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BOARDS--GET IT!!! > Rita's Newborn Questions > Flashcards

Rita's Newborn Questions Flashcards

1
Q

You are examining a 2 day old born vaginally who has a well-demarcated lump that does not cross midline. What is the most likely dx?

a) A cephalohematoma
b) A caput succedaneum
c) A mass

A

a) A cephalohematoma

  • -take longer to go away than caputs
  • -Caput succedaneums DO cross midline
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2
Q

What is the most common disease identified in the neonatal screening?

a) Phenylketonuria
b) Maple syrup urine disease
c) Hypothyroidism
d) Galactosemia

A

c) Hypothyroidism

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3
Q

Which of the following tests results from neonatal screening indicates possible hypothyroidism?

a) Normal TSH, low T3
b) Low TSH, high T4
c) Low T3, high T4
d) High TSH, low t4

A

d) High TSH, low t4

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4
Q

What will the average 8 lbs newborn weigh at 2-week check?

a) 7.5 lbs
b) 8.5 lbs
c) 9.5 lbs
d) 9 lbs

A

b) 8.5 lbs

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5
Q

What is expected DAILY wt gain for a 6 week old baby?

a) 5 ounce
b) 1 ounce
c) 2 ounces
d) 8 ounces

A

b) 1 ounce

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6
Q

When should you do the newborn screen?

a) At birth
b) After 24 hrs
c) After 48 hrs
d) After 24 hrs post feeding

A

d) After 24 hrs post feeding

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7
Q

How many kcal does a 0-6mos full-term baby need per kg?

a) 65
b) 105
c) 135
d) 150

A

b) 105

135kcal = lower limit of normal for preemies!

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8
Q

What test evaluates gestational age?

a) Dubowitz scale
b) Apgar
c) Hurwitz scale

A

a) Dubowitz scale

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9
Q

Which one of the following is a contraindication to breastfeeding?

a) c/s
b) mom taking Flagyl
c) mom has a hx of genital herpes

A

b) mom taking Flagyl

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10
Q

Which of the following is not associated with a significant increase in alpha feta protein taken in a pregnant mother?

a) Down syndrome
b) Multiple gestation
c) Spinal bifida occulta
d) Fetal death

A

a) Down syndrome

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11
Q

Which nutrient is not absorbed as well by preemies as opposed to full-term infants?

a) Carbohydrate
b) Fat
c) Protein

A

b) Fat

–harder to digest!

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12
Q

A newborn has retinitis, growth retardation, jaundice, hepatosplenomegaly, petechia, and microcephaly. What is the most likely dx?

a) CMV
b) rubella
c) toxoplasmosis

A

c) toxoplasmosis
- -> chorioretinitis!

CMV –> hearing problems

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13
Q

What is the tx of moderate jaundice at home?

a) breastfeed
b) offer glucose water
c) home phototherapy
d) stop breastfeeding for 24 hrs

A

a) breastfeed

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14
Q

Which of the following is an example of the best nutrition intake?

a) A 2yo taking >32 ounces of milk
b) a 3yo on skim milk
c) A 9 month old on whole cow’s milk

A

b) a 3yo on skim milk

A 2yo taking >32 ounces of milk
–> will be Fe-deficient…Fe is critical for brain growth!
A 9 month old on whole cow’s milk
–> will be Fe-deficient…formula only until 1yr!

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15
Q

What is the normal weight gain for babies per month during the first 2 months of life?

a) 12 ounces
b) 16 ounces
c) 18-24 ounces
d) 36 ounces

A

c) 18-24 ounces
- -> 1-2 lbs or 18-32 ounces = ideal answer

36 ounces
–> >2 lbs/month…too much!

