Variations Booklet Flashcards
What accounts for the general redness of the neonate?
High circulation rate, and thin skin
What happens to infant color with vigorous crying?
Purple lividity d/t sluggish circulation
What causes mottling?
General circulatory instability
What is the Harlequin color change?
a cutaneous condition seen in newborn babies characterized by momentary red color changes of half the child, sharply demarcated at the body’s midline
How do you differentiate ecchymosis from localized cyanosis?
Cyanosis has momentary blanching pallor
What is acrocyanosis?
Peripheral cyanosis of the neonate. Benign and transitory, unless accompanied by midline cyanosis
How does jaundice progress?
From head down
When is newborn jaundice concerning?
Before 24 hours of age, or persisting beyond 3 weeks
What are milia of the neonate? Is treatment warranted?
Common, benign keratin filled cysts that appear as superficial, uniform, pearly white to yellowish domed lesions measuring 1-2 mm in diameter
Arise from not fully developed sebaceous glands–No treatment needed
When do forcep marks disappear?
Within 2 months
What nerve may be affected with forceps/suction? What does this result it?
CN VII, resulting in facial palsy
Swelling of the head that crosses midline = ? What causes this? Is treatment necessary?
Caput succedaneum
Birthing process
Will resolve within a few days
What are cephalohematomas? Is treatment necessary?
Rupture of the subperiosteal
No treatment–will resolve within 2-3 weeks, but may need to monitor bili levels
Where does facial nerve injury usually occur?
At the exit of the nerve from the stylomastoid foramen
What is Mobus syndrome?
Failure of CN VII to develop in birth, resulting in permanent facial asymmetry, and an inability to suck
What is plagiocephaly? Is treatment needed?
a condition characterized by an asymmetrical distortion (flattening of one side) of the skull. It is characterized by a flat spot on the back or one side of the head caused by remaining in a supine position for too long
Self limiting
What is the eye color of most caucasians infants? Why?
Blue, due to a lack of pigment deposition
What are Brushfield spots, and what are they associated with?
Speckling of the Iris by white spots– associated, but not specific to Down syndrome
What causes the bluish tinge to the sclera of infants?
Immature sclera
True or false: Subconjunctival hemorrhages at birth are concerning
False– self limiting
When is visual fixation present and the ability to follow?
by term
How can you induce eye opening in an infant?
Hold them upright and tip them forward
Pupillary reflexes are developed when?
after 28-30 weeks gestation
True or false: nystagmus early in life is normal
True, but only for 3-6 months
What is Graefe’s sign?
A band of white sclera above the iris when the eyes are not moving. This is not indicative of intracranial HTN
What is the setting sun sign? What does this indicate?
Repeated head nods cause the irises to deviate downward, and appear to sink beneath the lower lids.
This can be benign, or indicate impingement of the dilated suprapineal recess on the tectum
True or false: the Doll’s eye movements should always be normal in an infant
True
What is the most common cause of chemical conjunctivitis in the newborn?
Use of silver nitrate drops in the treatment of gonococcal conjunctivitis
What is the etiology and prognosis for a subconjunctival hemorrhage in a neonate?
Usually d/t birthing trauma, but can be caused by coughing spells.
Self limiting.
What is the most common type of tumor in infancy?
Hemangiomas
What are nevus flammeus (port wine stains)? Prognosis?
Vascular malformations of mature, dilated dermal capillaries.
May involve hypertrophy of underlying structures, and poor self image
What is the most common vascular malformation of the infant?
-Salmon patches
What are salmona patches/stork bites?
Small pink-red patches on the infant’s neck eyes, or upper lids.
Benign and self limiting
What are strawberry marks? When do these usually appear? Prognosis?
Bright or dark red, raised/bump lesion on the head, chest or upper back, that looks like a strawberry, formed by hemangiomas.
At birth or in the first two months
Grows for several months, then fades, with complete disappearance by age 9
What are cavernous hemangiomas? Prognosis?
Large hemangioma that involved deeper layers of skin than strawberry marks. Also more blue in color.
Grow rapidly at first, but then shrinks at 12-18 months to completely fade away
What is nevus spilus? Prognosis?
Brown patch within which are darker flat or raised melanocytes
Benign unless grows a ton or has dysmorphic features
What are congenital pigmented nevi?
Birthmarks. Benign
What are mongolian spots? In whom do they usually occur? Prognosis?
Blue to slate gray areas on the back (usually) that look like bruises. More common in blacks, asians, and native americans. Disappear within the first year.
What are accessory nipples?
Solitary or multiple nipples in a unilateral or bilateral distribution along the anterior axillary fold.
