Neonatal Medicine

Question 1

When to suspect RD in term infants ?

Answer 1

>60 breaths per minute
Labored breathing with chest wall recession (sternal and subcostal)
Nasal flaring
Expiratory grunting
Cyanosis

Question 2

X ray of TTN shows?

Answer 2

Fluid in the horizontal fissure

Question 3

Non pulmonary causes of RD?

Answer 3

CHD
Sever anemia
Metabolic acidosis
Hypoxic ischemic / neonatal encephalopathy

Question 4

Meconium aspiration could be passed antenatally because of?

Answer 4

Fetal hypoxia

Question 5

Meconium aspiration pathophysiology 3?

Answer 5

Mechanical obstruction
Chemical pneumonitis
Predispose to infection

Question 6

X-ray of meconium aspiration?

Answer 6

Hyperinflation lung
Patches of consolidation and collapse
High incidence of leak causing pneumothorax and pneumomediastinum.

Question 7

Infants with meconium aspiration are at risk of? And it makes it difficult to?

Answer 7

Persistent Pulmonary hypertension of the newborn

Achieve adequate oxygenation.

Question 8

Does tracheal suction or removal of meconium with intubation reduce the the severity of the aspiration ?

Answer 8

No evidence

Question 9

RFs for pneumonia?

Answer 9

Prolonged rupture of membrane
Chorioamnoitis
Low birth weight

Question 10

What predispose the infant to milk aspiration?

Answer 10

Neurological damage
Preterm infant 
RD
BPD( GER is causing the aspiration )
Cleft palate

Question 11

Persistent pulmonary hypertension of the newborn is associated with?

Answer 11

Meconium aspiration
RDS
Septicemia
Birth asphyxia

Question 12

Management of PPHN?

Answer 12

Mechanical ventilation
Inhaled nitric oxide
Sildenafil
ECMO

Question 13

How to suspect DH?

Answer 13

Failure to respond to resuscitation

RD

Question 14

Once diagnosis of DH is made what to do and why?

Answer 14

Large NGT is passed and suction applied to prevent distention of the intrathoracic bowel.

Question 15

RD sign of heart failure what should you palpate ?

Answer 15

Femoral artery (AC) or interrupted aortic arch

Enlarged liver from venous congestion.

Question 16

Early onset sepsis start? Caused by?

Answer 16

Less than 48 hours

Ascend from birth canal to amniotic fluid then direct contact with the lung from AF

Question 17

In contrast to early onset infection pathophysiology, how is congenital viral and listeria acquired?

Answer 17

Via Placenta

Question 18

CRP takes how long to rise?

Answer 18

12-24 hrs

Question 19

Causes of late onset infection

Answer 19

Neonate environment
CVL for parenteral nutrition
Tracheal tubes
Invasive procedure breaking skin barrier

Question 20

How to monitor response to therapy with ABX ?

Answer 20

CRP levels monitoring

Question 21

Conjunctival chlamidya usually present? Identified with? Treated with? Screen?

Answer 21

1-2 week after birth but may present shortly
Immunoflorescent staining
Erythromycin for 2 week
Screen the partner

Question 22

Umbilical infection if the skin surrounding it inflamed give?

Answer 22

Systemic antibiotics

Question 23

If the umbilicus is still sticky suspect and not involuting ? Treat with?

Answer 23

Umbilical granuloma
Apply silver nitrate and protect surround skin
Apply ligature around the base

Question 24

Causes of hypoglycemia

Answer 24

Polycythemia
IUGR 
Large for dates
Preterm
Mother with DM
Hypothermic

Question 25

Symptoms of hypoglycemia

Answer 25

``` Jitters Lethargy Apneoa seizures Irritability Drowsiness ```

Question 26

What happens if glucose got extravasated into the skin?

Answer 26

Necrosis and reactive hypoglycemia

Question 27

How to prevent hypoglycemia?

Answer 27

Early and frequent milk feeding

Question 28

When to give glucose infusion?

Answer 28

If two reading below 2.6 despite adequate feeding One very low below 1.6 Symptomatic

Question 29

How to recognize seizures from normal movement?

Answer 29

Unstimulated repetitive rhythmic movement despite restraint | Accompanied by eye movement and changes in respiration