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Pediatrics shelf > BRS pediatrics > Flashcards

BRS pediatrics Flashcards

1
Q

Strawberry hemangiomas? When do they resolve? Do they need intervention?

A

Benign proliferative vascular tumors
Increase in size after birth but resolve in 18-24 months
Intervene if they compromise vision or airway

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2
Q

When is neonatal acne seen?

A

After 1-2 weeks of life

  • Virtually NEVER present at birth
  • No treatment necessary
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3
Q

MIcrocephaly is head circumference under the ___ percentile

A

Under 10th percentile

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4
Q

Caput succedaneum?

A

Diffuse edema or selling of soft tissue of scalp that crosses the cranial sutures and usually the midline

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5
Q

Craniotabes?

A

Soft areas of the skull with a “ping pong ball” feel

  • NOT related to rickets
  • Disappears within weeks or months
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6
Q

Cephalohematoma?

A

Subperiosteal hemorrhages 2/2 birth trauma confined and limited by cranial sutures (usually involves parietal or occipital bones)

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7
Q

Craniosynostosis?

A

Premature fusion of the crania sutures –> results in abnormal shape and size of skill

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8
Q

An abnormal red reflex can be caused by ____ (examples)

A

Cataracts
Glaucoma
Retinoblastoma
Severe chorioretinitis

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9
Q

Pierre Robin syndrome?

A

Micrognathia (small chin)
Cleft palate
Glossoptosis (downward displacement or retraction of tongue)
Obstruction of upper airway

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10
Q

Macroglossia might be seen in?

A

Beckwith-Wiedemann syndrome (hemihypertrophy, visceromegaly, macroglossia)
Hypothyroidism
Mucopolysaccharidosis

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11
Q

Epstein pearls?

A

Small, white, epidermoid-mucoid cysts found on gum, hard palate
- Usually disappear in a few weeks

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12
Q

Diminished femoral pulses? Increased femoral pulses?

A

Diminished: Coarctation of aorta
Increased: PDA

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13
Q

Presence of one umbilical artery might suggest ______ in a newborn

A

Congenital renal anomalies

- Umbilical cord should have TWO umbilical arteries, ONE vein, and ABSENCE of urachus

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14
Q

Normal newborn heart rate?

A

95-180

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15
Q

How to dx respiratory distress?

A

RR: >60
Deep respirations
Cyanosis
Expiratory grunting
Intercostal or sternal retractions
BUT PRETERM INFANTS HAVE PERIODIC BREATHING THAT HAS NO CLINICAL SIGNIFICANCE
- Irregular breathing with short, apneic bursts that last 5-10 seconds

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16
Q

Poland syndrome?

A

Absence of formation of ribs or agenesis of the pectoralis muscle
- Look for chest asymmetry

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17
Q

Diastasis recti?

A

Separation of the left and right side of the rectus abdominis at the midline of the abdomen. It is a common condition in newborns, especially in premature and African American infants.
- No tx necessary; will gradually disappear as muscle grows

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18
Q

Umbilical hernia in an infant must be treated. T/F?

A
  • Most close spontaneously and usually no treatment is required.
  • Persist beyond 4–5 years of age and those that cause symptoms may require surgical treatment.
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19
Q

Urine draining from the umbilicus?

A

Think PERSISTENT URACHUS

- Failure of the urachal duct to close –> fistula between bladder and umbilicus

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20
Q

Meconium plug? Meconium ileus? When is meconium usually passed?

A
  • Meconium plug is obstruction of the left colon and rectum caused by dense dehydrated meconium.
  • Meconium ileus is the occlusion of the distal ileum caused by inspissated (thickened and dried) and viscid meconium, usually secondary to a deficiency of pancreatic enzymes and the resulting abnormally high protein content of intestinal secretions.

Meconium plug and meconium ileus, which can be the first manifestations of cystic fibrosis, cause delay in the elimination of meconium, resulting in abdominal distension.

Normally, meconium stool is passed within 24 hours after birth in 90% of term infants and within 48 hours in 99%.

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21
Q

Most common cause abdominal mass in neonate?

