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neonatology Flashcards

1
Q

NB resucitation: Apnea or HR<100

A

Provide positive-pressure ventilation

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2
Q

NB resuscitation: HR<60 after PPV

A

continue PPV; start chest compressions

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3
Q

NB resuscitation: HR<60 after compressions

A

administer epi IV or ET

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4
Q

APGAR score: HR<100; blue; grimacing; limp; slow irregular RR

A

APGAR=3

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5
Q

order of disappearance in a sick baby

A

color; respiration; muscle tone; reflex; cardiac rate

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6
Q

order of appearance in a resuscitated baby

A

cardiac rate; color; respiration; reflex; muscle tone

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7
Q

essential intrapartum newborn care

A

dry the baby; delayed cord clamping; early skin-to-skin contact; delayed washing; non separation of mother and NB

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8
Q

NB Care

A

Erythromycin 0.5% ointment or Tetracyline 1%; Vit K 1mg IM; Hep B; BCG

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9
Q

NB Screening test

A

Congenital Hypothyroidism; CAH; Galactosemia; G6PD; PKU; done at 48hrs old RA9288

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10
Q

when to repeat NBS?

A

if blood collected <24hrs old; repeat at 2weeks old

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11
Q

normal BW and BL; delayed physical; mental; and sexual dvt; sluggish; feeding difficulties; hyponatremia; edema of scrotum/genitals; prolonged physiologic jaundice

A

Congenital Hypothyroidism

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12
Q

deficiency of 21hydroxylase; vomiting; failure to thrive; normal at birth; signs of sexual and somatic precocity

A

CAH

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13
Q

feeding intolerance; vomiting; jaundice; convulsions; lethargy; hypotonia; MR

A

Galactosemia

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14
Q

episodic/chronic hemolytic anemia; symptoms develop 1-2days after exposure to substance with oxidant properties; Heinz bodies; reticulocytosis; jaundice; ARF

A

G6PD

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15
Q

substances implicated in G6PD

A

sulfonamides; nalidix acid; nitrofurantoin; chloramphenicol; antimalarials; vit K analogs; ASA; benzene; naphthalene

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16
Q

enzyme deficient in PKU

A

phenylalanine HYDROXYLASE

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17
Q

most common manifestation of PKU without treatment

A

developmental delay

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18
Q

unpleasant musty odor; severe vomiting; hypertonic; hyperactive DTR’s; seizures in infant

A

PKU

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19
Q

defective enzyme in Maple Syrup urine dse causing buildup of leucine; isoleucine; and valine

A

alpha ketoacid dehydrogenase

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20
Q

flat blue gray with well-define margins in NB

A

mongolian spot

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21
Q

small papules or pustules on an erythematous base filled with eosinophils

A

erythema toxicum

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22
Q

small inclusions cysts; pearly white; usually on the face

A

milia

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23
Q

lacy pattern on the skin similar to cobblestones; vasomotor response to cold stress

A

cutis mamorata

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24
Q

open and closed comedones from circulating androgens

A

neonatal acne

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25
Q

subperiosteal bleed due to birth trauma; does NOT cross suture lines

A

cephalhematoma

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26
Q

swelling of the scalp due to birth trauma; involves the presenting part; CROSSES suture lines

A

caput succedaneum

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27
Q

arm adducted; pronated; and internally rotated; (C5-C6 involvent); if with C4 involvement there is ipsilateral diaphragmatic paralysis

A

Erb-Duchenne palsy

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28
Q

claw hand; (C8-T1 involvement; if with T1 sympathetic fibers involvent: Horner Syndrome)

A

Klumpke palsy

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29
Q

reflex present at 4-6mos of life; arms adduct and extend; hands open; legs flex when loweing the entire body abruptly while the baby is supine and head; back; and legs supported

A

Moro reflex

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30
Q

most commonly fractured bone during delivery

A

clavicle

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31
Q

defect in the lid (small notch to a large cleft)

A

coloboma

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32
Q

incomplete closure of branchial clefts

A

branchial cleft cyst

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33
Q

cystic dilatation of thyroglossal duct remnants; seen in the midline

A

thyroglossal duct cyst

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34
Q

incomplete closure of the umbilical ring; associated with diastasis recti

A

umbilical hernia

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35
Q

herniation of peritoneum and abdominal contents at the base of the umbilicus; with sac

A

omphalocele

36
Q

herniation without a sac; defect lateral to the umbilius

A

gastroschisis

37
Q

urethral opening on the dorsal penis

38
Q

urethral opening on the ventral penis; more common

A

hypospadia

39
Q

accumulation of fluid in the tunica vaginalis; resolves by 12mos old

40
Q

timing of surgery in undescended testes

A

not later than 9-15mos old(majority descends in the first 3mos; if not; it will remain undescended)

41
Q

aka IUGR;BW<3rd percentile

42
Q

symmetric IUGR;earlier onset

A

associated with dse seriously affects fetal cell number like chromosomal; genetic malformation; teratogenc; infectious; severe maternal HTN

43
Q

assymetric IUGR;late onset

A

associated with poor maternal nutrition or late onset/exacerbation of maternal vascular dse

44
Q

hypoglycemic; plethora; increase risk of: RDS; congenital heard dse; lumbosacral agenesis; hyperbilirubinemia

