Case Studies (Muskovitz) - W2 Flashcards
A full-term male is delivered vaginally to a 32-year-old woman. She has a history of infertility and this pregnancy was conceived with in-vitro fertilization. Pregnancy was complicated by size greater than dates for the past 4 weeks. At the time of rupture of membranes there was copious amounts of amniotic fluid. The infant required suctioning of the pharynx to clear the airway. After 5 minutes the infant had difficulty breathing with additional secretions in the pharynx. In the NICU a nasogastric tube inserted in the nose could not be advanced past 12 cm. Physical exam was normal except for difficulty breathing which seemed to improve with pharyngeal suctioning. Birth weight 7 lbs. X-ray demonstrated the nasogastric tube folded in the proximal esophagus. Normal lungs, heart and bowel gas were noted.
What is the diagnosis?
A. Choanal atresia
B. Retained fetal lung fluid (TTNB)
C. RDS
D. Esophageal atresia with tracheoesophageal fistula
What is the diagnosis?
A. Choanal atresia
B. Retained fetal lung fluid (TTNB)
C. RDS
D. Esophageal atresia with tracheoesophageal fistula
What is the embryology of esophageal atresia?
A. Incomplete division of the cranial part of the foregut.
B. Incomplete recanalization of the larynx.
C. Incomplete development of type II alveolar cells.
D. Arrest of lung development in the saccular stage.
A. Incomplete division of the cranial part of the foregut.
B. Incomplete recanalization of the larynx.
C. Incomplete development of type II alveolar cells.
D. Arrest of lung development in the saccular stage.
What type of TEF is most likely in the case?
A. Isolated esophageal atresia
B. Esophageal atresia with distal TEF
C. “H” type TEF
D. None of the above
A full-term male is delivered vaginally to a 32-year-old woman. She has a history of infertility and this pregnancy was conceived with in-vitro fertilization. Pregnancy was complicated by size greater than dates for the past 4 weeks. At the time of rupture of membranes there was copious amounts of amniotic fluid. The infant required suctioning of the pharynx to clear the airway. After 5 minutes the infant had difficulty breathing with additional secretions in the pharynx. In the NICU a nasogastric tube inserted in the nose could not be advanced past 12 cm. Physical exam was normal except for difficulty breathing which seemed to improve with pharyngeal suctioning. Birth weight 7 lbs. X-ray demonstrated the nasogastric tube folded in the proximal esophagus. Normal lungs, heart and bowel gas were noted.
A. Isolated esophageal atresia
B. Esophageal atresia with distal TEF
C. “H” type TEF
D. None of the above
How did we know it was a distal fistula with the case? A. Distal TEF is always present with esophageal atresia.
B. A distal fistula cannot be diagnoses without surgery.
C. The respiratory difficulty suggests aspiration pneumonitis.
D. Air in the bowel confirms a distal fistula.
How did we know it was a distal fistula with the case? A. Distal TEF is always present with esophageal atresia.
B. A distal fistula cannot be diagnoses without surgery.
C. The respiratory difficulty suggests aspiration pneumonitis.
D. Air in the bowel confirms a distal fistula.
What if their was no air (gas) in the bowel?
Would suggest a proximal atresia
What is the cause of size greater than dates with esophageal atresia?
A. Dating of the pregnancy was off by 4 weeks.
B. Undiagnosed diabetes resulted in macrosomia.
C. Esophageal atresia led to polyhydramnios.
D. “H-type” TEF is associated with poor swallowing.
What is the cause of size greater than dates with esophageal atresia?
A. Dating of the pregnancy was off by 4 weeks.
B. Undiagnosed diabetes resulted in macrosomia.
C. Esophageal atresia led to polyhydramnios.
D. “H-type” TEF is associated with poor swallowing.
How did we know there was an esophageal atresia?
When putting in the nasal gastric tube, it only went down 12cm and stopped.
A female infant with birthweight 1100 grams is delivered by emergent C/section. Her mother is a 14-year-old woman who presents to the emergency room with seizures. Pregnancy had been undiagnosed. Her blood pressure was 190/125, and she had severe proteinuria. A diagnosis of eclampsia was made and delivery was undertaken. At delivery the amniotic fluid volume was normal and the placenta was unremarkable. The infant had severe retractions and required
intubation for cyanosis.She was admitted to the NICU. Initial chest x-ray showed aground glass appearance to the lung fields, air-bronchogram formation and reduced lung volumes.
What is the most likley diagnosis?
A. Congenital group B strep pneumonia
B. Tension pneumothorax
C. Diaphragmatic hernia
D. Respiratory distress syndrome
What is the most likley diagnosis?
A. Congenital group B strep pneumonia
B. Tension pneumothorax
C. Diaphragmatic hernia
D. Respiratory distress syndrome
What causes respiratory distress syndrome?
Immature type II pneumocytes fail to produce adequate surfactant.
What is respiratory distress syndrome treated?
- artificial surfactant administered to the baby will improve complicance
When and who do we give glucocorticoids to?
Give glucocotricoids to the MOM to try and speed up lung development if they have a risk of early delivery.
Need to give 38 hours before to see best effect.
A full-term male is delivered vaginally to a 28-year-old woman. Pregnancy was complicated by size less than dates beginning at 20 weeks. Ultrasounds in the pregnancy failed to demonstrate amniotic fluid. No vaginal leaking was noted. At delivery the infant had severe retractions and poor oxygenation. Multiple contractures of the large joints were noted. Chest x-ray demonstrated very clear, small lungs. Emergent ultrasound failed to demonstrate kidneys. The infant was offered comfort care and died within 12 hours of birth.
What is the diagnosis?
A. Severe RDS
B. Renal agenesis with pulmonary hypoplasia (Potter syndrome)
C. Pulmonary agenesis
D. Tracheal atresia
What is the diagnosis?
A. Severe RDS
B. Renal agenesis with pulmonary hypoplasia (Potter syndrome)
C. Pulmonary agenesis
D. Tracheal atresia
Why is there a small amount of amniotic fluid with Potter’s syndrome?
Aminiotic fluid is of renal origin and the kidneys are absent.
What is the pathophysiology of Potter’s syndrome?
chronic oligohydramnios retards lung development and leads to pulmonary hypoplasia.
