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  • Question 1 - A systolic murmur is heard in an asymptomatic, pink, term baby with normal...

    Incorrect

    • A systolic murmur is heard in an asymptomatic, pink, term baby with normal pulses and otherwise normal examination. There are no dysmorphic features on the routine first-day neonatal check. What is the MOST appropriate action to be taken immediately?

      Your Answer: Discharge with written advice about possible symptoms of heart disease and clinical review in one week

      Correct Answer: Pre-and post-ductal saturations

      Explanation:

      Certain CHDs may present with a differential cyanosis, in which the preductal part of the body (upper part of the body) is pinkish but the post ductal part of the body (lower part of the body) is cyanotic, or vice versa (reverse differential cyanosis). The prerequisite for this unique situation is the presence of a right-to-left shunt through the PDA and severe coarctation of the aorta or aortic arch interruption or severe pulmonary hypertension. In patients with severe coarctation of the aorta or interruption of the aortic arch with normally related great arteries, the preductal part of the body is supplied by highly oxygenated pulmonary venous blood via the LA and LV, whereas the post ductal part is supplied by deoxygenated systemic venous blood via the RA, RV, main pulmonary artery (MPA) and the PDA. In the new-born with structurally normal heart, a differential cyanosis may be associated with persistent pulmonary hypertension of the new-born. In the cases of TGA with coarctation of the aorta or aortic arch interruption, the upper body is mostly supplied by systemic venous blood via the RA, RV, and ascending aorta, whereas the lower body is supplied by highly oxygenated pulmonary venous blood via the LA, LV, MPA, and then the PDA. For accurate detection of differential cyanosis, oxygen saturation should be measured in both preductal (right finger) and post ductal (feet) parts of the body.

    • This question is part of the following fields:

      • Neonatology
      28.2
      Seconds
  • Question 2 - In term babies with persistent jaundice, what is the time period over which...

    Correct

    • In term babies with persistent jaundice, what is the time period over which one must consider biliary atresia as the probable cause?

      Your Answer: 14 days

      Explanation:

      After a period of 14 days, if jaundice persists in a term new-born, having ruled out the other possibilities, biliary atresia should be considered as a possible diagnosis.Biliary atresia is a rare but serious condition. Symptoms include obstructive jaundice (dark urine and pale stool). Management:Surgery within 8 weeks is recommended. Survival is around 90% using current treatment regimes. Without treatment, children will survive to around 18 months.

    • This question is part of the following fields:

      • Neonatology
      36.9
      Seconds
  • Question 3 - Which of the following is incorrect? ...

    Incorrect

    • Which of the following is incorrect?

      Your Answer: Infancy is the first 1 year of life

      Correct Answer: The embryonic phase is the first 20 weeks in utero

      Explanation:

      The embryonic period comprises of the first 8 weeks of pregnancy. It is divided into a preembryonic phase (from the 1st to the 3rd week), in which the three germinal layers arise, and into the embryonic phase proper (from the 4th to 8th week), in which the embryonic organ anlagen arise.

    • This question is part of the following fields:

      • Neonatology
      134
      Seconds
  • Question 4 - You have been called to see a 5 hour old infant exhibiting signs...

    Incorrect

    • You have been called to see a 5 hour old infant exhibiting signs of respiratory distress. The baby was born premature, and the mothers membranes had ruptured more than 24 hours before delivery. You are concerned that the infant is at risk of sepsis.The following statement best describes sepsis:

      Your Answer: Shock

      Correct Answer: Dysregulated inflammatory response to infection

      Explanation:

      Sepsis can be described as a condition in which there is a dysregulated inflammatory response to an infection. In the case of neonates, sepsis can be life threatening and may present with respiratory distress more than 4 hours after birth, shock, seizures, and multi organ failure. Risk factors that further point to sepsis include prolonged rupture of maternal membranes for more than 24 hours before birth, a history of a maternal fever during labour, or parenteral antibiotic treatment given to the mother for a suspected or confirmed bacterial infection.

    • This question is part of the following fields:

      • Neonatology
      1075.5
      Seconds
  • Question 5 - A baby is delivered at 26 weeks. Full course of antenatal steroids was...

    Correct

    • A baby is delivered at 26 weeks. Full course of antenatal steroids was administered. There was a delay in clamping the cord. No respiratory effort is observed, and the heart rate is slow. What should be the next step in management of this case?

