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Pediatric Shelf > Neonatology Diseases: Sx, Tx, Dx > Flashcards

Neonatology Diseases: Sx, Tx, Dx Flashcards

1
Q

Sturge Weber Syndrome

A
  • Vascular cutaneous malformation w/ trigeminal distribution
  • Port wine stain (Facial Angioma)
  • Also involves meninges
  • Seizures, MR, contralateral hemiparesis *Choroidalangiomas
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2
Q

Twin to Twin Transfusion

A
  • 15% of monochorionic twins
  • S/Sx: Hct difference of ≥15% between twins *Recipient: Polyhydraminos, plethora, ↑Hct, hyperviscosity syndrome, hyperbilirubinemia
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3
Q

Polydactyl

A
  • Postaxial (5th finger side)
  • Normal occurrence in AA
  • Tx: Surgical removal
  • Abnormal in whites; Careful cardiac exam
  • Preaxial(thumb)
    • Abnormal in all races
    • Investigate further *Associated w/ Trisomy 13
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4
Q

Cleft Lip and Palate

A

*Complications: Recurrent otitis media, Hearing loss, Speech defects
*Tx: Repair
Lip: 2-3m
Palate: 6mto5y

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5
Q

Propanolol (during pregnancy)

A
  • Causes growth retardation, hypoglycemia, apnea

* Decreases ability of asphyxiated newborn to ↑HR/CO

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6
Q

Opioid (Narcotics) in Newborn

A

*Hx of maternal narcotic use
- Demerol for labor pain control
- Heroin
*S/Sx
Lethargic, limp, depressed respirations *Tx
Manage ABCs
Naloxone

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7
Q

Subgaleal (or subaponeurotic hemorrhage)

A 
*S/Sx
  Similar feel to cephalohematoma (“squishy”), crosses midline (entire scalp),
fluid wave
  Rapidly expands
  Signs of hypovolemia from hemorrhage
  Tachycardia
*Tx
  Careful monitoring, transfer to NICU
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8
Q

Erb-Duchenne Palsy

A

o Cervicalnerves5and6
o S/Sx
Unable to abduct, externally rotate, or supinate
Arm will remain internally rotated at side w/ forearm protonated
Won’t move w/ Moro reflex
oMay co exist w/ phrenic nerve palsy (Cervicalnerves3,4,5)
Ipsilateral hemiparesis of the diaphragm
Asymmetry on inspiration when it doesn’t flatten
“See Saw”
Typically resolves on own

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9
Q

Clavicle Fracture

A

o Initial presentation may be pseudoparalysis Refusal to move arm
Mimics Erb-Duchenne
o Dx
Can be identified at birth by crepitus
Those not discovered in newborn present later with a callus formation
o Tx
Reassurance

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10
Q

Hypothermic Infant

A 
o Interaction will ↑ metabolic rate and subsequently ↑ RR to maintain O2
  Metabolic acidosis
  Become tachypenic 
o Tx
  Warmer
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11
Q

Bleeding in Newborn

A

o W/ hematemesis or melena first establish source

  • Maternal vs. Fetal
  • Apt-Downey test: Fetal Hb is alkali resistant
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12
Q

Breast Feeding Contradindications

A 
o Active TB, HIV
o Medications
  Antineoplastic, lithium, cyclosporine, illicit drugs, amphetamines, ergotamines,
and bromocriptine (↓ lactation)
  Most ABx safe (except Tetracyclines)
o Galactosemia
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13
Q

Acrocyanosis

A

o W/ Cutis Marmorata (mottling of the skin w/ venous predominance) Vasomotor instability

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14
Q

Milia

A

o Small cysts around the pilosebaceous follicles

White papules surrounding the nose Disappear in 1st weeks

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15
Q

Pustular Melanosis

A

o Benign transient rash characterized by small dry superficial vesicles over a dark base o Blacks
o Differentiate from HSV or Bacterial (ex. Impetigo)
o Lesions are filled w/ eosinophils

