UWorld educational objectives Flashcards
Laboratory findings of infants of diabetic mothers
Hypoglycemia
Polycythemia, low iron
Hypocalcemia & hypomagnesemia
Hyperbilirubinemia
Educational objective:
Metabolic complications of infants of diabetic mothers include hypoglycemia, hypocalcemia, and hypomagnesemia. Serum calcium level should be obtained for symptomatic neonates (eg, jitteriness), particularly if serum glucose is normal.
What can cause shoulder dystocia in a newborn?
Fetal macrosomia is a risk factor for shoulder dystocia. Excessive traction on the head and neck during a difficult delivery can result in Erb-Duchenne (C5-6 damage) palsy with the characteristic “waiter’s tip” posture. Management involves observation alone because most infants recover arm function spontaneously within a few months.
Management of shoulder dystocia
Fetal macrosomia is a risk factor for shoulder dystocia. Excessive traction on the head and neck during a difficult delivery can result in Erb-Duchenne palsy with the characteristic “waiter’s tip” posture.
Management involves observation alone because most infants recover arm function spontaneously within a few months.
What if shoulder dystocia remains longer, 3-9 months?
Surgical intervention (eg, nerve graft, reconstruction, decompression) can be considered for infants with no improvement by age 3-9 months but is not necessarily curative
What is Klumpke palsy?
is a rare complication of shoulder dystocia caused by injury to the 8th cervical and 1st thoracic nerves. Presentation can include hand paralysis (ie, “claw hand”) and ipsilateral Horner syndrome.
Why do we urge early breastfeeding?
early feeding helps prevent hypoglycemia and can decrease the risk of hyperbilirubinemia. For these reasons, routine newborn care (eg, vitamin K, hepatitis B vaccine, erythromycin eye ointment) can be postponed for an hour to allow for skin-to-skin time
What does Immediate routine neonatal resuscitation involve?
Immediate routine neonatal resuscitation includes drying, stimulating, and warming. Healthy newborns should be placed on the mother’s chest for skin-to-skin care, which provides warmth and allows early breastfeeding initiation.
Clinical findings in Neonatal herpes simplex virus infection
Skin-eye-mouth Mucocutaneous vesicles Keratoconjunctivitis CNS Seizures, fever, lethargy Temporal lobe hemorrhage/edema Disseminated Sepsis, hepatitis, pneumonia
When does Neonatal herpes simplex virus infection shows?
CNS disease typically presents in the second or third week of life with signs of encephalitis, including seizure, lethargy, and poor feeding. A full fontanel is suggestive of increased intracranial pressure.
Educational objective:
Neonatal herpes simplex virus infection typically results from vertical transmission during delivery. The presentation in newborns with CNS disease (ie, encephalitis) typically occurs in weeks 2-3 of life with seizure and temporal lobe hemorrhage.
How does Cytomegalovirus (CMV) and Toxoplasma gondii present in newborns?
Cytomegalovirus (CMV) and Toxoplasma gondii can cause neonatal seizures, but intracranial calcifications are seen on neuroimaging in both conditions. In addition, symptomatic congenital toxoplasmosis and CMV infection also typically present with other findings such as jaundice, hepatosplenomegaly, and chorioretinitis.
How does group B Streptococcus and Listeria monocytogenes present in neonates?
Neonatal bacterial meningitis due to group B Streptococcus and Listeria monocytogenes can cause fever and seizure. Imaging findings may include cerebral edema, hydrocephalus, and abscess but not temporal lobe hemorrhage, which is highly specific for HSV.
How do you manage clavicular fracture in newborns?
Management includes reassurance and gentle handling, as most neonatal clavicular fractures heal rapidly without complications (7-10 days)
To decrease pain, arm motion may be restricted by pinning the infant’s sleeve to the shirt.
Risk factors for neonatal clavicular fractures.
Birth weight >4 kg, shoulder dystocia, and vacuum delivery are risk factors for neonatal clavicular fractures.
How does ectopic pregnancy manifests?
Ectopic pregnancy, which occurs when a developing blastocyst implants in an extrauterine location (eg, fallopian tube), can present with nausea/vomiting, pelvic pain, and vaginal bleeding. Therefore, all reproductive-age women with these symptoms require pregnancy testing.