      Your Answer: 5 inflation breaths

      Explanation:

      Most infants have a good heart rate after birth and establish breathing by about 90 s. If the infant is not breathing adequately aerate the lungs by giving 5 inflation breaths, preferably using air. Until now the infant’s lungs will have been filled with fluid.

    • This question is part of the following fields:

      • Neonatology
      36.8
      Seconds
  • Question 6 - Congenital hypothyroidism is associated with which of the following clinical features? ...

    Incorrect

    • Congenital hypothyroidism is associated with which of the following clinical features?

      Your Answer: Frontal bossing

      Correct Answer: Cardiomegaly

      Explanation:

      Congenital hypothyroidism results from insufficient levels of thyroid hormone in the body since birth, which is either due to dysgenesis of the thyroid gland or dyshormonogenesis. The important features of this disease include coarse facial features (macroglossia, large fontanelles, depressed nasal bridge, hypertelorism, etc.), failure to thrive, cardiomegaly, hypotonia, umbilical hernia, and low core body temperature among many others. Frontal bossing is the usual feature of rickets and acromegaly. Mitral regurgitation is not usually associated with congenital hypothyroidism.

    • This question is part of the following fields:

      • Neonatology
      18.6
      Seconds
  • Question 7 - All of the following conditions because feeding problems for a neonate except for...

    Incorrect

    • All of the following conditions because feeding problems for a neonate except for which one?

      Your Answer: Hiatus hernia

      Correct Answer: Physiological jaundice

      Explanation:

      Physiological jaundice is the condition in which there is a yellow discolouration of the eyes and the skin of the baby caused by the build up of bilirubin in the blood due to an immature liver. No other symptoms accompany physiological jaundice, thus it will not present with difficulty in feeding. All the other conditions listed can present with feeding problems.

    • This question is part of the following fields:

      • Neonatology
      24.6
      Seconds
  • Question 8 - Which of the following is NOT a risk factor for neonatal polycythaemia? ...

    Incorrect

    • Which of the following is NOT a risk factor for neonatal polycythaemia?

      Your Answer: Small for their gestational age (SGA)

      Correct Answer: Jaundice

      Explanation:

      Polycythaemia is a commonly occurring neonatal disorder, which is characterized by a venous haematocrit ≥ 65%. It increases the blood viscosity and causes microcirculatory flow impairment in the end-organs. Causes of polycythaemia are multi-factorial, but the significant risk factors are maternal diabetes, SGA, LGA or post-term birth, infants with chromosomal abnormalities, and delayed clamping of the cord. Jaundice is not a recognized risk factor for polycythaemia.

    • This question is part of the following fields:

      • Neonatology
      17
      Seconds
  • Question 9 - Parents of a new-born are worried about cot death. What advice will you...

    Incorrect

    • Parents of a new-born are worried about cot death. What advice will you give?

      Your Answer: Reassure

      Correct Answer: Child should sleep on the back with legs towards the end of the cot

      Explanation:

      Cot death also know as SIDS or Sudden Infant Death syndrome. Putting a baby to sleep on his back has been shown to reduce the risk of SIDS.

    • This question is part of the following fields:

      • Neonatology
      33.9
      Seconds
  • Question 10 - A woman gave birth to an infant at 39 weeks' gestation. The infant...

    Correct

    • A woman gave birth to an infant at 39 weeks' gestation. The infant has a pulse of 110 bpm, grimaces upon nasal stimulation and has good muscle tone. Moreover, the colour of the infant is pink except for the extremities, which are blueish. What is the infants APGAR score?

      Your Answer: 7

      Explanation:

      Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the health care provider how well the baby is doing outside the mother’s womb. More specifically, five components are assessed and these are the appearance (A), the pulse (P), the grimace (G), the activity (A) and the respiration (R). A normal APGAR score is considered to be 10 points, 2 points given for each normal component. In this case, 1 point is given for the appearance due to the bluish extremities, 2 points are given for the pulse which is higher than 100 bpm, 1 point is given for the grimacing, 2 points are given for the activity due to the good muscle tone and 1 point is given for the respiration due to gasping. Total score is 7 points.

    • This question is part of the following fields:

      • Neonatology
      26.3
      Seconds
  • Question 11 - A new-born with a history of extended resuscitation is admitted in the neonatal...