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16
Q

When is jaundice pathological in a full-term infant?

a) Day 1 of life
2) Day 4 of life
3) Day 5 of life

A

a) Day 1 of life

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17
Q

A 12 hour old breastfeeding full-term newborn has an elevated direct and total bilirubin. What are you concerned about?

a) Biliary atresia
b) Physiological jaundice
c) Breast milk jaundice
d) Hepatitis A

A

a) Biliary atresia

–> direct bili = conjugated

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18
Q

Which is the best way to transition BF baby to formula?

a) slow wean over months
b) just go to formula
c) substitute one feeding every 2-3 days

A

c) substitute one feeding every 2-3 days

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19
Q

What best describes erythema toxicum?

a) flesh colored umbilical papules
b) multiple non erythematous macular lesions
c) erythematous papules
d) grouped vesicles

A

c) erythematous papules

flesh colored umbilical papules = Molluscum

grouped vesicles = herpes

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20
Q

A newborn has ABO incompatibility. What is the most likely tx?

a) exchange transfusion
b) Phototherapy
c) RhoGAM
d) IV antibiotics

A

b) Phototherapy

exchange transfusion = for Rh disease

RhoGMA = given for Rh

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21
Q

Which of the following is the least likely to cause a bilirubin of 19 in an 18 hour old newborn with 2 feedings of breastmilk?

a) RH or ABO disease
b) Breast Feeding Jaundice
c) Sepsis
d) Congenital spherocytosis

A

b) Breast Feeding Jaundice

Congenital spherocytosis = generally, mild hemolytic anemia

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22
Q

Which one of the following is the appropriate tx of a newborn of a Hepatitis B positive mom?

a) Give Hepatitis B vaccine
b) Give hepatitis B vaccine and Hep B immune globulin
c) give Hep B immune globulin
d) Do nothing

A

b) Give hepatitis B vaccine and Hep B immune globulin

- -> within 12 hrs!

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23
Q

Which of the following is not a long-term effect of toxoplasmosis in a newborn?

a) hydrocephalus
b) microcephaly
c) chorioretinitis
d) learning disability
e) anemia

A

e) anemia

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24
Q

Which of the following is not a presenting sign of symptomatic toxoplasmosis in a newborn?

a) maculopapular rash
b) generalized lymphadenopathy
c) Thrombocytopenia
d) Hepatosplenomegaly
e) Hearing loss

A

e) Hearing loss

- -> is CMV!

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25
Q

What is the most common way to acquire toxoplasmosis?

a) consumption of poorly cooked meats
b) accidental ingestion of sporulated oocysts from soil or food
c) blood product transfusion
d) congenital transmission of primary maternal infections

A

b) accidental ingestion of sporulated oocysts from soil or food

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26
Q

How long does it take for a IgM-specific antibodies to be detected in toxoplasmosis infections?

a) one week
b) two weeks
c) three weeks
d) four weeks

A

b) two weeks

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27
Q

What do you need to screen for in child with asymptomatic CMV infection?

a) Vision
b) PPD
c) hearing

A

c) hearing

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28
Q

Which one of the following port wine stains on a newborn face is worrisome?

a) on the eyelid
b) covering the entire right side of the face
c) on the chin
d) on the nape of the neck

A

b) covering the entire right side of the face

- -> Sturge Weber!…see glaucoma, seizures…

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29
Q

What is the most common underlying problem of neonates with jaundice in the US?

a) RH negative sensitization
b) G6PD deficiency
c) ABO sensitization
d) Biliary atresia

A

c) ABO sensitization

G6PD deficiency = only African Americans

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30
Q

If a 3 week old thriving baby, who is breastfeeding, has no BM for 4 days. You would consider this to be:

a) normal
b) A sign of Hirschsprung’s
c) A sign of constipation
d) A sign of malrotation

A

a) normal
- -> breastmilk so well-matched to baby that no residue is left!

