Reading the Head in Children

What this deck covers

Reading the Head in Children in twelve illustrated clinical cases with worked explanations – case presentations built around clinical images, radiology, teaching illustrations and real laboratory data, with the reference range beside every value a case quotes. This visual, data-interpretation style of practice suits candidates preparing for MRCPCH AKP in particular, alongside Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

The twelve cases, in order

1. A long narrow head, and a ridge you can feel
2. A flat patch at the back of the head
3. A head on the ninety-first centile
4. A head that has fallen off its centile
5. A fontanelle that looks full
6. A fontanelle still open at eighteen months
7. A forehead with a keel down the middle
8. Two clinics, two different measurements
9. A ridge on the forehead, and nothing else
10. A baby who always looks the same way
11. One eyebrow higher than the other
12. A skull that gives under the finger

What this deck teaches

• The tape gives a number, not a diagnosis. Three of these twelve children have a head circumference on a perfectly normal centile and a skull that is not normal at all. Look down on the head as well as measuring it.
• A fused suture stops growth across itself. The skull then lengthens in the plane of the fusion, so the shape tells you which suture closed: long and narrow, keeled at the front, or flattened on one side.
• Ear forward is moulding, ear back is a suture. Positional flattening carries the whole side of the head forward into a parallelogram. A fused lambdoid suture tethers the corner and makes a trapezoid.
• Crossing centiles is the finding. A head that changes its rate of growth needs explaining whatever centile it has reached, and a soft fontanelle does not exclude it while the sutures are open.
• Normal at birth then falling away is acquired. The shape of the line separates a head that was always small from one that stopped growing, and it dates the insult without any imaging.
• A fontanelle is felt upright and settled. Crying and lying flat both raise it, so a full fontanelle in a screaming supine baby has to be felt again before it means anything.

Exam pearls from this deck

• A normal circumference does not mean a normal skull. Look from above.
• Ear forward is a parallelogram and moulding. Ear back is a trapezoid and a suture.

The twelve worked cases in this deck, with the images and the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all neurology illustrated case decks · neurology board questions for bank-style drilling · the free Pediatric Exam Review Sets · pediatric reference values.