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Pediatrics > Neonatology > Flashcards

Neonatology Flashcards

1
Q

[EINC]

What are the steps in EINC?

A
  1. Immediate drying
  2. Uninterrupted skin-to-skin contact
  3. Delayed cord clamping after 1-3 minutes
  4. Breastfeeding
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2
Q

[EINC]

What are the mechanism of heat loss in a newborn?

A
  1. Convection
  2. Conduction
  3. Heat radiation
  4. Evaporation
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3
Q

[Birth weight]

Low birth weight

A

<2500g

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4
Q

[Birth weight]

Very low birth weight

A

<1500g

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5
Q

[Birth weight]

Extremely low birth weight

A

<1000g

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6
Q

[Gestational Age]

Late preterm

A

> / 34 but < 37 weeks

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7
Q

[Gestational Age]

Very preterm birth

A

<32

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8
Q

[Gestational Age]

Extremely preterm birth

A

<28

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9
Q

____ BW is less than 3rd percentile for calculated age

A

SGA

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10
Q

____ BW is > 90th percentile for gestational age

A

LGA

associated with maternal DM and obesity, risk for hypoglycemia, polycythemia

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11
Q

[EINC]

What is the objective of thorough drying?

A

To stimulate breathing, provide warmth

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12
Q

[EINC]

What is the objective of early skin to skin contact?

A

To provide warmth, bonding, prevent infection, and hypoglycemia

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13
Q

[EINC]

What is the objective of delayed cord clamping

A
  1. Reduce anemia in term and preterm

2. Reduce IVH and transfusions in preterm

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14
Q

What are the components of APGAR?

A 
Activity - active
Pulse - >100bpm
Grimace - Active motion
Appearance - body pink, extremities blue
Respiration - vigorous cry
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15
Q

RA ____

Newborn Screening test

A

RA 9288

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16
Q

In normal infants, NBS is done at __ hours

A

24 to 48 hours

If blood was collected <24hrs, repeat at 2 weeks old

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17
Q

For preterm infants, NBS should be done _____ day old

A

5-7 days old

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18
Q

How many diseases does Expanded NBS covers?

A

28 diseases

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19
Q

[Diagnosis]

Normal birth weight and length
Delayed physical, mental and sexual development;

Sluggish, deeding difficulties

Edema of scrotum and genitals, prolonged jaundice

A

Congenital Hypothyroidism

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20
Q

What is the most common cause of congenital hypothyroidism?

A

Thyroid Dysgenesis

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21
Q

[Diagnosis]

Normal at birth but with signs of sexual and somatic precocity within 1st 6 months of life

Hyponatremia, hyperkalemia, hypoglycemia

A

Congenital Adrenal Hyperplasia

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22
Q

Marked elevation of 17-OHprogesteron is normally elevated in the first ____ DOL in sick pre-term infants

A

2-3 DOL

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23
Q

Most common enzyme deficiency associated with CAH?

A

21-hydroxylase enzyme

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24
Q

What is the treatment for CAH

A

Glucocorticoid replacement 15 to 20mg/m2/24 hours administered orally in 3 divided doses

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25
Q

What is the DOC for salt-wasting type of CAH

A

Fludrocortisone

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26
Q

What are the enzyme deficiency in Galactosemia?

A
  1. Galactose-1-phosphate uridyltansferase (classic)
  2. Galactokinase (cataract)
  3. Galactose-4-epimerase
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27
Q

What is the enzyme deficient in phenylketonuria?

A

Phenylalanine hydroxylase

Increased Phe

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28
Q

What is the damaging by product of phenylalanine that disrupts normal metabolism and causes brain damage?

A

Phenylethylamine

unpleasant musty odor

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29
Q

What is the most common manifestation of phenyketonuria?

A

developmental delay

Infant: severe vomiting, hypertonic, hyperactive DTRs

Older: hyperactive with purposeless movements, rhythmic rocking and athetosis, unpleasant musty odor

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30
Q

What is the enzyme deficiency in MSUD?

