EM neonatology

Question 1

Phrenic nerve injury is due to overstretching of the anterior roots of ______. This results from lateral hyperextension of the neck, especially during breech births or difficult forceps delivery

Answer 1

cervical nerves 3, 4 and 5

Question 2

MSAFP can be elevated in _____

Answer 2

open neural tube defects, bowel malformations

Question 3

MSAFP is high and the ACE is normal, there may be a malformation other than an open neural tube defect. The most probable cause of these labs is the

Answer 3

omphalocele, in which the bowel protrudes into a sac extending off of the fetal abdomen. This malformation can be easily identified during a sonographic examination.

Question 4

Endotracheal intubation and suction should be done first to remove any meconium that is present in the trachea before giving positive pressure ventilation.

Answer 4

Nasopharyngeal suction and tactile stimulation will push the meconium present in the trachea into the lungs and can cause aspiration pneumonia.

Question 5

What is the most common neuronal injury in brachial plexus…

Answer 5

neuropraxia, involves damage to the nerve sheath alone and is associated with interruption in conduction of impulses down the nerve fiber resulting in a temporary conduction block. Complete spontaneous recovery with 90% to 100% return of function usually occurs.

Question 6

In neonatal CMV infection findings at the time of diagnosis in the newborn period that are predictors for long-term poor neurologic and developmental outcomes include

Answer 6

intracranial abnormalities on CT scan, especially calcifications, CSF protein concentrations greater than 120 mg/dl, and placentomegaly.

Question 7

Management of suspected brachial plexus injury requires gentle handling of the affected limb, radiographs of the clavicle and humerus to exclude bony injury, observation for respiratory distress indicating diaphragmatic injury, and referral to

Answer 7

physical therapists for passive range of motion exercises including the neck and proximal arm beginning 7 to 10 days after birth.

Question 8

Clubfoot, or talipes equinovarus, is a congenital foot disorder characterized by plantar flexion of the ankle, adduction of the heel, high midfoot arches, and adduction of the forefoot. Treatment consists of

Answer 8

manipulation and casting and it should be initiated immediately upon diagnosis. Two to four months of serial casting and manipulation are often needed to correct a clubfoot.

Question 9

Children born to _____ mothers show prenatal and postnatal growth problems, mental retardation, maxillary hypoplasia, congenital heart disease, and abnormal palmar creases.

Answer 9

Alcohol is the most common drug that is abused during pregnancy.

Question 10

______ causes congenital problems in the heart and great vessels.

Answer 10

Lithium carbonate is used for bipolar problems (Ebstein’s anomaly)

Question 11

______ causes a multitude of abnormalities with emphasis on skeletal, face, skull, limbs, and vertebral column.

Answer 11

Methotrexate

Question 12

______ can cause varying degrees of masculinization of the female fetus. The ambiguous external genitalia can have fused labia and clitoral hypertrophy.

Answer 12

Testosterone, ethisterone, and norethisterone

Question 13

____ results in a wide range of skeletal, CNS, and growth problems.

Answer 13

Aminopterin

Question 14

Stunted growth, skeletal anomalies, corneal opacities, cleft palate, and hypoplasia of organs can be seen with

Answer 14

busulfan.

Question 15

____ induces skeletal malformations as well as external ear, cardiac, and GI malformations.

Answer 15

Thalidomide. This drug is a potent teratogen and is used as a tranquilizer or sedative.

Question 16

Approximately eight hours after a forceps delivery the newborn is observed to be lacking unilateral facial movement. What is the most probable cause?

Answer 16

Neurapraxia of the facial nerve (VII)

Question 17

Genetically, twins are divided into 2 groups: monozygotic (MZ) or identical twins that are derived from a single fertilized egg that splits and dizygotic (DZ) or fraternal twins that are derived from 2 fertilized eggs that were released during the same cycle. The inheritance of twinning differs between MZ and DZ twins.

Answer 17

The rate of MZ twinning is constant around the world and appears to be a purely random event, whereas the incidence of DZ twinning changes throughout different races and times in history and appears to be inherited through maternal lines only.

Question 18

DZ twins are in essence siblings that are born at the same time and will have 2 separate placentas (dichorionic) and 2 separate amniotic sacs (diamnionic).

Answer 18

The identical or MZ twin may have the same placenta and the same amniotic sac (monochorionic and monoamniotic), but this depends on the exact timing of the egg split.

Question 19

Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of surfactant lipoproteins in the alveoli. It is a genetic disorder with an autosomal recessive mode of inheritance. There is mutation in surfactant-B protein (SP-B), surfactant-C protein (SP-C), and beta chain of granulocyte macrophage colony stimulating factor (GM-CSF). Two clinical forms have been described in children:

Answer 19

A fulminant and often fatal form presents with respiratory distress soon after birth (Congenital PAP)
Gradually progressive type presenting in older infants and children (Acquired PAP)

Question 20

Meconium plug syndrome or a functional immaturity of the colon, specifically the myenteric plexus nerve cells, is a transient disorder of the newborn colon. Intestinal dilatation, evidenced as abdominal distension along with delayed passage of meconium for 24-48 hours are characteristic features.

Answer 20

Bilious vomiting may occur. Incidence is increased in premature infants of diabetic mothers and infants whose mothers received magnesium sulfate for toxemia. Plain films of the abdomen usually reveal multiple dilated loops of bowel with an absence of rectal gas.

Question 21

Apgar score is a system of assessing newborns immediately after birth to help identify those requiring resuscitation and to predict survival in the newborn period. The 1-minute score may signal the need for immediate resuscitation, and the 5-minute, 10-minute, and subsequent scores may indicate the probability of success.

Answer 21

The score is based on observation of 5 signs, including heart rate, respiratory effort, muscle tone, reflex response, and color. Each receives an individual score between 0 and 2. The highest possible score is 10.

Question 22

low AFP, low unconjugated estriol (uE3), high human chorionic gonadotropin (hCG), and high inhibin-A are associated with a higher risk of _______

Answer 22

trisomy 21 or Down syndrome