Module 5: Paediatrics Flashcards
most common cause of acute respiratory obstruction in young children
croup
steeple sign think
is what
croup
loss of normal lateral convexities of the subglotic trachea
H Influenza causes
epiglottitits
thumb sign is what
swelling of epiglottis
epiglottitis asphyxiation is cause by what
aryepiglotic folds
exudative infection of the trachea can cause
exudative tracheatitis
exudative tracheatitis bug is
Staph A
exudative tracheatitis buzzword sign
linear soft tissue filling defect within the airway
what is the next step is there is pseudothickening from neck not being truly lateral
in retropharyngeal cellulitiis and abscess
repeat with extended neck
Retropharyngeal abscess vs suppurative node?
Retropharyngeal abscess is midline
supparative node is medial to the carotid
subglottic hemangioma
can cause what
subglottic obstruction.
Like croup but will b e one sided
subglottic haemangiomas are associated with
cutaenous haemangiomas (50%0
PHACES syndrome (7%)
what is the PHACEs syndrom e
Posterior fossa
Haemgiomas
Arterial anomalies
Coarctation of aorta, cardiac defects
Eye abnormalities
Subglottic haemangiomas
measurements of concern on lateral xr
for retropharyngeal absess
C2 >6mm
>22mm at C6
Should adenoids encroach on the airway
no
Exudative tracheitis sign on lateral radiograph
linear filling defect
meconium aspiraiton more common in what delivery time baby
term or post-mature babies
meconium aspiraiton appearance of lungs
ropy
hyperinflated
20-40% have pnuemothoraxx
TTN affects which ne wborn (dleivery style)
c-section
diabetic mother
maternal sedation
TTN findings start at what time
6 horus
TTN is normally done by what time frame
3 days
SDD (surfatant deficiency) which babies
pre term
Chest radiograph appearance of SDD
low lung volums and bilateral granular opacities
NOT pleural effusion as with B haemolytic pnuemonia
surfactant replacement therapy risks
pulmonary haemorrhage
PDA
Neonatal pneumoina
look like what on radiograph
patchy
asymmetric hilar densitiies
hyper inflation
Beta haemolytic strep pneumonia
neonate
dirty birth canal
low lung volums
GRANULAR opacities
pleural effusions
Persistent pulmonary HTN
caused by
primary
secondary to hypoxia (infection, aspiraiton)
pulmonary interstitial emphysema
linear lucencies
PIE vs bronchopulmonary dysplasia
age
PIE less than 2 weeks
Chronic lung disease - who get this?
small, pre term kid.
after 2 weeks get hazy lungs.
band like opacities is a buzzword
Pulmonary hypoplasia causes
Primary or secondary
secondary
- decreased hemithoracic volume ( decreased vascular supply, decreased fluid
decreased hemithoracic volume what can cause this,
(CONGENTIAL DIAPHRAGMATIC hernia
types of bronchopulmonary sequestration
intralobar
extralobar
bronchopulmonary sequestration distinction is based on
pleural covering
sequestration blood supply
intralobar drains to pulmonary veins
extra drain to systemic veins
neonatal lung volumes on radiograph
if low
surfactant deficiency
heta haemolyticpneumonia (pleural effusion)
neonatal lung volumes on radiograph
if high
meconium aspiration
transient tachypnoea
neonatal pneumonia
more common?
sequestration type?
intralobar
how do people with intralobar sequestration present
pneumonia in their late teens / adult
intralobar is commonly which segment
left lower lobe posterior segments
no pleural cover for sequestration ascribed to
intralobar
Extralobar sequestration present in
infancy
what are the associations to extralobar sequstration
Congenital Cystic Adenomatoid malformation (CCAM)
Congenital diaphragmatic hernia
vertebral anomalies
congenital heart disease
pulmonary hypoplasia
why does extralobar sequestration rarely get infected?
has its ow pleural covering
bronchogenic cysts - do they connect to the airway?
if they have gas in them?
no
if gas in them consider infection
CCAM / CPAM different types
1 - 3
cystic
solid
3 is middle ground
if theres systemic arterial feeding a CCAM?
not a CCAM but a sequestration
congital lobar emphysema has preference for which lobe?
left upper lobe
how to treat congenital lobar emphysema
lobectomy
congenital Bochdalek hernia is found where?
back left of the diaphragm
associations of Congenital Diaphragmatic Hernia
malrotated
congenital heart disease
mortality of the congenital diaphragmatic hernia
is associated to the hypoplasia
what is round pneumonia
less than 8 years old
looks like a mass
Common bug for round pneumonia
S Pneumoniae
What is Swyer James
unilateral lucent lung
post viral lung infection in childhood post infectious obliterative bronchiolitis
the size of the affected lobe is smaller! Of note for a lucent lung
what causes papillomatosis ?
perinatal HPV
sickle cell kids get what in bones
infarcts
H shaped vertebra
cystic fibrosis vs primary ciliary dyskinesia
sodium pump broken therefore thick secretions in CF. Men are missing vas deferens.
