Examination

Question 1

Steps of the exam?

Answer 1

Head to toe systematic

Question 2

What do you notice in general observation?

Answer 2

vitals (RR 35-60) (HR 120-160)
appearance - weight, length, 
posture, 
movements
plethoric or pale (i.e. anaemia), 
jaundice, 
rashes

Question 3

What do you look for in the face?

Answer 3

Head circumference (macro/microcephaly)
fontanelle
face characteristics
eyes (red reflex)
palate
clavicles

Question 4

How could the fontanelle be affected?

Answer 4

Tense fontanelle = raised ICP, caput succedaneum, cephalohematoma, chignon à cranial USS

Depressed fontanelle = dehydrated

Question 5

What do you look for in the abdomen?

Answer 5

Breathing, chest wall movement, HR, abdomen, cord (fall off by 40 days), hernias, pectus

Question 6

What do you look for in the pelvis and lower limbs?

Answer 6

Femoral pulses, genitalia (testes in scrotum, hypospadias, clitoromegaly), anus (patency)

Question 7

How do you assses muscle tone?

Answer 7

Muscle tone, whole of back and spine, DDH, club feet (positional vs. true talipes), hands and feet

§ Fully dorsiflex the foot to touch lower leg to see if true talipes equinovarus (will not be possible)

Question 8

Which reflexes do you test for in the neonate?

Answer 8

Moro - spreading out the arms (abduction)
pulling the arms in (adduction)
crying (usually)

Stepping - baby appears to take steps or dance when held upright

Assymetric Tonic - When the face is turned to one side, the arm and leg on that side extend, and the arm and leg on the opposite side flex

Palmar - newborn to clench an object when pressure and touch are applied to the palm

Babinski - firmly stroking sole of foot leads to big toe extension

Question 9

What does the Biochemical screen (Guthrie Test Asses)?

Answer 9

Congenital hypothyroidism
Sickle cell disease
Cystic Fibrosis
Phenylketonuria
Medium Chain Acyl CoA dehydrogenase deficiency (MCADD)
Glutaric Aciduria T1
Isovaleric Acidaemia
Homocystinuria
Maple Syrup Urine
Disease (MSUD)

Question 10

What do you asses in the hearing exam?

Answer 10

Measured at Birth

1 - Evoked Otoacoustic Emission (EOAE) Testing – all babies receive this test!

2 - (if first abnormal) : Automated Auditory Brainstem Response (AABR) Audiometry

Question 11

What is postional talipes

Answer 11

foot remains inwards and downwards (as in utero) due to compression

resolves in up to 6 months with repositioning and physio

Question 12

What is talipes equanovarus? How is it managed?

Answer 12

club foot

• inverted and supinated
• foot is shorter and calf muscles thinner
• more common in males
• may be due to oligohydroamnios
• managed using Ponsetti Method (plaster casting and bracing)
• if severe then surgery