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RACP Written Exam Cram Series > Neonates Cram > Flashcards

Neonates Cram Flashcards

1
Q

Layers of the scalp and which bleeds occur between layers?

A 
Skin
Connective tissue
- caput - 
Apneurosis
Loose connective tissue
- cephalohaematoma - 
Periosteum
- subgaleal - 
Bone
- subdural -
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2
Q

Complications of cephalohaematoma?

A 
Underlying fracture in 10-25%
Calcification of haematoma
Skull deformity
Infection - most commonly E Coli
Hyperbilirubinaemia
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3
Q

Cause of subgaleal haemorrhage? Complications of subgaleal?

A

Shearing of emissary veins causing bleeding that crosses suture lines
Blood loss - 20-40% of circulating volume
Coagulopathy
Skull fracture
Hyperbilirubinaemia

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4
Q

Risk factors and complications of clavicle fracture?

A

Operative delivery
Shoulder dystocia
Breech

Erb’s palsy - c5-6 nerve roots “waiter’s tip”

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5
Q

Management of brachial plexus injuries?

A

Conservative
Physiotherapy
Splinting to reduce contractures
Surgical repair if absent biceps function at 6-12 weeks

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6
Q

Long term outcome following kernicterus with neurological signs?

A

75% mortality

Survivors have choreoathertoid CP

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7
Q

Mechanism of phototherapy?

A

Photochemical reaction

  1. reversible photo isomerisation converts toxic to non-toxic isomer
  2. formation of lumirubin which can be excreted by the kidneys
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8
Q

NAS peak onset RF and treatment

A
  • Usually onset D3 of life
  • 70% of of infants whose mothers on methadone
Reduce stimuli
Barrier cream
Demand feed
Pharmacological treatment indicated in 3x scores >8 or 2x >12
Morphine NOT naloxone (rapid withdrawal)
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9
Q

Facial nerve injury risk factors, presentation and management?

A

Forceps birth
Usually only mandibular branch - lip weakness when crying
Usually spontaneous resolution 2-6 weeks

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10
Q

Phrenic nerve injury presentation and management?

A

Resp depression, reduced breath sounds and hemidiaphragm on CXR
Lie on affected side
Spontaneous recovery 1-3 months. May require plication if not resolved.

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11
Q

Causes of retinal haemorrhages in neonates?

A

Late onset HMD
Meningococcal meningitis
Moderate head injury in a child w vWD
Pertussis

NOT SIDS

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12
Q

Findings in retinopathy of prematurity and RFs?

A

Small intra-retinal haemorrhages in the neo vascular ridge, may extend to vitreous seen from 32-34/40 CGA onwards

Prematurity
Low birth weight/IUGR
Oxygen therapy
Male

Laser for Gr3 and above
Long term risk of retinal detachment , myopia. strabismus, glaucoma

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13
Q

Causes of cataracts in neonate?

A 
Congenital glaucoma (most common)
HSV/Varicella infection
Birth trauma due to forceps
Dermoid tumour
Mucopolysaccharidoses
Peters anomaly
Sclerocornea
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14
Q

Cause of congenital glaucoma?

A

Improper development of aqueous outflow system
Tears in Descement membrane
Leads to raised intraocular pressure and risks loss of vision
Surgical management required

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15
Q

Key features of neonatal encephalopathy and risk factors?

A
  1. Reduced level of consciousness
  2. Difficulty initiating and maintaining respiration
  3. Depressed tone & reflexes

IUGR is strongest risk factor
70% associated with events prior to labour
- unemployment, FHx seizures/neurological disease, infertility, thyroid disease, PET, placental conditions

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16
Q

Neonatal markers of hypoxic ischaemic encephalopathy?

A

Apgar of <5 at 5min, 10min
Umbi artery acidaemia pH <7.0/base excess >12
Deep nuclear grey matter injury or watershed cortical injury on MRIB
Multi-system organ failure

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17
Q

Developmental outcomes associated with hypoxic ischaemic encephalopathy?

A

Spastic quadriplegia
Dyskinetic cerebral palsy
Death

Moderate: 5% mortality, 20% neuro sequalae
Severe: 75% mortality 90-100% neuro sequelae

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18
Q

Mechanism of therapeutic hypothermia and SEs?

