Nelson - The Newborn Infant

Question 1

Initial examination of a newborn infant should be performed when

Answer 1

As soon as possible after delivery

Question 2

After a stable DR course, a 2nd and more detailed examination should be performed within

Answer 2

24h of birth

Question 3

Normal pulse in the neonate

Answer 3

120-160bpm

Question 4

Normal RR in the neonate

Answer 4

30-60bpm

Question 5

T/F Pulse oximetry is part of the routine screening for newborn infants

Answer 5

T

Question 6

T/F An O2 sat more than or equal to 95% after 24h of birth in otherwise healthy appearing term infants has >99% sensitivity and specificity to rule out CHD

Answer 6

T

Question 7

Which part of the PE should be done first in a relaxed quiet infant?

Answer 7

Palpation of the abdomen or auscultation of the heart

Question 8

T/F Coarse, tremulous movements with ankle or jaw myoclonus is significant in newborns and should be worked up

Answer 8

F, More common and less significant in newborns than at any other age

Question 9

T/F Convulsive twitching is normal in neonates usually occurring in a quiet state

Answer 9

T

Question 10

When confined to 1 or more extremities of a female infant, edema may be the initial sign of

Answer 10

Turner syndrome

Question 11

T/F Acrocyanosis is harmless cyanosis of the hands and feet especially when they are cool

Answer 11

T

Question 12

Localized cyanosis is differentiated from ecchymosis by

Answer 12

Momentary BLANCHING pallor with cyanosis that occurs after pressure

Question 13

T/F Postmature infants tend to have paler skin than premature infants

Answer 13

T

Question 14

Skin finding in neonates that if large may trap platelets and produce DIC or interfere with local organ function

Answer 14

Cavernous hemangiomas

Question 15

Slate-blue, well-demarcated areas of pigmentation called Mongolian spots are benign and tend to disappear within

Answer 15

1st year of life

Question 16

T/F Tufts of hair over the lumbosacral spine suggest an underlying abnormality including tumors

Answer 16

T

Question 17

What is erythema toxicum

Answer 17

Benign white papules on an erythematous base that develop 1-3 days after birth

Question 18

Erythema toxicum persists for as long as

Answer 18

1 week

Question 19

Erythema toxicum contain what cells

Answer 19

Eosinophils

Question 20

A benign lesion predominantly seen in black neonates that contain neutrophils

Answer 20

Pustular melanosis

Question 21

Pustular melanosis is present when and lasts until when

Answer 21

At birth until 2-3 days

Question 22

T/F Pustular melanosis and erythema toxicum need to be distinguished from more dangerous vesicular eruptions

Answer 22

T

Question 23

Normal size of the anterior fontanelle

Answer 23

20±10mm

Question 24

A third fontanel suggests what chromosomal abnormality

Answer 24

Trisomy 21

Question 25

T/F A third fontanel may be seen in premature infants

Answer 25

T

Question 26

T/F Megalencephaly (excessively large head) may be familial

Answer 26

T

Question 27

T/F Depression of the skull (indentation, fracture, ping pong ball deformity) is usually of prenatal onset

Answer 27

T

Question 28

Atrophic or alopecia scalp may represent what congenital abnormality

Answer 28

Aplasia cutis congenita

Question 29

T/F Möbius syndrome is associated with SYMMETRIC facial palsy

Answer 29

T

Question 30

Absence or hypoplasia of the 7th nerve nucleus

Answer 30

Möbius syndrome

Question 31

T/F Conjunctival and retinal haemorrhages in neonates are usually benign

Answer 31

T

Question 32

T/F Retinal haemorrhages are more common in SVD than vacuum- or forceps-assisted deliveries

Answer 32

F, less common in SVD

Question 33

T/F Retinal haemorrhages are usually bilateral, intraretinal, and in the posterior pole

Answer 33

T

Question 34

Retinal haemorrhages resolve in most infants by

Answer 34

2 weeks of age

Question 35

Retinal haemorrhages resolve in all infants by

Answer 35

4 weeks of age

Question 36

A cornea >___cm in diameter in a term infant (with photophobia and tearing) suggests congenital glaucoma and requires prompt ophthalmologic consultation

Answer 36

1

Question 37

T/F The presence of bilateral red reflexes warrants an immediate ophthalmologic consultation

Answer 37

F, WHITE reflex warrants an immediate ophthalmologic consultation

Question 38

T/F the tympanic membrane in the neonate normally appears pearly white

Answer 38

F, dull gray

Question 39

T/F Precocious dentition usually indicates extraction

Answer 39

F, not usually indicated

Question 40

Temporary accumulations of epithelial cells on the hard palate on either side of the raphe

