Pediatrics - New born assessment

Question 1

What is an acceptable amount of weight loss in the first week of life? When should they be back to their birth weight by?

Answer 1

• Decreased up to 10% in first week

- Should return to birth weight by day 10 to 14.

Question 2

What do you suspect in a mother with a lack of milk production following a delivery in which she required a 4 unit transfusion of blood?

Answer 2

• Sheehan syndrome

Question 3

What is the average head circumference?

Answer 3

35cm or 20 inches

Question 4

What is the expected rate of head circumference growth in the first year? The following 3-6 months?

Answer 4

• 2cm per month for 1 year

- 1cm per month afterward for 3 - 6 months

Question 5

Causes of asymmetrical small for gestational age (late onset, head sparing)

Answer 5

• HTN
• Nutrition
• Drugs
• ETOH
• Smoking

Question 6

Causes of symmetrical SGA?

Answer 6

• TORCH
• Congenital Abn.
• Idiopathic syndromes

Question 7

Child with absent red reflex and strabismus what are you concerned for?

Answer 7

• Retinoblastoma

Question 8

What are features of an innocent murmur?

Answer 8

• mid-systolic
• grade 1-3 (soft)
• localized
• poor conduction
• musical or vibratory in character
• variable with position and respiration
• no other signs of heart disease
• Typically heard in high output states: such as fever or illness
• Age over 2 and no symptoms

Question 9

what are the 4 S’s of innocent murmurs

Answer 9

S: aSymptomatic
S: Soft
S: left Sternal Edge
S: Systolic only

Question 10

A systolic murmur with a wide fixed split S2 is caused by which defect?

Answer 10

Atrial septal defect

Question 11

Describe a typical murmur heard with a PDA?

Answer 11

Machinery sound at 2nd L intercostal space

Question 12

A holosystolic murmur heard at the left sternal border is caused by which defect?

Answer 12

Ventral septal defect

Question 13

When is a diastolic murmur normal?

Answer 13

Never

- Mitral stenosis or aortic regurgitation most common

Question 14

Why does congenital hip dysplasia occur?

Answer 14

• Poorly developed acetabulum

- May also have deformity of the head of the femur

Question 15

What is a postive Barlow or Ortolani?

Answer 15

PALPABLE click or clunk

Question 16

If someone is positive for hip dysplasia how do you manage initially?

Answer 16

• Follow-up in two weeks. If still the same refer to pediatric ortho
• 0-6 month they will wear Pavlik Harness
• At 6-18 months then put into short leg spica cast
• 18+ surgery pelvic-femoral osteotomy

Question 17

What are risk factors for hip dysplasia?

Answer 17

• Left side
• Breech position
• Female
• First born
• Family Hx
• Usually painless

Question 18

Should you do an X-ray of someone with congenital hip dysplasia?

Answer 18

No - bones are not ossified in new born period. An ultrasound should be perform instead.

Question 19

What is a hemangioma of infancy?

Answer 19

• vascular proliferation of the endothelial lining
• appears at birth can increase and size and then resolve
• 50% resolve by 5 years of age, others can take up to 10 years
• if questions asks when will majority be gone by say 10 years

Question 20

What is the best treatment of hemangioma of infancy if does not resolve spontaneously?

Answer 20

• Propranolol (topical)

Question 21

What is Sturge-Weber Syndrome?

- What test do they need?

Answer 21

Sporatic disorder with - hemangiomatous facial lesions (Port wine stain) in the distribution of the trigemical nerve that is associated with a similar intracranial lesion
- They need brain imaging

Question 22

What is Orchiopexy? At what age do you do it?

Answer 22

Surgically descending the testicles

- This is done if not spontaneously descended by 12 months

Question 23

Why is 12 months the cut off for allowing testes to decend?

Answer 23

• Spermatogenesis starts to occur around 12 months. At this time the high temperature can result in damage

Question 24

What is cryptorchidism?

Answer 24

• non-descended testes

Question 25

What are retractile testes?

