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peds4 Flashcards

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1
Q

bronchopulm displasia

A

chronic complication of RDS; pathologic changes that affect lung growth

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2
Q

diagnosis of bronchopulm dysplasia

A

mechanical ventilation during the first 2 weeks of life; clinical signs of respir compromise persistent beyond 28 days of life; need for supplemental oxygen beyond 28 days of life; characteristic CXR

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3
Q

prognosis for infant with RDS

A

with aggressive treatment in the NICU, >90% survive

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4
Q

persistent pulm hypertension of the newborn occurs most freq in what GA?

A

full term or post-term

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5
Q

most common causes of persistent pulm hypertension of the newborn

A

perinatal asphyxia and meconium aspiration syndrome

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6
Q

hypoxemia is a potent pulm vasoconstrictor

A

which explains why perinatal asphyxia is a cause of pulm hypertension

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7
Q

ECMO

A

extra-corporeal membrane oxygenation

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8
Q

inhaled NO

A

may be used as a potent pulm vasodilator

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9
Q

what does CXR look like in infants with meconium aspiration syndrome?

A

increased lung volume with diffuse patchy areas of atelectasis and pulm infiltrates alternating with areas of hyperinflation

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10
Q

a couple of bad consequencees of meconium aspiration syndrome?

A

pneumothorax and pneumomediastinum; also persistent pulm htn of the newborn, bacterial pneumonia, and lont term reactive airway disease

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11
Q

apnea of prematurity

A

resp pause lasting 15-20 sec OR resp pause of any duration resulting in cyanosis or ox desat as evidenced on pulse ox

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12
Q

most frequent type of apnea in the newborn

A

mixed (of central and airway obstruction), not either one on its own

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13
Q

incidence of idiopathic apenea of prematurity

A

frequency increases with decreasing gestational age; as high as 85% in infants less than 28 weeks and 25% in infants 33-34 weeks

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14
Q

management of apnea

A

respiratory stimulant medications (caffeine or theophylline), ventillation as needed, CPAP as needed

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15
Q

direct bilirubin

A

bilirubin is conjugated in the liver; most of it goes into bile and into the small intestine

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16
Q

indirect (unconjugated)bilirubin

A

this is the bilirubin as a result of hemoglobin breakdown; it has not gone to the liver yet

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17
Q

physiologic jaundice

A

often occurs during the first week of life; most freq caused by indirect (unconjugated) hyperbilirubinemia

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18
Q

visible jaundice occurs at what bilirubin level

A

5 mg/dL

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19
Q

direct hyperbilirubinemia

A

when the conjugated form is greater than 15% of the total bilirubin level; this is always pathologic in neonates

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20
Q

breastfeeding jaundice

A

causes indirect hyperbilirubinemia; occurs within the first week; related to suboptimal milk intake; decreased stooling leads to decreased passage of bilirubin in the stool; note that breastfeeding is associated with higher peak bilirubin levels than formula feeding

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21
Q

breast milk jaundice

A

causes indirect hyperbilirbinemia; typically occurs after the first week; likely related to breast milk’s high levels of beta-glucuronidase and high lipase

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22
Q

when should jaundice be evaluated

A

when it appears in a baby less than 24 hours after birth; when bilirubin rises more than 5-8 mg/dL in a 24 hour period; the rate of rise of bilirubin exceeds 0.5 mg/dL per hour (suggestive of hemolysis)

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23
Q

exchange transfusion

A

performed for rapidly rising bilirubin levels secondary to hemolytic disease

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24
Q

when indirect bilirubin gets so high that it passes through the BBB, where dies it most freq localize? Note that it is Indirect that gets into the brain

