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Royal College Exam > NICU > Flashcards

NICU Flashcards

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1
Q

Management of temperature instability in a newborn

A
  • Plastic wrap
  • Radiant heat source
  • Incubator with heat and humidity (40-60%)
  • Continuous monitoring of the infant’s temperature to avoid hypothermia
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2
Q

Prevention of IVH in newborn

A
  • Avoid operative delivery (forceps/vacuum)
  • Avoid clinical instability (acidosis, hypoxia, hypotension) – fluctuations in BP or Pco2 can impact development of IVH
  • Antenatal corticosteroids (decrease risk of death, grade II and IV IVH and PVL)
  • Prophylactic administration of low-dose indomethacin (0.1 mg/kg/d x 3 ds) for VLBW preterm infants – reduces severe IVH
  • “Neuroprotection” – head midline, cluster handling
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3
Q

Initial fluids for pre-term infant

A

D10W at 80 cc/kg/day

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4
Q

Prevention of RDS

A
  • Antenatal corticosteroids to infants 24-32 weeks GA

- Intrapartum fetal monitoring (to reduce risk of asphyxia – associated with worse RDS)

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5
Q

Prevention of ROP

A

Minimize exposure to inspired O2

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6
Q

Retinal angiogenesis begins..and ends…

A

begins at 16 weeks GA and ends by 40 weeks

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7
Q

Most common type of craniosynostosis

A

Scaphocephaly - sagittal suture fusing prematurely (80% of cases in males)

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8
Q

Complications of being post-dates (3)

A

(1) Fetal macrosomia
(2) Meconium aspiration
(3) Shoulder dystocia

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9
Q

Most common cause of sensorineural hearing loss

A

Genetic causes (50%) - usually bilaterally (others include infections [e.g., CMV, toxoplasmosis, congenital rubella, congenital syphillis] and anatomic)

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10
Q

Features of Noonan syndrome

A

Common findings include a short webbed neck, chest deformity (pectus excavatum), cryptorchidism, intellectual disability (mental retardation), bleeding diathesis, and lymphedema (puffy hands and feet); cardiac defects: pulmonic stenosis and hypertrophic cardiomyopathy
ALSO: Hypotonia in neonatal period

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11
Q

Presenting features of PUV

A

Abdominal distension due to enlarged overdistended bladder or urinary ascites, difficulty with voiding, or a poor urinary stream, failure to thrive, urosepsis, poor urinary stream, and straining or grunting while voiding

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12
Q

Appearance of erythema toxicum

A

Multiple erythematous macules and papules (1 to 3 mm in diameter) that rapidly progress to pustules on an erythematous base

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13
Q

Marijuana use and breastfeeding?

A

Not enough evidence. Existing evidence suggest THC excreted into breast milk in moderate amounts.

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14
Q

Effects of twin-twin transfusion syndrome

A

Recipient twin: CHF, hydrops, polycythemia, respiratory issues
Donor: hypovolemic, hypoglycemic

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15
Q

Nerves involved in Erb’s palsy

A

Brachial plexus: C5-T1

Erb’s palsy: C5,C6 +/- C7

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16
Q

Features of Erb’s palsy

A

Asymmetric Moro
Absent biceps reflex
Intact grasp
No wrist extension

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17
Q

Red flags for sacral dimple

A 
>0.5cm
Above gluteal crease (>2.5cm from anus)
Multiple dimples
Associated with patch of hair, hemangioma
(looking for spina bifida occult)
Neurological findings
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18
Q

Duration of risk for hypoglycaemia in neonates

A

LGA, IDM = 12 hours

SGA = 36 hours

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19
Q

Period of time after which you can stop resuscitating neonate with no heart rate

A

10 minutes

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20
Q

Most common cause of hypertension in a newborn

A

Renovascular - accounts for 50% of cases of hypertension in neonates, including thrombi related to UV lines

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21
Q

Indications for LP in newborn

A

Unwell baby

WBC <5

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22
Q

GBS prophylaxis with penicillin allergy

A

History of anaphylaxis - clindamycin or erythromycin
No history of anaphylaxis - cefazolin
(cefazolin preferred)

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23
Q

Components of Sarnat staging

A

Level of consciousness, tone, reflexes, seizures (yes/no)

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24
Q

Reason for giving babies irradiated blood?

A

To prevent GVHD

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25
Q

In preterm babies, are vaccines given based on corrected or chronological age?

A

Chronological age

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26
Q

What are the criteria for cooling in HIE?

A

TWO of the following:
1. Apgars 16 within first hour
and
Sarnat stage II or III (moderate or severe) encephalopathy

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27
Q

Who are antenatal steroids indicated for?

A

< 34 weeks, improve lung development, decrease IVH/NEC/mortality

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28
Q

Indication for MgSO4

A

< 32 weeks - neuroprotection, decrease rates of CP

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29
Q

CNS finding in congenital CMV

A

periventricular calcifications

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30
Q

Electrolyte abnormalities in IDM

A

hypocalcemia, hypoglycemia

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31
Q

Vit K recommendations

A

< 1500 g = 0.5 mg
> 1500 g = 1 mg
can give oral alternative (2mg at first feed, repeat at 2-4 weeks and 6-8 weeks)

32
Q

When does apnea of prematurity resolve?

