Infancy & Early Childhood - Test 2

Question 1

What is the APGAR score?

Answer 1

Appearance (skin color)

Pulse

Grimace (response to catheter in nostril)

Activity

Respiratory

Question 2

When is the APGAR score measured (When in the baby’s life)? What is a normal APGAR score?

Answer 2

first minute of life and 5th minute of life

less than 7 is abnormal

Question 3

What are normal newborn vitals (respirations, HR, temp, blood pressure)?

Answer 3

Respirations: 30-60 breaths per minute

Heart Rate: 100-160 bpm

Temperature: 96-99.5 F

Blood pressure: 60-80/40-50 mmHg

Question 4

When a baby is born, we give it three post-parturition medications. What are they?

Answer 4

erythromycin eye ointment

Intramuscular vitamin K

Hepatitis B immunization

Question 5

Is it good for the mother and baby to initiate skin-to-skin after birth?

Answer 5

yes

Question 6

How do you assess intake in a breastfeeding infant? (8 points)

Answer 6

Frequency of latch (normal every 1-3 hours)

Duration of latch (10-30 minutes)

Infant feeding cues (rooting [moving head], wake up, chews on hands)

Behavior at breast (stays latched, active/audible swallowing)

Quality of latch (opens mouth wide to latch)

Feeling of breast milk emptying

Observe mother breast feed

Daily weights, urine, and stool output

Question 7

Is weight loss normal after birth? Why?

Answer 7

yes

babies lose water weight

Question 8

How much weight can newborns lose? When do they start to regain their weight?

Answer 8

newborns can lose up to 10% of their weight

babies begin to regain weight in 3 days and should regain their birth weight around 2 weeks

Question 9

What is the expected urine output for the 5 days of life?

Answer 9

1 = 1 diaper

2 = 2 diapers

3 = 3 diapers

4 = 4 diapers

5+ = 5+ diapers

Question 10

Is it normal for a baby to not produce any urine during the first day of life?

Answer 10

NO!!!!

Question 11

Name the type of stool

black and tarry. Passes in first 3 days of life

Answer 11

meconium

Question 12

Name the type of stool

Dark green and sticky. Begins at day 4

Answer 12

transitional stool

Question 13

Name the type of stool

green-yellow-brownish. Liquid but not watery

Answer 13

normal infant stool

Question 14

is it normal for a baby to not pass stool within the 1st 24 hours of life?

Answer 14

NO!!!

Question 15

If a baby doesn’t pass stool within the first hour, what are some of the possible causes?

Answer 15

no butthole (imperforate anus)

hirschprung’s, meconium plug, meconium ileus, neurointestinal disorders

Question 16

If a baby has pale stools, what could be a cause?

Answer 16

no bile –> biliary obstruction or atresia

Question 17

If a baby has blood in stool, what could be a cause?

Answer 17

anal fissure, swallowed maternal blood, milk protein intolerance

Question 18

should babies sleep in a flat crib, on their own, and on their back?

Answer 18

yeah

Question 19

What are some signs of respiratory distress?

Answer 19

cyanosis

tachypnea

nasal flaring

grunting

subcostal retractions

Question 20

What is the differential for a cyanotic baby?

Answer 20

depends on whether the baby is presenting with respiratory distress!!!

Question 21

A pre-maturely born (cannicular stage; 16-25 weeks) baby becomes cyanotic. You observe nasal flaring, subcostal retractions, grunting, and tachypnea. Because you want the baby to become exposed to radiation, you order a CXR to diagnose this baby. What does this baby have and explain the pathophysiology?

Answer 21

This baby has NRDS

premature babies lack sufficient surfactant, which is produced by type II pneumocytes. Surfactant deficiency causing decreased lung compliance and atelectasis. Blood being shunted through areas of atelectasis leads to hypoxia

Question 22

How do you treat a pre-mature baby with NRDS? What would you do if a baby might be born pre-maturely?

Answer 22

exogenous surfactant

steroids to increase surfactant production before birth

Question 23

A term baby is born today. After delivery, you notice this baby is becoming cyanotic. The baby is showing signs of respiratory distress. You run some tests and realize that the baby has increased pulmonary vascular resistance. You decide to order a CXR. What’s going on with this baby? Explain the pathophysiology

Answer 23

Meconium aspration syndrome

The baby aspirated meconium (shit). Aspirated meconium causes obstruction and inflammation of the lung. The inflammation causes increased pulmonary vascular resistance

Question 24

A baby is cyanotic. This little shit was born at term, and doesn’t have poop around his mouth. You decide to do a pulse ox on his right and left hands. His right hand has a higher O2 saturation compared to his left. What does this baby have? how do you treat this guy?

Answer 24

Persistent Pulmonary Hypertension (PPHN)

Failure of pulmonary vascular resistance to decrease due to maladaptation after birth or maldevelopment of system

respiratory support

Question 25

A baby was born to a mother who did not recieve prenatal care. The mother tested positive for GBS. The baby is now cyanotic and is showing signs of repsiratory distress. CXR shows this. What does this baby have?

Answer 25

pneumonia

Question 26

A baby is cyanotic and is showing signs of respiratory distress. You exhausted your differentials. You take an CXR and you see this. What does the baby have?

Answer 26

Transient tachypnea of the newborn (TTN) diagnosis of exclusion usually resolves within 24-72 hours NOTICE THE FISSURE IN THE RIGHT LOBE

Question 27

A baby is diagnosed with a respiratory illness. According to this CXR, what does the baby have?

Answer 27

pneumothorax

Question 28

A baby is jaundiced. What are some potential causes?

Answer 28

Hemolytic disease (ABO and Rh), fetal delivery trauma, and increased interohepatic circulation (slow bowel reabsorbs the junk) are pretty high on the DDx

Question 29

When evaluating jaundice, what labs are helpful?

Answer 29

total serum bilirubin ABO or Rh disease (coombs test)

Question 30

Do all babies need phototherapy for jaundice? How do you know?

Answer 30

no. It depends on the nomogram

Question 31

What does human breast milk contain?

Answer 31

protein fats (medium-chain and long-chain polyunsaturated fatty acids; LCPUFA have docosahexaenoic acid (DHA) which is important for brain and eye development) biological components (antibodies, etc)

Question 32

What are the height equations for a male and female?

Answer 32

male = [father height + (mother height + 4)]/2 female = [(father height - 4) + mother height]/2

Question 33

What is the differential for failure to thrive?

Answer 33

Question 34

Are adverse childhood experiences associated with a higher risk of disease and early morality?

Answer 34

yes

Question 35

If you are born prematurely, are you at higher risk for disease?

Answer 35

yeah

Question 36

When is autism screened?

Answer 36

around 2 years old

Question 37

What can a 6 month do in terms of developmental milestones?

Answer 37

palmer reflex disappears can sit up can roll over can transfer objects between hands can rake grasp can babble can respond to name stranger anxety

Question 38

What can a 1 year old do in terms of developmental milestones?

Answer 38

can stand starts walking point throw ball babinski reflexes disappear two-pincher grasp perform simple commands can say mama and dada

Question 39

What is the screening tool for ASD?

Answer 39

CHAT