Neonatology test


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Neonatology test

  1. 1. Neonatology End-of-Posting Test90 minutes written paper.Define: Perinatal mortality rateAns: Number of stillborn and neonatal deaths within the first 7 days per 1000 live birthsDefine: Neonatal mortality rateAns:Number of neonatal deaths within 1 month after birth per 1000 live birthsDefine: Post neonatal mortality rateAns:Number of infant deaths after 1 month from birth till 1 year of age per 1000 live birthsDefine: Infant mortality rateAns:Number of deaths from time of birth till 1 year of age per 1000 live birthsDefine: PosttermAns:Birth after 42 completed weeks of gestationDefine: PretermAns:Birth before 37 completed weeks (37+0) of gestationDefine: Small for gestational ageAns:Weight below 10th percentile of the population for that age.Alt answer:(i)5th percentile(2 S.D). (ii)3rd percentileDefine: Low birth weightAns:Birth weight less than 2.5kgWhat are Singapores current:a)PMR b)NMR c)PNMR d)IMR Ans:a)1.2 b)2.1 c)1.9 d)4.0Low birth weight:a)Incidence b)Proportion of neonatal deathsAns:a)7% b)60-80%
  2. 2. What is the range in a term infant of:a)Lengthb)Head circumferenceAns:a)(43-45)-(53-56)cmb)(30-32)-(36-38)cmWhat may the following abnormalities in the maternal historyresult in or be associated with the newborn?a)Oligohydramnios - give 3b)Polyhydramnios - give 2 a)Renal agenesis, Prematurity, Small for gestational age, Pulmonaryc)Mild diabetes - give 2 hypoplasiad)Severe diabetes b)Oesophagial atresia, Hydrops fetalise)Graves disease c)Hypoglycaemia,?macrosomiaf)Hyperparathyroidism d)?Congenital defects,?Sacral agenesisg)Aspirin e)Thyrotoxicosis, Drug-induced hypothyroidismh)Phenytoin f)Hypercalcemiai)Naphthalene g)Intracranial haemorrhage, early closure of PDAj)Pethidine h)Facial abnormalitiesk)Local anaesthetics entering i)Jaundice in a G6PD babyblood j)Respiratory depressionAns: k)Convulsions,?arrhythmiasName 6 common problems the intra-uterine growth retarded fetuscan have during labour and the early newborn periodAns:Hypothermia, hypoglycaemia, IUD, Meconium aspiration, Birth Trauma, PolycythemiaNOT: Birth asphyxia(protected against!)The fetus inspite of a low arterial PO2 is not anaerobic because:Ans:Fetal haemoglobin (HbF) has a greater affinity for oxygen, and is saturated at low PO2.Name 4 mechanisms accounting for newborn heat loss:Ans:Conduction, Convection, Radiation, EvaporationNOT: Poor thermoregulation, etc. etc.Describe the natural history of respiratory distress syndrome.Ans:1)Presents before 6 hours2)Maximum at about 48 hours3)Remains static for about 24 hours4)Improves on the 2nd or 3rd day5)Baby can die of hypoxia at any time.
  3. 3. Name 3 ways respiratory distress syndrome be prevented?Ans:1)Prevent premature births.2)2 does of steroids(dexamethasone) completed by 24 hours before delivery.3)Prophylactic intra-tracheal surfactant before the first breathWhat is the specific therapy for RDS?Ans:Direct delivery of surfactant (eg via ETT)Name 5 ways a neonate with respiratory distress is monitored.Ans:a)Hourly HR,RR,BP, temperatureb)Hourly/3 hourly respiratory assessmentc)Transcutaneous O2/CO2d)Daily fluid balancee)6 hourly ABG if severeName 4 ways transient tachypnoea of the newborn differs from HMD(RDS)?Ans:a)TTNB in term infants, HMD in premature infantsb)TTNB usually just tachynpnoeic without retractions. HMD more severe with retractions.c)TTNB self resolving, HMD usually requires intervention.d)TTNB - lungs well expanded. HMD - atelectasis, collapse, whitewash, etc. XRay signsWhat are the long term complications of mechanical ventilation? Give 3.Ans:a)Bronchopulmonary dysplasiab)Subglottic stenosisc)Hyperactive airwayd)Retinopathy of prematurityThe blood volume of a newborn is about:Ans:85ml/kgThe range of haemoglobin at birth is:Ans:14-20 g/dLWhen does physiologic anaemia of the newborn occur?Ans:Between 2 and 4 months
