Case 1

You are a evaluating a female patient at 5 day of life, who is brought by parents to
her first follow-up visit, referring exclusive breast feeding and jaundice 3 days of
evolution, cephalocaudal progression, no other associated symptoms. Parents
refer to be healthy, mother is 21 and father 25 years old. On examination she is
alert, responsive, with coarse facies, HR 156 bpm, RR 48 rpm, T. 36.8 C, with
jaundice in conjunctiva, trunk and upper extremities. 1.5cm posterior fontanelle,
cardiopulmonary without aggregates, abdominal umbilical hernia is reducible
approx. 3 cm in diameter, decreased muscle tone. You request laboratory tests,
confirming that the mother and the patient are blood group O positive, BT 19.2 mg /
dl, BI 15.6 mg / dl, metabolic screening with TSH 16.2.

1. What is the main suspect in the etiology of hyperbilirubinemia?

A) Galactosemia
B) Congenital hypothyroidism
C) Blood group incompatibility
D) Biliary atresia

2. What is the most common complication of this condition, if not providing

timely treatment?

A) Cirrhosis
B) Kernicterus
C) Delayed psychomotor development
D) Heart Failure
3. What is the initial management of this patient?

A) Stop breastfeeding
B) Continuous phototherapy with eye protection
C) Start fasting and parenteral solutions
D) Exchange transfusin

4. What study would seek to corroborate his suspected diagnosis?

A) Serum galactose
B) Scintigraphy liver and biliary tract
C) Complete thyroid profile
D) Direct Coombs

Case 2

Male patient, 40 days old, history of preterm birth at 31 weeks of gestation,

maternal preeclampsia. The mother is 29 years old, apparently healthy, diagnosed
with preeclapmsia at 29 weeks of gestation, handled with alpha-methyldopa,
without adequate control of blood pressure. The patient was obtained abdominally,
rated Apgar 7/9, weight 1,950g, height 43cm, received a single dose of exogenous
surfactant, and remained intubated for 3 days. Currently weighing 2,300g, O2 by
nasal prongs, requiring in the last 24 hours increased in FiO2 from 30 to 45% with
Hb. 7.6, Ht. 22% Plaq 167,000.

1. What is the pathophysiology of anemia in this patient?

A) Iron deficiency
B) Folate deficiency
C) Erythropoietin deficiency
D) Deficiency of vitamin B12
2. What is the management indicated at this time?
A) Transfusion of packed red blood cell
B) Increase the intake of dietary iron
C) Start folic acid
D) Exogenous erythropoietin
3. If you choose to transfuse this newborn, what would be the volume
indicated for transfusion?
A) 100 ml
B) 45 ml
C) 15 ml
D) 60 ml
4. What type of anemia would you expect in this patient?
A) Microcytic, hypochromic, regenerative
B) Megaloblastic and regenerative
C) Normocytic, normochromic, hypo- or aregenerative
D) Normocytic, normochromic, regenerative