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PCM IV Final > VanGarsse: Management and Exam of the Healthy Neonate > Flashcards

VanGarsse: Management and Exam of the Healthy Neonate Flashcards

1
Q

Sx of hypoglycemia

A
  • hypothermia
  • jitteriness
  • tremors
  • hypotonia
  • irritability
  • lethargy
  • stupor
  • apnea
  • poor feeding
  • seizures
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2
Q

Jaundice/hyperbilirubinemia

A
  • values above 25mg/L
  • can result in BIND (bilrubin induced neurologic desfunction and/or kernicterus
  • risk factors include ABO incompatibility, excessive bruising, prematurity, sepsis, heart disease
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3
Q

What is the first thing we look for in the new baby?

A
  • is it breathing?
  • watch for see-saw respirations
  • belly goes up, chest goes down
  • look for retractions and “singing”
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4
Q

What are some pleural space problems that could happen?

A
  • effusion
  • pneumothorax- much more common than effusion
  • most commonly spontaneous pneumo or from PPV during resuscitation
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5
Q

What color is the color we want to see on our baby?

A
  • pink is GOOD

- Blue is bad

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6
Q

What is Acrocyanosis?

A
  • blue discoloration of the perioral area, feet, and hands
  • normal for first 24 hrs
  • closely associated with cool surroundings
  • perioral changes seen with sucking/feedings
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7
Q

For how long after birth is central cyanosis normal?

A
  • like 10 minutes

- if it continues, think cardiac stuff

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8
Q

Do bruises blanch?

A
  • no

- but cyanosis blanches… that is important

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9
Q

Does jaundice in the first 24 hours concern us and deserve further evaluation?

A

-yes

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10
Q

What does grayish hue mean?

A
  • most often indicates severe acidosis in the newborn and often poor outcome
  • gray is bad!
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11
Q

How does a full term baby look with position at rest?

A
  • flexed, with resistance noted when extremities moved

- flaccid full term/late preterm babies deserve attention/work up

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12
Q

is a strong lusty cry reassuring?

A

-hell yes it is

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13
Q

What does a high pitched cry mean?

A

-infant with CNS/head trauma and or substance withdrawal

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14
Q

What are we looking for in the eyes?

A
  • red reflex…. if not there, retinoblastoma
  • in white it’s red
  • in darker skinned, pearly gray, vessels still present
  • white means pathology… URGENT REFERRAL
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15
Q

what else do we look for in the eyes?

A
  • size, placement, rotation shoud be noted

- palpebral fissure angle is from medial to the lateral canthus

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16
Q

is subconjunctival hemorrhage worrying?

A
  • no

- it looks scary as shit though

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17
Q

when people say that a baby has low set ears, what do they really mean?

A

-the baby’s ears are just posteriorly rotated

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18
Q

What else do we look for on the ears

A
  • check for patency of EAC, tympanic membranes rarely viewed on the newborn exam
  • significance of pre-auricular skin tags and “pits” are often debated
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19
Q

What do we look for in the Nose?

A
  • misshapen secondary to birthing or intrauterine positioning
  • call ENT if you see this
  • usually just swelling and it’s fine
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20
Q

Causes of Nasal obstruction?

A
  • mucus
  • edema
  • anatomical: tumor, encephalocele, Choanal atresia
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21
Q

What are we looking for in the mouth?

A
  • micrognathia: pierre robin sequence

- cleft lip and palate may also be associated with a syndrome

22
Q

Are epstein pearls a big deal?

A

-no

23
Q

What do we look for in the Neck?

A
  • webbing like in turner’s syndrome

- excess skin at the base of the neck is common in trisomy-21 (down)

24
Q

What do we have to check for in clavicles?

A
  • make sure they’re there

- see if they’re fractured

25
Q

What is the goal of cardiac exam?

A
  • ensure the absence of heart disease

- determine if the heart is the source of the problem in the “ill” neonate

26
Q

What is the normal heart rate for an infant?

A

-100-160 BPM

27
Q

Which pulses should be examined simultaneously on an infant?

A

-femoral and brachial pulses

28
Q

Does the absence of a murmur during auscultation of the chest does not ensure there are no pathological structural problems?

