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  • Question 1 - In which of the following ethnic backgrounds are Mongolian blue spots most likely...

    Incorrect

    • In which of the following ethnic backgrounds are Mongolian blue spots most likely to be found?

      Your Answer: African

      Correct Answer: White European

      Explanation:

      Mongolian spots are, hyper-pigmented, non-blanching patches present on the back and gluteal region at birth. They are commonly found in African and Asian ethnic groups, and can also present in infants of Mediterranean and middle eastern descent. Though the spots usually disappear by puberty, some may persist into adulthood.

    • This question is part of the following fields:

      • Neonatology
      6
      Seconds
  • Question 2 - 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
      10.4
      Seconds
  • Question 3 - A 27-year-old pregnant female had a pre pregnancy BMI of 33 kg/m2. She...

    Correct

    • A 27-year-old pregnant female had a pre pregnancy BMI of 33 kg/m2. She is found to have gestational diabetes and ultrasonography estimates a fetal macrosomia. BP is 127/72 mmHg. This primigravida is at greatest risk for which of the following obstetric emergency?

      Your Answer: Shoulder dystocia

      Explanation:

      Shoulder dystocia occurs when the fetal anterior shoulder impacts against the maternal symphysis following delivery of the vertex. Less commonly, shoulder dystocia results from impaction of the posterior shoulder on the sacral promontory. Risk Factors for Shoulder DystociaMaternalAbnormal pelvic anatomyGestational diabetesPost-dates pregnancyPrevious shoulder dystociaShort statureFetalSuspected macrosomiaLabour relatedAssisted vaginal delivery (forceps or vacuum)Protracted active phase of first-stage labourProtracted second-stage labour

    • This question is part of the following fields:

      • Neonatology
      17.7
      Seconds
  • Question 4 - Which of the following chemical substances is NOT a component of amniotic fluid?...

    Correct

    • Which of the following chemical substances is NOT a component of amniotic fluid?

      Your Answer: Interleukin-1

      Explanation:

      Amniotic fluid is the protective liquid that surrounds the fetus in utero. It prevents the fetus from injury, protects the umbilical cord from compression, and provides necessary nutrients and a medium for growth and movement. Amniotic fluid originates from the maternal plasma initially, but by 16th week of gestation, fetal kidneys start making urine which contributes to further production of the amniotic fluid. Amniotic fluid contains a number of chemical substances including hormones, tumour markers, nutrients, electrolytes, and immunoglobulins. Main substances found in amniotic fluid include carbohydrates, proteins, lipids, lactoferrin, insulin-like growth factor, granulocyte colony-stimulating factor, erythropoietin, etc. Interleukin-1 is not a component of AF.

    • This question is part of the following fields:

      • Neonatology
      10.4
      Seconds
  • Question 5 - What is the most probable diagnosis in an infant with persistent neonatal hypoglycaemia...

    Correct

    • What is the most probable diagnosis in an infant with persistent neonatal hypoglycaemia and positive urine ketones?

      Your Answer: Maple syrup urine disease

      Explanation:

      The most probable diagnosis for this patient is Maple syrup urine disease (MSUD).Note:- Healthy new-borns have blood sugars between 3.3 and 5 mmol/L- Neonatal hypoglycaemia is glucose < 2.2 mmol/L if measured in the first 3 days of life.- Neonatal hypoglycaemia is glucose < 2.5 mmol/L after the first 3 days of life.Causes of persistent hypoglycaemia include:- Preterm- IUGR- SGA- Hyperinsulinism due to maternal diabetes- Beckwith-Wiedemann syndrome- Hypoxia at birth- Sepsis- Cardiopulmonary disease- Inborn errors of metabolism- Hepatic enzyme deficiencies- Glycogen storage disease

    • This question is part of the following fields:

      • Neonatology
      8.5
      Seconds
  • Question 6 - A neonate of Asian parents presents with jaundice appearing less than 24 hours...

    Correct

    • A neonate of Asian parents presents with jaundice appearing less than 24 hours after birth. You are concerned about glucose-6-phosphate dehydrogenase deficiency. What is the mode of inheritance of this condition?

