Term
| what are things affecting neonatal outcome in the prenatal period |
|
Definition
poverty
low SES
poor maternal nutrition
age extremes (<16, >35)
ethnicity
maternal injections
maternal disease
maternal drugs
chromosomes |
|
|
Term
| what are the things affecting neonatal outcome in a pretern infant |
|
Definition
respiratory distress syndrome: lack of surfactant before 33-35wk
severe immaturity
intraventricular hemorrhage
congenital abnormalities
infection
necrotizing entercolitis: if you feed premature baby too soon it causes necrosis |
|
|
Term
| what are the things affecting neonatal outcome in a full term infant and tx |
|
Definition
infection neconium aspiration pneumonia: when baby has fetal asyphytal dystrphus it decreases tone and sphinctor relaxes and it poops and it can be aspirated
if not clear of the poop only suction mouth and trachea if the baby isnt vigrous |
|
|
Term
|
Definition
| 20th week gestation to 28th day after birth |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| fetal growth falls into 5th percentile for gestational age |
|
|
Term
| explain the precedure in the delivery room, when to ventilate, when to do compressions |
|
Definition
ask OB if their term, pink, crying, moving? If yes provide warmpth, clear airway, dry
if not clear airway, dry, stimulate (rub spine), assess breathing, assess HR in umbilical cord
if HR <100 then begin positive pressure ventilation
if HR <60 begin chrst compressions
if none of this works give IV epi or intubate and give epi
as soon as >60 DC compressions
as soon as >100 DC ventilator |
|
|
Term
| what characterictis are worth zero in apgar score |
|
Definition
HR 0
no respirations
no muscle tone
no reflex irritability
blue |
|
|
Term
| what characteristics are worth one in apgar score |
|
Definition
HR <100
weak cry
some flexion
some reflex irritabilty
pink body, blue limbs |
|
|
Term
| what characteristics are wirth two in apgar score |
|
Definition
HT >100
cigrous cry
UE/LE flexed
reflex withdrawl
pink |
|
|
Term
| what are normal abnormalities that bring down apgar score |
|
Definition
| color and flexability are usually 1 |
|
|
Term
| what is caput succadaneum and tx |
|
Definition
swelling spreads across suture lines due to mom's pelvis pressure
NOT RESTRICTED by suture lines
TX: none |
|
|
Term
|
Definition
subperiosteal bleeding due to forceps delivery
swelling WILL NOT cross suture lines
NEVER aspirate, leave it alone
could form bone in trauma areas |
|
|
Term
| what are the parts of a newborn physical examination |
|
Definition
general appearance
vital signs
gestational age
neuromuscular maturity
maturity rating
skin
HEENNT
chesk
neck
CVS
genitalia
extremities
abdomen
hips
neurology - babinski (toes should go up) |
|
|
Term
| what are signs of respiratory distress |
|
Definition
grunting, flaring, retractions,
CXR with snow storm/ground glass
RR >60
O2 <95% |
|
|
Term
| what are causes of neonatal respiratory distress |
|
Definition
lack of surfactant (<32 weeks)
hypoglycemia
pneumonia
premie - RDS
pneumothorax
sepsis |
|
|
Term
| what are the labs that should be done on a baby with respiratory distress |
|
Definition
chest roentenogram: determine pattern of RDS, pneumothorax, cardiomeagly, congenital abnormalities
arterial blood gas: determine severity of compormise
CBC: determine anemia, polycythemia, neutropenic, sepsis, DIC
blood culture: identify pathogen
blood glucose: determine hypoglycemia (cause and effect of respiratory distress)
ECHO: when there is murmur or cardiomeagly
electrocardiogram |
|
|
Term
| TX of infant respiratory distress |
|
Definition
ABC
oxygen
ventilation
surfactant administration
antibiotics
follow blood gasses
electrolytes |
|
|
Term
| complications of infant respiratory distress and their fixes (5) |
|
Definition
PDA: premes do not tolerate PDA, need to close!
Pulmonary interstitial emphysema: fix with jet ventiation, NO ventilation, or extraproporial oxygenation
pneumothorax: low up lung with high pressure
bronchopulmonary dysplasia: when baby is dependent on O2 for >36wk after birth
retinopathy of prematurity: due to high pressure O2 ventilation |
|
|
Term
| what is kernicterus, when does a baby get it |
|
Definition
| yellow staning of the brain due to bilirubin level >20% |
|
|
Term
| what are the signs of the three phases of kernicterus |
|
Definition
1. lethargy, poor feeding, vomiting, high pitched cry, seizure
2. spasticity, M. rigidiy, irritability, opithotonus
3. spasticity decreases and neurologic symptoms begin |
|
|
Term
| when a baby has high bilirubin what labs do you run |
|
Definition
total and direct bilirubin
Hb/HCT
peripherial blood smear
retic count
blood type and Rh - mom and baby
direct coombs test
CBC, urine, hemoglobin
G6PDH screen
osmotic fragility |
|
|
Term
| how is high bilirubin treated |
|
Definition
phototherapy
exchange transfusion
phenobarbitol |
|
|
Term
| what is the most common cause of early onset neonatal sepsis |
|
Definition
| infection begins in uteri (maternal GU track colonization) |
|
|
Term
| what microbes cause early onset neonatal sepsis |
|
Definition
GBS!!!
