Neonatology MCQ COPY Flashcards
Multiple Choice (120 cards)
1
Q
A newborn born to a mom with positive anti Ro. Had “normal fetal cardiac assessment’ and now a normal exam, ecg and echo. What is the next step
A
ECG at 12 months
2
Q
First step investigation to Anti-Ro +/- Anti-La Pregnancy Pregnancy monitoring
A
Home fetal Doppler for fetal echo weekly/biweekly from pregnancy week 17 - week 26
3
Q
Neonate with exposure to Anti-Ro +/- Anti-La with normal fetal echos
A
postnatal EKG and echocardiogram: first moth of life and 1 year of age (optional)
4
Q
4 questions pre-birth in NRP
A
Gestational age
Fluid clear
Additional risk factors
Cord management plan
5
Q
A
Normal Infant - Diastasis Recti
6
Q
1 hour old 36 weeker born via CS. Presenting with grunting. O2 87%, RR 70, HR 150, BP 65/40. Xray shows fluid in the fissures and small pleural effusion. No murmur. What is the most likely diagnosis?
A
TTNB
7
Q
A baby is born to a mother on methadone. What is the minimum time required to observe the baby for withdrawal?
A
72 hours
8
Q
You are caring for a 30wk preterm infant. Until what age should you correct for their growth and development?
A
24 months for growth and development
9
Q
How long do you use corrected gestational age in an extreme preterm?
A
36 months or 3 years
10
Q
What is the initial PIP used for resuscitating term neonates?
A
20-25cm H2O
11
Q
Monozygotic twins born at 36 weeks gestational age. Twin A is 2500 g and has a hematocrit of 0.7. Twin B is 1800 g and has a hematocrit of 0.35. What complication is Twin A most likely to develop?
A
Congestive heart failure
12
Q
A 36 weeker weighs 1800g and is induced for maternal hypertension. What lab abnormality is most likely?
A
Polycythemia
13
Q
You receive a call from a midwife who attended a home birth. The baby is noted to be otherwise well but jaundiced at 12 hours of life. What would you recommend?
A
Check bilirubin level
14
Q
A 41-week-old with meconium aspiration syndrome intubated on 40% oxygen is awaiting air transfer to a higher level of care. The RR calls you about an acute deterioration. They are confident that the tube is in the correct position, but are concerned about decreased air entry to the left lung fields and think the trachea is deviated toward the right. What is the MOST appropriate course of action?
A
Transilluminate and perform needle thoracentesis.
15
Q
9 day old ex 32 week baby in NICU with 24 hour history of new onset apneas. Mom was GBS positive and did not get antibiotics. Baby is cultured and started on antibiotics. Cultures grow gram positive cocci in clusters at 18 hours. What is the organism?
A
staph aureus
16
Q
GBS Gram Stain
A
Strep agalactiae. They are gram positive cocci in chains and pairs
17
Q
Monochoronic twins . Twin A 2800g, Hct 70, Twin B 2100, Hct 30. What complication will twin B have
A
Hypovolemia
18
Q
Baby born at 36 weeks via cesarean section gestation now 1 hour old. Presenting with grunting, work of breathing. SpO2 ~88%. RR 70. Normal BP and HR. Normal cardiovascular exam. CXR shows fluid in the fissure. What is your management plan:
A
Give oxygen
19
Q
Gonorrhoea Treatment Protocol for mother negative in pregnancy
A
no ointment
20
Q
Gonorrhoea Treatment Protocol for mother with high risk of exposure
A
test at delivery, give ceftriaxone if no close follow up possible
21
Q
Gonorrhoea Treatment Protocol mother positive in pregnancy
A
single dose of ceftriaxone IM or IV pending test results
22
Q
Alternative for Gonorrhoea if unable to give Ceftriaxone
A
Cefotaxime
23
Q
Preterm baby (32 week) born to a mom on phenytoin. Day 1 of life, the baby’s head ultrasound reveals a grade 1 IVH. What is the most appropriate next step?
A
Second dose of IM Vitamin K
24
Q
Baby born and found to have a positive PKU screen, what do you do next?
