Pediatric newborn assessment

Question 1

What is the most common cause of a large for gestational age of an infant?

Answer 1

Maternal diabetes

Question 2

What are some ddx for a small for gestational age infant?

Answer 2

Maternal drug use, chromosomal abnormalities, exposure to intrauterine viral infection, multiple gestation, advanced maternal age.

Question 3

A 3 day oldnewborn presents with small pustules on erythematous blotchy base. What is the most likely diagnosis?

Answer 3

Erythema toxicum

Question 4

A 4 day old newborn presents with small pustules on erythematous blotchy base. What is the tx for the suspected diagnosis?

Answer 4

Self limiting; resolves 1-2 weeks

Question 5

A newborn presents with small, white Papules concentrated on the nose, cheeks, forehead and chin. What is the most likely dx?

Answer 5

Milia

Question 6

A newborn presents with small, white Papules concentrated on the nose, cheeks, forehead and chin. When do these usually resolve!?

Answer 6

1-2 months

Question 7

An AA newborn present with large, blue-black macules concentrated on the back and buttock. What is the most likely diagnosis and what advice should you give the parents?

Answer 7

Mongolian spots, resolve most of the time by age 4

Question 8

A newborn presents with a slightly pink, irregularly shaped lesion on the back of the neck. What is the most likely diagnosis?

Answer 8

Nevus simplex

Question 9

A newborn presents with a slightly pink, irregularly shaped lesion on the back of the neck. What is the tx and parent education?

Answer 9

None. Most resolve spontaneously by age 2, but some can persist. It occurs secondary to surface capillary dilation. Benign

Question 10

What type of skin conditions are commonly seen in preterm infants?

Answer 10

Vernix caseosa and lanugo

Question 11

What is vernix caseosa?

Answer 11

Greasy covering

Question 12

What is lanugo?

Answer 12

Fine hairs

Question 13

What type of skin condition is commonly seen in post term infants?

Answer 13

Dry, cracked, peeling skin

Question 14

When should the anterior fontanelle be closed? How large should it be initially?

Answer 14

Around 10-24 mnths, 1-4 cm

Question 15

When should the posterior fontanelle be closed? How large should it be initially?

Answer 15

1-3 mnths; 1 cm

Question 16

A newborn presents with a third fontanelle along the Sagittal suture. What disorder is this associated with?

Answer 16

Trisomy 21

Question 17

A newborn presents with premature fusion of one or more sutures. What is the diagnosis and what should happen if these is found on exam?

Answer 17

Craniosynostosis; prompt referral to neurologist

Question 18

A newborn presents with capital succedaneum. What will be found on physical exam?

Answer 18

Palpable sweeping crossing the midline

Question 19

A newborn presents with capital succedaneum. What is the cause?

Answer 19

Fluid accumulation secondary to birth trauma

Question 20

What should posteriorlu rotated or low-set ears prompt suspicion of

Answer 20

Congenital abnormalities

Question 21

A newborn presents with preauricular pits and deafness. What other system should be looked at?

Answer 21

GU. Renal ultrasound

Question 22

How should hearing be assessed in the newborn period?

Answer 22

Auditory brain stem response or evoked otoacoustic emission testing

Question 23

What infants should be screened for hearing?

Answer 23

All

Question 24

A newborn presents with an absent red reflex. What disorders is this associated with?

Answer 24

Congenital cataracts, glaucoma, retinoblastoma

Question 25

A newborn presents with gray/yellow spots at the periphery of th iris. What is this called and what condition is it associated with?

Answer 25

Brushfield spots, Down syndrome

Question 26

What eye disorder is almost always present in the newborn period?

Answer 26

Strabismus. Problem if it is fixed or something persists past 4 mnths if age

Question 27

How is nasal patency tested in the newborn

Answer 27

Test nare individually by placing cold metal object below the nose to check for fogging or using a cotton wisp to check for air movement

Question 28

Why is nasal patency so important in the newborn?

Answer 28

They are obligate nasal breathers. Bilateral obstruction can result in infant death

Question 29

How is choanal atresia or stenosis confirmed in the newborn

Answer 29

AXial CT

Question 30

A newborn presents with small, pearly nodules along the midline of the hard palate. What is the dx and parent education?

Answer 30

Epstein pearls; Benign retention cysts

Question 31

A newborn presents with a small mandible and tongue, along with a clefted soft palate. What is the dx?

Answer 31

Pierre-robin syndrome

Question 32

A newborn is diagnosed with Pierre -robin syndrome. What should you tell the parents about positioning the baby?

