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Neonates Flashcards

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1
Q

An elevated lactate to N-acetylaspartate ratio on MR spectroscopy is
consistent with HIE- True or false?

A

True

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2
Q

Injury to the grey matter is unusual in HIE- True or False?

A

FALSE

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3
Q

Prominent occipital white matter changes may indicate that the infant was
hypoglycaemic- true or false?

A

TRUE
White matter looks like sugar?

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4
Q

The current recommended target saturations for infants of less than 28 weeks
gestation during their NICU stay is closest to?

A

91-95%

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5
Q

What is prune belly syndrome?

A

Genitourinary tract abnormalities
include massive dilation of the ureters
and upper tracts and a very large
bladder, with a patent urachus, or a
urachal diverticulum and
cryptorchidism. Cardiac abnormalities.
Common in both genders.

Prune makes you pee into your bladder

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6
Q

What is Bardet-Biedel syndrome?

A

This results in the characteristic retinal changes (retinitis pigmentosa), post-axil polydactyly, obesity, renal dysfunction, abnormalities of the genitalia and intellectual disability

Can’t read the takes of beetle and the bard because no vision and fingers cant hold book. Also not smart.

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7
Q

Side effects of Topiramate?

A

Kidney stones, metabolic acidosis and language impairment

Used to treat seizures. Your mate has kidney stones and lots of acid. + can’t talk

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8
Q

Common side effects of Levetiracetam

A

Behavioural side effects are the most common side effect of levetiracetam. Older children need to be warned about low mood and the risk of suicidal ideation.

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9
Q

Which congenital condition has the highest prevalence in Aus and Nz?

A

Bilateral hearing impairment. Approximately 1-2:1000 live newborns have congenital sensorineural hearing loss bilaterally.

Cystic fibrosis: 1:2,500
Galactosaemia: 1:70,000
Hypothyroidism: 1:3,500
Neuroblastoma: 1-2:100000 children aged <15 years, congenital incidence even less

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10
Q

What is G6PD a disorder of?

A

Disorder of NADPH production. Important for preventing oxidative injury.

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11
Q

Mode of inheritance for congeinital chloride diarrhoea?

A

Autosomal recessive

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12
Q

What are the effects of impaired Cl absorption on bicarb and sodium in congenital chloride diarrhoea?

A

Impaired Cl abs = reduced bicarb and sodium absorption –> increased plasma renin-aldo ratio

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13
Q

A 2-month-old neonate presents for review of right upper quadrant abdominal mass, infantile haemangiomas and poor growth- > cause

A

Hypothyroidism

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14
Q

What bug is a spirochaete?

A

Treponema pallidum is a spirochaete, congenital syphilis is highly infectious and so contact precautions are vital. The treatment is with penicillin IV.

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15
Q

What happens to the vernix at 24, 38, 40 and >42 weeks

A

24 – 38 weeks: Thick layer over skin
38 – 39 weeks: Back, scalp, skin creases
40 – 41 weeks: Minimal, only in creases
>42 weeks: Not present

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16
Q

What happens to neonatal skin at 24, 32, 36, 40 and >42 weeks

A

24 – 31 weeks: Thin, translucent with visible veins on abdomen and may be oedematous
32 – 35 weeks: Thicker and smooth, no oedema
36 - 39 weeks: Pink
40 – 41: Early desquamation, more pale
>42: Thick, pale, desquamation

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17
Q

What happens to Lanugo at 22, 33, 38 and >42 weeks

A

22 – 32 weeks: Covering entire body
33 – 37 weeks: Covering body except face
38 – 41 weeks: Shoulders only
>42 weeks: Absent

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18
Q

What does parecovirus present with in babies

A

Septic shock picture
MRI shows white matter changes

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19
Q

When is the most common time period for CP injury to occur? Ie brain injury that causes CP

A

In Antenatal period

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20
Q

What accounts for 50% of SSNHL in kids? (non-syndromic)

A

Connexin 26 gene OR GJB2 mutation.

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21
Q

Lesion at optic chiasm will do what to your vision?

A

Bitemporal haeminopia

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22
Q

What is Neopterin used for?

A

Marker of CNS inflammation. Catabolic product so gets worse with each day.
Measured in CSF

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23
Q

Can single gene testing be used for detecting triplet repeat disorders?

A

YES

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24
Q

What is the most common genetically inherited peripheral neuropathy?

