CLIPP 9

Question 1

feedings per day and duration

Answer 1

8-12 per day for 10-15min/time

Question 2

stool and urines / day at d3-5 and d5-7

Answer 2

d3-5: 3-4, 3-5

d5-7: 3-6, 4-6

Question 3

what vitamin do newborns need and in what amount? who is exempt?

Answer 3

D - 400 IU daily

-exempt if formula-fed exclusively and having 1L to 1Q per day

Question 4

seizures vs jitters in infants

Answer 4

• newborns rarely have generalized tonic clonic seizures and instead may have apnea, lip smacking etc, eye fluttering, horizontal deviation
• jitters are stimulated, go away with passive gentle flexion and are generalized and symmetric
• clonus up to 10 beats in newborn if no other neuro sx and no asymmetric or up to 3 in 1-2 month old is normal, brief myoclonus is also okay esp when falling asleep
• clonus = twitching and rhythmic jerks when trying to hold in stretched state vs myoclonus = involuntary jerks

Question 5

presentation of salt-wasting CAH

Answer 5

dehydration, lethargy, vomiting, virilization

Question 6

one cause / association of hypoglycemia

Answer 6

low temperature

Question 7

common finding in congenital hypothyroidism

Answer 7

constipation, may also see umbilical hernia, hypotonia, jaundice

Question 8

calculating fontanel size, associations with large, small, sunken, bulgy, exemptions

Answer 8

h+w / 2
AF: mean is 2.1, @SD is .6 and 3.6
PF: most is below .5
large: skeletal, chromosomal, malnutrition, hypothyroid, high ICP
small: microcephaly, craniosynostosis, hyperthyroidism, normal variant
sunken: dehydrated
bulging: hydrocephalus, meningitis, lead poisoning, subdural hematoma
exempt: if crying or if lying vs sitting - can change it.

Question 9

important cause of decreased feeding

Answer 9

CAH

Question 10

inborn errors of metabolism - sx and lab

Answer 10

appear fine in 1-2 days of life but then can get lethargic, dehydrated–>encephalopathy
-hyperammonemia and elevated urine orotic acid

Question 11

most common cause worldwide of hypothy

Answer 11

iodine deficiency

Question 12

hypothyroidism transiently due to

Answer 12

babies of graves mothers who take anti-thy drugs or passage of thyrotropin receptor blocking Ab via placenta

Question 13

two populations in whom congenital hypothyroidism is common in

Answer 13

native americans, hispanics

Question 14

primary vs secondary, tertiary hypothyroidism

Answer 14

• primary: HPA is functioning, TSH high

- secondary, tertiary: abnormalities at pituitary or hypothalamus

Question 15

why do CH patients appear normal at birth?

Answer 15

moms thyroid hormone can protect hypothyroid fetus and only several months after birth does the baby start to show signs

Question 16

one of most common causes of preventable mental retardation

Answer 16

CH

Question 17

next steps in dx CH and tx

Answer 17

confirmatory measurements of TSH and T4 and started on Levo

Question 18

musty sweaty odor, seizures

Answer 18

PKU ( due to phenylacetate)

Question 19

timing of specimen collection

Answer 19

asap - initial likely before 24h age (no later than d/c time and no later than 7d of age), another before 2w

Question 20

goal of Levo tx

Answer 20

maintain TSH at 1 and t4 in upper half of normal range - normalization of TSH within 1-2 months has good prognosis for neurologic outcomes

Question 21

after starting levo, measure TSH at..

Answer 21

2 and 4 weeks post tx and..
every 1-2 months if under 1y old
eery 2-3 months til 3 yo
every 3-12 months til growth is done

Question 22

Levo at 0-6months of age

Answer 22

10-15 mcg/kg/day

Question 23

large tongue, puffy skin around eyes, bad muscle tone, outty bellybutton

Answer 23

hypothyroidism

Question 24

botulism

Answer 24

hypotonia, lethargy, constipation , absent dTRs, weka cry, respi failure