Kaplan Pediatrics: Chapter 1 Newborn

Front 1

The APGAR helps identify infants who require what?

What does it stand for?

Back 1

Resuscitation

Appearance, Pulse, Grimace, Activity, Respiration

Front 2

-

Back 2

-

Front 3

A newborn infant has a blue-gray pigmented lesion on the sacral area. It is clearly demarcated & does not fade into the surrounding skin. What is the most likely diagnosis? What must you differentiate them from...how?

Back 3

Mongolian Spots

Child Abuse = fade into surrounding skin & have different colors

Front 4

Describe Erythema Toxicum
1. when do they appear?
2. what are they full of when scraped?
3. what must you differentiate it from?

Back 4

Small papules or pustules on a red base (50% of full-term babies have it!!!)
1. appear AFTER the 1st day & may last several weeks
2. Eosinophils
3. Staphylococcal Scalded Skin Syndrome = full of neutrophils, skin culture reveals S. aureus, & infant looks ill.

Front 5

Milia

Small inclusion cysts & are pearly white

Epstein's Pearls

**these benign lesions usually exfoliate & disappear within the first few weeks. No treatment necessary

Back 5

What are these called? What is their definition? What are they called if they are in the mouth?

Front 6

Cutis Marmorata

Back 6

This is a vasomotor response to cold stress. The skin assumes a lacy pattern similar to cobblestones. A persistent form is seen in Trisomy 21 & 18

Front 7

A newborn has a flat, salmon-colored lesion on the glabella, which becomes darker red when he cries. What is the best course of management? What must it be differentiated from?

Back 7

the SALMON PATCH is commonly seen over the eyelids, glabella, & in nuchal area. It is a flat vascular lesion that disappears with time, except for those in the Nuchal area, which may persist.

Port Wine Stains = permanent & unilateral

Front 8

Capillary Hemangioma

Back 8

These skin lesions start out as macular lesions in the first few months & quickly grow in the first year of life. They can occur anywhere & are bright red, reminiscent of a strawberry. Rx is usually not necessary b/c they regress spontaneously

Front 9

Nevus Sebaceus (of Jadossohn)

Back 9

Seen in infancy, these are yellow-orange hairless plaques resembling flat warts located on the scalp. B/c they have a potential to become malignant, they are usually removed by adolescence

Front 10

Cafe-au-lait spots

Back 10

These are tan or light brown flat lesions. They can occur anywhere, vary in size, & are sharply demarcated

Front 11

Cephalohematoma

Overlying nondepressed skull fracture

Jaundice = may require phototherapy

Back 11

This is a subperiosteal bleed due to birth trauma. Because it is limited to bone, it DOES NOT CROSS the suture line

What can it be associated with?

What can these be a common cause of?

Front 12

Caput Seccedaneum

Back 12

This is a swelling of the scalp, which involves the presenting part (often Occiput-Anterior). It is caused by the pressure exerted on that part during labor & delivery. Involving the SCALP only, the swelling crosses suture lines & resolves quickly over several days

Front 13

Subcutaneous Fat Necrosis

Back 13

Look for a history of difficult labor & delivery, particularly forceps & vacuum extraction. Rubbery, firm nodules are palpated on the cheeks or buttocks but also the back or extremities. The majority of these lesions resolve spontaneously, although occasionally calcium deposits occur in the lesions

Front 14

What nerve roots does Erb-Duchenne Palsy affect?

Describe the deficit

Back 14

C5-C6

Arm is adducted & pronated & internally rotated

Front 15

What happens if only C4 is affected during traumatic delivery of a newborn?

Back 15

Ipisilateral diaphragmatic paralysis

Front 16

What nerve roots does Klumpke Paralysis involve? What deficit does it produce?

