Neonatology

Question 1

premature fusion of suture, abnormally shaped skull, hard, non-movable ridge over the suture

Answer 1

Cranial synostosis

Question 2

soft areas, usually parietal bones @ the vertex near the sagittal suture

Answer 2

Craniotabes

Question 3

symmetrical facial palsy, absence/hypoplasia of the 7th nerve nucleus

Answer 3

Mobius syndrome

Question 4

predictors of neonatal death

Answer 4

APGAR & umbilical pH

Question 5

contraindication to breastfeeding

Answer 5

Amphetamines, Antineoplastics,
Bromocriptine,
Chloramphenicol, Clozapine, Cocaine, Cyclophosphamide,
Diethylbestrol, Doxorubicin, 
Ergots, 
Gold salts, 
Heroin, 
Immunosuppressants, iodides, 
lithium, 
methimazole, methylamphetamine, 
phencyclidine, 
radiopharmaceuticals, 
thiouracil

Question 6

Associated w/ premature labor, abruption placenta, multiple congenital anomalies, fetal neuromuscular dysfunction, gastrointestinal obstruction, TORCH, trisomy 18 & 21, Kippel-Feil, hydrops

Tx: serial amniocentesis

Answer 6

Polyhydramnios

- AF vol >2000ml, AF index >24cm

Question 7

Assoc w/ congenital anomalies, IUGR, renal agenesis (Potter), drugs interfering w/ fetal urination, prune belly syndrome

Answer 7

Oligohydramnios

- AF vol <500ml, AF index <5cm

Question 8

most serious complication of Oligohydramnios

Answer 8

pulmonary hypoplasia

Question 9

↑AFP

Answer 9

open NTD, 
gastroschisis, 
omphalocoele, 
twins, 
congenital nephrosis

Question 10

↓AFP

Answer 10

trisomy 18 & 21,

IUGR

Question 11

1st audible heart sound

Answer 11

16-18 wks

Question 12

initial movement

Answer 12

18-20 wks

Question 13

Predominant cause of antepartum fetal distress

Answer 13

uteroplacental insufficiency

Question 14

• Fetal heart rate acceleration that follow fetal movt

- Reactive (normal) – 2 FHR acceleration of at least 15bpm lasting 15 secs

Answer 14

NST

Question 15

• Fetal heart rate response to spontaneous, nipple or oxytocin-stimulated contraction
• Fetal compromise – 3 contraction in 10 mins followed by late decelerations
• Contraindicated in preterm PROM, previous uterine scar from a CS, multiple gestation, incompetent cervix or placenta previa

Answer 15

CST

Question 16

early deceleration

Answer 16

head compression

Question 17

variable deceleration

Answer 17

cord compression

Question 18

late deceleration

Answer 18

fetal hypoxemia

Question 19

Best available chemical indices of fetal maturity

Answer 19

AF creatinine & lecithin

Question 20

lecithin:sphingomyelin ratio at 35 wks

Answer 20

2:1

Question 21

MC indication for Amniocentesis

Answer 21

advance maternal age

Question 22

causes of early lung maturation

Answer 22

Severe premature separation of the placenta
PROM
Narcotic addiction
Maternal hypertensive, renal vascular dse

Question 23

causes of delayed lung maturation

Answer 23

Hydrops fetalis

Maternal diabetes w/o vascular dse

Question 24

used to diagnose fetal hematologic abnormalities, genetic d/o, infection & fetal acidosis

Answer 24

Cordocentesis/ percutaneous umbilical blood sampling

Question 25

Accurately diagnosed by amniotic fluid analysis & treated w/ intrauterine intraperitoneal/ intraumbilical vein transfusions of packed Rh negative blood cells

Answer 25

Fetal Erythroblastosis

Question 26

↓incidence & recurrence of NTD

Answer 26

Folic Acid

Question 27

dose of folic acid for (+) hx of NTD or 1st degree relative w/NTD

Answer 27

4mg/day 1month prior conception

Question 28

fertilization of an ovum by an insemination that takes place after one ovum has already been fertilized

Answer 28

Superfecundation

Question 29

fertilization & subsequent development of an ovum when a fetus is already present in the uterus