Answer 32

Prone positions will often control respiratory difficulties caused by the tongue occluding the airway

Question 33

A newborn presents with large tongue that appeared to be larger than the mouth. What disorderly is this associated with?

Answer 33

Trisomy 21

Question 34

What is a common cause of a newborn having difficulty latching during breast feeding

Answer 34

A shortened frenulum

Question 35

A newborn presents with webbed/redundant skin of neck. What disorder is this associated with?

Answer 35

Turner

Question 36

A newborn presents with a midline mass on the anterior neck. What is the most concerning diagnosis!”?

Answer 36

Thyroidmegaly.

Question 37

A newborn presents with a mass anterior to the SCM. What is the most likely diagnosis?

Answer 37

Brachial cleft

Question 38

A newborn presents with a mass posterior to the SCM. What is the most likely diagnosis?

Answer 38

Cystic hygroma

Question 39

A newborn presents with a mass inside the SCM. What are the top two ddx?

Answer 39

Torticollis, hematoma

Question 40

A newborn presents with grunting, intercostal retractions, and tachypnea. PE shows cyanosis. What are the most common causes of the suspected diagnosis?

Answer 40

Aspiration, congenital pneumonia, transient tachypnea

Question 41

What is considered newborn tachypnea?

Answer 41

>60 breaths per min

Question 42

A newborn present with unilateral decreased breathsounds. What are 2 ddx?

Answer 42

Pneumothorax; diaphragmatic hernia

Question 43

A newborn presents with cyanosis, chf, and diminished peripheral pulses, what ddx is the most serious?

Answer 43

Heart dz

Question 44

A newborn presents with a prune belly. What condition is this associated with?

Answer 44

Renal issues Prune belly- absence of musculature

Question 45

A newborn presents with a sever scaphoid belly and respiratory distress. What is the most likely diagnosis?

Answer 45

Diaphragmatic hernia

Question 46

Where should the liver be located in a newborn?

Answer 46

About 1 cm below th coastal Margin

Question 47

A newborn presents with delayed stool (>24 hours after birth). What condition is this associated with?

Answer 47

Hirschsprung disease

Question 48

A newborn presents with a urethra that is proximal and ventral to its normal location. What is the likely diagnosis?

Answer 48

Hypospadias

Question 49

A newborn presents with a urethra that is proximal and ventral to its normal location. What further work up is warranted and what is contraindicated?

Answer 49

Bilateral renal US; circumsicion.

Question 50

What is epispadias?

Answer 50

Dorsal displacement of the urethra

Question 51

When are testes supposed to descend in the newborn?

Answer 51

By 9 mnths is age.

Question 52

At what age should you refer to a pediatric urologist for undescended testes?

Answer 52

Age 1

Question 53

Are inguinal hernias more likely to be seen in a preterm, term, or post term infant “?

Answer 53

Epreterm

Question 54

What is a very common finding in newborn males due to the patency of the process vaginalis?

Answer 54

Hydroceles

Question 55

At what age to hydroceles typically resolve?

Answer 55

18 mnths.

Question 56

A newborn female presents with vaginal leucorrhea and bloody dc within the labia. What is the most likely cause and what should you tell the parents?

Answer 56

Maternal estrogen. Resolve in 7-10 days, but more slowly in breastfed child

Question 57

A newborn female presents with a fused introitus. What medicine can be used to resolve the problem?

Answer 57

Estrogen or beclomethasone cream for 5 to 10 days

Question 58

What is the Barlow maneuver?

Answer 58

An attempt to dislocate the hip via posterior pressure. Examiner adducts fully flexed hips while pushing the thighs posteriorly.

Question 59

What is a positive Barlow?

Answer 59

If the femoral head is felt to dislocate or leave the acetabulum

Question 60

What is the ortolani maneuver?

Answer 60

Attempts to identify a hip that’s dislocated or subluxed.

Question 61

How is the ortolani maneuver performed?

Answer 61

Grasp the medial aspect of the flexed knee with thumb and fully abduct the hips. Feel for a spasm or a clunk as the hips are brought to full abduction

Question 62

What is indicated in a positive Barlow or ortolani maneuver?

Answer 62

Bilateral US

Question 63

What increases the risk for developmental hip dislocation?

Answer 63

Breech position delivery

Question 64

What is talipes equinovarus?

Answer 64

Club foot

Question 65

What is indicated for clubfeet?

Answer 65

Immediate ortho referral

Question 66

What are the 2 earliest infant reflexes?

Answer 66

Sucking and rooting

Question 67

What is the Moro reflex?

