Common post natal problems

Question 1

what is plethora caused by and how do we test for it?

Answer 1

polycythenia - high red cell conc in the blood

• full blood count - haematocrit, IV fluids

Question 2

central cyanosis needs investigation with

Answer 2

oxygen sats

Question 3

why do pre terms get jaundice

= what does this cause

Answer 3

• increased red cell turn over
• immaturity of the hepatic enzymes that process bilirubin

unconjugated hyperbilirubiemia

Question 4

jaundice - 1st 24 Hours causes?

Answer 4

pathological -
Haemolytic ( Rh incompatibility, other antibodies, hereditary anaemias e.g. G6PD deficiency, spherocytosis )
Sepsis

Question 5

jaundice - 2nd day - 2/3rd week causes?

Answer 5

Physiological 
Dehydration/poor feeding
Breast milk
Sepsis
Polycythaemia
Bruiding e.g. cephalohaematoma
Haemolytic 
Crigler-Najjar Syndrome

Question 6

prolonged jaundice >2 weeks term and > 3 weeks pre term

Answer 6

Breast milk
Sepsis
Haemolytic 
Hypothyroidism
Cholestasis e.g. biliary atresia - conjugated

Question 7

jaundice treatment aims

Answer 7

• bring down unconjgated bilirubin
• hydrate
• phototherapy
• exchange transfusion
• immunoglobulin

Question 8

extremely common rash that occur in neonates?

Answer 8

Erythema toxicum

• maculo-papular rash, white pustules
• fades within 1 week

Question 9

why do babies get Mongolian blue spots?

Answer 9

accumulation of melanocytes

- darker pigmented skin

Question 10

Capillary vascular malformations - Stork marks

Answer 10

capillary dilatation

naevus simplex

Question 11

Port Wine Stain

Answer 11

dilated mature capillaries in the superficial dermis - will be there for life

Question 12

syndromes associated with port wine stain?

Answer 12

Sturge Weber - trigeminal nerve

- Klippel-Trenaunay

Question 13

strawberry naevus are?

Answer 13

cluster of dilated capillaries

Question 14

cold stress increases what?

Answer 14

metabolic acidosis - hypoglycaemia

Question 15

what babies are at risk of hypoglycaemia

Answer 15

premature
perinatal stress
infants of diabetes
sepsis 
hypothermia

Question 16

Hypoglycaemia - in first 48 hours is defined as?

Answer 16

blood sugar <2 mol/l

Question 17

symptoms of hyperglycaemia in a neonate

Answer 17

• Jitteriness
• Temperature instability
• Lethargy
• Hypotonia
• Apnoea, irregular respirations
• Poor suck / feeding
• Vomiting
• High pitched or weak cry
• Seizures
• Asymptomatic

Question 18

tongue ties affect?

Answer 18

Restriction of tongue protrusion beyond the alveolar margins AND feeding is affected - frenotomy

Question 19

signs of increased respiratory effort?

Answer 19

Grunting
Retractions
Nasal flaring

Question 20

Areas to Assess for Retractions? (4)

Answer 20

Substernal

Subcostal

Intercostal

Suprasternal

Question 21

absent or weak femoral pluses can indicated

Answer 21

duct dependent congenital cortication of the aorta

• blood pressure in all 4 limbs
• ECHO

Question 22

how does a cleft palate from?

Answer 22

maxillary and medial nasal processes fail to merge, usually around 5 weeks gestation

Question 23

most common cleft palate/lip

Answer 23

left sided unilateral

Question 24

associated anomalies with clot lip/palate

Answer 24

hearing screening
ECHO
tris 13= patau’s
tris 18 = EDWARDS

Question 25

Ophthalmology examination in babies?

Answer 25

red reflex

Question 26

Ophthalmology screening in babies - cataract features

Answer 26

• lens opacification
• If undetected early could lead to blindness
• May require no treatment
• May require lens removal and artificial lens

Question 27

how can Retinoblastoma

be picked up on examination

Answer 27

leukocoria - white-red reflex

laser therapy, chemo, removal of eye

Question 28

urates in the nappy (brick dust) can be caused by?

Answer 28

poor feeding

Question 29

spinal dimples - features of NORMAL

Answer 29

small , close to anus in the midline, no associated skin features

Question 30

Spinal dimples can be a sign of?

• clinical signs of this

Answer 30

spina bifida occulta

• large m off middle, cutaneous marker (hair). - spinal imagine

Question 31

common finding with new born heads?

Answer 31

Cephalohaematomas - soft and non - translucent

- limits of cranial sutures, parietal bone

Question 32

Cephalohaematomas - where is the haemorrhage?

• the increase in haemolysis mast cause

Answer 32

beneath the pericardium

• resolution in the 3-4 weeks

pronged neonatal jaundice

Question 33

Talipes/club foot can be?

most common?

Answer 33

Medial (varus) or lateral (valgus)

• positional , flexible not rigid

Question 34

Developmental Dysplasia of the Hip - what tests do we do?

Answer 34

Barlow test - adducting the hip, pressure to see if dislocates

Ortolani test - abducting outward, testing if it slips back into joint

• click or a clunk
• hip can become dislocated

Question 35

risk factor for DDH

Answer 35

• breach
• breach in last month of pregnancy
• family history
• fixed foot deformity

Question 36

Treatment of DDH

Answer 36

Relocate head of femur to acetabulum so hip develops normally

PAVIK harness
- surgical reduction

Question 37

Tris 21 is screened for in?

Answer 37

1st trimester

- screening test

Question 38

Features of Tris 21
- how may a child present ? (5)

dysmorphic features (7)

Answer 38

• hypotonia - marked head lag
• cardiac defects -ECHO
• learning difficulties
• Haematological problems
• Thyroid problems
• Low set ears, upward slanting palpebral fissures, epicanthic folds, single palmar creases, wide sandal gap