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Hamilton 2020 Questions > Neonatology > Flashcards

Neonatology Flashcards

1
Q

Duodenal atresia, AVSD, hypotonia, myelodysplasia

Associated with which chromosomal abnormality? 
A. Trisomy 13
B. Trisomy 18
C. Trisomy 21
D. Sex chromosome aneuploidy
A

C. Trisomy 21

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2
Q

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

A. Trisomy 13

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3
Q

Coarctation, lymphedema, nuchal skin fold

Associated with which chromosomal abnormality? 
A. Trisomy 13
B. Trisomy 18
C. Trisomy 21
D. Sex chromosome aneuploidy
A

D. Sex chromosome aneuploidy

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4
Q

Overlapping fingers, SGA, rocker bottom feet

Associated with which chromosomal abnormality? 
A. Trisomy 13
B. Trisomy 18
C. Trisomy 21
D. Sex chromosome aneuploidy
A

B. Trisomy 18

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5
Q

During your postnatal ward round at a busy Canadian level II centre, in which of these scenarios are you least likely to recommend breastfeeding?

  1. Mother is HIV positive on antiretroviral medications
  2. Mother has a single oral lesion consistent with HSV
  3. Mother has a history of Hepatitis B acquired in childhood
  4. Mother is in a methadone program and drug screens are consistently negative for other substances
A
  1. Mother is HIV positive on antiretroviral medications
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6
Q

Which of the following is the most likely association found in the neonate?

  1. Maternal Graves disease – hyperthyroidism
  2. Maternal diabetes mellitus – hyperglycemia
  3. Maternal hyperparathyroidism – hyponatremia
  4. Maternal SLE – supraventricular tachycardia
  5. Maternal vitamin D deficiency – hypercalcemia
A
  1. Maternal Graves disease – hyperthyroidism
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7
Q

Which of the following constellations of features BEST describes fetal alcohol syndrome?

  1. Elfin facies, irritability, and supravalvular aortic stenosis
  2. Growth deficiency, microcephaly, developmental delay, short palpebral fissures
  3. IUGR, triangular-shaped face, clinodactyly
  4. Short stature, webbed neck, pulmonic stenosis
  5. Weakness, club feet, immobile face, inadequate respirations
A
  1. Growth deficiency, microcephaly, developmental delay, short palpebral fissures
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8
Q

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?

  1. This is a triplet pregnancy
  2. Mother’s HbA1c is 9%
  3. Mother reports heroin use
  4. Mother’s previous two babies were born at 30 weeks and 28 weeks gestation
A
  1. Mother reports heroin use
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9
Q

Which of the following is correct regarding intrauterine growth restriction (IUGR)?

  1. It is commonly associated with methadone use in pregnancy
  2. IUGR infants at increased risk of hemolytic disease due to ABO incompatibility
  3. IUGR infants may be found to have leukocytosis and elevated CRP due to in-utero inflammation
  4. IUGR infants may be found to have polycythemia and thrombocytopenia on blood smear
A
  1. IUGR infants may be found to have polycythemia and thrombocytopenia on blood smear
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10
Q

Which of the following is the correct association?

  1. Oesophageal atresia – oligohydramnios
  2. IUGR – oligohydramnios
  3. Posterior urethral valves – polyhydramnios
  4. Renal agenesis - polyhydramnios
A
  1. IUGR – oligohydramnios
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11
Q

Which of the following is correct regarding Vitamin K in the newborn?

  1. Is an essential cofactor for the synthesis of coagulation factors II, VIII, IX, X
  2. Is readily transported across the placenta
  3. Is present in cow’s milk at higher concentration than in breast milk
  4. Single oral dose after delivery prevents hemorrhagic disease of the newborn
A
  1. Is present in cow’s milk at higher concentration than in breast milk
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12
Q

Which is correct? In a healthy baby the transition from fetal to neonatal circulation involves:

  1. Closure of the ductus venosus, (becoming the ligamentum of teres), the fetal connection from the umbilical arteries
  2. Functional closure of the foramen ovale in response to increased left atrial pressure
  3. Blood flow in the ductus arteriosis continuing to shunt right to left until it closes
  4. The ductus arteriosus closing in response to decreasing Pa02
A
  1. Functional closure of the foramen ovale in response to increased left atrial pressure
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13
Q

Which of the following is least likely to be picked up using pulse oximetry screening?

