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Boot camp > Pediatrics - New born assessment > Flashcards

Pediatrics - New born assessment Flashcards

1
Q

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

A
  • Decreased up to 10% in first week

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

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2
Q

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?

A
  • Sheehan syndrome
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3
Q

What is the average head circumference?

A

35cm or 20 inches

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4
Q

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

A
  • 2cm per month for 1 year

- 1cm per month afterward for 3 - 6 months

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5
Q

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

A
  • HTN
  • Nutrition
  • Drugs
  • ETOH
  • Smoking
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6
Q

Causes of symmetrical SGA?

A
  • TORCH
  • Congenital Abn.
  • Idiopathic syndromes
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7
Q

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

A
  • Retinoblastoma
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8
Q

What are features of an innocent murmur?

A
  • 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
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9
Q

what are the 4 S’s of innocent murmurs

A

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

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10
Q

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

A

Atrial septal defect

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11
Q

Describe a typical murmur heard with a PDA?

A

Machinery sound at 2nd L intercostal space

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12
Q

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

A

Ventral septal defect

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13
Q

When is a diastolic murmur normal?

A

Never

- Mitral stenosis or aortic regurgitation most common

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14
Q

Why does congenital hip dysplasia occur?

A
  • Poorly developed acetabulum

- May also have deformity of the head of the femur

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15
Q

What is a postive Barlow or Ortolani?

A

PALPABLE click or clunk

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16
Q

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

A
  • 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
17
Q

What are risk factors for hip dysplasia?

A
  • Left side
  • Breech position
  • Female
  • First born
  • Family Hx
  • Usually painless
18
Q

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

A

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

19
Q

What is a hemangioma of infancy?

A
  • 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
20
Q

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

A
  • Propranolol (topical)
21
Q

What is Sturge-Weber Syndrome?

- What test do they need?

A

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

22
Q

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

A

Surgically descending the testicles

- This is done if not spontaneously descended by 12 months

23
Q

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

A
  • Spermatogenesis starts to occur around 12 months. At this time the high temperature can result in damage
24
Q

What is cryptorchidism?

A
  • non-descended testes
25
Q

What are retractile testes?

A

Testicles which are non-descended but can be milked down

26
Q

What is congenital adrenal hyperplasia

A
  • 21 hydroxylase enzyme deficiency
  • Therefore decreased cortisol and aldosterone
  • Also cannot break down 17- hydroxyprogesterone which are converted to testosterone, DHEA, and androstenedione
27
Q

What electrolyte abnormality will you expect with congenital adrenal hyperplasia?

A
  • High potassium
28
Q

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

A
  • Clitoromegaly
29
Q

What is the classic presentation of Erb’s palsy?

A
  • Affected limb in “waiter tip” position
  • Shoulder ADDucted, IR
  • Elbow extended, pronated
  • Wrist flexed
  • Asymmetric Moro reflex
30
Q

Which nerve roots are affected in ERBs palsy?

A

C5 and C6

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

31
Q

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

A

Shoulder distocia

32
Q

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

A

Evaluation of the forward parachute response

  • FORWARD, this reflex does not develop until later
33
Q

Most full term infants regain their birth weight by age:

3 days
5 days
10 days
2 weeks
3 weeks
A

10 days

34
Q

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

A

Evaluate caloric intake and parent interaction

35
Q

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

A

Shallow, poorly developed acetabulum

36
Q

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
A

Observation

37
Q

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
A

C5-C7

- Wrist is flexed hinting that C7 is involved.

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