A

Hydronephrosis
Other:
- Multicystic kidneys
- Ovarian cysts

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22
Q

What other things might be present if you feel the liver on the LEFT side of a infant?

A
  • Situs inversus
  • Asplenia
  • Polysplenia syndrome
23
Q

Hydrometrocolpos cause?

A

Caused by an imperforate hymen with retention of vaginal secretions.

It presents as a small cyst between the labia at the time of birth or as a lower midline abdominal mass during childhood.

24
Q

Hypo vs epispadias; which is associated with other urinary malformations?

A

Epispadias is often associated with bladder extrophy

Hypospadias is NOT associated with an increased incidence of associated urinary malformations

25
Q

When do the testes descend in males with cryptorchidism?

A

In most males with cryptorchidism, the testes de- scend spontaneously before 12 months of age. Cryptorchid testes that do not descend by this age are predisposed to future malignancy.

26
Q

Rocker bottom feet is associated with?

A

Trisomy 18

27
Q

Absence of hypoplasia of the radius may be associated with?

A

TAR syndrome (Thrombocytopenia Absent Radii)
Fanconi anemia
Holt-Oram syndrome

28
Q

Edema of feet and hypoplastic nails is characteristic of:

A

Turner syndrome

Noonan syndrome

29
Q

What is noonan syndrome?

A

“Male Turner syndrome” but can be seen in women

  • Chromosome 12 disorder
  • Short stature, shield chest
  • Short webbed neck with low hairline
  • Hypertelorism (wide spaced eyes)
  • Epicanthal skin folds, downslanting palpebral fissues, low set ears
  • Right sided heart lesions like PULMONARY VALVE STENOSIS (vs Turner’s who have LEFT sided heart lesions)
  • Mental retardation in 25%
30
Q

What defines preterm delivery?

A

Less than 37 weeks from the first day of the LMP

- 7% of all births

31
Q

Complications of being preterm?

A 
Disrupted mother–father–infant interaction Perinatal asphyxia
Hypothermia
Hypoglycemia
Hypocalcemia
Respiratory distress syndrome (hyaline membrane disease; surfactant deficiency syndrome) Fluid and electrolyte abnormalities
Indirect hyperbilirubinemia
Patent ductus arteriosus
Intracranial hemorrhage
Necrotizing enterocolitis
Infections
Retinopathy of prematurity
Bronchopulmonary dysplasia
Anemia
32
Q

Post term delivery is defined by? Complications?

A

42 weeks or more from first day of the LMP

  • increased incidence of fetal and neonatal morbidity and death from the consequences of placental insufficiency including:
    • severe intrauterine asphyxia
    • meconium aspiration syndrome
    • polycythemia
33
Q

What is considered small for gestational age (SGA) and LGA?

A

SGA: Infants that are born weighing below the fifth percentile for corresponding gestational age as a result of IUGR are considered SGA.

LGA: Newborns are considered LGA if their birth weight is > 90th percentile for their gestational age at birth. These infants should be distinguished from those infants born with high birth weight (birth weight >4,000g). A newborn maybe LGA with a birth weight >90th percentile for the gestational age at birth, without having an absolute birth weight above 4,000 g.

34
Q

Clinical problems of SGA infants?

A 
Perinatal asphyxia
Hypothermia
Hypoglycemia
Polycythemia
Thrombocytopenia
Hypocalcemia
Meconium aspiration syndrome
Intrauterine fetal death
Hypermagnesemia (if mother is treated with magnesium for hypertension or preterm labor)
35
Q

Common causes of increased weight/LGA?

A

Maternal diabetes
Beckwith-Wiedemann syndrome
Prader-Willi syndrome
Nesidioblastosis (diffuse proliferation of pancreatic islet cells)

36
Q

LGA infant complications?

A

hypoglycemia and polycythemia

37
Q

How do you define cyanosis

A

Directly related to the absolute concentration of UNOXYGENATED or REDUCED hemoglobin

  • > 3 g/dL of reduced Hgb in arterial blood
  • > 5 g/dL of reduced Hgb in capillary blood
38
Q

Initial steps in evaluation cyanotic infant?