    Incorrect

    • A new-born with a history of extended resuscitation is admitted in the neonatal unit. His mother had a difficult delivery and the baby boy weights 4.9 kg. He is unstable and you observe petechial bleeding on his legs. There is also oozing around the umbilicus. Blood exam reveals a prolonged PT, thrombin time, and APPT. What is the most probable diagnosis?

      Your Answer: Haemorrhagic Disease of the New-born (HDN)

      Correct Answer: Disseminated Intravascular Coagulation

      Explanation:

      In this case there is evidence of disseminated intravascular coagulation (DIC) caused by severe birth asphyxia. The baby was born weighing 4,9 kg which is a large size for a new-born and thus a difficult delivery with potential birth asphyxia.

    • This question is part of the following fields:

      • Neonatology
      40.4
      Seconds
  • Question 12 - Which of the following can cause an increase in alpha-fetoprotein in the pregnant...

    Incorrect

    • Which of the following can cause an increase in alpha-fetoprotein in the pregnant mother?

      Your Answer: Chromosomal trisomies

      Correct Answer: Posterior urethral valves

      Explanation:

      Alpha-fetoprotein (AFP) is a plasma protein produced by the embryonic yolk sac and the fetal liver. AFP levels in serum, amniotic fluid, and urine functions as a screening test for congenital disabilities, chromosomal abnormalities, as well as some other adult occurring tumours and pathologies.Pregnant maternal serum AFP levels are elevated in:- Neural tube defects (e.g., spina bifida, anencephaly)- Omphalocele- Gastroschisis- posterior urethral valves- nephrosis- GI obstruction- teratomas

    • This question is part of the following fields:

      • Neonatology
      23.2
      Seconds
  • Question 13 - A neonate has been observed, by his parents, twitching and jerking in his...

    Incorrect

    • A neonate has been observed, by his parents, twitching and jerking in his sleep. Which one of the following is not a cause of neonatal seizures?

      Your Answer: Metabolic disorder

      Correct Answer: Neonatal myoclonus

      Explanation:

      Benign neonatal sleep myoclonus (BNSM) is a disorder commonly mistaken for seizures during the new-born period. It is characterized by myoclonic lightninglike jerks of the extremities that exclusively occur during sleep; it is not correlated with epilepsy.Causes of neonatal seizures:Hypoxic-ischemic encephalopathy: Hypoxic-ischemic encephalopathy disrupts the ATP-dependent sodium-potassium pump and appears to cause excessive depolarization.Intracranial haemorrhage: occurs more frequently in premature than in term infants. Subarachnoid haemorrhage is more common in term infants. This type of haemorrhage occurs frequently and is not clinically significant. Typically, infants with subarachnoid haemorrhage appear remarkably well. Metabolic disturbances include hypoglycaemia, hypocalcaemia, and hypomagnesemia. Less frequent metabolic disorders, such as inborn errors of metabolism, are seen more commonly in infants who are older than 72 hours. Typically, they may be seen after the infant starts feeding.Intracranial infections (which should be ruled out vigorously) that are important causes of neonatal seizures include meningitis, encephalitis (including herpes encephalitis), toxoplasmosis, and cytomegalovirus (CMV) infections. The common bacterial pathogens include Escherichia coli and Streptococcus pneumoniae.Cerebral malformationsBenign neonatal seizures

    • This question is part of the following fields:

      • Neonatology
      33
      Seconds
  • Question 14 - A new-born child is not moving his left arm properly. He had shoulder...

    Correct

    • A new-born child is not moving his left arm properly. He had shoulder dystocia during childbirth. His arm is hanging down with the shoulder internally rotated, elbow extended, forearm pronated and wrist flexed. What is the most likely diagnosis?

      Your Answer: Erb palsy

      Explanation:

      Erb’s palsy is a paralysis of the arm caused by injury to the brachial plexus, specifically the severing of the upper trunk C5-C6 nerves.The infant with an upper plexus palsy (C5-C7) keeps the arm adducted and internally rotated, with the elbow extended, the forearm pronated, the wrist flexed, and the hand in a fist. In the first hours of life, the hand also may appear flaccid, but strength returns over days to months.The right side is injured in 51% of cases. Left side occurs in 45% of patients and bilateral injuries, in 4%.

