Newborn Assessment

Question 1

How much weight loss is acceptable after birth?

Answer 1

10% of birth wt can be lost in first 7d

Question 2

When does birth weight need to be regained by?

Answer 2

DOL 10 - 14

Question 3

When does the weight double by?

Answer 3

4 - 5 months

Question 4

How do you measure height prior to 2y and after 2 y

Answer 4

supine <2y, standing after

Question 5

how much do term babies gain/day?

Answer 5

20 - 30g

Question 6

How much do babies grow length wise in cm in first year?

Answer 6

25cm

Question 7

how much do babies grow in length in their second year ?

Answer 7

12cm

Question 8

How much does the head circumference grow/month in first year?

Answer 8

2cm

Question 9

What are the causes of asymmetrical SGA?

Answer 9

late onset and head sparing. Causes are; HTN, drugs, eton, smoking

Question 10

What are the causes of symmetrical SGA?

Answer 10

Torch, congenital abn. idiopathic/syndrome

Question 11

What does the mnemonic 4xS means in relation with innocent murmurs?

Answer 11

aSymptomatic, Soft, left Sternal edge, Systolic only

Question 12

what are the usual features of innocent murmurs? (physiologic, flow murmurs)

Answer 12

Mid systolic, soft in intensity (Gr 1 - 3), localized, poorly conducted, musical or vibratory in character, variable with position and respiration, not associated with other signs of heart disease

Question 13

What are you worried about with a white red reflex?

Answer 13

Congenital cataract, retinoblastoma

Question 14

How do you differentiate cong. cataracts and retinoblastoma?

Answer 14

if child has strabismus or esotropia then it is more likely retinoblastoma because tumour is causing shift.

Question 15

3 yo in ER cold like sx, past 2d with cough, viral sx everything else ok but you hear a murmur?

Answer 15

high output state (increased with fever)

Question 16

when do children get worsening of innocent (systolic murmur)

Answer 16

high output state

Question 17

What physical features suggest DDH?

Answer 17

asymmetry in gluteal folds, shortened leg, thigh may be shortened as well

Question 18

if + ortolani or barlow maneuver what do you do next?

Answer 18

f/u in 2 weeks

Question 19

If you f/u a + ortolani and barlow removal after 2 weeks at f/u then what do you do?

Answer 19

send to paediatric ortho

Question 20

What is the best management for a 22mo with DDH?

Answer 20

Femoral osteotomy

Question 21

RF for DDH?

Answer 21

Frank breech, female, first born, family hx, left hip

Question 22

When is XR good for DDH?

Answer 22

After 4 months of age because there is no ossification of bone

Question 23

how do you treat hemangiomas? (best tx)

Answer 23

propranolol

Question 24

What are the physical signs of sturge weber syndrome?

Answer 24

PWS, macrocephaly, ocular manifestations, soft tissue hypertrophy, hemiparesis, visual loss, hemianopsia

Question 25

What is sturge weber syndrome?

Answer 25

Sporadic disorder with a haemangiomatous facial lesion (port wine stain) in the distribution of the trigeminal nerve associated with a similar lesion intracranially

Question 26

how do you investigate sturge weber syndrome

Answer 26

image the head as the hemangioma follows the trigeminal nerve distribution

Question 27

What procedure do you do for undecscended testes?

Answer 27

orchiopexy

Question 28

Ddx of unpalatable testes

Answer 28

retractile testes, ectopic testes, cryptochordism

Question 29

congential adrenal hypoplasia what is the deficiency

Answer 29

21 hydroxylase deficiency

Question 30

What endocrine deficiency causes high K+?

Answer 30

aldosterone deficiency

Question 31

What is high in the blood when 21 hydroxylase deficiency is present?

Answer 31

17 oh Progesterone. This happens in CAH

Question 32

What does the "waiter tip position" of a newborn arm indicate?

Answer 32

Erbs Palsy

Question 33

What is the presentation of Erbs Palsy

Answer 33

Position in "waiter tip position" (Shoulder; adducted, internally rotated/ Elbow; extended, pronated/ Wrist; flexed)

Question 34

Wat are the three typical brachial plexus injuries? (nerve roots)

Answer 34

Avulsed c5, Ruptured C6, Stretched c7

Question 35

What does an adducted, internally rotated shoulder, with an extended, pronated elbow and flexed wrist mean?

Answer 35

Erbs Palsy

Question 36

Each of the following is an important component in the neuromotor assessment of infants below 3 months of age EXCEPT: ``` Evaluation for asymmetry of movement Assessment of primitive reflexes Evaluation of abnormalities in tone Evaluation of the forward parachute response Measurement of head circumference ```

Answer 36

Evaluation of the forward parachute reflexes

Question 37

Most full term infants regain their birth weight by age: ``` 3 days 5 days 10 days 2 weeks 3 weeks ```

Answer 37

10d

Question 38

A mother brings her 4 week old baby to your office for examination. She complains that he does not drink much and that she does not know what to do. His birth weight was 3.5 kg. His present weight is 3.6 kg. Which one of the following is the most appropriate course of action? Refer mother and child to a social worker for evaluation and give another appointment in 1 week Order a complete blood count and a sweet chloride test Reassure the mother that some children do not gain much weight during the first month of life Evaluate caloric intake and parent interaction Change the milk formula for an iron enriched formula

Answer 38

Evaluate caloric intake and parent interaction

Question 39

A newborn girl is noted to have a palpable clunk when the hip is abducted, flexed, and lifted forward Which of the following is the most likely mechanism of disease? Decreased epiphyseal blood flow resulting in osteonecrosis Displacement of the capital femoral epiphysis Failure of osteoid to mineralize Increased intra-articular pressure Muscle imbalance resulting from spasticity Shallow, poorly developed acetabulum

Answer 39

F. Shallow, poorly developed acetabulum

Question 40

An otherwise healthy 6-month-old girl is brought to the physician because of a hemangioma on her neck that has been enlarging since 6 weeks of age. The lesion was 0.5 cm at 6 weeks of age and is now 2 cm. It is raised, erythematous, and blanches with pressure; there is no ulceration Growth is appropriate for age, and laboratory studies show no abnormalities. Which of the following is the most appropriate next step in management? ``` Observation Intralesional antiangiogenic factor therapy Intralesional interferon therapy Oral corticosteroid therapy Laser therapy ```

Answer 40

Observation

Question 41

You are called to evaluate a full-term infant. The infant's mother expressed concern about her newborn's arm shortly after delivery. The mother's prenatal history is notable for gestational diabetes mellitus that was well-controlled with diet. . The infant's size was appropriate for gestational age. On physical exam, pupils are equal round and reactive to light. There is limited movement of her right arm. Her upper arm is adducted and internally rotated, her elbow is extended, forearm pronated, and wrist and fingers flexed. Biceps and Moro reflexes were absent on the right side. No sensory loss was noted. There is no crepitus over the collarbones. The other arm was normal and the rest of the physical examination was unremarkable. This pattern of injury is caused by injury to which structures? ``` A. C5-C7 B. C5-C6 C. C5-T1 D. C8-T1 E. Radial nerve ```

Answer 41

C5- C7

Question 42

What is the nerve root injury associated with Erbs Palsy

Answer 42

C5 - C7 The arm is adducted with the forearm extended, internally rotated, and pronated, generating the classic “waiter's tip” appearance. The biceps and Moro reflexes are absent on the affected side and sensory function usually is preserved. This infant also has wrist and finger weakness suggesting injury to C7.