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מבחן גמר בילדים > פגות וגיל היילוד > Flashcards

פגות וגיל היילוד Flashcards

1
Q

APGAR score
time of mesurement

A

A- apperance
0- blue
1- pink body + blue extremiteis
2- pink
P-pulse
0-absent
1- < 100
2- >100
G- grimace (reflexs)
0- abscent
1- grimaces
2- grimces + coughs, cries, pulls away
A- activity (tone)
0- weak
1- some movments
2- active
R- respiration
0- abscent
1- slow, irregular + weak cry
2- normal breathing + vigorous cry

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2
Q

Apgar score:
whats its means to have the following scores:
0-3
4-7
8-10

A

0-3 - immidiate resuscitation
4-7 possible resuscitation, continue suppory and observe
8-10 no further untervention

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3
Q

Meconium aspiration syndrome

risk factor?
presentation?
mgmt?

A

Risk factors- Postterm infants (GA > 41)
Presenation- peinatal asphyxia or respiratory distress
Mgmt- induction of delivery prior 41 wks, respiratory support as needed. NO inhaled in severe cases

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4
Q

Persistent pulmonaey HTN of the newborn

definition?
presentation
Dgx?
Mgmt?

A

Pulmonary vascular resistance remain abnormally eleveted after birth (R –> L shunting

presenation- cyanosis + respiratory distrees in first 24h
Dgx- definite by ECHO- eleveted RV pressure + ecidance of pulmonary HTN

Mgmt- repiratory support and tx underline ceause

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5
Q

Transient tachypnea of the newborn (TTN)

what is the most common finding on X-ray?

and when it usally resolved?

A

Perihilar streaking

resolve within 24 - 72hours

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6
Q
A
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7
Q

infant born via rapid vaginal delivery and had rapid breathing and oxygenation issues shortly after birth.

which condition is most likley?

A

TTN
Transient tacypnea of the newborn

*also after C-section

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8
Q

What is the name of the sunstance that cover the newborn after delivery?

A

Vernix caseosa- importent to immunity

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9
Q

what is that in the newborn in reaction to cold?

A

Cutis mamorata- עור שיש

can be normal or secondary to infection/ neonates/ hypothyroidisim/ down

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10
Q

What is the main reason for central cyanosis in newborn

A

Cyanotic heart disease

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11
Q

what we see in this 2 photos

(unrelated to each other)

A

above- harlequin dyschromia- שינוי צבע זמני בילודים בחצי גוף / גפה אחת נובע מאי יציבותצ ווסקולרית זמנית

below- Mangiolian spots - dermal melanocytosis- שכיח בילדים כהי עור, לרוב חולף עד גיל שנתיים

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12
Q

Which disease a/w this finding

A

Cafe au leit

NF if > 6 spots

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13
Q

which disease is a/w this finding?

what we also need to check

A

port wine

Struge weber syndrome

eye testing- gluocoma
Brain MRI- leptomeningial angioma

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14
Q

What this finding in newborn, what can we see histologicllay

when disapear

A

Erythema toxicum
shows in 2-3 days of life

diseapper- after a week from newborn.

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15
Q

What is the name of this finding?
to whice type of infection its resembele?

A

Pustular melanosis
more in black babies.
could last months
resemble HSV or S.aureus

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16
Q

What is the findings?

A

Salamon patch
normal and mostly resolve withing the 1st year

more porminant in cry or Tm change

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17
Q

What is the name of this finding?

A

Milia

נובע מאצירת שומן בבלוטות שומן בפנים. נעלם תוך מספר שבועות מהלידה

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18
Q

Which newborn reflex disapear first and which one last for life?

A

dissapear first- rooting reflex
last for life- parachute reflex

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19
Q

When is the ant. and the post fortanelle closes?

A

ant. frontanella- 4-24 months
post- until 2 month of age (large fronatelle - suspect for hypothyroidism/ down)

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20
Q

Which type of hematoma crossing the suture line?

A

Subgleal hematoma

יכול להיות דימום מסיבי צריך לנטר

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21
Q

Which type of hematoma does not cross suture line?

