Neonatology – Set 4

What this deck covers

Neonatology – Set 4 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. Long pauses with a slow heart rate
2. Timing of his earliest head scan
3. Reaching full enteral volume
4. Arterial catheter tip on the film
5. Why her eyes need watching
6. Very preterm with a high sodium
7. Protecting the very preterm lung
8. Milky tube aspirate on day 9
9. Source of a very preterm brain bleed
10. Timing of the first eye screen
11. Parents ask when the pauses stop
12. Slow weight gain at 4 weeks
13. Bone protection in early IV nutrition
14. How severe is the day 2 bleed
15. Keeping an arterial catheter open
16. Monitor alarm at the cot side
17. Tender chest lump at 7 weeks
18. Starting fluid volume for her size
19. Parents ask about fluid on the brain
20. Pale leg after catheter insertion
21. Maternal supply runs short
22. Bright white matter on day 5
23. Oxygen need at 36 weeks
24. Retinal findings at 35 weeks
25. High sodium on day 3
26. Frequent pauses despite a clean screen
27. Venous catheter over liver shadow
28. Why preterm white matter is fragile
29. Bilious aspirates and blood on day 16
30. Steroid course during ventilation
31. Enlarging ventricles at 24 days
32. Why early birth weakens bone
33. Bloody urine and a flank mass on day 4
34. Planning discharge home
35. Parenteral protein at the start
36. Preterm scan at 5 weeks
37. Ridge with new vessels and plus
38. Kidney tests soon after birth
39. Pauses return on day 12
40. Supplements on full feeds
41. Widened wrists at 9 weeks
42. Salt level falls at 5 weeks
43. Neuroprotection in preterm labour
44. Confirming test for bloody urine
45. Protection before a winter discharge
46. Motor outlook after white-matter cysts
47. First milk for a 27-week boy
48. Eyes after treated retinopathy
49. Early detection of a motor problem
50. Follow-up of a 20-week scan finding

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Gastro-oesophageal reflux, T4 to T6 high, or T12 to L1 low, Volume-targeted ventilation, At 36 weeks postmenstrual age, Calcium alone, with phosphate added at full feeds, Gentle tactile stimulation, Likely after a bleed of any grade, At 4 to 6 weeks, then near term age, Restrict fluids to let the sodium settle, Rapid myelination of the cerebral cortex, Acetazolamide with furosemide, Completed retinal screening, Early vitrectomy of both eyes, From the first day of life.

Clinical pearls from this deck

• Twenty seconds, or shorter with a slow heart or a drop in saturation, in a preterm baby, and only after sepsis is excluded.
• Scan early because the bleed comes early and quietly; scan again later for what follows it.
• Start trophic, then climb by about 30 mL/kg a day if the baby is well.
• Arterial line: high T6 to T9, low L3 to L4; the zone between belongs to the gut and kidneys.
• In the preterm retina, too much oxygen early is as harmful as too little.
• Very preterm, falling weight, rising sodium: the water is leaving through the skin.

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.