Week 6 Flashcards by Josephine Dijk

Which factor is considered more important than gestational category alone when assessing the impact of perinatal brain injury?

A) Type of delivery
B) Developmental age at time of lesion
C) Birth weight at delivery

Correct answer: B

Explanation: The maturation of brain structures at the time of the lesion is more predictive of outcomes than whether the birth is simply classified as preterm or full-term.

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Which of the following classifies a newborn as extremely preterm (EPT)?

A) Birth weight under 1500 grams
B) Gestational age under 32 weeks
C) Gestational age before 28 weeks

Correct answer: C

Explanation: Extremely preterm (EPT) is defined as birth before 28 weeks gestational age. viability begins around 22 weeks

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Which of the following is an evidence-based public health strategy to reduce preterm birth risk?

A) Encouraging early return to physical activity after conception
B) Antenatal screening for maternal psychological health
C) Increasing gestational weight gain targets across all pregnancies

Correct answer: B

Explanation: Screening and addressing maternal mental health (e.g., depression, abuse) during pregnancy helps reduce risk for preterm birth, particularly when paired with responsive care systems.

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Which perinatal brain injury is characterised by necrosis and softening of white matter around the lateral ventricles, typically resulting in demyelination and gliosis?

A) Perinatal arterial ischemic stroke (PAIS)
B) Periventricular leukomalacia (PVL)
C) Intraventricular haemorrhage (IVH)

Correct answer: B

Explanation: PVL = softening of white matter, due to necrosis, demyelination, and gliosis near the ventricles. Often caused by hypoxia/ischaemia, especially in preterm infants.

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Which of the following is the most common type of perinatal brain injury in preterm infants?

A) Perinatal arterial ischemic stroke
B) Basal ganglia-thalamus HIE
C) Periventricular leukomalacia (PVL)

Correct answer: C

Explanation: PVL is the most common brain injury in preterm infants, due to their vulnerability to hypoxic-ischemic white matter damage.

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A preterm infant suffers a germinal matrix that spreads into the lateral ventricles. What condition is this describing?

A) Periventricular leukomalacia (PVL)
B) Intraventricular haemorrhage (IVH)
C) Hypoxic-ischemic encephalopathy (HIE)

Correct answer: B

Explanation: IVH involves bleeding from the germinal matrix into the ventricular system, increasing intracranial pressure. In severe cases, it can lead to PHI.

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What is a possible consequence if intraventricular haemorrhage extends into surrounding white matter?
A) Watershed pattern injury
B) Periventricular haemorrhagic infarction (PHI)
C) Parasagittal necrosis

Correct answer: B

Explanation: PHI is a more severe progression of IVH, where bleeding extends into cerebral cortex and white matter, causing infarction and necrosis.

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Which HIE pattern is associated with poor motor function, unconsciousness, and near-total asphyxia?

A) Watershed pattern
B) Germinal matrix pattern
C) Basal ganglia-thalamus pattern

Correct answer: C

Explanation: The basal ganglia-thalamus pattern of HIE is more severe, often involving motor deficits, coma, and poor prognosis, linked to total asphyxia.

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Which perinatal brain injury is associated with blockage of blood flow in the middle cerebral artery, affecting both cortical and subcortical regions?

A) Periventricular leukomalacia
B) Perinatal arterial ischemic stroke (PAIS)
C) Intraventricular haemorrhage

Correct answer: B

Explanation: PAIS most often affects the middle cerebral artery, damaging cortex, basal ganglia, internal capsule, and cerebellum.

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Which two injuries are more commonly associated with full-term infants than with preterm infants?

A) PVL and IVH
B) HIE and PAIS
C) GMH and PHI

Correct answer: B

Explanation: HIE and perinatal stroke (PAIS) are more typical in full-term births, whereas PVL and IVH are more common in preterm infants.

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Which of the following injuries is least likely to affect motor functions in isolation?

