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Practice Questions > Pediatric newborn assessment > Flashcards

Pediatric newborn assessment Flashcards

1
Q

What is the most common cause of a large for gestational age of an infant?

A

Maternal diabetes

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2
Q

What are some ddx for a small for gestational age infant?

A

Maternal drug use, chromosomal abnormalities, exposure to intrauterine viral infection, multiple gestation, advanced maternal age.

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3
Q

A 3 day oldnewborn presents with small pustules on erythematous blotchy base. What is the most likely diagnosis?

A

Erythema toxicum

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4
Q

A 4 day old newborn presents with small pustules on erythematous blotchy base. What is the tx for the suspected diagnosis?

A

Self limiting; resolves 1-2 weeks

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5
Q

A newborn presents with small, white Papules concentrated on the nose, cheeks, forehead and chin. What is the most likely dx?

A

Milia

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6
Q

A newborn presents with small, white Papules concentrated on the nose, cheeks, forehead and chin. When do these usually resolve!?

A

1-2 months

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7
Q

An AA newborn present with large, blue-black macules concentrated on the back and buttock. What is the most likely diagnosis and what advice should you give the parents?

A

Mongolian spots, resolve most of the time by age 4

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8
Q

A newborn presents with a slightly pink, irregularly shaped lesion on the back of the neck. What is the most likely diagnosis?

A

Nevus simplex

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9
Q

A newborn presents with a slightly pink, irregularly shaped lesion on the back of the neck. What is the tx and parent education?

A

None. Most resolve spontaneously by age 2, but some can persist. It occurs secondary to surface capillary dilation. Benign

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10
Q

What type of skin conditions are commonly seen in preterm infants?

A

Vernix caseosa and lanugo

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11
Q

What is vernix caseosa?

A

Greasy covering

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12
Q

What is lanugo?

A

Fine hairs

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13
Q

What type of skin condition is commonly seen in post term infants?

A

Dry, cracked, peeling skin

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14
Q

When should the anterior fontanelle be closed? How large should it be initially?

A

Around 10-24 mnths, 1-4 cm

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15
Q

When should the posterior fontanelle be closed? How large should it be initially?

A

1-3 mnths; 1 cm

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16
Q

A newborn presents with a third fontanelle along the Sagittal suture. What disorder is this associated with?

A

Trisomy 21

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17
Q

A newborn presents with premature fusion of one or more sutures. What is the diagnosis and what should happen if these is found on exam?

A

Craniosynostosis; prompt referral to neurologist

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18
Q

A newborn presents with capital succedaneum. What will be found on physical exam?

A

Palpable sweeping crossing the midline

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19
Q

A newborn presents with capital succedaneum. What is the cause?

A

Fluid accumulation secondary to birth trauma

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20
Q

What should posteriorlu rotated or low-set ears prompt suspicion of

A

Congenital abnormalities

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21
Q

A newborn presents with preauricular pits and deafness. What other system should be looked at?

A

GU. Renal ultrasound

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22
Q

How should hearing be assessed in the newborn period?

A

Auditory brain stem response or evoked otoacoustic emission testing

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23
Q

What infants should be screened for hearing?

A

All

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24
Q

A newborn presents with an absent red reflex. What disorders is this associated with?

A

Congenital cataracts, glaucoma, retinoblastoma

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25
Q

A newborn presents with gray/yellow spots at the periphery of th iris. What is this called and what condition is it associated with?

A

Brushfield spots, Down syndrome

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26
Q

What eye disorder is almost always present in the newborn period?

A

Strabismus. Problem if it is fixed or something persists past 4 mnths if age

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27
Q

How is nasal patency tested in the newborn

A

Test nare individually by placing cold metal object below the nose to check for fogging or using a cotton wisp to check for air movement

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28
Q

Why is nasal patency so important in the newborn?

A

They are obligate nasal breathers. Bilateral obstruction can result in infant death

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29
Q

How is choanal atresia or stenosis confirmed in the newborn

A

AXial CT

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30
Q

A newborn presents with small, pearly nodules along the midline of the hard palate. What is the dx and parent education?

A

Epstein pearls; Benign retention cysts

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31
Q

A newborn presents with a small mandible and tongue, along with a clefted soft palate. What is the dx?

