q

When is auscultation of the fontanels specifically indicated?

A

infants with multiple hemangiomas or heart failure

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45
Q

What does the appreciation of a bruit over the fontanels or lateral skull indicate?

A

may be a normal finding; a bruit in infant with suspected cardiac failure is a/w an intracranial arteriovenous malformation- which may be the cause of the CHF

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46
Q

Where is the sagittal suture located?

A

the sagittal suture extends midline between the two parietal bones to the PF

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47
Q

Where is the lambdoidal suture located?

A

the lambdoidal suture extends posterolaterally across the cranium to separate the occipital and parietal bones

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48
Q

What is formed at the intersection of the lambdoidal and sagittal sutures?

A

the PF

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49
Q

What is the approximate size of the PF?

A

0.5cm in Caucasian infants; 0.7cm in AA

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50
Q

When does the PF close?

A

approximately by 2-3mo of age

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51
Q

How does the PF typically present?

A

soft and flat on palpation

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52
Q

If present, where can a third fontanel be found?

A

may occur along the sagittal suture between the AF and PF

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53
Q

Is the third fontanel a true fontanel?

A

No, it is a defect of the parietal bone

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54
Q

What might the presence of a third fontanel indicate?

A

may be a normal variation or may be a/w Down syndrome or congenital hypothyroidism

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55
Q

Where is the squamosal suture located?

A

extends above the ear to separate the temporal bone from the parietal bone

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56
Q

Where is the sphenoid fontanel located?

A

at the intersection of the coronal and squamosal sutures and posterior to the frontal bone, distal to the parietal bone and anterior to the temporal bone

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57
Q

Where is the mastoid fontanel located?

A

at the intersection the squamosal and lambdoidal sutures and posterior to the temporal bone, distal to the parietal bone and anterior to the occipital bone

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58
Q

Under what conditions can the mastoid fontanel, sphenoid fontanel and squamosal suture be palpated?

A

only with increased ICP as with severe hydrocephalus, but may be palpable in preterm infant r/t rapid brain growth

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59
Q

How is mobility of the sutures assessed?

A

placing the thumbs on the bones on either side of the suture and gently pressing down alternately with one thumb then the other

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60
Q

How are normal sutures described?

A

approximated and mobile, may be split up to 1 cm

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61
Q

What are overriding sutures?

A

with molding, the edge of the bone on one side of the suture will feel as if is it on top of the edge of the opposing bone

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62
Q

What suture is commonly overriding?

A

lambdoidal sutures- the parietal bone on top of the occipital bone due to molding after birth or with minor decrease in hydration

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63
Q

What is craniosynostosis?

A

premature fusion of the suture

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64
Q

How is craniosynostosis differentiated from an overriding suture?

A

presents as a peaking of the approximated bones and is immobile

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65
Q

How is head shape affected by craniosynostosis?

A

premature closure stops perpendicular growth to the suture but allows parallel bone growth and compensatory expansion at the functional sutures leading to abnormal head shape

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66
Q

When can craniosynostosis present?

A

may be present at birth, or later in infancy

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67
Q

How does brachycephaly occur?

A

fused coronal sutures limit forward growth of the skull and lead to a broad shaped skull

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68
Q

How does scaphocephaly occur?

A

premature closure of the sagittal suture limits lateral growth and results in a long, narrow head

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69
Q

How does plagiocephaly occur?

A

closure of a laterally positioned suture results in asymmetric skull shape

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70
Q

What is the term for an abnormally shaped preterm infant’s head relating to postnatal positioning and without craniosynostosis?

A

dolichocephaly

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71
Q

How can craniosynostosis present?

A

can be a primary finding or may be a/w a genetic syndrome (Apert or Crouzon) or the result of a metabolic disorder (hypothyroidism)

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72
Q

what is the incidence of isolated craniosynostosis?

A

0.4-1 per 1,000 live births

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73
Q

What are craniotabes?

A

palpation of the skull may reveal areas of soft or thinning bone

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74
Q

What is the Macewen sign?

A

palpating the skull in an area of thinning bone that elicits collapse with recoil of the underlying bone and a snapping sensation

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75
Q

Why are craniotabes sometimes present?

A

an incidental finding on the parietal bones near the sagittal suture; d/t external pressure from prolonged vertex engagement or pressure of the fetal head on the uterine fundus with breech position; or r/t internal pressure and hydrocephalus

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76
Q

If craniotabes are present due to external pressures, when can they be expected to resolve?

