neonatology Flashcards Preview

US Pediatric Boards Edited > neonatology > Flashcards

Flashcards in neonatology Deck (146):
1

What is primary vs secondary apnea?

Primary is reversed with tactile stimulation but secondary requires positive pressure ventilation

2

What is the diagnosis in a healthy newborn with respirations>60, retractions and grunting but normal CXR?

Transient tachypnea of the newborn

3

Newborn had increased anion gap metabolic acidosis, thrombocytopenia, high serum ammonia and elevated urine ketones, what is the likely diagnosis?

Organic acidemias

4

Newborn with high ammonia, high PT/PTT and serum glutamic oxaloacetic transaminase who presents with respiratory alkalosis?

Citrullinemia

5

What could be the cause of elevated AFP?

RAIN= renal disease, abdominal wall defects, incorrect dates /multiple pregnancy and neuro defects (anencephaly or spina bifida)

6

Low AFP is associated with what?

Trisomy 21 and 18

7

What is a measure of fetal autonomic nervous system integrity?

Non stress test

8

What measures uteroplacental insufficiency and tolerance of labor?

Stress test

9

What is included in the biophysical profile?

Non stress test + ultrasound for fetal movement, HR, breathing, tone and amniotic fluid

10

What is the result of deficient surfactant in alveolar lining?

Rds

11

What is the diagnosis and what should you do of the fetus has HR>240?

Svt- Give anti arrhythmic to mother to avoid congestive Heart failure and hydrops

12

What condition causes X-ray findings of granular lung opacification and air bronchograms? What is the classic description on chest xray

Rds - ground glass appearance

13

What are symptoms or rds?

Respiratory distress in the newborn. Cyanosis is possible

14

How can you distinguish RDS from pneumonia in a newborn ?

Calculate ratio of bands to neutrophils. If >0.2, think sepsis !

15

What 6 coexisting conditions can worsen RDS?

PDA
Hypoglycemia
Hypocalcemia
Anemia
Acidosis
Hyperbili

16

What can occur in a patient with RDS and hyperbilirubinemia?

Threshold for kernicterus is lower

17

What 3 factors increase the risk for RDS?

Diabetes, c sections, birth asphyxia

18

What 2 factors decrease the risk for RDS?

Prolonged rupture of membranes, prenatal steroids

19

What test can predict the risk of RDS?

L:S ratio > 2 suggests a low risk for RDS

20

When is mechanical ventilation indicated in a patient with RDS?

Ph <7.2 and pCo2 > 60

21

What 3 things does administration of surfactant cause in the lungs?

Decreased oxygen requirements, reduces inspiratory pressure and improved lung compliance

22

What is pulmonary interstitial emphysema ?

Air leak into the interstitium due to mechanical ventilation -- leads to PTX

23

What is the goal po2 in an infant with RDS?

50-70

24

Patients on prolonged ventilator support are at risk for what and why?

Bronchopulmonary dysplasia due to prolonged oxygen exposure and barotrauma

25

What are the indications for ECMO?

Infant with reversible lung disease for less than 14 days and failure of other methods. Pt can not have intracranial bleed or congenital heart disease

26

What is the treatment of BPD and what is a side effect of this treatment?

Diuretics - can increase risk of hypocalcemia

27

What is found on X-ray in a newborn with BPD?

Diffuse opacities, cystic areas with streaky infiltrates and ground glass appearance

28

What is the name of a chronic lung disease of the newborn that is not associated with prolonged ventilator use?

Wilson Mikity syndrome

29

What is the difference between BPD and Wilson Mikity syndrome ?

BPD has inflammatory changes in lung tissues but MKS does not

30

What is the empiric treatment of neonatal sepsis?

Ampicillin and gentamicin

31

What bacteria should you be concerned about if infants mother had flu like illness during pregnancy?

Listeria

32

When toxoplasmosis infection occurs early in pregnancy, what is the risk and severity of infant infection?

Lower chance of infection but more severe disease

33

What are some symptoms of toxoplasmosis in a newborn?

Microcephaly, hydrocephaly, chorioretinitis, cerebral calcifications, jaundice and hepatosplenomegaly

34

How is diagnosis of toxoplasmosis made?

