Pediatrics CMS III Final ACTUAL EXAM 2024 COMPLETE 170 QUESTIONS WITH DETAILED VERIFIED ANSWERS (100% CORRECT ANSWERS ) / ALREADY GRADED A+ 1. full term 2. post -term 3. pre -term - ANSWER1. first day of 37th week (37 -42 weeks) 2. born on or after first day of week 42 (>42 weeks) 3. born on or before the last day of the 37th week (<37 weeks) gestational age - ANSWERnumber of weeks from the first day of mom's last period low birth weight is defined as - ANSWER<2500 grams (5.5 lbs) VLBW: <1500 g ELBW: <1000 g this is not dependent on gestational age; can have a full term baby with low birth we ight T/F: pulmonary HTN is normal in a fetus - ANSWERTRUE 90% of twins are - ANSWERdizygotic (fraternal) -occurs from simultaneous shedding of two oocytes and fertilization by different sperm monozygotic or identical twins occurs from splitting of the z ygote at various stages of development T/F: preeclampsia is completely reversible by delivery of the baby - ANSWERTRUE -preeclampsia is the leading cause of maternal mortality in the U.S T/F: if mom is a diabetic, there is a higher risk for the baby to h ave congenital anomalies - ANSWERTRUE -VSD -neural tube defects -abnormal GU -Small left colon syndrome -Caudal regression syndrome -->almost always infant of diabetic mother How does ultrasound determine fetal age - ANSWERmeasure Crown Rump Length (CRL) -most accurate between 7 -14 weeks medications used to suppress premature labor - ANSWERTacolysis T/F: baby Johnny is 3 months old therefore he is still a neonate - ANSWERFALSE -neonate is less than 1 month old -infant is less than 1 year old 1. Average for gestational age? - ANSWER10% -90% 1. Risk for babies born from teen mothers 2. Risk for babies born from older mothers (>38 years old) - ANSWER1. Risk small gestational age (<10%); premature delivery and low birth weight 2. Downs Syndrome Clinical p roblems associated with large gestational age (>90%) - ANSWER -will have to perform a C. Section or delivery by forceps or vacuum -->more traumatic birth -this increases the risk for cephalohematoma, birth injuries like clavicle fx, brachial plexus injury, f acial nerve palsy and hypoglycemia standard tool in assessing newborns that's used immediately after delivery to evaluate their immediate adaptation to extrauterine life - ANSWERAPGAR Appearance Pulse Grimace Activity Respiration The APGAR score is recorded at 1 minute and 5 minutes. What is the protocol for a cyanotic baby? - ANSWERAt 1 minute an infant can be cyanotic -if it does not clear by 5 minutes an additional score should be added at 10 minutes A baby is just born. Their HR is 90 bpm, they have a good strong cry, they have some bending of the arms and legs, they grimace and cough during stimulation, and the baby is pink. What APGAR score should this baby receive? Is this a normal score? - ANSWER8 -1 point for a HR less tha n 100 beats per minute -2 points for strong cry -1 point for some flexing of arms and legs -2 points for grimace and cough to stimulation -2 points for pink color This is a good score! >5 in first minutes and 8 -10 by five minutes has dec morbidity/morta lity APGAR scores that indicate increased morbidity and mortality - ANSWER -A score <4 at 1 minute: severe depression requiring immediate resuscitation -A score <8 at 5 minutes: inc risk of cns dysfunction remember: normal scores= >5 in first minute and 8-10 in first five minutes criteria used that aids in determining the gestational age in preterm and term infants - ANSWERNew Ballard Scale https://www.youtube.com/watch?v=GNqzV7LuFGE Newborn post -partum routine protocols 1. eye prophylaxis given for chlamydia or gonorrhea 2. prophylaxis against hemorrhagic disease of the newborn 3. newborn screen blood work 4. first vaccine given - ANSWER1. silver nitrate solution or erythromycin ointment 2. vit K IM 3. hematocrit to look for anemia/polycythemia and coombs test to determine blood type 4. Hep B fetal hydrops - ANSWERedema and effusions into the body cavities of the fetus -can occur as a result of erythroblastosis fetalis (hemolytic disease of the new born) A neonate was born just a few hours ago. You notice tachypnea/grunting and increased work of breathing. You obtain ABG's which show hypercapnia, hypoxemia, and acidosis. What's the most likely diagnosis? What would you see on CXR? What is this cause d by? Best tx option? - ANSWERRespiratory Distress Syndrome/Hyaline Membrane Disease -CXR would show air bronchograms and ground glass appearance -Due to surfactant deficiency -treat with surfactant replacement and respiratory support What can be given t o the mom to prevent Hyaline membrane disease/RDS - ANSWERAntenatal steroids -improve respiratory outcome -best if given >48 hours before delivery -often use at 24 -34 weeks (When they know lungs are still not fully matured) Most common cause of respirator y distress in full term infants; more common in C -
sections especially - ANSWERTransient Tachypnea of the Newborn -occurs when fetal lung fluid isn't removed quickly -will see tachypnea WITHOUT increased work of breathing -just give O2 for this Transient Tachypnea of the newborn on CXR - ANSWERstreaky perihilar shadows or visible fluid densities in the intralobar fissues If a newborn has O2 sats that are higher in the upper body than in the lower body think - ANSWERPersistent Pulmonary HTN of th e newborn -this occurs from failure in transition away from fetal circulation Signs of meconium aspiration syndrome and tx - ANSWER -presence of meconium amniotic fluid -CXR showing patchy infiltrations; air leaks with a ball valve effect -nasopharyngeal suctioning; NO ABX unless it transitions to a lobar segmented PNA leading cause of neonatal bacterial infection - ANSWERGroup B Strep -PCN/Ampicillin is given to mom while in labor if she tested positive during the screening culture and is having a vagi nal delivery Early onset (<7 days) of Group B strep in a neonate can progress into - ANSWERpneumonia/sepsis -if present in first 48 hours will present w/ respiratory symptoms and escalate to sepsis -why it's important to screen all mothers for this! periodic breathing is normal in neonates. When should you be worried when it comes to apnea in a neonate? - ANSWERif there's a respiratory pause >20 seconds +cyanosis/pallor/hypotonia/bradycardia <60 bpm
sections especially - ANSWERTransient Tachypnea of the Newborn -occurs when fetal lung fluid isn't removed quickly -will see tachypnea WITHOUT increased work of breathing -just give O2 for this Transient Tachypnea of the newborn on CXR - ANSWERstreaky perihilar shadows or visible fluid densities in the intralobar fissues If a newborn has O2 sats that are higher in the upper body than in the lower body think - ANSWERPersistent Pulmonary HTN of th e newborn -this occurs from failure in transition away from fetal circulation Signs of meconium aspiration syndrome and tx - ANSWER -presence of meconium amniotic fluid -CXR showing patchy infiltrations; air leaks with a ball valve effect -nasopharyngeal suctioning; NO ABX unless it transitions to a lobar segmented PNA leading cause of neonatal bacterial infection - ANSWERGroup B Strep -PCN/Ampicillin is given to mom while in labor if she tested positive during the screening culture and is having a vagi nal delivery Early onset (<7 days) of Group B strep in a neonate can progress into - ANSWERpneumonia/sepsis -if present in first 48 hours will present w/ respiratory symptoms and escalate to sepsis -why it's important to screen all mothers for this! periodic breathing is normal in neonates. When should you be worried when it comes to apnea in a neonate? - ANSWERif there's a respiratory pause >20 seconds +cyanosis/pallor/hypotonia/bradycardia <60 bpm
