Pediatrics - Neonatology

Front 1

apgar score

Back 1

heart rate
respiration
color
tone
reflex irritability

Front 2

routine newborn care

Back 2

cleanse and rinse
bacterocidal agent to cord
1% silver nitrate or 0.5% erythromycin for eyes
1mg vitamin K IM

Front 3

birth injuries

Back 3

subconjunctival hemorrhage
skull fracture
brachial palsy
clavicular fracture
facial nerve palsy
caput succedaneum
cephalohematoma
subcutaneous fat necrosis

Front 4

subconjunctival hemorrhage

Back 4

from sudden increase in intrathoracic pressure passing through canal; resolves spontaneously

Front 5

skull fractures of newborn

Back 5

linear --> most common; no symptoms nor treatment needed
depressed --> elevate to prevent cortical injuries
basilar --> fatal

Front 6

brachial palsy

Back 6

Erb-Duchene --> C5-C6; no sholder abduction, external rotation or supination of arm
Klumpke --> C7/C8 +- T1; paralyzed hand +- Horner syndrome
most will recover

Front 7

clavicular fracture

Back 7

from shoulder dystocia in vertex position and arm in extension in breech; palpable callus within a week; immobilization

Front 8

facial nerve palsy

Back 8

from forceps or pressure during delivery; improves over week or neuroplasty

Front 9

caput succedaneum

Back 9

diffuse edematous swelling of scalp which crosses suture lines; spontaneously dissapears

Front 10

cephalohematoma

Back 10

diffuse edematous swelling of scalp which does not cross suture lines; spontaneously dissapears

Front 11

subcutaneous fat necrosis

Back 11

difficult labor/delivery, perinatal asphixia, prolonged hypothermia; hypocalcemia

Front 12

cutis marmorata

Back 12

lacy, reticulated vascular pattern over skin on most of the body; improves but may be associated with syndromes

Front 13

milia

Back 13

firm white papules, inclusion cyst and Epstein pearls on palate midlines; resolves

Front 14

salmon patch

Back 14

nevus simplex; pale pink vascular macules usually symmetric; facial ones dissapear

Front 15

mongolian spots

Back 15

blue to slate-gray macules on presacral, back or posterior thighs; improves; differentiate from child abuse

Front 16

erythema toxicum

Back 16

firm yellow-white papules/pustules with erythematous base; self-limited; differentiate from SSSS

Front 17

port-wine stain

Back 17

vascular malformation, permanent, unilateral; rule out Sturge-Weber; laser treatment

Front 18

hemangioma

Back 18

superficial --> bright red protuberant sharply demarcated; involutes in years
deep --> bluish hue firm cystic; may persist; check internal organs; laser therapy

Front 19

neonatal acne

Back 19

erythematous papules on face from high maternal androgens; no treatment

Front 20

preauricular tags/pits

Back 20

may indicate hearing loss and GU anomalies

Front 21

nevus sebaceous

Back 21

area of alopecia with nodular orange skin; possible malignancy; remove before adolescence

Front 22

coloboma of iris

Back 22

cleft at six-o-clock position; most have other eye anomalies; CHARGE association

Front 23

aniridia

Back 23

hypoplasia of iris; associated with Wilms tumor

Front 24

brachial cleft cyst

Back 24

mass on lateral neck; infections are common; surgical removal

Front 25

thyroglosal duct cyst

Back 25

mass on neck midline; moves with swallowing

Front 26

congenital torticollis

Back 26

knotted-up sternocleidomastoid; treat with passive ROM exercises

Front 27

breast hypertrophy

Back 27

common; should be symmetric; otherwise may be absecess or mastitis

Front 28

suppernumerary nipples

Back 28

usually along mammary gland; associated with renal and cardiovascular anomalies

Front 29

Poland syndrome

Back 29

amastia, pectoralis muscle aplasia, rib deformities, webbed fingers, radial nerve aplasia

Front 30

pectus excavatum/carinatum

Back 30

usually benign; correction for cosmetic reasons

Front 31

diaphramagmatic hernia

Back 31

scaphoid abdomen and bowel sounds in chest

Front 32

omphalocele

Back 32

sac covered protrusion through umbilicus; associated with malformations and chromosome disorders

Front 33

umbilical hernia

Back 33

most close spontaneously; consider congenital hypothyroidism

Front 34

gastroschisis

Back 34

uncovered protrusion lateral to abdominal midline; may have intestinal atresia

Front 35

abdominal masses in newborn

Back 35

polycystic kidney disease, hydronephrosis, enlarged bladder

Front 36

hydrocele

Back 36

transitory; palpation and illumination of testes diffrentiated from inguinal hernia

Front 37

hypospadia

Back 37

urethral opening on ventral surface of penis

Front 38

epispadia

Back 38

urethral opening on dorsal surface

Front 39

undescended testes

Back 39

usually in inguinal canal; differentiate from retractile testes; if not descended by one year then surgical removal to avoid sterility and malignancy

