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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
Duodenal atresia (bilious, within 12 hours)
CXR: "double bubble" (air in stomach + in duodenum) Tx: IVF/electrolytes; NGT decompression; Duodenostomy Associations: Down's, VACTERL, Polyhydraminos
26
VACTERL:
Vertebral defects: Anal atresia; Cardiac abn; TEF; | Renal; Limb syndrome
27
Necrotizing Enterocolitis (premature, bloody stools)
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
Failure to pass meconium (Hirschprung's)
initial: rectal exam (large, voluminous passage after exam) next step: barium enema (megacolon prox to obstruction) confirmatory: rectal biopsy (absent ganglionic cells)
29
Physiologic jaundice
-undersecretion; starts day 2-3; peaks at day 5 | if jaundice appears day 1 = pathological
30
Exaggerated physiologic jaundice (breastfeeding jaundice)
-due to dehydration, not enough milk | Tx: increase feedings 20 mins/1-2 hrs
31
Breast milk Jaundice
-due to factor in breast milk that > circulation of bilirubin Tx: continue breastfeeding; usually resolves by 12th week
32
Jaundice: kernicterus
-Unconjugated crosses BBB - | hypotonia, seizures, choreoathetosis, SN hearing loss = immediate exchange transfusion
33
Bilirubin: > 10-12 mg/dL | Failure of therapy or suspected bilirubin encephalopathy
Phototherapy | Exchange transfusion
34
Neonatal sepsis: causes | - within first 24 hours - after 24 hours - > 1 month
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
Neonatal sepsis: Empiric treatment
< 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
Seizures in newborn: Tx
1: Phenobarbital 2: Phenytoin + correct electrolytes
37
Substance abuse and neonatal withdrawal: tx
best initial if substance unknown: opioids + phenobarbital
38
Genetics/Dysmorphology:
Diagnosis: karyotype analysis
39
Turner syndrome: XO
Sporadic: no increased risk in other pregnancies | Estrogen-progesterone, GH, Vit D, Calcium
40
NF1 | COFFINS
NF1 gene chromosome 17: autosomal dominant | Next step: opthalmologic exam (lisch nodules)
41
NF2
chromosome 22: autosomal recessive | - acoustic neuromas (bilateral deafness) + hypopigmented
42
FTT:
< 2 yrs old failure to gain weight (< 5th percentile) | first step: dietary modification (if stable)
43
malnutrition:
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
Diaper rash (diaper dermatitis)
Tx: oxide paste or petrolatum
45
Candidal infection
-involve skin folds; tomato-red plaques, satellite papules | Tx: clomitrazole cream or topical nystatin
46
Breastfeeding: contraindications
(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
Infant botulism vs Adult botulism
-ingestion of spores in environmental dust (vs preformed) | Tx: Human-derived botulism immune globulin (vs equine)
48
Milestones: Delayed speech
Perform: Hearing/sensory test
49
Enuresis: | involuntary 2x/week for 3 months in > 5 yrs old
initial: UA; possible infection: culture; recurrent: VCUG or U/S tx: behavioral and motivational (alarms) 2nd line: tricyclic drugs, imipramine, desmopressin
50
Encopresis: | unintentional > 4 yo
initial: abd XR (distinguish btwn retentive and nonretentive) Tx: Retentive (constipation) - stool softener, disimpact Tx: Nonretentive (abuse) - behavior modification
51
Child abuse: Labs, Orders, Tx
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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