E. coli, H. influenza, L. monocytegens |
|
|
Term
| when should you worry about a early onset neonatal infection |
|
Definition
| if membranes rupture more than 18h before birth |
|
|
Term
| what are clinical signs of neonatal sepsis |
|
Definition
respiratory distress
hypoglycemia
fever/hypothremia
cyanosis
poor feeding
lethargy
multiorgan failure
DIC
shock |
|
|
Term
| when does late neonatal sepsis occur |
|
Definition
|
|
Term
| what causes late neonatal sepsis |
|
Definition
GBS!!
pneumococcus, meinigiococcus |
|
|
Term
| what does a mongolian spot look like, where, on who |
|
Definition
typical gray lesion
on lumbosacral
asian, AA, histpanic |
|
|
Term
| erythema toxicum neonatorum: when does it appear, what does it look like, where, lab data |
|
Definition
24-48h after birth
yellow papules/pustules, red ring
eosinophils on smear (no bacteria) |
|
|
Term
| transient neonatal pustular melanosis: when does it appear, what does it look like, where at, tx |
|
Definition
present at birth and fades in 24-48h
littlr ed pustule tos on forehead and scalp
tx: none |
|
|
Term
| what is the main thing you should look for in hemangomas, what does it signify |
|
Definition
| when seen in midline worry about intracranial extension |
|
|
Term
| what rash is associated strongly with syndromes |
|
Definition
|
|
Term
| what does a nevus flammeus look like |
|
Definition
| red splotchy area on nape of neck |
|
|
Term
| what is another name for nevus flammeus |
|
Definition
|
|
Term
| what does a nevi look like, tx |
|
Definition
hyperpigmented lesion
could become malignant, remove in infancy |
|
|
Term
| explain the progression of fine motor skills |
|
Definition
3mo: supports weight on forearms with open hands
6mo: sits for a moment, transfer objects
9mo: pull to stand, pincer
12: walk with hand held, release object on command
18: walk with help, feed from spoon
24: run |
|
|
Term
| exolain the progression of social and language skills |
|
Definition
3mo: smile, coo, laugh
6mo: shows likes and dislikes, babbles
9mo: patty cake, peak aboo
12mo: comes to call, 1-2 words
18mo: mimics actions, 6 words
24mo: plays with others, 3-4word sentences |
|
|
Term
| what is a sign of prematurity and is also a sign of ricketts |
|
Definition
|
|
Term
| when should the anterior frontanell close, when is it a problem if it hasnt |
|
Definition
12mo close
15mo is a problem |
|
|
Term
| what should you look for on an opthalmoscope exam |
|
Definition
PERRLA
PAPILLEDEMA: hyperemia of optic nerve
dilated vessels
bulging optic disc margins
retinal hemorrhages
macular star (retinal edema) |
|
|
Term
| what is mydriasis a sign of |
|
Definition
| sympathetic overactivity: hyperthyroid, anxiety |
|
|
Term
|
Definition
| morphine poisoning, neurosyphillis |
|
|
Term
| what are unequal pupils a sign of |
|
Definition
|
|
Term
| what are irregular pupils a sign of |
|
Definition
|
|
Term
| what is an argyll robinson pupil caused by |
|
Definition
|
|
Term
| what are dilated and fixed pupils a sign of |
|
Definition
|
|
Term
| what are signs of horners |
|
Definition
lack of ciliospinal reflex
papilledema
irregural pupils |
|
|
Term
| what is horizontal nystagmus a sign up |
|
Definition
| labrynth or vestibular injury |
|
|
Term
| what is vertical nystagmus a sign of |
|
Definition
|
|
Term
| what is the trigeminal nerve composed of, how do you test the trigeminal nerve |
|
Definition
sensory to face
opthalmic, maxillary, and mandibular branches
corneal respons, motor massetes, pterygoig, jaw jerk |
|
|
Term
| what does the facial nerve do |
|
Definition
facial muscles
nasolabial folds
eye closure
taste to anter 2/3 of tongue |
|
|
Term
| what can cause paralysis of the facial nerve |
|
Definition
| trauma, infection, tumor, HTN, toxins, myasthenia gravis |
|
|
Term
| what can help diagnose a facial nerve lesion |
|
Definition
| involvement of 6th and 8th CN |
|
|
Term
| what is the cause of bells palsy |
|
Definition
isolated loss of CN7 activity
lower motor neuro issue |
|
|
Term
| what occurs if the upper motor neuron CN7 is damaged |
|
Definition
| paralysis of lower part of face on opposite side of lesion |
|
|
Term
| what is it called if the entire face is paralyzed |
|
Definition
ramsay hunt syndrome
herpetic pinna
(bells palsy? accoridng to review) |
|
|
Term
| what is the function of cn8 |
|
Definition
|
|
Term
| what is the function on cn9 |
|
Definition
gag reflex
taste posterior 1/3 of tongue |
|
|
Term
| what is the function of CN10 |
|
Definition
soft palate movement
vocal cord movement |
|
|
Term
| what is the function of cn11 |
|
Definition
| SCM and trapezius movement |
|
|
Term
