Peds 3 Flashcards
(45 cards)
MOA of Phenobarbital in treating jaundice
Phenobarbital induces UGT, thus increasing conjugation of bili
Most common cause of baby born with poor feeding, tachypnea, hypothermia, and poor perfusion
Group B Strep pneumonia
How do you prevent GBS infection in a newborn
Screen mothers at 35 weeks gestation, and give IV Penicillin during labor to those with high risk or positive GBS
Most common organisms of early-onset neonatal sepsis (within 6 days of life)
GBS (#1) , E. Coli, H. flu, Listeria monocytogenes
Tx of early onset neonatal sepsis
Abx directed at most common pathogens - usually combo of IV aminoglycosides and Penicillin
Tx of late onset neonatal sepsis (7-90 days of life)
Beta-lactamase resistant abx (such as vancomycin) and often 3rd generation cephalosporin
What is greatest risk factor for neonatal sepsis
Prematurity (#1)
Additional risk factors include low birth weight, rupture of membranes >18 hrs before deliver, young maternal age, initial apgar <5
Describe congenital adrenal hyperplasia
Disorder of adrenal steroid production with an enzymatic deficiency (most common 21-hydroxylase)
Causes inadequate production of cortisol (causing increase in ACTH), and excessive production of androgens (due to increased ACTH, leading to virilization)
Describe difference in presentation of 21 a-hydroxylase deficiency and 11 b-hydroxylase deficiency
Both have decreased cortisol, causing increased ACTH, and increased androgens
21 = has decreased mineralocorticoids (decreased BP and hyperkalemia)
11 = has increased intermediated mineralocorticoid (increased BP)
o If there is a 1 in the first digit of deficient enzyme (11 or 17) – will be HTN
o If there is a 1 in the second digit of deficient enzyme (11 or 21) – will be masculinization
Definition of hermaphroditism
Discrepancy between gonad morphology and external genitalia
Describe 5 alpha-reductase deficiency
Phenotypically normal female with functioning testicular tissue and short, blind-end vagina
Due to inability of 5 a-reductase to convert testosterone to DHT, which is needed for development of male external structures
Describe true hermaphroditism vs. pseudohermaphroditism (female and male)
True = both male and female internal genitalia (testes and ovaries)
Pseudo female = 46, XX with internal female and external male (usually caused by CAH)
Pseudo male = 46, XY with internal male and external female (e.g. 5 a-reductase deficiency)
What serum level should you check for in a baby with suspected CAH
Increased 17-hydroxyprogesterone
What is the classic disease associated with female with primary amenorrhea
5 alpha-reductase deficiency (46, XY with female phenotype)
Decreased androgen binding or androgen insensitivity
Describe difference in obstruction in meconium ileus vs. Hirschsprung disease
Meconium ileus = Seen in CF. Leads to obstruction of the ileum and a narrow, underdeveloped colon (microcolon)
Hirschsprung = Level of obstruction usually at the rectosigmoid junction, with proximal dilated colon
What are the 5 T’s that cause R-to-L shunt (early cyanosis
o Truncus arteriosus (1 vessel) o Transposition (2 switched vessels) o Tricuspid atresia (3 = tri) o Tetralogy of Fallot (4 = tetra) o TAPVR (5 letters in the name)
Describe transposition of the great vessels
- LV enters into the pulmonary trunk
- RV enters into the aorta
- Not compatible with life unless a shunt is present to allow mixing of blood (e.g. VSD, PDA, or PFO)
Describe Tetralogy of Fallot
- (a) Pulmonary valve stenosis
- (b) RV hypertrophy
- (c) VSD
- (d) Overriding aorta (sitting over VSD)
Describe tricuspid atresia
• Absence of tricuspid valve and hypoplastic RV
• Requires 2 shunts:
o ASD to get blood from RA to LA
o VSD to get blood from LV to RV so it can go to the lungs
Describe Truncus arteriosus
• Failure of truncus arteriosus to divide into pulmonary trunk and aorta
Describe total anamalous pulmonary venous return with obstruction
- Pulmonary veins drain into R heart circulation (e.g. SVC, coronary sinus, RA)
- Associated with ASD and sometimes PDA to allow for R-to-L shunting
What disorders often present with hemarthrosis (bleeding into joint spaces)
Clotting defect (e.g. Hemophilia)
Common presentation of platelet disorders
- Easy or prolonged mucosal bleeding
- Ecchymosis
- Petechiae
Lab findings in Hemophilia
Increased PTT