A

Cooling to 33-35C within 6hrs of birth
Reduces cerebral metabolic rate, reduced apoptosis, lower nitric oxide production and free radicals and is neuroprotective
Improved survival/outcomes at 18mths

SEs:
thrombocytopenia, bradycardia, subcutaneous fat necrosis and hypercalcaemia

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19
Q

Periventricular injury outcome most associated?

A

Spastic diplegia

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20
Q

Neonatal stroke outcome most associated?

A

Spastic hemiplegia

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21
Q

Congenital infection CP associated?

A

Spastic quadriplegia

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22
Q

Severe perinatal asphyxia CP associated?

A

Dyskinetic CP

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23
Q

Grade IV intraventricular haemorrhage outcome?

A

Cerebral palsy with spastic hemiparesis if unilateral, quadriparesis if bilateral
Intellectual deficit

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24
Q

Risk factors for IVH and protective factors?

A

Chorioamnionitis
Very low birthweight or <32/40
Coag abnormalities, hypoxia, neonatal transport, CPR, mechanical ventilation
Intrapartum asphyxia

Protective:
Antenatal steroid therapy, term infant

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25
Q

Symptoms of IVH?

A

Usually asymptomatic until neurological sequqale evident in later infancy as spastic motor deficit
25-50% detected on routine CrUSS screening

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26
Q

Necrosis of cerebral white matter surrounding lateral ventricles and involving area adjacent to trigones/frontal horn?

A

Periventricular leukomalacia

Usually asymptomatic until later infancy - may have lower limb weakness

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27
Q

Area of most arterial ischaemic stroke in neonates?

A

MCA distribution
Arm and face affected > lower limb
Most common presentation is focal seizures

28
Q

Risk factors for TTN

A

Prematurity
Cesarean
Infants of diabetic mothers
Maternal asthma

29
Q

Risk factors for meconium aspiration?

A

Post-dates

SGA

30
Q

Signs of severe mechanism asp syndrome?

A

Pneumothorax/pneumomediastinum
PPHN
Pre-post ductal SpO2 difference due to R->L shunting

31
Q

Severe hypoxia in 100% FiO2
R -> L shunt. Normal heart structure on TTE
Single loud S2 +/- gallop rhythm of systolic regard murmur

A

Persistent Pulmonary Hypertension

PPHN

32
Q

Reversible causes of PPHN?

A 
Alveolar hypoxia (eg mec asp)
Sepsis
Birth asphyxia
LV dysfunction/CHD
Polycythemia
Hypoglycaemia/hypocalcaemia
33
Q

Difficult/irreversible causes of PPHN?

A

Intrauterine asphyxia
Maternal prostaglandin use, SSRI use resulting in early duct closure
Congenital diaphragmatic hernia
Primary pulmonary hypoplasia

34
Q

Management of PPHN?

A

Lower pulmonary vascular resistance by O2, respiratory alkalosis, pulmonary vasodilators
Nitric oxide - reduces PPHN by 40%

35
Q

Incidence of unilateral pneumothorax in all newborns?

A

1-2%

36
Q

Subcutaneous emphysema in neonate?

A

Pneumomediastinum

37
Q

Ventilated VLBW infant with hyperaemia and hypercarbia within first 4 days of life? May progress to reduced cardiac output

A

Pulmonary interstitial emphysema

Decrease MAP - consider HFOV - position with affected side down

38
Q

Risk factors for prev delivery?

A 
Maternal age - young/old
Cervical incompetence
Uterine malformation
Substance use (cocaine)
Maternal medical illness
Multiple pregnancy
Polyhydramnios
Fetal anomaly
Antepartum haemorrhage
Chorio
HTN/PET
39
Q

Benefit of Magnesium sulphate in premature delivery?

A

Decreases risk of cerebral palsy

40
Q

PDA incidence in prev infants?

A

30% of very low birth weight

41
Q

Complications of NEC?

A

Growth delay
Neurodev disability
Increased mortality

42
Q

Organisms most commonly associated with late onset sepsis in prems?

