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Peds Step 2 > Neonate > Flashcards

Neonate Flashcards

1
Q

what does the APGAR score tell you?

A

resuscitation need/effectiveness:
1 minute: evaluates conditions during L/D
5 minutes: response to resuscitation efforts
does NOT imply mortality

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2
Q

APGAR

A 
Appearance: blue-extremities-normal
Pulse: less than 60, 60-100, 100+
Grimace: no response, +grimace/weak cry, sneeze/cough
Activity: none-some flexion-active mvmnt
Respirations: absent-weak/irreg-strong
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3
Q 
neonatal conjuctivitis timeline
most likely cause
day 1
day 2-7
>7 days
>3 wks
A

day 1: chemical (from silver nitrate)
day 2-7: Gonorrhea (ppx: ointments, tx: ceftriaxone)
>7 days: Chlamydia (PO erythromycin)
>3 wks: HSV (acyclovir and topical vidarabine)

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4
Q

what given immediately after birth

A 
erythromycin or tetracycline ointment
(prevent Gonorrhea NOT Chlamydia conjunctivitis)
silver nitrate? 
give vitamin K IM dose
Hep B vaccine (+HBIG if Hep B+ mom)
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5
Q

screening tests prior to d/c neonate

A 
PKU (low phenylalanine diet)
CAH
biotinidase
B-thalassemia
galactosemia (no lactose)
hypothyroidism (cretinism)
homocysteinuria
cystic fibrosis (initial test: sweat chloride, best: CFTR gene)
hearing test
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6
Q

normal newborn derangements

A 
transient polycythemia
splenomegaly
transient tachypnea (wet lungs, C-section, give PPV; if +4hrs consider sepsis)
trainsient hyperbilirubinemia
subconjunctival hemorrhage
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7
Q

newborn skull fxs

A

basilar: most fatal
depressed: needs sx
linear: most common

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8
Q

caput succedaneum vs cephalohematoma

A

caput saccedaneum: soft tissue swelling that DOES cross suture lines
cephalohematoma: subperiosteal hemorrhage that DOES NOT cross suture lines (below periosteum so follows compartments)
(should self-resolve)

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9
Q

“waiter’s tip”

A

Duchenne-Erb Paralysis (C5-6)

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10
Q

“claw hand” (lack of grasp reflex)

A 
Klumpke Paralysis (C7-8 +/- T1)
paralyzed hand with Horner syndrome
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11
Q

causes of polyhydramnios

A

neurological: Werdnig-Hoffman: fetus not swallowing
GI: instestinal atresia

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12
Q

causes of oligohydramnios

A

prune belly: lack of abd. muscles so cannot bear down and urinate
renal agenesis: Potter syndrome
fetus may have flat facies due to lack of fluid

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13
Q

diaphragmatic hernia types

A

Bochdalek: most common, posterolateral defect
Morgagni: retro or parasternal defect

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14
Q

associations:
Omphalocele
Umbilical hernia
Gastroschisis

A

Omphalocele: Edwards (trisomy 18) +sac, midline
Umbilical hernia: congenital hypothyroidism
Gastroschisis: intestnal atresias, no sac, lateral

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15
Q

most common abdominal mass in children?
presents how?
best imaging?
tx?

A

Wilms tumor
aniridia, palpable renal mass, n/v, constipation, GU malformations, MR (WAGR syndrome, chrom. 11 deletion)
initial: abdominal U/S, CT with contrast is most accurate
tx: total nephrectomy +/- chemo/radiation, if b/l do partial nephrectomy

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16
Q

most common cancer in infancy, also most common extracranial solid malignancy?
presents how?
dx?

A

Neuroblastoma: adrenal medulla tumor
hypsarrhythmia (EEG) and opsomyoclonus (“dancing eyes, dancing feet”)
dx: ^VMA and metanephrines in urine

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17
Q

orchipexy of cryptorchid testicle prevents ?

A

sterility, but does not decrease risk of malignancy

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18
Q

hypospadias vs epispadias

A

hypo: ventral (lower) side, associated with cryptorchidism and inguinal hernias
epi: on dorsal (top) surface, associated with urinary incontinence and bladder exstrophy
both: DO NOT CIRCUMCISE, need surgical correction

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19
Q

developmental reflexes

A 
Sucking
Grasping
Babinski
Rooting
Moro
Stepping
Superman
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20
Q

1st minute of life:
what to suction first?
SpO2?
HR?

