ryan pediatric (part two)

Craniosynostosis

what is premature closure of the suture lines?

craniotabes

what is softening of the skull bones?

Ricketts and syphilis

what is craniotabes secondary to?

posterior (and then anterior)

what fontanel closes first?

swelling of the occipital parietal area secondary to vacuum extractor on the scalp

what is caput succedaneum?

1-2 days

when does caput succedaneum resolve?

flattening of the skull, often due to positioning

what is plagiocephaly?

torticollis

what is plagiocephaly associated with?

due to tightness of SCM, considered a packaging problem, could be due to birth injury

what is cervical torticollis?

hypoplasia of the jaw

what is micrognathia?

may form

with micrognathia, pending the cause, what might happen to jaw overtime with growth of child?

bruise from birth injury

what is cephalohematoma?

fistula from thyroid cartilage to skin

what is a thyroglossal duct cyst?

congenital cells remaining after formation of thyroid

what causes thyroglossal duct cyst?

dimpling of area or mass

if an infant has a thyroglossal duct cyst, what will be on neck?

birth injury from shoulder dystocia, seen with clavicle fracture

what is brachial plexus palsy associated with?

transient or permanent

brachial plexus palsy can cause what type of paralysis?

neck stiffness

what is nuchal rigidity?

in tripod position

if a pt has nuchal rigidity, how do they often present?

blinks, facial regard

what are visual milestones at birth?

fixes on objects

what are visual milestones at 1 month?

coordinated eye

what are visual milestones at 1 1/2-2 mos?

eye converge/reach

what are visual milestones at 3 mo?

20/50 acuity

what are visual milestones at 12 mos?

red reflex

for the funduscopic exam in peds pts, what should be evaulated?

20/40

what is the visual acuity at 3 years?

20/30

what is the visual acuity at 4-5 years?

20/20

what is the visual acuity at 6-7 years?

fixed

with strabismus, at 2-4 weeks of age, the eyes are...

coordinate and follow

with strabismus, at 5-6 weeks of age, the eyes...

freely focus

with strabismus, at 3 months of age, the eyes...

birth injury, trauma, coughing

what causes subconjunctival hemorrhage in infant? older child?

white specks on iris, can be normal

what are brushfield spots?

downs

what can brushfield spots be seen in?

dacrosytenosis

what is narrowing of the tear duct?

startles/blinks

what is auditory acuity for 0-2mos?

facial or body response

what is auditory acuity for 2-3 mos?

turns eyes/head to sound

what is auditory acuity for 3-4 mos?

turns to voice/conversation

what is auditory acuity for 6-7 mos?

check canals (that's it... don't do ear exam on newborns)

what should be done for otoscopic exam in infants?

congenital condition, can have normal auricle and canal atresia, usually seen in syndromes

what is auditory atresia?

10 months of age

for dental development, when do teeth erupt by?

5-7 months

what is the average age for eruption of the lower central incisors?

20 teeth

how many teeth should be present by age 26 months?

6-7 years of age

when does shedding of baby teeth begin?

too much fluoride

what is fluorosis caused by?

no (cosmetic concern)

is fluorosis pathologic?

0.25 mg

what is the fluoride dose for 6 months-3 years (for those who do not have it in their water supply)?

0.5 mg

what is the fluoride dose for 3-5 years (for those who do not have it in their water supply)?

1 mg

what is the fluoride dose for 5-14 years (for those who do not have it in their water supply)?

birth injury that causes trauma, congenital obstruction

what can cause choanal atresia?

child is a mouth breather

what is a sign that a child might have choanal atresia?

hold mouth closed and then hold closed one nostril at a time

how can you test for patency when choanal atresia is suspected?

mucous retention cyst, benign

what are mucoceles?

ankyloglossia ("tongue tied")

what is the medical term for prominent frenulum?

feeding and speech

if ankyloglossia is not treated, what might it interfere with?

thrush, not easily removed with scraping

what is oral candidiasis?

no teeth to serve as barrier (usually lessens with development of teeth)

why do babies drool?

retention cysts found on hard palate

what is epstein perles?

hypothyroidism and hypocalcemia

what is laryngeal hoarseness seen in?

increased ICP, narcotic addiction

a shrill high-pitched cry can be found in episodes of...

paralysis, MR, severe illness

what is absence of cry or voice found with?

congenital lack of fusion in mid-maxillary area, often associated with lip involvement

what is cleft palate?

hyperresonant

describe lung sounds on child on percussion

stills murmur

what is a functional murmur aka?

coarctation

it is important to check the femoral pulse for what?

stills murmur, venous hum, cardiac bruits, pulmonary branch stenosis

what are normal cardiac findings that disappear w growth?

protuberant due to weak abd mm

describe shape of abdomen of child

bring knees up (relax mm)

how should pt be positioned to palpate the abdomen?

2 weeks

the umbilical cord falls off in...

18 mo

when does hydrocele usually resolve?

inguinal hernia

what does hydrocele increase the potential of?

12 mo

when should testicles be descended by?

CA and infertility

cryptorchidism increases the risk of...

poor hygiene or trauma

what are labial adhesions secondary to in infants?

physiological leukorrhea, foreign body

what can cause vaginal discharge in infant?

intraabdominal disease, pelvic or rectal disorder

when is a rectal exam indicated for pediatric pt?

infants

when is bow legged normal?

18 months to 6-7 years of age

when is knocked knee normal?

unstable hip

what is Barlow's sign evaluating for?

Barlow's sign

what test in hip exam is actually subluxing (partially dislocating) the joint?

hip dislocation

what is ortolani's sign evaluating for?

Ortolani's sign

what test in hip exam actually reduces the dislocation?

congenital anomaly or hemorrhage

what is cranial n deficiency a concern of?

CN XII

what CN is tested by pinching nostrils to see if mouth opens?

abnormal

the neuro exam is ___ if primitive reflexes are absent, present longer than normal, or associated with posturing/twitching

6 months in most infants (may last up to 24 months)

Babinski-fanning of toes typically will last up to...

eyes blink with light stimulus

what is blinking reflex?

acoustic blinking reflex

what is the reflex called when eyes blink in response to sound?

goes away over time (get used to stimulus)

what is habituation w the blinking reflex?

birth to 4 months

when is the rooting reflex (CN V) present?

curves toward stimulated side

what is Galant's?

birth to 2 months

when is Galant's trunk incurvature present?

birth to 2 months (t)

when is tonic neck reflex present?

CP

after 2 months, what is tonic neck reflex a persisting concern of?

startle reflex from loud noise to sudden movement

what is the moro reflex?

4 months

how long does moro reflex last?

parachute reflex (extensor reflex)

what is the reflex where when held in the prone position an infant slowly lowers the head and extends arms and legs in protective manner?

begins at 8 months and does not disappear (protective response)

when does parachute reflex begin and disappear?

suspend baby in prone position, head lifts up and spine straightens

what is Landau reflex?