March 2018 Flashcards
What increases the risk for NEC?
a. Minimal enteral feeding
b. Drugs that inhibit gastric acid secretion
c. Prophylactic enteral antibiotics
d. Probiotics
B
Nelsons 20th ed p.871: Emerging evidence indicates that use of inhibitors of gastric acid secretion (H2-receptor blockers, proton pump inhibitors) or prolonged empirical antibiotics in neonatal period is associated with increased risk of NEC.
Most common cause of antenatal fetal distress?
a. DM
b. Multiple pregnancy
c. Hypertension
d. Uteroplacental insufficiency
D
Nelsons 20th ed p.806 The predominant cause of antepartum fetal distress is uteroplacental insufficiency….
Blood transfusion not indicated?
a. Asymptomatic preterm with Hgb 7 g/dl
b. Asymptomatic term infant with Hgb 10 g/dl
c. Infants with HMD on respiratory support
d. Symptomatic term infant with Hgb 8 g/dl
B
Suggested transfusion thresholds (Hgb)
- No respiratory support
WEEK 1: 10
WEEK 2: 8.5
WEEK 3: 7.5 - Presence of respiratory support
WEEK 1: 11.5
WEEK 2: 10
WEEK 3: 8.5
(Nelson 21st Table 124.4)
Excessively small anterior & posterior fontanel can be found in?
a. Congenital rubella syndrome
b. IUGR
c. Congenital hyperthyroidism
d. None of the above
C
Because symptoms are usually not present at birth, the clinician depends on neonatal screening tests for the diagnosis of congenital hypothyroidism. The anterior and posterior fontanels are open widely, and the presence of this sign at birth may be a clue to early recognition of congenital hypothyroidism (Nelson 21st p2917)
Mother is on heroin while pregnant. True of effects of heroin on newborn EXCEPT
a. Increase risk of congenital anomaly
b. Decrease incidence of RDS
c. Decrease hyperbilirubinemia
d. All of the above are true
A
Heroin in pregnancy
- preterm birth
- neonatal abstinence syndrome
- growth delay (LBW)
- Lower incidence of respiratory distress syndrome
- Lower incidence of hyperbilirubinemia
- NO significant differences in head circumference or frequency of congenital anomalies
(NCBI)
Which should be given attention after birth?
a. Cephalhematoma
b. Caput succedaneum
c. Tongue thrusting
d. None of the above
A
Caput succedaneum is a benign self limited condition
Tongue thrusting or extrusion reflex (when the tongue is touched, it extrudes) is a primitive reflex
Cause of symmetric facial palsy?
a. Hypoplasia of 7th nerve nucleus
b. CN7 peripheral facial palsy
Newborn with asphyxia, cyanotic at birth. Responds intermittently to 100% O2 via hood. CXR is normal. What to consider?
a. Congenital heart disease
b. PPHN
c. Respiratrory distress syndrome
d. Meconium aspiration syndrome
B
Hyperoxia test responsive, so CHD less likely. Clear CXR, so RDS, MAS less likely
Period of teratogenesis?
a. 1-14 days
b. 14 days to 9 weeks
c. 9 weeks onwards
d. None of the above
B
The embryonic period, during which organogenesis takes place, occurs between implantation at around 14 days to around 60 days postconception. This is usually the most sensitive period to teratogenesis when exposure to a teratogenic agent has the greatest likelihood of producing a malformation.
(NCBI)
Multidrug resistant TB is resistant to:
a. Isoniazid & Rifampicin
b. Isoniazid & Ethambutol
c. Isoniazid & Pyrazinamide
d. Rifampicin & Pyrazinamide
A
TB Guidelines 4th ed p.168 Multidrug-resistance (MDR): resistance to at least both isoniazid & rifampicin.
How many weeks from illness can TST be positive
a. 2-12 weeks
b. 8-16 weeks
c. 8-12 weeks
d. 2-16 weeks
A
TB Guidelines 4th ed p.83 In most children the delayed-type hypersensitivity response to tuberculin, which is the estimated interval between TB exposure and detectable skin test reactivity (referred to as the window period) ranges from two to twelve weeks.
Treatment of Category 1A TB
a. 2HRZE/4HR
b. 2HRZE/10HR
c. 2HRZES/1HRZE/5HRE
d. 2HRZES/1HRZE/9HRE
B
TB Guidelines 4th ed p.151 Table 11.5 Recommended treatment regimens for adults and children
Xray findings in Primary TB EXCEPT
a. Calcifications
b. Lymphangitis
c. Pleural effusion
d. All of the above can be seen in primary TB
A
TB Guidelines 4th ed p.95 In primary TB, the following radiographic changes may be seen: parenchymal involvement (primary focus), lymphangitis, localized pleural effusion, and regional lymphadenitis. The primary complex is composed of all of the above 4 findings. The most common radiologic finding is lymphadenopathy.
Steroids can be used in TB EXCEPT
a. Pleural thickening in pleural effusion
b. TB meningitis in HIV negative
c. TB pericarditis
d. Miliary TB
A
TB Guidelines 4th ed p.157 The benefit of corticosteroids has been evaluated in the following forms of complicated tuberculosis: 1) TB meningitis, 2) TB pericarditis, 3) TB pleural effusion, where a recent systematic review concludes that there is insufficient data to support routine use. Although steroids do not appear to reduce the development of residual pleural thickening, some studies showed a significantly more rapid resolution of symptoms. 4) Endobronchial TB, 5) Miliary TB
Baby was born to a mother with TB. (+) hepatosplenomegaly. On xray, 2-3 mm calcific lesions Given antibiotic but no response.
a. Congenital TB
b. CMV
c. Bacterial sepsis
d. Toxoplasmosis
A
TB Guidelines 4th ed p.61-62 Perinatal/Postnatal Tuberculosis
To delineate, Cantwell and colleagues have defined congenital TB as any infant with a TB lesion and one or more of the following criteria: 1) present within the first week of life, 2) a primary hepatic complex or caseating hepatic grabuloma, 3) TB infection of the placenta or endometrial TB in the mother; or exclusion of the possibility of postnatal transmission by ecluding TB in other contacts.
In the absence of the aforementioned criteria and the non-specific clinical features, a clinician relies
On having a high index of suspicion and a detailed history & PE…..