A

mouth than nose
focus on airway
spO2: 60-65%
HR should be +100, if not: PPV

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21
Q

min 1-5

A

want APGAR 7-10
SpO2: 80-85%, if less FiO2, PPV
HR: 60-100: PPV, if less than 60: cardiac problem (do CPR (3:1) and give EPI in umb. vein)

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22
Q

min 5-10

A

2nd APGAR
SpO2: 90-95%, if less FiO2, PPV
HR: same as min 1-5
continue to do APGAR scores after if still low

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23
Q

RDS

A

lack of surfactant, atelectasis
premature infant
hypoextended lungs
may need intubation and surfactant

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24
Q

jittery, tremors, lethargy, seizures in neonate, think?

A

hypoglycemia (but may be sepsis)

tx: IV bolus 2mL/kg D50, if refractory D5 or D10 constant infusion

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25
Q

bronchopulmonary dysplasia

A

decreased surfactant (RDS) leading to alveolar de-recruitment leading to scarring
premature infant with ^ respiratory demand
dx: ground-glass opacities, ^FiO2 req. for 28ds+
tx: steroids (in utero)
f/u: to assess for DPLD

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26
Q

ROP (retinopathy of prematurity)

A

neoangiogenesis worsened by ^FiO2
premie, see BVs on asymptomatic screen
tx: laser ablation
f/u: still may get early glaucoma

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27
Q

IVH

A

caused by highly vascular lining of ventricles, sensitive to changes in BP
asymptomatic screen
see ^ICP (bulging fontanelles, coma seizure)
dx: cranial doppler
tx: VP shunt/drain
f/u: MR, seizure

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28
Q

NEC

A

dead gut, premie in ICU who has bloody BM
dx: XR showing air in wall of intestine (pneumatosis intestinalis)
tx: NPO, IV abx (G-), TPN
f/u: surgery

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29
Q

both gastroschisis and omphalocele have ? and are tx with ?

A

^AFP

tx: silo

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30
Q

worsening jaundice at about 7-14 days (direct hyperbili) think ?
what to do next?

A

biliary atresia
dx: U/S showing absent ducts
HIDA scan after 5-7 days phenobarbital (stim. biliary tree to secrete bile)
tx: resect

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31
Q

NTD is found how?

A

^AFP, see on U/S

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32
Q

spina bifida occulta

A

only breakdown of caudal spine

+/- tuft of hair

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33
Q

meningocele

A

breakdown of caudal spine + out pouching of sac with CSF

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34
Q

meningomyelocele

A

breakdown of caudal spine + out pouching of sac with CSF and nerves

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35
Q

NTDs may lead to?

A

Arnold Chiari malformation, hydrocephalus, developmental delay, focal neuro deficit below lesion

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36
Q

ToF: 4 things
associated with ?
presentation?

A

pulmonary stenosis, overriding aorta, RVH, VSD
chromosome 22 deletion, Downs (endocardial cushion defect)
acrocyanosis, holosystolic murmur at LLSB, boot-shaped heart and decreased vasculature on CXR

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37
Q

VSDs seen in ?

A

Downs, Edwards, Pataus, infants of DM moms

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38
Q

most common cardiac defect in Downs

A

endocardial cushion defect of AV canal

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39
Q

3 holosystolic murmurs

A

MR, TR, VSD

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40
Q

transposition of great vessels needs ?
see what on CXR?
tx?

A

needs PDA, ASD, or VSD to oxygenate blood
CXR: “egg on a string”
tx: PGEs, 2 surgeries

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41
Q 
pulses?
pulsus alternans
pulsus bigeminus
pulsus bisferiens
pulsus tardus et parvus
pulsus paradoxus
A

pulsus alternans: LV systolic dysfunction
pulsus bigeminus: HOCM
pulsus bisferiens: aortic regurg
pulsus tardus et parvus: aortic stenosis
pulsus paradoxus: cardiac tamponade and tension PTX

42
Q

absent pulses + single S2, ^RV impulse, gray cyanosis, globular-shaped heart + pulmonary edema on CXR, think ?

