March Week 2 (by Dr Nigra)

 GS and Serletti JM, Consultation with the Specialist: Pediatric Approach to Craniosynostosis. Pediatr. Rev., Oct 1998; 19: 352 – 359

1. What is the name of the suture line that runs down the middle of the forehead? What is the name for the keel-shaped deformity of the forehead type that a child gets if this closes prematurely?
A. Metopic suture, trigoncephaly
B. Lamboidal suture, brachycephaly
C. Saggital suture, scaphocephaly
D. Coronal suture, plagiocephaly

2. What are the features that demonstrate true lamboidal synostosis causing plagiocephaly, as opposed to deformational plagiocephaly?
A. palpable ridge over the suture line
B. ipsilateral occipitomastoid buldge
C. posterior displacement of the ipsilateral ear
D. tilt in the base of the skull when viewed from the back of the child’s head
E. trapezoidal shape of the head when viewed from the vertex
F. All of the above.

3. To what shape is the head of a child with deformational or positional plagiocephaly compared?
A. parallellogram
B. trapezoid
C. pentagon
D. triangle

4. What are the major ocular complications of craniosynostosis that we have to worry about?
A. proptosis and resultant exposure keratopahy
B. amblyopia secondary to ptosis and strabismus with orbital asymmetry
C. papilledema and optic atrophy, secondary to increased intracranial pressure
D. loss of conjugate vision from severe hypertelorism
E. All of the above.

5. Craniosynostosis of the sutures at the base of the skull can lead to midface hypoplasia. What are the possible complications?
A. upper airway narrowing, stridor, and sleep apnea
B. malocclusion
C. hearing problems
D. All of the above.

6. What would you recommend to a mother of a 2 month old child with positional or deformational plagiocephaly, after ruling out craniosynostosis?
A. change in position of the bed to encourage the child to look out into the room in the opposite direction
B. more tummy time
C. physical therapy to maximize range of motion of the neck
D. change of sleep position
E. All of the above.

7. What is the most useful diagnostic test to identify the skull shape and presence or absence of involved suture lines in suspected craniosynostosis?
A. Head CT with 3 dimentional reconstruction
B. Head ultrasound
C. Plain radiographs of the skull
D. Head MRI