Pediatrics - New born assessment Flashcards
What is an acceptable amount of weight loss in the first week of life? When should they be back to their birth weight by?
- Decreased up to 10% in first week
- Should return to birth weight by day 10 to 14.
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?
- Sheehan syndrome
What is the average head circumference?
35cm or 20 inches
What is the expected rate of head circumference growth in the first year? The following 3-6 months?
- 2cm per month for 1 year
- 1cm per month afterward for 3 - 6 months
Causes of asymmetrical small for gestational age (late onset, head sparing)
- HTN
- Nutrition
- Drugs
- ETOH
- Smoking
Causes of symmetrical SGA?
- TORCH
- Congenital Abn.
- Idiopathic syndromes
Child with absent red reflex and strabismus what are you concerned for?
- Retinoblastoma
What are features of an innocent murmur?
- 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
what are the 4 S’s of innocent murmurs
S: aSymptomatic
S: Soft
S: left Sternal Edge
S: Systolic only
A systolic murmur with a wide fixed split S2 is caused by which defect?
Atrial septal defect
Describe a typical murmur heard with a PDA?
Machinery sound at 2nd L intercostal space
A holosystolic murmur heard at the left sternal border is caused by which defect?
Ventral septal defect
When is a diastolic murmur normal?
Never
- Mitral stenosis or aortic regurgitation most common
Why does congenital hip dysplasia occur?
- Poorly developed acetabulum
- May also have deformity of the head of the femur
What is a postive Barlow or Ortolani?
PALPABLE click or clunk
If someone is positive for hip dysplasia how do you manage initially?
- 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
What are risk factors for hip dysplasia?
- Left side
- Breech position
- Female
- First born
- Family Hx
- Usually painless
Should you do an X-ray of someone with congenital hip dysplasia?
No - bones are not ossified in new born period. An ultrasound should be perform instead.
What is a hemangioma of infancy?
- 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
What is the best treatment of hemangioma of infancy if does not resolve spontaneously?
- Propranolol (topical)
What is Sturge-Weber Syndrome?
- What test do they need?
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
What is Orchiopexy? At what age do you do it?
Surgically descending the testicles
- This is done if not spontaneously descended by 12 months
Why is 12 months the cut off for allowing testes to decend?
- Spermatogenesis starts to occur around 12 months. At this time the high temperature can result in damage
What is cryptorchidism?
- non-descended testes
What are retractile testes?
Testicles which are non-descended but can be milked down
What is congenital adrenal hyperplasia
- 21 hydroxylase enzyme deficiency
- Therefore decreased cortisol and aldosterone
- Also cannot break down 17- hydroxyprogesterone which are converted to testosterone, DHEA, and androstenedione
What electrolyte abnormality will you expect with congenital adrenal hyperplasia?
- High potassium
In a female with congenital adrenal hyperplasia what would be your first clue towards this deficiency?
- Clitoromegaly
What is the classic presentation of Erb’s palsy?
- Affected limb in “waiter tip” position
- Shoulder ADDucted, IR
- Elbow extended, pronated
- Wrist flexed
- Asymmetric Moro reflex
Which nerve roots are affected in ERBs palsy?
C5 and C6
- Sometimes C7 is involved which will affect the radial nerve and limit wrist extension
What part of the birth history will increase suspicion for Erbs palsy?
Shoulder distocia
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
Evaluation of the forward parachute response
- FORWARD, this reflex does not develop until later
Most full term infants regain their birth weight by age:
3 days 5 days 10 days 2 weeks 3 weeks
10 days
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
Evaluate caloric intake and parent interaction
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
Shallow, poorly developed acetabulum
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
Observation
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
C5-C7
- Wrist is flexed hinting that C7 is involved.