  1. Pulmonary atresia with intact septum
  2. Total anomalous pulmonary venous return
  3. Truncus arteriosus
  4. Unbalanced atrioventricular septal defect
A
  1. Unbalanced atrioventricular septal defect
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14
Q

Which of the following perinatal management strategies is least effective at reducing brain injury in the preterm?

  1. 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
  2. Treatment of chorioamnionitis with penicillin + macrolide in mothers <32+6 weeks with PPROM
  3. Delayed umbilical cord clamping from 30 – 120s and therapeutic hypothermia if baby meets criteria A/B + C for hypoxic ischemic encephalopathy
  4. Vasopressors in hypotension and prophylactic indomethacin to close the patent ductus arteriosis
  5. Ventilation: volume targeted, target PCO2 45-55 mmHg (avoid <35 and > 60) in 1st 72 hours
A
  1. Delayed umbilical cord clamping from 30 – 120s and therapeutic hypothermia if baby meets criteria A/B + C for hypoxic ischemic encephalopathy
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15
Q

Which of the following are not associated with the harmful effects of oxygen?

  1. Retinopathy of prematurity
  2. Hypoxic ischemic encephalopathy
  3. Hemolytic disease of the newborn
  4. Cerebral palsy
A
  1. Hemolytic disease of the newborn
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16
Q

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?

  1. Skin to skin with mom, reassess
  2. CPAP, PEEP 5 cm H2O
  3. Give a dose of sedation to decrease work of breathing and prevent flipping into PPHN
  4. Full septic work-up and start antibiotics
A
  1. Skin to skin with mom, reassess
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17
Q

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:

  1. Confirm the diagnosis of meconium aspiration syndrome with a CXR
  2. Intubate using sedation and muscle relaxation
  3. Increase PEEP to 8 and reassess
  4. Insert a UVC and UAC for better access and PaO2 monitoring
A
  1. Intubate using sedation and muscle relaxation
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18
Q

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?

  1. Increase the rate to 60 to improve oxygenation
  2. Increase the PEEP to 7 to improve CO2 clearance
  3. Continue ongoing sedation and muscle relaxation to improve ventilation and oxygenation
  4. Give a bolus of normal saline 10ml/kg
A
  1. Continue ongoing sedation and muscle relaxation to improve ventilation and oxygenation
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19
Q

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?

  1. There is a significant respiratory acidosis that needs to be corrected
  2. The kidneys are over-compensating for the ventilator induced respiratory alkalosis
  3. The babies biggest problem is severe hypoxemia
  4. The gas cannot be interpreted because there is an air bubble in the sample
A
  1. The babies biggest problem is severe hypoxemia
20
Q

Baby has meconium aspiration and PPHN. Gas: 7.19/45/36/14/-10. In this baby, what is the likely etiology of the acidosis?

  1. Pneumonia with systemic inflammatory response (vasodilatory shock), secondary to the meconium aspiration
  2. Over-ventilation and squeezing the heart with high peak inspiratory pressure
  3. Decreased left cardiac output due to high right sided pressures and subsequent poor filling
  4. Adrenal insufficiency causing systemic hypotension as a consequence of the prolonged resuscitation
A
  1. Decreased left cardiac output due to high right sided pressures and subsequent poor filling
21
Q

Which of the following congenital anomalies would most likely require immediate surgical treatment in the first week of life?

  1. Congenital cystic malformation of the lung
  2. Tracheoesophageal fistula
  3. Bilateral cleft lip and palate
  4. Laryngomalacia
A
  1. Tracheoesophageal fistula
22
Q

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?

  1. You should place this baby supine, he is term and is at risk of SIDS
  2. You should place this baby prone, this will facilitate breathing
  3. When examining the palate, you should avoid digital palpation
  4. An oral airway or LMA is contraindicated in babies with this phenotype
A
  1. You should place this baby prone, this will facilitate breathing
23
Q

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?

