UWorld educational objectives Flashcards
Laboratory findings of infants of diabetic mothers
Hypoglycemia
Polycythemia, low iron
Hypocalcemia & hypomagnesemia
Hyperbilirubinemia
Educational objective:
Metabolic complications of infants of diabetic mothers include hypoglycemia, hypocalcemia, and hypomagnesemia. Serum calcium level should be obtained for symptomatic neonates (eg, jitteriness), particularly if serum glucose is normal.
What can cause shoulder dystocia in a newborn?
Fetal macrosomia is a risk factor for shoulder dystocia. Excessive traction on the head and neck during a difficult delivery can result in Erb-Duchenne (C5-6 damage) palsy with the characteristic “waiter’s tip” posture. Management involves observation alone because most infants recover arm function spontaneously within a few months.
Management of shoulder dystocia
Fetal macrosomia is a risk factor for shoulder dystocia. Excessive traction on the head and neck during a difficult delivery can result in Erb-Duchenne palsy with the characteristic “waiter’s tip” posture.
Management involves observation alone because most infants recover arm function spontaneously within a few months.
What if shoulder dystocia remains longer, 3-9 months?
Surgical intervention (eg, nerve graft, reconstruction, decompression) can be considered for infants with no improvement by age 3-9 months but is not necessarily curative
What is Klumpke palsy?
is a rare complication of shoulder dystocia caused by injury to the 8th cervical and 1st thoracic nerves. Presentation can include hand paralysis (ie, “claw hand”) and ipsilateral Horner syndrome.
Why do we urge early breastfeeding?
early feeding helps prevent hypoglycemia and can decrease the risk of hyperbilirubinemia. For these reasons, routine newborn care (eg, vitamin K, hepatitis B vaccine, erythromycin eye ointment) can be postponed for an hour to allow for skin-to-skin time
What does Immediate routine neonatal resuscitation involve?
Immediate routine neonatal resuscitation includes drying, stimulating, and warming. Healthy newborns should be placed on the mother’s chest for skin-to-skin care, which provides warmth and allows early breastfeeding initiation.
Clinical findings in Neonatal herpes simplex virus infection
Skin-eye-mouth Mucocutaneous vesicles Keratoconjunctivitis CNS Seizures, fever, lethargy Temporal lobe hemorrhage/edema Disseminated Sepsis, hepatitis, pneumonia
When does Neonatal herpes simplex virus infection shows?
CNS disease typically presents in the second or third week of life with signs of encephalitis, including seizure, lethargy, and poor feeding. A full fontanel is suggestive of increased intracranial pressure.
Educational objective:
Neonatal herpes simplex virus infection typically results from vertical transmission during delivery. The presentation in newborns with CNS disease (ie, encephalitis) typically occurs in weeks 2-3 of life with seizure and temporal lobe hemorrhage.
How does Cytomegalovirus (CMV) and Toxoplasma gondii present in newborns?
Cytomegalovirus (CMV) and Toxoplasma gondii can cause neonatal seizures, but intracranial calcifications are seen on neuroimaging in both conditions. In addition, symptomatic congenital toxoplasmosis and CMV infection also typically present with other findings such as jaundice, hepatosplenomegaly, and chorioretinitis.
How does group B Streptococcus and Listeria monocytogenes present in neonates?
Neonatal bacterial meningitis due to group B Streptococcus and Listeria monocytogenes can cause fever and seizure. Imaging findings may include cerebral edema, hydrocephalus, and abscess but not temporal lobe hemorrhage, which is highly specific for HSV.
How do you manage clavicular fracture in newborns?
Management includes reassurance and gentle handling, as most neonatal clavicular fractures heal rapidly without complications (7-10 days)
To decrease pain, arm motion may be restricted by pinning the infant’s sleeve to the shirt.
Risk factors for neonatal clavicular fractures.
Birth weight >4 kg, shoulder dystocia, and vacuum delivery are risk factors for neonatal clavicular fractures.
How does ectopic pregnancy manifests?
Ectopic pregnancy, which occurs when a developing blastocyst implants in an extrauterine location (eg, fallopian tube), can present with nausea/vomiting, pelvic pain, and vaginal bleeding. Therefore, all reproductive-age women with these symptoms require pregnancy testing.
Fetal growth restriction (FGR) is characterized by: estimated fetal weight <10th percentile or birth weight <3rd percentile. Asymmetric FGR, in which head circumference is normal, is most commonly due to uteroplacental insufficiency (eg, maternal chronic hypertension) in the second/third trimester.
estimated fetal weight <10th percentile or birth weight <3rd percentile.
Asymmetric FGR, in which head circumference is normal, is most commonly due to:
uteroplacental insufficiency (eg, Uteroplacental insufficiency (HTN), Maternal malnutrition) in the second/third trimester.
Indications for intubation and invasive mechanical ventilation in severe acute asthma include?
Indications for intubation and invasive mechanical ventilation in severe acute asthma include:
- impending respiratory failure (high or inappropriately normal PaCO2 in relation to the work of breathing),
- altered mental status,
- lack of improvement despite a time-limited trial of noninvasive positive pressure ventilation.
The first step in management of a newborn with suspected congenital diaphragmatic hernia is __________. A gastric tube should also be placed immediately to __________. Bag-and-mask ventilation can exacerbate respiratory decline and should be avoided.
endotracheal intubation
decompress the stomach and bowel
Viral bronchiolitis typically presents in children age ______ with cough and increased work of breathing (eg, tachypnea, retractions). Diagnosis is typically clinical, but chest x-ray findings include ?
<2 years
peribronchial cuffing, increased interstitial markings, and the absence of a focal consolidation.
A large thymic silhouette is a normal finding on frontal chest x-ray in children age ___ because it is relatively large compared to the small thorax. The thymus normally atrophies after puberty. Therefore, opacities in this location in adults raise concern for a pathologic cause (eg, ______,________).
<3
lymphoma, germ cell tumor
___________ presents with increased work of breathing, hypoxia responsive to oxygen, and ground-glass opacities on x-ray; management includes exogenous surfactant administration. Neonates of mothers with _________ are at increased risk due to delayed fetal lung maturation.
Neonatal respiratory distress syndrome
diabetes and poor glycemic control
Not all patients with cystic fibrosis are identified through newborn screening. Therefore, the presence of _____, ________, _______, and signs of ______ (eg, poor growth, deficiency of fat-soluble vitamins) should prompt an evaluation.
nasal polyps,
recurrent sinopulmonary infections
digital clubbing
pancreatic insufficiency
_____________ can occur when a large volume of blood product is rapidly transfused, particularly in children age <3 with chronic anemia. Signs include respiratory distress, hypertension, tachycardia, and pulmonary edema within 6 hours of transfusion initiation. Management includes diuresis (eg, furosemide).
Transfusion-associated circulatory overload
_______________, which causes a persistent oxygen requirement, is commonly seen in premature infants, especially in those requiring prolonged mechanical ventilation or oxygen supplementation.
Bronchopulmonary dysplasia (chronic lung disease of the neonate)
___________ in children can present with secondary enuresis. Severe cases can result in cardiovascular complications.
Obstructive sleep apnea
Congenital diaphragmatic hernia results in herniation of abdominal contents into the thoracic cavity. Patients have respiratory distress at birth with absent breath sounds on the affected side, a ______ chest, and a ____ abdomen. Chest x-ray shows intrathoracic bowel loops and a displaced cardiac silhouette.
barrel-shaped
scaphoid