A
Check serum phenylalanine level
25
Mom given IV magnesium during labor for preeclampsia. What is the most likely side effect?
Hypotonia
26
A 6 week old ex 30 weeker is transferred from tertiary care to step down NICU. While in tertiary care received 48 hr of respiratory support, NG tube for feeding.
Following transfer to level 2 NICU, develops worsening abdominal distention and occult blood is positive in stool. Vital signs are stable. AXR shows distended bowel loops. Next best step in management
Start broad spectrum IV Antibiotics
27
Baby born at 38 weeks GA, healthy pregnancy, no gestational diabetes, birth weight 4.1 kg. Blood glucose checked at 1 hour of life was 3.2. Baby is well. When should the blood glucose be checked again?
Repeat in 3-6 hours
28
Neonate a few weeks old was brought to care for respiratory distress. Has crackles on the right side of the chest. Chest x-ray shows right diaphragmatic hernia or eventration (question tells you this). What is the next best test?
Fluoroscopy
29
Best modality for diagnosis of diaphragmatic eventration?
Chest US - demonstrates minimal or paradoxical diaphragm movements with breathing (diaphragm rises with inspiration, falls with expiration)
30
Which of the following associated with a sacral dimple in a neonate would prompt you to investigate further?
Above gluteal cleft
31
Sacral Dimple Red Flags (5)
1. Location above gluteal fold ( > 2.5cm from anal verge)
2. > 5mm width across base
3. Deep, unable to visualize base
4. Associated skin findings like tuft of hair, hemangioma, subcutaneous appendage
5. Other findings: leaking from pit, lower extremity or sphincter anomalies
32
Term baby born to 24 yo G1 mom with limited prenatal care. At 2 weeks of life, baby has worsening rhinitis, red/brown rash worse on hands and feet, and diffuse lymphadenopathy. Which investigation will reveal the diagnosis?
VDRL
33
Term neonate on day 14 of IV acyclovir for an HSV-positive vesicular rash near her eye. Full septic work up, including LP, was negative. Best next step?
Stop IV acyclovir
34
Term baby born at regional centre presented with apgars of 1, 3, and 5. Cord gas was 6.95. Baby is now intubated. What is the best management until transfer to tertiary care centre
Turn the warmer off
35
Term baby presents with platelets initially 50 on cord gas. A few hours later, platelets are 8, and baby has intracranial hemorrhage. Mom’s platelets are normal. What is the next best management
Transfuse platelets - specifically HPA-1a negative platelets
36
What do antibodies in Neonatal AUTOimmune thrombocytopenia react with?
maternal autoantibodies that react with BOTH maternal and fetal platelets
37
What do antibodies in Neonatal ALLOimmune thrombocytopenia react with?
maternal antibodies directed towards fetal and neonatal platelets
38
Apgar question: at 1 min of life baby is blue, HR 80, grimaces to suction, floppy and has intermittent poor respiratory effort 5 min of life baby is acrocyanotic, HR 140, no grimace, hypotonic, and requiring IPPV for intermittent resp effort. Calculate APGARs.
3, 4
39
8 day old baby ex 33 weeker who needed chest tube for pneumo at day 2 of life. HUS at DOL 3 was normal. What your next step?
No further imaging
40
First head US timing for infant < 31 weeks?
4 - 7 days post birth
41
Repeat HUS timing for infant < 31 weeks?
4 - 6 weeks post birth
42
Routine HUS gestational age
< 31+6 OR < 36+6 with risk factors for IVH
43
Risk Factors for IVH (6)
1. Prematurity
2. Low birth weight (< 1000g)
3. Lack of maternal prenatal corticosteroid use
4. Birth outside a tertiary care centre
5. Histological chorioamnionitis
6. Events with cerebral blood flow instability in early post natal course
44
A 2 day-old months female failed twice the hearing screen. What to do?
CMV PCR on urine
45
Newborn via elective C-section. Mom had N. Gonorrhea in pregnancy, untreated. Baby looks well. What is the most appropriate management?Newborn via elective C-section. Mom had N. Gonorrhea in pregnancy, untreated. Baby looks well. What is the most appropriate management?
