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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
Neonatal Torticollis
o Asymmetric shortening of SCM o Causes Fixed position in utero Postnatal hematoma
26
Periodic Breathing
o Normal in preterms | Irregular breathing w/ short apenic bursts ≤5 to 10s
27
Umbilicus
o 2 arteries, 1 vein | 1 artery suggests renal malformation
28
Diastasis Recti
o Separation of the rectus abdominis @ midline | o Benign
29
Umbilical Hernia
o Soft swelling beneath umbilicus o May protrude during crying o Most close spontaneously
30
Persistent Urachus
o Urine draining from bladder to umbilicus
31
Hydrometrocolpos
o Cysts between the labia | Caused by an imperforate hymen and collection of secretions behind
32
Male Genitalia - Hypospadias - Epispadias - Hydrocele - Cryptorchidism
``` 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
Absence/ Hypoplasia of Radia
o TAR Syndrome (thrombocytopenia, absent radii), Fanconi Anemia, Holt-Oram Syndrome
34
Edema of Feet w/ Hypoplastic Nails
Turner Syndrome & Noonan Syndrome
35
Rocker Bottom Feet
Trisomy 18
36
Post-Term
o Placental insufficiency | Intrauterine asphyxia, meconium aspiration, polycythemia
37
Small for Gestational Age (SGA)
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
Large for Gestational Age
o Causes Diabetes, Beckwith-Wiedmann Syndrome, Prader-Willi Syndrome, Nesidioblastosis (diffuse proliferation of pancreatic islet cells)
39
Cyanosis
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
Respiratory Distress Syndrome, RDS (Hyaline Membrane Disease or Surfactant deficiency Syndrome)
o Sufficient surfactant @ 30-32w RDS more likely/severe 28d Need supplemental O2 for >28d Characteristic CXR Retinopathy of prematurity
41
Term infant w/ Respiratory Distress
o Persistent Pulmonary HTN (PPHN) Especially w/ C section o Meconium Aspiration Syndrome (MAS) Especially post term
42
Persistent Pulmonary HTN (PPHN)
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
Meconium Aspiration Syndrome (MAS)
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
Apnea of Prematurity
``` 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
Neonatal Jaundice
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
Heroin Withdrawal
o Jitteriness, hyperreflexia, irritability, tremulousness/tremors, feeding intolerance o High pitched cry
47
Esophageal Atresia w/ Transesophageal Fistula (TEF)
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
Omphalocele
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
Gastroschisis
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
Intestinal Obstruction
o Meconiumileus Wrap in sterile wet gauze CF Air remains trapped in meconium giving it a soap bubble appearance on XR
51
Hypoglycemia
o Glc
52
Infants of Diabetic Mothers
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
Polycythemia
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
Choanal Atresia
``` 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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