Peds 3 Flashcards
MOA of Phenobarbital in treating jaundice
Phenobarbital induces UGT, thus increasing conjugation of bili
Most common cause of baby born with poor feeding, tachypnea, hypothermia, and poor perfusion
Group B Strep pneumonia
How do you prevent GBS infection in a newborn
Screen mothers at 35 weeks gestation, and give IV Penicillin during labor to those with high risk or positive GBS
Most common organisms of early-onset neonatal sepsis (within 6 days of life)
GBS (#1) , E. Coli, H. flu, Listeria monocytogenes
Tx of early onset neonatal sepsis
Abx directed at most common pathogens - usually combo of IV aminoglycosides and Penicillin
Tx of late onset neonatal sepsis (7-90 days of life)
Beta-lactamase resistant abx (such as vancomycin) and often 3rd generation cephalosporin
What is greatest risk factor for neonatal sepsis
Prematurity (#1)
Additional risk factors include low birth weight, rupture of membranes >18 hrs before deliver, young maternal age, initial apgar <5
Describe congenital adrenal hyperplasia
Disorder of adrenal steroid production with an enzymatic deficiency (most common 21-hydroxylase)
Causes inadequate production of cortisol (causing increase in ACTH), and excessive production of androgens (due to increased ACTH, leading to virilization)
Describe difference in presentation of 21 a-hydroxylase deficiency and 11 b-hydroxylase deficiency
Both have decreased cortisol, causing increased ACTH, and increased androgens
21 = has decreased mineralocorticoids (decreased BP and hyperkalemia)
11 = has increased intermediated mineralocorticoid (increased BP)
o If there is a 1 in the first digit of deficient enzyme (11 or 17) – will be HTN
o If there is a 1 in the second digit of deficient enzyme (11 or 21) – will be masculinization
Definition of hermaphroditism
Discrepancy between gonad morphology and external genitalia
Describe 5 alpha-reductase deficiency
Phenotypically normal female with functioning testicular tissue and short, blind-end vagina
Due to inability of 5 a-reductase to convert testosterone to DHT, which is needed for development of male external structures
Describe true hermaphroditism vs. pseudohermaphroditism (female and male)
True = both male and female internal genitalia (testes and ovaries)
Pseudo female = 46, XX with internal female and external male (usually caused by CAH)
Pseudo male = 46, XY with internal male and external female (e.g. 5 a-reductase deficiency)
What serum level should you check for in a baby with suspected CAH
Increased 17-hydroxyprogesterone
What is the classic disease associated with female with primary amenorrhea
5 alpha-reductase deficiency (46, XY with female phenotype)
Decreased androgen binding or androgen insensitivity
Describe difference in obstruction in meconium ileus vs. Hirschsprung disease
Meconium ileus = Seen in CF. Leads to obstruction of the ileum and a narrow, underdeveloped colon (microcolon)
Hirschsprung = Level of obstruction usually at the rectosigmoid junction, with proximal dilated colon
What are the 5 T’s that cause R-to-L shunt (early cyanosis
o Truncus arteriosus (1 vessel) o Transposition (2 switched vessels) o Tricuspid atresia (3 = tri) o Tetralogy of Fallot (4 = tetra) o TAPVR (5 letters in the name)
Describe transposition of the great vessels
- LV enters into the pulmonary trunk
- RV enters into the aorta
- Not compatible with life unless a shunt is present to allow mixing of blood (e.g. VSD, PDA, or PFO)
Describe Tetralogy of Fallot
- (a) Pulmonary valve stenosis
- (b) RV hypertrophy
- (c) VSD
- (d) Overriding aorta (sitting over VSD)
Describe tricuspid atresia
• Absence of tricuspid valve and hypoplastic RV
• Requires 2 shunts:
o ASD to get blood from RA to LA
o VSD to get blood from LV to RV so it can go to the lungs
Describe Truncus arteriosus
• Failure of truncus arteriosus to divide into pulmonary trunk and aorta
Describe total anamalous pulmonary venous return with obstruction
- Pulmonary veins drain into R heart circulation (e.g. SVC, coronary sinus, RA)
- Associated with ASD and sometimes PDA to allow for R-to-L shunting
What disorders often present with hemarthrosis (bleeding into joint spaces)
Clotting defect (e.g. Hemophilia)
Common presentation of platelet disorders
- Easy or prolonged mucosal bleeding
- Ecchymosis
- Petechiae
Lab findings in Hemophilia
Increased PTT
