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PPS - From Nelson's > Neonate > Flashcards

Neonate Flashcards

1
Q

small white rash on erythematous base

erythema toxicum contains

A

eosinophils

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2
Q

vesicopustular eruption

pusutular melanosis contains

A

PMNs or neutrophils

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3
Q

hard palate beside raphe accumulation of epithelial cells

A

epstein pearls

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4
Q

solid flank mass
hematuria
hypertension
thrombocytopenia

A

renal vein thrombosis

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5
Q

urine output in neonates

A

void by 12 hrs

about 95% preterm and term void in 24 hours

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6
Q

meconium passage

A

usually 12 hours

99% of term and 95% preterm pass by 48 hrs

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7
Q

t or f

apgar used to predict neuro outcome

A

false

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8
Q

convection

A

heat energy to cooler surroundings

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9
Q

conduction

A

heat to colder materials touching baby

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10
Q

radiation

A

infant to other nearby cooler object

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11
Q

evaporation

A

skin and lungs

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12
Q

nursery temp at

A

22-26 degrees celsius

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13
Q

vernix shed in

A

2-3 days

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14
Q

advantage circumcision

A 
decrease:
phimosis
uti
penile cancer
std
hiv
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15
Q

most accurate measure AOG in utz first trimester

A

crown rump length

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16
Q

most accurate measure AOG in utz up to 30wks

A

biparietal diameter

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17
Q

most common cause of fetal distress

A

uteroplacental insufficiency

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18
Q

uteroplacental insufficiency

manifests as

A

iugr
fetal hypoxia
increased vascular resistance of fetal vessels
mixed respiratory and metabolic acidosis

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19
Q

components of bpp

A 
heart rate
movement
tone
breathing
amniotic fluid volume
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20
Q

high risk for fetal alcohol syndrome if

A

> 7drinks per week

or >3drinks at a time

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21
Q

lecithin: sphingomyelin ratio indicative of lung maturity

A

2:1

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22
Q

oligohydramnios

A 
Amniotic fluid leak/rupture of membranes
Intrauterine growth restriction
Fetal anomalies
Twin–twin transfusion (donor)
Renal agenesis (Potter syndrome)
Urethral atresia
Prune-belly syndrome
Pulmonary hypoplasia
Amnion nodosum
Indomethacin
Angiotensin-converting enzyme
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23
Q

polyhydramnios

A 
Anencephaly
Hydrocephaly
Tracheoesophageal fistula
Duodenal atresia
Spina bifida
Cleft lip or palate
Cystic adenomatoid lung malformation
Diaphragmatic hernia
Syndromes:
Achondroplasia
Klippel-Feil
Trisomy 18
Trisomy 21
TORCH (toxoplasmosis, other agents, rubella, cytomegalovirus,
herpes simplex)
Hydrops fetalis
Multiple congenital anomalies
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24
Q

Accutane (isotretinoin)

A

Facial-ear anomalies, heart disease, CNS anomalies

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25
Q

Alcohol

A

Congenital cardiac, CNS, limb anomalies; IUGR; developmental delay; attention deficits; autism

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26
Q

Amphetamines

A

Congenital heart disease, IUGR, withdrawal

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27
Q

Angiotensin-converting enzyme inhibitors

and angiotensin receptor antagonists

A

Oligohydramnios, IUGR, renal failure, Potter-like syndrome

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28
Q

Azathioprine

A

Abortion

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29
Q

Carbamazepine

A

Spina bifida, possible neurodevelopmental delay

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30
Q

Carbon monoxide

A

Cerebral atrophy, microcephaly, seizures

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31
Q

Chloroquine

A

Deafness

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32
Q

Cigarette smoking

A

LBW for gestational age

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33
Q

Cocaine/crack

A

Microcephaly, LBW, IUGR, behavioral disturbances

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34
Q

Danazol

A

Virilization

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35
Q

Lithium

A

Ebstein anomaly, macrosomia

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36
Q

Methyl mercury

A

Minamata disease, microcephaly, deafness, blindness, mental retardation

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37
Q

Misoprostol

A

Arthrogryposis, cranial neuropathies (Möbius syndrome), equinovarus

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38
Q

Mycophenolate mofetil

A

Craniofacial, limb, cardiovascular, CNS anomalies

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39
Q

Penicillamine

A

Cutis laxa syndrome

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40
Q

Phenytoin

A

Congenital anomalies, IUGR, neuroblastoma, bleeding (vitamin K deficiency)

