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2.1) My Cards > 1.3 MTB Step 3 - The Newborn (Respiratory Distress) > Flashcards

1.3 MTB Step 3 - The Newborn (Respiratory Distress) Flashcards

Cards Complete: Day 1 - 5/9/2019 * Day 2 - 5/11/2019 * Day 3 - 5/19/2019 Day 4 - 6/18/2019 Day 5 - 7/18/2019

1
Q

RESPIRATORY DISTRESS IN THE NEWBORN

What is the Best INITIAL Test for a Newborn in Respiratory Distress?

A

Chest X-Ray (CXR)

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2
Q

RESPIRATORY DISTRESS IN THE NEWBORN

What are (5) Diagnostic Studies, other than the best initial test, that should be done on a Newborn in Respiratory Distress?

A
  1. Arterial Blood Gas (ABG)
  2. Blood Cultures (Sepsis)
  3. Blood Glucose (Hypoglycemia)
  4. CBC (Anemia or Polycythemia)
  5. Cranial Ultrasound (Intracranial Hemorrhage)
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3
Q

RESPIRATORY DISTRESS IN THE NEWBORN

What is the Best INITIAL Treatment for a Newborn in Respiratory Distress?

A

Oxygen: Keep SaO2 > 95%

Give Nasal CPAP to prevent Barotrauma and Bronchopulmonary Dysplasia if the Neonate’s Oxygen requirement is High.

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4
Q

RESPIRATORY DISTRESS IN THE NEWBORN

When should you consider Empiric Antibiotics for a Newborn in Respiratory Distress?

A

Suspected SEPSIS

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5
Q

RESPIRATORY DISTRESS IN THE NEWBORN

If Oxygen Therapy does not improve Hypoxemia in a Newborn in Respiratory Distress, what other causes of hypoxemia should the patient be evaluated for?

A

Cardiac causes of Hypoxia (i.e., Congenital Heart Defects)

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6
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

What are (4) Clinical Features of Respiratory Distress Syndrome?

A
  1. Premature Neonate
  2. Tachypnea
  3. Nasal Grunting
  4. Intercostal Retractions within hours of Birth
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7
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

  1. What is the Hallmark Diagnostic Finding in Respiratory Distress Syndrome (RDS)?
  2. What (2) Findings eventually follow the hallmark finding?
A
  1. Hypoxemia
  2. Hypercarbia & Respiratory Acidosis
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8
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

What is the Best INITIAL Test for Respiratory Distress Syndrome?

A

Chest X-Ray (CXR) = Atelectasis & Air Bronchograms

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9
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

What is the Best PREDICTIVE Test (eg, prior to birth) for Respiratory Distress Syndrome?

A

Lecithin-Sphingomyelin (L/S) ratio: on Amniotic Fluid prior to birth

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10
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

What Infection looks identical to Respiratory Distress Syndrome on Chest X-Ray (CXR)?

A

Pneumonia

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11
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

  1. What is the Best INITIAL Treatment for Respiratory Distress Syndrome?
  2. What is the Most EFFECTIVE Treatment for Respiratory Distress Syndrome?
A
  1. Oxygen and Nasal CPAP
  2. Exogenous Surfactant administration (proven to decrease mortality)
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12
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

What is the First synthetic Peptide-containing Surfactant approved for treatment of Neonatal Respiratory Distress Syndrome?

A

Lucinactant

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13
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

What is the Mechanism of Surfactant?

A
  • Prevents collapse of the Alveoli by decreasing Surface Tension.
  • It is produced by Type II Pneumocytes, which start to develop around 24 weeks gestation. However, not enough surfactant is secreted until 35 weeks gestation.
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14
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

Which (2) Medications should you give as Primary Prevention for Respiratory Distress Syndrome (RDS)?

A
  1. Antenatal Corticosteroid (e.g., Betamethasone): This is most effective if > 24 hours before delivery and < 34 weeks gestation.
  2. Tocolytics (e.g., Oxytocin, Nifedipine): Delays Birth to Avoid Prematurity.
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15
Q

RESPIRATORY DISTRESS IN THE NEWBORN

RESPIRATORY DISTRESS SYNDROME (RDS)

What are (3) Common Adverse Effects / Associated Disorders caused by both the Hypoxia from respiratory distress, as well as from the High-concentration Oxygen Treatment that follows the diagnosis?