Back 16

C7-T1

Paralysis of the intrinsic hand muscles

***Ipisilateral Horner Syndrome is seen if the sympathetic fibers of T1 are involved

Front 17

This is usually a peripheral palsy, again secondary to difficult delivery. B/c it is a flaccid paralysis, the AFFECTED SIDE DOES NOT MOVE when the baby cries

Back 17

Facial palsy

Front 18

Most commonly fractured bone during delivery & is associated with babies who are LGA & Shoulder Dystocia. What does PE reveal? What can be felt over the fracture? Is treatment usually indicated?

Back 18

Clavicular Fracture

Fussy baby with asymmetric Moro reflex

Crepitus

Rx is usually not indicated

Front 19

What do Subconjunctival Hemorrhage usually result from?

Back 19

Increased pressure during passage thru the birth canal

Front 20

Coloboma

Back 20

This is a congenital anomaly in the lid, ranging from a small notch to a large cleft. It can also involve the retina or iris

Front 21

What is Aniridia associated with? What tumor do you always think of?

Back 21

Hemihypertrophy

Wilm's tumor = kidney tumor

Front 22

What are Pre-auricular skin tags, pre-auricular pits, & malformed ears sometimes associated with?

Back 22

hearing loss and/or GU anomaly

Front 23

This congenital anomaly results from injury to the SCM during delivery, or less commonly from a congenital cervical anomaly. How is it usually treated?

Back 23

Congenital Torticollis

Stretching exercises

Front 24

What is Breast Hypertrophy in the neonate due to?

Back 24

temporary condition secondary to increased circulating hormones

Front 25

What are Supernumerary Nipples (Polythelia) sometimes associated with?

Back 25

Renal & CV anomalies

Front 26

This syndrome has amastia, pectoralis muscle aplasia, rib deformities, webbed fingers, & radial nerve aplasia

Back 26

Poland Syndrome

Front 27

What are the causes of most Abdominal masses in the newborn?

Back 27

Renal = hydronephrosis & Polycystic Kidney Disease

Front 28

This arises from incomplete closure of the fascia of the umbilical ring.

What is it associated with?

Back 28

Umbilical Hernia

Diastasis Recti = separation of the rectus abdominis muscle into right and left halves

**usually close spontaneously by 5 years of age

Front 29

What is an Omphalocele?

What is treatment?

What is it associated with?

Back 29

Herniation of peritoneum & abdominal contents into the base of the umbilical cord = abdominal viscera herniate thru the umbilical & supraumbilical portions of the abdominal wall into a sac covered by peritoneum & amniotic membrane

Immediate Surgical repair

GI & congenital heart defects & Beckwith-Wiedemann's Syndrome (exophthalmos, macroglossia, gigantism, hyperinsulinemia, & hypoglycemia)

Front 30

Define Gastroschisis

Back 30

Contains no sac; the intestine is herniated thru the abdominal wall lateral to the umbilicus

Front 31

What is the cause of Omphalocele?

Back 31

results from arrested folding of the embryonic disc

Front 32

Epispadia

Back 32

Condition in which the urethral opening is located on the dorsum of the penis shaft

Front 33

Hypospadia

Back 33

Condition in which the urethral opening is located on the ventral side of the penis shaft

Front 34

What is sometimes associated with Hypospadia?

Back 34

Chordee

Front 35

What should be avoided in Hypospadia?

Back 35

Circumcision b/c the foreskin is needed for repair

Front 36

What must Cryptorchid testes be differentiated from?

Back 36

Retractile Testes = result from an active cremasteric reflex & do not require treatment
-can be manipulated into the scrotum with gentle pressure...cryptorchid testes cannot be manipulated down

Front 37

1. This is a collection of fluid in the scrotum, specifically the tunica vaginalis.

2. What happens to most of them?

3. Reduction of these by compression should raise suspicion of what?

4. How is 1 diagnosed?

Back 37

1. Hydrocele
2. Involute by 1 year of age
3. Hernia
4. Transillumination

Front 38

A 1-month-old fair-skinned baby presents with projective vomiting of 4 days' duration. Physical exam reveals a baby with eczema & a musty odor. Which screening test would most likely be abnormal?

