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Neonatal Board Questions > FEN > Flashcards

FEN Flashcards

1
Q

Fatigue, irritability, constipation, cardiac failure.

What deficiency?

A

B1 = Thiamine

Beriberi

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2
Q

Photophobia, conjunctivitis, FTT, scaling, epiphyseal bone formation, abnormal tooth enamel.
What deficiency?

A

Vitamin A

A is pointy like teeth

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3
Q

FTT, photophobia, dermatitis, mucositis.
What deficiency?
Associated with:

A

B2 = Riboflavin

Associated with glutamic aciduria type 1

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4
Q

Dermatitis, mucositis, hypochromic anemia, seizures. What deficiency?
Associated with

A

B6 = Pyridoxine

Associated with homocystinuria

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5
Q

Alopecia, dermatitis, scaling, seborrhea.
What deficiency?
Associated with

A

Biotin
Associated with biotinidase deficiency, B-methylcrotonyl glycinuria, propionic acidemia, pyruvate dehydrogenase complex deficiency

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6
Q

Vitamin deficiency: Poor wound healing, bleeding gums.
What deficiency?
Associated with

A

Vitamin C = Ascorbic acid

Associated with transient tyrosinemia (Tangerines are made of Vitamin C)

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7
Q

Rickets, FTT, tetany.

What deficiency?

A

Vitamin D

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8
Q

What immunoglobulins are kept and lost during Holder pasteurization?

A

IgA and G preserved

IgM destroyed

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9
Q

Anemia, osteoporosis, depigmentation of hair and skin, neutropenia, poor weight gain.
What deficiency?

A

Copper

Critical for production of red blood cells and hemoglobin. Also iron absorption.

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10
Q

Chromium responsible for

A

Glucose regulation and insulin metabolism

Chromium coats a Hershey’s kiss

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11
Q

Microcytic, hypochromic anemia; FTT.

What deficiency?

A 
Iron deficiency 
(Vitamin C enhances absorption)
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12
Q

Manganese role

A

Enzyme activation ie. superoxide dismutase
Normal bone structure
CHO metabolism

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13
Q

Cardiomyopathy. What deficiency?

A

Selenium

Selena broke your heart

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14
Q

FTT, alopecia, dermatitis, diarrhea. What deficiency?

A

Zinc –> Acrodermatitis enterohepatica

Commonly perianal dermatitis

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15
Q

Maternal zinc deficiency

A

IUGR, congenital anomalies

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16
Q

pH in RTA type 1

A

> 6.5

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17
Q

pH in RTA type 2

A

<6.5 (can be >6.5 before acidosis is established. Losing bicarb proximally so distal end makes up for it by secreting more H+)

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18
Q

Which type of RTA has hypercalciuria/nephrocalcinosis?

A 
Type 1
(Possibly thought that increased bone breakdown and calcium release to help buffer the extra acid)
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19
Q

When do different disaccharides reach adult levels?

A

Sucrase, Maltase, isomaltase by 28 weeks
Lactase by 36 weeks
(Carb digestion and absorption adequate because of colonic salvage pathway)

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20
Q

Colonic salvage pathway

A

Colonic bacteria help ferment malabsorbed CHO to acids which are absorbed in the colon

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21
Q

Colostrum whey to casein ratio

A

80:20

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22
Q

Mature breast milk whey to casein ratio

A

55:45

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23
Q

Preterm formula whey to casein ratio

A

60:40 or 80:20

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24
Q

Effect on ECF, ICF and TBW as gestational age increases

A

ECF and TBW decrease

ICF increases

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25
Q

When does nephrogenesis start and when is it complete?

A

5th week;

34-36 weeks

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26
Q

When does urine production begin in the fetus?

A

10-12 weeks gestation

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27
Q

Urine output at 20 weeks gestation vs term

A

5 mL/hr –> ~50 mL/hr

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28
Q

How much of amniotic fluid is comprised of urine?

A

90%

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29
Q

Endothelin effect? Produced by? Stimulated by?

A

Renal vasoconstrictor
Produced by renal vascular endothelial cells
Stimulated by Ang II, bradykinin, epinephrine, stress

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30
Q

Menkes disease

A

X-linked recessive disorder; inability of absorption of copper

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31
Q

What is administered with iron to prevent iron induced hemolysis?

