Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics 2 > general 1 > Flashcards

general 1 Flashcards

1
Q

list risk factors for babies born to adolescent mothers

A

at greater risk for low birth weight…

  1. lower birth weight
  2. vertically acquired STIs (due to higher incidence of STIs in adolescent population)
  3. poorer developmental outcomes
  4. increased risk of fetal death

**infants born to adolescent mothers DO NOT have increased incidence of chromosomal abnormalities; trisomy 21 is more likely in older mothers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the risks of tobacco use in pregnancy

A

maternal tobacco use increases risk for low birth weight in the fetus

NO characteristic facies associated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

is there any safe amount of alcohol in pregnancy

A

no–always risk of FAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is FAS

A

distinct pattern of facial abnormalities, growth deficiency and evidence of CNS dysfunction

in addition to cognitive disability, victims of fetal alcohol syndrome exhibit other neurobehavioral deficits such as poor motor skills and hand-eye coordination and learning problems (difficulties with memory, attention and judgement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

have distinctive effects of marijuana on the fetus been identified

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the effect of cocaine use on the fetus

A

causes vasoconstriction leading to placental insufficiency and low birth weight

may lead to subtle yet significant later deficits in some kids including in cognitive performance, information processing and attention tasks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

list maternal factors that limit fetal growth in utero

A
  1. poor weight gain in the third trimester
  2. preeclampsia
  3. maternal prescription or illicit drug use
  4. maternal infections
  5. uterine abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

list placental factors that limit fetal growth in utero

A
  1. placenta previa
  2. placental abruptions
  3. abnormal umbilical vessel insertions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

list fetal factors that limit fetal growth in utero

A
  1. fetal malformations
  2. metabolic disease
  3. chromosomal abnormalities
  4. congenital infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what does it mean for an infant to be SGA

A

newborns noted to be smaller than expected for their gestational age

not synonymous but often used interchangeably with–
fetal growth restriction
IUGR
intrauterine growth retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

list factors that increase the risk of transmission of HIV from mother to infant

A
  1. frequent unprotected sex during pregnancy (increases risk of chorioamnionitis which, along with other STIs, increase risk of HIV transmission)
  2. advanced HIV maternal disease (may indicate high viral load)
  3. membrane rupture greater than 4 hours prior to delivery if mother not on ARVs
  4. vaginal delivery
  5. breastfeeding
  6. premature delivery (before 37 weeks GA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the components of the APGAR score

A 
Appearance (skin color)
Pulse (HR)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration

score of 0, 1 or 2 for each component with final score ranging from 0-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

define SGA

A

weight below the 10th percentile for GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

define microcephalic

A

head circumference below 10th percentile for GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is a term infant

A

born at more than 37 weeks GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe the Ballard gestational age assessment tool

A

uses signs of physical and neuromuscular maturity to estimate gestational age

can be helpful if there is no early US to help date the pregnancy or if the GA is in questions because of uncertain maternal dates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

list the risks that face SGA newborns

A
  1. hypoglycemia
  2. hypothermia
  3. polycythemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why are SGA infants at risk for hypoglycemia and what are the symptoms

A 
happens because--
decreased glycogen stores
heat loss
possible hypoxia
decreased gluconeogenesis

commonly asymptomatic, though may exhibit poor feeding and listlessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

why are SGA infants at risk for hypothermia and what are the symptoms

A 
happens because--
cold stress
hypoxia
hypoglycemia
increased surface area
decreased subQ insulation

commonly asymptomatic, though may exhibit poor feeding and listlessness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

why are SGA infants at risk for polycythemia and what are the symptoms

A

happens because–
chronic hypoxia
maternal-fetal transfusion

“ruddy” or red color to skin, respiratory distress, poor feeding, hypoglycemia

*infants with slugging blood flow (hyperviscosity) because of a critically elevated Hb/Hct may have resp distress secondary to inadequate oxygenation of end organ tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are TORCH infections

A

refers to prenatal or congenital infections

Toxoplasmosis
Rubella
CMV
HSV2

now also… HIV, Hep B, human parvovirus, syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what would you expect to see on brain imaging in an infant with congenital CMV

A
  1. intracranial calcifications (appear as bright areas on CT)
  2. diminished number of gyri and abnormally thick cortex (lissencephaly/agyria-pachygyria)
  3. enlarged ventricles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what does congenital CMV cause?

