NICU

Question 1

A 3 day old baby has a new onset of seizures. The delivery was uncomplicated (not 100% sure this was in question). The baby is lethargic and tachypneic on exam. She started vomiting. Her blood work includes a normal ammonia and lactate. PH is 7.25, base deficit neg 10. CSF is normal. Cause of seizure:

a. Inborn error of metabolism
b. HIE
c. IVH
d. GBS sepsis or meningitis

Answer 1

HIE

As per Nelson’s, most common cause of neonatal seizures is HIE. Would explain the normal labs and CSF too.

Question 2

Six day old baby presents in shock, afebrile. Glucose 1.6 and cardiomegaly on CXR. What is the most likely etiology of the shock? (no concensus)

a. Congenital heart disease
b. Sepsis
c. Inborn error of metabolism
d. Adrenal insufficiency

Answer 2

CHD

Question 3

Newborn baby with bump on head as shown below. Term infant, afebrile, spontaneous vaginal delivery. What should you do?
CT brain, to determine the extent of the bleed as this can be very serious
Close observation over 24 hours with serial head circumference measurement
Repeat CBC
Reassure that this will resolve over the course of 2-12 weeks

Answer 3

Reassure that this will resolve over the course of 2-12 weeks
Cephalohematoma: subperiosteal hemorrhage, confined within sutures, appears within hours after birth. Occurs in 1-2% of births. No overlying discoloration, firm tense mass. Resorbed within 2 weeks to 3 months depending on size. Linear skull fracture underneath is present in 10-25% of cases. No treatment required, risk of hyperbilirubinemia.

Question 4

An 8 day old infant presents with Na 164, K 4.7. What is the most likely etiology?

a) Munchausen by proxy
b) Inadequate breastfeeding
c) CAH
d) RTA

Answer 4

inadequate breastfeeding

Hypernatremia, normal K
Munchausen by proxy: diagnosis of exclusion
Inadequate breastfeeding: dehydration with hypernatremia
CAH: would be salt wasting at this time therefore hyponatremia + hyperkalemia
RTA: generally presents with non anion gap metabolic acidosis (hyperchloremia) with low bicarbonate. HyPOkal

Question 5

You attend delivery of a 33 week infant, who requires 15 minutes of resuscitation including PPV, CPR and 2 rounds of epinephrine. Apgars are 2, 4 and 4. Initial gas is 6.98. What disqualifies this patient from cooling?

a. Gestational age
b. Length of resuscitation
c. APGAR at 10 min
d. Gas

Answer 5

GA
Must be at least 36 weeks to qualify for cooling
-Criteria:
-Need 2 out of 3 of these: APGARs <5 at 10 minutes, ongoing resuscitation at 10 minutes, umbilical cord gas or 1hr gas with pH <7 or base deficit >16
PLUS
moderate or severe encephalopathy demonstrated by seizures or signs in 3/6 categories

Question 6

You are called to see a newborn with the following rash. What is it?

a. Herpes simplex virus
b. Miliaria
c. Erythema toxicum
d. Neonatal pustular melanosis

Answer 6

erythema toxicum
benign, self-limited, occurs in ~50% of term newborns
-firm yellow-white 1-2mm pustules/papules on erythematous base
-may be in certain areas or widely distributed, palms and soles usually spared
-peak incidence in 2nd day of life, but may be in first few days
-On a stained smear → would see eosinophils and no organisms (sterile) **I recall being pimped on this once, so it may be important?
-no therapy required

Question 7

Newborn with difficult delivery. Myrdriasis. Normal tone. Slightly irritable. What is his Sarnat stage?

a) 0
b) 1
c) 2
d) 3

Answer 7

1
Mild = Sarnat 1
Moderate = Sarnat 2
Severe = Sarnat 3

Question 8

You are seeing a 1 day old newborn, with truncus arteriosus. What are they most likely to develop over the first week of life?

1. pulmonary edema
2. severe cyanosis
3. shock
4. pulmonary hypertension

Answer 8

pulm edema
Truncus Arteriosus
Single arterial trunk arising from the heart and supplying the systemic, pulmonary and coronary circulations
VSD always present, with trunk overriding the VSD and receiving blood from both ventricles
Both ventricles are at systemic pressure and eject blood into the truncus
When pulmonary vascular resistance is relatively high after birth, pulmonary blood flow may be normal; as pulmonary resistance drops in the first month of life, blood flow to the lungs is greatly increased and heart failure ensues
Because of the large volume of pulmonary blood flow, clinical cyanosis is usually mild

Question 9

A 7 day old baby has lax abdominal muscles, bilateral cryptorchidism, poor urine stream and bilateral abdominal masses. What is the most likely cause of the abdominal masses?
a.  Hydronephrosis
B. Multicystic kidneys
C. Polycystic kidneys
D. Wilms tumor

Answer 9

hydronephrosis
Prune belly syndrome - Triad of
Deficient abdominal muscles
Cryptorchidism
Urinary tract abnormalities

Question 10

Newborn baby with 0.8 x 0.4 cm blister on right hand. Term infant, normal pregnancy. Mom had normal antenatal screening with no concerns, normal physical exam. Born by spontaneous vaginal delivery. What should you do?

a. Reassure
b. Treat with antibiotics
c. Treat with acyclovir

Answer 10

reassure

sucking blister - assuming “newborn” is in first 28 days and not right at birth

Question 11

A mother brings in her baby with concerns about his head shape. This is what the head looks like (this was the exact photo from the exam!)

What is the most likely diagnosis?
Positional plagiocephaly
Lambdoid craniosynostosis
Dolicocephaly
Scaphocephaly

Answer 11

Positional plagiocephaly

Anterior displacement of ear on affected side of flattening makes this more likely positional plagiocephaly

Question 12

What is the most common cause for central apnea in a 2 month old baby who is an ex-34 weeker? (*note: ‘apnea of prematurity’ was not an answer option)
Seizures
RSV

Answer 12

RSV
34 + 8 = corrected GA of 42 weeks
RSV likely more common than seizures
pnea of prematurity typically resolves before 37 weeks postmenstrual age (PMA) in infants delivered after 28 weeks gestation. In contrast, in infants born before 28 weeks, apnea frequently persists until term PMA]. However, significant apnea does not typically persist beyond 43 weeks PMA

Question 13

You are informed that a mother in labour is GBS +, and during her last delivery she developed a maculopapular rash when she was given penicillin. Which of the following is the appropriate antibiotic for her now?

a. Clindamycin
b. Penicillin
c. Cefazolin
d. Cloxacillin

Answer 13

cefazolin
Adequate IAP consists of at least one dose given at least 4 h before birth of:
IV penicillin G (initial dose 5 million units) or ampicillin (initial dose 2 grams)
OR
IV cefazolin (initial dose 2 grams) if the mother is allergic to penicillin but at low risk for anaphylaxis

anaphylaxis should be treated with IV clindamycin when the GBS isolate is sensitive to clindamycin and erythromycin OR with IV vancomycin when the isolate is resistant to clindamycin or susceptibilities are unknown. Because the efficacy of the latter two regimes has not been confirmed in clinical trials, they should be considered inadequate IAP

Question 14

A baby was born with perinatal distress. He is currently irritable, hyperreflexic and has mydriasis. What Sarnat stage is he?

a. Sarnat stage 0
b. Sarnat stage 1
c. Sarnat stage 2
d. Sarnat stage 3

Answer 14

sarnat 1 (think SYMPATHETIC)

includes LOC
spontaneous activity
Neuromusc control
Primary reflex
autonomic system
seizures
EEG

Sarnat 2 is PARAsymp - misosis brady, lethargic etc.
Sarnat 3 is absent everything

Question 15

What is the most common cause for hypertension in a newborn?

a. Coarctation of the aorta
b. Renovascular
c. Hydronephrosis

Answer 15

renovascular
Hypertension in the premature infant is most often associated with umbilical artery catheterization and renal artery thrombosis. Hypertension during early childhood may be due to renal disease, coarctation of the aorta, endocrine disorders, or medications. In older school-aged children and adolescents, primary hypertension becomes increasingly common.

Question 16

Why do premature babies receive irradiated blood?

a. To avoid CMV (
b. To prevent GVHD
c. To decrease the risk of febrile transfusion reactions

Answer 16

B

a. To avoid CMV (this is leukoreduction!!)
b. To prevent GVHD (although rare, irradiation prevents GVH)
c. To decrease the risk of febrile transfusion reactions

Question 17

A baby is born post dates and had meconium stained amniotic fluid. After birth he is in respiratory distress. Both pre and post ductal sats are low. He fails a hyperoxia test. What is the diagnosis?

a. PPHN
b. MAS
c. TGA

Answer 17

pphn

Pulse oximetry assessment generally demonstrates a difference of greater than 10 percent between the pre- and postductal (right thumb and either great toe) oxygen saturation. This differential is due to right-to-left shunting through the patent ductus arteriosus (PDA). However, it is important to recognize that the absence of a pre- and postductal gradient in oxygenation does not exclude the diagnosis of PPHN, since right-to-left shunting can occur predominantly through the foramen ovale rather than the PDA.
if CXR is normal pphn

Question 18

A newborn baby is bleeding. How do you differentiate DIC from hemorrhagic disease of the newborn due to vitamin K deficiency?

a. Low platelets
b. Low PTT
c. High PT
d. High fibrinogen

Answer 18

low plt
In Vitamin-K deficient hemorrhagic disease of the newborn, you see
Prolonged INR and aPTT
Decreased prothrombin (II) and factors VII, IX, X (1972)
Normal bleeding time, fibrinogen, factors V + VIII and platelets
In DIC you see a consumptive coagulopathy with
Decreased platelets
Prolonged INR/aPTT
Decreased fibrinogen
Decreased factors V + VIII
Increased D-dimer

Question 19

In twin to twin transfusion syndrome, what does the recipient twin have?

a. CHF
b. RDS
c. High output failure

Answer 19

CHF

Question 20

A newborn baby has significant resp distress, then respiratory rate drops, then HR drops. There is minimal air entry on one side. What do you do first?

a. Needle the chest
b. Bag the baby
c. Intubate

Answer 20

needle the chest
Delivery Room Emergencies
Emergency evacuation without radiographic confirmation is indicated
A 23-gauge butterfly needle or angiocatheter attached to a stopcock syringe should be inserted perpendicular to the chest wall above the rib in the 4th intercostal space at the level of the nipple

