The newborn Flashcards
In an otherwise well term baby, at the discharge examination at 5 days, you auscultate a pansystolic murmur over the precordium and posteriorly over the left scapula. You make the diagnosis of patent ductus arteriosus. You explain to the parents that patent ductus arteriosus:
a) May lead to cyanosis
b) Increase the risk of the baby developing endocarditis
c) May lead to left heart failure and requires treatment now
d) Explains the difficulty palpating peripheral pulses in the legs
e) Will most likely close by 1 year of age
e) Will most likely close by 1 year of age
A mother of a newly delivered normal appearing female baby mentions to you that a family member had coarctation of the aorta. The absence of which of the following associations with coarctation may be reassuring?
a) The absence of tachypnoea and peripheral cyanosis in the neonate
b) The absence of heart failure in the newborn period
c) The absence of hypotension in the neonate
d) The absence of epicanthic folds, small low set ears, Brushfield spots, and being small for gestation age
e) The absence of neck webbing and being a normal size for gestation
e) The absence of neck webbing and being a normal size for gestation
Which of the following statements regarding the newborn period is correct:
a) A serum glucose below 2.6 mmol is safe for all infants
b) The serum glucose may be below 1.0 mmol without symptoms
c) The infant brain can not use fatty acids as an energy source
d) Bile stained vomiting may be an innocent finding
e) Low glucose should always be treated with an IV dextrose infusion
b) The serum glucose may be below 1.0 mmol without symptoms
A 23-year-old gravida 1 delivers her first baby, a 2.5kg female at 38 weeks gestation. The newborn has hepatosplenomegally, cataracts and a patent ductus arteriosus. At 8 weeks gestation, the mother had a maculopapular rash with few other symptoms apart from a sore throat for which she was given Amoxycillin. The subsequent pregnancy course had been uncomplicated. Which of the following tests during pregnancy would have been most likely to have predicted the findings in the baby:
a) Culture for HSV
b) Serial Rubella titres
c) Amniocentesis for karyotype
d) Urinalysis for CMV
e) VDRL test
b) Serial Rubella titres
The following cord venous blood gases were obtained at the delivery of a well-formed normal appearing term baby that required resuscitation for secondary apnoea. PH 7.20, base deficit 7.0mmol/L, PO2 30mmHg, PCO2 40 mmHg. Pethidine had been given intramuscularly 45 minutes before delivery. The most likely reason for the neonatal condition based on these results is:
a) Intrapartum hypoxia
b) Congenital diaphragmatic hernia
c) Suppression of respiration due to Pethidine
d) Peripartum infection
e) Fetomaternal haemorrhage and neonatal hypovolaemia
d) Peripartum infection
After delivering a child who has a previously undetected congenital abnormality, which of the following advice to the patient is incorrect?
a) Reassurance that the appropriate paediatric and specialist advice will be sought promptly.