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16
Q

Erythema Toxicum Neonatorum

A 
o Benign rash in first 72h
o Erythematous macules, papules, & pustules (flea bite like)
-On trunks & extremities
- Not palms/soles 
o Lesions are filled w/ eosinophils
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17
Q

Nevus Simplex (Salmon Patch or Telangiectastic Nevus)

A

o Most common vascular lesion of infancy
o Pink macular lesion on nape of neck (stork bite), upper eyelids, galbella, or nasolabial
folds

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18
Q

Nevus Flammeus (Port Wine Stain)

A

o Capillary hemangioma over face or trunk
o Those over CN V-1 (Trigeminal) may be associated w/ intracranial or spinal vascular
malformations, seizures, & intracranial calcifications
- Sturge-Weber Syndrome

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19
Q

Neonatal Acne

A

1-2w after birth (not present @ birth)

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20
Q

Caput Succedaneum

A

o Diffuse edema of soft tissue of the scalp that crosses sutures & midline
o Can sometimes be ecchymotoic

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21
Q

Cephalohematomas

A

o Subperiosteal hemorrhages secondary to birth trauma, confined by sutures (bc
subperiosteal)
o No ecchymosis discoloration
o Usually parietal or occipital bones

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22
Q

Craniosynostosis

A

o Premature skull fusion

Abnormal shape

23
Q

Macroglossia

A

o Beckwith-Wiedeman Syndrome
Hemihypertrophy, visceromegaly, macroglossia
o HoThyroidism

24
Q

Midline clefts or Masses

A

o Goiter
Secondary to maternal antithyroid meds or maternal thyroid stimulating Auto
Ab

25
Q

Neonatal Torticollis

A

o Asymmetric shortening of SCM
o Causes
Fixed position in utero
Postnatal hematoma

26
Q

Periodic Breathing

A

o Normal in preterms

Irregular breathing w/ short apenic bursts ≤5 to 10s

27
Q

Umbilicus

A

o 2 arteries, 1 vein

1 artery suggests renal malformation

28
Q

Diastasis Recti

A

o Separation of the rectus abdominis @ midline

o Benign

29
Q

Umbilical Hernia

A

o Soft swelling beneath umbilicus
o May protrude during crying
o Most close spontaneously

30
Q

Persistent Urachus

A

o Urine draining from bladder to umbilicus

31
Q

Hydrometrocolpos

A

o Cysts between the labia

Caused by an imperforate hymen and collection of secretions behind

32
Q

Male Genitalia

  • Hypospadias
  • Epispadias
  • Hydrocele
  • Cryptorchidism
A 
o Hypospadias
  Urethral Meatus Ventral
  Not associated w/ ↑ incidence of urinary malformations o Epispadia
  Urethral Meatus Dorsal
  Often associated w/ bladder extrophy
  Protrusion of bladder from abdominal wall, w/ exposure of its mucosa
  Extremities
o Hydrocele
  Scrotal swelling
  Fluid in tunica vaginalis   Resolve spontaneously
o Cryptorchidism
  Surgery should not take place
33
Q

Absence/ Hypoplasia of Radia

A

o TAR Syndrome (thrombocytopenia, absent radii), Fanconi Anemia, Holt-Oram
Syndrome

34
Q

Edema of Feet w/ Hypoplastic Nails

A

Turner Syndrome & Noonan Syndrome

35
Q

Rocker Bottom Feet

A

Trisomy 18

36
Q

Post-Term

A

o Placental insufficiency

Intrauterine asphyxia, meconium aspiration, polycythemia

37
Q

Small for Gestational Age (SGA)

A

o Complications
Hypoxemia, perinatal asphyxia, hypocalcemia, Hypomagnesaemia
Floppy
Polycythemia (>65% Hct)
From ↑ erythropoietin in response to hypoxia
↑ blood viscosity; “hyperviscositysyndrome” ; Jittery, seizures
Changes in cerebral blood flow Renal V. thrombosis
NEC
o Tx
- Partialexchangefusion
o Hypothermia
From ↓ability to thermoregulate from ↓ subq fat
o Hypoglycemia
From ↓ glycogen stores
Manage w/ early and frequent feeds
o Associated w/ higher incidence of major congenital abnormalities

