pedia Flashcards
Amniotic fluid l:s ratio
More than 2
shake test for?
how much ethanol
for lung maturity
95%ethanol +af
hyaline membrane diseases x ray findings
white out
b/l ggo
black+patent bronchus
air bronchogram sign
preterm 1st day resp distress diagnosis
hyaline membrane dis
hyaline memb dis in preterm less than ?weeks
less than 34 weeks
4 tests for Hyaline M D
1 shake test
2 amniotic fluid l:s ratio
3 nile blue sulphatase test
4 phosphatidyl glycerol level
what color what cells in nile blue sul.test
%?
orange colored fat cells
50%
resp distress preterm 1_7 days
apnea of prematurity
doc for apnea of prematurity
caffiene
resp distress in preterm baby who is on persistent oxygen support
bronchopulmonary dysplasia
bronchopulmonary dysplasia in preterm cause
> 21% oxy + >28 days
multifocal cystic luscencies in preterm lung in ?
bronchopulmonary dysplasia
term baby
resp distress
cxray-fluid in fissure/pulmonary effuson
diagnosis
TTNB
transient tachypnea of new born
TTNB xray findings
fluid in fissure
plueral effusion
post term baby
resp distress MAS cxray
1 perihilar linear opacities
2 hyperinflation(small airway obstructed)
post term baby resp distress is seen in
meconium aspiration syndrome- meconium stained liquor
resp distress in neonate with scaphoid abdomen
congenital diaphragmatic hernia
“BPL”
full form and found in
bockdeleck hernia- poterior- left
found in -congenital diaphragmatic hernia
nasogastric tube in neonate goes in thorax?
congenital diaphragmatic hernia
resp distress in baby
h/o sibling death
surfactant protein B
pulmonary alveolar proteinosis
crazy pavement appearance on hrct in neonate
h/o sibling death
pulmonary alveolar proteinosis
surfactant protien deficient in PAP
SP-B
Low birth weight baby
<2.5 kg
Very low birth weight baby
<1.5 kg
Extremely low birth weight baby
<1 kg
Small for gestational age sga
<10th percentile
Large for gestational age lga
> 90th percentile
Average for gestational age a g a
> 10th<90th percentile
Physiological weight loss of term baby recovered by how many days
10% by 10D
Physiological weight loss of Pritam baby recovered by how many days
15% by 15D
I U G R definition
<10th percentile + abN doppler indices
Causes of symmetrical i u g r
Congenital Malformation congenital infections
Causes of asymmetrical iugr
utero placental insufficiency
pOnderal index
wt(gm)/femur lt cube cm
Pondral index more than two in symmetrical or asymmetrical
Symmetrical
Pondral index less than 2 in symmetrical or asymmetrical or normal
Asymmetrical and normal
Poor prognosis in symmetrical or asymmetrical i u g r
In symmetrical
Good progresses in symmetrical or asymmetrical iugr
In asymmetrical
Head circumference decreased in symmetrical or asymmetrical iugr
In symmetrical
Heads circumference normal in symmetrical or asymmetrical i u g r
In Asymmetrical
Abdominal circumference decrease in symmetrical or asymmetrical iugr
in both
Head sparing scene in symmetrical or asymmetrical iugr
In asymmetrical
Most common cause of mortality in neonate
prematurity>birth asphyxia>sepsis >congenital anomalies
Most common cause of mortality under 5
Pneumonia >diarrhoea >injury >malaria
10 newborn benign lesions
1 Erythema toxicum 2neonatal pastular dermatosis
3 milaria 4 harley quin 5 cutis marmorata 6 mangolian spots 7 capillary
hemangioma 8 acne 9 cradle cap 10 nipple discharge also known as mastitis
neonatorum or vaginal discharge
erythema toxicum aspirate has eosinophils or neutrophils
eosinophils with erythematous base
erythema neonatorum also known as
Erythma toxicum
erythema toxicum seen in which part of body
Trunk
Neonatal pustular dermatosis has eosinophils or neutrophils
Neutrophils
Sweat duct occlusion in neonates is
Milaria
Half body colour change in neonate due to
vasospasm
Cutis marmorata due to
vasospasm
Mongolian spots commonly seen at which level
LS
Mongolians disappear by
2 years
capillary hemangioma also known as
Strawberry Hemangioma/ stork bites/ salmon patch/ naevus simplex / port wine stain/ nevus flammeus
Does capillary hemangioma resolve on its own
Yes by 2 years
