Emma Holiday Review Flashcards
1
Q
How is intussusception treated?
A
Both diagnose and treat intussusception w/ barium enema (fluid injected into rectum)
2
Q
When assessing Moro on LGA newborn r. arm remains extended and medially rotated
A
LGA = large for gestational age
Erb-Duchenne (Erb’s palsy) C5-C6: brachial plexus injury during birth (typically from shoulder dystocia)
-refer if not better by 3-6 mo for surgical repair
=> waiter’s tip deformity
3
Q
3 days old, bili at 10, direct at .5, eating and pooping well
A
Physiologic jaundice
-liver conjugation not yet mature
4
Q
Describe why babies born to mother w/ GDM are at an increased risk for renal or splenic vein thrombosis
A
B/c of increased viscosity of blood, polycythemia = increased RBC percent of blood make up
-b/c large babies need more O2, hypoxia stimulates EPO production
5
Q
Tiny white spots on 2 week old’s nose
A
= Milia
- keratin filled cysts: can occur at any age but common in newborns
- disappear on own w/in weeks to mo
6
Q
Tx for TTN
A
Treating transient tachypnea of the neborn = most common cause of respiratory distress in term neonates
Self-resolves in hours to days, can give supportive O2 but not usually needed
7
Q
Congenital infxn:
Cataracts, deafness, heart defect, extramedullary hematopoesis
A
Rubella
8
Q
2 mo old baby has colicky abd pain and current jelly stool w/ a sausage shaped mass in RUQ
A
= Intussusception
-part of intestine invagintaes (folds into) another section => obstruction
- Current jelly stool = stool mixed w/ blood and mucus
- sausage shaped mass felt upon palpation = the intussusception
9
Q
Claw hand in newborn: forearm supinated and wrist/fingers are flexed + Horner’s syndrome
A
Klumpke’s paralysis: lower brachial plexus (C8-T1) injury
10
Q
Newborn w/ midline defect w/ no bowel present
(a) Tx
A
= Umbilical hernia
(a) Doesn’t require repair unless persists past age 2-3
11
Q
How to treat a 4 day old w/ bilateral purulent conjunctivitis
A
3-5 DOL w/ bilateral purulent conjuncitivitis = gonococcal conjunctivitis
Tx: topical azithromycin + IV 3rd gen ceph (Ceftriaxone)
12
Q
Why do mothers w/ gestational diabetes have larger babies?
A
Mothers w/ gestational DM have increased risk of LGA (large for gestational age)/macrosomia b/c extra blood glucose crosses placental barrier => triggers fetal insulin release
-insulin acts as growth hormone
13
Q
1 wk old baby w/ bileous vomiting, draws up his legs, has abdominal distention
A
Malrotation and volvulus
- Malrotation = during development the intestines fail to rotate 270 ccw around the SMA => intestines set into wrong part of the abdomen so they become blocked or twist
- Volvulus = bowel twists on its own blood supply since it is not properly fixed in place, can be fatal if becomes ischemic
14
Q
What is the danger of untreated gonococcal conjunctivitis?
