Midwifery Practice and Normal Neonate MCQ examples Questions and Answers

Midwifery Practice and Normal Neonate MCQ examples Questions and Answers The number of fontanelles that you would expect to be able to palpate on Jack is: a) 1 b) 2 c) 3 d) 6 b) 2 If you could palpate a third fontanelle this might indicate that Jack has: a) Plagiocephaly b) Excessive moulding c) A congenital abnormality: Trisomy 21 d) Craniosinotosis c) A congenital abnormality: Trisomy 21 You explain to Kelly that Jack has 'caput' because there is a swelling on his head that: a) Is a light pinky colour and located at the base of his hairline b) Does not cross a suture line and pits with digital pressure c) Is firm and coloured like a reddish bruise d) Is a diffuse oedematous swelling of the soft tissues of his scalp and crosses a suture that will resolve in 24-48hours d) Is a diffuse oedematous swelling of the soft tissues of his scalp and crosses a suture that will resolve in 24-48hours The physical characteristics of Jack at 41 weeks gestation include all of these EXCEPT: a) Dry, peeling skin b) Ears stiff with instant recoil c) Abundance of vernix d) Scrotum with deep rugae a) Abundance of vernix Radiation is the most predominate mode of heat loss for Jack. Radiation refers to: a. loss of heat through water evaporation from the baby b. loss of heat through the baby shivering c. loss of heat from the baby's surface to surrounding colder objects d. loss of heat to moving air or fluid around the baby c. loss of heat from the baby's surface to surrounding colder objects Kelly asks how many hours a day does Jack is likely to sleep. You reply that it is usual for a newborn to sleep: a. 8 - 10 hours b. 10 - 12 hours c. 14 - 16 hours d. 18 - 20 hours c. 14 - 16 hours You palpate Jacks femoral pulses. If you found an asynchronous pulsation this may indicate: a. poor circulation to the legs b. common finding in the first weeks of examination' c. congenital cardiovascular anomaly d. less blood volume being pumped d. congenital cardiovascular anomaly Barlow's test is used to: a. Check the baby's buttocks creases are symmetrical b. Check that the limbs are of equal length c. Confirm that the pelvis is stable d. To access if hip is subluxable (can be easily dislocated of the acetabulum). e. None of the above d. none of the above Which of the following findings is Jack at increased risk of having because it occurred to his sister: a) Breech presentation b) Developmental dysplasia of the hips c) Port wine stain birthmark d) Absent red eye reflex Developmental dysplasia of the hips You examine Jacks genitalia. The most common finding in the male newborn is: a) Hydrocele b) Epispadias c) Inguinal hernia d) Chordee a) Hydrocele AT one week Kelly complains that Jack's umbilical cord is smelly. You: a.Tell her that often happens and reassure her all is well b.Inspect the cord and surrounding skin c.Clean the cord with antiseptic d.Phone a pediatrician b) Inspect the cord and surrounding skin As a midwife you are always ready to resuscitate a baby but which one of the following might reassure you that resuscitation is less likely to be needed for Charlotte's baby a) Meconium in the liquor b) Reassuring heart rate c) Prolonged labour d) Assisted delivery b) Reassuring heart rate Which of the following is NOT a characteristic of fetal circulation: a) Shunt dependent b) Hypogastric arteries c) Low oxygen affinity haemoglobin d) High pulmonary resistance c) Low oxygen affinity haemoglobin You explain that Charlottes fetus is able to produce urine from which gestation? a) 8-10 weeks b) 10-12 weeks c) 24-26 weeks d) 32-34 weeks b) 10-12 weeks Charlotte rapidly gives birth to Rosie in 2 ½ hours. She weighs 4320g and after attempting to feed has been disinterested in the last 32 hours requiring some expressed breast milk top-ups. Rosie is at an increased risk of hypoglycaemia because of: 1) Her size 2) Her disinterest in feeding 3) Her precipitous birth 4) Hypoxia that occurred during labour a) 1 and 2 b) 1, 2 and 3 c) 1, 2, and 4 d) 3 and 4 b) 1, 2 and 3 You clamp and cut Rosie's cord. This closes the ductus venosus because: a) Higher oxygen concentrations are now present as she is breathing b) The umbilical vein closes and systemic vascular resistance is increased c) The inferior vena cava is now receiving deoxygenated blood d) Higher pressure in the left atrium closes the foramen ovale decreasing vascular resistance d) Higher pressure in the left atrium closes the foramen ovale decreasing vascular resistance When listening to Rosies' heart you place your stethoscope on the area between the 4th and 5th rib