A newborn infant is born at 40 weeks gestation to a G1P1 mother. The pregnancy was uncomplicated and was followed by the patient's primary care physician. The mother has no past medical history and is currently taking a multi-vitamin, folate, B12, and iron. The infant is moving its limbs spontaneously and is crying. His temperature is 98.7°F (37.1°C), blood pressure is 60/38 mmHg, pulse is 150/min, respirations are 33/min, and oxygen saturation is 99% on room air. Which of the following is the best next step in management?
ANo further management needed
BIntramuscular (IM) vitamin K and topical erythromycin
CFluid resuscitation
DVitamin D and IM vitamin K
ESilver nitrate eye drops and basic lab work
A 4-week-old infant is brought to the physician by his mother because of blood-tinged stools for 3 days. He has also been passing whitish mucoid strings with the stools during this period. He was delivered at 38 weeks' gestation by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. He was monitored in the intensive care unit for a day prior to being discharged. His 6-year-old brother was treated for viral gastroenteritis one week ago. The patient is exclusively breastfed. He is at the 50th percentile for height and 60th percentile for weight. He appears healthy and active. His vital signs are within normal limits. Examination shows a soft and nontender abdomen. The liver is palpated just below the right costal margin. The remainder of the examination shows no abnormalities. Test of the stool for occult blood is positive. A complete blood count and serum concentrations of electrolytes and creatinine are within the reference range. Which of the following is the most appropriate next step in management?
APerform stool antigen immunoassay
BPerform an air enema on the infant
CAssess for IgA (anti‑)tissue transglutaminase antibodies (tTG)
DStop breastfeeding and switch to soy-based formula
EContinue breastfeeding and advise mother to avoid dairy and soy products
A previously healthy 10-day-old infant is brought to the emergency department by his mother because of episodes of weakness and spasms for the past 12 hours. His mother states that he has also had difficulty feeding and a weak suck. He has not had fever, cough, diarrhea, or vomiting. He was born at 39 weeks' gestation via uncomplicated vaginal delivery at home. Pregnancy was uncomplicated. The mother refused antenatal vaccines out of concern they would cause side effects. She is worried his symptoms may be from some raw honey his older sister maybe inadvertently fed him 5 days ago. He appears irritable. His temperature is 37.1°C (98.8°F). Examination shows generalized muscle stiffness and twitches. His fontanelles are soft and flat. The remainder of the examination shows no abnormalities. Which of the following is the most likely causal organism?
AListeria monocytogenes
BNeisseria meningitidis
CEscherichia coli
DClostridium botulinum
EClostridium tetani
+ 7 more in the PDF
Browse all chapters