Paediatric Quiz 1

Term infants typically have smooth, pink skin, possibly with traces of lanugo, and minimal vernix.

Vertical transmission during delivery is the main route.

CONS is a major pathogen in hospitalized and preterm infants.

Birth asphyxia results from failure of gas exchange causing low oxygen and high carbon dioxide levels.

Cerebral palsy is the most frequent long-term complication from hypoxic brain injury.

Therapeutic hypothermia is most effective when started within the first 6 hours of life.

The priority is to open the airway and provide effective ventilation, especially if the baby is apneic or bradycardic.

Delayed umbilical stump separation beyond 3 weeks may suggest leukocyte adhesion defect or other immunodeficiencies.

Beta-glucuronidase increases bilirubin reabsorption from intestines.

Biliblankets enable continued contact and breastfeeding during therapy.

Grunting is a sign of respiratory distress and should prompt evaluation for pulmonary or cardiac pathology.

Blood culture is the gold standard for confirming bloodstream infection.

Intrapartum prophylaxis dramatically reduces neonatal GBS infections.

3.5 mm ETT is standard for term infants.

TTN typically improves quickly without need for surfactant; RDS is more severe and persistent.

Preterm babies lose heat easily due to their large surface area, limited fat stores, and immature skin.

This combo provides broad coverage including GBS and gram-negative organisms.

Early surfactant therapy reduces RDS severity and improves survival in extremely preterm infants.

Conjugated bilirubin is eliminated mainly in stool through bile.

A failed newborn hearing screen should be followed up with repeat testing and referral to audiology to ensure early intervention for hearing loss.

Caffeine is a respiratory stimulant used to treat and reduce apnea episodes in preterm neonates.

Gasping is ineffective breathing and warrants PPV, regardless of heart rate.

Patent ductus arteriosus causes a continuous murmur due to flow from aorta to pulmonary artery.

Jitteriness is a common and early sign of hypoglycemia in neonates, especially in infants of diabetic mothers or those small for gestational age.

PROM (>18 hours) allows ascending bacteria from the genital tract to infect the neonate.

Lethargy and poor feeding are early neurological signs of HIE due to brain hypoxia.

Listeria can cause in utero infection via hematogenous spread across placenta.

Direct overhead positioning ensures effective skin exposure.

A cephalohematoma is a subperiosteal bleed that does not cross suture lines and may take weeks to resolve.

Sepsis can trigger DIC, leading to low platelet counts.

A poor seal prevents air entry into lungs.

Fever often signals infection like chorioamnionitis, a major risk factor.

Prompt antibiotic therapy is life-saving in suspected sepsis; don’t wait for labs.

CRP is a sensitive inflammatory marker used to support the diagnosis.

Hip assessments (Barlow/Ortolani maneuvers) are done with the baby supine, hips and knees flexed to evaluate for instability.

Delay in management may lead to irreversible brain injury such as cerebral palsy or cognitive delay.

Turner syndrome (45,XO) presents with features like webbed neck, lymphedema, and widely spaced nipples.

Anti-D prevents maternal sensitization against Rh-positive fetal cells.

Sulfonamides displace bilirubin from albumin, increasing free bilirubin levels.

Therapeutic hypothermia (33–34°C) slows brain metabolism, reducing damage from hypoxic-ischemic events.

Most neonates require 10–14 days of antibiotics for bloodstream infections.

A poor suck reflex may indicate neurologic or muscular dysfunction and requires immediate evaluation.

Human milk reduces NEC, improves immunity, and supports neurodevelopment.

At 10 minutes, target preductal SpO₂ is 85–95%.

Immature immunity makes preterm and LBW babies especially vulnerable.

Due to anaerobic metabolism, lactic acid accumulates, resulting in metabolic acidosis.

Post-term neonates often have peeling or cracked skin, meconium staining, and reduced vernix.

A 28-week preterm infant typically has thin skin, absent breast tissue, and minimal cartilage in the ears.

Group B Streptococcus is the most common cause of early-onset neonatal sepsis, acquired during delivery.

Prolonged or obstructed labor can compromise fetal oxygenation and lead to birth asphyxia.

Intrapartum antibiotics reduce group B streptococcus and other bacterial transmission during delivery.