A

hypoplastic left heart

tx: 3 surgeries or transplant

43
Q

severe dyspnea, early/frequent resp. infections, single S2, bounding peripheral pulses

A

truncus arteriosis

tx: sx to prevent pulmonary HTN (within 4 mos)

44
Q

where does oxygenated blood from the pulmonary veins return to in TAPVR?

A

to the SVC instead of left atrium
if obstructed presents earlier and shows pulmonary edema on CXR
if not obstructed presents at age 1-2 with RHF and SOB, CXR shows “snowman” or “figure 8” sign
both dx with echo and need sx

45
Q

EKG findings in VSDs

A

RVH from L–>R shunt, could later lead to Eisenmenger syndrome (R–>L)

46
Q

cyanotic heart defects

A

R–>L shunts

ToF, TGV, TA, TAPVR, hypoplastic left heart

47
Q

VSD

A

loud pulmonic S2, holosystolic murmur of LLSB, increased markings on CXR
dx: echo, cardiac cath definitive
tx: diuretics, digoxin, may need sugary
f/u: CHF, endocarditis, pulmonary HTN

48
Q

fixed wide splitting of S2
dx?
tx?

A

ASD
dx: echo, most definitive is cardiac cath; ^vascular markings and cardiomegaly on CXR
tx: most spontaneous, tx of transcath closure
f/u: dysrhythmias and paradoxical emboli from DVTs

49
Q

machinery-like (multi phasic) murmur after day 1, wide pulse pressure, bounding pulses?
when is it pathologic?

A

PDA
after 24 hrs of life, normal in 1st 12 hrs
dx: echo, cardiac cath most accurate, LVH on EKG
tx: indomethacin unless need it
f/u: resp. infections, infective endocarditis

50
Q 
CXR findings:
pear-shaped heart:
boot:
jug handle:
"3":
A

pear-shaped heart: pericardial effusion
boot: ToF
jug handle: primary pulmonary artery HTN
“3”: coarctation of aorta (also rib notching)

51
Q

hearing loss, syncope, normal vitals and exam, fam hx of sudden cardiac death, think ?

A

long QT syndrome

52
Q

tx for coarctation

A

surgical resection of narrow segment and then balloon dilation if recurrent stenosis

53
Q

transposition of the great vessels associated with ?

A

mom was DM before pregnancy (failure to twist wk 8)
RA->RV->aorta->VC (unO2)
LA->LV->pulm. a.->pulm v. (O2)

54
Q

when is hyperbili pathologic in newborn?

A
  • it appears on 1st day of life (normal rise after 72 hrs)
  • rises +5mg/dL/day
  • rises +19.5 mg/dL in term baby
  • D. bili rises +2 mg/dL at any time
  • persists after 2nd week of life
55
Q

hypotonia, seizures, choreoathetosis, hearing loss, consider?

A

kernicterus: bilirubin in basal ganglia

56
Q

consider exchange transfusion if bilirubin rises to ?

A

20-25 mg/dL

if lower use phototherapy

57
Q

common complication of TE fistula

A

aspiration pneumonia

58
Q

signs seen with upper GI series in pyloric stenosis

A

string sign: thin column of barium leaking through tightened muscle
shoulder sign: filling defect in antrum due to prolapse of muscle inward
mushroom sign: hypertrophic pylorus against duodenum
railroad track sign: excess mucosa in pyloric lumen causing 2 columns of barium
doughnut sign seen in intussusception (and in pyloric stenosis?)
double bubble with duodenal atresia, malrotation

59
Q

associations:
choanal atresia:
duodenal atresia:
Hirschsprung:

A

choanal atresia: CHARGE syndrome
duodenal atresia: trisomy 21 (Downs), annular pancreas, polyhydramnios
Hirschsprung: trisomy 21 (Downs)
Imperforate anus: trisomy 21 (Downs)

60
Q

CHARGE syndrome

A 
Coloboma of eye
Heart defects
Atresia of choanae (blue with feeding, pink with crying)
Retardation of growth/development
GU defects
Ear anomalies/deafness
61
Q

failure to pass meconium for over 48 hrs, LBO, tight sphincter, inability to pass gas, think?
dx, tx?

