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Old 09-09-2012
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Arrow Gyrus Daily Questions; Pediatrics #36

A newborn infant becomes markedly jaundiced on the second day of life, and a faint petechial eruption first noted at birth is now a generalized purpuric rash. Hematologic studies for hemolytic diseases are negative. Acute management should include which of the following steps?

a. Liver ultrasound
b. Isolation of the infant from pregnant hospital personnel
c. Urine drug screen on the infant
d. Discharge with an early follow-up visit in 2 days to recheck bilirubin
e. Thyroid hormone assay
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Old 09-09-2012
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tough one....."split hair" type

i guess the baby has some congenital infection probably rubella or CMV

would pick A.....
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Old 09-09-2012
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Agree.
I would go with B
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Blueberry muffin
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Old 09-10-2012
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The answer is b.

the patient described most likely has a congenital or acquired infection requiring immediate diagnosis and treatment.

Among the important causes of neonatal sepsis are prenatal infections, including congenital syphilis, toxoplasmosis, cytomegalic inclusion disease, and rubella. Useful diagnostic studies, in addition to cultures for bacteria, include specific serologic tests for pathogens, viral cultures, lumbar puncture, and x-rays of the chest and long bones.

Longitudinal striations in the metaphyses are characteristic of congenital rubella, whereas osteochondritis or periostitis usually indicates congenital syphilis. Congenital syphilis, cytomegalovirus, and rubella can be highly contagious. Urine can contain rubella virus for more than 6 months and is, therefore, a special hazard to nonimmune pregnant women.
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