Newborn mcq

Download Newborn mcq

Post on 16-Jul-2015

732 views

Category:

Health & Medicine

8 download

Embed Size (px)

TRANSCRIPT

<ul><li><p>MCQ OF NEWBORN </p><p>Abdulrahman Bashire</p></li><li><p>ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 1</p><p>1) Newborn infants commonly have:-A. Capillary hemangioma on the forehead.B. Posterior cranial fontenalle.C. Metopic sutures.D. Impalpable coronal sutures.E. Skin tag in front of the ear.</p><p> Ans:- ABC2) The following should be investigated in five day old baby:-</p><p>A. Erythema ToxicumB. Cloudy corneaC. Divarication of rectiiD. Subconjunctival hemorrhageE. Preauricular skin tags</p><p> Ans:-BE</p><p>3) During morning rounds in the newborn nursery, you examine a healthy infant who hasblotchy erythematous macules that are 2 to 3 cm in diameter. The macules are scatteredover the trunk, face, and proximal extremities; the palms and soles are spared. Eachmacule has a 1- to 3-mm central vesicle or pustule.Of the following, the MOST likelyadditional finding in this patient is</p><p> A. pigmented macules located at sites of resolving pustules B. presence of lesions at birth C. pustules coalescing into bullae D. Wright stain of a smear of the vesicopustular contents revealing a predominance of eosinophils E. Wright stain of a smear of the vesicopustular contents revealing a predominance of polymorphonuclear neutrophils Preferred Response: DThe infant described in the vignette exhibits the classic presentation of erythema toxicumneonatorum. Tiny vesicles or pustules arise from blotchy erythematous macules, withlesions characteristically appearing at 24 to 48 hours after birth. The pustules do not coalesce intobullae. Wright staining of the pustular contents reveals a predominance of eosinophils, notneutrophils. Because the lesions are seen in healthy infants, it has been suggested that this benigncondition be renamed; suggested names include benign neonatal rash or benign erythemaneonatorum.</p><p>Transient neonatal pustular melanosis (TNPM) is another well-recognized benign dermaleruption of infancy in which pustular lesions spontaneously resolve into transient pigmentedmacules . TNPM may be present at birth, and examination of pustular contents reveals apredominance of neutrophils.</p><p>Infantile acropustulosis is a chronic or recurring benign condition manifested by intenselypruritic pustules on hands and feet. Characteristic papules and pustules may coalesce into bullae.</p></li><li><p>ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 2</p><p>Infantile acropustulosis frequently is confused with scabies infestation. The lesions resolvespontaneously at 1 to 2 years of age.</p><p>4) You are examining a newborn who is the product of an uneventful pregnancy, labor, anddelivery. Apgar scores were 9 at both 1 and 5 minutes. Findings on the initial physicalexamination are unremarkable except for the presence of vesicopustules and frecklelikemacules (Item Q33A), some of which have a collarette of surrounding scale. Wright stainof a smear of the vesicopustular contents reveals a predominance of polymorphonuclearneutrophils.Of the following, the MOST likely diagnosis is</p><p> A. congenital candidiasis B. erythema toxicum neonatorum C. infantile acropustulosis D. miliaria rubra E. transient neonatal pustular melanosis Preferred Response: ECharacteristic lesions of transient neonatal pustular melanosis (TNPM) may be present at birth asvesicles, pustules, or ruptured vesicles or pustules that have a collarette of surrounding scale.Pigmented macules (Item C33A) often develop at the sites of resolving pustules or vesicles.Primary lesions usually disappear by 5 days of age; the secondary pigmented lesions may remainup to 3 months. TNPM occurs more commonly in African-American infants.Lesions can occur on palms and soles. Pustular contents reveal a predominance of neutrophils onWright stain examination, as reported for the newborn in the vignette. Infants who have congenital cutaneous candidiasis may present with scaling, erythematouspapules and pustules (Item C33B) at birth. Candida albicans can penetrate through the amnion andchorion to cause congenital infections. Scrapings from lesions prepared with potassium hydroxidedocument pseudohyphae (Item C33C) or budding yeast. Term infants who have erythema toxicum neonatorum exhibit vesicopustular lesions (ItemC33D) that usually overlie erythematous macules. Lesions of erythema toxicum rarely are presentat birth, and Wright stain of smears of pustular contents reveals a predominance of eosinophils.