left of the sternum to listen to which heart sound? a) Mitral b) Aortic c) Pulmonic d) Tricuspid d) Tricuspid Charlotte's has declined Vitamin K. You review the signs and symptoms of Vitamin K deficiency bleeding that could alert her to a problem. Signs of Vitamin K deficiency bleeding are: a) Urates in the nappy b) Lethargy, petechiae and bleeding from umbilicus c) Petechiae, jaundice and ooze from the umbilicus d) Lethargy, temp of 36.5, and delayed meconium passage b) Lethargy, petechiae and bleeding from umbilicus Fill in the gap: You explain that Rosie is more likely to develop jaundice as she produces ________ bilirubin than an adult? a) twice the amount of b) triple the amount of c) quadruple the amount of d) ten times the amount of a) twice the amount of When considering jaundice which of the following may increase bilirubin production? a) Vitamin K administration b) Hyperthermia c) Sepsis d) Early frequent feeding c) Sepsis Bilirubin conjugated in the liver can be deconjugated in the gut and can enter the enterohepatic bilirubin circulation. The enzyme responsible for this is: a) Bilirubin Oxidase b) Bilirubin hydrogenase c) Beta-glucuronidase d) Biliverdinreductase c) Beta-glucuronidase/glucoronyl transferase In fetal circulation which vessel carries oxygenated blood to the fetus? The umbilical vein In fetal circulation which vessels carry deoxygenated blood from the fetus to the placenta? The umbilical arteries What changes occur when the baby takes its first breath? The lungs are filled with air instead of fluid. Higher oxygen levels in the blood and alveoli filled with air instead of fluid allows for vascular resistance to decrease. This results in a greater increase in pulmonary blood flow. What are the anatomical changes that occur when the baby's lungs fill with air and the placenta is removed? Placenta is removed from circulation. Foramen ovale and Ductus Venosus and Arteriosus close. Higher pressure in the left atrium due to increased pulmonary blood flow cause the foraman ovale to close. Higher concentrations of oxygen in the blood, decreased prostaglandin levels and decreased pulmonary vascular resistance closes the ductus arteriosus. When the umbilical cord is clamped, the umbilical vein closes, systemic vascular resistance is increased and this causes the ductus venosus to close. When a baby is born and takes its first breath, the change in pulmonary pressure causes which embryonic vessel to constrict? Ductus Arteriosus What is the function of foramen ovale, and where is it situated anatomically in the fetus? The foramen ovale is anatomical opening between the right atrium and left atrium. It carries blood from the inferior vena cava into the left atrium, thereby bypassing the lungs. (Some blood flow enters the right atrium.) Why does the foramen ovale close? The first breath: the pulmonary alveoli open up and then the pressure in the pulmonary tissues decreases. Blood from the right heart rushes to fill the alveolar capillaries. Pressure in the right side of the heart decreases. Pressure in the left side of the heart increases as more blood is returned from the well-vascularized pulmonary tissue via the pulmonary veins to the left atrium. This closes foramen ovale When should the foramen ovale close? Closes shortly after birth Once closed what does the foramen ovale then become? The fossa ovalis What is the function of the ductus artieriosus, and where is it situated anatomically in the fetus? A vessel that connects the main pulmonary artery to the aorta. The blood flow that does enter the right atrium (mainly from the superior vena cava, 52% oxygen saturated) enters the right ventricle and then the main pulmonary artery where the blood flow then enters the ductus arteriosus which connects to the aorta. Once again, most blood flow bypasses the lungs and is directed to the systemic circulation. Blood flow is flowing in a right to left direction. Why does the ductus arteriosus close? Higher concentrations of oxygen in the blood, decreased prostaglandin levels and decreased pulmonary vascular resistance closes the ductus arteriosus. When does the ductus arteriosus close? The ductus arteriosus should functionally close within 8-10 hours and structurally within several months (in mature infants). Once closed what does the ductus arteriosus become? Ligamentum arteriosum What is the function of the ductus venosus? fetal blood vessel connecting the umbilical vein to the IVC. Blood flow regulated via sphincter then carries mostly highly oxygenated blood Once closed what does the ductus venosus become? The ligamentum venosum What is a patent