A 24-Hour-Old Boy Is in the Newborn Nursery for Routine

question 56

Multiple Choice

A 24-hour-old boy is in the newborn nursery for routine monitoring and evaluation.  The infant was born at 38 weeks gestation via unassisted vaginal delivery after 18 hours of labor.  Apgar scores were 7 and 8 at 1 and 5 minutes after birth, respectively.  Maternal prenatal testing, including negative group B streptococcus, was unremarkable.  Birth weight was 2.7 kg (6 lb) , which is average for gestational age.  Temperature is 36.7 C (98 F) , pulse is 148/min, and respirations are 35/min.  On physical examination, he is breathing comfortably but crying intermittently.  The anterior fontanelle is open, soft, and flat.  The posterior fontanelle is difficult to palpate due to the presence of a 7 x 7 cm area of swelling across the vertex of the head, extending from the right to left parietal regions.  The patient has normal tone and the presence of the Moro, suck, and palmar grasp reflexes.  The remainder of the physical examination is unremarkable.  The patient's father is very concerned about the head swelling and says, "His head is still very misshapen, and it appears the same as yesterday.  It looks like something is terribly wrong."  Which of the following is the most appropriate response?

• A)A complete blood count and coagulation studies will help determine the severity of his condition.
• B)I would like to obtain imaging to determine where the swelling originates.
• C)Immediate transfer to the intensive care unit is necessary for closer monitoring of vital signs.
• D)The swelling can be monitored by your primary care provider and will likely resolve in a few days.
• E)The swelling should be closely monitored but has risk of calcification after several weeks.

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Definitions:

Civilian Casualties

Non-military individuals who are injured or killed in a conflict or in a tragic event.

Arms Race

a competition between nations for superiority in the development and accumulation of weapons, especially between the Cold War superpowers.

Trade Territory

A geographic area where a company or country has exclusive rights or advantages for conducting commercial activities.

Neutral Belgium

Refers to Belgium's policy of neutrality before and during parts of both World War I and World War II, attempting to avoid entanglement in the conflicts of its larger neighbors.