Gen Peds / Neonate / Development / Immunizations

Question 1

How do you calculate apgar score in newborn?

Answer 1

Appearance:
o 0 = completely blue
o 1 = extremities blue
o 2 = completely pink

Pulse
o 0 = absent
o 1 = 100

Grimace/rxn
o 0 = absent
o 1 = grimace
o 2 = cough/sneeze/cry

Activity/muscle tone
o 0 = limp
o 1 = some flexion
o 2 = active/spontaneous

Resp effort
o 0 = absent
o 1 = slow weak cry
o 2 = regular, good cry

Question 2

What are some complications seen in SGA infants?

Answer 2

• polycythemia (from fetal hypoxia high EPO)
• meconium aspiration
• hypoglycemia
• hypocalcemia
• hypothermia

Question 3

What are the live vaccines?

Answer 3

• rotavirus
• MMR
• Varicella
• Influenza (intranasal)
• Polio (oral)

Question 4

What are contrainidications to specific vaccines?

Answer 4

all: anaphylaxis to vaccine
live: SCID, pregnancy, HIV
rotavirus: hx of intussusception, hx uncorrected congenital malformation of GI
pertussis: encephalopathy w/in 1 week of previous dose, progressive neuro d/o

Question 5

When does weight double? triple?

Answer 5

birth weight in 2 wks
double by 5 months
triple by 12 months

Question 6

What is height/weight of baby at 12 mo?

Answer 6

triple weight

height increase by 50%

Question 7

How do you look for intraventricular hemorrhage?

Answer 7

screen w/ head ultrasound in patient

Question 8

What are contraindications to breastfeeding?

Answer 8

• galactosemia
• mom abuse street drugs, alcoho, chemo, others (lithium, cyclosporine, amphetamines, ergotamines, bromocriptine)
• varicella w/in 2 days of delivery
• herpetic breast lesion
  maternal HIV, active untreated TB, malaria, typhoid, septicemia
• abx safe except tetracycline

Question 9

Until when do you see thymus on CXR?

Answer 9

until 3 years old = sail sign

Question 10

Is Rh or ABO jaundice expected to be more severe?

Answer 10

Rh = more strongly positive direct coombs

Question 11

What is pattern of physiologic jaundice?

Answer 11

start by day 2/3, peak to no more than 12 by day 4/5

Question 12

What are sx of biliary atresia? How do you diagnose?

Answer 12

initially well then conjugated bili in first 2 months –> jaundice, pale stool, dark urine

Dx: US or cholangiogram

Question 13

What things increase risk of kernicterus?

Answer 13

sulfisoxazole/other drugs that displace bilirubin from albumin
met acidosis, hypoalbuminemia, neonatal sepsis

Question 14

What are some risk factors for neonatal polycythemia (hct > 65)? presentation?

Answer 14

in maternal DM, hypertension, smoking, IUGR –> have hypoxemia/nutritional deprivation leading to increased EPO

sx: ruddy skin, hypoglycemia, resp distress, cyanosis, apnea, irritability, tachypnea, can get seizure

Question 15

What are the complications of twin-twin transfusion for each twin?

Answer 15

donor = risk oligohydramnios, anemia, hypovolemia w/ shock

recipient = polyhydramnios, LGA, hyperbilirubinemia, resp distress, hypocalcemia, convulsions, renal vein thrombosis

Question 16

What anomalies assocaited w/ oligohydramnios?

Answer 16

renal agenesis or obstruction

Question 17

What anomalies associated with polyhydramnios?

Answer 17

duodenal atresia, TE fistula, anencephaly

Question 18

What is erb duchenne?

Answer 18

C5/C6

arm cannot be abducted or externally rotated, forearm cannot be supinated

Question 19

What is klumpke?

Answer 19

C7/C8

palsy of hand + horners syndrome

Question 20

What is next step in subgaleal hemorrhage?

Answer 20

send to ICU for monitoring, risk of hypovolemic shock from blood loss

Question 21

What is next step if simple post-axial polydactylyl?

Answer 21

surgically remove after birth

Question 22

What are risks of baby drinking goats milk?

Answer 22

inadequate folate and iron –> prone to anemia

Question 23

What are apneic episodes in infant?

Answer 23

normal in preemie (not full term)

in preemie: 2/2 incompletely developed resp center, have periodic breathing = 3-10 sec pauses

in term: suspect sepsis, GE reflux, CHD, seizure, RSV, hypoglycemia, obstruction

Question 24

What is transient tachypnea of newborn? CXR?

Answer 24

see after C section due to retained fetal lung fluid

CXR = prominent pulm vascular marks + hyperexpansion

resolves in 3 days w/ supportive

Question 25

What are sx of milk protein allergy?

Answer 25

blood streaked mucousy loose stools or severe constipation

Question 26

What is colic?

Answer 26

crying > 3 hrs/day usually in evening > 3 xwk for > 3 wks

Question 27

What are some associations w/ infants of DM moms?

Answer 27

polycythemia, hypoglycemia (from beta cell hyperplasia/insulinemia), hypocalcemia at 48 hr from delayed PTH

also: CHD, caudal regression, LGA, neural tube defects, increased RDS

Question 28

What is effect of lithium in first trimester?

Answer 28

ebstein anomaly = dispalced tricuspid into RV

Question 29

What is effect of ACE inhibiotrs?

Answer 29

renal dysgenesis, oligohydramnios

Question 30

What is effect of dilantin exposure?

Answer 30

midface hypoplasia, ocular hypertelorism, distal phalngeal hyperplasia

Question 31

What is effect of propanolol?

Answer 31

growth retardation when given through pregnancy

decreased ability to increase HR/CO, hypoglycemia, apnea

Question 32

What are causes of hypocalcemia of newborn?

Answer 32

early = maternal DM, NRDS, sepsis, hypo Mg

late = hypo PTH or high phosphate intake

have tetany and seizure