VanGarsse Flashcards
TQ The second MC illness seen in physician office in peds
Otitis media
TQ What is the difference between acute otitis media (AOM) and otitis media with effusion (serous) (OME)?
- 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
- 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+
MEE (middle ear effusion) component of both AOM and OME
T/F
- 99% of children get OM by 2 years old
- More common in males, native americans, and in certain families (genetic)
True
TQ
What are some environmental causes of OM?
- *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
What are some protective factors against OM?
Breastfeeding
Pneumococcal vaccine (decr 7%)
TQ
What is the pathogenesis of acute otitis media?
Earlier event (cold)>>
Inflam/congestion of respiratory mucosa>>
Eustachian tube obstruc/dys>>
Movement of secretions neg pressure >>
Microbial growth
MC bacteria causing AOM?
- 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
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
Acute Otitis Media
A normal eardrum looks gray (pearly), translucent, & concave (slightly)
What could an abnormal ear drum look like? 
- Inflammation (redness)
- Fluid (clear/bubbles/opaque/yellow)
- Bulging/retracted
- Mobility
What is the purpose of inserting tubes into a pt’s ear canal?
To equalize pressure to help perserve hearing
T/F
Effusion may occur weeks after onset of acute otitis media
TRUE (up to 4, 12, 16 wks!)
See air bubbles on eardrum?
OME
TQ
What is a “pneumatic otoscopy”?
- 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*
TQ
T/F You can diagnose AOM without a middle ear effusion (based on pneumatic otoscopy +/- tympanometry)
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
When treating OM it is impt to be prompt, because this may prevent development of complications such as…
- mastoiditis :(
- systemic spread of infection
- chronic hearing loss
Tx of OM?
In addition to..
- Topical pain relief (if TM intact)
- Oral pain meds (IBUPROFEN, acetaminophen + Hydrocodone (Lortab))
- # 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 
- Inflammation of the external auditory canal or auricle
- Infectious, allergic, and dermal disease
- Acute bacterial MC
Otitis Externa
Difference in anatomy of the ear b/t infants and older children/adults?
- 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)
- 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)
Otitis Externa (OE)
TQ
Causes of OE?
- *P. aeruginosa
- S. aureus
- Enterobacter aerogenes
- Proteus mirabilis
- Klebsiella pneumonia
- Streptococci + coag-neg staph
- Diphtheroids
- Fungi: Candida + Aspergillus
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
Otitis Externa
Tx of OE?
- Clean the ear canal (gently)
- Treat inflam + infx: drops
- Control pain
- Culture severe or recalcitrant cases
- Avoidance or prevention
TQ
Timeline for appearance of sinuses? (sinusitis can occur at any age!)
- Ethmoidal & maxillary sinuses are present at birth
- Sphenoid: 5 years
- Frontal: 7-8 years
Pathogenesis of sinusitis?
cold–>swelling–>cant drain–>infx (like AOM)
- Nasal obstruction (polyps, foreign bodies, etc) (unilateral ear rhinorrhea)
- Immune system deficiencies (any cause)
TQ
Bacterial causes of sinusitis?
- Streptococcus pneumoniae: 30%
- H. Influenzae (non-typeable): 20% (50% b-lactamase +)
- Moraxella catarrhalis: 20% (100% b-lactamase +) amox/clav!
- Typically follows URI
- Mucosal thickening, edema, and inflammatory changes
- Ostiomeatal complex obstructed
- Decreased clearance of bacteria from the nasopharynx
Sinusitis
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
Acute bacterial sinusitis
note:chronic sinusitis may have symptoms for 3 months or more.
TQ
- Sinus aspirate
- only truly accurate method of diagnosis, but not practical
- Radiology: plain films are not helpful
- CT is gold standard, BUT……
DO NOT ORDER A CT B/C OF RADIATION EXPOSURE
Tx of acute sinusitis?
- Similar to AOM
- treat until symptoms gone for 7 days
TQ
Complications of sinusitis?
- Periorbital (Preseptal) cellulitis
- Orbital cellulitis (emergency–>brain!)
- **Osteomyelitis of the frontal bone: POTT PUFFY TUMOR
Sinusitis w/ Peri-orbital cellulitis vs. just orbital cellulitis?
- peri-orbital: no pain w/ moving eyes
- orbital: hurts w/ movement + proptosis
MC reason for older kids and adults to seek medical care……
sore throat
- 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…. 
Group A strep pharyngitis
TQ
What is the six point scale indicative of GAS?
- 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)
Why do you treat GAS?