Question 21

48 hour old term newborn is jaundiced, bili 221 (total). He has lost 8% of birth weight. Coombs negative. What is your management? (phototherapy charts provided)

a. weight + check bili in 24 hours
b. start phototherapy
c. exchange transfusion

Answer 21

weight and check bili 24 h

Question 22

You attend the delivery of a 36 week baby. There was some nonreassuring fetal heart rate tracing. After initial cleaning and stimulation, baby has no respiratory effort, HR was 48bpm. What do you do next?

a) CRP + bag-mask ventilation in 100%O2
b) CPR + bag-mask ventilation in RA
c) Bag-mask ventilation in 100%O2
d) Bag-mask ventilation in RA

Answer 22

BMV- RA

Initial FiO2 for PPV:
35 weeks GA or older: 21%
Less than 35 weeks GA: 21-30%
Turn up to 100% O2 when compressions started

Question 23

8 day old baby, exclusively breastfed with the following bloodwork: Na 161, K 4.4, Cl 99. What is the reason?

a) Hypernatremia due to breastfeeding dehydration
b) CAH

Answer 23

breastfeeding
Hypernatremia with normal K and Cl
CAH: Hyponatremia + hyperkalemia
Other question had RTA as an option - would see hyperchloremia, usually with hypokalemia

Question 24

Neonate 1 month old presents with feeding well, but the following BW: total bili 228, Conjugated 200, Unconjugated. Gaining weight

a) Galactosemia
b) Neonatal hepatitis
c) Breastmilk jaundice

Answer 24

b) Neonatal hepatitis

Direct fraction 200/228 = 88% (anything > 20% abnormal)
Galactosemia - can have conjugated or unconjugated hyperbilirubinemia, but classic form (most common) would present in first few days of life after introduction of cow’s milk based feed - jaundice, vomiting, hepatomegaly, FTT, lethargy, diarrhea, sepsis. Would not be feeding well!

Question 25

Breastfeeding jaundice @ 3 weeks. Mom A+, baby O+. Gaining weight.

a) Breastmilk jaundice
b) ABO incompatibility

Answer 25

ABO incompatible

Question 26

You have just given surfactant to a 28 week old prem baby. You tell the parents that surfactant:

a) Increases the risk of IVH
b) Decreases the risk of chronic lung disease
c) Decreases mortality from RDS
d) Increases the risk of pneumothorax

Answer 26

) Decreases mortality from RDS

a) Increases the risk of IVH (no, antenatal corticosteroids decreases risk of IVH)

Question 27

Maternal history of methadone use, how long you have to watch the baby

a) 5 days
b) 10 days
c) 21 days
d) 2 days

Answer 27

a) 5 days

According to lecture, long half-life of methadone means onset of symptoms can be delayed to 4-5 days

Question 28

6 day old baby with enlarged liver, hypotonic, lethargic. Unsure if gave temperature. 02 88% on 100% FI02. Next step?

a) Start PGE
b) Start antibiotics

Answer 28

a) Start PGE

Failed repsonse to 100% O2 makes this more likely cardiac; age of presentation also makes sense

Question 29

Microcephaly and 3lb baby. What was the fetus most likely exposed to in utero?

a) Pre-eclampsia
b) Maternal infection
c) Smoking

Answer 29

3lb = 1.36 kg - therefore (assuming term) symmetric SGA with microcephaly

Pre-eclampsia
Fetal effects if placental insufficiency issues - has to be severe and usually get head sparing

Maternal infection
Likely TORCH infection

Smoking: Increases risk miscarriage, stillbirth, preterm birth, low birth weight, placental abruption/previa

Question 30

Baby 33 weeks GA, apgars 2,4,4, at 1,5,10 minutes, ph 6.8, base excess 20 what excludes child from cooling?
a) Gestation age

Answer 30

GA
Who should not be cooled?
Evidence of severe head trauma or intracranial bleeding
Currently no published studies showing that cooling infants >6 h of age or <36 weeks’ gestational age is beneficial
Initiation of cooling for infants with very severe encephalopathy, congenital anomalies or abnormal chromosomes is best performed in consultation with a tertiary centre

Question 31

Teratogenic effects of carbamazepine

a) Neural tube defect
b) Cleft lip and palate

Answer 31

a) Neural tube defect

Some folic acid antagonists that have been linked to an increased risk of NTDs include valproic acid, carbamazepine, and methotrexate

Question 32

Teen Parents with a 23 weeker what do you do?

a) They are Teens so their opinion doesn’t matter
b) Respect their decisions for resuc
c) Decide what to do because you’re the doc
d) Must resuc all babies over 22 GA

Answer 32

b) Respect their decisions for resuc

Given the lack of moral authority on the suggested level of care, parents may choose a nonrecommended option. Health care professionals (HCPs) should engage with them to determine their infant’s management plan.

Question 33

39 week old baby at 30 hours of life. Bili 270. No G6PD, CBC normal showing no hemolysis, DAT negative. What should you do? (Photo and exchange graphs given)
Give IVIg and prepare for exchange
Start intensive photo and recheck bili in 6 hours
Ensure good feeding and check bili in 12 hours
Start exchange transfusion

Answer 33

Start intensive photo and recheck bili in 6 hours

IVIG may reduce the need for exchange transfusion in infants with hemolytic disease caused by Rhesus (Rh) or ABO incompatibility

Question 34

APGAR scores for a baby. 1 minute: HR 80, grimace with suction, blue, limp, irregular resps. 5 minute: HR 140, no response to suction, acrocyanosis, limp, irregular resps.
4,4
3,4
3,5

Answer 34

3,4

APGARS
activity, pulse, grimace, appearance, resp

Question 35

Term baby, 4500g. Plethoric and lethargic. HGb 270ish, Hct 0.72. Gas normal. WBC normal, plts in 500s.
iv antibiotics
iv fluids with D10
partial exchange transfusion

Answer 35

partial exchange
Defined as central hematocrit 65% or higher in peripheral venous sample
Higher in capillary samples therefore confirm with venous
Some also define Hgb >220, but Hct more clinically relevant
Causes: DCC, intrauterine hypoxia, TTTS, placental insufficiency, LGA babies, IDDM, endocrinopathies
Exaggerated by dehydration

Asymptomatic (UTD)
Hct 0.6 - 0.7: monitor, adequate hydration (supplement if needed), blood glucose monitoring, bilirubin check, repeat CBC in 12-24 hours
Hct >0.7: consider IV hydration
Hct >0.75: partial exchange transfusion
*Nelson’s says PET should be considered if the Hct is >0.7-0.75, or lower if symptomatic
Symptomatic
IV hydration
PET if worsening symptoms or Hct >0.7-0.75
Infants that get PET are at increased risk of NEC

Question 36

Term baby with difficult labour and delivery (required resuscitation, asphyxiated).  Baby found to be irritable and hyperreflexic.  What is the Sarnat stage?
0
1
2
3

Answer 36

sarnat 1

Question 37

.  41 weeker, mom has placental abruption, baby born asystolic, when can you stop resuscitation?
A.     	5 minutes
B.     	10 minutes
C.     	15 minutes
D.     	20 minutes

Answer 37

10min
An Apgar score of 0 at 10 minutes is a strong predictor of mortality and morbidity in late preterm and term infants. We suggest that, in infants with an Apgar score of 0 after 10 minutes of resuscitation, if the heart rate remains undetectable, it may be reasonable to stop assisted ventilation; however, the decision to continue or discontinue resuscitative efforts must be individualized.

Question 38

You are seeing a 2 day old term baby. Their delivery was complicated by perinatal asphyxia requiring resuscitation. They are doing well now however you note the following findings on physical exam:
What is your next step in management?
A. Serum calcium
B. Admit baby for observation
C. Serum glucose
D. Draw CBC and start antibiotics

Answer 38

Hypercalcemia, a potentially life-threatening complication of SCFN, occurs in approximately 36 to 56 percent of affected neonates. Hypercalcemia may be asymptomatic or may present with irritability, hypotonia, anorexia, or vomiting
Google subcutaneous fat necrosis - this picture comes up!
CFN most often develops in full-term (>37 weeks gestational age) neonates who have experienced hypoxia or other perinatal stress. Therapeutic hypothermia with cooling of the body or head for neonatal asphyxia is an additional risk factor
serum calcium levels must be monitored for several months after the diagnosis.

Question 39

A term baby is born by emergency C/S for placental abruption. Appropriate resuscitation is conducted. What is the earliest that the resuscitation can be discontinued?
5 minutes
10 minutes
20 minutes
30 min

Answer 39

10 min

Question 40

An infant has a sacral dimple. What would make you more concerned about spinal dysraphism?
1-Mongolian spot over dimple
2-Located above gluteal cleft
3-Located 2 cm from anus
4- 3mm in diameter

Answer 40

gluteal cleft
deep and large (greater than 0.5 cm), fall within the superior portion or above the gluteal crease (>2.5 cm from the anal verge), or are associated with other cutaneous markers for NTDs (eg, hypertrichosis, and discoloration), are more likely to be associated with an underlying NTD

Question 41

35+6 week infant born to a mother who is GBS unknown. ROM x 12 hours. Infant is well. What do you do?
CBC, Cx and Empiric abx x 36h.
CBC and observe if WBC <5
CBC and observe if WBC >5
observe

Answer 41

OBSERVE
Well infant, GBS negative/unknown with no other risk factors
Routine newborn care
One other risk factor (ROM > 18 hours or maternal fever
Adequate IAP - routine newborn care
Inadequate IAP - VS q3-4h for min 24 hours
Multiple risk factors or chorio (no matter what the IAP)
Individualized care, minimum VS q3-4h x24 hours
CBC at 4 hours of life may be helpful

Question 42

Most common cause of hypertension in a newborn?
Hydronephrosis
Coarctation of aorta
Renovascular
CAH

Answer 42

renovascular

Question 43

A 29+2 week GA infant in the NICU. When should ROP screening start?

a) 31 weeks
b) 32 weeks
c) 33 weeks
d) 34 weeks

Answer 43

do it if <31w or <1250g at birth

ANSWER-33 weeks

31 weeks or 4 weeks PNA, which ever is later

Question 44

4. 2 kg infant born to a mother with gestational diabetes. Glucose at 2 hours of age is 2.1. What is your management?
   a) Continue to measure glucose every 3-4 hours for the next 36 hours.
   b) Feed the infant. Recheck glucose in 1 hour.
   c) Feed the infant. Recheck glucose before next feed in 3-4 hours.
   d) Continue to monitor glucose every 3-4 hours for the next 12 hours.

Answer 44

d) Continue to monitor glucose every 3-4 hours for the next 12 hours.

