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4th year passmedicine by topic > Fetal Medicine > Flashcards

Fetal Medicine Flashcards

1
Q

Describe Apgar score parameters?

A

A score of 0-3 is very low score, between 4-6 is moderate low and between 7 - 10 means the baby is in a good state

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2
Q

Apgar score components include?

A

Pulse Respiratory effort Colour Muscle tone Reflex irritability

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3
Q

A score of 0 in the agpar score parameters is?

A 
Absent pulse
No resp effort
Blue all over
Flaccid
No reflex irritability
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4
Q

A score of 1 in the agpar score parameters is?

A

< 100 pulse
Resp effort weak & irregular
Body pink, extremities blue
Limb flexion Grimace

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5
Q

A score of 2 in the agpar score parameters is?

A 
> 100 pulse
resp effort Strong, crying
Pink baby
Muscle tone - Active movement
Cries on stimulation/sneezes, coughs
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6
Q

Normal term babies often have hypoglycaemia especially in the first 24 hrs of life

A

true

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7
Q

Normal term babies often have hypoglycaemia without sequalae due to

A

they can utilise alternate fuels like ketones and lactate

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8
Q

There is no agreed definition of neonatal hypoglycaemia but a figure of < 2.6 mmol/L is used in many guidelines.

A

true

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9
Q

Transient hypoglycaemia in the first hours after birth is common.

A

true

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10
Q

Persistent/severe hypoglycaemia may be caused by:

A 
preterm birth (< 37 weeks)
maternal diabetes mellitus
IUGR
hypothermia
neonatal sepsis
inborn errors of metabolism
nesidioblastosis
Beckwith-Wiedemann syndrome
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11
Q

Neonatal hypoglycaemia leads to hypo/hyperthermia

A

hypothermia

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12
Q

Neonatal hypoglycaemia symptoms - autonomic (hypoglycaemia → changes in neural sympathetic discharge)

A

‘jitteriness’
irritable
tachypnoea
pallor

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13
Q

Neonatal hypoglycaemia symptoms - neuroglycopenic

A 
poor feeding/sucking
weak cry
drowsy
hypotonia
seizures
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14
Q

Management of neonatal hypoglycaemia depends on

A

severity of the hypoglycaemia and if the newborn is symptomatic

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15
Q

Management of neonatal hypoglycaemia - asymptomatic

A

encourage normal feeding (breast or bottle)

monitor blood glucose

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16
Q

Management of neonatal hypoglycaemia - symptomatic or very low blood glucose

A

admit to the neonatal unit

intravenous infusion of 10% dextrose

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17
Q

Causes of neonatal hypotonia include:

A

neonatal sepsis
Werdnig-Hoffman disease (spinal muscular atrophy type 1)
hypothyroidism
Prader-Willi

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18
Q

Causes of maternal hypotonia include:

A

maternal drugs e.g. benzodiazepines

maternal myasthenia gravis

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19
Q

Neonatal sepsis occurs when a serious bacterial or viral infection in the blood affects babies within the first ? days of life.

A

28

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20
Q

Neonatal sepsis is categorised into early-onset and late-onset
- define

A

(EOS, within 72 hours of birth)

LOS, between 7-28 days of life

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21
Q

Neonatal sepsis account for 10% of all neonatal mortality

A

true

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22
Q

Black race is an independent risk factor for group B streptococcus-related sepsis

A

true

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23
Q

The overall most common causes of neonatal sepsis are ?, accounting for approximately two thirds of neonatal sepsis cases

A

The overall most common causes of neonatal sepsis are group B streptococcus (GBS) and Escherichia coli, accounting for approximately two thirds of neonatal sepsis cases

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24
Q

Early-onset sepsis in the UK is primarily caused by

A

Early-onset sepsis in the UK is primarily caused by GBS infection (75%)

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25
Q

Late-onset sepsis usually occurs via the transmission of pathogens from the environment post-delivery, this is normally from contacts such as the parents or healthcare workers
Infective causes are more commonly

A

coagulase-negative staphylococcal species such as Staphylococcus epidermidis, Gram-negative bacteria such as Pseudomonas aeruginosa, Klebsiella and Enterobacter, and fungal species

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26
Q

Risk factors of neonatal sepsis

A

Mother who has had a previous baby with GBS infection, who has current GBS colonisation from prenatal screening, current bacteruria, intrapartum temperature ≥38ºC, membrane rupture ≥18 hours, or current infection throughout pregnancy
premature
low birth weight
,aternal chorioamnionitis

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27
Q

Neonatal sepsis - Patients typically present with a subacute onset of what most commonly?