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41
Q

Prednisone

A

Oral clefts

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42
Q

Quinine

A

Abortion, thrombocytopenia, deafness

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43
Q

Selective serotonin reuptake inhibitors

A

Small increased risk of congenital anomalies, persistent pulmonary hypertension of newborn

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44
Q

Statins

A

IUGR, limb deficiencies, VACTERAL

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45
Q

Stilbestrol (diethylstilbestrol [DES])

A

Vaginal adenocarcinoma in adolescence

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46
Q

Streptomycin

A

Deafness

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47
Q

Tetracycline

A

Retarded skeletal growth, pigmentation of teeth, hypoplasia of enamel, cataract, limb
malformations

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48
Q

Thalidomide

A

Phocomelia, deafness, other malformations

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49
Q

Toluene (solvent abuse)

A

Craniofacial abnormalities, prematurity, withdrawal symptoms, hypertonia

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50
Q

Topiramate

A

Cleft lip

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51
Q

Valproate

A

CNS (spina bifida), facial and cardiac anomalies, limb defects, impaired neurologic function, autism
spectrum disorder

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52
Q

Vitamin D

A

Supravalvular aortic stenosis, hypercalcemia

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53
Q

Warfarin (Coumadin)

A

Fetal bleeding and death, hypoplastic nasal structures

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54
Q

Phenobarbital—

A

bleeding diathesis (vitamin K deficiency), possible long-term reduction in IQ, sedation

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55
Q

Dexamethasone—

A

periventricular leukomalacia

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56
Q

amnion nodosum (granules in amnion) and oligohydramnios assoc with

A

pulmonary hypoplasia and renal agenesis

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57
Q

fetal transfusion syndrome

A

difference 5g/dL

>20% weight difference

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58
Q

Symmetric iugr

A 
Earlier onset
Chromosomal
Genetic
Teratogen
Malformation
Infection
Severe hypertension
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59
Q

Asymmetric iugr

A

Late onset
Preserve Doppler waveform in carotids
Poor maternal nutrition
Preeclampsia, chronic hypertension

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60
Q

Insensible water loss <1000g infant

A

2-3 ml/kg/hr

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61
Q

Insensible water loss 2000-2500g infant

A

0.6 - 0.7 ml/kg/hr

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62
Q

Parental nutrition requirements

A

2.5-3.5 g/dL amino acids
10-15 g/dL glucose
2.2 kcal/mL intralipid

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63
Q

Calorie intake >100kcal per kg per 24 hr

A

Gain 15g /kg/24 hours

Positive nitrogen balance 150-200mg.kg.24hrs

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64
Q

Tip of not should be

A

2.5cm or 1 inch from lower end of stomach

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65
Q

Swelling that crosses suture lines

A

Caput succedaneum

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66
Q

Subperiosteal bleeding

Limited to one bone

A

Cephalhematoma

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67
Q

Collection of blood under aponeurosis
Usually in vacuum
Ruptured emissary veins

A

Subgaleal hematoma

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68
Q

Tears in tentorium cerebelli

A

Subdural hemorrhage

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69
Q

IVH found in

A

Gelatinous subependymal germinal matrix

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70
Q

Predisposing factors for IVH include

A

prematurity, RDS, hypoxicischemic or hypotensive injury, reperfusion injury of damaged vessels, increased or decreased cerebral blood flow, reduced vascular integrity, increased venous pressure, pneumothorax, thrombocytopenia, hypervolemia, and hypertension.

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71
Q

Ventriculomegaly is defined as

A

mild (0.5-1 cm dilation), moderate (1.0-1.5 cm dilation), or severe (>1.5 cm dilation).