Answer 67

Allow the infants head to suddenly drop 1-2 cm; observe for abduction of the shoulders and elbows along with spreading and extending if fingers, followed by addiction and flexion of the same

Question 68

When does the Moro reflex disappear

Answer 68

3-4 mnths

Question 69

When does the palmar/plantar grasp reflex disappear

Answer 69

4 mnths

Question 70

What is the traction response?

Answer 70

Pulling the infant by the arms to a sitting position and observe the head lag initially, finally coming briefly to midline before falling forward

Question 71

Placing reflex?

Answer 71

Infant dangled about the bed, allowing the toe to ha e minimal contact with surface. Extremity will respond w/ flexion is a stepping response

Question 72

How should deep tendon reflexes appear in the newborn

Answer 72

Brisk, clonus May be seen

Question 73

A positive babinski reflex is... in the newborn

Answer 73

Normal. May be seen as late as 2 Years old.

Question 74

A newborn presents with poor feeding, lethargy, jitteriness, tremulousness, and irritability. BLood glucose level is 40. What is the tx for the suspected diagnosis?

Answer 74

A Bolus of dextrose and water (D10W) and IV glucose

Question 75

What maternal disorder most common causes hypoglycemia of the newborn

Answer 75

Diabetes

Question 76

Hypoglycemia of the newborn is associated with way intrauterine complication?

Answer 76

Intrauterine growth restriction

Question 77

How else can hypoglycemia of the newborn present

Answer 77

Asymptotic

Question 78

What is normal blood glucose level at 3 hours of age?

Answer 78

50 to 80

Question 79

A newborn presents with jaundice during the first 24 hours of life. Labs reveal a positive Coombs test, increased reticulocytes, and a decreased H/H. What are the top two differentials?

Answer 79

ABO incompatibility and Rh isoimmunization

Question 80

What is the treatment for a jaundiced baby in the first 24 hours of positive Coombs test?

Answer 80

Transfusion; phototherapy

Question 81

What are the most common causes of unconjugated hyperbilirubinemia?

Answer 81

Physiologic jaundice, prematurity, and breast feeding jaundice

Question 82

What are the two groups of etiologies for newborn jaundice?

Answer 82

Excess production of bilirubin or decreased rate of conjugation w/ normal reticulocyte counts

Question 83

What are common causes of excess production of bilirubin?

Answer 83

Hemolysis secondary to blood group senstization or hereditary spherocytisis or G6PD

Question 84

What are commonly n causes of decreased rate of conjugation with normal reticulocyte count?

Answer 84

Physiologic jaundice, more uncommon: Gilbert or crigler-najjar syndrome

Question 85

A newborn presents with jaundice 24 hours after birth. What is the MC cause of this jaundice?

Answer 85

Physiological jaundice.

Question 86

A newborn presents with jaundice 4 days after birth. On day 4, the bilirubin level is 10. On day 5 the level is 13, and by day 6 the bilirubin level is at 17. Is treatment indicated at this time?

Answer 86

Yes. Tx hyperbilirubenemia if > 15, or if not descending.

Question 87

What is the tx of hyperbilirubenemia?

Answer 87

Phototherapy

Question 88

A newborn presents with jaundice during the first 24 hours of life. Coombs test is negative. What are the top 2 differentials at this point?

Answer 88

G6PD deficiency, hereditary spherocytosis

Question 89

A newborn presents with jaundice during the first 24 hours of life. Coombs test is negative. A peripheral smear show spherocytes. What is the most likely diagnosis?

Answer 89

Hereditary spherocytosis

Question 90

A newborn presents with jaundice during the first 24 hours of life. Coombs test is negative. A peripheral smear show spherocytes what is the recommended tx?

Answer 90

Blood transfusion if severe, phototherapy

Question 91

A newborn presents with bilirubin levels greater than 20-25. What is the most concerning complication?

Answer 91

Kernicterus

Question 92

What are the recommendation for bilirubin screening in the newborn?

Answer 92

All infants before 24 hours

Question 93

newborn presents with jaundice during the first 24 hours of life. Coombs test is negative. A peripheral smear show spherocytes. What other finding may be present on physical exam?

Answer 93

Splenomegaly

Question 94

what is the ortolani maneuver?

Answer 94

grasp medial aspect of knee and abduct hip whil applying anterior force to the femur-results in reduction of hip joint

Question 95

what is the barlow maneuver?

Answer 95

adduct the fully flexed hip while applying posterior force to the femur, resulting in dislocation of the hip