  1. Surfactant increases the incidence of air leaks in RDS
  2. Administration of exogenous surfactant will inhibit endogenous surfactant production, this is why a trial of CPAP is first attempted
  3. Administration of surfactant improves arterial oxygenation
  4. Surfactant administration reduces the incidence and severity of chronic lung disease
A
  1. Administration of surfactant improves arterial oxygenation
24
Q

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?

  1. Increase PIP
  2. Increase PEEP
  3. Increase rate
  4. Decrease FiO2 to decrease ROP risk
A
  1. Increase PEEP
25
Q

26 weeker, intubated, post BLES. Ventilator settings are: PIP 20 PEEP 7 rate 40 (RR 40), FiO2 80%. Arterial gas: 7.16/65/135/21/-4. What is the most appropriate ventilator setting change at this time?

  1. Increase PIP and decrease FiO2
  2. Increase PEEP and decrease FiO2
  3. Increase rate and decrease FiO2
  4. Decrease FiO2
A
  1. Increase rate and decrease FiO2
26
Q

In contrast to ‘classic’ bronchopulmonary dysplasia, the ‘new’ BPD is characterized by different histopathology. The most striking abnormality is:

  1. Decrease in alveolar septation
  2. Diffuse leukocytic infiltration
  3. Hypertrophy of airway smooth muscle
  4. Lung parenchymal fibrosis
A
  1. Decrease in alveolar septation
27
Q

Baby is now term corrected. She was treated with caffeine initially then it was discontinued at 34 weeks. She now continues to have apneas and bradycardias up to 5 times per day. What is the most likely cause of the apneas?

  1. Apnea of prematurity
  2. Gastroesophageal reflux disease
  3. An undiagnosed inborn error of metabolism
  4. Kangaroo care / skin-to-skin contact exposure
A
  1. Apnea of prematurity
28
Q

Which of the following is NOT a clinical sign of a patent ductus arteriosis in a preterm infant?

  1. Tachycardia
  2. Intermittent systolic murmur
  3. Wide pulse pressure
  4. Oligemic lung fields on chest x-ray
A
  1. Oligemic lung fields on chest x-ray
29
Q

Which of the following is false?

  1. Intraventricular hemorrhage (IVH) is the most frequent type of intracranial hemorrhage in the newborn
  2. Most IVH occur with symptoms of bradycardia, desaturation, and acidosis
  3. Post-hemorrhagic hydrocephalus occurs due to adhesive arachnoiditis
  4. Prematurity is the biggest risk factor for IVH
A
  1. Most IVH occur with symptoms of bradycardia, desaturation, and acidosis
30
Q

Which of the following is true regarding screening in preterm infants in Canada?

  1. ROP examinations are recommended for all babies <2000g who were ventilated in greater than 50% O2
  2. Head ultrasound to screen for IVH is recommended in babies < 34 weeks gestation
  3. ROP examinations should be performed after 4 weeks of age or 31 weeks corrected
  4. Renal ultrasounds should be performed to screen for nephrocalcinosis in babies born at <30 weeks
A
  1. ROP examinations should be performed after 4 weeks of age or 31 weeks corrected
31
Q

You are called to assess a 4 week old, ex 25 week infant with vomiting of her last 2 NG feeds. Abdomen is distended and tender. You place the baby NPO, start antibiotics and order abdominal x-rays. Which of the following are not radiological features of necrotizing enterocolitis?

  1. Pneumatosis intestinalis
  2. Portal venous air
  3. Double bubble
  4. Pneumoperitoneum
A
  1. Double bubble
32
Q

36 week infant, CPAP for 12 hours for TTN/RDS D10W by IV for hypoglycemia for 48 hours – breastfeeding This is Ms. J’s second late preterm infant and she eagerly asks when Baby J can have her car seat test to go home. Which of the following re: the ‘infant car seat challenge’ (ICSC) is true?