A) Basal ganglia-thalamus HIE
B) PAIS involving internal capsule
C) Watershed pattern of HIE

Correct answer: C

Explanation: The watershed pattern primarily affects white matter but may spare motor areas, especially if the cortical motor strips are intact.

Watershed: bloedstroom vanaf zijkant hersenen naar midden en vanaf midden naar zijkant. Als er een stroke is kan de watershed gebroken worden

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Which HIE pattern typically results from near-total asphyxia and is associated with depressed consciousness and poor motor outcomes?

A) Watershed pattern
B) Basal ganglia-thalamus pattern
C) Germinal matrix haemorrhage

Correct answer: B

Explanation: The basal ganglia-thalamus pattern is a deep grey matter injury, linked to severe hypoxia, coma, and motor dysfunction. It reflects prolonged blood/oxygen deprivation.

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What distinguishes the watershed pattern of HIE from the basal ganglia-thalamus pattern?

A) Watershed pattern affects deep grey matter; basal ganglia-thalamus pattern affects cortical white matter.

B) Watershed pattern involves white matter between arteries and is typically less severe; basal ganglia-thalamus involves deep grey matter and is more severe.

C) Watershed pattern is seen only in full-term infants; basal ganglia-thalamus is seen only in preterm infants.

Correct answer: B

Explanation: Watershed pattern = white matter, less severe.
Basal ganglia-thalamus = deep structures, more severe and disabling.

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Which injury results from bleeding into the ventricles from the germinal matrix and can increase intracranial pressure in preterm infants?

A) Hypoxic-ischemic encephalopathy
B) Intraventricular haemorrhage (IVH)
C) Perinatal arterial ischemic stroke (PAIS)

Correct answer: B

Explanation: IVH arises from germinal matrix fragility, common in preterm infants, and may lead to ventricular dilation and pressure buildup.

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Which perinatal injury results from a blockage in the middle cerebral artery and often leads to unilateral damage to cortical and subcortical structures?

A) Intra-venticular haemorrhage (IVH)
B) Periventricular leukomalacia (PVL)
C) Perinatal arterial ischemic stroke (PAIS)

Correct answer: C

Explanation: PAIS typically involves the middle cerebral artery, affecting cortex, basal ganglia, and internal capsule, often unilateral.

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Which condition is defined by necrosis and demyelination of white matter near the lateral ventricles, often with cyst development and gliosis?

A) Periventricular leukomalacia
B) Hypoxic-ischemic encephalopathy
C) Intraventricular haemorrhage

Correct answer: A

Explanation: PVL is a classic preterm injury, with white matter necrosis, gliosis, and possible cyst formation, usually due to hypoxia/ischemia.

White matter = PVL
Purely V(w)hite loss

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Which injury can result in periventricular haemorrhagic infarction (PHI) if bleeding extends into the white matter?

A) PVL
B) IVH
C) HIE

Correct answer: B

Explanation: IVH that worsens can cause PHI — bleeding that invades surrounding white matter, leading to infarction and necrosis.

IVH = Blood leakes into ventricles and IN SEVERE CASES white matter –> PHI)

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Which injury is most likely to result in white matter damage without cortical involvement and is often associated with motor deficits like cerebral palsy?

A) Perinatal stroke
B) PVL
C) Basal ganglia-thalamus HIE

Correct answer: B

Explanation: PVL involves white matter only, especially around ventricles, and often leads to motor impairment without direct cortical damage.

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A full-term infant presents with depressed consciousness, seizures, and an MRI showing watershed-pattern injury. Which perinatal brain injury is most likely?

A) Germinal matrix haemorrhage
B) Periventricular leukomalacia
C) Hypoxic-ischemic encephalopathy

Correct answer: C

Explanation: Watershed injury on MRI + seizures + term birth = classic for HIE, not hemorrhagic injury.

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Which of the following clinical tools is used immediately after birth to assess a newborn’s physiological status and potential distress?
A) COAT scale
B) Glasgow Coma Scale
C) APGAR score

Correct answer: C

Explanation: APGAR (Appearance, Pulse, Grimace, Activity, Respiration) is used at 1 and 5 minutes post-birth to quickly evaluate the infant.