A

-hell no

29
Q

Is a murmur a big deal in the newborn infant?

A
  • no

- most babies have murmurs in the newborn period …. most transient and innocent

30
Q

Which murmurs deserve further evaluation?

A

-loud murmurs with harsh qualities, to and fro murmurs, or pansystolic murmurs which persist past the first few hours of life

31
Q

what does the disappearance of a murmur in a clinically deteriorating infant indicative of?

A

-a “ductal dependent” lesion (coarctation of aorta, tricuspid atresia, pulmonary atresia)

32
Q

What is the most important part of the respiratory system evaluation?

A
  • observation of the newborn breathing

- Stethoscope use is for evaluation of the quality, qunaitiy, and equality of air movement

33
Q

What do we want to look for with the stethoscope in the chest?

A
  • ensure the absence of bowel sounds in the chest and to localize abnormal sounds
  • stridor, crepitance, crackles
34
Q

what doe we look for on the chest?

A
  • supernumery nipples
  • more common in black ppl
  • in white ppl, associated with renal anomalies
35
Q

What abdomen things could we see?

A
  • omphalocele
  • gastroschisis
  • obvious and require urgent surgical intervention
36
Q

How many vessels will there be in an umbilical cord?

A
  • 3

- 2 arteries, 1 vein

37
Q

Does a cephalohematoma cross the suture lines?

A
  • No!
  • weeks to months for resolution
  • late can mimic a fracture on xray
38
Q

What is caput succedaneum

A
  • boggy area of edema and or bruising, crosses suture lines, gone in days, present at birth (generally does not enlarge)
  • remember that the cap (baseball hat) goes across suture lines
  • disappears without treatment
  • no pathological significance
39
Q

What is the least common but most dangerous extracranial injury?

A
  • subgaleal hemorrhage
  • lots of blood loss
  • enlarges after birth
  • crosses suture lines
  • fluid wave
  • can cover entire scalp and extend into the neck
40
Q

What do we want to look for in the back?

A
  • abnormal curves/position
  • the number one reason for abnormal curves is an underlying defective fusion
  • hair tuft
  • dimples separate from gluteal crease
  • skin tags or pits
41
Q

What extremity do we need to pay attention to?

A
  • the hip!
  • developmental dysplasia of the hip is a thing
  • re examin the hips before discharge!
42
Q

What are we looking for in the genitalia?

A
  • if it’s ambiguous, urgent evaluation

- endocrinologic emergency

43
Q

What might we find on the female genitalia?

A
  • muscous
  • hymen has some openings
  • labial mass in the groin
  • hymenal tags very common
  • it’s all good in the clitoral hood
44
Q

What might we see in the male genitalia?

A
  • hypo or epispadias

- white sebaceous cysts are relatively common on the distal foreskin and of no consequence

45
Q

When do we need the surgeon evaluation if the testicles aren’t down?

A

-by 9-12 months… if after that, get the surgeon

46
Q

What could the absence of the anus mean?

A
  • VATER
  • Vertberal defects, ventricular septal defect
  • anal atresia
  • T-E fistula/esophageal atresia
  • Radial dysplasia
47
Q

What is Vernix?

A

-the white cheesy stuff that babies have all over….. goes away eventually

48
Q

What are long nails, lack of vernix, peeling/dry skin signs of?

A

-post maturity

49
Q

What is erythem toxicum neonatorum?

A
  • benign rash of the newborn
  • usually appears second to third day of life
  • erythematous base with 1-2 mm pustules or papules
  • spares palms, soles
  • Pustule/vesicles contain debris and eosinophils
50
Q

What are Milia

A
  • appear on face and scalp
  • 1-2 mm white, firm papules on the face and bridge of the nose
  • resolve spontaneously by a few months
  • appear at 36 weeks gestation
51
Q

What are those things that can be found on the butt and kinda look like bruises?

A
  • Slate grey spots (dermal melanosis)
  • macular to patch size
  • more common in darker skinned races, but affects all
  • benign
  • those on the lower back/buttocks tend to resolve over several years
  • formerly “mongolian spots”
  • make sure you document these things because they look like bruises…. police will probably ask ha ha

PCM IV Final (5 decks)

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