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Pediatrics > Emma Holiday Review > Flashcards

Emma Holiday Review Flashcards

1
Q

How is intussusception treated?

A

Both diagnose and treat intussusception w/ barium enema (fluid injected into rectum)

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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

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3
Q

3 days old, bili at 10, direct at .5, eating and pooping well

A

Physiologic jaundice

-liver conjugation not yet mature

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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

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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
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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

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7
Q

Congenital infxn:

Cataracts, deafness, heart defect, extramedullary hematopoesis

A

Rubella

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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
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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

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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

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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)

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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

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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
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14
Q

What is the danger of untreated gonococcal conjunctivitis?

A

Untreated gonococcal conjunctivitis can cause corneal ulceration

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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
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16
Q

Congenital infxn:

Microcephaly, periventricular calcifications, deafness, thrombocytopenia, petechiae

A

CMV

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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

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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

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19
Q

How to treat congenital CMV

A

Tx congenital CMV w/ ganciclovir, but won’t prevent MR

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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
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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

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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

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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
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24
Q

Pyloric stenosis

(a) metabolic complication
(b) tx

A

Pyloric stenosis

(a) Hypochloremic, metabolic alkalosis
(b) Surgery to widen the pylorus

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25
Q

Tx for congenital syphilis

A

Penicillin

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26
Q

Baby of what age w/ a fever > 100.4 is sepsis until proven otherwise

A

Baby 100.4 F = sepsis until proven otherwise

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27
Q

Xray finding of necrotizing enterocolitis

A

Pneumatosis intestinalis = air/gas in the bowel wall

-associated w/ ischemia

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28
Q

Which heart defects are associated w/ congenital rubella

A

PDA, VSD

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29
Q

Congenital infection:

Hydrocephalus, intracranial calcifications, chorioretinitis

A

Congenital infxn w/ triad: hydrocephalus, intracranial calcifications + chorioretinitis = toxoplasmosis

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30
Q

Neonatal conjunctivitis on day 7-14

A

Neonatal conjunctivitis day 7-14 w/ red conjunctiva w/ mucoid discharge and lid swelling = chlamydia conjunctivitis

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31
Q

Which inborn error of metabolism may present w/ jaundice, cataracts, and seizures

A

Galactosemia

-G1p accumulates to damage kidney, liver, and brain

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32
Q

Tx for congenital rubella

A

No treatment

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33
Q

Risk factors for necrotizing enterocolitis

A
  • premature gut

- introduction of feeds/formula

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34
Q

Newborn w/ ambiguous genitalia. One month later: vomiting, low Na, high K+, acidosis

A

= Congenital adrenal hyperplasia = 21 hydroxylase deficiency = deficient production of hormones by adrenal gland

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35
Q

What are 2 major worrisome complications of meconium aspiration syndrome

A

Pulmonary artery HTN, pneumonitis

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36
Q

38 week LGA infant born by C/S to an A2GDM has dyspnea/grunting

A

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
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37
Q

Normal RR for newborn- 1 yr old

A

Under 1 yoa: normal RR 30-40 breaths per minute

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38
Q

Which GU d/o is associated w/ prune belly syndrome

A

Prune belly syndrome = congenital absence of abdominal muscles
-associated w/ cryptorchidism (teste(s) not in scrotum)

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39
Q

Why are babies born to mothers w/ GDM are at an increased risk for jaundice

A

Big babies have more RBCs => have more RBCs to break down => increased risk for kernicterus (bilirubin induced brain damage)

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40
Q

Why is diaphragmatic hernia so dangerous in a newborn?

(a) What can be done if dx prenatally
(b) Tx?

A

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

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41
Q

Congenital infection:

Maculopapular rash on palms and soles, snuffles, periostitis

A

Congenital infection

-Maculopapular rash on palms and soles, snuffles, periostititis = Syphilis

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42
Q

1 day old, bili at 14, direct is .5

A

Possibly pathologic jaundice b/c bili > 12.

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43
Q

Thick yellow/white oily scale on inflammatory base on scalp of 1 week old F

Tx

A

= Seborrheic dermatitis (dandruff)

-gently clean w/ mild shampoo

44
Q

What do both Gilbert’s syndrome and Crigler-Najjar syndrome cause?

