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BOARDS > Neonatology > Flashcards

Neonatology Flashcards

1
Q

associated with elevated AFP

A 
RAIN
Renal (nephrosis, renal agenesis, polycystic kidney)
Abdominal wall defects
Incorrect dating/multiple gestation
Neuro (anencephaly, spina bifida)
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2
Q

associated with low AFP

A

chromosomal abnormalities (trisomy 18 or 21)

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3
Q

measures spontaneous fetal movement and heart rate activity

A

non stress test

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4
Q

measures autonomic nervous system integrity

A

non stress test (by measuring spontaneous fetal movement and HR activity)

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5
Q

measure uteroplacental insufficiency and tolerance of labor

A

contraction stress test (by measuring fetal HR in response to uterine contraction)

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6
Q

positive contraction stress test

A

late decelerations after 50% of contractions - requires further work up

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7
Q

biophysical profile

A

non stress test and US to evaluate: fetal movement, reactive HR, breathing, tone and volume of amniotic fluid

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8
Q

apnea

A

no breathing >20 seconds

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9
Q

apnea of prematurity treatment

A

caffeine and theophylline

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10
Q

how to help reverse primary apnea

A

tactile stimulation and blow by oxygen

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11
Q

how to help secondary apnea

A

PPV

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12
Q

pressure needed to inflate lungs with first breath

A

60 mm Hg

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13
Q

fluid in the interloper fissures and increased interstitial pulmonary markings in baby born by c-section

A

TTN

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14
Q

TTN typically resolves in

A

72 hours

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15
Q

hyaline membrane disease aka

A

RDS

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16
Q

granular opacification’s and air bronchograms with a ground glass appearance obscuring heart and diaphragm borders on xray

A

RDS

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17
Q

granular opacification’s and air bronchograms with a ground glass appearance obscuring heart and diaphragm borders on xray that is progressively worsening despite respiratory assistance

A

GBS pneumonia

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18
Q

testing to indicate low risk of RDS

A

lethicin:sphingomyelin ratio >2

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19
Q

mechanical ventilation indicated in RDS when pH and CO2 ___

A

pH <7.2 and pCO2>60

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20
Q

clinical improvements expected with giving surfactant in RDS

A

decrease O2 requirement, increased lung compliance and decreased inspiratory pressure

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21
Q

BPD treatment

A

diuretics

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22
Q

babies with BPD are at risk for

A

hypocalcemia 2/2 diuretic use

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23
Q

BPD is present in infants who

A

require oxygen past 28 days after birth and/or at 36 weeks corrected GA

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24
Q

diffuse opacities with cystic areas and streaky infiltrates and ground glass appearance in infant on xray

A

BPD

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25
Q

sepsis treatment in neonates

A

ampicillin and gentamicin (enterobacter and serratia are resistant to cefotaxime)

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26
Q

placenta with white nodules think

A

listeria

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27
Q

early onset GBS presents when

A

first 7 days of life

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28
Q

late onset GBS presents when

A

usually first month of life but can be up to 90 days

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29
Q

late late onset GBS presents when

A

up to 6 months in preemies

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30
Q

when to screen for GBS

A

35 to 37 weeks

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31
Q

management of well appearing infant with inadequate treatment of GBS

A

monitor for 48 hours

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32
Q

management of infant born to mom suspected to have chorioamnionitis

A

CBC and blood culture with antibiotics pending culture results

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33
Q

management of clavicular fracture

A

observation, callus usually recedes by 2 years

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34
Q

erb’s palsy location of injury

A

C5-C7

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35
Q

erb’s palsy description

A

waiter’s tip - adducted and internally rotated arm with wrist and fingers flexed

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36
Q

klumpke palsy location

A

C8, T1

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37
Q

klumpke palsy description

A

claw hand (affects muscles of the hand)

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38
Q

klumpke palsy can be associated with

A

Horner syndrome

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39
Q

umbilical cord should fall off by

A

2 week visit

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40
Q

umbilical cord that is attached after 1 month think

A

LAD or low WBC

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41
Q

test to perform if single umbilical artery

A

renal US

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42
Q

SGA definition

A

<10th%ile, <2500g

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43
Q

LGA definition

A

> 90th%ile >3900g

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44
Q

SGA babies at higher risk for

A

temperature instability, polycythemia and fasting hypoglycemia

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45
Q

full term baby

A

38-42 weeks

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46
Q

newborn with dry skin that is peeling, long fingernails decreased lanugo on back and ears with strong recoil