A
  1. hearing loss(–>onset of hearing loss may be after newborn period, often progressive)
  2. microcephaly and intracranial calcifications(–> developmental delay, cerebreal palsy; require ongoing developmental assessment)
  3. hepatosplenomegaly(–> can be expected to resolve spontaneously within a few weeks)
  4. rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what feeding is recommended for premature infants

A

breastmilk plus fortifier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how often should mothers breastfeed their babies

A

when there are signs of hunger (about 8-12 times a day)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

list the absolute contraindications to breastfeeding

A
  1. maternal HIV infection
  2. active HSV lesions on breast
  3. active untreated tuberculosis
  4. active maternal use of some non presecription drugs of abuse
  5. infants with galactosemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the benefits to the child of breastfeeding

A
  1. stimulates GI growth and motiblity
  2. decreases risk of acute illnesses during breastfeeding period
  3. lower rates of diarrhea, acute and recurrent otitis media and UTIs
  4. reduction in obesity, cancer, adult CAD, allergic conditions, T1DM and IBD
  5. neurodevelopmental advantage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what are the maternal benefits to breastfeeding

A

decreased risk of breast and ovarian cancers, and decreased risk of osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what are 4 common signs of an inborn error of metabolism and when do they tend to present

A
  1. anorexia
  2. lethargy
  3. vomiting
  4. seizures

tend to present 24-72 hr after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how common are inborn errors of metabolism in the neonate

A

1/5 sick full term neonates without risk factors for infection will have a metabolic disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what two things are neonates routinely screened for?

A

metabolic disorders and congenital deafness

**2010 guidelines recommend screening all newborns for significant congenital heart defects via pulse ox

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what metabolic conditions are screened for in the neonate

A
  1. PKU
  2. hypothyroid
  3. galactosemia
  4. hemoglobinopathy
  5. maple syrup urine disease
  6. CAH
  7. CF
  8. G6PD deficiency
  9. toxoplasmosis

**many states now screen for more than 30 diseases using tandem mass spectrometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the leading cause of congenital infection in the US

A

CMV

*more than 90% of kids with CMV infection have no clinical evidence of disease as newborns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

symptoms of congenital CMV in the neonate

A
  1. skin–> petechiae, purpura, ecchymosis, jaundice
  2. hepatobiliary–> high direct bilirubin, elevated ALT, hepatomegaly
  3. hematopoietic–> thrombocytopenia, anemia, splenomegaly
  4. CNS–> microcephaly, intracranial calcifications on CT, poor feeding, lethargy, seizures, increased CSF protein
  5. auditory–> sensorineural hearing loss
  6. visual–> chorioretinitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what does a HEADDSSS interview consist of

A 
Home
Education/employment
Eating disorder screening
Activities/affiliations/aspirations
Drugs
Sexuality
Suicidal
Safety
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are the standard elements of newborn resuscitation

A
  1. warm and dry the infant and remove any wet linens immediately –> infants have large surface area relative to body weight and can thus experience significant hypothermia from evaporation
  2. stimulate the infant to elicit a vigorous cry–>helps clear lungs and mobilize secretions
  3. suction amniotic fluid from the infants nose and mouth–> this clears upper airway
  4. initiate further resuscitation if required–> may include blow by oxygen, PPV/bag valve, chest compressions, meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what % newborns require some assistance to initiate breathing

A

10%

fewer than 1% require extensive resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how can you stabilize infants temperature

A

skin to skin contact with mother

radiant warmer

incubator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

define rooting reflex

A

newborn turns head towards your finger when you touch his cheek

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

define sucking reflex

A

newborn sucks on your finger when you touch the roof of his mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

define startle/moro reflex

A

support newborns head with one hand and buttocks with other

with head in midline position, hand supporting it quickly dropped to position approximately 10 cm below starting position and head caught in new position

newborn should flex thighs and knees, fan and clench fingers, and arms first thrown outward then brought together as though embracing something