A
Untreated gonococcal conjunctivitis can cause corneal ulceration
15
Q
Why do we care about hyperbilirubinemia (besides that you look yellow…)
A
Neurological toxic effects of indirect bilirubin
- indirect bili can cross the BBB, despite in the basal ganglia and brainstem and cause kernicterus (bilirubin-induced brain dysfunction)
- esp if bili > 20
16
Q
Congenital infxn:
Microcephaly, periventricular calcifications, deafness, thrombocytopenia, petechiae
A
CMV
17
Q
VACTERL association
A
VACTERL/VATER association = non-random co-occurence of birth defects
Vertebral, anal atresia, cardiac, radial, renal, limb
Association (not a syndrome) b/c the complications are not pathogenically related, but they attend to occur together
18
Q
Blotchy red spots with overlying white/yellow papules
A
= Erythema toxicum
- appears 2-5 days after birth
- harmless, rash generally disappears on own in 2 weeks
Extremely common- up to 1/2 of term newborns
-very distressing to parents but completely harmless
19
Q
How to treat congenital CMV
A
Tx congenital CMV w/ ganciclovir, but won’t prevent MR
20
Q
Newborn w/ defect right of midline w/ no sac
A
= Gastroschisis
Intestines outside of body b/c of hernia (hole in abdominal wall)
- no sac covering
- surgical repair
21
Q
How to treat 10 day old baby w/ red conjunctiva w/ mucoid discharge and lid swelling
A
Tx for chlamydia conjunctivitis = oral azithromycin
22
Q
Pathophysiology of RDS
A
RDS (infant respiratory distress syndrome) = premature infants caused by developmental insufficiency of surfactant production and structural immaturity of the lungs
-surfactant = complex substance of lipids and proteins made by type II pneumocytes to prevent collapse of the terminal air-spaces (where alveoli develop) throughout inhale exhale cycle
23
Q
What tests would you order in a baby w/ > 100.4 F
A
R/o sepsis
- CBC w/ differential
- CXR
- blood culture
- urine culture (use catheter)
- possibly lumbar picture
24
Q
Pyloric stenosis
(a) metabolic complication
(b) tx
A
Pyloric stenosis
(a) Hypochloremic, metabolic alkalosis
(b) Surgery to widen the pylorus
25
Tx for congenital syphilis
Penicillin
26
Baby of what age w/ a fever > 100.4 is sepsis until proven otherwise
Baby 100.4 F = sepsis until proven otherwise
27
Xray finding of necrotizing enterocolitis
Pneumatosis intestinalis = air/gas in the bowel wall
| -associated w/ ischemia
28
Which heart defects are associated w/ congenital rubella
PDA, VSD
29
Congenital infection:
Hydrocephalus, intracranial calcifications, chorioretinitis
Congenital infxn w/ triad: hydrocephalus, intracranial calcifications + chorioretinitis = toxoplasmosis
30
Neonatal conjunctivitis on day 7-14
Neonatal conjunctivitis day 7-14 w/ red conjunctiva w/ mucoid discharge and lid swelling = chlamydia conjunctivitis
31
Which inborn error of metabolism may present w/ jaundice, cataracts, and seizures
Galactosemia
-G1p accumulates to damage kidney, liver, and brain
32
Tx for congenital rubella
No treatment
33
Risk factors for necrotizing enterocolitis
- premature gut
| - introduction of feeds/formula
34
Newborn w/ ambiguous genitalia. One month later: vomiting, low Na, high K+, acidosis
= Congenital adrenal hyperplasia = 21 hydroxylase deficiency = deficient production of hormones by adrenal gland
35
What are 2 major worrisome complications of meconium aspiration syndrome
Pulmonary artery HTN, pneumonitis
36
38 week LGA infant born by C/S to an A2GDM has dyspnea/grunting
TTN - transient tachypnea of the newborn
-tachypnea ( > 40-60 of newborn) w/in 1-2 hours after birth due to retention of lung fluid
Risk factors: babies who were
- born before 28 weeks
- born by C section
- born to mothers w/ diabetes
37
Normal RR for newborn- 1 yr old
Under 1 yoa: normal RR 30-40 breaths per minute
38
Which GU d/o is associated w/ prune belly syndrome
Prune belly syndrome = congenital absence of abdominal muscles
-associated w/ cryptorchidism (teste(s) not in scrotum)
39
Why are babies born to mothers w/ GDM are at an increased risk for jaundice
Big babies have more RBCs => have more RBCs to break down => increased risk for kernicterus (bilirubin induced brain damage)
40
Why is diaphragmatic hernia so dangerous in a newborn?
(a) What can be done if dx prenatally
(b) Tx?
Pulmonary hypoplasia
(a) Dx prenatally: plan delivery at center w/ ECMO (extracorporeal life support)- respiratory support device
(b) Let lungs mature 3-4 days then do surgical repair
41
Congenital infection:
Maculopapular rash on palms and soles, snuffles, periostitis
Congenital infection
-Maculopapular rash on palms and soles, snuffles, periostititis = Syphilis
42
1 day old, bili at 14, direct is .5
Possibly pathologic jaundice b/c bili > 12.
43
Thick yellow/white oily scale on inflammatory base on scalp of 1 week old F
Tx
= Seborrheic dermatitis (dandruff)
-gently clean w/ mild shampoo
44
What do both Gilbert's syndrome and Crigler-Najjar syndrome cause?
