Neonatology Flashcards
Duodenal atresia, AVSD, hypotonia, myelodysplasia
Associated with which chromosomal abnormality? A. Trisomy 13 B. Trisomy 18 C. Trisomy 21 D. Sex chromosome aneuploidy
C. Trisomy 21
Cutis aplasia, cleft lip/palate, postaxial polydactyly
Associated with which chromosomal abnormality? A. Trisomy 13 B. Trisomy 18 C. Trisomy 21 D. Sex chromosome aneuploidy
A. Trisomy 13
Coarctation, lymphedema, nuchal skin fold
Associated with which chromosomal abnormality? A. Trisomy 13 B. Trisomy 18 C. Trisomy 21 D. Sex chromosome aneuploidy
D. Sex chromosome aneuploidy
Overlapping fingers, SGA, rocker bottom feet
Associated with which chromosomal abnormality? A. Trisomy 13 B. Trisomy 18 C. Trisomy 21 D. Sex chromosome aneuploidy
B. Trisomy 18
During your postnatal ward round at a busy Canadian level II centre, in which of these scenarios are you least likely to recommend breastfeeding?
- Mother is HIV positive on antiretroviral medications
- Mother has a single oral lesion consistent with HSV
- Mother has a history of Hepatitis B acquired in childhood
- Mother is in a methadone program and drug screens are consistently negative for other substances
- Mother is HIV positive on antiretroviral medications
Which of the following is the most likely association found in the neonate?
- Maternal Graves disease – hyperthyroidism
- Maternal diabetes mellitus – hyperglycemia
- Maternal hyperparathyroidism – hyponatremia
- Maternal SLE – supraventricular tachycardia
- Maternal vitamin D deficiency – hypercalcemia
- Maternal Graves disease – hyperthyroidism
Which of the following constellations of features BEST describes fetal alcohol syndrome?
- Elfin facies, irritability, and supravalvular aortic stenosis
- Growth deficiency, microcephaly, developmental delay, short palpebral fissures
- IUGR, triangular-shaped face, clinodactyly
- Short stature, webbed neck, pulmonic stenosis
- Weakness, club feet, immobile face, inadequate respirations
- Growth deficiency, microcephaly, developmental delay, short palpebral fissures
You are counseling a mother who is worried that her baby will need breathing support. Which of the following is NOT a significant risk factor for the development of respiratory distress?
- This is a triplet pregnancy
- Mother’s HbA1c is 9%
- Mother reports heroin use
- Mother’s previous two babies were born at 30 weeks and 28 weeks gestation
- Mother reports heroin use
Which of the following is correct regarding intrauterine growth restriction (IUGR)?
- It is commonly associated with methadone use in pregnancy
- IUGR infants at increased risk of hemolytic disease due to ABO incompatibility
- IUGR infants may be found to have leukocytosis and elevated CRP due to in-utero inflammation
- IUGR infants may be found to have polycythemia and thrombocytopenia on blood smear
- IUGR infants may be found to have polycythemia and thrombocytopenia on blood smear
Which of the following is the correct association?
- Oesophageal atresia – oligohydramnios
- IUGR – oligohydramnios
- Posterior urethral valves – polyhydramnios
- Renal agenesis - polyhydramnios
- IUGR – oligohydramnios
Which of the following is correct regarding Vitamin K in the newborn?
- Is an essential cofactor for the synthesis of coagulation factors II, VIII, IX, X
- Is readily transported across the placenta
- Is present in cow’s milk at higher concentration than in breast milk
- Single oral dose after delivery prevents hemorrhagic disease of the newborn
- Is present in cow’s milk at higher concentration than in breast milk
Which is correct? In a healthy baby the transition from fetal to neonatal circulation involves:
- Closure of the ductus venosus, (becoming the ligamentum of teres), the fetal connection from the umbilical arteries
- Functional closure of the foramen ovale in response to increased left atrial pressure
- Blood flow in the ductus arteriosis continuing to shunt right to left until it closes
- The ductus arteriosus closing in response to decreasing Pa02
- Functional closure of the foramen ovale in response to increased left atrial pressure
Which of the following is least likely to be picked up using pulse oximetry screening?
- Pulmonary atresia with intact septum
- Total anomalous pulmonary venous return
- Truncus arteriosus
- Unbalanced atrioventricular septal defect
- Unbalanced atrioventricular septal defect
Which of the following perinatal management strategies is least effective at reducing brain injury in the preterm?
- Antenatal steroids for mothers at risk of preterm labour <34+6 weeks and Magnesium sulphate for mothers at risk of preterm labour < 33+6 weeks
- Treatment of chorioamnionitis with penicillin + macrolide in mothers <32+6 weeks with PPROM
- Delayed umbilical cord clamping from 30 – 120s and therapeutic hypothermia if baby meets criteria A/B + C for hypoxic ischemic encephalopathy
- Vasopressors in hypotension and prophylactic indomethacin to close the patent ductus arteriosis
- Ventilation: volume targeted, target PCO2 45-55 mmHg (avoid <35 and > 60) in 1st 72 hours
- Delayed umbilical cord clamping from 30 – 120s and therapeutic hypothermia if baby meets criteria A/B + C for hypoxic ischemic encephalopathy
Which of the following are not associated with the harmful effects of oxygen?