A
  • detailed history and physical examination
  • serum electrolytes
  • serum glucose
  • arterial blood gas (ABG; ± 100% oxygen test; 100% O2 helps determine if its a cardiac or respiratory cause)
  • CBC
  • CXR
  • At times: cultures, pre- and post-ductal PaO2 measurements, electrocardiogram, and echocardiogram may be warranted.
39
Q

Why do you get an ABG with 100% oxygen when evaluating cyanosis?

A

In heart disease infants (tetralogy, truncus), PaO2 only increases 15-20 mmHg because of reduced pulmonary blood flow

In lung disease, PaO2 increases to levels greater than 150mmHg EXCEPT in infants that have severe lung disease or PPHN as they may have large R->L shunts via foramen ovale or PDA

40
Q

Management of cyanosis?

A
  • O2

- Correct temperature, hematocrit, glucose and calcium levels

41
Q

Common pulmonary causes of respiratory distress?

A

Preterm:
- RDS/Hyaline membrane disease/Surfactant deficiency syndrome (higher in white males!)

Term:

  • Meconium aspiration syndrome
  • Persistent pulmonary hypertension of the newborn
42
Q

When do you start making surfactant and when do you make a sufficient amount?

A

Starts 23-24 weeks

Sufficient at 30-32 weeks

43
Q

How do you determine fetal lung maturity?

A

Presence of surfactant in amniotic fluid obtained by amniocentesis.

  • Lecithin-to-sphingomyelin (L:S) ratio greater than 2:1
  • Presence of phosphatidylglycerol (a minor phospholipid in surfactant)
44
Q

Risk factors of RDS?

A
  • Low L:S ratio
  • Prematurity
  • Mother with previous preterm infant with RDS
  • Mother with diabetes
  • Neonatal hypothermia
  • Neonatal asphyxia
45
Q

Clinical features of RDS?

A

Increasing respiratory distress during the first 24–48 hours of life

  • Tachypnea
  • Retractions
  • Expiratory grunting
  • Cyanosis
  • Clinical features are more severe and prolonged in preterm infants of less than 31 weeks gestation.
46
Q

How do you dx RDS?

A

CXR is diagnostic

  • Diffuse atelectasis with an increased density in both lungs - Fine, granular, GROUND-GLASS appearance of the lung
  • Air bronchograms (increased density of the pulmonary field surrounding air filled small airways)
47
Q

Management of RDS?

A
  1. Supplemental O2.
  2. CPAP, a technique for maintaining end-expiratory airway pressure greater than atmospheric pres-sure for the spontaneously breathing infant, promotes air exchange.
  3. Mechanical ventilation may be indicated if hypercarbia and respiratory acidosis develop.
  4. Exogenous surfactant administered into the trachea is OFTEN CURATIVE.
48
Q

Two chronic complications of RDS?

A

BPD:
(1) Mechanical ventilation during the first 2 weeks of life
(2) Clinical signs of respiratory compromise persisting beyond 28
days of life
(3) Need for supplemental oxygen beyond 28 days of life
(4) Characteristic CXR

Retinopathy of prematurity

49
Q

Most common causes of PPHN?

A

Perinatal asphyxia

MAS

50
Q

What is PPHN?

A

PPHN is any condition, other than congenital heart disease, as- sociated with low blood flow to the lungs after birth

51
Q

Pathophys of PPHN?

A

Increased pulmonary vascular resistance results in sig- nificant right-to-left shunting through the foramen ovale or ductus arterio- sus with resulting hypoxemia

52
Q

Why would you get an echocardiogram in PPHN?

A

To rule out congenital heart disease and to assess the degree of pulmonary hypertension and right-to-left shunting.

53
Q

Management of PPHN?

A
  • Prevention of hypoxemia since hypoxemia is a potent pulmonary vasoconstrictor
  • Mechanical ventilation if O2 alone isnt enough
  • ECMO (extracorporeal membrane oxygenation) and high frequency ventilation in severe cases
  • Inhaled Nitric Oxide as a potent pulmonary vasodilator

Pediatrics shelf (2 decks)

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