Newborn Emergencies

Ghazala Q. Sharieff, MD, FACEP, FAAP, FAAEM

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  1. A 10-day old male presents with bilious emesis. What is the most likely diagnosis?

    2. Your answer:
    Pyloric stenosis
    Malrotation with midgut volvulus
    Feeding intolerance
    Appendicitis

  2. A 2-week-old-male presents with lethargy and vomiting. His electrolytes reveal sodium of 121 meq/L, potassium of 7.0-meq/l and blood glucose of 40 mg/dl. What is the most likely diagnosis?

    3. Your answer:
    Inborn error of metabolism
    Congenital adrenal hyperplasia
    Pyloric stenosis
    Dehydration

  3. The drug of choice for treating a newborn with presumed ductal-dependant cyanotic congenital heart disease is:

    4. Your answer:
    Dobutamine
    Prostaglandin E1
    Indomethacin
    Morphine

  4. How should a neonate with lethargy and a blood sugar of 20mg/dl be treated?

    5. Your answer:
    50% dextrose solution
    25% dextrose solution
    Oral feeds with apple juice
    10% dextrose solution

  5. A 2-day-old female presents with abdominal distension and vomiting. She has not yet passed a meconium stool. What is the most likely diagnosis?

    6. Your answer:
    Necrotizing enterocolitis
    Hirschsprung Disease
    Malrotation with midgut volvulus
    Constipation

  6. A 3-week-old female presents with persistent seizures despite aggressive management with benzodiazepines and phenobarbital. The mother reports giving her daughter some water to “stop her from getting dehydrated.” What is the most likely cause of her status epilepticus?

    7. Your answer:
    Hyponatremia
    Hypokalemia
    Diabetes insipidus
    Hypoglycemia

  7. A 1-week-old male presents with some mild erythema around his umbilicus extending onto the abdominal wall. Which of the following is the correct management for this patient?

    8. Your answer:
    Topical antibiotic ointment and recheck the patient the next day
    Discharge on cephalexin and recheck the next day
    Perform a full septic workup and admit the patient
    Reassurance and continue with alcohol wipes of umbilicus

  8. A 5-day old, well-appearing male is brought to the ED by his mother today because she noted that he has a cluster of vesicles on his scalp. Which of the following should be the management approach?

    9. Your answer:
    Discharge, with next day follow up
    Skin biopsy
    IV acyclovir and a full septic workup
    Oral acyclovir

  9. Which of the following heart rates is most suggestive of supraventricular tachycardia in a newborn?

    10. Your answer:
    230 BPM
    150 BPM
    210 BPM
    180 BPM

  10. Vaginal bleeding in a 3-day-old female is:

    11. Your answer:
    Is most commonly due to a vaginal foreign body-such as baby wipes
    Is always indicative of child abuse
    May be due to withdrawal of maternal hormones
    Is suspicious for gonorrhea

  11. A 3-week old male presenting to the emergency department with vomiting and altered mental status and acidosis. What additional laboratory test should be included in your evaluation?

    12. Your answer:
    Ammonia level
    Cortisol level
    Serum acetone
    Thyroid function test

  12. Which of the following are causes of shock in the newborn?

    13. Your answer:
    Infection
    Inborn errors of metabolism
    Child abuse
    All of the above

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