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Morning Report

COLLEEN MARTY

 JULY 6, 2015

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In clinic…

!"tient pre#ent# $or %&o 'ell c(il) c(ec*

No #peci+c p"rent"l concern#, ecept t("t (e(") perio)# )-ring '(ic( (e '"# re"ll. $-##."ro-n) / &ont(# -t t(e#e #ee& to e gettingetter

or&-l" $e) "n) e"ting 'ell

leeping t(ro-g( t(e nig(t 536 )".#4'ee*

Meeting &ile#tone#

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A))ition"l i#tor.

!"#t Me)ic"l i#tor.

Neg"ti7e 7on 8iller"n)9# p"nel prior to circ-&ci#ion

"&il. Me)ic"l i#tor.

Mot(er 'it( 7on 8iller"n)9#

Mot(er 'it( )epre##ion

oci"l i#tor.

Li7e# 'it( Mo& "n) :")

:") i# pri&"r. c"regi7er '(ile Mo& 'or*# )-ring t(e)"., (o'e7er Mo& recentl. ;-it (er

in"nce# "re tig(t, -t t(e. ("7e ")e;-"te $oo) "n)nece##itie#

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8eig(t

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eig(t

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e") Circ-&$erence

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!(.#ic"l E"&General: Alert, "cti7e in$"nt o., #&iling "n) inter"cti7e Crie# 'it( e"& -t e"#il.

con#ol"le

Skin: :r., ro-g( &"c-lop"p-l"r r"#( on il"ter"l "r "n) #c"lp 'it( "re"# o$ecori"tion

Head: M"crocep("lic 'it( pro&inent, l"rge $ore(e") Anterior $ont"nelle $-ll '(enre#ting "n) -lging 'it( cr.ing

Eyes: cler"e '(ite, p-pil# e;-"l "n) re"cti7e, re) re?e nor&"l il"ter"ll.

Ears: Nor&"l il"ter"ll.

Nose:  Cle"r

Mouth: No perior"l or gingi7"l c."no#i# or le#ion# Tong-e i# nor&"l in "ppe"r"nce

Lungs: Cle"r to "-#c-lt"tion il"ter"ll.

Heart: Reg-l"r r"te, reg-l"r r(.t(&, no &-r&-r, no g"llop or r-, nor&"l 1 @ 2 "n)nor&"l perip(er"l p-l#e#

Abdomen: o$t, non3ten)er o'el #o-n)# nor&"l no &"##e#, no org"no&eg"l.

GU: Nor&"l &"le 3 te#te# )e#cen)e) il"ter"ll. "n) circ-&ci#e)

Femoral pulses: pre#ent il"ter"ll.

Extremities: etre&itie# nor&"l

Neuro: Alert, &o7e# "ll etre&itie# #pont"neo-#l., no (e") l"g, #it# 'it( #-pport, lo'eretre&itie# #lig(tl. (.pertonic "lt(o-g( e"& li&ite) )-e to p"tient "git"tion4cr.ing

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% &ont( ol) &"le'it( ne' on#et

&"crocep("l.

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 T"le

Co&&on c"-#e# o$&"crocep("l. in c(il)ren

EE U!3TO3:ATE ARTICLE

MACROCE!ALY IN INANT AN: CIL:REN

http://www.uptodate.com/contents/image?imageKey=PEDS/74157&topicKey=PEDS%2F2849&source=outline_link&search=macrocephaly+children&selectedTitle=1%7E70&utdPopup=truehttp://www.uptodate.com/contents/image?imageKey=PEDS/74157&topicKey=PEDS%2F2849&source=outline_link&search=macrocephaly+children&selectedTitle=1%7E70&utdPopup=true

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 T"le

Clinic"l $e"t-re# o$ #electe)#.n)ro&e# "##oci"te) 'it(&"corcep("l.EE U!3TO3:ATE ARTICLE

MACROCE!ALY IN INANT AN: CIL:REN

http://www.uptodate.com/contents/image?imageKey=PEDS/75193&topicKey=PEDS%2F2849&source=outline_link&search=macrocephaly+children&selectedTitle=1%7E70&utdPopup=truehttp://www.uptodate.com/contents/image?imageKey=PEDS/75193&topicKey=PEDS%2F2849&source=outline_link&search=macrocephaly+children&selectedTitle=1%7E70&utdPopup=true

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Nor&"l e") Bro't(

e") gro't( D Bener"l g-i)eline# reg"r)ing (e") gro't(, "re?ection o$ r"in gro't(, incl-)e t(e $ollo'ing

T(e "7er"ge (e") circ-&$erence "t irt( i# 1/F inc(e# =/5

c&>

e") circ-&$erence -#-"ll. i# 0% to 0G inc(e# =1 to 2 c&>l"rger t("n c(e#t circ-&$erence "t irt(

e") circ-&$erence incre"#e# "pproi&"tel. 0%inc(e#4&ont( =1 c&4&ont(> )-ring t(e +r#t .e"r o$ li$e, 'it( t(e

&o#t r"pi) gro't( occ-rring )-ring t(e +r#t #i &ont(#, 'it( "n

incre"#e o$ 0G inc(e# =2 c&> in t(e +r#t &ont( "n) 2F inc(e#=6 c&> in t(e +r#t $o-r &ont(#

Hr"in 'eig(t )o-le# . $o-r to #i &ont(# o$ "ge "n) triple#. one .e"r o$ "ge

T(e &"

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 T"leMe"#-re&ent o$ (e")circ-&$erenceEE U!3TO3:ATE ARTICLE

MACROCE!ALY IN INANT AN: CIL:REN

http://www.uptodate.com/contents/image?imageKey=PEDS/70799&topicKey=PEDS%2F2849&source=outline_link&search=macrocephaly+children&selectedTitle=1%7E70&utdPopup=truehttp://www.uptodate.com/contents/image?imageKey=PEDS/70799&topicKey=PEDS%2F2849&source=outline_link&search=macrocephaly+children&selectedTitle=1%7E70&utdPopup=true

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M"crocep("l.