A 
Respiratory distress (85%)
Grunting
Nasal flaring
Use of accessory respiratory muscles
Tachypnoea
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28
Q

Temperature is not usually a reliable sign as the temperature can vary from being raised, lowered or normal for neontal sepsis

Term infants are more likely to be ?
Pre-term infants are more likely to be ?

A

Term infants are more likely to be febrile

Pre-term infants are more likely to be hypothermic

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29
Q

Neonatal sepsis ix wht will usually establish the diagnosis

A

Blood culture

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30
Q

sepsis - in neonates, parameters on full blood examination are usually not always useful for diagnosis, rather may help to exclude healthy neonates

A

true

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31
Q

neonatal sepsis - what will sequential assessment will help to guide management and patient progress with treatment

A

crp

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32
Q

metabolic acidosis is particularly concerning for neonatal sepsis, particularly a base deficit of ≥10 mmol/L

A

true

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33
Q

first-line regimen for suspected or confirmed neonatal sepsis

A

intravenous benzylpenicillin with gentamicin

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34
Q

Neonatal Sepsis - Other important management factors to consider include

A

Maintaining adequate oxygenation status
Maintaining normal fluid and electrolyte status
Prevention and/or management of hypoglycaemia
Prevention and/or management of metabolic acidosis

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35
Q

Jaundice in the first 24 hrs is normal

A

false

always pathological

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36
Q

Causes of jaundice in the first 24 hrs

A

rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase

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37
Q

Jaundice in the neonate from the c. 2-14 days is common (up to 40%) and usually physiological.

A

true

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38
Q

Jaundice in the neonate from the c. 2-14 days is common (up to 40%) and usually physiological. is most commonly seen in which babies

A

breastfed

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39
Q

If there are still signs of jaundice after 14 days a prolonged jaundice screen is performed, including:

A 
conjugated and unconjugated bilirubin
direct antiglobulin test (Coombs' test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs
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40
Q

Causes of prolonged jaundice

A 
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
congenital infections e.g. CMV, toxoplasmosis
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41
Q

Newborn resuscitation - first thing to do?

A
  1. Dry baby and maintain temperature
  2. Assess tone, respiratory rate, heart rate
  3. If gasping or not breathing give 5 inflation breaths
  4. Reassess (chest movements)
  5. If the heart rate is not improving and <60bpm start compressions and ventilation breaths at a rate of 3:1
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42
Q

Peripheral cyanosis, for example of the feet and hands, is very common in the first 24 hours of life and may occur when the child is crying or unwell from any cause

A

true

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43
Q

Central cyanosis can be recognised clinically when the concentration of reduced haemoglobin in the blood exceeds

A

5g/dl

44
Q

the hyperoxia test / nitrogen washout test is used to

A

may be used to differentiate cardiac from non-cardiac causes

45
Q

Describe The nitrogen washout test

A

The infant is given 100% oxygen for ten minutes after which arterial blood gases are taken. A pO2 of less than 15 kPa indicates cyanotic congenital heart disease

46
Q

Causes of cyanotic congenital heart disease

A

tetralogy of Fallot (TOF)
transposition of the great arteries (TGA)
tricuspid atresia

47
Q

Initial management of suspected cyanotic congenital heart disease

A

supportive care
prostaglandin E1
used to maintain a patent ductus arteriosus in ductal-dependent congenital heart defect

48
Q

Acrocyanosis is

A

peripheral cyanosis around the mouth and the extremities

49
Q

Acrocyanosis is always pathological

A

false
often seen in healthy newborns
It is caused by benign vasomotor changes that result in peripheral vasoconstriction and increased tissue oxygen extraction and is a benign condition
it occurs immediately after birth in healthy infants. It is a common finding and may persist for 24 to 48 hours.