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72
Q

Cutz to screen for ivh

A

For <1000g highest risk
<32 weeks aog

Done within first 3-7 days of life

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73
Q

Repeat cutz to check for PVL

A

36-40 weeks aog

Cystic lesion 2-4 weeks after

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74
Q

Target Temp therapeutic hypothermia

A

33.5 first six hours

For 72 hours

75
Q

Poor prognosis HIE

A

pH <6.7
Apgar scores of 0-3 at 5 min, high base deficit (>20-25 mmol/L), decerebrate posture, severe basal ganglia–thalamic lesions, persistence of severe HIE at 72 hr, and lack of spontaneous activity are also at increased risk for death or impairment.

76
Q

Brain death HIE

A

coma unresponsive to pain, auditory, or visual stimulation; apnea with Pco2 rising from 40 to >60 mm Hg without ventilatory support; and absence of brainstem reflexes (pupillary, oculocephalic, oculovestibular, corneal, gag, sucking)

Persistent for 2 days in term, 3 days preterm

77
Q

Typical spinal cord injuries at birth

A

level of the 4th cervical vertebra with cephalic presentations and the lower cervical–upper thoracic vertebrae with breech presentations

78
Q

First thoracic root injured especially sympathetic

A

Paralyzed hand
Ptosis
Miosis

Horner syndrome

79
Q

Which paralysis has better prognosis

Upper or lower part of arm

A

Upper part of arm

80
Q

Nerve injury edema and heals spontaneously

A

Neuropraxia

81
Q

Nerve injury with intact myelination sheath but nerve fiber disrupted

A

Axonotmesis

82
Q

Nerve injury total disruption or root avulsion

A

Neurotmesis

83
Q

Lung catecholamines for transition to neonatal life

A

Vasopressin
Prolactin
Glucocorticoids

84
Q

risk for RDS

A 
premature
maternal diabetes
multiple births
cs
precipitous delivery
asphyxia
cold stress
maternal hx of prev babies
85
Q

RDS causes

A

dec lung compliance
insuff alveolar ventilation
small tidal vol
inc dead space

86
Q

indication for ventilation and surfactant

A

on CPAP 40-70% o2 but still with sats <85%

87
Q

contraindication to indomethacin

A 
plt <50, 000
bleeding
oliguria up 1cc/kg/hr
nec
intestinal perforation
crea >1.8 mg/dL
88
Q

four histo stages of bpd

A
  1. acute lung injury
  2. exudative bronchiolitis
  3. proliferative bronchiolitis
  4. obliterative fibroproliferative bronchiolitis
89
Q

oxygenation index formula

A

= MAP x Fio2 x 100/ PaO2

90
Q

mean airway pressure

A

[(PIP - PEEP) x. RR x IT / 60 ] + PEEP

91
Q

OI >40

A

mortality >80%

92
Q

ECMO not used for

A

high risk of IVH
<2kg
<34 weeks

93
Q

anteromedial CDH

A

morgagni

94
Q

posterolateral CDH

A

bochdaleck

95
Q

poor prognosis CDH

A

lung head ratio <1
(good prognosis if >1.4)
presence of liver in thoracic cavity

96
Q

paraesophageal hernia

A

gastroesophageal junction is in normal place

97
Q

air on xray

A

15-30 mins in jejenum
2-3 hrs ileum
3 hrs colon

98
Q

absence of rectal gas by __ hrs is abnormal

A

24hrs

99
Q

xray meconium ileus

A

loops may vary in width

bubbly granular appearance in severe cases

100
Q

tx meconium ileus or plug

A

gastrografin enema

101
Q

triad of NEC

A
  1. ischemia
  2. enteral nutrition
  3. bacterial translocation
102
Q

pathogens recovered NEC

A 
e coli
klebsiella
clostridium perfringens
staph epidermidis
astrovirus
norovirus
roatvirus
103
Q

indication of surgery for nec

A

pneumoperitoneum

postive culture on paracentesis

104
Q

relative indication for nec

A

failure of med tx
single fixed bowel loop
ab wall erythema
palpable mass

105
Q

mechanism of hyperbil

A
  1. increased liver load
  2. reduced activity of transferase enzyme
  3. competes or blocks transferase enzyme
  4. decreased bili uptake in liver
106
Q

