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Compiled PPS board reviewer > Neonatology/Critical Care > Flashcards

Neonatology/Critical Care Flashcards

1
Q

When is neonatal mortality the highest?

A

In 1st 24 hours after birth

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2
Q

Leading cause of infant death in the post-neonatal period?

A

SIDS

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3
Q

What is nonstress test

A

FHR and reactivity

Positive = good

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4
Q

What is a stress test?

A

FHR response to contractions

Positive = late decelerations = bad

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5
Q

What is a biophysical profile

A 
NST
Movements
Breathing
Tone
Amniotic fluid index

0 or 2 points each
>8/10 reassuring

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6
Q

Oligohydramnios is associated with…

A

Renal anomalies
Pulmonary hypoplasia
Limb contractures
Cord compression

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7
Q

Polyhydramnios is associated with…

A

Intestinal obstruction
Neurologic disorders
Maternal diabetes

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8
Q

When does twin-twin transfusion happen

A

Monochorionic/diamniotic twins, placental AV anastomoses

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9
Q

Findings in donor twin in twin-twin transfusion

A

Anemia
Hypovolemia
Oligohydramnios
LBW

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10
Q

Findings in recipient twin in twin-twin transfusion

A

Polycythemia
Polyhydramnios
CHF
Hydrops

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11
Q

What are complications of hypothermia in the DR?

A

Metabolic acidosis
Hypoxemia
Hypoglycemia
Renal loss of water & salt

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12
Q

Considerations for LGA infants

A

May be normal
IDM
Obesity/insulin resistance
Beckwith-Wiedemann

Increased risk of:

  • Hypoglycemia
  • Birth trauma
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13
Q

Small for Gestational Age

A

May be normal
Consider chromosomal abnormalities or infection

If IUGR, increased risk for:

  • Perinatal asphyxia
  • Hypothermia
  • Hypoglycemia
  • MAS
  • Polycythemia
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14
Q

Perinatal period

A

28wks ega to 7 days of life

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15
Q

Neonatal period

A

Birth to 28 days

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16
Q

Infant period

A

Birth through 1 year

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17
Q

Preterm

A

<37wks

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18
Q

Term

A

37 -41+6

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19
Q

Postterm

A

> 42wks ega

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20
Q

LBW

A

<2500g

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21
Q

VLBW

A

<1500g

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22
Q

ELBW

A

<1000g

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23
Q

What maternal medications decrease Vitamin K levels?

A

Anticonvulsants
Warfarin
AntiTB meds

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24
Q

What is eye ointment given for?

A

To prevent gonococcal opthalmia – NO EFFECT ON CHLAMYDIAL CONJUNCTIVITIS

1% silver nitrate aqueous solution
0.5% erythromycin ointment
1% tetracycline ophthalmic ointment

Silver nitrate can cause chemical conjunctivitis

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25
Q

Coag findings in vitamin K deficiency

A

Low PT, normal fibrinogen, normal platelets

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26
Q

Whey:Casein in human milk

A

80: 20 in colostrum
55: 45 in mature milk (>1 month)

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27
Q

Expected growth in the first2 weeks

A

20 mg/kg/day
110-120 kcal/kg/day
50% of kcals from fat

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28
Q

How does preterm human milk compare to term milk?

A 
Increased protein
" sodium
" lactoferrin
" lysozyme
" LC PUFAs
" IgA

BUT, inadequate protein, calcium, phosphorus, vitamin D, iron

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29
Q

Causes of false negative NBS

A
  • Insufficient feeding
  • Blood transfusion - galactosemia, hemoglobinopathies
  • TPN or ABX
  • Dialysis
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30
Q

Causes of false positive NBS

A
  • TPN or ABX

- Hemoglobinopathies

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31
Q

When is the peak hematocrit

A

2hrs of life

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32
Q

What is a normal hct?

A

45-55%, need venous sample

Capillary samples artificially high due to sludging

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33
Q

What newborns ar at risk for congenital syphillis if maternal nontreponemal and treponemal serology is positive?