    • This question is part of the following fields:

      • Neonatology
      32.6
      Seconds
  • Question 15 - The following are the causes of hydrops fetalis EXCEPT? ...

    Correct

    • The following are the causes of hydrops fetalis EXCEPT?

      Your Answer: Hepatitis A

      Explanation:

      Hydrops fetalis is a serious condition characterized by excessive fluid accumulation resulting in oedema in one or more of the fetal compartments. The most likely cause is fetal anaemia, and the condition may lead to ascites and pleural effusion. The anaemia that results in hydrops may be caused by Rh incompatibility, Parvovirus B19 infection, toxoplasmosis, hepatitis B, maternal syphilis (strong association), Cytomegalovirus, Turner syndrome, and Noonan syndrome.

    • This question is part of the following fields:

      • Neonatology
      15.2
      Seconds
  • Question 16 - A term baby with a birth weight of 4.5 kg with meconium aspiration...

    Incorrect

    • A term baby with a birth weight of 4.5 kg with meconium aspiration syndrome is intubated and ventilated. Conventional ventilation was unsuccessful and so a trial of high-frequency oscillatory ventilation has commenced. Settings are mean airway pressure 14 cmH2O, delta P 25, rate 10 Hz, FiO2 1.0. Baby's oxygen saturations are 84%. Blood gas shows pH 7.32, CO2 6.5 kPa, BE -4. Chest X-ray shows poorly inflated lungs.What is the first change that should be made to the ventilation?

      Your Answer: Decrease mean airway pressure

      Correct Answer: Increase mean airway pressure

      Explanation:

      The baby needs more oxygen saturation which could be attempted by increasing the mean airway pressureAfter initial resuscitation and stabilization, the following should be the ventilator settings used:Rate: 30-40/minutePeak inspiratory pressure (PIP) – determined by adequate chest wall movement.An infant weighing less than 1500 grams: 16-28 cm H2O.An infant weighing greater than 1500 grams: 20-30 cm H2O. Positive end expiratory pressure (PEEP): 4 cm of H2O OR 5-6 cm if FiO2 > 0.90.FiO2: 0.4 to 1.0, depending on the clinical situation.Inspiratory time: 0.3-0.5 sec.After 15 to 30 minutes, check arterial blood gases and pH.If the PaO2 or the O2 saturation is below accepted standards, the FiO2 can be raised to a maximum of 1.0. If the PaO2 or O2 saturation is still inadequate, the mean airway pressure can be raised by increasing either the PIP, PEEP, inspiratory time or the rate, leaving inspiratory time constant.If the PaCO2 is elevated, the rate or peak inspiratory pressure can be raised.

    • This question is part of the following fields:

      • Neonatology
      72.6
      Seconds
  • Question 17 - A new-born baby is born with a midline lumbosacral cystic lesion. Occipitofrontal circumference...

    Correct

    • A new-born baby is born with a midline lumbosacral cystic lesion. Occipitofrontal circumference was above the 90th percentile.The next best step is?

      Your Answer: Cranial ultrasound

      Explanation:

      The baby may have hydrocephalus and no surgery can be done until it is excluded.Cranial sonography is an important part of neonatal care in general, and high-risk and unstable premature infants, in particular. It allows rapid evaluation of infants in the intensive care units without the need for sedation and with virtually no risk. Expectedly, sonography represents an ideal imaging modality in neonates due to its portability, lower cost, speed, and lack of ionizing radiations. Although there are numerous indications for cranial sonography, it appears to be most useful for detection and follow-up of intracranial haemorrhage, hydrocephalus, and periventricular leukomalacia (PVL).

    • This question is part of the following fields:

      • Neonatology
      24.3
      Seconds
  • Question 18 - Persistent pulmonary hypertension is NOT a recognized complication of which of the following?...

    Incorrect

    • Persistent pulmonary hypertension is NOT a recognized complication of which of the following?

      Your Answer: Group B streptococcal septicaemia (GBS)

      Correct Answer: Duct dependent congenital heart disease

      Explanation:

      Persistent pulmonary hypertension of the new-born is secondary to the failure of normal circulatory transition at birth, leading to an abnormally high pulmonary vascular resistance. This elevated resistance causes right-to-left shunting of blood and hypoxemia. It can be caused by parenchymal lung diseases (meconium aspiration syndrome, pneumonia or ARDS), lung hypoplasia (like occurring in oligohydramnios or diaphragmatic hernia), or it can be idiopathic. Other possible causes include maternal indomethacin use, group B streptococcal septicaemia, and high-pressure ventilation. Duct dependent congenital heart disease does not lead to persistent pulmonary hypertension.