A

basal gang, hippocampus, and brainstem nuclei

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25
clinical features of bilirubin getting into your brain
choreoathetoid cerebral palsy, hearing loss, opisthotonus, seizures, and oculomtor paralysis
26
most common signs in infants with drug abusing mothers
jitteriness and hyperreflexia, with irritability, tremulousness, feeding intolerance, and excessive wakefulness
27
what is the most common type of esophageal atresia?
atresia of the esopagus (proximal pouch) with a distal tracheoesophageal fistula
28
associated malformations are found in what percent of infants with esoph atresia
50%
29
most cases of diaphragmatic hernias involve which side of the diaphragm?
the left
30
scaphoid abdomen
abdominal contents in the abdomen; sign of diaphragmatic hernia
31
omphalocele
abdominal organs covered with a peritoneal sac herniate centrally through the umbilical ring area; there is an increased risk of other congenital anomalies
32
gastroschesis
fissure of the anterior abdominal wall (usually right side) ; there is no peritoneal sac covering the bowel is the only viscera that herniates; no increased risk of other congenital anomalies
33
what is the most common type of intestinal obstruction?
intestinal atresia
34
volvulus
loops of intestine twist, can lead to restricted circulation and gangrene;
35
hirschrpung disease- more common in males or females?
males
36
diagnosis of hirschsprung disease
rectal biopsy showing absence of ganglion cells
37
management of hirschsprung
resection of the affected segment
38
NEC clinical features
abdominal distension and tenderness; residual gastric contents, billous aspirate, bloody stools, abdominal erythema
39
NEC may lead to what?
thrombocytopenai, DIC, and death
40
classic radiograph findings in NEC
abdominal distension, air-fluid levels, thickened bowel walls, pneumatosis intestinalis (air in the bowel wall) and venous portal gas
41
pneumoperitoneum
suggestive of NEC that perforated
42
definition of hypoglycemia
serum glucose less than 40 mg/dL
43
small left colon syndrome
condition that occurs exclusively in infants of diabetic mothers; they present with abdominal distension and failure to pass meconium due to decreased caliber of left colon
44
definition of polycythemia
central venous hematocrit greater than 65% (22-ish hgb)
45
increased risk of NEC with polycythemia
TRUE
46
management of polycythemia
partial exchange transfusion, in which blood is removed and replaced with saline
47
cause of direct hyperbilirubinemia
choledochal cyst (cystic dilation of the bile duct)
48
soap bubble on abdominal radiograph
meconium ileus
49
fragile x syndrome
unstable repeat sequences (number of specific nucleotide copies within a gene increases)
50
genomic imprinting
the expression of the gene depends on which parent you inherited that chromosome from; example is 11q region on chrom 15 (prader willi vs angelman)
51
marfan syndrome
autosomal dominant connective tissue disorder; affects the ocular, cardiovascular, and skeletal systems; gene defect is fibrillin on chrom 15; decreased upper to lower segment body ratio
52
ocular findings in marfans syndrome
upward lens subluxation and retinal detachment
53
diagnosis of marfans?
mostly on clinical findings, but, interestingly, homocystinuria has similar findings so you need to rule that out first;
54
marfans syndrome patients are at increased risk for endocarditis
right
55
prader willi genetics
absence of paternally derived part of chrom 15
56
craniofacial findings of prader willi
almond shaped eyes and fishlike mouth
57
growth problems in prader willi syndrome
failure to thrive initially followed by obesity as a result of hyperphagia; also short stature with small hands and feet
58
other features of prader willi
hypogonadism, hypotonia (in infancy that can lead to poor feeding), mental retardiation
59
what percent of alveolar development occurs after birth?
90 percent
60
alveoli increase in number until what age
8 yo
61
three reasons that infants are more prone to resp problems than older kids and adults
smaller air passages, less compliant lungs with more compliant chest wall, less efficient pulm mechanisms
62
inspiratory stridor suggests what kind of obstruction?
extrathoracic
63
two examples of extrathoracic obtruction
croup and laryngomalacia
64
what is laryngomalacia
softening of the laryngeal cartilage that collapses into the airway, esp when patient is in a supine position
65
expiratory wheezing suggests what?
intrathoracic obstruction like asthma and bronchiolitis
66
crackles or rales suggest what
parenchymal disease like pneumonia or pulm edema
67
epiglottitis most common in what age? What gender?
2-7 year olds; equal in boys and girls
68
epiglottitis is caused by what?
HIB (hemophilus influenzae type B) was most common; also group A strep, strep pneumonia, and staph
69
clinical features of epiglottitis
abrupt onset of upper airways disease without prodrome
70
what do lab studies of epiglottitis reveal?
leukocytosis with left shift; blood culture will show HIB
71
what is classix xray finding of epiglottitis?
thumb print epiglottis on lateral x ray
72
what should the airway look like?
cery red swollen epiglottis
73
management of epiglottitis
medical emergency! Controlled nasotracheal intubatio; avoid examining the throat as this might cause resp distress
74
antibiotic therapy for epiglottitis
2nd or 3rd gen cephalosporin; if epiglottitis is secondary to HIB then give rifampin to non-immunized house-hold contacts less than 4 yo
75
laryngotracheobronchitis (aka croup)
inflamm and edema of the subglottic larynx, trachea and bronchi
76
two forms of croup
viral and spasmodic
77
what is the most common cause of stridor
viral croup
78
age of croup
3 months to 3 years; male to female ratio is 2:1
79
season for croup
late fall and winter
80
most common cause of viral croup
parainfluenza; but can also be caused by RSV, rhinovirus, adeno , influenza A and B, and mycoplasma pneumoniae
81
cause of spasmodic croup
hypersensitivity reaction
82
clinical feature of viral croup
begins with URI for 2-3 days followed by stridor and cough; eventually barky cough; can last 3-7 days
83
what does xray show for croup?
"steeple sign" of subglottic narrowing
84
treatment for spasmodic croup
resolves without treatment
85
management of viral croup
supportive care (col mist and fluids), systemic corticosteroids such as IM dexamethasone, nebulized budesonide, or oral corticosteroids
86
children with resp distress from croup get treated how?
should be hospitalized; racemic epinephrine aerosols, which vasoconstrict subglottic tissue
87
bacterial tracheitis
uncommon, but can be a cause of stridor
88
causes of bacterial tracheitis
staph aureus, strep, HIB
89
clinical features of bacterial tracheitis
abrupt onset; high fever, and mucous and pus in the trachea
90
management of bacterial tracheitis
anti-staph agent and airway support
91
bronchiolitis
inflamm bronchiolar obstruction
92
most common cause of bronchiolitis
RSV
93
less common causes of bronchiolitis
parainflluenza, adeno, rhino, mycoplasma pneumoniae
94
bronchiolitis predominantly affects what age
kids less than 2 yo
95
clinical features of bronchiolitis
onset is gradual with URI sx then tachypnea, fine rales, wheezing; liver and spleen may be enlarged due to lung hyperinflation
96
cxr for bronchiolitis
hyperinflation with air trapping; patchy infiltrates and atelectasis
97
will babies have recurrent wheezing after they recover from bronchiolitis?
yes
98
when do babies with bronchiolitis usually recover by?
2 weeks
99
what is a complication of bronchiolitis?
apnea
100
management of bronchiolitis
primarily supportive; you can try nasal bulbs, nebulized racemic epinephrine may be helpful, aerosolized ribavirin (against RSV) may possibly help but evidence is lacking

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