What does this disease result from a defect in?

Back 38

PKU

Hydroxylation of Phenylalanine to Tyrosine

Front 39

What are the symptoms of an affected PKU infant?

Back 39

1. Mental retardation (most common)
2. Projectile vomiting which can be confused with Pyloric Stenosis
3. Fair-hair, fair-skinned, blue eyes
4. Eczematous rash & musty odor

Front 40

What are the blood levels of Phenylalanine & Tyrosine in an affected PKU infant?

Back 40

Phenylalanine = high

Tyrosine = normal

Front 41

What do pregnant women with a high level of phenylalanine have a higher rate of?

Back 41

Spontaneous Abortions

Front 42

Galactosemia results from a deficiency of __1__. __2__ then accumulates, injuring the __3__, __4__, __5__

Back 42

1. Galactose-1-phosphate uridyl transferase
2. Galactose-1-phosphate
3. kidney
4. liver
5. brain

Front 43

What is the presentation of Galactosemia?

Back 43

1. jaundice
2. vomiting
3. hypoglycemia
4. seizures
5. cataracts
6. hepatosplenomegaly
7. poor weight gain

**often times the initial presentation is E. coli sepsis

Front 44

You are called to see a 9.5 lb infant who is jittery. PE reveals a large plethoric (red-faced) infant who is tremulous. A murmur is heard. Blood sugar is low. What is the most likely cause?

Back 44

Infant of Diabetic Mother

Front 45

What is the presentation of Infants of Diabetic Mothers?

Back 45

1. Ruddy, plethoric complexion
2. LGA -> birth trauma
3. Hypoglycemia -> jitters, tremors, & excitability
4. RDS -> Insulin can block surfactant production
5. Hypertrophic Cardiomyopathy, Hyperbilirubinemia, & Polycythemia
6. Congenital anomalies -> cardiac defects, lumbrosacral agenesis, small left colon

Front 46

Define SGA

Back 46

babies whose birth weight falls below the 3rd percentile for their calculated gestational age

Front 47

Define the 2 types of SGA

Which one is usually later onset?

Back 47

Symmetric = all growth variables (weight, length, HC) are equally affected

Asymmetric = relative sparing of the head

Later onset -> Asymmetric

Front 48

How do you differentiate SGA babies from Preterm babies?

Back 48

Preterm babies are proportionately small & their weights fall in the normal range for the GA
-use Ballard scoring system to determine GA

Front 49

What are 5 complications of SGA babies?

Back 49

1. Fetal death
2. Asphyxia = deficiency of oxygen and excess of carbon dioxide in the blood and body tissues
3. Cold stress
4. Hypoglycemia
5. Polycythemia/Hyperviscosity from hypoxia

Front 50

Describe the risk factors for RDS

Back 50

Immaturity of Surfactant due to Prematurity
-results in Atelectasis & V/Q mismatch

Front 51

What is the presentation of RDS?

Back 51

manifest soon after birth
-tachypnea
-nasal flaring
-retractions
-cyanosis
-grunting
-Apnea may occur as the infant tires

Pt's condition peaks at about the 3rd day

Front 52

What signals improvement of RDS?

Back 52

Spontaneous diuresis

Front 53

What is the diagnostic test for RDS?

Back 53

**Clinical presentation usually makes the diagnosis

CXR usually demonstrates a reticular-granular pattern "Ground-glass" with air bronchograms
-Air bronchogram = pulmonary infiltration or edema in the tissues immediately adjacent to the bronchi

Front 54

A term neonate born by C-section has tachypnea, mild retractions, & grunting. O2 requirement is minimal. CXR shows fluid in the fissure & prominent vascular markings

Back 54

Transient Tachypnea of the newborn

Front 55

What is Persistent Fetal Circulation (Primary Pulmonary HTN of the Newborn)?

What is the treatment?

