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neonatology Flashcards

0
Q

What is primary vs secondary apnea?

A

Primary is reversed with tactile stimulation but secondary requires positive pressure ventilation

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1
Q

What are the 5 basic causes of apnea?

A

Metabolic, infectious, neurological, cardiac and Gi

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2
Q

What is the diagnosis in a healthy newborn with respirations>60, retractions and grunting but normal CXR?

A

Transient tachypnea of the newborn

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3
Q

Newborn had increased anion gap metabolic acidosis, thrombocytopenia, high serum ammonia and elevated urine ketones, what is the likely diagnosis?

A

Organic acidemias

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4
Q

Newborn with high ammonia, high PT/PTT and serum glutamic oxaloacetic transaminase who presents with respiratory alkalosis?

A

Citrullinemia

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5
Q

What could be the cause of elevated AFP?

A

RAIN= renal disease, abdominal wall defects, incorrect dates /multiple pregnancy and neuro defects (anencephaly or spina bifida)

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6
Q

Low AFP is associated with what?

A

Trisomy 21 and 18

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7
Q

What is a measure of fetal autonomic nervous system integrity?

A

Non stress test

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8
Q

What measures uteroplacental insufficiency and tolerance of labor?

A

Stress test

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9
Q

What is included in the biophysical profile?

A

Non stress test + ultrasound for fetal movement, HR, breathing, tone and amniotic fluid

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10
Q

What is the result of deficient surfactant in alveolar lining?

A

Rds

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11
Q

What is the diagnosis and what should you do of the fetus has HR>240?

A

Svt- Give anti arrhythmic to mother to avoid congestive Heart failure and hydrops

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12
Q

What condition causes X-ray findings of granular lung opacification and air bronchograms? What is the classic description on chest xray

A

Rds - ground glass appearance

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13
Q

What are symptoms or rds?

A

Respiratory distress in the newborn. Cyanosis is possible

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14
Q

How can you distinguish RDS from pneumonia in a newborn ?

A

Calculate ratio of bands to neutrophils. If >0.2, think sepsis !

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15
Q

What 6 coexisting conditions can worsen RDS?

A 
PDA 
Hypoglycemia
Hypocalcemia
Anemia
Acidosis
Hyperbili
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16
Q

What can occur in a patient with RDS and hyperbilirubinemia?

A

Threshold for kernicterus is lower

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17
Q

What 3 factors increase the risk for RDS?

A

Diabetes, c sections, birth asphyxia

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18
Q

What 2 factors decrease the risk for RDS?

A

Prolonged rupture of membranes, prenatal steroids

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19
Q

What test can predict the risk of RDS?

A

L:S ratio > 2 suggests a low risk for RDS

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20
Q

When is mechanical ventilation indicated in a patient with RDS?

A

Ph <7.2 and pCo2 > 60

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21
Q

What 3 things does administration of surfactant cause in the lungs?

A

Decreased oxygen requirements, reduces inspiratory pressure and improved lung compliance

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22
Q

What is pulmonary interstitial emphysema ?

A

Air leak into the interstitium due to mechanical ventilation – leads to PTX

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23
Q

What is the goal po2 in an infant with RDS?

A

50-70

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24
Q

Patients on prolonged ventilator support are at risk for what and why?

A

Bronchopulmonary dysplasia due to prolonged oxygen exposure and barotrauma

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25
Q

What are the indications for ECMO?

A

Infant with reversible lung disease for less than 14 days and failure of other methods. Pt can not have intracranial bleed or congenital heart disease

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26
Q

What is the treatment of BPD and what is a side effect of this treatment?

A

Diuretics - can increase risk of hypocalcemia

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27
Q

What is found on X-ray in a newborn with BPD?

A

Diffuse opacities, cystic areas with streaky infiltrates and ground glass appearance

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28
Q

What is the name of a chronic lung disease of the newborn that is not associated with prolonged ventilator use?

A

Wilson Mikity syndrome

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29
Q

What is the difference between BPD and Wilson Mikity syndrome ?

A

BPD has inflammatory changes in lung tissues but MKS does not

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30
Q

What is the empiric treatment of neonatal sepsis?

A

Ampicillin and gentamicin

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31
Q

What bacteria should you be concerned about if infants mother had flu like illness during pregnancy?

A

Listeria

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32
Q

When toxoplasmosis infection occurs early in pregnancy, what is the risk and severity of infant infection?

A

Lower chance of infection but more severe disease

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33
Q

What are some symptoms of toxoplasmosis in a newborn?

A

Microcephaly, hydrocephaly, chorioretinitis, cerebral calcifications, jaundice and hepatosplenomegaly

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34
Q

How is diagnosis of toxoplasmosis made?

