Paediatrics/ Newborn and Infants

Question 1

What is a term infant?

Answer 1

A baby born between 37-weeks and 42-weeks gestation

Question 2

What is a term Premature?

Answer 2

Less than 37 weeks

Question 3

What is a term Postterm?

Answer 3

More than 42 weeks

Question 4

When are Apgar scores measured?

Answer 4

At 1 and 5 minutes after birth

Question 5

When should Apgar scores be repeated if the initial scores are less than 7?

Answer 5

At 10, 15, and 20 minutes after birth

Question 6

What are the five Apgar categories?

Answer 6

1. Heart rate
2. Respiratory effort
3. Muscle tone
4. Reflex irritability
5. Color

Question 7

What is the maximum number of points on the Apgar score?

Answer 7

There are up to 2 points in each category for a maximum of 10 points.

Question 8

How many vessels does a normal umbilical cord have?

Answer 8

Three (two arteries and one vein)

Question 9

How long does it typically take an umbilical cord stump to fall off?

Answer 9

1-3 weeks

Question 10

How should the umbilical cord be maintained?

Answer 10

• Air dry by keeping the diaper below the umbilicus
• alcohol is not recommended
• bathe the baby with a sponge bath but do not immerse the abdomen in water.

Question 11

What is the typical weight of a healthy newborn?

Answer 11

2.5-4 kg

Question 12

What is the typical Length?

Answer 12

46-54 cm

Question 13

What is the typical Head circumference?

Answer 13

32-38 cm

Question 14

What is the definition of low birth weight (LBW)?

Answer 14

Less than 2500 g at birth

Question 15

What are the causes of LBW?

Answer 15

• Intrauterine growth restriction (IUGR)
• prematurity
• normal variant

Question 16

What is the predominant cause of LBW in the United States?

Answer 16

Prematurity

Question 17

What are the factors associated with IUGR (estimated fetal weight <10th percentile)?

Answer 17

• Genetic abnormalities
• multiple gestation
• fetal insulin deficiency
• placental insufficiency
• maternal disease (eg, HTN, sickle cell disease)
• drug use

Question 18

What is large for gestational age (LGA)?

Answer 18

Larger than 90th percentile for gestational age

Question 19

What is the weight of a term LGA baby?

Answer 19

More than 4000 g

Question 20

What is the most common cause of LGA babies?

Answer 20

Maternal diabetes

Question 21

Normal newborns may lose up to what percentage of their weight in the first week of life?

Answer 21

Up to 10%

Question 22

A healthy baby should regain this weight by how many weeks of life?

Answer 22

2 weeks

Question 23

In the first couple of months, about how much weight should a baby gain per day?

Answer 23

1 oz (or 28 g)

Question 24

A normal baby’s respiratory rate and heart rate are slower than those of a normal adult. True or false?

Answer 24

False

Question 25

A normal baby’s blood pressure is lower than that of a normal adult. True or false?

Answer 25

True

Question 26

Doing a good initial heart examination rules out heart abnormalities. True or false? Why?

Answer 26

False ## Footnote Some abnormalities may not be evident initially (eg, high pulmonary artery [PA] pressures on day one may diminish L → R shunting, so murmur of a ventral septal defect [VSD] is not appreciable)

Question 27

When does the anterior fontanelle close?

Answer 27

During second year of life

Question 28

When does the Posterior fontanelle close?

Answer 28

First few months of life

Question 29

What is head “molding” in a newborn?

Answer 29

Irregularly shaped head with palpable ridges

Question 30

What causes head "molding" in a newborn?

Answer 30

Pressure in the birth canal during labor and delivery

Question 31

How long does head "molding" of newborn normally last?

Answer 31

It should disappear within a week

Question 32

What is caput succedaneum?

Answer 32

Diffuse soft tissue edema of the scalp

Question 33

What causes caput succedaneum?

Answer 33

Pressure on presenting part of scalp during delivery

Question 34

Does caput succedaneum require treatment?

Answer 34

No. It resolves on its own in a few days.

Question 35

What is cephalohematoma?

Answer 35

Hemorrhage below the lining of the bones of the skull

Question 36

What usually causes cephalohematoma?

Answer 36

Small tearing of vessels during delivery

Question 37

What are worrisome causes of cephalohematoma?

