-
-
Apgar
- Appearance: blue, extremities, normal
- Pulse: <60, 60-100, >100
- Grimace: No response, grimace, sneeze
- Activity: No tone, flexion, active
- Resp: none, weak, strong
-
Newborn conjunctivitis by days
- 1: chemical irritation
- 2-7: N gonorrhea
- >7: Chlamydia trachomatis
- 3 weeks: herpes
-
Newborn eye care
Erythro or tetracycline ointment, silver nitrate solution
-
Screening tests for newborns
- PKU,
- CAH,
- biotinidase,
- beta thal,
- galactosemia,
- hypothyroid,
- homocysteinuria
-
Phenylketonuria
- PAH (phenylalanine hydroxylase) deficiency
- Mental retardation
-
Newborn tachypnea
- Transient is <4 hours and is due to not enough fluid pushed out of lungs
- Over 4 hours, evaluate for sepsis with blood and urine cultures
-
Birth skull fractures
- Most common is linear
- Depressed needs surgery
- Basilar is most fatal
-
Birth scalp injuries
- Caput succedaneum: crosses suture lines
- Cephalohematoma: subperiosteal hemorrhage, doesn't cross
-
Erb paralysis
- C4-C6
- Waiter's tip: can't abduct, external rotate, or supinate
-
Klumpke paralysis
- C7-C8, +/- T1
- Claw hand with horner syndrome
-
Polyhydramnios causes
- Werdnig-hoffmann: neurological inability to swallow
- Intestinal atresias
-
Oligohydramnios causes
- Prune belly: no abdominal muscles to bear down to urinate
- Renal agenesis, Potter syndrome
-
Diaphragmatic hernia types
- Morgagni: midline defect
- Bochdalek: bilateral defects
-
Omphalocele associations
- Has a sac
- Inc AFP, assoc with Edwards (Tri18)
-
Umbilical hernia associations, tx
- Hypothyroidism
- 90% close on own by 3, surgery after 4
-
Wilms tumor presentation, dx, tx
- Palpable. WAGR (wilms, aniridia, GU malformations, retardation. Chrom 11 deletion). Constipation, N/V, abdominal pain.
- Best initial U/S, most accurate is CT
- Total nephrectomy, chemo, radiation
-
Neuroblastoma
signs
metastasis rate
- Hypsarrythmia (dancing eyes), opsoclonus (dancing feet)
- 50-60%
-
Cryptochordism risks
- Surgery can decrease risk of infertility
- Malignancy risk cannot be decreased
-
Associations of hypo and epispadias
- Hypo: cryptorchidism, inguinal hernias, don't circumcise
- Epi: Urinary incontinence, bladder exstrophy
-
Tetralogy of Fallot chromosome, presentation
- Chrom 22 deletions
- Cyanosis, holosystolic murmur at left sternal, Squatting
-
Holosystolic murmurs
- Mitral regurg
- Tricuspid regurg
- VSD
-
Transposition murmur, CXR, tx
- Single S2
- Egg on a string
- 2 surgeries each with 50% mortality
-
Pulses:
Pulsus alternans,
bigeminus,
tardus et parvus,
paradoxus
- Pulsus alternans: LV systolic dysfunction. Alternating strong and weak beats
- Bigeminus: Hypertrophic obstructive cardiomyopathy. 2 beats together then a pause
- tardus et parvus: Aortic stenosis. weak and late
- paradoxus: cardiac tamponade and tension pneumothorax. dec with inspiration
-
Hypoplastic left heart syndrome:
components,
presentation,
tests
- LV hypoplasia, Mitral atresia, aortic valve lesions
- No pulse, single S2, gray
- CXR: globular heart, pulm edema. Echo is most accurate
-
Truncus arteriosus tx
Surgery early since pulmonary HTN develops by 4 months
-
TAPVR CXR
- If no obstruction: CHR shows snowman/figure 8 sign
- Obstruction: pulm edema
-
ASD types
- Primum: has mitral valve abnormalities
- Secundum: commonest, center of septum
- Sinus venosus defect: least common
-
PDA timing, pulses, tests, tx
- Up to 12 hrs is normal, >24 hrs is pathologic
- Wide pulse pressure, bounding
- Echo is initial, cardiac cath is most accurate, EKG shows LVH to high systemic resistance
- Indomethacin
-
CXR:
Pear,
Jug handle,
3 like,
rib notching
- Pear: pericardial effusion
- Jug: Primary pulm artery HTN
- 3: Coarctation
- Rib: Coarctation
-
Coarctation of the aorta presentation and tests
- CHF, resp distress, different pressures and pulses
- CXR, cath is most accurate
-
Pathologic jaundice
- 1st day
- bili rises >5/day
- above 19.5 in term
- direct >2
