The DuctDependent Newborn

What this deck covers

The DuctDependent Newborn in twelve board-style clinical cases with worked explanations, written for the Saudi Prometric (SCFHS) exam, MRCPCH Part 1 and Part 2, the Arab Board, DHA and OMSB. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong.

Diagnoses and management options tested

Across the twelve cases you are asked to choose between options such as: Overwhelming late-onset sepsis, A metabolic disorder presenting late, Non-accidental injury with hypovolaemia, A second intravenous access site, Airway kit and someone able to intubate, A cross-matched unit of blood, Consistent with persistent pulmonary hypertension only, A right-sided aortic arch indenting the trachea, An egg-on-side silhouette with a narrow waist, A boot-shaped heart with an uplifted apex, Immediate assessment and an urgent echocardiogram, Transposition of the great arteries, Obstructed anomalous pulmonary venous drainage, Coarctation of the aorta.

Exam pearls from this deck

• A duct-dependent circulation is one in which the duct carries blood the heart itself cannot deliver.
• Differential cyanosis — blue blood crossing into the descending aorta
• Apnoea is the most dangerous early effect of prostaglandin, and it can come within minutes of starting.
• A pre-ductal PaO2 below 100 mmHg in 100 per cent oxygen is a cardiac right-to-left shunt
• Pulmonary oligaemia means reduced blood flow to the lungs, and it makes the fields strikingly dark.
• Coarctation is a narrowing of the aorta, characteristically just beyond the origin of the left subclavian artery.
• In transposition the aorta arises from the right ventricle and the pulmonary artery from the left.
• Start prostaglandin on suspicion. The echocardiogram can wait; the duct cannot.
• Foot above hand is reverse differential cyanosis — transposition with arch obstruction, or with pulmonary hypertension.

The deck above is free and needs no sign-in. Work through it once for recognition, then again a week later for recall — the questions are written in the format the exam actually uses.