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

define palmar and plantar grasp reflexes

A

newborn grasps fingers when you stroke it against the palm of his hand or plantar surface of foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

define asymmetrical tonic neck response

A

turning newborns head to one side causes gradual extension of arms towards direction of infants gaze with contralateral arm flexion like a fencer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

define stepping response

A

newborns legs make stepping motion when hold him vertically above table and stroke dorsum of foot against table edge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

ddx for SGA newborn with microcephaly and purpuric rash

A
  1. TORCH infection
  2. FAS–unlikely to be sole etiology
  3. chromosomal abnormality–rash unlikely
  4. prenatal tobacco exposure
  5. HIV infection–most asymptomatic at birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what tests are usually included in prenatal lab screening

A

serological screening to determine status for HIV, rubella, hep B

blood type and Rh

urine drug screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

test for hep B

A

maternal hep B surface antigen (HBsAg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

test for rubella

A

maternal and infant rubella titre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

test for toxoplasmosis

A

infant toxo titre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

test for CMV

A

infant urine culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

list methods of decreasing risk of vertical HIV transmission in positive mother

A
  1. tx of mother with combo ARV therapy if viral load above 1000
  2. cesarean delivery if possible prior to onset of labour at 38 weeks
  3. no breastfeeding (if clean water is available…breastfeeding okay if poor water sources)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what are the routine newborn meds

A

vitamin K

hep B vaccine

erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

why is vitamin K given to the newborn

A

IM injection to prevent hemorrhagic disease of the newborn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

why is hep B vaccine given to newborns

A

regardless of maternal test resuts

immunoglobin only given to kids at risk of vertical transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

why is erythromycin eye ointment given

A

to prevent gonococcal conjunctivitis

(chlamydia trachomatis conjunctivitis more common but occurs at 7-14 days after birth….neonatal prophylaxis does little to prevent it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

how do you treat congenital CMV and why

A

treat with either parenteral ganciclovir or oral valganciclovir

decreases progression of hearing impairment and diminished developmental impairment in infants with CMV infection and CNS involvement

treat for 6 months

(no data for tx of asymptomatic CMV infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

how should congenital CMV infection be followed up

A
  1. audiometry–> ABR or acoustic emissions until at least 12 months then age appropriate
  2. ophthalmoscopy, vision function–> at newborn, 12 mo, 3 years, preschool
  3. neuro exam/devel assessment by primary care physician–> at each check up until school age
  4. neuro/neuropsych referral as indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

list risk factors for neonatal respiratory distress

A
  1. maternal diabetes
  2. prematurity
  3. maternal GBS infection
  4. c section delivery
  5. premature rupture of membranes more than 18 hours (prolonged PROM)
  6. meconium in amniotic fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

why is the following a risk factor for neonatal respiratory distress:
maternal diabetes

A

risk factor for respiratory distress syndrome among others

60
Q

why is the following a risk factor for neonatal respiratory distress:
prematurity

A

predisposes to RDS caused by lung immaturity and lack of surfactant

most infants born at 36 weeks GA do not have RDS

61
Q

why is the following a risk factor for neonatal respiratory distress:
maternal GBS infection

A

risk factor for neonatal sepsis– > respiratory distress

62
Q

why is the following a risk factor for neonatal respiratory distress:
c section

A

predisposes to transient tachypnea of the newborn (TTN)

63
Q

why is the following a risk factor for neonatal respiratory distress:
premature rupture of membranes more than 18 hours before

A

risk factor for neonatal sepsis

64
Q

why is the following a risk factor for neonatal respiratory distress:
meconium in amniotic fluid

A

risk factor for meconium aspiration syndrome

65
Q

what does the apgar score describe

A

condition of the newborn infant immediately after birth and is a tool for standardized assessment

provides mechanism to record fetal to neonatal transition

affected by GA, maternal meds, resuscitation and cardiorespiratory and neuro conditions that may be present in the infant

poor neuro outcome is better associated with documented asphyxia–> important to obtain good arterial blood gasses to look for metabolic acidosis

apgar score alone correlated poorly with future neuro outcome of the term infant

66
Q

can low apgar scores of 1-5 be conclusive markers or an acute intrapartum hypoxic event?

