PEDS

Question 1

What is considered full term birth

Answer 1

39-40 weeks

Question 2

What is considered early term birth

Answer 2

37-38 weeks

Question 3

What is considered late term birth

Answer 3

41 weeks

Question 4

What is considered postterm birth

Answer 4

> 42 weeks

Question 5

What is considered low birth weight

Answer 5

<2,500g regardless of gestational age

Question 6

What is the difference between a miscarriage and a stillbirth

Answer 6

miscarriage is <20wks gestation and <500g
stillbirth is =>20wks gestation and >500g

Question 7

when should you begin resuscitationon a newborn post-delivery

Answer 7

Begin resuscitation if onset of respirations has not yet occurred within 30–60 seconds

Question 8

what are the five components of the APGAR score and what do the scores mean

Answer 8

Reassuring: 7–10
Moderately abnormal: 4–6
Low: 0-3

Question 9

what do you do if an infant has an APGAR score below 7

Answer 9

In infants with a score below 7, the Apgar assessment is performed at 5–minute intervals for an additional 20 minutes.

Persistently low Apgar scores are associated with long-term neurologic sequelae.

Question 10

What are the indications for using positive pressure ventilation to resuscitate a newborn and what is the rate/ minute

Answer 10

Indicated if there is inadequate respiratory effort (e.g., gasping, apnea) or a heart rate < 100 bpm

40-60/min with room air if >35wks gestation or FiO2 21-30% is <35

Question 11

what is the next step if you fail to resuscitate a newborn with positive pressure ventilation or compressions are required

Answer 11

intubation

Question 12

What are the indications for chest compressions to resuscitate a newborn and how are they done with 2 providers? with 1?

Answer 12

• Indicated if heart rate is < 60 bpm despite adequate ventilation for 30 seconds
• Preferably use the two thumb-encircling hands technique if two health care providers are present.
• Use the two finger technique if only one health care provider is present. 3 chest compressions followed by 1 inflation (90 compressions/minute and 30 inflations/minute)

Question 13

What are the indications for IV epi to resuscitate a newborn

Answer 13

IV epinephrine if heart rate < 60 bpm despite adequate ventilation and chest compressions for at least 30–60 second

Question 14

when should you consider terminating reuscitation of a newborn

Answer 14

If there is no evidence of ROSC within 20 minutes, consider termination of resuscitation.

Question 15

What are the preventative medications delivered immediately after birth and what do they prevent

Answer 15

• Ophthalmic antibiotics: to prevent gonococcal conjunctivitis (erythromycin ophthalmic ointment)
• Vitamin K: to prevent vitamin K deficiency bleeding of the newborn (VKDB)

Question 16

what is a normal respiratory rate and heart rate of a newborn

Answer 16

• Respiratory rate: 40–60 breaths per minute
• Heart rate: 120–160 beats per minute

Question 17

what is a normal pH of a newborn

Answer 17

pH: ≥ 7.2 (slightly more acidic than adult)

Question 18

when do you expect the first passage of urine and meconium for a newborn

Answer 18

• First passage of urine within 24 hours of birth
• First passage of meconium (a black-green, tarry substance that forms the newborn’s feces) within 48 hours after birth

Question 19

Describe the weight gain/loss of a newborn and the timeline of these changes (what % of body weight over how many days)

Answer 19

• Loss of up to 7% of birth weight in first five days of life is normal and no specific treatment is required.
• Newborns normally regain their birth weight by the time they are 10–14 days old

Question 20

What is the Ballard Score

Answer 20

• A physical examination that is performed on newborns shortly after delivery to estimate gestational age.
• Using the New Ballard Score, six physical characteristics and six neuromuscular findings are assigned a score from -1 to 5. After adding the scores, the final value may range from -10 to 50;
• -10 corresponds to a gestational age of 20 weeks, whereas 50 corresponds to a gestational age of 44 weeks.

Question 21

What are the consequences of intrauterine estrogen exposure

Answer 21

• Due to maternal estrogen crossing the placenta and stimulating growth of the fetal endometrial lining. Withdrawal bleeding occurs 1–2 weeks after delivery and is self-limited.
• Breast bud development is normal in newborns, independent of sex.

Question 22

what is the method of screening for critical congenital heart defects? What findings are considered abnormal

Answer 22

Simultaneous pulse oximetry of the right hand and foot

The screen is abnormal if the oxygen saturation is
* < 90% in either the hand or the foot OR,
* if after three measurements, the oxygen saturation is 90–94% in both the hand and foot OR
* the saturation differs by ≥ 4% between the right hand and either foot saturation.

Question 23

What is the method of screening for congential deafness

Answer 23

Otoacoustic emissions (OAE) or automated auditory brainstem response (AABR)

Question 24

Foot of a 1-week-old newborn

Multiple papules can be seen on a partially erythematous base. There is also diffuse erythema and scaling of the skin on the outer edge of the foot and between the toes.