A
  1. Retinopathy of Prematurity (ROP): Hypoxemia
  2. Intraventricular Hemorrhage.
  3. Bronchopulmonary Dysplasia: Prolonged high-concentration oxygen (prevent with CPAP).
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16
Q

RESPIRATORY DISTRESS IN THE NEWBORN

TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)

What is the Clinical Presentation of TTN?

A

Tachypnea AFTER a Term Birth of an infant delivered by Cesarean Section or Rapid Second stage of Labor which typically resolves in 24-48 hours.

17
Q

RESPIRATORY DISTRESS IN THE NEWBORN

TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)

What is the likely Cause of TTN?

A

Retained Lung Fluid

Retained fluid in the Lungs causes Increased Airway Resistance and Decreased Lung Compliance

18
Q

RESPIRATORY DISTRESS IN THE NEWBORN

TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)

  1. What is the Best Test for suspected TTN?
  2. What (3) Findings are you looking for on this Test?
A
  1. Chest X-Ray (CXR)
  2. Look for these 3 Findings:
    • Air Trapping
    • Fluid in Fissures
    • Perihilar Streaking
19
Q

RESPIRATORY DISTRESS IN THE NEWBORN

TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)

What is the Best INITIAL Treatment for TTN?

A

Oxygen (minimal requirements needed): Results in rapid improvement within hours to days.

20
Q

RESPIRATORY DISTRESS IN THE NEWBORN

MECONIUM ASPIRATION

What is the Clinical Presentation of Meconium Aspiration?

A

Severe Respiratory Distress and Hypoxemia in a Term Neonate with Hypoxia or Fetal Distress in utero.

21
Q

RESPIRATORY DISTRESS IN THE NEWBORN

MECONIUM ASPIRATION

What are (3) Problems Meconium Aspiration causes?

A
  1. Blockage of Alveoli
  2. Decreased Gas Exchange
  3. Irritation of Airway, causing inflammation then Pneumonia
22
Q

RESPIRATORY DISTRESS IN THE NEWBORN

MECONIUM ASPIRATION

  1. What is the Best Test for Meconium Aspiration?
  2. What (3) Findings are you looking for on this Test?
A
  1. Chest X-Ray (CXR):
  2. Look for these 3 Findings:
    • Patchy Infiltrates
    • Increased AP diameter (barrel chest)
    • Flattening of Diaphragm
23
Q

RESPIRATORY DISTRESS IN THE NEWBORN

MECONIUM ASPIRATION

What are the (4) Therapies for Meconium Aspiration?

A
  1. Positive Pressure Ventilation (PPV)
  2. High-Frequency Ventilation
  3. Nitric Oxide Therapy
  4. Extracorporeal Membrane Oxygenation
24
Q

RESPIRATORY DISTRESS IN THE NEWBORN

MECONIUM ASPIRATION

What are (2) possible Complications of Meconium Aspiration?

A
  1. Pulmonary Artery Hypertension
  2. Air Leak (pneumothorax, pneumomediastinum)
25
Q

RESPIRATORY DISTRESS IN THE NEWBORN

DIAPHRAGMATIC HERNIA

What are (2) Physical Signs of Diaphragmatic Hernia?

A

Respiratory Distress

and

Scaphoid Abdomen

distress related to pulmonary hypoplasia

26
Q

RESPIRATORY DISTRESS IN THE NEWBORN

DIAPHRAGMATIC HERNIA

  1. What is the Best Test for suspected Diaphragmatic Hernia?
  2. What are you looking for on this Test?
A
  1. Chest X-Ray (CXR)
  2. Loops of Bowel visible in the chest.
27
Q

RESPIRATORY DISTRESS IN THE NEWBORN

DIAPHRAGMATIC HERNIA

What are the (2) Treatments for Diaphragmatic Hernia?

A
  1. Immediate Intubation (may require extracorporeal membrane oxygenation),
  2. followed by Surgical Correction

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