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Pediatrics > Quick Review - newborn > Flashcards

Quick Review - newborn Flashcards

1
Q

Port Wine stain (nevus flemmus; stork bite, angel kiss)

A

Evaluate for Sturge-Weber syndrome (AV malformation)

-seizures, mental retardation, glaucoma

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2
Q

Hemangioma (red, sharply-demarcated benign tumor)

A
  • 70% regress by 7 yo; observation

- consider underlying organ involvement if deep

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3
Q

Caput Succedaneum vs Cephalohematoma

A

Caput succedaneum: Crosses suture lines

Cephalohematoma: Does not cross suture lines

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4
Q

Preauricular tags/pits

A

Hearing loss: Hearing test

GU abnormalities: U/S of kidneys

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5
Q

Coloboma of iris (hole in iris)

A

Screen for CHARGE syndrome: CHD7 gene

Coloboma, Heart defects, Atresia of nasal choanae, Retardation (growth), GU abnormalities, Ear abnormaities

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6
Q

Aniridia (absence of iris)

A

Wilm’s tumor: WT1 chromosome 11

Screen for with abdominal U/S Q3 months until 8yo

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7
Q

Omphalocele

A

GIT protrustion WITH sac (failure of GI sac to retract)

-screen for trisomy; MC Edwards 18 (N inhibin A)

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8
Q

Gastroschisis

A

Abdominal defect lateral to midline WITH OUT sac

-Immediate surgical intervention

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9
Q

Umbilical Hernia

A

Screen with TSH; 90% close by age 3 yo

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10
Q

Hydrocele

A

-Painless, fluid filled scrotal swelling

Differentiate from inguinal hernia (reducible)

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11
Q

Undescended tested (cryptorchidism)

A

Surgical orchiopexy @ 6 months

> risk malignancy @ 1 yr.

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12
Q

Hypospadias (ventral)

A

Do not circumcise

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13
Q

Epispadias (dorsal)

A

Urinary incontinence; surgical evaluation for bladder exstrophy

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14
Q

Inguinal hernia (usually indirect)

A

Inguinal bulge or reducible scrotal swelling

-Surgery

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15
Q

Infant of diabetic mother

A

Hypoglycemia - large for GA, plethora, jittery, macrosomia

Tx: glucose, small meals

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16
Q

Infant of diabetic mother risks

A
  • obesity, diabetes -truncus arteriosis

- small left colon syndrome -RDS

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17
Q

Erb’s paralysis (upper trunk C5 C6)

A
  • adducted, internally rotated arm; forearm pronated
  • good prognosis (80% fully recover)
  • most feared risk: Phrenic N paralysis
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18
Q

Respiratory Distress Syndrome (RDS): testing

premature neonate within hours of birth

A

Best initial: CXR (ground glass appearance)

Best predictive: L/S ratio on amniotic fluid prior to birth

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19
Q

RDS: TX

A

initial: O2 + CPAP
effective: exogenous surfactant
prevent: betamethasone >24 hrs before birth or <34 wks gestation (not indicated postnatal)

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20
Q

Transient Tachypnea of Newborn (TTN)

-C section or rapid second stage labor

A

CXR: air trapping, fluid in fissures, perihilar streaking
Tx: oxygen; rapid improvement within hrs/days
> 4 hours = sepsis: evaluate with blood/urine cultures

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21
Q

Meconium Aspiration

A

CXR: patchy infiltrates, > AP diam., flattened diaphragm
Tx: +/high pressure ventilation, NO, ECMO
Prevent: ET intubation, airway suction in depressed infants

22
Q

Diaphragmatic Hernia

A

CXR: Loops of bowel visible in chest/air fluid levels
Tx: Immediate intubation, surgical correction +/-ECMO

23
Q

Meconium plugs (lower colon) Ileus (lower Ileum)

A

Abdominal XR

Tx: Ileus with gastrografin enema

24
Q

TE fistula (nonbilous, 1st feed)

A

Dx: NG tube coils in chest
CXR: +/- new infiltrate (aspiration pneumonia common)
Association: VACTERL syndrome

25
Q

Duodenal atresia (bilious, within 12 hours)

A

CXR: “double bubble” (air in stomach + in duodenum)
Tx: IVF/electrolytes; NGT decompression; Duodenostomy
Associations: Down’s, VACTERL, Polyhydraminos

26
Q

VACTERL:

A

Vertebral defects: Anal atresia; Cardiac abn; TEF;

Renal; Limb syndrome

27
Q

Necrotizing Enterocolitis (premature, bloody stools)