A

post-term

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47
Q

normal arterial blood gas for newborn

A

pO2 60-90 and pCO2 35-45

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48
Q

normal scalp pH

A

> 7.25

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49
Q

bilateral ankle clonus in newborn

A

normal

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50
Q

1 minute Apgar reflects

A

life in the uterus and endurance to delivery

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51
Q

5 minute Apgar reflects

A

transition and adjustment to the world

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52
Q

5 minute Apgar reflective of difficult adjustment

A

7

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53
Q

chest compressions at delivery if

A

HR<60 even with PPV

54
Q

CPR in neonate

A

100 compressions/minute with one breath every 3 compressions

55
Q

VLBW definition

A

<1500 grams

56
Q

mean arterial pressure in preemies

A

should not be less than the corrected GA

57
Q

thrombocytopenia in preemie without another known cause think

A

HSV

58
Q

patchy areas of atelectasis alternating with areas of hyperinflation on xray

A

meconium aspiration

59
Q

most likely complication of meconium aspiration

A

persistent pulmonary hypertension

60
Q

pneumatosis intestinalis with air in the biliary tree

A

NEC

61
Q

bloody stools, erythema of abdominal wall and thrombocytopenia

A

NEC

62
Q

long term complication of NEC

A

intestinal strictures

63
Q

NEC management

A

NG tube to intermittent suction, NPO with IV fluids and antibiotics

64
Q

bilirubin up to what can be normal within first 24 hours of full term

A

12.4

65
Q

what race has higher risk for hyperbilirubinemia

A

east asian

66
Q

most common cause of unconjugated hyperbilirubinemia

A

breastfeeding jaundice (decreased caloric intake = increased enterohepatic circulation)

67
Q

when does breastmilk jaundice occur

A

days 6 to 14 and may persist for 1 to 3 months

68
Q

physiologic jaundice peaks

A

day 3

69
Q

phototherapy is contraindicated in

A

direct hyperbilirubinemia or family history of light sensitive porphyria (causes bronze baby syndrome)

70
Q

factors that can worsen neonatal jaundice

A

anything that competes for binding to albumin ex: sulfonamides. or sever acidosis

71
Q

complications of exchange transfusion

A

high K+, low calcium, thrombocytopenia and hypovolemia

72
Q

hypoglycemia in preemie

A

<25

73
Q

hypoglycemia in full term

A

<35

74
Q

hypoglycemia treatment

A

2-3 mL/kg D10 bolus

75
Q

infants of diabetic mothers are at increased risk for

A

polycythemia (increased EPO), hypoplastic L colon, hypoglycemia, LGA 2/2 increased insulin levels

76
Q

hypocalcemia defintion

A

Ical <4.5 and total calcium <8.5

77
Q

EKG finding with hypocalcemia

A

prolonged QT interval

78
Q

consider what if mom was on mag

A

hypocalcemia

79
Q

hypocalcemia not responding to calcium

A

check magnesium

80
Q

anemia in full term infant

A

<13

81
Q

test to check fetal blood in mom

A

kleihauer betke test

82
Q

polycythemia definition

A

central venous HCT >65

83
Q

Hgb nadir in full term occurs when

A

2 to 3 months

84
Q

Hgb nadir in preemies occurs when

A

1 to 2 months

85
Q

polycythemia leads to

A

hypoglycemia, hyperbilirubinemia, thrombocytopenia

86
Q

test of neonate’s gastric aspirate to determine if it is maternal blood

A

apt test

87
Q

prolonged PT in a bleeding infant think

A

vitamin K deficiency

88
Q

prolonged PTT can be normal up until when

A

9 months

89
Q

early onset hemorrhagic disease of the newborn

A

within 7 days - bleeding at circumcision or umbilical cord in breastfed infant not given IM vitamin K