ductus arteriosus? Common in females 2-3 times more than males, unknown reason why. If instead of functional closure after birth there is patent structure then aortic blood is shunted into the pulmonary artery. Most common congenital anomaly associated with maternal rubella infection during early pregnancy. Premature infants usually have a PDA due to hypoxia and immaturity. Surgical closure of PDA is achieved by ligation and division of the DA. What is a patent foramen ovale? ... most common form of an Atrial Septal Defects (ASDs) ... a small isolated patent foramen ovale is of no hemodynamic significance; but if other defects present (e.g. pulmonary stenosis or atresia), blood is shunted through the foramen ovale into the left ventricle, producing cyanosis, a dark bluish coloration of the skin and mucous membranes resulting from deficient oxygenation of the blood. ... A probe patent foramen ovale is present in up to 25% of people. A probe can be passed from one atrium to the other through the superior part of the floor of the fossa ovalis. Though not clinically significant (usually small) but may be forced open because of other cardiac defects and contribute to functional pathology of the heart. Results from incomplete adhesion between the original flap of the valve of the foramen ovale and the septum secundum after birth. By what week gestation do fetal kidneys have a full complement of nephrons? 35 weeks By what gestation is nephrogensis believed to cease? 35-36 weeks At birth the kidneys must now take over the role of the placenta. List at least 2 functions of Tom's kidneys that were previously done by the placenta e.g. fluid balance 1. osmolarity 2. Acid base balance List 2 factors that occur at birth that signal the kidneys to take over renal function 1. Increased blood flow/perfusion from clamping of the cord 2. Clamping of the cord thought to assist but probably more haemodynamic or morphological factors Glomerular filtration capability is limited therefore a baby . . . . has a reduced ability to concentrate or dilute his urine and little reserve to deal with increased levels of solutes. This also means he has a reduced ability to excrete drugs efficiently. What shape is a babys bladder and when would it be palpable? Cigar shaped, palpable when full 2cm above symphysis pubis You will normally let the mom know that their newborn should be able to pass urine when? Within 24hours Describe what normal urine looks like in the first 48 hours pale, straw coloured, until large volume of fluid ingested may be cloudy due to presence of urates/mucus Red stuff in the nappy.. what is that? Urates. Common finding in first two days. May indicate dehydration if baby day 3-4. Due to solutes being unable to be reabsorbed due to immature renal system Tom is weighed at Day 3 due to Kims request: He has lost 5% of his weight and you reassure her that this is normal and as he is feeding so well most likely due to his renal system: How is this involved in weight loss and what is this process called? Total body water content of the newborn is in larger proportion than that of an adult. After birth there is a shift of volume from the intracellular fluid compartment to the extracellular where it is lost through urine output and insensible water losses. This contributes to a 5-10% weight loss. This shift also protects the baby from dehydration until feeding volumes increase. The utlisation of BAT can also add to the weight loss. Drugs may interfere with Toms ability to void: Name one commonly associated with epidural analgesia. Lignocaine When, how and why does ovulation occur? How does the timing of ovulation effect cycle length? When and how does fertilisation occur? What is a blastocyst? What hormones does it release? What is a corpus luteum? What hormone does it release? When does the placenta take over? How does this impact on the menstrual cycle? How is EDD calculated? List five potential teratogens for a developing embryo or fetus -Alcohol -Infections (e.g. Toxoplamosis, Rubella, Cytomegalovirus, ---Herpes, Varicella, HIV, Listeria) -Drugs (e.g. methamphetamine, Cocaine, heroin) -Radiation (XRays) -Environmental toxins (e.g. mercury, Lead, pestcides) What are some common environmental toxins and what strategies could you discuss to minimise exposure? •Avoiding paint supplies such as stained glass material, oil paints and ceramic glazes, and instead using watercolour or acrylic paints and glazes. •If living in a home built before 1978, checking whether lead paint has been used. If such is the case, paint that is crumbling or peeling should not be touched, a professional