| what is teh function of CN12 |
|
Definition
|
|
Term
| what is the cause of a complex partial seizure |
|
Definition
| may have temporal lobe lesion |
|
|
Term
| what are other names for abscence seizure |
|
Definition
simple abscnce
petite mal seizure |
|
|
Term
| clinical signs of petite mal seizure |
|
Definition
sudden stop of motor activity or speech
day dreamming, gazing
blank expression with flickering eyelid
lasts 30sec
NO AURA, NO POST ICTAL PHASE EVEN THOUGH ITS A GENERALIZED SEIZURE |
|
|
Term
| what are diagnostic signs of petite mal seizure |
|
Definition
EEG spikes at 3 sec wave discharge
abnormal EEG |
|
|
Term
| what seizures have post ictal phase |
|
Definition
| all generalized except petite mal |
|
|
Term
| what do you always need to RO with petite mal seizure |
|
Definition
| make sure their not ADHD! run EEG! |
|
|
Term
| febrile seizure: cause, timing |
|
Definition
9mo - 5yo
strong family history
incomplete myelination
fever/infection |
|
|
Term
| febrile seizure: clinical signs |
|
Definition
duration 10 min
generalized tonic clonic
postictal without neuro signs |
|
|
Term
| what is an atypical febrile seizure characterized by |
|
Definition
>15 min
recurrs within 24h
focial seizure - not tonic clonic
abnormal neuro exam |
|
|
Term
| tx of typical febrile seizure, difference for atypical |
|
Definition
DONT COOL RAPIDLY CAN CAUSE SEIZURE - fever control
diazepam
anticonvulsants - until seizure free for 2y
atypical: need to do EEG |
|
|
Term
| what is the diagnostic work up for seizures |
|
Definition
| CT, EEG, Electrolytes, MRI, LP |
|
|
Term
| define status epliepticus |
|
Definition
| continous seizure or serial convulsions without normal cnsciousness in between >30min can cause hypoxic damage |
|
|
Term
|
Definition
suction, oxygen
ABCs
blood sample
exam for trama
monitor ICP
papilledema exam
IV fluids and meds |
|
|
Term
| what are signs of a basillar skull fracture |
|
Definition
CSF otorrhea or rhinorrhea
battle sign: blood coming out of ear or large echymosis behind ear
anterior fossa freacure: racoon eyes |
|
|
Term
| what do you do if someone has a depressed skull fracture |
|
Definition
| >3-5mm needs surgical correaction |
|
|
Term
| how do you know someone has a concussion? |
|
Definition
| you dont! only 10% loose conciousness |
|
|
Term
| define subdural hematoma, what is the cause |
|
Definition
| bleed between brain and dura due to rupture of CORTICAL VEINS |
|
|
Term
| why is a subdural hematoma so dangerous |
|
Definition
| blood disintergrades, membrane encepasulates hematoma, may graduall increase in size |
|
|
Term
| symptoms of subdural hematoma |
|
Definition
vomiting, irritability, shrill cry, headache, bulging frontanelle
SETTING SUN EYES
retinal hemorrhage |
|
|
Term
| what type of head injury is characteristic of shaken baby syndrome |
|
Definition
|
|
Term
| what should the work up be for subdural hematoma, why |
|
Definition
CT/MRI - for bleed evaluation
PT/PTT - to proove there wasnt a clotting disorder for court |
|
|
Term
|
Definition
| bleed between the skull bone and dura mater in extradural space via rupture of MIDDLE MENINGEAL ARTERY (or dural vein) |
|
|
Term
| symptoms of epidural hamtoma |
|
Definition
| usually brief LOC, then lucid interval where they feel fine, then fall asleep and dont wake up or progressive LOC, Vomiting, headache, neuro signs |
|
|
Term
| chromosomal disorders causing microcephaly |
|
Definition
trisomy 13
trisomy 18
5P: cri du chat |
|
|
Term
| genetic disorders causing microcephaly |
|
Definition
|
|
Term
| syndromes causing microcephaly |
|
Definition
angleman
preder willi
smith lemi opitz
cornelis de lange
skeletal dwarf syndrome
cokayne syndrome
rubinstein taybi syndrome
hallermann steiff syndrome |
|
|
Term
| infections causing microcephaly |
|
Definition
rubella
CMV
toxoplasmosis
syphillis |
|
|
Term
| congenital malformations causing microcephaly |
|
Definition
myelomeningocele / arnold chiari malformation
hydrocephalus |
|
|
Term
| what is the function of the liver |
|
Definition
| process carbs, proteins, lipids |
|
|
Term
| explain the timeline of hepA antibodies |
|
Definition
anti-HepA IgM lasts for a few days -6mo
anti-HepA IgG lasts for life |
|
|
Term
| what is the hepA vaccine schedule |
|
Definition
1st dose at 1yo
2nd dose at 18mo |
|
|
Term
| what is the procedure for immunoprophylaxis for perinatal HepB transmission |
|
Definition
Ig and vaccine within 12h of birth, 2mo, 6mo
if you dont know if mom is positive do it anyways |
|
|
Term
| what is the most common cause of chronic liver disease |
|
Definition
|
|
Term