@2 hours if BG > 2.0 can continue checking. If 1.8-2.0 then feed and recheck in 1 hour. If <1.8 then initiate IV dextrose. Since baby is LGA, checking should continue for 12 hours; if SGA 36 hours.

Question 45

8 day old baby. Na 165, K 4.7.  
Breastfeeding failure
CAH
?
?

Answer 45

breastfeeding

Question 46

You attend delivery of a 33 week infant, who requires 15 minutes of resuscitation including PPV, CPR and 2 rounds of epinephrine. Apgars are 2, 4 and 4. Initial gas is 6.98. What disqualifies this patient from cooling?
Gestational age
Length of resuscitation
APGAR at 10 min
Gas

Answer 46

GA
need to be >36w or <6h

Criteria A
Any two of the following:
Apgar score <5 at 10 min of age.
Continued need for ventilation and resuscitation at 10 min of age.
Metabolic acidosis with pH <7 or base deficit >16 mmol/L in cord or arterial blood gases measured within 1 h of birth.
+
SARNAT 2 or 3 wiht seizures, OR at least one sign out of 3 categories/6 cateogries

Question 47

24h old newborn with the picture shown above. What to do/tell parents?
1 Head imaging to see extent
2No further intervention and it will resolve spontaneously in 2-12 weeks
3 Provide analgesia and it will resolve spontaneously in the next few days
4 Monitor head circumference and Hgb x 24 hours as can become hemorrhagic shock

Answer 47

No further intervention and it will resolve spontaneously in 2-12

Question 48

Neonate with E. coli bacteremia, midline abdominal mass on physical examination. Increased serum creatinine. What investigation would most likely confirm the diagnosis?
Renal ultrasound
VCUG
CT abdomen
Urine culture

Answer 48

VCUG

Question 49

Mother uses marijuana for chronic pain. Breastfeeding. What do you tell her about the risks to the baby:

a) continue breastfeeding. Benefits of breastfeeding outweigh risk of marijuana
b) marijuana is contraindicated due to risks on the developing brain
c) recent studies on the legal use of marijuana found no risk
d) Counsel to stop using marijuana. Risks to baby unknown.
e) Call CAS

Answer 49

counsel to stop mariguana as risk unknown for baby

Question 50

You are called to a twin delivery. Twin A is 2800g with Hct 0.70 and Twin B is 2100g and Hct 0.40 What are you most likely to see in Twin A:

a) Hypoglycemia
b) RDS
c) CHF

Answer 50

CHF
recipeint, polyhydramios, hydrop,s plethoric, LGA, polycythemic, hypervolemic, cardiac hypertrophy, myocardial dysfunction, RVOT, artertial thick walls

Question 51

A baby is diagnosed with Erb’s palsy. What are you likely to see:

a) symmetric Moro
b) intact biceps reflex
c) intact grasp reflex
d) intact wrist extension

Answer 51

intact grasp reflex
adduction and internal rotation of the arm with pronation of the forearm.

In erb’s palsy C5+ C6 - there is assymetric Moro, and absent biceps reflex
they can still extend forearm and have hand grasp
When C7 is additionally involved in upper palsy, there is also flexion of the wrists and fingers (C7 controls finger extension). - cant extend wrist

Question 52

28 week infant, 32 weeks currently. Feeding well on gavage feeds. Using HF 4L/min room air. What should his transfusion threshold be?
100
75
85
115

Answer 52

85

week 1-resp support 115/no resp support 100

week 2 100/85
week 4 85/75

Question 53

You are informed that a mother in labour is GBS +, and during her last delivery she developed a maculopapular rash when she was given penicillin. Which of the following is the appropriate antibiotic for her now?

a. Clindamycin
b. Penicillin
c. Cefazolin
d. Cloxacillin

Answer 53

cefazolin

Question 54

A baby was born with perinatal distress. He is currently irritable, hyperreflexic and has mydriasis. What Sarnat stage is he?

a. Sarnat stage 0
b. Sarnat stage 1
c. Sarnat stage 2
d. Sarnat stage 3

Answer 54

sarnat 1

alertness, muscle tone, seizures, pupils, resp, duration (<24h)

Question 55

An ex-preterm baby is now 8 weeks old but is still in the NICU. When do you give his first vaccines?

a. Now
b. When he is 8 weeks corrected
c. When he is discharged from the NICU

Answer 55

now

Question 56

Why do premature babies receive irradiated blood?

a. To avoid CMV
b. To prevent GVHD
c. To decrease the risk of febrile transfusion reactions

Answer 56

prevent gvhd

Question 57

In twin to twin transfusion syndrome, what does the recipient twin have?

a. CHF
b. RDS
c. High output failure

Answer 57

CHF

Question 58

A newborn baby has significant resp distress, then respiratory rate drops, then HR drops. There is minimal air entry on one side. What do you do first?

a. Needle the chest
b. Bag the baby
c. Intubate

Answer 58

needle the chest

Question 59

48 hour old term newborn is jaundiced, bili 221 (total). He has lost 8% of birth weight. Coombs negative. What is your management? (phototherapy charts provided)

a. weight + check bili in 24 hours
b. start phototherapy
c. exchange transfusion

Answer 59

weight PLUS bili check 24 hours

Question 60

You attend the delivery of a 36 week baby. There was some nonreassuring fetal heart rate tracing. After initial cleaning and stimulation, baby has no respiratory effort, HR was 48bpm. What do you do next?

a) CRP + bag-mask ventilation in 100%O2
b) CPR + bag-mask ventilation in RA
c) Bag-mask ventilation in 100%O2
d) Bag-mask ventilation in RA

Answer 60

Bag-mask ventilation in 100%O2

Question 61

8 day old baby, exclusively breastfed with the following bloodwork: Na 161, K 4.4, Cl 99. What is the reason?

a) Hypernatremia due to breastfeeding dehydration
b) CAH

Answer 61

Hypernatremia due to breastfeeding dehydration

Question 62

Neonate 1 month old presents with feeding well, but the following BW: total bili 228, Conjugated 200, Unconjugated. Gaining weight

a) Galactosemia
b) Neonatal hepatitis
c) Breastmilk jaundice

Answer 62

neonatal hepatitis
neonatal hepatitis, which can occur in either a sporadic or a familial form, is a disease of unknown cause. Patients with the sporadic form presumably have a specific yet undefined metabolic or viral disease. Familial forms, on the other hand, presumably reflect a genetic or metabolic aberration.

Question 63

An Asian baby presents at 12 hours of life with jaundice. Mother is O+, the baby is A+. The bilirubin is 200. What is the diagnosis?

a. ABO incompatibility
b. G6PD
c. Rh incompatibility
d. Physiological jaundice

Answer 63

a. ABO incompatibility

Question 64

You have just given surfactant to a 28 week old prem baby. You tell the parents that surfactant:

a) Increases the risk of IVH
b) Decreases the risk of chronic lung disease
c) Decreases mortality from RDS
d) Increases the risk of pneumothorax

Answer 64

c) Decreases mortality from RDS

Question 65

Maternal history of methadone use, how long you have to watch the baby

a) 5 days
b) 10 days
c) 21 days
d) 2 days

Answer 65

5 days
heroin exposure causes earlier and shorter withdrawal, whereas methadone and buprenorphine exposure lead to later onset and longer withdrawal. Of the nonopioids, methamphetamines cause immediate withdrawal, psychotropic medications usually induce transitional and self-limiting

Question 66

Mom with GBS and hx of maculopapular rash when given Pen in last delivery. What antibiotic

a) penicillin
b) cefazolin
c) clinda
d) erythromycin

Answer 66

cefaz

Question 67

6 day old baby with enlarged liver, hypotonic, lethargic. Unsure if gave temperature. 02 88% on 100% FI02. Next step?

a) Start PGE
b) Start antibiotics

Answer 67

start PGE

Question 68

Microcephaly and 3lb baby. What was the fetus most likely exposed to in utero?

a) Pre-eclampsia
b) Maternal infection
c) Smoking

Answer 68

maternal infxn
symmetric (head circumference, length, and weight equally affected) or asymmetric (with relative sparing of head growth)
Symmetric IUGR often has an earlier onset and is associated with diseases that seriously affect fetal cell number, such as conditions with chromosomal, genetic, malformation, teratogenic, infectious, or severe maternal hypertensive etiologies.

Question 69

Causes of asx IUGR

Answer 69

Asymmetric IUGR is often of late onset, demonstrates preservation of Doppler waveform velocity to the carotid vessels, and is associated with poor maternal nutrition or with late onset or exacerbation of maternal vascular disease (preeclampsia, chronic hypertension).

Question 70

Teen Parents with a 23 weeker what do you do?

a) They are Teens so their opinion doesn’t matter
b) Respect their decisions for resuc
c) Decide what to do because you’re the doc
d) Must resuc all babies over 22 GA

Answer 70

b) Respect their decisions for resuc

At 23, 24 or 25 weeks’ GA, counselling about outcomes and decision making around whether to institute active treatment should be individualized for each infant and family. (Strong Recommendation)
At 23 and 24 weeks’ GA, active treatment is appropriate for some infants. (Weak Recommendation)

Question 71

Newborn with unilateral miosis, ptosis, brachial plexus injury and phrenic nerve injury from shoulder dystocia. What do you tell mom? (similar previous question didn’t have phrenic nerve injury in it) [CPS statement on brachial plexus injury did not answer this question]

a. Thoracic injury will be permanent
b. Brachial injury will be permanent
c. Symptoms will be chronic and require surgery
d. All injuries will resolve in a few weeks

Answer 71

symptoms will be chronic and require surgery

Question 72

Newborn receives vit K at birth. At what time does classic hemorrhagic disease of the newborn present? (similar previous question on vitamin K but did not ask about timing) [CPS]

a. Within the first 24h
b. Within the first week
c. After the Third week of life

Answer 72

within first week CLASSIC

Question 73

Newborn 36+4wks GA in respiratory distress in labour and delivery. At 1h of life, still has mild increased work of breathing with RR80, SpO2 89% on RA, HR 150, BP 65/33. CXR shows fluid in the fissure on the R and a small pleural effusion on the L. What is the next step?

a. O2 as required
b. CPAP
c. Furosemide
d. Prostaglandins

Answer 73

O2 as required (as per Nelson’s oxygen is first line, CPAP if ongoing/increasing WOB; Danielle’s group chose this)
b. CPAP (as per lecture, pathophysiology of TTN would need distending pressure)

Question 74

Kid with NEC features, you’re in the periphery, what would you do next?

a. Arrange for urgent transfer to tertiary care center
b. Give broad spectrum antibiotics
c. Change formula
d. Start TPN

Answer 74

broad spectrum abx

cessation of feeding, nasogastric decompression, and administration of intravenous fluids.

