Neurology
The first line drug for neonatal seizures.
What is phenobarbital
The first line treatment for respiratory distress syndrome.
What is surfactant?
The medications we use to try to close the PDA are...
What are indomethacin, ibuprofen, and Tylenol?
A 2-week-old boy is brought to the clinic for persistent vomiting. The neonate is exclusively fed a standard cow milk–based formula. He takes 4 oz every 2 hours and vomits after every feeding, despite burping. The emesis is not bloody, bilious, or projectile. He has 4 yellow, seedy, soft stools per day without blood. He is otherwise healthy. The neonate was born at term via an uncomplicated delivery and had an unremarkable newborn nursery course. His weight today is greater than his birth weight. His vital signs and physical examination findings are unremarkable.
Of the following, the MOST likely cause of this neonate’s symptoms is:
A. gastroesophageal reflux disease
B. milk protein allergy
C. overfeeding
D. pyloric stenosis
C. Overfeeding
What is the classic triad of renal vein thrombosis?
1. Gross hematuria
2. Flank mass
3. Thrombocytopenia
A term neonate was born via vaginal delivery after an uncomplicated pregnancy. His Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. His initial physical examination findings were normal. Twelve hours after birth, he develops episodes of apnea accompanied by twitching in the right face and arm and is transferred to the neonatal intensive care unit.
Of the following, the BEST next step in this neonate’s evaluation is:
A. initiate a sepsis evaluation
B. obtain a blood glucose measurement
C. perform electroencephalography
D. perform head ultrasonography
B. obtain a blood glucose measurement
In the delivery room, at 5 minutes after birth, a 28 weeks’ gestation newborn who is wrapped in a polyethylene bag is receiving continuous positive pressure ventilation of 5 cm H2O with a fraction of inspired oxygen of 70%. He is pink and well perfused, with a heart rate of 135 beats/min and flexion of all extremities.
Of the following, the best NEXT step in this neonate’s management is to:
A. obtain a blood glucose level
B. obtain an arterial blood gas measurement
C. place an umbilical venous catheter
D. wean the fraction of inspired oxygen
D. wean the fraction of inspired oxygen
A female newborn is rooming in with her mother on the maternity ward. The mother is concerned about her child’s coloring, which she states appears blue. She reports that the neonate otherwise seems fine, and she has no other concerns. The neonate appears appropriate for gestational age, is in no distress, and has symmetric bluish-purple discoloration of her extremities. Her examination findings are otherwise normal.
Of the following, the BEST next step in management of this neonate is
A. chest radiography
B. complete blood count
C. echocardiography
D. reassurance
D. reassurance
Thirty minutes after birth, a neonate has a point-of-care glucose level of 52 mg/dL (2.89 mmol/L). A repeat point-of-care glucose level at 1 hour after birth is 35 mg/dL (1.94 mmol/L). He was born at 40 weeks’ gestation with a birth weight 3.98 kg (large for gestational age). The neonate’s mother does not have a history of diabetes, and her glucose tolerance test result during pregnancy was normal. The birth weights of her other 4 children were all above 3.8 kg. The neonate is asymptomatic and has normal physical examination findings.
Of the following, the BEST next step in this neonate’s management is to:
A. administer 10% dextrose intravenously
B. administer 25% dextrose orally
C. repeat the point-of-care glucose level in 1 hour
D. send blood to the laboratory for a plasma glucose level
D. Send blood to the laboratory for a plasma glucose level
A woman who recently received a diagnosis of factor V Leiden mutation has no history of bleeding problems or coagulopathy. Recently married, she and her husband are concerned about the effect of this diagnosis on the pregnancy or fetus. Of the following, compared with nonaffected women, women with factor V Leiden mutation during pregnancy:
A. are more likely to be of Asian descent
B. demonstrate no added hypercoagulability related to pregnancy
C. are more likely to experience very early pregnancy loss
D. have higher risk for second-trimester losses
E. usually have growth-restricted fetuses
D. have higher risk for second-trimester losses
An 18-hour-old male is noted to be cyanotic. His respiratory rate is estimated at 55 breaths per minute. Respirations are labored and irregular. Breath sounds are present over both lung fields. He holds his right arm in adduction and internal rotation. Hand grasp is normal bilaterally. An asymmetric Moro reflex is documented.
