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99 Cards in this Set
- Front
- Back
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If the maternal history includes polyhydramnios, the infant should be observed closely for signs of
a) bowel obstruction b) cardiac defects c) hepatic encephalopathy d) bleeding |
a) bowel obstructions
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A Ladd's Procedure is required in order to cut the obstructing bands associated with
a) esophogeal atresia b) malrotations c) esophogeal obstruction d) pierre robin syndrome |
b) malrotation
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What is one of the cardinal signs of bowel obstruction?
a) vomiting b) diarrhea c) green bilious emesis d) poor feeding |
c) green bilius emesis
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The majority of _____ is stored during the latter part of the third trimester.
a) insulin b) yellow fat c) glucose d) glycogen |
d) glycogen
-Infants born preterm may have inadequate amounts of stored glycogen and available glycogen stores may be depleted rapidly after birth. |
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What is the difference between SGA and IUGR?
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SGA or symmetric growth restriction means the infant has lower weigth and smaller head. IUGR infants have head sparing or asymmetric growth restriction
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Why are babies of diabetic mother at risk for low blood sugar?
a) elevated infant insulin level b) elevated maternal insulin level c) elevated maternal glucose level d) elevated infant glucose level |
a) elevated infant insulin level: When the fetus is delivered and the umbilical cord is cut, glucose supply is abruptly stopped, yet the infant's insulin level can remain elevated
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An A1C of ____ is the threshold for diagnosing diabetes.
a) 5.5 b) 6 c) 6.5 d) 7 |
c) 6.5: greater than or equal to
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For a term infant, how fast should you administer a D10 bolus?
a) over 1-2 min b) over 5 min c) 1ml per min d) 2ml per min |
c) 1ml per min
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What is the recommended dosing of a D10W bolus
for hypoglycemia? |
2ml/kg
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What is the recommended dosing of a D10w bolus
for hypovolemia? |
10ml/kg
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What is the maximum concentration of D10W that can go through a peripheral line?
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D12.5W
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Are there any medications that cannot be given through the UVC?
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No
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Can dopamine be given in the UVC or UAC?
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UVC
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Can epinephrine be given in the UVC or UAC?
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UVC
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Where should blood be infused? UVC or UAC?
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UVC
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Can vasopressors be given through the UAC?
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No
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Can you administer a calcium bolus into a UAC in an emergency?
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NO!
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Where should the UVC tip be located?
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At the IVC/RA junction.
*Remember UVC=IVC location |
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What is added to all medications running through a central line?
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1:1 Heparin
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Where should the tip of the UAC catheter be locatated?
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Between T6 and T9
*Remember UAC=arTery=T6-T9 |
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What signs would spasming or clotting related to a UAC present in the distal extremity?
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Poor perfusion, blanching, tissue necrosis, white/blue/black discoloration, coldness compared to the other extremity
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What areas distal to a UAC line need to be monitored for changes?
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back, buttocks, groin, abdomen, legs, feet and toes
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How long should it take to withdraw blood from a UAC line to prevent cerebral hemoglobin desaturation?
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40-60 sec
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What is Atresia of the intestinal tract?
a) dislocation b) malformation c) obstruction d) narrowing |
c) complete obstruction
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An abnormal or surgically made passage between a hollow or tublular organ and the body surface is:
a) a fistula b) atresia c) coarctation d) herniation |
a) a fistula
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What is the normal core body temperature range?
a) 97-99 b) 97.7-99.7 c) 97.7-99.5 d) 97.5-99.5 |
c) 97.7-99.5
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What is the main purpose of brown fat?
a) glucose utilization b) temperature regulation c) bilirubin regulation d) water storage |
a) temperature regulation
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During what trimester does most of the brown fat get
stored? |
Third trimeter
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What does brown fat require to be broken down and metabolized to help regulate temperature?
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Glucose and oxygen
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Would pulmonary blood vessel contriction cause left or right or right to left shunting of blood?
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Right to left shunting due to increased pulmonary vascular resisitance.
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The transfer of heat between two solid objects that are in contact with each other is known as:
a) conduction heat loss b) radiation heat loss c) convection heat loss d) evaporation heat loss |
a) conduction heat loss
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What is heat loss by convection?
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Heat loss from air currents, drafts, fans...
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Immediatly after delivery, an infant is at most risk for
_____ heat loss until it is dried off. |
Evaporative
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An infant close to a cold closed window, or an infant placed in direct sunlight is at risk for what type of heat loss/gain?
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Radiation
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Candidates for therapeutic hypothermia must be within ___ hours of birth.
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6
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Candidated for therapeutic hypothermia must be greater than or equal to ___ weeks gestation.
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36
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Candidates for therapeutic hypothermia must be greater than or equal to ___ grams.
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1800
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When measuring pre and post ductal O2 saturations, a reading of ____% or higher in the hand as compared to the foot is evidence of right to left shunting at the ductus arteriosus.
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10%
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What could it mean if the right hand O2 saturation is lower than the foot saturation by 10% or more?
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Transposition of the great arteries
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What medicaiton is given for transposition of the Great Arteries?