Question 75

Kid with TEF on CXR, what to do?

a. Continuous suction and surgery

Answer 75

continous suction and surgery

Prone positioning minimizes movement of gastric secretions into a distal fistula, and esophageal suctioning minimizes aspiration from a blind pouch. Endotracheal intubation with mechanical ventilation is to be avoided if possible because it can worsen distention of abdominal viscera.
Surgical ligation of the TEF and primary end-to-end anastomosis of the esophagus are performed when feasible

Question 76

Term newborn female is born vigorous and is pink with crying. As she settles, she progressively becomes cyanotic. She is bagged on RA and becomes pink but when the bagging is stopped, she becomes cyanotic again. What is the most likely diagnosis?

a. Bilateral choanal atresia
b. Congenital heart disease
c. Tracheoesophageal fistula
d. Tracheal web

Answer 76

Bilateral choanal atresia

neonates are obligate nasal breathers
Classic finding is pink when crying (because breathing through mouth) and blue when settled

Question 77

37wk GA newborn in L&D. After 30 seconds of drying, warming and stimulating, he is apneic, flaccid and cyanotic with HR 48. What is your next step? [cps]

a. Chest compressions and ventilated with RA
b. CPR and ventilate with 100% O2
c. PPV with 100% O2
d. PPV with room air

Answer 77

ppv RA

Question 78

Primiparous Asian mom with blood group A+. Her term newborn is jaundiced at 12h of life. What is the most likely diagnosis?

a. G6PD
b. Physiologic jaundice
c. ABO incompatibility
d. Rh incompatibility

q

Answer 78

g6pd
All mothers should be tested for ABO and Rh(D) blood types and be screened for red cell antibodies during pregnancy.
If the mother was not tested, cord blood from the infant should be sent for evaluation of the blood group and a DAT (Coombs test)
Blood group evaluation and a DAT should be performed in infants with early jaundice of mothers of blood group O
Selected at-risk infants (Mediterranean, Middle Eastern, African or Southeast Asian origin) should be screened for G6PD deficiency
A test for G6PD deficiency should be considered in all infants with severe hyperbilirubinemia

Question 79

Term baby well on exam, bili 221 at 48h; DAT neg. what do you do? (given 2 bili charts; graph it, see it doesn’t meet photo level, but is in high intermediate zone)

a. Conventional photo
b. Intensive photo
c. Arrange f/u in 72h
d. f/u in 24h for rep bili & wt check

Answer 79

f/u in 24h for rep bili & wt check

Question 80

NAS baby, treatment
a. Morphine

141. Breastfeeding mom on SSRI, what should she do?
     a. Continue breastfeeding

Answer 80

a

Question 81

Mother has recurrent HSV. THere were no active lesion at delivery. For how long after delivery is the infant at risk for PERINATAL transmission?

a) 2 weeks
b) 6 weeks
c) 16 weeks
d) 36 week

Answer 81

6w
In most cases, the initial symptoms of NHSV infection present within the first four weeks of life. Occasionally, disease presents for the first time between four and six weeks after birth.

Question 82

A 3 day old baby has a new onset of seizures. The delivery was uncomplicated (not 100% sure this was in question). The baby is lethargic and tachypneic on exam. She started vomiting. Her blood work includes a normal ammonia and lactate. PH is 7.25, base deficit neg 10. CSF is normal. Cause of seizure:

a. Inborn error of metabolism
b. HIE
c. IVH
d. GBS sepsis or meningitis

Answer 82

GBS

Question 83

Term newborn has petechiae and bruising. The baby is well. On bloodwork his platelets are low at 16, WBCs are 18 and his Hgb is 140. He is given a platelet transfusion and a repeat platelet count is 16. The mother’s CBC shows platelets are normal. What is the best treatment: ***Q

a. Random donor platelets
b. PLA-1 negative platelets
c. IVIG
d. Washed maternal platelets

Answer 83

washed maternal plt
Neonatal alloimmune thrombocytopenia is caused by the transplacental transfer of maternal autoantibodies directed against antigens present on the fetal platelets (antigens shared with father).
· Consider NAIT in an apparently well child who within the first few days after delivery has generalized petechiae and purpura.
· Lab: normal maternal platelet count

Question 84

Mom has fever (38.5) in labour and delivers baby. OB says chorioamniotis. What do you want to do with baby?

a. Observe – at minimum observe for 24 hours with vitals q3-4h and reassessment prior to DC
b. CBC + observe 24h – cps statement says to “consider CBC”
c. CBC, blood culture and antibiotics
d. CBC, blood culture, LP and antibiotics

Answer 84

CBC and observe 24 hours

Question 85

newborn screen positive for congenital hypothyroidism. TSH is very high (47). What to do?

a. Repeat TSH, fT4
b. Start therapy
c. Bring in for examination

Answer 85

start therapy

TSH> 17 is elevated
If TSH 17-40, then repeat TSH with free T4
If TSH >40 repeat the labs first to confirm the diagnosis start thyroxine immediately and organize imaging.

Question 86

Infant with brachial plexus injury. Persists after 1 month. What to do?

a. Refer
b. MRI of spine
c. Observe

Answer 86

refer

· Brachial plexus injuries present as flaccid paralysis of the arm at birth, can arise from injuries from C5-T1
· 75% of infants will demonstrate full recover within first month, while 25% will have residual effects
· incomplete recovery by 4 weeks of life suggests that full recovery in unlikely
· incomplete recovery by 4 weeks of life warrants referral to a multidisciplinary brachial plexus team including neurologists, plastic surgeons, physio, rehabilitation therapists.

Question 87

Infant with horner syndrome and not moving arm. What investigations?

a. MRI
b. nerve conduction studies

Answer 87

?CXR

• Brachial plexus injuries are clinical diagnoses.
  · Not moving arm: total paralysis therefore all nerve roots from C5-T1 involved
  · Can be associated with phrenic nerve palsy: if newborn with brachial palsy has tachypnea and requires oxygen, possibility of phrenic nerve involvement increases and US of hemidiaphragmatic movement can be indicated. Diagnosis made with chest radiograph

Question 88

Mother has twins. Twin #1 with Hct 70, #2 with Hct 40. What will twin #2 have?

a. Heart failure
b. Hyper bili
c. Cyanosis

Answer 88

Heart failure (as per lecture, donor twin has high output heart failure)

Question 89

SGA baby with increasing glucose requirement. GIR ~11mg/kg/min with BG 1.8. What is the diagnosis.

a. Cortisol deficiency
b. Growth hormone deficiency
c. Hyperinsulinism

Answer 89

c. Hyperinsulinism
Risk factors for hyperinsulinism are SGA, HIE, premature newborns, IUGR, pre-eclampsia. Most common cause of persistent hypoglycemia in early infancy

Question 90

89. Which of the following predisposes to late hemorrhagic disease of the newborn:
    a. Breastfeeding
    b. Prematurity
    c. cystic fibrosis
    d. maternal phenytoin
    e. oral antibiotics

Answer 90

cf
Late (2-8 weeks of life)
· Disorders that result from the malabsorption of vitamin K (biliary atresia)
· Cystic fibrosis, primary cholangitis, BA, celiac disease contribute to fat malabsorption, since Vit K is a fat soluble vitamin, pts with these conditions can become vitamin K deficient.

Question 91

A newborn infant had thin meconium at delivery but had good Apgars and required only 2 minutes of free flow O2. Now at 12 hours of age he has increasing work of breathing. On CXR there is hyperinflation of the RUL with mediastinal shift. What is the most likely diagnosis?

a. Meconium aspiration syndrome
b. Neonatal pneumonia
c. CCAM
d. Congenital lobar emphysema

Answer 91

Congenital lobar emphysema
Distention of the affected lobe, mediastinal shift, compression and atelectasis of the contralateral lung. Diaphragm often flattened because of hyperinflation.
· Congenital lobar emphysema usually arises from progressive lobar hyperinflation secondary to obstruction of the developing airway.

Question 92

10. Baby born with inability to open one eye and pupillary constriction - which nerves are likely to have been injured at birth?
    a. C5,C6,C7
    b. C5,C6,C7,C8, T1
    c. C7,C8,D1

Answer 92

C5,C6,C7,C8, T1
 horners syndrome (miosis and ptosis).

Question 93

A newborn baby has copious oral secretions and respiratory distress. What is the most appropriate next test?

a. Insertion of orogastric catheter
b. CXR
c. Abdominal U/S
d. Barium swallow

Answer 93

a. Insertion of orogastric catheter
Espophageal atresia presents with frothing and bubbling at the mouth and nose after birth as well as episodes of coughing cyanosis and respiratory distress.
inability to pass an orogastric tube or nasogastric tube suggests esophageal atresia.

Question 94

Description of a child with renal stones. Was a prem. Which medication was the child likely on in the neonatal period that would contribute to this picture?

a. gentamicin
b. furosemide
c. thiazide

Answer 94

furosemide
nephrocalcinosis: calcium salt formation and aggregation within the renal tubules
· Loop diuretics à increased PO4 excretion + decreased calcium resorption à increased RF of nephrocalcinosis.
· Acetazolamide can be used to improve calcium and phosphate excretion in babies receiving loop diuretics.
· Thiazide (reduces Na resorption in the distal loop of Henle but also increases Ca resorption)

Question 95

Term BB, mom with gestational diabetes. DOL 1. Glucose 1.4. What is your next step in management? [Note: this question is often repeated with more detail explaining that the neonate is symptomatic, lethargic and hypoglycemic]

a. Bolus glucose by NG
b. Bolus 1 cc/kg of D50W
c. Run IV D10 @ 80 cc/kg/day
d. Frequent breastfeeding

Answer 95

run d10 IV 80cc/kg/d
Natural trough in BG at 1-2 hours post delivery, infants at risk should be screened at 4-6 hours of age
· IDMs experience asymptomatic hypoglycemia at 1 hour of age – this population should be screened earlier
· LGA and IDMs do not require further screening if BG > 2.6 mmol
· Preterm and SGA infants may be vulnerable up to 36 h of age. Screening for preterm infants and SGA infants can be discontinued after 36 hours of age (if BG maintained > 2.6 mmol)

Question 96

Baby boy presents lethargic with a serum glucose of 1.4. Pregnancy, labour and delivery were all uncomplicated. What do you do next:

a. Breast feed on demand
b. Top up cup feed
c. give 1ml/kg of D50W
d. Start D10W at 80cc/kg/day

Answer 96

Start D10W at 80cc/kg/day

Question 97

Bili question. 37 weeker. Mild lethargy. Total bili 280 @ 30 weeks. No ABO. Give 3 bili charts. Mgt? [Likely error: 30 hours]

a. Follow-up in 24 hours
b. Phototherapy and repeat bili in 6 hours
c. Exchange
d. IVIG

Answer 97

Phototherapy and repeat bili in 6 hours – this question does not specify that there is significant lethargy, isoimmune hemolytic disease, G6PD, asphyxia, resp distress, sepsis, acidosis which would warrant using the high risk curve (high risk cut off for exchange transfusion is 270)

Question 98

30 hr old, 37 week baby, with unconjugated bilirubin 275. Graphs provided for bili reference. What do you do now? No hemolysis on smear, no ABO incompatability

a. re-check bili in 6 hrs
b. IV fluids and prepare for exchange transfusion
c. IV fluids and prepare for IVIG

Answer 98

IV fluids and prepare for exchange transfusion
healthy newborns, exchange transfusion should be considered when TSF concentration 375-425
Risk factors: isoimmune hemolytic disease, G6PD deficiency, asphyxia, respiratory distress, significant lethargy, temperature instability, sepsis, acidosis
· Exchange transfusion level for medium risk (35-37+6 and well) is 290
· Exchange transfusion level for high risk (35-37+6 and risk factors) is 270.

