pediatrics

Question 1

APGAR - scoring system (everything)

Answer 1

(appearance, pulse, grimace, activity, respiration)
HR: 0 / <100 / >100
Resp: none / irregulalar shallow gasps / cry
color: blue / blue extrem / pink
tone: none / weak passive / active
reflex: none / facial grimace / active withdrawal

Question 2

APGAR - outcome

Answer 2

not predictive - score 0-3 in 5 mins and longer compared to infants with score 7-10 have worse neurologic outcome

Question 3

newborn care

Answer 3

1. vit K (IM) 2. umbilical cord care 3. hearing test

4. newborn screening test 5. prophylactic eye erythromycin (only n. gonor, not for chlamydia)

Question 4

caput succedaneum vs cephalehematoma according to definition + outcome

Answer 4

caput –> diffuse swelling, crosses sutures lines, disappears in 1st days, may lead to molding for weeks
cephal –> subper hemorr, NOT cross. may have underling fracture, may calcify, jaundice, resolve in 1/2-3 months

Question 5

birth injury - skull fractures - definition + outcome

Answer 5

in utero from bones or forcerps pressure:

linear: no symptoms + no treatment (MC)
depressed: elevate to prevent cortical injury

Question 6

birth injury - clavicular fracture - definition + outcome

Answer 6

with shoulder dystocia in vertex position + arm extension in breech, assymetric moro
palpable callus within a week
treatment: immobilization of arm + shoulder

Question 7

birth injury - facial nerve palsy - definition + outcome

Answer 7

• in utero or delivery from bones or forcerps pressure
• improvement over weeks (as long fibers were not torn)
• need eye care, neuroplasty of no improvement (torn)

Question 8

birth injury - brachial palsy - definition

Answer 8

1. Erb-Ducenne (C5-6): cannot abduct, ext rotate + supinate

2. Klumpke (C7-8 +/- T1): paralyzed hand +/1 Horner

Question 9

birth injury - brachial palsy - outcome/treatment

Answer 9

• most full recover in months (depends on injured or lacerated
• proper positioning + partial immobilization
• massage + range motion exercise
• if no recovery in 3-6 months –> neuroplasty

Question 10

physical examination of newborns - extremities

Answer 10

1. syndactyly: fusion of fingers or toes (x-rays before surgery, to see if 2 bones)
2. polydactyly: >5, no treatment if good blood supply
3. finger tag: thin stalk, poor circulation, tie off at base
   - -> autoamputation

Question 11

physical examination of newborns - head

Answer 11

1. aniridia: iris hypoplasia (defect mey go through retina) (wilms tumor)
2. coloboma of iris: cleft at 6 o clock (most with other abnorm, associated with CHARGE)
3. prearicular tags/pits: look for hearing loss + GU probl