A

Immunofluorescence

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35
Q

What is the best imaging study for toxoplasmosis?

A

MRI to diagnose encephalitis if ring enhancing lesions

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36
Q

What is the difference between cmv and toxo when looking at MRI?

A

Cmv calcifications are peri ventricular but with toxoplasmosis are diffuse

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37
Q

If asymptomatic at birth, what later signs can toxoplasmosis cause?

A

Deafness, blindness, seizures, MR

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38
Q

What is the treatment for toxoplasmosis?

A

Pyrimethamine, sulfadiazine and folinic acid

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39
Q

What two palsied are associated with clavicle fracture in the newborn?

A

Erbs and phrenic nerve

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40
Q

What is the injury associated with the arm internally rotated and addicted with flexed wrist?

A

Erbs palsy, c5-7 Injury

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41
Q

What should you be concerned about if clavicle fracture leads to respiratory distress?

A

Phrenic nerve palsy

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42
Q

What is the injury associated with claw hand?

A

Klumpke palsy at C8 T1

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43
Q

What is the difference between klumpke and Erb palsy in relation to reflexes?

A

In Erb palsy the grasp reflex is intact but is lost in klumpke

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44
Q

Which palsy can be associated with Horner syndrome?

A

Klumpke

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45
Q

What two maternal conditions can cause neonatal heart block?

A

Lupus and sjogren

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46
Q

What do you do if you find a newborn with a single umbilical artery?

A

Renal ultrasound

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47
Q

What are the common complications of umbilical artery and vein catheter placement?

A

NEO CATH = Necrosis , embolize ruin (liver), omphalitis, compromised femoral pulse, accidental hemorrhage, traumatic perforation thrombosis and hepatic (dysfunction)

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48
Q

When should the umbilical cord fall of and what is the concern if it does not?

A

Should fall off by 2 weeks ; if attached past 1 month, consider leukocyte adhesion deficiency

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49
Q

When is a baby considered SGA?

A

In the lower 10th percentile for gestational age

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50
Q

When is a baby considered LGA?

A

In the upper 10th percentile for weight for gestational age

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51
Q

What is considered a full term baby?

A

38-42 weeks

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52
Q

What is seen in a post term newborn?

A

Dry peeling skin, long fingernails, decreased lanugo, ears with strong recoil

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53
Q

What is the most common cause of fetal demise?

A

Chromosomal abnormalities and congenital malformations

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54
Q

What is a normal scalp pH?

A

7.25 or higher

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55
Q

What are some causes of delayed passage of meconium?

A

Meconium plug syndrome
Hirschsprung
Imperforate anus

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56
Q

For the purpose of boards, when do you intubate a meconium baby?

A

If baby is floppy, suction and intubate

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57
Q

What is the presentation and How do you diagnose Hirschsprung’s disease?

A

No meconium passage after 48 hours or abdominal distention with diarrhea may be present - diagnosis with biopsy

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58
Q

What condition is Hirschsprung’s disease associated with?

A

Down’s syndrome

59
Q

What is meconium ileus associated with?

A

Cystic fibrosis

60
Q

What occurs in the affected segment of bowel with Hirschsprung’s ?

A

The recto-sigmoid colon is contracted and the region proximal is distended

61
Q

What do you do in an infant with bilateral ankle clonus?

A

Nothing - can be normal

62
Q

How much pressure is needed to inflate the lungs for the first breath?

A

60 mmHg

63
Q

What should you do in the presence of bradycardia and impaired ventilators efforts in a newborn?

A

Positive pressure ventilation

64
Q

How should apgars be used to determine use of CPR?

A

Do NOT wait for one minute apgar scores to decide to start CPR !

65
Q

What is the normal fetal placental weight ratio of a term baby? How should it change during pregnancy?

A

6.5 - 7

The ratio should increase progressively - if not, think of decreased fetal growth

66
Q

When should chest compressions be started in a newborn?

A

If HR <60 despite adequate ventilation

67
Q

How should chest compressions be delivered in a neonate?

A

100 per minute with one ventilation per 3 compressions

68
Q

What should you look out for in a newborn who was born at home??

A

Hemorrhage
Sepsis
Vit K deficiency and bleeding

69
Q

What is the difference between silver nitrate and erythromycin ophthalmic eye ointment

A

Silver nitrate only protects against Gonorrhea. Erythromycin is needed to prevent chlamydia infection

70
Q

What do you do for an anuric infant?

A 
Evaluate abdomen and genitals
Make sure adequate fluid intake
Cath urine specimen
Bun/creatinine
Renal ultrasound
71
Q

What is a very low birth weight infant?