Question 99

at 5 days of life
exchange transfusion level? and intensive 
phtotherapy level
For high risk 
Low risk

Answer 99

exchange
400 for low risk
300 high risk

photo
250 low risk
350 high risk

Question 100

Newborn baby with low hemoglobin. Kleihauer-Betke test ordered. What does this test?

a. Mom’s blood for fetal hemoglobin
b. Baby’s blood for maternal hemoglobin
c. Mom’s blood for blood type and reactivity to baby blood type
d. Baby’s blood for blood type and reactivity to mother’s blood type

Answer 100

. Mom’s blood for fetal hemoglobin

Question 101

3 day old baby with tachypnea, jitteriness, myoclonus and normal glucose. Treatement?

a. Amp/gent
b. Vit B
c. Morphine

Answer 101

morphine
Clinical signs of NAS reflect dysfunction in 4 domains: control and attention, motor and tone control, sensory integration and autonomic functioning.

Question 102

Term newborn baby in the nursery is found to be jittery, tachypneic with nasal flaring, with myoclonus. Normal glucose. Based on the most likely diagnosis, what is your next management?

a. Morphine
b. Benzos

Answer 102

morphine

Question 103

Baby was tachypneic, increased HR, then RR =6 and HR and BP drops. Can’t hear murmur in lung field. Mgt?

a. Needle
b. IV epi
c. Intubate
d. Bag mask valve

Answer 103

needle
Emergent treatment without CXR confirmation if unresponsive to resuscitation efforts, asymmetric breath sounds, bradycardia, cyanosis. Needle thoracentesis followed by chest tube for definitive management.

Question 104

9 month old baby presents with respiratory distress, indrawing. HR 150. Given 100% non-rebreathing mask initially. Acute deterioration, RR =6, diminished air entry, cyanotic, and HR 96. Can’t hear murmur in lung field. What would be your next management?

a. intubate and ventilate
b. bag mask ventilation
c. needle thoracentesis

Answer 104

needle thoracentesis

Question 105

aby now corrected 39 weeks. GA 25 weeks. had unremarkable NICU stay. Treated with caffeine for apnea of prematurity. Now still has 5-6 episodes of apnea, with transient bradycardia. What is the problem?

a. persistent apnea of prematurity
b. seizures
c. hypoglycemia

Answer 105

persistant apnea of prematurity
Apnea of prematurity usually resolves by 37 weeks of postconceptal age, may persist beyond term gestation particularly in extremely preterm infants (GA < 28 weeks)
does not predict SIDS

Question 106

Mother comes in at 6pm and delivers 39wk baby at 8pm. Received antibiotics and is GBS positive. Baby’s initial CBC is normal, baby looks well. She wants to go home next morning with the baby and says she lives very close to the hospital. You should:

a. Keep baby in hospital for 24 hours and then reassess
b. Discharge baby in morning and do CBC prior to d/c.
c. Keep baby in hospital for 48 hours for observation.
d. Do a full septic workup and start baby on antibiotics.

Answer 106

a. Keep baby in hospital for 24 hours and then reassess

Question 107

Pregnant mom who has a previous child. She is GBS positive, comes in at 6:00pm and gets IV penicillin. At 8:00pm, she delivers a healthy baby boy at 39 weeks. Babe is well and has a normal CBC. She is wondering when she can go home (she lives
close to the hospital)?
a. start amp/gent
b. observe until 24 hours
c. observe until 48 hours
d. full septic work-up

Answer 107

observe till 24 h

Question 108

Baby born at 27 weeks GA via spontaneous vaginal delivery. Baby is apneic, cyanotic, low tone. Heart rate is 100. Your next step is:

a. Dry, stimulate, suction baby.
b. Polyethylene bag, stimulate, suction baby.
c. PPV with O2 and chest compressions.
d. PPV with room air and chest compressions.

Answer 108

b. Polyethylene bag, stimulate, suction baby.

Polyethylene bag-<32 weeks

Question 109

Baby is 12hrs old Presents with two afebrile seizures – generalized tonic-clonic seizures. Mother had a remote history of drug abuse. Baby born at term without complications. Your next step after admission to the NICU and oxygen for baby is:

a. Administer morphine IV
b. Administer Phenobarbital 20 mg/kg bolus
c. Administer methadone

Answer 109

b. Administer Phenobarbital 20 mg/kg bolus
Age 1-4 days
· HIE: most common cause of neonatal seizures. 50-60% of patients, seizures secondary to encephalopathy usually occur within the first 12 hours of birth
· Vascular events: IVH, ischemic strokes 10-20% of patients.
· Infection: TORCH, meningitis, herpes encephalitis

Question 110

36 hours of life, newborn found to be sneezing, has diarrhea and jittery. Mother most likely abused which drug:

a. Valproic acid
b. Lithium
c. Methadone
d. Cocaine

Answer 110

methadone
TX- morphine/methadone and buprenorphine treat NAS)
valproate - inc neural tube defect
lithrium- ebstein anomaly - TV changes, cardiomeg, GI bleed,hypo, HSM, DI,
cocaine- sx 48-72 hrs, present upto 7 days

Question 111

Baby born to drug abuse. Presents with tachycardia, sneezing. Which drug did mom use:
a. Methadone
—————
Newborn is sneezing, what could this be associated with?
a. methadone

Answer 111

sneezing with metahdone

Question 112

week old breastfed infant comes with Na 165, K 4.1, Cl 120. What is the Diagnosis?

a. CAH
b. RTA
c. Munchausen
d. Breastfeeding dehydration

Answer 112

CAH: hyponatremia with hyperkalemia
RTA: affects H+/K+ transporter, hyper/hypokalemia, acidosis, hypocalcemia/hyperchloremia

Cl = 120 is high - maybe they remembered wrong since all the other ones had normal Cl

Question 113

You are counseling a mother who is 24 weeks pregnancy, with threatened pre-term labour. Which of the following is true?

a. all 24 weekers are resuscitated
b. resuscitation is based on parental wishes
c. 24 weekers are not resuscitated due to poor outcomes at this GA
d. resus is up to the team based on how baby does at birth

Answer 113

resuscitation is based on parental wishes

Question 114

You are counseling a pregnant teenage girl and her boyfriend at 23 weeks gestation. She is in labour. You discuss the high morbidity at this gestational age, if the baby survives at all. What is true about the resuscitation of this newborn:

a. Since they are teenagers, the physician decides.
b. There is legislation in Canada that says all babies 22 weeks and older require resuscitation.
c. The parents’ wishes should be supported whether they want to resuscitate or not.
d. Given the high mortality at this gestation, the baby should not be resuscitated.

Answer 114

c. The parents’ wishes should be supported whether they want to resuscitate or not.

22GA or 24GA with weight 350g - PALLIATION RECC
23-34w, 25w GA with aneimial or abn placental care - both icu or pallaition concisdered

25GA, 24 and well growth, ICU recc

Question 115

A full term newborn develops petichiae and bruising. The baby is otherwise well appearing. On bloodwork, platelets are 12, WBCs are 18, Hgb 140. He is given a platelet transfusion and a repeat platelet count is 16. The mother’s CBC shows platelets of 240. What is the best treatment?

a. PLA-1 negative platelets/ Human platelet antigen neg
b. IVIG (
c. Pooled door platelets

Answer 115

PLA-1 negative platelets/ Human platelet antigen neg
if NAIT is anticipated, the mother’s platelets can be collected prior to delivery and used for transfusion. Maternal platelets need to be concentrated, however, in order to reduce the amount of antibody-containing serum given to the neonate. Otherwise, donor platelets that are typed and matched for the patient can be used.

Question 116

Newborn with platelets of 12, transfused and post-transfusion platelets
were 16. Mom’s CBC was normal. What do you do?
a. transfuse single donor platelets
b. transfuse PLA-1 negative platelets
c. give IVIG
d. give steroids

Answer 116

b. transfuse PLA-1 negative platelets

Question 117

Six day old baby presents in shock, afebrile. Glucose 1.6 and cardiomegaly on CXR. What is the most likely etiology of the shock? (no concensus)

a. Congenital heart disease
b. Sepsis
c. Inborn error of metabolism
d. Adrenal insufficiency

Answer 117

CHD
who have congenital heart disease or congestive heart failure appear to be at increased risk for the development of hypoglycemia. The pathogenesis of hypoglycemia is unclear, although perhaps decreased hepatic perfusion compromises the rate of glucose production
?Beckwith-Wiedmann syndrome - ?? hypoglycemia, cardiomegaly?

