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OSCEs > NIPE > Flashcards

NIPE Flashcards

1
Q

What questions might you want to ask before/whilst performing NIPE exam?

A

Maternal history:

  • Pregnancy details: date/time and type of delivery/complications/high-risk antenatal screening results
  • Breech presentation: if breech at 36 weeks gestation or delivery (if earlier), the baby will need to have an USS of their hips as there is an increased risk of DDH
  • Risk factors for neonatal infection
  • Abnormalities notes on antenatal scans
  • FHx: 1st degree relatives with hearing problems/hip dislocation/childhood heart problems/congenital cataracts/renal problems

Newborn history:

  • feeding pattern
  • urination
  • passing of meconium
  • parental concerns
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2
Q

What are you looking for on general inspection?

A
  • Pallor: underlying anaemia (haemorrhage) or poor perfusion (congestive cardiac failure)
  • Cyanosis: poor circulation (peripheral vasoconstriction secondary to hypovolaemia) or inadequate oxygenation of the blood (right-to-left cardiac shunting)
  • Jaundice
  • Posture (Erb’s palsy, hemiparesis)
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3
Q

How do you assess tone in a newborn?

A
  • Gently move the newborn’s limbs passively and observe the newborn when they’re picked up
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4
Q

What are common causes of hypotonia in newborns?

A
  • Down’s syndrome
  • Prader-Willi syndrome
  • Hypothyroidism
  • Cerebral palsy
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5
Q

What do you need to assess in terms of the baby’s head?

A
  • Head circumference
  • Head shape (sutures, fontanelles, cranial moulding, caput succedaneum, cephalhaematoma, subgaleal haemorrhages, craniosynostosis)
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6
Q

What are the causes of microcephaly?

A
  • Normal variation, familial
  • Congenital infections (TORCH)
  • Perinatal brain injury (HIE)
  • Foetal alcohol syndrome
  • Patau syndrome
  • Craniosynostosis
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7
Q

What are the causes of macrocephaly?

A
  • Hydrocephalus
  • Cranial vault abnormalities
  • Genetic abnormalities
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8
Q

Describe caput succedaneum. How long does it take to resolve?

A
  • Diffuse subcutaneous fluid collection with poorly defined margins caused by pressure on the presenting part of the head during delivery
  • Crossing suture lines
  • Resolves over the first few days
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9
Q

Describe cephalhaematoma. How long does it take to resolve?

A
  • Subperiosteal haemorrhage which occurs in 1-2% of infants and may increase in size after birth
  • Haemorrhage is bound by the periosteum, therefore, the swelling does not cross suture lines
  • More common with instrumental delivery and may cause jaundice, therefore, bilirubin should be monitored
  • Can take a few months to resolve
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10
Q

Describe subgaleal haemorrhages.

A
  • Occur between the aponeurosis of the scalp and periosteum and form a large, fluctuant collection which crosses suture lines
  • They are rare but may cause life-threatening blood loss
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11
Q

Describe craniosynostosis.

A
  • Condition in which one or more of the fibrous sutures in an infant skull prematurely fuses
  • Changes the growth pattern of the skull which can result in raised ICP and damage to intracranial structures
  • Surgical intervention is required with the primary goal being to allow normal cranial vault development to occur
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12
Q

What does a tense bulging fontanelle indicate?

A

Raised ICP (hydrocephalus)

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13
Q

What does a sunken fontanelle indicate?

A

Dehydration

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14
Q

What are common facial birthmarks that might be seen during NIPE?

A
  • Salmon patch
  • Haemangiomas
  • Port-wine stain
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15
Q

Describe salmon patch birthmark.

A
  • Naevus simplex
  • Red or pink patches
  • Often on infant’s eyelids, head, or neck
  • Caused by capillary malformation
  • Very common and usually fade by the age of 2
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16
Q

Describe haemangiomas.

A
  • Strawberry naevus
  • Blood vessels which form a raised red lump on the skin which appears soon after birth
  • Typically get bigger over the first 6-12 months and then shrink and disappear by the age of 7
  • May require treatment if they affect vision, breathing, or feeding
17
Q

Describe port-wine stains.

A
  • Naevus flammeus
  • Red/purple marks on the face and neck
  • Typically present from birth and do not regress
  • May be associated with Sturge-Weber syndrome and Klippel-Trenaunay syndrome
18
Q

Describe slate-grey naevus.

A
  • AKA Mongolian blue spot
  • Benign, flat birthmark with wavy borders and irregular shape
  • Usually located over the sacrum
  • Most commonly blue in colour and can be mistaken for a bruise
  • Normally disappear within 3-5 years
19
Q

Describe erythema toxicum.

