Neonatology

Question 1

APGAR categories 2 vs 1

Answer 1

Appearance– 2= pink 1=blue extremities
Pulse= 2= >100, 1=<100
Grimace= 2=cough with catheter, 1=grimace
Activity (tone)- 2=active motion, 1=some flexion
Respirations. 2= good cry, 1=slow

Question 2

Milia

Answer 2

pustules on the face, dissapear after a few weeks

Question 3

Pustular melanosis (def and tx)

Answer 3

pustule over a dark base. Disappears on its own

Question 4

Erythema toxicum neonatorum (def, bx, tx)

Answer 4

pustules/papules with red base with EOSINOPHILS.

Benign, no tx needed

Question 5

Nevus simplex (def, path, tx)

Answer 5

Red patch on the neck or face
Vascular anomoly
No tx

Question 6

Nevus flammenus (path, tx)

Answer 6

Vascular malformation –> aka Port wine stain

Tx- r/o sturge webar syndrome

Question 7

Caput succedaneum vs cephalohematoma

Answer 7

caput succedaneum is fluid under the scalp that CROSSES suture lines

Cephalohematoma is blood in the periosteal space that is CONTAINED by the sutures

Question 8

Epstein pearls

Answer 8

White cysts on te hard palate of an infant, will disappear ont heir own

Question 9

Classic poland syndrome finding

Answer 9

Absence of ribs or agenesis of the pectoralis muscle –> chest asymmtry

Question 10

Diminished femoral pulses in a newborn

Answer 10

coarctation

Question 11

Increased femoral pulses in a new born

Answer 11

PDA

Question 12

One umbilical artery instead of two is concerning for

Answer 12

Renal pathology

Question 13

Diastasis recti (path and tx)

Answer 13

Rectus abdominus muscle is not fused at midline.

No tx, it will improve as baby grows

Question 14

MCC of abdominal mass in newborn

Answer 14

Hydronephrosis

Question 15

Hydrometrocolpos (def and presentatino)

Answer 15

Imperforate hymen –> retain vaginal secretions –> presents with labial cyst or abdominal mass

Question 16

Hypospadias path

Answer 16

Failure of uretheral folds to fuse

Question 17

Epispadias is associated with which other malformation

Answer 17

bladder extrophy

Question 18

First step in evaluating cyanotic infant

Answer 18

ABG + 100% O2

Question 19

ABG shows massive improvement with 100% o2

Answer 19

Respiratory pathology

Question 20

ABG improves by about 15-30 mmhg with 100% o2

Answer 20

Congential heart defect that doesn’t involve the pulmonic outflow tract (truncus)

Question 21

ABG imnproves by only about 5mmhg

Answer 21

Congenital heart defect involving the pulmonary outflow tract (tetrology)

Question 22

MCC of resipiratory distress in preterm infant

Answer 22

Respiratory distress syndrome

Question 23

2MCC of resp distress in TERM infants

Answer 23

Meconium aspiration

Persistent pulmonary htn of newbown

Question 24

When does surfactant reach appropriate levels for life

Answer 24

30 weeks gestation

Question 25

2 things to look for in amniotic fluid to determine lu;ng maturity

Answer 25

Lecithin:Sphingo ratio >2 | Presence of phosphatitylglycerol

Question 26

4 risk factors for RDS

Answer 26

Prematuirty Maternal diabetes Csection Neonatal asphyxia

Question 27

Dx and characteristic findings of RDS

Answer 27

CXR --> diffuse ground glass opacities and air bronchograms

Question 28

Tx for RDS

Answer 28

O2 --> CPAP

Question 29

2 major acute complications of RDS

Answer 29

PTX | Interventricular hemorrhage

Question 30

2 common chronic complications of RDS

Answer 30

``` Bronchopulmonary dysplasia (if on vent) Retinopathy of prematuirty ```

Question 31

PPHN definition

Answer 31

anything BESIDES heart disease that causes decreased blood flow to the lungs

Question 32

2MCC of PPHN

Answer 32

Meconium aspiration and Perinatal asphyxia

Question 33

Characteristic blood gas of PPHN

Answer 33

Pre and post ductal PaO2 are extremely different | because increased lung pressure results in R-->L shunt through PFO or PDA

Question 34

2 tests to evaluate PPHN

Answer 34

CXR --> decreased lung markings | Echo

Question 35

Cornerstone of tx for PPHN

Answer 35

OXYGEN!! because hypoxemia is a vasoconstrictor in the lung, you give O2 to vasodilate f/u with ventilation if o2 is insufficient

Question 36

2 times when MAS is most common

Answer 36

``` after 42 weeks gestatino Fetal distress (they poop sometimes) ```

Question 37

CXR findings of MAS

Answer 37

Increased lung volume with diffuse areas of atelectasis and parenchymal infiltrates

Question 38

Management of MAS

Answer 38

Suction airway of baby, and perineum of mom O2 + vent if needed

Question 39

2 definitions of apnea of prematurity

Answer 39

1- apnea x15-20seconds | 2- any apnic episode accompanied by bradycardia or cyanosis

Question 40

Central vs secondary apena

Answer 40

Central - no chest wall movement Secondary- chest wall moves, but no airflow --> apnea monitors wont pick this up!! because it only looks for chest motions

Question 41

Workup guidelines for apnea of prematurity

Answer 41

Seek underlying cause (infection, lung dz, hyperthermia). if nothing is found, then consider idiopathic apnea of premaurity

Question 42

Idiopathic apnea of prematurity (IAP) course

Answer 42

Presents in first week of life, then resolves after several more weeks or months

Question 43

IAP management (non med vs medical)

Answer 43

Airway support | -Respiratory simulants! Caffeine or theophylline)

Question 44

When does jaundice lvl peak in term vs preemie

Answer 44

``` Term= 3-4 days Premie= 5-7 days ```

Question 45

3 critera for evaluating hyperbili in a newborn

Answer 45

1- hyperbili present in first 24h 2- bili rises >6 in a 24h period 3- rate of rice exceeds 0.5/h

Question 46

2 steps in Workup for indirect hyperbili

Answer 46

Coombs | CBC + Retic and smear

Question 47

Frist step in workup of conjugated hyperbili (then 2 other steps)

Answer 47

Hepatic ultrasound (for cysts) HIDA + phenobarb (for biliary atresia) Viral serologies for hepatitis

Question 48

When to use exchange transfusion for bilirubin

Answer 48

Rapidly rising, especially in the setting of hemolytic diseaes

Question 49

Management of diaphragmatic hernia

Answer 49

Intubation. NOT a bag mask, as this will further compress the lungs

Question 50

Which abdominal wall defect is associated with other congenital abonormalities

Answer 50

Omphalocele (heart dz, Beckwith wiedmann) OmphaloCELE is CENtral and associated with CYNDromes

Question 51

Dx test and finigs for meconium ileus

Answer 51

Abdominal xray --> intestinal distention WITHOUT air fluid levels. Soap bubble appearance to the meconium plug

Question 52

3 features seen in babies of diabetic mothers

Answer 52

1- macrosomia (due to increased fat storage and hepatomegaly) 2-increase skeleton length, small head 3-Plethoric

Question 53

Failure to pass meconium in infant of diabeti cmother

Answer 53

Small left colon syndrome --> abdominal distention, FTPM

Question 54

Clinical features of polycythemia

Answer 54

Plethoric, cyanotic, poor feeding, jittery, acidosis

Question 55

Tx of polycythemia

Answer 55

Partial exchange transufsion