A

Abdominal XR: pneumatosis intestinalis (air in bowel wall, not lumen like normal; dilated loops with intramural air)
Tx: NPO; NGT; Broad spectrum; surgical resection

28
Q

Failure to pass meconium (Hirschprung’s)

A

initial: rectal exam (large, voluminous passage after exam)
next step: barium enema (megacolon prox to obstruction)
confirmatory: rectal biopsy (absent ganglionic cells)

29
Q

Physiologic jaundice

A

-undersecretion; starts day 2-3; peaks at day 5

if jaundice appears day 1 = pathological

30
Q

Exaggerated physiologic jaundice (breastfeeding jaundice)

A

-due to dehydration, not enough milk

Tx: increase feedings 20 mins/1-2 hrs

31
Q

Breast milk Jaundice

A

-due to factor in breast milk that > circulation of bilirubin
Tx: continue breastfeeding; usually resolves by 12th week

32
Q

Jaundice: kernicterus

A

-Unconjugated crosses BBB -

hypotonia, seizures, choreoathetosis, SN hearing loss = immediate exchange transfusion

33
Q

Bilirubin: > 10-12 mg/dL

Failure of therapy or suspected bilirubin encephalopathy

A

Phototherapy

Exchange transfusion

34
Q

Neonatal sepsis: causes

- within first 24 hours - after 24 hours - > 1 month

A

within 24 hours: Pneumonia (Group B or E. Coli)
> 24 hours: Bacteremia or Meningitis (S. Aureus, E.coli)
> 1 mo:Bacteremia/Meningitis (N. meningitidis, S Pneumo)

35
Q

Neonatal sepsis: Empiric treatment

A

< 1 month old Empiric Tx: Ampicillin + Gentamicin
< 1 month old meningitis possible: Ampicillin + Cefotaxime
> 1 month old: Cefotaxime
> 1 month old meningitis possible: Cefotaxime + Vanc

36
Q

Seizures in newborn: Tx

A

1: Phenobarbital 2: Phenytoin + correct electrolytes

37
Q

Substance abuse and neonatal withdrawal: tx

A

best initial if substance unknown: opioids + phenobarbital

38
Q

Genetics/Dysmorphology:

A

Diagnosis: karyotype analysis

39
Q

Turner syndrome: XO

A

Sporadic: no increased risk in other pregnancies

Estrogen-progesterone, GH, Vit D, Calcium

40
Q

NF1

COFFINS

A

NF1 gene chromosome 17: autosomal dominant

Next step: opthalmologic exam (lisch nodules)

41
Q

NF2

A

chromosome 22: autosomal recessive

- acoustic neuromas (bilateral deafness) + hypopigmented

42
Q

FTT:

A

< 2 yrs old failure to gain weight (< 5th percentile)

first step: dietary modification (if stable)

43
Q

malnutrition:

A

decreased weight > decrease in height
Next step: Oral rehydration w/ dobhoff tube (nasal psg)
- IVF only if pt is in shock/risk of heart failure

44
Q

Diaper rash (diaper dermatitis)

A

Tx: oxide paste or petrolatum

45
Q

Candidal infection

A

-involve skin folds; tomato-red plaques, satellite papules

Tx: clomitrazole cream or topical nystatin

46
Q

Breastfeeding: contraindications

A

(1) HIV (2) CMV (3) HSV if on breast (4) HBV until vaccine

5) Breast ca. (6) substance abuse - alcohol, nicotine (7)Specific meds (8) acute disease absent in infant (TB

47
Q

Infant botulism vs Adult botulism

A

-ingestion of spores in environmental dust (vs preformed)

Tx: Human-derived botulism immune globulin (vs equine)

48
Q

Milestones: Delayed speech

A

Perform: Hearing/sensory test

49
Q

Enuresis:

involuntary 2x/week for 3 months in > 5 yrs old

A

initial: UA; possible infection: culture;
recurrent: VCUG or U/S
tx: behavioral and motivational (alarms)
2nd line: tricyclic drugs, imipramine, desmopressin

50
Q

Encopresis:

unintentional > 4 yo

A

initial: abd XR (distinguish btwn retentive and nonretentive)
Tx: Retentive (constipation) - stool softener, disimpact
Tx: Nonretentive (abuse) - behavior modification

51
Q

Child abuse: Labs, Orders, Tx

A

initial: PT, PTT, platelets, BT, CBC; skeletal survey
severe: head CT/MRI, LFT, abd CT
Tx: treat medical/surgical issues then report to CPS

Pediatrics (14 decks)

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