NICU 1

Question 1

why is caffeine good

Answer 1

• Improves apnea
• Less need for ventilation, CPAP and oxygen.
• Reduces rates of BPD
• Improves the rate of survival without neurodevelopmental disability at 18 to 21 months in infants with very low birth weight … but barely makes a difference at 5 yrs of age

Question 2

when should we do HUS

Answer 2

7-14 days
4-6 weeks
term corrected

Question 3

What are the issues with twin-twin transfusion for the donor

Answer 3

oligohydramniosanemia
anemia
poor growth
microcardia
hypoglycemia
hypovolemia
*arterial side

Question 4

What are the issues with twin-twin transfusion for the recipient

Answer 4

polyhydramnios
hydrops
hypertrophic cardio
plethoric
myocardial dysfunction
* venous side

Question 5

when does TTTS occur?

Answer 5

monozygotic twins
share a common placenta
have an AV connection between their circulation

Question 6

baby born at term, presents with inc WOB. CXR shows hyperinflation and tracheal deviation but still see lung markings. DDX

Answer 6

congenital lobar emphysema
usually present in newborn (max 5 mo)
resp distress
ball valve effect
hyperinflation
tracheal deviation

Question 7

what prenatal lab values might indicate a T21

Answer 7

HIGH BHCG and inhibin

LOW estradial and alpha feto

Question 8

what disorders are associated with large anterior fontanelle

Answer 8

prematurity/IUGR
hydrocephalus 
achondroplasia
T13, 18, 21
congenital rubella
OI
Russel silver

Question 9

what % of cephalohematoma will have a underlying skull fracture?

Answer 9

10-25%

Question 10

what are causes of leukoria in a newborn?

Answer 10

cataracts
chorioretinitis
ROP
retinoblastoma

Question 11

baby has hematuria and new onset of HTN and low PLT. You feel an abdo mass. Dx

Answer 11

renal vein thrombosis

Question 12

if i have a pt with ambigious genitalia and I find gonads. WHat lab analysis will help differentiate?

Answer 12

Testosterone and DHT

1. if Normal T and low DHT = 5 alpha reductase
2. if Normal T and HIGH DHT = androgen insensitivity
3. If both LOW = error in steroid met/testosterone synthesis defect or absent or defective testes

Question 13

what metabolite is elevated in 21 hydroxylase def?

Answer 13

17 - OHP

Question 14

how do you manage an acute adrenal crisis?

Answer 14

NS bolu
mainetnance at 1.5
hydrocortisone at 100mg/m2/day
treat hyperkalemia if too high

Question 15

what side does CDH tend to occur on and why is CDH bad?

Answer 15

left

1. parenchymal insuff - no enough alveoli
2. pulm HTN - blood shunted away from lungs causing worsening acidosis and vasoconstriction

Question 16

How do you manage CDH?

Answer 16

1. ABC
2. intubate immediate
3. BLES
4. NG
5. close monitoring of acid base balance
6. Sx when stable

Question 17

what are the 6 MC features of baby with suspected galactosemia?

Answer 17

Cataracts - galactose accumulation
vomiting/poor feeding
Liver failure - hepatomegaly, Jaundice - unconjugated progressing to conjugated, coag issues
renal tubular dysfunction
hypotonia
E.Coli sepsis

Question 18

what are indications for surfactant?

Answer 18

Intubated prem with RDS
MAS on 50% FIO2
Pneumonia or pulm hemorrhage
OI > 15
if < 29 weeks and need transport

Question 19

what are complications of surfactant admin

Answer 19

blocked tube
bradycardia
pneumothorax
pulm hemorrhage

Question 20

what are early and late signs of kernicterus?

Answer 20

early: poor suck, hypotonia, Sz
late: Hypertonia, high pitched cry, opisthotonus, retrocollis , fever

Question 21

what maternal drugs will lead to early hemorrhagic disease of the newborn?

Answer 21

Carbamazepine
phenytoin
INH
Warfarin
Rifampin
cephalosporins
barbiturates

Question 22

what are lab abn in Vit K def bleeding

Answer 22

INR > 4
PT > 4x
rest normal

Question 23

if a baby has congenital heart block second to maternal SLE, is the permanent or not

Answer 23

permanent

Question 24

when does neonatal lupus present

Answer 24

can be at birth or within 6 week

typical malar rash is present and last 3-4 mo