7 Flashcards
Baby is acrocyanotic, has HR 120, grimace, regular respirations, good activity, and is resisting extension of muscles. What is score
9 (1 off for acrocyanosis)
What does APGARs stand for?
Appearance Pulse Grimace Activity Respirations
What pulse in APGARS is normal?
> 100
What is normal for respirations in APGARS?
Regular
Newborn s/p c-section with grunting and chest xr that shows hyperextended and wet lungs. What is likely cause?
TTN; self-limited, resolved by 48 hours; may need to provide PPV
35 week old with little air movement and increased respiratory effort. CXR shows hypoinflated lungs and atelectasis. What is going on and what to do?
RDS, give surfactant (ideally give corticosteroids to mom prenatally when premature)
Which babies are screened for hypoglycemia?
Abnormally sized (LGA, SGA, IUGR) and IDA (infants of diabetic mothers)
What is retinopathy of prematurity?
Neoangiogenesis due to oxygen requirement, can lead to retinal detachment or blindness; tx with laser ablation
Premature baby with bulging fontanelles. What dx is important to considers in premature babies, especially < 34 weeks
IVH, vascularity of ventricles highly susceptible to bp changes before involution at 34; dx with cranial doppler
Neonate with bloody stools and air in bowel (pneumatosis intestinalis) on XR. What is it?
Necrotizing Fascitis of Bowels
When can you say “failure to pass meconium”
Nothing after 48 hours
What’s on your ddx for failure to pass meconium?
meconium ileus, imperforate anus, hirschsprungs
What to consider in neonate with imperforate anus
VACTERL deformities (vertebral, anus, cardiac, trachea, esophagus, renal, limb)
Newborn fails to pass meconium. Did not have newborn screen. Likely diagnosis?
Meconium ileus due to CF. Remove with enema. Confirm dx with sweat chloride test.
What’s the path behind hirschprung disease?
Failure of migration of inhibitory auerbach/meissner plexus
A neonate has failure to pass meconium. On examination, a finger is placed in anus and there is explosive diarrhea. What is likely diagnosis?
Hirschsprung disease. Finger released block.
You suspect a child with FTPM has hirschsprung. What to do to diagnosis?
XR followed by imaging with contrast enema. Helps identify bad colon -> then biopsy and eventually surgically remove
Polyhydraminos, downs syndrome, bilious emesis. What is it?
Duodenal atresia; XR will show double bubble PLUS no gas beyond; tx is surgery
What is an annular pancreas?
Failure of pancreas apoptosis; effectively same as duodenal atresia (surgery will give you answer); primary problem of genetics (Downs associated)
What are four causes of bilious emesis?
Malrotation, duodenal atresia, annular pancreas, intestinal atresia
What two causes of bilious emesis are associated with Downs?
Duodenal atresia and annular pancreas
Newborn in hospital has non-biliious emesis, gurgling and bubbling. What should be done to diagnose?
NG tube with XR. Does it get to stomach or does it coil up indicating TE fistula; must provide parenteral nutrition until corrected surgically
When does pyloric stenosis manifest?
2-8 weeks
2 causes of non-bilious vomiting?
TE fistula, pyloric stenosis
4 week old, non-bilious projectile vomiting, olive-shaped mass, visual peristaltic wave. What to do?
Pyloric stenosis; US will show donut sign; Get labs; tx with pyloromyotomoy
A child has pyloric stenosis. What to do before surgery?
Make sure labs are good. If low Cl and K and metabolic alkalosis, give fluids and correct.
Four things to assess vomiting
How old is baby
Other defects/Downs
Color - bilious or not?
Projectile?
DDx for Conjugated/Direct Hyperbilirubinemia
Biliary Atresia
Sepsis
Metabolic Derangements
2 causes of unconjugated hyperbilirubinema
Hemolytic, hemorrhagic
Can conjugated/direct bili cross BBB?
NO, trapped in urine and will be excreted
Is unconjugated/indirect bili fat soluble?
YES, can cross BBB and cause kernicterus
Why does unconjugated hyperbili in first week of life called “physiologic jaundice”?
As a result of overwhelming the system, limited capacity of liver to conjugate. Watch it, expect to resolve by 1 weeks
Is conjugated hyperbili pathologic?
YES
Scaphoid abdomen, bowel sounds in lung fields, minimal breath sounds
Diaphragmatic hernia
Baby is born with intestines protruding into umbilical cord, protected by peritoneal layer. What is it?
Omphalocele - will be midline and bulging, looks like an O
Baby is one week old with jaundice, and labs show direct hyperbili. You suspect biliary atresia. What to do?
US first. If no duct, give phenobarbitol (stimulates bile production) and f/u with HIDA scan; tx is surgery
What serum marker in antenatal screen indicates neural tube defect?
AFP, will be increased
Newborn has out-pouching of lower back with just CSF. What is it?
Meningocele
What is in the out-pouching of myelomeningocele?
CSF and nerves
In FTT, which growth curve will change last?
Head circumference
When should a kid be able to ride tricylce?
3 yrs
When should stranger danger develop?
6 mo
When should a child be able to hop?
4 years
What is risk to pregnant mom when her toddler has parvovirus?
Hydrops
What is German Measles?
Rubella
Rash that starts at face and moves down
Measles and Rubella
Measles prodrome
Cough, coryza, conjunctivitis, koplik spots
What is potential future complication of measles
Subacute Sclerosing Pan Encaphilitis
Since mealses and rubella rash can appear similarly, how to differentiate?
Rubella = generalized and tender lymphadenopathy
Roseola prodrome
high-spiking fever (like 104), once fever breaks THEN rash develops
Is the rash of roseola exact opposite that of measles and rubella?
YES; roseola starts on trunk and THEN goes out to extremities and head
what NOT to use for fever mgmt in virus?
Aspirin - causes Reye syndrome
What do we call varicella in a kid?
chicken pox
Varicella in an adult?
Shingles
Unvaccinated pubertal male with parotid swelling and orchitis
mumps
What’s a potential complication of mumps?
infertility
What bug is responsible for hand foot mouth disease?
Coxackie A
What can be used to shorten duration of shingle outbreak?
Acyclovir
