Neonatology Flashcards
1
Q
RDS is ___ deficiency
A
Surfactant
2
Q
Age at risk for RDS?
A
Preterm
3
Q
Age at risk for TTN
A
Usually term
4
Q
How does TTN happen?
A
Delayed resorption of fetal lung fluid
5
Q
TTN CXR
A
Wet silhouette, fluid in fissures
6
Q
Risk factor for TTN
A
Short labour, Elective CS
7
Q
CXR in RDS
A
Homogenous infiltrates, Air bronchogram, Groundglass appearance
8
Q
RDS prevention?
A
Corticosteroids prenatally
9
Q
RDS treatment
A
Surfactant
10
Q
MAS treatment
A
inhaled NO
11
Q
MAS CXR
A
Patchy atelectasis
12
Q
What ratio indicates lung maturity?
A
Lecithin/Sphinngomyelin ratio > 2:1
13
Q
Fluid in fissures appears in
A
TTN
14
Q
Complication of MAS
A
Pneumothorax
15
Q
BRUE is >1 of:
A
1-Cyanosis
2-Change of tone
3-Absent/irregular breathing
4-Altered level of responsiveness
16
Q
Red flags of BRUE
A
1- <60 days 2-Unwell upon exam 3->1 episode 4->1min 5-Born<32weeks 6-FH SIDS
17
Q
BRUE low risk management
A
Observe 1-4 hrs, Pertussis PCR, outpatient visit
18
Q
Physiologic Jaundice appears on __ day, and disappears on __ day
A
2-3, 7th
19
Q
Physiologic Jaundice’s peak is __ mg/dL
A
<13 mg/dL (if term)
20
Q
Physiologic Jaundice’s rate of bilirubin’s rise is __ mg/dL/d
A
<5 mg/dL/d
21
Q
Pathological Jaundice’s rate of bilirubin’s rise is __ mg/dL/d
A
> 5 mg/dL/d
22
Q
Pathological Jaundice appears in ___ day
A
First 24 hrs of life
23
Q
Unconjugated bilirubin features:
A
Lipid soluble, crosses BBB
No urine excretion, Kernicterus
24
Q
Conjugated bilirubin features:
A
Water soluble, Doesn’t cross BBB,
No kernicterus, + urinary excretion
25
Where does unconjugated bilirubin accumulate causing kernicterus?
Basal ganglia and brain stem nuclei
26
Kernicterus leads to _____
Sensorineural hearing loss
27
If jaundice was indirect, what do we think ?
Coombs + or -
28
Breastfeeding jaundice
- Feeding inadequate, baby dehydrated
- First time mothers
- First week of life
- Tx is breastfeeding education
29
Breast milk jaundice
- Problem in the MILK
- Feeding is adequate
- Second week of life, resolve by 2-3m
- Tx is phototherapy
30
How to deliver glucose concentration of > 12.5% in neonate with hypoglycemia?
Via central line
31
Biliary atresia initial test
RUQ US
32
Biliary atresia initial management
Kasai
33
Biliary atresia definitive management
Liver transplant
34
Type of jaundice in Biliary atresia?
Direct hyperbilirubinemia
35
Biliary atresia pathogenisis
Extrahepatic bile duct fibrosis
36
US of biliary atresia shows:
Absent/abnormal gallbladder and CBD
37
Cow milk deficient in
Iron, Copper, Vit C
38
Human milk deficient in
Vit D and Riboflavin
39
Caput Succedeum
Crosses suture lines
Disappears in a few days
Maximum size at birth
40
Cephalhematoma
Doesn’t cross suture lines
Resolves in 2 wks
Maximum size 1d after birth
41
Coloboma association
CHARGE
42
Early introduction of cow’s milk leads to
Iron deficiency anemia
43
When do breastfed infants need iron?
> 4 m
44
Newborn growth rate in grams
30 g/day
45
Which Ig present in colostrum?
IgA
46
Do not brrastfeed
| Do not give expressed milk
```
1- Mother has HIV
2- Mother has Ebola
3- Mother has Human T-lymphotropic virus
4- Mother uses illicit drugs
5- Child has Galactosemia
```
47
Do not brrastfeed
Do not give expressed milk
(Temporarily)
Mother has untreated Brucellosis
Mother has HSV w/ lesions on breast
Mother is taking certain meds
48
Temporarily do not breastfeed, expressed is okay
Untreated active TB
| Varicella (developed bw 5 days prior to delivery and 2 days following delivery)
49
Human milk stays in freezer for
6m
50
Human milk stays in fridge
4 d if fresh
| 1 d if previously frozen
51
Human milk stays in counter for
4 hrs if fresh
| 1 hr if previously frozen
52
Parenteral nutrition options for <3wks
Peripheral line
| Central line
53
Parenteral nutrition options for >3wks
Peripheral dwell line
| Central tunneled line
54
Hirschsprung disease associated with
Down Syndrome
55
Squirt sign present in
Hirschsprung
56
Hirschprung disease Tx
First stage: diverting colostomy to relieve the dilated bowel.
- Second stage: Resection of the aganglionic segment & anastomoses
57
Meconium ileus Tx
Enema with a contrast agent
58
Meconium ileus associated with
Cystic Fibrosis
59
Patient with Meconium plug, what to do next?