Which of the following tests is the best first step to determine the cause of this patient’s respiratory distress?
A. Head CT
B. Videofluroscopic swallow study
C. X-ray of the clavicle
D. CXR
E. ABG
D. CXR
Bonus for 200: Can you explain what exactly you are looking for? (Hint this is a neuro question)
Two hours after delivery, a neonate born at 39 weeks’ gestation has a choking episode while breastfeeding. On physical examination, the neonate is gagging on oral secretions. An orogastric tube is placed and a chest radiograph is obtained. The prenatal history and delivery were uncomplicated other than significant polyhydramnios.
Of the following, evaluation of this neonate will MOST likely include
A. computed tomography of the chest
B. echocardiography
C. esophagoscopy
D. upper gastrointestinal tract contrast study
B. Echocardiography
A 4-day-old male infant is brought to the emergency department for evaluation of fast breathing and poor feeding. He was born at term via vaginal delivery and went home from the hospital the next day. His mother’s breast milk came in a couple of days ago, and he had been eating well until 8 hours before presentation. He latches well but seems to be breathing too quickly to suck and swallow. On physical examination, his heart rate is 170 beats/min, respiratory rate is 70 breaths/min, blood pressure is 70/40 mm Hg in the right arm, and oxygen saturation is 65% in room air measured in the right hand. He is tachypneic but not in distress. His lungs are clear to auscultation bilaterally, heart sounds are a normal S1 and a single S2 with a II/VI holosystolic murmur at the left sternal border, abdomen is benign, and capillary refill is brisk. A chest radiograph is obtained.
What is the next best step?
A. initiate prostaglandin infusion
B. intubate for impending respiratory failure
C. perform echocardiography
D. perform electrocardiography
A. Initiate prostaglandin infusion
Bonus for 100 points: What are the side effects of prostaglandin infusion?
Following an emergency cesarean section for fetal distress, a female at 33 weeks gestation is noted to have a portion of the stomach, small bowel, and proximal colon protruding outside the body from the right paraumbilical area. The defect does not contain a peritoneal sac covering.
Which of the following exposures during pregnancy have been demonstrated to be associated with this clinical finding?
A. Cocaine
B. Sertraline
C. Carbamazepine
D. Isoretinoin
E. Lithium
A. Cocaine
A 2-day-old, full term male neonate is seen in the emergency department. This morning, while changing his diaper, his mother noticed blood mixed in the stool. The infant has been fussy for a few hours. He was delivered vaginally during a planned home delivery attended by a neighbor who has experience in performing home births but is not a qualified midwife. The neonate did not receive any medications at the time of or after delivery. He is exclusively breastfed and has been feeding well. The infant’s heart rate is 156 beats/min and blood pressure is 88/35 mm Hg (mean = 43 mm Hg). The infant is awake and fussy. He appears pink and well perfused, with scattered petechiae over the abdomen and blood oozing from the umbilical cord. His abdomen is soft and nontender. Laboratory tests are ordered, and a peripheral intravenous line is placed.
Of the following, the BEST next step in this neonate’s management is to
A. administer ampicillin and gentamicin, intravenously
B. administer vitamin K, intravenously
C. infuse fresh frozen plasma
D. infuse platelets
B. administer vitamin K, intravenously
A male infant is delivered after induction of labor at 37 weeks of gestation. Fetal ultrasonography performed just before induction revealed an abnormal area in the cerebrum along the distribution of the left middle cerebral artery thought to represent an arterial ischemic stroke. Amniotic fluid is clear and Apgar scores are 6 and 8 at 1 and 5 minutes, respectively. Initial physical examination findings are normal. Because of the antenatal ultrasonography finding, you admit the infant to special care and discuss likely symptoms of stroke with the nursing staff. Of the following, the MOST common symptom to first appear in neonates with arterial ischemic cerebral infarction (stroke) is:
What are seizures?