Inherited causes of indirect hyperbilirubinemia due to either decreased or total deficiency of glucoronyl transferase
45
How to repair hypospadias
Use the foreskin in eventual surgical repair
Foreskin needed in repair => DON'T circumcise
46
Baby born w/ respiratory distress w/ excess drooling
Tracheo-esophageal fistula (TE fistula)
-esophageal atria + TE fistula
47
What is the class 1E (r/o) diagnosis for direct hyperbilirubinemia
Sepsis
-galactosemia, hypothyroid, choledochal cyst, CF
48
Neonatal conjunctivitis on day 3-5
Neonatal conjunctivitis + bilateral purulent conjunctivitis = gonococcal conjunctivitis
49
Strawberry hemangioma
(a) Tx
= Capillary hemangioma
-hemangiona = benign growth/tumor of endothelial cells that line BVs
- common on eyes
- tx: oral propranolol
50
What is a L/S ratio?
(a) What may a low L/S ratio indicate?
L/S ratio = lecithin-sphingomyelin ratio
-test of fetal amniotic fluid to assess for fetal lung immaturity
(a) low L/S ratio indicates fetal lung immaturity => give antenatal betamethasone to prevent RDS
51
What is a complication of chlamydia conjunctivitis?
(a) How would this be diagnosed
Complication of chlamydia conjunctivitis = chlamydial pneumonia
-cough, nasal drainage => scattered crackles
(a) Bilateral infiltrates on CXR
52
Effect of maternal gestational diabetes on serum glucose of babies
Gestational diabetes can cause hypoglycemia in child: maternal hyperglycemia => fetal hyperinsulinemia
53
5 day old former 33 weeker develops bloody diarrhea
= Necrotizing Enterocoloitis
-necrosis (tissue death) of portions of the bowel
-seen primarily in premature infants
54
Baby born w/ respiratory distress, scaphoid abdomen, and abnormal CXR
Scaphoid abdomen = when abdomen is sucked inwards, in newborn it may represent a diaphramatic hernia
-hole in diaphragm => abdominal contents move into the chest cavity
55
Multiple gray-blue patches on the back and buttocks of an infant
= Mongolian spots
- benign, flat, wavy bordered gray-blue congenital birthmark
- normally disappears by 3-5 yoa
56
Treatment of meconium aspiration syndrome
Intubate and suction to suction meconium from below the vocal cords
57
Newborn male w/ no palpable testes
Cryptorchidism = absence of one or both testes from scrotum
58
2 wk old infant w/ bileous vomiting w/ pregnancy complicated by polyhydramnios
= Intestinal atresia or annular pancreas
Intestinal atresia = narrowing or absence of a portion of the intestine
-usually from vascular accident in utero => ischemia of bowel segment
Annular pancreas = duodenum constricted by pancreatic tissue
59
Newborn w/ midline defect covered by a sac
Omphalocele
-type of hernia, muscles in abdominal wall don't close properly so intestines remain outside the abdominal wall
-associated w/ other birth defects
60
What other d/o is an umbilical hernia associated w/
Congenital hypothyroidism and big tongue
61
Breast feeding vs. breast milk jaundice
Breast feeding jaundice: due to decreased feeding (baby not getting enough breast milk) => dehydrated baby gets constipated (retains meconium) + reabsorb deconjugated bili
Breast milk jaundice- breast milk has glucoronidase and de-conj bili
62
41 week AGA infant born after ROM yielded greenish-brown fluid
AGA = appropriate for gestational age (birth weight)
= Meconium aspiration syndrome- when meconium (first stool) is in the lungs. Meconium sometimes expelled into amniotic fluid prior to birth or during labor, then sometimes inhaled by baby
63
Periostitis in a newborn
Periostitis = inflammation of periosteum around bone
-associated w/ congenital syphilis
64
Salmon patch on newborn's forehead/eyelid
= Nevus simplex (salmon patch)
- common congenital capillary malformation: 1/3 of all newborns, due to dilation of certain BVs
- pink, flat, not palpable (only difference is appearance)
- self limited w/in 18 mo
65
When does neonatal acne peak?
Tx?
Neonatal acne peaks around 2 mo
-rarel needs tx
66
When does physiologic jaundice resolve?
Gone by about 5 days of life when liver conjugation is mature
67
Tracheo-esophageal fistula
(a) Diagnostic test
(b) What group of birth defects does this belong with?
