PANCE book - Exam of newborn

Question 1

Ballard score

Answer 1

newborn assessment of activity, position, and tone to evaluate neuromuscular and physical maturity

rubric estimates gestational age

Question 2

Causes of infant’s being small for gestational age

Answer 2

maternal drug use, chromosomal abnormality, viral infection, multiple birth, advanced maternal age, placental insufficiency, or lack of maternal weight gain

Question 3

What is advanced maternal age?

Answer 3

> 35 yo

Question 4

Most common cause of being large for gestational age

Answer 4

maternal diabetes

Question 5

When should complete newborn exam be done?

Answer 5

within 24 hrs of birth

Question 6

erythema toxicum

Answer 6

common rash in newborns 3-5 days old

small pustules with erythematous bases

spontaneous resolution in 1-2 wks

Question 7

milia

Answer 7

common newborn rash

very small, white papules mostly on face

resolves w/o treatment in 1-2 months

Question 8

miliaria

Answer 8

common newborn rash; “heat rash”

caused by blockage of eccrine sweat glands, resulting in flushed macular appearance

light clothing and decreased humidity speeds resolution

Question 9

Mongolian spots

Answer 9

blue-black macule concentrated on back and buttocks of dark-skinned infants

most resolve in 4 yrs but may persist for life

Question 10

craniosynostosis

Answer 10

premature fusion of one or more sutures

necessary to refer to neuro

Question 11

Anterior fontanelle closes around _____ months and posterior fontanelle closes at _____ months.

Answer 11

10-26 mon

1-3 mon

Question 12

If a third fontanelle is seen along sagittal suture this may be associated with ________.

Answer 12

Trisomy 21

Question 13

caput succedaneum

Answer 13

fluid accumulation under scalp secondary to birth trauma

Question 14

subgaleal hemorrhage

Answer 14

occurs beneath scalp; uncommon but results in enough blood loss to cause hemorrhagic shock!

Question 15

How is hearing assessed in newborns?

Answer 15

auditory brain stem response or evoked otoacoustic emission testing

Question 16

Absence of red reflex in infant may suggest what?

Answer 16

congenital cataracts, glaucoma, or retinoblastoma

Question 17

Brushfield spots

Answer 17

gray/yellow spots at periphery of iris associated with Down syndrome

Question 18

subconjunctival hemorrhages in newborns

Answer 18

benign finding associated with trauma of delivery; resolves with time

Question 19

strabismus in newborns

Answer 19

“cross eyed”

almost always present in newborn period and is not pathologic unless persists past 4 months

Question 20

choanal atresia

Answer 20

• unilateral or bilateral nasal obstruction
• bilateral results in respiratory distress as infants are obligate nasal breathers
• obstruction confirmed with CT

Question 21

esophageal atresia presents as..

Answer 21

excessive drooling

Question 22

Epstein pearls

Answer 22

small, pearly nodules along midline of hard palate; benign cysts

Question 23

What indicates a submucosal cleft?

Answer 23

bifid uvula

Question 24

Mouth findings of trisomy 21 infants

Answer 24

large tongue

Question 25

webbed or redundant skin of neck may suggest _________.

Answer 25

Turner syndrome

Question 26

Midline/thyroid neck mass finding

Answer 26

thyromegaly; congenital hypothyroidism and requires immediate attention to prevent growth failure/cretinism

Question 27

neck mass finding within sternocleidomastoid suggests ________.

Answer 27

Torticollis, hematoma

Question 28

signs of respiratory distress

Answer 28

grunting, intercostal retractions, tachypnea (+60), cyanosis

Question 29

finding with pneumothorax or diaphragmatic hernia

Answer 29

decreased breath sounds unilaterally | pneumothorax would also have mediastinal shift

Question 30

Most common causes of respiratory distress in newborn

Answer 30

aspiration, congenital pneumonia, transient tachypnea

Question 31

Concerning findings in heart exam

Answer 31

rapid heart rate, cyanosis, CHF, diminished peripheral pulses *murmurs may or may not be pathologic

Question 32

Prune belly or absence of abdominal musculature may indicate what?

Answer 32

renal anomalies

Question 33

What are prominent kidneys suggestive of?

Answer 33

hydronephrosis or cystic kidney disease

Question 34

severely scaphoid belly + respiratory distress indicates?

Answer 34

diaphragmatic hernia

Question 35

What may delayed stool production (+24 hrs) indicate?

Answer 35

Hirschsprung disease

Question 36

signs of neurotubular defect or spina bifida on exam

Answer 36

gluteal cleft with pits, birthmarks, or tufts of hair

Question 37

Normal HR at birth to 6 months

Answer 37

average 130-140, normal range up to 180-190

Question 38

Avg HR 6-14 years old

Answer 38

90

Question 39

respiratory rate at birth

Answer 39

30-60 bpm

Question 40

respiratory rate 8-15 yrs old

Answer 40

15-25 (similar to adult)

Question 41

When should testes descend?

Answer 41

usually at 3 months and 80% by 9 mon; if over 1 year refer to urologist

Question 42

Concerns of prolonged empty scrotal sac?

Answer 42

testicular cancer and infertility; refer to endocrinologist

Question 43

hydrocele

Answer 43

commonly observed (80% of newborns) collection of fluid in scrotum due to patency of vaginalis process

Question 44

How is hydrocele mass differentiated from inguinal hernia?

Answer 44

transillumination

Question 45

Which conditions are commonly associated with ambiguous genitalia?

Answer 45

``` chromosomal anomalies adrenal hyperplasia (affects testosterone) ```

Question 46

How to treat vaginal adhesions in newborns?

Answer 46

estrogen or beclomethasone cream x 5-10 days | if doesn't resolve, refer to urologist

Question 47

Exams to test for developmental hip dislocation

Answer 47

Barlow maneuver: adduct fully flexed hip while pushing thigh posteriorly; dislocation + test Ortolani maneuver: grasp medial aspect of flexed knee and fully abduct hip; feel for spasm or clunk

Question 48

When should newborn's hip clicking need ultrasound and referral to pediatric ortho?

Answer 48

- If Barlow and/or Ortolani maneuvers are positive | - If hip click persists past 1 month old

Question 49

sucking and rooting reflex

Answer 49

earliest reflexes | when face stroked the baby will turn head towards that side and if offered nipple or finger will suckle

Question 50

Moro reflex

Answer 50

allow infant's head to drop 1-2 cm and observe for abduction of shoulders and elbows with spreading and extending of fingers; then adduction and flexion of same disappears by 3-4 months old

Question 51

grasp reflex

Answer 51

placement of finger in palmar or plantar surface elicits grasping response disappears by 4 months old

Question 52

Babinski reflex of infant

Answer 52

test is positive with upgoing plantar may exist until 2 yo

Question 53

traction response

Answer 53

pull infant by arms to sitting position | observe initial head lag, coming briefly to midline, then falling forward

Question 54

Placing reflex

Answer 54

when infant dangled over flat surface with toe barely touching, triggers stepping response or extremity flexion