Pediatrics Flashcards
At birth give…
0.5% erythromycin ophthalmic ointment
M1mg vit k IM
At discharge give…
If Mom is HbSAg neg(“•> hep b vaccine
Mom is hbsag pos—> HepB IVIG AND vaccine
Hearing test for
- PKU
- galactosemia
- hypothyroidism
Abnormalities in the newborn
Hemangioma Erythema toxicum Port wine stain Mongolian spots Preauricular tags Coloboma Aniridia Branchial cleft cyst Thyroglossal duct cyst Omphalocele Gastrocjisis Umbilical.hernia Hydrocepe Uneescended testes Hypospadoas Epispadias Inguinal hernia
Mongolian spots
- rule out child abuse but usually fade
Erythema toxicum
- self limiting
Port wine stain ( nevus flammeus)
Dx sturge Weber- MR, glaucoma, seizures ( anti convulsants)
Hemangioma
- tx with steroids
- grow then involute by age 5-9
Preauricular tags
Asscd with hearing loss and GU abnormalities ( do u/s kidneys)
Coboloma
Asscd with CHARGE syndrome
Aniridia
Asscd with wilms tumor ( abd u/s q3 until 8
Branchial cyst
Asscd with infxn
Thyroglossal cyst
Asscd with thyroid ectopia and infection
Omphalocele
Asscd with chromosomes abnormalities- screen for trisomy 21,18,13
Gastrochisis
Asscd with intestinal atresia
Umbilical hernia
Asscd with congenital hypothyroidism
Hydrocele
Asscd with umbilical hernia
Undesxended testes
Asscd with malignancy >.1 year
Infant of Diabetic mothers
Lab abnormalities
Asscd with
Hypocalcemia Hypoglycemia Hypomagnesemua Hyperbilirubinemia Polycythemia
Cardiac defects(asd,VSD, transposition) Small left colon
Respiratory disease
What to order on ccs
Best initial test
Best initial treatment
Abg CBC Glucose BCx Cranial u/s
Best initial test CXR
Best initial treatment
Oxygen SaO2> 95%
NasAl ap
Empiric ABx
If oxy does not improve—> cardiac
Neonatal RDS
Best initial test CXR
Best predictive test lecithin/sphingomyelin ratio
Best initial treatment oxy and nasal cpap most effective therapy exogenous surfactant (Lucinactant)
Antenatal betamethAsone
Tocolytics to prevent premature
Possible complications:
Retinopathy of prematurity
Bronchopulmonary dysplasia
Intraventricular hemmorrhage
Meconium aspiration
Tx
Prevention
Possible complications
PPV ( positive pressure ventilation)
High frequency ventilation
Nitric oxide therapy
ECMO
Ppx: endorrqcheal intubation And airway suction
Complications:
- pulmonary artery hypertension
- Ptx
- Pmeumomediastonum
- Aspiration pneumonitis
Meconium plugs and meconium ileus
Plugs: CF Hirschprungs Maternal drug use Small left colon
Ileus:
CF
Duodenal atresia
Presents with vomiting gastric and bilious material
PolyhydrAmnios
Rx with ng tube decompression and surgery
Double bubble diff Dx
Duodenal atresia
Annular pancreas
Malrotation
Volvulus
Failure to pass meconium
Best initial test: rectal exam
Next step in the work up: barium enema
Best confirmatory test: rectal biopsy
If jaundice in the first 24 hours of life ( pathological )…
Dx tests
- total and direct bill
- blood type in infant and Mom
- Coombs test
- CBC, retic ct, and blood smear
- UA and urine Cx
Prolonged jaundice ( more than 2 weeks and indirect bilirubin
Hemolysis
G6PD, elliptocytosis, spherocytosis, PKD
UTI or other infection
Gilbert’s Or Crigler Najjar
Prolonged jaundice (more than 2 weeks and elevation of direct bili… consider cholestatsis
Initial test
Most specific
LFT
U/S And liver biopsy
Kernicterus Tx
Exchange transfusion!!!
Neonatal sepsis workup
1) CBC with diff
2) ua and ur cx
3) CXR
4) bcx
Early onset sepsis cAused by
Late onset sepsis cAused by…
Tx
Pneumonia
Meningitis and bacteremia.
Empiric treatment with ampicillin and gentamicin
If meningitis is possible—> cefotaxime
TORCH
T : toxoplasmosis Choriotetinitis Intracranial calcification Hydrocephalus Dx with ItM against toxoplasmosis
O: other : syphillis Desquamating skin rash Snuffles Osteochondritos And periostitis Best initial: vdrl Most specific IgN- fta-abs
Varicella Pneumonia Limb hypoplasia Cutaneous scars Seizures Mr best initial test IgM serology Most specific: pcr of amniotic fluid
R: rubella Blueberry muffin spots Deafness, cataracts, And heart defects Dx with maternal rubella immune status negative or unknown Or IgM against rubella
C: cmv
Microcephaly with peri ventricular calcification
Petecyia with thrombocytopenia
Sensinoneural hearing loss
Dx urine or saliva cmv Cx
Serum cmv IgM Ab
H: herpes
First week : pneumonia/shock
Second week: skin vesicles Keratoconjumctivis
Third to fourth week: acute meningoencephalitis
Dx
Best initial: tzanck smear
Most specific: hsv pcr
Seizure workup in neonate
EEG
CBC and electrolytes, calcium, magnesium, glucose
Amino acid assay and urine organic acids
BCx And UrCx
Total cord blood IgM
Lp
Head u/s
Substance abuse and withdrawal
Tx
Opioids and phenobarbital
Teratogens
Andsthetics Barbiturates Magnesium sulfate Phenobarbital Sulfonamides NSAIDs Ace I Isotretinoin Phenytoin Des Tetracycline Lithium Warfarin Valproate/carbamazepine
Respiratory and cns depression Respiratory and cns depression Respiratory depression Vit k deficiency Displaces bilirubin from albumin Premature closure of DA Craniofacial abnormalities, CHD HypoplAstic nails, iugr, typical facies - caginal adenocarcinoma - enamel hypoplasia, teeth discoloration - ebstein anomaly - facial dysmormhophksm, chondrodysppasia - MR, NTD
Beckwith-Wiedemann syndrome
Igf2 disruption at 11p15.5
Multiorgan enlargement
Increased risk of abd tumors so you need U/S And AFP every 6 months to 6 years
Pierre robin
Asscd with fetal alcohol syndrome and Edwards
Mandibulsr hypoplasia
Cleft lip
Monitor airway!!!
CI to breastfeeding
Galactosemia Hiv Hsv if lesions Are present Acute maternal disease Maternal cancer receiving treatment Substance abuse
