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Pediatric Clerkship > Newborn > Flashcards

Newborn Flashcards

1
Q

APGAR

A

Activity (muscle tone), Pulse, Grimace, Appearance (Color), Respirations; 2pts each

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2
Q

What does APGAR tell you at (A) 1 minute, (B) 5 minutes

A

(A) how tolerated labor (B) response to resuscitation

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3
Q

APGAR is NOT a therapy ____ or ____ factor

A

guide; prognostic

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4
Q

Erb-Duchenne; tx

A

C5-C6; arm extended and medially rotated; refer if not better by 3-6 months

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5
Q

Klumpke

A

C7-C8 + T1

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6
Q

Clinical signs for clavicular fracture of newborn; tx

A

crepitus and discontinuity of clavicle (will form callus in 1 wk); no tx but can use fig-8 splint

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7
Q

Caput succedaneum

A

“edema crosses suture lines”

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8
Q

Cephalohematoma

A

“fluctuance doesn’t cross suture lines” (dent in head)

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9
Q

Mongolian spot

A

Asians; congenital dermal melanocytosis, will go away

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10
Q

Nevus simplex (salmon patch)

A

vascular birthmark that occurs in 33 percent of newborns; blanch when compressed; bilateral/symmetric

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11
Q

Milia

A

pearly white bumps on a baby’s nose, chin or cheeks

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12
Q

Erythema toxicum neonatorum (ETN)

A

in at least half of all infants; self-limited; lesions surrounded by blotchy, erythematous halo

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13
Q

Strawberry hemangioma

A

most common on the face, scalp, back, or chest; ABSENT AT BIRTH

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14
Q

Neonatal acne

A

often on nose/cheeks; peaks at around 2mo; no tx

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15
Q

Nevus sebaceous; tx

A

“an area of alopecia with orange colored nodular skin”; remove before adolescence (can become malignant)

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16
Q

Seborrhetic dermatitis; tx

A

thick, yellow/white oily scale on inflammatory base; clean gently w/ mild shampoo

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17
Q

____ and ____ are two disorders screening in every state.

A

phenylketonuria; galactosemia

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18
Q

Phenylketonuria

A

def phe hydrolxalase; sxs- MR, athetosis, seizures, vomiting, dev delay over 1st few months

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19
Q

Phenylketonuria signs; tx

A

fair hair/eyes/skin, musty smell; low phe diet

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20
Q

Galactosemia

A

def G1P-uridyltransferase–G1P accum to damage kidney/liver/brain

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21
Q

Galactosemia sxs; tx

A

MR direct hyperbili & jaundice, ↓glc, cataracts, seizures; predisposed to E. coli sepsis; tx-no lactose

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22
Q

Ddx Yellow Baby (4)

A

Jaundice = phys, breast feeding, breast milk, pathologic

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23
Q

3 days old, bili @ 10, direct is 0.5. Eating & pooping well

A

Phys jaundice–gone by 5th DOL; b/c liver conjugation not yet mature

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24
Q

7 days old, bili @ 12, direct is 0.5. dry mucous membranes, not gaining weight

A

Breast feeding Jaundice–↓feeding = dehydration = retain meconium & re-absorb deconjugated bili

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25
Q

14 days old, bili @ 12, direct is 0.5. Baby regained birth weight, otherwise healthy

A

Breast milk Jaundice–Breast milk has glucuronidase and de-conj bili

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26
Q

Pathologic Jaundice –on 1st DOL, bili >___, d-bili >____, rate of rise >____ EX: 1 day old, bili @ 14, direct is 0.5

A

> 12; >2; >5/day

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27
Q

Pathologic jaundice–next steps

A

Coombs test; if (+) – Rh/ABO incompatibility; if (-) –twin/twin or mom/fetus transfusion, spherocytosis, G6PDH def, etc.

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28
Q

7 days old. Dark urine, pale stool. Bili @ 12, dbili is 8. LFTs also elevated

A

Biliary atresia – Bile ducts cannot drain bile; causes liver failure. Need surgery!!

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29
Q

Ddx hyperbilirubinemia

A

ALWAYS R/O SEPSIS!!!, biliary atresia, galactosemia, hypothyroid, choledochal cyst, CF

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30
Q

Inherited causes of indirect hyperbili (2)

A

(1) Gilbert– ↓glucoronyl transferase level; (2) Crigler-Najjar – (type1) total deficiency

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31
Q

Inherited causes of direct hyperbili (2)

A

Dubin Johnson = black liver; Rotor = No black liver

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32
Q

Indirect bili can cross _____ and deposit into BG/brainstem nuclei and cause _____ (esp if bili >20)

A

BBB; kernicterus

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33
Q

Kernicterus tx

A

1st = Phototherapy–ionizes the uncoj bili so it can be excreted; 2nd = Double volume exchange transfusion if that doesn’t work

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34
Q

Baby born w/ respiratory distress, scaphoid abdomen & bowel in thoracic cavity– MC? Can’t miss?

