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Question 1

XR of a newborn with increased respiratory effort shows “wet” looking lungs, no consolidation, and no air bronchograms.. What is the cause?

Answer 1

TTN

Question 2

I say “ground glass” CXR, you say….

Answer 2

RDS

Question 3

Which side do diaphragmatic hernias typically occur?

Answer 3

L - causes hear to be pushed to R and constricts lungs

Question 4

What needs to be ruled out before preterm babies can go home?

Answer 4

Hypothermia
Hypoglycemia
Respiratory distress
Apnea
Hyperbilirubinemia
Feeding difficulty

Question 5

What is cut off for hypoglycemia?

Answer 5

45

Question 6

When do blood sugars typically fall and rise in neonatal period?

Answer 6

Fall first 1-2 hrs neonatal after placenta separates, then reaches stable point at 3-4 hrs (65-71)

Question 7

What are risk factors for developmental dysplasia of the hips?

Answer 7

Breech position (30-50% of DDH cases occur in infants born in the breech position)
Gender (9:1 female predominance)
Family history

Question 8

What supplement should exclusively breast fed babies get?

Answer 8

400 U Vitamin D

Question 9

What’s on your differential for a baby with low temp?

Answer 9

sepsis, disorders of metabolic function, and abnormal brain thermoregulation.

Question 10

What is about average for breast feeding of neonate?

Answer 10

every 2-3 hours for 10-15 minutes per breast

Question 11

How many wet diapers per day indicates adequate breast feeding?

Answer 11

> 6 per day

Question 12

How do seizures manifest in young infants?

Answer 12

often subtle and may manifest as jerking or horizontal deviation of the eyes; blinking or fluttering of the eyelids; drooling, sucking, or lip smacking; tonic posturing of a limb; or apnea.

Question 13

How do we screen for “critical congenital heart diseases” following birth?

Answer 13

pulse oximetry to screen for “critical” cardiac defects, i.e. those that typically require surgery or cardiac catheterization in the first year of life.

Question 14

A baby girl failed hearing exam at the hopsital. when to repeat?

Answer 14

At 3 mo

Question 15

How would a baby with congenital adrenal hyperplasia present?

Answer 15

decreased activity, virilized genitalia in female baby, poor weight gain; newborn screen measure 17-OH-Progesterone

Question 16

When does polycythemia of newborn typically occur?

Answer 16

In first few hours of life

Question 17

When would you see following constellation of sx?

Feeding problems
Decreased activity
Constipation
Prolonged jaundice
Skin mottling
Umbilical hernia

Answer 17

Congenital hypothyroidism

Question 18

If a newborn has an inborn error of metabolism, what is the eventual risk?

Answer 18

progressive encephalopathy

Question 19

When may you see large fontanelles?

Answer 19

Skeletal disorders (e.g., rickets, osteogenesis imperfecta)
Chromosomal abnormalities (e.g., Down syndrome)
Hypothyroidism
Malnutrition
Increased intracranial pressure

Question 20

When may you see small fontanelles?

Answer 20

Microcephaly
Craniosynostosis
Hyperthyroidism
A normal variant

Question 21

Meningitis, hydrocephalus, subdural hematoma, and lead poisoning may all lead to increased intracranial pressure and _______ fontanelles

Answer 21

BULGING = meningitis, hydro, subdural hematoma, lead poisoning

Question 22

In which patients are umbilical hernias more common?

Answer 22

premature infants and congenital hypothyroidism

Question 23

Newborn has Hypotonia, large fontanelles, an umbilical hernia, and jaundice - what is likely diagnosis?

Answer 23

Congenital hypothyroidism

Question 24

What electrolytes to look to in evaluated CAH?

Answer 24

Potassium (high), sodium (low) –> follow up with 17 OH Progesterone

Question 25

If you suspect a child has an inborn error of metabolism, what lab should you look at?

Answer 25

Ammonia

Question 26

What level of bili poses risk of bilirubin-induced neurologic dysfunction?

Answer 26

TsB > 25

Question 27

If a newborn has delay in diagnosis of congenital hypothyroidism, what signs may it develop?

Answer 27

large tongue, hoarse cry and puffy myxedematous facies

Question 28

I say albinism, musty order, failure to meet milestones, seizures -- you say...

Answer 28

PKU

Question 29

What is fever without a source?

Answer 29

when a complete history has been obtained and a detailed physical examination performed, and there is no identified source of the child's fever.

Question 30

Fever in newborn. What is on your ddx?

Answer 30

``` viral syndrome Urinary tract infection (UTI) - most common Meningitis Sepsis/Bacteremia Pneumonia Bacterial gastroenteritis Osteomyelitis Septic arthritis ```

Question 31

What sx indicate meningitis as cause of infant fever?

Answer 31

``` Fever Hypothermia Bulging fontanelles Lethargy Irritability Restlessness Paroxysmal crying (crying when picked up) Poor feeding Vomiting and/or Diarrhea ```

Question 32

What is kernigs sign?

Answer 32

For meningitis - Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.

Question 33

What is brudzinski sign?

Answer 33

For meningitis - severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Question 34

What labs is CSF sent for in LP evaluation of fever in infant?

Answer 34

gram stain, cell counts, chemistries, and culture

Question 35

What do you expect the glucose and protein to be in CSF of bacterial meningitis?

Answer 35

Bacterial meningitis = Glucose LOW Protein HIGH (both would be normal in viral meningitis)

Question 36

Why do we look for nitrites as sign of infection in urine?

Answer 36

Gram negative bacteria which normally cause UTIs have capacity to convert nitrates to nitrites

Question 37

How is leukocyte esterase helpful in dip for UTI?

Answer 37

byproduct of leukocyte breakdown, thus indicates presence of leukocytes and infection

Question 38

List 4 oral abx appropriate in UTI tx

Answer 38

Cephalexin/Keflex Trimethoprim/Sulfamethoxazole Nitrofurantoin Amoxicillin/Clavulonate (augmentin)

Question 39

What is the use of a voiding cystourethrogram?

Answer 39

Demonstrates presence of vesicoureteral reflux, an important risk factor for recurrences of urinary tract infections

Question 40

After infant has febrile UTI, what should be examined?

Answer 40

US of bladder and kidneys to screen for abnormalities