Tracheo-esophageal fistula
(a) Place feeding tube and take Xray, see the coil of the feeding tube stuck in the thorax (b/c of esophageal atresia)
(b) VACTERL association: non-random co-occurence of birth defects
68
Why are Rotor syndrome and Dubin-Johnson syndrome grouped together
Both cause an increase in conjugated bilirubin
- both autosomal recessive
- similar features: main symptom as a non-itching jaundice
Differentiated by appearance of liver (black pigmented liver in Dubin-Johnson)
69
Area of alopecia w/ orange colored nodular skin in newborn
Tx
= Nevus sebaceous = congenital hairless plaque on face or scalp
-remove before adolescence b/c it can undergo malignant degeneration
70
What else would you look for in a baby w/ choanal aresia?
Chonala atresia = choana (back of nasal passage) is blocked => cyanotic when feeding but pink up when cry
CHARGE associated anomalies- coloboma (hole in the structures of the eye), heart defects, atresia of the nasal choana, retarded growth, GU anomalies, ear anomalies/deafness
71
Risks of LGA
Risks of macrosomia-
- increased risk of birth trauma: Clavicle, Erbs
- C section
- TTN (transient tachypnea of newborn)
72
What maternal disorder increases a baby's risk for small left colon and caudal regression syndrome
Mothers w/ pre-existing diabetes have increased risk of having babies w/
- small left colon syndrome
- caudal regression
73
2 inherited causes of indirect hyperbili
- Gilbert: decreased glucoronyl transferase level
| - Crigler-Najjar: total deficiency in glucoronyl transferase level
74
32 week premie has dyspnea, RR of 80 w/ nasal flaring
Tachypnic, increased work of breathing and premature => RDS (respiratory distress syndrome)
75
What congenital d/o does duodenal atresia have a strong association w/
Down syndrome
76
Congenital infxn:
Limb hypoplasia, cutaneous scars, cataracts, chorioretinitis, cortical atrophy
Congenital varicella from mom infected in 1st or 2nd trimester
77
What two disorders are screened for in every state?
PKU and galactosemia
78
How to assess pathologic jaundice
Coombs test- detect antibodies against RBCs
(+): means Rh or ABO incompatibility
(-): twin or mom transfusion, spherocytosis, G6pD deficiency etc
79
On the first day of life, what level of bili and d-bili indicate pathologic jaudice
Pathologic jaundice if bili > 12, d-bili > 2, rate of rise > 5/day
-if under = physiologic jaundice, watch and wait
80
Why are babies born to mothers w/ GDM are at an increased risk for RDS
High insulin levels interfere w/ cortisol surge prior to birth that stimulates lung maturation
81
Differentiate neonatal conjunctivitis w/
(a) bilateral purulence
(b) lid swelling, red conjunctiva w/ mucoid discharge
Neonatal conjunctivitis w/
(a) Bilateral purulence, bit earlier in life (3-5 days) = gonococcal
(b) Lid swelling, mucoid discharge, bit later in life (7-14 days) = chlamydia
82
1 week old baby becomes cyanotic when feeding but pinks up when crying
Choanal atresia = back of nasal passage (choana) is blocked
- presents when feeding bc oral air passages are blocked by the tongue
- improves when cries b/c oral airway is opened up and used
83
Which inborn error of metabolism may present w/ vomiting, seizures, and athetosis (writhing)
PKU = phenylketonuria
84
Triad of congenital toxoplasmosis
Congenital toxoplasmosis triad
(1) hydrocephalus
(2) intracranial calficiations
(3) chorioretinitis
85
When palpating clavicles on LGA you feel crepitus and discontinuity on the left
Dx?
Tx?