A

Diaphragmatic hernia; pulmonary hypoplasia

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35
Q

Pulm hypoplasia tx

A

if dx prenatally, plan delivery at @ place w/ ECMO–Let lungs mature 3-4 days then do surg

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36
Q

Baby is born w/ respiratory distress w/ excess drooling. MCC?

A

TE-fistula

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37
Q

TE-fistula diag test; other clinical signs to look for?

A

test–place feeding tube, take xray, see it coiled in thorax; VACTER

38
Q

1 week old baby becomes cyanotic when feeding but pinks up when crying. dx?

A

choanal atresia [congenital, back of the nasal passage (choana) is blocked by abnormal bony or soft tissue due to failed recanalization]

39
Q

Choanal atresia–what else to look for?

A

CHARGE [coloboma, heart defects, retarded growth, GU, ear anomalies, deafness]

40
Q

32 wk premie has dyspnea, RR of 80 w/ nasal flaring

A

RDS

41
Q

Respiratory distress syndrome–prenatal dx; tx

A

L/S

42
Q

38 wk LGA infant born by C/S to an A2GDM has dyspnea/grunting

A

transient tachypnea of newborn (TTN)

43
Q

Transient tachypnea of newborn (TTN)–pathophys; tx

A

lung fluid not squeezed out; minimal O2 needed and self-resolves in hrs-days

44
Q

41 wk AGA infant was born
after ROM yielded greenish-
brown fluid

A

Meconium aspiration syndrome

45
Q

Meconium aspiration syndrome–next steps; complications

A

intubate/suction BEFORE stimulation; pulmonary artery HTN, pneumonitis

46
Q

Gastroschisis: will see high maternal ___ in preg; [is/is not] associated w/ other disorders

A

AFP; IS NOT

47
Q

Gastroischisis: complications

A

atretic or necrotic [req removal], short gut syndrome

48
Q

Omphalocele [w/ sac] associated w/ ____ and ____ birth defects; also w/ Beckwith Wiedemann

A

Edwards; Patau

49
Q

Beckwith Wiedemann Syndrome clinical

A

big baby w/ big tongue, ↓glc, ear pits, omphalocele; [inc risk childhood cancer]

50
Q

Umbilical hernia assoc w/ ______; tx

A

congenital hypothyroidism (also big tongue); NONE unless there past age 2-3yo

51
Q

4wk old infant w/ non- bileous vomiting and palpable “olive”

A

pyloric stenosis

52
Q

Pyloric stenosis–metabolic complications; tx

A

hypochloremic met alkalosis; immediate surg

53
Q

2wk old infant w/ bileous vomiting. The pregnancy was complicated by polyhydramnios

A

Intestinal atresia or Annular pancreas

54
Q

Intestinal atresia [duodenal esp] and Annular pancreas assoc w/ ____

A

Down syndrome

55
Q

1 wk old baby w/ bileous vomiting, draws up his legs, has abd distension

A

Malrotation and volvulus; Ladd’s bands [cecum to abd wall] can also kink the duodenum

56
Q

MC pathophys malrotation

A

no rotating 270˚ ccw around SMA

57
Q

3 day old newborn has still not passed meconium (name 2)

A

(1) Hirschprung’s (2) Meconium ileus

58
Q

Meconium ileus–dx, tx

A

[consider CF if +FH] gastrograffin enema is dx & tx

59
Q

Hirschprung’s–dx

A

DRE–>exposion of poo; bx showing no ganglia is gold standard

60
Q

5 day old former 33 weeker develops bloody diarrhea

A

Necrotizing enterocolitis

61
Q

Necrotizing enterocolitis–RF; tx

A

Premature gut, introduction of feeds, formula; NPO, TPN (if nec), antibiotics and resection of necrotic bowel

62
Q

On xray, necrotizing enterocolitis shows _____.

A

pneumocystis intestinalis (air in wall)

63
Q

2mo old baby has colicky abd pain and current jelly stool w/ a sausage shapend mass in the RUQ

A

Intussusception

64
Q

Intussusception–dx, tx

A

barium enema is dx/tx

65
Q

Newborn male with no palpable testes; what is this associated with?

