Neonatal Medicine

Question 1

features of respiratory distress of the newborn

Answer 1

tachypnoea (>60 breaths/min), grunting, intercostal recession, nasal flare, cyanosis

Question 2

what is meconium aspiration syndrome?
how is it investigated?
how is it treated?

Answer 2

Aspiration of meconium during delivery causing pneumonitis
Chest x ray – patchy infiltrates
Tx : surfactant

Question 3

what causes persistent pulmonary hypertension of the newborn (PPHN)

Answer 3

high pulmonary vascular pressure causing left-right shunting + poor oxygenation

Question 4

tx of PPHN

Answer 4

nitric oxide (pulmonary vasodilator)

Question 5

chest xray findings in heart failure secondary to congenital heart disease

Answer 5

cardiomegaly and pulmonary oedema

Question 6

ground glass appearance on CXR

Answer 6

acute respiratory distress syndrome

Question 7

tx of acute respiratory distress syndrome

Answer 7

steroids
exogenous surfactant
respiratory support (Invasive ventilation/continuous positive airway pressure/oxygen)

Question 8

what causes transient tachypnoea of newborn

Answer 8

delay in resporption of lung fluid

Question 9

what is seen on CXR in transient tachypnoea of newborn

how is it treated?

Answer 9

fluid in horizontal fissure

resolves spontaneously in a few days

Question 10

what is a patent ductus arteriosus (PDA)

Answer 10

failure of ductus arterious to close between descending aorta and pulmonary trunk leading to left-right shunting and fluid overload – heart failure

Question 11

features of PDA

Answer 11

continuous machine like murmur
bounding pulse
wide pulse pressure

Question 12

what closes PDA in majority of cases?

Answer 12

indomethacin - inhibits prostaglandin synthesis

Question 13

what is given if surgical repair required for congenital heart defect?

Answer 13

prostaglandins- keep duct open until surgical repair

Question 14

organism responsible for conjunctivitis in newborns

Answer 14

chlamydia

Question 15

what does jaundice within 24hrs indicate

Answer 15

PATHOLOGY

• rhesus / ABO incompatibility
• glucose 6 phosphate deficiency
• hereditary spherocytosis

Question 16

when are rhesus -ve mothers offered prophylactic anti- D

Answer 16

28 + 34 weeks

15000 units

Question 17

what events in pregnancy would a rhesus -ve mother get anti-D

Answer 17

ectopic pregnancy
amniosentisis
trauma e.g. any vaginal bleeding/miscarriage

Question 18

dose of anti-D given after delivery to rhesus -ve mother

Answer 18

500 units

Question 19

when should anti-D not be given after delivery

Answer 19

if Coombs test +ve / infant bilirubin raised

it is too late

Question 20

what is G6PD

Answer 20

lack of glutathione which combats oxidative stress

- intravascular haemolysis

Question 21

inheritance of G6PD

Answer 21

X linked recessive

Question 22

what is seen on blood film of G6PD

Answer 22

heinz bodies

Question 23

most common cause of jaundice day 2-14

Answer 23

physiological

Question 24

presentation of cephalohaematoma

Answer 24

swelling of head 24-48 hours post birth

• clear edges that end at suture lines
• most common parietal region
• discolouration of the swollen site due to presence of coagulated blood – may need transfusion/phototherapy if significant
• can take months to resolve

Question 25

presentation of caput succedaneum

Answer 25

swelling of head present at birth

• diffuse boggy swelling that crosses suture lines
• typically seen at vertex
• resolves within days

Question 26

most common cause of meningitis in neonate

Answer 26

Group B strep

Question 27

ratio of compression to ventilation in newborn resuscitation

Answer 27

3:1

Question 28

death in the neonatal period is defined as what ?

Answer 28

death in first 28 days of life

Question 29

what injection is given shortly after birth + why?

Answer 29

One off IM Vit K injection to prevent haemorrhage disease of the newborn

Question 30

when is the heel-prick test performed

Answer 30

between 5 - 9 days old

Question 31

what is the heel-prick test looking for

Answer 31

Cystic fibrosis

- if raised immunoreactive trypsinogen (IRT) the baby will then get a sweat test

Question 32

causes of hypotonia in a neonate

Answer 32

sepsis
hypothyroidism
Prader-Willi syndrome

Question 33

most common causative organism in neonatal sepsis

Answer 33

Group B strep

Question 34

steps of neonatal resus

Answer 34

1. dry baby
2. assess tone, breathing, HR
3. open airway – 5 inflation breaths
4. 3:1 compressions to breaths

Question 35

what hearing test is offered to newborns?

what test is then offered if findings are abnormal?

Answer 35

otoacoustic emissions test

- offered auditory brainstem response if abnormal

Question 36

features of shaken baby syndrome

Answer 36

retinal haemorrhages
subdural haematoma
encephalopathy

Question 37

causes of pulmonary hypoplasia

Answer 37

pulmonary hypoplasia = underdeveloped lungs
causes
- oligohydramnios
- congenital diaphragmatic hernia

Question 38

signs of a congenital diaphragmatic hernia

Answer 38

scaphoid (concave) abdomen
displaced apex beat
decreased air entry

Question 39

what is meconium aspiration syndrome

Answer 39

respiratory distress as a result of meconium in the trachea
increased risk if:
post term
lateral HTN / pre-eclampsia

Question 40

presentation of choanal atresia

Answer 40

cyanosis when feeding that improves when baby cries

Question 41

features of fetal alcohol syndrome

Answer 41

IUGR
microcephaly
microganthima 
smooth / absence philtre 
thin lip 
short palpebral fissures