A

a few weeks

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77
Q

If craniotabes are present due to internal pressures, when can they be expected to resolve?

A

resolution depends on the degree and persistence of internal pressure causing bone thinning

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78
Q

What is the most common form of trauma to the head during birth?

A

caput succedaneum

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79
Q

What is a caput?

A

edema of the presenting part of the scalp caused by pressure that restricts the return of venous and lymph flow during labor and delivery; may be accentuated by vacuum assist

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80
Q

What are the defining characteristics of a caput?

A

edema pits with pressure, edges are poorly defined and crosses suture lines

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81
Q

When can a caput be expected to resolve?

A

caput is noted immediately after birth and resolves within a few days (unlike a cephalhematoma)

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82
Q

How is a cephalhematoma formed?

A

the result from the collection of blood between the periosteum and the skull

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83
Q

Why might a cephalhematoma not be evident at birth?

A

may be obscured by a caput

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84
Q

What are the defining characteristics of a cephalhematoma?

A

clearly demarcated edges confined by suture lines

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85
Q

How long does it take for a cephalhematoma to resolve?

A

with time it may liquefy and become fluctunant on palpation; takes weeks to months to resolve completely

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86
Q

What are the most common locations for a cephalhematoma to present?

A

the parietal and occipital bones

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87
Q

How frequently are cephalhematomas associated with depressed skull fractures?

A

rarely

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88
Q

What is the most potentially serious lesion presenting from birth trauma?

A

a subgaleal hemorrhage

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89
Q

What actions in a delivery increase the risk of a resultant subgaleal hemorrhage?

A

most common with instrumental vaginal delivery, especially vacuum; sometimes occurs with CSX or any maneuver during delivery that produces a shearing forces to the scalp resulting in tearing of the large emissary veins

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90
Q

What is a subgaleal hemorrhage?

A

bleeding into the galen aponeurotica or subaponeurotica space, which extends from the orbital ridges to the nape of the neck and laterally to the ears

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91
Q

Why is a subgaleal hemorrhage potentially life threatening?

A

this potential space produces a large compartment capable of containing the total blood volume of an infant (5-22% mortality rate is blood loss is extensive and not diagnosed early)

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92
Q

How does a subgaleal hemorrhage typically present?

A

generalized scalp edema, usually with ecchymosis, BL or unilateral periorbital and periauricular edema

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93
Q

How does a subgaleal hemorrhage present on palpation?

A

the ballotable fluid mass crosses the sutures and can be manually repositioned from the eyebrows to the nape of the neck, differentiating it from a caput.

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94
Q

If permitted to progress, a subgaleal hemorrhage will result in, what?

A

severe anemia, hypotension and death

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95
Q

How is a subgaleal hemorrhage managed?

A

volume resuscitation, blood replacement and treatment of presenting clot abnormalities

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96
Q

What additional scalp traumas may occur resulting from delivery?

A

puncture from scalp electrodes, lacerations from fetal blood sampling or uterine incision, bruises, abrasions or subQ fat necrosis from an instrument delivery

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97
Q

How should trauma from a delivery be described?

A

by appearance, size, location near sutures or fontanel or underlying bones

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98
Q

When are open scalp defects (aplasia cutis congenita) observed?

A

may be a normal variant but are sometimes a/w trisomy 13

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99
Q

What skull malformations are the result of an incomplete neural tube closure?

A

encephalocele

100
Q

Where do encephaloceles most commonly present?

A

central nervous tissue can protrude from a defect anywhere on the skull but most commonly midline and in the occipital area

101
Q

A through examination of the scalp should include what elements?

A

assessment of the hair for quantity, texture, distribution and hair whorls

102
Q

What attributes of the hair may be a/w congenital anomalies?

A

a low hair line, an increased quantity of hair and brittleness

103
Q

What accounts for the presence of hair whorls?

A

the slope of each hair follicle is a/w the stretch of skin during brain growth

104
Q

Why are hair whorls typically present in the posterior parietal region?

A

the most rapid brain growth occurs at 16 to 19 weeks GA and results in a hair whorl in it’s corresponding region of concentrated growth

105
Q

How many hair whorls is considered normal?

A

1-2

106
Q

What scalp features may indicate mental retardation or aberrant brain growth?

