Clinical Reasoning and Newborn Exam I

Question 1

critical thinking

Answer 1

tying ones medical knowledge with clinical encounter

-and formulating a diagnosis with therapeutic strategy

Question 2

steps in clinical reasoning

Answer 2

patient story
data acquisition
problem presentation
hypothesis
select a script for illness (acquire more data if need)
diagnosis

Question 3

signalment

Answer 3

who and what it is

-the patient identifying information

Question 4

chief complaint

Answer 4

health issue of patient

Question 5

history

Answer 5

what has happened

Question 6

proper history

Answer 6

should give you diagnosis 80-90% of the time

Question 7

miss more diagnosis

Answer 7

by not looking

-not doing good physical exam

Question 8

ptyalism

Answer 8

excessive salivation

Question 9

conformation bias

Answer 9

tendency to search for or interpret info in a way that confirms ones preconceptions

Question 10

umbilical vein

Answer 10

carry oxygenated blood to the liver or IVC (via ductus venosus)

Question 11

ductus venosus

Answer 11

allow oxygenated blood in umbilical vein to pass to the inferior vena cava

Question 12

semi-oxygenated blood in right atrium

Answer 12

1- can go to right ventricle
> to pulmonary artery
-lungs have air sacs full of fluid
-hypoxic pulmonary vasoconstriction
-increased resistance
-high pressure to lungs
-less likely to flow this way
-also high P in right heart
-higher than P in left atrium

2- blood flows foramen ovale - right atrium to left atrium

• blood to left ventricle
• then to aorta
• distributes to body

Question 13

foramen ovale

Answer 13

allows blood from right atrium to left atrium

Question 14

lung blood flow before birth

Answer 14

high resistance

Question 15

ductus arteriosus

Answer 15

connection between pulmonary artery and aorta

• allows blood from pulmonary artery to aorta
• this direction because high lung R

Question 16

internal iliac arteries

Answer 16

branches to umbilical artery (2x)

• brings deoxygenated blood to placenta
• placenta has low R so blood is directed here

Question 17

after birth changes

Answer 17

• placenta removed
• lung bring in air

cause lots of changes

Question 18

placenta removed

Answer 18

whartons jelly contraction

• natural clamp
• to very high R

Question 19

whartons jelly

Answer 19

contracts around vessels as temperature falls

Question 20

lung changes

Answer 20

fluid replaced by air

• oxygen levels rise
• stops the hypoxic pulmoanry vasoconstriction
• results in dilation
• causes decreased R in lungs
• right heart pressure falls
• oxygenated blood to left atrium
• increases pressure in left side of heart
• causes close of foramen ovale (first few minutes)

Question 21

ductus arteriosus changes

Answer 21

• first few hours of life
• constriction of ductus arteriousus
• sense high oxygen levels
• also senses placenta removed - prostaglandin decrease

Question 22

umbilical artery changes

Answer 22

high resistance

• no blood that way
• have smooth muscle that contracts

over course of few hours

Question 23

umbilical vein changes

Answer 23

no blood flow after placenta removed

-blood clots off

Question 24

ductus venosus changes

Answer 24

no blood flow after placenta removed

-blood clots off

Question 25

newborn exam

Answer 25

first day of life

observation
vital signs
head to toe exam

keep baby warm and clean everything

Question 26

observation of baby

Answer 26

color
skin (bluish on back normal)
jaundice
pallor (anemia)

muscle tone and activity

Question 27

vital signs of baby

Answer 27

temp (36.5-37.5)
breathing (30-60, irregular normal)
heart rate (100-160 bpm)

Question 28

breathing problem

Answer 28

nasal flaring

Question 29

head to to exam of baby

Answer 29

fontanelles (A/P)
uneven head shape normal
-goes away 2-3 days

eye discharge
-blood on white of eye - from birth - goes away

finger in mouth - sucking
-cleft lip/palate - can’t suck

swollen breasts - normal

swollen belly - obstruction or infection

umbilical hernia - usually goes away

spinal defects

anus - first stool passage - should be first 24 hours

genitals - urethra opening

• two testes
• females -white or blood discharge

normal weight 2.4 - 4 kilos