A
  • Treatment is inadequate, unkn or undocumented
  • Treatment was <30 days before delivery
  • Mother was not treated with PCN
  • Maternal nontreponeal titers not decreased 4-fold or more

If maternal treatment is adequate, infant positive nontreponemal test = passively acquired antibody

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34
Q

Vomiting, musty/mousy odor, seizures, hypertonicity, MR

A

Phenylketonuria

Defect in tyrosine pathway (phenylalanine hydroxylase or cofactor tetrahydrobiopterin) –> accumulation of phenylalanine in CNS

Rx: low phenylalanine diet

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35
Q

Most common cause of genetic hearing loss

A

Non-syndromic

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36
Q

Hearing testing in first 6mos

A

ABR

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37
Q

Delayed cord release

A

> 2 weeks

  • urachal abnormalities - US
  • LAD
  • infection
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38
Q

Causes of delayed stooling

A

GI obstruction

  • no emesis –> lower
  • meconium disease - plug or ileus (CF)
  • congenital aganglionosis/Hirschsprung disease
  • small left colon (IDM, drug abuse)
  • MgSO4
  • hypothyroidism
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39
Q

What percentage of infants void within 24 hours?

A

95%

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40
Q

Physiologic jaundice

A

Increased RBC load
“ enterohepatic circulation
Decreased glucuronyl transferase

Term peak 3-5days, PT later and higher

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41
Q

Concerning rate of bilirubin rise

A

> 0.5mg/dL/hr

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42
Q

Caput succadeneum

A

Fluid/bruising under skin

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43
Q

Cephalohematoma

A

Beneath periosteum - does not cross suture lines

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44
Q

Subgaleal hematoma

A

Between aponeurosis and periosteum - crosses suture lines

Can lose entire blood volume in area

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45
Q

Inspiratory stridor, worse with agitation, better with prone positioning

A

Laryngomalasia

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46
Q

Expiratory stridor

A

Tracheomalasia, usually in preterm babies after long duration of ET tube

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47
Q

Causes of EO Sepsis

A

GBS, E.coli, Listeria, H.flu, enterococcus

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48
Q

Causes of LO Sepsis

A

CNS, S aureus, pseudomonas, GBS

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49
Q

10% symptomatic, sensorineural hearing loss (progressive, can initially pass)

A

CMV, gancyclovir (to prevent hearing loss)

50
Q

Cats, meats, intracranial calcifications, blindness, MR

A

Toxo

Pyrimethamine, sulfonamides, folinic acid

51
Q

Primary infection, intrapartum exposure, periventricular calcifications, can be isolated/disseminated or SEM

A

HSV

Acyclovir

52
Q

Cataracts, blindness, deafness, microcephaly, MR, CHD

A

Rubella

53
Q

VACTERL Findings

A 
V ertebral
A norectal
C ardiac
TE F
R enal, radial
L imb
54
Q

Gastroschisis

A

Not covered
Usually to right side of cord
Malrotation always associated, otherwise no associated anomalies

55
Q

Omphalocele

A

Bowel in covering sac
Umbilical cord part of sack
80% with associated anomalies
Mortality due to other anomalies

56
Q

Chronic HTN

A

Incr perinatal mortality
IUGR
Incr risk of pre-E
Incr risk of abruption

57
Q

Risks of htn to fetus/neonate

A 
IUGR
PT delivery
Thrombocytopenia
Neutropenia
Exposure to meds
Death
58
Q

Pre-existing DM

A 
Incr fetal loss
Congenital anomalies
- Caudal dysplasia/sacral agenesis
- NT defects
- CHD
- Small left colon
IUGR
59
Q

Gestational Diabetes

A 
LGA 2/2 hyperinsulinemia
Incr perinatal mortality
-RDS
-Preterm delivery
-Asphyxia
Birth injury
Hypoglycemia
Polycythemia/thromboses
IV septal hypertrophy
Impaired glucose tolerance later in life
60
Q