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Which clinical features are more characteristic of a hemorrhagic perinatal brain injury than HIE?

A) Seizures, depressed consciousness, bilateral white matter lesions
B) Germinal matrix rupture, blood in ventricles, increased intracranial pressure
C) Lack of motor reflexes, abnormal EEG, and parasagittal cortical damage

Correct answer: B

Explanation: Intracranial hemorrhages (PVL& IVH) involve bleeding, often from the germinal matrix, and cause ventricular dilation and pressure

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What long-term outcome is common to both HIE and intracranial hemorrhages in neonates?
A) Complete sensory recovery
B) No risk for neurodevelopmental disorders
C) Risk of epilepsy, cognitive impairment, and motor deficits

Correct answer: C

Explanation: Both injury types can lead to motor, cognitive, sensory, and neurological issues, including epilepsy or ADHD.

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What sensory consequence can result from perinatal brain injury due to damage in early sensory pathways?
A) Enhanced visual tracking and auditory filtering
B) Complete recovery of all perceptual functions by age 2
C) Impaired sensation and perception, such as blindness or deafness

Correct answer: C

Explanation: Damage from perinatal brain injury can disrupt the development of sensory systems, leading to permanent deficits like blindness or deafness, especially if critical sensory input is lost during sensitive periods.

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Which of the following statements about cerebral palsy is TRUE?

A) It is a progressive neurological disorder that worsens over time.
B) It exclusively results from birth-related complications after delivery.
C) It is a non-progressive disorder affecting movement, posture, and often sensory or cognitive functions.

Correct answer: C

Explanation: CP is non-progressive and affects motor control, posture, and often cognition, sensation, and behaviour. It can occur prenatally, perinatally, or postnatally.

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A child shows signs of poor balance and coordination, and cerebellum damage. Which type of cerebral palsy is most likely? A) Ataxic B) Dyskinetic C) Spastic

Correct answer: A

Which brain region is most likely affected in a child with ataxic who exhibits poor balance, coordination issues, and tremors? A) Basal ganglia B) Cerebellum C) Motor cortex

Correct answer: B Explanation: Ataxic CP is caused by cerebellar damage, leading to balance and coordination issues and tremors.

Which type of cerebral palsy is characterized by increased muscle tone and exaggerated reflexes? A) Dyskinetic B) Spastic C) Ataxic

Correct answer: B Explanation: Spastic CP is the most common type and features hypertonia and hyperreflexia, due to motor cortex damage. (80-90% of cases)

Which of the following best describes dyskinetic cerebral palsy? A) Stiff muscles and poor posture B) Poor coordination and shaky movements C) repetitive and unpredictable movement due to loss of voluntary motor control

Correct answer: C Explanation: Dyskinetic CP involves damage to the basal ganglia and presents with dystonia (twisting) and chorea (jerky, unpredictable motion).

A child with cerebral palsy displays poor balance, tremors, and coordination difficulties. What type of CP is this? A) Spastic B) Dyskinetic C) Ataxic

Correct answer: C Explanation: These are classic signs of ataxic CP, resulting from cerebellar damage.

Which brain region is primarily affected in spastic cerebral palsy? A) Basal ganglia B) Motor cortex C) Cerebellum

Correct answer: B Explanation: The motor cortex controls voluntary muscle movement and posture; its damage leads to spasticity.

Which combination correctly pairs CP type with its primary motor symptom and damaged brain region? A) Spastic – jerky movement – cerebellum B) Ataxic – balance issues – cerebellum C) Dyskinetic – hypertonia – motor cortex

Correct answer: B Explanation: Ataxic CP stems from cerebellar damage and presents with poor balance and coordination.

What distinguishes hemiplegic cerebral palsy from diplegic cerebral palsy? A) Hemiplegia affects both legs; diplegia affects one side. B) Hemiplegia affects one side of the body; diplegia affects both legs symmetrically. C) Hemiplegia always leads to blindness; diplegia leads to hearing loss.