A

Vitamin E (antioxidant)

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32
Q

Hemolytic anemia, reticulocytosis, thrombocytosis, acanthocytosis, neurologic sequelae.
What deficiency?

A

Vitamin E

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33
Q

Preterm milk has higher __ than term milk

Lower __

A

Higher protein and electrolytes

Lower lactose

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34
Q 
Which is greater in breast milk vs formula?
Long chain unsaturated FAs
Carnitine
Cholesterol
DHA
Amino acids
A 
Long chain unsaturated FAs- Breast milk
Carnitines- Breast milk
Cholesterols- Breast milk
DHAs- Breast milk
Amino acids- Formula
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35
Q

Fat and protein difference in hind and foremilk

A

Higher fat in hindmilk; Lower CHO; Similar protein

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36
Q

What component of breast milk is the most variable?

Which is most constant?

A

Triglycerides (vary by GA, time and maternal diet)

Cholesterol (does not vary by maternal diet)

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37
Q

What percentage of calories should protein provide to prevent negative nitrogen balance?

A

7-15%

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38
Q

What is resting metabolic rate of neonate?

A

40-60 kcal/kg/day

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39
Q

Energy requirement for enterally vs parenterally fed infants?

A

Enterally- 100-130 kcal/kg/day

Parenterally- 85-95 kcal/kg/day

40
Q

Which part of the intestine is responsible for absorption of fat soluble vitamin and zinc?

A

Ileum

Jejunum is responsible for some fat absorption but not fat soluble vitamins

41
Q

Proteinuria, hypoproteinemia, hyperlipidemia, edema

A

Congenital nephrotic syndrome

Finnish type most common

42
Q

Large placenta + elevated AFP

A

Congenital nephrotic syndrome

Finnish type

43
Q

Cataracts, glaucoma, hypotonia, areflexia, mental deficiency, tubular dysfunction, proteinuria, aminoaciduria, cryptorchidism

A

Lowe syndrome - X-linked recessive ie. oculocerebrorenal syndrome

44
Q

Elevated AFP and increased nucleotide pyrophosphates in skin fibroblasts

A

Lowe syndrome- X-linked recessive ie. oculocerebrorenal syndrome

45
Q

Triangular facies, protruding ears, large eyes with strabismus, drooping mouth

A

Bartter syndrome

46
Q

Electrolyte derangements seen in Bartter syndrome

A

Hypokalemic metabolic alkalosis

Hypercalciuria

47
Q

What happens when ureteric bud fails to develop?

A

Renal agenesis

48
Q

MCC hydronephrosis. First step after birth.

A

No specific cause, usually resolves before birth.
Do postnatal ultrasound even if resolves before birth (should wait 7-10 days to ensure normal water losses have occurred)

49
Q

FENa, urine osmolality, urine Na in prerenal vs renal tubular injury

A

Prerenal: FENa<2%, Uosm: high, UNa: low (dehydration –> increased Na and water reabsorption to try and inc BP)
Renal: FENa>2%, Uosm: low, UNa: high (inappropriate excretion of Na and water –> low urine osmolality and high urine Na)
(explanation pg. 1467 Brodsky)

50
Q

Which hormone plays the biggest role in fetal growth?

A

ILGF-2

51
Q

Which hormone plays the biggest role in placental regulation of fetal nutrient supply?

A

Placental lactogen

52
Q

Essential fatty acids

A

Alpha Linolenic and linoleic acids

53
Q

Which fatty acids play a role in brain and retinal development?

A

Long chain polyunsaturated FAs such as omega 6 and 3

DHA and ARA

54
Q

Contraindications to breastfeeding

A

HSV lesion on the breast, HIV, active TB, active breast abscess, galactosemia, drugs

55
Q

How does GFR change with increasing gestational age?

When at adult levels?

A

Increases
Doubles in first two weeks
Reaches adult levels by 1 year

56
Q

How do ACS affect insensible water loss?