A

Inherited causes of indirect hyperbilirubinemia due to either decreased or total deficiency of glucoronyl transferase

45
Q

How to repair hypospadias

A

Use the foreskin in eventual surgical repair

Foreskin needed in repair => DON’T circumcise

46
Q

Baby born w/ respiratory distress w/ excess drooling

A

Tracheo-esophageal fistula (TE fistula)

-esophageal atria + TE fistula

47
Q

What is the class 1E (r/o) diagnosis for direct hyperbilirubinemia

A

Sepsis

-galactosemia, hypothyroid, choledochal cyst, CF

48
Q

Neonatal conjunctivitis on day 3-5

A

Neonatal conjunctivitis + bilateral purulent conjunctivitis = gonococcal conjunctivitis

49
Q

Strawberry hemangioma

(a) Tx

A

= Capillary hemangioma
-hemangiona = benign growth/tumor of endothelial cells that line BVs

  • common on eyes
  • tx: oral propranolol
50
Q

What is a L/S ratio?

(a) What may a low L/S ratio indicate?

A

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
Q

What is a complication of chlamydia conjunctivitis?

(a) How would this be diagnosed

A

Complication of chlamydia conjunctivitis = chlamydial pneumonia
-cough, nasal drainage => scattered crackles

(a) Bilateral infiltrates on CXR

52
Q

Effect of maternal gestational diabetes on serum glucose of babies

A

Gestational diabetes can cause hypoglycemia in child: maternal hyperglycemia => fetal hyperinsulinemia

53
Q

5 day old former 33 weeker develops bloody diarrhea

A

= Necrotizing Enterocoloitis
-necrosis (tissue death) of portions of the bowel

-seen primarily in premature infants

54
Q

Baby born w/ respiratory distress, scaphoid abdomen, and abnormal CXR

A

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
Q

Multiple gray-blue patches on the back and buttocks of an infant

A

= Mongolian spots

  • benign, flat, wavy bordered gray-blue congenital birthmark
  • normally disappears by 3-5 yoa
56
Q

Treatment of meconium aspiration syndrome

A

Intubate and suction to suction meconium from below the vocal cords

57
Q

Newborn male w/ no palpable testes

A

Cryptorchidism = absence of one or both testes from scrotum

58
Q

2 wk old infant w/ bileous vomiting w/ pregnancy complicated by polyhydramnios

A

= 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
Q

Newborn w/ midline defect covered by a sac

A

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
Q

What other d/o is an umbilical hernia associated w/

A

Congenital hypothyroidism and big tongue

61
Q

Breast feeding vs. breast milk jaundice

A

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
Q

41 week AGA infant born after ROM yielded greenish-brown fluid

A

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
Q

Periostitis in a newborn

A

Periostitis = inflammation of periosteum around bone

-associated w/ congenital syphilis

64
Q

Salmon patch on newborn’s forehead/eyelid

A

= 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
Q

When does neonatal acne peak?

Tx?

A

Neonatal acne peaks around 2 mo

-rarel needs tx

66
Q

When does physiologic jaundice resolve?

A

Gone by about 5 days of life when liver conjugation is mature

67
Q

Tracheo-esophageal fistula

(a) Diagnostic test
(b) What group of birth defects does this belong with?

A

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
Q

Why are Rotor syndrome and Dubin-Johnson syndrome grouped together

A

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
Q

Area of alopecia w/ orange colored nodular skin in newborn

Tx

A

= Nevus sebaceous = congenital hairless plaque on face or scalp

-remove before adolescence b/c it can undergo malignant degeneration

70
Q

What else would you look for in a baby w/ choanal aresia?

A

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
Q

Risks of LGA

A

Risks of macrosomia-

  • increased risk of birth trauma: Clavicle, Erbs
  • C section
  • TTN (transient tachypnea of newborn)
72
Q

What maternal disorder increases a baby’s risk for small left colon and caudal regression syndrome

A

Mothers w/ pre-existing diabetes have increased risk of having babies w/

  • small left colon syndrome
  • caudal regression
73
Q

2 inherited causes of indirect hyperbili

A
  • Gilbert: decreased glucoronyl transferase level

- Crigler-Najjar: total deficiency in glucoronyl transferase level

74
Q

32 week premie has dyspnea, RR of 80 w/ nasal flaring

A

Tachypnic, increased work of breathing and premature => RDS (respiratory distress syndrome)

75
Q

What congenital d/o does duodenal atresia have a strong association w/

A

Down syndrome

76
Q

Congenital infxn:

Limb hypoplasia, cutaneous scars, cataracts, chorioretinitis, cortical atrophy

A

Congenital varicella from mom infected in 1st or 2nd trimester

77
Q

What two disorders are screened for in every state?