PCD - cilia motile doesn’t work. Therefore lower lobe predominant. Men sperm not motile
PCK and Kartaganers relationship
50% will have Kartageneres (situs inversus)
Thmic rebound on PET
can be bright
and large
Germ cell tumour in anterior mediastinal masses - three types
Teratoma - calc and fat
Seminoma - bulky lobulated
NSGCT - necrotic
Middle mediastinal masses
Lymphadenopathy (TB or lymphoma)
Duplication cysts (bronchogenic or enteric)
Bronchogenic - water attenuation.
Enteric- water attenuation close the oesophagus.
Posterior mediasintal mass
Neuoblastoma
Ewing sarcoma
Neuroenteric cyst
Extramedllary hematopoiesis
posterio med mass - neuroblastoma
found in age -
less than 2
Askin (PNET) is now considered to be
past of the Ewing sarcoma .
Neuroenteric cyst - associated with
vertebral anomalised
What is extramedullar hematopoiesis
myloproliferative disorder patients, manifests with big liver and spleen.
mediastinal mass by age
?lymphoma
if over 10
if under think thymus
how to distinguish between a pleuropulmonary blastoma and an askin tumour
PPB doesn’t invade the ribs
Course of the umbilical venous cathter
umbilical vein
left portal vein
ductus venosus
hepatic vein
IVC
mbilica lartery cathter should sit
T8-10
or
L3 - L5
Esophageal atresia subtypes
number
ax
common type
air in stomach means
5
VACTERAL
N - blind oesophagus, oesophagus to trachea
H type
VACTERAL is WHAT
most common affected
Vertebral anomalies
Anal
Cardiac
TE fistula
Renal
Limb
heart and kidneys
Vascular ring that goes between the oesophagus and the trachea
Pulmonary sling
most common symptomatic ring
doulbe aortic arch
neonatal obstruction - high causes
Midgut volvulus or malrotation
duodenal atresia
duodenal web
annular pancreas
jejuna atresia
neonatal obstruction - low causes
Hirschsprung
meconium plug syndrome
ileal atresia
meconium ileus
anal atresai / colonc atresia
radiograph
triple bubble dx
jejunal atresia - caused by vascular insult during development
doulbe bubble with gas
distal gas excludes atresia.
ddx - duodenal web, stenosis or volvulus midgut
radiograph
multiple diffuse dilated loops
differential and management plan
low obstruction
enema contrast
then upper GI if that is normal
malrotation puts which ligament on the right
Trietz
malrotation blood vessel orientation
SMA to the right of the SMV
Corkscrew duodenum is diagnositc of
midgut volulus
pyloric stenosis age range
2 - 12 weeks
pyloric stenosis length criteria
4mm and 14mm
single wall and legnth
two types of gastric volvulus
organoaxial
mesenteroaxial
duodenal web is posiootined
distal to ampulla vater (bilious vomitting )
duodenal web is ax with what
downs and malrotation
annular pancreases causes waht in adults vs kids
adults pancreatitis
kids - duodenal obstruction
differentials for long microcolon
meconium ileus (CF patients)
Distal ileal atresia (fetus gets a vascular insult to cause this)
large bowel contrast enemea
caliber change
ddx
small left colon syndrome or Hirschsprungs
what is small left colon syndrome
transient functional colonic obstruction
relieved by contrast enems
who gets small left colonic syndrome
infants of diabetic mothers
(NOT ax to CF)
what is Hirschsprungs
failure of ganglion cells to migrate and innervate the distal colon
appearance of hirschsprungs
rectum is smaller than sigmoid or sawtooth pattern (spasm)
what is total colonic aganglionosis
super rare version of Hirschprungs
affects the Terminal ileus
mimic microcolon.