Rectal biopsy
60
Patient w\ Meconium ileus, what to do next?
Sweat chloride test
61
Triple bubble seen with
Jejunal atresia
62
Double bubble seen with
Duodenal atresia
63
Intussusception px
Currant jelly stool
Intermittent abx pain
Sausage shaped abdx mass
64
Intussusception Tx
Air/Saline enema
| Surgery
65
Intussusception Dx
Target sign on US
66
When is surgical reduction done in Intussusception?
When a pathological lead sign is suspected
67
Treatment of choice for Intussusception?
Nonoperative reduction using hydrostatic or pneumatic pressure by enema
68
Most common cause of acute abdomen in premature infants.
NEC
69
NEC risk factors
Prematurity
| Enteral feeding
70
NEC X-Ray findings
Pneumatosis intestinalis
Portal venous gas
Pneumoperitoneum
71
NEC Tx
Bowel rest
Abx
+/- surgery
72
NEC Indication of surgery:
perforation (Pneumoperitoneum), peritonitis and/or clinical worsening despite medical therapy
73
Cyanosis that is relieved after crying
Bilateral choanal atresia
74
Bilateral choanal atresia Dx
inability to pass NG tube
75
Bilateral choanal atresia Tx
Urgent insertion of an oropharyngeal airway as a temporary airway until surgery
76
asymmetrical moro reflex (absent in on side) →
Clavicular fracture (it causes Erb palsy)
77
Absent moro reflex →
Cerebral palsy
78
Total plexuses palsy (upper limb)
C5-C8 and sometime T1
79
Intermediate plexus palsy:
C7-C8
80
Extended upper plexus palsy:
C5-C7
81
Upper plexus palsy (Erb palsy):
C5-C6 – “Bad shoulder, good hand”
82
Lower plexus palsy (Klumpke palsy):
C8-T1 – “Good shoulder, bad hand”
83
Brachial plexuses injury risk factor
Shoulder dystocia
84
Which conjunctivitis presents within 2-5d of life?
N Gonorrhea
85
N Gonorrhea conjunctivitis Tx and prophylaxis
IM Ceftriaxone, prophylaxis is erythromycin
86
Which conjunctivitis presents within 7-14 d of life?
Chlamydia Trachomatis
87
Chlamydia Trachomatis conjunctivitis Tx and prophylaxis
Tx is oral erythromycin
| No effective prophylaxis
88
Chemical conjunctivitis cause and Tx
Silver nitrate irritation, Tx is lubrication
89
Target sign is seen in
Pyloric stenosis & Intussusception
90
Pyloric stenosis clinical features
Projectile, non bilious vomiting
Immediate postprandial vomiting
Hungry between feeds
91
Pyloric stenosis management
Treat electrolyte imbalance, pyloromyotomy
92
Pyloric stenosis electrolyte imbalance
Hypochloremic hypokalemic metabolic alkalosis
93
Gastroschisis is abdominal defect ____ to umbilicus
LATERAL
94
Omphalocele is failure of intestines to return to abdominal cavity with gut ____ umbilicus
through
95
Omphalocele/Gastroschisis Tx
Surgical silo
Nasogastric suction
IVF
Surgery
96
Neonatal Polycythemia Hct
> 65%
97
Olive shaped abdx mass
Pyloric Stenosis
98
SIDS risk factor
Prematurity and prone sleeping
99
SIDS prevention
Pacifier and sleeping on the back
100
Epiglottitis pathogen
Haemophilus influenza
101
Bronchiolitis pathogen
RSV
102
Laryngotracheitis pathogen
Para influenza virus (croup)
103
Barky cough is usually with 
Croup
104
Focally diminished breath sounds
Foreign body
105
Stridor improves when prone
 Laryngomalacia
106
Laryngomalacia Dx
Laryngoscopy
107
Croup Tx
Mild: steroids and humidified air
Severe: Steroids and racemic epinephrine
108
How do you tell if croup is severe
Stridor at rest
109
Epiglottitis features
Extremely sore throat
Drooling
High fever
Sniffing position
110
Best initial test for epiglottitis
Laryngoscopy
111
Most accurate test for epiglottitis
Culture from tracheal aspirate
112
Most accurate test for croup
PCR of virus
113
Best initial test for croup
Clinical dx
114
Bronchiolitis vaccine
Palivizumab
115
Palivizumab for bronchiolitis is given to:
Chronic lung disease of prematurity
Hemodynamically significant congenital heart disease
Less than 29 weeks of gestation
116
Apgar score is evaluate it based on
Heart rate, respiration, color, tone, reflex irritability
117
Small for gestational age is defined
2 SD < mean weight for GA/<10 percentile
118
Most common type of skull fracture during delivery
Linear and no treatment needed
119
Jaundice occurs with cephalhematoma or caput?
cephalhematoma
120
Breast milk predominant protein:
Whey
121
Human milk vs cow milk, which has more of what?
Human: Lactose
Cow: Protein
122
Most common diaphragmatic hernia?
Bochdalek hernias
123
Most common diaphragmatic hernia?
Bochdalek hernias
124
Kcal of 1 ml of human milk vs cow
70 in human’s milk
| 67 in cow’s milk