–after 5-7 days without BM –> then worry

in formula-fed baby, be worried after > 2 days w/no BM

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31
Q

A 4 week old baby presents with non-bilious, projectile vomiting. The most likely dx is:

a) malrotation
b) pyloric stenosis
c) intestinal obstruction
d) volvulus

A

b) pyloric stenosis

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32
Q

When does an infant roll from stomach to back?

a) 1-2 mos
b) 3-4 mos
c) 5-6 mos
d) 6-7 mos

A

b) 3-4 mos

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33
Q

Which of the following infants will definitely need FISH testing/microarray?

a) an infant with an isolated cleft palate
b) an infant with clindodactyly of the fifth finger
c) an infant with tetralogy of Fallot
d) an infant with hydrocele

A

c) an infant with tetralogy of Fallot
- -> FISH testing is older genetic test, not as accurate as microarray

isolated cleft palate = more environmental than genetic

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34
Q

An infant presents with cataracts, congenital glaucoma, congenital heart disease, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, and growth retardation. What is the most likely dx?

a) Cytomegalovirus
b) Toxoplasmosis
c) Rubella syndrome
d) Syphilia

A

c) Rubella syndrome

**key: cataracts, congenital heart disease

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35
Q

What is the preferred tx of choice for syphilis?

a) Erythromycin
b) Penicillin
c) Cefotaxime
d) Zithromax

A

b) Penicillin

- -> always!

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36
Q

If a pt has syphilis for more than 1 year, what is the correct tx?

a) Penicillin IV
b) IM Penicillin G benzathine weekly for 3 weeks
c) Amoxil BID for one month
d) Tetracycline for 4 weeks

A

b) IM Penicillin G benzathine weekly for 3 weeks

Penicillin IV –> newborns always get IV

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37
Q

A 2month old presents after an episode of sepsis for a f/u visit. He has gained 2 lbs since birth and had a decrease in head circumference from the 50th to the 25th percentile. In addition, he has inguinal and axillary adenopathy of 1cm, decrease in head, and has hepatomegaly. Which of the following is included in the infectious disease differential?

a) Herpes simplex, type 2 infection
b) HIV infection
c) Chlamydia infection
d) Congenital Gonorrhea

A

b) HIV infection

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38
Q

Which of the following is the most helpful in confirming a dx of Chlamydia pneumonia in a one month old with a cough?

a) Chest x-ray showing lobar consolidation
b) decrease serum immunoglobulins
c) Lymphocytosis
d) Mother with no prenatal care

A

d) Mother with no prenatal care

Chest x-ray showing lobar consolidation
–> hyperaeration, flattening of the diaphragm are seen with chlamydia

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39
Q

A social worker brings a child in prior to placement with a chief complaint of copious vaginal d/c. A culture is positive for chlamydia. From the social perspective, what is the next best step?

a) Reassure the social worker that this is a prenatal transmission.
b) Tell the social worker the result and allow her to decide the next step
c) Tell the social worker the result and tell of the likelihood of sexual abuse
d) Call the foster family with the result

A

c) Tell the social worker the result and tell of the likelihood of sexual abuse

40
Q

Which of the following is a nontreponemal test for syphilis?

a) Veneral Disease Research Laboratory microscopic slide test (VDRL)
b) Fluorescent treponema antibody absorbed (FTA-ABS)
c) Treponema pallidum particle agglutination (TP-PA)
d) TORCH titer

A

a) Veneral Disease Research Laboratory microscopic slide test (VDRL)
- -> VDRL and RPR = non-treponemal tests

41
Q

Which of the following anticipatory guidance would be helpful in decreasing the risk of toxoplasmosis?

a) when camping, treat water from streams with iodine
b) do not go barefoot in high-risk areas
c) wash hands after changing cat litter
d) avoid handling contaminated diapers

A

c) wash hands after changing cat litter

42
Q

What PE finding distinguishes a newborn with congenital toxoplasmosis from a newborn with congenital cytomegalovirus (CMV)?

a) Jaundice
b) Microcephaly
c) Cerebral calcifications
d) Petechial rash

A

c) Cerebral calcifications

43
Q

What congenital infection can present with sniffles, lymphadenopathy, Pseudoparalysis of parrot, CNS abnormalities, and low birth weight?

a) CMV
b) Rubella
c) Toxoplasmosis
d) Syphilis

A

d) Syphilis

- -> syphilis = snuffles!