A

no

67
Q

what does a neonates birth weight indicate

A

the health of the intrauterine environment

68
Q

define LGA

A

newborns with birth weight above 90th percentile

many infants are constitutionally large but most important pathologic etiology is maternal gestational diabetes

69
Q

what are some potential clinical problems being LGA

A
  1. often must be delivered by c section, forceps or vacuum extraction –> assoc complications
  2. birth injuries are more common such as fractured clavicle, brachial plexus injury and facial nerve palsy
  3. hypoglycemia is especially common in LGA infants born to diabetic mothers
70
Q

define appropriate for gestational age infants

A

between 10th and 90th percentiles

71
Q

define SGA

A
  1. newborns with birth weights below either the 3rd or 10th percentile
  2. may have low birth weight due to prematurity but low birth weight also results from many other causes–> up to 70% of SGA infants are small simply due to constitutional factors (maternal ethnicity, parity, weight or height)
  3. dx with SGA at birth
  4. differs from IUGR because IUGR is dx with pregnancy
72
Q

what are some potential clinical problems with SGA

A
  1. temperature instability
  2. inadequate glycogen stores
  3. polycythemia and hyperviscosity
73
Q

from a blood flow perspective, what 4 things are essential for a successful transition to extrauterine life at birth?

A
  1. removal of the low-resistance placental circulation by cutting the umbilical cord
  2. initiation of air breathing by the newborn infant
  3. reduction of the pulmonary arterial resistance
  4. closure of the PFO and PDA
74
Q

what happens physiologically when the infant takes its first breath

A

first breath results in replacement of the lung fluid by air –> fluid leaves the lungs by combo of being squeezed out during uterine contractions with vaginal delivery and absorption by pulmonary lymphatics

delayed absorption of pulm fluid results in TTN

75
Q

what causes TTN

A

delayed absorption of pulmonary fluid by the pulmonary lymphatics at birth

76
Q

HR and RR in first hour of life

A

160-180 bpm

60-80 resps per min

77
Q

HR and RR in second hour of life assuming successful transition

A

120-160 bpm

40-60 rpm

78
Q

what conditions will cause evidence of abnormal transition to extrauterine life?

A

TTN

persistent pulmonary hypertension of the newborn (PPHN)–persistence of fetal circulation

79
Q

what are the signs of respiratory distress

A

tachypnea
retractions
grunting

intercostal and subcostal indrawing reflect increased WOB due to decreased lung compliance (from primary lung pathology or edema)

grunting is at end of expiration–air being expelled through partially closed glottis as infant attempts to increased transpulmonary pressures, increased lung volumes and improve gas exchange

80
Q

respiratory ddx in the cyanotic newborn

A

common:
TTN
RDS

uncommon:
pneumothorax
diaphragmatic hernia
choanal atresia
pulmonary hypoplasia
PPHN
81
Q

cyanotic congenital heart defects ddx in cyanotic newborn

A

common:
tetralogy of fallot
transposition of the great arteries

uncommon:
truncus arteriosus
tricuspid atresia
total anomalous pulmonary venous return
pulmonary atresia
82
Q

what is transposition of the great arteries?

A

defect in which the aorta and pulmonary arteries are transposed resulting in resp distress and cyanosis as the ductus arteriosus closes shortly after birth

one risk factor is being born to a diabetic omther.

often associated with other congenital heart defects–> VSD–> murmur may be heard

83
Q

what are the general classes of defects on the ddx for a cyanotic newborn

A 
respiratory
congenital heart defect
CNS
infectious 
other
84
Q

CNS ddx in cyanotic newborn

A

hypoxic-ischemic encephalopathy
intraventricular hemorrhage
sepsis/meningitis

85
Q

infectious ddx in cyanotic newborn

A

septic shock

meningitis

86
Q

other ddx in cyanotic newborn

A

respiratory depression secondary to maternal meds

hypothermia

polycythemia/hyperviscosity

87
Q

what is the primary anabolic hormone for fetal growth

A

insulin

88
Q

what is the effect of maternal hyperglycemia on the neonate

A

high maternal serum glucose–> hyperglycemia in the fetus–> stimulates fetal pancreatic beta cells and development of hyperinsulinemia

maternal insulin does not cross placenta

89
Q

what is the effect of hyperinsulinemia in utero?