The rash spares the palms and soles

What is the diagnosis, prognosis, etiology, pathology, treatment, and defining features of this lesions

Answer 24

Diagnosis: Erythema toxicum neonatorum
Prognosis: typically resolves without complications within 7–14 days
Etiology: unknown (probable contributing factors: immature sebaceous glands and/or hair follicles
Pathology: Biopsy or smear of pustula (rarely necessary): ↑ eosinophil
Treatment: observation only
Defining Features: This rash appears within first week of life, includes small, red macules and papules that progress to pustules with surrounding erythema will be located on trunk and proximal extremities and spare the palms of hands and soles of feet

Question 25

A Native american 4 year old presents with a ∼5 cm, blue-gray macula with irregular borders is visible on the back. The macula has no evidence of hypertrichosis. What is the diagnosis, prognosis, etiology, pathology, treatment, and defining features of this lesions

Answer 25

**Diagnosis**: Congenital dermal melanocytosis **Prognosis**: usually resolves spontaneously during childhood (typically by the age of 10 years) **Etiology**: melanocytes migrating from the neural crest to the epidermis during development become entrapped in the dermis **Pathology**: High power shows occasional deep dendritic melanocytes, with melanin granules dissecting bundles of dermal collagen. No associated melanophages **Treatment**: Observation **Defining Features**: most commonly seen on the buttocks, flank and shoulders. important to document the diagnosis because they may resemble bruises and lead to false suspicions of child abuse

Question 26

A newborn presents with a variablly pigmented patch >20cm covering its enitre back and buttocks. The darker portions of the lesions have increased hair growth. What is the diagnosis, prognosis, etiology, pathology, treatment, and defining features of this lesions

Answer 26

**Diagnosis**: Congenital melanocytic nevus **Prognosis**: large nevi are at risk of degeneration → frequent follow-up **Etiology**: Believed to develop due to unregulated growth of melanoblasts during fifth to twenty fourth week of gestation **Pathology**: Focal collection of melanocytes within the dermis and enhanced pigmentation of the basal layer of the epidermis. Single nevus cells extend between collagen bundles. **Treatment**: surgical excision or laser ablation (depending on type and size of lesion) **Defining Features**: increased hair growth sets it apart from congenital dermal melanocytosis. Grows in proportion to the child's growth, with the fastest growth occurring in the first few months of infancy.

Question 27

A 4-year-old boy is brought to the physician by his mother because of painless lesions on his face that he has had since shortly after birth. They recently moved to the USA from Indonesia where they had limited access to healthcare. A photograph of the lesions is shown. What is the diagnosis, prognosis, etiology, pathology, treatment, and defining features of this lesions

Answer 27

**Diagnosis**: Infantile hemangioma (strawberry hemangioma) **Prognosis**: Spontaneous resolution is common **Etiology**: Abnormal development of vascular endothelial cells. Rapid proliferation followed by subsequent spontaneous slow involution **Pathology**: convoluted proliferation of capillary like vascular spaces **Treatment**: if uncomplicated just watch it if complicated laser away **Defining Features**: most commonly affects girls on the head or neck, will be a solitary lesions and progress through blanching of skin → fine telangiectasias → red painless papule or macule (strawberry appearance) before spontaneous involution

Question 28

What is the diagnosis, prognosis, etiology, pathology, treatment, and defining features of this lesions

Answer 28

**Diagnosis**: **Prognosis**: **Etiology**: **Pathology**: **Treatment**: **Defining Features**:

Question 29

What is the diagnosis, prognosis, etiology, pathology, treatment, and defining features of this lesions

Answer 29

**Diagnosis**: **Prognosis**: **Etiology**: **Pathology**: **Treatment**: **Defining Features**:

Question 30

Two hours after a 2280-g (5-lb) male newborn is born at 38 weeks' gestation to a 22-year-old primigravid woman, he has 2 episodes of vomiting and jitteriness. The mother has noticed that the baby is not feeding adequately. She received adequate prenatal care and admits to smoking one pack of cigarettes daily while pregnant. The newborn's temperature is 36.3°C (97.3°F), pulse is 171/min and respirations are 60/min. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination shows facial plethora. Capillary refill time is 3 seconds. Laboratory studies show: * Hematocrit 70% * Leukocyte count 7800/mm3 * Platelet count 220,000/mm3 * Serum * Glucose 42 mg/dL * Calcium 8.3 mg/dL What is the most likely cause of these findings?

Answer 30

Intrauterine hypoxia This patient's neonatal polycythemia is most likely due to intrauterine hypoxia. The hypoxic state leads to increased erythropoiesis, which boosts the production of RBCs to facilitate tissue oxygenation. At birth, newborns typically present with elevated venous hematocrit (> 65%), respiratory distress, cyanosis, apnea, poor feeding, hypoglycemia (due to increased glucose uptake by the circulating RBCs), and plethora. Further manifestations may include lethargy, irritability, jitteriness, seizures, and vomiting. Risk factors for developing neonatal polycythemia include maternal tobacco use, maternal diabetes, small or large size for gestational age, and delayed umbilical cord clamping.

