Peds Final Flashcards
Define APGAR
When/why would these be repeated
Why is this done at two different time intervals
Appearance:
0- cyanotic 1- Acrocyanosis/blue extremity 2- all pink
Pulse:
0- none 1- <100bpm 2- >100bpm
Grimace w/ nare suction:
0- none 1- grimace/cry 2- sneeze/cough/withdraw
Activity:
0- limp/none 1- some flexion 2- active
Respiration:
0- none 1- weak/slow/irregular 2- strong cry
Rpt q5min if score <8 (max of 10)
1min: tolerance of birth
5min: tolerance to life
Newborn respiratory rate
Newborn HR
What are the next steps taken for abnormal HR ranges
30-60/min w/ inc number if premature
120-160
> 100: routine care
60-99: ventilation support
<60: ventilation w/ compressions
What is the compression/ventilation ratio during NRP
How do premature/neonates respond to hypoxia
What is the positioning and rate of ventilations when using BVM
3 compression : 1 respiration
Two thumbs > two fingers
Apnea rather than tachypnea
Sniffing position (neck w/ slight extension), 40-60 bpm
What is the next step if infant’s chest fails to rise w/ BMV
When is this next step preferred
What fluids are used during NRP
Intubation
Transport
10mL/kg NS for hypo-volemia/tension
What is the next step for asystole/bradycardia unresponsive to O2
Rules for Narcan usage in newborns
? care is routine for all infants and w/ ? goal
IV Epinephrine
Only if opiates used during labor
Not if maternal addict or methadone use d/t withdrawal seizures
Nursing- prevent illness/complications w/ high level of morbidity/mortality
What are the two categories of standard nursery care and what is done during each
Which test is state mandated
A) Shortly after:
Erythromycin ointment- G/C conjunctivitis
Vit K injection- Hemorrhagic Dz of Newborn
HBV- only vaccine given at birth
B) 24hr Routine Care: Bilirubin screen Congenital heart screening Gene/Metabolic screen (AKA- newborn screen) Hearing
Genetic/Metabolic:
CF CAH PKU Sickle TSH
Congenital heart dz screening is done at 24hrs of life/before d/c and is interpreted how
Spo2 95% or higher w/ 3% or less difference between right hand/foot= negative screening, plan for d/c
SpO2 90-94% in right hand/foot or 3% difference= repeat in one hour; same results- repeat again in one hour; 3 readings in same range= echo
SpO2 <90% in right hand/foot= +screen- order Echo
Infant length is done in ? position until ? time frame and when are inaccurate measurements most likely to occur
Criteria for Low/Very Low birth weights
What are the RFs for LBW
Laying down until 2yrs old;
First week d/t positioning
Low: <2500gm; Very: <1500gm
Previous LBW baby Age <16, >35 Socioeconomic status Tobacco/ETOH/Drugs Poor weight gain during pregnancy Education No antenatal care
During newborn exam, an anterior fontanelle bigger than ? size suggests ? issue
An absence and totally closed suggests ?Dx
Define Caput Seccedaneum
Anterior suture >5cm- hypothyroid
Craniosynostosis
Boggy, edematous swelling crossing lines, self resolves
Define Cephalohematoma
? head malformation is associated w/ vacuum deliveries and how is it Tx
Define Hydrocephalus and the two types
Leads to RBC breakdown/jaundice causing swelling w/out crossing suture lines
Subgleal hemorrhage- swelling crosses suture lines, pushes ears anteriorly;
Tx: Compression w/ resuscitation PRN
Inc CSF volume;
Communicates w/ subarachnoid/Obstructed
How does Hydrocephalus present
How is this Tx
What can cause an abnormal red reflex on newborn eye exam
Bulging fontanelles
Macrocephaly
Setting sun gaze
Ventriculoperitoneal shunt
Leukocoria: cataract, tumor, retinopathy of prematurity
What optic abnormality can be normal on a newborn exam until 4mon old
What considered normal/abnormal ear positioning
Define Epstein Pearls and Bohn Nodules
Disconjugate gaze d/t failure of eyes to move in same direction
1/3 above canthus/occipital protuberance
20* from anterior of lobe to superior helix
EP: Keratin cysts on gums/palate
BN: Keratin cysts on salivary tissues
When conducting new born exams, how do neck bulge locations hint at Dx
How are lower extremity pulses assessed during newborn exam
? abdomen shape suggests diaphragmatic hernia
Anterior midline: thyroid d/o
Anterior to SCM: brachial cleft cyst
Posterior to SCM: cystic hygroma
Brachial and femoral together:
Pulse pressure >40mm= r/o PDA
LE < UE pulse= r/o coarctation
Scaphoid
What do each of the following suggest for cardiac d/o/dz
