NEONATOLOGY Flashcards
Seen this in a newborn
What is the finding? What is the cause?
Erb-Duchenne palsy
(upper brachial plexus palsy involving C5-C7)
Seen this in a newborn
What is the finding? What is the cause?
Klumpke palsy
(lower brachial plexus palsy involving C8-T1)
Gross hematuria, a new mass palpable in flank of a newborn
What is going on?
Renal vein thrombosis (RVT)
When does physiologic jaundice start to become apparent? (earlier jaundice would likely be pathologic)
48-72 hours
Most common causes of neonatal sepsis? (3)
1 - E.coli
2 - Listeria
3 - GBS
An newborn refuses to move arm, with XR shows extensive bone destruction in the diaphyses and solid periosteal new bone formation
What is going on? What is the underlying cause?
Pseudoparalysis
Caused by congenitial syphillis
What is this finding? What is it associated with?
Scaphoid abdomen
Associated with congenital diaphragmatic hernia (CDH)
Displaced apical impulse, respiratory distress, bowel sounds over chest
What is going on?
CDH
What are long term risks for neonate with IUGR? (2)
1 - Metabolic syndrome
2 - Hypertension
Non-blanching, non-tender, bluish, flacutuant swelling lateral to midline of lower mouth, might displace tongue slightly to left
What is it? Cause?
Ranula
Pseudocyst associated with sublingual & submandibular glands
Short palpebral fissures, ptosis, long and smooth philtrum, thin upper lip
What is going on? What is the common associated heart disorder?
Fetal alcohol syndrome
Septal defects (ASD, VSD)
Which birth weight is associated with increased risk of neonatal hypoglycemia?
< 2500g
What gestational age is associated with increased risk of neonatal hypoglycemia?
< 37 wks GA
What is Galeazzi sign? How is it helpful?
Asymmetry in hieght of knees due to shortening of thigh on affected side
Used to detect dysplasia of hip in patients > 3mo
When Barlow & Ortolani tests no longer helpful?
3 months of age
What are risk factors for dysplasia of hip (DDH) in infants? (3)
1 - Girl
2 - Breech
3 - Family history of DDH
When weight loss in first 2 weeks of life is too much?
> 10%
Fleshy-color smooth surface lesion noted to protrude from inferior portion of the vagina of the newborn
What is it? Management?
Hymental tag
Reassurance
Fleshy-color smooth surface lesion noted to protrude from inferior portion of the vagina of the newborn
What is it? Management?
Hymental tag
Reassurance
What is this finding? Which syndrome is it associated with ?
“Mitten hand”
Syndactyly of the 2nd, 3rd, and 4th fingers and toes
Associated with Apert syndrome
When does lanugo disappear from face in fetus?
between week 33 and 37
When does hair becomes fine and wooly in fetus?
between 28 and 36 weeks
When rugae begins to develop on scrotum in fetus?
between 28 and 35 weeks
When vernix starts decrease in fetus?
~38 weeks
Duodenal treasia and endocardial cushion defect
Which syndrome?
Trisomy 21
Clenched hands, cystic hygroma, horseshoe kidney
Which syndrome?
Trisomy 18
Severe midline facial abnormalities, polydactyly
Which syndrome?
Trisomy 13
Fetal hydrops, coarctation
What is going on?
Turner syndrome
Limb defects (missing arms/legs), or ear malformation in newborn
Maternal exposure to what drug ?
Thalidomide
Limb defects (missing arms/legs), or ear malformation in newborn
Maternal exposure to what drug ?
Thalidomide
What are newborn defects seen in maternal exposure to warfarin during pregnancy? (2)
1 - Nasal hypoplasia
2- Stippled epiphyses
What are components of WAGR syndrome?
1- Wilm’s tumor
2- Aniridia
3 - GU malformations
4 - Reduced intellectual capacity
Mass located anterior to the SCM muscle in a child
What is it?
Brachial cleft cyst
Indurated, reddish nodules and plaques on lower back and buttocks of an infant with history of traumatic birth?
What are they? What is the potential risk?
Subcutaneous fat necrosis
Risk of hypercalcemia
What are 5 components of APGAR score?
1 - Breathing
2 - Heart beat
3 - Muscle tone
4 - Grimace
5 - Skin color
Which reflex can be elicited in healthy 1-yo
Parachute reflex
Which type of medications can cause oligohydramnios of fetus?
ACEi
Color differences in half part of the body, quickly returns to normal (within several minutes) with reposition, in first couple weeks of life.
What is it? Management?
Harlequin color change
Nothing (benign).
Scant ear cartilage with pinna returns slowly from folding
What is estimated gestational age?
32-35 weeks
Thin cartilage, pinna springs back from folding
What is estimated gestational age?
36 - 39 weeks
Areola first raised, but breast tissue not yet palpable
What is the estimated gestational age?
34 - 35 weeks
What is recommended delivery room temperature?
22 - 26 C
Newborn with bilious vomiting - contrast enema shows small-diameter sigmoid and descending colon with dilated air-filled loops of small bowel
What is going on? What is the associated disorder?