    • This question is part of the following fields:

      • Neonatology
      113.2
      Seconds
  • Question 19 - Which is the most common cardiac defect in babies with Down's syndrome? ...

    Incorrect

    • Which is the most common cardiac defect in babies with Down's syndrome?

      Your Answer: Tetralogy of Fallot

      Correct Answer: Atrioventricular septal defect (AVSD)

      Explanation:

      Congenital heart defects are common (40-50%); they are frequently observed in patients with Down syndrome who are hospitalized (62%) and are a common cause of death in this aneuploidy in the first 2 years of life.The most common congenital heart defects are the following:- Endocardial cushion defect (43%), which results in atrioventricular septal defect (AVSD)/AV canal defect- Ventricular septal defect (32%)- Secundum atrial septal defect (10%)- Tetralogy of Fallot (6%)- Isolated patent ductus arteriosus (4%).About 30% of patients have more than one cardiac defect. The most common secondary lesions are patent ductus arteriosus (16%), atrial septal defect, and pulmonic stenosis (9%). About 70% of all endocardial cushion defects are associated with Down syndrome.Valve abnormalities, such as mitral valve prolapse or aortic regurgitation may develop in up to 40-50% of adolescents and adults who were born without structural heart disease.

    • This question is part of the following fields:

      • Neonatology
      9.1
      Seconds
  • Question 20 - What is the optimal pressure to be used when providing inflation breaths to...

    Incorrect

    • What is the optimal pressure to be used when providing inflation breaths to a term new-born who is unable to breathe spontaneously?

      Your Answer: 20 cmH2O

      Correct Answer: 30 cmH2O

      Explanation:

      According per the national guidelines, 5 inflation breaths should be given with a gas pressure of 30cmH2O for term babies. Each breath should be given for 2-3 seconds. Pre-term babies should be aerated with a lower pressure of 20-25cmH2O.

    • This question is part of the following fields:

      • Neonatology
      71.1
      Seconds
  • Question 21 - A floppy new-born baby has epicanthic folds, a thin upper lip and smooth...

    Incorrect

    • A floppy new-born baby has epicanthic folds, a thin upper lip and smooth philtrum. He was monitored closely throughout pregnancy for intra-uterine growth retardation (IUGR) and a ventricular septal defect. What is the most likely diagnosis?

      Your Answer: Turner syndrome

      Correct Answer: Fetal alcohol syndrome

      Explanation:

      Fetal alcohol syndrome (FAS) is a common yet under-recognized condition resulting from maternal consumption of alcohol during pregnancy. The diagnosis of fetal alcohol syndrome (FAS) is based on findings in the following 3 areas: (1) characteristic facial anomalies (see image below), (2) growth retardation (intrauterine growth restriction and failure to have catch-up growth), and (3) CNS involvement (cognitive impairment, learning disabilities, or behavioural abnormalities).Key characteristic craniofacial abnormalities include the following:- Smooth philtrum- Thin, smooth vermilion border of the upper lipShort palpebral fissures (< 10th percentile for age)Other craniofacial abnormalities are as follows:- Midface hypoplasia- Microphthalmia- Strabismus- PtosisCNS and neurobehavioral abnormalities include the following:- Microcephaly- Intellectual impairment (mild-to-moderate mental retardation)- Cognitive impairment- Developmental delay- Irritability in infancy- Hyperactivity in childhood or attention deficit hyperactivity disorder (ADHD)- Seizures- Delayed or deficient myelination- Agenesis or hypoplasia of the corpus callosumSkeletal abnormalities include the following:- Radioulnar synostosis- Flexion contractures- Camptodactyly- Aberrant palmar creases, especially hockey-stick palmar crease- Clinodactyly- Klippel-Feil anomaly- Hemivertebrae- Scoliosis- Dislocated jointsOther major congenital anomalies include the following:- Cleft palate- Heart defects- Renal anomalies- DiGeorge sequenceFunctional problems include the following:- Refractive problems (e.g., myopia, astigmatism)- Hearing lossGrowth deficiency includes the following:- Infant small for gestational age (< 10th percentile for weight or length)- Postnatal growth deficiency

    • This question is part of the following fields:

      • Neonatology
      26.2
      Seconds
  • Question 22 - All of the given options cause persistent neonatal hypoglycaemia EXCEPT? ...