Fetal growth restriction (FGR) is characterized by: estimated fetal weight <10th percentile or birth weight <3rd percentile. Asymmetric FGR, in which head circumference is normal, is most commonly due to uteroplacental insufficiency (eg, maternal chronic hypertension) in the second/third trimester.
estimated fetal weight <10th percentile or birth weight <3rd percentile.
Asymmetric FGR, in which head circumference is normal, is most commonly due to:
uteroplacental insufficiency (eg, Uteroplacental insufficiency (HTN), Maternal malnutrition) in the second/third trimester.
Indications for intubation and invasive mechanical ventilation in severe acute asthma include?
Indications for intubation and invasive mechanical ventilation in severe acute asthma include:
- impending respiratory failure (high or inappropriately normal PaCO2 in relation to the work of breathing),
- altered mental status,
- lack of improvement despite a time-limited trial of noninvasive positive pressure ventilation.
The first step in management of a newborn with suspected congenital diaphragmatic hernia is __________. A gastric tube should also be placed immediately to __________. Bag-and-mask ventilation can exacerbate respiratory decline and should be avoided.
endotracheal intubation
decompress the stomach and bowel
Viral bronchiolitis typically presents in children age ______ with cough and increased work of breathing (eg, tachypnea, retractions). Diagnosis is typically clinical, but chest x-ray findings include ?
<2 years
peribronchial cuffing, increased interstitial markings, and the absence of a focal consolidation.
A large thymic silhouette is a normal finding on frontal chest x-ray in children age ___ because it is relatively large compared to the small thorax. The thymus normally atrophies after puberty. Therefore, opacities in this location in adults raise concern for a pathologic cause (eg, ______,________).
<3
lymphoma, germ cell tumor
___________ presents with increased work of breathing, hypoxia responsive to oxygen, and ground-glass opacities on x-ray; management includes exogenous surfactant administration. Neonates of mothers with _________ are at increased risk due to delayed fetal lung maturation.
Neonatal respiratory distress syndrome
diabetes and poor glycemic control
Not all patients with cystic fibrosis are identified through newborn screening. Therefore, the presence of _____, ________, _______, and signs of ______ (eg, poor growth, deficiency of fat-soluble vitamins) should prompt an evaluation.
nasal polyps,
recurrent sinopulmonary infections
digital clubbing
pancreatic insufficiency
_____________ can occur when a large volume of blood product is rapidly transfused, particularly in children age <3 with chronic anemia. Signs include respiratory distress, hypertension, tachycardia, and pulmonary edema within 6 hours of transfusion initiation. Management includes diuresis (eg, furosemide).
Transfusion-associated circulatory overload
_______________, which causes a persistent oxygen requirement, is commonly seen in premature infants, especially in those requiring prolonged mechanical ventilation or oxygen supplementation.
Bronchopulmonary dysplasia (chronic lung disease of the neonate)
___________ in children can present with secondary enuresis. Severe cases can result in cardiovascular complications.
Obstructive sleep apnea
Congenital diaphragmatic hernia results in herniation of abdominal contents into the thoracic cavity. Patients have respiratory distress at birth with absent breath sounds on the affected side, a ______ chest, and a ____ abdomen. Chest x-ray shows intrathoracic bowel loops and a displaced cardiac silhouette.
barrel-shaped
scaphoid
Kartagener syndrome, a subgroup of primary ciliary dyskinesia, is characterized by a classic triad of ?
situs inversus, recurrent sinusitis, and bronchiectasis.
Transient tachypnea of the newborn is a self-limited condition caused by delayed resorption and clearance of pulmonary fluid and is more common in infants delivered by _______. Infants present shortly after birth with respiratory distress and fluid in the interlobar fissures on chest x-ray.
cesarean section.
________ occur after bacterial pneumonias lead to pleural inflammation and exudation of fluid into the pleural space. Small effusions in children without respiratory distress can be managed with oral antibiotics and close outpatient follow-up. Moderate or large effusions require drainage.