50
Q

Moro reflex is

A

Head extension causes abduction followed by adduction of the arms
Present from birth to around 3-4 months of age

51
Q

Grasp reflex is

A

Flexion of fingers when object placed in palm

Present from birth to around 4-5 months of age

52
Q

Rooting reflex is

A

Assists in breastfeeding

Present from birth to around 4 months of age

53
Q

Stepping reflex is

A

Also known as walking reflex

Present from birth to around 2 months of age

54
Q

Sudden infant death syndrome is the commonest cause of death in the first year of life. It is most common at

A

3 months of age.

55
Q

Sudden infant death syndrome major risk factors

A 
putting the baby to sleep prone
parental smoking
prematurity
bed sharing
hyperthermia/ head covering
56
Q

Sudden infant death syndrome incidence increases in winter

A

true

57
Q

Sudden infant death syndrome Protective factors

A

breastfeeding
room sharing (but not bed sharing, which is a significant risk factor)
the use of dummies (pacifiers)

58
Q

Following a cot death siblings should be screened for

A

potential sepsis and inborn errors of metabolism.

59
Q

The risk of SDLD decreases with gestation

A

true
50% of infants born at 26-28 weeks
25% of infants born at 30-31 weeks

60
Q

risk factors for SDLD include

A

male sex
diabetic mothers
Caesarean section
second born of premature twins

61
Q

SDLD Chest x-ray characteristically shows

A

‘ground-glass’ appearance with an indistinct heart border

62
Q

SDLD mx

A

prevention during pregnancy: maternal corticosteroids to induce fetal lung maturation
oxygen
assisted ventilation
exogenous surfactant given via endotracheal tube

63
Q

Infantile colic describes a relatively common and benign set of symptoms seen in young infants. It typically occurs in infants aged?

A

less than 3 months old

64
Q

Infantile colic sx

A

characterised by bouts of excessive crying and pulling-up of the legs, often worse in the evening.

65
Q

Infantile colic occurs in up to 20% of infants. The cause of infantile colic is unknown.

A

true

66
Q

Necrotising enterocolitis is one of the leading causes of death among premature infants.

A

true

67
Q

Necrotising enterocolitis sx

A

feeding intolerance, abdominal distension and bloody stools, which can quickly progress to abdominal discolouration, perforation and peritonitis.

68
Q

Abdominal x-rays are useful when diagnosing necrotising enterocolitis, as they can show:

A

dilated bowel loops (often asymmetrical in distribution)
bowel wall oedema
pneumatosis intestinalis (intramural gas)
portal venous gas
pneumoperitoneum resulting from perforation
air both inside and outside of the bowel wall (Rigler sign)
air outlining the falciform ligament (football sign)

69
Q

Meconium aspiration syndrome refers to

A

respiratory distress in the newborn as a result of meconium in the trachea

70
Q

Meconium aspiration syndrome occurs when?

A

in the immediate neonatal period

71
Q

Meconium aspiration syndrome is more common in

A

post-term deliveries - babies born after 42 weeks

maternal hypertension, pre-eclampsia, chorioamnionitis, smoking or substance abuse.

72
Q

commonest cause of respiratory distress in the newborn period.

A

Transient tachypnoea of the newborn

73
Q

Transient tachypnoea of the newborn is caused by

A

delayed resorption of fluid in the lungs

74
Q

Transient tachypnoea of the newborn is more common following?>

A

It is more common following Caesarean sections, possibly due to the lung fluid not being ‘squeezed out’ during the passage through the birth canal

75
Q

Transient tachypnoea of the newborn CXR

A

Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure

76
Q

Transient tachypnoea of the newborn mx

A

Supplementary oxygen may be required to maintain oxygen saturations. Transient tachypnoea of the newborn usually settles within 1-2 days

77
Q

Microcephaly may be defined as

A

occipital-frontal circumference < 2nd centile

78
Q

Microcephaly causes

A

normal variation e.g. small child with small head
familial e.g. parents with small head
congenital infection
perinatal brain injury e.g. hypoxic ischaemic encephalopathy
fetal alcohol syndrome
syndromes: Patau
craniosynostosis

79
Q

Cleft lip and palate commonest variants are:

A

isolated cleft lip (15%)
isolated cleft palate (40%)
combined cleft lip and palate (45%)

80
Q

Cleft lip and palate pathophysiology?

