Neonatology

Question 1

Newborn with C8-T1 nerve root injury (name 3 findings)

Answer 1

Klumpke palsy. Clx: hand paralysis and Horner syndrome (ptosis, miosis, anhidrosis/harlequin sign = impaired facial flushing), and heterochromia (iris pigment in first few months is under sympathetic control.

Question 2

Vascular accident involving the right umbilical vein or the right omphalomesenteric artery

Answer 2

Gastroschisis

Question 3

Newborn with symptomatic hypoglycemia (tx)

Answer 3

Give D10W 2 cc/kg (NOT oral glucose since symptomatic)

Question 4

Breastmilk jaundice duration

Answer 4

Usually start 3-5 DOL, peaks 2 weeks, may be present up to 2-3 months

Question 5

Post-term infant physical exam findings

Answer 5

Dry peeling skin, less than normal SQ tissue, long fingernails, +/- meconium staining of skin/cord/nails

Question 6

Newborn with mom having Maternal Hep B

Answer 6

Give HBV and HepB immunoglobulin

Question 7

IUGR complications

Answer 7

Metabolic syndrome, hypertension, non-EtOH fatty liver without cirrhosis, and minimal decrease IQ/executive fx

Question 8

Vascular accident of right umbilical vein or omphalomesenteric artery

Answer 8

Gastroschisis (premature involution or disruption of said veins => necrosis of lateral abdominal wall => gastroschisis)

Question 9

Baby girl with fleshy-colored smooth surfaced lesion protruding from inferior portion of the vagina

Answer 9

Hymenal tag, benign, no workup needed (VS. Sarcoma botryoids - appear in young children, appearance of bunches of grapes).

Question 10

Hepatitis B newborn vaccine recommendations

Answer 10

If mom HBsAg (-) => wait until 1 month for 1st dose. If mom HBsAg (+) => get HepB vaccine (dose not count toward 3-dose series) and HBIG within 12 hours of birth => get HepB vaccine at 1, 2, and 6 months of chronological age.

Question 11

Normal newborn penis length

Answer 11

> 2 cm (if less than 2 cm, needs endocrine evaluation)

Question 12

Normal newborn liver examination

Answer 12

Can be palpable up to 3 cm in normal infant

Question 13

Normal newborn kidney examination

Answer 13

Lower portion palpable, especially in 1st DOL before bowels fill with gas

Question 14

When are premies expected to catch up with peers in growth parameters

Answer 14

Most by 2 YEARs of age

Question 15

Erb’s palsy treatment

Answer 15

PT and observe

Question 16

Erb’s palsy treatment

Answer 16

PT and observe

Question 17

Test for SCID in newborn screen

Answer 17

T-cell receptor excision circles (TREC)

Question 18

10 day old with seizure, has not been feeding well, has fever, emesis, lethargy, jaundice, hepatomegaly, and cataracts

Answer 18

Classic galactosemia with E. coli sepsis

Question 19

Causes of symmetrical IUGR

Answer 19

Early effects => chronic EtOH, genetic dz, early infection, chronic anemia, chronic hypertension, chronic cigarette, SLE

Question 20

Causes of asymmetrical IUGR

Answer 20

Later in pregnancy => uteroplacental insufficiency, acute HTN, multiple gestation, abnormal placental structure, late pregnancy substance use

Question 21

Neonate with generalized hypotonia (what other findings might you expect?)

Answer 21

Polyhydramnios (pharyngeal weakness => difficulty swallowing amniotic fluid => polyhydramnios)

Question 22

Single umbilical artery (management)

Answer 22

Comprehensive physical exam, not necessarily routine renal ultrasound (but increase risk of RENAL abnormalities. Other anomalies also occur)

Question 23

Fetal tracing shows lowest point of deceleration at peak of contraction with uniform wave shape

Answer 23

Early deceleration 2/2 increase vagal tone from head compression = benign

Question 24

Fetal tracing shows varied shape, peak, and duration of deceleration without correlation with contraction

Answer 24

Variable deceleration 2/2 compression of umbilical cord

Question 25

Fetal tracing shows deceleration with lowest point after peak of contraction

Answer 25

Late deceleration 2/2 associated with placental insufficiency (possibly bad => get fetal scalp pH measurement)

Question 26

Neonate with severely thickened skin with large, shiny plates of hyperkeratotic scales. Deep erythematous fissures separate the scales and contraction abnormalites of eyes, ears, mouth, and appendages (dz?)

Answer 26

Harlequin ichthyosis

Question 27

Term infant develops tachypnea, hypoxia, and grunting 1 hour after birth. CXR shows fluid in fissures, flattening of diaphragm, and prominent pulmonary vasculature (dz and tx)

Answer 27

Transient tachypnea of newborn, self-resolves => supportive

Question 28

Term infant with tachypnea, cyanosis only in lower body, loud 2nd heart sound. CXR shows clear lungs and decrease vascular markings. (Dz and association)

Answer 28

Persistent pulmonary hypertension of newborn (associated with maternal SSRI use)

Question 29

LGA newborn with lethargy, tremors, cyanosis, and seizures

Answer 29

Hypoglycemia

Question 30

Newborn with jaundice, hypocalcemia, and hypoglycemia (assciation)

Answer 30

Polycythemia

Question 31

Abdominal wall defect with covered membrane (associations)

Answer 31

Omphalocele => Beckwith-Wiedemann, Trisomies

Question 32

Absent abdominal wall musculature, cryptorchidism, and urinary tract malformation

Answer 32

Prune belly syndrome aka Eagle-Barrett syndrome (belly looks wrinkled and like a prune)

Question 33

When is chorionic villus sampling preformed?

Answer 33

At 10-12 weeks of pregnancy (late 1st trimester)

Question 34

When is amniocentesis preformed?

Answer 34

At 12-16 weeks of pregnancy (early 2nd trimester)

Question 35

Jaundice in the first 24 hours of life (management)

Answer 35

Likely non-physiologic => CBC, reticulocyte, Tbili and Dbili, and Coombs (Blood culture unnecessary if well appearing)