Neonatology

Question 1

what is the most likely diagnosis for newborn presenting with small pelvis, flattened dimpled buttocks, hyperextended knees and Xray shpwing no sacrum in setting of maternal diabetes?

Answer 1

Caudal regression syndrome

Question 2

What is the most likely diagnosis for a newborn presenting with elevated right hemidiaphragm, decreased air entry on right, weak cry and medially rotated right arm that hangs by the sign with forearm pronated in setting of difficult or breech birth?

Answer 2

Right diaphragmatic paralysis

Question 3

What is the most likely diagnosis for newborn with abdominal distention associated with dilated bowel loops, a small amount of free intraperitoneal air, and bubbles of gas in the bowel wall?

Answer 3

Necrotizing enterocolitis

associated with prematurity and formula feeding

Question 4

What is the most likely diagnosis for infant older than 6 months with softened spring like area of bone of the parietal region that gives a sensation of ping pong ball when depressed?

Answer 4

Craniotabes

due to treponema pallidum infection

Question 5

What is considered inadequate prophylaxis in a group B strep positive mother?

Answer 5

penicillin/ ampicillin/ cefazolin given less than 4 hours prior to delivery

Question 6

What nerve root is injured in congenital brachial plexus palsy associated with anisocoria?

Answer 6

T1

Question 7

What is the likely diagnosis for newborn with phenotypic features consistent with Trisomy 13 or 18 but normal karyotype born to a mother who has Crohn disease?

Answer 7

Methotrexate exposure

Question 8

what is the most likely diagnosis of newborn presenting with refusal to move limb, irritability, Xray showing bands of increased density across the metaphyses and periostitis, hemorrhagic rhinitis (snuffles), thrombocytopenia, liver dysfunction, and rash on palms and soles?

Answer 8

Congenital syphilis

Question 9

What is the most likely diagnosis for newborn presenting with microcephaly, hydrocephaly, brain calcifications, cataracts, microphthalmia, chorioretinitis, dermatomal hypopigmented scarring, and limb malformations?

Answer 9

Congenital varicella infection

eye anomalies, limb malformation, CNS anomalies

Question 10

What is the normal penile length of a newborn?

Answer 10

more than 2 cm

Question 11

When is umbilical hernia surgery performed? (3)

Answer 11

1. symptomatic (pain, nonreducible)
2. persists at 5-6 years old
3. increases in size between 1-2 years old

Question 12

What nerve root injury results in Horner syndrome (ptosis, miosis, and anhidrosis) during a brachial plexus injury?

Answer 12

T1

Question 13

What is the most likely diagnosis for newborn presenting with upper arm adducted and internally rotated with the forearm extended and normal movement of hand and wrist after delivery and what is the treatment?

Answer 13

Erb’s palsy

physical therapy and observation

(waiter’s tip posture)

Question 14

What is the most important factor of supernumerary digits that prompts an orthopedic consultation?

Answer 14

a bony articulation in the digit

Question 15

What is the most likely diagnosis for newborn with gross hematuria, flank mass, and thrombocytopenia in setting of hypertension and oliguria?

Answer 15

Renal vein thrombosis

associated with perinatal asphyxia, maternal diabetes, shock

Question 16

What is the treatment for a newborn of a diabetic mother presenting with hypoglycemia and poor feeding?

Answer 16

IV D10W at 2 ml/kg

Question 17

What is the most likely diagnosis for newborn presenting with bluish, nonblanching, fluctuant swelling lateral to the midline of the lower mouth like a belly of a frog?

Answer 17

Ranula

(pseudocyst associated with sublingual/ submandibular glands)

(tx: surgery)

Question 18

What is the most likely diagnosis of newborn presenting with intense period of reddening of large portion of skin when newbon placed on their side and what is the treatment?

Answer 18

Harlequin color change

no treatment (benign due to imbalance of autonomic vascular system)

Question 19

What group is at greatest risk for developmental dysplasia of hip?

Answer 19

females with breech presentation

Question 20

What are the components of the APGAR score?

Answer 20

1. heart rate (1 if less than 100)
2. respiratory effort (1 for weak cry)
3. skin color (1 for acrocyanosis)
4. muscle tone (1 for arms legs flexed w/ little movement)
5. reflex irritability (1 for facial grimace only)

Question 21

what is a potential complication in both twins involved in a twin-to-twin transfusion syndrome?

Answer 21

hydrops fetalis

Question 22

What maternal serum marker is a screening tool for neural tube defects like myelomeningocele?

Answer 22

alpha fetoprotein

Question 23

What are neonatal side effects associated with maternal use of lisinopril (or other ACE inhibitors)?

Answer 23

1. VSD

2. Meningomyelocele

Question 24

What is the most likely diagnosis for newborn with fleshy colored smooth surfaced lesion protruding from the superior/ inferior portion of the vagina? and what is the treatment?

Answer 24

Hymenal tag

no treatment needed

Question 25

What is the most likely diagnosis for newborn presenting with mitten hand (syndactyly of 2nd, 3rd, 4th, and 5th digits) and premature fusion of both coronal sutures and 1 sagittal suture?