What is meconium periotonitis ?
calcified mass in mid abdo
sterile periotneal reaction to an intra utero bowel perforaiton
Imperforate anus / ectopic anus
associated to
tethered cord
- need US to review for this
VACTERL
Tender abdomen in an oler child
AIM diagnosis
Appendicitis or adhesion
inguinal hernia or Itussusception
Midgut volvulus / meckels
Appendicitis size
> 6mm
intusseption target sign size
how does it affect the tratment
> 2.5cm - likely to be ileocolic and so air enema
<2.5 small bowel small bowe, not getting an air enema
Meckels diverticulum rule of 2s
Persistent omphalomesenteric duct
2% of population
2 hetertopic mucosa (gastric and pancreatic)
2 ft from IC valve
2 inhes long and 2cm in diameter
present symtpoms pre-2yo
Which nuclear medicine scan in meckels
pertechnetate
WHAT IS an enteric duplication cyst
failure to canalize.
Can communicate with GI lumen.
common in ileal region.
can cause IN UTERO obstruction and perforation
distal intestinal obstruction syndrome
affects which patient group
CF
aren’t compliant with their pancreatic enzymes
NEC
who gets
prem
low birth weighty
cardiac
perinatal asphyxia
Hirschsprung
what does NEC look like?
Pneumatosis
Focal dilated bowel (especially in right lower wquadrant)
featureless small bowel (oedema)
unchanging bowel gas pattern
what is Gastroschisis
extra-abdominal evisceration of neonatal bowel through paraumbilical defect
Gastroschisis
membrane
sided
ax anomalies
AFP level
OUtcome
complications post repair
NO membrane
right sided
ax anomalies are RARE
Maternal serum AFP will be elevated.
Outcome is usually good
bad reflux
What is omphalocele
congenital midline defect with herniation of gut at the base of the umbilical cord
omphalocele
membrane
ax anomalies
outcomes
DOES have a membrane
ax tto Trisomy 18 and others
Outcomes not good
umbilical cord cysts
What is physiological gut herniation
normal around 6- 8 weeks.
does not cintain any liver
what to see on mesenteric adenitis
cluster of right lower quadrant lymph nodes
in heterotaxia syndromes cardiac malformation s are more comon with with side/
right sided
reverse aorta /IVC more common in which heterotaxy
Right sided
Liver tumours can be categorised based on
age
Hemangioendothelioma
hepatoblastoma
mesenchymal hamartoma
found in which age group
0 - 3
What is a hemangioendothelioma
Ax with kasaback - Merritt Syndrome (platelet pooling - highly vascular)
get high output HF.
hepatoblastoma is associated with what syndromes
hemi-hypertrophy
wilms
beckwith weidemann
what marker in blood is elevated in hepatoblstoma
AFP
but also bHcG which can cause precocious puberty
mesenchymal hamartoma has what appearance?
cystic
no calc
but large portal vein feeding
liver tumours by age over
5
HCC - afp also high
Fibromellar subtype - central scar
Undifferentiated embryonal sarcoma
what is an undifferentaited embryonal sarcoma
ax to mesenchymal hamartoma.
cystic, more aggressive. septations and fibrous pseudocapsule.
aggressive paeds tumour.
choledochal cysts are classified into
5 types
type 1 choledochal cyst is
focal dilation of the CBD and is by far the most common
Carolis
type of disease
ax
features
what is the central dot sign
AR disease
ax to PCKD and medullary sponge kidney
intrahepatic duct dilatation
central dot sign is portal vein surrounded by cysts
hereditory hemorrhagic telangiectasia aslo called
osler weber rendu
causes of prolonged nenatal jaundice
Biliary atresia
hepatittis
paeds patient with gallstones think
sickle cell
Absent gallbladder think
biliary atresia
features of pancreas in CF patients
fibrosis - low T1 and T2
fatty change - high T1
cysts are common
Cystic fibrosis
compication of enzyme replacement therapy is what
Fibrosing colonopathy
what is schwachwan-Diamond syndomrome
other cause of shit pacnreas
loose stool, short and have eczema
what is dorsal pancreatic agenesis?
only a ventral bud.
therefore no tail and likely to get diabetes as most beta cells are in the pancreatic tail
paediatric pancreatic mass by age
1 - pancreatoblastoma
6 - adenocarcinoma
15 - solid pseudopapillary tumour of the pancreas
renal agenesis comes in what two flavours
both kidneys absent (potter)
one kidney absent - reproductions associations
what are the associations of unilateral absence of kidney
70% of women with unilateral agenesis
genital anomalies
- unicornuate uterus, rudimentary horn
20% men missing epidydimis and vas deferens on the same side. Seminal vesicle cyst on that side
panckae adrenal helps discern
surgically absent or congenitally absent kidney
risks of a horsehwoe kidney
can get mashed against the spine
drianage issues - stones, infeciton -risk of cancer . Wilms, TCC. renal carcinoid.