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Prostaglandin E
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What does Prostaglandin E do?
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Keeps the ductus Arteriosis open
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What is a normal arterial HCO3?
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19-26
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What is a normal arterial PO2?
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60-80
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What is a normal capillary PO2?
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None, this is not an accurate test!
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What is a normal base excess?
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-4 - +4
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What makes a blood gas compensated?
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A normal pH
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What are some causes of metabolic acidosis? CATA
a) pneumothorax b) air way obstruction c) shock d) pneumonia e) hypothermia f) hypoglycemia g) sepsis |
c) shock
e) hypothermia f) hypoglycemia g) sepsis |
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What is used to treat respiratory acidosis?
a) sodium bicarb bolus b) D10w bolus c) Iv sedation d) CPAP |
d) CPAP
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What is the Tip-to-Lip rule for ETT depth insertion?
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Add 6 to the infants weight in kg
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How much distance should be allowed when trimming the ET tube and why?
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4 cm from the lip to the tube connector since resistance is linearly proportional to the length of the tube, trimming the ET tube also offers the advantage of decreasing resisitance to improve ventilation
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Where should the tip of the ETT tube sit?
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mid-trachea
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The failure to adequately absorb fetal lung fluid into the pulmonary circulation and lymphatics is the primary result of:
a) meconium aspiration b) TTN c) RDS d) Pneumonia |
b) TTN
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RDS results from immature lungs and decreased ____,
giving a granular appearance on CXR. |
lung surfactant
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Infants of diabetic moms are at increased risk for:
a) TTN b) RDS c) meconium aspiration d) pneumonia |
b) RDS because of delayed lung surfactant
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A baby is born with a sunken abdomen, and a large chest and is experiencing respiratory distress. What might they have?
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Congenital Diaphragmatic Hernia
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What should be done quickly to the infant who is cyanotic and gasping right after birth with suspected Congenital Diaphragmatic Hernia?
a) immediatly bag the infant with T-piece resuscitator b) intubate the infant c) place the infant prone and insert a nasopharyngeal airway |
b) intubate the infant, avoid PPV with bag mask
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After stabilizing the infant with Congenital Diaphragmatic Hernia, what should be done to prevent air from entering the bowel and further compressing the lungs?
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Insert an OG or NG tube and frequently aspirate air.
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What is choanal atresia?
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One or both of the nasal passages are blocked by a bony septum or soft tissue.
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What is the typical symptom of choanal atresia?
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A cyanotic infant that pink up when crying.
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Why does crying help an infant with choanal atresia?
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Because it forces them to breath out of their mouth, instead of their blocked nasal passage(s).
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How do you rule out choanal atresia?
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Try to pass a catheter through each nare.
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What is the main source of airway obstruction with an infant born with Pierre Robin Syndrome?
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Their tongue
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What can be done to maintain the airway of an infant with Pierre Robin syndrome if prone positioning does not work?
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Insert a nasopharyngeal tube, a 2.5mm ET tube
*Note that you are NOT attempting to place the endotracheal tube tip into the trachea, but just to the end of the nasa passage |
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What kind of mask can be used to maintain an open airway for an infant with Pierre Robin Syndrome?
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An LMA
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Elevated pulmonary vascular resistance cause _____ to ____ shunting of blood across the patent ductus arteriosus and/or foramen ovale which leads to hypoxemia. The above described condition is termed____.
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right to left, PPHN
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True or False: PPHN may be associated with pulmonary diseases including meconium aspiration, pneumonia, RDS, congenital diaphragmatic hernia, or with cardiovascular abonormalities.
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True.
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Choking, coughing, and cyanoisis with feedings are signs of:
a) Tracheoesophageal Fistula b) transposition of the great arteries c) choanal atresia d) congenital diphragmatic hernia |
a) tracheoesophageal fistula
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What is done to stabilize infants with known TEF?
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Make NPO, insert repogal, position prone
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How are TEF patients positions
a) prone b) supine c) on their side d) with head turned to the side |
a) prone with HOB elevated to reduce reflux of secreitons form stomach into trachea
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An infant that has a hole in their diaphragm that allows the stomach and bowel to migrate up into the chest area is diagnosed with a ____.
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Congenital diaphragmatic hernia
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What is the problem with the lungs in an infant with a congenital diaphragmatic hernia?
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The stomach and/or bowels squish up into the lung area and prevent it from expanding.
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What respiratory conditions is very common in patients with congenital diaphragmatic hernia?
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PPHN
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An infant is born with unsuspected congenital diaphragmatic hernia. She presents immediatly with prfound cyanosis, respiratory distress and a sunken abdomen. Bag mask PPV is started. What is expected to happen?
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As the abdomen and intestines fill with air from while PPV is being performed, the lungs and heart are further compressed causing further respiratory and circulatroy distress.
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How are infants with suspected congenital diphragmatic hernia stabilized respiratory wise?
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immediate intubation
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What the risk of proper ventilation of a hypoplastic lung for an infant with a congenital diaphragmatic hernia?
