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Final exam > Nb Exam > Flashcards

Nb Exam Flashcards

1
Q

What is objective of red eye reflex exam
What referral for abnormal Rer?

A

Obj
Confirm clarity of len
Confirm presence of retina

Referral- consult

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2
Q

when is surfactant produced

A

~32 wks

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3
Q

embryology
state what each layer of embryonic cells becomes

endoderm
mesoderm
ectoderm
trophoblast
epiderus

A

endoderm- epithelium
mesoderm- muscle
ectoderm - nervous system
trophoblast- placenta
epiderus- nuchal crest

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4
Q

When do fetal structures change during extra uterine transition?

A
  1. 1st breath reduces pulmonary resistance. Lung expansion opens lungs. Deoxygenated blood goes to lungs
  2. Oxygenated blood returns to left atrium- increases pressure = foramen ovale closes
    (note closure may be incomplete in first 24-48 hrs- and heart murmurs maybe heard. Anatomically closes1yr

3 ductus arteriosis- triggered to close by increase in oxygen + prostaglandins Functionally closed by 8-10hrs but may not anatomically close for several mths

4) ductus venosus- First to close - closes relative to umbilical blood flow

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5
Q

what are 4 ways to lose heat

A

conduction (heat loss when having direct contact)
evaporation (when water evaporates from skin)
convection (fan - move air or water molecules across skin
radiation (e.g.heat loss to surrounding colder solid object not directly in contact with skin)

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6
Q

what are urates - what is normal

A

pink / brick red staining on nappy
common / normal in first few days, but after few days, it may indicate dehydration

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7
Q

What could (unexpectedly) low or raised temp signal?
What is referral

A

GBS infection
Consult (temperature instability)

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8
Q

Jaundice
What are indicators it may be pathological

A

Jaundice develops <48hrs old
Baby is sleepy, feeding poorly, reduced urine output
Jaundice persisting 7-10 days (should decline over this period)
Sclera/ blanched gums indicate yellow

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9
Q

What are referrals for jaundice

A

<24 hrs- transfer
SBR >250 in 48hrs- consult
sBR >300 any time- consult
Prolonged / >150 in first 2 wks - consult
Significant jaundice previous baby- consult

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10
Q

Vitamin k deficiency bleeding

Cause
timing
Risks
Signs

A

Baby needs vitamin k to produce clotting factors
Vit k synthesised In intestine by bacteria- requires feeding to be established

Types
Early <48hrs
Classic 2-7
Late 1wk- 6mths

Risk factors
Premature
Birth trauma/ asphyxia/ cephaehaematoma/ known hepatic disease
Mum is on anticoagulants, anticonvulsant/ antibiotics / anti turbuculosis

Signs
Bleeding, bruising
Not feeding
Prolonged jaundice

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11
Q

brown fat

A
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12
Q

describe glucose regulation for nb

A

NORMAL for BGL’s to fall in first 2-6hrs ( transient period of hypoglycaemia + active ketogeneisis)
then rise slowly / steadily over next 24hrs

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13
Q

Signs of neonatal hypoglycaemia

A

often vague / non-specific
jitteriness
cyanosis
apnoea
weak cry
lethargy
floppy
refusal to feed

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14
Q

neonatal response to SSRI’s

A
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15
Q

normal weight loss in nb

A

<10% normal.
@ 7%, assess feeding
@10-12.5% consult
>12.5% Transfer

regain birth weight by 10-14 days

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16
Q

Signs that baby is full term

A
  • flexed limbs (preterm are extended)
  • ear returns to normal when folded
  • cartilage / curves of pinna are complete
  • there are creases over whole of sole of foot in first 12hrs
  • genitalia well developed (testes descended)
  • scarf sign (crossing arm across midline)- elbow doesn’t reach midline
  • plantar creaes
    *
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17
Q

describe normal neonatal breathing patterns

rate
rhythm
chest/abdo movement
nose
sound
colour

A

rate- 30-60 rpm
rhythm- regular + irregular periods, apnoea <20 sec
chest/abdo movement- SYNCHRONISED diaphram + abdo movements (NOT in-drawing)
nose- breathing through nose - no nasal flaring
sound- silent (no grunting)
colour- pink (not pale / cyanosis)

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18
Q

what are rales + rhonchi ?
what causes these
what do you do?