  1. The CPS recommends an infant car seat challenge for infants <37 weeks gestational age prior to discharge home.
  2. The CPS recommends an infant car seat challenge for infants <37 weeks gestational age who required respiratory support for greater than 4 hours prior to discharge home.
  3. Clinicians can feel confident that an infant’s passing an ICSC test indicates safety for discharge regarding respiratory stability.
  4. The ICSC test to screen other populations before discharge (ex. Infants with neurological impairment, hypotonia, or low birth weight) is up to the individual clinician.
A
  1. The ICSC test to screen other populations before discharge (ex. Infants with neurological impairment, hypotonia, or low birth weight) is up to the individual clinician.
33
Q

39 weeks to a 29 year old G1, GBS negative, ROM 20 hours, no maternal fever. Mom did not receive any medication. SVD with cord around the neck. Stimulation, PPV 30 seconds. Now: Sats 99% in room air, HR 154, RR 50. The most appropriate management for this baby now is:

  1. Admit to nursery for observation, at risk of sepsis and perinatal depression, vital signs q 4 hours, CBC and CRP at 4 hours
  2. May go to post-natal ward with Mom, vital signs q 1hour x 3 hours then q2 hours for 24 hours
  3. May go to post-natal ward with Mom, vital signs q 4 hours x 24 hours, CBC and CRP at 4 hours
  4. May go to post-natal ward with Mom, vital signs q 4 hours x 24 hours, reassess before discharge
A
  1. May go to post-natal ward with Mom, vital signs q 4 hours x 24 hours, reassess before discharge
34
Q

Which of the following are true?

  1. Caput succadaneum is a subcutaneous hemorrhage requiring no intervention, that is limited by suture lines
  2. Subgaleal hemorrhage occurs in the subaponeurotic space, crosses suture lines, and has associated risk of mortality
  3. Cephalohematoma is a risk factor for jaundice and infection, thus requires drainage in the first 24-48 hours after birth
  4. All neonatal skull fractures require urgent neurosurgical referral, with vacuum extraction occurring within 6 hours after the injury
A
  1. Subgaleal hemorrhage occurs in the subaponeurotic space, crosses suture lines, and has associated risk of mortality
35
Q

Which of the following is NOT an association or complication of LGA?

  1. Birth trauma (dystocia, fractures, ICH, hip)
  2. Asphyxia / HIE
  3. Anemia
  4. Hypoglycemia
A
  1. Anemia
36
Q

41 week baby with initial HR <60 requiring PPV by mask and chest compressions but no epinephrine. APGARS 1, 2, 6, 8. Baby is now 3 hours old on CPAP PEEP 6 with regular non laboured respirations in 40% FiO2, RR 45, and HR 110. Initial labs have been sent off and a CXR is ordered. Other than some stiffening of the arms and legs when they drew blood work, she is overall hypotonic and with paucity of spontaneous movements. The cord gases are : A 6.98/80/20/9/-19 and V 6.99/75/24/10/-18. Which of the following is the most appropriate next action?

  1. Intubate the baby now with sedation and muscle relaxation
  2. Turn down the overhead warmer / isolette and initiate passive cooling
  3. Prepare for sterile insertion of UVC and UAC catheters
  4. Discontinue respiratory support, this is severe hypoxic ischemic encephalopathy
A
  1. Turn down the overhead warmer / isolette and initiate passive cooling
37
Q

Which of the following are true?

  1. The pattern of injury associated with HIE in term infants including basal ganglia, internal capsule, and cerebellar hemorrhages predicts motor and cognitive outcomes.
  2. Neonatal stroke is acutely seen as loss of grey white matter differentiation on MRI followed by eventual volume loss +/- cyst formation after 1 month.
  3. In a term infant with encephalopathy a normal T1/T2 MRI at 72 hours rules out metabolic disorders i.e. maple syrup urine disease, non-ketotic hyperglycinemia, or creatine deficiency.
  4. MRI is the modality of choice in trauma when detection of bony fractures is a priority.
A
  1. Neonatal stroke is acutely seen as loss of grey white matter differentiation on MRI followed by eventual volume loss +/- cyst formation after 1 month.
38
Q

All of the following are recognized causes of ‘floppy baby’ except:

  1. Trisomy 21
  2. Zellweger syndrome
  3. Becker muscular dystrophy
  4. Spinal muscular atropy
  5. Prader Willi syndrome
A
  1. Becker muscular dystrophy
39
Q

Which of the following is true?