      Your Answer: X-linked

      Explanation:

      Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency in humans.It has a high prevalence in persons of African, Asian, and Mediterranean descent. It is inherited as an X-linked recessive disorder.G6PD deficiency is polymorphic, with more than 300 variantsG6PD deficiency can present as neonatal hyperbilirubinemia. Besides, persons with this disorder can experience episodes of brisk haemolysis after ingesting fava beans or being exposed to certain infections or drugs. Less commonly, they may have chronic haemolysis. However, many individuals with G6PD deficiency are asymptomatic.Most individuals with G6PD deficiency do not need treatment. However, they should be taught to avoid drugs and chemicals that can cause oxidant stress. Infants with prolonged neonatal jaundice as a result of G6PD deficiency should receive phototherapy with a bili light.

    • This question is part of the following fields:

      • Neonatology
      8
      Seconds
  • Question 7 - At term, what is the normal amount of amniotic fluid? ...

    Incorrect

    • At term, what is the normal amount of amniotic fluid?

      Your Answer: 1000ml

      Correct Answer: 600ml

      Explanation:

      In the first trimester of pregnancy, amniotic fluid is produced from maternal plasma where there is a rapid bi-directional diffusion across the foetal skin. At 10 weeks the volume is about 25ml. By 16th weeks of gestation the foetal kidneys make urine that contributes to the increasing volume of amniotic fluid, along with nasal secretions. At 20 weeks, the level is 400ml and increases to 800ml at 28weeks, after which it reduces to 600ml at term.

    • This question is part of the following fields:

      • Neonatology
      4.3
      Seconds
  • Question 8 - 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: 5x inflation breaths

      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
      19
      Seconds
  • Question 9 - 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
      10
      Seconds
  • Question 10 - What is the most common cardiac abnormality found in Noonan syndrome? ...

    Correct

    • What is the most common cardiac abnormality found in Noonan syndrome?

      Your Answer: Pulmonary stenosis

      Explanation:

      Noonan syndrome is one of the most common genetic diseases associated with congenital heart defects, being second in frequency only to Down syndrome.Pulmonary stenosis and hypertrophic cardiomyopathy are generally the most common congenital heart defects found in Noonan syndrome.Pulmonary stenosis is often associated with a thickened and dysplastic valve. It is usually difficult to obtain a satisfactory result using the transcatheter balloon dilatation of such dysplastic valves, so surgical intervention is more likely to be needed.Hypertrophic cardiomyopathy involves predominantly the ventricular septum as asymmetric septal hypertrophy, but may also affect the ventricular free walls. Left ventricular outflow tract obstruction may occasionally be produced.

    • This question is part of the following fields:

      • Neonatology
      5.3
      Seconds
  • Question 11 - The new-born hearing test is best carried out within the first four or...

    Incorrect

    • The new-born hearing test is best carried out within the first four or five weeks of life, until what age can it be performed?

      Your Answer: 15 weeks

      Correct Answer: 12 weeks

      Explanation:

      Ideally, the test is done in the first 4 to 5 weeks, but it can be done at up to 3 months of age.The identification of all new-borns with hearing loss before age 6 months has now become an attainable realistic goal. In the past, parents and paediatricians often did not suspect a hearing loss until the age of 2-3 years, after important speech and language milestones have not been met. By the time these milestones are missed, the hearing-impaired child has already experienced irreversible delays in speech and language development.

    • This question is part of the following fields:

      • Neonatology
      7.8
      Seconds
  • Question 12 - Which of the following is incorrect? ...

    Incorrect

    • Which of the following is incorrect?

      Your Answer: The neonatal mortality rate is the number of deaths in the neonatal period divided by 1000 births

      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
      9.8
      Seconds
  • Question 13 - A premature neonate at 28 weeks gestation suffers from right sided intraventricular haemorrhage...

    Correct

    • A premature neonate at 28 weeks gestation suffers from right sided intraventricular haemorrhage with no ventricular dilation while on the ventilator. What advice should ideally be given to the parents in this situation?

      Your Answer: It is probable that there will be no significant long-term effects but his development will be closely followed just in case

      Explanation:

      There are four types of IVH. These are called grades and are based on the degree of bleeding.Grades 1 and 2 involve a smaller amount of bleeding. Most of the time, there are no long-term problems as a result of the bleeding. Grade 1 is also referred to as germinal matrix haemorrhage (GMH).Grades 3 and 4 involve more severe bleeding. The blood presses on (grade 3) or directly involves (grade 4) brain tissue. Grade 4 is also called an intraparenchymal haemorrhage. Blood clots can form and block the flow of cerebrospinal fluid. This can lead to increased fluid in the brain (hydrocephalus).