LP helps identify CNS infection, especially if neurological signs are present.

Chest compressions are given for 60 seconds before reassessment.

Cooling is typically maintained for 72 hours to maximize neuroprotection.

Sepsis occurring after 72 hours is categorized as late-onset.

Initial resuscitation begins with room air (21% O₂); supplemental oxygen is added only if necessary.

Due to anaerobic metabolism, metabolic acidosis is common in asphyxiated neonates.

Serum bilirubin measured in the lab is the most accurate method.

Corticosteroids accelerate surfactant production in fetal lungs and reduce incidence of RDS.

Symmetrical movement of all limbs is a normal finding, suggesting intact motor pathways and healthy tone.

A blood glucose level of more than 45 mg/dL after 24 hours of life is considered normal for a term neonate.

EEG helps monitor seizure activity and brain function in neonates undergoing therapeutic hypothermia.

Bradycardia >120 bpm is not a clinical concern; severe asphyxia causes heart rates below 100 or 60 bpm.

Opisthotonos is a classic sign of kernicterus in neonates.

Warmth is part of the initial steps for all at-risk infants.

A bulging anterior fontanelle when the baby is calm is concerning for increased intracranial pressure, such as from hydrocephalus or meningitis.

The “Pulse” component of the Apgar score measures heart rate.

Healthy weight gain in preterms is approximately 15–20 g/kg/day to mimic intrauterine growth rates.

Jaundice progresses from the face downward as bilirubin levels rise.

Secondary apnea occurs after prolonged hypoxia and requires PPV.

Placental insufficiency leads to chronic fetal hypoxia, making it a leading cause of birth asphyxia. Acute events like cord prolapse are less common.

Prolonged resuscitation beyond 10 minutes is associated with poor neurological outcomes.

Resuscitation is ideally done by a team of at least 3–4 trained members.

PDA is a cardiac condition and does not directly affect bilirubin metabolism.

Feeding improves stool passage and bilirubin clearance.

HIE can cause long-term neurological damage including cerebral palsy.

Each breath should be delivered over about 1 second.

Neurologic symptoms in jaundiced infants suggest acute bilirubin toxicity.

Post-conceptional (or corrected) age is calculated by adding the age at birth to the number of weeks since birth — used to assess developmental milestones in preterms.

Crepitus and tenderness over the clavicle, along with asymmetric Moro reflex, strongly suggest a clavicle fracture.

Cranial ultrasound is the preferred non-invasive tool to detect intraventricular hemorrhage in preterm neonates.

An Apgar score of 4–6 at 1 and 5 minutes suggests moderate asphyxia.

Testicular torsion is a surgical emergency characterized by acute swelling, redness, and pain in the scrotum.

Cranial ultrasound or MRI can detect brain injury due to hypoxia, such as periventricular leukomalacia.

Most maternal IgG is transferred in the third trimester, which preterm babies miss — making them more vulnerable to infections.

Leukopenia may reflect bone marrow suppression or overwhelming infection.

Rh incompatibility arises when an Rh-negative mother carries an Rh-positive fetus.

Septic neonates often appear lethargic, poorly perfused, and hypotonic.

Large gastric residuals and bloating are warning signs for NEC or poor tolerance to enteral feeds.

Gilbert syndrome results from mildly reduced bilirubin conjugation activity.

Shock presents with signs of poor circulation like prolonged CRT and low BP.

Observation and good feeding are adequate when bilirubin is below treatment level.

Too much oxygen causes oxidative damage, increasing risk of ROP and chronic lung disease.

Preterm babies lack insulating fat and have immature skin, making them prone to hypothermia.

Oxygen saturation is carefully titrated to avoid both hypoxia and hyperoxia; 90–95% is ideal in most stable preterms.

A murmur associated with clinical signs like poor feeding warrants urgent evaluation with echocardiography to rule out congenital heart disease.

Follow-up is essential to detect late-onset hyperbilirubinemia after early discharge.

Developmental milestones (especially motor and cognitive) are interpreted using corrected age until about 2 years.

Bilirubin nomograms guide treatment thresholds by age in hours.

Managing fluid status and thermoregulation are essential.