44
Q

A 2 week old presents with mucopurulent eye d/c w/injection and edema of the conjunctiva. The 15 yo mother had no prenatal care. What si the most likely organism?

a) Staphylococcus aureus
b) Gonococcus
c) C. Pneumoniae
d) C. Trachomatis

A

d) C. Trachomatis

45
Q

What is the most common cause of hyperbilirubinemia in the neonatal period?

a) ABO incompatibility
b) RH factor
c) Physiological immaturity
d) Hemolysis

A

c) Physiological immaturity

- -> many babies have a little jaundice!

46
Q

A newborn has multiple papules and pustules on the face. What is the most likely dx?

a) herpes simplex
b) Erythema toxicum
c) CMV
d) Acne

A

d) Acne

47
Q

Which of the following would you expect a 5 month old to do?

a) Roll from front to back
b) Sit unsupported
c) Crawl
d) Parachute

A

a) Roll from front to back

48
Q

What is the toddler’s task for socialization?

a) solitary play
b) intentional play
c) parallel play
d) cooperative play

A

c) parallel play

49
Q

What reflex starts at 8 dos and lasts for your life?

a) Parachute
b) Moro
c) tonic neck
d) Palmar

A

a) Parachute

50
Q

What is the tx of choice for Chlamydia conjunctivitis?

a) erythromycin ophthalmic drops
b) erythromycin suspension
c) Gentamicin ophthalmic drops
d) Azithromycin ophthalmic drops

A

b) erythromycin suspension

- -> always treat orally!

51
Q

What is the most common cause of conjunctivitis in the newborn period?

a) chemical
b) Gonorrhea
c) Chlamydia
d) Staph aureus

A

a) chemical

- -from eye drops!

52
Q

Which of the following is a characteristic physical sign of Fragile X syndrome in adolescent males?

a) Small posteriorly rotated ears
b) Macroorchidism
c) Hypertonia
d) Double hair whirl

A

b) Macroorchidism

- -> = abnormally large testes

53
Q

Which of the following physical stigmata are common in newborns with Down syndrome?

a) Microcephaly, flattened philtrum, downward slanting eyes
b) Hypotonia, large appearing tongue and small mouth, upward slant to eyes
c) Lymphadenopathy, coarc of the aorta, webbed neck
d) Funnel or pigeon-breasted chest, arachnodactyly, brush field spots

A

b) Hypotonia, large appearing tongue and small mouth, upward slant to eyes

Microcephaly, flattened philtrum, downward slanting eyes
–> fetal alcohol syndrome

Lymphadenopathy, coarc of the aorta, webbed neck
–> Turner’s syndrome

Funnel or pigeon-breasted chest, arachnodactyly, brush field spots
–> Marfan’s syndrome

54
Q

A 2 month old infant, with a hx of sacral myelomeningocele repair, has an increase in HC from the 75th to the 95th percentile. What is the most appropriate first action?

a) order a stat head CT scan
b) refer to neurosurgery for management
c) recheck it at the next well-child visit
d) recheck and replot the child’s HC

A

d) recheck and replot the child’s HC

55
Q

A 2 week old presents with mucopurulent eye d/c with injection and edema of the conjunctiva. The 15 yo mother had no prenatal care. What is the most likely organism?

a) Staph aureus
b) Gonococcus
c) C. Pneumoniae
d) C. Trachomatis

A

d) C. Trachomatis

56
Q

Which of the following is a sign of ineffective nursing technique in a new mother?

a) A weight loss of 2% on day 7
b) A weight loss of 4% on day 4
c) Fewer than 5 diapers w/urine in a 24 hr period
d) Fewer than 3 stool every day

A

c) Fewer than 5 diapers w/urine in a 24 hr period

57
Q

A first-born newborn child has an elevated total bilirubin of 12 on day 10 of life with a normal direct. He is B+ and his mother is O-. What is the most likely reason for the hyperbilirubinemia?

a) RH incompatibility
b) ABO incompatibility
c) Gilbert syndrome
d) Biliary atresia