- Retinopathy of prematurity
- Hypoxic ischemic encephalopathy
- Hemolytic disease of the newborn
- Cerebral palsy
- Hemolytic disease of the newborn
38 week GA, elective c-section, grunting at 10 minutes - RR of 70 and minimal indrawing. O2 saturations are 98% in room air. What do you do next?
- Skin to skin with mom, reassess
- CPAP, PEEP 5 cm H2O
- Give a dose of sedation to decrease work of breathing and prevent flipping into PPHN
- Full septic work-up and start antibiotics
- Skin to skin with mom, reassess
41 week baby, meconium at delivery. At 60 minutes: spontaneous respiratory efforts with significant work of breathing on mask CPAP PEEP 7 in 100% FiO2. Saturations are 88% and she has peripheral IV access. Cap gas is: 7.16/65/36/17. Your next step is to:
- Confirm the diagnosis of meconium aspiration syndrome with a CXR
- Intubate using sedation and muscle relaxation
- Increase PEEP to 8 and reassess
- Insert a UVC and UAC for better access and PaO2 monitoring
- Intubate using sedation and muscle relaxation
Baby with meconium aspiration and PPHN. Patient is placed on settings of PIP 20, PEEP 5, rate of 40, still in 100%, saturations of 88-90%. She has frequent desaturations to the 50%, is labile with handling and is asynchronous on the ventilator. What is the next most appropriate action?
- Increase the rate to 60 to improve oxygenation
- Increase the PEEP to 7 to improve CO2 clearance
- Continue ongoing sedation and muscle relaxation to improve ventilation and oxygenation
- Give a bolus of normal saline 10ml/kg
- Continue ongoing sedation and muscle relaxation to improve ventilation and oxygenation
Baby has meconium aspiration and PPHN. With sedation, the baby is less labile, saturations 88-92%. Current settings are 22/7 rate 50 in 100% FiO2. The blood pressure is 40/19 Gas from arterial line: pH 7.20 PaCO2 45 PaO2 36 Bicarb 14 base deficit -10. Which of the following is correct?
- There is a significant respiratory acidosis that needs to be corrected
- The kidneys are over-compensating for the ventilator induced respiratory alkalosis
- The babies biggest problem is severe hypoxemia
- The gas cannot be interpreted because there is an air bubble in the sample
- The babies biggest problem is severe hypoxemia
Baby has meconium aspiration and PPHN. Gas: 7.19/45/36/14/-10. In this baby, what is the likely etiology of the acidosis?
- Pneumonia with systemic inflammatory response (vasodilatory shock), secondary to the meconium aspiration
- Over-ventilation and squeezing the heart with high peak inspiratory pressure
- Decreased left cardiac output due to high right sided pressures and subsequent poor filling
- Adrenal insufficiency causing systemic hypotension as a consequence of the prolonged resuscitation
- Decreased left cardiac output due to high right sided pressures and subsequent poor filling
Which of the following congenital anomalies would most likely require immediate surgical treatment in the first week of life?
- Congenital cystic malformation of the lung
- Tracheoesophageal fistula
- Bilateral cleft lip and palate
- Laryngomalacia
- Tracheoesophageal fistula
38 week infant having intermittent desaturations since birth. On low flow O2 which is ‘occasionally helpful’. You find him placed side lying with a few rolls, with significant work of breathing. For this baby, which of the following is correct?
- You should place this baby supine, he is term and is at risk of SIDS
- You should place this baby prone, this will facilitate breathing
- When examining the palate, you should avoid digital palpation
- An oral airway or LMA is contraindicated in babies with this phenotype
- You should place this baby prone, this will facilitate breathing
26 weeks, 900g infant, now 20 minutes old is on CPAP PEEP 6 in 28% oxygen. The medical student on the team asks whether you plan to intubate the baby and administer surfactant. Which of the following is true?
- Surfactant increases the incidence of air leaks in RDS
- Administration of exogenous surfactant will inhibit endogenous surfactant production, this is why a trial of CPAP is first attempted
- Administration of surfactant improves arterial oxygenation
- Surfactant administration reduces the incidence and severity of chronic lung disease
- Administration of surfactant improves arterial oxygenation
26 weeker, intubated, post BLES. At 4 hours of age: Arterial gas: pH 7.30 PaCO2 35 PaO2 35 Bicarb 20; PIP 15cm H20, PEEP 5cm H2O, rate 40 (RR70), FiO2 60%. What is the most appropriate ventilator setting change at this time?
- Increase PIP
- Increase PEEP
- Increase rate
- Decrease FiO2 to decrease ROP risk
- Increase PEEP