Master the board step 3
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Master the board step 3

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Pediatrics<br />

Failure to Pass Meconium<br />

··<br />

Best initial test: Rectal examination. A patent rectum with passage of a large<br />

voluminous stool after digital exam suggests Hirschsprung disease.<br />

··<br />

Next <strong>step</strong> in <strong>the</strong> workup: Barium enema (megacolon proximal to obstruction)<br />

··<br />

Best confirmatory test: Rectal biopsy (absent ganglionic cells). Treatment is<br />

surgical resection.<br />

An absent anal opening on exam suggests imperforate anus. Treatment is<br />

surgical reconstruction.<br />

Jaundice in <strong>the</strong> Newborn<br />

Jaundice<br />

Physiologic<br />

Pathologic<br />

Coombs (+)<br />

··<br />

Rh/ABO<br />

incompatibility<br />

··<br />

Thalassemia minor<br />

Indirect<br />

High Hgb<br />

··<br />

Polycy<strong>the</strong>mia<br />

·<br />

·<br />

· Twin-twin transfusion<br />

· Maternal-fetal<br />

transfusion<br />

··<br />

Delayed cord<br />

··<br />

IUGR<br />

··<br />

Infant of diabetic mo<strong>the</strong>r<br />

Coombs (-)<br />

Normal/Low Hgb<br />

··<br />

Spherocytosis<br />

··<br />

Elliptocytosis<br />

·<br />

·<br />

· G6PD deficiency<br />

· Pyruvate kinase<br />

··<br />

Sepsis<br />

·<br />

·<br />

Direct<br />

· TORCH infections<br />

· Total parenteral<br />

nutrition<br />

··<br />

Hypothyroid<br />

··<br />

Galactosemia<br />

··<br />

Tyrosinemia<br />

··<br />

Cystic fibrosis<br />

··<br />

Choledochal cyst<br />

When is hyperbilirubinemia considered pathological?<br />

··<br />

It appears on <strong>the</strong> first day of life.<br />

··<br />

Bilirubin rises > 5 mg/dL/day.<br />

··<br />

Bilirubin > 12 mg/dL in term infant.<br />

··<br />

Direct bilirubin > 2 mg/dL at any time.<br />

··<br />

It is present after <strong>the</strong> 2nd week of life.<br />

365

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