Correct answer: B Explanation: Hemiplegia = one side (arm and leg), diplegia = usually both legs, more symmetrical.

Which form of cerebral palsy involves impairment in all four limbs? A) Diplegia B) Quadriplegia C) Hemiplegia

Correct answer: B Explanation: Quadriplegia (or tetraplegia) affects both arms and both legs, often associated with more severe motor disability.

A child with CP has impaired movement in both legs, but normal use of arms. Which type of distribution is this? A) Hemiplegia B) Quadriplegia C) Diplegia

Correct answer: C Explanation: Diplegia most commonly involves the lower limbs, especially in preterm children with periventricular leukomalacia.

What is a key finding from research on children with watershed-pattern HIE but no major motor disability? A) They typically show no cognitive impairment at any age. B) IQ scores were unrelated to the severity of the watershed pattern. C) Total IQ negatively correlates with watershed injury severity, despite absence of CP.

Correct answer: C Explanation: Even without CP, cognitive deficits (like lower IQ) were found to be related to watershed severity, supporting the idea of growing into deficits.

What best illustrates the concept of "growing into deficits" in children with early HIE? A) Symptoms improve spontaneously over time. B) Problems only appear after age 42 months and span multiple domains. C) Behavioural symptoms disappear by age 3.

Correct answer: B Explanation: Before 42 months, only behavioural issues are seen. Afterward, more widespread deficits (EF, motor, socioemotional) emerge — classic growing into deficits.

According to meta-analysis on preterm birth, which neuropsychological domains are most consistently affected? A) Behaviour and visual perception B) Academic achievement and executive functions C) Language and balance

Correct answer: B Explanation: Academic performance and executive functions are most impacted by PT birth — more than behaviour — but effects may emerge later in development.

Which of the following is a common socioemotional outcome for preterm children? A) Heightened peer sensitivity and emotional regulation B) Reduced risk for attachment problems C) Withdrawal from peers and insecure attachment

Correct answer: C Explanation: PT children are more likely to withdraw socially, have disorganised or insecure attachment, and show reduced joint attention.

At age 5, Simon shows underdeveloped cognition, clinical risk for depression and hyperactivity, and low socioemotional function. What concept best explains these emerging symptoms? A) Neuroplastic rebound B) Growing into deficits C) Compensatory overdevelopment

Correct answer: B Explanation: “Growing into deficits” reflects how problems (especially from early injuries like HIE) may not manifest early, but emerge with age as demands on cognition and behaviour increase.

Which of the following was found to be the strongest overall predictor of positive cognitive outcome in longitudinal research on preterm children? A) Birth weight B) Neonatal medical risk C) Socioeconomic status (SES)

Correct answer: C Explanation: Higher SES consistently emerged as the most robust predictor for cognitive outcomes — even more than medical or birth-related factors.

Which family characteristic had the greatest impact on cognitive outcomes in preterm (PT) infants, particularly those with high susceptibility? A) Maternal emotional distress (MED) B) Breastfeeding duration C) Parent age at delivery

Correct answer: A Explanation: MED strongly influenced PT outcomes — more so than in full-term children. In PT infants, lower MED led to significantly better cognitive development.

What interaction effect was found between preterm status and maternal emotional distress (MED)? A) MED influenced both PT and full-term infants equally. B) PT infants were more sensitive to MED levels than full-term infants. C) Full-term infants showed worse outcomes under high MED.

Correct answer: B Explanation: This supports the differential susceptibility model: PT children (higher susceptibility) are more affected by MED, while full-term infants remain relatively stable.

According to the research, neonatal stress related to mechanical ventilation is best conceptualized as: A) A minor medical confounder B) A key injury characteristic C) A psychosocial stressor influencing neurodevelopment

Correct answer: C Explanation: Mechanical ventilation isn’t just a medical treatment — it induces stress, which in turn has neurodevelopmental implications, especially in preterm infants.

