High Yield Peds Review

Question 1

What does APGAR tell you?

Answer 1

info about how the newborn tolerated labor (1 min) and newborn’s response to resuscitation (5 min)

Question 2

Newborn PE with edema crossing suture lines

Answer 2

caput succedaneum

Question 3

Newborn PE with fluctuance edema that doesn’t cross suture lines

Answer 3

Cephalohematoma

Question 4

Newborn PE see area of alopecia w/ orange colored nodular skin?

Answer 4

nevus sebaceous

Question 5

How do you treat newborn w/ nevus sebaceous?

Answer 5

remove before adolescnec b/c it can undergo malignant degeneration

Question 6

Newborn PE see skin area w/ thick, yellow/white oily scale on inflam base?

Answer 6

seborrheic dermatitis

Question 7

How do you treat newborn seborrheic dermatitis?

Answer 7

gently clean with mild shampoo

Question 8

What are the 2 most important neonatal screening tests?

Answer 8

1. Phenylketonuria

2. Galactosemia

Question 9

What’s Phenylketonuria? What are s/s

Answer 9

Deficiency in phenal hydrolxalase; S/s: MR, vomting, athetosis, seziures, developmental delay over 1st few months, fair hair/eyes/skin, musty smell

Question 10

How do you treat PKU?

Answer 10

low phen diet

Question 11

What’s galactosemia?

Answer 11

deficiency in G1P-uridyl transferase leads to G1P accumuation in kidneys, liver, brain

Question 12

What are s/s of glactosemia? How do you treat them?

Answer 12

MR with direct hyperbili & jaundice, hypoglycemic, cataracts, seizures
Tx: lactose free diet

Question 13

What are newborns with galactosemia predisposed to?

Answer 13

predisposed to E. coli sepsis

Question 14

3 day old with bili at 10, direct: 0.5. Eating and pooping well. What does he have? What causes it? Treatment?

Answer 14

Physiologic jaundice due to immature liver conjuncation

Should be gone by 5th DOL

Question 15

7 day old with bili 12, direct: 0.5. Dry mucous membranes, not gaining weight. What does he have and what causes it?

Answer 15

Breastfeeding jaundice due to decreased feeding leads to dehydration, retained meconium and reabsorption of deconjungated bili

Question 16

14 day old bili 12, direct: 0.5. Baby regained birth weight, otherwise healthy. What does he have and what causes it?

Answer 16

Breastmilk jaundice due to glucuronidase in breastmilk that deconjuncates bili

Question 17

1 day old with bili: 14, direct: 0.5. What’s the biggest concern? What’s the next thing you do?

Answer 17

pathological jaundice on 1st DOL with bili >12, direct bili > 2 or rate of rise > 5/day. Want to do Coombs test

Question 18

What does it suggest if coombs test is positive or negative for patholgical jaundice (1 day old with bili of 14, direct: 0.5)

Answer 18

If positive means Rh or ABO incompatability

If negative means twin/twin or mom/fetus transfusion, IDM, spherocytosis, G6PDH deficiency, etc

Question 19

7 day old with dark urine, pale stool, bili 12, direct bili: 8 and elevated LFTs. What’s the concern? Tx?

Answer 19

biliar atresia. Bile ducts can’t drain bile causing liver failure. Needs surgery

Question 20

What are some causes of direct hyperbilirubenemia in newborn?

Answer 20

biliary atresia (see w/ elevated LFTs, pale stool, dark urine), sepsis, glactosemia, hypothyroidism, choledochal cyst, CF, dubin johnson, rotor

Question 21

What are 2 random inherited causes of indirect hyperbili?

Answer 21

1. Gilberts: decreased glycoronyl transferase levels (norm conjugates bili)
2. Crigler-Najjar (type 1): total defieciency in glycoronyl transferase

Question 22

What are 2 randominherited causes of direct hyperbili?

Answer 22

DiRect

1. Dubin Johnson: see black liver, can’t see GB, hepatocytes can’t secrete conjugated bili. benign AR
2. Rotor syndrome: norm liver, benign AR

Question 23

Why do we care about hyperbilirubinemia?

Answer 23

indirectbil can cross BBB and deposit in BG and brainstem nuclei causing kernicterus (esp if bili >20)

Question 24

What’s the treatment for hyperbilirubinemia and how does it work?

Answer 24

phototherapy ionizes unconjugated bili so it can be excreted. Double volume exchange transfusion if that doesn’t work

Question 25

What the biggest concern w/ baby born w/ respiratory distress, scaphoid abd and CXR with bowels in thoracic cavity? How do you treat it?

Answer 25

Diaphragmatic hernia can cause pulm hypoplasia

Tx: if dx prenatally, delivery at place w/th ECMO, let lungs mature 3-4 days then do surgery

Question 26

Baby born with respiratory distress and excess drooling, concern? how to test?

Answer 26

TE-fistula

Dx: place feeding tube, take XR, it would coil in thorax

Question 27

If a baby has TE-fistula, what else would you want to look for?

Answer 27

VACTER assoc anomalies: vertebral, anal atresia, cardiac, TE-fistula, radial and renal anoms

Question 28

1 wk old baby becomes cyanotic with feding, pink when cries?

Answer 28

Choanal atresia

Question 29

What else do you look for in choanal atresia?

Answer 29

CHARGE assoc anomalies - coloboma, heart defects, atreia choanal, retarded growth, GU anomalies, ear anomalies/deafness

Question 30

32 wk premie with dyspnea, RR of 80 with nasal flairing? Tx?

Answer 30

RDS

Tx: O2 w/ nasap CPAP to keep alveoli open

Question 31

What are prenatal dx for RDS, how do you train it?

Answer 31

L/S <2

Tx: antenatal betamethasone

Question 32

38 wk LGA infant born by C/S to A2GDM has dyspnea and grunting? Tx?

Answer 32

Transient tachypnea of newborn (TTN) due to retained lung fluid
Tx: min. O2 needed, self-resolves in hours to days

Question 33

41 wk AGA infant born after ROM yielded green/brown fluid? Tx?

Answer 33

Meconium aspiration syndrome

Tx: intubate and suction before stimulation