Benign.
What is the prognosis for ankyloglossia?
Benign unless hinders speech
What is geographic tongue? Prognosis?
an inflammatory condition of the mucous membrane of the tongue characterized by areas of smooth, red depapillation which migrate over time
Totally benign.
What is the treatment for neonatal teeth?
Removal if present a choking hazard
How common is thrush in the neonate?
Somewhat common, and usually benign.
What are retention cysts? Prognosis/treatment?
Clusters of small, white or yellow follicles or ulcers on an erythematous base in the oropharynx
Self limiting.
What are epstein pearls? Prognosis/treatment?
White remnants of sebaceous glands on the hard palate. Benign and self limiting
What are mucoceles? Prognosis/treatment?
painless, bluish, fluctuant, tense papules on the lips, tongue, or buccal mucosa.
Resection is curative
What is congenital epulis? Prognosis/treatment?
Granular cell tumor found on the anterior maxillae.
Resection is curative.
What is the treatment for an absent antihelix?
Molding or otoplasty once greater than 5 yo
Before what gestational week is cartilage not present in any part of the ear? When is it fully formed?
34 weeks
37-40 weeks
What are the ear characteristics in fragile X syndrome?
Large and prominent
What are the ear characteristics with Patau syndrome?
Malformed
What forms at the same time the ear forms in gestation?
Genital tract
What abdominal organ pathology is correlated with low set ears?
Renal agenesis
What branchial arch does the pinna develop from? Tragus?
Second for pinna
First for tragus
What are preauricular skin tags/tragal defects associated?
Other first branchial cleft abnormalities, such as cleft lip/palate
What is cortical thumb, and what does it indicate?
Having thumb enclosed within the palm–can be normal and resolve by 7 months, or represent an UMN lesion
How can you differentiate cortical thumb that is a sign of UMN lesions, vs a benign, and solitary finding?
Look for other s/sx of UMN lesions such as muscle tone, tendon reflexes etc
What is the most common etiology of bowing of the legs?
Delivery trauma–assess for motor/sensory problems
What is the normal position of the legs in utero?
Hips-Flexed, abducted, and externally rotated
Knees-flexed and internally rotated
What happens to the number of creases on the sole of the foot with increasing gestational age?
Increases–none before 28 weeks, 37 weeks decent amount, and term cover entire surface
What is metatarsus varus (metatarsus adductus)? Prognosis/treatment?
Adduction and supination of the foot from molding during birth
Corrective treatment, but not surgery
What are cavus feet? Prognosis/treatment?
Exaggeration in the medial longitudinal arch, associated with hindfoot varus that appears later in childhood. Associated with spinal cord disease
May lead to compromised foot function, thus surgery is usually indicated.
What are flexible (pronated) flatfeet? Prognosis/treatment?
Benign and common finding of feet d/t bone laxity in the arches. Usually will improve by 6 years.
Can give arch support if does not resolve, but special shoes have not been shown to alter outcomes.
What is genu recurvatum? Prognosis/treatment?
Congenital hyperextension of the knees d/t molding in utero.
Responses to conservative treatment.
What is tibial torsion? Prognosis/treatment?
Internal (or external) tibial torsion causing intoeing. 2/2 normal uterine positioning. Usually appears in the second year of life.
Usually self limited and resolves with growth
What is femoral torsion? Prognosis/treatment?
Internal torsion of the femur that leads to gait abnormalities of unknown etiology.
Correct sitting posture if needed, but usually resolves on its own
What is developmental dysplasia of the hip? Prognosis/treatment?
“Dislocatable” hip (not truly dislocated) that are postnatal in origin, usually a result of breech presentation. May be a sign of neuromuscular disorder.
Splints and harnesses are used to correct this.
What is the Ortolani test?
Checking for laxity in the femoral head by lifting legs anteriorly
What is the most important test in assessing for developmental dysplasia of the hip?
Barlow Test
What are annular bands? Prognosis/treatment?
Constriction rings that involve one or more of the extremities, usually associated with LAD.
Treatment involves observation, unless there is a risk of amputation.
What is talipes equinovarus? Prognosis/treatment?
“clubfoot” where the foot is inverted and internally rotated. Can be an isolated abnormality, or indicative of neuromuscular disorders
Conservative treatment is indicated, but may require surgery.
What are calcaneovalgus feet? Is it usually unilateral, or bilateral? Prognosis/treatment?
Hyperdorsiflexed foot with forefoot abduction 2/2 in utero positioning. Usually unilateral.
Usually self limiting, with resolution in the first 6 months