Which of the following combinations reflects the best set of predictors for long-term cognitive outcomes in preterm children? A) Birthweight, sex, and race B) SES, MED, and parent-child interaction C) Gestational age, neonatal lesion, and Apgar score

Correct answer: B Explanation: While medical factors matter, SES, maternal emotional health, and family dynamics explain far more outcome variance.

According to the Diathesis-Stress Model, how do individuals with low susceptibility respond to negative environments? A) They experience worsening outcomes B) They remain relatively unaffected C) They improve due to stress exposure

Correct answer: B Explanation: In this model, only highly susceptible individuals are negatively affected by stressors. Low susceptibility individuals are relatively stable.

Which of the following best defines the Differential Susceptibility Model? A) Only vulnerable individuals deteriorate under stress B) Some individuals benefit more from positive environments and suffer more in negative ones C) All individuals respond equally to environmental input

Correct answer: B Explanation: Differential susceptibility means some individuals are more responsive in both directions — they can thrive or decline depending on the quality of the environment.

What distinguishes the Differential Susceptibility Model from the Diathesis-Stress Model? A) Susceptibility is irrelevant in both models B) Only the Diathesis-Stress Model includes genetic predisposition C) In Differential Susceptibility, high-risk individuals benefit more from positive environments

Correct answer: C Explanation: This is the core distinction — susceptibility is bi-directional in Differential Susceptibility, but one-directional (only bad outcomes) in Diathesis-Stress.

A preterm child with high susceptibility scores extremely well on cognitive tests after being raised in a highly stimulating home. Which model explains this best? A) Diathesis-Stress Model B) Differential Susceptibility Model C) Neuroconstructivism

Correct answer: B Explanation: This case shows thriving despite risk, due to a positive environment — classic differential susceptibility.

Which of the following best describes the Differential Susceptibility Model? A) Highly susceptible individuals are mainly vulnerable to negative environments. B) Susceptibility has no influence on developmental outcomes. C) Highly susceptible individuals may show worse outcomes in negative environments and better outcomes in positive environments.

Correct answer: C Explanation: The Differential Susceptibility Model proposes that individuals who are more sensitive to environmental influences can experience both more negative and more positive outcomes depending on the quality of the environment.

According to the research at 36 months, what combination predicted better cognitive functioning in high-distress preterm (PT) children? A) Higher maternal depression and neonatal risk B) Low vagal tone and permissive parenting C) Positive parenting combined with high temperamental distress

Correct answer: C Explanation: In PT children with high distress temperament, positive parenting predicted better cognitive functioning — a pattern consistent with differential susceptibility.

What finding at 11 years supports the diathesis-stress model over the differential susceptibility model? A) Preterm children showed benefits from enriched learning environments. B) Higher maternal stress (PPQ) predicted lower IQ in vulnerable groups but not FT children. C) Higher SES protected both vulnerable groups and FT groups from stress equally.

Correct answer: B Explanation: This result fits the diathesis-stress model, where vulnerable groups (VPT) are harmed by negative environments (high maternal stress) but do not gain more from positive ones. PPQ = perinatal post traumatic stress

In the behavioural outcome research at 36 months, which family factor predicted more externalising behaviour? A) Higher SES B) Positive parenting C) Higher maternal depression

Correct answer: C Explanation: Maternal depression was one of the strongest predictors of increased externalising behaviours in the child.

What child characteristic was shown to reduce externalising behaviour in early childhood? A) High neonatal risk B) Higher vagal tone C) Low attention regulation

Correct answer: B Explanation: Children with higher vagal tone (a marker of better physiological regulation) showed lower levels of externalising problems.

What was a novel finding in the academic outcome research from grades 3–8, regarding birth and injury characteristics? A) APGAR score was unrelated to outcome B) Male sex was associated with improved academic performance C) APGAR score (>7) was a positive predictor of academic achievement

Correct answer: C Explanation: For the first time, early injury indicators like 1-min APGAR showed predictive power for academic outcomes — better scores linked to better achievement.