</p><p>Infantile acropustulosis presents as pustules or vesicles (Item C33E) localized to the handsand feet. It may be present at birth but more commonly develops in the first weeks and monthsafter birth, possibly continuing or recurring throughout infancy and early childhood. Lesions arevery similar to those of infantile scabies infestation. Pustular contents may reveal prominentneutrophils and occasional eosinophils without evidence of the mites, ova, or feces seen inscabies. An absence of hyperpigmentation in resolving lesions and a prolonged or recurringcourse distinguishes infantile acropustulosis from TNPM.</p><p>Miliaria rubra (prickly heat or heat rash) is caused by intraepidermal obstruction of the sweatducts. A secondary local inflammatory response is responsible for the erythema (Item C33F)associated with the papules and vesicles. Miliaria rubra occurs later than miliaria crystallina,usually beyond thefirst postnatal week. Hyperpigmented, frecklelike lesions are not expected inmiliaria rubra.</p><p>5) The following is true regarding changes in the fetal cardiovascular system after birth:A. There is normally immediate closure of the ductus arteriosus</p></li><li><p>ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 3</p><p>B. Hypoxia-induced vasoconstriction is the mechanism of closure of the ductusarteriosus</p><p>C. The ligamentum teres is the remnant of the umbilical veinD. Regression of right ventricular hypertrophy occurs postnatallyE. Inferior vena caval pressure falls after birth</p><p> Ans:-CDEOcclusion of the umbilical cord removes this low resistance capillary bed from the circulation;breathing results in a marked decrease in pulmonary vascular resistance, hence there is increasedpulmonary blood flow returning to the left atrium raising the pressure in the left atrium causingthe foramen ovale to close. As pressure in the systemic circulation rises, shunt through the ductusarteriosus reverses. As the pO2 rises, synthesis of bradykinin and prostacyclins is inhibited, thuscausing closure of the ductus arteriosus. The ductus arteriosus can take up to 3 months to close innormal neonates.</p><p>6) Neonatal RDS:-A. Seen in most babies of birth weight &lt; 2.5 kg.B. More common in infants of diabetic mothers.C. Associated with prolonged rupture of membrane.D. Less sever in babies of Afro-Caribiean origin than Caucasians.E. Exacerbated by hypothermia.</p><p> Ans:-BDE7) The following are causes of generalized hypotonia in 2 days old infants:-</p><p>A. PrematurityB. HypothyroidismC. Myotonic dystrophyD. Spinal dysraphyismE. Anterior horn cell disease</p><p> Ans:-ACE8) Regarding surfactant:-</p><p>A. Production begins at 30 weeksB. It is produced by Type II pneumocytes in the walls of the bronchiC. Testosterone stimulates surfactant productionD. Production is increased during a stressful event like hypothermiaE. Betamathasone given to the mother improves surfactant production in the</p><p>premature baby Ans:- E</p><p>Surfactant production begins at 20-22 weeks. It is produced by Type II pneumocytes which are inthe walls of the alveoli. The hormones testosterone and insulin inhibit surfactant production;hence hyaline membrane disease is more common in males than females and more common ininfants of diabetic mothers. Surfactant production is suppressed if the baby is hypothermic,hypoxic, acidotic or hypoglycemic.Although dexamethasone is more commonly used, betamethasone has an identical effect on lungmaturation</p><p>9) Concerning fetal lung development:-</p></li><li><p>ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 4</p><p>A. Type pneumocytes are present at 24 week gestationB. Cuboidal cells are capable of gas transfer in uteroC. There is virtually no smooth muscle in the terminal &amp; respiratory bronchioles at</p><p>6 month of ageD. The large airways are formed at 16 week gestationE. Alveoli are completely formed at birth</p><p> Ans:-AD10) Congenital CMV infection:-</p><p>A. Only 10% of affected pregnancies have resulting long term sequel at birthB. Diagnosis is by viral isolation from the urineC. Hearing loss can develop gradually over the first 5 yearsD. The affected newborn should be treated with ganciclovirE. Intracranial calcifications are seen in a periventricular distribution</p><p> Ans:- ABCECongenital CMV occurs in approximately 1% of all live births and only 10% of these infectionsresult in clinical symptoms. Severe clinical disease is associated with primary maternal infectionin pregnancy. Infection in early gestation carries a far greater risk of severe fetal disease. In CMVintra-cranial calcifications are in a periventricular distribution. Ganciclovir is only used if there isCNS involvement, chorioretinitis or pneumonitis.