Pediatrics Neonatology

Front 1

At the 1st minute of life, a newborn was noted to have acrocyanosis, HR of 130, grimaces to stimulation, has good respirations, and with active movement of extremities. What is the APGAR score at this time?

Back 1

8

Front 2

EINC core steps

Back 2

Immediate and thorough drying

Early skin-to-skin contact

Properly-timed cord clamping

Non-separation of mother and baby

Front 3

Length of time for thorough drying in EINC

Back 3

30 seconds

Front 4

Location of cord clamping

Back 4

1st clamp 2 cms from base, 2nd clamp 5 cms from base

Front 5

How long must washing be delayed, as to not remove the vernix early

Back 5

6 hours

Front 6

Probable cause of eye redness in a patient 12-24 hours old

Back 6

Silver nitrate

Front 7

Probable cause of eye redness in a patient 2-3 days (48-72 hours) old

Back 7

N. gonorrhea

Front 8

Probable cause of eye redness in a patient 5-7 days old

Back 8

S. aureus

Front 9

Probable cause of eye redness in a patient 2 weeks old

Back 9

Chlamydia

Front 10

6 conditions tested by newborn screening tests

Back 10

Congenital hypothyroidism, Congenital adrenal hyperplasia, Galactosemia, G6PD deficiency, Phenylketonuria, Maple syrup urine disease

Front 11

Newborn presents with sluggishness, jaundice, and edema of genitals. Normal birth weight and length. Diagnosis

Back 11

Congenital hypothyroidism

Front 12

Earliest possible sign of congenital hypothyroidism

Back 12

Prolonged physiologic jaundice

Front 13

Deficiency and subsequent increase of what substance occurs in congenital adrenal hyperplasia

Back 13

Deficiency of 21-hydroxylase enzyme

Increased serum 17-hydroxyprogesterone (17-OHP)

Front 14

3 distinct enzyme deficiencies in galactosemia

Back 14

Galactose-1-phosphate uridyltransferase

Galactokinase

Galactose-4-epimerase deficiency

Front 15

Most common enzyme deficiency in galactosemia

Back 15

Galactose 1 phosphate uridyltransferase

Front 16

Episodic or chronic hemolytic anemia that develops 1-2 days after exposure to a substance with oxidant properties. Decreased Hgb and Hct, Heinz bodies and reticulocytosis

Back 16

G6PD Deficiency

Front 17

Drugs that can trigger G6PD deficiency

Back 17

Sulfonamides, vitamin K analogs, ASA, nitrofurantoin, antimalarials, nalidixic acid, napthalene, benzene, chloramphenicol

Front 18

Deficient enzyme in Phenylketonuria, which results in musty odor of skin, breath, or urine

Back 18

Phenylalanine hydroxylase

Front 19

Deficient enzyme in Maple syrup disease, resulting in encephalopathy and maple syrup odor of urine

Back 19

Alpha-keto acid dehydrogenase

Front 20

Most common skin lesion found in newborns

Back 20

Erythema toxicum. Small papules or pustules on an erythematous base

Front 21

Lacy pattern on skin similar to cobblestones as a result of vasomotor response to cold stress

Back 21

Cutis Marmorata

Front 22

Similarity and difference between cephalhematoma and caput succedaneum

Back 22

Both occur due to birth trauma

Cephalhematoma is a periosteal bleed that does not cross suture lines

Caput succedaneum is a swelling of the scalp that crosses the suture lines

Front 23

Collection of blood beneath the aponeurosis covering the scalp and the entire length of the occipitofrontalis muscle. Associated with vacuum-assisted delivery and patients have to be monitored for hypotension and hyperbiliribunemia

Back 23

Subgaleal hematoma

Front 24

Moro reflex is normal in this age range

Back 24

Birth up to 4-6 months

Front 25

Newborn presents with adducted arm, pronated and internally rotated. Diagnosis

Back 25

Erb-Duchenne palsy (C5-C6, upper trunk)

Front 26

Newbron presents with claw hand. Diagnosis

Back 26

Klumpke palsy (C6-T1, lower trunk)

Front 27

Most commonly fractured bone during delivery

Back 27

Clavicle

Front 28

Newborn presents with lateral neck mass. Probable diagnosis.

Back 28

Brachial cleft cyst. Incomplete closure of brachial clefts

Front 29

Newborn presents with midline neck mass. Probable diagnosis

Back 29

Thyroglossal duct cyst. Cystic dilatation of thyroglossal duct remnants

Front 30

Herniation of abdominal contents associated with diastasis recti. No sac

Back 30

Umbilical hernia

Front 31

Herniation of abdominal contents at the base of the umbilicus with a sac

Back 31

Omphalocele

Front 32

Herniation of abdominal contents without a sac; defect is lateral to the umbilicus

Back 32

Gastroschisis

Front 33

Newborn presents with signs of respiratory distress with noted scaphoid abdomen and increased chest wall diameter. Diagnosis

Back 33

Diaphragmatic hernia

Front 34

Initial management for diaphragmatic hernia

Back 34

immediate intubation.