M"crocep("l. OC gre"ter t("n t'o : "o7et(e &e"n $or gi7en "ge, #e, "n) ge#t"tion =FK ile>

E7"l-"tion #(o-l) e initi"te) 'it(

ingle "nor&"l &e"#-re&ent

!rogre##i7e enl"rge&ent

Incre"#e in OC 2c&4&ont(

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I&port"nt i#tor. "n)

E"& in)ing# ign# o$ ele7"te) IC!, tr"-&", or in$ection  

-rgent e7"l-"tion

.n)ro&ic $e"t-re#  con#i)er )i#c-##ing 'it(

genetic#

:e7elop&ent"l )el".  ne-roi&"ging

Nor&"l )e7elop&ent, re"##-ring e"&  &e"#-re OC# o$ 1#t )egree rel"ti7e# =plot on

t(e 'e"7er c-r7e>, -ltr"#onogr"p(.

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ig-re8e"7er C-r7eEE U!3TO3:ATE ARTICLE

MACROCE!ALY IN INANT AN: CIL:REN

http://www.uptodate.com/contents/image?imageKey=PEDS%2F80059&topicKey=PEDS%2F2849&rank=1%7E70&source=see_link&search=macrocephaly+children&utdPopup=truehttp://www.uptodate.com/contents/image?imageKey=PEDS%2F80059&topicKey=PEDS%2F2849&rank=1%7E70&source=see_link&search=macrocephaly+children&utdPopup=true

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I&"ging Con#i)er"tion#

!l"in r")iogr"p(#

in)ing# o$ #*elet"l ).#pl"#i"

Incre"#e) IC! ='i)ening o$ #-t-re#, pro&inent &"r*ing# on t(einner t"le o$ t(e #*-ll, ero#ion o$ t(e #ell" t-rcic">

Ultr"#onogr"p(.

in$"nt# 'it( nor&"l ne-ro)e7elop&ent"l e"&in"tion

no e7i)ence o$ incre"#e) IC!

 open "nterior $ont"nelle

MRI "n) CT Anor&"l ne-ro e"&

!rogre##i7el. enl"rging OC

Incre"#e) IC!

Clo#e) "nterior $ont"nelle

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C"#e Contin-e)

I&"ging t-)ie# U Encep("logr"p(. Etr"3"i"l #p"ce Etr"3

"i"l #p"ce# "re enl"rge) T(e#-"r"c(noi) &e&r"ne "ppe"r# to e p-#(e)

)o'n onto t(e #-r$"ce o$ t(e r"in T(e ?-i) int(e etr"3"i"l #p"ce# ("7e#o&e intern"l ec(oe#

I&pre##ion Enl"rge) #-)-r"l #p"ce# 'it(co&ple ?-i) in t(e

#-)-r"l #p"ce# T(i# i# 'orri#o&e $or #-)-r"l(e&orr("ge

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Initi"l e") CT =124201%>

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I&"ging Cont9)

CT Hr"in 8O Contr"#t

I&pre##ion1 Mo)er"te enl"rge&ent o$ t(e etr"3"i"l ?-i) #p"ce#

.?-i) '(ic( i# (.per)en#e to intr"7entric-l"r C,#-gge#ting#-)-r"l (.gro&"# 7er#-# c(ronic #-)-r"l(e&"to&"#, 'it( -lging o$ t(e $ont"nelle "n) #pl".ingo$ t(e cr"ni"l #-t-re# No #*-ll $r"ct-re note) MRI 'it(contr"#t reco&&en)e) $or $-rt(er e7"l-"tion i$ clinic"ll.in)ic"te)2 Mil) enl"rge&ent o$ t(e l"ter"l "n) t(ir) 7entricle#Nor"in p"renc(.&"l "nor&"lit. i)enti+e)

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I&"ging Cont9)

R O##eo-# -r7e. Nor&"l

Op(t("l&olog. e"& No retin"l (e&orr("ge#Nor&"l 7i#-"l "c-it.

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L" 8or*3-p

CHC 8HC 1F6 =12K N, F5K L, 55K Eo#>,ct /56, !lt 556

CM! ALT %, AT FF, C" 10%

!T4INR 12140

!TT /5

on 8iller"n) !"nel 'nl =Ag, 8, "n) "ctorIII Acti7it.

"ctor I 3 'nl

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ollo' -p e") CT

=%42015>

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O-tco&e# o$ In$"nt# 'it(

 THI

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O-tco&e# $or In$"nt#

'it( THI  Yo-nger c(il) "ge "t in

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Ongoing M"n"ge&ent

Clo#e &onitoring $or ne-ro)e7elop&ent"l)el".#

E"rl. Inter7ention re$err"l

Re(" re$err"l

!"rent"l #-pport

oci"l #er7ice#