Answer 40

Epstein pearls

Question 41

T/F Clusters of small white or yellow follicles or ulcers on erythematous bases found on the anterior tonsillar pillars warrant empiric treatment

Answer 41

F, clear without treatment in 2-4 days

Question 42

T/F Neonates do not have active salivation

Answer 42

T

Question 43

T/F Ankyloglossia is usually an indication for frenulotomy

Answer 43

F, rarely a reason for cutting

Question 44

T/F Frenotomy may reduce maternal nipple pain and improve breastfeeding scores more rapidly than no treatment but over time neonates not treated with frenotomy also had successful feeding

Answer 44

T

Question 45

T/F Suckling callus disappear when suckling ceases

Answer 45

T

Question 46

T/F Throat of a newborn infant is hard to see

Answer 46

T, because of the low arch of the palate

Question 47

T/F Neonatal tonsils are small

Answer 47

T

Question 48

Shield-shped chest may be seen in what chromosomal abnormality

Answer 48

Turner syndrome

Question 49

T/F RR should be counted for a full minute with the infant in the resting state, preferably asleep

Answer 49

T

Question 50

T/F In premature infants, the RR is higher and fluctuates more widely

Answer 50

T

Question 51

T/F An RR consistently greater than 60bpm that persists for more than 30 minutes is an indication to rule out pulmonary, cardiac, or metabolic disease etiologies

Answer 51

F, 60 minutes or 1 hour

Question 52

T/F The breathing of newborn infants at rest is almost entirely nasal

Answer 52

F, diaphragmatic (during inspiration, the soft front of the thorax is usually drawn inward while the abdomen protrudes, producing a paradoxic movement)

Question 53

T/F Paradoxic/diaphragmatic breathing always signifies insufficient ventilation and should be investigated

Answer 53

F

Question 54

Expiratory grunting is benign if it resolves between ___ mins after birth

Answer 54

30 and 60 mins

Question 55

Normally, breath sounds of neonates are vesicular

Answer 55

F, bronchovesicular

Question 56

T/F Suspicion of pulmonary pathology in neonates should always be verified with a chest radiograph

Answer 56

T

Question 57

Neonatal pulse is usually ___ bpm at rest, but may vary normally from ___bpm in relaxed sleep to ___bpm during activity

Answer 57

110-140, 90, 180

Question 58

Pulse rate of SVT

Answer 58

>220

Question 59

Preterm infants usually have a higher resting HR up to ___

Answer 59

160bpm

Question 60

The easiest and most accurate noninvasive method available for BP measurements

Answer 60

Oscillometric method

Question 61

The normal liver is palpable as much as ___cm below the rib margin

Answer 61

2

Question 62

T/F At no other period than the neonatal period does the amount of air in the GIT cry so much, nor is it usually so great under normal circumstances

Answer 62

T

Question 63

T/F The intestinal tract is gases at birth

Answer 63

T

Question 64

Gas is swallowed soon after birth, and gas should normal be present in the rectum on roentgenogram by

Answer 64

24 hr of age

Question 65

The cause of most neonatal abdominal masses

Answer 65

Renal pathology

Question 66

A solid flank mass clinically associated with hematuria, hypertension, and thrombocytopenia

Answer 66

Renal vein thrombosis

Question 67

Abdominal distension at birth or shortly afterward suggests

Answer 67

Obstruction or perforation of the GIT often as a result of meconium ileus

Question 68

Abdominal distension later after birth suggests

Answer 68

1) Lower bowel obstruction 2) Sepsis 3) Peritonitis

Question 69

Abdominal wall defect that occur THROUGH the umbilicus

Answer 69

Omphalocele

Question 70

Abdominal wall defect that occur lateral to the midline

Answer 70

Gastroschisis

Question 71

Abdominal defect usually associated with other congenital anomalies and syndromes

Answer 71

Omphalocele

Question 72

Anomaly of the umbilical cord associated with an increased risk for occult renal anomaly

Answer 72

Single umbilical artery

Question 73

T/F A normal scrotum at birth is relatively large

Answer 73

T

Question 74

Most neonates void by

Answer 74

12hr

Question 75

Approximately 95% of preterm and term infants void within

Answer 75

24hr

Question 76

99% of term infants and 95% of preterm infants pass meconium within

Answer 76

48hr

Question 77

T/F Passage of meconium does not rule out an imperforate anus

Answer 77

T, a rectal-vaginal fistula may be present