A

Branched chain alpha-keto acid dehydrogenase complex

L, I, V

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31
Q

[PE findings at birth]

slate blue, well demarcated areas of pigmentation over the buttocks and back

A

Mongolian spots

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32
Q

[PE findings at birth]

small, white, vesiculopustular papules on an erythematous base after 1-3 days, with eosinophils

A

Erythema toxicum

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33
Q

[PE findings at birth]

Vesiculopustular eruption over a dark macular base around the chin, neck, back and soles. contains neutrophils

A

Pustular melanosis

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34
Q

[PE findings at birth]

Cysts appearing on the hard palate which is composed on accumulations of epithelial cells

A

Epstein pearls

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35
Q

[PE findings at birth]

pearly white papule seen mostly on the chins and around the cheeks

A

Milia

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36
Q

[PE findings at birth]

open and closed comedones or inflammatory pustules after a weeks from delivery

A

Neonatal acne

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37
Q

[PE findings at birth]

pink macular lesions on the nape, glabella, upper eyelids, nasolabial region

A

Nevus simplex

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38
Q

[PE findings at birth]

hair that covers the skin of preterm infants

39
Q

[PE findings at birth]

thick, white creamy material usually absent in post term infants

A

vernix caseosa

40
Q

[PE findings at birth]

mottling of the skin with venous prominence. Cobblestone, lacy appearance

A

cutis marmorata

41
Q

What are the possible causes of absent moro reflex?

A
  1. Clavicular fracture

2. Brachial plexopathy

42
Q

[Birth injury]

At point of contact, can extend across sutures; shifts with gravity

A

Caput succedaneum

43
Q

[Birth injury]

Usually over parietal bones, does not cross sutures; more fluctuant after 48 hours, distinct margins, initially firm

A

Cephalhematoma

44
Q

[Birth injury]

beneath epicranial aponeurosis; may extend to orbits, nape of neck

can have crepitus or fluid wave; progressive, may be massive

A

Subgaleal hemorrhage

45
Q

[Diagnosis]

12hours DOL, frothing at the mouth of secretions. Regurgitated when given milk

155bom, RR 68, harsh breath sounds, good cardiac tone, soft abdomen, cyanotic lips and nailbeds

A

EA with TEF

Dx: inability to pass an NGT or OGT in the newborn

Manage: maintain patent airway, prone position, esophageal suctioning, surgery

46
Q

What is the most common type of EA?

47
Q

[Diagnosis]

Newborn, tachypnea, grunting, use of accessory muscles with cyanosis at the 2nd hour of life, scaphoid abdomen, PMI shifted near the sternal side

A

Congenital Diaphragmatic hernia

48
Q

What is the most common type of diaphragmatic hernia?

A

Bochdalek hernia

49
Q

[Omphalocele vs Gastroschisis]

Extrusion of abdominal viscera, present sac,
below the umbilicus, umbilicus is at the
center of the membrane,
normal bowel and alimentation

A

Omphalocele

more commonly associated with congenital anomalies

50
Q

[Omphalocele vs Gastroschisis]

Extrusion of abdominal viscera, no sac, lateral to the umbilicus, the umbilical cord is left of the defect, bowel is inflamed, delayed alimentation

A

Gastroschisis

51
Q

[Diagnosis]

Newborn. Abdominal distention with abdominal erythema ; baby cries more when touched

52
Q

What is the histologic finding in Necrotizing enterocolitis?

A

Coagulation necrosis

53
Q

___ refers to a thickened bowel walls and air in bowel wall

A

pneumatosis intestinalis

54
Q

What are the triad of the pathophysiology of NEC?

A
  1. Intestinal ischemia
  2. Enteral nutrition
  3. Pathologic organism
55
Q

[Respiratory condition]

AOG at which surfactant is present in fetal lung

A

20 weeks AOG

56
Q

[Respiratory condition]

AOG at which the surfactant is present in the amniotic fluid

A

28 and 32 weeks

57
Q

[Respiratory condition]

mature levels of pulmonary surfactant are present in ____

A

35 weeks AOG

58
Q

What is the major component of surfactant

A

Phosphatidylcholine

59
Q

Apnea is the cessation of breathing for more than ____

A

20 seconds

or any duration if accompanied by cyanosis and bradycardia

60
Q

What is the most common cause of apnea?

A

Idiopathic apnea of prematurity

61
Q

In neonates, what is the HR to initiate CPR

62
Q

This drug is given to neonates presenting with apnea which acts a by lowering the threshold of response to hypercapnia and enhance the contractility of the diaphragm

A

Methyxanthine (Caffeine or theophylline)

63
Q

What is the CXR finding of RDS

A

Fine reticular granularity of the parenchyma and air bronchograms

64
Q

What is the CXR finding of TTH?

