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MRCOG Part 2 Clinical Skills, Teaching and Research > Neonatology from busy SpR > Flashcards

Neonatology from busy SpR Flashcards

(60 cards)

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1
Q

Breastfeeding + Aspirin

A

Risk Reye’s sydnrome

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2
Q

BF + Bromocriptine/carberfoline

A

Suppressess lactation

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3
Q

BF + Caribmazole

A

Affect neonatal thyroid function, nodular goitre

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4
Q

BF + Chlorampheniclol

A

Leucopenia, aplastic anaemia acid

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5
Q

BF + cyclophosphamide

A

Discotinune during BF and for 36hr after stopped

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6
Q

BR + diazepam

A

Lethargy, drowiness, hyperbilirubimae

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7
Q

Erbs
- Nerve roots
- Cause
- Symptoms

A

C5/C6
Excessive displacement of head to the opposite side or depression of the shoulder on same side

Medially roasted and forearm pronated (waiters tip), sensory loss of lateral side of arm/

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8
Q

Klumpke’s
- Nerve roots
- Cause
- Symptoms

A

C8/T1

Small muscles of claw hand, sensory loss of medial side of arm

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9
Q

What are the 4 key adaptations of the fetal circulation?

A
  • Ductus venous
    (oxygenated blood coming from placenta umbilical vein, divides 1 to liver and ductus arterioles into inferior vena cava)
  • Forman ovale - semi oxygenated blood from IVC & SVC into R atrium shunts to L side of heart (low pressure) and into aorta
  • Ductus arteriosus - blood in pulmonary artery is connects to ductus arteriosus, placenta releases prostaglandin which keeps this open
  • Umbilical arteries - blood from aorta sends blood to body, common iliac which splits into internal. Umbilical arteries carrying deoxygenated blood back to placenta
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10
Q

What are the remnants of each fetal adaptation called after birth?

A

Foramen vale - fossa ovalis
Ductus arteriosus - ligament arteriosus
Umbilical arteries - proximal superior vesical arteries, distal medial umbilical arteries
Umbilical vein - round ligament of the liver
Ductus venous - ligament venous

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11
Q

What proportion of adults have a patent foramen ovale?

A

25-30%

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12
Q

In what conditions is the foramen ovale less likely to close?

A

Born premature
Congenital rubella infection

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13
Q

In what % of cases is a patent ductus arteriosus isolated?

A

90%
10% other congenital heart defects (tetralogy- necessary for survival)
Pink upper limbs, blue lower limbs

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14
Q

How common are cardiac congenital malformation

A

7-8/1000
6-10% all infant mortality

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15
Q

How often does neonatal examination fail to detect CHD?

A

50%

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16
Q

What is eisenmenger syndrome?

A

Left to right heart shunt that not corrected leading to pulmonary HTN, R ventricular becomes hypertrophied. R to L shunt.
Hypoxia - polycythemia, clubbing

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17
Q

How is combined pulse oximetry measured in neonate

A

Pre-ductal - Right hand
Post-ductal - any foot

Improves detect of CHD to 90%

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18
Q

What is considered a normal combined pulse oximetry?

A

Both >95% and less to equal to 2% difference

At birth lower, in health term baby does not reach 90% in 1st 5 mins and gradient remains

Screening normally done 4-12 hours after birth

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19
Q

How to calculate APGARs

A
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20
Q

What scores of APGAR are considered normal?

A

> 7 are good
4-6 fairly low
<3 criticality low

Normally measured at 1 and 5 mins

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21
Q

Draw diagram showing location caput, cephalohaematoma, subgleal haemorrhage, extradural haemorrhage

A
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22
Q

Cephalohaematoma
- How common
- Location
- Association
- When does it present

A

1%
bleeding beneath periosteum, does not cross suture line
Associated with jaundice
May not appear until 2nd day of life, takes severeal weeks to disappear

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23
Q

Subglaleal hemorrhage
- How common
- Location
- Association
- RF

A
  • Rare
  • Bleeding beneath aponeurosis, crosses midline
  • Associated with shock, anaemia, neonatal death
  • Increased risk ventouse delivery
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24
Q