A

Decreases IWL at any given age d/t greater skin maturation and better perfusion

57
Q

Most prevalent fatty acids in human milk

A

Oleic acid > palmitic acid

58
Q

Most predominant carbohydrate in breast milk

A

Lactose

59
Q

Rapid correction of hyponatremia can lead to

A

cerebral demyelination

60
Q

Indications for dialysis

A 
Hyperkalemia
Hyponatremia with symptomatic volume overload
Hyperphosphatemia
metabolic acidosis
hypocalcemia
uremic symptoms 
inability to provide nutrition d/t fluid restriction
*not creatinine value*
61
Q

Calories of protein, carbs and fat

A

4
3.4
9

62
Q

Hematuria, thrombocytopenia, renal failure, palpable flank mass

A

Renal vein thrombosis

63
Q

How do Na, Cl, Ca, phos, Mg, iron change with advancing GA?

A

Na, Cl decrease

Ca, phos, Mg, iron increase

64
Q

Liver involvement at birth in ARPKD

A

~50-60%

65
Q

MC symptom with ARPKD

A

Severe hypertension

66
Q

Which PKD has multi system involvement?

A

ADPKD

AR only has liver involvement

67
Q

Where does ADH work?

A

Late distal tubule and collecting ducts

68
Q

What is the primary determinant of water excretion in the kidney?

A

ADH

69
Q

Side effects of thiazides

A

HyperGLUC

  • glycemia
  • lipidemia
  • uricemia
  • calcemia (vs loops lose calcium)
70
Q

MC form of PKD

A

ADPKD

71
Q

Cilia related disorder

A

ARPKD

72
Q

Defect of PKHD1 gene

A

ARPKD

73
Q

Scaly dermatitis, alopecia, FTT, increased infection, thrombocytopenia. What deficiency?

A

Essential fatty acid deficiency (EFAD)

74
Q

Intralipid includes which FAs?

A 
Omega 6 (linoleum acid) >
omega 3 (limolenic acid)
75
Q

Vitamin D & Calcitriol in relation to calcium prenatally and postnatally

A

Fetal calcium homeostasis is independent of vitamin D and calcitriol
Postnatally, a deficiency in the above will impair calcium absorption

76
Q

What happens to calcium levels after birth

A

Transient drop but they return to normal within 48 hours

77
Q

Treatment for SIADH

A

Fluid AND Na restriction

Total body Na is normal, but total body water is elevated, relative hyponatremia

78
Q

Majority of dietary fat in the form of

A

Triglycerides

79
Q

How is calcium transferred from mother to fetus?

A

Mother to placenta via facilitative diffusion
Placenta to fetus via ATP pump on basal surface of syncytium
Fetus is HYPERcalcemic to mother

80
Q

Glucogenic amino acids

A

Alanine, glycine, glutamate

Give rise to glucose or glycogen

81
Q

Ketogenic amino acids

A

Leucine and lysine

yield acetyl-CoA or acetoacetyl-coa

82
Q

Elevated plasma 7-dehydrocholesterol

A

Smith Lemli opitz syndrome

83
Q

Triad of Sotos syndrome

A

Overgrowth, characteristic facial features, learning disabilities and ID

84
Q

How many kcal/kg/d necessary for proper growth and energy expenditure

A

105-130 kcal/kg/day

85
Q

Triene: Tetraene ratio >0.4

A

EFAD

86
Q

How maternal glucose transported

A

facilitated diffusion

87
Q

Essential Amino acids

A 
Histidine
Isoleucine
Leucine
Lysine
Methionine
Phenylalanine
Threonine
Tryptophine
Valine
"the HILL My Pop TRYd To ski in VAIL"
88
Q

Conditionally essential amino acids in preterms

A

Arginine
Cysteine
Taurine
Tyrosine

89
Q

Intralipid made of

A

100% soybean oil

90
Q

Na, Ca, K, Cl, Mg, Phos higher or lower in human vs cow’s milk?

A

Lower

91
Q

Osmolarity equation

A

(Na x 2) + BuN /2.8 + Glucose / 18

92
Q

When nephrogenesis finished

A

34-36 weeks

93
Q

When does fetal urine output begin

A

9-11 weeks

94
Q

Peak fetal growth rate

A

mid 30 weeks (33-35)

95
Q

Nitrogen intake equation

A

protein intake (g/day) x 0.16

Neonatal Board Questions (12 decks)

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