A

b) ABO incompatibility
- -> baby +, mom - = RH set-up
- -> RH incompatibility trumps ABO

58
Q

Which of the following infants is at greater risk for neonatal jaundice?

a) a 42 week old female with A+ blood whose mother is AB+
b) A newborn feeding with soy formula
c) An African American male with G6PD deficiency
d) A post-term infant

A

c) An African American male with G6PD deficiency

59
Q

A 7 day old born by C-section presents to the ED with a fever of 101. The high WBC is consistent with sepsis and his CSF is normal. What is the best tx regimen?

a) Ampicillin and cefotaxime
b) Ampicillin and Gentamicin
c) Ceftriaxone and Ampicillin
d) Cefotaxime

A

b) Ampicillin and Gentamicin

60
Q

A newborn presents with fever, seizures, full fontanelle, hypotonia, hepatomegaly, vomiting, and hypoglycemia. Which of the following would represent a sepsis workup for this child’s presentation?

a) CBC with diff, blood culture, urine culture
b) CBC w/diff, blood culture, urine culture, CSF culture, gram stain
c) CBC w/diff, blood culture, urine culture, Chest x-ray, CSF culture and gram stain, CRP
d) CBC w/diff, blood culture, urine culture, CSF culture and gram stain, CRP

A

d) CBC w/diff, blood culture, urine culture, CSF culture and gram stain, CRP

**chest x-ray not needed if no tachypnea

61
Q

An African American male has prolonged jaundice with a normal direct bilirubin and an elevated total bilirubin. The mother is A+ and the child is O+. What is the most likely dx?

a) Physiologic jaundice
b) ABO setup
c) RH incompatibility
d) G6PD deficiency

A

d) G6PD deficiency

62
Q

Which of the following exacerbates physiologic jaundice?

a) frequent breastfeeding
b) exposure to the sun
c) giving extra water
d) cephalohematoma

A

d) cephalohematoma

63
Q

What is the best way to prevent hemorrhagic disease of the newborn?

a) Vitamin K 5mg IM
b) the use of probiotics in formula
c) Vitamin K 1mg IM
d) Oral Vitamin K

A

c) Vitamin K 1mg IM

64
Q

What is the optimal time for the GBS rectal and vaginal screening test?

a) 29 to 31 weeks
b) 31 to 33 weeks
c) 35 to 37 weeks
d) 37 to 39 weeks

A

c) 35 to 37 weeks

65
Q

How long would you expect it to take the very preterm low birth weight AGA infant to catch up?

a) 1 year
b) 2 years
c) 3 years
4) 4 years

A

b) 2 years

66
Q

A newborn is born to an IV drug-using mom without prenatal care. What is the next step in the management of this child in terms of hepatitis B?

a) Give HBIG w/in 24 hrs and give Hep B before d/c, followed by Hep B #2 at 1 month.
b) Give HBIG w/in 12 hours along w/Hep B vaccine, followed by Hep B #2 at 1 month.
c) Give HBIG before d/c followed by Hep B #2 at 1 month.
d) Give Hep B vaccine before d/c followed by Hep B #2 at 1 month.

A

b) Give HBIG w/in 12 hours along w/Hep B vaccine, followed by Hep B #2 at 1 month.

67
Q

How to manage a 2 week old with an umbilical granuloma?

a) high dose steroid ointment
b) do nothing
c) silver nitrate application
d) electrocautery

A

c) silver nitrate application

68
Q

What is the definition of a late preterm infant?

a) 34 week 0 day to 36 weeks 6 days
b) 35 weeks 0 day to 37 weeks 6 days
c) 35 weeks 0 day to 38 weeks 0 days
d) 34 weeks 0 days to 38 weeks 6 days

A

a) 34 week 0 day to 36 weeks 6 days

69
Q

A newborn presents with fever, seizures, full fontanelle, hypotonia, hepatomegaly, vomiting, and hypoglycemia. Which of the following would represent a sepsis workup for this child’s presentation?

