UT High Yiedl Flashcards
What does APGAR tell you?
General info about how newborn tolerated labor and how responding to resuscitation
What does APGAR not tell you?
Not predictive of outcome, does not guide therapy
What does it mean if arm extended and medially rotated after birth?
Erb Duchenne = waiters tip
C5-C6
Tx: refer at 3-6 mo for surgery
What does it mean if you feel crepitus at clavicle in newborn? What should you do?
clavicle fracture
tx: reassurance and watch
What is edema on baby’s head that crosses suture lines?
caput
What is fluctuant mass on baby’s head that does not cross suture lines?
cephalohematoma
What are mongolian spots made of?
arrested melanocytes
What is pale pink vascular macules on nuchal area and face?
salmon patch = nevus simplex
less sharply demarcated than hemangiomas
facial regress, nuchal stick around
What is firm white papule on day of life 1 w/ keratin?
milia
When do you see neonatal acne?
week of like 1-2
Firm yellow white pustules/papules on erythematous base?
filled with eos
erythema toxicum
What is area of alopecia w/ orange colored nodular skin?
management?
nevus sebaceous
remove before adolesence b/c risk of malignant degeneration
What is treatment for cradle cap?
mild shampoo or antifungal
What are two disorders screened for in every state?
galactossemia
PKU
What is PKU? How does it present?
deficient Phe hydroxylase
see sx a few months later, MR, delay, athetosis, seizure, vomit
fiar hair, eyes, skin, musty
What is galactosemia? How does it present?
Deficient G1P uridyl-trasnferase
G1P accumulates to damage kidney/liver/brain
sx right away b/c galactose crosses the placenta
MR, direct hyperbili, jaundice, low glucose, cataracts, seizure
predisposed to E coli sepsis
What is physiologic jaundice?
b/c liver conjugation not mature, gone by day 5, bili
What is breastfeeding jaundice mech?
increased enterohepatic circulation –> reabsorb deconjugated bili
What is breast milk jaundice?
breast milk has glucoronidase that deconjugated bili in infant GI tract
Causes of direct hyperbili?
galactosemia hypothyroid choledochal cyst CF biliary atresia SEPSIS!
Inherited indirect hyperbili?
gilbert + crigler-najjar
Inherited direct hyperbili?
rotor (no black liver) + dubin johnson (black liver)
What is mech of phototherapy?
isomerizes unconjugated bilirubin so can be excreted
Treatment for diaphragmatic hernia?
give lungs 3-4 days to mature then do surgery
*deliver at a facility with ECMO
Resp distress w/ excess drooling: dx? what else should you look for?
place feeding tube, take xray
look for VACTERL: vertebral, anal atresia, cardiac, radial, renal
What should you think if 1 wk old cyanotic when feeding but pink when crying? What else should you look for?
choanal atresia
CHARGE: coloboma, heart defects, retarded growth, GU anomalies, deafness
How do you diagnose RDS prenatal?
L/S ratio
Treat RDS?
O2 therapy w/ nasal CPAP to keep alveoli open
When do you use theophylline in NICU?
for central apnea
What is pathophys in TTN? signs in CXR?
path: retained fluid
CXR: perihilar streaking, retained fluid in fissures, air trapping
risks: C section
Meconium aspiration syndrome next best step? complications?
intubate + suction before stimulation
complications: pneumonia, pneumonitis, pulm artery HTN
What is defect lateral to midline w/o sac?
gastroschisis
not associated w/ other anomalies
problem –> bowel exposed gets scarred –> bowel resection –> etc
What is defect in midline covered by sac?
Associated w/ what disease
omphalocele
associated w/ beckwith wiedemann = big baby w/ big tongue, ear pits, low glucose
When do we treat umbilical hernia?
if persists past age 2-3
Metabolic complication w/ pyloric stenosis?
hypochloremic metabolic alkalosis
2 wk old w/ biliious vomiting + polyhydramnios?
duodenal atresia
1 wk old baby w/ billious vomiting, draws up legs, ab distension?
malrotation and volvulus
–> ladds bands can kink the duodenum
3 day old has not passed meconium?
CF –> gastrograffin enema = Dx/Tx
HIrshprungs –> squirt sign = explosion of poo w/ enema, tx ganglia
What do you see on CXR w/ ENC?
pneumocystitis intestinalis (air in the wall)
What is treatment for NEC?