A

cryptorchidism; assoc w/ prune belly syndrome

66
Q

Cryptorchidism–MC location of testes; dx; tx

A

inguinal canal; US if not palpable; sx if not descended by 1yo [avoid sterility/cancer]

67
Q

Newborn male with urethral opening on the ventral surface; what do you NOT DO?

A

hypospadias; circumcise (foreskin used in repair)

68
Q

Newborn w/ ambiguous genitalia and 1mo later has vomiting, dec Na and inc K acidosis

A

Congenital adrenal hyperplasia

69
Q

Congenital adrenal hyperplasia–MCC; dx; tx

A

21 Hydroxylase def (auto recessive); 17-OH progesterone before ACTH bolus; hydrocortisone + fludrocortisone

70
Q

IDM–tx of moms w/ preexisting diabetes (esp type 1)

A

Control glc in the 1st trimester & take 4mg folate/day

71
Q

IDM–moms w/ preexisting diabetes (esp type 1) fetal complications (5)

A

Placental insufficiency/IUGR, Congenital heart dz, NTD, Caudal regression syndrome, Small left colon syndrome

72
Q

IDM–moms w/ gestational DM–complications of large gest. age

A

inc risk birth trauma (clavicle, Erbs), c/s and transient tachypnea of newborn (TTN)

73
Q

IDM–moms w/ gestational DM–hypoglycemic baby complications/tx

A

neonatal seizure; feed frequently if glc

74
Q

IDM–moms w/ gestational DM–hypocalcemic baby complications

A

neonatal seizure

75
Q

IDM–moms w/ gestational DM–reason for polycythemic baby

A

big babies need more O2 and hypoxia inc EPO

76
Q

IDM–moms w/ gestational DM–polycythemic baby complications

A

renal/splenic vein thrombosis

77
Q

IDM–moms w/ gestational DM–reason for jaundice baby

A

more RBCs to break down (risk for kernicterus)

78
Q

IDM–moms w/ gestational DM–reason for respiratory distress syndrome

A

inc insulin interferes w/ cortisol surge prior to birth that normally stimulates lung maturation [CHECK L/S ratio >2]

79
Q

Neonatal fever work-up for baby

A

fever >100.4 = sepsis until proven otherwise; urine, blood, CSF, CXR

80
Q

Gestational RF neonatal sepsis (6)

A

Prematurity, chorioamnionitis, intrapartum fever, maternal leukocytosis,
prolonged rupture of membranes (>18hrs), GBS+ mom

81
Q

Neonatal sepsis–MC bugs

A

Group B Strep, E. Coli, Lysteria monocytogenes

82
Q

Neonatal sepsis–empiric tx

A

Amp + gent until 48hr cx are negative; Cefotaxime + Amp if meningitis suspected

83
Q

Maculopapular rash on palms and soles, snuffles, periostitis–diagnosis, tx

A

Syphilis; PCN

84
Q

Hydrocephalus, intracranial calcifications and chorioretinitis–diagnosis, tx

A

toxoplasmosis; sulfadiazine + leucovorin

85
Q

Cataracts, deafness and heart defects (esp PDA, VSD), extramedullary hematopoeisis–diagnosis, tx

A

Rubella; no tx

86
Q

Microcephaly, periventricular calcifications, deafness, thrombocytopenia and petechiae–diagnosis, tx

A

CMV; ganciclovir, but won’t prevent MR

87
Q

Limb hypoplasia, cutaneous scars, cataracts, chorioretinits, cortical atrophy–diagnosis, tx

A

Cong Varicella if mom infected 1st or 2nd trimester; If mom exposed 5 days before – 2 days after delivery, baby gets VZIG

88
Q

DOL 1-3, red conjunctiva and tearing–diagnosis

A

chemical conjunctivitis caused by silver nitrate drops; not common b/c we use erythromycin

89
Q

DOL 3-5, bilateral purulent conjunctivitis can cause corneal ulceration–diagnosis, tx

A

Gonococcal conjunctivitis; topical erythromycin + IV 3rd gen ceph

90
Q

DOL 7-14, red conjunctiva w/ mucoid discharge & lid swelling–diagnosis, tx

A

Chlamydia conjunctivitis; oral erythromycin

91
Q

Chlamydia conjunctivitis complication

A

chlamydial pneumonia [cough, nasal drainage, scattered crackles + bilat infiltrates on CXR]

Pediatric Clerkship (5 decks)

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