Neonatology

Question 1

APGAR

Answer 1

APGAR (0, 1, 2 in each category)

Appearance (blue/pale, pink trunk, all pink)

Pulse (0, 100)

Grimace with stimulation (0, grimace, grimace and cough)

Activity (limp, some, active)

Respiratory effort (0, irregular, regular)

Question 2

APGAR Scores

Answer 2

Scores of 8–10: Typically reflect good cardiopulmonary adaptation.
Scores of 4–7: Indicate the possible need for resuscitation. Infants should be observed, stimulated, and possibly given ventilatory support.
Scores of 0–3: Indicate the need for immediate resuscitation.

Question 3

A complication of unconjugated hyperbilirubinemia that results from irreversible bilirubin deposition in the basal ganglia, pons, and cerebellum. It typically occurs at levels of > 25–30 mg/dL and can be fatal

Answer 3

Kernicterus

Question 4

Treatment of unconjugated hyperbilirubinemia versus conjugated hyperbilirubinemia and can lead to skin bronzing.

Answer 4

Treat unconjugated hyperbilirubinemia with phototherapy (for mild elevations) or exchange transfusion (for severe elevations > 20 mg/dL). Start phototherapy earlier (10–15 mg/dL) for preterm infants. Phototherapy is not indicated for conjugated hyperbilirubinemia and can lead to skin bronzing.

Question 5

The most common cause of respiratory failure in preterm infants

Answer 5

Respiratory distress syndrome

Question 6

1. “Ground-glass” appearance, diffuse atelectasis, and air bronchograms on CXR.
2. Retained amniotic fluid results in prominent perihilar streaking in interlobular fissures. Resolves with O₂ administration.

Answer 6

1. RDS

2. TTN

Question 7

1. Coarse, irregular infiltrates; hyperexpansion and pneumothoraces.
2. Nonspecific patchy infiltrates; neutropenia, tracheal aspirate, and Gram stain suggest the diagnosis.

Answer 7

1. Meconium aspiration

2. Pneumonia

Question 8

An Lecithin to Sphingomyelin ratio ____ indicates a need for maternal glucocorticoid administration.

Question 9

Hernia tin of the intestine through an abdominal defect next to the umbilicus usually on the right (no sac)

Answer 9

Gastrochisis

Question 10

Hernia toon of the abdominal viscera at the umbilicus

Answer 10

Omphalocoele

Question 11

Double bubble sign

Bilous Emesis after the first feeding

Answer 11

Duodenal atresia

Question 12

Not present until 72 hours after birth

Answer 12

Physiologic jaundice

Question 13

ESSENTIAL INTRAPARTUM NEWBORN CARE

Answer 13

1. Immediate and thorough Drying
2. Early Skin to skin contact
3. Properly-timed cord clamping
4. Non-separation of mother and baby

Question 14

Newborn Screening Tests include (6)

Answer 14

Congenital hypothyroidism
CAH
Galactosemia
g6PD
MSUD
phenylketonuria

Question 15

Normal birth wt and length
Delayed development
Sluggish
Feeding difficulties
Hypothermia 
Prolonged physiologic jaundice 
Edema of genitals

Answer 15

Congenital hypothyroidism

Question 16

Enzyme deficiency in congenital adrenal hyperplasia

Answer 16

21-hydroxylase enzyme = cortisol deficiency

Question 17

Vomiting, failure to thrivePseudohermaphroditism
Low serum Ma Co cortisol
High K
Increased 17-hydroxyprogesterone

Answer 17

Congenital Adrenal Hyperplasia

Question 18

Symptoms develop 1-2 days after exposure to oxidant properties
Exposure causes hemolysis
Jaundice
Anemia
Acute renal failure
Heinz bodies

Answer 18

G6PD

Question 19

Substances with oxidant properties

Answer 19

Sulfonamide 
Nalidixc acid
Nitro duration
Chloramphenicol
Antimalarials
Vitamins K analogs
ASA 
Benzene
Naphthalene

Question 20

Enzyme deficiency in phenylketonuria

Answer 20

Phenylalanine hydroxylase

Question 21

Vomiting
Hypertonic
Hyperactive DTRs
Seizures 
Athetoid
Unpleasant misty odor

Answer 21

Phenylketonuria

Question 22

Accumulation of branched chain ketoacid due to defective branched chain alpha ketoacid dehydrogenase complex

Irritability 
Poor feeding
Maple syrup odor
Encephalopathy
Central respiratory failure

Answer 22

MSUD

Question 23

Essential Amino acids for removal in MSUD

Answer 23

Valine
Isoleucine
Leucine

Question 24

Subperiosteum bleed due to birth trauma

Does not cross suture lines

Answer 24

Cephalhematoma

Question 25

Diaphragmatic hernia posterolateral portion of the diaphragm

Answer 25

Bochdalek form

Question 26

Scaphoid abdomen and increased chest wall diameter

Answer 26

Diaphragmatic hernia

Question 27

Accumulation of fluid in tunica vaginalis

Answer 27

Hydrocele

Question 28

1. Lateral to Epigastric vessels and projects through Inguinal ring
2. Medial to Epigastric vessels and projects through the abdominal wall

Answer 28

1. Indirect Inguinal hernia

2. Direct Inguinal hernia

Question 29

If testes has not descended by ____ months it will remain undescended

Answer 29

4 months

Question 30

Most common cause of PPHN

Answer 30

Meconium Aspiration Syndrome

Question 31

DIRECT COOMBS positive
Spherocytes in blood smear
Increased retic count
Increased B1
Jaundice
Mild hepatosplenomegaly

Answer 31

ABO incompatibility