A

an abnormally placed whorl, absence of a hair whorl or unusual hair growth

107
Q

What feature of the scalp correlates with central nervous system development?

A

scalp hair in the newborn has variable coarseness and the thickness of scalp hair growth patterns correlates with CNS development

108
Q

What is alopecia?

A

an abnormal deficiency of hair that may be diffuse or focal

109
Q

What is typical of diffuse alopecia?

A

commonly due to a genetic anomaly in the hair follicles or is syndromic

110
Q

What is typical of focal alopecia?

A

often traumatic or a/w underlying scalp lesions

111
Q

What is hirsutism?

A

excessive hair growth

112
Q

What can cause hirsutism?

A

genetic, syndromic, metabolic, drug-induced or an isolated finding

113
Q

What is aplasia cutis congenita and where is it commonly found?

A

an uncommon scalp lesion found primarily at the vertex just in front of the lambda

114
Q

How does aplasia cutis congenita typically present?

A

a hairless, circumscribed area of 1cm or more, surface is often shiny, cicatrical and flat/keloid; occasional blistering/ulceration w/serosanguinous exudate or fresh granulation

115
Q

What is the risk of aplasia cutis congenita?

A

potential underlying defect and other assoc major defects; usually is an isolated finding

116
Q

What are the long term implications for an aplasia cutis congenita?

A

resolves with a residual scar formation and absence of hair growth

117
Q

How should examination of the face begin?

A

observation of the relationships b/w eyes, ears, nose & mouth

118
Q

What is the relative size of the newborn forehead and why?

A

takes up the upper half of the face and reflects the large cranial volume needed for rapid brain growth

119
Q

What may indicate face or brow presentation at delivery or nuchal cord?

A

facial bruising, petechiae and progressive edema

120
Q

What might occur as the result of prolonged intrauterine compression from oligohydramnios?

A

unusual flattening of facial features

121
Q

What can occur from a forceps assisted delivery?

A

bruises, abrasions or subQ fat necrosis

122
Q

How are facial movements assessed for symmetry?

A

during crying

123
Q

How will an infant present if there has been damage to CN7 prior to or during delivery?

A

paralysis of the affected side of the face; extensive damage can involve the entire side of the face and cause drooping of the muscles on the affected side of the face

124
Q

What portion of CN7 is most commonly damaged?

A

the mandibular branch which controls the muscles around the lips

125
Q

How do infants present if the mandibular branch of CN7 has been damaged?

A

decreased mv’mt on the affected side bc weakened facial muscles allow the mouth to be pulled to the unaffected side (“drooping mouth”)

126
Q

How can CN7 damage be differentiated from asymmetric crying facies?

A

loss of forehead wrinkling and nasolabial fold and partial closing of the eye on the affected side

127
Q

if nerve damage is caused by pressure, when are facial effects expected to resolve?

A

hours to weeks after birth

128
Q

When does congenital facial palsy occur?

A

often spontaneous but is also a/w difficult or instrumented delivery requiring forceps

129
Q

What might a persistent palsy indicate?

A

an underlying, more central abnormality

130
Q

What is asymmetric crying facies?

A

a congenital absence or hypopasia of the depressor anguli oris muscle (DAOM) on one side

131
Q

What does the depressor anguli oris muscle (DAOM) control?

A

frowning; with resulting asymmetry of the face with crying

132
Q

Abnormal formation or placement of the ears may be associated with what?

A

chromosomal anomalies and syndromes, however a wide variety of minor structural variations fall within the normal range

133
Q

In a term infant, how should the pinna appear?

A

should be well formed with cartilage that recoils easily after folding

134
Q

Why might there by temporary asymmetry of the ears?

A

r/t unequal intrauterine pressure on the sides of the head (common)

135
Q

Especially hairy ears involving both the pinna and the lobes are present in what groups of infants?

A

may be familial, syndromic or infants of mothers with poorly controlled DM

136
Q

Pits and tags are remnants of what embryologic structures and where are they located?

A

these minor malformations are located anterior to the tragus and are thought to be remnants of the first brachial cleft or arch

137
Q

How can a preauricular sinus present?

A

may be blind or it may communicate with the internal ear or brain

138
Q

In the context of chronic infx, what treatment may be necessary for a preauricular sinus?

A

surgical removal of the entire tract

139
Q

What is a Darwinian tubercle and what does it indicate?