  4. 4. Name 4 common causes of anaemia due to blood loss at birth:Ans:a)Feto-feto transfusion (twins)b)Feto-placental transfusionc)Vasa praeviad)Placenta praeviae)Intracranial haemorrhage/SAH/SDHHaemorrhagic disease of the newborn is due a deficiency of:Ans:vitamin K dependant clotting factors 2,7,9,10What method of feeding is associated with an increase in HDN? Ans:Breast feedingWhat controversy exists in the prevention of HDN?Ans:One study showed that i/m Vit K is associated with an increase in adult tumors.On the other hand, there is poor compliance when oral Vit K is given.List 4 advantages of breast feeding over infant formula.Ans:a)Cheapb)Secretory IgA protects babyc)Less minerals which may overload the kidneyd)Maternal-infant bondinge)Reduces risk of breast cancer(Many more reasons possible)True or false?:a)A breast fed infant nurses 4 times a day a)Fb)Breast feeding stools are yellow and loose b)Tc)The stools are less frequent than in formula fed babies c)Fd)Breast feeding is associated with higher levels of conjugated hyperbilirubinaemia d)F<>Ans:Breast feeding is absolutely contraindicated in: (T/F)a)Infants with jaundice a)Fb)Maternal tuberculosis with sputum -ve for AFB b)Fc)Maternal intake of antimetabolites c)TAns:Define total parenteral nutrition and list 2 diseases where TPN is indicated.Ans:
  5. 5. a)Provision of calories, minerals and nutrients in amounts to prevent catabolismand promote growth directly into the bloodstream without oral(enteral) feeding.b)Necrotizing enterocolitis, massive gut resection, anastomotic leakageThe caloric density of the following are:a)Breast milk a)67-70 kcal/gb)Humanised milk b)67 kcal/gc)Premature formula c)80 kcal/gAns:Name 3 ways in which premature formula differs from humanised formulaAns:a)More proteinb)More calories per gramc)More vitaminsd)Less fatWhat is the fluid requirements for:a)Term infant Day 1 a)60 ml/kg/dayb)Term infant Day 7 b)150 ml/kg/dayc)Preterm infant Day 7 c)160 ml/kg/dayd)During phototherapy d)add 20 ml/kg/dayAns:The following are indications of a fluid overload state:(T/F)a)Hypernatraemia a)Fb)Urine output <1 ml/kg/hr b)Fc)Weight gain of 100g over 24g c)Td)Basal crepitations d)Te)Bradycardia e)Ff)Periorbital edema f)TAns:A well term infant loses up to (A)% of birth weight in the first week of life;Birth weight is regained by (B) and thereafter gains (C)g/day.His caloric intake/requirement is (D)kcal/kg/day with (E)g/kg/day of proetin for cellular growth.Ans:a)10b)10-14 dayc)30d)100-120e)2-5List 4 features specifically suggestive of necrotising enterocolitisAns:a)Bleeding GITb)Abdominal distension and gastric aspirationc)Intramural or portal vein gas(aerobilia)
  6. 6. d)Systemic disturbance (eg Hypotension)A 3 hour old term infant, delivered vaginally, presents with blood-stained gastric aspirateName a test you would do and describe the principle of the test.Ans:Apt test. Base is added to the aspirate, which will lyse any maternal(?) RBCs which are present,which are less resistant than fetal(?) RBCs. This distinguishes swallowed maternal blood fromfetal GI bleeding.The following may present with bilious vomiting:(T/F)a)Tracheo-oesophageal fistula a)Fb)Malrotation b)Tc)Gastritis c)Fd)Jejunal atresia d)TAns:List 5 clinical manifestations of neonatal hypoglycaemia:Ans:1)Jittery2)Irritable3)Poor suck4)Seizures5)Comaetc.Describe 3 mechanisms causing hypoglycaemia,and give 2 examples of diseases for each mechanismAns:1)Hyperinsulinism - (a)Infant of diabetic mother (b)Nesidioblastosis(pancreatic tumor)2)Low glucose stores - (a)Prematurity (b)IUGR (c)Sepsis3)Decreased gluconeogensis - (a)Galactosaemia (b)Glycogen storage disorders (c)Cortisol def.(d)Panhypopit.Give 3 reasons for jitteriness in an infant of a diabetic mother.Ans:1)Hypoglycaemia2)Hypocalaemia3)HypothermiaWith respect to hypocalcaemia, indicate (T/F):a)Asymptomatic hypocalcaemia should always be treated a)Fb)May present with seizures b)Tc)Is defined by an ionised calcium level < 6mg/dL(2 mMol/L) c)Fd)is seen in DiGeorge syndrome d)TAns:The following are true of rickets of prematurity: (T/F)