Maternal hyperthyroidism

A

IUGR
Preterm birth
Tachycardia

61
Q

SLE

A

Antibodies destroy fetal cardiac conduction pathway

Effects independent of maternal disease severity

62
Q

Maternal myasthenia gravic

A

Abs to acetylcholine receptors

Effects correlate with severity of illness in mother

Weakenss w/in 12-72hrs of birth

Resolves in 6 weeks

Rx with antiholinesterase and give supportive care

63
Q

AMA

A

Spont abortion, chromosomal abnormalities, congenital malformations, premature delivery, PIH, gestational diabetes

Incr incidence of nondisjunction during meiosis

Trisomies 21, 18, 13; Klinefelter syndrome

64
Q

Low MSAFP

A

Incorrect fetal age
Trisomies 13, 18, 21
IUGR
Fetal demise

65
Q

High MSAFP

A 
Incorrect fetal age
Multiple gestation
NT defects
Turner syndrome
Gastroschisis
Omphaloceles
GI obstruction
Sacrococcygeal teratoma
66
Q

What’s included in triple screen

A

AFP hCG uE3
NTD I - -
T21 D I D
T18 D D D

67
Q

Fetal Alcohol Exposure

A 
Most common teratogenic exposure
Microcephaly
Neurosensory hearing loss
CHD: VSD
Growth deficiency
MR
68
Q

Magnesium

A

respiratory depression, hypotonia

69
Q

Opiates

A

Respiratory depression, withdrawal

70
Q

Indomethacin

A

Intestinal perforation, oliguria

71
Q

Phenobarbital

A

Bleeding (vit K déficience)

72
Q

Propranolol

A

Hypoglycemia, bradycardia, apnea

73
Q

Cigarettes

A

Growth restriction

74
Q

Cocaine

A

Abruption

75
Q

Blood pressure maintained, tachycardia, vasoconstriction

A

Compensated Shock

76
Q

Hypotension (<5th percentile)

A

Decompensated Shock

77
Q

Progressive end organ dysfunction leading to irreversible organ damage and death

A

Irreversible Shock

78
Q

7m/o with diarrhea, vomiting, decreased urine output

A

Hypovolemic shock

  • decreased preload, osmotic diuresis, hemorrhage
  • tachycardia, poor perfusion
79
Q

8d/o with poor feeding, tachypnea, mottled

A

Cardiogenic Shock

  • cardiomyopathies, arrhythmias, obstructive disorders (coarctation, tamponade)
  • large heart, gallop, murmur, HSM, JVD (think tamponade)
80
Q

14d/o with fever, lethargy, extreme tachycardia

A

Septic Shock

  • different etiologies
  • tachypnea, grunting, tachycardia, warm extremities, bounding pulses
81
Q

4y/o with peanut allergy who went to the circus

A

Distributive Shock

  • anaphylaxis, neurogenic (spinal cord injury)
  • tachycardia, warm extremities, stridor/wheezing with anaphylaxis
82
Q

Rx Shock

A

ABCs
Vascular access - IO early
Fluid administration 20mL/kg crystalloid, repeat as necessary (60-200mL/kg)
Recognize no or poor response to fluid with cardiogenic shock

83
Q

Vasoactive medications

A
  • Dopamine
  • Cold shock –> epi
  • Warm shock –> norepi
  • Cardiogenic shock –> milrinone
  • Refractory shock in pts at risk for adrenal insufficiency –> steroids
84
Q

Complications of near drowning

A

Hypoxemia 2/2 aspiration or reflex laryngospasm

Complications of hypoxemia:

  • Pulm (ARDS, pulm edema)
  • Neuro (edema, increased ICP)
  • CV (arrhythmia, asystole)
  • Renal (renal failure, ATN)
  • Metabolic (acidosis, hypernatremia in the Dead Sea)
85
Q

Poor prognostic indicators in near drowning:

A
  • 10 min
  • resuscitation >25 min
  • resuscitation in ER
  • water temp >10C

Survival 75%

86
Q

Most common fatal foreign body aspiration

A

Balloons

87
Q

First degree burn

A

superficial/sunburn

88
Q

2nd degree burn

A

Partial thickness

  • superficial - pain/blisters
  • deep - white, leathery
89
Q

3rd degree burn

A

full thickness

  • well-demarcated, painless, no blistering
  • requires skin grafting
90
Q

4th degree burn

A

full thickness plus adjacent structures

- requires reconstructive surgery

91
Q

Treatment of burns in 1st 24 hrs

A

1st 24hrs:

  • 4mL/kg x %BSA + maintenance OR
  • 2000mL/m2 BSA + 5000mL/m2 TBSA
  • 1/2 over 1st 8 hours, rest over 16 hours
  • crystalloid x 24 hours, then colloid later
  • target UOP >1mL/kg/hr
92
Q

Half life of CO

A
  • 300min room air
  • 90min with HF non-rebreather mask
  • hyperbaric oxygen for COHb >25% (half-life decreases to 30 min)
93
Q

Dog bite rx

A
  • isolate dog if possible (r/o rabies)
  • wound care/cleaning
  • ABX NOT INDICATED
  • pasteurella canis most common
94
Q

Rx cat bites

A
  • wound care essential
  • wounds SHOULD NOT be sutured unless on face
  • ABX!! pasteurella multocida –> Augmentin or Clindamycin
95
Q

What has the highest case fatality rate of any infectious diseae?

A

Rabies

96
Q

Most common carriers of rabies

A

Bats, skunks, foxes, raccoons

97
Q

Domestic Animal Bite and Rabies

A
  • PPX immediately if animal rabid or bite is to the head/neck region
  • If animal is healthy, observe animal x 10 days, PPX pen
  • If animal unavailable, consider PPX if rabies is common in region
98
Q

Bat, raccoon, skunk, fox bites

A
  • Consider rabid

- Begin PPX immediately - rabies Ig and vaccine

99
Q

Indications for giving Crotalid anti venom for snake bites

A
  • any systemic symptoms
  • bite to face or neck
  • for all rattlesnake and water moccasin bites
  • small snakes release more toxin
100
Q

Rx of brown recluse spider bites

A

Debridement and ABX for necrosis >2cm in 48hrs

101
Q

Leading cause of death from spider bites

A

Black widow

102
Q

Systemic symptoms of black widow bite

A

muscle spasms, autonomic stimulation, coma

103
Q

Antivenom for suspected black widow bite

A

Lactrodectus antivenom

104
Q

Core body temp >40C with CNS dysfunction

A

Heat stroke

105
Q

AVPU

A
  • Alert
  • Responds to Voice
  • Responds to Pain
  • Unresponsive
106
Q

Glasgow Coma Scale

A
  • Eye opening (4 pts)
  • Verbal (5 pts)
  • Motor (6 pts)
    Coma = GCS <8, intubation indicated
107
Q

Middle meningeal artery, initial loss of consciousness with lucid interval

A

Epidural hematoma

108
Q

Bridging veins, slow deterioration

A

Subdural hematoma

109
Q

Severe brain injury, blood in CSF

A

SAH

110
Q

Pain RLQ on palpation of L side

A

Rovsing’s sign

111
Q

Pain on internal rotation of right hip

A

Obturator sign (appendix in pelvis)

112
Q

Pain on extension of right hip

A

Iliopsoas sign (retrocecal appendix)

113
Q

Most common abdominal emergency in children <2yrs

A

Intussusception

114
Q

Potential lead points for intussusception

A

Sm bowel lymphoma, Meckel diverticulum, HSP, CF

115
Q

Sausage shaped mass on right side

A

Intussusception

116
Q

Most common presenting sign of midgut volvulus

A

Emesis

117
Q

Gasless abdomen, double bubble sign

A

Midgut volvulus

118
Q

Misplaced duodenum, corkscrew sign on UGI

A

Midgut volvulus

119
Q

Upper abd pain after blunt and pain

A

= pancreatitis

lipase more specific than amylase level

120
Q

Painless rectal bleeding

A

MECKELS DIVERTICULUM

  • incomplete obliteration of omphalomesenteric duct
  • rule of 2’s
    • 2% population
    • 2:1 male:female
    • 2 feet from the ileocecal valve
    • 2 inches long
121
Q

Best imaging study for ovarian torsion

A

Transvaginal US

Compiled PPS board reviewer (60 decks)

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