NPO, TPN (if necessary), abx, resent necrotic bowel
risk: prematurity
most important = stop feeding
Newborn male w/ no palpable testes – where are they? next best test?
usually in inguinal canal
if not there –> do US
What is prune belly syndrome?
problem w/ ventral musculature of abdomen, have cryptorchidism
When do you surgery for cryptorchidism?
at 1 yr, decreases sterility makes it easier to detect cancer
What is it called if newborn has urethral opening on ventral surface?
hypospadia
What do you not do in hypospadias?
circumcise –> foreskin used for repair
What is treatment for 21 hydroxylase?
give hydrocortisone and fludrocortisone
Baby w/ anterior midline mass that doesnt pee?
posterior urethral valves = common cause of anuria
Tx: catheterize then surgical correction
Associations w/ pre-existing maternal DM?
IUGR, congenital, caudal regression, small left colon
Associations w/ gestational DM?
LGA, hypoglycemia, hypocalcemia, polycythemia, jaundice
Risks of LGA?
increased risk of birth trauma –> clavicle, erbs, TTN
What are complications of neonatal hypoglycemia?
seizure
Why polycythemia in LGA?
big baby needs more O2 = hypoxia –> more EPO
What should you order in baby
CBC w/ diff, CXR, blood culture, urine culture (w/ catheter), LP
What are risk factors for neonatal sepsis?
premature, chorioamnionitis, intrapartum fever, maternal leukocytosis, prolonged rupture of membranes (>18 hrs), GBS+ mom
What are most common bugs for neonatal sepsis? empiric treatment?
GBS, E Coli, Listeria
ampicillin + gentamicin
Neonate w/ maculopapular rash on palm/soles, snuffles, periostitis?
treat?
syphilis
Tx: penicillin
Neonate w/ hydrocephalus, intracranial calcifications, chorioretinitis? Treat?
toxo
Tx: sulfadiazine + leucovorin
Neonate w/ cataracts, deafness, heart defects (esp PDA/VSD), extramedullary hematopoiesis? Treat?
Rubella
Tx: none
Neonate w/ microcephaly, periventricular calcifications, deafness, thrombocytopenia, petechiae? Treat?
CMV
Tx: ganciclovir
Neonate w/ limb hypoplasia, cutaneous scars, cataracts, chorioretinitis, cortical atrophy? Treat?
Congenital varicella
if mom infected 5 days before or 2 days after delivery –> baby gets VZIG
Treat gonococcal conjuncitivits?
topical erythromycin and IV 3rd gen Ceph
Treat chlamydia conjunctivitis (mucopurulent/mucoid)?
oral erythromycin
complication = chlamydia pna
IQ in Down syndrome?
moderate MR and dev delay
Associations w/ Down syndrome: Heart? GI? Endocrine? MSK? Neuro? Cancer?
Heart: endocardial cushion, VSD GI: hirshprung, duodenal atresia Endocrine: hypothyroid MSK: atlantoaxial instability Neuro: alzheimers (APP on 21) Cancer: ALL
Associated anomalies w/ turner? treatment?
coarctation of aorta, bicuspid aortic valve, horseshoe kidney
treat: give estrogen to undergo puberty and avoid osteoporosis
What are associations w/ klinefelters?
increased risk of gonadal malignancy
What syndrome: manidublar hypoplasia, glossoptosis, cleft soft palate, w/ FAS or edwards?
Pierre robyn seuqence
What syndrome: broad square face, short stature, self injurious, del 17?
smith mcguinnes
What chr is prader willi?
chr 15
What chr is williams?
chr 7
What syndrome: IUGR, hypertonia, distinct facies, limb malformations, self injurious behavior, hyperactive?
cornelia de lange
What is genetics of fragile X?
CGG repeats on X chr
What syndrome: AD, w/ advanced paternal age, short palpebral fissures, white forelock, deafness
Waardenburg
Multiple infecitons and no tonsils?
Bruton agammaglobulinemia
B cells normal but low Igs in later kid? complication?
CVID –> increased lymphoid tissue so increased risk lymphoma
Most common B cel defect w/ recurrent URIs and diarrhea?
IgA deficiency
3 wk old w/ seizure, truncus arteriosus, micrognathia?
DiGeorge, chr 22
Inheritance of SCID? treat?
MC XR, also AR ADA deficiency
tx –> BM transplant by age 1 or death
Dx chronic granulomatous disease?
nitrotetrazolium blue, flow cytometry
What disease w/ severe eczema, petechiae, recurrent ear infections? What IG make up?
wiskott aldrich
high IgE/IgA, low/normal IgG/IgM
prolonged bleeding after circumcision
When do you double length by?
4-5 years
Breast milk vs formula?
breast milk = whey, more lactose, more long chain fatty acids, less Fe but better absorbed
What should you think if kid always 5% in height, parents late bloomers? Bone age?
constitutional growth delay
bone age