  7. 7. a)May result in pathological fractures a)Tb)Doesnt affect growth in length b)Fc)Causes a decline in serum alkanline phosphatase c)Fd)Is never due to phosphate deficiency d)F (Always is)Ans:Describe how you would symptomatic hypoglycaemia in a term newborn.Ans:1)Early feeding2)i/v 10% dextrose 2-4ml/kg over 5 mins3)maintenance drip of 10% dextrose 6-8ml/kg4)Check blood sugar level in 30 minutes5)Observe for hypoglycaemic signs6)Consider glucagon/hydrocortGive 4 reasons why preterm infants are more prone to infections.Ans:1)Weak immune system2)Frequently breached physical barriers (Invasive procedures)3)Nosocomial infections (during prolonged hospital stay)4)Antibiotic treatment removes commensal organismsDescribe 4 methods used in the NICU to decrease the incidence of infection.Ans:1)Handwashing2)Aseptic technique3)Personal medical equipment4)Barrier and reverse barrier nursingName 3 risk factors in infants for early onset sepsisAns:1)Chorioamnionitis2)Heavy Group B Strep colonization3)Prolonged rupture of membranesList 6 tests your would do when investigating a newborn for early onset sepsis.Ans:Chest X Ray, Neutrophil count, Platelets, ESR/CRP, Blood C/S, CSF, Torch serologyThe commonly used first line of antibiotic treatment for newborns is:Ans:Penicillin/Amoxycilin + GentamycinMatch the following features with the appropiate aetiological agent:1)Cutaneous scars a)Parvovirus
  8. 8. 2)Blue berry muffin rash b)Syphillis3)Metaphysitis c)Rubella4)Non-immune hydrops d)Toxoplasmosis5)Intracranial calcification e)VaricellaAns:1)Cutaneous scars e)Varicella2)Blue berry muffin rash c)Rubella3)Metaphysitis b)Syphillis4)Non-immune hydrops a)Parvovirus5)Intracranial calcification d)ToxoplasmosisVaricella zoster immune globulin must be given to infants whose mothersdeveloped chicken buring during the time from:Ans:5 days before to 2 days after birthSeizures seconday to asphyxia usually occur ____ hours after the hypoxic episode.Ans:6.Are they(post-hypoxic seizures) controlled easily or with much difficulty?Ans:Much difficultyHow may seizures be clincially distinguished from tremors? (3 ways)Ans:1)Uprolling of eyes in seizures2)Seizures not controllable by flexing/holding arms3)Baby may not be alert or respond to mother4)Not brought on by simple stimuli5)Coarse infrequent tremors in seizures.6)Seizures last longerName 3 signs of subtle seizuresAns:1)Uprolling of eyes or staring2)Baby stops moving3)Abnormal posture4)ApnoeaName the 3 common sites of intracranial haemorrhageAns:
  9. 9. 1)Subdural2)Subarachnoid3)IntraventricularWhy is periventricular haemorrhage common in the preterm? (2 reasons)Ans:1)Pressure passive cerebral blood flow (Poor BP control)2)Poorly supported vessels of germinal matrix (weak blood vessels)Name 2 clinical states which predispose a preterm to periventricular haemorrhageAns:1)Birth asphyxia2)HypotensionWhat pathological changes occuring after PVH are associated with a poorer long-termprognosis?Ans:1)?Hydrocephalus2)?Periventricular leukomalaciaDescribe the pupillary and tone disturbances associated with the following stages of HIE. Stage 1 Stage 2Muscle tonePupilsAns: Stage 1 Stage 2Muscle tone Normal DecreasedPupils Dilated ConstrictedWhat Apgar scores are associated with a high probability of poor long-term prognosis?Ans:Apgar 5min < 3 or 10min < 3Name 4 Anatomical Sites and 4 examples of diseases where decreased tone at birth mayoriginateAns:1)Cerebrum: HIE/Drugs2)Spincal cord: Trauma3)Anterior horn cell: Spinal muscular atrophy4)Muscle: Muscular dystrophy (eg Duchennes)Current survival rates in Singapore of newborns by birth weight grouping are about:1)400-500g: ____2)750-1000g: _____3)1.0-1.5kg: _____4)> 2.5kg: _____
  10. 10. Ans:1)< 50%2)70-80%3)75-80%4)> 99%1)Most infants with cerebral palsy are either preterm or term infants with low 1 Apgar scores (T/F)2)Disability rates in survivors with birth weights below 1.5kg is: (a)5-10% (b)10-20% (c)20-30%Ans:1)False2)(b)