Respiratory Distress And Neonates

Front 1

What are the normal respiratory features in a newborn baby ?

Back 1

1. Respiratory rate 35 - 45 per min.
2. No recession
3. No grunting
4. No cyanosis
5. No stridor
6. No apnoea
7. No nasal flare

Front 2

What are the clinical features of respiratory distress in a child ?

Back 2

1. Respiratory rate of more than 60 per min.
2. Recession
3. Grunting
4. Cyanosis

Front 3

What are the pulmonary causes of Respiratory Distress in neonates ?

Back 3

1. RDS
2. MAS
3. TTN
4. Pneumonia
5. Pneumothorax
6. Pulmonary haemorrhage
7. Congenital lung abnormalities
8. Hyaline membrane disease

Front 4

What are the extra-pulmonary causes of Respiratory Distress in neonates ?

Back 4

1. Cerebral abnormalaties
2. Choanal atreasie
3. Micrognathis
4. T-O fistula
5. Cardiac abnormalities
6. Diaphragmantic hernia
7. Septicaemia

Front 5

List the special investigations you would employ to confirm the underlying cause of Respiratory Distress.

Back 5

1. Chest radiograph
2. FBC
3. CRP
4. Blood culture
5. Hyperoxia test
6. ABG
7. Acid-base
8. Oxygen saturation

Front 6

What is the percentage of oxygen saturation needed to alleviate cyanosis in a preterm and term neonate, respectively ?

Back 6

Preterm- 88 - 92 %

Term- 92 - 95 %

Front 7

What is the arterial pressure for oxygen needed to alleviate cyanosis in a preterm and term neonate, respectively ?

Back 7

Preterm- 60 - 75 mmHg

Term- 60-90 mmHg

Front 8

What are the guidelines for referral in a neonate with Respiratory Distress ?

Back 8

1. Severe grunting despite CPAP
2. Severe rib recession despite CPAP
3. Apnoea
4. PaCO2 > 7.5 kPa
5. Respiratory acidosis
6. Central cyanosis

Front 9

What are the dangers of too little oxygen in neonates ?

Back 9

Hypoxia
Acidaemia
Death

Front 10

What are the dangers of too much oxygen in neonates ?

Back 10

Retinopathy of prematurity
Bronchopulmonary dysplasia

Front 11

Discuss the pathogenesis of ROP.

Back 11

High levels of oxygen cause firstly a vasoconstrictive phase. Then a prolifitive phase- abnormal growth of retinal vessels which lead to bleeding in vitreous and eventually retinal detachment. This can cause blindness or regression.

Front 12

Define: Bronchopulmonary dysplasia.

Back 12

A condition characterized by any preterm baby <32 gestational weeks still requiring supplemental oxygen at 36 gestational weeks.

Front 13

What are the risk factors for BPD ?

Back 13

1. Immaturity
2. Oxygen toxicity
3. Baro- and volutrauma
4. Infection
5. Patent ductus artereosus

Front 14

What are the radiological features of a neonate with BPD ?

Back 14

1. Diffuse haziness
2. Cystic

Front 15

Discuss the pathogenesis of BPD.

Back 15

Firstly cellular and interstitial injury occurs causing fibrosis. This leads to cellular hyperplasia and airway muscularisation and hyperreactivity.

Front 16

List the aetiology of hyaline membrane disease.

Back 16

1. Preterm babies
2. Asphyxia
3. Infant diabetic mother

Front 17

True or false: Hyaline membrane disease is characterized by a pneumocyte 2 deficiency.

Back 17

False. It is caused by a surfactant deficiency.

Front 18

Discuss the pathophysiology of MAS.

Back 18

Atelectasis and hyperinflation occurs. This causes hypoxemia and hypercapnia. Persistent pulmonary hypertension develops. Chemical pneumonitis occurs which results in surfactant inactivation.

Front 19

Discuss the clinical presentation of transient tachypnoea of a neonate (TTN).