| how is hep C diagnosed in kids, explain the timeline for when it will be positive |
|
Definition
nucleic acid testing for HepC RNA
use when hepatitis C is suspected or when child is born to hepC mother
if baby doesnt show positive by 3mo then they didnt get it from mom |
|
|
Term
|
Definition
males = females
1:1000 babies |
|
|
Term
| what is the cause of noonan syndrome |
|
Definition
| chromosal 12q PTP11 encoding protein tyrosine phosphatase SHP2 mutation increases function which messes up heart and growth factors and hormones and such |
|
|
Term
| what is the inheritence of noonan |
|
Definition
|
|
Term
| musculoskeletal/facial signs of noonan |
|
Definition
forehead slanting and broad
posterior rotated thick ears
down slanting eyes
hypertelorism
neck webbing
short stature - not assoc with CHF
chest deformity
muscular hypotonia
scolosis and kyphosis |
|
|
Term
| what are the CV signs in noonan |
|
Definition
pulmonary stenosis
heart disease
unusual EKG: LAD, deep S precordial
thrombocytopenia
factor XI deficient: easy bruising |
|
|
Term
| what are genital, learning, eye signs of noonan |
|
Definition
undescended testes
learning dissabilities
strabusmus, refractor error pitosis |
|
|
Term
| what are abdominal organ signs of noonan |
|
Definition
|
|
Term
|
Definition
valcectomy
heart transplant
Ca channel blockers |
|
|
Term
|
Definition
| chromosome 12q PTPN11 mutation |
|
|
Term
| signs of lepoard syndrome |
|
Definition
| noonan + lentigines, hearing loss |
|
|
Term
| cause of cardiofascious cutaneous syndrome |
|
Definition
|
|
Term
|
Definition
fluttering og eyelids
oral adversion
tactile hypersensitivity |
|
|
Term
| cause of costello syndrome |
|
Definition
|
|
Term
| musculoskeletal and facial signs of costello syndrome |
|
Definition
coarse features
large head
short neck
sparse curly hair
short wide nose
thick prominant lips
large tongue
ulner deviation |
|
|
Term
| skin signs in costello syndrome |
|
Definition
loos skin on hands and feet
nasal papillomata
tumor predisposition (not just skin) |
|
|
Term
| heart signs of costello syndrome |
|
Definition
|
|
Term
| what are common facial symptoms of noonan, costello, lepoard, and CSC |
|
Definition
large head
low set posteriorly rotated ears
flat nasal bridge
downward slant of palpebral fissures |
|
|
Term
| what are symptoms only found in noonan |
|
Definition
bleeding diathesis
unusual EKG
juvenile myelomonocytic leukemia |
|
|
Term
|
Definition
|
|
Term
|
Definition
| unusual forces on normal tissue puts pressure on area |
|
|
Term
|
Definition
| abnormal break down of dissue |
|
|
Term
| what is an example of disruption |
|
Definition
|
|
Term
|
Definition
| abnormal organization of cells, tissues come together poorly |
|
|
Term
| what is an example of dysplasia |
|
Definition
|
|
Term
|
Definition
hypotonia: mouth open, protruding tongue
upslanting palpebral fissures
conductive, sensorneural heating loss
cindodactyly: hypoplasia of midpharynd of 5th finger
endocardial cursion defect (highest cause of mortality) |
|
|
Term
| why do kids with down syndrome need to be cleared for physical activity |
|
Definition
could have asymptomatic AA dislocation
could cause compression of spinal cord |
|
|
Term
| what is the cause and rate of down syndrome in mothers 15-29 yo |
|
Definition
| 1/5000 usually due to translocation |
|
|
Term
| what is the rate of down syndrome in moms 40-44yo, and cause |
|
Definition
|
|
Term
| what is the rate of down syndrome in moms 45yo+, and cause |
|
Definition
|
|
Term
|
Definition
prominent occiput
low set ears
clenched hands
low arch dermal ridge pattern on fingertips
short sternum
crossed legs
VSD, PDA!!! |
|
|
Term
| what is the prognosis of trisomy 18 |
|
Definition
50% die within 1st week
40% die in second week
10% survive first year |
|
|
Term
| deletion 5p syndrome signs |
|
Definition
ocular hypertension: lots of space between inner canthi of eye
broad or beaked nose
microcephaly
cranial asymmetry
low set simple ear
preauricular dimple
cry like cat |
|
|
Term
| signs of XO/turner syndrome |
|
Definition
female
short
congenital lymphadema with residual puffiness
broad chest
widly spaced nipples
BICUSPID AORTIC VALVE
COARCTATION OF AORTA |
|
|
Term
|
Definition
male
normal life span
often trouble maker
mild CT dysplasia
macro-orchidism
macrocephaly
prognathism |
|
|
Term
|
Definition
| protruding jaw and dentral crowding |
|
|
Term
| signs of bardet biedl syndrome |
|
Definition
obesity
retinal pigmentation
retinal dystrophy
poor night vision
polydactyly
abnormal calyces
hypogonadism |
|
|
Term
| what are the signs of the vater association |
|
Definition
vertebral anomalies
VSD
anal atresia