A

rales- discontinous clicking / rattling
ronchi- continous rattling (“snoring”)

caused by lung fluid not yet absorbed. Shoud clear after 1 hr.

mgt
if baby is full term / healthy + alert, with normal resp+ HR–> recheck in 15mins, and monitor every 15mins until they go.
CONSULT IF these persist, or other signs of respiratory distress
(pale/ cyanosis, tachycardia, - tachyapnoea, lethargy, poor tone)

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19
Q

What are the 4 listening positions

A

ALL - aortic
PRACTITIONERS- pulmonic
TAKE -tricuspid
MONEY- mitral

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20
Q

what are heart murmurs?

what is mgmt? (Incl. referrals)

are they a reliable measure of cardiac anomalies

A

heart murmurs- Sounds that may be heard due to abnormal valves/ defects

most NB’s have soft murmurs that are transient and not associated with anomalies
if you hear a heart murmur at initial exam but no symptoms (colour, poor feeding, resp rate), CONSULT
usually you reassess at 24hrs and it passes within 1st week

if you hear heart murmor WIth Symptoms- TRANSFER

many serious cardiac malformations are silent - observe for general symptoms (colour, resp, feeding behaviour, muscle tone)

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21
Q

what is referral for persistent / recurrent cyanosis

A

transfer

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22
Q

what is referral for persistent tachycardia

A

consult

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23
Q

what is referral for absent femoral pulse

A

consult

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24
Q

what is hypoxaemia?
what is referral

A

<90% oxygen sat
Consult (may indicate congenital heart defect, or other respiratory / infections that may be causing hypoxaemia)

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24
Q
A
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25
Q

What are neonatal reasons for emergency

A

CNS
* convulsions
* unresponsive
* limpness / hypotonic (with abnormal vital signs/ other abnormality)
* severe infant depression at birth (1min Apgar ≤6 and litte improvement at 10mins)

HAEMATOLOGY
* neonatal subgaleal haemorrhage- with concerns about babys vitals/ongoing bleeding/ head circumferance Increasing

RESPIRATORY
* apnoea (stop breathing for >20secs and needs resus)

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26
Q

what is purpose of pulse oximetry

what are referrals

A

to detect hypoxaemia (low oxygen saturation levels) caused by congenital heart disease in NB before onset of symptoms
note- congenital heart disease is most common group of congenital malformations

≥95% = “PASS”

90-94% = “inconclusive”- repeat 3 times then consult

<90% oxygen sat- CONSULT

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27
Q

what is definition / referral for microcephaly

A

HC <3rd percentile

CONSULT

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28
Q

What is difference between

-caput
-cephaehaematoma
-subgaleal haemorrhage

A

Caput
present at birth
oedema sitting above periosteum (crosses sutures)
generally doesn’t require treatment

cephaehaematoma
develops after birth
bleeding UNDER periosteum
does not cross sutures

subgaleal haemorrhage
bleeding into epicranial space and periosteum
boggy swelling
increases in size, head circumference, signs of shock
risk- vacuum delivery
- TRANSFER- if vital signs normal and HC stable / no ongoing bleeding
- EMERGENCY- if concern about baby’s vitals / bleeding/ HC increasing

29
Q

what may a bulging fontanelle indicate

A

hydrocephalus (build up of CSF)
Intracranial haemorrhage

30
Q

what is ankyloglossia
when is treatment warranted

A

tongue tie

when lingual frenulum is abnormally short or tight = restricted movement of tongue

“not very BF difficulty is due to tongue tie, and not every tongue tie causes a BF issue”

NOT recommended unless there is clear association with breastfeeding difficulty

MCNZ
* expects MW’s assess BF and make appropriate/timely referral for ankyloglossia
* allows MW ‘s that have competed training to carry out frenotomy

31
Q

what happens to skin ph after birth

A

falls (becomes more acidic)

32
Q

what is lanugo
what does it indicate

A

fine soft downy hair
more likely to be present if baby is preterm

33
Q

what is vernix
what are it’s benefits

A

waxy cheese like substance on baby
antimicrobial + thermoregulation- leave in situ

34
Q

what is acrocyanosis

A

transitory
bluish hands / feet
first 2-6hrs post birth

cause- delay for peripheral perfusion to be fully established

35
Q

superficial capillary naevi

when do they go

A

stork bites
mainly go in 1st year

36
Q

hyperpigmented macules

A

mongolian blue spots
usually fade over 1st year of life- some persist into adulthood

37
Q

what are strawberry naevus

A

develop after birth - grow fast in first few months, then stop.
caused by overgrowth of cells
usually shrink over few years

38
Q

what is erythema toxicum

A

small red lesions with white centre
rash can be extensive
1st week of life
NOT an infection -clears by itself

39
Q

milia

A

exposed sebaceous glands on face - disappear after 4-6wks

40
Q

p

petechiae

A

small pinpoint skin lesions- looks a bit bruised
disappear 48-72hrs

41
Q

how/ when does the cord separate

what is best way to care for cord

A

cord separation
process of ‘dry gangrene’ Saprophytic action
can become quite sticky around hte base- should gently remove sticy material.
VERY small amount of dark blood may be seen
Any further discharge- blood / serous/ purpulent may indicate infection
redness at base usually infeciton