Does cavernous hemangioma resolve on its own
No
Cradle cap also known as
seboric dermatitis
Seboric dermatitis in neonates resolves by
One week
Seboric dermatitis also seen in
LCH
Black Harry cerebriform appearance in
Congenital melanocytic nevi
Mastitis neonatarum due to
Maternal estrogen
Minimum apgar score
Zero
Severe asphyxia in apgar score
<3
apgar score prognostic or guide
Prognostic
Timing of apgar score
1 and 5 minutes after birthminute
Components of apgar score
1 appearance= pink/ blue extremities/ cyanosis
2 pulse =>100/<100/no pulse
3 grimace= cries and pullsaway/ gremace and weak cry/ no response
4 activity= active/ arms and legs flexed/ no movement
5 respiratory effort= strong cry/ slow irrregular /no breathing
4thcomponent of apgar score
activit=active movement/arms legs flexed/movement
R in apgar score stands for
respiratory efforts
Sepsis screen components
Leukopenia tLC<5000
Neutropenia anc<1800
Immature neutrophils to total neutrophils ratioI/T ratio>0.2
Micro ESR in first hour>15mm
CRP positive
Leukopenia inseps score is
<5000
Neutropenia in sepsis score is (anc)
<1800
sepsis score is used in
Neonatal sepsis
What sepsis score is indicator of starting antibiotics
> =2
Most common cause of neonatal sepsis
KLEBSIELLA
Most common cause of early onset sepsis in neonates
gbs= s.agalacti
Most effective measure to prevent neonatal sepsis is
handwash
Earliest clinical feature of neonatal sepsis
reduced feeding
Initial investigation for neonatal sepsis
sepsis screen
Investigation of choice for neonatalsepsis
culture
Risk factor of neonatal surface
Preterm/ r o m18hrs/ p p v
s agalacti is found in
vaginal flora
Micro ESR in neonatal sepsis
> 15mm in 1st hr
Temperature range for neonates
36.5-37.5
Hypothermia in neonates
<36.5
Cold stress in neonates
36-36.5
Moderate hypothermia in neonates
32-36
Severe hypothemia in neonates
<32
Non shivering thermogenesis seen in
babies
cold stress
Brown fat produces heat by
Non shivering thermogenesis
uncoupling
Brown fat present in(4)
nape of neck/ axilla /scapula/ adrenals
Is shivering present in cold stress in neonates
no
For components of kangaroo Mother Care
1 position
2 nutrition
3 support
4 discharge early
KMC to be continued till what age
> 35 weeks
Incubator heating by
convention
Axiliary temperature >37.5 is
hyperthermia
Pathological jaundice appears when(2)
1 <24hrs
2after 3 weeks
Most common cause of pathological jaundice appearing in less than 24 hours
abo/rh incompatibility
Pathological jaundice persisting for
> 14 days
Pathological jaundice persisting for .14 days seen in
1Hypothyroidism
2 crigler najar
3 breast milk jaundice
Crammar rule
Palms and soles involved in jaundice
Palms and souls involved in jaundice at what concentration
More than 15mg per DL
Palms and souls involved in jaundice at what concentration
More than 15mg per DL
Pathological jaundice when bilirubin increases by what in one day
5 mg per DL per day
Pathological jaundice at what bilirubin concentration
15 MG per DL
Stool play coloured urine staining yellow
In conjugated hyperbilirubinemia
Direct bilirubin in conjugated hyperbilirubinemia
More than 2 mg per DL
Most common cause of direct bilirubinemia
Extra hepatobiliary atresia EHBA
initial investigation for E H B A
USG
USG finding in Ehba
1 Small contracted gallbladder
2 Triangular chord sign
Highest negative predictive value in ehba in
hida scan
Gold standard for EHBA
Intraop cholangiogram or percutaneous cholangiogram
Iordinated contrast under fluoroscopy puncture liver insert contrast to see while radical done in
Intraop cholangiogram or percutaneous choLangiogram
Pregnandiol Present in
Causes
breast milk
Breast mikk jauncice(unconjug)
Pregnandiol is
Beta glucoronidase
Breast milk jaundice presents
Two to three weeks
Management of breast milk jaundice
Phototherapy
Stool yellow urine pale seen in
Unconjugated Breast milk jaundice
Breastfeeding jaundice due to
Dehydration
Management of breastfeeding jjaundice
Breastfeeding
UDP Glucoronye transferase Deficiency
Unconjugated Bilirubinemia
UDPGT mildly deficient in
Gilbert syndrome
Gilbert syndrome is autosomal dominant or recessive