90
Q

diagnosis of vitamin K deficiency

A

bleeding and elevated PT that improves after giving vitamin K (levels aren’t accurate)

91
Q

seizure within 24 hours of delivery is most likely 2/2

A

birth asphyxia (most do not have long term sequelae)

92
Q

treatment for seizures 2/2 HIE

A

phenobarbital

93
Q

protrusion of bowel through the base of the umbilical cord

A

omphalocele

94
Q

abdominal wall defect associated with syndromes

A

omphalocele (beckwith woodman and chromosomal abnormalities)

95
Q

herniation of bowel through defect in abdominal musculature to the R of the umbilicus

A

gastroschisis

96
Q

scaphoid abdomen with decreased breast sounds on the L side

A

diaphragmatic hernia

97
Q

diaphragmatic hernia mangement

A

intubation and ventilation, NG to keep stomach decompressed and parenteral nutrition until surgical repair

98
Q

IVH usually occurs when

A

within firs 96 hours

99
Q

grade 1 IVH

A

germinal matrix

100
Q

grade 2 IVH

A

IVH without dilation

101
Q

grade 3 IVH

A

IVH with dilation

102
Q

grade 4 IVH

A

IVH w. dilation and parenchymal involvement

103
Q

soft boggy and crosses suture lines

A

caput succedaneum

104
Q

beta adrenergic in mom

A

ex: terbutaline - can cause hyperinsulinism and then hypoglycemia

105
Q

one time use of corticosteroids in mom

A

decreased risk of RDS, IVH and NEC

106
Q

repeated corticosteroid use in mom

A

head growth impairment

107
Q

signs of alcohol withdrawal in newborn

A

hyperactive, irritable, hypoglycemia

108
Q

cocaine effects on newborn

A

at risk for anomalies due to vascular constriction (cerebral infarction, limb anomalies, urogenital defects) and increased risk of placental abruption

109
Q

signs of barbiturate withdrawal in newborn

A

hyperactive, irritable, crying, poor suck/swallow corodination

110
Q

signs of opioid withdrawal in newborn

A

hyperirritablity, tremors, jittery, hypertonia, loose stool, emesis, feeding difficulty, seizures

111
Q

management of opioid withdrawal in newborn

A

methadone and/or oral morphine

112
Q

time to discharge after c-section

A

72 hours

113
Q

enlarged posterior fontanelle, umbilical hernia and jaundice

A

hypothyroidism

114
Q

displaced PMI in posters newborn w/ history of mec-stained amniotic fluid

A

pneumothorax

115
Q

congenital malformations associated with carbamazepine and phenytoin

A

spina bifida

116
Q

DES associated with increased risk of what cancer

A

vaginal adenocarcinoma

117
Q

ACE inhibitors increase risk of what congenital abnormality

A

renal dysgenesis, oligohydramnios and skull defects

118
Q

most common effect of cigarette smoke on newborn

A

low birth weight

119
Q

excessive hyperthermia from prolonged hot tube use associated with

A

neural tube defects

120
Q

virus during pregnancy associated with risk of developing heart failure

A

parvovirus B19 (fifth disease)

121
Q

frequent abnormality with single umbilical artery

A

trisomy 18

122
Q

placenta of most identical twins

A

diamniotic, monochorionic

123
Q

what scalp pH requires immediate delivery

A

<7.2

124
Q

baseline fetal HR that defines fetal tachycardia

A

> 160

125
Q

baseline fetal HR that defines fetal bradycardia

A

<120

126
Q

fall in fetal HR at the beginning of contraction peak that returns after the contraction ends

A

late deceleration (check fetal pH, potentially ominous)

127
Q

change in mean pulmonary artery pressure at birth

A

decreases

128
Q

change in pulmonary vascular resistance at birth

A

decreases

129
Q

change in pulmonary blood flow at birth

A

increases

130
Q

firm, fluctuant swelling that extends to the front of the ears and causes ears to push out laterally

A

subgaleal hemorrhage

131
Q

location of surfactant production and storage

A

type 2 alveolar epithelial cells

132
Q

tachypnea with differential cyanosis, tricuspid regurgitation and low narrowly split 2nd heart sound

A

persistent pulmonary hypertension

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