Immunofluorescence

35

What is the best imaging study for toxoplasmosis?

MRI to diagnose encephalitis if ring enhancing lesions

36

What is the difference between cmv and toxo when looking at MRI?

Cmv calcifications are peri ventricular but with toxoplasmosis are diffuse

37

If asymptomatic at birth, what later signs can toxoplasmosis cause?

Deafness, blindness, seizures, MR

38

What is the treatment for toxoplasmosis?

Pyrimethamine, sulfadiazine and folinic acid

39

What two palsied are associated with clavicle fracture in the newborn?

Erbs and phrenic nerve

40

What is the injury associated with the arm internally rotated and addicted with flexed wrist?

Erbs palsy, c5-7 Injury

41

What should you be concerned about if clavicle fracture leads to respiratory distress?

Phrenic nerve palsy

42

What is the injury associated with claw hand?

Klumpke palsy at C8 T1

43

What is the difference between klumpke and Erb palsy in relation to reflexes?

In Erb palsy the grasp reflex is intact but is lost in klumpke

44

Which palsy can be associated with Horner syndrome?

Klumpke

45

What two maternal conditions can cause neonatal heart block?

Lupus and sjogren

46

What do you do if you find a newborn with a single umbilical artery?

Renal ultrasound

47

What are the common complications of umbilical artery and vein catheter placement?

NEO CATH = Necrosis , embolize ruin (liver), omphalitis, compromised femoral pulse, accidental hemorrhage, traumatic perforation thrombosis and hepatic (dysfunction)

48

When should the umbilical cord fall of and what is the concern if it does not?

Should fall off by 2 weeks ; if attached past 1 month, consider leukocyte adhesion deficiency

49

When is a baby considered SGA?

In the lower 10th percentile for gestational age

50

When is a baby considered LGA?

In the upper 10th percentile for weight for gestational age

51

What is considered a full term baby?

38-42 weeks

52

What is seen in a post term newborn?

Dry peeling skin, long fingernails, decreased lanugo, ears with strong recoil

53

What is the most common cause of fetal demise?

Chromosomal abnormalities and congenital malformations

54

What is a normal scalp pH?

7.25 or higher

55

What are some causes of delayed passage of meconium?

Meconium plug syndrome
Hirschsprung
Imperforate anus

56

For the purpose of boards, when do you intubate a meconium baby?

If baby is floppy, suction and intubate

57

What is the presentation and How do you diagnose Hirschsprung's disease?

No meconium passage after 48 hours or abdominal distention with diarrhea may be present - diagnosis with biopsy

58

What condition is Hirschsprung's disease associated with?

Down's syndrome

59

What is meconium ileus associated with?

Cystic fibrosis

60

What occurs in the affected segment of bowel with Hirschsprung's ?

The recto-sigmoid colon is contracted and the region proximal is distended

61

What do you do in an infant with bilateral ankle clonus?

Nothing - can be normal

62

How much pressure is needed to inflate the lungs for the first breath?

60 mmHg

63

What should you do in the presence of bradycardia and impaired ventilators efforts in a newborn?

Positive pressure ventilation

64

How should apgars be used to determine use of CPR?

Do NOT wait for one minute apgar scores to decide to start CPR !

65

What is the normal fetal placental weight ratio of a term baby? How should it change during pregnancy?

6.5 - 7
The ratio should increase progressively - if not, think of decreased fetal growth

66

When should chest compressions be started in a newborn?

If HR <60 despite adequate ventilation

67

How should chest compressions be delivered in a neonate?

100 per minute with one ventilation per 3 compressions

68

What should you look out for in a newborn who was born at home??

Hemorrhage
Sepsis
Vit K deficiency and bleeding

69

What is the difference between silver nitrate and erythromycin ophthalmic eye ointment

Silver nitrate only protects against Gonorrhea. Erythromycin is needed to prevent chlamydia infection

70

What do you do for an anuric infant?

Evaluate abdomen and genitals
Make sure adequate fluid intake
Cath urine specimen
Bun/creatinine
Renal ultrasound

71

What is a very low birth weight infant?

Infant <1500 g

72

What is an appropriate arterial BP of a preterm baby?