A

high levels in third trimester cause increased growth of insulin sensitive organ systems (heart, liver, muscle) and general increase in fat synthesis and deposition–> increased body fat, muscle mass, organomegaly–> LGA

brain and kidneys are not insulin sensitive and thus are not large

90
Q

how are the first trimester HbA1c levels and risk for major malformations related

A

directly–> higher HbA1c, higher risk

infants born to women with HbA1c levels above 12% have at least a 12 fold increase in major malformations

91
Q

is feeding a tachynpic infant by mouth contraindicated?

A

no, though many are reluctant

many infants with RR 60-80 tolerate oral feeds but some may need NG or IV fluids if resp distress worsens with feeds

RR above 80 usually causes difficulty with both oral and NG feeds –> IV

92
Q

what should a mother do if kid is unable to breastfeed because of tachypnea

A

pump–> ensures milk production and adequate supply when baby is better

baby should be fed expressed breast milk supplemented with formula as needed

93
Q

do we worry about asymptomatic hypoglycemia?

A

yes–can have negative consequences for long term neurodevelopment

94
Q

which infants should be screened for hypoglycemia

A 
SGA
LGA
late preterm 
infants of diabetic mothers 
--even if asymptomatic
95
Q

what is the fetal blood glucose level in utero

A

approximately 2/3 of moms

96
Q

when should glucose levels stabilize in the neonate

A

by 3-4 hours after birth

97
Q

what is the dubowitz score

A

based on infants external physical characteristics and neurologic findings

requires infant be alert and active

98
Q

what is the ballard score

A

shortened version of the dubowitz score

allows assessment in extreely premature infants

99
Q

when should the gestational age assessment be done in an infant

A

every neonate between 12-24 hours of life

accuracy is about plus or minus two weeks

100
Q

clinical features of developmental dysplasia of the hip (DDH)

A

partial or complete dislocation

instability of the femoral head

101
Q

what are risk factors for DDH

A

breech position (30-50% DDH cases occur in infants born breech)

gender (9:1 female)

family history

102
Q

how often and for how long will the typical breastfed infant feed?

A

on demand every 2-4 hours for 10-15 min on each side

103
Q

what are the recommendations regarding vitamin D on discharge

A

exclusively breastfed infants receive a daily dose of 400 IU of vitamin D because human milk does not provide adequate intake

should continue until child weaned to cows milk or formula with vit D

104
Q

ddx for tachypnea in the newborn

A

RDS

TTN

pneumothorax

hypoglycemia

CHF

neonatal sepsis

congenital diaphragmatic hernia

severe coarctation of the aorta

meconium aspiration

maternal drug exposure

hypothermia

105
Q

what is RDS

A

respiratory distress syndrome

caused by deficiency of lung surfactant and delayed lung maturation

can occur as late as 37 weeks gestation

most common cause of respiratory distress in premature infants

remember that there may be surfactant deficiency and delayed lung maturation in infants of diabetic mothers

106
Q

what is TTN

A

results of delayed clearance of fluid from the lungs following birth

much more common in infants born to diabetic mothers and by c section

often considered a disorder of term infants –> TTN does occur in premature infants

107
Q

what causes a pneumothorax in a newborn

A

caused by collection of gas in pleural space with resultant lung collapse

common risk factors:
mechanical ventilation
underlying lung disease–> meconium aspiration or severe RDS

relatively uncommon but important to consider

more likely in premature infant with RDS

108
Q

what most often causes neonatal sepsis

A

GBS

prolonged PRO (early membrane rupture) associated with increased risk of neonatal sepsis

109
Q

what is a congenital diaphragmatic hernia?

