Infant

Question 1

Normal newborn heart rate:

Answer 1

120-150bpm

Question 2

normal newborn resp rate:

Answer 2

40

Question 3

In addition to the normal stuff you do during an adult abdominal exam, what else are you doing for the newborn?

Answer 3

palpate kidneys, check umbilicus

Question 4

This is a genetic anomaly that is characterized by the stomach pushed out through abdominal abnormality and covered in umbilical sheath.

Answer 4

omphalocele

Question 5

This abdominal abnormality is similar to the omphalocele, but is not a/w with a genetic disease, and does not involve the umbilical sheath.

Answer 5

gastrochisis

Question 6

T/F: you should retract the foreskin on all newborn exams to check for hypospadias

Answer 6

FALSE: don’t retract foreskin, phimosis is normal until age 5. (but do check for hypospadias)

Question 7

Mom is worried, her newborn girl seems to be having a vaginal bloody discharge. What should you tell her?

Answer 7

It is very common as a result of w/d from maternal hormones

Question 8

Where is a common place for a newborn to have a fracture as result of difficult vaginal birth?

Answer 8

clavicles

Question 9

When this abnormality is missed, it is a common source for litigation because if caught and treated before 6 months of age, any future sequelae can be avoided. You can identify this condition using what 2 special tests?

Answer 9

hip dysplasia. Barlow and Ortaloni

Question 10

During the ________ special test, the hip is dislocated due to internal rotation. During the _______ test, the hip clunks back into place with external rotation

Answer 10

barlow, ortaloni

Question 11

singal palmar crease is indicative of ________

Answer 11

down’s/trisomy

Question 12

clinical term for “webbed digits”

Answer 12

syndactly

Question 13

clinical term for “club foot”

Answer 13

congenital talipes equinovarus

Question 14

what are some spinal defects that would lead you to suspect spina bifida?

Answer 14

Mild: hairy tufts, pigmentation change, clefts
Moderate: meningocele
Severe: Meningomyelocele, teratomas, sinus tracts

Question 15

How can you edu mothers about prevention of spinal defects/spina bifida?

Answer 15

take folic acid!!

Question 16

This newborn skin abnormality is important to document b/c it looks like bruising and could be confused with child abuse

Answer 16

Mongolian spots

Question 17

This skin finding is pretty common, it involves papules filled with eosinophils. Benign, no tx required

Answer 17

ETN–Erythema toxicum neonatorum

Question 18

This skin finding involves papules that are filled with neutrophils. They do NOT have an erythematous base, and are completely benign. They often heal as freckles.

Answer 18

TPN–Transient pustular melanosis

Question 19

These 2 skin findings are a result of withdrawal from mom’s hormones. They are benign and will self resolve after several days if newborn’s skin is kept clean.

Answer 19

neonatal acne and sebaceous gland hyperplasia

Question 20

This is a self-limited skin finding known as an “angel kiss” or a “stork bite”

Answer 20

hemangioma

Question 21

This is a common skin irritation of the scalp in newborns

Answer 21

cradle cap aka seborrhea dermatitis

Question 22

Average head circumference for newborn

Answer 22

34-35cm

Question 23

Term for when both nares are NOT patent bilaterally

Answer 23

coanal atresia

Question 24

When examining the skull, the ________fontanelle is easiest to palpate, and should close by _________months of age

Answer 24

anterior, 12

Question 25

Head trauma from vaginal birthing is common. Which type is well localized (does not cross suture lines), and can be a/w jaundice or skull fx?

Answer 25

cephalohematoma

Question 26

Which birthing head trauma is generalized, boggy feeling, and likely benign?

Answer 26

Caput succedaneum

Question 27

absent red reflex is indicative of what?

Answer 27

leukocoria–>retinoblastoma

Question 28

Newborn reflexes:

Answer 28

1) palmar/plantar grasp
2) rooting
3) moro (drop)
4) stepping reflex

Question 29

At what gestational age do you declare an infant “premature”?

Answer 29

<37 weeks

Question 30

At what gestational age do you declare an infant “post-term”?

Answer 30

> 42 weeks

Question 31

post term infants are at risk for? (3)

Answer 31

1) asphyxia
2) mesoconium aspiration
3) trisomies

Question 32

What is the most accurate way to assess gestational age?

Answer 32

early US

Question 33

If mom had no prenatal care, and no US prior to giving birth in the ED, what test could you use to determine gestational age?

Answer 33

Ballard test

Question 34

The Ballard tests adds what two scores together (and compares with gestational estimation of age) to determine true gestational age?

Answer 34

1) neuromuscular maturity (involve general posture)
2) physical maturity (development)

added scores are ideally 40 = 40 weeks

Question 35

What’s the preferred tx of neonatal jaundice?

Answer 35

phototherapy converts bilirubin to urobilirubin to be excreted in urine

Question 36

Aside from a single palmar crease, what are some other physical exam findings that would indicate Down’s/Trisomy 21?

Answer 36

1) sandal toe
2) poor tone
3) almond eyes
4) flat nose
5) small ears
6) Brushfield (white) spots on iris
7) large fontanelles

Question 37

50% of Down’s babies will also have what congenital defect?

Answer 37

AV septal defect

Question 38

Fetal development of the lungs is finishing around ___ weeks. So if baby is born sooner than this, _________disease is common.

Answer 38

34-36 weeks, hyaline membrane dz (no surfactant production)

Question 39

What will hyaline membrane dz look like on CXR?

Answer 39

ground glass

Question 40

You see lots of air in the abdomen on a neonatal KUB. What do you suspect?

Answer 40

necrotizing enterocolitis (bacteria producing gasses as waste product)

Question 41

Infant comes in with parents c/o ABDOMINAL DISTENSION, blood in stool, diarrhea, feeding intolerance, lethargy, temperature instability and vomiting. What tests will you order to help dx? What do you suspect prior to getting results?

Answer 41

Suspect necrotizing enterocolitis. Order CBC, lactic acid level, CXR

Question 42

How will you tx necrotizing enterocolitis?

Answer 42

1) rest gut
2) decompress gut w/ NG tube
3) IV fluids
4) abx

Question 43

Undescended testicle?

Answer 43

cryptorchidism

Question 44

Cryptorchidism is common, especially in premature males. At what age do you start to become concerned if there are no signs of dropping? And then what do you do?

Answer 44

6 months. (Most will descend by 3 mo). If not, refer to Uro for sx intervention

Question 45

Apgar scores should be recorded how long after birth?

Answer 45

1 minute and 5 minutes. (20 minutes is ok for depressed/distressed baby)

Question 46

There are 5 Apgar categories. What are they?

Answer 46

1) HR
2) resp effort
3) muscle tone
4) response to cath in nose
5) color

Question 47

Apgar scores are doled out 0-2 for each category with a max healthy score of 10. What are the criteria?

Answer 47

1) 0–no pulse, 1– 100bpm, reg
2) 0–no effort, 1–slow/irreg, 2–strong, crying
3) 0–no tone, 1–some flexion, 2–active movement
4) 0–no response, 1–grimace, 2–cough/sneeze
5) 0–pale/blue, 1–pink trunk, blue extremities, 2–all pink