Question 118

You are called to the resuscitation of a 26 weeker. Needs PPV in the case room. How to administer?

a. flow inflating bag with oxygen
b. self inflating bag with oxygen
c. self inflating bag without oxygen
d. self inflating bag with reservoir with oxygen

Answer 118

flow inflating bag with oxygen
Air (21% oxygen) is recommended as the initial gas for all babies, with the exception of very preterm (< 32 weeks) babies in whom supplemental oxygen (between 30% and 90%)
Self-inflating resuscitation bags, even without a reservoir, can deliver higher concentrations of oxygen than previously suggested

Question 119

Newborn, a 30-week premie. Not breathing after stimulation. What do you do?

a. self-inflating bag, room air
b. self-inflating bag, oxygen reservoir
c. self-inflating bag, oxygen reservoir with O2 being blown through
d. anesthesia bag, connected to oxygen source

Answer 119

anesthesia bag - connected to oxygen
>35w GA 21%
<35w GA 21-30%

Question 120

You are resuscitating a 27-weeker at birth after stimulation and drying. What do you use:

a. Self-inflating bag with no O2 source
b. Self-inflating bag with O2 source
c. Flow inflating bag with O2 source

Answer 120

flow inflating bag with o2 source

Question 121

One of your patients, a newborn baby, has a positive newborn thyroid screen with a TSH of 27. Next step?

a. repeat the screen
b. start thyroxine
c. bring the patient in for a full exam
d. do a nuclear thyroid scan

Answer 121

rpt screen
Repeat TSH, T4 for all high TSH results. If low T4, high TSH, start treatment. If normal, transient hypothyroidism (maternal antithyroid meds or antibodies). Normal T4 with high TSH needs more repeats.

Question 122

Child with bubbling oral secretions, difficulties passing an NG tube. Also noted to have a hemivertebrae. What to do?

a. echocardiography
b. spine MRI
c. MRI head

Answer 122

echo
r/o VACTERL

vetrebal abn
anal
cardiac
TE
renal abn
limb abN

Question 123

what does CHARGE mean

Answer 123

coloboma
Heart dect
atresia of choanae
genital abn
Ear - deafness

CHD7 mutation

Question 124

Baby with increased secretions from mouth, cough. CXR shows hemivertebrae. What else do you order?

a. Abdo U/S
b. Echo

Answer 124

echo

Question 125

Most common reason for delayed respiratory effort in a newborn
a. maternal opiods in labour
—————
Newborn doesn’t breathe at birth. What is the most likely cause?
a. maternal morphine use

Answer 125

maternal opioids

Question 126

Newborn with an Erb’s palsy. Which is true?

a. extension at the wrist
b. preserved grasp
c. symmetric moro

its like waiter tip at the back (give me a 5)

Answer 126

Erb’s Palsy (C5-C6): loss of sensation in the arm and paralysis and atrophy of the deltoid, biceps, and brachialis muscles.[8] The position of the limb is characteristic: the arm hangs by the side and is rotated medially; the forearm is extended and pronated. The arm cannot be raised from the side; all power of flexion of the elbow is lost, as is also supination of the forearm

asx moro with notic neck and absent bicep relfex, RISK of phrenic nerve

Question 127

Klumpke palsy = C8-T1 = claw-like deformity
o paralyzed hand, absent grasp, intact bicep reflex, may also have Horner syndrome
o 1% of cases, paralysis of upper arm has better prognosis than lower arm
o

Answer 127

Treatment: supportive, positioning, ROM exercises, nerve grafting if persistent

Question 128

1. 7 day old being resuscitated. Rate of compressions to ventillations. Patient is intubated.
   a. 3:1
   b. 5:1
   c. 15:2
   d. 100:1

Answer 128

3:1

Question 129

You are in the resuscitation of a premature infant. There is continued apnea with no heart rate despite aggressive measures. After what amount of time would you stop resuscitative efforts.

a. 10 minutes
b. 15 minutes
c. 20 minutes
d. 30 minutes

Answer 129

“if there is no heart rate after 10 minutes of complete and adequate resuscitation efforts, and there is no evidence of other causes of newborn compromise, discontinuation of resuscitation efforts may be appropriate

Question 130

What is important in the direct pathogenesis of BPD in a VLBW infant?

a. PPV
b. Barotrauma
c. Surfactant deficiency
d. Oxygen toxicity

Answer 130

barotrauma or oxygen toxicity

Question 131

22. Baby at 48 hour of age bili 210. Need to plot on bili chart and mgmt?
    a. weigh and reassess bili in 24 hr
    b. bili in 72 hr
    c. nothing (could be this?)

Answer 131

weight and r/a in 24 hours

FALLS high intermediate, if DAT NEG, then routine care, if DAT + then f/u 24-48h

Question 132

A term 2 day old baby boy who is breastfeeding well is jaundiced. He is ready for discharge. His bilirubin at 48 hours is 271. What would be your management? (they provide the bilirubin risk chart as well as the chart for phototherapy from the CPS guidelines)

a. Regular phototherapy
b. Intensive phototherapy
c. Follow up bilirubin in 48 hours
d. Follow up weight and bilirubin in 24 hours

Answer 132

intesnive phototherapy

Question 133

Term baby with bili of 221 at 48 hrs

a. photo now
b. coombs + bloodwork
c. f/u at 24 hrs
d. f/u at 72 hrs

Answer 133

fu 24 hours

Question 134

3 day old infant with HR 200, BP 90/60. Irritable and poor feeding. Mom hypothyroid on replacement. Most likely dx?

a. SVT
b. sepsis
c. CAH
d. thyrotoxicosis

Answer 134

. thyrotoxicosis

Neonatal thyrotoxicosis from maternal transfer of thyroid stimulating antibodies. The prevalence of Grave’s disease in pregnancy is 0.2%.

Question 135

Mother with longstanding hypothyroidism on L-thyroxine treatment. Denies any other drug use and is otherwise healthy. Term infant at day 1 is irritable with poor feeding. Heart rate is 220 and blood pressure is 96/60. What is the most likely cause?

a. Abstinence
b. Thyrotoxicosis
c. SVT

Answer 135

thyrotoxicosis

Question 136

You are present at the resuscitation of a 27 week infant. After initial resuscitation the patient still has a poor respiratory effort. What would you use for your initial resuscitation?

a. Self inflating bag with no oxygen source
b. Self inflating bag connected to an oxygen source
c. Self inflating bag with oxygen reservoir connected to an oxygen source
d. Flow inflating bag connected to an oxygen source

Answer 136

flow inflating bag connected to oxygen source

Question 137

You are informed that a newborn sibling of a patient in your practice has received a positive thyroid screen. His TSH was 27.6. The MOST IMPORTANT step would be to:

a. Repeat the screen (with a T4)
b. Start thyroxine
c. Bring patient in for a full physical exam
d. Do a nuclear thyroid scan

Answer 137

rpt screen with a t4

Question 138

Which of the following is true about surfactant?

a. Increases risk for intraventricular hemorrhage
b. Decreases mortality secondary to respiratory distress syndrome
c. Decreases incidence of BPD

Answer 138

dec mortality secondary to RDS

Question 139

Unstable premature neonate on Ventilator with significant oxygen needs. Desaturates with handling but recovers with bagging. What is the best management.

a. Increase sedation
b. Give surfactant
c. Give prostaglandins
d. Give indomethacin

Answer 139

increase sedation

Question 140

Baby born after hypoxic event because of a prolapsed cord. On the first day of life he is hyperreflexic and has a exaggerated Moro reflex. He does not have any seizures. He is discharged on day four of life. His EEG and MRI are normal. What can you tell his parents about his prognosis.

a. Impossible to determine his prognosis at this time
b. He will have a good neurological outcome
c. It is likely that he will have some neurodevelopmental delay
d. He will likely have severe impairments

Answer 140

will have good neurological outcome

Question 141

A term IDM newborn is seen at 48 hours of age with a grade 3/6 SEM at the LSB. On echo there is hypertrophy of the septal muscle but no decrease in function. What is the clinical course:

a. Will resolve with no treatment
b. corticosteroids
c. Will improve with digoxin

Answer 141

will resolve with no tx

Question 142

32 wk prem, now 9 days old, born to GBS +ve mother who did not receive intrapartum antibiotics, increasing apneas for 24 hours. Gram stain shows gram +ve cocci in clusters. What is the organism?

a. GBS
b. staph aureus
c. staph epi (coag NEG)
d. E. Coli

Answer 142

staph epi (coag NEG)

Question 143

Mother with +ve GBS never got treated intrapartum abx. Baby born 32 wk now 9 days. Has been having increasing apneas in the past 24 h. Blood culture done shows GP cocci in clusters after 18 h of culture. What most diagnosis

a. GBS
b. Strep viridans
c. S aureus
d. Coag neg staph

Answer 143

coag NEG staph

Question 144

16. Which is best predictor of severity of Rh disease?
    a. gestational age
    b. cord haemoglobin
    c. cord bilirubin
    d. ?maternal antibody titres

Answer 144

cord bilirubin
Amniocentesis was classically used to assess fetal hemolysis. Hemolysis of fetal RBCs –> hyperbili before anemia. Bili is cleared by the placenta but enter the amniotic fluid and can be measured by spectrophotometry
Maternal titres - presence of elevated Ab titers or a rapid rise suggests significant hemolytic disease but exact titre correlates poorly with disease severity

Question 145

Which of the following is the best predictor of risk of Rh autoimmune hemolytic disease at the time of delivery?

a. Bili in the cord
b. Hb in the cord
c. Mom’s Ant-Rh titres
d. Gestional age

Answer 145

bili in cord

Question 146

2 y.o. diagnosed with spastic diplegia. Born at term, with APGARS of 6 at 1 minute, and 8 at 5 minutes. Parents are asking if this is related to “perinatal asphyxia” – how would you counsel them:

a. low probability – Apgars of 6 and 8 rule out the possibility of perinatal asphyxia
b. low probability – most cases of cerebral palsy are related to an event occurring before labour
c. high probability – most cases of CP are caused by perinatal asphyxia
d. cannot form an opinion, because you cannot diagnose CP before 2 yrs

Answer 146

LOW PROB

most cases of cerebral palsy are related to an event occurring before labour

Spastic diplegia (35% of cases) is usually caused by PVL associated with prematurity, ischemia, infection or endocrine/metabolic causes
Neonatal signs consistent (not necessarily diagnostic) with an acute peripartum or intrapartum event:
Apgar score of <5 at 5 minutes and 10 minutes.
Fetal umbilical artery pH <7.0, or base deficit ≥12 mmol/L, or both.
Neuroimaging evidence of acute brain injury seen on brain MRI
Presence of multisystem organ failure consistent with systemic hypoxic-ischemic insult.

Question 147

42. Nurse call you because a 2 day old baby in nursery has a vesicle on the upper lip. Most likely diagnosis:
    a. Varicella
    b. Herpes
    c. Sucking blister

Answer 147

sucking blister
Intact blisters or erosions may be found on the forearm, wrist, hands or fingers. They resolve within a few days. Suckling ‘blisters’ are firm swellings on the upper lip and are a hyperplastic response to suckling.

