PreTest Pediatrics: "The Newborn Infant"

Question 1

What test should you do in a case of bloody meconium?

Answer 1

The Apt-Downey test can distinguish maternal from fetal hemoglobin and can tell you if the blood is from mom (placental abruption) or baby (GI bleed).

Question 2

One of these is not safe in breastfeeding: 
•Carbamazepine
•Amphetamines
•Ibuprofen
Which is it?

Answer 2

Amphetamines

Question 3

Babies of diabetic mothers are at increased risk of hypoglycemia and hypo-__________.

Answer 3

calcemia

Diabetic mothers make less PTH.

Question 4

List three treatment recommendations for NEC.

Answer 4

• Nasogastric decompression
• Fluid resuscitation
• Serial abdominal films (to evaluate for perforation)

Question 5

Small-for-dates infants are at higher risk of ______________.

Answer 5

congenital anomalies

Question 6

If the screening test for galactosemia comes back positive, you should ______________.

Answer 6

have the parents switch to soy-based formula immediately (until further testing confirms or denies the condition)

Question 7

Describe a subgaleal hematoma versus a cephalohematoma.

Answer 7

• Subgaleal hematomas are bleeds between the periosteum and the skin fascia. These are revealed by rapidly growing swellings that cross midline. They can be deadly due to large bleeds.
• Cephalohematomas are bleeds within the periosteum that do not cross midline and are benign.

Question 8

Describe neonatal hyperviscosity syndrome.

Answer 8

Pregnant women who develop toxic syndromes in the third trimester (such as uteroplacental insufficiency) can have children with polycythemia because they are hypoxic. This leads to neurologic deficits –because of “sludgy” blood –and tremulousness due to hypoglycemia, itself a complication of polycythemia.

Question 9

Being post dates is a risk factor for _____________.

Answer 9

meconium aspiration

Question 10

What is chemical conjunctivitis?

Answer 10

Some places still use silver nitrate for prophylaxis against bacterial conjunctivitis (it’s an old treatment), and it can cause conjunctivitis for the first day of life.

Question 11

You see a neonate with purulent ocular discharge. How might you know whether it is gonococcal or chlamydial?

Answer 11

The timing! Gonococcal conjunctivitis presents within 5 days, while chlamydial conjunctivitis presents after one week.

Question 12

Why would you not do an ELISA to diagnose HIV in a neonate from an HIV-positive mother?

Answer 12

ELISA tests for antibodies, which the mother will pass to her newborn.

Question 13

Neonate of an HIV-positive mother? Give ___________.

Answer 13

zidovudine

Question 14

What is a sign of Turner’s at birth that you for sure did not learn for Step 1?

Answer 14

Edema over the dorsum of the hands or feet.

Question 15

Mongolian spots tend to disappear by _____________.

Answer 15

1 to 2 years of age

Question 16

Describe the most common type of esophageal atresia.

Answer 16

Esophagus stops at the oral end and connects to the trachea at the gastric end.

Question 17

What negative effect do beta-blockers have on neonates?

Answer 17

The ones that cross the placenta (all except labetalol) decrease the ability of the neonate to increase cardiac output (a big problem for any infant with respiratory compromise).

Question 18

Physiologic jaundice should not exceed ____________.

Answer 18

bilirubin of 12

Question 19

Kernicterus is rare in infants with bilirubins less than _______________.

Answer 19

20

Question 20

Jaundice appearing within the first day of life is usually related to _______________.

Answer 20

hemolytic illness

Question 21

Why is goat’s milk not recommended for young children?

Answer 21

It is low in folate and iron.

Question 22

Recurrent OM and hearing loss are complications of ______________.

Answer 22

cleft palate

Question 23

What is the treatment recommendation for transient tachypnea of the newborn?

Answer 23

Supportive therapy (maintenance of O2 levels)

Question 24

Apnea in a ____________ should warrant further investigation; congenital heart disease, RSV, GERD, and seizures are all potential causes.

Answer 24

term infant

Idiopathic apnea is common in premature infants.

Question 25

What lab sign is sensitive in diagnosing TTTS?

Answer 25

A hematocrit difference greater than 15

Question 26

Why are natal teeth often extracted?

Answer 26

They are often loose, and the tooth can be aspirated.

Question 27

If a neonate develops signs of serious infection within the first two or three days of life, then you should institute what precaution regarding exposure to others?

Answer 27

Isolate the child from hospital staff as an infection this early in life is likely a TORCH infection and could infect the pregnant woman and her fetus.

Question 28

Subgaleal hematomas present with what altered vital sign?

Answer 28

Tachycardia

Question 29

In addition to Erb-Duchenne paralysis, cervical root injury can also cause ______________.

Answer 29

phrenic nerve paralysis

Question 30

How often are pneumothoraces during labor?

Answer 30

1-2%

They are rarely symptomatic, however. For those that are symptomatic, you can decompress it or do 100% oxygen.

Question 31

Does Potter sequence cause beronchopulmonary dysplasia or pulmonary hypoplasia?

Answer 31

Pulmonary hypoplasia

BPD is a diagnosis of premature lungs.

Question 32

What is the constellation of symptoms seen in Waardenburg syndrome?

Answer 32

• Lateral displacement of the medial canthi (the medial corner of the eye)
• Wide nasal bridge
• Deafness

Question 33

A child with a large, flat vascular lesion on the face may be at risk for __________.

Answer 33

seizures

Large facial hemangiomas can be a feature of Sturge-Weber syndrome, which has tram track calcifications in the brain.