3-7days
clamp can come off 2-3 days

42
Q

what is treatment for umbilical hernia

A

unless very large, closes spontaneously by 2-3yrs

43
Q

when can you palpate kidneys

A

1st 24-48hrs

44
Q

what is polydactyly

A

extra digits

45
Q

what is single palmar crease associated with

A

Downsyndrome T21

46
Q

What is inguinal hernia / mgmt

A

rx - consult

47
Q

when do you consult for no pasage of mec

A

36hrs post partum

48
Q

what is rx for undescended testes

A

primary

49
Q

what is expected nappy output in 1st wk

A

day 1: 1 wet nappy / 1+ mec
2: 2 wet nappies / 3+ mec
3: 3 wet nappies /3+ transitional
5-7: 6-8 wet nappies / 3-5 yellow stools

50
Q

what is traction response
when does baby have this

A

lifting baby up by hands, head lags behind
>37wks

51
Q

asymmetric tonic neck reflex

A

when baby lies on their side- limbs on same side relax, limbs on other side flex

strong / present 30-36wks

52
Q

moro reflex

A

(startle reflex)- responding to loud noise/ sudden lowering of head

53
Q

stepping response

A

simulated walking
indicates mature extension/flexion mechanisms

54
Q

Developmental dysplasia of hips
describe barlow and ortalani test

A

barlow
* test to see joint laxity / capability for joint to dislocate with ease
* procedure- lift leg and ADDUCT - testing whether head of femur slides over rim) -
“PALPABLE clunk

** ortalani
**examines for presence of dislocated hip”
procedure- ABDUCT
testing whether dislocated head can be slid back into acetabulum
palpable and audible CLUNK

55
Q

what is general attitude to early signs baby is not well

A
  • babies can become unwell very quickly
  • they don’t show signs of illness the way adults do
  • signs are often subtle- baby that has been feeding well, then stops feeding / persistent low grade jaundice
  • LISTEN to mum if she is worried
56
Q

metabolic screen
-can you use alcohol swab?

A

no -alcohol can affect accuracy of results
don’t warm foot with warm water/ warmed cloth

57
Q

when is bed sharing associated with increased SUDI risk

A

evidence indicates it is the circumstances of bedsharing that lead to SUDI risk, not bed sharing itself

vulnerable baby (not breastfed, maternal smoking, premature, young age <3mths)
impaired mum (refent maternal alcohol / drug consumption / overtired)
physical environment (excess bedding, crowding)

58
Q

what is management if baby has ‘sticky eyes’ in first week of life

A

most commonly related to inflamed tear duct

recommend
-regular cleansing of eye
gentle massage
few drops of breastmilk

if infection is suspected
- take swab for cultures + sensitivities BEFORE starting treatment

consider chlamydia if eye is red + inflamed, or infection doesn’t resolve quickly

59
Q

Persistent pulmonary hypertension of newborn

what is it
signs
risk factors

A

Fetal circulation persists at birth

signs- cyanosis

Risk factors- antidepressants

asssssment-
monitor colour + breathing

mgmt
give oxygen, check pulse oximetry, call NICU

60
Q

how do we assess risk of breastfeeding if mum is taking maternal psychotrophic meds

A

‘relative infant dose’ <10%
% baby receives s mum’s weight

61
Q

what is ‘poor neonatal adaptation’

A

collection of symptoms seen in some babies exposed to (AD’s and antipsychotics)

poor feeding, vomiting diarrhoea
tremors, irritability, lethargy
hyper/hypotonia
instable body temp
tachyapnoea
hypoglycaemia

usually mild / self resolve in <72hrs

62
Q

what are signs of baby exposed to benzodiazepines / opiates in trimester 3

A

hypotonia
hypothermia
respiratory depression
neonatal abstinence (tremors, feeding difficulty, irritability)

BUT NEVER ASSUME these signs are solely due to maternal medicine, they may also indicate baby is seriously unwell, so you need to investigate

63
Q

what is FASD

what are signs

A

Fetal alcohol syndrome disorder

umbrella term for range of lifelong physical, cognitive and beavhiour impairments including Fetal alcohol syndrome)

signs:
- small eye openings
- thin upper lip
- flat midface
- absent/ elongated groover between upper lip and nose
- low birthweight

64
Q

what is neonatal abstinance syndrome

A

sudden withdrawal of opiates

symptoms- irritability, hypertonia, tremores, feeding intolerance, respiratory distress

65
Q
A
66
Q

what is plantar reflex

A

press index under toes and toes curl inwards

67
Q

what is babinski reflex

A

place finger on outer edge- toes splay outwards

68
Q
A
69
Q

How do we support baby born to drug dependent mother

A

expect baby to be normal, except likely SGA
Don’t necessarily need NICU
DON’T GIVE NALOXONE TO BABY AT RISK OF DRUG WITHDRAWAL (MUM HAS BEEN TALKING OPIOIDS)

Assessments
vital obs
wrap snugly

signs of withdrawal
tremors, irritability, hypertonicity + hyperactivity, vomiting, high pitched cry, maybe Resp distress

70
Q
A
71
Q
A

Final exam (18 decks)

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