Neonatology Flashcards

Question

What are causes of bilious vomiting in neonates?

Answer 1

Necrotising enterocolitis Duodenal atresia Meconium ileus

Answer 2

Duodenal atresia Double bubble sign = dilation of both the duodenum and the stomach.

Answer 3

Meconium ileus

Answer 4

Oesophageal atresia

Answer 5

Microcephaly Thin upper lip Smooth, flat philtre Short palpebral fissure Learning disability Behavioural difficulties Hearing + vision problems Cerebral palsy

Answer 6

Congenital cataracts Congenital heart disease Learning disability Hearing loss

Answer 7

Fetal growth restriction Microcephaly Hydrocephalus Learning difficulty Limb hypoplasia Scarring/skin changes in the dematomes Cataracts

Answer 8

Exomphalos/Omphacele = abdominal contents protrude through the umbilical ring - covered with a transparent sac Gastoschisis = abdomianl contents protrude through defect in anterior abdominal wall - no covering sac

Answer 9

Investigate with a blood film analysis Rhesus haemolytic disease (RHD) ABO incompatibility Glucose-6-phosphate dehydrogenase (G6PD) deficiency hereditary spherocytosis

Answer 10

Bilious vomiting Haemodynamic instability

Answer 11

C. Pneumothorax The baby has meconium aspiration syndrome, which is associated with high rates of air leak, pneumothorax and pneumomediastinum. The sudden development of profound respiratory distress suggests a pneumothorax. Not B: This is the failure of the foetal circulation to adapt to extra-uterine conditions. Meconium aspiration causes hypoxia and pulmonary vasoconstriction, maintaining higher pulmonary pressures

Answer 12

Air-fluid levels

Answer 13

Failure to pass meconium within 48hrs Billous vomiting Abdominal distension

Answer 14

Most common cause of respiratory distress in the newborn period Delayed resorption of fluid in the lungs Low oxygen sats at birth Resolves within a couple of days

Answer 15

Hyperinflation of the lungs | Fluid in the horizontal fissure

Answer 16

Both present with billous vomiting Duodenal atresia = few hours after birth Malrotation = 3-7 days after birth + signs of haemodynamical instability

Answer 17

Ladd's procedure

Answer 18

Soft, distended

Answer 19

Respiratory distress | Patchy infiltrates on CXR

Answer 20

Most common cause of respiratory distress in the newborn period Delayed resorption of fluid in the lungs Low oxygen sats at birth Resolves within a couple of days

Answer 21

Hyperinflation of the lungs | Fluid in the horizontal fissure

Answer 22

Toxoplasmosis

Answer 23

Cytomegalovirus

Answer 24

Transient tachypnoea of the newborn

Answer 25

Chest compressions rate of 100-120/min, ratio of 15:2

Answer 26

A. 9: One point is lost for blue extremities, which is very common immediately postpartum

Answer 27

at 1, 5 and 10 minutes.

Answer 28

at 1, 5 and 10 minutes.

Answer 29

-Apgar score of 7–10 as reassuring -a score of 4–6 as moderately abnormal - a score of 0–3 as low

Answer 30

D. Observe and reassess at next interval In first 10 minutes of life, suboptimal SpO2 readings can be expected from a healthy neonate. Transient cyanosis is very common initially after birth. It does not require any further management as it usually self-resolves. APGAR scores, including appearance/colour, should be assessed at 1 min, then reassessed at 5 and 10 minutes.

Answer 31

The 2015 Resuscitation Council guidelines made the following changes to paediatric basic life support compression:ventilation ratio: 1. lay rescuers should use a ratio of 30:2 2. If there are two or more rescuers with a duty to respond then a ratio of 15:2 should be used -age definitions: an infant is a child under 1 year, a child is between 1 year and puberty Key points of algorithm (please see link attached for more details) 1. unresponsive? 2. shout for help 3. open airway 4. look, listen, feel for breathing 5. give 5 rescue breaths 6. check for signs of circulation -infants use brachial or femoral pulse, children use femoral pulse 7. 15 chest compressions:2 rescue breaths (see above) -chest compressions should be 100-120/min for both infants and children -depth: depress the lower half of the sternum by at least one-third of the anterior–posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child) -in children: compress the lower half of the sternum -in infants: use a two-thumb encircling technique for chest compression

Answer 32

A subaponeurotic haemorrhage or subgaleal haemorrhage is a rare condition seen in newborns caused by rupturing of the emissary veins that connect the dural sinuses and the scalp veins. This leads to blood accumulating in the aponeurosis of the scalp and periosteum (can cause widespread bleeding--> shock) -These can occur secondary to ventouse delivery and are an important differential to caput succedaneum. -They cross cranial sutures (like caput succedaneum) but run deep to the galeal aponeurosis and are bloody rather than serosanguinous or oedematous fluid in nature.