A

small nodule appearing on the upper helix; normal variant

140
Q

What does a poorly formed external ear possibly indicate?

A

a possible chromosomal anomaly or syndrome

141
Q

How can ear position be assessed?

A

by extending a line from the inner to the outer canthus of the eye toward the ear; if insertion of the ear falls below this line, it is considered low set

142
Q

Describe the appearance of an infant’s external auditory canal.

A

it is short and may contain vernix, interpartum blood or mec debris (making otoscopic examination difficult)

143
Q

What should the external ear be examined for?

A

inspected visually to assess presence and patency of the auditory canal

144
Q

What may increase an infant’s risk for hearing loss?

A

a small or abnormally developed ear

145
Q

What trauma to the eyes can occur with a NSVD?

A

bruises, edema of the eyelids and sclera hemorrhage

146
Q

What causes a conjunctival or subconjunctical hemorrhage?

A

results from the rupture of a capillary of the mucous membrane that lines the eyelids and is reflected onto the eyeball (conjunctiva)

147
Q

How does a conjunctival or subconjunctical hemorrhage present?

A

it is seen as a bright red area on the sclera near the iris

148
Q

When does a conjunctival or subconjunctical hemorrhage resolve?

A

spotaneously resolves within a week to ten days without residual effect

149
Q

What can cause inflammation of the conjunctiva?

A

prophylaxis silver nitrate gtt (less often with erythromycin ointment)

150
Q

What is a coloboma?

A

an absence or defect of some ocular tissue, including the eyelid

151
Q

What is ptosis?

A

a paralytic drooping of an eyelid when the lids are fully open

152
Q

How does nevus simplex present on the eyelids and glabella?

A

as a common vascular birthmark

153
Q

When does tear formation begin?

A

not usually until 2-3mo of age

154
Q

When does the nasolacrimal duct become fully patent?

A

not until 5-7 mo

155
Q

Until the nasolacrimal duct is patent, what is a common finding?

A

purulent of mucoid eye drainage

156
Q

When is nasolacrimal duct drainage concerning?

A

When in the context of conjunctival inflammation with redness or swelling

157
Q

When infection is not suspected, how can nasolacrimal duct drainage be treated?

A

lacrimal massage and gentle cleansing with water and a cotton ball

158
Q

What is the relative size of symmetric eyes?

A

the distance bw the outer canthi can be divided into equal thirds, with one normal palpebral fissure length fitting into the inner canthal distance

159
Q

What is hypertelorism?

A

if the eyes are more widely spaced

160
Q

What is hypotelorism?

A

if the eyes are closely spaced

161
Q

What is an eye characteristic found in Asian population and 20% of non-Asian population?

A

the epicanthal fold is a vertical fold of skin on either side of the nose that covers the lacrimal caruncle

162
Q

Why does the epicanthal fold that covers the lacrimal duct disappear in non Asian populations?

A

By 10 y; the growth of the nasal bridge catches up to that of the medial canthal skin

163
Q

What might epicanthal folds with upslanting palpebral fissures and hypertelorism?

A

Down syndrome

164
Q

How are eyebrows normally positioned?

A

eyebrows normally extend above the eye in a curve approximately the length of the palpebral fissure

165
Q

What do eyebrows that meet at the glabella and abnormally long or tangled eyelashes suggest?

A

Cornelia de Lange syndrome

166
Q

What facilitates the eye exam?

A

spontaneous opening by the infant

167
Q

What can encourage spontaneous opening of the eye?

A

auditory stimulus, changing the infant’s position, gentle swinging or dimming the lights

168
Q

What happens if the infant’s eyes are forcefully opened?

A

the eyelids will evert, making visualization impossible

169
Q

How do you conduct an opthalmoscopic exam?

A

first adjust for focus and then supply a small round white beam of light; direct the light into the pupil from 6” to assess constriction, PERL

170
Q

What is a red light reflex?

A

when a bright light is directed at the newborn’s lens, a clear red color is reflected from the retina back to the examiner

171
Q

What will interrupt a red light reflex?

A

an opacity of the lens or cornea

172
Q

What is implied by a lack of a red light reflex?

A

congenital cataracts, glaucoma or a retinoblastoma

173
Q

How might the red light reflex appear in dark-skinned infants?

A

pales from orange toward grey in the most pigmented infants

174
Q

What is a keyhole shaped iris?

