Fetus and Newborn

Question 1

baby with meconium aspiration and respiratory distress?

Answer 1

meconium plug - may cause pneumothorax

Question 1

besides hypoglycemia, what other electrolyte abnormalites can be present in a infant of a diabetic mother?

Answer 1

hypocalcemia (tremors, twitches, seizures, also can lead to prolonged QT) and hypomagnesemia

Question 2

persistent posterior fontanelle, umbilical hernia, jaundice

Answer 2

hypothyroidism

Question 3

what are some compliations of exchange transfusion?

Answer 3

thrombocytopenia, portal vein thrombosis, NEC, electrolyte imbalances, GVHD, infection

Question 4

protruding tongue with small mouth +/- cleft palate

Answer 4

pierre robin syndrome

Question 5

what should concern you more - pre-axial (thumb/toe) or post-axial (pinky) polydactyly?

Answer 5

pre-axial

Question 6

what is the underlying injury in Horner Syndrome?

Answer 6

damage to sympathetic fibers of T1

ptosis, miosis, enophthalmos, delayed pigmentation of iris

Question 6

what is considered abnormal penile length in term neonate?

Question 6

when after needle decompression do you consider a chest tube?

Answer 6

pneumothorax still >20% or still having hypoxia or distress

Question 7

what are the xray findings of intersitial pulmonary fibrosis in an infant?

Answer 7

early on, bilateral reticular infiltrates occurs with development of multi-cystic lesions

occur in premies with no history of RDS/HMD

Question 8

what are craniotabes?

Answer 8

soft areas of the skull away from the fontanelle - associated with syphillis, hydrocephalus, and rickets

Question 8

management options for PPHN?

Answer 8

mechanical ventilation

hyperventilation (lowers CO2)

pressors (to reverse shunting)

sedation

iNO

ECMO

Question 9

what are the chronic signs of kernicterus(>1 yr)

Answer 9

hypotonia, active DTRs, obligatory tonic neck reflexes, delayed motor skills

Question 10

what is RDS also known as?

Answer 10

hyaline membrane disease

Question 10

would hypoxemia due to pulmonary hypertension be improved with oxygen?

Answer 10

nope.

Question 12

who should be screened for developmental hip dysplasia?

Answer 12

breech presentation, daughters of mother’s with DDH

Question 13

what congential defects are common in infants of diabetic mothers?

Answer 13

VSD

caudal regression syndrome

neural tube defects

GI atresia

microcolon (small left colon syndrome) - will have normal bowel function in future

GU malformations

Question 13

what radiologic finding may you see in a baby with meconium peritonitis

Answer 13

intraabdominal calcifications

Question 14

what should you look for if a newborn has jaundice within first 24 hours?

Answer 14

infection!

Question 16

are infants of mothers with gestational diabetes at risk for congenital heart disease?

Answer 16

no, just babies of mother’s with type 1 or type 2 diabetes

Question 18

where are thryoglossal duct cysts?

Answer 18

midline, most with swallowing and tongue protrusion

Question 20

if a fetus/newborn has a single umbilical artery, what should you do?

Answer 20

look for other congenital anomalies

Question 21

what are the acute signs of kernicterus?

Answer 21

poor sucking, stupor, hypotonia, seizures

hypertonia of extensor muscles, pisthotonus, retrocollis, fever

hypertonia

Question 22

which could have other related congential anomalies - omphalocele or gastroschisis?

Answer 22

omphalocele

Question 24

what is picture B

Answer 24

Klumpke paralysis

lower part of brachial plexus (C8 and T1 parts)

claw like posturing of the hand

mostly seen in breech delivery

less likely to improve but may with PT

Question 25

what is the cutoff for hypoglycemia in a newborn?

Question 26

what syndromes are associated with multiple areas of craniosynostosis?

Answer 26

Crouzon or Alperts

Question 28

large protruding tongue

Answer 28

hypothyroidism, Down syndrome, Beckwidth-Wiedemann, hemangioma, isolated macroglossia

Question 30

physical exam findings with patent ductus arteriosis?

Answer 30

continuous machine like murmur

bounding pulses

wide pulse pressure

hyperdynamic precordium

worsening respiratory status

Question 31

is it okay to use indomethacin if a baby has an IVH?

Answer 31

yes

don’t use with poor kidney function, NEC, decreased UOP, low platelets, or bleeding issues

Question 32

what is picture A

Answer 32

Erb palsy - damange to upper part of brachial plexus (5th and 6th cervical roots)

“waiter’s tip” position

resolves spontaneously

palpate for ipsilateral clavicle fractures

Question 33

what is a complication of iNO?

Answer 33

methemoglobinemia

Question 34

what should you think of in a coughing newborn?

Answer 34

viral pneumonia

Question 35

in what cells is surfactant stored in?

Answer 35

type 2 alveolar cells

Question 36

what ratio is measured to indicate fetal lung maturity?

Answer 36

lecithin-sphingomyelin ration

lecithin is much higher than sphingomyeline in mature lungs

(equal in immature lungs)