A

70% gram-positive organisms

50% coagulase negative staph (S epidermis, S haemolytic, S Capitis)

43
Q

Most important indicator f severity in retinopathy of prematurity?

A

Presence of plus disease

  • vessel tortuosity
  • vessel engorgement
  • pupil rigidity
  • vitreous haze
44
Q

Retinal vascularisation occurs when in gestation?

A

15-18 weeks
Vessels extend from optic disc and grow peripherally
VEGF contributes to abnormal development

45
Q

Physiology contributing to osteopenia of prematurity?

A
  1. Passage of Ca/Phos via placenta >24/40 peaks 32-36
  2. GIT absorption is poor
  3. Renal loss
46
Q

Risk factors for metabolic bone disease?

A 
Prematurity
Inactivity
Delay in establishment of enteral feeding >4/52
Short gut/NEC
CLD - steroid/diuretic treatment
47
Q

Best biochem marker for bone turnover?

A

ALP
>750 osteopenia
>1000 rickets

48
Q

Risk factors for bronchopulmonary dysplasia?

A 
Infants < 1250g (97%)
Prematurity
Male sex
PDA
Increased pulmonary artery pressure
49
Q

Prevention of BPD?

A 
Prevention of prev birth
Antenatal steroids
CPAP rather than mechanical ventilation
Early caffeine therapy
Supplemental vit A
50
Q

Complications of BPD?

A 
Pulmonary artery hypertension
Systemic hypertension
Asthma like symptoms
Sleep disordered breathing/sleep hypoxia
Resp infections
51
Q

Ear shape for gestation?

A

24 – 33 weeks: Flat, shapeless. No cartilage
34 – 35 weeks: Minor superior incurving. Minimal cartilage
36 – 38 weeks: Upper 2/3 incurving. Thin cartilage
>39 weeks: Full incurving. Cartilage.

52
Q

Sole creases for gestation?

A 
24 – 31 weeks: No anterior creases
32 – 33 weeks: 1 or 2 anterior creases
34 – 35 weeks: 3 or 4 anterior creases
36 – 37 weeks: Creases covering 2/3 of anterior sole
>38 weeks: Heel creases
53
Q

Lanugo for gestation?

A

22 - 32 weeks: entire body and face
32 - 37 weeks: body only
>38 weeks: shoulders only
>42 weeks: none

54
Q

34 week infant renal function vs term infant?

A

Reduced glomerular filtration rate

55
Q

Sugars in breastmilk?

A

Glucose

Galactose

56
Q

Ex-prem infant with resp distress and CXR shows reticular, bubbly appearance?

A

Interstitial pulmonary fibrosis

57
Q

Resp distress and scaphoid abdomen?

A

Congenital diaphragmatic hernia

58
Q

Benefits of volume guarantee ventilation?

A

Consistent tidal volume delivered

Prevents frequent desaturation

59
Q

Disadvantages of volume guarantee ventilation?

A

Volutrauma (if volume is too high)
Barotrauma if excess PIP is required to reach the volume target
Can’t be auto-weaned

60
Q

Benefits of pressure control ventilation?

A 
Limits PIP - reduces barotrauma
Adjustable IT
Reduces WOB
Improves V/Q mismatch as the pressure is achieved throughout the inspiratory cycle
Allows for spont resp
61
Q

Disadvantages of pressure control ventilation?

A

Higher variation in volume delivered

Increased WOB with spont resps

62
Q

Factors influencing oxygenation?

A

PEEP

FiO2

63
Q

Factors influencing ventilation (removal of CO2)?

A 
MAP
 - increase PIP
 - increase PEEP (makes the most difference)
 - increase inspiratory time
Resp rate
64
Q

Maternal smoking increases risk of which long term outcomes?

A 
SIDS
T2DM
Obesity
HTN
Nicotine dependance
Asthma, LRTI, reduced lung function
Impaired academic performance
ADHD, behavioural problems
Psychiatric illness
65
Q

Jaundice
Poor tone
Large anterior fontanelle
Umbi hernia

A

Hypothyroidism

66
Q

What GA can infants co-ordinate suck and swallow?

A

From 33-34 CGA

RACP Written Exam Cram Series (19 decks)

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