TE fistula with esophageal atresia
radial dysplasia, hypoplasia, polydactyly, syndacdyly
renal anomaly
single ulbilical artery |
|
|
Term
| conditions causing wheeze |
|
Definition
viral bronchiolitis
post-bronciolitis wheeze syndrome
asthma
GERD/aspiration
laryngo-tracheo-broncho-malacia |
|
|
Term
| define acte viral bronchiolitis |
|
Definition
| inflammation of bronchioles causing airway obstruction |
|
|
Term
| who gets viral bronchiolitis |
|
Definition
|
|
Term
| when is RSV/viral bronchiolitis most common |
|
Definition
|
|
Term
| what causes most URI/LRI in kids |
|
Definition
|
|
Term
| what is the most common cause of acute viral bronchilitis, second, and third |
|
Definition
| RSV, S. pneumo, adenovirus |
|
|
Term
| why are premature babies susceptible to bronchiolitis |
|
Definition
underdeveloped immune system
low birth weight
altered airway |
|
|
Term
|
Definition
humans only resivour
resporatory drops
fomites- survives on stethascope 6h
50% of medical personall are carrying it in season
fluid from EYES and NOSE worse |
|
|
Term
| symptoms of viral bronchilitis |
|
Definition
tachypenia, retractions, hyperinglation, wheeze, crackles
hypoxemia: restless, tachy, HTN
hypercarba: drowsey, flushing |
|
|
Term
| RSV: incuvation, infection time, complications |
|
Definition
incubation 2-8d
URI 2-3d
LRI 1 week
VIRAL SHEDDING CAN REAMIN HIGH FOR 3-4 WEEKS |
|
|
Term
| what disease is associated with RSV |
|
Definition
|
|
Term
| what is used for RSV prophylaxis, when |
|
Definition
synags: palivizuamb
high risk infants: prematyre, CHD, lung disease, <6mo in RSV season) |
|
|
Term
|
Definition
INSPIRATORY sound due to turbulence in UPPER airway
can be combined with exporatory sound from subepiglottic area (sign of respiratory failure) |
|
|
Term
| what questions do you need to ask when baby has stridor |
|
Definition
acute or persistant
associated symptoms
aggregating factors
association with feeding or change in position
hx or airway insturmentation, asthma, GERD |
|
|
Term
| what do you do in a resporatory emergency from stridor |
|
Definition
airway intervention: keep child in moms arms, dont gets tests, administer O2 and racemic epi, obtain CPR supplies, head to OR, anasthesia, fluids, antibiotics, restrain sedate, laryngoscopy, bronchoscopy, intubation
return to peds ICU |
|
|
Term
| when someone has stridor you always check for... |
|
Definition
external masses
hemangomia
FTT
pectus |
|
|
Term
| what is the diagnostic test for stridor |
|
Definition
| bronchoscopy: should be rigid and flexible |
|
|
Term
| what are causes of upper respiratory obestruction |
|
Definition
laryngotracheobronchitis - croup
supraglottitis - epiglottitis
bacterial tracheitis
peritonsilar abscess
retropharyngeal abscess
diptheria
spasmodic croup
foreign body
allergic reaction
trauma or burns
hypocalcemia
laryngomalacia: floppy airway |
|
|
Term
|
Definition
| inflammation of larynx and subglotttis |
|
|
Term
|
Definition
3mo - 3yo
with genetic diminished IgE/histamine response |
|
|
Term
| what is the timeine of croup |
|
Definition
|
|
Term
|
Definition
barking cough
inspiratory stridor
unable to feed or lay down
hoarsness |
|
|
Term
| take to hospital for croup if |
|
Definition
high clinical score
poor resopnse to therapy
need O2
poor hydration
toxic look
<6mo
poor home situation
reoccuring ER visits |
|
|
Term
|
Definition
steroids
racemic epi - must observe for reciporical bronchoconstriction
intubation if severe
humidified O2 |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
rapid onset
drooling
asphyxia
fever
plum sign
anxiety |
|
|
Term
| what is the first thing you do when kid has epiglottitis |
|
Definition
done examine, baby could close airway
secure airway first |
|
|
Term
|
Definition
nightime sudden onset
brassy cough
no prodrome fever |
|
|
Term
| explain the progression of a hemalgioma |
|
Definition
endothelial proliferation: begins pale/purple in first 2 weeks of life and proliferates for a year
involutation in childhood: blue gray in center, marbling
gone by adolescence: if present past it is a concern |
|
|
Term
| what is the most common childhood tumor |
|
Definition
|
|
Term
| where are most hemangiomas |
|
Definition
|
|
Term
| what percent of hemangomias require therapy |
|
Definition
|
|
Term
| what are hemagological signs of a proliferating hemangomia |
|
Definition
mature and immature endothelail cells
mast cells
pericytes
fibroblasts |
|
|
Term
| what is the cause of congenital hemangioms and prognosis |
|
Definition
do not have GLUT1 transporters
begins to go away very soon (lots of change on follow up exam) no need for therapy |