a) CBC w/diff, blood culture, urine culture
b) CBC w/diff, blood culture, urine culture, CSF culture and gram stain
c) CBC w/diff, blood culture, urine culture, Chest x-ray, CSF culture and gram stain, CRP
d) CBC w/diff, blood culture, urine culture, CSF culture and gram stain, CRP

A

d) CBC w/diff, blood culture, urine culture, CSF culture and gram stain, CRP

70
Q

Which of the following exacerbates a physiologic jaundice?

a) frequent breastfeeding
b) exposure to the sun
c) giving extra water
d) cephalohematoma

A

d) cephalohematoma

71
Q

You are seeing an infant with bloody muchpurulent d/c on day 7 of life. What is the tx of choice?

a) Ampicillin 100mg/kg
b) Erythromycin 4mg/kg
c) Ampicillin 20mg/kg
d) Erythromycin 50mg/kg

A

d) Erythromycin 50mg/kg

72
Q

What is the most likely cause of foul smelling d/c from the umbilicus with periumbilical erythema and streaking?

a) Balanitis
b) Omphalitis
c) Patent Urachus
d) Paraphimosis

A

b) Omphalitis

73
Q

What would be a normal stool for a breastfed 1 month old infant?

a) mustard colored and pasty
b) yellow and seedy
c) yellow and formed
d) green and formed

A

b) yellow and seedy

- -> always seedy!

74
Q

A mother with a newborn asked about co-sleeping. Based on the latest guidelines, what would be the most appropriate response?

a) Do not co-sleep as you can roll over on your baby
b) Tell me more about beliefs around co-sleeping
c) Babies need to sleep on their back in the same room as their mother
d) Never co-sleep with your baby

A

b) Tell me more about beliefs around co-sleeping
- -> need to explore the issue with the parent so she can partner with you in deciding this may not be the best idea
- -> we need to understand that this practice is steeped in tradition–impt to work w/families cultural beliefs

75
Q

A mother with Marfan syndrome comes w/her 5yo for a checkup. The child has myopia and a positive wrist and thumb sign. She reports that she was told by her last HCP not to worry about the child. What is the next best step?

a) Raise the issue of genetic referral
b) Reassure her
c) Follow the child for further signs of Marfan syndrome
d) Refer to ophthalmology

A

a) Raise the issue of genetic referral
- -> impt to help mother decide what she wants to do
- -> while ophtal eval may be needed, she needs other evals including cardiac referral…would be better to start w/the referral that would give her a broader view of the problem

76
Q

Which of the following is appropriate advice for the mother of a newborn?

a) The child should sleep on her back
b) The child should sleep on her back or side
c) The child should be allowed to sleep in a car seat at night
d) The child can sleep on her comforter

A

a) The child should sleep on her back

77
Q

A 5yo female presents for a school physical with a complaint of hyperactivity, a mild developmental delay, aversion of gaze, hand mannerism, long thin face with a sightly dysmorphic ear. What is the most likely dx?

a) Fragile X
b) Turner syndrome
c) Fetal alcohol syndrome
d) Williams syndrome

A

a) Fragile X

Turner syndrome = delay in onset of puberty, short state, webbed neck, and coarctation of the aorta

Fetal alcohol syndrome = thin upper lip, short palpebral fissures, and flattened philtrum, CNS dysfunction, growth retardation

Williams syndrome = supravalvular aortic stenosis, cheerful affect, typical ‘elfin’ faces, developmental delay

78
Q

A newborn presents with cataracts, congenital glaucoma, congenital heart disease, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash,and growth retardation. What is the most likely dx?

a) CMV
b) Toxoplasmosis
c) Rubella syndrome
d) Syphilis

A

c) Rubella syndrome

syphilis = lymphadenopathy, bone lesions, snuffles

79
Q

A well-appearing,well-dressed 11 month old has a long philtrum, midface hypoplasia, microcephaly, developmental delay, and myopia. The mother denies drinking alcohol during the pregnancy. What is the next best step?

a) refer the mother-child to child protective services
b) refer the child to early intervention
c) refer to the child to cardiology
d) refer the mother to AA