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Pneumothorax
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What can be done to the freshly born infant with diaphragmatic hernia until they are able to be intubated?
a) blow by and OG/NG tube insertion b) PPV and pulse ox application c) prone positioning and PPV d) blow by and prone positioning |
a) blow by and OG/NG tube insertion to aspiration air form the intestines every few minutes(or hook up to suction)
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What is the type of univeral blood transfused to neonates?
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O-
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What routes can dopamine be given?
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Peripheral IV, UVC
*Not through UAC, Peripheral Art line, ET |
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Where can Sodium Bicarb be given?
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Through any IV
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Why is it recommended that dopamine be administered through a central line?
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Infiltration can cause tissue sloughing and necrosis :(
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What is phentolamine mesylate given for?
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It is given subcutaneously to treat dopamine infiltrations.
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With caput succedaneum, the head swells with:
a) blood b) serosanguinous fluid |
b) serosanguinous fluid
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With caput succedaneum, can the edema cross the suture lines?
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Yes
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With a cephalohematoma, does the swelling/fluid cross the suture lines?
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No
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What is a normal CRP?
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<1
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_____ is a protein produced by liver celss during inflammation, infection, trauma, or tissue necrosis.
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CRP
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In the presence of infection, immature forms of neutrophils- bands and meta's- are released from the bone marrow into the blood stream as the body attempts to maximize the number of circulating neutrophils. This is termed a ______.
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Left shift
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What is the problem with an infant with a low ANC?
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They are immunocompromised as they have depleated their neutrophil storage pool and are not going to be able to mobilize enough neutrophils necessary to fight a bacterial infect.
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How is ANC calculated?
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(segs+bands+metas)/100 x wbc count
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What is a normal Gent peak level?
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5-12
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What is a normal Gent trough?
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0.1-1
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A neonate with a pneumo may exhibit which of the following signs?
1) increaed wob 2) bradycardia 3) asymmetric appearing chest 4) cyanosis 5) decreased femoral pulse a) 1,2,4 b) 1,3,5 c) all are correct |
c) all are correct
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An infant presents with tachypnea, tachycardia, hypotonia, temp 101.5, with a normal CBC. You talk to the MD and they say the normal CBC reassures them the infant is fine. Your assessment of this response is:
a) you agree that close obs is all that is necessary since the CBC is normal b) you are concerned because the infant 's clinical presentation is not being adequately considered, work-up and treatment for possible infections is indicated c) you are concerned because you think a CBC and CRP should also be re-evaluated in 8-12 hrs |
b) work up is needed r/t clinical presentation despite the normal cbc
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A term infant is breastfeeding when his mother asks you to come in and assess him because he vomited lime green emesis. The infants abdomen is not distended and he is irritable and crying. Which of the following should be performed emergently?
a) a barium enema to evalulate for an colonic obstruction b) a swallow study with contrast to evaluate for trachea-esophageal fistula c) an uppper gi to evaulate for malrotation |
c) an upper gi to check for malrotation
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A term infant weighing 1400 grams is born to an underweight mother. A bedside glucose test at 30 min of life reads 10. The infant has no sign of hypoglycemia. Which of the following orders is most
appropriate? a) gavage feed 7mLs of brest milk or formula and recheck sugar in 30-60 min after b) insert an iv ang dive 2.8 mL bolus of D10W followed by an IV infusion of D10W at 80/kg/day, recheck sugar in 15-30 min c) send a confirmatory plasma glucose to the lab and if low, insert an IV and give a 2.8 mL bolus of D10W followed by an IV infusion of D10W at 80/kg/day, recheck the glucose 15-30 min after the bolus |
b) give the bolus, and start iv(dont wait for lab to confirm result)
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The function of brown fat is to
a) generate heat when it is metabolized b) provide a rapidly available source of glucose in the first day of life c) provide an insulating layer of fat in the first month of life |
a) generate heat when it is metabolized
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An infant is delivered to a healthy woman with good prenatal care. Within minutes of birth, the infant developed respiratory distress. Blow-b oxygen, then cpap was initiated. The infant further deteriorated so bag/mask PPV was given. You observe a shift in the PMI to the right, a barrel chest, and a sunken abdomen. Which of the following is most likely present?
a) diaphragmatic hernia b) tension pneumothorax c) tracheoseophageal fistula |
a) diaphragmatic hernia
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An infant is delivered to amother whole membranes were ruptures for 24 hrs. He is healthy at birth and breastfed well, but the next day he is hypotonic, with hr of 200, rr of 80, and weak central pulses. Which of the following orders would be appropriate?
a) apply an ice pack to the fact to treat SVT b) CBC with differential, CRP and blood culture c) Type and corss match, then give 10ml/kg of RBC |
b) CBC with diff, CRP and blood cuture
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An infant is delivered via emergency C/S because of placental abruption. They physical exam reveals HR of 180-200, pale skin color, prolong cap refill time, weak brachial and femoral pulses, moderate respiratory distress. Which of the followng therapies do you expect with be ordered:
a) D10W bolus, 10 mL/kg IV b) FFP, 10 mL/kg IV c) O- PRBC, 10 mL/kg IV |
c) O- blood
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