A

Cephalohematoma- local hematoma sub periosteal, 1-2% of deliveries. no need to inteven

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22
Q

What is Craniosynostosis?

A

early closure of suture, causes abnormal skull stracture

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23
Q

Erb’s palsy

which nerves are demege and how can we tell in physical exmination?

A

C5-C6
non-symmetrical moro
Grasps normal unilateral

most of the time- fully recover

Tx- follow-up and exresice to prevent stroctures

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24
Q

איזו תסמונת גמילה מתבטאת באי יכולת להירדם, עיטושים, פיהוקים חוסר עלייה במשקל ופרכוסים

symptoms 1-5d after delivery SGA child

and which syndrome with the same clinical presentation but after 1-4 wks

A

1-5 days =Heroin
1-4 wks = metadhone

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25
Q

איזו תסמונת גמילה ביילוד מתבטאת לאחר כשבוע עם שיהוקים, תנועות פה חריגות אי שקט וחוסר שינה ולאחר מכן עם תאבון מוגבר, הזעות ומחזורי שינ מופרעים

A

Phenobarbital withdrwal

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26
Q

Which substance use is a/w
היפרדות שליה, אספיקציה, IUGR, Low IQ, מיקרוצפלוס

A

Cocaine

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27
Q

Which heart condition is a/w fetal alcohol syndrome?

A

mainly malformations in septum

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28
Q

what are the long term complications of fetal alcoghol syndrome?

A

בעיות קשב וריכוז, הפרעות התנהגות ובמקרים חמורים פיגור שכלי

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29
Q

When jaundice is consider pathological?

A
  • delivery < 24h
  • Bilirubin elevation rate > 5 mg/dl/day
  • Direct Bili > 2mg/dl
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30
Q

Causes of jaundice in the following time frame
* 24h
* 2-3days
* after 7 days
* > 1 month

A

24h- pathological
2-3days- Breastfeeding, sepsis, UTI
after 7 days- Breast-milk, sepsis, biliary atresia, hepatitis, galactosemia, hypothyroidism, CF
> 1 month- shypilis, Toxo, biliary atresia, galactosemia, hepatitis, pyloric stenosis, hypothyroidisim

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31
Q

Breastfeeding vs breastmilk jaundice

reasons for each one

A

breasfeeding- not enoughe milk = dhydration = concentrate of bili
tx- more feeding, using formula if needed

Breastmilk- substance inhibit the conjugtae enzyme
tx phototherapy

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32
Q

Which disease is a/w bronze baby syndrome

A

phototherapy to biliary atresia = high levels of direct bilirubin

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33
Q

most common cause of direct bilirubin in newborn

A

Biliary atresia

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34
Q

Which syndrome is a/w defect of the liver to excrete direct bilirubin and the liver has grossly black apperance with normal liver enzymes

A

Dubin Jhonson syndrome

rare to present in neonates

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35
Q

Which TORCHES inf. is most common cause of neonatal cholestasis?

A

CMV

but all of them can cause

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36
Q

Most common cause of ABO incompatibility ?
how many will actually develop hemolysis?

A

mom O
newborn A/B

only 10% with mismatch will develop hemolysis

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37
Q

which syndrome is a/w jaundice after stress?

isolated

A

Gilbert syndrome

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38
Q

Tx for Crigler najar syndrome?

A

Phenobarbital

severe damage in the enzyme that conjugate

only type II

type I- complete absence of the enzyme

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39
Q

what is the DDx for prolong jaundice?

A

Down
hypothyroidism
breastfeeding
Gilbert / Crigler najar

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40
Q

Biliary atresia
1. when jaundice show after birth?
2. colour of stool
3. Dgx- findings?
4. Tx?

A
  1. progressive jaundice around 1 wk after delivery
  2. a-cholic stool
  3. US- Triangular cod sign / small Gallbladder
  4. Tx- Kasai procedure- חיבור בן הכבד לדאודונום ליציאת המרה. עדיף לפני גיל 30 יום לפרוגנוזה טובה יותר
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41
Q

Which syndrome is AD, self resolving and a/w low bile ducts and destruction of the arcitecture?

