Ped Flashcards
1
Q
Differenciate : Gastroschisis and Omphalocele
A
- Gastroschisis is the right of midline and without a membrane. It’s typically not associated with chromosomal abnormalities but is more susceptible to twisting and infection. Think “angry sounding” and “angry looking” disease.
- Omphalocele is in the midline and covered with a membrane. It’s more commonly associated with chromosomal abnormalities (such as Beckwith-Wiedemann syndrome).
2
Q
Describe : Neural Tube Defects
A
- Neural tube disorders are a product of genetic syndromes and folate deficiency in mom during pregnancy.
- Spina bifida stems from difficulties with fusion of the caudal neural tube. That means the front of the spine forms normally, but back of it doesn’t.
- This is a spectrum of disease, from an incomplete spine but with skin intact (Spina Bifida Occulta) to a complete open sac of neural tissue and CSF (meningomyeloscele).
- Spina Bifida is treated (Folate supplementation) and screened for during pregnancy.
- A **Positive AFP screen will prompt an Ultrasound **of baby revealing the defect.
- If prenatal care was absent, the physical exam of the neonate could show something as subtle as a tuft of hair or a dimple up to something as obvious as a large sac-like structure.
3
Q
Differenciate : Spina Occulta, Meningocele and Myelomeningocele
A
- Occulta = bony defect without protrusion of meninges or spina cord; may have overlying hair
- Meningocele = extrusion of meninges (no spinal cord) in sac outside spine
- Myelomeningocele = extrusion of meninges and spinal cord in sac outside spine
4
Q
When is clef lips and palates repaired?
A
- Cleft lips : by 10-12 weeks
- Palates : by 10-12 months
to preserve speech function.
5
Q
Describe : Choanal Atresia (8)
A
- This is an atretic or anatomically stenosed connection between the nose and mouth.
- Unilateral or bilateral (which is an emergency).
- In severe cases the baby will be blue at rest as they are obligate nose breathers (think breathing and breastfeeding simultaneously).
- They will pink up with crying (as he/she uses his/her mouth).
- If there’s a partial obstruction there might be a childhood snore. Kids shouldn’t snore.
- If there’s complete atresia a catheter will fail to pass.
- If it’s incomplete a fiber-optic scope will identify the lesion.
- Surgery is required to open the atretic passage.
6
Q
Describe : Necrotizing Enterocolitis (NEC) (4)
A
- If it’s a **premature baby **and bloody diarrhea the diagnosis can essentially be assumed.
- An** x-ray / babygram** will show pneumatosis intestinalis (air in the wall of the bowel) to confirm the diagnosis.
- The baby needs to go NPO immediately and get started on TPN and IV antibiotics.
- Hold off from surgery unless there’s no improvement or conditions worsen.
EN RÉSUMÉ : Premature infant + bloody stool = NEC Make NPO and start antibiotics
7
Q
Describe : Meckel’s Diverticulum
A
- remnant of the omphalomesenteric (Vitelline) duct which can contain gastric tissue. That can cause acid secretion and contribute to bleeding by forming ulcers.
- It presents with either Fecal Ocult Blood Test + , iron deficiency anemia, or hematochezia
- The bleeding is painless and may be intermittent.
- The classic rule of 2s is often pimped, but rarely tested: <2 years old, 2:1 ♂:♀, 2 inches in length, 2 feet from the ileocecal valve, 2% of the population.
- To diagnose, do a** Meckel’s scan (technicium-99 radionucleotide scan)**.
- Treat it surgically.
8
Q
Describe : Swallowed blood in neonates (5)
A
- A baby presenting with blood emesis or stool can cause some excitement.
- During the peripartum process, babies can swallow maternal blood which can cause bloody GI outs.
- The** Apt test **(alkali denaturation test) in neonates can determine if the blood is of maternal or fetal origin.
- Fetal blood is resistant to denaturation, yield a positive test and require further investigation.
- Maternal blood will yield a negative test; it just requires reassurance that no further testing is needed.
9
Q
How are acute asthma exacerbations streated? (3)
A
- ** albuterol/ipratropium (Duonebs®) **and IV steroids that get transitioned to orals.
- Treatment may require escalating therapy (magnesium, subQ epi) up to intubation.
- Hospital admission is determined based on the need for supplemental oxygen, as well as the Peak Flow prior to and after bronchodilator therapy in the ED.
