HX AND PHYSICAL

Question 1

Wide fontanel may be due to:

Answer 1

Rickets
Increased ICP
Hypothyroidism
Downs Syndrome
Osteogenesis Imperfecta
Achondroplasia
Familial Macrocephaly
Normal Variant

Question 2

EYE what do we see

Answer 2

 The shape and position of the eyes should be noted. Standard measurements exist for eye spacing
 General: Strabismus, nystagmus, slant of palpebral fissures, hypo/ hypertelorism, discharge,
swelling, prominent epicantal folds…
 setting sun sign (a sign of increased intracranial pressure as in Hydrocephalus)
 The eyelids may reveal ptosis, entropion or ectropion
 Conjunctiva, sclera, cornea, pupils (Look for pallor, jaundice, bitot’s spots, xerosis, keratitis,
keratomalacia, leukocoria)
 The palpebral and bulbar conjunctivae may reveal pallor or injection. Focal subconjunctival
hemorrhages are commonly seen in the newborn period

Question 3

Blue sclerae are associated with:

Answer 3

 Osteogenesis imperfecta,
 Iron deficiency anemia
 Severe acute Malnutrition
 Ehler’s danlos syndrome
 Pseudoxanthoma elasticum
 Marfan’s syndrome
 Long-term use of corticosteroids.
 Hypophosphatasia
 Rheumatoid Arthritis
 Juvenile Paget disease
 Healed Sceleritis
 Buphthalmus
 May be Normal variant

Question 4

Causes of elevated JVP (Jugular venous distension):

Answer 4

1. Right ventricular failure
2. Pericardial compression (constriction/tamponade) – little or no pulsations when severe
3. Tricuspid stenosis
4. Superior venacava (SVC) obstruction – no pulsations
5. Circulatory overload
6. Renal failure
7. Excessive fluid administration
8. Atrial septal defect with mitral valve disease