Rourke Baby Record -Physical examination- misc part 2

Question 1

What causes a cleft lip/palate

Answer 1

congenital

Question 2

What should you inspect for when looking for a cleft palate

Answer 2

Visual Inspection for cleft lip:

• Inspect the baby’s upper lip for any visible gaps, notches, or asymmetry.
• A cleft lip may be:
  Unilateral (one side of the lip).
  Bilateral (both sides of the lip).
  Complete or partial (affecting the lip only or extending into the nose).

Palpation for cleft lip
* Gently feel the lip for subtle irregularities if visual inspection is inconclusive.

Visual inspection for cleft palate:
* Gently open the baby’s mouth and use a light source to inspect the roof of the mouth (hard and soft palate).
* Look for a visible gap or abnormal opening in the palate.

Palpation for cleft palate:

• With a clean, gloved finger, gently run your fingertip along the palate.
• Feel for any discontinuity, hole, or unusual soft spot that may not be visible.

Inspect the Uvula:

• Check for a bifid (split) uvula, which may indicate a submucosal cleft.

Question 3

What can celft lips/palates cause

Answer 3

issues feeding leading to poor weight gain

Associated Conditions:

Clefts can occur as part of syndromes (e.g., Pierre Robin sequence), so further evaluation may be necessary.

Question 4

When does surgical intervention take place for lip and palate

refer to ENT

Answer 4

lip- 3-6 months of age
palate - 9-18 months of age to facilitate normal speech development

Question 5

What is occult spinal dysraphism

Answer 5

group of congenital defects of spinal and spinal cord

often not immediately visible but can lead to neuro issues if not dx’d

Question 6

What are 5 key things to look for when checking an infant for spinal malformations

Answer 6

• tufts of hair mildline lower back
• dimples near base of spine
• pigmented spots over the spine
• lipomas along back
• sinuses or fistulas near sacrum

If any of these skin findings are present, further imaging (typically an ultrasound or MRI of the spine) is required

Question 7

What can tufts of hair along spine indicate

Answer 7

Small patches of coarse or abnormal hair growth on the lower back, especially in the midline (usually in the lumbosacral region), can suggest an underlying spinal cord abnormality.

Question 8

What can dimples near base of spine indicate

Answer 8

Small, often non-raised areas of skin, typically near the base of the spine (sacral area). A dimple may have a pit or indentation at the base, which could indicate a tethered spinal cord

tethered cord or other structural abnormalities

Tethered cord syndrome (TSCS) is a nervous system disorder that occurs when the spinal cord is attached to the spinal canal wall, limiting its movement

Question 9

What does the presence of pigmented spots over spine indicate

Answer 9

associated with neurocutaneous syndromes or spinal dysraphism

Neurocutaneous syndromes are a group of rare, lifelong neurological disorders that cause tumors to grow in the brain, spinal cord, skin, organs, and bones. They are caused by abnormal cell development in the embryo and are characterized by skin differences and tumors in various parts of the body.

Spinal dysraphism, also known as a neural tube defect (NTD) or spina bifida, is a congenital condition that occurs when the spine and spinal cord don’t develop properly during pregnancy

Symptoms can range from mild to severe, and can include weakness, clumsiness, incontinence, sensory loss, and orthopedic deformities

Question 10

What does the presence of lipomas along the back indicate

Answer 10

form of spinal dysraphism

Spinal dysraphism, also known as a neural tube defect (NTD) or spina bifida, is a congenital condition that occurs when the spine and spinal cord don’t develop properly during pregnancy

Symptoms can range from mild to severe, and can include weakness, clumsiness, incontinence, sensory loss, and orthopedic deformities

Question 11

What does the presence of sinuses or fistulas near the sacrum indicate

Answer 11

Sinus or Fistula: A small, abnormal opening or tract in the skin near the sacrum can be associated with spinal defects, often resulting in the formation of a cyst or infection.

Question 12

What is an imperforate anus

Answer 12

congenital defect where opening of anus is absent or abnormal preventing proper bowel function

always check infants for anal patency by visual inspection and probing if necessary

Question 13

What are care instructions for an infants umbilical cord stump

2

Answer 13

• keep dry
• clean with mild soap and water PRN

Question 14

What is omphalitis

Answer 14

infection of umbilical cord stump

Question 15

What are s/s of omphalitis

Answer 15

redness, swelling, warmth, discharge, odor

Question 16

When should umbilical stump fall off by

Answer 16

3 weeks

Question 17

If umbilical stump has not fallen off by 3 weeks or shows signs of abnormal growth what should you suspect

Answer 17

umbilical granuloma (growth of tissues at stump site)

Question 18

Is neonatal jaundice common

Answer 18

yes common in first few days of life

Question 19

what typically causes jaundice of newborn

Answer 19

physiologic jaundice- results from the immature liver’s inability to fully process bilirubin, a byproduct of red blood cell breakdown

Question 20

When does physiologic jaundice typically resolve

Answer 20

self resolves by 2 weeks of age

Question 21

If jaundice lasts more than 2 weeks what should be suspected

Answer 21

pathologic jaundice- underlying issues like hemolytic disease, liver dysfunction, or biliary atresia.

Hemolytic disease is a term for a blood disorder that occurs when red blood cells are destroyed faster than the body can produce them

Biliary atresia is a serious liver condition that occurs when a baby’s bile ducts are blocked or don’t develop normally- results in liver damage

Question 22

What testing should be done if jaundice persists over 2 weeks of age

Answer 22

Bilirubin testing- total and conjugated (direct)

Question 23

What is total bilirubin and conjugated bilirubin

Answer 23

total–> direct and indirect bilirubin

conjugated–> refers to bilirubin that has been processed by the liver.
–> Elevated levels of conjugated bilirubin (direct bilirubin) are often more concerning, as they can indicate liver or biliary tract issues.

Question 24

What is biliary atresia

Answer 24

rare but serious liver condition where the bile ducts are blocked or absent, preventing bile from draining from the liver.

leading cause of cholestasis in newborns, the most frequent reason for cirrhosis and liver-related death in infants and children, and the foremost indication for liver transplantation in the pediatric population.

manifests exclusively in the first weeks of life with jaundice and pale (acholic) stools

Question 25

What are red flags for biliary atresia

2

Answer 25

• alcholic stools (play, clay colored indicated absence of bile in GI tract typically from blockage)
• prolonged jaundice that is primarily conjugated

Question 26

what is congenital muscular torticollis (CMT)

Answer 26

a condition in which an infant develops a twisted neck due to tightness or shortening of the sternocleidomastoid (SCM) muscle, one of the key muscles involved in neck movement

Question 27

What would you find on inspection that would indicate CMT in newborns

3

Answer 27

• head tilting to one side and the chin turning to the opposite side
• facial asymmetry (one ear being closer to the shoulder than the other, or one side of the face appearing more flattened due to positional skull deformities (like plagiocephaly))
• neck position - notice whether the child holds their head to one side in a persistent manner. Sometimes, babies may show preference for turning their head to one side while feeding or resting

Deformational, or positional, plagiocephaly is when a baby develops a flat spot on one side of the head or the whole back of the head

Question 28

What is often palpable in infants with CMT

Answer 28

palpable muscle mass over SCM- muscles may feel thickened or rope like

Question 29

How do you check ROM to test for CMT

3

Answer 29

• neck rotation left and right noting any restriction or resistance
• lateral flexion- tilt head from side to side noting any limitation in movement
• flexion and extension- can infant flex by bringing chin to chest and extend by tilting head backward

A limited range of motion or resistance to turning in one direction is a key sign of CMT.

TX typically PT, rarely sx intervention