How to sub-arachnoid haemorrhage occur? Progonsis>

A

Small vessels normally veins
Silent bleed, may present with fits
Good prognosis

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25
Sub dural haemorrhage association, outcomes
Associated with excessive moulding forces or difficult delivery of head Large infra-tentorial bleeds associated with poor outcome
26
How common is intra-ventricular haemorrhage? What is associated with poorer outcomes
2% normal babies at term, increased in preterm Poorer prognosis if brain parenchyma involved 50% cerebral palsy if post haemorrhage hydrocephalus
27
What is periventricular leukomalacia? - Biggest risk factor - Outcomes assocated
White-matter brain injury near lateral venticules - Most likely to affect preterm infants, <1500g - Can manifest as cerebral palsy >50%
28
Rate of stillbirth in UK Stillbirth risk at 39 weeks
1 in 200 39/40 1/1000
29
Draw neonatal resuscitation flow diagram
30
How many insufflation breaths?
5
31
Acceptable pre ductal SPO2 at 2, 5 and 10 mins
2 65% 5 85% 10 90%
32
Before what gestation should be wrapped in plastic bag?
<32 weeks
33
For inflamtion breaths what inflation pressures should be used <32 or >32
<32 25cm H20 >32 30 cm H20 Start in air
34
What % of oxygen should be used >32 28-32 < 28
>32 21% 28-32 21-30% <38 30%
35
Ratio chest compressions to inflations
3:1
36
What should the temperature of delivery room be in neonatal resuscitation?
26C
37
How common is physiological neonatal jaundice? When does is present in term and preterm infant?
30-50 term neonates, unconjugated Term neonates - D3 Preterm neonate - D5 Does not present in 1st 24hrs
38
What is jaundice considered pathological?
Conjugated Marked jaundice >250-300 micro mol/L Prolonged >10 days term/14 days preterm Occurs 1st 24 hrs Accosted with other illness
39
Causes of haemolytic neonatal jaundice
Rhesus disease, ABO haemolytic disease of glucose-6-phosphate dehydrogenase deficiency, hereditary spherocytosis, pyruvate kinase deficiency, polycythaemia, TTTS, haemoglobinopathies
40
What can high levels of unconjugated bilirubin cause in neonate?
Kericterus - crosses BBB basal ganglia involved, athetoid cerebral palsy + deafness, seizures, neonatal death More likely extreme preterm, sepsis, acidosis
41
How is jaundice treated>
Phototherapy Exchange transfusion - based on unconjugated bilirubin concerntaiton
42
Inheritance of Glucose-6-phosphate dehydrogenase deficiency
X linked recessive
43
Which clotting factors of vitamin K dependant?
2, 7, 9, 10
44
What is haemorrhage disease of the newborn
Babies relative low vitamin K and can suffer harmorrhagic complications which can be fatal
45
How is the risk of haemorrhage disease of the newborn minimised?
1mg vit K fine at birth PO regime's available 2mg
46
Which babies required additional vitamin K?
If give oral vitamin K at birth and breast-fed 2mg at 1 week and 1 monthly until weaned
47
Which babies at high risk of HDN?
Pre-term * Small for gestation age * Badly bruised * Breech deliveries * Operative delivery * Maternal anti-convulsant therapy * Maternal / neonatal liver disease * Admission to SCBU * Poor feeding
48
How common is RDS before 32 weeks & term?
<32 40-50% Term 2/1000
49
NNT for AN steroid to prevent RDS/NND/IVH < 31 weeks and >34 weeks
<31 5 >34 94
50
How common is TTN - term - CS before labour - CS in labour - VD
- term 6/1000 - CS before labour 35/1000 - CS in labour 12/1000 - VD 5/1000
51
Complications of preterm
Resp - RDS, TTN, chronic lung disease - Apnoea of prematurity Neuro - ICH, IVH, HIE Infection NEC Retinopathy Anaemia Patent ductus arteriosus
52
Which tests included in health prink test
Sickle cell CF Congeitnal hypothyroid PKU MCADD Mayple syrup urine disease Isovaleric acidaemia Glutaaric aciduria type 1 homocystinuria
53
Which neonates at risk of neonatal hypoglycaemia
DM mothers Mother taken BB IUGR
54
How to Dx neonatal hypoglycaemia?
A value <1.0mmol/l at any time A single value <2.5mmol/l in a neonate with abnormal clinical signs A value <2.0mmol/l and remaining <2.0mmol/l at next measurement in a baby with a risk factor for impaired metabolic adaptation and hypoglycaemia but without abnormal clinical signs.
55
Treatment neonatal hypoglycaemia
Buccal dextrose + feeding plan if 1-1.9 <1 or persistent - medical R/V
56
Fetal blood volume is what proportion of body weight?
10-12%
57
Additional blood from delayed cord clamping if baby 3500g 1
166ml
58
How common is neonatal hip dysplasia
0.5-1.5%
59
Risk factors for neonatal hip dysplasia?
Female 8:1 Fix (6% sibiling, 12% parent) Breech Multiple preg 1st preg LGA Oligo Postural and non portal abnormality - club foot, torticollis
60
How common hip dysplasia bilateral? Which leg more likely to be effected
20-40% bilateral L > R x 3

MRCOG Part 2 Clinical Skills, Teaching and Research (6 decks)

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