Week 8 ped differences HEENT Flashcards
infant head
fontanels are open
suture lines palpable until about 6 months
infant neck
trachea is more cylindrical
lies deeper and is more flexible
child head
fontanels closed by 18-24 months
subtle changes in facial and skull bones
child neck
nose and thyroid cartilage enlarge in adolescent
trachea grows
infant lymphatic system
same distribution of nodes as in adult
small, mobile nodes may be palpable
unable to produce antibodies
child lymphatic system
tonsils may be enlarged
infant thyroid
difficult to palpate due to neck size
eye formation
during the first 8 weeks of gestation
- lacrimal drainage complete at birth
- by 2-3 weeks old gland begins producing full volume tears
vision development
term infants: hyperopic 20/400
peripheral vision fully developed at birth
- central vision develops later
3-4 months: binocular vision developed
6 months: infant can differentiate colors
4 years: adult visual acuity achieved
inner ear
development in 1st trimester
external auditory canal
shorter than in adults
eustachian tube
wider, shorter, and more horizontal than in adults
salvation
increased by 3 month
- more drooling
sinuses
maxillary and ethmoid present at birth, but small
frontal and sphenoid sinuses begin to develop around 3 years of age, complete development in late adolescence.
teeth
6-24 months: 20 deciduous teeth erupt
permanent teeth begin form in the jaw by 6 months old
- eruption begins around 6 years, completes around 14-15
plagiocephaly
head shape uneven on back of head
- cones out to one side
brachycephaly
flat back of head
- cones out laterally on both side
dolichocephaly
head shape cones out posteriorly
- long sides
Trisomy 21 signs
depressed nasal bridge epicanthal folds mongoloid slant of eyes low-set ears large tongue
fetal alcohol syndrome signs
poorly formed philtrum widespread eyes inner epicanthal folds mild ptosis hirsute forehead short nose thin upper lip
Pierre-Robin sequence
triad of
- micrognathia
- glossoptosis
- palatal clefting
positional molding
flattening
- contralateral occipital bossing (outward)
- ipsilateral ear displaced anteriorly
unilateral lambdoid synostosis
flattening of back of head
- parietal bossing (protrusion)
- ipsilateral occipitomastoid bossing
- ipsilateral ear displaced posteriorly (variable)
cholesteatoma
trapped epithelial tissue behind the tympanic membrane that is often the result of untreated or chronic recurrent otitis media
thyroglossal duct cyst patho
palpable cystic mass in then neck
- remnant of fetal development
– rises from the foramen cecum at junction of anterior 2/3 and posterior 1/3 of tongue.
-
thyroglossal duct cyst subjective
tenderness, redness, swelling in midline of neck
difficulty swallowing or breathing
thyroglossal duct cyst objective
freely moveable cystic mass in neck midline
moves upward with tongue protrusion and swallowing
may have small opening in skin, with drainage of mucus
branchial cleft cyst patho
congenital lesion formed by incomplete involution of brachial cleft
- epithelium-lined cyst with or without a sinus tract to overlying skin
branchial cleft cyst subjective
painless mass in lateral neck
may have intermittent swelling and tenderness
discharge if associated with a sinus tract
branchial cleft cyst objective
oval, moderately movable smooth, non-tender fluctuant mass along anteromedial border of sternocleidomastoid muscle
usually asymptomatic
if infected: tenderness and erythema
torticollis patho
shortening or excessive contraction of the sternocleidomastoid muscle
- often result of birth trauma or inter-uterine malposition
Acquired: tumor, trauma, CN IV palsy, muscle spasms, infection, drug ingestion
torticollis subjective
stiff neck, dec. ROM in neck
possible vision problem
torticollis objective
head tilted and twisted toward affected muscle with chin elevated and turned toward opposite side
hematoma may be palpated shortly after birth, and within 2-3 weeks
firm, fibrous mass may be felt in muscle
encephalocele patho
neural tube defect with protrusion of brain and membranes that cover it through openings in the skull
- failure of the neural tube to close completely during fetal development
- can occur anywhere on scalp
- genetic component: FHX of spina bifida or anencephaly
encephalocele subjective
before birth are visible only by intrauterine US or seen immediately after birth
encephalocele objective
visible sac of tissue protruding through skull
craniofacial abnormalities or other brain malformations
- hydrocephalus
hydrocephalus patho
problem in the formation, flow, or absorption of CSF that leads to an increase in volume of the CSF
- congenital malformation, infections
- acquired: intracranial mass, intracranial hemorrhage, meningitis, trauma
hydrocephalus subjective
poor feeding
irritability
dec. activity
vomiting
hydrocephalus objective
head enlargement separation of cranial sutures dilated scalp veins tense anterior fontanelle sunsetting sign inc. muscle tone: spasticity macewen sign
microcephaly patho
circumference of head is smaller than normal because the brain has not developed properly or has stopped growing
- present at birth, may develop in first few years of life
Congenital: infections, neuroanatomic abnormalities
microcephaly subjective
intellectual disability
microcephaly objective
head circumference is 2-3 SD below mean for age
Craniosynostosis patho
premature closure of one or more cranial sutures before brain growth completes
- leads to misshapen skull
craniosynostosis subjective
abnormally shaped skull, usually not accompanied by intellectual disability
craniosynostosis objective
skull growth restricted perpendicular to fused suture
if multiple sutures fuse while brain is still growing, intracranial pressure can increase.
retinoblastoma patho
embryonic malignant tumor arising from the retina
- develops during first 2 years of life
- autosomal dominant trait or chromosomal mutation (RB1 gene on chromosome 13)
retinoblastoma subjective
FHX of retinoblastoma
white reflex on photographs
retinoblastoma objective
leukocoria, a white reflex
ill-defined mass arising from retina on funduscopic examination
- chalky white areas of calcification
retinopathy of prematurity patho
disruption of normal progression of retinal vascular development in preterm infant
- abnml proliferation of blood vessels
retinopathy of prematurity subective
low birth weight preterm other associated factors - anemia - poor wt gain - blood transfusion - resp. distress - breathing difficulties
retinopathy of prematurity objective
straight, temporally diverted blood vessels on funduscopic examination
- can be mild with no visual defects, or refractive error, amblyopia, or progress to retinal detachment and blindness
retinal hemorrhages in infancy patho
abnml bleeding of the blood vessels in the retina
- shaken baby syndrome
- HTN
- bleedin problems/leukemia
- meningitis/sepsis/endocarditis
- vasculitis
- retinal disease
- anema
- hypoxia
retinal hemorrhages in infancy subjective
altered responsiveness without good explanation
- suspicion of physical abuse
retinal hemorrhages in infancy objective
dilated funduscopic examination shows retinal hemorrhages