Conjunctival culture and one dose of IM ceftriaxone
46
Newborn with acrocyanosis, HR of 90, irregular respirations, grimacing and floppy. What is the Apgar score?
4
47
4 day old baby girl born to O+ mom, Baby is A- , Bili is 420 . Parents are of Northern European descent; DAT is negative. What diagnosis is most likely?
Hereditary spherocytosis
48
Term Newborn baby born Via C section, Meconium stained amniotic fluids. Apneic at birth, got suctioned and then got intubated; Still cyanotic, Given 2 gases done after 100% FIO2 and intubated.
R Radial artery: 7.28 CO2 30 PO2 70
Umbilical artery: 7.25 CO2 35 PO2 30
PPHN
49
Baby has had jaundice since 4 days old, is now 7 days old. Bilirubin is 300, conjugated is 180. Temp 35, poor feeding. What is the cause?
Septicemia
50
Term baby exposed to opioids in utero. Despite optimal doses of morphine, remains symptomatic. Best medication to add?
Clonidine
51
Newborn term baby with petechiae all over. Stable. Has a normal exam. Mom has normal platelets. No family history of bleeding disorders. Baby’s platelets are 12. What do you do:
Platelet transfusion
52
4-day old newborn, born at home. Now has respiratory distress - HR 180, SpO2 88%, SBP 90. Has an active precordium, delayed cap refill, liver is 5cm below the costal margin. Gas shows metabolic acidosis and respiratory compensation, no lytes or lactate given. What is the most important medication to start? (did not tell us re: sepsis risk factors or temp).
Prostin
53
A term newborn is born limp, dried and stimulated. It has been 1 minute and they are still limp and not breathing. What do you do?
PPV
54
A 2.4 kg term infant female has a blood glucose check at 2 hours that is 2.1, no mention of symptoms. Mom expresses desire to exclusively breastfeed. Treatment
BF and oral glucose gel 0.5 ml/kg and re-check in 30 mintues
55
A 3-week-old infant who was born at 30 weeks has been transferred to a Level 2 community nursery from a regional level 3 center. He was intubated and given surfactant at birth and quickly weaned to room air. He has had reflux and diarrhea on NG feeds.
Over that last 24 hours, he has had increased reflux symptoms, decreased activity level and stools are now occult blood positive. On exam, he has normal vitals, abdomen distension, and decreased activity level. An AXR shows non-specific dilated loops of bowel. What is the best NEXT step in management?
IV antibiotics
56
A 3-day old term infant presents with irritability and poor feeding. The infant’s HR is 200, BP 90/60mmHg, and is very irritable with handling. Antenatal history is unremarkable except for long-standing maternal hypothyroidism on synthroid. Mom denies and any other medication or substance use in pregnancy. What is the most likely diagnosis?
Neonatal thyrotoxicosis
57
17yo adolescent 8 weeks pregnant, has been treated with fluoxetine for depression for the past 2 y and has been stable. She is worried about effects on the baby. What is the recommendation?
Continue the medication
58
Maternal Paroxetine (SSRI) use is associated with what?
small increase in cardiac malformations
59
Newborn with this rash. What is the diagnosis?
Erythema toxicum
60
Histopathology of Erythema Toxicum
Wright stain and/or Tzanck smear of a pustule) shows Eosinophils and the absence of multinucleated giant cells
61
Histopathology of Transient Neonatal Pustular Melanosis
Wright stain shows Neutrophils
62
What is this rash? (clinical history of CNS abnormalities)
Incontinentia pigmenti - peripheral eosinophilia, classic seizures, occular changes, needs a skin biopsy and genetics referral
63
Term baby DOL4 with bili of 240. No risk factors. Otherwise well. What is your plan? (Note: no bili graphs given)
Reassurance that no treatment is needed
64
4 hour old 35 week GA infant. The mother was given Pen V 1h prior to delivery. The baby’s APGARs were 8/9 and they had been breathing spontaneously in room air. Baby has had 4 episodes of desaturation with bradycardia requiring vigorous stimulation. What do you do?