Back 19

1. In term babies
2. Elective caesarean babies
3. Mild to moderate respiratory distress
4. Can be asymptomatic

Front 20

Discuss the chest radiograph of a baby with transient tachypnoea of the newborn (TTN).

Back 20

1. Perihilar streaking
2. Fluid in lung fissures
3. Increased lung volumes

Front 21

Early onset group B streptococci disease in newborns usually presents with ?

Back 21

Pneumonia.

Front 22

True or false: The chest x-ray of a baby with pneumonia might be similar to that of a baby with HMD.

Back 22

True.

Front 23

A baby of 32 gestational weeks is 3 hours old and presents with respiratory distress. What is the most likely underlying condition and what is the cause ?

Back 23

Hyaline membrane disease, and a decrease in surfactant.

Front 24

A baby with respiratory distress is 2 hours old and born at 40 gestational weeks. The amniotic fluid is meconium stained. What is the most likely diagnosis and the complications thereof ?

Back 24

Meconium aspiration syndrome, complications include: pneumomediatinum and pneumothorax.

Front 25

What are the common causes of an inspiratory stridor, in infants ?

Back 25

1. Laryngomalacia
2. Post-intubation
3. Vocal cord palsy
4. Supraglottic and glottic webs
5. Micrognathia

Front 26

What are the common causes of a biphasic stridor, in infants ?

Back 26

1. Subglottis stenosis/web
2. Subglottis haemangioma
3. Vascular rings
4. Tracheal stenosis

Front 27

What are the common causes of a expiratory stridor, in infants ?

Back 27

1. Mediastinal masses
2. Tracheomalacia

Front 28

Which conditions are associated with apnoea. in infants ?

Back 28

1. Immaturity
2. Birth asphyxia
3. Respiratory distress
4. Obstructed airways
5. CNS conditions
6. Septicaemia
7. GORD
8. Overheating
9. Metabolic abnormalities

Front 29

True or false: Neonates are exclusively mouth breathers.

Back 29

False. They are obligate nose breathers.

Front 30

A 3 hour old baby presents with foam drooling. What is the most likely diagnosis ?

Back 30

Tracheo-oesophageal fistula.

Front 31

A baby delivered by a caesarean section presents with respiratory distress. This is his radiograph. What is the most likely diagnosis ?

Back 31

Wet lung or transient tachypnoea of the newborn.

Front 32

This radiograph is from a newborn with signs of respiratory distress. What is the most likely diagnosis ?

Back 32

Hyaline membrane disease.

Front 33

Discuss the technical assessment of a chest radiograph.

Back 33

The following should be assessed:
1. Rotation
2. Lung volumes
3. Non-lordotic
4. Exposure

Front 34

Assess the technical aspect of the following radiograph. What is wrong with it ?

Back 34

Nothing.

Front 35

Assess the technical aspect of the following radiograph. What is wrong with it ?

Back 35

It is a rotated radiograph.

Front 36

How would you recognize hyperinflated lungs on a radiograph (with regards to neonates) ?

Back 36

The diaphragm normally is at the height of the 8th-9th posterior rib endings or 6th anterior rib endings.

Front 37

Comment on the lung volume of the following radiograph.

Back 37

The lungs are hyperinflated.

Front 38

A neonate presents with respiratory distress. This is the radiograph. What is the most likely diagnosis ?

Back 38

Meconium aspiration syndrome.

Front 39

Discuss how you would determine the cardio thoracic ratio.

Back 39

< 60% is normal

Front 40

You took a radiograph of the chest of a neonate. The radiograph shows the heart to be a 'egg-on-side' shape. What is the most likely diagnosis ?

Back 40

TGA (Transposition of the great arteries).

Front 41

During the inspection of a radiograph, which structures should you be looking at ?

Back 41

1. Artefacts
2. Skeletal
3. Soft tissue
4. Heart
5. Diaphragm
6. Thymus
7. Lungs