10
Q
Describe difference unconjugated and conjugated bili
A
Conjugated = ALWAYS pathalogical
11
Q
Describe difference between physiologic and pathalogic bilirubin
A
12
Q
Describe workup for jaundice
A
13
Q
Describe : Breast feeding jaundice (4)
A
- quantity issue in newborns** ≤ 7 days** old.
- Without sufficient volume, the bowels don’t move fast enough; the **body reabsorbs bilirubin and bilirubin builds up. **
- By increasing the number of feeds the problem fixes itself.
- In order to be reabsorbed from the gut the bilirubin must be unconjugated so there will be an elevation in indirect bilirubinemia.
14
Q
Describe : Breast milk jaundice (aka “human milk jaundice”) (4)
A
- a “quality” issue that occurs at 6-14 days.
- The thought is that **breast milk inhibits glucuronyl transferase **(the conjugation enzyme).
- This typically does not cause kernicterus.
- Formula can be temporarily substituted for breast feeding (preferred) or used to supplement breast feeding.
15
Q
What’s the difference between breast feeding jaudice and breast milk jaundice?
A
17
Q
Describe : Transient Tachypnea of the Newborn (TTN) (5)
A
- Delayed clearance of fetal lung fluid (mainly seen in Cesarean deliveries).
- This is the (near) term infant that has grunting and tachypnea
- Hyperexpanded and “wet” appearing CXR.
- This can simply be a delayed transition (resolving under 6 hours after birth) but TTN can be present for 24-48 hours.
- Treat with supplemental oxygen or CPAP/intubation if needed.
18
Q
Describe : Syndrome de détresse respiratoire (4)
A
- Has multiple factors but usually from surfactant deficiency causing atelectasis.
- This infant is usually premature and has a history of perinatal distress but will also present with grunting.
- CXR will show low lung volumes and a uniform granular pattern.
- If severe, will require surfactant administration and mechanical ventilation.
19
Q
Differenciate conjunctivitis in newborns (3)
A
23
Q
Describe : Erythema Infectiosum (8)
A
- parvovirus B19
- usually a nonspecific prodrome that gives rise to an erythematous rash.
- It’s isolated to the face bilaterally (slapped-cheek).
- You may see some spread to the trunk/limbs, which will be lacy or reticular in appearance.
- This disease is benign on its own in a normal healthy baby and** resolves spontaneously**.
- If there’s increased cell turnover with increased baseline reticulocyte production (sickle cell) or decreased production (anemia, heavy metals) this infection may precipitate an aplastic crisis.
- If baby gets sick and is near mom while she’s pregnant it can cause hydrops fetalis in the new baby. Separate any gravid mom.
- Can see arthritis in adults.
24
Q
Describe : Rougeole (4)
A
- paramyxovirus
- obvious prodrome of low grade fever and the “four hard Cs” – **cough, coryza (runny nose), conjunctivitis, and Coplik Spots (Koplik Spots) **
- The rash starts on the face, after the prodrome. As it spreads to the body, fever starts with the rash.
- Later in life a potentially lethal complication (subacute sclerosing panencephalitis) can occur.
25
Q
Décrire : Rubéole
A
- Caused by the togavirus named Rubella
- The rash itself looks just like rougeole. It starts on the face, spreads down to the toes, and is likewise macular.
- However, during the rash these patients don’t look as sick as rougeole.
- The rash tends to be fainter and spreads quicker.
- The prodrome of tender generalized (periorbital, postauricular) lymphadenopathy precedes the rash.
- Forchheimer spots on the palate (red enanthem) can be seen.
- Since measles and rubella look the same they’re in the same vaccine.
26
Q
Describe : Roseole
A
- Caused by HHV-6
- there’s a prodrome of a high-fever (>40 C) that breaks as the rash starts.
- The rash is a macular rash that begins on trunk and spreads to the face.
- Febrile seizures may result from extreme fever during the prodrome.
28
Q
Differenciate epidural and subdural hematoma
A
The epidural hematoma
* caused by trauma to the side of the head
* a loss of consciousness followed by a lucid interval, then coma.
* The CT shows a **lens-shaped hematoma. **
The subdural hematoma
* caused by major trauma (peds struck, high speed MVA - teens) or by abuse (shaken baby – infants).
* There’s a coma and the child stays in it.
* Look for a concave or crescent shaped hematoma.