A

Infant <1500 g

72
Q

What is an appropriate arterial BP of a preterm baby?

A

Should not be less than the corrected gestational age

73
Q

What must be done for every VLBW infant with no obvious cause for preterm birth?

A

Septic workup + amp and gent

74
Q

What type of fluid is appropriate for VLBW infants?

A

D10

75
Q

What bone disease is at increased risk in premies and why?

A

Rickets because of inadequate intake and absorption of calcium and phosphorus

76
Q

What is the caloric requirement for a premie?

A

120 kcal/kg/day

77
Q

What are some classic signs of NEC?

A

Bloody stool, abdominal wall erythema and thrombocytopenia

78
Q

What is the classic X-ray finding in NEC?

A

Air in the biliary tree & pneumatosis intestinalis

79
Q

What is the long term complication of NEC?

A

Intestinal strictures

80
Q

How should NEC be managed?

A

NG tube to LIS, IVF, antibiotics
Possible surgical intervention
NPO x 3 weeks

81
Q

Up to What bilirubin level is considered normal in the first 24 hours in a full term newborn?

A

12.4

82
Q

Up to what age can anemia of ABO or Rh incompatibility be seen?

A

Up to 2 months

83
Q

Which type of blood incompatibility can occur in a first born child?

A

ABO or

Rh only if previous miscarriage

84
Q

What jaundice occurs in the first few days of life due to dehydration?

A

Breast feeding jaundice

85
Q

In which type of jaundice should newborns not be given breast milk?

A

Breast milk jaundice

86
Q

When is phototherapy contraindicated?

A

Elevated direct bili or family hx of light sensitive porphyria

87
Q

What causes bronze baby syndrome ?

A

Phototherapy in a child with high conjugated (direct) bilirubin

88
Q

What should you do in a newborn <24 hours old with jaundice and why ?

A

Total and direct bili levels - elevated bili in first 24 hours is never normal

89
Q

What risk factors DECREASE incidence of neonatal jaundice?

A

Maternal heroin, smoking, alcohol and phenobarbital

90
Q

What types of endocrine disorders can cause jaundice?

A

Hypothyroid and hypopituitary

91
Q

What are two syndromes that can cause jaundice?

A

Gilbert disease and Lucy Driscoll syndrome

92
Q

What 4 causes of increased enterohepatic Circulation can lead to jaundice?

A

Obstruction, pyloric stenosis, meconium ileus, Hirschsprung’s

93
Q

What are 4 causes of jaundice that lead to elevated direct and indirect bili?

A

Galactosemia, tyrosinosis, hypermethioninemia and cystic fibrosis

94
Q

What medication can cause high bilirubin and why?

A

Sulfonamides - compete for space on albumin

95
Q

What are 4 complications of exchange transfusion ?

A

Elevated potassium, thrombocytopenia, hypocalcemia and hypovolemia

96
Q

If dextrostix accucheck read is abnormal, what is the next step?

A

Verify with serum glucose

97
Q

What is the definition of hypoglycemia in premies and full term newborns ?

A

<25 in a premie

<35 in full term newborn

98
Q

What is the most important initial step for management of very low birth weight infant?

A

Maintaining euglycemia and body temp

99
Q

How would you treat hypoglycemia in a newborn?

A

2-3 ml/kg of D10 bolus or glucagon IM

100
Q

What abnormalities should you be concerned about in a newborn born to a mother treated with tocolytics? Why?

A

Hypoglycemia ( tocolytics stimulate fetal insulin )

101
Q

What are some classic exam findings in a newborn with hypoglycemia ?

A

Jitteriness, lethargy, apnea,
Cyanosis, seizures
Tachypnea

102
Q

What are 3 common complications seen in an LGA baby?

A

Hypoglycemia , polycythemia and hypo plastic left colon

103
Q

What EKG finding may indicate hypocalcemia?

A

Prolonged QT

104
Q

What are two classic signs of hypocalcemia?

A

Chvosteks - facial twitching on tapping

Trousseau - carpopedal spasm

105
Q

What may be the cause of late onset hypocalcemia on an infant?

A

Giving cows milk causes high phosphate load on the kidneys

106
Q

What is the definition of hypocalcemia?

A

Ionized Ca < 4.5 or

Total Ca < 8.5

107
Q

What problem should you think of in an infant born to a mother on mag sulfate? Why?

A

Hypocalcemia - high mag will decrease PTH secretion

108
Q

How do you treat hypocalcemia ?

A

Increase calcium in IV or with calcium gluconate

109
Q

What test will detect fetal cells in mothers blood?

A

Kleihauer Betke

110
Q

What percentage of hgb is fetal hgb at birth?