Should not be less than the corrected gestational age

73

What must be done for every VLBW infant with no obvious cause for preterm birth?

Septic workup + amp and gent

74

What type of fluid is appropriate for VLBW infants?

D10

75

What bone disease is at increased risk in premies and why?

Rickets because of inadequate intake and absorption of calcium and phosphorus

76

What is the caloric requirement for a premie?

120 kcal/kg/day

77

What are some classic signs of NEC?

Bloody stool, abdominal wall erythema and thrombocytopenia

78

What is the classic X-ray finding in NEC?

Air in the biliary tree & pneumatosis intestinalis

79

What is the long term complication of NEC?

Intestinal strictures

80

How should NEC be managed?

NG tube to LIS, IVF, antibiotics
Possible surgical intervention
NPO x 3 weeks

81

Up to What bilirubin level is considered normal in the first 24 hours in a full term newborn?

12.4

82

Up to what age can anemia of ABO or Rh incompatibility be seen?

Up to 2 months

83

Which type of blood incompatibility can occur in a first born child?

ABO or
Rh only if previous miscarriage

84

What jaundice occurs in the first few days of life due to dehydration?

Breast feeding jaundice

85

In which type of jaundice should newborns not be given breast milk?

Breast milk jaundice

86

When is phototherapy contraindicated?

Elevated direct bili or family hx of light sensitive porphyria

87

What causes bronze baby syndrome ?

Phototherapy in a child with high conjugated (direct) bilirubin

88

What should you do in a newborn <24 hours old with jaundice and why ?

Total and direct bili levels - elevated bili in first 24 hours is never normal

89

What risk factors DECREASE incidence of neonatal jaundice?

Maternal heroin, smoking, alcohol and phenobarbital

90

What types of endocrine disorders can cause jaundice?

Hypothyroid and hypopituitary

91

What are two syndromes that can cause jaundice?

Gilbert disease and Lucy Driscoll syndrome

92

What 4 causes of increased enterohepatic Circulation can lead to jaundice?

Obstruction, pyloric stenosis, meconium ileus, Hirschsprung's

93

What are 4 causes of jaundice that lead to elevated direct and indirect bili?

Galactosemia, tyrosinosis, hypermethioninemia and cystic fibrosis

94

What medication can cause high bilirubin and why?

Sulfonamides - compete for space on albumin

95

What are 4 complications of exchange transfusion ?

Elevated potassium, thrombocytopenia, hypocalcemia and hypovolemia

96

If dextrostix accucheck read is abnormal, what is the next step?

Verify with serum glucose

97

What is the definition of hypoglycemia in premies and full term newborns ?

<25 in a premie
<35 in full term newborn

98

What is the most important initial step for management of very low birth weight infant?

Maintaining euglycemia and body temp

99

How would you treat hypoglycemia in a newborn?

2-3 ml/kg of D10 bolus or glucagon IM

100

What abnormalities should you be concerned about in a newborn born to a mother treated with tocolytics? Why?

Hypoglycemia ( tocolytics stimulate fetal insulin )

101

What are some classic exam findings in a newborn with hypoglycemia ?

Jitteriness, lethargy, apnea,
Cyanosis, seizures
Tachypnea

102

What are 3 common complications seen in an LGA baby?

Hypoglycemia , polycythemia and hypo plastic left colon

103

What EKG finding may indicate hypocalcemia?

Prolonged QT

104

What are two classic signs of hypocalcemia?

Chvosteks - facial twitching on tapping
Trousseau - carpopedal spasm

105

What may be the cause of late onset hypocalcemia on an infant?

Giving cows milk causes high phosphate load on the kidneys

106

What is the definition of hypocalcemia?

Ionized Ca < 4.5 or
Total Ca < 8.5

107

What problem should you think of in an infant born to a mother on mag sulfate? Why?

Hypocalcemia - high mag will decrease PTH secretion

108

How do you treat hypocalcemia ?

Increase calcium in IV or with calcium gluconate

109

What test will detect fetal cells in mothers blood?

Kleihauer Betke

110

What percentage of hgb is fetal hgb at birth?

50%

111

What hgb level is considered to be "anemia" in a full term infant?