A

Charcot Marie Tooth Disease

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25
Anterior location of a burn is most likely child abuse- true or false
FALSE. Abuse generally younger kids and can be anywhere
26
Which CHD will give you cyanosis with a NORMAL examination on day 2 of life?
TAPVR Normally an associated ASD but cyanosis once PDA closes
27
What is the first line treatment for gonococcal conjunctivitis?
IV Cefotaxime and PO azithro. NOT BEN PEN due to increasing ressitance
28
What are the two mechanisms that cause physiological jaundice in neonates
Increased bilirubin production because of increased breakdown of fetal erythrocytes. Hepatic excretory capacity is low both because of low concentrations of the binding protein ligandin in the hepatocytes and because of low activity of glucuronyl transferase, the enzyme responsible for binding bilirubin to glucuronic acid, thus making bilirubin water soluble (conjugation).
29
In infants of a diabetic mother, what happens to the insulin, ketones an urine reducing sybstances at the time of a hypo
Insulin will be high because of the persistent hyperglycemia in pregnancy. Low ketones as high insulin means FFA cant be utilised. This also means low reducing substances in the urine.
30
When does the thymic shadow become less visible?
Age 2-8.
31
What is the greatest risk factor for GBS infection in neonates?
Pre term ROM. Means the baby is smaller GA so higher risk of contracting.
32
What are immediate/short-term side effects of antenatal steroids for the baby?
IUGR Reduced foetal movements Increased risk of maternal chorio and hence early onset sepsis in babies
33
What is dyskeratosis congenita?
Defect in telomere maintenance so EARLY AGEING. Causes reticular skin rash, nail dystrophy and low white cells
34
What is the formula for calculating cuffed and uncuffed ETT size in paeds?
age/4 + 4= uncuffed age/4 + 3.5 = cuffed Think in neonate, 4 cuffed and 3/5 uncuffed (age 0_
35
Is Duschens and out or in frame mutation
OUT of frame. If mutation is outside the frame, changes the whole thing vs in the frame.
36
What does a lesion in pituitary/optic chiasm cause in terms of visual disturbance?
Bitemporal haemanopia
37
At what gestational age do babies respond to light?
32 weeks
38
Which base pairs are pyrimadines and which ones are purines?
CYTOSINE and THYMINE are PYRIMADINES- they all have Y in them
39
What receptors take on COVID-19
ACE receptors
40
What is the inheritance for complete androgen insensitivity?
X linked recesive
41
Which renal syndrome has renal stones? (barter vs gitelman)
Barter- bartender- drinks on the rocks- made of calcium- renal stones
42
Name the downstream arteries of the aortic arch
Arch 1+2- Max you can get so maxillary Arch 3- like abC- Carotid Arch 4- 4 limbs- Subclavian Arch 6- 26s look like bleomycin- lung- pulmonry
43
What is the treatment for atrial flutter in neonates?
Cardioversion or Amiodarone if stable
44
What is a common bug causing submandibular lymphadenopathy?
Mycobacterium
45
What is an ECG finding for myocarditis post COVID
prolonged PR
46
What is congenital hypoventilation syndrome associated with?
Hirschsprung disease
47
Why is the plasma half life of nitric oxide so short
Broken down by nitrix oxide reductase which binds to Hb That's why the inhaled nitric oxide monitor is close to the ETT
48
When is pressure swing the smallest? (What type of ventilation)
high frequency with volume gurantee
49
In high frequency ventilation, what improves gas exchange
reduced MAP Think of gas flow and pressures.
50
What is the most important determinant of oxygenation during high frequency oscilaltion ventilation
MAP
51
Which ventilation is best for CLD
High frequency ventilation because it reduces sheer pressure
52
Mechanism of HIE
Essentially either reduction in SYSTEMIC oxygenation or reduced cerebral blood flow. (Need hypoxia AND ischaemia) Reduced oxygenation = increased BP and redistribution of blood to vital organs ie brain. Too much blood to brain= loss of regulation and reduced CBF = ischaemia. (Also from the body, if hypoxia persists, BP will drop to preservation mode which also reduces cerebral blood flow)
53
Out of glutamate, GABA (gamma acitobutarate) and NMDA- which neurotransmitters are good vs bad>
GAMMA= GOOD. (sa re ga ma is a good show) Glutamate and NMDA= bad.
54
Action of glutamate in the setting of hypoxia?
Essentially excess glutamate causes excitation of NMDA and AMPA which INCREASE cellular permeability to sodium and calcium (and water) leading to oedema and apoptosis
55
Incidence of HIE and death rate
In the developed world, incidence is estimated at 1-8 per 1,000 live births, and in the developing world, estimates are as high as 26 per 1,000. Death: 20-30% die in first year, and 50-60%have long term neurological disability
56
Name factors that determine the degree of neuronal damage in HIE
1. Duration of inttial insult 2. Severity of initial insult 3. Location of initial insult 4. Effects of reperfusion injury 5. Apoptosis
57