What mediated the relationship between prematurity and academic outcomes in the 8-year study? A) Sex differences B) Neonatal medical risk C) Early inhibition skills at 20 months

Correct answer: C Explanation: Prematurity predicted lower academic achievement, and this was mediated by early inhibition capacity, highlighting the role of executive functioning.

What was the role of early inhibition (assessed at 20 months) in predicting academic outcomes at 8 years? A) It had no predictive power compared to SES. B) It directly mediated the effect of prematurity on academic performance. C) It only affected behavioural outcomes, not academic ones.

Correct answer: B Explanation: Early inhibition was a mediating variable — meaning premature birth influenced early inhibition, which in turn influenced academic achievement later.

What did the 36-month behavioural outcome study reveal about the interaction between parenting and temperament? A) Negative parenting led to internalising symptoms in all children. B) Preterm children with high distress showed more externalising with negative parenting. C) Parenting style had no effect on behavioural outcomes in preterm children.

Correct answer: B Explanation: The interaction of distress temperament and parenting clearly followed the differential susceptibility pattern — negative parenting worsened, while positive parenting improved behaviour.

According to the 11-year follow-up, what was the most important predictor of IQ differences between VPT and FT children? A) Neonatal brain injury B) Maternal post-traumatic stress (PPQ) C) SES alone

Correct answer: B Explanation: Maternal PPQ scores predicted lower IQ in VPT children only — supporting the diathesis-stress model (negative environments hurt the vulnerable most).

Which of the following best describes the role of early inhibition in the relationship between prematurity and academic achievement? A) Early inhibition moderates the effect of academic achievement on prematurity. B) Early inhibition mediates the relationship, explaining how prematurity impacts academic outcomes. C) Early inhibition has no measurable influence on academic development in preterm children.

Correct answer: B Explanation: Mediation means that early inhibition acts as the mechanism through which prematurity affects later academic achievement. That is, being born preterm impairs inhibition development, which in turn lowers academic outcomes.

Which early social communication behavior is considered a strong predictor of socioemotional outcome in preterm infants? A) Hand preference and early vocalisation B) Responding to joint attention and behavioural requests C) Preference for solitary play and rapid motor development

Correct answer: B Explanation: Responding to joint attention, behavioural requests, and social interaction were highlighted as early social communication predictors at 12 months.

In the 12-month study, which factor best supported the differential susceptibility model for preterm (PT) children? A) Only maternal depression predicted outcomes in both groups B) MED and triadic interactions predicted socioemotional outcomes in PT but not FT children C) Outcomes were identical regardless of parenting quality

Correct answer: B Explanation: This pattern — where PT children are more affected by family-level emotional factors (e.g. parental distress, triadic synchrony) — is classic differential susceptibility.

At 3 years of age, which factor mediated the difference in socioemotional outcomes between full-term and preterm children? A) SES B) Paternal emotional distress C) Child gender

Correct answer: B Explanation: Paternal emotional distress was found to mediate differences between FT and PT children's socioemotional outcomes, though the effect was weaker than in previous studies.

What pattern was observed in the 9-year study regarding family conflict and socioemotional outcome? A) No impact of conflict on either FT or PT children B) Conflict predicted outcomes equally across FT and PT children C) Maternal and paternal conflict mediated socioemotional outcome differences between FT and PT children

Correct answer: C Explanation: Parental conflict (both maternal and paternal) mediated the FT/PT outcome differences, showing socioemotional vulnerability in PT children — consistent with diathesis-stress or partial susceptibility.

Which summary statement best captures the research findings across all time points? A) Injury severity is the only reliable predictor of socioemotional outcome B) Socioemotional outcomes in FT children are more sensitive to family factors than in PT C) PT children are more susceptible to family and emotional environments, but outcomes depend on multiple interacting predictors

Correct answer: C Explanation: The conclusion is that PT children show more sensitivity to context (differential susceptibility), but SES, injury, child temperament, and parenting all contribute to long-term outcomes.

Week 6 Flashcards

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