Mehl. pulmo: TEF, choanal, diaph hernia, NRDS 04-03 (4) Flashcards
TEF = Tracheoesophageal fistula.
HY peds condition
.
TEF. definition?
proximal esophagus ends in a blind pouch + the distal esophagus connects to the trachea.
proximal esophagus ends in a blind pouch + the distal esophagus connects to the trachea.?
TEF = Tracheoesophageal fistula.
TEF. CP?
Will present as a neonate who coughs up milk with initial feeding
Will present as a neonate who coughs up milk with initial feeding?
TEF.
TEF. what is highest yield point regarding diagnostic?
Highest yield point about TEF is that diagnosis is made via insertion of
nasogastric tube (which cannot be inserted fully because it hits the blind
pouch of the esophagus).
TEF. embriology abnormality?
An NBME Q wants “endoderm” as the abnormal embryology for TEF (makes sense, since esophagus is epithelial lining of the gut -> endoderm)
Weird condition in which the nasal passages don’t develop patency, so
the neonate is an obligate mouth-breather?
Choanal atresia.
Choanal atresia. definition?
Weird condition in which the nasal passages don’t develop patency, so the neonate is an obligate mouth-breather
Choanal atresia.
CP?
Will present as a child who becomes blue/hypoxic while breast feeding (because he can’t breathe through the nose), then cries/becomes pink once detaching from the breast
Will present as a child who becomes blue/hypoxic while breast feeding
(because he can’t breathe through the nose), then cries/becomes pink
once detaching from the breast?
Choanal atresia.
Choanal atresia. how made diagnosis?
Similar to TEF, diagnosis is made via insertion of nasogastric tube.
Choanal atresia. part of what syndrome?
Part of CHARGE syndrome
CHARGE syndrome?
Part of CHARGE syndrome -> Coloboma of the eye (hole in the eye), Heart defects, Atresia of the choanae, Renal defects, Genitourinary
anomalies, Ear anomalies
Congenital diaphragmatic
hernia. one of the highest yield ped condition.
Cause?
Caused by failure of formation of pleuroperitoneal membranes.
Caused by failure of formation of pleuroperitoneal membranes?
Congenital diaphragmatic
hernia.
Congenital diaphragmatic
hernia. occur on what side?
Always occurs on the left, where bowel from the abdomen can herniate
up into the left-chest.
Always occurs on the left, where bowel from the abdomen can herniate
up into the left-chest?
Congenital diaphragmatic
hernia.
Congenital diaphragmatic
hernia. CP? regarding bowel sounds
Can present as decr. bowel sounds in the abdomen + incr. bowel sounds in the
left hemithorax
Congenital diaphragmatic
hernia. what vignette might say?
Vignette might say there are cystic-appearing areas in the left hemithorax seen on CXR (loops of bowel).
Neonatal respiratory distress syndrome (NRDS).
definition? what case, what weeks born?
Aka hyaline membrane disease.
The answer on USMLE for respiratory distress in kid who is born <34 weeks’ gestation.
NRDS. cause pathophysiology?
Due to insufficient surfactant production by type II pneumocytes due to
decr. lamellar bodies (the specialized organelles that produce surfactant).
NRDS. lecithin/sphingomyelin?
These kids have decr. lecithin/sphingomyelin ratio (i.e., <2.0). Normally it is >2-2.4.
NRDS. another name for lecithin?
dipalmitoyl phosphatidylcholine
NRDS.
USMLE can give simple vignette of NRDS and then ask for various manipulation of the ratio – i.e., “ incr. sphingomyelin” might be an answer (makes sense, since this would decr. the ratio)
.
NRDS. decr. surfactant –> ? –> elastics?
Decr. surfactant production means decr. alveolar compliance and INCR. elastic recoil.
Surfactant is hydrophobic and normally prevents the alveoli from collapsing, so if it’s deficient, the hydrophobic interactions of the alveolar walls enable incr. collapsing/elastic recoil.
NRDS. CXR? buzzy
CXR shows a “reticulogranular” appearance.
Very buzzy and HY.
NRDS. what is done in order to prevent it?
In order to prevent NRDS, a pregnant woman giving birth <34 weeks’ gestation must be TWO boluses of corticosteroids within 24 hours of parturition, which accelerate fetal lung maturity.
NRDS.
For example, there is a
2CK Q where they tell you a woman giving birth at 33 weeks’ gestation was
given a bolus of corticosteroids 12 hours ago. They ask for next best step –>?
answer = “bolus of corticosteroids.”
Sounds weird because they said it was just done, but she needs TWO boluses
NRDS. management sequence? 3/4
Tactile stimulation –> place under warming lights –> exogenous surfactant and oxygen
NRDS. what is tactile stimulation?
warming, drying, and rubbing the back or the soles of the feet —–> stimulates spontaneous breathing
Tactile stimulation –> place under warming lights –> exogenous surfactant and oxygen. in what pathology?
NRDS.