A

Pierre-robin syndrome

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32
Q

A newborn is diagnosed with Pierre -robin syndrome. What should you tell the parents about positioning the baby?

A

Prone positions will often control respiratory difficulties caused by the tongue occluding the airway

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33
Q

A newborn presents with large tongue that appeared to be larger than the mouth. What disorderly is this associated with?

A

Trisomy 21

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34
Q

What is a common cause of a newborn having difficulty latching during breast feeding

A

A shortened frenulum

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35
Q

A newborn presents with webbed/redundant skin of neck. What disorder is this associated with?

A

Turner

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36
Q

A newborn presents with a midline mass on the anterior neck. What is the most concerning diagnosis!”?

A

Thyroidmegaly.

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37
Q

A newborn presents with a mass anterior to the SCM. What is the most likely diagnosis?

A

Brachial cleft

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38
Q

A newborn presents with a mass posterior to the SCM. What is the most likely diagnosis?

A

Cystic hygroma

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39
Q

A newborn presents with a mass inside the SCM. What are the top two ddx?

A

Torticollis, hematoma

40
Q

A newborn presents with grunting, intercostal retractions, and tachypnea. PE shows cyanosis. What are the most common causes of the suspected diagnosis?

A

Aspiration, congenital pneumonia, transient tachypnea

41
Q

What is considered newborn tachypnea?

A

> 60 breaths per min

42
Q

A newborn present with unilateral decreased breathsounds. What are 2 ddx?

A

Pneumothorax; diaphragmatic hernia

43
Q

A newborn presents with cyanosis, chf, and diminished peripheral pulses, what ddx is the most serious?

A

Heart dz

44
Q

A newborn presents with a prune belly. What condition is this associated with?

A

Renal issues

Prune belly- absence of musculature

45
Q

A newborn presents with a sever scaphoid belly and respiratory distress. What is the most likely diagnosis?

A

Diaphragmatic hernia

46
Q

Where should the liver be located in a newborn?

A

About 1 cm below th coastal Margin

47
Q

A newborn presents with delayed stool (>24 hours after birth). What condition is this associated with?

A

Hirschsprung disease

48
Q

A newborn presents with a urethra that is proximal and ventral to its normal location. What is the likely diagnosis?

A

Hypospadias

49
Q

A newborn presents with a urethra that is proximal and ventral to its normal location. What further work up is warranted and what is contraindicated?

A

Bilateral renal US; circumsicion.

50
Q

What is epispadias?

A

Dorsal displacement of the urethra

51
Q

When are testes supposed to descend in the newborn?

A

By 9 mnths is age.

52
Q

At what age should you refer to a pediatric urologist for undescended testes?

A

Age 1

53
Q

Are inguinal hernias more likely to be seen in a preterm, term, or post term infant “?

A

Epreterm

54
Q

What is a very common finding in newborn males due to the patency of the process vaginalis?

A

Hydroceles

55
Q

At what age to hydroceles typically resolve?

A

18 mnths.

56
Q

A newborn female presents with vaginal leucorrhea and bloody dc within the labia. What is the most likely cause and what should you tell the parents?

A

Maternal estrogen. Resolve in 7-10 days, but more slowly in breastfed child

57
Q

A newborn female presents with a fused introitus. What medicine can be used to resolve the problem?

A

Estrogen or beclomethasone cream for 5 to 10 days

58
Q

What is the Barlow maneuver?

A

An attempt to dislocate the hip via posterior pressure. Examiner adducts fully flexed hips while pushing the thighs posteriorly.

59
Q

What is a positive Barlow?

A

If the femoral head is felt to dislocate or leave the acetabulum

60
Q

What is the ortolani maneuver?

A

Attempts to identify a hip that’s dislocated or subluxed.

61
Q

How is the ortolani maneuver performed?

A

Grasp the medial aspect of the flexed knee with thumb and fully abduct the hips. Feel for a spasm or a clunk as the hips are brought to full abduction

62
Q

What is indicated in a positive Barlow or ortolani maneuver?

A

Bilateral US

63
Q

What increases the risk for developmental hip dislocation?

A

Breech position delivery

64
Q

What is talipes equinovarus?

A

Club foot

65
Q

What is indicated for clubfeet?

A

Immediate ortho referral

66
Q

What are the 2 earliest infant reflexes?