A

Prominent pulmonary vascular markings, fluid in the intralobar fissures, overaeration, flat diaphragm

65
Q

[Diagnose: CXR]

Finely granular lungs; ground glass appearance

A

Hyaline membrane disease

66
Q

[Diagnose: CXR]

prominent pulmonary vascular markings, fine lines in fissures

67
Q

[Diagnose: CXR]

bubbly lungs

A

Bronchopulmonary dysplasi

68
Q

[Diagnose: CXR]

Coarse streaking granular pattern of both lung fields

69
Q

[Diagnose: CXR]

Perihilar streaking

A

Neonatal pneumonia

70
Q

[Jaundice: Physiologic/Pathologic]

visible only on the 2nd - 3rd day

A

Physiologic

71
Q

[Jaundice: Physiologic/Pathologic]

decline to adult level by 10-14 days of life

A

Physiologic

72
Q

[Jaundice: Physiologic/Pathologic]

appears in the first 24 to 36 hours

A

pathologic

73
Q

[Jaundice: Physiologic/Pathologic]

serum bilirubin rising >5mg/dL/24 hours

A

pathologic

74
Q

[Jaundice: Physiologic/Pathologic]

TB increases >0.5mg/dL/hour

A

Pathologic

75
Q

What substance in milk that contributes to breastfeeding jaundice?

A

Glucurinidase

76
Q

Kernicterus results from deposition of unconjugated bilirubin in what part of the brain

A

ganglia and brainstem

77
Q

[Coomb’s Test]

____ detect antibodies that are bound to the surface of RBCs

A

Direct Coombs

78
Q

[Coomb’s Test]

detects antibodies agains RBCs that are unbound

A

indirect coombs

79
Q

What is the most common cause of hemolytic disease of the newborn?

A

ABO incompatibility

80
Q

What are the lab test results in ABO incompatibility?

A
  1. (+) coombs test
  2. Spherocytes in blood smear
  3. Hemoglobin is usually normal but maybe as low as 10-12g/dL
  4. Increased reticulocyte count
  5. Increased B1
81
Q

What is injected to the mother to reduce the Rh hemolytic disease?

A

Anti-D gamma globulin immediately after the delivery of each Rh + infant

82
Q

What are the Rh incompatibility lab results?

A
  1. (+) Direct Coombs test
  2. Anemia
  3. Increased reticulocyte count
  4. B1 rises rapidly
  5. B2 may also be elevated
83
Q

What are the conditions that are coombs test negative with high hemoglobin and increased B1?

A
  1. Polycythemia
  2. Infant of diabetic mother
  3. SGA
  4. Delayed cord clamping
  5. Twin transfusion / maternal-fetal transfusion
84
Q

What are the conditions that are Coombs test negative with normal / low hemoglobin and normal reticulocyte count

A
  1. Enclosed hemorrhage
  2. Increased enterohepatic circulation
  3. Decreased calories
  4. Disorders of conjugation
85
Q

What are the conditions that are coombs test negative with normal / low hemoglobin and increased reticulocyte count

A
  1. Spherocytosis
  2. Elliptocytosis
  3. G6PD
  4. Pyruvate kinase deficiency
86
Q

What are the conditions that can cause coomb’s test positive?

A
  1. ABO incompatibility

2. RH incompatibility

87
Q

[Congenital infection]

vesicular lesions on the face and mouth

88
Q

[Congenital infection]

purpuric hemorrhagic lesions all over the body

89
Q

[Congenital infection]

maculpapular rash; periostitis of the bone

90
Q

[Congenital infection]

chorioretinitis
CT: Periventricular calcifications

91
Q

[Congenital infection]

Chorioretinitis, microcephaly, hepatosplenomegaly

CT: Intracerebral calcifications

A

Toxoplasmosis

92
Q

[Congenital infection]

Cutaneous scars

CT: Cortical atrophy

93
Q

Accumulation of fluid in the tunica vaginalis; majority are non-communicating; resolves by 12 months

A

Hydrocele

may be observe up to 1 year of age

94
Q

Undescended testes may be observed up to ____ months of age

A

3-4 months

Pediatrics (15 decks)

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