- Shortens clinical illness
- Prevents complications (AOM, acute bacterial sinusitis, peritonsillar/retropharyngeal abscess, rheumatic fever)
- Prevent spread to others
TQ
Differential of GAS pharyngitis/tonsillitis?
- **Viruses #1 cause
- Neisseria gonorrhea
- Corynebacterium diphtheria
- Mycoplasma pneumoniae
- **Infectious Mononucleosis**
- Non-group A streptococci (C & G) (tx if S/S)
- Gray exudate on tonsils
- hepatosplenomagly
- fever
- fatigue
- sore throat
- swollen lymph glands
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.
Older kid presents w/:
- Malaise
- Fever (low grade)
- Sore throat (maybe)
- Abdominal pain
Then
- Cervical lymph node swelling
- Moderate fever
- tonsillitis/pharyngitis
EBV in Mononucleosis
- 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? 
EBV mono Tx:
- Symptoms
- Corticosteroids?
- Antivirals (acyclovir) not recommended
- Vitamins ? (appetite is low, can’t hurt)
Often associated with GAS infection?
EBV mono
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
Hand-Foot-Mouth & bottom Disease
-Coxsackie A16!!!
Also: Enterovirus 71 and others (mostly Coxsackie A & B)
- 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?
Bronchiolitis (expiratory wheezes w/ clear rhinorrhea…prob due to RSV)
Pneumonia would show distress
Causes of bronchiolitis?
- RSV most common etiologic agent (>50%)
- Adenovirus
- Human metapneumovirus
- Influenza virus
- Parainfluenza virus
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 
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 
- First sign=rhinorrhea (1-3 days)
- Then cough
- Then wheezing
Bronchiolitis
Co-infection with >1 virus can alter clinical manifestations and/or severity 
-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 …
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 
____: Crackles and wheezing on auscultation, slower onset (also in atypical)…bronchiolitis
_____: Sudden chills, fever, cough, chest pain…pneumonia
Viral Bacterial
TQ #1 cause of pneumonia in a neonate?
- # 1 Bacteria: *GBS, E. coli, other gran - rods, s. pneumo, H. flu
- # 2 Viruses: HSV, entero, adeno
- Fungus: candida
1 cause of pneumonia in a 3wk-3 mo yo?
TQ
#1: RSV, other resp viruses (flu, paraflu, Human metapneumovirus, adeno -Bacteria: S. Pneumo, H flu, chlamydophila pneumoniae
1 cause of pneumonia in a 4 month-4 yo?
- RSV, other resp viruses
- Bacteria: S. Pneumo, H flu, mycoplasma, moraxella, Group A strep
TQ #1 cause of pneumonia in a \>5 yo?
#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
TQ
- spread of infection along the airways
- Direct injury to resp epithelium
- Airway obstruction from airway swelling, secretions and “cellular debris”*****
- Young infants plug
Viral pneumonia
Streaky CT w/ flattened diaphragm
- 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
Mycoplasma/chlamydophila
lobar…lost heart border on CT=pneumonia
- 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
S. pneumo pneumonia
- 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
Group A strep
emphysema, effusion
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
Staph cavitary lesions
- 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
Immune-mediated platelet destruction
- 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
Primary ITP
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
ITP (diagnosis of exclusion
Classification:
- Newly diagnosed
- Persistent (3-12 months)
- Chronic (>12 months)
ITP:
- (increased/decreased) platelet count
- (increased/decreased) MPV
ITP:
- DECREASED platelet count
- INCREASED MPV
Significantly elevated MPV suggests (once ITP is confirmed):
Macrothrombocytopenia
Mildly elevated MPV suggests:
Destruction
Low MPV suggests:
Wiskott Aldrich syndrome
Presence of schistocytes on peripheral smear suggests:
Microangiopathic process (DIC, HUS, TTP)
+ direct Coombs suggests:
autoimmune process
Fibrin degradation products and fibrinogen measurements suggest:
DIC
Edema in HSP can lead to:
Intussusception
-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
Henoch-Schonlein purpura
The single most important lab for HSP is:
Urinalysis (UA)
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?
Fragile X (X-linked dom)
250 CGG repeats on FMR1 gene on X chromosome>>
FMR1 promotor methylated>>
Silenced>>
No FMRP
- 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?
Trisomy 21
(Dx: FISH)
Congenital heart defects! (Endocardial cushion defects (AV canal) or VSD
may also have duodenal atresia, Hirschsprung, etc
Pt w/ trisomy 21…what do you worry about as they get older?
- Cataracts and refractive errors!
- AA subluxation!
- hearing loss
- developmental delay
- hypothyroidism
Pt presents for sports physcial.
