Council on Medical Student Education in Pediatrics

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COMSEP Clinical Cases

ISSUES UNIQUE TO NEWBORN

  1. A newborn has an APGAR score of 5 at one minute and 9 at five minutes. What are the components of the APGAR score? How is the APGAR score used?
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  2. A six-hour-old infant born at term is persistently tachypneic with respiratory rates in the 80's. What additional information would be helpful in evaluating this infant? Discuss the diagnostic considerations and initial approach to the evaluation of this child.
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  3. An eight hour-old neonate is noted to have a distended abdomen and has not passed a meconium stool. How would you evaluate and treat this patient?
  4. A full-term infant appears yellow at 48 hour of age. She weighs 3700 g. The total bilirubin is 13 mg/dl and the indirect is 12.7. What components of the history, physical examination and laboratory data would be helpful in evaluating this child?
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  5. An otherwise thriving 21-day-old infant appears yellow. What additional history and evaluation would be important in assessing this infant?
  6. A twenty-four-hour-old infant has not passed meconium. Discuss the possible explanation and your concerns.
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  7. The mother of a newborn infant asks your advice about why she should breast-feed her infant. She will need to return to work in 8 weeks and wonders if she should just bottle feed. How would you counsel her?
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  8. A term newborn weights 4800 grams. His mother is an insulin dependent diabetic who had good control during her pregnancy. What immediate complications might this infant experience in the nursery?
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  9. A mother with no prenatal care and a history of known substance abuse just delivered a baby at term. What special medical and social concerns do you have about caring for this infant? What evaluations and treatments are necessary before discharge?
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  10. The parents of a newborn boy ask your opinion about whether the baby should be circumcised. How should you counsel these parents?
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  11. What anticipatory guidance would you give the parents of a healthy, full-term, first born infant at the time of discharge from the newborn nursery?
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  12. The breast-feeding mother of a 4-week-old infant is concerned that her baby is not gaining enough weight. Her mother-in-law has encouraged her to start formula supplements. The baby's birth weight was 3500 g. His current weight is 4300 g. How would you evaluate this infant and counsel the mother? What cultural beliefs might be important to discuss.
  13. A full term newborn weighs 2000 grams. What factors might have contributed to this infant's small size? How do you assess the maturity of this infant? What should you monitor in the nursery?
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  14. A term female is delivered via c-section because a frank breech presentation. What features of the history and physical examination would support your concern about developmental hip dysplasia in this child?

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