A

Can last up to 44 weeks, up to 20% of preterm infants can still have apnea/bradycardias at corrected term GA

33
Q

What is kernicterus?

A

Pathologic yellow staining of basal ganglia

34
Q

Syndromes that affect the bilirubin conjugation enyzme (UGT1A1)

A

Crigler-Najjar

Gilberts

35
Q

Recommended time and method to do a bilirubin check in a newborn infant?

A

within 72 hrs, serum or transcutaneous level

36
Q

What is VACTERL

A 
Vertebral anomalies
Anorectal
Cardiac
Trachoesophageal fistula
Renal
Limb anomalies
37
Q

Most common type of TEF

A

Distal fistula, esophageal atresia

38
Q

TEF is associated with what risk factors

A

advanced maternal age
obesity
low SES
smoking

39
Q

Most common anomaly associated with omphalocele

A

cardiac! (TOF)

40
Q

Most common anomaly associated with gastroschesis

A

intestinal atresia

41
Q

Neonatal hypocalcemia. What other electrolyte abnormality should you look for and treat?

A

Hypomagnesemia

42
Q

Risk factors for neonatal hypoglycemia

A 
SGA < 10%
LGA > 90%
IDM
preterm < 37 wks
Perinatal asphyxia
43
Q

LGA infant. Blood glucose 2.0 at 2 hrs of age. What do you do?

A

Feed, recheck in 1 hr

If > =2.6, continue usual care
If < 2.6, consider IV tx

44
Q

GIR of TFI 80 cc/kg/day of D10W

A

5.5 mg glucose/kg/min

45
Q

SGA infant. blood glucose 2.3 before their 3rd feed. What do you do?

A

refeed, check glucose in 1 hr

If >= 2.6, continue usual care
If < 2.6 consider IV tx

46
Q

LGA infant. blood glucose 1.6 at 2 hrs of life. What do you do?

A

Consider IV treatment!

47
Q

At what GIR should you think of hyperinsulinism?

A

GIR >10

48
Q

Three medications used to manage hyperinsulinism?

A

Diazoxide
Octreotide
Glucagon

49
Q

Most common cause of CAH? What is the lab test to confirm this?

A

21-hydroxylase deficiency

Test: 17-OH-progesterone

50
Q

Side effects of inhaled nitric oxide?

A

NO2 and methemoglobin production

51
Q

Bronchopulmonary sequestration typically occurs in what lobe

A

LLL

52
Q

Congenital lobar emphysema typically occurs in what lobe

A

LUL

53
Q

Syndromes associated with CDH

A

T13, T 18, T21, Turners

54
Q

Common cause of elevated TSH after birth?

A

Measurement of sample < 24 hrs of life (all babies have peak in TSH)

55
Q

Most common cause of hemolytic disease of the newborn

A

ABO incompatibility

56
Q

Definition of polycythemia

A

Hct > 0.65

57
Q

When would you consider an exchange transfusion for polycythemia?

A

Hct > 0.7 (asymptomatic)

Hct > 0.65 (symptomatic - signs of hyperviscosity)

58
Q

Baby with hirschprungs failed hearing screen. What syndrome do you suspect?

A

Waardenburg

59
Q

Definition of ophthalmia neonatorum

A

conjunctivitis occurring in first 4 weeks of life, regardless of bug

60
Q

Metabolic abnormalities associated with subcutaneous fat necrosis

A

hypercalcemia
hypoglycemia
thrombocytopenia

61
Q

Overlapping fingers, microcephaly, rocker-bottom feet

A

Edwards syndrome T18

62
Q

Midline cleft lip, polydactyly, scalp abnormalities, microcephaly, hypoplastic/absent ribs

A

Patau syndrome T13

63
Q

Role of MgSO4 for mom of preterm infant

A

Should give to mom if < 32 wks GA

Neuroprotection, decreases risk of CP

64
Q

What is an illegal substance that protects against RDS?

A

Heroin!

65
Q

Two medications you would give a 3 week old baby presenting with ICH (hemorrhagic disease of the newborn)

A

FFP

Vit K

66
Q

FiO2 for PPV in baby 36 weeks GA

A

21% (>=35 wks)

67
Q

FiO2 for PPV in baby 34 wks GA

A

21-30% (< 35 wks)

68
Q

FiO2 when doing chest compressions

A

100%

69
Q

Best way to assess HR during compressions

A

ECG monitoring

70
Q

You are providing PPV to a newborn. When do you assess the HR?

A

after 15 s of PPV

71
Q

Estimate of depth of ETT?

A

nare to tragus length

72
Q

When you are doing compressions, when do you reassess HR?

A

after 60 seconds

73
Q

Most common type of craniosynostosis

A

Scaphoscephaly

74
Q

What measurements constitute an atypical sacral dimple?

A

> 5mm in size, > 2.5cm from anal verge

75
Q

When do you screen for ROP?

A

at 31 weeks CGA or 4 weeks GA, whichever is LATER

Royal College Exam (32 decks)

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