  1. Erb’s palsy involves C6, C7, & C8
  2. Klumpke’s palsy involves C7, C8, & T1
  3. Facial nerve palsy: persistently closed eye
  4. In full nerve injury, neuroplasty is advised at the end of the first year of life
A
  1. Klumpke’s palsy involves C7, C8, & T1
40
Q

On day 1 of life, you are managing a 39 week infant with APGARS 3, 8. Growth parameters: Weight 2.1kg and HC 34cm. Current fluids at 10 hours of age are D12.5W at 100ml/kg/day. Serum glucose is now 1.8. What is the baby’s glucose infusion rate and what is the likely physiologic diagnosis?

  1. GIR: 8-9 mg/kg/min; Diagnosis: inborn error of glucose metabolism
  2. GIR 5-6 mg/kg/min; Diagnosis: inborn error of glucose metabolism
  3. GIR 8-9mg/kg/min; Diagnosis: hyperinsulinism
  4. GIR 5-6 mg/kg/min; Diagnosis: hyperinsulinism
A
  1. GIR 8-9mg/kg/min; Diagnosis: hyperinsulinism
41
Q

A 1 week old male presenting to the emergency department with normal HR, BP, and saturations, but altered level of consciousness and acidosis. What additional test should be included in the initial evaluation to help make the diagnosis and guide treatment?

  1. Cortisol level
  2. Serum ketones
  3. Thyroid function test
  4. Ammonia level
A
  1. Ammonia level
42
Q

You are paged by a family physician in the community about a baby with a bilirubin level of 350. Baby was born at 36+6 weeks and is now 96 hours old. Birth weight was 3100g and current weight is 3000g. GBS positive in previous pregnancy, and blood type O. Baby is exclusively breastfeeding. Which of the following is the correct next step?

  1. Perform a full septic workup including LP (this is significant jaundice with risk factors for sepsis)
  2. Send a CBC and coombs test now
  3. Start phototherapy and recheck bilirubin in 12 hours with a CBC and coombs test
  4. Baby is older now, the risk of kernicterus is much lower than in the first 24 hours, if she is feeding well, with good hydration, can repeat in 24 hours
A
  1. Send a CBC and coombs test now
43
Q

A 34 week infant was born to an A negative mother with anti-D antibodies. Maternal titers were up to 1:256 in the pregnancy. Cord hemoglobin was 90, with a bilirubin of 130. His jaundice and hemolysis were treated appropriately. On day 4 of life, he develops feeding intolerance and abdominal distension. These GI symptoms are most likely due to:

  1. Acquired sepsis from multiple blood product exposure and invasive lines
  2. Portal vein thrombosis secondary to invasive catheters causing portal hypertension and ascites
  3. Necrotizing enterocolitis secondary to ischemia/bowel hypoperfusion as a result of anemia or exchange transfusion
  4. An inborn error of metabolism, causing neonatal hepatitis, jaundice, and hyperammonemia
A
  1. Necrotizing enterocolitis secondary to ischemia/bowel hypoperfusion as a result of anemia or exchange transfusion
44
Q

All of the following are usually associated with congenital hypothyroidism except:

  1. Prolonged jaundice
  2. Umbilical hernia
  3. Small anterior fontanelle
  4. Hypotonia
A
  1. Small anterior fontanelle
45
Q

Which statement is correct regarding Neonatal Alloimmune Thrombocytopenia?

  1. Mother is often also thrombocytopenic
  2. Risk of intracranial hemorrhage highest during first 96 hours
  3. IVIG is not an effective treatment
  4. Expect a higher platelet count than in autoimmune thrombocytopenia
A
  1. Risk of intracranial hemorrhage highest during first 96 hours
46
Q

You are caring for twins with an antenatal history of moderate (stage III) twin-twin transfusion syndrome. Twin A had a hematocrit of .75, Twin B had a Hct .30. Which of the following is most likely?

  1. Twin A had a history of oligohydramnios
  2. Twin A is at increased risk of congenital heart disease
  3. Twin B’s bladder was visualized antenatally
  4. Twin B will require an partial exchange transfusion with 0.9% NS
A
  1. Twin A is at increased risk of congenital heart disease

Hamilton 2020 Questions (29 decks)

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