    Incorrect

    • All of the given options cause persistent neonatal hypoglycaemia EXCEPT?

      Your Answer: Hypoxia at birth

      Correct Answer: Phenylketonuria

      Explanation:

      Neonatal hypoglycaemia is a serious condition that needs prompt attention and management. The accepted criteria to define neonatal hypoglycaemia is blood sugar levels less than 2.2mmol/L during the first 3 days of life and less than 2.5mmol/L later on. Multiple aetiologies and various risk factors are involved in causing hypoglycaemia in new-borns; the most common and important causes include prematurity, erythroblastosis fetalis, hypoxia at birth, sepsis, inborn errors of metabolism, hypopituitarism, and hyperinsulinism due to maternal diabetes. Inborn errors of metabolism that lead to persistent neonatal hypoglycaemia are maple syrup urine disease, glycogen storage disease, fatty acid enzyme deficiencies, and fructose intolerance. Phenylketonuria does not cause hypoglycaemia.

    • This question is part of the following fields:

      • Neonatology
      1509.8
      Seconds
  • Question 23 - A neonate was delivered 24 hours ago at the gestational age of 29...

    Correct

    • A neonate was delivered 24 hours ago at the gestational age of 29 weeks. His birth weight was recorded to be 1 kg. Due to his critical state, the baby was intubated and ventilated. Prior to his intubation, the baby was managed with CPAP, but he seemed to get exhausted. He is now on SiMV (spontaneous intermittent mechanical ventilation). The ventilator settings are as follows: targeted tidal volume 9 ml, maximum PIP 30, PEEP 5, rate 40/min, FiO2 0.3. Baby's oxygen saturations are 93%. Blood gas shows pH 7.41, CO2 3.9 kPa, BE -4. Which of the following changes need to be made to the ventilator settings initially?

      Your Answer: Decrease targeted tidal volume

      Explanation:

      Synchronized IMV (SIMV) with pressure support, used in the alert infant. SIMV guarantees a minimum minute volume while allowing the patient to trigger spontaneousbreaths at a rate and volume determined by the patient. Extra breaths are boosted with pressure support. Tidal Volume (Vt) is normally approximately 6-10 mL/kg and 4-6 ml/kg in the preterm.Respiratory rate (RR) is usually 30-60 BPM. Tidal volume and respiratory rate are relatedto respiratory minute volume as follows: Vm(mL/min) = Vt x RR .This baby is overventilated with a low CO2. Tidal volumes should generally be targeted at 4-6 ml/kg and this baby is being targeted at 9 ml/kg which exposes the baby to damage to the distal airways from this ventilation which can lead to bronchopulmonary dysplasia.

    • This question is part of the following fields:

      • Neonatology
      84.4
      Seconds
  • Question 24 - A 37 week foetus is found to be in transverse position on ultrasound....

    Correct

    • A 37 week foetus is found to be in transverse position on ultrasound. The position has not changed despite attempting External Cephalic Version at 36 weeks and the due date is in a week. What is the preferred option of delivery for a foetus in a transverse lie?

      Your Answer: Caesarean section

      Explanation:

      A transverse lie is a common malpresentation. It occurs when the fetal longitudinal axis is perpendicular to the long axis of the uterus. The location of the spine determines if the foetus is back up (the curvature of the spine is in the upper part of the uterus) or back down (the curvature of the spine is in the lower part of the uterus).Good antenatal care, ECV, and elective caesarean section are the mainstay of the management.Spontaneous delivery of a term foetus is impossible with a persistent transverse lie and, in general, the onset of labour is an indication for the lower segment caesarean section (LSCS) in a case of a transverse lie.

    • This question is part of the following fields:

      • Neonatology
      25
      Seconds
  • Question 25 - Which of the following is true of congenital cytomegalovirus infection? ...

    Incorrect

    • Which of the following is true of congenital cytomegalovirus infection?

