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Neurology

Neurologic Examination of the Newborn Infant KEY POINTS: BASIC ELEMENTS OF THE NEONATAL NEUROLOGIC EXAMINATION 1. Mental status (level of alertness) 2. Eyes and other cranial nerves 3. Primitive (neonatal) reflexes 4. Motor and sensory function 5. Deep tendon reflexes 1. What are a normal baby’s biobehavioral states? ▪ Crying, inconsolable ▪ Alert and irritable, possibly tremulous or jittery ▪ Awake, alert, calm ▪ Drowsy ▪…

Infection and Immunity

Developmental Immunology 1. In which way is the immune response of the neonate unique? Except in the case of congenital infection, all pathogen encounters in the neonatal period are first-time encounters. For those first-time exposures to pathogens, neonates are dependent on the innate immune system. The innate immune system comprises cells and mechanisms that defend in a nonspecific manner. T- and B-cell responses are part of…

Hematology and Transfusion Medicine

Normal Erythrocyte Values of Neonates 1. A term newborn infant on the day of birth has a hemoglobin (Hgb) of 11.8 g Is that value low or is it within the expected (normal) reference range? Expected values, also called “reference ranges,” for Hgb and hematocrit on the day of birth are a function of gestational age, increasing gradually through the second and third trimesters. Studies with…

Gastroenterology and Nutrition

Development of the Gastrointestinal System 1. How does the primitive gut develop in the fetus, and what are its three divisions? Folding occurs along the embryo in a cephalocaudal progression that leads to the incorporation of some of the endodermal-lined yolk sac into the embryo, which in turn results in the creation of the primitive gut. The primitive gut is composed of the foregut, midgut, and…

Fluid, Electrolyte, Acid–Base, and Renal-Developmental Physiology and Disorders

1. How does the principal function of the kidney differ in fetal and neonatal life? During fetal life the placenta is responsible for fetal water and electrolyte homeostasis. The principal function of the fetal kidney is the continuous excretion of water and electrolytes into the amniotic cavity, which is essential for maintenance of amniotic fluid volume. Normal amniotic fluid volume is essential for normal lung development.…

Endocrinology and Metabolism

Hypocalcemia 1. What perinatal factors are associated with hypocalcemia in the immediate newborn period? ▪ Prematurity ▪ Asphyxia ▪ Maternal diabetes ▪ Maternal hyperparathyroidism ▪ Transient congenital hypoparathyroidism ▪ Congenital absence or hypoplasia of the parathyroid glands (sporadic or as part of DiGeorge syndrome) 2. How are calcium levels expected to change in premature infants during the first few days of life? In newborn infants there…

Cardiology Secrets

History of Pediatric Cardiology 1. When was the first report of a successful ligation of a patent ductus arteriosus (PDA)? The first successful ligation of a PDA was by Gross and Hubbard in 1938. 2. Who was responsible for the first successful palliation of cyanotic congenital heart disease? Dr. Alfred Blalock (Professor of Surgery at Johns Hopkins), Dr. Helen Taussig (Director of the Pediatric Cardiology Clinic…

NICU Environment and Principles of Infection Control

1. What are some general measures that can reduce or minimize the risk of nosocomial infections? Nosocomial infections are a serious concern in the NICU setting. The extremely small and immunologically compromised status of the patients makes them particularly vulnerable. Success in preventing nosocomial infections depends largely on a team approach, with the full commitment of frontline staff. The most effective measures are strict hand-washing and…

Family-Centered and Developmental Care in the Neonatal Intensive Care Unit

1. What is patient-and family-centered care? Patient- and family-centered care is an approach to planning, delivery, and evaluation of health care that supports partnerships among patients, families, and health care practitioners. It is founded on the principle that the family plays a vital role in ensuring the health and well-being of the infant. Family-centered care provides care to families in a manner that involves respect and…

Self-assessment: Answers

Chapter 1 1. What is the most appropriate description of the arterial supply of the pelvis? B is correct. The internal iliac artery arises at the level of the lumbosacral articulation and passes over the pelvic brim, continuing downward on the posterolateral wall of the cavity of the true pelvis. The anterior division provides the superior, middle and inferior vesical arteries that provide the blood supply…

Self-assessment: Questions

Chapter 1 1. What is the most appropriate description of the arterial supply of the pelvis? A. The external iliac artery arises at the level of the lumbosacral articulation and passes over the pelvic brim B. The anterior division provides the superior, middle and inferior vesical arteries that provide the blood supply for the bladder C. The uterine artery initially runs downward in the subperitoneal fat…

OSCE stations: Answers

Chapter 6 In this scenario, a pregnant woman of unstated gestational age is presenting for a booking visit. The woman is obese, is on treatment for hypertension and is taking high-dose folic acid. She is living with her husband with no mention of children. She is positive for glycosuria, which is a distractor. You should establish from the history the gestational age, the details of her…

OSCE stations: Questions

Format of and approach to OSCE stations OSCE is the abbreviation used for objective structured clinical examination. The OSCE stations are written to comply with the ‘2 + 8’ format. This involves 2 minutes’ reading time and 8 minutes’ performance per station. OSCEs are used for assessment of clinical skills. Typically, a sound performance includes acquiring pertinent clinical information (history and/or examination), requesting and interpreting investigations…

Medicolegal aspects of obstetrics and gynaecology

Learning Outcomes After studying this appendix you should be able to: Knowledge criteria Discuss the issues of confidentiality and consent in under-16-year-olds (Fraser competency) and vulnerable adults. Outline the legal regulation of abortion, sexual offenders and assisted reproduction and the relative legal status of the fetus and the mother. Describe the principles of child protection. Describe the principles and legal issues surrounding informed consent. Clinical competencies…

Governance, audit and research

Learning Outcomes After studying this appendix you should be able to: Knowledge criteria Understand the principles of storage, retrieval, analysis and presentation of data. Discuss the range of uses of clinical data, its effective interpretation and associated confidentiality issues. List the basic principles of the Data Protection Act. Describe the audit cycle as applied to obstetrics and gynaecology locally and nationally (specifically related to maternal and…