Parapneumonic effusions
The risk of ________ is increased in premature neonates, particularly those with respiratory distress syndrome who are receiving mechanical ventilation. Transillumination reveals increased brightness on the affected side. Hemodynamic instability or signs of __________ (eg, mediastinal shift) warrant emergency needle thoracostomy.
pneumothorax
tension pneumothorax
Bronchopulmonary dysplasia is a chronic complication of prematurity caused by the _________ and characterized by a prolonged oxygen requirement. Histologic findings include a decreased number and septation of alveoli.
arrest of pulmonary development
Neonatal respiratory distress syndrome presents immediately after birth with increased work of breathing and hypoxia in premature neonates. Pathogenesis involves surfactant deficiency, causing increased __________ and diffuse atelectasis (seen on chest x-ray as diffuse ground-glass opacities).
alveolar surface tension
Patients with structural airway disease, especially cystic fibrosis and asthma, are susceptible to __________. Allergic sensitization to them is signified by high levels of circulating IgE. it must be suspected when lung function declines without explanation, or persistent lower respiratory infection symptoms occur despite adequate antibiotic therapy.
allergic bronchopulmonary aspergillosis (ABPA)
Croup is a viral infection in which edema and narrowing of the proximal trachea result in a ______ and ________ Treatment with corticosteroids with or without nebulized epinephrine decreases airway inflammation.
barky cough and inspiratory stridor.
Neonatal respiratory distress syndrome, seen in premature neonates with surfactant deficiency, causes increased work of breathing and hypoxemia. Atelectasis and diffuse alveolar collapse are seen on chest x-ray as:
1.
2.
a reticulogranular pattern (ie, ground-glass appearance) with air bronchograms.
_________ should be suspected in an enterally fed, premature or very-low-birth-weight infant with nonspecific apnea, lethargy, and abdominal distension. Pneumatosis intestinalis on abdominal x-ray is diagnostic.
Necrotizing enterocolitis
A __________ is a congenital neck mass that often presents in later childhood after an upper respiratory tract infection. It is typically located inferior to the mandible and anterior to the sternocleidomastoid muscle.
branchial cleft cyst
Otitis externa (“swimmer’s ear”) is a painful infection of the external auditory canal. It often occurs after outdoor water exposure due to alterations in ear canal pH, loss of cerumen, skin maceration, and introduction of bacteria. ________ is the most common pathogen.
Pseudomonas aeruginosa
_________ is a complication of acute otitis media. It is characterized by fever, otalgia, and mastoid process inflammation with displacement of the auricle.
Acute mastoiditis
Chronic suppurative otitis media is often preceded by an episode of acute otitis media and is defined as chronic (>6 weeks), purulent otorrhea with tympanic membrane perforation. Treatment is an ototopical fluoroquinolone to target the most common pathogens, _________ and ____________
Staphylococcus aureus
Pseudomonas aeruginosa.
Cholesteatomas in children can either be congenital or acquired secondary to chronic middle ear disease. New-onset hearing loss or chronic ear drainage despite antibiotic therapy are typical presenting symptoms of cholesteatomas, and _______ and _________ may be seen within retraction pockets of the tympanic membrane on otoscopy.
granulation tissue and skin debris
Otitis externa (“swimmer’s ear”) is characterized by pain, erythema, and edema of the external auditory canal. It frequently occurs after water exposure or trauma to the canal. _________ is appropriate unless complicated by diabetes mellitus, HIV, or infection that has spread beyond the external auditory canal.
Topical antipseudomonal treatment
Topical therapy (eg, ciprofloxacin [± glucocorticoid] drops) is appropriate for uncomplicated otitis externa; antibiotic resistance is unlikely due to the high antibiotic concentration delivered to the site of infection. If the canal is too swollen, wick placement is used to facilitate drug delivery.
________ result from the accumulation of keratin debris and squamous epithelial cells within a tympanic membrane retraction pocket. Symptoms include ____________and _________, and examination often reveals a pearly white mass behind an intact tympanic membrane.
Cholesteatomas
persistent otorrhea and conductive hearing loss
_________ is a rare but potentially fatal infection that presents with acute onset of fever, sore throat, and signs of upper airway obstruction (eg, stridor, drooling).
Epiglottitis
Plain x-rays may help confirm the diagnosis by revealing an enlarged epiglottis (thumb sign).
A ________ should be suspected in a toddler or young child with unilateral, foul-smelling, purulent nasal discharge.
nasal foreign body
In children, a midline, cystic neck mass that moves with swallowing is likely a __________.it forms from retained epithelium from the embryologic descent of the ____ gland.
thyroglossal duct cyst.
thyroid
Choanal atresia is a congenital obstruction of the posterior nasopharynx. Because neonates are obligate nasal breathers, bilateral choanal atresia presents with cyanosis that worsens during ___ and improves when _____. The diagnosis is supported if a small catheter cannot be passed from the nares into the oropharynx.
feeding
crying
Otitis media with effusion (OME) is defined by middle ear fluid without tympanic membrane (TM) inflammation (eg, bulging, erythema). Examination shows ________and _________. Management is observation with follow-up for resolution because chronic OME is associated with speech delay and long-term hearing loss.
air-fluid levels and poor TM mobility
__________ is the most common cause of stridor in infants and is due to collapse of the supraglottic tissues during inspiration. Stridor increases with exertion (eg, crying, feeding) and improves with prone positioning.
Laryngomalacia
Congenital ________ infection is the most common cause of nonhereditary sensorineural hearing loss in children. The infection is frequently asymptomatic in infants but can cause progressive or delayed-onset, unilateral or bilateral hearing loss later in childhood.
cytomegalovirus
____________ presents shortly after birth with choking or coughing during feeding. Diagnosis is confirmed by resistance of nasogastric tube advancement beyond the proximal esophagus. Because it often occurs with VACTERL association (Vertebral, Anal, Cardiac, TracheoEsophageal fistula, Renal, and/or Limb anomalies), all patients who have TEF with EA should undergo screening echocardiography and renal ultrasonography.
Tracheoesophageal fistula (TEF) with esophageal atresia (EA)
___________ presents with inspiratory stridor due to dynamic collapse of the supraglottic tissues on inspiration. Stridor increases in periods of increased airflow (eg, crying, feeding).
Laryngomalacia
After securing the airway in patients with epiglottitis, initial treatment consists of broad-spectrum antibiotic therapy with ____ (targeting Haemophilus influenzae and Streptococcus species) and _______ (targeting Staphylococcus aureus).
ceftriaxone
vancomycin
When caring for an unemancipated minor, informed consent from ____ parent or guardian is considered legally sufficient to justify proceeding with therapy. Physicians should also provide care in urgent situations without waiting for parental consent.
one
Adolescent confidentiality regarding sensitive issues, including treatment for sexually transmitted infections, mental health concerns, and substance use, should be protected. When transferring care, it is preferable to provide the medical record directly to the ______ rather than providing a copy to the _____
new provider
parent.
Physicians should have a high suspicion for ____ in children with sudden changes in mood, behavior, or academic work, as well as in children with stressful family environments or parents with active drug/alcohol abuse.
abuse
Parental consent is required prior to providing nonemergency medical care for a minor who does not qualify for confidential care (eg, pregnant) or is not emancipated (eg, married). ____ from the child is ideal but not required to proceed with treatment.
Assent
Parents who are themselves minors can give consent to medical care for their child. However, consent is _______ in emergency situations.
not required parents cannot refuse life-saving treatment for their child.
Parents who are themselves minors can give consent to medical care for their child. However, consent is _______ in emergency situations.
not required parents cannot refuse life-saving treatment for their child.
Limitations to adolescent confidentiality ?
determinations of imminent risk (eg, suicidality, homicidality) and threats to safety (eg, sexually abusive relationships, intoxicated driving). Additional risks to confidentiality should also be discussed with adolescent patients, including guardian access to information through the electronic medical record and patient portal, direct medical record requests, and insurance/billing statements.
is Parent-requested drug testing recommended?
Parent-requested drug testing without the knowledge of an adolescent is not recommended. Responding to the request should include exploration of the parents’ concerns, education about the limitations of drug testing, and evaluation of the patient privately.
what is advance care planning?
Discussions regarding advance care planning for adolescents with chronic, life-limiting illnesses (eg, cystic fibrosis) should take a family-centered approach and directly involve the adolescent patient. Discussion should include information regarding prognosis, care options, and the patient’s and family’s preferences for end-of-life care.
In a nonemergency situation in which a parent refuses potentially life-saving treatment for their child, the physician should seek a _____ mandating treatment.
court order
Disclosure of an HIV diagnosis to a child with perinatally acquired infection should occur by ________ to foster patient autonomy, increase medication adherence, and prevent transmission. The physician should respect the family’s concerns and offer joint participation in establishing a timeline and plan for disclosure to the child.
adolescence
Parental notification is generally _______ for a general mental health concern
not required
Parental notification is generally not required for a general mental health concern unless it poses a serious safety threat; parental notification is required when there is concern for self-harm.
Exceptions to maintaining the confidentiality of minors include?
Exceptions to maintaining the confidentiality of minors include suicidal ideation and potentially dangerous self-harming behavior. Ideally, adolescents should be involved in creating a plan to inform their parents.