should remove the paint and the site should be avoided while the paint is removed or sanded. •To decrease exposure to pesticides; washing all produce thoroughly, peeling the skin from fruits and vegetables or buying organic produce if possible. •Avoiding any cleaning supply labelled "toxic" or any product with a warning on the label, and instead trying natural products, baking soda, vinegar and/or water to clean. During the ovulatory phase of the menstrual cycle a)A surge of LH and FSH occurs b)There is a drop in the woman's basal temperature c)A surge of progesterone and oestrogen occurs d)The muscles of the cervix contract and the os closes tightly a)A surge of LH and FSH occurs The function of the corpus luteum is to a)Stimulate mammary development in preparation for lactation b)Produce oestrogen and progesterone until the placenta takes over c)Produce HCG until HPL is produced by the placenta d)Form the graafian follicle before it is ejected by the ovum b)Produce oestrogen and progesterone until the placenta takes over Following fertilisation, the cells within the blastocyst begin to differentiate according to the part of the embryo they will become. The outer layer of cells will form the placenta. This layer is called a)the trophoblast b)the corpus luteum c)the hypoblast d)the mesoderm a)the trophoblast You are discussing screening with Phoebe. She asks you "what is a neural tube defect?" The neural tube is a tube with develops in the first 3 weeks of pregnancy, and is what develops into a baby's brain and spinal cord. If the neural tube does not close properly this is known as a neural tube defect. An example of a neural tube defect is spina bifida In your answer give the gestation in which the neural tube develops AND one example of a neural tube defect. 1.GASTRULATION the embryonic disc forms 3 layers - ENDODERM Inner cell layer of the embryonic disc MESODERM Middle cell layer of the embryonic disc ECTODERM Top cell layer of the embryonic disc. Will later form: skin, hair, lenses of the eyes, lining of the internal and external ear, nose, sinuses, mouth, anus, tooth enamel, pituitary and mammary glands, and all parts of the nervous system. (IE THE NEURAL TUBE ARISES FROM THE ECTODERM) What is the definition of Neurulation? The ectoderm grows forming a thickened area. The ectoderm forms a pear shaped neural plate with a groove in it (called the neural groove). This is what will form the embryos nervous system. The neural groove and embryo then thickens and resembles the sole of a shoe. Somites (bumps and ridges) appear on either side of the neural groove (along the sole of the shoe) Neural tube folds and fuses at several points along the length of the neural tube. The budding somites "zipper" the neural tube closed. Cardiovascular development The heart is the first organ to function within an embryo. It starts to function at the beginning of the fourth week when the nutritional and oxygen requirements of the growing embryo can no longer be met by diffusion from the placenta. What is the name of the process which involves the heart separating into the atrial and ventricle chambers? Septation of the heart At what week in embryological life does the separation occur? 7. At what week in embryological life does the separation occur? Kyra says, "I usually drink 2 glasses of wine with dinner. That doesn't sound too excessive does it?" The midwife's best response would be "You should not drink alcoholic beverages at all during pregnancy" As the embryo progresses to a fetus the vasculature is still remarkably different to that of the adult, including the presence of three vascular shunts. Describe the role of each of these shunts: Foramen ovale blood travels from the right atrium to the left atrium Ductus venosus blood from the umbilical vein bypasses the liver to enter the inferior vena cava Ductus arteriosus blood passes from the pulmonary trunk into the aorta What are the three layers which form in the human embryo during gastrulation? Endoderm, Ectoderm, Mesoderm The embryonic period is classed as: From weeks 2-10 from LMP The fetal period is classed as From weeks 10-40 from LMP Apposition: The blastocyst is resting on top of the endometrium but is not firmly embedded. The blastocyst needs to imbed to begin nutrient transfer. Adhesion: Outer call layer of the blastocyst known as trophoblasts, multiply, invade and adhere to the endometrial tissue. Trophoblasts differentiate into: -Cytotrophoblasts -Syncitiotrophoblasts. They produce human chorionic gonadotropin (hCG) which ensures that the endometrium will remain receptive to the implanting embryo.