Answer 29

Superfetation

Question 30

level of Hgb and %BW difference for Fetal transfusion syndrome

Answer 30

5g/dL hemoglobin & 20% body weight difference

Question 31

Overt/ asymptomatic bacterial infection

Answer 31

``` GBS L.monocytogenes, U.urealyticum, M.hominis, Chlamydia, T.vaginalis, G.vaginalis, Bacteroides sp ```

Question 32

symmetric IUGR

Answer 32

``` Earlier onset Chromosomal, genetic, malformation, teratogenic, infectious, or severe maternal hypertension ```

Question 33

asymmetric IUGR

Answer 33

Late onset Poor maternal nutrition Late onset or exacerbation of meternal vascular disease

Question 34

TPN amount of the ff to promote optimal growth amino acid __ g/dL glucose __ g/dL 20% intralipid __kcal/mL electrolytes, trace elements & minerals

Answer 34

AA: 2.5-3 g/dL glucose: 10-15 g/dL 20% intralipid: 2.2kcal/mL

Question 35

Most important problem of central vein infusion

Answer 35

Sepsis: coagulase negative staphylococcus (MC) | Thrombosis, extravasation of fluid & accidental dislodgement of catheters

Question 36

Metabolic complication of TPN

Answer 36

``` Hyperglycemia Osmotic diuresis & dehydration; azotemia; nephrocalcinosis; hypoglycemia (accidental cessation of infusate); hyperlipidemia, hypoxemia & hyperammonemia ```

Question 37

Infants who require long term parenteral nutrition w/ no enteral nutrition leads to

Answer 37

metabolic bone dse, cholestatic jaundice, liver dse

Question 38

Feeding very small amounts of enteral nourishment to VLBW preterm infants to stimulate development of the immature GIT

Answer 38

trophic feeding

Question 39

benefits of trophic feeding

Answer 39

- Enhanced gut motility - Improved growth - Shortened hospital stay - ↓ need for parenteral nutrition - Fewer episode of sepsis

Question 40

Intestinal tract readiness for trophic feeding

Answer 40

- Active bowel sounds - Passage of meconium - Absence of abdominal distention & Bilious gastric aspirates or emesis

Question 41

criteria for discharge

Answer 41

- Nutrition by nipple - Growth steady increments 10-30 g/24hr - Temperature stabilized - No recent apnea/ bradycardia - Parenteral drug discontinued or converted to oral - Stable infant w/ BPD on O2 by NC w/ careful ffup & pulse oximetry monitoring - ROP screening, hearing screen - BP for those who had indwelling umbilical arterial catheters (check for renal vascular hypertension) - Hemoglobin/hematrocrit to evaluate for anemia - Weight approaches 1800-2100g

Question 42

diffuse, sometimes ecchymotic, edematous swelling - Extend across midline & suture lines - Disappears in 1st wk of life

Answer 42

Caput Succedaneum

Question 43

subperiostreal hemorrhage, firm tense mass - Always limited to surface of 1 cranial bone - Resorbed w/in 2wks – 3 mos

Answer 43

Cephalhematoma

Question 44

collection of blood beneath the aponeurosis that covers the scalp - Firm fluctuant mass, ↑size - Hypotension & hyperbilirubinemia - Resolve over 2-3 wk period

Answer 44

Subgaleal hemorrhage

Question 45

- Prematurity, RDS, hypoxic-ischemic or hypotensive injury, reperfusion injury of damaged vessels, ↑/↓ cerebral blood flow, ↓vascular integrity, ↑venous pressure, pneumothorax, hypervolemia & hypertension - Majority have no clinical symptoms - Rarely present at birth; 50% w/in the 1st DOL; 75% w/in the 1st 3DOL - Severe IVH acute deterioration on 2nd or 3rd DOL - Apnea, pallor, cyanosis, poor suck, abnormal eye signs, high-pitched, shrill cry, muscular twitching, convulsions, ↓muscle tone, shock, metabolic acidosis & a ↓hct or failure of the hct to ↑ after transfusion

Answer 45

Intraventricular hemorrhage

Question 46

Bleeding isolated to the subependymal area

Answer 46

Grade I IVH

Question 47

Bleeding w/in the ventricle w/o evidence of ventricular dilatation

Answer 47

Grade II IVH

Question 48

Intraventricular hemorrhage w/ ventricular dilatation

Answer 48

Grade III IVH

Question 49

Intraventricular & parenchymal hemorrhage

Answer 49

Grade IV IVH