A

malformation resulting from defect in development of diaphragm

allows passage of organs from abdomen into chest cavity–> impairs lung development

most on left side

1/2200-5000 live births

110
Q

what is the most common type of congenital diaphragmatic hernia

A

about 95% of all cases

Bochdalek hernia–> posterolateral

111
Q

what are two important diagnostic clues for congenital diaphragmatic hernia

A

absent breath sounds or presence of bowel sounds on one side of the chest

112
Q

what tests should be considered/ordered to evaluate a cyanotic newborn

A
  1. arterial blood gases
  2. blood and CSF culture
  3. CBC with diff
  4. chest radiograph
  5. echocardiogram
  6. oxygen challenge test
  7. physical exam
  8. pulse ox
113
Q

why do you order this test to evaluate a cyanotic newborn?

arterial blood gasses

A

show oxygenation, ventilation and acid base status

knowing pCO2 helps to understand cause

114
Q

why do you order this test to evaluate a cyanotic newborn?

blood and CSF cultures

A

ID infectious organisms if suspect sepsis

115
Q

why do you order this test to evaluate a cyanotic newborn?

CBC w diff

A

rule out neutropenia, leukopenia, abnormal immature-to-total neutrophil ratio, and thrombocytopenia

116
Q

why do you order this test to evaluate a cyanotic newborn?

CXR

A

integral part of initial assessment of newborn with resp distress

size and shape of heart

appearance of lungs–> pna? meconium asp? RDS? pneumothorax?

normal inspiratory films should have 8 or more intercostal spaces of lung fields on both sides

117
Q

how many intercostal spaces should you be able to see on normal inspiratory films for a newborn

A

8

118
Q

why do you order this test to evaluate a cyanotic newborn?

echo

A

gold standard to diagnose CHD and PPHN

indicated when there is a persistent cyanosis and no indication of lung disease or when there are other signs suggesting heart defect (murmur, abnormal ECG, CXR with abnormal cardiac contour)

119
Q

why do you order this test to evaluate a cyanotic newborn?

oxygen challenge test (hyperoxia test)

A

can help differentiate between cardiac and pulm etiology in cyanotic newborns

oxygen will increase PaO2 of infant with respiratory etiology but will not really affect those with cardiac etiology

120
Q

what tests should you order to evaluate a tachypnic newborn

A
  1. CBC and diff
  2. serum or plasma glucose
  3. blood cx
  4. CSF for culture
  5. blood gas or pulse ox monitoring
  6. CXR
121
Q

why do you do this test to evaluate a tachypnic newborn?

blood cx

A

may be the only sign of early sepsis or pna

122
Q

why do you do this test to evaluate a tachypnic newborn?

CSF for culture

A

part of eval of any infant with suspected sepsis or meningitis

very young infants with these conditions may have no localizing signs and only subtle clinical symptoms (i.e temp instability, lethargy, poor feeding)

123
Q

newborn CXR with “wet” looking lungs, no consolidation and no air bronchograms–dx?

A

TTN

124
Q

newborn CXR with diffuse reticulogranular appearance of lung fields (“ground glass”) and air bronchograms–dx?

A

likely RDS

125
Q

newborn CXR with air filled loop of bowel in the left side of the chest, displacing the heart and mediastinum to the contralateral side–dx?

A

diaphragmatic hernia

126
Q

what would a newborn CXR for infant with pneumonia look like

A

findings may be similar to TTN on CXR but clinically more concerning for sepsis

127
Q

TTN on CXR

A

“wet” looking lungs, no consolidation and no air bronchograms

128
Q

RDS on CXR

A

diffuse reticulogranular appearance of lung fields (“ground glass”) and air bronchograms

129
Q

can glucometer testing be used to confirm hypoglycemia?

A

no–> only for screening or ongoing monitoring

low reading by glucometer should be confirmed by serum or plasma glucose

130
Q

tx of hypoglycemic baby who is asymptomatic

A

oral or NG feeds

131
Q

tx of hypoglycemia in symptomatic infant

A

IV infusion of dextrose started immediately

132
Q

example of a recombinant vaccine

A

guardasil–HPV

133
Q

example of a protein vaccine

A

Menactra–meningococcus C

134
Q

example of a polysaccharide vaccine

A

quadrivalent meningococcus vaccine

135
Q

in what population can we use polysaccharide vaccines

A

over 2 years old because less immunogenic

136
Q

what type of vaccines most often contain live microorganisms

A

vaccines against viruses

137
Q

why do live vaccines have a particular advantage

A

small dose (virus replicates in the recipient)

stimulus more closely resembles that associated with a natural infection

138
Q

what are the challenges of live vaccines

A

difficult to store

may potentially be inactivated

often difficult to know who is eligible for a live vaccine–> immunocompromised patients and pregnant people may be at risk

theoretical risk of viral shedding to immunocompromised contacts of live vaccine recipients

rare but live vaccines can reproduce some of the symptoms of the disease they are meant to prevent though at lower intensity

