Week 2

Question 1

By what age should a child be referred for not sitting unsupported

Answer 1

9 months

Question 2

What age should a child be referred for not walking unsupported

Answer 2

18 months

Question 3

What age should a child be referred for no words by

Answer 3

2 years

Question 4

What is regression

Answer 4

Loss of milestones

Question 5

Red flag signs: positive

Answer 5

Loss of developmental skills

Concerns re hearing or vision

Floppiness

No speech by 18-24 months

Asymmetry of movement

Persistent toe walking

Head circumference >99th C or

Question 6

Congenital abnormalities account for what percent of all births

Answer 6

3%

Question 7

Birth asphyxia

Answer 7

Flat at birth

Metabolic acidosis in fetal, cord or early neonatal samples

Early onset moderate or severe encaphalopathy

Abnormal CTG, featal bradycardia or absense foetal HR

Question 8

Outcome of birth asphyxia

Answer 8

Multisystem dysfunction within 72 hours of birth

Hypoxic ischaemic encephalopathy

Question 9

Management of birth asphyxia

Answer 9

Seizures

Fluid balance, avoid cerebral oedema

Cardiac and resp support

Whole body cooling to 33-34C for 72 hours

Question 10

Meconium aspiration

Answer 10

Normally 10-20% of all deliveries at term

Presence raises possibility of fetal infection

Question 11

What is the meconium

Answer 11

First faeces of the newborn

Contains bile, amniotic fluid, endometrium

Question 12

How does the myconium affect the airway

Answer 12

MAS can affect the baby’s breathing in a number of ways, including chemical irritation to the lung tissue, airway obstruction by a meconium plug, infection, and the inactivation of surfactant by the meconium (surfactant is a natural substance that helps the lungs expand properly).

Question 13

Complications of Myconium asporation

Answer 13

PPHN

Airleak

Asphyxia - renal failure…

Question 14

Management of myconium aspiration

Answer 14

Oxygen - need to overcome hypoxaemia

Respiratory support - may need ventilation

Surfactant therapy

Question 15

By what age should a child be referred for no social smile

Answer 15

2 months

Question 16

innocent heart murmurs

Answer 16

1) still’s - LV outflow
2) pulmonary outflow
3) carotid/brachiocephalic arterial bruits
4) venous hum

Question 17

what kind of murmur is pansystolic heard best over left sternal edge

Answer 17

ventricular septal defect

Question 18

what kind of murmur splits the second heart sound

Answer 18

atrial septal defect

Question 19

what causes an ejection systolic murmur at the upper L sternal border radiating to back

Answer 19

pulmonary stenosis

Question 20

what causes an ejection systolic murmur heard best at the upper R sternal border radiating to the carotids

Answer 20

aortic stenosis - may be bicuspid, unicusp or dome

Question 21

changes in fetal pulmonary vascular circulation at birth

Answer 21

vascular resistance falls and pulmonary blood flow rises

Question 22

change in systemic vascular resistance at birth

Answer 22

increased

Question 23

what structures close in the fetal circulation at birth

Answer 23

ductus arteriosus
foramen ovale
ductus venosus

Question 24

how would you treat patent ductus arteriosus in pre-term infants compared to term

Answer 24

fluid restriction/diuretics 
prostaglandin inhibitors (indomethacin, ibuprofen)
surgical ligation 

in term good chance will close spontaneously - not prostaglandin sensitive

Question 25

management of coarctation of the aorta

Answer 25

re-open patent ductus arteriosus with prostaglandin resection with end-to-end anastomosis subclavian patch repair balloon aortoplasty

Question 26

fallot's tetralogy defects

Answer 26

``` pulmonary stenosis (difficult for bleed reaching pulmonary artery) ventricular septal defect overriding aorta - lies over the VSD and allows the entry of oxygenated and deoxygenated blood right ventricular hypertrophy - due to narrowed pulmonary artery ```

Question 27

treatment of tetralogy of fallot

Answer 27

shunt to increase blood flow to lungs, dilate the pulmonary artery

Question 28

paediatric heart conditions that present as cyanosis

Answer 28

tetralogy of fallot and transposition of great arteries

Question 29

paediatric heart conditions that present as heart failure

Answer 29

ventricular septal defect atrioventricular septal defect patent ductus arteriosus

Question 30

paediatric heart conditions that present as shock

Answer 30

aortic stenosis | coarctation of the aorta