jaundice in indirect hyperbil

A

bright yellow

107
Q

jaundice in direct hyperbil

A

green or muddy yellow

108
Q

value of bilis on pe

A

face 5mg/dL
mid ab 15
soles 20

109
Q

autosomal recessive
high unconjugated bili
nonhemolytic

A

crigler najjar

110
Q

physiologic jaundice

A

2-3 days seen
<5mg/dl rise per day
<12 terms (or 10-14mg/dl in preterms)
decreases to <2mg/dl on day 5-7

direct bili <2mg/dL always

111
Q

syndrome with inactivity of bilirubin glucoronyl transferase

A

gilbert syndrome

112
Q

phototherapy contraindicated in

A

porphyria

113
Q

physiologic anemia

A 
TERM 8-12wks (11g/dL)
PRETERM 6wks (7-10g/dL)
114
Q

test to determine fetal cells in maternal blood

A

kleihauer betke test

115
Q

delayed clamping causes

A

increase 20-40ml blood

30-35mg of iron

116
Q

rh (-) mom should have igG of D antigen measured at

A

12-16wks
28-32wks
36wks

117
Q 
diarrhea
rash
hepatitis
eosinophilia
after blood transfusion
A

graft versus host disease

118
Q

prevention of rh sensitization

A

Rhogam within 72 hours of delivery of rh + baby, ectopic, ab trauma in pregnancy, amniocentesis, abortion, chorionic villous sampling

may be given 28-32 weeks and then at birth

119
Q

neonatal RBC

A

decreased deformability and filterability

120
Q

fetal hemoglobin is __ resistant

A

alkali

APT TEST`

121
Q

result apt test

A

yellow brown color -> MATERNAL

pink color -> BABY

122
Q

normal cord length

A

55cm

123
Q

long cord

A

> 70cm

124
Q

intrauterine transplacental infection

A 
syphilis 
cmv
rubella
toxoplasmosis
parvovirus b19
varicella
125
Q

intrapartum infection

A 
hiv
hsv
hepa b
hepa c
tb
126
Q

common cause of nosoc infection

A 
coagulase neg staph
e coli
klebsiella
enterobacter
citrobacter
pseudomonas
serratioa
enterococci
satph aures
candida
127
Q

congenital pneumonia

A

cmv
rubella
treponema pallidum

128
Q

pneumonia during labor and delivery

A 
gbs
gram - enteric
listeria
mycoplasma
chlamydia
cmv
hsv
candida
129
Q

neonatal meningitis pathogen

A 
gbs
e coli
listeria
strep pneumoniae
hib
staph
kleb
enterobacter
pseudomonas
treponema pallidum
TB
130
Q

most important neonatal actor predisposing to infection is

A

prematurity

low birth weight

131
Q

risk factors for nosoc infection

A

prematurity,
low birthweight,
invasive procedures,
indwelling vascular catheters,
parenteral nutrition with lipid emulsions,
endotracheal tubes,
ventricular shunts,
alterations in the skin and/or mucous membrane barriers,
frequent use of broad-spectrum antibiotics,
and prolonged hospitalization

132
Q

most frequent nosoc

A

coagulase neg staph

133
Q

sirs

A

any 2:

  1. fever or hypothermia
  2. tachycardia/bradycardia
  3. tachypnea/bradypnea
  4. abnormal WBC
134
Q

ecthyma gangrenosum

A

pseudomonas

135
Q

small salmon pink papules

A

listeria monocytogenes

136
Q

bleuberry muffin

A

cmv
rubella
parvovirus

137
Q

common cause of death neonatal tetanus

A

aspiration pneumonia

138
Q

normal csf in infants 1 mo old

A

protein 84 +- 45 mg/dL
glucose 46 +- 10 mg/dL
leukocyte 11 +- 10
PMNs 2.2 +- 3.8%