Horseshoe assocaited syndromes
Turners syndrome
prune belly / eagle barrett syndrome
malformiaotn complex in med
tria
crap abdo muscles
hydroureteronephrosis
cryptochidism
what is congenital UPJ obstruction
most common congenital anomaly of the GU tract in neonates.
Auto Rec PKD get what
HTn and renal failure
fibrosis of liver and abnormal bile ducts
US features of Auto Rec PKD
kidneys are smoothly enlarged and diffusely echogneic.
loss of corticomedullary diferntiation
neonatal renal vein thrombosis
associate to
diabetic mothers
neonatal renal artery thrombis
cuases
preents as
umbilical catheter damage
present with severe hypertension
Congenital primary MEGureter
dildated ureter
NOT from obstructin
cuases of congenital mega ureter
distal adynamic segment (like Hirschsprungs)
reflux to the VUJ
idopathic
retrocaval ureter can cause
partial obstruction and recurrent UTI
what is the weigert - meyer rule
upper pole inserts inferiorly and medially.
up obstructs
low flow
what is a ureterocele?
cystic dilation of the intravesicular ureter xsecondary to obstruction at the ureteral orifice.
cobra head sign
ureterocele
posterior urethral valves affect swho?
male infants
vesicoureteral reflux (VUR)
horizontal insertion of ureters and get reflux.
what is the bladder urachus
attaches bladder to the abdo wall
can get infected
can become malignant (adeno)
renal masses by age
for SOLIDS
neonate
- nephrobnlastoma (Wilms)
- mesoblastic nephroma
around 4
- wilms
-lymphoma
- multilocular cystic nephroma
teenager
- rcc
- lymphoma
what are nephroblastomatosis
left over rest cells beyond 36 weeks. can be normal can turn to Wilms.
won’t be necrotic
what is a mesoblastic nephroma
fetal hamartoma. benign.
involves renal sinus.
can look like wilms but THINK OF AGE
cystic renal tumours for age
0 - 3
MDK
- no functioning renal tissues
can you be born with a Wilms tumour?
NO NO NO
wilms ax syndromes
bekwith-weidmen - macroglossia, omphalocele, hemihypertrophy, cardiac, big organs
sotos - macrocephaly, retarded (CNS stuff, ugly face
WAGR- wilms, anirirdia, genital, growth retarded
Drash - Wilms, Pseudohemaphroditism, prog glomerulonephritis
bekwith-weidmen -
macroglossia, omphalocele, hemihypertrophy, cardiac, big organs
sotos - macrocephaly, retarded (CNS stuff, ugly face
amnd WIlms
how to investigate Wilms
never biopsy
cystic renal mass in a 4 year old
Multilocular cystic nephroma
- non communicating fluid filled locules, surrounded by thick fibrous capsule
Neuroblastoma
occur in what age group
very young kids
Neuroblastoma
classically occur
abdo
but also thoracic and even eyes
Neuroblastoma
staging - what upstages it ?
midline
contralateral positive nodes all make it stage 3.
Neuroblastoma
ax
NF1
Hirschsprungs
DiGeorge
Beckwith wiedemann
Does wilms calcify
no - rarely (<10%)
neonatal adrenal haemorrhage can be caused by
bith truama / stress
adrenal haeorrhage on US
anechoic and avscular
most common cause of hydrometrocolpos
imperforate hymen
hydrometrocolpos is associated with
uterus didelphys
SACROCOCCYGEAL TERATOMA
most comon tumour of the fetus
ovarian masses are typically what kind
dermoids / teratomas (2/3)
what is a hydrocele?
collection of serous fluid.
painless scrotal swelling.
patent processus vaginalis
complicated hydrocele (one with septations)
hematocele or pyocele
clinical distinction
child
scrotal pain acutely
ddx
Testicular appendage torision
testicular torision
epididymo-orchitis
part of the epididymus is affected with epididymitis
head
isolated orchitis the
dx is
mumps
torsion of the testicular appendages
most common cause of acute scortal pain in which age group
7- 14 years
torsion of the testicular appendages
what sign is there on clinical
blue dot sign
testicle torsion can be caused by
failure of tunica vaginalis and testis to connect
extra testicular mass
will be rhabdomyosarcoma
testicular microlithiasis - what to do?