|
|
Term
| what are the types of congenital hemangiomas |
|
Definition
rapidly involuting
non-involuting |
|
|
Term
| what is the cause of infantile hemangioma, and prognosis |
|
Definition
GLUT1 endothelial glucose traported on blood endothelial barrier and placenta BBB
begins to go away in a year- may need therapy |
|
|
Term
| what is a bearded hemangioma distribution what is the concern |
|
Definition
make sure there isnt one in the mid
may cause airway obstricton
hemangioma preauriclar, chin, neck |
|
|
Term
| what are the concerns with a lumbosacral hemangioma |
|
Definition
neurological and GU abnormalities
teathered cord- get ultrasound before 6weeks
renal, bony sacral abnormalities
imperforate anus
leptomeningocele |
|
|
Term
| what is the concern with multiple cutaneous hemangioma |
|
Definition
| internal hemangioma ESP ON LIVER also on cns, eye, pancreas, GI, lung, spleen, airway |
|
|
Term
| what is the concern with liver hemangioma |
|
Definition
could be sign of HYPOTHYROIDISM
T3/4 are active but degraded by type 3 D3 enzyme
focal hepatic lesions are often hepatoblastoma make sure to CT when there is abdominal distension and monitor liver enzyme levels |
|
|
Term
| what is PHACE syndrome what is the concern, waht is it associated with |
|
Definition
20% of ingants with large cervicofacial hemangiomas will have associations with PHACE syndrome
psterior fossal malformation
arterial cardiac abnormalities
eye abnormalities
sternal cleft or supraulbilical raphe syndrome |
|
|
Term
| what are complications of hemangiomas |
|
Definition
disfigurment
ulceration
infection
local hemorrhage
compressed vital structures
high output cardiac function kassabach merritt phenomenon
psychological issues |
|
|
Term
| who gets keposiform hemangioendothelioma/tuffled angioma |
|
Definition
rare
males = females
usually present at birth, sometimes post natal (even young adult) |
|
|
Term
| signs of keposiform hemangioendothelioma/tuffled angioma |
|
Definition
non-focal lesions: trunk, neck, head, extremities
retroperitoneal and deep soft tissue lesions
skin is red/purple, thight, skiny |
|
|
Term
| MRI signs of keposiform hemangioendothelioma/tuffled angioma |
|
Definition
| hyperintensive lesion with ill define margins involving several tissue layers |
|
|
Term
| pathology keposiform hemangioendothelioma/tuffled angioma |
|
Definition
vascular and lymphatic components:
not independently stratified
vessels: compressed endothelium spindled and dilated
lymphatics: dilated, hyperplastic
GLuT1 negative |
|
|
Term
| tx keposiform hemangioendothelioma/tuffled angioma |
|
Definition
surgery best option if possible
treat KMP - most likley cause of death
look carefully, know when to investigate further, rafere early, provide support |
|
|
Term
| prognosis of keposiform hemangioendothelioma/tuffled angioma |
|
Definition
mortality in 30% usually due to KMP
will never fully regress and may come back surgery is best option if possible
difficult to tell if benign or malignant |
|
|
Term
| complications of keposiform hemangioendothelioma/tuffled angioma |
|
Definition
| lymphadema, chronic pain, orthopedia issues |
|
|
Term
| explain circulation in the womb |
|
Definition
gas exchange occurs in placenta
blood goes from atria (combined due to patent foramen ovale) into pulmonary artery then to ductus artriosis then aorta then bydy
pulmonary flow is low and vascular resistance is high
systemic vascular resistance is low |
|
|
Term
| explain the change from fetal circulation or normal, how long does it take for it to be normal |
|
Definition
pulmonary vascular resistance drops and pulmonary flow increases causing left atrial pressure and closure of patent foramen ovale
by 2-6 weeks the pulmonary vascular resistance is at adult levels |
|
|
Term
| what is the msot common congenital disease |
|
Definition
|
|
Term
| when is structural heart disease most likley to form |
|
Definition
|
|
Term
| what is the cause of heart problems in days 4-12, signs |
|
Definition
ductal dependent lesions - less critical
poor pulse, pulmonary edema, cyanosis |
|
|
Term
| what is the cause of heart problems in weeks 2-19 |
|
Definition
pulmonary overcirulcation
L to R shunt when PVR fails
LA/LV dilation
pulmonary HTN if PVR dosent fail |
|
|
Term
| pathogesis of hypoplastic left heart |
|
Definition
underdeveloped left heart and ascending aortia (and mitral valve)
PDA allows blood from the pulmonary arteries in to aorta - essential for life
lack of LV contraction forcing blood into systemic circulation causes hypoxia |
|
|
Term
| tx hypoplastic left heart |
|
Definition
may require transplant
PGE1!!!