Front 35

Most common form of diaphragmatic hernia

Back 35

Bochdalek form. Posterolateral portion of diaphragm

Front 36

Urethral opening on the dorsal penis

Back 36

Epispadia

Front 37

Urethral opening on the ventral surface of the penile shaft

Back 37

Hypospadia

Front 38

Accumulation of fluid in the tunica vaginalis. Resolves by 12 months old

Back 38

Hydrocele

Front 39

Usual hernia in a child that presents as reducible scrotal swelling

Back 39

indirect inguinal hernia

Front 40

If the testes has not descended after this number of months, it will remain undescended

Back 40

4 months

Front 41

Undescended testes is treated surgically not later than ________ old

Back 41

9-15 months

Front 42

Metric for low birth weight, very low birth weight, and extremely low birth weight

Back 42

LBW <2500g

VLBW <1500g

ELBW <1000g

Front 43

Metric for gestational age

Back 43

Late preterm =/>34 wks, <37 wks

Very preterm <32 wks

Extremely preterm <28 wks

Front 44

Difference between assymetric and symmetric presentation for small for gestational age newborns

Back 44

Assymetric: associated with poor maternal nutrition or late onset/exacerbation of maternal vascular disease. Fetus affected in late gestation

Symmetric: associated with genetic and metabolic conditions. Fetus affected early gestation <18 weeks

Front 45

Chest x-ray pattern for respiratory distress syndrome

Back 45

Ground glass pattern, air bronchograms

Front 46

Chest x-ray of a patient with transient tachypnea of the newborn

Back 46

Overaeration (Right hemidiaphragm goes beyond touching the 7th rib) and flat diaphragm

Front 47

Marked pulmonary hypertension that causes hypoxemia and right-to-left extrapulmonary shunting of blood

Back 47

Persistent pulmonary hypertension of the newborn

Front 48

Most common cause of Persistent pulmonary hypertension of the newborn

Back 48

Meconium aspiration

Front 49

X-ray pattern in patients with Persistent pulmonary hypertension of the newborn

Back 49

Coarse streaking granular pattern in both lung fields, flattened diaphragm, increased AP diameter

Front 50

A neonate born at 28 weeks of gestation is now 2 weeks old. Nasogastric feeds are started. 48 hours after starting feeds, neonate developed distended abdomen, bloody stool, and pneumatosis intestinalis on abdominal x-ray. Lab studies revealed thrombocytopenia. Diagnosis

Back 50

Necrotizing enterocolitis

Front 51

Histologic finding in necrotizing enterocolitis

Back 51

Coagulation necrosis

Front 52

X-ray pattern in necrotizing enterocolitis

Back 52

Pneumatosis intestinalis (air in bowel wall)

Portal venous gas and pneumoperitoneum indicate perforation

Front 53

Treatment for necrotizing enterocolitis

Back 53

Ampicillin, gentamycin, metronidazole

Front 54

Indications for surgery in necrotizing enterocolitis

Back 54

Evidence of perforation

Single fixed bowel loop on x-ray

Abdominal wall erythema

Palpable mass

Failure of medical management (48-72 hours of IV meds)

Front 55

Difference between physiologic and pathologic jaundice

Back 55

Physiologic jaundice: presents after 48th hour of life

Pathologic jaundice: presents in the 1st 24 hours of life

Front 56

Most common cause of hemolytic disease of the newborn

Back 56

ABO incompatibility. Mother is type O and baby is either A or B

Front 57

Lab findings in ABO incompatibility

Back 57

(+) direct Coombs test

Spherocytes in blood smear

Hgb normal or low

Increased reticulocyte

Increased B1

Front 58

Lab findings in Rh incompatibility

Back 58

(+) direct Coombs test

Anemia

Increased reticulocyte count

B1 rapidly rises in 1st 6 hours of life

B2 may also be elevated

Front 59

Difference between breastfeeding jaundice and breast milk jaundice

Back 59

Breastfeeding jaundice: 1st week of life. Accenuated unconjugated hyperbilirbunemia

Breast milk jaundice: beyond 1st week of life.

Front 60

Common organisms in neonatal sepsis

Back 60

GBS, E. coli, L. monocytogenes

Front 61

Transplacental infection presenting as hydrocephalus and intracranial calcifications. From ingestion of raw meat or handling cat feces

Back 61

Toxoplasmosis

Front 62

Treatment for toxoplasmosis

Back 62

Pyrimethamine and sulfonamide

Front 63

Transplacental infection manifesting as "blueberry muffin" rash, cataracts, congenital heart disease (PDA, pulmonic stenosis), retardation, and deafness

Back 63

Rubella

Front 64

Most common congenital infection that presents as microcephaly with periventricular calcifications

Back 64

Cytomegalovirus

Front 65

Treatment for CMV

Back 65

Ganciclovir

Front 66

Treatment for HSV

Back 66

Acyclovir

Front 67

Characteristics of early stage and late stage syphilis

Back 67

Early Stage: < 2 years, Maculopapular rash, periostitis of long bones

Late stage: > 2 years, Hutchinson teeth, saddle nose deformity

Front 68

Treatment for syphilis

Back 68

Penicillin