A neonate born at 41 weeks’ gestation is delivered precipitously. There is meconium-stained amniotic fluid. Routine delivery room care is provided. Thirty minutes after birth, the neonate developed respiratory distress with grunting, retractions, and an oxygen saturation of 88% in room air. A chest radiograph is obtained (Figure 1). Oxygen and intravenous fluid support are provided.
Of the following, this neonate will MOST likely require:
A. 6 to 24 hours of oxygen support
B. placement of a chest tube
C. prostaglandin infusion
D. renal ultrasonography
B. Placement of a chest tube
Children affected by fetal alcohol spectrum disorder have a higher incidence of what type of congenital cardiac abnormalities?
What are septal defects?
A newborn presents with gastroschisis. You anticipate the need for prolonged total parenteral nutrition. As you prepare orders for parenteral nutrition, you evaluate the need for addition of trace minerals. The trace mineral that requires the EARLIEST supplementation is:
What is zinc?
Following an uncomplicated vaginal delivery, a 6-hour old girl is noted to have bleeding from her umbilicus, heme-positive stools, and a large cephalohematoma. At birth, her mother refused vitamin K and topical ophthalmic antibiotic prophylaxis.
Which of the following is associated with early onset of this disorder?
A. Montelukast
B. Fluoxetine hydrochloride
C. Lisinopril
D. Lithium
E. Phenytoin
E. Phenytoin
A neonate’s state newborn screening test result is positive for spinal muscular atrophy. She has been well and has normal physical examination findings, including muscle tone, strength, and reflexes. Molecular genetic testing is performed; the findings demonstrate 0 copies of the SMN1 gene and 2 copies of the SMN2 gene, confirming a diagnosis of spinal muscular atrophy.
Of the following, the BEST next step in this neonate’s treatment is
A. deflazacort
B. fordadistrogene movaparvovec
C. onasemnogene abeparvovec
D. risdiplam
C. onasemnogene abeparvovec
A 14-day-old male infant who was born at 26 weeks’ gestational age is in the neonatal intensive care unit. The infant received a single dose of surfactant at 3 hours of age for respiratory distress syndrome. When in the respiratory cycle, in presence of surfactant, is the surface tension LOWEST in the alveolus?
End-expiration
Bonus for 500 points (if you can give the name + equation!)
What law did you use to answer this question?
A neonate who appears “dusky” is evaluated in the special care nursery. The neonate is vigorous and without distress. The oral mucosa, hands, and feet have a bluish-purple color. Vital signs include a heart rate of 145 beats/min, respiratory rate of 50 breaths/min, blood pressure in the right upper extremity of 75/45 mm Hg, and a room air oxygen saturation, measured by a pulse oximeter located on the right hand, of 65%. When the pulse oximeter is placed on the left lower extremity it measures an oxygen saturation of 80%.
Of the following, this child’s MOST likely diagnosis is
A. Ebstein anomaly
B. hypoplastic left heart syndrome
C. transposition of the great arteries
D. tricuspid atresia
C. Transposition of the great vessels
A 46-hour-old neonate has not yet stooled and has had only 1 small void. He was born at 39 weeks’ gestation via cesarean section. The pregnancy was uncomplicated with no significant findings on prenatal testing. Her group B β-hemolytic Streptococcus test result was positive, but she did not undergo labor before her cesarean section. The neonate had been breastfeeding well every 2 to 3 hours, but this morning his mother noted that he was fussy while trying to feed. His birth weight was 3,520 g, length was 52 cm, and head circumference was 36 cm. His physical examination findings are notable for a soft, nontender, distended abdomen with decreased bowel sounds. There is a small, closed dimple noted within the intergluteal cleft. The remainder of his examination findings are normal. During the examination, the infant has a large amount of nonbilious emesis.
Of the following the MOST likely cause of this infant’s findings is:
A. Cystic Fibrosis
B. Posterior Urethral valves
C. Pyloric stenosis
D. Spina Bifida Occulta
A. Cystic Fibrosis
A newborn female is evaluated in the nursery. The mother reports she took warfarin during pregnancy because she has a history of a DVT. The most likely physical finding for this infant is:
A. Absent limbs
B. Neural tube defect
C. IUGR
D. Ebstein anomaly
E. Nasal hypoplasia
E. Nasal hypoplasia