- Very tall
- Arachnodactyly
- Arm span>height
- Lens dislocation
- Incr aortic diameter (dilation)
What protein is abnormal
Fibrillin-1 (marfan’s)
Mut at FBN1 locus on chrom 15 (Autosomal Dom)
Skeletal manifestations of Marfans?
- Disproportionate growth of long bones
- pectus carinatum/excavatum
- arm span > ht
- arachnodactylyl
- scoliosis
- No puberty at 14 yo
- behavioral problems
- tall
- small testicles
- sparse facial hair
- gynecomastia
Klinefelters 47 XXY
each X decr IQ 10-15 pts
- no period at 15 yo
- avg school performance
- webbed neck
- short
- broad chest
- protruding ears
- lymphedema
- Congenital heart defects
- renal abnormalities
Turners (45XO)
- 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?
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)
TQ
Describe the categories of asthma.
- Intermittent:
- Mild persistent:
- Moderate persistent:
- Severe persistent:
- 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
TQ
Explain the Apgar scores. (5 categories)
What score constitutes no further assistance?
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
Describe the transition period of a neonate.
How long?
Temp:
Resp rate:
HR:
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!
TQ
What ophthalmic ointment Rx is given to neonate for prevention of Gonorrhea/Chlamydia (less against chlamydia)?
Erythromycin 0.5%
Feedings and early weight loss is especially important in:
- 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.
Jaundice/hyperbilirubinemia is seen when values are ≥ __mg% (mg/L).
Jaundice/hyperbilirubinemia is seen when values are ≥ 25mg% (mg/L).
How do you initially assess respiratory effort?
Watch the baby!
Initial and most effective evaluation is with the eyes and ears – unaided.
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.
TRUE
TQ
MC pleural space problem in terms of respiratory effort:
Pneumothorax
-MC spontaneous pneumothorax or from PPV during resuscitation
- 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
Acrocyanosis
T/F: Mottling of skin means poor perfusion.
TRUE
- Bluish discoloration of tongue/mucous membranes
- Persisting after the first 10 minutes of life is always abnormal – think cardiac dz/pulm dz
Central cyanosis
-Bruises do not blanch (eg, due to facial presentation), cyanosis blanches.
- 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?
GRAY IS BAD
Full term healthy babies should mostly be ______, with resistance noted when extremities moved.
Full term healthy babies should mostly be FLEXED, with resistance noted when extremities moved. (ie, no floppy baby)
“___ ______” is evaluated to ensure lack of opacity of the lens and cornea and to look for intraocular mass (retinoblastoma).
“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)
MC abnormal finding of the nose is being misshapen 2º to:
Birthing or intrauterine positioning
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?
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**
Normal HR in newborn is:
100-160
The disappearance of a murmur in a clinically deteriorating infant is indicative of a “ductal dependent” lesion: (3)
Coarctation of aorta
Tricuspid atresia
Pulmonary atresia
T/F: The most important part of the respiratory system evaluation is observation of the newborn breathing.
TRUE
- More common in African/Americans
- In white population – assoc with renal abnormalities (hydronephrosis, hypoplasia, etc)
- Anywhere along mammary line
Supernumerary nipples
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.
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.
Extreme distension of the abdomen at birth or shortly after… think pathology (3)
-Ascites (hydrops)
-Meconium ileus
-Intrauterine midgut volvulus
Absence of bowel sounds is a concern.
Shiny, taut abdomen = BAD.
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
Cephalohematoma (subperiosteal bleed)
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
Caput succedaneum (a baseball “cap” crosses suture lines)
- 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’
Subgaleal hemorrhage
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.
TRUE
T/F: Ambiguous genitalia requires urgent evaluation at appropriately staffed institution and is considered an endocrine emergency.
TRUE
Epispadias (dorsal meatal opening) is much less common and associated with:
Bladder exstrophy
(White sebaceous cysts are relatively common in the distal foreskin and of no consequence.)
How can test hydrocele vs hernia?
Transillumination (in hydrocele)
What are the VACTERL abnormalities?
Vertebral defects
Anal atresia
Cardiac defects
Tracheoesophageal fistula
Esophageal atresia
Renal abnormalities and/or radial dysplasia
Limb defects
- White, cheesy stuff that babies have all over (especially inguinal/axillary)
- Appears about 35 weeks and may be gone at 41 weeks
Vernix
Long nails, lack of vernix, peeling/dry skin – signs of post-maturity.
- 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
Erythema toxicum neonatorum (flea-bite syndrome)
- 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
Milia
- 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’
Slate Gray Spots (“Dermal Melanosis”)
