Aquifer Pediatrics 2023 Updated Exam Questions And Answers Tobacco Effects in Pregnancy - ANS- Low birth weight Fetal Alcohol Syndrome - ANS- Facial abnormalities, growth deficiency, CNS dysfunction, cognitive/behavioral issues Heroine Effects in Pregnancy - ANS- Fetal growth restriction, fetal death, placental abruption, preterm labor, intrauterine meconium Cocaine/Stimulant Effects in Pregnancy - ANS- Uteroplacental insufficiency, low birth weight SGA Infant - ANS- <10th percentile for weight or <3rd percentile What maternal factors can lead to an infant tha t is SGA? - ANS- Age extremes, poor weight gain in 3rd trimester, nulliparity, substance abuse, lower SES, AA race What fetal factors can lead to an infant that is SGA? - ANS- Chromosomal abnormalities/syndromes, metabolic disorders, congenital infections What medications can lead to an infant that is SGA? - ANS- Anti-metabolites, bromides, isotretinoin, steroids, propanolol, warfarin What exposures can lead to an infant that is SGA? - ANS- Metals, PCBs, toluene, drugs What uteroplacental issues can lead to an infant that is SGA? - ANS- Avascular villi, decidual a. arteritis, multiple gestation, partial molar pregnancy, infarction, placenta previa/abruption, single umbilical a. What are risk factors for early onset GBS infection? - ANS- Prolonged rupture of membranes, prematurity, intrapartum fever, mother with previous delivery of infant with GBS What factors determine management of newborn with GBS infection? - ANS- Clinical appearance, maternal chorioamnionitis, prop hylactic antibiotics, membrane rupture >18h, gestational age <37 weeks What is the management of GBS infection if newborn is ill -appearing? - ANS- CBC, blood culture, CXR, lumbar puncture AND empiric IV antibiotics What is the management of GBS infection if newborn does not appear ill? - ANS- CBC, blood culture AND/OR close observation for a few days APGAR - ANS- Appearance (skin color) Pulse (HR >100) Grimace (reflex irritability) Activity (muscle tone) Respiration (crying) What APGAR 5 -minute score in dicates need for continued resuscitation efforts? - ANS- > 7 What is the Ballard tool used for? - ANS- Estimate gestational age when no early U/S is available or age is in question What are components of the Ballard tool? - ANS- Neuromuscular maturity an d physical maturity What is examined for newborn neuromuscular maturity? - ANS- Posture, wrist position, arm recoil, popliteal angle, scarf sign, heel to ear position What is examined for newborn physical maturity? - ANS- Appearance and/or presence of sk in, lanugo, plantar crease, breasts, eyes, ears and genitals Symmetric Intrauterine Growth Restriction (IUGR) - ANS- Head circumference, length, weight proportionately small What often causes symmetric IUGR? - ANS- Congenital infections Asymmetric Intrauterine Growth Restriction (IUGR) - ANS- Decreased length and/or weight without a change in head circumference What often causes asymmetric IUGR? - ANS- Maternal smoking What are SGA newborns at risk of? - ANS- Hypoglycemia, hypothermia a nd polycythemia What are symptoms of hypoglycemia and/or hypothermia in newborns? - ANS- Asymptomatic or poor feeding and listless What are symptoms of polycythemia in newborns? - ANS- Ruddy complexion, respiratory distress, poor feeding and hypoglycemia Newborn Resuscitation (in addition to ABCs) - ANS- Universal precautions, warm & dry infant, remove wet linens, stimulate infant to cry (clear up lungs), suction nose & mouth, oxygen How is oxygen delivered to newborns for resuscitation? - ANS- Blow -by, PPV with bag mask, chest compression, medications Rooting Reflex - ANS- Stroke cheek Startle/Moro Reflex - ANS- Quickly "drop" baby while held causing knee flexion, arms to be thrown outward then inward (embracing) and fanning then clenching fingers Asymmetric Tonic Neck Response - ANS- Turning head to side causes extension of arm toward infant's gaze with CL arm flexion (fencer) What vitamin must be administered to all newborns? - ANS- K (IV form) What are the signs of early vitamin K deficiency in n ewborns? - ANS- Severe bleeding at <24 hours What causes early vitamin K deficiency in newborns? - ANS- Medications that interfere with how the body uses it (anti -epileptics, isoniazid) What are the signs of classical vitamin K deficiency in newborns? - ANS- 1-7 days after birth with bleeding from umbilical cord What are signs of late vitamin K deficiency in newborns? - ANS- 2-12 weeks (up to 6 months) in previously healthy infants only breastfed, may bleed into brain What is the management of newborns born to mothers positive for HBV? - ANS- Known (+) - vaccine + Ig within 12h of delivery, test for anti -HBs at 9 -18 months of age Unknown status - vaccine within 12h of delivery, or delay until results (effective up to 7 days) What is the difference between gonococcal and chlamydial conjunctivitis? - ANS- 1) Apparent soon after birth, can lead to blindness if not treated quickly 2) Presents 7 -14 days after birth, no prophylaxis What is t he prophylaxis for gonococcal ophthalmoplegia? - ANS- Erythromycin Prenatal Lab Screening - ANS- Type & screen, rubella IgG, HBsAg, HIV, RPR/VDRL, U/A, urine NAAT for G/C, GBS, HCV antibody +/ - TB skin or blood test