A

b) refer the child to early intervention
- -> no matter the reason, a child with a developmental delay needs a referral to EI to help improve his developmental outcomes

  • -while child may benefit from a neuro referral, there are no cardiac signs and child does not need to go to cardiology
  • -the presenting s/s can go w/other genetic d/o’s and it would be impt to consider referral to genetics
80
Q

A newborn fails his newborn hearing test. D/t the mother being an adolescent, the presence of IUGR, jaundice, and mild hepatomegaly, you suspect CMV. What is the best way to establish the dx of congenital CMV?

a) CMV specific IgM
b) Isolation of CMV from infant urine, pharynx, or peripheral blood leucocytes w/in first 3 weeks of life
c) Enzyme-linked immunosorbent assays (ELISA)
d) CMV antigenemia

A

b) Isolation of CMV from infant urine, pharynx, or peripheral blood leucocytes w/in first 3 weeks of life

CMV-specific IgM or CMV antigenemia –> usually used after the newborn period

ELISA –> not available for testing for CMV

81
Q

A baby is born to a mother with chronic Hep B. What is the best tx approach?

a) Administer interferon w/in 24 hrs
b) Administer hep B vaccine w/in 24 hrs
c) Administer interferon and nucleotide in combination daily
d) Administer HBIG and hep B vaccine w/in 12 hrs

A

d) Administer HBIG and hep B vaccine w/in 12 hrs

–interferon is used in the tx and is used in combination with a nucleotide

82
Q

A 2yo female has lymphedema of the hands and foot, with low posterior hairline, cubitus valgus, and a hx of IUGR. Which of the following defects is he most common among the children with this defect?

a) Supravalvular aortic valve stenosis
b) Mitral valve prolapse
c) Dissecting aortic arch
d) Coarctation of the aorta

A

d) Coarctation of the aorta
- -> is most common defect seen in Turner’s syndrome

Dissecting aortic arch/mitral valve prolapse –> Marfan syndrome

Supravalvular aortic valve stenosis –> Williams syndrome

83
Q

Joshua is a 9 month old infant son of parents of LA-French descent. The child stopped rolling over. Mother resorts he is increasingly irritable. Which of the following PE findings is most common w/Tay-Sachs disease?

a) cardiomyopathy
b) retinal detachment
c) “cherry red” spot on retina
d) hyporeflexia

A

c) “cherry red” spot on retina
- -> hallmark of Tay Sachs disease in a child w/developmental regression
- -> increased tone causes hyperreflexia, not hyporeflexia

cardiomyopathy –> Duchenne muscular dystrophy, mucopolysaccharidosis

84
Q

What is the hallmark of Prader-Willi syndrome in infancy?

a) FTT
b) 100% detection rate w/chromosome analysis for a 15q deletion
c) emergence of spasticity during toddler years
d) voracious appetite and development of obesity

A

a) FTT
- -> while a voracious appetite and development of obesity is the hallmark of children w/Prader-Willi, in infancy these children have hypotonia and feeding difficulties w/FTT
- -> detection rate for the deletion is not 100%

85
Q

A 15 day old infant with respiratory distress arrives in the ED. The exam reveals mild cyanosis, hepatosplenomegaly, and features consistent with Down syndrome. Which of the following is the most likely dx?

a) Complete AV canal (endocardial cushion defect)
b) Patent ductus arteriosus
c) ASD
d) VSD

A

a) Complete AV canal (endocardial cushion defect)

PDA, ASD, and VSD are acyanotic!