Answer 37

* Skull fracture * coagulopathy * intracerebral hemorrhage

Question 38

What kind of treatment does an uncomplicated cephalohematoma require?

Answer 38

Usually none (resolves on its own), but the baby may need treatment for hyperbilirubinemia from blood resorption

Question 39

Which crosses suture lines, cephalohematoma or caput succedaneum?

Answer 39

Caput succedaneum

Question 40

What does an absent red reflex indicate?

Answer 40

Something is inhibiting light from getting to the retina (eg, cataract, tumor)

Question 41

Intermittent strabismus is normal until what age?

Answer 41

3 months

Question 42

What test on physical exam can assess ocular alignment?

Answer 42

The Hirschberg corneal light reflex test

Question 43

How is the The Hirschberg corneal light reflex test performed?

Answer 43

The examiner notes the position of the corneal reflection from a light held 3 feet away from both eyes. Even with eye movement, the light should reflect in the same location of the cornea in each eye.

Question 44

What will you see with left exotropia (left eye deviated laterally) in the Hirschberg corneal light reflex test?

Answer 44

The corneal reflection on the right will be over the pupil while the reflection on the left will be over the medial iris.

Question 45

What is pseudostrabismus?

Answer 45

The perception of medial deviation (esotropia)

Question 46

What contributes to pseudostrabismus?

Answer 46

Prominent medial canthal folds and a flat nasal bridge

Question 47

What is the most common birth defect?

Answer 47

Hearing loss

Question 48

What procedures are available to screen infants for hearing loss?

Answer 48

Measurement of otoacoustic emissions (OAEs) and/or auditory brain response (ABR)

Question 49

All infants should be screened for hearing loss by what age?

Answer 49

1 month of age

Question 50

Why is it so important to test for hearing loss in infants?

Answer 50

Hearing loss can significantly delay a child’s development, especially language acquisition.

Question 51

Small, low-set, or floppy ears may be a sign of what other abnormalities?

Answer 51

* Chromosomal abnormality, renal abnormality

Question 52

A common benign newborn rash consisting of small white papules on a blotchy erythematous base is called what?

Answer 52

erythema toxicum

Question 53

What is the required treatment for erythema toxicum?

Answer 53

None (disappears on its own)

Question 54

A female baby has swollen nipples and white vaginal discharge with a tinge of blood. Is this normal? What is the cause?

Answer 54

Yes. Baby’s exposure to maternal hormones

Question 55

What is the American Academy of Pediatrics’ stance on routine circumcision?

Answer 55

Not medically necessary

Question 56

The Ortolani and Barlow maneuvers test for what abnormality?

Answer 56

Developmental hip dysplasia

Question 57

What are some late diagnostic signs of developmental hip dysplasia?

Answer 57

Asymmetry of the following: * thigh folds * hip abduction and/or * knee height

Question 58

Lumbosacral dimples or hair tufts are concerning for what type of abnormality?

Answer 58

Underlying vertebral/spinal cord abnormality (eg, neural tube defect)

Question 59

Does stroking the sole of the foot normally cause an infant’s toes to go up or down?

Answer 59

Up

Question 60

Stroking a newborn’s cheek causes him to turn his head to the same side and make sucking motions with his mouth. What is this called?

Answer 60

Rooting reflex

Question 61

When does the Moro reflex (startle reflex) normally disappear?

Answer 61

3-4 months

Question 62

Every US state has a newborn screening program for metabolic and other inherited disorders. True or false?

Answer 62

True

Question 63

Most state newborn screens include testing for what disorders?

Answer 63

Hypothyroidism, phenylketonuria, galactosemia, sickle cell disease

Question 64

What is the most common chromosomal abnormality?

Answer 64

Down syndrome (Trisomy 21)

Question 65

What are the most frequent causes of death in infants (\<12 months old)?

Answer 65

* Sudden infant death syndrome (SIDS) * perinatal conditions (eg, complications of prematurity) * congenital abnormalities * chromosomal abnormalities

Question 66

About how many hours does a newborn sleep per 24 hours?

Answer 66

16-20 ## Footnote Tip: *when you begin examining a newborn and s/he is not crying, take advantage of the opportunity to auscultate the heart and lungs and check for a red reflex.*