139
Q

list reasons you should vaccinate

A
  1. vaccines prevent uncommon diseases–>
    smallpox eradicated worldwide, polio eradicated in the west; 12 000 cases and 1000 deaths per year due to diphtheria before vaccination–now only 5 cases and no deaths per year in canada
  2. vaccines prevent uncommon diseases with devastating consequences –>
    tetanus –death in 50%, whereas the vaccine is 5% may have fever
  3. vaccination contributes to herd immunity –>
    to obtain the benefits of vaccination, more than 95% of any given population must be vaccinated; outbreaks cannot be prevented without this
  4. experts recommend it–> World Bank has stated that immunizations should be first among the public health initiatives in which governments around the world invest; considered the most cost-beneficial health interventions and one of the few that systematically demonstrate far more benefits than costs
140
Q

do to many vaccines at once overwhelm the immune system

A

no evidence to support this

human immune system has redundancy built in to the point that the immune response to a vaccine given in isolation is similar to that same vaccine given in combination with other vaccines

141
Q

which vaccines are recommended by the CPS

A
  1. 6-in-1–> diphtheria, tetanus, pertussis, polio, Hib
  2. MMR–> measles, mumps, rubella
  3. varivax–> chickenpox
  4. pneumococcus–> 13 valent is standard, protects against strep pneumo including meningitis and pneumonia
  5. meningococcus–> Men-C is standard, protects against sepsis and meningitis caused by N. meningitidis
  6. HPV–> strains 6, 11, 16, 18, protects against cervical cancer and genital warts
  7. rotavirus–> oral vaccine
  8. annual flu vaccine for all kids older than 6 mo
142
Q

how do you take a history relevant to vaccines

A
  1. present health
  2. PMHx
  3. current meds
  4. alllergies–eggs, previous anaphylaxis
  5. vaccine hx
    - -which vaccines
    - -when
    - -where
    - -how many doses
143
Q

list contraindications to vaccines

A
  1. cold
  2. moderate to severe illness with or without fever–> defer
  3. egg allergy if in the vaccine
  4. pregnancy–only to live attenuated

*breastfeeding and allergic conditions (eczema/asthma) are not contraindications

144
Q

what is the anaphylaxis risk of vaccines

A
  1. egg–> varies among populations
  2. more likely to occur in vaccines for yellow fever and flu (prepared from viruses grown in embryonated eggs)
  3. MMR vaccines–> may contain trace avian proteins
  4. anaphylaxis after measles vaccine is rare but reported in those with egg hypersensitivity
145
Q

what are the cardinal features of anaphylaxis

A
  1. itchy, urticarial rash (more than 90%)
  2. progressive, painless swelling (angioedema) of the face and mouth which ay be preceded by itchiness, tearing, nasal congestion or facial flushing
  3. respiratory symptoms–> sneezing, coughing, wheezing, laboured breathing, upper airway swelling–> potential for airway obstruction
  4. hypotension–> develops later and can progress to shock and collapse
  • involves at least two body systems
  • uncommon for unconsciousness to be the only symptom
146
Q

how do you manage anaphylaxis

A

(perform all together or in rapid sequence)

  1. call for assistance including an ambulance
  2. place patient in recumbent position, elevate feet if possible
  3. establish oral airway if necessary
  4. admin 0.01ml/kg (max 0.5 ml) of aqueous epinephrine 1:1000 by subQ or IM injection (in opposite limb to that in which vaccine was given)–> can be repeated twice at 20 min intervals in a different limb each time
    - -> 50mg/ml benadryl can be given as an addition
  5. monitor vitals and reassess patient frequently
  6. should be transferred to ER for observation as 20% of anaphylaxis episodes follow biphasic course with recurrence after 2-9 hour asymptomatic period

Pediatrics 2 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions