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Peds > VanGarsse > Flashcards

VanGarsse Flashcards

1
Q

TQ The second MC illness seen in physician office in peds

A

Otitis media

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2
Q

TQ What is the difference between acute otitis media (AOM) and otitis media with effusion (serous) (OME)?

A
  • Acute otitis media=acute infx
  • Otitis media w/ effusion is inflam of the middle ear w/ fluid, NO S/S of acute infx…is residual after AOM or due to dys from URI OME predisposes to AOM
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3
Q
  • Liquid in the middle ear
  • Just a symptom! no path/pathology etc
  • Fluid may–>conductive hearing loss: short term, 25% can have for 3 mos+
A

MEE (middle ear effusion) component of both AOM and OME

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4
Q

T/F

  • 99% of children get OM by 2 years old
  • More common in males, native americans, and in certain families (genetic)
A

True

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5
Q

TQ

What are some environmental causes of OM?

A
  • *Tobacco smoke exposure!
  • Other irritants (fireplaces, wood heat)
  • Socioeconomic Status: crowding, limited/available sanitation, access to medical care
  • Daycares (sick for 18-24 mo)
  • Congenital anomalies (clefts, downs)

Other Factors:

  • Sleep Position (back)
  • Seasonal (allergies, incidence of URI in fall/winter)
  • GERD
  • RAD/Asthma
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6
Q

What are some protective factors against OM?

A

Breastfeeding

Pneumococcal vaccine (decr 7%)

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7
Q

TQ

What is the pathogenesis of acute otitis media?

A

Earlier event (cold)>>

Inflam/congestion of respiratory mucosa>>

Eustachian tube obstruc/dys>>

Movement of secretions neg pressure >>

Microbial growth

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8
Q

MC bacteria causing AOM?

A
  • S. pneumoniae (40%)
  • H. influenzae (25-30%)
  • Moraxella catarrhalis (10-15%)
  • Staphylococcus aureus
  • Gram-negative organisms
  • Respiratory viruses (+ or – bacterial components) in up to 96% of cases
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9
Q

Peds pt presents w/:

  • Ear pain and fever
  • Holding ear/tugging on ear
  • Night-time irritability
  • Increased crying
  • Loss of hearing/plugged sensation
  • Purulent otorrhea (drainage…ear drum ruptured)
  • Conjunctivitis, especially with H. flu
A

Acute Otitis Media

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10
Q

A normal eardrum looks gray (pearly), translucent, & concave (slightly)

What could an abnormal ear drum look like? 

A
  • Inflammation (redness)
  • Fluid (clear/bubbles/opaque/yellow)
  • Bulging/retracted
  • Mobility
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11
Q

What is the purpose of inserting tubes into a pt’s ear canal?

A

To equalize pressure to help perserve hearing

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12
Q

T/F

Effusion may occur weeks after onset of acute otitis media

A

TRUE (up to 4, 12, 16 wks!)

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13
Q

See air bubbles on eardrum?

A

OME

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14
Q

TQ

What is a “pneumatic otoscopy”?

A
  • exam that determines mobility of TM in response to pressure changes…impt in dx of AOM
  • normally moves in response to pressure (inward w/ pos, outward w/ neg)
  • *Immobile TM=MEE*
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15
Q

TQ

T/F You can diagnose AOM without a middle ear effusion (based on pneumatic otoscopy +/- tympanometry)

A

FALSE

MUST do a pneumatic otoscopy + Bulging of TM

OR

New onset otorrhea not due to AOE

OR

Bulging of TM AND recent (<48 hrs) onset ear pain OR intense erythema of TM

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16
Q

When treating OM it is impt to be prompt, because this may prevent development of complications such as…

A
  • mastoiditis :(
  • systemic spread of infection
  • chronic hearing loss
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17
Q

Tx of OM?

In addition to..

  • Topical pain relief (if TM intact)
  • Oral pain meds (IBUPROFEN, acetaminophen + Hydrocodone (Lortab))
A
  • # 1: Penicillins (specifically Amoxicillin) first line…target cell wall of gram positive bacteria (S. Pneumo, H flu, Moraxella)
  • # 2: Amox/clavulanic acid second line: High rate of b-lactamases in some S. Pneumo…
  • Cephalosporins third line 
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18
Q
  • Inflammation of the external auditory canal or auricle
  • Infectious, allergic, and dermal disease
  • Acute bacterial MC
A

Otitis Externa

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19
Q

Difference in anatomy of the ear b/t infants and older children/adults?

A
  • Infants: Outer 2/3 of the ear canal cartilaginous, inner 1/3 is bony
  • Older child and adult: Outer 1/3 is cartilaginous.

The epithelium is thinner in the bony portion, without subcutaneous tissue (less room for swelling)

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20
Q
  • Chronic irritation/ maceration from excessive moisture in EAC
  • Loss of protective cerumen
  • Cerumen impaction, trapping moisture
  • Other causes of inflammation (viral infections, eczema/atopy, etc)
A

Otitis Externa (OE)

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21
Q

TQ

Causes of OE?

A
  • *P. aeruginosa
  • S. aureus
  • Enterobacter aerogenes
  • Proteus mirabilis
  • Klebsiella pneumonia
  • Streptococci + coag-neg staph
  • Diphtheroids
  • Fungi: Candida + Aspergillus
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22
Q

TQ

  • PAIN
  • Worsened with manipulation of pinna (very sensitive to pressure/stretching)
  • Preceded by itching
  • Otorrhea (d/c): cottage cheese, foul smelling, profuse
  • Extreme swelling + redness
A

Otitis Externa

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23
Q

Tx of OE?

A
  • Clean the ear canal (gently)
  • Treat inflam + infx: drops
  • Control pain
  • Culture severe or recalcitrant cases
  • Avoidance or prevention
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24
Q

TQ

Timeline for appearance of sinuses? (sinusitis can occur at any age!)

A
  • Ethmoidal & maxillary sinuses are present at birth
  • Sphenoid: 5 years
  • Frontal: 7-8 years
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25
Q

Pathogenesis of sinusitis?

A

cold–>swelling–>cant drain–>infx (like AOM)

  • Nasal obstruction (polyps, foreign bodies, etc) (unilateral ear rhinorrhea)
  • Immune system deficiencies (any cause)
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26
Q

TQ

Bacterial causes of sinusitis?

A
  • Streptococcus pneumoniae: 30%
  • H. Influenzae (non-typeable): 20% (50% b-lactamase +)
  • Moraxella catarrhalis: 20% (100% b-lactamase +) amox/clav!
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27
Q
  • Typically follows URI
  • Mucosal thickening, edema, and inflammatory changes
  • Ostiomeatal complex obstructed
  • Decreased clearance of bacteria from the nasopharynx
A

Sinusitis

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28
Q

TQ

  • Non-specific prolonged s/s of URI (>10-14 days)
  • **Purulent rhinorrhea after URI for 3-4+ days w/ fever (102+)
  • Halitosis
  • Decreased sense of smell
  • Headache or facial pain (can ‘radiate’ to teeth)
  • Facial pain that worsens with bending, etc
A

Acute bacterial sinusitis

note:chronic sinusitis may have symptoms for 3 months or more.

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29
Q

TQ

  • Sinus aspirate
  • only truly accurate method of diagnosis, but not practical
  • Radiology: plain films are not helpful
  • CT is gold standard, BUT……
A

DO NOT ORDER A CT B/C OF RADIATION EXPOSURE

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30
Q

Tx of acute sinusitis?

A
  • Similar to AOM
  • treat until symptoms gone for 7 days
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31
Q

TQ

Complications of sinusitis?

A
  • Periorbital (Preseptal) cellulitis
  • Orbital cellulitis (emergency–>brain!)
  • **Osteomyelitis of the frontal bone: POTT PUFFY TUMOR
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32
Q

Sinusitis w/ Peri-orbital cellulitis vs. just orbital cellulitis?

A
  • peri-orbital: no pain w/ moving eyes
  • orbital: hurts w/ movement + proptosis
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33
Q

MC reason for older kids and adults to seek medical care……

A

sore throat

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34
Q
  • primary concern of MOST
  • accounts for about 15-30% of all cases of pharyngitis in kids ages 5-15
  • Rare under the age of two years…..unless direct exposure to infected sibling, etc…. 
A

Group A strep pharyngitis

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35
Q

TQ

What is the six point scale indicative of GAS?

A
  • Age (5-15)
  • Season (fall, winter, early spring)
  • Evidence of acute pharyngitis on exam
  • Erythema, petchiae, edema, and/or exudates
  • Tender, enlarged (>1cm) anterior cervical lymph node
  • Moderate grade fever (101-104 F)
  • **Absence of usual signs of URI (cough, coryza, nasal congestion)
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36
Q

Why do you treat GAS?

A
  • Shortens clinical illness
  • Prevents complications (AOM, acute bacterial sinusitis, peritonsillar/retropharyngeal abscess, rheumatic fever)
  • Prevent spread to others
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37
Q

TQ

Differential of GAS pharyngitis/tonsillitis?

A
  • **Viruses #1 cause
  • Neisseria gonorrhea
  • Corynebacterium diphtheria
  • Mycoplasma pneumoniae
  • **Infectious Mononucleosis**
  • Non-group A streptococci (C & G) (tx if S/S)
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38
Q
  • Gray exudate on tonsils
  • hepatosplenomagly
  • fever
  • fatigue
  • sore throat
  • swollen lymph glands
A

Mononucleosis!!

  • Infants and young children: most often asymptomatic or like any other virus
  • Many young children do not produce heterophile antibodies…must perform EBV antibody titers.
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39
Q

Older kid presents w/:

  • Malaise
  • Fever (low grade)
  • Sore throat (maybe)
  • Abdominal pain

Then

  • Cervical lymph node swelling
  • Moderate fever
  • tonsillitis/pharyngitis
A

EBV in Mononucleosis

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40
Q
  • Splenomegaly: about 50% of patients (3rd week)
  • 10% of cases are caused by other viruses (CMV, HHV-6, Hep-B, etc)
  • 30 day incubation period is common (4-8 weeks).
  • Erythematous maculopapular rash, (esp w/ antibiotic use)

TX? 

A

EBV mono Tx:

  • Symptoms
  • Corticosteroids?
  • Antivirals (acyclovir) not recommended
  • Vitamins ? (appetite is low, can’t hurt)
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41
Q

Often associated with GAS infection?

A

EBV mono

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42
Q

Peds pt presents w/…whats the infx?

  • Most often mild illness
  • Painful oral lesions: decreased oral intake and dehydration
  • Moderate fever
  • Vesicles gone ~ 7days
  • Enterovirus version more likely to have CNS and more complicated course/death in very young.
  • Treatment is symptomatic relief and maintenance of hydration
  • Parents need reassurance but don’t ignore worsening of symptoms
  • Can reoccur due to multiple causes…so can be confusing to parents/docs
A

Hand-Foot-Mouth & bottom Disease
-Coxsackie A16!!!

Also: Enterovirus 71 and others (mostly Coxsackie A & B)

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43
Q
  • A 5 week old male presents with a chief complaint of ‘cough’.
  • 1 wk runny nose (clear)
  • cough began 3 days ago and worse at night
  • Breathing harder/SOB, course breath sounds, tight exp wheezes w/ retractions
  • NO fever
  • Decr feeding due to congestion and cough
  • Less wet diapers
  • Incr spitting up (+mucus)
  • No one sick at home

Thinking of URI, bronchiolitis, pneumonia @ this pt..
-tachypneic w/ head bobbing
-RR 70, HR 160, pulse ox 87% RA**
-tachycardic, CR 2 sec (N: capillary refill
Get baby oxygen Dx?

A

Bronchiolitis (expiratory wheezes w/ clear rhinorrhea…prob due to RSV)
Pneumonia would show distress

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44
Q

Causes of bronchiolitis?

A
  • RSV most common etiologic agent (>50%)
  • Adenovirus
  • Human metapneumovirus
  • Influenza virus
  • Parainfluenza virus
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45
Q

Pathogenesis of bronchiolitis?

1) Virus-induced necrosis of bronchiolar epithelium
2) Hypersecretion of mucus
3) Round cell infiltration and edema of submucosa>>mucus plugs that obstruct bronchioles
4) ????????
5) Respiratory obstruction results
6) Leads to air trapping and overinflation
7) If complete obstruction, trapped distal air>>atelectasis
8) ???????????
9) Severe obstructive disease and tiring of effort, hypercapnia can result 

A

1) Virus-induced necrosis of bronchiolar epithelium
2) Hypersecretion of mucus
3) Round cell infiltration and edema of submucosa>>mucus plugs that obstruct bronchioles
4) Bronchiolar wall thickening ( a two-fold decrease in diameter leads to an 16 fold increase in resistance!!! (R=1/r4))
5) Respiratory obstruction results
6) Leads to air trapping and overinflation
7) If complete obstruction, trapped distal air>>atelectasis
8) Ventilation-perfusion mismatch can occur, and hypoxemia develops (perfused w/o ventil)
9) Severe obstructive disease and tiring of effort, hypercapnia can result 

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46
Q
  • First sign=rhinorrhea (1-3 days)
  • Then cough
  • Then wheezing
A

Bronchiolitis
Co-infection with >1 virus can alter clinical manifestations and/or severity 

47
Q

-10 yr old boy presents w/ cc “fever and cough”
-sick for 4 days
-runny nose (clear) + nasal congest + cough (prod.)
-sore throat
-Fever of 102.5
-Cough worsened overnight
-Decr appetite
-Difficulty climbing stairs this AM
At this point thinking URI
-RR 40 HR 120 BP 100/66 O2 95%
-Appears tired, but interactive
-TM’s red bilat -tachypneic, faint exp wheezes, crackles RML
-cap refill Dx? Due to …

A

Pneumonia! due to mycoplasma (atypical b/c wheezes and red TM)
RR N=20…his is 40..
(Incr RR + fever/cough)= pneumonia

TWISTS:

  • Patient was not wheezing OR Patient had respiratory distress OR Pt appeared toxic? =S. pneumo
  • Pt had a normal lung exam and normal RR? URT 
48
Q

____: Crackles and wheezing on auscultation, slower onset (also in atypical)…bronchiolitis
_____: Sudden chills, fever, cough, chest pain…pneumonia

A

Viral Bacterial

49
Q 
TQ
#1 cause of pneumonia in a neonate?
A
  • # 1 Bacteria: *GBS, E. coli, other gran - rods, s. pneumo, H. flu
  • # 2 Viruses: HSV, entero, adeno
  • Fungus: candida
50
Q

1 cause of pneumonia in a 3wk-3 mo yo?

TQ

A 
#1: RSV, other resp viruses (flu, paraflu, Human metapneumovirus, adeno
-Bacteria: S. Pneumo, H flu, chlamydophila pneumoniae
51
Q

1 cause of pneumonia in a 4 month-4 yo?

A
  • RSV, other resp viruses
  • Bacteria: S. Pneumo, H flu, mycoplasma, moraxella, Group A strep
52
Q 
TQ
#1 cause of pneumonia in a \>5 yo?
A 
#1 Bacteria: Mycoplasma, S. pneumo, Chlamydophila pneumoniae, H flu,
#2 Viruses: influenza, adeno, other resp viruses

Note the progression of etiology:
Bacterial (neonate)>>viral>>bacterial (>5)….better immunity as you get older and when your a baby throne into a lot of dirty places

53
Q

TQ

  • spread of infection along the airways
  • Direct injury to resp epithelium
  • Airway obstruction from airway swelling, secretions and “cellular debris”*****
  • Young infants plug
A

Viral pneumonia
Streaky CT w/ flattened diaphragm

54
Q
  • attaches to resp epithelium
  • inhibits ciliary action
  • Leads to cellular destruction Inflammatory response in submucosa
  • Sloughed cellular debris, inflammatory cells and secretions cause obstruction and spread infection along bronchial tree (as in viral)
  • Abrupt onset
  • Fever
  • Malaise
  • Myalgia
  • HA
  • Photophobia
  • Sore throat -
  • Gradually worsening non prod cough
A

Mycoplasma/chlamydophila
lobar…lost heart border on CT=pneumonia

55
Q
  • produces local edema
  • Aids in proliferation of organisms and spread into adjacent portions of lung
  • Characteristic focal lobar involvement
  • “round pneumonia”
  • Fever, non productive cough, decreased BS over affected lobe
  • Complications include empyema, parapneumonic effusions
  • Hematologic spread can lead to meningitis, sepsis, suppurative arthritis, osteomyelitis
A

S. pneumo pneumonia

56
Q
  • more diffuse infection with interstitial Pneumonia
  • Necrosis of tracheobronchial mucosa
  • Large amounts of exudate, edema and local hemorrhage
  • Extension into alveolar septa
  • Involvement of lymph vessels=increased likelihood of pleural involvement
A

Group A strep

emphysema, effusion

57
Q

TQ

  • confluent bronchopneumonia
  • Often unilateral
  • Extensive areas of hemorrhagic necrosis
  • Irregular areas of cavitation of parenchyma, resulting in pneumatocoeles, empyema, bronchopulm fistulas
  • **After influenza infection
A

Staph cavitary lesions

58
Q
  • MC cause of thrombocytopenia from increased destruction of platelets in infants and children
  • Auto-Abs, drug-dependent Ab or allo-Abs interact with platelet membrane Ags, leading to increased platelet clearance from circulation
A

Immune-mediated platelet destruction

59
Q
  • Immune thrombocytopenic purpura
  • Acquired immune-mediated disorder characterized by isolated thrombocytopenia in the absence of any obvious initiating or underlying cause
  • MC immune-mediated thrombocytopenia in children
A

Primary ITP

60
Q

Presentation:

  • Sudden appearance of bruising or mucocutaneous bleeding
  • Often after viral illness
  • NO systemic sx such as fever, wt loss, bone pain
  • NO lymphadenopathy or HSM should be present
  • Other than bleeding, should appear well
A

ITP (diagnosis of exclusion
Classification:
- Newly diagnosed
- Persistent (3-12 months)
- Chronic (>12 months)

61
Q

ITP:

  • (increased/decreased) platelet count
  • (increased/decreased) MPV
A

ITP:

  • DECREASED platelet count
  • INCREASED MPV
62
Q

Significantly elevated MPV suggests (once ITP is confirmed):

A

Macrothrombocytopenia

63
Q

Mildly elevated MPV suggests:

A

Destruction

64
Q

Low MPV suggests:

A

Wiskott Aldrich syndrome

65
Q

Presence of schistocytes on peripheral smear suggests:

A

Microangiopathic process (DIC, HUS, TTP)

66
Q

+ direct Coombs suggests:

A

autoimmune process

67
Q

Fibrin degradation products and fibrinogen measurements suggest:

A

DIC

68
Q

Edema in HSP can lead to:

A

Intussusception

69
Q

-MC childhood systemic vasculitis
-Often follows URI (classically Group A Strep)
-Classic triad:
Skin (palpable purpura on buttocks/legs),
Arthralgia,
GI (abdominal pain - may be first sign)
-Vasculitis 2º to IgA1 immune complex deposition

A

Henoch-Schonlein purpura

70
Q

The single most important lab for HSP is:

A

Urinalysis (UA)

71
Q

TQ

  • 16 male w/ school/behavioral problems
  • Mental retardation + ADHD
  • Elongated face
  • Large cupped ears
  • High arched palate
  • Macro-orchidism
  • MVP, scoliosis, joint laxity
  • Anxiety

What would PCR reveal?

A

Fragile X (X-linked dom)
250 CGG repeats on FMR1 gene on X chromosome>>
FMR1 promotor methylated>>
Silenced>>
No FMRP

72
Q
  • Baby appearance slanted eyes w/ round face, flat face, epicanthal folds, small dysplastic ears, large tongue w/ small nose, short neck
  • Mom=Navajo
  • simean crease, short metacarpals, phalanges
  • sandletoe deformity (wide gap b/t 1st and 2nd toes)
  • high arched palate
  • hyperflexible

What should you worry about?

A

Trisomy 21
(Dx: FISH)
Congenital heart defects! (Endocardial cushion defects (AV canal) or VSD
may also have duodenal atresia, Hirschsprung, etc

73
Q

Pt w/ trisomy 21…what do you worry about as they get older?

A
  • Cataracts and refractive errors!
  • AA subluxation!
  • hearing loss
  • developmental delay
  • hypothyroidism
74
Q

Pt presents for sports physcial.

  • Very tall
  • Arachnodactyly
  • Arm span>height
  • Lens dislocation
  • Incr aortic diameter (dilation)

What protein is abnormal

A

Fibrillin-1 (marfan’s)
Mut at FBN1 locus on chrom 15 (Autosomal Dom)

75
Q

Skeletal manifestations of Marfans?

A
  • Disproportionate growth of long bones
  • pectus carinatum/excavatum
  • arm span > ht
  • arachnodactylyl
  • scoliosis
76
Q
  • No puberty at 14 yo
  • behavioral problems
  • tall
  • small testicles
  • sparse facial hair
  • gynecomastia
A

Klinefelters 47 XXY
each X decr IQ 10-15 pts

77
Q
  • no period at 15 yo
  • avg school performance
  • webbed neck
  • short
  • broad chest
  • protruding ears
  • lymphedema
  • Congenital heart defects
  • renal abnormalities
A

Turners (45XO)

78
Q
  • perpetually hungry child whos overwt
  • behavior problems
  • couldn’t gain wt + poor tone as infant
  • almond shaped eyes
  • small hands, feet, tapering of fingers
  • downturned mouth
  • narrow forehead
  • thin upper lip

What anomaly? Which parent?

A

Prader-Willi (Deletion of Dad’s 15)
Dx: Chromosomal microarray or FISH (15q11-13), PCR

Mom’s deleted=Angelman syn (happy puppet..ataxia w/ laughter)

79
Q

TQ

Describe the categories of asthma.

  • Intermittent:
  • Mild persistent:
  • Moderate persistent:
  • Severe persistent:
A
  • Intermittent: 2 days/wk or 2 nights/month
  • Mild persistent: >2 days/wk or >2 nights/month
  • Moderate persistent: everyday, but not all day
  • Severe persistent: constant symptoms
80
Q

TQ
Explain the Apgar scores. (5 categories)
What score constitutes no further assistance?

A 
Heart rate (0 to 2)
Respiratory effort (0-2)
Muscle tone (0 to 2)
Reflex irritability (0 to 2)
Color (0 to 2)

90% are between 7-10 (no further assistance)

  • term or late preterm
  • spontaneous respirations
  • good tone
  • pink color
81
Q

Describe the transition period of a neonate.
How long?
Temp:
Resp rate:
HR:

A

Transition period in neonate:

  • generally 4-6 hours (decrease in pulm vascular resistance, improve alveolar air exchange (oxygenation)
  • temp: 97.7-99.5
  • resp rate: 40-60
  • HR: 120-160 (80-160) – reflected by pink color and good tone!
82
Q

TQ
What ophthalmic ointment Rx is given to neonate for prevention of Gonorrhea/Chlamydia (less against chlamydia)?

A

Erythromycin 0.5%

83
Q

Feedings and early weight loss is especially important in:

A
  • infants of diabetic mothers (IDA)
  • small babies (IUGR/late-preterm)
  • large for gestational age (LGA)

Birth weight is regained by 10-14 days.
Normal weight gain 15-30 g/day.

84
Q

Jaundice/hyperbilirubinemia is seen when values are ≥ __mg% (mg/L).

A

Jaundice/hyperbilirubinemia is seen when values are ≥ 25mg% (mg/L).

85
Q

How do you initially assess respiratory effort?

A

Watch the baby!
Initial and most effective evaluation is with the eyes and ears – unaided.

86
Q

T/F: At rest, breathing almost entirely diaphragmatic (see-saw) pattern. If baby is quiet, relaxed and of good color, see-saw does not necessarily signify insufficient ventilation.

A

TRUE

87
Q

TQ
MC pleural space problem in terms of respiratory effort:

A

Pneumothorax
-MC spontaneous pneumothorax or from PPV during resuscitation

88
Q
  • Blue discoloration of the peri-oral area, feet, and hands
  • Normal for the first 24 hours
  • Closely associated with cool surroundings
  • Peri-oral changes seen with sucking/feedings
A

Acrocyanosis

89
Q

T/F: Mottling of skin means poor perfusion.

A

TRUE

90
Q
  • Bluish discoloration of tongue/mucous membranes
  • Persisting after the first 10 minutes of life is always abnormal – think cardiac dz/pulm dz
A

Central cyanosis
-Bruises do not blanch (eg, due to facial presentation), cyanosis blanches.

91
Q
  • Most often indicates severe acidosis in the newborn and often poor outcome
  • Seen in severe infections and cardiac dz with poor perfusion of tissue (shock)

What color?

A

GRAY IS BAD

92
Q

Full term healthy babies should mostly be ______, with resistance noted when extremities moved.

A

Full term healthy babies should mostly be FLEXED, with resistance noted when extremities moved. (ie, no floppy baby)

93
Q

“___ ______” is evaluated to ensure lack of opacity of the lens and cornea and to look for intraocular mass (retinoblastoma).

A

“RED REFLEX” is evaluated to ensure lack of opacity of the lens and cornea and to look for intraocular mass (retinoblastoma). (in darker skinned infants, may be more pearly gray – vessels still present)

94
Q

MC abnormal finding of the nose is being misshapen 2º to:

A

Birthing or intrauterine positioning

95
Q

TQ
One cause of nasal obstruction is choanal atresia.
What is choanal atresia?
What happens to the baby when crying vs. not crying in terms of cyanosis?

A

Choanal atresia (CHARGE mnemonic):
C-Coloboma
H-Heart defects
A-Atresia choanne
R-Retarded growth/development
G-Genital abnormalities
E-Ear abnormalities

**Baby may become cyanotic when NOT crying**

96
Q

Normal HR in newborn is:

A

100-160

97
Q

The disappearance of a murmur in a clinically deteriorating infant is indicative of a “ductal dependent” lesion: (3)

A

Coarctation of aorta
Tricuspid atresia
Pulmonary atresia

98
Q

T/F: The most important part of the respiratory system evaluation is observation of the newborn breathing.

A

TRUE

99
Q
  • More common in African/Americans
  • In white population – assoc with renal abnormalities (hydronephrosis, hypoplasia, etc)
  • Anywhere along mammary line
A

Supernumerary nipples

100
Q

Most infants have a rounded abdomen ion visual abdomen. A scaphoid abdomen is seen with _____________ hernia and in ___ infants.
A full upper abdomen with a flattened lower abdomen is indicative of a (proximal/distal) obstruction or atretic lesion.

A

Most infants have a rounded abdomen ion visual abdomen.
A scaphoid abdomen is seen with DIAPHRAGMATIC hernia and in SGA infants.
A full upper abdomen with a flattened lower abdomen is indicative of a PROXIMAL obstruction or atretic lesion.

101
Q

Extreme distension of the abdomen at birth or shortly after… think pathology (3)

A

-Ascites (hydrops)
-Meconium ileus
-Intrauterine midgut volvulus
Absence of bowel sounds is a concern.
Shiny, taut abdomen = BAD.

102
Q

TQ

  • May be B/L
  • DO NOT CROSS SUTURE LINES
  • Increase in size after delivery
  • Can be tense or fluctuant
  • Late can mimic a fracture on xray
  • Weeks to months for resolution
A

Cephalohematoma (subperiosteal bleed)

103
Q

TQ

  • Boggy area of edema and/or bruising
  • CROSSES SUTURE LINES
  • Gone in days (disappears without tx)
  • Present at birth (generally does not enlarge)
  • No pathological significance
A

Caput succedaneum (a baseball “cap” crosses suture lines)

104
Q
  • Least common of the extracranial injuries, but the most dangerous
  • Very significant amount of blood loss is possible
  • Enlarges after birth
  • Crosses suture lines
  • Can cover the entire scalp and extend in to the neck
  • ‘Fluid wave’
A

Subgaleal hemorrhage

105
Q

TQ
T/F: Re-examination of the hips before discharge has been shown to be the only consistent portion of the physical exam to pick up an abnormality not seen prior.

A

TRUE

106
Q

T/F: Ambiguous genitalia requires urgent evaluation at appropriately staffed institution and is considered an endocrine emergency.

A

TRUE

107
Q

Epispadias (dorsal meatal opening) is much less common and associated with:

A

Bladder exstrophy

(White sebaceous cysts are relatively common in the distal foreskin and of no consequence.)

108
Q

How can test hydrocele vs hernia?

A

Transillumination (in hydrocele)

109
Q

What are the VACTERL abnormalities?

A

Vertebral defects
Anal atresia
Cardiac defects
Tracheoesophageal fistula
Esophageal atresia
Renal abnormalities and/or radial dysplasia
Limb defects

110
Q
  • White, cheesy stuff that babies have all over (especially inguinal/axillary)
  • Appears about 35 weeks and may be gone at 41 weeks
A

Vernix
Long nails, lack of vernix, peeling/dry skin – signs of post-maturity.

111
Q
  • Benign rash of the newborn
  • Usually appears day 2-3 of life (gone in 7-14 days)
  • Erythematous base with 1-2mm pustules or papules
  • Spares palms/soles
  • Pustule/vesicles contain debris and eosinophils
A

Erythema toxicum neonatorum (flea-bite syndrome)

112
Q
  • Appear on face and scalp
  • 1-2mm white, firm papules on the face and bridge of the nose
  • Resolve spontaneously by a few months
  • Appear at 36 weeks gestation
A

Milia

113
Q
  • Slate blue/gray or black
  • Macular to patch size
  • More common in darker skinned races, but affects all (up to 90% Af-Am, 80% Asian)
  • Benign
  • Those on lower back/buttocks tend to resolve over several years
  • Resemble bruises
  • Formerly ‘Mongolian Spots’
A

Slate Gray Spots (“Dermal Melanosis”)

Peds (7 decks)

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