A

polygenic inheritance
maternal antiepileptic use increases risk
cleft lip results from failure of the fronto-nasal and maxillary processes to fuse
cleft palate results from failure of the palatine processes and the nasal septum to fuse

81
Q

Cleft lip and palate problems?

A

feeding: orthodontic devices may be helpful
speech: with speech therapy 75% of children develop normal speech
increased risk of otitis media for cleft palate babies

82
Q

Cleft lip and palate mx

A

cleft lip is repaired earlier than cleft palate, with practices varying from repair in the first week of life to three months

cleft palates are typically repaired between 6-12 months of age

83
Q

on the Y chromosome there is a sex-determining gene (SRY gene) which causes differentiation of the gonad into a testis

A 
true
if absent (i.e. in a female) then the gonads differentiate to become ovaries
84
Q

Ambiguous genitalia Most common cause in newborns is

A

congenital adrenal hyperplasia

85
Q

Neonatal blood spot screening (previously called the Guthrie test or ‘heel-prick test’) is performed at?days of life

A

Neonatal blood spot screening (previously called the Guthrie test or ‘heel-prick test’) is performed at 5-9 days of life

86
Q

Neonatal blood spot screening consists of?

A 
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
87
Q

most common congenital infection in the UK.

A

Cytomegalovirus

88
Q

The major congenital infections encountered in examinations are

A

rubella, toxoplasmosis and cytomegalovirus

89
Q

Features of Rubella infection?

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease (e.g. patent ductus arteriosus)
Glaucoma

90
Q

Features of Toxoplasmosis infection?

A

Cerebral calcification
Chorioretinitis
Hydrocephalus

91
Q

Features of Cytomegalovirus infection?

A

Growth retardation

Purpuric skin lesions

92
Q

Fetal alcohol syndrome features

A 
short ­palpebral fissure
thin vermillion border/hypoplastic upper lip
smooth/absent filtrum
learning difficulties
microcephaly
growth retardation
epicanthic folds
cardiac malformations
93
Q

Newborn babies are relatively deficient in

A

vitamin K

94
Q

Newborn babies are relatively deficient in vitamin K. This may result in

A

impaired production of clotting factors which in turn can lead to haemorrhagic disease of the newborn . Bleeding may range from minor brushing to intracranial haemorrhages

95
Q

haemorrhagic disease of the newborn risk factors?

A

Breast-fed babies are particularly at risk as breast milk is a poor source of vitamin K. Maternal use of antiepileptics also increases the risk

96
Q

all newborns in the UK are offered vitamin K, either intramuscularly or orally

A

true

97
Q

Infantile spasms, or West syndrome, is a type of childhood epilepsy which typically presents when?

A

4 to 8 months of life

98
Q

Infantile spasms features

A

characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms
this lasts only 1-2 seconds but may be repeated up to 50 times
progressive mental handicap

99
Q

Infantile spasms ix

A

the EEG shows hypsarrhythmia in two-thirds of infants

CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)

100
Q

Infantile spasms mx

A

poor prognosis
vigabatrin is now considered first-line therapy
ACTH is also used

101
Q

Shaken baby syndrome

This syndrome encompasses the triad of

A

retinal haemorrhages, subdural haematoma, and encephalopathy.

102
Q

Caput succedaneum describes

A

oedema of the scalp at the presenting part of the head, typically the vertex. This may be due to mechanical trauma of the initial portion of the scalp pushing through the cervix in a prolonged delivery or secondary to the use of ventouse (vacuum) delivery.

103
Q

Caput succedaneum sx

A

soft, puffy swelling due to localised oedema

crosses suture lines

104
Q

Caput succedaneum mx

A

No treatment is needed.

105
Q

A cephalohaematoma is seen as

A

a swelling on the newborns head. It typically develops several hours after delivery and is due to bleeding between the periosteum and skull. The most common site affected is the parietal region

106
Q

Cephalohaematoma Jaundice may develop as a complication.

A

true

107
Q

A cephalohaematoma up to 3 months to resolve.

A

true

4th year passmedicine by topic (96 decks)

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