A

50%

111
Q

What hgb level is considered to be “anemia” in a full term infant?

A

< 13

112
Q

What meets the criteria for polycythemia ?

A

Central venous hct >65 (not valid in heelstick)

113
Q

What are the complications of having polycythemia in a newborn?

A

Hypoglycemia, hyperbilirubinemia and thrombocytopenia

114
Q

When and what is the treatment for polycythemia ?

A

HCT >70 needs partial exchange transfusion

115
Q

What is the apt test?

A

Test for maternal blood in neonatal gastric aspirate

116
Q

What is a common cause of thrombocytopenia in a newborn?

A

Maternal ITP

117
Q

When do you see early onset hemorrhage in a newborn?

A

Within 3 days in Breast fed babies not given vitamin K

118
Q

What 3 medications may increase risk of hemorrhagic disease in the newborn?

A

Anticoagulants
Anticonvulsants
Antibiotics (tb meds, cephalosporins and quinolones)

119
Q

When should you give oral vitamin k in a newborn?

A

Never - it is insufficient for preventing hemorrhagic disease

120
Q

What test would you order in a newborn with protein and blood in the urine?

A

Renal ultrasound - look for ATN

121
Q

What is the cause and prognosis of a newborn with a seizure in the first 24 hours of life?

A

Birth asphyxia - likely to NOT have long term neuro developmental sequelae

122
Q

What is the initial drug of choice in a newborn with seizure ?

A

Phenobarbital

123
Q

What causes hyperalimentation induced cholestasis?

A

Protein intake > 2g/kg/day

124
Q

What medication can be used to treat hyperalimentation induced cholestasis?

A

Phenobarbital to stimulate bile secretion and decrease serum bili level

125
Q

What are some syndromes associated with cleft lip/palate?

A

Crouzon syndrome, apert and treacher Collins

126
Q

What are 4 common findings in beckwith wiedemann syndrome?

A

Omphalocele
Macroglossia
Macrosomia
Hypoglycemia

127
Q

How is gastroschisis different than omphalocele?

A

It is not covered by a membrane and only involves intestinal contents because it is near the umbilicus (not through the umbilicus like omphalocele)

128
Q

What is the most important goal in management of gastroschisis ?

A

Keep bowel moist!

129
Q

Which is associated with chromosomal defect, omphalocele or gastroschisis ?

A

Omphalocele

130
Q

What syndrome is TE fistula commonly associated with?

A

VACTERL

131
Q

What should you think in a patient with scaphoid abdomen?

A

Diaphragmatic hernia

132
Q

How do you manage TE fistula?

A

Protect the airway from secretions with auctioning and elevating the head

133
Q

What is an imperforate anus with a high obstruction?

A

Fistula connects into vagina or urinary tract

134
Q

What are grades 1-4 of IVH?

A

Grade 1 = germinal matrix
Grade 2 = IVH without dilation
Grade 3 = IVH with dilation
Grade 4 = IVH plus parenchymal involvement

135
Q

What is soft putting that crosses suture lines?

A

Caput succedaneum

136
Q

what is a firm bulge on the scalp that does not cross suture lines?

A

Ceohalohematoma

137
Q

How do you image an unstable vs stable newborn with suspected IVH?

A

Ultrasound if unstable

CT if stable

138
Q

What May terbutaline increase the risk for in a newborn?

A

Hyperinsulinemia and hypoglycemia

139
Q

What are 4 neonatal complications associated with maternal cocaine use?

A

Placental abruption
Cerebral infarction
Limb anomalies
Urogenital defects

140
Q

What symptoms are associated with alcohol withdrawal?

A

Hyperactivity, irritability and hypoglycemia

141
Q

What 4 symptoms are associated with barbiturate withdrawal?

A

Hyperactivity
Hyperphagia
Irritability
Poor suck swallow

142
Q

Cigarette smoking is associated with increased risk for what?

A

Low birthweight
Miscarriage
Prematurity
Cleft lip/palate

143
Q

What 6 symptoms are associated with opioid withdrawal ?

A 
Irritability
Tremors
Hypertonic
Diarrhea/vomiting 
Feeding difficulties
Seizures
144
Q

Of the following choices, What is the most important thing to do within the first hour of life?
A. Vitamin K
B. Erythromycin eye drops
C. Skin to skin contact w mother

A

Skin to skin contact

145
Q

You are presented with a 2 month old infant who “cries continuously”. Mother reports 1 hour of crying at 1 am and then 2 hours of crying at 5 am. What should you do?

A

Reassurance.

Crying of up to 3 hours per day is normal in infants >6 weeks old

pediatric Boards (23 decks)

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