Sepsis work-up and start antibiotics
65
Definition of apnea
cessation of breathing for > 20 seconds or 10-20 seconds if accompanied by bradycardia (HR < 80 bpm) or O2 sat < 80% in infants <37 weeks PMA
66
Pulse oximetry on a 24h old newborn shows 94% right hand and 96% right foot. What is the most appropriate next step?
No further testing required
gradient >3% would be abnormal
67
Newborn, term, asymptomatic. Mom is breastfeeding. 2 hr sugar is 1.9. How to manage?
Breastfeed and give 5ml/kg formula and re check in 30 minutes
68
A male neonate is born at 36 weeks GA to a healthy mom via urgent c-section for placenta previa and bleeding. Initial apgar were 7 and 9 but at 1h of age the neonate develops tachypnea, nasal flaring, intercostal indrawing and requires supplemental oxygen to maintain SpO2>92%. Maternal serology was protective and GBS is pending. What is the most appropriate initial treatment?
Start CPAP at 6cm H2O
69
2 day old term male is born via SVD to mother with chorioamnionitis. GBS pending. Patients vitals are temp 37.1, HR 150, RR 45. He is well appearing with a normal physical examination. What is your management?
vital signs q4h for 24 hours and CBC at 4 hours
70
You are about to start an infant on prostaglandins for a suspected ductal dependent cardiac lesion. What side effect should you monitor for?
Hypoventilation
71
Prostaglandin side effects (5)
1. Hypotension
2. Apnea
3. Flushing
4. Seizure
5. Fever
72
Maternal risk factors of early onset sepsis (5)
1. Intrapartum GBS colonization
2. GBS bacteruira during current pregnancy
3. Previous infant with invasive GBS disease
4. Rupture of membranes > 18 hours
5. Maternal fever
73
A preterm infant born at 28weeks, now 32 weeks corrected. Is now on room air and gavage feeds. What is the hemoglobin threshold for transfusion?
75
74
Suggested hemoglobin levels and hematocrit threshold for transfusing infants with anemia of prematurity - week 1, on respiratory support
Hgb 115 (Hct 35%)
75
Suggested hemoglobin levels and hematocrit threshold for transfusing infants with anemia of prematurity - week 1, no respiratory support
Hgb 100 (Hct 30%)
76
Suggested hemoglobin levels and hematocrit threshold for transfusing infants with anemia of prematurity - week 2, on respiratory support
Hgb 100 (Hct 30%)
77
Suggested hemoglobin levels and hematocrit threshold for transfusing infants with anemia of prematurity - week 2, no respiratory support
Hgb 85 (Hct 25%)
78
Suggested hemoglobin levels and hematocrit threshold for transfusing infants with anemia of prematurity - week 3, on respiratory support
Hgb 85 (Hct 25%)
79
Suggested hemoglobin levels and hematocrit threshold for transfusing infants with anemia of prematurity - week 3, on respiratory support
Hgb 75 (Hct 23%)
80
How many calories are in 30 mls of breast milk?
20 kcal
81
Concentration of breastmilk
20 kcal/oz
82
Mother IVDU. No prenatal care. Delivered and baby discharged. Mother cultures came back positive for gonorrhea but negative for chlamydia. Baby received eye erythromycin. What to do?
IM CTX x1
83
Baby has a constricted pupil, lethargic, hyperreflexic but floppy. Sarnat stage
Stage 2
84
Newborn baby. Mom who is on carbamazepine, refuses IM vitamin K injection, what should you do?
Give baby 2.0mg oral vitamin K, 1 dose now, 1 dose in 2-4 weeks, 1 dose in 4-6 weeks
85
Vitamin K dependent clotting factors
2, 7, 9, 10
86
Hemorrhagic disease of the newborn (HDNB) causes
vit K deficiency secondary to insufficient prenatal storage of vit K, combined with insufficient vit K in breast milk
87
IM Vitamin K dosing < 1500 mg
0.5 mg
88
IM Vitamin K dosing > 1500 mg
1 mg
89
Oral Vitamin K dosing
2 mg
90
Oral vitamain K dose timing
2mg at 1st feed, repeat at 2-4 weeks and 6-8 weeks
91
Soy formula in not recommended in which of the following groups because of phytoestrogen content
Congenital hypothyroidism
92
5 day old, born at 28wks GA. On CPAP 5 and FiO2 25%. Hemoglobin is 110. What to do?
