A 4-Hour-Old Boy Is Evaluated in the Nursery for Routine

question 233

Multiple Choice

A 4-hour-old boy is evaluated in the nursery for routine newborn care.  The patient was born at 38 weeks gestation via spontaneous vaginal delivery to an 18-year-old woman who did not receive prenatal care or take prenatal vitamins.  Birth weight is 3.6 kg (8 lb) .  Vital signs are normal.  Examination shows a sleeping infant in no distress.  There is molding of the occiput.  A soft mass inferior to the umbilical stump is 1.4 cm in diameter and covered by skin.  The mass increases in size when the infant cries and reduces into the abdominal cavity with gentle pressure.  The mass does not seem to be tender to palpation.  The rest of the examination is normal.  Which of the following is the best next step in management of this patient's mass?

• A)Abdominal ultrasound
• B)Immediate surgery
• C)Karyotype analysis
• D)Observation only
• E)Topical silver nitrate

---

Definitions:

Trephining

An ancient surgical intervention where a hole is drilled or scraped into the human skull, exposing the dura mater to treat health problems related to intracranial diseases or release pressured blood buildup from an injury.

Four Humors

An ancient medical theory that health is determined by the balance of four bodily fluids: blood, phlegm, black bile, and yellow bile.

Hippocrates

An ancient Greek physician who is often regarded as the "father of medicine", known for his contributions to the ethical and professional standards of medical practice.

Mental Illness

A wide range of mental health conditions that affect mood, thinking, and behavior, and can impact daily living, relationships, and physical health.