AR>AD
Gilbert syndrome presents when
In adults due to fever or stress
Criggler Nazar Types
Type one complete absence of udp gt
Type two severely deficient udp gt
Type one criggler Nazar Presents as
Neonatal kernicterus
Criggler najar Type two managed by
Phenobarbitone
Duvin Johnson is type of
Conjugated Hyperbilirubinemia
Dubin Johnson autosomal recessive
Autosumal Recessive
Crigglar Nazar autosomal recessive or dominant
Autosomal recessive
MRP2 defect Seen in
Dubin Johnson
Black liver in Devin Johnson due to
Epinephrine metabolites
Rotor syndrome is what type of bilirubinemia
Conjugated
OATP 1B1/OATP1B2 Defects seen in
Structural isomerization converts bilirubin into what
LumiRubin
Structural isomerisation is reversible or irreversible
Irreversible
Photo isomerization does what
Turns z form into E form
Three mechanisms in photo therapy
Structural isomerisation photoisomerization photo oxidation
Distance of phototherapy lamp
30 to 40 centimetre
Wavelength in photo therapy
460-490 nanometer
Colour of light in phototherapy
Blue Green more than blue
Type of lamp In photo therapy
L E D
Irredians using flux metre
30uW/cm2/nm
Screening for pathological joints done by
TCB Transcutaneous Billy Rubinometer
Drug of choice for neonatal seizures
phenobarb
Most common type of neonatal seizure
Subtle type
Grimace
Most common cause of neonatal seizures
Hypoxic ischemic encephalopathy
Causes of neonatal seizures
Hypolycemia <45gm%electrolyte imbalance pyredoxin deficiency
Best prognosis in neonatal seizures in
Focal Clonic
Worst prognosis in neonatal seizures
myoclinic
Bedside monitor for neonatal seizures
AIE amplitude integrated eeg
Initial investigation in neonatal seizures in H I E
Transcranial usg to rule out ivh Intra ventricular haemorrhage
Ivh is more common in pre term or term
Preterm
Investigation of choice for H I E
Diffusion weighted imaging mri to pick up ischemia
para sagital injury In term or pre term infant
Term
Para sagital or watershed injury causes
Spastic quadriplegia in turn babies
Status Marmoratus Seen in pre term or term babies
Term babies
Most common type of HIE
Chorioathetoid
status marmoratus show
chorioathetoid
Germinal matrix haemorrhage Seen in pre or term babies
Preterm
Periventricular leukomakasia seen in term or pre term babies
peterm
periventricular leukomalasia cause
spastic diplagia
garnet and sarnet staging for
hie
hyperalert baBy in which sarnet stage
1
mydriasis in which sarnet stage of hie
1
Miosis in which sarnet stage of hie
2
seizures common in which sarnet stage of hie
2
tonic neck reflex is strong in which sarnet stage of hie
2
stretch reflex overactive in which sarnet stage of hie
1 and 2
GATA 2 gene involved in
pulmonary alveolor proteinosis
downe’s score components(5)
1rr
2 cyanosis
3 retraction
4 grunting
5 air entry
Silverman Anderson
1 upper chest
2 lower chest retraction
3 xiphoid
4 nares dilation
5 expiratory grunt
Sea saw upper chest in which grade of Silverman andersongrade
3
expiratory grunt in Silverman Anderson heard on stethoscope in what grade
2
silveman Anderson is 123or 012
012
downe’s is 123or 012
012
rr conssered in downe’s score is
0=<60
1=60-80
2=>80
No cyanosis with oxygen what score on downe’s score
1
air entry decreased in what score of dwne’s score
1
IV fluids for what age of gestation in baby
<28wks
Lack of gut motiliy present at what age of gestation in baby
<28wks
Lack of coordination between suck and breathing at what age of gestation in baby
28-31wk
Coordination between suck and swallow and breathe appears between what gestational age in baby
32-34 wks
Mature sucking reflects present at what age of gestation of babies
> 34wks
Palladi or spoon feeding at word gestational age of baby
32-34wks
Gavage feeding or orrogastric or nasogastric tube feeding in what gestational age of baby
28-32wks
Breastfeeding in what gestational age of baby
> 34wks
Modified bells staging for
Necrotising enterocolitis
Management of 1A stage of necrotizing enterocolitis
NPO. Antibiotics three days
Gross bloody stool at what a stage of necrotizing Enterocolitis
1B