balance circulation O2, ventilation, acid/base
surgery |
|
|
Term
| surgery procress for hypoplastic left heart |
|
Definition
1. norwood procedure: reconstrict aorta, atrial septectomy
2. glenn procedure: superior venacava to pulmonary artery shunt
3. fontan procedure: inferior venacava to pulmonary artery |
|
|
Term
| why cant you just give baby los of O2 when they have a heart problem (like hypoplastic left heart) |
|
Definition
systemic flow is dependent on patent ductus and pulmonary systemic resistance balance
too much O2 couold cause patent ductus closure |
|
|
Term
| pathogenesis pulmonary atresia with intact ventricular septum |
|
Definition
obstrictred RV outflow
associated with coronary abnormalities
increases size od right heart |
|
|
Term
| disgnosis and tx pulmonary atresia with intact ventricular septum |
|
Definition
|
|
Term
| how is the outocme of pulmonary atresia with intact ventricular septum determined |
|
Definition
|
|
Term
| pathogenesis of aortic stenosis |
|
Definition
difficult for LV ot pump blood so it gets stronger and thicker and evuntally dilates and says screw it
endocardial fibroelastosis |
|
|
Term
|
Definition
| systolic ejection murmur - could be less prominate due to low CO |
|
|
Term
|
Definition
PGE1!!
baloon valvoplasty
valvotomy |
|
|
Term
| pathogenesis of coarctation of aorta |
|
Definition
aorta narrows in AREA OF DUCTUS ARTEROSIS INSERTION
LV has to push harded to get blood out and may not be able to get it to lower half of body |
|
|
Term
| signs of coractation of aorta |
|
Definition
radiofemoral delay
weak pulses in lower body
right arm HTN |
|
|
Term
|
Definition
|
|
Term
| prognosis of coarctation of aorta |
|
Definition
| low morbitity and mortality |
|
|
Term
| signs of pulmonic stenosis |
|
Definition
asymptomatic child
systolic ejection murmur with click
ECG: pulmonary stensosi and hypertrophy of right heart |
|
|
Term
|
Definition
|
|
Term
| what are the malformations in tertalogy of fallot |
|
Definition
pulmonary stenosis
overdiding aorta
VSD
right ventrical hypertrophy |
|
|
Term
| signs of tertaology of fallot |
|
Definition
cyanosis: shock within first 2 days of life
systolic murmur
ECG: RV hypertrophy |
|
|
Term
| why do kids with tertaology of fallot die in first two days of life |
|
Definition
|
|
Term
|
Definition
can mamage medicall until 6-12mo
pallitative shunt if pulmoary stresia of hypoplastic pulmonary atresia
severe cynaosis <3mo
persistent tet spels |
|
|
Term
| prognosis of tertaology of fallot |
|
Definition
| low morbidity and mortality with surgical intervention |
|
|
Term
| pathogenesis of transposition of great arteries |
|
Definition
aorta comes from RV and pulmonary arteries from LV
systems are parallel and there is no mixing of circulations |
|
|
Term
| who gets transposition of great arteries |
|
Definition
kids of mom with maternal diabetes
male > female |
|
|
Term
| signs of transposition of great arteries |
|
Definition
|
|
Term
| tx transposition of great arteries |
|
Definition
PGE1
surgery: arterial switch |
|
|
Term
| pathogenesis of total anomalous pulmonary venous return |
|
Definition
| systemic outflow obstriction |
|
|
Term
| signs of total anomalous pulmonary venous return |
|
Definition
very ill
shock
rspiratory distress
severe cyanosis |
|
|
Term
| total anomalous pulmonary venous return tx |
|
Definition
| EMERGENCY requires urgent surgery |
|
|
Term
| non-obstructive anomalous pulmonary venous return pathogenesis |
|
Definition
| large ASD with pulmonary overcirculation |
|
|
Term
| diagnosis of non-obstructive anomalous pulmonary venous return |
|
Definition
|
|
Term
| tx of non-obstructive anomalous pulmonary venous return |
|
Definition
| elective surgery in first year of life |
|
|
Term
| what is the most common skin disorder kin kids |
|
Definition
|
|
Term
| what is the cause of atopic dermatitis |
|
Definition
association with allergic rhinitis and asthma
genetic predisposition to atopy and environmental modulators |
