Clinical Reasoning and Newborn Exam II

Question 1

components of info from mother

Answer 1

prenatal care
previous pregnancies
health of other children
complications
family history genetics
lab finding (group B strep)

Question 2

central cyanosis

Answer 2

entire body

Question 3

acrocyanosis

Answer 3

only of extremities

Question 4

harlequin skin

Answer 4

one side red one side not

unknown cause
of no consequence
goes away

Question 5

newborn temp

Answer 5

36.5-37.5 C

Question 6

newborn resp

Answer 6

30-60 breaths/min

Question 7

newborn HR

Answer 7

100-160 bpm

Question 8

newborn vitals

Answer 8

temp
resp
HR
length, weight, head circumference

Question 9

APGAR

Answer 9

at one minute and 5 minutes

appearance, pulse, grimace, activity, respiration

scored 0-10

Question 10

baby problems

Answer 10

typically respiratory

Question 11

caput succedaneum

Answer 11

edema above periosteum which crosses suture lines

just watch it, should reabsorb

Question 12

cephalohematoma

Answer 12

bleeding under periosteum

-does not cross suture lines

Question 13

edema crossing suture lines

Answer 13

caput succedaneum

Question 14

choanal atresia

Answer 14

failure of communication between nose and pharynx

difficulty breathing and cyclic cyanosis

can pass feeding tube to check

Question 15

eye exam

Answer 15

look for red reflex

symmetry, set/shape, discharge, erythema, red light reflex

Question 16

cataract in eye

Answer 16

retinoblastoma

galactomsemia

Question 17

epstein pearls

Answer 17

white dots in mouth

not infection

Question 18

cleft palate and lips

Answer 18

look for other abnormalities

Question 19

neck

Answer 19

palpate clavicles

-for fracture after hard delivery

Question 20

cardiac exam

Answer 20

min of 4 spots

dextrocardia - listen on right side

also check femoral pulses

Question 21

meconium stained umbilical cord

Answer 21

meconium in amniotic fluid

can get sucked into lung

need resuscitated right away

Question 22

umbilical hernias

Answer 22

will typically go away

sometime surgically removed

Question 23

exam of back

Answer 23

sacral dimples
abnormal coloration
neurotube defect findings

Question 24

spina bifida

Answer 24

no external

sacral hair

Question 25

sacral dimple

Answer 25

used to need justification on MRI that things are fine

-now just monitor carefully

Question 26

butterfly mark

Answer 26

vascular problems

-need to be investigated

Question 27

barlow test

Answer 27

hips

push up and in

Question 28

ortolani test

Answer 28

hips

down and out

Question 29

subcoronal hypospadias

Answer 29

near head of penis

Question 30

midshaft hypospacias

Answer 30

along shaft of penis

Question 31

penoscrotal hypospadias

Answer 31

where penis and scrotum meet

Question 32

combined ventricular output

Answer 32

CVO

cardiac output with fetal circulation

40% to umbilical placental circulation

20-30% to fetal brain

Question 33

ductus arteriosus

Answer 33

patency maintained by prostacyclin I2 (PGE2)

Question 34

after birth - lung compliance improves

Answer 34

because of surfactant

Question 35

after birth and glucose

Answer 35

gluconeogenesis and glycogenolysis maintain levels

glycogenolysis - end of 3rd trimester

Question 36

neonatal seizures

Answer 36

can be suttle

• flickering of eyes
• result of hypoglycemia
• common cause is problem in glucose transition
• or insulomas