MTB 5 (Endo, Infectious)

Question 1

Common findings in Infants of DM mothers

Answer 1

Macrosomia
Small Left Colon Syndrome
Cardiac abnormalities
Renal Vein thrombosis

Question 2

Metabolic findings in IDM

Answer 2

Hypoglycemia
Hypocalcemia
Hypomagnesemia
Hyperbilirubinemia

Question 3

Cardiac changes in IDM and management

Answer 3

Asymmetric septal hypertrophy due to obliterated LV lumen -> Decreased CO
Dx: EKG and Echo
Tx: beta blockers, IVF

Question 4

Initial management of NB of diabetic mother w/shaking, holosystolic murmur, elevated BR

Answer 4

Check Blood sugar level
IDMs have high glucose levels
Upon delivery -> maternal glucose gone
Infants continue to make insulin = blood sugar levels drop

Question 5

MC presentation of CAH

Answer 5

Hypotensive child w/severe electrolyte abnormalities

Girls - ambiguous genitalia, inappropriate facial hair, virilization, menstrual abnormalities

Question 6

Electrolyte changes seen with CAH

Answer 6

HypoNatremia
HyperKalemia
HypoChloremia
Hypoglycemia

Decreased Aldosterone and cortisol

Question 7

How is CAH diagnosed

Answer 7

Serum electrolytes

Increased 17-OH progesterone

Question 8

Infants to mothers with Graves

Answer 8

If post thyroidectomy - Grave’s TSI levels increase to 500x normal after thyroidectomy
IgG autoabs cross placenta causing thyrotoxicosis in fetus and neonate

Question 9

Irritability or lethargy suggest

Answer 9

Meningitis

Question 10

MCC of neonatal sepsis

Answer 10

Pneumonia

Meningitis

Question 11

Signs and Sx’s of neonatal sepsis

Answer 11

Poor oral intake
Irritability
Hypo/hyperthermia
Resp distress
Jaundice
Vomiting
Bulging fontanelles

Question 12

How does infant botulinism present

Answer 12

Descending flaccid paralysis

BL bulbar palsy - ptosis, sluggish pupillary response to light, poor suck/gag reflex, drooling, constipation

Question 13

Cause of infant botulinism - not honey

Answer 13

Increased incidence in Cali, Penn, Utah from soil

Botulinim spores from environment/dust = spore ingestion

Question 14

Neonatal Toxoplasmosis Presentation

Answer 14

Chorioretinitis
Hydrocephalus
Multiple ring enhacing lesions - CT

Question 15

Neonatal Syphilis Presentation

Answer 15

Rash on palms and soles
Snuffles
Frontal bossing
Hutchinson teeth
Saddle nose

Question 16

Neonatal Rubella

Answer 16

PDA 
Blueberry muffin rash
Cataracts
Deafness
HSM
Thrombocytopenia

Question 17

Neonatal CMV

Answer 17

Periventricular calcifications 
Chorioretinitis
Microcephaly
Hearing loss - Unilateral
Petechiae

Question 18

Neonatal Herpes

Answer 18

Wk 1: shock and DIC
Wk 2: Vesicular skin lesions
Wk 3: Encephalitis

Question 19

Best initial Dx test for Neonatal Toxoplasmosis

Answer 19

Elevated IgM to toxo

Question 20

Most accurate Dx test for Neonatal Toxoplasmosis

Answer 20

PCR for toxo

Question 21

TX for Neonatal Toxoplasmosis

Answer 21

Pyrimethazine and sulfadiazine

Question 22

Best initial test for Neonatal Syphilis

Answer 22

VDRL or RPR

Question 23

Most accurate test for Neonatal Syphilis

Answer 23

FTA ABS or Dark Field Microscopy

Question 24

Tx for Neonatal Syphilis

Answer 24

PCN

Question 25

Test for Neonatal Rubella

Answer 25

Maternal IgM w/clinical Dx

Question 26

Tx for Neonatal Rubella

Answer 26

Supportive

Question 27

Best initial test for Neonatal CMV

Answer 27

Urine or Saliva viral titers

Question 28

Most accurate test for Neonatal CMV

Answer 28

Urine or Saliva PCR for viral DNA

Question 29

Tx for Neonatal CMV

Answer 29

GAnciclovir w/si's of end organ damage

Question 30

Best initial test for Neonatal Herpes

Answer 30

Tzanck smear

Question 31

Most accurate test for Neonatal Herpes

Answer 31

PCR

Question 32

Tx for Neonatal Herpes

Answer 32

Acyclovir | Supportive Care

Question 33

Varicella Presentation

Answer 33

Multiple highly pruritic vesicular rash - teardrops Begins on face Fever and malaise

Question 34

Best initial and most accurate test for Varicella

Answer 34

Initial - Tzanck - multinucleated giant cells | Accurate - Viral culture

Question 35

Tx for Varicella

Answer 35

Supportive, topical ointment

Question 36

Rubeola or measles Presentation

Answer 36

``` 3 C's: Cough Coryza Conjunctivities Koplik spot - gray macule on buccal surface ```

Question 37

Test for Rubeola or measles

Answer 37

most accurate - IgM abs

Question 38

Presentation of Fifth dz/erythema infectiosum

Answer 38

Low grade fever/no prodrome Progresses to rash w/slapped cheek - maculopapular rash starts on arms and spreads to trunk and legs Rash worsens w fever and sun exposure

Question 39

Presentation of Roseola

Answer 39

High Fever >40 C, no other sx's for 3-4 days THEN Progresses to maculopapular diffuse rash as fever breaks - begins on trunk, quickly spread to face and extremities lasting < 24 hours

Question 40

Mumps presentation

Answer 40

Fever precedes parotid swelling and/or orchitis