A

a coloboma of the iris

175
Q

Describe the iris of a newborn infant.

A

generally dark grey, blue or brown at birth

176
Q

When do infant’s acquire final iris pigmentation?

A

about 6mo

177
Q

What are brushfield spots?

A

white specks scattered linearly around the entire circumference of the iris

178
Q

With what syndrome do brushfield spots typically present?

A

Down syndrome, although may be a normal variant

179
Q

What might a blue sclera indicate?

A

OI

180
Q

What might a yellow sclera indicate?

A

hyperbilirubinemia

181
Q

In a normal gaze, what part of the sclera should never be visible?

A

above the iris

182
Q

What is the sunset sign and what is it associated with?

A

lid retraction and a downward gaze; seen in infants with hydrocephalus

183
Q

What is nystagmus?

A

rapid, searching movements of the eyeballs

184
Q

How might limited horizontal nystagmus be elicited and when does it disappear?

A

with rotational eye movement; 3-4 mo of age

185
Q

What presentation of nystagmus is always aberrant and likely a/w visual and/or neurologic abnormalities?

A

spontaneous horizontal, vertical or torsional nystagmus and persistent nystagmus

186
Q

From what does strabismus arise?

A

from muscular incoordination and gives the appearance of crossed eyes

187
Q

When does pseudostrabismus from a flat nasal bridge or epicanthal fold usual resolve?

A

by 1yr

188
Q

How do pseudostrabismus and strabismus differ?

A

pseudostrabismus has the presence of a symmetrical corneal light reflex

189
Q

Proptosis or enlargement of the eyeball is associated with what congenital condition?

A

hyperthyroidism

190
Q

What damage might congenital glaucoma cause to the neonatal eye?

A

damage to the eye with hemorrhage into its orbit

191
Q

What is the typical presentation of an infant’s nose?

A

generally smaller and flatter than an adult’s; nose should be symmetric and placed vertically in the midline

192
Q

Describe the nose of an infant with Down snydrome.

A

a very low nasal bridge with a broad base

193
Q

What might cause lateral deviation of the nasal septum?

A

position in utero or by a dislocated septum

194
Q

How can you determine if the nasal septum is deviated?

A

if the septum will not easily straighten and the nares remain asymmetric when the tip of the nose is pushed to midline- will require tx

195
Q

Elevating the tip of the nose slightly will allow the examiner to assess what features?

A

the nasal septum, the floor of the nose and the turbinates

196
Q

How can nasal patency be assessed?

A

by watching the infant breathe in a quiet state

197
Q

How will bilateral choanal atresia present in the neonate?

A

cyanosis at rest and pink when crying (because of breathing through the mouth)

198
Q

Nasal occlusion can also be acquired from accumulation of secretions and result in what signs and symptoms?

A

noisy respirations, feeding difficulties, respiratory distress or apnea

199
Q

What might excessive bulb suctioning cause?

A

aggravate the occlusive tendency of the nares

200
Q

How should nasal occlusion secondary to edema be treated?

A

intermittent installation of NS gtt

201
Q

What may result from the use of CPAP therapy?

A

erosive trauma to the nasal labia, nasi columella and nares

202
Q

How can the trauma r/t CPAP therapy be minimized?

A

preventative and protective skin coverings, monitoring the area for ulceration will minimize long-term disfiguring and scarring

203
Q

What anomalies are usually syndromic or a/w major CNS anomalies?

A

major nasal abnormalities (including clefts, single nares, masses and partial or complete hypoplasia)

204
Q

How should the lips and mucous membranes of a healthy term infant present?

A

pink; mild circumoral cyanosis is normal during transition and with crying during the first few days

205
Q

What is microstomia

A

small oral opening

206
Q

When is microstomia typically present?

A

storage diseases such as the mucopolysaccharidoses

207
Q

What “facies” are typically present with fetal ETOH syndrome?

A

a thin upper lip with a smooth philtrum and short palpebral fissures

208
Q

What elements of an infant’s cry should be assessed?

A

quality, strength, pitch and hoarseness or stridor

209
Q

Use of a tongue depressor for oral examination may result in what?

A

a strong protrusion reflex, making assessment difficult

210
Q

How might an infant’s mouth be opened safely?

A

gently pressing down on the chin

211
Q

How should a typically presenting tongue appear?

A

the tongue should fit well into the floor of the mouth and appear symmetric

212
Q

What is the danger with macroglossia?