Weak pulse
Bounding pulse
Single second sound
Holosystolic, continuous, harsh
Grade 3/>
Diastolic murmur
Hempatomegaly
Weak: poor CO/AS
Bounding: high CO, PDA
Second sound: cyanotic dz- truncus/hypoplastic heart
Holosystolic, continuous, harsh- pathologic
Grade 3/>: pathologic
Diastolic: pathologic
Hempatomegaly: left sided HF
? umbilical finding suggests need for detailed exam
Umbilical cord stump remaining longer than ? needs further work up
? DDxs need to be r/o if red granuloma/stump remnants remain
Two vessels: 1 artery, 1 vein instead of normal 2A/1V but no referral needed
1mon
Umbilical polp: sticky surface
Patent Urachas: urinary d/c
Meckels: proximal end of vitelline duct
Vitelline duct: odorous d/c
Since all infants are born w/ limited laxity, what are the three concerns if this persists
RFs for Congenital Hip Dysplasia
L > R w/ risk for changes including:
Flat acetabulum
Muscle contraction limiting ROM
Capsule tightening
Female First FamHx
Oligohydramnios
Breech
Swaddling- hips adduct/extended
Define Barlow Maneuver
Define Ortolani Maneuver
If ‘clunk’ is heard, ? is the next step
Hipp adduction, forward pressure w/ thumb- can cause femoral head to slip over posterior rim of acetabulum
Flex hips to 90*, abduct hip w/ anterior push/lift of trochanter; resets joints
Hip US at 4-6wks to avoid confusion w/ normal laxity
Congenital Hip Dysplasia referred to Peds Ortho will be placed in ? device for ? age groups
? is the MC foot d/o in infants and what are they at risk for developing ? later in life
How is this MC Dx
Pavlik harness- up to 6mon old
Metatarsus adductus- medial deviation of mid and forefoot;
Developmental hip dysplasia
Mid-heel bisector- line between toes 2-3
V-finger- no gap at base of 5th MT (styloid)
How are Metatarsus Adductus cases Tx
Define Talipes Equinovarus
What part of the leg is MC affected and what does this cause
Self-resolve, if not w/in 2yrs= Ortho referral
Clubfoot- entire leg involved d/t hypoplastic tarsals and limb muscles
Talus, causes foot shortening/calf atrophy
All cases of Clubfoot need to have ? DDx assessed for
What is a common abnormal seen on fe/male GU exam of a newborn
Define Spina Bifida
Hip dysplasia
Retractile testes, Hypertrophy labias
AKA Cleft Spine: Lumbosacral hair tuft concerning for spinal cord defects
When/How is Spina Bifida normally identified during pregnancy
Define Rachischisis and ? risk needs to be r/o
What are the categories of Spina Bifida
2nd-Trimester quad screen- maternal A-fetoprotein and fetal US
Spina Bifida Occulta- hair tuft/minor defect w/out neuro S/Sxs;
r/o connecting sinus d/t inc risk for meningitis
Meningocele- meninges herniates through neural arch
Meningomyelocele- meninges and cord herniate through neural arch
Myeloschisis- open skin w/ cord exposed
What are the primitive reflexes tested for on newborn exam
What do these reflexes evaluate
When do these normally disappear
Suck Moro Grasp
Brain stem, Basal ganglia
4-6mon d/t increased cerebral inhibition of cerebral influences
Only reflex not present at birth and never disappears
What reflexes disappear at 3, 4, 6 or 12mon
Facial palsy in newborn is associated w/ ?
Parachute- appears at 8-10mon; suspended face down, move towards table causes arm extension for protection
3: Asymmetric tonic neck
4: Rooting Placing Gallant
6: Moro Grasp
12: Babinski
Forcep delivery
Define the MC brachial plexus lesion
What reflex is present/absent in this MC
Define Klumpke Palsy and what reflexes are present/absent
Erb-Duchenne/Waiter’s Tip- C5/6/phrenic nerve lesion d/t shoulder dystocia
+ grasp, - bicep
C8-T1 lesion;
- grasp +bicep w/ claw hand
What syndrome is associated w/ Klumpke Palsy if a cervical sympathetic nerve root was injured
Define Vernix Caseosa
When is term infant desquamation typically seen
Ipsilateral Horner’s Syndrome
Chalky white mixture of shed epithelials cells, sebum, keratin and hair; common in preterms for suspected fetal protection
24-48hrs of life
Define Milia
Define Milia Rubra
Define Cutis Marmorata
Smooth, white papules on face/scalp d/t trapped keratin; self limited/resolves 1-4wks
Heat rash d/t overheated/febrile infant w/ erythematous papules; Tx/correct overheating
Mottling- cold response; persistent suggests hypothyroidism/vascular malformation
Define Slate Gray Nevi
Define Cafe Au Lait macules and when are further work ups indicated
Nevus Simplexes are AKA ?