86
Q

A newborn presents with lymphadenopathy, a decrease i the ability to move the left leg, COOMBS-negative hemolytic anemia, hepatomegaly, and snuffles. What is the most likely dx?

a) Congential herpes infections
b) Congenital CMV infection
c) Congenital syphilis
d) Congenital gonococcal infection

A

c) Congenital syphilis

87
Q

To which of the following substances is a child with spina bifida likely to be allergic?

a) eggs
b) pollens
c) latex
d) dust mite feces

A

c) latex
- -> latex is most common allergy d/t high number of medical procedures and exposure to latex in a hospital setting

children w/latex allergy may be allergic to: avocado, kiwi, banana, chestnut (high risk), apple, carrot, celery, melons, papaya, potato, tomato (medium risk)

88
Q

What is the preferred tx of choice for syphilis?

a) Erythromycin
b) Penicillin
c) Cefotaxime
d) Zithromax

A

b) Penicillin

89
Q

Which of the following is consistent with neonatal disseminated herpes disease?

a) hyperactive newborn with apparent spasticity
b) multiple papules scattered over the body
c) fever, grouped vesicles on the skin
d) purpuric rash over the body

A

c) fever, grouped vesicles on the skin

grouped vesicles = hallmark of herpes!

90
Q

What would you advise a breastfeeding mother whose infant is being tax’s for oral thrush?

a) give the Mycostatin as directed
b) It is not contagious
c) Wash the nipples w/soap and water following nursing
d) Use alcohol as disinfectant following feeding

A

a) give the Mycostatin as directed

???? no answer listed!

91
Q

What chart would you use to plot a female infant’s growth who is 34 weeks gestational age and 4 weeks chronological at the same time you are seeing her?

a) CDC growth charts from 0-3yrs
b) WHO chart for 0-2yo
c) Fenton Growth Chart
d) WHO chart for 0-3yo

A

c) Fenton Growth Chart

- -> is used in infants from 22 weeks up to 10 weeks post term or 50 week post-menstrual age

92
Q

A 37 late preterm infant weighed 5 lbs and 5 ounces at birth and is 7 days old today weighing 4 pounds and 5 ounces. What is the first step in the management of the infant?

a) Reassure the mother
b) Take a complete feeding and stopping hx
c) Recheck the weight
d) Counsel the mother about feeding and follow the infant in one week

A

c) Recheck the weight
- -> at 7 days, the infant should have lost no more than 7%

5lb 5 ounces = 85 ounces
4 lbs 5 ounces = 69 ounces

69/85 = 0.81 –> she lost more than 18% of birth wt

93
Q

When can newborn screening be carried out?

a) at 24 hrs after birth
b) 24 hrs after the infant’s first formula/breast feed
c) anytime after the infant is born
d) only after 48 hrs of having been regularly fed

A

b) 24 hrs after the infant’s first formula/breast feed
- -> with early d/c, this is a real issue…infant must have a feeding before the screening is done
- -> impt to watch home deliveries (many of these moms opt out of newborn screening)

94
Q

Which of the following infants is a candidate for Palivizumab (Synagis) based on the new guidelines?

a) a healthy 32 weeks gestation infant born in December
b) a 30 week gestation infant w/a hx of transient tachypnea
c) a 29.5 week gestation infant with a congenital neutropenia syndrome (Kostman’s syndrome)
d) a 32 week gestation infant with an ASD

A

c) a 29.5 week gestation infant with a congenital neutropenia syndrome (Kostman’s syndrome)
- -> Kostman syndrome or congenital neutropenia would be considered an immunodeficiency making this child eligible for Synagis

95
Q

What formula should be used in a preterm infant who is gaining weight and is now 5 months of age?

a) Formula 20 calories/ounce
b) Formula 22 calories/ounce
c) Formula 24 calories/ounce
d) Soy formula 20 cal/ounce

A

b) Formula 22 calories/ounce

- -> most babies use 24 cal/ounce in hospital and then switch over to 22 cal at home

96
Q

A preterm 28 weeks infant’s head is on the 90th percentile at 2 weeks and grows at a rate of 1.25cm/week. What is the next step after you recheck the head growth?

a) Do an MRI
b) Do an ultrasound of the head
c) Monitor in one week rather than doing any therapeutics at this time
d) Do a CT of the head w/ and w/out contrast

A

b) Do an ultrasound of the head
- -> this rate of growth indicates hydrocephalus
- -> ultrasound is least invasive and fairly accurate way of confirming the dx

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