Back 55

Occurs when severe hypoxemia causes pulmonary vasoconstriction -> R-to-L shunting thru PDA or Patent Foramen Ovale

Treament
-Hyperventilation to avoid acidosis
-maintaining optimal oxygenation to decrease pulmonary vasoconstriction
-Nitric Oxide to act as pulmonary vasodilators
-Extracorporeal Membrane Oxygenation

Front 56

Describe the characteristics of Physiologic Jaundice

Back 56

-NOT seen until AFTER the first day of life
-rarely exceeds 12.9-15 mg/dL
-UNconjugated
-resolves by 1 wk of age

Front 57

What are the risk factors for Neonatal Sepsis?

What are the common organisms?

Back 57

-Infection during pregnancy
-prematurity
-prolonged rupture of membranes

GBS, E.coli, Listeria
HSV, Enteroviruses

Front 58

How is Toxoplasmosis transmitted?

Back 58

ingesting undercooked or raw infected meat or from handling infected cat feces

Front 59

What are the manifestations of Toxoplasmosis on the neonate? (6)

Back 59

-Intracranial calcifications
-IUGR
-Microcephaly
-Seizures
-Blindness
-Hepatosplenomegaly

Front 60

What is the treatment of pregnant women with Toxoplasmosis infection?

Back 60

Spiramycin during 1st trimester

Pyrimethamine & Sulfonamide afterward

Front 61

What is the treatment for the neonate with Toxoplasmosis infection?

Back 61

Pyrimethamine, Sulfonamide, & Leucovorin (folinic acid)

Steroids for Chorioretinitis

Front 62

What are the signs & symptoms of CMV infection?

Back 62

1. IUGR (most common)
2. Prematurity
3. Petechiae
4. Hepatosplenomegaly
5. Jaundice (Direct)
6. Hearing Loss
7. Chorioretinitis
8. Microcephaly
9. Periventrincular Calcifications (vs. Intracranial for Toxo)

Front 63

Occurs in 80% of babies if the mother is infected in the 1st trimester.

Manifestations
-IUGR
-cataracts
-mental retardation
-microcephaly
-Heart defects = PDA, Pulmonary Stenosis
-Hepatosplenomegaly
-Deafness
-BLUEBERRY Muffin Lesions

Back 63

Congenital Rubella

Front 64

Under what time-frame should a neonate be treated when the mother develops Varicella?

Back 64

If the mother develops Varicella 5 days before to 2 days after delivers

Front 65

What are some associated conditions with TEF?

Back 65

Congenital Heart Diseases
-PDA
-Vascular rings
-Coarctation of the aorta

VACTERL
-Vertebral abnormalities
-Anal atresia
-Cardiovascular tree
-Trachea
-Esophagus
-Renal system
-Limb buds

Front 66

Pt presents with bilious vomiting with every feed. "Double bubble" is seen on abdominal films

Back 66

Duodenal Atresia

Front 67

What is duodenal atresia associated with?

Back 67

Downs Syndrome

Front 68

This should be suspected in any newborn who fails to pass meconium in the first 24-48 h of life

Back 68

Hirschsprung disease

Front 69

MC medical & surgical GI emergency in the newborn. 90% of cases occur in Preterm infants, presenting in the first 2 wks of life

What are symptoms usually related to?

What are the symptoms?

Back 69

Necrotizing Enterocolitis

Introduction of feeds

Bloody stools, apnea, lethargy, & abdonimal distension once perforation has occurred

Front 70

What is pathognomonic of Necrotizing Enterocolitis on plain Abdominal film?

Back 70

Pneumatosis Intestinalis = gas in the bowel wall

Front 71

In the newborn ICU, an infant is noted to have sucking movements, tongue thrusting, & brief apneic spells. The blooc counts & chemistries are normal

Back 71

Neonatal seizure

Front 72

What are 2 possible metabolic causes of seizures?

Back 72

Hypoglycemia & Hypocalcemia

Front 73

What is the MCC of neonatal seizures?

Back 73

Hypoxic-ischemic encephalopathy

Front 74

-

Back 74

-

Front 75

-

Back 75

-