A

Hirschsprung: lack of innervation of distal bowel by Auerbach plexus (constant contracture) (failure of migration) failure in distal colon, failure to pass meconium at 48 hrs, explosive with DRE
dx: XR: distended loops of bowel, good colon: dilated, contrast enema, high pressure on manometry
full thickness biopsy: lack of ganglionic cells in submucosa
sx: 3 stages

62
Q

VACTERL syndrome

A 
Vertebral anomalies
Anal atresia (imperforate)
CV anomalies
TEF
Esophageal atresia
Renal anomalies
Limb anomalies
63
Q

duodenal atresia is due to ?

A

lack/absence of apoptosis leading to improper canalization of duodenal lumen

64
Q

vomiting and colicky abdominal pain with air-fluid levels and “bird beak” appearance think?

A

volvulus

tx: untwisting surgically or endoscopically (+decompression)

65
Q

Intussusception imaging and tx

associations

A

U/S: doughnut/target sign
tx: barium enema (dx and tx) but CONTRAINDICATED if pt has signs of peritonitis, shock, perforation, fluid resuscitation, NGT decompression
associated with rotavirus vaccine, HSP

66
Q

painless BRBPR in kid under 2, think ?

dx/tx?

A

Meckel’s diverticulum, technetium-99m (99mTc) pertechnetate scan
true diverticula with all layers +/- ectopic gastric tissue
tx: surgery

67
Q

bilious vomiting 1st day vs 1st yr of life

A

1st day: duodenal atresia

1st year: volvulus, intussusception

68
Q

w/u for diarrhea/GE

A

stool studies: blood and leukocyte count
stool cultures with O/P
D. diff toxin
+/- sigmoidoscopy to look for pseudomembranes (C.diff)

69
Q

viral infectious diarrhea

winter vs year-round

A

winter: rotavirus, year round: adenovirus (endemic)
both have viral prodrome, fever, emesis, NO blood, and last less than 7 days
epidemic (cruise-ship): norwalk
-explosive, crampy, 1-2 days

70
Q

next step if see air in the bowel wall on abdominal XR
+vomiting, fever, abdominal distension in premie
+/- frank/occult blood in stool

A

(NEC) FIRST start abx: vanc, gentamicin, metronidazole
exclude perf via XR (pneumoperitoneum on CT)
start IVF, bowel rest, NGT for decompression
if refractory, sx to remove affected bowel
30% mortality

71
Q

findings in infants of diabetic moms (IDM)

A

macrosomia, polycythemia
small left colon syndrome
asymmetric septal hypertrophy (obliteration of LV lumen) leads to decreased CO (dx: EKG/echo, tx: BB/IVF)
renal vein thrombosis (hematuria, low plts)

72
Q

metabolic findings in IDM

A

hypoglycemia, hypocalcemia, hypomag, hyperbili (icterus/kernicterus)

73
Q

3 different deficiencies in CAH

A

21-hydroxylase: low aldo, ^testosterone, low cortisol
17-hydroxylase: ^aldo, low testosterone, low cortisol
11-B-hydroxylase: ^deoxycorticosterone (acts like aldo which is low), ^testosterone, low cortisol

74
Q

how to dx CAH

A

at birth: serum electrolytes and ^17-OHP levels (in 21-OH def, most common), virilization
hypotensive, hyponatremia, hypochloremia, hypoglycemia, hyperK, acidosis

75
Q

3 causes of rickets

A

Vit D deficient
Vit D dependent: can’t convert 25-OH to 1,25(OH)2
X-linked hypophosphatemic rickets: kidneys cannot retain phos resulting in inadequate mineralization

76
Q

rickets tx

A

replace Ca2+, phos, vit D (1,25-OH), cacitrol and annual blood vit D monitoring
ppx: give vit D supplements beginning at 2 mos to exclusively breast fed infants

77
Q

if febrile seizure what next steps to take

A

sepsis w/u: CBC with diff, blood culture, U/A with urine culture, CXR, LP

78
Q

neonatal sepsis most commonly due to what conditions, what orgs?
dx/tx

A

pneumonia, meningitis
GBS, E. coli, S. aureus, Listeria
dx: bld/ur cx, CXR
tx: amp and gent +/- cefotaxime, IVF

79
Q

pentad of scarlet fever

dx/tx?