< 13

112

What meets the criteria for polycythemia ?

Central venous hct >65 (not valid in heelstick)

113

What are the complications of having polycythemia in a newborn?

Hypoglycemia, hyperbilirubinemia and thrombocytopenia

114

When and what is the treatment for polycythemia ?

HCT >70 needs partial exchange transfusion

115

What is the apt test?

Test for maternal blood in neonatal gastric aspirate

116

What is a common cause of thrombocytopenia in a newborn?

Maternal ITP

117

When do you see early onset hemorrhage in a newborn?

Within 3 days in Breast fed babies not given vitamin K

118

What 3 medications may increase risk of hemorrhagic disease in the newborn?

Anticoagulants
Anticonvulsants
Antibiotics (tb meds, cephalosporins and quinolones)

119

When should you give oral vitamin k in a newborn?

Never - it is insufficient for preventing hemorrhagic disease

120

What test would you order in a newborn with protein and blood in the urine?

Renal ultrasound - look for ATN

121

What is the cause and prognosis of a newborn with a seizure in the first 24 hours of life?

Birth asphyxia - likely to NOT have long term neuro developmental sequelae

122

What is the initial drug of choice in a newborn with seizure ?

Phenobarbital

123

What causes hyperalimentation induced cholestasis?

Protein intake > 2g/kg/day

124

What medication can be used to treat hyperalimentation induced cholestasis?

Phenobarbital to stimulate bile secretion and decrease serum bili level

125

What are some syndromes associated with cleft lip/palate?

Crouzon syndrome, apert and treacher Collins

126

What are 4 common findings in beckwith wiedemann syndrome?

Omphalocele
Macroglossia
Macrosomia
Hypoglycemia

127

How is gastroschisis different than omphalocele?

It is not covered by a membrane and only involves intestinal contents because it is near the umbilicus (not through the umbilicus like omphalocele)

128

What is the most important goal in management of gastroschisis ?

Keep bowel moist!

129

Which is associated with chromosomal defect, omphalocele or gastroschisis ?

Omphalocele

130

What syndrome is TE fistula commonly associated with?

VACTERL

131

What should you think in a patient with scaphoid abdomen?

Diaphragmatic hernia

132

How do you manage TE fistula?

Protect the airway from secretions with auctioning and elevating the head

133

What is an imperforate anus with a high obstruction?

Fistula connects into vagina or urinary tract

134

What are grades 1-4 of IVH?

Grade 1 = germinal matrix
Grade 2 = IVH without dilation
Grade 3 = IVH with dilation
Grade 4 = IVH plus parenchymal involvement

135

What is soft putting that crosses suture lines?

Caput succedaneum

136

what is a firm bulge on the scalp that does not cross suture lines?

Ceohalohematoma

137

How do you image an unstable vs stable newborn with suspected IVH?

Ultrasound if unstable
CT if stable

138

What May terbutaline increase the risk for in a newborn?

Hyperinsulinemia and hypoglycemia

139

What are 4 neonatal complications associated with maternal cocaine use?

Placental abruption
Cerebral infarction
Limb anomalies
Urogenital defects

140

What symptoms are associated with alcohol withdrawal?

Hyperactivity, irritability and hypoglycemia

141

What 4 symptoms are associated with barbiturate withdrawal?

Hyperactivity
Hyperphagia
Irritability
Poor suck swallow

142

Cigarette smoking is associated with increased risk for what?

Low birthweight
Miscarriage
Prematurity
Cleft lip/palate

143

What 6 symptoms are associated with opioid withdrawal ?

Irritability
Tremors
Hypertonic
Diarrhea/vomiting
Feeding difficulties
Seizures

144

Of the following choices, What is the most important thing to do within the first hour of life?
A. Vitamin K
B. Erythromycin eye drops
C. Skin to skin contact w mother

Skin to skin contact

145

You are presented with a 2 month old infant who "cries continuously". Mother reports 1 hour of crying at 1 am and then 2 hours of crying at 5 am. What should you do?

Reassurance.
Crying of up to 3 hours per day is normal in infants >6 weeks old

146

What are the 5 basic causes of apnea?

Metabolic, infectious, neurological, cardiac and Gi