A

PKU and galactosemia

78
Q

How to assess pathologic jaundice

A

Coombs test- detect antibodies against RBCs

(+): means Rh or ABO incompatibility

(-): twin or mom transfusion, spherocytosis, G6pD deficiency etc

79
Q

On the first day of life, what level of bili and d-bili indicate pathologic jaudice

A

Pathologic jaundice if bili > 12, d-bili > 2, rate of rise > 5/day

-if under = physiologic jaundice, watch and wait

80
Q

Why are babies born to mothers w/ GDM are at an increased risk for RDS

A

High insulin levels interfere w/ cortisol surge prior to birth that stimulates lung maturation

81
Q

Differentiate neonatal conjunctivitis w/

(a) bilateral purulence
(b) lid swelling, red conjunctiva w/ mucoid discharge

A

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
Q

1 week old baby becomes cyanotic when feeding but pinks up when crying

A

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
Q

Which inborn error of metabolism may present w/ vomiting, seizures, and athetosis (writhing)

A

PKU = phenylketonuria

84
Q

Triad of congenital toxoplasmosis

A

Congenital toxoplasmosis triad

(1) hydrocephalus
(2) intracranial calficiations
(3) chorioretinitis

85
Q

When palpating clavicles on LGA you feel crepitus and discontinuity on the left

Dx?
Tx?

A

Clavicular fracture

-no tx needed

Crepitus = grating sound/sensation from friction btwn fractured parts of a bone

86
Q

7 day old w/ dark urine and pale stool

-bili 12, dbili 8, elevated LFTs

A

Biliary atresia = bile ducts cannot drain bile

=> liver failure => need surgery

87
Q

Differentiate caput succedanem vs. cephalohematoma

A

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
Q

Tx for hyperbilirubinemia

A

Phototherapy

-ionizes unconjugated bili so it can be excreted

89
Q

14 day old, bili at 12, dbili .5, baby regaining birth weight and otherwise health

A

Breast milk jaundice- due to glucoronidase and de-conj bili in breast milk

-consider breast milk in jaundice baby that is otherwise healthy

90
Q

Complication of natal hypoglycemia and hypocalcemia

A

Seizures => always check glucose and calcium

91
Q

What is hypospadias

A

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
Q

7 day old, bili at 12, dbili .5, dry mucous membranes, not gaining weight

A

Breast feeding jaundice- baby not getting enough breast milk

93
Q

Which inborn error of metabolism predisposes to E. coli sepsis

A

Galactosemia

94
Q

Supportive Tx for RDS

A

Supporting neonate in respiratory distress:

O2 therapy + nasal CPAP to keep alveoli open

95
Q

2 inherited causes of direct (conjugated) hyperbili

A

Dubin Johnson: black liver- hepatocyte defect in secreting conjugated bili into bile
-usually asymptomatic and harmless

Rotor: no black liver

96
Q

Tx for congenital toxoplasmosis

A

Tx congenital toxoplasmosis w/ sulfadiazine (sulfonamide abx) + leucovorin (chemotherapy adjuvant for toxoplasmosis retinitis)

97
Q

2 Ddx for 3 day old who has not passed meconium

A
  • 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
Q

If detected in utero what can be given to prevent RDS in premies

A

Give antenatal (before birth) betamethasone = steroid to speed up development

99
Q

Diagnostic test for Hirschsprung’s disease

A

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
Q

A1GDM vs. A2GDM

A

Gestational diabetes if classified by how it’s treated

A1GDM = treated w/ diet alone
A2GDM = treated w/ insulin
101
Q

Describe the pathophysiology of a black liver in Dubin Johnson Syndrome

A

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
Q

Tx for necrotizing enterocolitis

A

NPO, abx and resection of necrotic bowel ASAP

103
Q

Tx for cryptorchidism

A

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
Q

2 congenital infxns that can cause chorioretinitis

(a) How to distinguish

A

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
Q

4 wk old infant w/ non-bileous vomiting and palpable “olive”

A

= 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
Q

Differentiate gastroschisis vs. omphalocele

(a) location
(b) main distinction
(c) prognosis

A

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
Q

How would you treat a baby 100.4?

(a) What would you do differently if you suspect meningitis?

A

Empiric tx: ampicillin + gentamicin

(a) If meningitis suspected: Cefotaxine + ampicillin

Pediatrics (10 decks)

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