38
Q

Large for Gestational Age

A

o Causes
Diabetes, Beckwith-Wiedmann Syndrome, Prader-Willi Syndrome, Nesidioblastosis (diffuse proliferation of pancreatic islet cells)

39
Q

Cyanosis

A

o Related to the amount of unoxygenated Hb
>3 arterial or >5 capillary
o Causes
-5 T’s of Cyanotic CHD, Polycythemia, intraventricular hemorrhage, hypoglycemia, hypocalcemia, hypothermia, HoThyroidism
o 100%O2Test
-w/ Cyanotic Heart Disease (slight ↑)
Those w/ ↓ Pulmonary blood flow (ex. TOF) will only have slight ↑ in PaO2 (10-15 mmHg)
-w/ Normal or ↑ Pulmonary blood (ex. Truncus Arterious), PaO2 will ↑ ≥15-20 mmHg, but not close to 150mmHG total
-w/ Lung Disease
PaO2 will ↑ a lot (≥150 mmHg)
Except w/ Persistent Pulmonary HTN of NewBorn
May have a large R→L shunt through PFO or PDA
PaO2 will not ↑ ≥10-15 mmHg

40
Q

Respiratory Distress Syndrome, RDS (Hyaline Membrane Disease or Surfactant deficiency
Syndrome)

A

o Sufficient surfactant @ 30-32w
RDS more likely/severe 28d Need supplemental O2 for >28d
Characteristic CXR
Retinopathy of prematurity

41
Q

Term infant w/ Respiratory Distress

A

o Persistent Pulmonary HTN (PPHN)
Especially w/ C section
o Meconium Aspiration Syndrome (MAS)
Especially post term

42
Q

Persistent Pulmonary HTN (PPHN)

A

o Any condition other than CHD w/ low blood flow to the lungs after birth
o Causes
Perinatal asphyxia
Can result in ↑ pulmonary pressure while the systemic BP falls
o Causes a persistent R to L shunt across PDA or PFO Results in PPHN
MAS (meconium aspiration syndrome)
Any cause of fetal stress o ↑PVR
R→L Shunt through PFO or PDA o Cyanosis from Respiratory Failure
o Pre and Post Ductal PO2 differences
o CXR
?
o Echo
Rule out CHD, assess shunt
o Tx
O2
Important b/c hypoxemia is a potent vasoconstrictor (want to ↓PVR)
NO

43
Q

Meconium Aspiration Syndrome (MAS)

A

o Respiratory distress in term or post term newborn
o “PeaSoup” or Meconium stained amniotic fluid
o Meconium (first stools)
Can be passed as result of distress (e.g. hypoxemia)
o CXR
↑ Lung Vol, diffuse patchy atelectasis, parenchymal infiltrates alternating w/ hyperinflation
Possible pneumothorax
Diminished breath sounds on side
Loss of lung markings on CXR
o Endotracheal Suction after whole body is delivered (not intrapartum or after head only)

44
Q

Apnea of Prematurity

A 
o Respiratory pause >20s
o Caused by immature respiratory center
o Or pause of any length if accompanied by bradycardia/cyanosis or O2 desat 
o Types
  Central
  -Absent chest wall movement & no airflow
  Apnea secondary to Obstruction
  -Chest wall movement w/out airflow
  Won’t show as apnea on home monitors
o Tx
  Maintain neutral temp environment & Stimulation   Respiratory stim med
  Caffeine or Theophylline
45
Q