Transient dark macule on lower back/buttocks that fade w/ time
Sharply defined, pigmented macules;
6 or more/ 5cm or bigger to r/o NF-1, TB, McCune Albright Syndrome
Salmon patches
Stork bite- nape of neck
Angel kiss- forehead/eyelids
Define Nevus Flameus
? syndrome needs to be r/o depending on location
Define Erythema Toxicum Neonatorum
Port Wine Stain; d/t capillary bed malformation
Sturge Weber Syndrome if trigeminal nerve distribution
Pustules w/ erythematous base on trunk appearing 1-2 days after birth, resolves in 14days
What would be seen on microscopy slide of Erythema Toxicum Neonatorum
RFs for neonatal sepsis
Primitive reflexes are usually gone by ? age
Eosinophils
Prematurity GBS Fetal tachy Amnionitis Maternal fever PROM
4-6mon
Neonatal sepsis etiologies w/ early onsets
Neonatal sepsis etiologies w/ late onsets
Mycoplasma GBS- MC/#1 Klebsiella Listeria E coli Salmonella
Hflu Neisseria CMV HSV Enterovirus
Strep Staph
Early onset neonatal sepsis begins on ? day and presents w/ ?
Late onset neonatal sepsis begins on ? day and is more likely associated w/ ?
Fast onset of F/C/HOTN, hypotonia, respiratory distress
Insidious onset on day 8-28: Bulging fontanelle Direct hyperbilirubinemia Seizure Lethargy Fever Poor feeding/tone
What orders are needed for a neonatal sepsis work up
How are these Pts Tx
What two meds may be added after further eval/based on etiology
Glucose CXR CBC LP UA w/ culture Blood culture x 2
Draw labs, IV fluid, nutrition and:
IV Ampicillin w/ Genamicin
>3wks old: IV Ampicililn w/ Cefotaxime
Vancomycin: late onset/meningitis
Acyclovir- HSV infection
Three steps for newborn of GBS positive mother
1: infant have S/Sxs?
Yes: eval w/ empiric Tx
No: step 2
2: infant <35wks EGS?
yes; limited eval w/ 48hr observation
no: step 3
3: Two maternal ABX doses prior to delivery?
Yes: no eval/therapy, observe x48hrs
No: limited eval w/ 48hr observation
? PE finding is a sign of neonatal respiratory distress
What are 3 possible Dxs that can cause this PE finding
Respiratory Distress Syndrome is AKA ? and caused by ?
Grunting (can sound like meowing)
Dec functional residual capacity:
Pneumonia
Pulmonary edema
Peripheral airway obstruction
Hyaline Membrane Dz: dec surfactant from Type 2 pneumatocytes in <34wks EGA
RDS results in ? and looks like ? on CXR
How is RDS Tx prior to birth
How is RDS Tx after birth
End expiration atelectasis; Ground glass
Maternal steroids 32-34wks EGA
Intubation w/ surfactant/support via ET tube
What complications can arise from RDS
PDA: day 2-4 w/ L-R shunt (systemic to pulm) as pulmonary edema/hepatomegaly;
Tx: Fluid restriction w/ diuretic/NSAIDs
PTX- Sxs get chest tube
Bronchopulmonary dysplasia- caused by O2 toxicity/barotrauma
Retinopathy of prematurity- O2 toxicity vasoconstricts developing vessels= obliteration/blindness (term infant eyes fully vascularized- no risk)
What are the 3 RFs for Bronchopulmonary Dysplasia after RDS
Criteria for Apnea of Prematurity
What are the two types and causes
O2 dependence at 36wks old
RDS persists >14days
Prolong mechanical ventilation
10-20sec w/out pulmonary airflow
Central: medulla/pons don’t stimulate phrenic nerve (common in prematures)
Obstructive: malformation/positional
Apnea of Prematurity is traditionally ? type
How are Pts managed/Tx
? is the MC congenital tracheal abnormality
Central w/ peripheral component
O2, Stimulants: caffeine/theophylline
Tracheomalacia- floppy trachea worse during expiration (harsh, monophonic wheeze/normal voice/inspiration)
Four possible outcomes from Meconium Aspiration Syndrome
How are non-vigorous babies w/ aspiration managed
How does aspiration appear on CXRs
Respiratory distress
Pneumo-nia/nitis/thorax
Suction mouth/trachia
Unsuccessful: BVM w/ PPV
Coarse, irregular infiltrates predisposes Pt to pneumonia/Ptx