Front 40

hernias in newborn

Back 40

usually inguinal and indirect; surgical treatment

Front 41

syndactyly

Back 41

fusion of fingers or toes; get x-ray first for surgical planning

Front 42

polydactyly

Back 42

> 5 fingers; no treatment needed if good blood supply

Front 43

newborn screening

Back 43

do before discharge or fourth day
more realiable after 48 hours
examples: phenylketonuria, galactosemia, hypothyroidism

Front 44

phenylketonuria

Back 44

phenylalanine hydroxylase deficiency with excess phe; mental retardation, vomiting, abnormal movements, fair hari skin blue eyes, normal at birth; treatment is phenylalanine restriction for life

Front 45

galactosemia

Back 45

G-1-P uridyltransferase deficiency; jaundice, hypoglycemia, catarracts, mental retardation, e. coli sepsis; restric lactose

Front 46

intrauterine growth restriction

Back 46

symmetric --> genetic syndromes, chromosomal abnormalities, congenital infections, teratogens
assymetric --> uteroplacental insufficiency due to maternal diseases; placental dysfunction

Front 47

infants of diabetic mothers

Back 47

fetal hyperinsulinemia --> hypoglycemia
large for gestational age and plethoric
hyperbilirubinemia
tachypnea
cardiomegaly - assymetric septal hypertrophy
birth trauma - macrosomia
polycythemia
renal vein thrombosis

Front 48

causes of respiratory distress in newborn

Back 48

respiratory distress syndrome
transient tachypnea of the newborn
meconium aspiration
diaphragmatic hernia

Front 49

respiratory distress syndrome of newborn presentation

Back 49

due to surfactant deficiency in premature
tachypnea, nasal flaring, grunting
hypoxemia, hypercabia and respiratory acidosis

Front 50

respiratory distress syndrome of newborn diagnosis

Back 50

initial diagnostic test --> chest x-ray (ground glass appearance, atelectasis, air bronchograms)
most accurate test --> L/S ratio (done on amniotic fluid prior to birth)

Front 51

respiratory distress syndrome of newborn treatment

Back 51

best initial treatment --> oxygen + nasal continuous positive airway pressure
most effective treatment --> exogenous surfactant administration

prevention --> avoid prematurity with tocolysis
antenatal betamethasone

Front 52

transient tachypnea of newborn

Back 52

due to slow absorption of lung fluid with increased dead space
presents with tachypnea after birth
do chest x-ray (air trapping, fluid in fissures, perihilar streaking
improves within hours to days

Front 53

meconium aspiration presentation

Back 53

meconium passes as result of fetal hypoxia and distress
severe respiratory distress
hypoxemia
barrel chest

Front 54

meconium aspiration diagnosis

Back 54

chest x-ray --> patchy infiltrates, increased AP diameter, flattening of diaphragm

Front 55

meconium aspiration complications

Back 55

pneumothorax
aspiration pneumonitis
pulmonary artery hypertension

Front 56

meconium aspiration treatment and prevention

Back 56

treatment --> positive pressure ventilation, high frequency ventilation, nitric oxide, extracorporeal membrane oxygenation
prevention --> endotracheal intubation and airway suction of depressed infants with thick meconium

Front 57

diaphragmatic hernia

Back 57

abdominal content into thorax causes pulmonary hypoplasia
respiratory distress
scaphoid abdomen
bowel sounds in chest
bowel in chest seen in x-ray
diagnosis --> prenatal ultrasound
treatment --> immediate intubation and surgical correction

Front 58

meconium plugs

Back 58

seen in IODM, Hirchsprung, cystic fibrosis, maternal drug abuse

Front 59

meconium ileus

Back 59

mostly in cystic fibrosis
abdominal distention, vomitting, perforation, no passage of meconium within 24-48 hours
first test --> abdominal x-ray shows distention of bowel loops
treatment --> high gastrografin enemas

Front 60

tracheoesophageal fistula

Back 60

coughing choking or gagging with first feeding
respiratory distress
aspiration pneumonia
mostly proximal esophageal atresia and distal fistula with air in stomach

Front 61

necrotizing enterocolitis

Back 61

transmural intestinal necrosis associated with prematurity
bloody stools, apnea, lethargy, abdominal distention
pneumatosis intestinalis on abdominal x-ray is pathognomonic

Front 62

Hirchsprung disease

Back 62

initial test --> barium enema shws megaacolon proximal to aganglionic segment
best test --> rectal biopsy shows absent ganglionic cells

Front 63

duodenal atresia

Back 63

bilious vomiting from first feeding
abdominal x-ray shows double bubble sign
surgical correction

Front 64

kernicterus

Back 64

unconjugated bilirubin in basal ganglia and brain stem nuclei
hypotonia
seizures
opisthotonos
delayed motor skills
choreoathetosis
sensorineural hearing loss

Front 65

physiologic Vs. pathologic jaundice

Back 65

physiologic --> 2-3 day of life, dissapears by 5th, peak bilirubin 10-12mg/dL, rate of rise <5mg/dL/day
pathologic --> appears in 1st 24 hours, variable dissapearance, unlimited bilirubin, rate of rise > 5mg/dL/day