b) The background rate for all congenital abnormalities is around 7-10%
c) A time line of management options will be offered and explained
d) Information will be provided on the outcome in babies who have had similar occurrences in the unit
e) Explanation that routine ultrasound is only a screening tool and cannot pick up all abnormalities
b) The background rate for all congenital abnormalities is around 7-10%
Erbs Palsy which of the following is correct:
a) It follows 5% of all cases of shoulder dystocia
b) In 50% cases persists longer than 6 months
c) It could be prevented mostly by correct identification antenatally of selected cases needing Caesarean Section
d) Occurs because of stretching of C6 to T1 nerve roots
e) Has recurrence rate >10%
a) It follows 5% of all cases of shoulder dystocia
Regarding Group B streptococcal sepsis in the newborn, which of the following is true:
a) Long term sequelae can include cerebral palsy
b) The disease always presents in the first few hours after birth
c) Ceftriaxone is the antibiotic of choice
d) The disease is usually fatal
e) A negative blood culture rules out the diagnosis
a) Long term sequelae can include cerebral palsy
A 3.6kg term infant is examined 5 hours after birth as part of the normal newborn check. General examination is unremarkable and the baby is feeding well. The baby is pink and in no respiratory distress. Cardiac auscultation reveals a 3/6 soft systolic murmur over the precordium. The infant is well perfused, has normal pulses and is not in heart failure. Which of the following is the most appropriate plan for management for this infant:
a) Arrange an urgent echocardiogram
b) Take blood for chromosomes to look for a 22q deletion
c) Discuss the implications of the finding with the mother and arrange to re-examine the baby the following day
d) Arrange an urgent Chest x-ray and ECG
e) Admit to the neonatal unit
c) Discuss the implications of the finding with the mother and arrange to re-examine the baby the following day
Neonatal hypoglycaemia is a recognised complication in all of the following EXCEPT:
a) Infant of a diabetic mother
b) Beckwith-Wiedemann syndrome
c) Growth hormone deficiency
d) Erythema toxicum neonatorum
e) Perinatal asphyxia
d) Erythema toxicum neonatorum
Regarding the changes that occur in the transition from fetal to neonatal circulation which of the following is false:
a) The ductus arteriosus is kept patent in utero by circulating prostaglandins
b) Closure of the ductus arteriosus is functionally complete within 60 hours after birth in over 90% of term infants
c) If a cardiac murmur is heard in the first few hours of life in a term infant it is highly likely that the infant has significant congenital heart disease
d) Less than 10% of cardiac output enters the pulmonary circulation in the term fetus
e) The foramen ovale may be probe patent into adulthood
c) If a cardiac murmur is heard in the first few hours of life in a term infant it is highly likely that the infant has significant congenital heart disease
A 4.7 kg male infant is born to an insulin-dependent diabetic mother. The baby is given an early breastfeed and the first blood glucose is done 3 hours later. The blood glucose is 1.9 mmol/L. Which of the following is true:
a) This child will definitely need intravenous glucose at some stage in his management
b) His glucose requirement is most likely greater than 6mg/kg/min
c) The blood glucose is normal for a term infant of this age
d) Such infants should always be admitted to the neonatal or special care baby unit
e) Blood glucose should be monitored 4 hourly
b) His glucose requirement is most likely greater than 6mg/kg/min
You are asked to review a term infant at 8 hours of age who has signs of respiratory distress. The baby was born by normal vaginal delivery after an uneventful pregnancy. The membranes ruptured 18 hours prior to delivery but there were no maternal symptoms to suggest infection. On examination the baby is pink with a respiratory rate of 84/min and has increased respiratory effort with an expiratory grunt. Which of the following is FALSE:
a) Transient tachypnoea of the newborn (TTN) is the most likely diagnosis
b) There is no role for continuous positive airway pressure in this situation
c) Amoxycillin and gentamicin would give good antibiotic cover for common causes of congenital pneumonia
d) A normal CXR does not rule out a diagnosis of congenital pneumonia
e) The presence of a neutropaenia makes bacterial infection more likely
b) There is no role for continuous positive airway pressure in this situation
You undertake an initial examination on a female term newborn. You note that the anus is not present. Which of the following is false:
a) The baby should be admitted to the neonatal unit
b) Other congenital anomalies may be present
c) The baby should be allowed to feed normally
d) Meconium may be present in the urine
e) There is a risk of bowel perforation
c) The baby should be allowed to feed normally
A baby is born at 34 weeks gestation with haemolytic disease of the newborn requiring treatment with phototherapy and a double volume exchange transfusion. Which of the following statements regarding treatment of haemolytic disease of the newborn is true?
a) Phototherapy works by changing bilirubin to its water soluble isomer lumirubin
b) Exchange transfusion is a low risk procedure
c) Once the baby has been discharged from hospital no further follow up is required
d) The baby is not at increased risk of developing a conjugated hyperbilirubinaemia
e) The serum bilirubin level at which phototherapy should be started is not altered by the birth weight or gestational age
a) Phototherapy works by changing bilirubin to its water soluble isomer lumirubin