A

Sucking and rooting

67
Q

What is the Moro reflex?

A

Allow the infants head to suddenly drop 1-2 cm; observe for abduction of the shoulders and elbows along with spreading and extending if fingers, followed by addiction and flexion of the same

68
Q

When does the Moro reflex disappear

A

3-4 mnths

69
Q

When does the palmar/plantar grasp reflex disappear

A

4 mnths

70
Q

What is the traction response?

A

Pulling the infant by the arms to a sitting position and observe the head lag initially, finally coming briefly to midline before falling forward

71
Q

Placing reflex?

A

Infant dangled about the bed, allowing the toe to ha e minimal contact with surface. Extremity will respond w/ flexion is a stepping response

72
Q

How should deep tendon reflexes appear in the newborn

A

Brisk, clonus May be seen

73
Q

A positive babinski reflex is… in the newborn

A

Normal. May be seen as late as 2 Years old.

74
Q

A newborn presents with poor feeding, lethargy, jitteriness, tremulousness, and irritability. BLood glucose level is 40. What is the tx for the suspected diagnosis?

A

A Bolus of dextrose and water (D10W) and IV glucose

75
Q

What maternal disorder most common causes hypoglycemia of the newborn

A

Diabetes

76
Q

Hypoglycemia of the newborn is associated with way intrauterine complication?

A

Intrauterine growth restriction

77
Q

How else can hypoglycemia of the newborn present

A

Asymptotic

78
Q

What is normal blood glucose level at 3 hours of age?

A

50 to 80

79
Q

A newborn presents with jaundice during the first 24 hours of life. Labs reveal a positive Coombs test, increased reticulocytes, and a decreased H/H. What are the top two differentials?

A

ABO incompatibility and Rh isoimmunization

80
Q

What is the treatment for a jaundiced baby in the first 24 hours of positive Coombs test?

A

Transfusion; phototherapy

81
Q

What are the most common causes of unconjugated hyperbilirubinemia?

A

Physiologic jaundice, prematurity, and breast feeding jaundice

82
Q

What are the two groups of etiologies for newborn jaundice?

A

Excess production of bilirubin or decreased rate of conjugation w/ normal reticulocyte counts

83
Q

What are common causes of excess production of bilirubin?

A

Hemolysis secondary to blood group senstization or hereditary spherocytisis or G6PD

84
Q

What are commonly n causes of decreased rate of conjugation with normal reticulocyte count?

A

Physiologic jaundice, more uncommon: Gilbert or crigler-najjar syndrome

85
Q

A newborn presents with jaundice 24 hours after birth. What is the MC cause of this jaundice?

A

Physiological jaundice.

86
Q

A newborn presents with jaundice 4 days after birth. On day 4, the bilirubin level is 10. On day 5 the level is 13, and by day 6 the bilirubin level is at 17. Is treatment indicated at this time?

A

Yes. Tx hyperbilirubenemia if > 15, or if not descending.

87
Q

What is the tx of hyperbilirubenemia?

A

Phototherapy

88
Q

A newborn presents with jaundice during the first 24 hours of life. Coombs test is negative. What are the top 2 differentials at this point?

A

G6PD deficiency, hereditary spherocytosis

89
Q

A newborn presents with jaundice during the first 24 hours of life. Coombs test is negative. A peripheral smear show spherocytes. What is the most likely diagnosis?

A

Hereditary spherocytosis

90
Q

A newborn presents with jaundice during the first 24 hours of life. Coombs test is negative. A peripheral smear show spherocytes what is the recommended tx?

A

Blood transfusion if severe, phototherapy

91
Q

A newborn presents with bilirubin levels greater than 20-25. What is the most concerning complication?

A

Kernicterus

92
Q

What are the recommendation for bilirubin screening in the newborn?

A

All infants before 24 hours

93
Q

newborn presents with jaundice during the first 24 hours of life. Coombs test is negative. A peripheral smear show spherocytes. What other finding may be present on physical exam?

A

Splenomegaly

94
Q

what is the ortolani maneuver?

A

grasp medial aspect of knee and abduct hip whil applying anterior force to the femur-results in reduction of hip joint

95
Q

what is the barlow maneuver?

A

adduct the fully flexed hip while applying posterior force to the femur, resulting in dislocation of the hip

Practice Questions (6 decks)

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