Front 66

jaundice work-up in newborn

Back 66

1) determine if it's physiologic or pathologic
2) determine if it's direct or indirect
3) if indirect --> Coombs test; if negative -->
4) determine hemoglobin levels

Front 67

indirect hyperbilirubinemia, Coombs test +

Back 67

Rh/ABO incompatibility
thalassemia minor

Front 68

indirect hyperbilirubinemia, Coombs test -, high hb

Back 68

polycythemia
twin-twin transfusion
maternal-fetal transfusion
delayed cord
IUGR
infant of diabetic mother

Front 69

indirect hyperbilirubinemia, Coombs test -, low hb

Back 69

spherocytosis
eliptocytosis
G6PD deficiency
pyruvate kinase

Front 70

direct hyperbilirubinemia causes

Back 70

sepsis
TORCH
total parenteral nutrition
hypothyroidism
galactosemia
tyrosinemia
cystic fibrosis
choledochal cyst

Front 71

treatment of hyperbilirubinemia

Back 71

phototherapy (complications are loose stools, rash, overheating, dehydration, bronze baby)
if phototherapy is not enough --> double volume exchange transfusion

Front 72

Crigler-Najjar type I

Back 72

glucoronyl transferase deficiency leads to unconjugated hyperbilirubinemia
rapid rise in indirect bilirubin >20mg/dL, no hemolysis, kernicterus
Dx --> closed liver bipsy to measure glucoronyl transferase
Tx --> intensive phototherapy and exchange transfusions

Front 73

Crigler-Najjar type II

Back 73

partial glucoronyl transferase deficiency leads to unconjugated hyperbilirubinemia
milder than type I with no kernicterus
Tx --> phenobarbital

Front 74

Gilbert syndrome

Back 74

unconjugated hyperbilirubinemia
low glucoronyl transferase levels
benign, no treatment necessary

Front 75

Dubin-Johnson

Back 75

conjugated bilirubin cant get out of liver
mild disease detected in adolescence

Front 76

Rotor syndrome

Back 76

conjugated bilirubin can't get out of liver
mild disease detected in adolescence

Front 77

neonatal sepsis presentation

Back 77

irritability
poor feeding
fever
grunting
bulging fontanel
delayed capillary filling

Front 78

neonatal sepsis risk factors

Back 78

prematurity
chorioamnionitis
intrapartum fever
maternal leukocytosis
prolonged rupture of membranes

Front 79

neonatal sepsis bugs

Back 79

group B strep
E. coli
listeria

Front 80

neonatal sepsis work-up and diagnosis

Back 80

CBC
blood culture
urinalysis
urine culture
chest x-ray
if meningitis is suspected --> lumbar puncture

Front 81

neonatal sepsis treatment

Back 81

if no meningitis --> ampicillin + aminoglycoside
if meningitis --> ampicillin + 3rd gen ceph (except ceftriaxone)

Front 82

TORCH

Back 82

Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes

Front 83

toxoplasmosis congenital infection

Back 83

usually in cat feces or undercooked raw meat
chorioretinitis
hydrocephalus
generalized intracranial calcifications
seizures
visual impairments

treat mother with spiramycin
treat baby with sulfonamide for 6 months

Front 84

congenital rubella

Back 84

blueberry muffin spots
PDA
pulmonary artery stenosis
cataracts
congenital hearing loss

Front 85

cytomegalovirus neonatal infection

Back 85

periventricular calcifications
microcephaly
chorioretinitis
sensorineural hearing loss

Front 86

neonatal herpes

Back 86

disseminated --> pneumonia, shock, hepatitis
skin, eyes, mouth --> keratoconjunctivits
CNS --> meningitis, lethargy, seizures
outcomes --> deafness, blindness, microcephaly, seizures

diagnosis --> PCR + Tzanck smear culture
treatment acyclovir

Front 87

congenital syphilis

Back 87

before 2 --> fever, anemia, rash, jaundice, anemia
after 2 --> Hutchinson teeth, Clutton joints, saber shins, saddle nose, osteochondritis, rhagades
diagnosis --> radiographic bone changes, treponema in scrapings from lesions; most specific --> FTA-ABS
treatment --> penicillin

Front 88

TORCH work-up if suspected

Back 88

total cord IgM
urine CMV culture --> if negative, excludes CMV
IgM --> toxoplasmosis, rubella
maternal rubella status --> if positive, excludes it
PCR --> for herpes

Front 89

neonatal seizures causes

Back 89

hypoxic ischemic encephalopathy --> cerebral palsy
intraventricular hemorrhage --> preterm
metabolic --> IODM, inborn errors of metabolism, DiGeorge
infection --> TORCH, maternal fever, sepsis/meningitis

Front 90

neonatal seizures work-up

Back 90

EEG --> may be normal
CBC, electrolytes, glucose
if meningitis --> lumbar puncture
if infection --> blood and urine cultures
if preterm --> ultrasound of the head for intraventricular hemorrhage

Front 91

neonatal seizures presentation

Back 91

chewing, tongue thrusting, apnea, staring, blinking, color changes, desaturation