A 3-Hour-Old Girl Is Evaluated in the Newborn Nursery Due

question 396

Multiple Choice

A 3-hour-old girl is evaluated in the newborn nursery due to fussiness.  The patient breastfed immediately after birth but afterward has been difficult to console.  The father says, "Every time I pick her up she screams."  The neonate was born at 41 weeks gestation via spontaneous vaginal delivery to a 30-year-old primigravida.  The mother has type 1 diabetes mellitus, which was diagnosed at age 11 and is well controlled.  She had unremarkable serologic testing in the first trimester and a negative rectovaginal culture for group B Streptococcus at 35 weeks gestation.  The delivery was complicated by prolonged rupture of membranes of 21 hours.  The neonate was vigorous at birth with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively.  She weighs 3.6 kg (7 lb 15 oz) .  Vital signs are within normal limits.  Physical examination shows a quiet, alert girl in no distress.  Auscultation of the chest is normal.  Palmar grasp reflex is present and symmetric.  The patient cries with passive movement of the left arm, and there is crepitus with edema over the left mid-clavicle.  The presumed diagnosis is discussed with the parents.  The mother says, "I can't believe this happened.  I'm so worried.  What is the next step?"  Which of the following is the most appropriate response regarding management of this patient?

• A)An MRI should be performed to identify any associated nerve injury.
• B)No intervention is required as this condition typically heals without long-term sequelae.
• C)Non-urgent surgical correction is recommended to prevent disability or deformation.
• D)Physical therapy should be initiated as soon as possible to maintain upper extremity strength.
• E)Short-term casting of the upper extremity is indicated to ensure appropriate healing.

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Definitions:

Conviction

A firmly held belief or opinion, or the formal declaration that someone is guilty of a criminal offense based on a trial or plea.

Decision Schemes

Structured approaches or strategies used in the process of making choices or solving problems.

Realistic Conflict Theory

A social psychological model that suggests intergroup conflicts and hostility arise from competition over limited resources.

Cohesiveness

The quality of forming a united whole, often used to describe the degree of camaraderie and solidarity within a group.