45
Q

increased surface tension causes alveolar collpase and V/Q mismatch and hypoia; seen in preterms

46
Q

term; delivered by C-section; resolves in 4-5days; overaeration and flat diaphragm

A

Transient Tachypnea of the newbord (RDS II)

47
Q

causes pulmonary hypoplasia; scaphoid abdomen; bowel sounds heard over the chest

A

diaphragmatic hernia

48
Q

most common cause of persistent pulmonary hypertension of the newborn

A

meconium aspiration syndrome

49
Q

presents after 48th hr of life; TB increases not > 5mg/dL/day; TB peaks at 14-15 mg/dL; DB<10% of TB

A

Physiologic jaundice

50
Q

presents in the 1st 24 hrs of lfe; TB increases by >0.5 mg/dL/hr; TB increases to >15mg/dL; DB>10% of TB

A

Pathologic jaundice

51
Q

onset at 3-4DOL; 13% of breastfed infants; accentuated unconjugated hyperbilirubinemia; decreased milk intake; reduced caloric intake; few days duration

A

breastfeeding jaundice

52
Q

onset after 7th DOL; increased B1 in 2% of breastfed infants; presence of glucoronidase in some breast milk

A

breast milk jaundice

53
Q

how to reduce incidence of breastfeeding jaundice

A

frequent breastfeeding(>10/24hrs); rooming-in with night feeding; discouraging D5% or water supplementation; ongoing lactation support

54
Q

lab test requested for indirect hyperbilirubinemia in NB

A

Coomb’s test

55
Q

(+) Coomb’s test in indirect hyperbilirubinemia

A

Isoimmunization (Rh/ABO incompatibility)

56
Q

(-) Coomb’s test with increased Hb in indirect hyperbilirubinemia

A

polycythemia; twin-twin/ maternal-fetal transfusion; IDM

57
Q

intrahepatic causes of direct hyperbilirubinemia

A

sepsis/TORCHS; prolonged TPN; hypothyroidism; galactosemia; cystic fibrosis; alpha-1-antitrypsin deficiency

58
Q

extrahepatic causes of direct hyperbilirubinemia

A

choledochal cyst; biliary atresia

59
Q

most common cause of hemolytic disease in the NB; most cases are mild; jaundice; mild hepatosplenomegaly; phototherapy is benificial

A

ABO incompatibility

60
Q

rarely occurs in the 1st pregnancy due to too late for the mother to become sensitized and transmit antibody to her infant before delivery

A

Rh incompatibility

61
Q

(-) Coomb’s test with normal/decreased Hb and normal reticulocyte counts in indirect hyperbilirubinemia

A

enclosed hemorrhage;increased enterohepatic circulation;decreased calories(breastfeeding jaundice);disorders of conjugation(breastmilk jaundice)

62
Q

(-) Coomb’s test with normal/decreased Hb and increased reticulocyte count in indirect hyperbilirubinemia

A

with characteristic rbc morpholgy(spherocytosis;elliptocytosis); with noncharacteristic RBC morphology(G6PD deficiency; purvate kinase deficiency)

63
Q

early sepsis

A

birth to 7th day of life

64
Q

late sepsis

A

8th to 28day of life

65
Q

risk factors for developing neonatal sepsis

A

maternal infection during pregnancy; PPROM(18hrs); prematurity(MC predisposing factor for infxn)

66
Q

common organisms implicated in sepsis

A

GBS; E. coli; Listeria monocytogenes; HSV; enteroviruses

67
Q

gold standard in the diagnosis of neonatal sepsis

A

blood and urine cultures

68
Q

Tx for neonatal sepsis

A

ampicillin + 3rd gen cephalosporin or aminoglycoside; supportive

69
Q

infection from ingestion of infected raw meat; handling cat feces

A

Toxoplasmosis

70
Q

classic triad of toxoplasmosis

A

HYDROCEPHALUS; chorioretinitis; intracranial calcifications

71
Q

Tx for Toxoplasmosis

A

Pyremethamine and sulfonamide

72
Q

IUGR; cataracts; congenital heart dse(PDA); MR< deafness; blueberry muffin

73
Q

most common congenital infection

74
Q

may cause chorioretinitis; microcephaly; periventricular calcifications

75
Q

Tx for CMV

A

Ganciclovir

76
Q

Tx for HSV

A

Acyclovir; deliver by C-section if with active lesions

77
Q

maculopapular rash; snuffles; periostitis of long bones; hepatosplenomegaly

A

early stage(<2 yrs) syphilis

78
Q

Hutchinson teeth; saddle nose

A

Late stage(>2yrs) syphilis

79
Q

Tc for syphilis

A

Penicillin

80
Q

most common life threatening emergency of the GIT in neonates

81
Q

location of NEC

A

distal ileum and proximal colon

82
Q

greatest risk factor in developing NEC

A

prematurity

83
Q

initially presents as abdominal distention; gastric retention; lethargy; temperature instability; bloody stools in 25% of patients; progresses to bowel perforation; peritonitis; SIRS; shock; death

84
Q

AXR finding in NEC

A

pneumatosis intestinalis

85
Q

indications for surgery in NEC

A

evidence of perforation; failure of medical mgt; single fixed bowel loop on Xray; abdominal wall erythema; palpable mass

pediatrics (16 decks)

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