      Your Answer: Conductive hearing loss is the most frequent long-term consequence

      Correct Answer: Petechiae are due to thrombocytopenia

      Explanation:

      Cytomegalovirus (CMV) is the most frequent cause of congenital infection worldwide, with an estimated incidence in developed countries of 0.6-0.7% of all live births.The clinical spectrum of congenital CMV infection varies widely, from the complete absence of signs of infection (asymptomatic infection) to potentially life-threatening disseminated disease. At birth, 85-90% of infected infants are asymptomatic, and 10-15% present with clinical apparent infection (symptomatic disease).The presentation in this latter group is a continuum of disease expression whose more common findings are petechiae, jaundice, hepatomegaly, splenomegaly, microcephaly, and other neurologic signs.

    • This question is part of the following fields:

      • Neonatology
      65.3
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  • Question 26 - A 23-week-old neonate was delivered in triage following a quick delivery, there was...

    Incorrect

    • A 23-week-old neonate was delivered in triage following a quick delivery, there was no time for the administration of antenatal steroids. The baby was successfully intubated, and the first dose of surfactant had been given. Despite good chest wall movement and 2 min of chest compressions the heart rate remains very slow. The baby is approximately 18min old when the consultant arrives. Which of the following is the most appropriate next step in the management of this case?

      Your Answer: 0.1 ml/kg 1:10000 adrenaline

      Correct Answer: Consider reorientating care

      Explanation:

      The withdrawal and withholding of care has been reported in neonatology for over 30 years. ‘Withdrawal’ of life-saving treatment implies the elective discontinuation of ongoing life-supportive measures. ‘Withholding’ of treatment occurs when interventions necessary for immediate survival, such as surgical intervention or resuscitation (bag and mask/endotracheal ventilation, cardiac massage or adrenaline) are deliberately not administered.Withdrawal of treatment most commonly takes the form of withdrawing of ventilatory support. In the extremely premature neonate who has had poor response to bag and mask ventilation, this may mean stopping ventilation breaths, explaining to the parents the reason for discontinuation and offering comfort care according to the parents’ wishes. Parents should be prepared for the sequelae that may follow withdrawal from mechanical ventilation. The infant may become agitated secondary to hypoxia, display terminal gasping and, depending on the size and gestation of their infant, tachypnoea, intercostal recession or stridor may be evident. Parents may want to be involved in the extubation process. Following ventilator withdrawal, the length of time prior to death cannot be predicted and can be a significant cause of parental anguish if this is not explained. A side room and privacy should be made available for the family. NICE guidance suggests that women ‘should not be encouraged to hold their dead baby if they do not wish to’, although this is very much dependent on individuals.

    • This question is part of the following fields:

      • Neonatology
      56.5
      Seconds
  • Question 27 - A term baby with a birth weight of 4.2 kg with meconium aspiration...

    Incorrect

    • A term baby with a birth weight of 4.2 kg with meconium aspiration syndrome is intubated and ventilated. Conventional ventilation was unsuccessful and so a trial of high-frequency oscillatory ventilation has commenced. Chest X-ray shows good lung inflation. There is minimal chest wobbleť on the baby. Settings are mean airway pressure 16, delta P 25, rate 10 Hz, FiO2 0.5. Baby's oxygen saturations are 94%. Blood gas shows pH 7.19, CO2 9.3 kPa, BE -5. What is the first change that should be made to the ventilation?

      Your Answer: Increase mean airway pressure

      Correct Answer: Increase delta P

      Explanation:

      The baby is not clearing CO2 normally despite normal oxygenation so we should increase the delta P. Higher delta P will increase tidal volume and hence CO2 removal.After initial resuscitation and stabilization, the following should be the ventilator settings used:Rate: 30-40/minutePeak inspiratory pressure (PIP) – determined by adequate chest wall movement.An infant weighing less than 1500 grams: 16-28 cm H2O.An infant weighing greater than 1500 grams: 20-30 cm H2O. Positive end expiratory pressure (PEEP): 4 cm of H2O OR 5-6 cm if FiO2 > 0.90.FiO2: 0.4 to 1.0, depending on the clinical situation.Inspiratory time: 0.3-0.5 sec.After 15 to 30 minutes, check arterial blood gases and pH.If the PaO2 or the O2 saturation is below accepted standards, the FiO2 can be raised to a maximum of 1.0. If the PaO2 or O2 saturation is still inadequate, the mean airway pressure can be raised by increasing either the PIP, PEEP, inspiratory time or the rate, leaving inspiratory time constant.If the PaCO2 is elevated, the rate or peak inspiratory pressure can be raised.

