NB peds

Question 1

Normal RR for NB?

Answer 1

40-60 breaths per min

Question 2

Normal HR for NB?

Answer 2

120-160 BPM

Question 3

most likely cause of conjunctivitis in NB at day 1?

Answer 3

chemical irritation (due to silver nitrate)

Question 4

most likely cause of conjunctivitis in NB at day 2-7?

how do you tx it?

Answer 4

Neisseria gonorrhea

ceftriaxone

Question 5

most likely cause of conjunctivitis in NB at day >7?

tx?

Answer 5

Chlamydia trachomatis

tx: oral erythromycin

Question 6

most likely cause of conjunctivitis in NB in NB >3weeks?

tx?

Answer 6

herpes simplex

tx: systemic acyclovir, topical vidarabine

Question 7

2 abx drops given to NB to prevent ophthalmia neonatorum?

Answer 7

erythromycin or tetracycline ointment

silver nitrate solution

Question 8

what screening tests MUST be performed before d/c?

Answer 8

PKU, CAH, biotinidase, B thal, galactosemia, hypothryoid, homocysteinuria, CF

Question 9

G6PD deficiency

Answer 9

Xlinked R
defect -> dec. glutathione -> inc. RBC susceptibility to ox. stress -> HA

(enzyme needed to regen NADPH, which is nec to regen reduced glutathione)

triggers: sulfa drugs, antimalarials, infxn, fava beans
- back pain/hemoglobinuria a few days later
- Heinz bodies and bite cells

Question 10

PKU

Answer 10

• AR
  cause: deficient in phenylalanine hydroxylase (PAH) or tetrahydrobiopterin cofactor (less common)
• symptoms: MR, light skin, seizures, musty body odor
  tx: avoid phenylalanine until 16, increase tyrosine in diet

Question 11

classic galactosemia

Answer 11

AR

• lack of galactose 1Puridyltransferase (can’t convert galactose1P to glucose1P)
  symp: FTT, MR, jaundice, heptatomeg, infantile cataracts
  tx: exclude galactose and lactose from diet

Question 12

galactokinase deficiency

Answer 12

AR
can’t convert galactose to galactose 1P
- mild: galactose in blood/urine, infantile cataracts,

Question 13

what does NB hearing test exclude?

Answer 13

congenital sensorinerual hearing loss

Question 14

transient polycythemia of the NB

Answer 14

hypoxia during delivery -> EPO stim -> inc RBCs

infants first breath inc O2, drops EPO, normalizes

splenomegaly is NORMAL in NB

Question 15

transient tachypnea of the NB

Answer 15

MC in C section (vaginal canal compresses rib cage, helping remove excess pulm. fluid)

• excess fluid -> hypoxia
• if >4 hrs of tachypnea = sepsis, get cx
• if neuro signs (irritable, lethargic, temp, feeding probs) -> LP w/ CSF and cx

Question 16

transient hyperbilirubinemia

Answer 16

infantile spleen removes excess RBCS w/ HbF

- breakdown of RBCs-> physiological release of Hb -> rise in bilirubin

Question 17

what cause subconjunctival hem in the NB?

Answer 17

• passing thru birth canal: inc in intrathoracic pressure as chest compressed

Question 18

what are the major types of skull fx in the NB?

Answer 18

1. linear (MC, no symp, no tx)
2. depressed (can cause further cortical damage if no sx; elevate)
3. basilar (most fatal)

Question 19

scalp injuries in NB?

Answer 19

1. caput succadaneum (crosses suture lines; swelling of soft tissue)
2. cephalohematoma (superiosteal hem; does NOT cross)

Question 20

Which roots are involved in Erb-Duchenne palsy?

Answer 20

C5-C6
unable to abduct, ext rotate, or supinate
best tx: immobilized

Question 21

Which roots involved in Klumpke?

Answer 21

C7/8 and T1

• claw hand (lack of grasp reflex)
• paralyzed hand w/ HORNER’s

Question 22

what causes facial nerve palsy in NB?

Answer 22

forceps injury

Question 23

causes of polyhdramnios?

Answer 23

• neurologic: Werdnig-Hoffman (unable to swallow)

- GI: intestinal atresias

Question 24

causes of oligohydramnios?

Answer 24

• prune belly syndrome
• renal agenesis (incompatible w/ life)
• flat facies

Question 25

what kind of defects to elevated AFP levels indicate?

Answer 25

• neural tube and abdominal wall

Question 26

when should surgery be perfromed for umbilical hernia?

Answer 26

after age 4

likely to close spont by age 3

Question 27

what is the most common abdominal mass in kids?

Answer 27

wilms tumor

- highly assoc w aniridia

Question 28

Wilms tumors

Answer 28

aka nephroblastoma

• large palpable unilat flank mass, and/or hematuria
• lof mut of WT1/2 on chrom 11
• dx 1) abd U/S 2) confirm w/ contrast CT

Beckwith Wiedemann syndrome (WT, macroglossia, organomegaly, hemihypertrophy)

WAGR (WT, aniridia, GU abnormalities, mentral Retardation)

Question 29

neuroblastoma

Answer 29

• adrenal medulla tumor similar to pheochromocytoma
• • hypsarrthymia on EEG and opsomyoclonus **
    dx: increased VMA and metanephrines in urine
• MC cancer in infancy
• MC extracranial solid malignancy

Question 30

what is hydrocele a remnant of?

Answer 30

tunica vaginalis

- most resolve w/in 6 months

Question 31

after what age is orchipexy performed for cryptorchidism?

Answer 31

• age 6mo-1yr

Question 32

hypospadias

Answer 32

opening or urethra on ventral side of penis

• assoc w/ cryptorchidism/inguinal hernia
• circumcision CI

Question 33

epispadias

Answer 33

• opening on dorsal surface
• assoc w/ urinary incont
• eval for bladder extrophy