|
|
Term
| describe the lesion progression in atopic dermatitis |
|
Definition
typical: red plaque, hypekeratosis
secondary: wheep, ooze, crust, fissure, lichenification
secondary infection |
|
|
Term
| what are the causes of secondary infection in atopic dermatitis |
|
Definition
s. aureus
S. pyogenes
eczema herpeticum
VZV
molluscum
fungi |
|
|
Term
| infantile atopic dermatiits: age, location, appearance |
|
Definition
1-6mo to 2-3yo
itchy, red, plaque/papulae, oozing, crusting
cheeks, forehead, scalp, extensors |
|
|
Term
| childhood atopic dermatitis: age, location |
|
Definition
4-10yo
wrists, ankles, antecubital, popliteal |
|
|
Term
| adult atopic dermatitis: appearance, location |
|
Definition
flexural areas of arms, legs, neck
lichenification (hyperpigmentation in area of chronic scratching) |
|
|
Term
| what are some other signs of atopic dermatitis |
|
Definition
zerosis: generalized dryness
keratosis pilaris: keratin plugging of hair follicles
hyperlinearity of palms
dennie morgan folds: thick lower lip
altered cellular immunity; warts, herpe
hyper/hypo pigmentation |
|
|
Term
| prevention of atopic dermatitis |
|
Definition
|
|
Term
|
Definition
hydration
lubrication
anti-puritic
steroid |
|
|
Term
|
Definition
|
|
Term
| signs of seborrhea: appearance, location |
|
Definition
greasy red scaly
hair bearing, face, axilla, posterior auricle, intertrignious
cradle cap
adolescent: dandruff, posterior auricle cracking |
|
|
Term
|
Definition
|
|
Term
| cause of contact dermatitis |
|
Definition
irritant: exposure to chemical
allergic: T cell mediated |
|
|
Term
| triggers for allergic contact dermatitis |
|
Definition
| poison ivy, nickel, rubber, glue, dye, neomycin, topical anesthetics |
|
|
Term
| what is rhus dermatitis, signs |
|
Definition
poison ivy caused
linear streaks of red papules and vesicles
swelling if on face and genitalia
puritic |
|
|
Term
| location of diaper contact dermatitis |
|
Definition
convex perineum
lower abdomen
thighs
spares intertriginous |
|
|
Term
| tx diaper contact dermatitis |
|
Definition
|
|
Term
| candida diaper dermatitis: location, appearance |
|
Definition
bright red erruption, sharp borders, involves intertriginous areas
pin point satellite papules and pustules |
|
|
Term
| staph diaper dermatitis: appearance |
|
Definition
thin walled pustules with red halo
ruptured pustule with collarette scale around red base |
|
|
Term
| psoriatic diaper dermatitis appearance |
|
Definition
persistent diaper rash that wont respond to therapy
not much scaling or red plaques |
|
|
Term
| tranmission of tinea corporis |
|
Definition
|
|
Term
|
Definition
puritic anular lesion
central clearing
vesicular border |
|
|
Term
|
Definition
|
|
Term
| cuase of tinea versicolor |
|
Definition
|
|
Term
| appearance of tinea versicolor |
|
Definition
ovaly and scaly patches
upper chest back proximal extremities |
|
|
Term
|
Definition
|
|
Term
| eythema multiform minor aka |
|
Definition
| acute hypersensitivity syndrome |
|
|
Term
| cause of eythema multiform minor |
|
Definition
drugs, viruses, bacteria, food, immunizations
reoccurance associated with herpes
can progress to major |
|
|
Term
| appearance of eythema multiform minor |
|
Definition
symmetrical lesion on any part of body esp dorsum of hands, feet, extensors, extremities
no mucous membranes
dusky clusters, some white wheals, target lesions |
|
|
Term
| eythema multiform major aka |
|
Definition
severe acute hypersesitivity
steven johnson syndrome |
|
|
Term
| why are bacterial skin infections scary |
|
Definition
people think their a spider bite
increase is on rise
progress rapidly (esp on butt) in 24h to abscess |
|
|
Term
| how does MRSA skin infection appear |
|
Definition
cellulitis, fruncles, folliculitis, abscess
rapid papule with necrotic center
abscess in 24h to green puss |
|
|
Term
|
Definition
|
|
Term
|
Definition
bullous: bullous lesion on red base
non-bullous: red erosion with honey colored crust |
|
|