Clavicular fracture
-no tx needed
Crepitus = grating sound/sensation from friction btwn fractured parts of a bone
86
7 day old w/ dark urine and pale stool
-bili 12, dbili 8, elevated LFTs
Biliary atresia = bile ducts cannot drain bile
=> liver failure => need surgery
87
Differentiate caput succedanem vs. cephalohematoma
Edema that crosses suture lines = Caput succedanem
- extraperiosteal fluid collection due to pressure of scalp against dilating cervix during delivery
- tx: observation only
Fluctuance that doesnt cross suture lines = cephalohematoma = blood btwn skull and periosteum due to BV rupture
-tx: usually just observation, sometimes image if neurological symptoms appear, don't aspirate to remove blood (risk of infxn)
Cephalohematoma- swelling is periosteal => boundaries limited by the individual bones
88
Tx for hyperbilirubinemia
Phototherapy
-ionizes unconjugated bili so it can be excreted
89
14 day old, bili at 12, dbili .5, baby regaining birth weight and otherwise health
Breast milk jaundice- due to glucoronidase and de-conj bili in breast milk
-consider breast milk in jaundice baby that is otherwise healthy
90
Complication of natal hypoglycemia and hypocalcemia
Seizures => always check glucose and calcium
91
What is hypospadias
Hypospadias = when the urethral opening is not on the head of the penis (aka on the ventral surface)
=> can't pee standing up or it sprays, usually repaired
92
7 day old, bili at 12, dbili .5, dry mucous membranes, not gaining weight
Breast feeding jaundice- baby not getting enough breast milk
93
Which inborn error of metabolism predisposes to E. coli sepsis
Galactosemia
94
Supportive Tx for RDS
Supporting neonate in respiratory distress:
O2 therapy + nasal CPAP to keep alveoli open
95
2 inherited causes of direct (conjugated) hyperbili
Dubin Johnson: black liver- hepatocyte defect in secreting conjugated bili into bile
-usually asymptomatic and harmless
Rotor: no black liver
96
Tx for congenital toxoplasmosis
Tx congenital toxoplasmosis w/ sulfadiazine (sulfonamide abx) + leucovorin (chemotherapy adjuvant for toxoplasmosis retinitis)
97
2 Ddx for 3 day old who has not passed meconium
- Meconium ileus (thickens and congests in the intestines)- consider CF if have family history
- Hirschsprung's (congenital megacolon): absence of nerves in parts of the intestines due to defect in enteric nervous system
98
If detected in utero what can be given to prevent RDS in premies
Give antenatal (before birth) betamethasone = steroid to speed up development
99
Diagnostic test for Hirschsprung's disease
Hirschsprung's = congenital megacolon, part of LI or GI tract has no ganglion cells (=> cannot relax part of the colon to pass stool => obstruction) due to incomplete neural crest cell migration
Gold standard = biopsy revealing no ganglia
100
A1GDM vs. A2GDM
Gestational diabetes if classified by how it's treated
```
A1GDM = treated w/ diet alone
A2GDM = treated w/ insulin
```
101
Describe the pathophysiology of a black liver in Dubin Johnson Syndrome
On autopsy the liver of a Dubin Johnson pt will have a black appearance due to pigment accumulation
-hepatocyte defect in secreting conjugated bilirubin into bile
102
Tx for necrotizing enterocolitis
NPO, abx and resection of necrotic bowel ASAP
103
Tx for cryptorchidism
Cryptorchidism = absence of one or both testes from the scrotum
Tx = watch and wait, most will descend by 3 mo
If not descended by 1 year- surgery to avoid sterility/cancer
104
2 congenital infxns that can cause chorioretinitis
(a) How to distinguish
Varicella + Toxoplasmosis- both are congenital infxns that can cause chorioretinitis
(a) Distinguish by the other features
Varicella- limb hypoplasia, cutaneous scars, cataracts, cortical atrophy
Toxo- hydrocephalus, intracranial calcifications
105
4 wk old infant w/ non-bileous vomiting and palpable "olive"
= Pyloric stenosis = narrowing of pyloris- opening from stomach into SI, prevents emptying of stomach into SI
-olive-shaped mass in upper belly = the abnormal pyloris
106
Differentiate gastroschisis vs. omphalocele
(a) location
(b) main distinction
(c) prognosis
Look similar, both treated w/ surgery
Gastroschisis is lateral (not midline) and doesn't have a cover
-not associated w/ other d/o
Omphalocele- defect in midline and is covered by a sac
-associated w/ Edwards (trisomy 18), Patau (Trisomy 14), Beckwith Wiedemann Syndrome => worse prognosis
107
How would you treat a baby 100.4?
(a) What would you do differently if you suspect meningitis?
Empiric tx: ampicillin + gentamicin
(a) If meningitis suspected: Cefotaxine + ampicillin
