Newborn

Question 1

Purpose of newborn exam

Answer 1

Earliest possible detection of deviations, baseline for subsequent evaluations, parent counseling and assurance

Question 2

Newborn exam indications

Answer 2

Immediately after birth, before discharge from maternity unit, any concern about infant progress

Question 3

Newborn first exam

Answer 3

Apgar: Heart rate, respiratory effort, color, tone, reflex irritability – need discharge paperwork from hospital to get the score

Question 4

Growth measurements

Answer 4

Weight when naked – use same scale each time. Length when straight. Head circumpherence take 3 measurements.

Question 5

VS Newborn

Answer 5

HR 120-160, RR 40-60, Tem 36.5-37.5, BP

Question 6

General skin exam

Answer 6

Pink normal. Acrocyanosis normal, cyanosis, bruises look blue, jaundice, erythema toxicum snork bites, mongolian spots collection of malnin, benign pustular melanosis

Question 7

Erythema Toxicum

Answer 7

erythematous macules firm 1-3mm yellow or white papules or pustules, cause unsure, pustules contain eosinophils, appear first 3-4 days of life, range from birth to 2 weeks, benign self limiting

Question 8

Impetigo Neonatorum

Answer 8

Vesicular, pustular, or bullous from day 2-2 weeks. Lesions occur in moist or opposing surfaces of skin, unroofed do not form crusts, treat with antibiotics

Question 9

Mongolian spots

Answer 9

Most common in black infants, slate gray to blue black lesions, lumbosacral or butt, accumulation of melanocytes, fades by 7 years

Question 10

Causes for a weak cry in infant

Answer 10

sepsis, asphyxia, metabolic, narcotic use

Question 11

Causes for hoarsness

Answer 11

Hypocalcemia, airway injury

Question 12

High pitch cry

Answer 12

CNS causes, kernicterus

Question 13

Examine head and face

Answer 13

Shape of head, check fontanels, sutures, eyes, make sure nose is patent will sound congested from small passages, mouth lips make sure patent do a finger sweep, ears - low set = congitive delay if otic pit order kidney US since kidneys develop same week as ears, examine neck

Question 14

Caput Succedaneum

Answer 14

2 words, 2 suture lines. Boggy edema across lines disapears in a few days

Question 15

Cephalhematoma

Answer 15

Subperiosteal, weeks to resolve, does not cross lines

Question 16

Head exam

Answer 16

Check circumferences, shape: molding, brachycephaly, flat occiput - back to sleep. widening of the suture may indicate thyroid issue, fontanels, auscultate head for bruit

Question 17

Craniosynostosis

Answer 17

Premature closing of one or more cranial sutures, growth of the skull occurs parallel to the suture involved, early correction optimizese cosmetic appearance, can be part of Crouzon or Apert syndrome

Question 18

Chest distress signs

Answer 18

Grunting, tachypnea, nasal flaring, asymetric chest rise, suprasternal intercostal retraction. Look for deformities like pectus excavatum or carinatum

Question 19

Supernumerary Nipples

Answer 19

Males and females, pink or brown papules along the milk line on chest or abdomen. May contain breast tissue risk for neoplasia

Question 20

Cardiac assessment

Answer 20

110-160, color, perfusion, central cyanosis, murmurs, single s1 split s2

Question 21

Abdomen assessment

Answer 21

Scaphoid, distention, wall defect (gastroschisis), palpation kidneys are palpable, liver 2-3cm, spleen palpable, 2 artery 1 vein umbilicus, umbilical and inguinal hernias

Question 22

Genitalia

Answer 22

size, assess for hypospadias, epispadias, testes for crypoorchid or hydrocele, gemale can have prominent clitoris and minora from positioning in utero, skuin tags, discharge/blood, labial fusion Check patency and location of anus

Question 23

Hip and Extremities

Answer 23

erbs palsy: extended arm and internal rotation with limited movement. humerus fx. digital abnormalities – syndactaly, brachdactaly, polydachtaly, single palmar crease, hip dislocation - female, breach

Question 24

Feet and back

Answer 24

Check curvature, sinus tract, tuft of hair

Question 25

CNS

Answer 25

A&3, moving extremities, flexed body posture, minimal head lag, ventral suspension, vertical suspension

Question 26

Neonatal reflexes

Answer 26

autonomic behaviors that do not require higher level brain function, provides info on lower motor neurons and muscle tone, protective and disapear as higher level functions emerge

Question 27

Suck

Answer 27

stroke lips and mouth opens and sucking starts

Question 28

Rooting

Answer 28

stroke cheek, infant moves head towards stimulus and opens mouth

Question 29

Palmar grasp

Answer 29

place finger in palm, try to remove finger and tightens grasp

Question 30

Tonic neck

Answer 30

fencing posture. rotate head from midline to one side baby will extend arm where head is turned and flex opposite arm, same w legs

Question 31

Moro

Answer 31

hold baby so one hand supports head and the other supports buttocks, suddenly drop of the head in hand, response is hands open and extension and abduction of upper arms, then flexion of arms and audible cry

Question 32

Stepping

Answer 32

touch top of feet to edge of a table while held upright makes stepping movements

Question 33

Galant

Answer 33

trunk incurvation. Held in ventral suspension with chest in palm of hand, firm pressure applied to the baby side parallel to spine the response is flexion of the pelvis towards the side of stimulus

Question 34

Babinski

Answer 34

stimulus to outer edge of foot plantar flexion and flexion or extension of toes