What is the period of maximal neuronal injury in HIE
This is in the secondary phase- 6-72 hours posts injury.
58
Timing of intervention to reduce long term effects of HIE
6 hours
59
Name of staging system for HIE
SARNAT Looks at level of consciousness, muscle tone, spontaneous activity, posture, complex reflexes and autonomic function
60
Best imaging modality for HIE
MRI - loss of differentiation. CT can be used if not stable for MRI Video EEG is also good (brainz)
61
Treatment for HIE
Main= therapeutic cooling. Maintain temp between 33-34 within few hours has evidence of mod-severe encephalopathy Ideal is 33.5 for 72 hours
62
Period of rewarming? Ie how long should you rewarm for AFTER THERAPEUTIC COOLING for HIE
Rewarm for 12 hours, too quickly--> seizures
63
At what age is the LONG term effect of therapeutic cooling seeen
18 months
64
Side effects of therapeutic cooling
1. Bradycardia 2. Fat necrosis 3. Thrombocytopenia 4. Potential overcooling
65
Failure to establish spontaneous breaths at how many minutes= sign of bad outcome?
20 mins
66
First and second line for seizures in HIE
1. Phenobarbitol 2. Keppra
67
Why is an EEG not helpful for neonates seizures
Can arise from subcortical structures ie brainstem and limbus
68
Name the syndrome. AD inheriance. Seizure onset day 2-3 of life, 10-20 a day 90% resolve by 6 months and developmentally normal
Benign familial neonatal seizures
69
Myoclonic jerks on sleeping only Normal EEG Happens in first week of life
Benign neonatal sleep myoclonus
70
Resus settings for PIP and PEEP in term vs prem
Term 30/5 Prem 21/5
71
First and second most common timings for PIVH
1. >50% in first 24 hours 2. 20-30% day 4-7
72
Where is the germinal matrix layer
In the caudothalamic notch on the floor of the lateral ventricles. Includes delicate later of capillaries that is prone to bleeds
73
Describe the 4 grades of PIVH
1. Germinal matrix - in the cuadothalmic groove 2. IVH without ventricular dilatation 3. IVH with blood distending to lateral ventricle 4. Echogenic intraparenchymal lesion associated with PIVH ? extension of bleed vs venous infarction
74
Which grade of PIVH is most associated with CP/
Grade 3 Also post bleed ventricular dilatation
75
Presentation of Grade I - IV PIVH
Grade I and II asymptomatic Grade III and IV= shock, can progress to seizures
76
What is post-haemorrhagic ventricular dilatation
Dilatation of lateral ventricle post PIVH, happens in small minority and 50% get better and rest develop COMMUNICATION HYDROCEPHALUS
77
Common long term outcome of periventricular leukomalacia
Due to haemorrhagic necrosis 90% have spastic diplegia
78
How many and what are the stages of ROP
5 1- demaractation line 2- ridge 3- ridge with NEOVASCULARISATION 4- subtotal retinal detachment 5- total retinal detachment
79
What is zone 1, 2 and 3 in ROP
1: central, posterior around optic disc greatest risk The rest is as you move out
80
What does plus disease mean for ROP
tortuisity of retinal vessels, pupil rigidity and vitreous haze
81
Calories per 100mls of breast milk
70kcal
82
What is the most common risk factor for SNHL
low birth weight
83
Which maternal antibodies are associated with high risk of recurrent miscarraige
antiphospholipid antibodies
84
Medication for severe opiate withdrawal
Morphine
85
Difference between perinatal and neonatal mortality rate
Perinatal: 20 weeks to 6 days of birth Neonatal: 20 weeks to <28 days Written as /1000 births
86
Defn of infant mortality rate
Number of deaths in babies < 12 months per 1000 live births
87
What is the Barker hypothesis
Effect of foetal nutrition on adults
88
What is bronchopulmonary dysplasia and most common age of occurence
chronic lung disease <32 weeks
89
Definition of CLD
Premature and requiring oxygen at 28 days
90
What vaccine substitute can you give to high risk patients for RSV
Palivizumab, provides passive immunity against RSV infection and has been shown to decrease hospitalisation for RSV related illness.
91
Double bouble sign on AXR
Duodenal atresia Associated with T21
92
What is annular pancreas? what syndrome is it common in?
When pancreas squeezes on duodenum --> non billious vomiting. Common in T21
93
How much blood can be lost in a subgaleal
upto 80-90% of circualting blood volume. This is ~90ml/kg in babies so can have upto 250mls in the scalp (a glass of water in subgaleal)
94
What is maternal smoking (pre and post partum) associated with?
SIDS. one of the highest modifiable risk factors
95
Which type of branchial cyst is most common/
Type II, in STM muscle B= second letter in the alphabet
96
What condition (infection) can present with abnormal basal ganglia signalling on MRI
GBS Can present with basal ganglia involvement. Leigh disease also has this!
97
Most common cause of infant mortality in Australia?
Congenital malformations 2nd is birth trauma nad asphyxia
98
What is the most serious complication of giving surfactant
Pulmonary haemorrhage
99
What is a scaphoid abdomen pathgneumoic of
CDH

RACP Written (18 decks)

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