A

Alagille syndrome

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42
Q

alpha1 anti-trypsin def will lead to destruction of intra or extra hepatic bile ducts?

A

intra hepatic
כולסטזיס כרוני עד אי ספיקת כבד
לעיתים מעורבות ראתית- COPD בלא מעשנים

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43
Q

when we will give IVIG in neonate jaundice?

A

jaundice due ABO or RH

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44
Q

Defintion of cholestasis in newborn

A

eleveted of direct bilirubin > 2 wks of age

direct hyperbilirubinemia is always pathological

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45
Q

cholestasis in newborn is diveded to intra and extra hepatic.

what are the causes of each one

A

extra hepatic- biliary atresia
Intra hepatic- Viral hepatitis, Alagille syndrome, idiopathic hepatitis, metabolic disase (like congenital hemochromatosis)

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46
Q

most common menefistation of algille syndrome in heart

A

peiphareal pulmonary atrial stenosis
common CHD- TOF

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47
Q

Butterfly vertebra and posterio embryotoxon is a/w?

A

Alagille syndrome

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48
Q

Mutation in JAG1 or NOTCH2 is a/w which syndrome?

A

Alagille syndrome

AD

49
Q

DDx for low production of RBC in the newborn?

4

A
  • Blackfan diamond anemia
  • fanconi anemia
  • infection- parvo B19, CMV, measels
  • congenital leukemia
50
Q

Which are the main 2 types of coombs + hemolysis anemia in the newborn?

A

ABO inco.
Rh inco

51
Q

How can we asses the severity of the anemia in the fetus ?

A

Spectophotometric analysis- asses the levels of bilirubin במי השפיר

52
Q

When we wil use Kleihauer betke test

A

identify FHb in the mother blood - Fetal-maternal hemmorage

53
Q

What is the test shown here?
what is the dark spots?

A

Kleihauer betke test

in dark- the fetal RBC

54
Q

When the newborn get to the nadir value of Hb?

A

around 8-12wks after delivery ~ around Hb10-11

55
Q

Chest X-ray of Meconium aspiration syndrome?

A

הצללות דיפוזיות, היפראינפלציה , עלייה בסיכון לפניאומוטורקס ופניאומומדיאסטינום

56
Q

What is a complication of Meconium aspiration syndrome?

A

Persistent PHN

57
Q

Tx for MAS (meconium aspiration syndrome)

A
  1. respiratory support
  2. Surfactant / NO
  3. ventilation

3-5% mortality

58
Q

Dgx of TTN (transient tachypnea of the newborn)

A

אבחנה שבשלילה

רק אחרי ששללנו - RDS or pneumonia

59
Q

CXR of TTN?

A

ציור ריאתי מוגבר, נוזל בסדק הבין אונתי, היפראינפלציה ולעיתים גם נוזל פלאורלי

60
Q

Risk factor of TTN

A

fist delivery
maternal asthma or DM
ceaser section
twins
post -term prenancy

61
Q

Prognosis of TTN?

A

Self resolving after 24-72hrs

62
Q

DDx for meconium plug?

A
  • CF- 40% of cases
  • hirshpung - 40% of cases
  • Barium enema
63
Q

Tx options for meconium plug?

A

self resolving - 30%
glycerine candels
Rectum wash with isotonic water
Gastrophin חוקן- helps 95% must given IV fluid with the procedure

64
Q

Meconium iliues.
what is the main etiology?

A

CF

65
Q

Tx for meconium ileus?

A

חוקן גסטרופין
אם אין תגובה / חשד לפרפורציה:
לפרוטומיה

66
Q

Meconium ileus on XCR

A

מעי דק מרוחב באופן בלתי שווה + מיקרוקולון

67
Q

RDS definition

A

חוסר בסורפקטנט המאפיין תינוקות שנולדים טרם המועד

68
Q

most common cause of respiratory distress in preterm infants?

A

RDS due to surfactant def.