Transfuse PRBCs
93
Newborn of a mother who used methadone. What is the minimum amount of time to monitor the baby?
72hs
94
A term male newborn had a prenatal ultrasound at 32 weeks showing bilateral (15mm) Grade 3 hydronephrosis. What is your next step?
Renal ultrasound at 2 weeks of life
95
Mom goes into precipitous labour at 29 weeks GA. There is no time to transfer to a tertiary care centre. What measures can you do to neuroprotect baby?
Delayed cord clamping
96
Mother with new 6 week old baby, diagnosed with postpartum depression, family doc wants to start SSRI. She is primarily breastfeeding. Best course of action?
Take SSRI and continue breastfeeding
97
When to check for ROP in a baby born at 29 weeks?
33 weeks
98
Baby who is now 1800g, has head that is ~3rd percentile. What is the BEST explanation for why this occurred?
Maternal infection
99
APGARS, Pale, HR 90, Grimace + Cry with suction, limp, no resp effort
2
100
Pale and tachycardic baby now 6d old, born at home, following several bloody stools
hemorrhagic disease of newborn
101
3 day old exclusively BF little babe. 3000g was birthweight. Now weight is 2750g. Mom is feeding 9x per day, babe is peeing 7x per day. What do you do?
Follow up weight in 24hr
102
Baby born at 36 weeks by CS for FTT. Apgars 7/9. No infectious RF. Mom is GBS pending. Now requiring O2 to keep >92 with mild WOB. Cause?
TTNB
103
Most common sequelae of NEC
Stricture
104
Baby first noted to have jaundice at 4 days of life. Now 1 week old, with total bilirubin 380, conjugated 150, presented with poor feeding, vomited once, and has temp 35. No vital signs mentioned. Most likely diagnosis?
Sepsis
105
Term newborn baby in the nursery is found to be jittery, tachypneic with nasal flaring, with myoclonus. Normal glucose. Based on the most likely diagnosis, what is your next management?
Morphine
106
Pustular melanosis
107
Erythema toxicum
108
Miliaria
109
Newborn baby with bump on head as shown (-->). Term infant, afebrile, spontaneous vaginal delivery. What should you do?
Reassure that this will resolve over the course of 2-12 weeks
110
A 5 day old baby is seen in your clinic. Pregnancy was unremarkable, no ABO incompatibility. The baby is breastfeeding. The unconjugated bilirubin is 200. What do you do?
Reassure
111
You attend delivery of a 33 week infant, who requires 15 minutes of resuscitation including PPV, CPR and 2 rounds of epinephrine. Apgars are 2, 4 and 4. Initial gas is 6.98. What disqualifies this patient from cooling?
Gestational age (< 36 weeks)
112
24h old newborn with the picture shown. What to do/tell parents?
No further intervention and it will resolve spontaneously in 2-12 weeks
113
Mother uses marijuana for chronic pain. Breastfeeding. What do you tell her about the risks to the baby:
Continue breastfeeding. Benefits of breastfeeding outweigh the risk of marijuana
114
Contraindications to breast feeding
Active TB
Varicella
HIV
Uncontrolled substance use (PCP, cocaine, meth etc)
Radiopharmcologic agents
anti-neoplastic agents
115
Seborrheic Dermatitis
116
An 7 day old term Asian baby presents with jaundice. He looks well. Mom’s blood type AB+, baby B+. Hgb 104, bilirubin 207, retics 8%. Most likely etiology:
G6PD
117
28 week infant, 32 weeks currently. Feeding well on gavage feeds. Using HF 4L/min room air. What should his transfusion threshold be?
85
118
Baby born at 42 weeks after placental abruption, asystolic since birth and ongoing appropriate resus. After how long can you stop resuscitating?
20 minutes (despite adequate resuscitative efforts)
119
Mother has recurrent HSV. There were no active lesions at delivery. For how long after delivery is the infant at risk for PERINATAL transmission?
6 weeks
120
