Exam (elaborations)
WGU D119 Pediatric Primary Care
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WGU D119 Pediatric Primary Care
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WGU D119 Pediatric Primary CareAPGAR: Newborn Crying, Acrocyanotic, Moving All Extremities, HR 130, Grimaces
to Stimulation - ANSWER Score = 8 (loses 1 pt for color and 1pt for irritability)
What does APGAR score at birth reflect? - ANSWER How baby did during
labor/delivery (1min). Response to resuscitation (5 min)
T or F The APGAR predicts neurologic outcomes - ANSWER FALSE
What is the deformity associated with extension and medial rotation of the arm with
Moro (startle) reflex assessment? - ANSWER Erb-Duchenne (C5-6) Refer if not
better by 3-6 months for neurosurgery
LGA infant with crepitus and discontinuity on palpation of clavicle? - ANSWER
Clavicular Fracture. Treatment: None needed, callus formation at 1 week, MAY use
figure 8 splint.
Term for newborn with edema that crosses the suture line? - ANSWER Caput
Succedaneum (Spongy, pitting edema)
Term for newborn with head fluctuance that does NOT cross suture line? - ANSWER
Cephalo-hematoma
Blue/slate gray macule on back or thigh? - ANSWER Mongolian spots (Arrested
Melanocytes)
Pale pink vascular macule in NUCHAL AREA and FACE. The lesions on the face will
disappear while the other persists. The lesions are MORE RED WHEN BABY IS
ANGRY. dx? - ANSWER Nevus Simplex (Salmon Patch). Face generally fades,
Firm white papules on a newborn's face filled with keratin? - ANSWER Milia (Day of
life 1) - not to be confused with neonatal acne (Week of life 1-2)
Newborn firm yellow white pustules and papules on an erythematous base? -
ANSWER Erythema Toxicum (Filled with eosinophils)
Red, sharply demarcated raised lesions appearing in first two months, rapidly
expand, then involuting by age 5-9? - ANSWER Hemangioma
What is the cause of neonatal acne? - ANSWER Maternal Androgens
Area of alopecia with orange colored nodular skin (Newborn)? - ANSWER Nevus
Sebaceous
Remove before adolescence b/c it can undergo malignant degeneration.
, Thick, yellow/white oily scale on an inflammatory base on a newborn's scalp? -
ANSWER Seborrheic Dermatitis (Cradle Cap) - Treat with baby shampoo on a soft
toothbrush or with antifungal
What 2 Neonatal Screens are always done? - ANSWER PKU (Phenylketonuria): s/s
MR, vomiting, athetosis, seizures and Galactosemia s/s MR direct hyperbili/jaundice
3 day old with bilirubin 10, direct 0.5, eating/pooping well? - ANSWER Physiologic
Jaundice - gone by 5th day of life (immature liver) bilirubin usually doesn't go above
15
7 day old, bilirubin 12, direct 0.5, dry mucous membranes, not gaining weight? -
ANSWER Breastfeeding Jaundice (or lack of breastfeeding). Baby is dehydrated,
can be latching problems or not feeding long or often enough.
14 day old, bilirubin 12, direct 0.5. Has regained birth weight. - ANSWER Breast Milk
Jaundice (milk contains glucuronidase and de-conjugates bilirubin)
1 day old bilirubin 14, direct 0.5? - ANSWER Pathologic Jaundice (>12, direct >2,
day of life 1, fast rate of rise >5/day). Next best test is a Coombs test (+ means Rh or
ABO incompatibility; - indicated maternal fetal transfusion, twin/twin trasfusion, IDM,
spherocytosis
7 day old with dark urine, pale stool. Bilirubin 12, direct 8, LFT's elevated: -
ANSWER Biliary Atresia - can't drain bile, leads to liver failure, requires surgical
intervention
5 causes of direct hyperbilirubinemia - ANSWER r/o SEPSIS, galactosemia,
hypothyroidism, choledochal cyst, cystic fibrosis
Inherited causes of indirect hyperbilirubinemia? - ANSWER Gilbert syndrome -
decrease in UGT1A1 (asymptomatic)
Crigler-Najjar syndrome - total loss of UGT1A1 (in type 1; type 2 is about 90% loss)
Inherited causes of direct bilirubinemia? - ANSWER Dubin-Johnson - black liver
Rotor Syndrome
What is the concern for hyperbilirubinemia in the newborn? - ANSWER Kernicterus -
Indirect bili can cross BBB and deposit in basal ganglia and brainstem nuclei (>20 is
huge concern). Treatment: Phototherapy or exchange transfusion for very high
levels.
What does phototherapy do for hyperbilirubinemia - ANSWER Coverts unconjugated
bilirubin to an isomer that is water soluble
1 week old baby with cyanosis when feeding but pinks up when crying? - ANSWER
Choanal Atresia - Restricted nasal passages (choana). Associated with CHARGE
syndrome (Coloboma, Heart defects, Atresia choanal, Growth retardation, Ear
anomalies)
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