Answer 25

Apert syndrome

Question 26

What is the most likely diagnosis of newborn presenting with well circumscribed, nontender, nonfluctuant, reddish-purplish nodules over the lower posterior trunk and lateral portions of buttocks?

Answer 26

Subcutaneous fat necrosis | no tx

Question 27

what gestational age is an infant born with a raised areola, superior incurving of ear, scant ear cartilage with slow return from folding and 2-3 anterior sole creases?

Answer 27

34-35 weeks | sole creases start at 32-33 weeks

Question 28

what is the most likely diagnosis for newborn with delayed passage of meconium, abdominal distention with bilious vomiting, and contrast enema showing small sigmoid and descending colon with abrupt caliber trnasition at splenic flexure?

Answer 28

Small left colon syndrome | associated with maternal use of insulin

Question 29

What is the most likely medical complication of a baby born to a mother using lithium for bipolar disorder?

Answer 29

Ebstein anomaly | apical displacement of the tricuspid valve

Question 30

What cardiac abnormality is maternal SSRI use associated with?

Answer 30

Persistent pulmonary hypertension of newborn

Question 31

What is the most likely diagnosis for a newborn presenting with respiratory depression, apnea, generalized hypotonia, and meconium plug syndrome after birth to a mother with hypertension?

Answer 31

Hypermagnesemia | mother treated with magnesium to prevent eclampsia

Question 32

What maternal substance use is associated with gastroschisis?

Answer 32

Cocaine

Question 33

What is the most likely diagnosis for newborn with aplasia/ hypoplasia of abdominal muscles, bilateral cryptorchidism, and urinary tract anomalies?

Answer 33

Prune Belly syndrome | Eagle-barrett

Question 34

.... sign is asymmetry in the height of the knees due to shortening of the thigh on the affected side done with hips in 90 degree flexion

Answer 34

Galezzi sign

Question 35

What is the diagnostic test of choice for hip dysplasia in an infant less than 4 months of age?

Answer 35

Ultrasound | Xray can be done if older than 4 months

Question 36

What is the most likely diagnosis of infant presenting with abdominal distention, bilious vomiting, and Xray showing distended loops of intestine, absence of air-fluid levels and soap bubble appearance of portions of the intestine?

Answer 36

Meconium ileus | associated with pancreatic insufficiency

Question 37

What is a side effect correlated with use of oral erythromycin (for Chlamydia conjunctivitis) or azithromycin?

Answer 37

Pyloric stenosis

Question 38

What is the most likely diagnosis for newborn presenting with nasal hypoplasia and stippled epiphyses in mother with deep venous thrombosis?

Answer 38

Fetal Warfarin syndrome

Question 39

what is the most likely diagnosis for newborn presenting with compressible, nonpulsatile mass on the posterolateral neck that transilluminates and is not attached to underlying skin?

Answer 39

Cystic hygroma

Question 40

What is the next step in management for newborn with jaundice within the first 24 hours of life?

Answer 40

tbili, dbili, CBC with smear, retic count, direct coombs and blood culture (pathologic jaundice)

Question 41

What is the most likely diagnosis for pt presenting with thin upper lip, smooth thin philtrum, short palpebral fissures, shortened nose, midface hypoplasia, mild ptosis, and intellectual disabilties?

Answer 41

Fetal alcohol syndrome | associated with VSD

Question 42

what is the recommended delivery room temperature?

Answer 42

71.6-78.8 degress F (22-26 degrees C)

Question 43

What therapeutic treatment is used for type II Crigler-Najar for patients with prolonged unconjugated hyperbilirubinemia?

Answer 43

Phenobarbital

Question 44

What is the gestational age associated with sole creases?

Answer 44

32-33 weeks: 1-2 creases 34-35 weeks: 2-3 creases 36-67 weeks: 2/3 of the sole has creases 38-41: entire sole has creases

Question 45

What complication can results in respiratory distress in a newborn with Erb palsy?

Answer 45

diaphragmatic paralysis (due to phrenic nerve damage) | dx: fluoroscopy

Question 46

What is the electrolyte imbalance associated with subcutaneous fat necrosis?

Answer 46

hypercalcemia

Question 47

what is the most likely diagnosis for pt presenting with microcephaly, midfacial hypoplasia, low set ears, mild hypertelorism, depressed nasal bridge, cleft lip and palate, hypoplastic digits (finger like thumbs), and coarse hair?

Answer 47

Fetal hydrantoin syndrome | due to phenytoin

Question 48

What is the best initial step in management of a newborn who had a resolved seizure episode?

Answer 48

check glucose and electrolytes

Question 49

What is the most likely diagnosis for a healthy newborn with a rash described as macules with central pustules on an erythematous base?

Answer 49

Erythema neonatorum toxicum

Question 50

What is the best initial step in management for a newborn with asymptomatic pneumothorax?

Answer 50

100% oxygen trial (no other treatments needed)

Question 51

When should a newborn receive positive pressure ventilation?

Answer 51

if heart rate less than 100 bpm