Answer 25

Testicles which are non-descended but can be milked down

Question 26

What is congenital adrenal hyperplasia

Answer 26

- 21 hydroxylase enzyme deficiency - Therefore decreased cortisol and aldosterone - Also cannot break down 17- hydroxyprogesterone which are converted to testosterone, DHEA, and androstenedione

Question 27

What electrolyte abnormality will you expect with congenital adrenal hyperplasia?

Answer 27

- High potassium

Question 28

In a female with congenital adrenal hyperplasia what would be your first clue towards this deficiency?

Answer 28

- Clitoromegaly

Question 29

What is the classic presentation of Erb's palsy?

Answer 29

- Affected limb in "waiter tip" position - Shoulder ADDucted, IR - Elbow extended, pronated - Wrist flexed - Asymmetric Moro reflex

Question 30

Which nerve roots are affected in ERBs palsy?

Answer 30

C5 and C6 | - Sometimes C7 is involved which will affect the radial nerve and limit wrist extension

Question 31

What part of the birth history will increase suspicion for Erbs palsy?

Answer 31

Shoulder distocia

Question 32

Each of the following is an important component in the neuromotor assessment of infants below 3 months of age EXCEPT: -Evaluation for asymmetry of movement - Assessment of primitive reflexes - Evaluation of abnormalities in tone - Evaluation of the forward parachute response Measurement of head circumference

Answer 32

Evaluation of the forward parachute response * FORWARD, this reflex does not develop until later

Question 33

Most full term infants regain their birth weight by age: ``` 3 days 5 days 10 days 2 weeks 3 weeks ```

Answer 33

10 days

Question 34

A mother brings her 4 week old baby to your office for examination. She complains that he does not drink much and that she does not know what to do. His birth weight was 3.5 kg. His present weight is 3.6 kg. Which one of the following is the most appropriate course of action? Refer mother and child to a social worker for evaluation and give another appointment in 1 week Order a complete blood count and a sweet chloride test Reassure the mother that some children do not gain much weight during the first month of life Evaluate caloric intake and parent interaction Change the milk formula for an iron enriched formula

Answer 34

Evaluate caloric intake and parent interaction

Question 35

A newborn girl is noted to have a palpable clunk when the hip is abducted, flexed, and lifted forward Which of the following is the most likely mechanism of disease? Decreased epiphyseal blood flow resulting in osteonecrosis Displacement of the capital femoral epiphysis Failure of osteoid to mineralize Increased intra-articular pressure Muscle imbalance resulting from spasticity Shallow, poorly developed acetabulum

Answer 35

Shallow, poorly developed acetabulum

Question 36

An otherwise healthy 6-month-old girl is brought to the physician because of a hemangioma on her neck that has been enlarging since 6 weeks of age. The lesion was 0.5 cm at 6 weeks of age and is now 2 cm. It is raised, erythematous, and blanches with pressure; there is no ulceration Growth is appropriate for age, and laboratory studies show no abnormalities. Which of the following is the most appropriate next step in management? ``` Observation Intralesional antiangiogenic factor therapy Intralesional interferon therapy Oral corticosteroid therapy Laser therapy ```

Answer 36

Observation

Question 37

You are called to evaluate a full-term infant. The infant's mother expressed concern about her newborn's arm shortly after delivery. The mother's prenatal history is notable for gestational diabetes mellitus that was well-controlled with diet. . The infant's size was appropriate for gestational age. On physical exam, pupils are equal round and reactive to light. There is limited movement of her right arm. Her upper arm is adducted and internally rotated, her elbow is extended, forearm pronated, and wrist and fingers flexed. Biceps and Moro reflexes were absent on the right side. No sensory loss was noted. There is no crepitus over the collarbones. The other arm was normal and the rest of the physical examination was unremarkable. This pattern of injury is caused by injury to which structures? ``` A. C5-C7 B. C5-C6 C. C5-T1 D. C8-T1 E. Radial nerve ```

Answer 37

C5-C7 | - Wrist is flexed hinting that C7 is involved.