    • This question is part of the following fields:

      • Neonatology
      44.2
      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
      13.9
      Seconds
  • Question 15 - Which of the following is associated with neonatal vitamin E deficiency? ...

    Correct

    • Which of the following is associated with neonatal vitamin E deficiency?

      Your Answer: Thrombocytosis

      Explanation:

      Vitamin E deficiency in premature infants has been described as being associated with low haemoglobin levels in the 2nd month of life, haemolytic anaemia associated with thrombocytosis. Recently, low vitamin E concentrations were suspected as being associated with sudden death in infancy.

    • This question is part of the following fields:

      • Neonatology
      4.9
      Seconds
  • Question 16 - Which of the following is responsible for the closure of the ductus arteriosus...

    Incorrect

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

      Your Answer: Increased left atrial pressure

      Correct 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
      7.2
      Seconds
  • Question 17 - 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: 25 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
      7.8
      Seconds
  • Question 18 - Female twins are born. They are noted by the midwife to be identical....

    Incorrect

    • Female twins are born. They are noted by the midwife to be identical. They separated in the womb after implantation but before day 8.What type of twin is this?

      Your Answer: Dichorionic monoamniotic

      Correct Answer: Monochorionic diamniotic

      Explanation:

      A monochorionic diamniotic (MCDA) twin pregnancy is a subtype of monozygotic twin pregnancy. An MCDA pregnancy results from a separation of a single zygote at ,4-8 days (blastocyst) following formation. These fetuses share a single chorionic sac but have two amniotic sacs and two yolk sacs. It accounts for the vast majority (70-75%) of monozygotic twin pregnancies although only ,30% of all twin pregnancies. The estimated incidence is at ,1:400 pregnanciesThe layman term is that the twins are identical – in reality, they are phenotypically similar, and of course of the same gender.

    • This question is part of the following fields:

      • Neonatology
      12
      Seconds
  • Question 19 - Macrosomia is NOT commonly found in which of the following genetic abnormalities? ...

    Correct

    • Macrosomia is NOT commonly found in which of the following genetic abnormalities?

      Your Answer: Silver-Russell syndrome

      Explanation:

      Macrosomia can be defined as either a birth weight greater than 4kg or birth weight greater than 90% for the gestational age. Risk factors for macrosomia include maternal diabetes, excessive gestational weight gain, pre-pregnancy obesity, male gender, ethnicity, and advanced gestational age. Genetic conditions associated with macrosomia are Bardet-Biedl syndrome, Perlman syndrome, Beckwith-Wiedemann syndrome, and Prader-Willi syndrome. Silver-Russell syndrome is associated with intrauterine growth retardation and post-natal failure to thrive.

    • This question is part of the following fields:

      • Neonatology
      4.8
      Seconds
  • Question 20 - A female presents to obstetric triage at 24 weeks with cramping pain and...

    Incorrect

    • A female presents to obstetric triage at 24 weeks with cramping pain and is threatening preterm labour. The parents would like to know the statistics relating to survival and outcome if their baby is born at this gestation. Which particular study would be useful to review before this consultation?

      Your Answer: SafeBoosC

      Correct Answer: EPICURE

      Explanation:

      EPICure is a series of studies of survival and later health among babies and young people who were born at extremely low gestations -from 22 to 26 weeks.Boost II is a double-blind randomised controlled trial (RCT) comparing the effects of targeting arterial oxygen saturations between 85% and 89% versus 91% and 95% in preterm infants.OSCAR Xe is not the name of a study. Baby-OSCAR is an RCT to determine whether a confirmed large patent ductus arteriosus in very premature babies should be treated with ibuprofen within 72 hours of birth.SafeBoosC is a trial to examine if it is possible to stabilise the cerebral oxygenation of extremely preterm infants in the first 72 hours of life with the use of NIRS oximetry and a clinical treatment guideline. TOBY Xe is an RCT looking at the neuroprotective effects of hypothermia combined with inhaled xenon following perinatal asphyxia.

    • This question is part of the following fields:

      • Neonatology
      84.3
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neonatology (10/20) 50%
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