Neonatal Jaundice

A

o Visible jaundice in neonate TB >5 o Peak
Term: Day 3-4
Preterm: Day 5-7 o Evaluate always if
Jaundice in .5/hour
Suggestive of hemolysis o DirectHyperbiliEval
Hepatic US (Choledochal Cyst), Serology (Hepatitis), Radio isotope scan for hepatobilliary tree (biliary atresia), sepsis
o Tx
Phototherapy
Exchange transfusion for rapid rises in TB from hemolysis or extremely high TB
Complications: coagulopathy (bleeding)
o Complications
Indirect crosses BBB
Acute Bilirubin encephalopathy
o High pitched cry, lethargy, poor feeding, hypotonia
Localizes in Basal Ganglia & Hippocampus

46
Q

Heroin Withdrawal

A

o Jitteriness, hyperreflexia, irritability, tremulousness/tremors, feeding intolerance
o High pitched cry

47
Q

Esophageal Atresia w/ Transesophageal Fistula (TEF)

A

o Often associated w/ Polyhydramnios
o Copious oropharyngeal secretions
↑ risk of aspiration, choking, or pneumonia feeding attempted o Associatedmalformations
CHD, anorectal, renal, skeletal, or the VACTERL Association CH5 III.A.8
o Evaluation
Insert oral gastric tube until resistance

48
Q

Omphalocele

A

o Centrally
Through umbilicus o True hernia sac
Covered w/ peritoneal sac
But not w/ skin like in an umbilical hernia (which can resolve on own, usually
protrudes w/ crying)
o Frequent association w/ other congenital malformations (heart, kidney)
CHD
TOF & ASD
Beckwith-Wiedemann Syndrome
Exophthalmos, macroglossia, gigantism, hyperinsulinemia,
hypoglycemia, midline defects (eg. Omphalocele)
o Dx: Polyhydramnios on US
90% diagnosed Prenataly (so usually pt. w/ no prenatal care)
o Tx
Surgery

49
Q

Gastroschisis

A

o Fissure of abdominal wall located right paraumbilical area (nonmidline)
Umbilicus looks normal
o Not true hernia sac
No peritoneal sac covering
o No association w/other malformations
o Increased risk of damage to bowel from exposure to amniotic fluid
o Tx
Immediately wrap in sterile saline dressings and cover in plastic
Surgery

50
Q

Intestinal Obstruction

A

o Meconiumileus
Wrap in sterile wet gauze
CF
Air remains trapped in meconium giving it a soap bubble appearance on XR

51
Q

Hypoglycemia

A

o Glc

52
Q

Infants of Diabetic Mothers

A

o Large bc of ↑ body fat and visceromegaly Liver, adrenals, heart
o Typically LGA, but can be SGA if mother has serious DM w/ vascular complications causing placental insufficiency
o Complications
Hypoglycemia (typically 1st 24h), polycythemia, hypocalcemia (typically 48-
96h), hypomagnesaemia Hypertrophic Cardiomyopathy, PPHN, RDS, renal vein thrombosis
Hypocalcemia presents w/ twitching/tremors, seizures, arrhythmias o Tx:IVCalciumGluconate
Malformations
Structural heart, CNS, Musculoskeletal, Hypoplastic Left Colon, Caudal
Regression Syndrome (hypoplasia of the sacrum and LE)

53
Q

Polycythemia

A

o Hct>65%
o Causes
↑ Erythropoietin in response to placental insufficiency, fetal hypoxia, ↑
placental transfusion from delayed cord clamping
o Tx
Partial Exchange Transfusion
Blood is removed and then replaced w/ same volume of plasma (normal saline)

54
Q

Choanal Atresia

A 
o S/Sx
  Trouble breathing when sleeping or eating
  Improved breathing w/ crying o Dx
  Unable to pass NG tube
  Lack of fogging on a cold metal instrument under the nares 
o CHARGE association
  Coloboma
  Absence or defect of ocular tissue
     o Usually the retina
     o Impaired vision   
  Heart disease (TOF)
  Atresia of the choanae
  Retarded growth and development
  Genital hypoplasia
  Ear abnormalities (cup ears & hearing loss)

Pediatric Shelf (6 decks)

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