Meconium ileus
Associated with cystic fibrosis
(in fact 80-90% of neonate with meconium ileus has CF)
Neonate with mom who is HBsAg-positive.
What is the management?
Give BOTH HepB vaccine and HBIG
Long, wide, protruding ears
Associated with which syndrome?
Fragile X syndrome
Hypoplastic testes in a male neonate?
What is the associated syndrome?
Klinefelter
What is this finding?
Which are 2 congenital conditions it is associated with?
Arachnodactyly
1 - Neonatal Marfan syndrome
2 - Congenital contractural arachnodactyly syndrome
Hypothermia, vomiting, frequent stools, feeding difficulties, excessive crying in a newborn
What is the drug that mother was on that can cause these?
SSRI
Aplasia or hypoplasia of abdominal muscles
Which syndrome? What are 4 associated problems?
Prune belly syndrome
1 - Bilateral undescended testes
2 - GU tract and renal anomalies
3 - Pulmonary atresia
4 - Cardiac abnormalities
5 - MSK abnormalities
What syndrome caused by CHD7 gene? What are the components of syndrome?
CHARGE syndrome
1 - Coloboma
2 - Heart defect
3 - Atresia choanae
4 - Restricted growth and development
5 - Genital anomalies
6 - Ear anomalies
Which factor in a case of supernumerary digits on a hand would warrant orthopedic consultation
A bony articulation of the digit
Soft, painless, compressible, nonpusatile mass on lateral neck that transluminates well, not involving underying tissue.
What is it? What causes it? What types of condition this finding is associated with ?
Cystic hygroma
Abnormal development of the lymphatic system -> obstruction of normal lymphatic flow and sequestration of lymphatic fluid
Karyotypic abnormalities (up to 70%) - trisomies, Turner, Klinfelter
Neonate with myelomeningocele and heart issues
What antihypertensive medication in mother causes this? When was she exposed?
ACEi
exposed in 1st trimester
Which illicit drug by mother can cause gastroschisis?
Cocaine
(vasoconstriction)
Bilious emesis, abdominal distension, “soap bubble” appearance of portions of intestinal contents
What is going on? Likely underlying diagnosis?
Meconium ileus
Cystic fibrosis
Neonate with flattened dimpled buttocks, small pelvis, absence of sacrum
What is going on? What are conditions this finding is associated?
Caudal regression syndrome
Associated with
1 - Diabetic mother
2 - VACTERL
Which antiepileptic might cause neural tube defect?
Valproate
What are 3 clinical features of Wiscott-Aldrich syndrome? (WAS)
1 - Eczema
2 - Immunodeficiency
3 - Thrombocytopenia
(eXit) (X = X-linked)
What is the hematologic complication in neonate whose mom was on phenytoin?
Vitamin K deficiency bleeding
What is the classic triad of neonatal renal vein thrombosis?
1 - Hematuria
2 - Flank mass
3 - Thrombocytopenia
Short and upturned nose, stubby digits, hypoplastic nails
What is the maternal drug exposure?
Phenytoin
Prevention of GBS in newborn for mom who is GBS positive
Penicilline (or ampicillin) every 4 hours until delivery
What is anicosiria?
Unequal pupils
(might be caused by miosis in one pupil)
What are 3 components of Horner’s syndrome?
If seen in a newborn, what is it associated with?
1 - Miosis
2 - Ptosis
3 - Anhidrosis
Associated with lower brachial plexus injury that involves T1
Treatment of Criggler-Nijjar syndrome type II
Phenobarbital
(doesn’t work for type I where there is no UGT enzyme production at all)
Macules with central pustules on erythematous base in neonate
What is it? When will they resolve?
Erythema toxicum neonatorum
Resolves within first week of life
What are these? Treatment?
Milia
Nothing - benign
What is this ? Treatment ?
Epstein pearl
(like milia, but in mouth)
Nothing - benign
What is management of newborn whose mom is positive for HbsAg?
HBIG at birth
Hep B at birth, 1, 2 and 6 months
Test for HbsAg and anti-Hbs-Ag at 9-12 months (after completing the vaccine series)
Inclusion bodies seen in cells of ocular discharge
What is going on? Treatment?
Chlamydial conjunctivitis
Oral erythromycin / azithromycin
Descending colon with abrupt caliber transition at the splenic flexture, small sigmoid, normal rectum - seen in a newborn
What is going on? What is the associated maternal condition?
Small left colon syndrome
Associared with maternal diabetes
Apnea, decreased bowel sound in all quadrants in a newborn
What is going on? What does the mother have?
Hypermagnesemia !
(mother has pre-eclampsia, got Mg)
Management of CDH with respiratory distress? (3)
1 - Intubation
2 - Mechanical ventilation after intubation (do NOT bag mask)
3 - Passing an NG/Repogle to decompress abdominal contents
Which maternal medication associated with persistent pulmonary hypertension in a newborn?
SSRIs
