Term
| Risk factors for neonatal physiologic jaundice |
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Definition
- male gender
- Asian
- cephalohematoma
- breast-feeding
- maternal DM
- prematurity
- polycythemia (Hct > 65%)
- trisomy 21
- cutaenous bruising
- hypothyroidism
- delayed BM
- upper GI obstruction
- swallowed maternal blood
- sibling with physiologic jaundice
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Term
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Definition
- unconjugated bilirubin deposits in brain cells, especially basal ganglia, globus pallidus, putamen, caudate nuclei
- initial signs: lethary, poor feeding, loss of moro reflex
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Term
| Is physiologic jaundice mostly due to uncojugated or conjugated hyperbilirubinemia? What is the incidence in the first week of life in term and preterm infants? |
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Definition
- physiologic jaundice = unconjugated hyperbilirubinemia
- seen in 60% of full term infants and 80% of preemies
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Term
| When does bilirubin peak in full term infants and at what level? |
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Definition
| Peak bilirubin concentrations of 5-6 mg/dL - usually seen between the 2nd and 4th days of life. |
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Term
| How is the dx of physiologic jaundice made? What is the pattern? What is the mechanism? |
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Definition
- Basically exclude other causes of jaundice
- Jaundice begins on face and progresses to chest, abdomen, and feet
- Due to infant's limited ability to conjugate bilirubin (liver is immature) and inability to excrete unconjugated bilirubin.
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Term
| Causes of nonphysiologic jaundice (7) |
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Definition
- septicemia
- biliary atresia
- hepatitis
- galactosemia
- hypothyroidism
- CF
- hemolytic anemias (congenital like spherocytosis or drug-induced)
- Ab against fetal RBCs
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Term
| Findings that suggest nonphysiologic jaundice (4) |
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Definition
- jaundice starts in first 24-36 hrs of life
- bilirubin rate of rise > 5 mg/dL/24 hr
- bilirubin >12 mg/dL in full-term infant w/o risk factors for physiologic jaundice
- jaundice persists after 10-14 days of life
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Term
| Causes of jaundice that presents within first 24 hrs (6) |
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Definition
- erythroblastosis fetalis
- hemorrhage
- sepsis
- CMV
- rubella
- congeital toxoplasmosis
- jaundice presenting in first 24 hrs requires immediate attention!
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Term
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Definition
- 2% of full term breast-fed infants
- unconjugated bilirubin elevations occur after 7th day of life (up to 30 mg/dL)
- If breast-feeding is continued (or stopped then resumed), the levels gradually decrease
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Term
| 2 criteria for diagnosis of juvenile rheumatoid arthritis |
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Definition
- onset before age 16
- sx for six weeks or more
- it is the most common rheumatologic d/o in children
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Term
| systemic onset JRA - presentation/sx (5), complications (4), labs, px |
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Definition
- Daily high-spiking fevers, rash, arthralgias that wax and wane with fever; lymphadenopathy and orangomegaly
- complications: pericarditis, hepatitis, pleural effusion, encephalopathy
- labs: leukocytosis, anemia, thrombocytosis, elevated ESR, usually RF and ANA are negative
- px: 50% have complete recovery, 25% develop chronic/destructive dz
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Term
| polyarticular JRA - sx, who get its, px |
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Definition
- 5 or more joints involved; mild or absent systemic sx
- commonly affects teenage girls (as young as 8 yo)
- Patients that are RF negative have better px (5-10% progress to severe dz)
- RF + pts have worse px - 50% progress to chronic dz
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Term
| Pauciarticular/oligoarticular JRA - sx, two types |
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Definition
- less than 5 joints involved
- early onset type: mostly females; almost always ANA + ;50% have anterior uveitis (*require routine slit lamp exam!*)
- late onset type: boys < 8, can progress to lumbar/sacral joint involvement (AS)
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Term
| Neuroblastoma - signs/symptoms (4), labs (1) |
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Definition
- may or may not have abdominal mass (tends to be nontender and crosses midline)
- compressive sx secondary to mass (respiratory sx, Horner's syndrome, etc)
- "raccoon eyes" = proptosis and bluish discoloration of eyes d/t mets to bone/skin
- paraneoplastic syndrome: opsoclonus myoclonus = chaotic eye movements and myclonic jerks (auto-Ab)
- labs: elevated HVA and VMA in >90% of patients
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Term
| Neuroblastoma - major ddx and how does it present? |
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Definition
- Major ddx is Wilm's tumor
- Wilm's tumor sx include hematuria and HTN; if mass is present it usually doesn't cross midline
- Neuroblastoma patients are usually younger and sicker (fevers, etc)
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Term
| 2 categories of acyanotic congenital heart defects |
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Definition
- defects with with L to R shunt (VSD, ASD, etc)
- defects that affect pressures: Ao or pulmonic stenosis, coarctation of the Ao
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Term
| Most common type of VSD and its presentation/timing, work-up |
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Definition
- most VSDs are small, membranous VSDs and are asymptomatic
- they present with murmur: harsh, holosystolic, loudest at LLSB
- may not be audible until 2-6 mo
- note: murmur of large VSD often is softer than that of a small VSD (less significant pressure gradient across the defect). Large VSD may also may diastolic murmur heard at apex d/t increased flow across the mitral valve.
- work-up for suspected large VSD may include echocardiogram and bubble study
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Term
| symptoms that may be associated with large VSD (5); problems that can occur with untreated large VSD (2) |
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Definition
- dyspnea
- feeding difficulties
- growth failure
- profuse perspiration
- infant may become "dusky" when feeding or crying
- can lead to recurrent infxns and heart failure
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Term
| what CXR (2) and EKG (1) findings are seen with large VSD? |
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Definition
- CXR: cardiomegaly, pulmonary vascular congestion
- EKG: biventricular hypertrophy
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Term
| Tx for small and large VSD's |
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Definition
- Small VSDs - usually close spontaneously between 6-12 mo (no tx necessary)
- Symptomatic pt with large VSD - start treating with diuretics, ACE-I to decrease afterload, and sometimes digoxin. If child still has large shunt at 1 yo do surgical closure.
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Term
| PDA is most commonly seen in ____. |
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Definition
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Term
| When does ductus close in term infants? |
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Definition
| usually within 10-15 hours; almost always by 2 days |
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Term
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Definition
- often asymptomatic
- large defects may cause mild growth failure and exercise intolerance
- tolerated well in childhood, but can lead to pulmonary HTN in the adult
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Term
| ASD - physical exam finding, CXR, EKG |
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Definition
- PE: fixed splitting of S2; systolic murmur at LUSB an midsternal border d/t increase flow from RV into pulmonary a. Can also have LLSB diastolic murmur d/t increased flow across tricuspid valve.
- CXR: R-side enlarged. Increased pulmonary vascularity
- EKG: RV hypertrophy, +/- R axis deviation
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Term
| AVSD (endocardial cushion defect/AV canal defect) - physical exam findings, tx |
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Definition
- PE: systolic murmur (increased flow into pulmonary a.), LLSB diastolic murmur, +/0 widely split S2
- tx: requires correction during infancy to prevent complications - heart failure, recurrent pulmonary infxns, growth failure, pulm HTN, shunt reversal, etc.
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