    • This question is part of the following fields:

      • Neonatology
      74.9
      Seconds
  • Question 28 - Which of the following maternal factors is associated with oligohydramnios? ...

    Incorrect

    • Which of the following maternal factors is associated with oligohydramnios?

      Your Answer: Maternal cystic fibrosis

      Correct Answer: Maternal thrombotic disorder

      Explanation:

      Oligohydramnios is a deficiency in the amniotic fluid volume, measured via ultrasound. Maternal factors associated with oligohydramnios include conditions where there is placental insufficiency such as chronic hypertension, preeclampsia or a thrombotic disorder, post-term pregnancy, premature rupture of membranes, certain chromosomal abnormalities, and obstructions of the foetal urinary tract. On the other hand conditions that are associated with polyhydramnios (excess amniotic fluid) include maternal diabetes, multiple gestations, Rh incompatibility and pulmonary abnormalities.

    • This question is part of the following fields:

      • Neonatology
      19.5
      Seconds
  • Question 29 - A child presents with lymphoedema. Clinical examination reveals she has widely spaced nipples...

    Incorrect

    • A child presents with lymphoedema. Clinical examination reveals she has widely spaced nipples and a systolic murmur. Her femoral pulses are absent. Her mother admits she did not have any scans during gestation. What is the most probable diagnosis?

      Your Answer: Edward syndrome

      Correct Answer: Turner syndrome

      Explanation:

      Turner syndrome is a genetic disease that affects females. It presents with wide-spread nipples, low hairline, lymphoedema, short 4th metacarpals, high-arched palate, cardiac problems, and horseshoe kidneys.

    • This question is part of the following fields:

      • Neonatology
      47
      Seconds
  • Question 30 - Which of the following is responsible for the closure of the ductus arteriosus...

    Correct

    • Which of the following is responsible for the closure of the ductus arteriosus at birth?

      Your Answer: Reduced level of prostaglandins

      Explanation:

      The ductus arteriosus is normally patent during fetal life; it is an important structure in fetal development as it contributes to the flow of blood to the rest of the fetal organs and structure. From the 6th week of fetal life onwards, the ductus is responsible for most of the right ventricular outflow, and it contributes to 60% of the total cardiac output throughout fetal life. Only about 5-10% of its outflow passes through the lungs.This patency is promoted by continual production of prostaglandin E2 (PGE2) by the ductus.In the foetus, the oxygen tension is relatively low, because the pulmonary system is non-functional. Coupled with high levels of circulating prostaglandins, this acts to keep the ductus open. The high levels of prostaglandins result from the little amount of pulmonary circulation and the high levels of production in the placenta.At birth, the placenta is removed, eliminating a major source of prostaglandin production, and the lungs expand, activating the organ in which most prostaglandins are metabolized. In addition, with the onset of normal respiration, oxygen tension in the blood markedly increases. Pulmonary vascular resistance decreases with this activity.Normally, functional closure of the ductus arteriosus occurs by about 15 hours of life in healthy infants born at term. This occurs by abrupt contraction of the muscular wall of the ductus arteriosus, which is associated with increases in the partial pressure of oxygen (PO2) coincident with the first breath. A preferential shift of blood flow occurs; the blood moves away from the ductus and directly from the right ventricle into the lungs. Until functional closure is complete and PVR is lower than SVR, some residual left-to-right flow occurs from the aorta through the ductus and into the pulmonary arteriesA balance of factors that cause relaxation and contraction determine the vascular tone of the ductus. Major factors causing relaxation are the high prostaglandin levels, hypoxemia, and nitric oxide production in the ductus. Factors resulting in contraction include decreased prostaglandin levels, increased PO2, increased endothelin-1, norepinephrine, acetylcholine, bradykinin, and decreased PGE receptors. Increased prostaglandin sensitivity, in conjunction with pulmonary immaturity leading to hypoxia, contributes to the increased frequency of patent ductus arteriosus (PDA) in premature neonates.Although functional closure usually occurs in the first few hours of life, true anatomic closure, in which the ductus loses the ability to reopen, may take several weeks. The second stage of closure related to the fibrous proliferation of the intima is complete in 2-3 weeks.

    • This question is part of the following fields:

      • Neonatology
      21
      Seconds

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