Question 148

A baby is born and has low platelets ( <20). He is given random donor platelets but after the count is still less than 20. His mother’s platelets are normal. Baby is stable and there is no bleeding. What should be done now?

a. transfuse PLA-1 negative platelets
b. transfuse single donor platelets
c. IVIG
d. do nothing

Answer 148

PLA1 neg
PLT >50 = no therapy, repeat a few days later

- PLT <50 = infuse maternal PLT into baby, if available, or request CMV-negative, irradiated, PLA1–negative PLT (may give random donor PLT and IVIG while waiting), check PLT count 1h after transfusion and obtain head US to rule out ICH

- Measure PLT q6h × 24h, then q2d once stable

- Consider IVIG in neonates who require repeated PLT transfusions


Question 149

A baby is born by c-section at 6h since membranes ruptured. Mother has active HSV lesions. The baby is asymptomatic. When should cultures of the baby be done?

a. Immediately and start Acyclovir
b. After 48h
c. When the baby is symptomatic
d. Observe only

Answer 149

right away start acylvor
A is true if it’s mother’s first episode (IV acyclovir x10d and swab mucous membranes before acyclovir is started), but if recurrent episode, would just swab mucous membranes at 24 hours (CPS Statement - Neonatal HSV)

Mucous membrane swabs should be obtained from the mouth, nasopharynx, and conjunctivae at least 24h after delivery (additional swabs may be obtained, ex. from sites of scalp electrodes)
If swab negative = 10 days
If swab +ve, blood and CSF neg = 14 days
If swab +ve, blood OR CSF pos = 21 days
If she has recurrent disease swab at 24 hours and only treat if positive
If swab +ve and CSF and blood neg = 14 days
If swab +ve and CSF or blood pos = 21 days

Question 150

Abstinence from methadone? Neonatal sx?

a. Hyporeflexia
b. Constipation
c. Sneezing
d. Lethargy

Answer 150

sneezing

Question 151

Newborn with BWT 2.5 kg. Hypoglycemic. Next magt

Answer 151

CHECK GLUCOSE AT 2 HRS AND EVERY 3-6 HOURS (BEFORE FEEDS) AS LONG AS INFANT REMAINS WELL, UNTIL FEEDS ARE ESTABLISHED AND GLUCOSE ≥2.6 mmol/l
<1.8 mmol/L or <2 mmol/L on subsequent checks, consider IV treatment
1.8-2 at 2 hrs of age or 2-2.5 mmol/L at subsequent checks, refeed and check in an hr
>2 at 2 hrs of age, or >2.6 mmol/L at subsequent checks → routine care

Question 152

5 kg baby born to diabetic mother, has early feed, but 2 hours later, blood glucose 1.9 and baby asymptomatic. What do you do?

a. Re-feed and check in 1 h
b. Bolus NS
c. Bolus D10W 2ml/kg and start IV infusion
d. Supplement breast feed with formula and check sugar in one hour

Answer 152

refeed and check in 1 hour

Question 153

Management of neonate (2500g, 40wks) with BG=1.9 1 hour after first breastfeed. Asymptomatic. What is your management?

a. breastfeed
b. bolus D10W then run IV D10W
c. give feed with formula or EBM
d. IV D10W @ 4cc/hr

Answer 153

vreastfeed

Question 154

. 3-4 day old newborn infant with petechiae/purpura in mouth, normal CBC and Hb, but platelets 12; after one random-donor platelet transfusion, platelets 16. Mother has platelets 80, CBC otherwise normal. Baby stable, no active bleeding. How would you treat this baby?

a. Give single donor platelets
b. Give PLA-1 negative platelets
c. Exchange transfusion
d. IVIG

Answer 154

Important distinction
Neonatal ALLOIMMUNE (NAIT) - give PLA-1 negative platelets (or washed maternal)

Neonatal AUTOIMMUNE (ITP) - give IVIG
the matenral plt is LOW took

Question 155

Neonate with petechiae. CBC= normal Hgb & wbc but platelets 20. Mom’s CBC also shows low platelets. How to treat baby?

a. regular plt transfusion
b. IVIG
c. Transfusion with special platelets

Answer 155

IVIG

Question 156

Neonate with thrombocytopenia. No response to platelet transfusion. Mom has low platelets too. Treatment?

a. Transfuse with platelets again.
b. Transfuse with PLA-1 negative platelets
c. IVIG
d. Exchange transfusion

Answer 156

IVIG

Question 157

Newborn with cardiomegaly and glucose of 1.9, now in failure. What is the most likely reason for shock?

a. Sepsis
b. Cardiogenic
c. Metabolic
d. Adrenal

Answer 157

cardiogenic

Question 158

A 3-month old baby presents with in shock with tachypnea, normal pulses, cap refill of 3 seconds, and a liver palpable 5 cm below the right costal margin. Most likely origin of his shock:

a. cardiogenic
b. metabolic

Answer 158

cardiogenic

Question 159

Newborn delivered with thin mec, initially fine but then begins to decompensate about 1 hour later. CXR reveals lucent area in one lobe, with mild mediastinal shift. Most likely diagnosis?

a. Meconium aspiration
b. Congenital lobar emphysema
c. CCAM
d. pneumonia

Answer 159

congenital lobar emphysema

Question 160

n ex-32 week prem is on caffeine, now 39 weeks, but continues to have episodes of apnea – what is the reason?

a. Apnea of prematurity
b. Seizures
c. GERD

Answer 160

apnea of prematurity

Question 161

Which would be indications for giving surfactant?

a. preterm baby with meconium aspiration FiO2 28%
b. preterm baby born 72 hours ago who received 3 doses of surfactant
c. preterm baby on ventilation with FiO2 of 50%
d. 29 week old baby with no respiratory symptoms who is being transferred

Answer 161

preterm on vnentliation with fi02 50%

Question 162

In infants, under what circumstance do the guidelines recommend surfactant administration?

a. Still requiring more than FiO2 0.5 at 3 days of life
b. a 29-week premature infant without respiratory distress requiring transfer to another centre
c. Premature infants who have received 3 doses of surfactant in the past 2 days and are still requiring ventilation.

Answer 162

needing fi02 or 50%, can rpt q2h
Intubated infants with mec aspiration syndrome requiring more than 50% oxygen should receive surfactant
- Infants who are at significant risk of RDS should receive prophylactic natural surfactant as soon as stable within a few minutes after intubation
- Infants with RDS who have persistent or recurrent oxygen and ventilatory requirements within the first 72h of life should have repeated doses of surfactant but administering more than 3 doses has not been shown to have a benefit
-infant outside tertiary <29w

Question 163

Baby born to mother who is a known heroin addict. After 3 minutes of bagging, there is no self-initiated respiratory efforts. What would you do next?

a. Give Narcan
b. Continue bagging until there is respiratory effort
c. dont intubate

Answer 163

bagging
erspiratory depression from opiates should be treated with narcan (0.1 mg/kg) IV or IM but this is contraindicated in infants born to mothers with opiate addiction as it may precipitate acute neonatal withdrawal with seizures. Artificial respiration should be continued until the infant is able to sustain ventilation. (Nelsons)
Pharmacologic treatment of heroin and methadone withdrawal requires opiate replacement during the first week or 2 of life. (Nelsons

Question 164

A newborn infant is noted to be in respiratory distress following a c-section delivery. The pregnancy was significant for mild polyhydramnios. The baby responds temporarily to suctioning.

a. hypoglycemia
b. tracheoesophageal fistula

Answer 164

tef

UTD: Polyhydramnios and a nonvisualized or small stomach (image 1), whether due to partial obstruction or imaging of gastric secretions, are the two key abnormalities that should prompt consideration of esophageal atresia.

Question 165

24-hour-old neonate with little urine output and CR of 80. Best explanation?
a. Cr represents mom’s value

Answer 165

Serum creatinine at birth is equal to the concentration in the mother (usually less than 88), it then rapidly declines over the first week of life (in term) and 1-2 months (in preterm) to nadir values (18-35) which remains stable through the first year of life. Newborns are considered to have renal failure if the serum creatinine is >133.

Question 166

. A newborn with 37.8 axillary temperature. What should be done next?

a. Repeat after 20 minutes of unbundling
b. Do a tympanic temperature
c. Do CBC
d. Full Septic W/U

Answer 166

a. Repeat after 20 minutes of unbundling

Question 167

A term newborn has bilateral infiltrates on CXR and is currently intubated. He desaturates significantly with handling but improves with bagging. What would you do?

a. increase sedation
b. give surfactant
c. start prostaglandins

Answer 167

increase sedation

Question 168

ex-30 week prem, now at 39 weeks corrected has had an uneventful course. He had apnea of prematurity treated with caffeine. He is still having apneas with occasional bradycardia 5-6 times a day. What is the likely cause?

a. Apnea of prematurity
b. Seizures
c. GERD

Answer 168

apnea of prematurity

Question 169

What are risk factors for unconjugated hyperbilirubinemia in a neonate?

a. Prematurity
b. LGA
c. male

Answer 169

PREM
Almost all preterm infants less than 35 weeks gestation have elevated bilirubin (UpToDate) also cpephlaheoma, asian, vrusing, or family hx
Male sex is a risk factor for the development of severe hyperbilirubinemia (CPS Statement - Hyperbilirubinemia)

Question 170

116. Which of the following scenarios is an indication to intubate and suction for a meconium delivery?
     a. thick meconium
     b. apgars <5
     c. no spontaneous respiratory effort

Answer 170

no spontaneous resp

Question 171

33 week premature infant is born to a mother with hypertension. Baby is SGA. What other associated findings do you expect?

a. Polycythemia
b. hyperglycemia
c. hypomagnesimia
d. hypercalcemia

Answer 171

33 week premature infant is born to a mother with hypertension. Baby is SGA. What other associated findings do you expect?

a. Polycythemia (placental insufficiency leads relatively hypoxic environment and increased EPO production)
b. hyperglycemia
c. hypomagnesimia
d. hypercalcemia

Question 172

What is true about surfactant therapy in premature infants?

a. use of surfactant decreases morbidity
b. use of surfactant decreases mortality
c. there is no benefit

Answer 172

surfactant dec mortality
“Surfactant replacement therapy, either as rescue treatment or prophylactic natural surfactant therapy reduces mortality (evidence level 1a) and several aspects of morbidity in babies with RDS

Question 173

Newborn with axillary temperature of 37.8 degrees, well normal exam. What do you do?

