Neonatology

Question 1

Caudal regression syndrome is most likely associated with which maternal condition?

Answer 1

Gestational diabetes

Question 2

What does VACTERL stand for?

Answer 2

V- vertebral anomalies
A- anal atresia
C- cardiac defects
T-E fistula
R- renal/radial anomalies
L- limb (radial) anomalies

Question 3

Most common site of diaphragmatic hernia

Answer 3

Posterolateral; second most common (right behind the sternum)

Question 4

Depressed nasal bridge, hypertelorism, cleft palate, finger-like thumbs, coarse hair and hirsutism, hypoplasia of distal phalanges; name of syndrome and intrapartum exposure to which medication will cause this?

Answer 4

Fetal hydantoin syndrome; exposure to phenytoin

Question 5

Neural tube defects are associated with which intrapartum medication exposure?

Answer 5

Valproic acid, carbamazepine (anti-seizure medications)

Question 6

Difference between erythema toxicum vs transient pustular melanosis?

Answer 6

Erythema toxicum– not present at birth, erythematous base with central pustule (eosinophilic reaction of body)

Transient pustular melanosis– non-erythematous, pigmented base; common in AA infants; can be present at birth and can include palms and soles as well

Question 7

Miliaria rubra/crystallina

Answer 7

Obstruction of sweat glands or over-heating/sweating of skin (heat rash) with papulovesicular lesions; rubra (red appearing), crystallina (clear appearing) involves different layers of the epidermis

Question 8

% of those who are breech in the 3rd trimester developing DDH?

Answer 8

12%

Question 9

When should you screen for DDH with hip ultrasound?

Answer 9

Ultrasound at 6 weeks of age

Question 10

Concerns for low apgars with subsequent gross hematuria and decreased UOP; what are you concerned about?

Answer 10

Renal vein thrombosis secondary to hypercoagulable state related to perinatal asphyxia

Question 11

Vernix covers the whole body between which gestational ages?

Answer 11

24-38 weeks

Question 12

One to two anterior sole creases with no heel creases; what age?

Answer 12

32-33 weeks

Question 13

Scant ear cartilage with slow return to normal upon folding; what gestational age?

Answer 13

32-35 weeks

Question 14

No breast buds; what gestational age?

Answer 14

<36 weeks

Question 15

Reduction in caliber of large intestine at the splenic flexure on barium enema with findings concerning for obstruction; diagnosis and what maternal comorbidity is this most likely related to?

Answer 15

Neonatal small left colon syndrome–related to maternal gestational or T1/2 diabetes

Question 16

Difference between Crouzon and Apert syndrome?

Answer 16

Both have premature fusion of sutures (craniosynostosis) but fusion of 2-5th digits (syndactyly) is pathognomonic for Apert (digits are not apert?), syndactyly is not seen in Crouzon syndrome

Question 17

Exposure to what maternal medication can also lead to withdrawal symptoms?

Answer 17

SSRIs, would do eat/sleep/console just like for NOWS; this is usually rare, but can happen in mom’s using SSRI for anxiety/depression

Question 18

Manifestations of ACE-I use during pregnancy in a neonate?

Answer 18

Teratogenic effects (septal defects, neural tube defects)

Question 19

True. IUGR is associated with an increased risk of metabolic syndrome in the future.

Answer 19

True.

Question 20

Nerves affected by Erb’s vs Klumpke’s palsy

Answer 20

C5-C7 Erb’s and C8-T1 Klumpke (remember T1 contains sympathetic ganglia, and can manifest as ptosis as well)

Question 21

Unconjugated hyperbilirubinemia etiologies

Answer 21

Crigler-Najjar Type I (absent UDP-glucuronyltransferase--severe)
Crigler-Najjar Type II (partially functioning UDP-glucuronyltransferase)
Gilbert Syndrome (Ineffective uptake of unconjugated bilirubin from the serum--most common, large portion of population is asymptomatic--may emergence in times of stress and adolescence
*All are autosomal recessive

Question 22

Medication that can help conjugate bilirubin?

Answer 22

Phenobarbital (can use for CN type II and Gilbert)

Question 23

Risk factors for transient tachypnea of the newborn?

Answer 23

Late preterm delivery (34-37 weeks), maternal diabetes, maternal asthma, C-section delivery

Question 24

Pneumothorax treatment

Answer 24

Symptomatic– needle thoracotomy

Not symptomatic– 100% FiO2 oxygen

Question 25

True or False: CF in a newborn presents as respiratory distress or respiratory failure.

Answer 25

False: usually presents with GI manifestations.

Question 26

Soap bubbles sign on KUB can be seen in what neonatal disorder?

Answer 26

Meconium ileus (air mixing with thick meconium creates what looks like soap bubbles)

Question 27

SSRI use during pregnancy can be associated with which neonatal findings?

Answer 27

One trimester: cardiac defects

Third trimester: serotonin withdrawal, persistent pulmonary hypertension

Question 28

Hemorrhagic disease of the newborn (bleeding out of orifices at <24 hrs of life) is associated with which intrapartum medications?

Answer 28

Any meds that interfere with Vitamin K function: Anti-epileptics (phenytoin), Warfarin, anti-TB meds (Isoniazid, Rifampin)

Question 29

Midface hypoplasia, microcephaly, short and upturned nose, limb dysmorphia (hypoplastic finger nails, digitized or finger-like toes), congenital heart abnormalities

Answer 29

Fetal Hydantoin Syndrome 2/2 to exposure to anti-epileptic medications