Pulmonary Peds

Question 1

what to observe in newborns

Answer 1

gender
respiratory effort 
assessment of color
deformation or malformation 
assessment of movement

Question 2

what does lanugo mean?

Answer 2

fine hair all over the body

Question 3

preterm baby has more

Answer 3

more muscular tone and hyper-reflexia

Question 4

cradle crap

Answer 4

seborrhea (all over body)

• usually self limiting
• emollient, gently exfoliation with soft brush
• use topical ketoconazole cream or low potency steroid

Question 5

salmon patches

Answer 5

“stork bites”

• benign
• nervus simplex

Question 6

angle kisses

Answer 6

capillary malformations

-benign

Question 7

facial infantile hemangioma

Answer 7

fade with time

-benign

Question 8

transient neonatal pustular melanosis

Answer 8

• lesions eventually fade
• no treatment needed
• small rashes, fade after days-weeks
• can have some hyper-pigmentation after pustules fade, does go away

Question 9

sicking blisters

Answer 9

vesicles or bullar at sites of excessive suckling

• mongolian spot
• don’t fade over time

Question 10

acropustulosis of infancy

Answer 10

pustules on extremities

• hands and feet
• benign
• can use steroids topically

Question 11

milia

Answer 11

very common

• pearly spots across nose
• retention of keratin in pilosebaceous units

Question 12

cutis marmorata

Answer 12

vascular response to cold

Question 13

erythema toxicum

Answer 13

diffuse rash, over face and trunk
-appears 24-48 hours, disappears 5-7 days later
no treamtent

Question 14

neonatal acne

Answer 14

appears 3 weeks of age

• resolves by 4 months
• gently cleansing only needed

Question 15

port wine stain

Answer 15

large macuole across face

-if across V1 distribution across face-> Sturge Weber syndrome

Question 16

cephalohematoma

Answer 16

sub-periosteal hematoma does not cross suture lines

-may calcify

Question 17

caput secundum

Answer 17

• edema superficial to periosteum extends across suture lines
• can see jaundice if have a bilirubin problem

Question 18

congenital glaucoma

Answer 18

increased IOP, abnormal angle

Question 19

white pupillary reflex

Answer 19

leukocoria

-retinoblastoma, congenital cataract

Question 20

ear normal set?

Answer 20

line from inner epicanthal fold should transect top third of the ear

Question 21

choanal atresia

Answer 21

one nares not open

Question 22

bite in uvela

Answer 22

submucosa cleft palate

Question 23

epsteins pearls

Answer 23

benign inclusion cysts on palate

Question 24

webbing of neck is common in

Answer 24

turner’s syndrome

Question 25

what are signs of distress in newborns

Answer 25

``` tachypnea nasal flaring subcostal retractions grunting cyanosis ```

Question 26

ground glass syndrome

Answer 26

respiratory distress syndrome | HMD

Question 27

most common mass felt in newborns

Answer 27

hydropnephrosis

Question 28

kids that are born breach most likely will have

Answer 28

hip dysplasias

Question 29

trisomy 21

Answer 29

epicanthal folds, upslanted palpebral fissures, flat nasal bridge, protruding tongue, low set ears, brushfield spots, simian crease on palm, space between first and second toes (sandal gap), excess skin at nape of neck, hypotonia

Question 30

second most common trisomy

Answer 30

trisomy 18 | Edwards syndrome

Question 31

trisomy 18

Answer 31

prominent occiput, low set ears, clenched hand, rocker bottom feet, severe congenital heart defects -survival into school age possible

Question 32

trisomy 13

Answer 32

patau syndrome - cleft lip, clenched hand, overlapping fingers, polydactyl, clubfoot, aplasia cutis congenita, congenital heart defects - usually survive to 6 months

Question 33

risk factors for trisomy 21

Answer 33

advancing maternal age

Question 34

most important things to look for in newborn screening?

Answer 34

congenital adrenal hyperplasia congenital hypothyroidism cystic fibrosis sickle cell disease

Question 35

clinical jaundice is first noted in

Answer 35

sclera and face

Question 36

upper limit of normal adult bilirubin

Answer 36

1mg/dL

Question 37

direct bilirubin is

Answer 37

conjugated | -can't be absorbed my intestinal cells, broken down by intestinal bacteria enzymes

Question 38

indirect bilirubin is

Answer 38

un-conjugated

Question 39

hyperbilirubinemia in newborns

Answer 39

increased supply: life span of fetal RBC only 85 days | decreased metabolism: bilirubin clearance decreased in newborns and increased enterohepatic circulation

Question 40

infants have what kind of intestine?

Answer 40

sterile - no bacteria present to convert conjugated bilirubin to urobilirubin - beta glucuronidase in intestinal wall deconjugates bilirubin, which is then reabsorbed

Question 41

BIND

Answer 41

bilirubin induced neurological dysfunction - total bili >25-30 mg/dL - basal ganglia and brainstem nuclei for auditory and oculomotor function most affected

Question 42

ABE

Answer 42

acute bilirubin encephalopath - infant initially sleepy but arousable, mild hypotonia, high pitched cry - difficult to console, hypertonia with arching neck and trunk. Seizure, respiratory failure

Question 43

Kernicterus

Answer 43

``` chronic and permanent sequelae and BIND -first year after birth cognitive function relatively spared choreoathetoid cerebral palsy (dystonia, tremor, chorea) sensorineural hearing loss limitation of upward gaze ```