</p><p>11) The following conditions will present with cyanosis in the first week of life:A. Aortic stenosisB. Transposition of the great vesselsC. Hypoplastic left heart syndromeD. Fallot's tetralogyE. Fallot's pentalogy</p><p> Ans:- BAny cardiac lesion which allows a mixing of blood along with a right to left flow or any cardiaclesion wherein pulmonary perfusion is impaired results in cyanosis. Left heart problems oroutflow tract obstructions present as cardiac failure. Fallot's pentalogy includes an ASD alongwith the tetrad of infundibular pulmonary stenosis, RVH, over-riding of the aorta and a VSD.Babies with tetralogy of Fallot usually have a patent ductus arteriosus at birth that providesadditional pulmonary blood flow, so severe cyanosis is rare early after birth.As the ductus arteriosus closes, as it typically will in the first days of life, cyanosis can develop orbecome more severe.The degree of cyanosis is proportional to lung blood flow and thus depends upon the degree ofnarrowing of the outflow tract to the pulmonary arteries.</p><p>12) Pulmonary surfactantA. Is partly recycled by endocytosis into the synthesizing cellB. Is produced by type alveolar cellsC. Reduction in pulmonary flow can cause a decrease in surfactant productionD. Synthesis is inhibited by thyroxineE. Synthesis is stimulated by glucocorticoids</p><p> Ans:- ACE</p></li><li><p>ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 5</p><p>Dipalmityl- phosphotidyl choline is the main component of surfactant and is produced by Type-alveolar cells (granular pneumocytes). Its half-life is 14 hours and its main function is to reducethe surface tension of the alveoli.</p><p>13) Lung surfactantA. Decreases the surface tension within an alveolusB. Causes an increase in chest wall complianceC. Is a glycoproteinD. Maintains the same surface tension for different sized alveoliE. Appears only after the 1st week of life</p><p> Ans:- ASurfactant is a dipalmitoyl-phosphatidyl choline and is a phospholipid, which prevents alveolarcollapse by reducing alveoli surface tension. It is produced by type-II pneumocytes and is seen atabout 24 weeks gestation. It causes an increase in lung compliance only (not chest wallcompliance).</p><p>14) The following organisms cause conjunctivitis:-A. Epstein Barr virusB. Chlamydia trachomatisC. AdenovirusD. Haemophilus influenzaeE. Neisseria gonorrhoeae</p><p> Ans:- BCDEChlamydia trachomatis causes conjunctivitis in 30-50% of neonates born to mothers withcervicitis. It is a purulent conjunctivitis, which develops 5-14 days after birth and isindistinguishable from gonococcal infection. It is diagnosed on a swab scraped over the lowereyelid (to allow cells to be collected dont forget it is an intracellular organism) by directfluorescent antibody, ELISA or PCR. Tetracycline ointment topically is combined with oralerythromycin the oral antibiotic is to prevent relapse after ointment is discontinued and toprevent progression to pneumonia. Gonococcal conjunctivitis presents earlier than chlamydialdisease (usually within 2 days), is diagnosed on gram stain and culture and should be treated withIV penicillin and chloramphenicol eye drops. Dont forget sexual health screening for the motherand informing public health of ophthalmia neonatorum. Adenovirus causes conjunctivitis insummer outbreaks; enterovirus, coxsackie and herpes simplex are other viral causes.</p><p>15) Concerning blood flow in the fetus:-A. Blood flow from right to left through the foramen ovaleB. Blood in the ascending aorta has higher oxygen content than in the descending</p><p>aortaC. The ductus arteriosus is closedD. Pulmonary pressure equal systemic pressureE. Hemoglobin may be 20 gm/dl</p><p> Ans:-ABE16) -In a healthy baby the transition from fetal to neonatal circulation involves:-</p><p>A. Functional closure of the foramen ovale in the first 24 hours</p></li><li><p>ABDULRAHMAN BASHIRCHILDREN HOSPITAL BENGHAZI 6</p><p>B. Blood flow in the ductus arteriosus continues from right to left until its closureC. Decrease in pulmonary artery resistance following closure of the ductus arteriosusD. The ductus arteriosus closes in response to decreased oxygen concentrationsE. The umbilical artery is a branch of the common il...</p></li></ul>