69
Q

CXR of RDS

A

Ground glass or Great white out appearance
Air bronchogram

70
Q

Definiton of apnea of prematurity?

A

Respiratory pause > 20s or respiratory pause + O2 desatration and or bradycarda

Dgx pf exclusion

71
Q

Tx for apnea of prematurity?

A
  1. stable thermal enviroment- incubator / radient warmer
  2. O2 supplement 90-95%
  3. Caffeine
72
Q

when panea of prematrity typically resolves?

A

around 42 weeks of postmenstural age

73
Q

first line tx of RDS?

A

Surfactant

74
Q

Which ppx tx is recommended to reduce risk of RDS in preterm delivery at 34 WGA?

true also for babies for week < 37

A

Antenatal steroids

75
Q

which abdominal X-ray finding is the hallmark of NEC?

A

Pneumatosis intestinalis = gas within wall of intestines

76
Q

Which labratory finding in NEC is a/w poor prognosis ?

A

Neutropenia

77
Q

Which lab findings is correlate with NEC?

A

Hyponathremia
eleveted lactate&raquo_space; acidosis / metabolic or respiratory
pancytopenia

78
Q

What is the relations in NEC between onset of NEC and neonate age

A

as delivery was earlier&raquo_space; the onset of NEC will be later

79
Q

פג מתייצג עם בטן תפוחה וקשה, דם בצואה , לתרגיה ונראה טוקסי
בצילום חזה התמונה הבאה

מה האבחנה?

A

Pneumatosis intestinalis = pathognemonic for NEC

80
Q

immidiate mgmt for NEC

A

Bowl rest, de-compression
broad spectrum Abx- after culture

81
Q

a pre-term baby present with erythema and distention around the abdomen.

CXR showing the following picture.

what is the finding and what is the dgx?

A

pneumoperitoneum = air above the liver on lateral decubitus films = bowl perforaiton

82
Q

What are the indications for laprotomy in NEC?

A
  1. perforation / positive culture from peritoneumמוחלט
    יחסי
  2. clinical worsening on optimal therapy
  3. fixed loop
  4. erythema on abdomen surface

complication- Short bowl syndrome, strictures, infection and necrosis of wound

83
Q

prognosis of NEC + pneumatosis inestinalis?

A

20-50% fail under Tx

mortality rate 20-50%

84
Q

What is the most effective way to prevent NEC

A

Breastfeeding

85
Q

Risk factors for RDS

A

Maternal DM
low apgar score
previous kid with RDS
c-section

86
Q

Which clinical findings is a/w shock and RDS

A

בצקות פריפריות
איליוס
אוליגוריה

87
Q

When we will intubate RDS ?

A

Saturation O2% < 90% under CPAP
or
PH < 7.2
or
PCO2 ~60
or severe apnea

always add surfactant

88
Q

Tx for Hypotension in RDS
and For resistant Hypotension

A

Hypotension- IV fluids + Dopamine
Resistant Hypotension- Hydrocortisone (susp. adrenal insuff.)

89
Q

Empiric Abx for RDS

A

Ampiciliin + Gentamycin

90
Q

Intracranial ventricular hemmorhage

when it mainly occur? (after delivery)

A

3 days after delivery in neonates

91
Q

A neonate present in his 3rd day of life with hypotension, apnia and sezuries.

במישוש, המרפס פתוח והמטוקריט נמוך, שאינו מגיב למתן דם

מה האבחנה האפשרית?

A

IVH

92
Q

What are the complications of IVH

A
  1. PVL (perivantricular leukomalacia)- נגעים נקרוטיים / ציסטות בחמור הלבן,סממן לפגיעה דיפוזית מוחית הפוגיה במיאלנציה
  2. PPH (post hemorragic hydrocephalus)- follow-up on US and consider הכנסת נקז
  3. CP, seziures
93
Q

Prevention of IVH?

