Neonatology – Set 3

What this deck covers

Neonatology – Set 3 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Breathing fast after a good start
2. Labile cyanosis, hand above foot
3. Sudden collapse with frothy secretions
4. Why green-liquor lungs rupture
5. Grey and gasping, film not back
6. Plan for a well boy breathing fast
7. First chest film at 29 weeks
8. The noise he makes breathing out
9. Well at 3 days, near-normal film
10. Oxygen threshold on CPAP
11. Sick at 3 hours, about to be intubated
12. Confirming it on the heart scan
13. First surfactant dose at 31 weeks
14. Lung water at the first breaths
15. Refractory hypoxaemia at 20 hours
16. Ventilator change for a bleeding lung
17. Planned removal at 4 months
18. Fast breathing in a well term girl
19. Going home after a stormy start
20. Giving it without a ventilator
21. Air back within the hour
22. Stable on the ventilator, next test
23. Grunting from birth at 32 weeks
24. Parents ask about leaving it alone
25. Hand and foot oximetry gap
26. Air leak risk after the treatment
27. Green liquor and a barrel chest
28. Ventilated with a white-out film
29. Oximetry goals while in oxygen
30. Quiet left side, film minutes away
31. The fetal finding that matters most
32. Worsening hypoxia on full support
33. Why it followed the earlier treatment
34. Grunting despite headbox oxygen
35. Antenatal chest cysts
36. Birth history of a fast-breathing boy
37. Air entry on one side only
38. Why a bolus down the tube works
39. Grunting at 6 hours after long rupture
40. Correcting his results after the bleed
41. Where the retained fluid goes
42. Circulation change at the first breath
43. Lowering the risk next pregnancy
44. Sudden collapse on CPAP at 10 hours
45. Chest film at 4 hours
46. What would have helped before birth
47. Aims for a ventilated blue newborn
48. White side, heart pulled toward it
49. Rising pressures at 30 hours
50. Waters broke at home, the missed step

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Delayed clearance of fetal lung fluid, Surfactant deficiency from immature lungs, Over-expanded lungs with fluid in the fissures, Any need above 21%, 100 mg/kg (1.25 mL/kg), Raise PEEP and mean airway pressure, Yearly echocardiograms until adulthood, Urine culture from a bag specimen, Left-to-right shunting across the duct, Intravenous hydrocortisone, A dominant cyst larger than 2 cm, Intubation and conventional ventilation, Raise PEEP and inflation pressure to re-open it, Albumin bolus to raise blood pressure.

Clinical pearls from this deck

• A good first few hours, then distress: think infection, not transition.
• Hand higher than foot, labile colour, clear lungs: pulmonary hypertension of the newborn until the scan says otherwise.
• Blood up the tube after surfactant, with a big duct: think of a lung bleed.
• Meconium works as a one-way valve: gas in, not out, and the lung pops.
• Tension in a collapsing baby: decompress first, film later.
• Wet lungs dry out in one to three days: support and watch.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all neonatology case decks · pediatric reference values.