A
  • Very common and benign condition seen in newborns
  • Presents with various combinations of erythematous macules, papules, and pustules
  • Lesions usually appear from 48h of age and resolve spontaneously
20
Q

What do you look for when assessing a newborn’s face?

A
  • Appearance: any dysmorphic features (e.g. epicanthic folds in Down’s syndrome)
  • Asymmetry: asymmetry of the face many indicate facial nerve palsy secondary to instrumental delivery
  • Trauma: bruising or lacerations likely to have occurred during labour
  • Nose: assess patency of the nasal passages
21
Q

What do you look for when assessing a newborn’s eyes?

A
  • Inspect for erythema or discharge (conjunctivitis)
  • Assess sclera for jaundice, subconjunctival haemorrhages
  • Position and shape, e.g. ptosis or epicanthic folds
  • Fundal/red reflex
22
Q

What might an absent fundal reflex indicate? How should you manage newborns with absent fundal reflex?

A
  1. Congenital cataracts, retinal detachment, vitreous haemorrhage, retinoblastoma
  2. Immediate ophthalmology referral
23
Q

What should look for when assessing the ears?

A

Inspect the pinna - note any asymmetry, skin tags, pits, or the presence of accessory auricles

24
Q

What do you look for when assessing a newborn’s mouth?

A
  • Clefts of the hard and soft palates

- Tongue-tie (ankyloglossia)

25
Q

What do you assess next in NIPE, after fully assessing the head and face?

A

Neck and clavicles

26
Q

How do you assess neck and clavicles in a newborn?

A
  • Inspect length of the neck and note any abnormalities such as webbing
  • Inspect for neck lumps, i.e. cystic hygroma
  • Look and feel for evidence of clavicular fracture
27
Q

How do you assess the upper limbs during NIPE?

A
  • Assess symmetry
  • Inspect the fingers (note any extra or abnormal digits, and trident hand)
  • Inspect the palms (note lack of 2 palmar creases)
  • Palpate the brachial pulse on each upper limb (asymmetry suggests coarctation of the aorta)
28
Q

How do you assess the chest during NIPE?

A

Inspect:

  • RR
  • Work of breathing
  • Pectus excavatum/carinatum

Palpate:
- Cap refill on sternum

Auscultate:

  • Lungs
  • Heart
29
Q

How do you assess the abdomen during NIPE?

A

Inspect:

  • abdominal distension –> bowel obstruction, NEC, organomegaly, ascites
  • umbilicus - erythema, discharge, hernias
  • inguinal hernia (groin)

Palpate:

  • liver
  • spleen
  • kidneys
  • bladder
30
Q

What are you looking for when inspecting genitalia in NIPE?

A

Females:
- ambiguous genitalia (CAH)

Males:

  • position of urethral meatus (hypospadias, epispadias)
  • size of penis (should be at least 2cm)
  • assess for testicular swelling indicative of hydrocele
  • check to see if both testes have descended
31
Q

How do you assess the lower limbs during NIPE?

A

Inspect:

  • symmetry
  • oedema
  • ankle deformities (talipes/clubfoot)
  • missing or extra digits

Assess tone
Assess movement in both limbs
Assess the range of knee joint movement (?hypermobility)
Palpate and compare femoral pulses

32
Q

Describe Barlow’s test.

A
  • Performed by adducting the hip
  • Apply light pressure on the knees with thumb, directing the force posteriorly
  • If the hip is dislocatable the test is considered positive
33
Q

Describe Ortolani’s test.

A
  • Used to confirm posterior dislocation of the hip
  • Flex the hips and knees of a supine infant to 90 degrees
  • With your index fingers placing anterior pressure on the greater trochanters, gently and smoothly abduct the infant’s legs using your thumbs
  • Positive sign: distinctive ‘clunk’ which can be heard and felt and the femoral head relocated anteriorly into the acetabulum
34
Q

What are you looking for when assessing the back and spine during NIPE?

A
  • Scoliosis
  • Hair tufts (spina bifida)
  • Naevi
  • Birthmarks
  • Sacral pits (spina bifida)
35
Q

What is important to determine when assessing the anus in NIPE?

A

Is it patent?

Ask if baby has passed meconium, and if meconium passage was delayed by >24h

36
Q

What can delayed passage of meconium indicate?

A

Obstruction or Hirschsprung’s disease

37
Q

What reflexes must be assessed during NIPE?

A
  • Palmar grasp reflex
  • Sucking reflex
  • Rooting reflex
  • Stepping reflex
  • Moro reflex

OSCEs (45 decks)

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