a. Full septic work up and antibiotics
b. Rectal temperature
c. Take off all clothes for 20 minutes and recheck temperature
d. CBC and diff

Answer 173

Take off all clothes for 20 minutes and recheck temperature

Question 174

Newborn weights 4.5 kg. He is plethoric and lethargic with poor feeding. Venous blood work shows hemoglobin of 170, hematocrit of 0.72, and glucose of 3.4 with rest of bloodwork normal. What do you do?

a. Give 4mls/kg D 10W
b. Partial exchange transfusion
c. Start antibiotics
d. Septic workup

Answer 174

partial exchange

polycythemia = hematocrit of 65% or higher (Nelsons)

Question 175

Term newborn with bilateral infiltrates on chest X-ray is currently intubated. He desats with handling but improves with bagging. What do you do?

a. Sedate
b. Give surfactant
c. Start prostaglandins

Answer 175

sedation

Question 176

Newborn has a flank/abd mass. What is the most likely cause

a. Wilms tumour
b. Hydronephrosis
c. Polycystic kidney
d. Neuroblastmoa

Answer 176

hydronephrosis

Question 177

What is the most specific indication of seizures in neonate

a. Tachycardia
b. Abnormal eye movements
c. Irregular breathing
d. Tachypnea

Answer 177

abn eye movement

Question 178

Neonate, now two weeks old, with abdominal mass palpable. Has a history of umbilical catheterization. What is the cause of hepatosplenogegaly?

a. Portal vein thrombosis
b. Infection

Answer 178

portal vein thrombosis

Question 179

Newborn with meconium stained liquor, needed resuscitation, poor apgars. Cyanotic and in 100% O2 had a PO2 of 70 with a normal CO2 (Rt Radial A). Cord gas had O2 of 30. CXR normal sized heart and decreased vascularity. Most likely diagnosis

a. PPHN
b. TGA
c. TAPVD
d. Meconium aspiration syndrome

Answer 179

ppHN

Question 180

. Baby with symmetric IUGR (?one version says with microcephaly). Cause?

a. Maternal smoking
b. Maternal infection / congenital infection
c. Placental insufficiency
d. Maternal Malnutrition
e. Maternal PIH / preeclampsia

Answer 180

matneral infxn
Symmetric IUGR = head circumference, length, weight equally affected
- earlier onset, associated with chromosomal, genetic, malformation, teratogenic, infectious, or severe maternal hypertensive etiologies
- consider incorrect overestimation of gestational age
Asymmetric IUGR = relative sparing of head growth
- late onset, preservation of doppler waveform velocity to carotid vessels, associated with poor maternal nutrition or late onset/exacerbation of maternal vascular disease (preeclampsia, chronic hypertension)

Question 181

All of the following are normal in a baby except:

a. Transient cyanosis with feeds
b. Hypotonic after feeding
c. Irreg respiration pattern in REM sleep
d. Sigh following a brief period of apnea

Answer 181

transient cyanosis wiht feeds

Question 182

Newborn was recently extubated after a course of systemic corticosteroids. What is the likely side effect?

a. hypotension
b. hypoglycemia
c. leucopenia
d. hypertrophic cardiomyopathy

Answer 182

HCM

Question 183

2 month old ex 32 weeker who was ventilated with Ua/Uv lines. Now has HSM but has an otherwise normal physical exam. What is the likely cause?

a. hepatic hemangioma
b. portal vein thrombosis
c. hereditary spherocytosis
d. congenital CMV
e. fungal infection

Answer 183

portal vein thrombiosis

• clots form in/about the tips of 95% of catheters placed in umbilical artery
• thrombosis is risk associated with UAC and UVC
• with UVC, can get portal HTN from portal vein thrombosis, especially with omphalitis

Question 184

What is true about neonatal chest compressions:

a. Required after 30 seconds of PPV with HR less than 60
b. Chest compressions to be done at a ratio of 5:1 with every breath
c. 2 finger technique is preferred
d. Required after no response to stimulation

Answer 184

required after 30 sec ppv wiht HR less then 60
Babies who experience persistent bradycardia (HR <60) despite 30s of effective ventilation should receive chest compressions and 100% oxygen
The recommended chest compression to ventilation ratio is 3:1

Question 185

Which of the following is an indication to intubate and suction for a meconium stained delivery:

a. No respiratory effort
b. Thick meconium
c. Apgars <5

Answer 185

no resp effort

Question 186

Full term baby delivered to an O+ mom. Looks well but pale. Hb is 70, he is hemodynamically stable. What is the most likely diagnosis?

a. ABO incompatability
b. Chronic fetal maternal hemorrhage
c. Rh incompatability

Answer 186

abo incomtapbile
Anemia in first few days is most frequently a result of hemolytic disease of the newborn (erythroblastosis fetalis)

ABO incompatibility is the most common cause of hemolytic disease of the newborn

Transplacental hemorrhage with bleeding from fetal into maternal circulation reported in 5-15% of pregnancies but is not usually sufficient to cause clinically apparent anemia at birth (Nelsons)

Question 187

3 mos girl BW SGA at 2200g at GA38, now wt 10th, ht 25th, HC 50th
a. 2 yr for catch up growth in IUGR
b. f/u in 6 mos no nutritional intervention
c. need w/u for organic FTT
d. increase dietary protein
e. if not at 50th%ile by 6 months then needs work up for organic FTT
UpToDate:

Answer 187

2 year to catchu up growhth in IUGR
n the absence of congenital abnormalities, CNS injury, VLBW, or marked IUGR, the physical growth of LBW infants tends to approximate that of term infants by the 2nd year
VLBW infants may not catch up, especially if they have severe chronic sequelae, insufficient nutritional intake, inadequate caretaking environment
both premature and IUGR are at risk for significant metabolic conditions (eg. obesity, type 2 DM) and CVS disorders (ischemic heart disease, hypertension) as adults - hypothesized to involve insulin resistance

Question 188

3 week old who is brought to the office because mother thinks he is too yellow. Breastfed. Otherwise well. Total bili is 180. Direct is 8. What do you do?

a. septic workup
b. investigate for blood group incompatibility
c. reassure mother that condition may last for 4-12 weeks
d. investigate for metabolic disease

Answer 188

reassure last 4-12w

Question 189

3 mos girl BW SGA at 2200g at GA38, now wt 10th, ht 25th, HC 50th

a. 2 yr for catch up growth in IUGR
b. f/u in 6 mos no nutritional mgmt
c. need w/u for organic FTT
d. increase dietary protein

Answer 189

2 yr catch up

Question 190

2 day old infant presents with fever of 39.5 ax. He is breast-fed and his weight has fallen from 3.8 to 3.5 kg. He is lethargic but rouses during the examination. His fontanelle is normal. Na 150, K 7.3, Cl 110, BUN 8, Cr 110, uncong bili 190, normal CBC. What is the likely diagnosis?

a. hypernatremic dehydration due to decreased fluid intake
b. hypertonic breast milk
c. diabetes insipidus
d. sepsis
e. meningitis

Answer 190

sepsis

Question 191

A full term newborn is having episode of cyanosis and apnea that are worse when he is attempting to feed but seems better when he is crying. Which of the following is the most appropriate next step?

a. Echo
b. Hb electrophoresis
c. Hypoxia test
d. Passage of catheter into the nose

Answer 191

PASS CATHETER IN NOSE
Airway - choanal atresia (improves with crying), micrognathia/retrognathia/Pierre Robin Sequence (obstruction worse supine), laryngomalacia (worse with crying and feeding), vocal cord paralysis
Breathing - neonatal pneumonia, CCAM, CDH
Circulation - polycythemia, methemoglobinemia, CHD (typically worse with feeding and crying)

Question 192

Most likely cause of late hemorrhagic disease of the newborn:

a. phenytoin use in mom
b. baby was not given vit K
c. oral antibiotics
d. cystic fibrosis

Answer 192

CF

Question 193

Baby born to heroin addict mom. Apneic despite bag and mask ventilation. Best management:

a. Narcan
b. intubate until baby breathes on own
c. bag and mask ventilation until baby breathe on own

Answer 193

intubate till breath on own

Question 194

Which of the following are true?

a. fetal p02 is 25-30
b. the incidence of asymptomatic PFO in the adult population is 10%
c. umbilical vein closes after umbilical artery

Answer 194

A fetal po2 is 25-30
cord venous gas the pO2 is higher than the arterial 
?does ‘pO2’ refer to UV or UA?
pO2 of fetal UA is 20
pO2 of fetal UV is 30-35

PFO occurs in 25-30% of the general population

Question 195

87. 28wker. Intubated for RDS. Picture of club foot. What do you do?
    a. call ortho stat for serial casts
    b. consult ortho initially
    c. consult ortho when bb extubated
    d. observation only

Answer 195

consult ortho when extubated

Question 196

Newborn’s visual acuity is closest to:

a. 20/20
b. 20/10
c. 20/200
d. 20/400

Answer 196

20/400

Question 197

l`ate hemorrhagic disease of the newborn is associated with:

a. CF
b. breast feeding
c. maternal phenytoin ingestion
d. prematurity

Answer 197

CF

Question 198

. You are on home call. A nurse calls you about an 8h old baby of a mom with 27h ruptured membranes. Baby now having episodes of “bicycling” and tachypnea. Baby has baseline hypotonia. You tell her:

a. do CBC/ESR, call back
b. continue observation
c. bolus Phenobarbital, call back if child has seizures
d. set up for an LP, you’re on the way

Answer 198

set up LP - on the way

Question 199

Newborn bb, few days old. Increased direct bili, increased WBC, low platelets, low Hb, hepatosplenomegaly. Next?

a. bone marrow aspiration
b. peripheral blood smear
c. abdominal ultra-sound
d. likely bacterial infection

Answer 199

bacteiral infection

Question 200

Baby with jaundice, low platelet count, looks septic. What is the cause? (Lab values given)

a. TORCH infection
b. galactosemia
c. bacterial sepsis

Answer 200

sepsis

Question 201

Which of the following predisposes to late hemorrhagic disease of the newborn:

a. breastfeeding
b. prematurity
c. cystic fibrosis
d. maternal phenytoin
e. oral antibiotics

Answer 201

CF

Question 202

You are called from a family doctor about a 5 day old jaundiced baby. Well looking. Total bili is 355, direct is normal.  He is breastfed. What do you recommend?
a. septic work up
b. investigate for a metabolic disease
c. coombs test and hg
d. start phototherapy
e observe

Answer 202

start photo