139
Q

initial empiric

A

ampicillin + aminoglycoside (gentamicin) or cefotax

140
Q

nosoc NICU empiric

A

ampicillin +

oxacillin/nafcillin OR vancomycin

141
Q

empiric gram negative

A

ampicillin

+ aminoglycoside or 3rd gen ceph

142
Q

listeria tx

A

ampicillin

143
Q

GBS tx

A

penicillin

144
Q

enterococci tx

A

penicillin (or ampicillin or pipericillin)

and aminoglycoside

145
Q

duration bloodstream infection

A

7-10 days

or 5-7 days after clinical response

146
Q

nosocomial pneumonia

A

methicillin/vancomycin + aminoglycoside/3rdgen ceph

147
Q

chlamydia trachomatis pneumonia

A

erythromycin
or
cotrimoxazole

148
Q

u. urealyticum infection

A

erythromycin

149
Q

duration gram neg meningitis

A

21 days or

14 days after sterilization of CSF

150
Q

b fragilis infection

A

metronidazole

151
Q

Intrauterine growth

restriction

A

CMV, Plasmodium, rubella,
toxoplasmosis, Treponema
pallidum, Trypanosoma cruzi, VZV

152
Q

Cataracts

A

Rubella

153
Q

Cardiac defects

A

Rubella

154
Q

Hydrocephalus

A

HSV, lymphocytic choriomeningitis

virus, rubella, toxoplasmosis

155
Q

Intracranial calcification

A

CMV, HIV, toxoplasmosis, T. cruzi

156
Q

Limb hypoplasia

A

VZV

157
Q

Microcephaly

A

CMV, HSV, rubella, toxoplasmosis

158
Q

Microphthalmos

A

CMV, rubella, toxoplasmosis

159
Q

Carditis

A

Coxsackieviruses, rubella, T. cruzi

160
Q

Encephalitis

A

CMV, enteroviruses, HSV, rubella,

toxoplasmosis, T. cruzi, T. pallidum

161
Q

Hepatosplenomegaly

A

CMV, enteroviruses, HIV, HSV,
Plasmodium, rubella, T. cruzi,
T. pallidum

162
Q

Hydrops

A

Parvovirus, T. pallidum,

toxoplasmosis

163
Q

Petechiae, purpura

A

CMV, enteroviruses, rubella, T. cruzi

164
Q

Pneumonitis

A

CMV, enteroviruses, HSV, measles,
rubella, toxoplasmosis, T. pallidum,
VZV

165
Q

Retinitis

A

CMV, HSV, lymphocytic
choriomeningitis virus, rubella,
toxoplasmosis, T. pallidum, West
Nile virus

166
Q

Skin lesions

A

Enteroviruses, HSV, measles, rubella,

T. pallidum, VZV

167
Q

Thrombocytopenia

A

CMV, enteroviruses, HIV, HSV,

rubella, toxoplasmosis, T. pallidum

168
Q

Deafness

A

CMV, rubella, toxoplasmosis

169
Q

Convulsions

A

CMV, enteroviruses, rubella,

toxoplasmosis

170
Q

ADE Oxygen

A

Retinopathy of prematurity,

bronchopulmonary dysplasia

171
Q

ADE

Chloramphenicol

A

Gray baby syndrome—shock, bone

marrow suppression

172
Q

ADE

NaHCO3

A

Intraventricular hemorrhage

173
Q

ADE

Amphotericin

A

Anuric renal failure, hypokalemia,

hypomagnesemia

174
Q

ADE

Indomethacin

A

Oliguria, hyponatremia, intestinal

perforation

175
Q

ADE

Tetracycline

A

Enamel hypoplasia

176
Q

ADE

Calcium salts

A

Subcutaneous necrosis

177
Q

ADE

Prostaglandins

A

Seizures, diarrhea, apnea, hyperostosis,

pyloric stenosis

178
Q

ADE

Dexamethasone

A

Gastrointestinal bleeding, hypertension,
infection, hyperglycemia,
cardiomyopathy, reduced growth

179
Q

ADE

Iodine antiseptics

A

Hypothyroidism, goiter

180
Q

ADE

Erythromycin

A

Pyloric stenosis

181
Q 
hie location?
Stupor or coma
Seizures
Hypotonia
Oculomotor abnormalities
Suck/swallow abnormalities
A

Selective neuronal

necrosis

182
Q

hie location?
Proximal limb weakness
Upper extremities affected more
than lower extremities

A

Parasagittal injury

183
Q

hie location?
Unilateral findings
Seizures common and typically focal

A

Focal ischemic

necrosis

184
Q

hie location?
Bilateral and symmetric weakness in
lower extremities
More common in preterm infants

A

Periventricular injury

PPS - From Nelson's (24 decks)

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