Answer 33

D. Intraventricular haemorrhage In neonatal practice the vast majority of IVH occur in the first 72 hours after birth, the aetiology is not well understood and it is suggested to occur as a result of birth trauma combined with cellular hypoxia, together the with the delicate neonatal CNS.

Answer 34

B. Congenital diaphragmatic hernia Pulmonary hypoplasia in CDH occurs alongside the hernial development rather than as a direct result of it, as part of a sequence Pulmonary hypoplasia is a term used for newborn infants with underdeveloped lungs Causes include oligohydramnios congenital diaphragmatic hernia

Answer 35

Undertaken by opthalmologists 1. 30 – 31 weeks gestational age in babies born before 27 weeks 2. 4 – 5 weeks of age in babies born after 27 weeks Screening should happen at least every 2 weeks and can cease once the retinal vessels enter zone 3, usually at around 36 weeks gestation.

Answer 36

1. First line is transpupillary laser photocoagulation to halt and reverse neovascularisation. 2. Other options are cryotherapy and injections of intravitreal VEGF inhibitors (very low dose avastin) 3. Surgery may be required if retinal detachment occurs

Answer 37

The retina is divided into three zones: 1. Zone 1 includes the optic nerve and the macula 2. Zone 2 is from the edge of zone 1 to the ora serrata, the pigmented border between the retina and ciliary body 3. Zone 3 is outside the ora serrata The retinal areas are described as a clock face, for example “there is disease from 3 to 5 o’clock”. The areas of disease are described from stage 1 (slightly abnormal vessel growth) to stage 5 (complete retinal detachment). “Plus disease” describes additional findings, such as tortuous vessels and hazy vitreous humour.

Answer 38

Retinal blood vessel development starts at around 16 weeks (same time as foetal movements) and is complete by 37 – 40 weeks gestation. The blood vessels grow from the middle of the retina to the outer area. This vessel formation is stimulated by hypoxia, which is a normal condition in the retina during pregnancy. When the retina is exposed to higher oxygen concentrations in a preterm baby, particularly with supplementary oxygen during medical care, the stimulant for normal blood vessel development is removed. When the hypoxic environment recurs, the retina responds by producing excessive blood vessels (neovascularisation), as well as scar tissue. These abnormal blood vessels may regress and leave the retina without a blood supply. The scar tissue may cause retinal detachment.

Answer 39

eyes, heart, hip problems in family

Answer 40

breech presentation (>34 weeks), when did they turn?

Answer 41

A set of abnormalities affecting the head and face, consisting of a small lower jaw (micrognathia ), a tongue that is placed further back than normal (glossoptosis), and blockage (obstruction) of the airways.

Answer 42

when the external ear is small and not formed properly

Answer 43

An Erbs palsy is the result of injury to the C5/C6 nerves in the brachial plexus during birth. It is associated with shoulder dystocia, traumatic or instrumental delivery and large birth weight. Damaged to the C5/C6 nerves leads to weakness of shoulder abduction and external rotation, arm flexion and finger extension. This leads to the affected arm having a “waiters tip” appearance: 1. Internally rotated shoulder 2. Extended elbow 3. Flexed wrist facing backwards (pronated) 4. Lack of movement in the affected arm 5. Function normally returns spontaneously within a few months. If function does not return then they may required neurosurgical input.

Answer 44

volvulus/malroation (admit, NBM, IV fluids), xray and upper GI contrast)

Answer 45

Hypospadias is a birth defect in boys in which the opening of the urethra is not located at the tip of the penis -referral to urology for followup (contraindication to circumscision)

Answer 46

Slate gray nevi (Mongolian blue spots)

Answer 47

Sturge-Weber syndrome

Answer 48

STURGE. S – Seizures. T – Tram track calcifications. U – U/L port wine stain and weakness (usually opposite side) R – Retardation.v

Neonatology Flashcards

(74 cards)