6 month follow up then yearly
highly depbated
Testicular cancer categories
Germ Cell
-seminoma
- non seminoma (teratoma, yolk sacs, mixed germ cells)
Non germ cell
–sertoli and leydig
which germ cell tumours are seen in first dcade of life
yolk sac tumour and teratoma
Marker in Yolk sac tumour
AFP super elevated
Sertoli cell tumours have what appearance
burnt out tumour with scar and calc.
sertoli cell tumour assocaited to..
Peutz Jeghers
Why can lymphoma hide in tests
blood testes barrier
testicular lymphoma appearance
multiple hypoechoic masses
in kids, fractures, get periosteal reaction in how many days s
7- 10 day
list Salter Harris classifications 1 - 5
SALTR
slipped.
Away form the joint
Lower.
Through.
Ruined, compression
what is a toddlers fracutre
oblique fracture of the midshaft of the tibia in a child learning to wlak
where do kids get stressed fracture
calcaneus - after a cast is removed
tibia - proximal posterior aspect
common paeds elbow fractures
Lateral condylar fracture
medial epicondyle fracture
uncommon paeds elbow fracture
medial condyle and lateral epicondyle
Nursemaids elbow is what
arm is pulled on, radial head can sublux ino the annular ligament
what is sinding-larsen-johansson
chronic traction injury on
insetion of the patellar tendon on the patella
in contrast to osgood schlatter
what is a cortical desmoid?
lucency at the back of the feumur condyles.
scoop like defect
provs a chronic tug lesion from the adductor magnus
what is Blounts disease
tibia vara
eg. Rickets.
Congenital rubella can affect neonatal bones how?
celery stalk appearance.
lucency of the metaphysis.
appear in first week of life
Syphilis neonatal bone changes
specific sign is
Wimberg sign
- periosteal reaction along medial portion of the proximal metaphysis of the tibia
Caffey disease is a disorder comprising of
soft tissue swelling
periosteal reaction
irritability
Caffey and hot bone scan
classically affecting
the mandible
clavicle and ulna are other sites
How does protaglandin therpay affect neonatal bones
causes periosteal reaction (shoulders)
often in kids who have had PDA kept open from prostaglandin therapy E1/E2
what is physiologic periostitis?
happends around 3 months, resolve by 6
Femur is involved then the sital tibia.l
Langerhans cell histiocytosis is also called what
EG
eosinophilic granuloma
skull classic appearance in LCH
bevelled edges
LCH in the spine get
vertebra plana
osteomyelitis in the bone end changes with age
why
to do with the epiphyseal plate.
very young has vessels across the plate, then these regress so there is no blood transport of bacteri across.
but once the palte fuses the infection can get across again
brachydactylu means
short fingers
syndactyly means
fused fingers
camptodactyly means
contractures of fingers
Clinodactyly meanss
inclinded fingers
amelia means
limb is absent
meromelia means
limb is mostly absent
acromelic means
hands and feet are short
mesomelic means
forearm and lower leg are short
Rhizomelic means
femur and humerus are short
micromelic means
short all over
which type of melic is achondroplasia
rhizomelic
vertebral bodies in thantophoric dwarfism are
flat
telhpone receiver femur
thanotrophic dwarfism
blue eyes, hearing impairement and lucent skull / multiple fractures
osteogenesis imperfecta
describe some of the bone features in osteogenesis imperfecta
fibula longer than tibia
hyperplastic callus around multiple fractures
lucent skull
wormian bones
flat/beaked vertebral bodies
bone in bone appearanve of vertebra relate to
osteopetrosis
what is pycnodysostosis?
osteopetrosis
wormian bones
acro-osteolysis
wide obtuse mandible
what is Klippel FeiL?
congenital fusion of the cervical spine
high riding scapula
list three mucopolysaccharidoses
Hunters / Hurlers / Morquio
vertebrla body shape in the muopolysaccharidoses
hands
oval shaped with anterior beak
hands - wide metacarpal bone with proximal tapering
Gauchers is what kind of disease
Lysosomal storage disease
Signs of gauchers
big spleen
big liver
avn of femoral heads
H shaped vertebra
bone infarcts
Erlenmeyer flask shaped femurs
what is a caudal regression syndrome
spectrum of disease
sacral / coccyx agenesis.