A

impedes closure of the mouth, may obscure airway

213
Q

What conditions present with macroglossia?

A

Bechwith-Wiedemann, hypothyroidism and mucopolysaccharidosis

214
Q

Is there macroglossia associated with Down syndrome or Robin sequence?

A

No, the tongue may appear large with micrognathia

215
Q

What is the frenulum?

A

attaches the underside of the tongue to the floor of the mouth, usually midway between the tongue’s ventral surface and tip

216
Q

When does a tongue tie require treatment?

A

a very thick and prominent frenulum is rare; if limiting movement or pulls the tongue to a V at the tip- it is abnormal and requires tx

217
Q

What might white patches on the tongue and mucous membranes be?

A

residual milk or leukoplakia (normal in darkly pigmented infants)

218
Q

How do lesions of a Candida (oral thrush) present?

A

if the white coating cannot be easily removed with a tongue blade or cotton swab

219
Q

What is a mucocele or ranula?

A

a translucent of bluish swelling under the tongue, mucous or salivary gland retention cysts that usually spontaneous resolve

220
Q

What should be palpated within the oral cavity?

A

continuity of the hard and soft palate, strength and coordination of suck, gag reflex, lumps or masses on the gum line

221
Q

What are Epstein pearls and where do they present?

A

small whitish-yellow clusters- epithelial inclusion cells; at the junction of the hard and soft palates and on the gums

222
Q

When are Epstein pearls expected to resolve?

A

by a few weeks of age

223
Q

In what population are natal teeth a common variant?

A

Native American; rarely seen in Causcasian infants

224
Q

Where are natal teeth or eruption cysts with teeth usually seen?

A

lower incisor region

225
Q

Why are natal teeth a potential risk?

A

they are usually immature caps of enamel and dentine with poor root formation and may be very mobile; caus ulceration of tongue, pain w/feeding, presumed risk for aspiration

226
Q

If natal teeth are firmly planted, what is a dentist’s likely recommendation for tx?

A

removal may impact future dentition and the dentist may choose to leave it in place and do a f/u exam to assess for complications

227
Q

What are possible etiologies for excessive oral secretions?

A

esophageal atresia, poor swallow from a neurologic abnormality

228
Q

How can esophageal patency be assessed?

A

passage of a large bore (usually 10Fr) OGT with CXR confirmation

229
Q

What is the typical presentation of an infant’s neck?

A

normally short, severe shortness may be syndromic

230
Q

How can the shape and symmetry of the neck best be observed?

A

elevate the shoulders, allowing the head to fall back slightly

231
Q

Asymmetry of the neck is most likely due to what forces?

A

in utero positioning

232
Q

Is it possible to palpate the thyroid gland?

A

very difficult to do unless it is enlarged

233
Q

What is the etiology of a congenital goiter?

A

intrauterine deprivation of thyroid hormone, very rare

234
Q

What is the most commonly seen neck mass in neonates?

A

Cystic hygroma

235
Q

What is the etiology of cystic hygromas?

A

development of sequestered lymph channels, which dilate into cysts

236
Q

Describe a cystic hygroma.

A

soft and fluctuant, transilluminate well and usually visualized laterally over the clavicle

237
Q

What are the potential risks a/w cystic hygromas?

A

may cause severe feeding difficulties or airway compromise

238
Q

How are cystic hygromas managed?

A

very small lesions may regress spontaneously, but surgical resection is usually required

239
Q

A mass appearing high in the neck may be…?

A

a thyroglossal duct cyst or a brachial cleft cyst

240
Q

Where can a branchial sinus be visualized?

A

anywhere along the sternocleidomastoid muscle

241
Q

Why is surgery often indicated for a branchial sinus?

A

it may communicate with deeper structures and infx may necessitate surgical removal of the entire sinus tract

242
Q

What syndromes present with neck webbing?

A

Turner, Noonan and Down syndrome

243
Q

What birth history increases the risk for clavicle fx?

A

h/o shoulder dystocia or macrosomia

244
Q

How may an infant in pain relating to a clavicular fx present?

A

nonrespiratory tachypnea

245
Q

What might be felt from a manual exam of the clavicles?

A

movement of the bone ends and crepitus may not be felt soon after birth; or a fx may not be evident for wks until a callus has formed and can be palpated as a mass

Physical Assessment (11 decks)

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