A 
fever
pharyngitis
sand-paper rash
strawberry tongue
cervical LAD

dx: clinical, ^ASO titers, ESR, CRP
tx: PCN, azithromycin, cephs

80
Q

HSV presentation based on weeks

A

wk 1: shock and DIC
wk 2: vesicular rash
wk 3: encephalitis

81
Q

croup dx/tx

A

dx: clinical, do not need CXR
tx: steroids if mild, mod-sec give racemic EPI

82
Q

1st step if suspect epiglottitis

A

intubate (preferrably in the OR)

next: ceftriaxone 7-10 ds, rifampin for close contacts

83
Q

stages in Pertussis

A

Catarrhal: 14 ds congestion/rhinorrhea
Paroxysmal: 14-30 ds severe cough/whoop/vomit
Convalescent: 14 ds decrease cough

84
Q

Pertussis dx/tx

A

dx: “butterfly pattern” on CXR, PCR of nasal secretions, B. pertussis toxin ELISA
tx: erythromycin/azithromycin in catarrhal (1st) stage
isolate, macrolides for close contacts

85
Q

Diptheria dx/tx

A 
gray pseudomembrane (do not scrape!), get culture of membrane
tx: antitoxin (abx not effective)
86
Q

congenital hip dysplasia tx

A

Pavlik harness

87
Q

LCP disease ages, dx, tx

A

2-8
XR show jt effusions and widening
tx: rest and NSAIDs, then sx to BOTH hips

88
Q

SCFE age, dx, tx

A

adolescent
XR shows joint space widening
tx: internal fixation with pinning

89
Q

tricky vitamin derangement tricks
vitamin A low/high
vit B2
vit B5

A 
vitamin A low/high: low: hypoPTH, high: hyperPTH, pseudotumor cerebri
vit B2 (riboflavin): think "flavor": angular chelosis, stomatitis, glossitis (mouth stuff)
vit B5 (panthothenic acid): burning feet syndrome (run from the panther)
90
Q

failure to pass meconium in CF newborn

dx/tx

A

meconium ileus
dx: XR will show “transition point” and gas-filled plug
tx/dx: water enema, (w/u CF) sweat Cl-

91
Q

malrotation vs duodenal atresia on XR

A

both have double-bubble, malrotation will have normal gas pattern, duodenal atresia will have NO gas
(annular pancreas presents same as duodenal atresia)

92
Q

intestinal atresia

A

vascular accidents in utero (mom does cocaine)
+/- polyhydramnios
XR: double-bubble and multiple air-fluid levels
tx: sx, worry about short-gut syndrome

93
Q

find pyloric stenosis, what to do next?

A

give IVF and correct e-lyte derangements, THEN myomectomy

94
Q

w/u for physiologic jaundice (^I. bili)

A
  1. Coombs: if +: isoimmunization
  2. Hgb: if low: hemorrhage (cephalohematoma)
    if ^: transfusion (twin/twin, delayed clamping)
  3. if Hgb normal, get Retic count:
    if ^: hemolysis: G6PD def, pyruvate kinase def, Hgb SS
    if not ^: reabsorption problem: breast feeding (quantity) vs breast milk (quality) jaundice
95
Q

meningitis abx in infants less than 30 ds

A

vanc
cefotaxime (ceftriaxone causes hyperbili in kids)
ampicillin
+/- steroids

96
Q

if want to know if baby less than 18 mos is HIV+

A

DNA PCR, cannot use ELISA

97
Q

most common cause osteomyelitis

dx/tx

A 
S. aureus
if see salmonella, think SCD
if toxic: give abx then biopsy
if nontoxic: XR, if + biopsy, if - MRI, if + biopsy
abx 4-6 wks
98
Q

septic joint

A

Gonorrhea, *S.aureus

dx: arthrocentesis, +50,000 WBC

99
Q

treatment:
scabies
lice
pinworm

A

scabies: permethrin, lindane
lice: permetrhin
pinworm: albendazole

100
Q

pneumonia less than 5yo

A

typically viral, still treat with ceftriaxone and azithromycin (CAP)

101
Q

TB testing

A

less than 5: PPD

older than 5: IGRA

Peds Step 2 (3 decks)

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