VACTERL and currarino traids syndromaes assocaited
what does talipes mean
congenital
what does Pes mean
foot
or
acquired
what does equines mean in context of foot
plantar flexed ankle
cavus foot
high arch
hindfoot valgus get what
lose the longitudinal arch as the talus has slid forward
hindfoot valgus causes
flat foot
dindfoot varus causes
club foot
Talocalcaneal coalition happens where
calcaneonaviuclar coaliton happens where
Middle facet
Anterior facet
what sign exists for the talocalcaneal coalition?
continuous C sign
vertical talus (equinus hindfoot valgus) is associated with what
myelomeningocele
sex dominance in DDH
female
DDH occurs due to
abnormal position in utero
more common in oligohydramniotic pregnancies
what are the risk factors for DDH
Female
irstborn baby
family histroy
breech
oligohydramnios
metatarsus adductus
spina bifida
normal alpha angle in Graf measurement s
60 degrees
Slipped Upper Femoral epiphysis
what is it and what imaging needsd to be done
Salter Harris 1 through the femoral physis - needs to be fixed .
Frog leg view is the radiographs needed
Male / Female preference of Perthes
boys
ages are 5 - 8
what sign tolook for on perthes frog leg view
subchondral lucency / crescent sign
age difference of Perthes vs SUFE
Perthes are younger 5 - 8
SuFE is teenager
fraying , cupping and irregularity along the physeal margin
whats the diagnosis
rickets
what is the anterior rib ends appearance in rickets
rachititc rosary
why does scurvy not occur before 6 months
maternal buffer
scorbutic rosary is assocaited to
scurvy
lead poisoning can cause what in the leg
wide sclerotic metaphyseal line
(doesn’t spare the fibula as might be expected in a normal vairant line)
what are the differentials for lucent metaphyseal bands
leukaemia
infection (TORCH)
neuroblastoma mets
endocrine (rickets and scurvy)
high supispicion fracturefor NAT
metaphyseal corner fracture/bucket handle (non ambulatory child)
posterior rib fracutres
non ambulatory todler fracture
which kind of skull fracture might be llegit accidnetal
parietal
Dating a fracture
Periosteal reaction
- less than a week
complete healing
- 12 weeks
which fractures heal without a periosteal reaction
metaphyseal
skull
costochondral junction
Classic NAI mimics
Rickets and OI - multiple fractures
what is choanal atresia
imaging
ax
oronasal membrane seperates the nasal cavity from the oral cavity
Thickened vomer on imaging
ax with charge
Congential piriform aperture stenosis
causes what to not form
further imaging
primary palate doesn’t form
have to image the brain as midlinedefects are associated
most common type of branchial cleft cyst is
2nd
why does fibromatosis coli look like there are two sometimes
two heads to SCM
Retinoblastoma
what is the significance of unilateral, bilateral and ?trilateral disease
unilateral - sporadic
bilateral and tri (pineal) - related to Chrom 13 auto dom.
RB suppressor gene on chrom 13 links to what tumours
melanoma
fibrosarcoma
osteosarcoma
retinoblastoma
what will retinoblatoma have on imaging
calcification
what causes ischaemia in a tethered cord
growth of spine quicker than cord, and pulling on the cord.
Secondary causes of tethered cord
myelomeningocele
filum terminale lipoma
trauma
what should get screened for tethered cord
anal atresia
which kind of dimples around the gluteal crease need screening
high dimples above the level of the crease
PERIVENTRICULAR LEUKOMALACIA IS CAUSED BY
`ischaemia to watershed areas.
after 1 -3 weeks get cystic change
Germinal matrix haemorrhage seen in
prem babies.
What age is germinal matrix only present in the caudothalamaic groove
32 weeks
nowhere by 36 weeks.
Premature suture closure
dolichocephaly
sagittal
Premature suture closure
trigonocephaly
metopic
pointed forehead
Premature suture closure
coronal
brachycephaly
Premature suture closure
plagiocephaly
unilateral lamboid
Premature suture closure
bilateral lamboid
turricephaly