Question 31

A 4-day-old newborn is brought to the physician because of a 1-day history of a generalized rash. He was born at term. The mother had no prenatal care and has a history of gonorrhea, which was treated 4 years ago. The newborn is at the 50th percentile for head circumference, 60th percentile for length, and 55th percentile for weight. His temperature is 36.8°C (98.2°F), pulse is 152/min, and respirations are 51/min. Examination shows an erythematous maculopapular rash and pustules with an erythematous base over the trunk and extremities, sparing the palms and soles. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?

Answer 31

Erythema toxicum neonatorum Erythema toxicum neonatorum appears within the first week of life as small, red macules and papules that progress to pustules with surrounding erythema. It is most likely caused by the immaturity of the sweat glands and follicles. The rash appears on the trunk and proximal extremities, but the palms and soles are typically spared. Although erythema toxicum sounds ominous, the condition is benign and requires no treatment. Complete resolution of the rash occurs within 7–14 days.

Question 32

What are potential causes of bilateral absence or prolonged presense of primitive reflexes in a child

Answer 32

most commonly CNS dysfunction, secondary to * perinatal asphyxia * hypoxic-ischemic encephalopathy * intracranial hemorrhage * cerebral palsy

Question 33

What are potential causes of unilateral absence or asymmetry of primitive reflexes in a child

Answer 33

* eripheral nerve dysfunction (e.g., brachial plexus injuries) * Musculoskeletal involvement (e.g., neonatal clavicle fracture) * Unilateral CNS injury (e.g., perinatal brain injury)

Question 34

what is the description and typical age rage of the Glabellar tap sign

Answer 34

Tapping the glabella elicits blinking Birth–6 month

Question 35

what is the description and typical age rage of the Snout reflex

Answer 35

Applying light pressure to closed lips causes the lips to pucker birth - 4 mths

Question 36

what is the description and typical age rage of the Rooting reflex

Answer 36

Stroking the cheek causes the mouth to open and the head to turn towards the stimulus 24 wks gestation - 4 mths (may occur in sleep upto 1 yr)

Question 37

what is the description and typical age rage of the sucking reflex

Answer 37

Touching the lips and/or oral palate elicits sucking of the stimulus. early in utero - 3mths (may persist in sleep)

Question 38

what is the description and typical age rage of the asymmetrical tonic neck reflex (ATNR)

Answer 38

When the infant is lying supine, turning the head to one side elicits extension of the ipsilateral extremities and flexion of the contralateral extremities (fencing posture) birth - 7 mths

Question 39

what is the description and typical age rage of the Moro (startle) reflex

Answer 39

When the infant experiences a loud noise or sudden movement, they abduct and extend their arms and fingers before bringing them back to midline. 28 wks gestation - 6 mths ## Footnote May be unilaterally reduced or absent in infants with ipsilateral brachial plexus injuries or neonatal clavicle fracture

Question 40

what is the description and typical age rage of the palmar grasp reflex

Answer 40

Pressing or placing something into the infant's palm causes the fingers to flex towards the palm. 32 weeks' gestation–4 month ## Footnote May be unilaterally reduced or absent in infants with ipsilateral brachial plexus injuries

Question 41

what is the description and typical age rage of the plantar grasp reflex

Answer 41

Pressing the infant's sole beneath the toes causes their toes to flex towards the sole 32 weeks' gestation–12 month

Question 42

what is the description and typical age rage of the Extensor plantar (Babinski) reflex

Answer 42

Stroking the sole of the foot upwards elicits dorsiflexion of the big toe and fanning of the other toes. Birth–12 months (may be a normal finding up to 24 month ## Footnote A positive Babinski sign at > 24 months of age is a sign of an upper motor lesion

Question 43

what is the description and typical age rage of the Landau reflex

Answer 43

When the infant is held prone in the air, the head raises, the back arches, and the legs extend. When the head is flexed downwards, the legs will also flex downwards. 3–24 months ## Footnote Infants with hypotonia will have a weak Landau reflex (e.g., hang in an inverted U-shape), while those with hypertonia will remain stiff and resist head flexion

Question 44

what is the description and typical age rage of the parachute reflex

Answer 44

When the infant is held prone in the air, lowering the infant towards a flat surface causes the arms and the hands to reach towards the surface 7 months–throughout life ## Footnote Absence may suggest neuromotor deficit

Question 45

what is the description and typical age rage of the Truncal incurvation (Galant) reflex

Answer 45

When the infant is held prone in the air, stroking the paravertebral region causes the lower back and hip to curve inwards on the same side. Birth–4 months

Question 46

what is the description and typical age rage of the stepping reflex

Answer 46

Holding the infant upright in a standing position elicits a walking motion, with alternating flexion and extension of the legs Birth–3 month

Question 47

what is the description and typical age rage of the