Neonatology/Peds

Question 1

When do the fontanelles close

Answer 1

Anterior: 9-12 months
Posterior: 2-4 months
bulging = increased ICP.

Question 2

cephalhematoma vs caput

Answer 2

caphalhematoma (confined to periosteum) does not cross suture lines– can calcify and cause deformation. similar to subgaleal hemorrhage.
caput can cross suture lines that resolves within days

Question 3

what does the red reflex test for

Answer 3

see the retina– if absent it could be congenital cataract or retinoblastoma (most common eye cancer in kids) or persistent hyperplastic primary vitreous.

Question 4

VSD mumur

Answer 4

harsh blowing pan systolic murmur

Question 5

coarctation murmur

Answer 5

heart more at apex and interscapular over back.

Question 6

MRSOPA for NRP–chest does not rise

Answer 6

Mask: inadequate seal between mask and face
Reposition: correct head position)not flexed nor hyperextended)
suction
open mouth
pressure: increase PIP 20-25
alternate airway/intubation

Question 7

benign jaundice is _____

Answer 7

conjugated. Due to breast feeding, east asian ethnicity. oxytocin used in labour, late preterm, scalp injury, delayed cord clamping.

Question 8

causes of unconjugated hyperbilirubinemia

Answer 8

hemolytic disease
sepsis
DIC
extravasation
polycythemia
increase in enterohepatic circulation
decreased clearance.

Question 9

any jaundice presenting within ____ of age is pathologic

Answer 9

24 hours of age.
if there is a rapid riase in bili >3.5
serum bili>normal for gestational age
jaundice persisting after 10-14 days
stool clay/white colored
conjugated bili>34

all are considered pathological

Question 10

complications of severe unconjugated hyperbilirubinemia

Answer 10

sensorineural hearing loss
neurologic damage
depisite in basal ganglia –> cerebral palsy
if kernicterus –> death.

Question 11

Indications for tubes for recurrent AOM

Answer 11

OME in children who are at risk for speech, language, or learning problems, regardless of hearing status; referral within three months is recommended (see ‘Children at risk for speech, language, or learning issues’ above)

●Tympanic membrane changes (eg, retraction pockets (picture 2A-B)) (see ‘Structural damage to tympanic membrane or middle ear’ above)

●Persistent OME-associated hearing loss with a hearing threshold of ≥41 dB (see ‘Hearing threshold ≥41 dB’ above)

●Bilateral OME for ≥3 months, unilateral OME for ≥6 months, or recurrent episodes of AOM with cumulative duration of OME for ≥6 of the previous 12 months

Question 12

5 cyanotic congenital heart diseases

Answer 12

“five T’s” of cyanotic congenital heart disease–tetralogy of Fallot: VSD, pulmonary stenosis, right ventricular hypertrophy

TGA: transposition of the great arteries: pulmonary arteries on the left side of the heart and aorta on the right side. Can be partially corrected with oxygen at early stage but requires surgery

TAPVC: Total anomalous pulmonary venous return. a birth defect of the heart in which the veins bringing blood back from the lungs (pulmonary veins) don’t connect to the left atrium like usual.

truncus, and tricuspid valve abnormalities (tricuspid atresia, stenosis, and displacement

Question 13

ductus arteriosus

Answer 13

DA closes after birht because it causes ligamentum arteriosum. if left patent it causes a left to right shunt, that later complicates into eisenmengers syndrome and a right-left reveresal. It is originally an ACYANOTIC heart defect.

In utero and early birth, oxygenated blood comes from placenta to the right side of heart, but then goes through foramen ovale in the right atria to enter into the left side, where it gets circulated to the aorta and through the body. A lotof blood bypasses the pulmonary artery system and there is high pulmonary resistence.

Question 14

Note;

Answer 14

This patient with exercise
intolerance and a heart murmur
at the left lower sternal
border (LLSB), together with cardiac
catheterization
showing an increase in oxygenation in the right ventricle
, most likely has a ventricular septal defect
(VSD), the most common type of acyanotic congenital heart disease. The condition can cause fatigue
, shortness of breath
, exercise intolerance, and failure to thrive. VSDs are a type of left-to-right shunt, wherein oxygenatedblood in the left heart passes through the defect and enters the right heart. Patients are acyanotic since deoxygenated blood from the right heart is unable to enter the systemic circulation
. Other causes of left-to-right shunts include atrial septal defect
, patent foramen ovale
, and patent ductus arteriosus
.

In contrast, in a right-to-left shunt, deoxygenated blood from the right heart
passes through a defect and enters the left heart
. The deoxygenated blood subsequently enters the systemic circulation
, resulting in cyanosis. Causes of right-to-left shunts include Tetralogy of Fallot
and Eisenmenger syndrome , among others.

Question 15

pulmonary truncus arteriosus

Answer 15

failure of neural crest cells to properly migrate to the bulbus cordis. Causes a single trunk to arise from the heart and the arota and pulmonary vessels are fused. there is mixing of rhe right(deoxy) and left blood, causes high pulmonary pressures and cyanosis.

Question 16

TGV

Answer 16

transposition of great vessels: two separate closed systems. Aorta connected toRS, Pulmonary artery connected to left side. No mixing. Cyanosis. only way to survive is if there is a VSD, ASD, or PDA which would allow some mixing of blood. Causes a continuous machine-like murmur.

Question 17

tetrology of fallot

Answer 17

pulmonary stenosis
right ventricular hypertrophy (boot)
VSD: hole between left to right, but then causes right to left eisenmengers syndrome.
displaced aorta overriding.

holosytolic heart murmur at LLSB

level of cyanosis is dependent onseverity of pulmonary stenosis. Can causes tet spells: crying or feeding causes spasms of the infundibular septum and causes cyanosis. Squatting down causes increased peripheral resistance.

Question 18

total anomalous pulmonary venous return

Answer 18

pulmonary veins fuse at the wrong location (on the right atrium). Oxy blood ends up on the wrong side of the heart. need ASD for right atrium blood to go to left and then to rest of body.

Usually will see puomonary hypertension since the right side is receiing all the blood. cyanotic.

tricuspid atresia and TAPVR is associated with systolic ejection murmur because of ASD.

Question 19

cyanotic diseases

Answer 19

tetrology of fallot (unless has patent ductus arteriosus to help override)
transposition of the great arteries
total anomalous pulmonary venous return TAPVR
Tricuspid puolmonary atresia (no tricuspid valve and thus no separation between right atria and ventricle).
truncus arteriosis

acyanotic disease: VSD, ASD, Coarctation of aorta, patent ductus arteriosus (unless eisenmengers syndrome later on reverses it and thus causes differential cyanosis)