examination of the newborn

Question 1

Describe erythema toxicum

Answer 1

Lesions distributed all over body (palms and soles spared) and lasts few days, child is otherwise well
- central papule surrounded by erythema

Question 2

treatment for erythema toxicum

Answer 2

Nil

Question 3

Where do blue spots typically occur

Answer 3

dark blue/purple macular lesions on sacrum, buttocks or lower limbs usually in dark skinned individuals and usually fades in 4 years

Question 4

lifespan of haemangioma

Answer 4

will get larger, darker and raised over first few months then may shrink by 1 year

Question 5

lifespan of salmon patch/angel kiss

Answer 5

red/pink light lesion on forehead between eyebrows and may change colour over time- nothing to worry about

Question 6

lifespan of portwine stain and associations

Answer 6

won’t fade over time, can use laser therapy to some effect

may be associated with sturge-weber syndrome (epilepsy)

Question 7

management of cleft lip and palate

Answer 7

surgery is primary treatment to establish normal facial anatomy and feeding function

Question 8

characteristics of Down’s Syndrome

Answer 8

flattened nasal bridge
epicanthic folds
flat occiput
floppy infant

Question 9

what is talipes and what are the different types

Answer 9

the sole of the foot is turned medially and the foot is inteverted
can b positional or postural

Question 10

Management of talipes

Answer 10

corrective splinting, taping and casting

Question 11

what is developmental dysplasia of the hip

Answer 11

Abnormal relationship between the femoral head and acetabulum in the developing hip in otherwise healthy infants

Question 12

how does hip dysplasia present

Answer 12

• frank dislocation
• subluxation
• instability
• dysplasia of femoral head

Question 13

what specific examinations might you undertake for hip dysplasia and the findings

Answer 13

Barlow manoeuvre: examiner adducts hip while applying a posterior force on the knee to promote dislocation
Ortolani sign- examiner abducts the hip while applying an anterior force on the femur to reduce the hip joint

Question 14

Mx of hip dysplasia

Answer 14

infants before walking age: flexion-abduction splinting
if identified later (6m-2 years) may require closed reduction and immobilisation
>18m need open reduction

Question 15

associations with hip dysplasia

Answer 15

• Larsen syndrome
• Ehlers-Danlos syndrome
• Down’s syndrome

Question 16

which congenital condition is associated with ambiguous genitalia

Answer 16

CAH- monogenic autosomal recessive disorder resulting in inadequate cortisol +/- aldosterone synthesis

Question 17

symptoms of salt-wasting crisis in aldosterone deficiency

Answer 17

lethargy, vomiting, hyponatraemia, hyperkalaemia, dehydration and hypovolaemic shock esp. in male neonate

Question 18

treatment of CAH

Answer 18

fluid resus
corticosteroids
fludrocortisone
NaCl
clitoroplasty

Question 19

what is spina bifida

Answer 19

common and treatable congenital spinal cord malformation resulting from a defect in neural tube development

Question 20

risk factors for spina bifida

Answer 20

• maternal folate deficiency
• exposure in early pregnancy to excessive heat (fever, sauna)
• certain medications (carbamezapine, valproic acid, methotrexate)

Question 21

pre-natal screening for spina bifida

Answer 21

• maternal serum alpha-fetoprotein level
• USS
• amniocentesis

Question 22

Mx of spina bifida

Answer 22

antibiotics to prevent CNS infection

urgent surgical closure within 24-48 hours of birth

Question 23

characteristics of cephalohaematoma

Answer 23

subperiosteal haemorrhage- never extends across suture line, often caused by traumatic delivery
usually resolves in 6 weeks no sequelae

Question 24

common complications of shoulder dystocia

Answer 24

neonatal clavicle fracture

brachial plexus injury- Erb’s palsy

Question 25

When can vitamin K deficient bleeding disorder occur

Answer 25

• early onset haemorrhagic disease within first few days of life
• late onset at 4-6 weeks old

Question 26

Causes of jaundice within first 24 hours of life

Answer 26

haemolysis

sepsis

Question 27

aetiology of physiological jaundice

Answer 27

as a product of foetal red blood cell breakdown and low hepatic activity due to low glucuronyl transferase

Question 28

why are breastfed babies more likely to have physiological jaundice

Answer 28

due to beta-glucuronidase in breast milk which uncouples bilirubin from glucuronic acid to be reabsorbed in the gut lumen

Question 29

complications of high unconjugated bilirubin

Answer 29

kernicterus- cerebral palsy, deafness