- after 2nd week
-
Kernicterus presentation
- Hypotonia
- Sz
- Choreoathetosis
- Hearing loss
-
Pyloric stenosis dx
- initial test is US
- Accurate test is upper GI series which shows string sign, shoulder sign, mushroom sign, and railroad track sign (excess mucosa)
-
CHARGE syndrome
- Coloboma of eye, CNS anomalies
- Heart defects
- Atresia of choanae
- Retardation of growth
- GU defects
- Ear anomalies and/or deafness
-
Choanal atresia presentation and dx
- Blue with feed, pink with cry
- CT scan
-
VACTERL syndrome
- Vertebral anomalies
- Anal atresia
- CV anomalies
- TEF
- Esophageal atresia
- Renal anomalies
- Limb anomalies
-
Intussuception tx
- Fluids
- Electrolytes
- Then NGT decompression
- Barium enema is dx and curative
- 10% recur
- Surgery if no cure with barium
-
IDM complications
- Macrosomia
- Septal hypertrophy
- Small left colon
- renal vein thrombosis (mass, bruit, hematuria, thrombocytopenia)
- Hypoglycemia - sz
- HypoCa - tetany lethargy
- HypoMg - HypoCa and PTH dec
- Hyperbili
-
CAH defects, metabolic abnormalities
- 21 hydroxylase, 17 hydroxylase, 11b hydroxylase
- HypoNa, HypoCl, Hypoglycemia, HyperK, acidosis
-
Rickets types
- Vit D deficiency
- Vit D dependent: cant convert
- X-linked hypophosphatemic rickets - cant retain P in kidney
-
Vit D supplements
Exclusive breastfed at 2 months
-
TORCH
- Toxo
- Other - syphilis
- Rubella
- CMV
- HSV
-
Neonatal Toxoplasmosis: presentation, tests, tx
- Chorioretinitis, Hydrocephalus, Ring enhancing lesions
- Initial: IgM, Accurate: PCR
- Pyrimethamine and sulfadiazine
-
Neonatal rubella: presentation, tests, tx
- PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin, hyperbili
- Maternal IgM
- Supportive
-
Neonatal CMV: presentation, tests, tx
- Periventricular calcifications, chorioretinitis, hearing loss, petechiae
- Initial urine or saliva viral titers. Accurate urine or saliva PCR
- Ganciclovir if signs of end organ
-
Neonatal herpes presentation, tests, tx
- Week 1: shock and DIC. Week 2: vesicular skin lesions. Week 3: encephalitis
- Initial tzanck, Accurate PCR
- Acyclovir
-
Rubeola/measles: etiology, presentation, dx, tx
- Paramyxovirus
- Cough, coryza, conjunctivitis. Koplik spots
- CLinical. IgM Ab
- Supportive
-
Fifth disease/Erythema Infectiosum: etiology, presentation, dx, tx
- Parvovirus B19
- Fever, URI, slapped cheek rash
- Clincal
- Supportive
-
Roseola: etiology, presentation, dx, tx
- Herpes 6 and 7
- Fever, URI, rash
- Clinical
- Supportive
-
Mumps: etiology, presentation, dx, tx
- Paramyxovirus
- Fever, parotid swelling, orchitis
- Clinical
- Supportive
-
Croup: etiology, presentation, dx, tx
- Parainfluenza 1 and 2, or RSV
- Barking, coryza, inspiratory stridor, hypoxia when flat, steeple sign on CXR
- Clinical
- Steroids if mild, if severe racemic epinephrine
-
Epiglottitis: etiology, presentation, dx, tx
- HiB
- Hot potato, Fever, drooling, tripodding, cherry red epiglottis
- Clinical, thumb print on xray
- Intubate, ceftriaxone for 7-10d, Rifampin to close contacts
-
Whooping cough: etiology, presentation, dx, tx
- Bordetella pertussis
- Catarrhal- congestion and rhinorrhea for 14 days. Paroxysmal: coughing episodes with whoops and vomiting for 14-30d, Convlescent stage for 14 days
- Clinical, butterfly CXR, PCR or ELISA
- Erythromyci or azithromycin in catarrhal stage, isolate, macrolides for close contacts, DTaP
-
Diptheria: etiology, presentation, dx, tx
- Corynebacterium diphtheriae
- Pharyngitis, gray vascular pseudomembranes
- Dont scrape, Culture
- Antitoxin
-
Legg-Calve Perthes disease: etiology, presentation, dx, tx
- Avascular necrosis of femoral head
- Age 2-8. Painful limp
- Xray with joint effusions and widening
- Rest, NSAIDs, bilateral surgery
-
Slipped capital femoral epiphysis
- Obese teens, painful limp, external rotation
- Xray with widening of joint space
- Tx with internal fixation
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