A

Celestone (steroids)- בסיכון ללידה מוקדמת
להיזהר בלידה מכשירנית

94
Q

What are the 4 grade of IVH

A

I- sub epyndymal. 15% risk for permenent neurologic deficit
II- in ventricles w/o enlargment
III- ventricals + enlargment of ventricles
IV- Ventricles + brain parencyma- 75% risk for permenent neurologic deficit

95
Q

Tx for PPH (post hemmoragic hydrocephalus)

A

VP shunt (when its progressive and symptomatic)

96
Q

When and to whom we will do US screeing of the brain?

A

all neonates < 32 wks, in day 3 and day 7 of life
and when reach to 36-40wks &raquo_space; evaluate PVL

97
Q

most sensetive way to asses PVL?

A

MRI

98
Q

Which cardian anomalies are a/w DM in pregnancy?

A

TGA, VSD

99
Q

Which disease is a/w all of the following presenation in the newborn
RDS- preterm
TTN- term
Jaundice
polyhydramnius
Kideny damage
sacral agenesis
Meconium pluglimbs deformations
hypoglycemia and hypocalcemia

A

DM

100
Q

what is Bronchopulmonary displasia (BPD)

A

Chronic lung disease a/w disruption of normal pulmonary development and injury to premature lungs

usally present infants with RDS who continue to depends on respiratory support beyond 28d of life / 36wks of postmenstrual age

101
Q

risk factors for Bronchopulmonary dysplasia

A

Fetal growth restriction
maternal smoking

102
Q

Dgx of BPD

A

neonate < 31 weeks - need O2 supplementation when 36 wks of age or discharge (the longest)
or
neonate >32 - needed O2 after 28-55 days

103
Q

CXR of BPD

A

היפראינפלציה ועכירות אינטרסציאלית
במצב חמור- שינויים ציסטים

104
Q

Common complication of BPD?

A

PHT ~15% of kids up to cor pulmonale and right heart failure

105
Q

how many kids with congenital CMV will be symp. at delivery?

A

~10%

106
Q

What cerachtristic uniqe for congenital CMV

A

Peri-ventricular calcifications
(in toxo its diffuse)
+
microchephalus (in toxo is macro)
hearing loss.

107
Q

What we see in lab of congenital CMV?

PLT count
Liver enzyme
Bilirubin
Hb?

A

Throbocytopenia
eleveted liver enzyme
direct bilirubin elevation
anemia

108
Q

Definite dgx of congenital CMV?

A

PCR in 3wks. from blood, urine or saliva

109
Q

Tx for Congenital CMV?

and what its side effect

A

Ganacyclovir - reduce hearing loss and improve development prognosis

Side effect- neutropenia and myelosuppression. can give GCSF or stop tx.

110
Q

Which congenital TORCES infection is a/w this picutre

A

Syphilis

Hutchinsons teeth

111
Q

Dgx of congenital rubella?

A

Rubella IgM
culture

must isolate the infected babies from pregnant womens- can secrete the virus fora whole year

112
Q

A newborn present with bulberry muffin rash + PDA + hearing loss and cataracts.

what is the most likely congenital inf.

A

Rubella

113
Q

Which congenital inf. is a-symtomatic at birth but shows up a few days later?

A

HSV

114
Q

A baby present with Chorioretinitis + macrochepalus + Diffuse brain lesions (enahance ring lesions)

what is the most likley congenital inf?

A

TOXO

115
Q

Tx for toxoplasma and who we treat?

A

Treat everyone- symp. or non symp

1 year tx of- Leucovorin, pyrimethamine, sulfadiazine
for hydrocephalus- shunt

116
Q

C/I for breastfeeding

maternal causes

5

A
  • HIV, HTLV
  • active TB- only after 2w of tx
  • VZV- baby should recive IVIG
  • HSV- if theres active lesion around breast area
  • Chemotherapy
117
Q

C/I for beastfeeding on the newborn

baby side

3 metabolic diseases

A
  • Galactosemia
  • Maple syrup
  • PKU
118
Q

Dgx of lactose intolerance?

and which formula should they get

A

Diarrhea , gases,

  • אבחנהחומרים מחזרים בצואה- מעיד על אי ספיגת פחמימות
    LactoFree Formula

מבחן גמר בילדים (23 decks)

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