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Test 9: Jaundice, anaemia and polycythaemia

  1. What is the definition of jaundice?
    • An increase in the concentration of bilirubin in the serum.
    • The yellow discolouration of the skin and sclera due to deposits of bilirubin.
    • A general feeling of nausea and lethargy.
    • Yellow skin due to eating carrots.
  2. Bilirubin is formed by the breakdown of:
    • Haemoglobin
    • Bile
    • Stercobilin
    • Proteins
  3. What is the normal total serum bilirubin concentration (TSB) in cord blood?
    • 0 µmol/l
    • Less than 35 µmol/l
    • 35–55 µmol/l
    • More than 55 µmol/l
  4. Before bilirubin can be excreted by the newborn infant it must first be:
    • Oxidised in the kidney
    • Haemolysed in the blood stream
    • Conjugated in the liver
    • Digested in the gut
  5. Jaundice lasting more than 3 weeks after delivery may be caused by:
    • Hypothyroidism
    • Hyperthyroidism
    • Hypoglycaemia
    • Anaemia
  6. Jaundice is commonest in:
    • Preterm infants
    • Term infants
    • Postterm infants
    • Underweight for gestational age infants
  7. Hepatitis commonly presents with obstructive jaundice and:
    • Dark stools
    • Pale stools
    • Blood-stained stools
    • Blood in the urine
  8. Jaundice between day 2 and 7 is:
    • Always abnormal
    • Usually a sign of haemolytic disease
    • Always treated with phototherapy
    • Common in normal, healthy infants
  9. Haemolytic disease of the newborn is caused by:
    • Lack of vitamin K
    • Bacteria crossing the placenta from the mother to the fetus
    • A cephalhaematoma or bruising
    • Damage to fetal red blood cells caused by maternal antibodies
  10. ABO haemolytic disease is likely in the following combination of blood groups:
    • The mother is A and the infant is B.
    • The mother is A and the infant is O.
    • The mother is O and the infant is A.
    • The mother is O and the infant is O.
  11. A positive Coomb’s test in the cord blood is found in:
    • Hepatitis
    • Physiological jaundice
    • ABO incompatibility
    • Jaundice of immaturity
  12. Hydrops (generalised oedema of the newborn) is common in:
    • ABO haemolytic disease
    • Rhesus haemolytic disease
    • Biliary atresia
    • Jaundice of immaturity
  13. Anti-D immunoglobulin should be given after delivery, miscarriage or antepartum haemorrhage to:
    • All women
    • All women who have had a previous infant with Rhesus haemolytic disease
    • All Rhesus-positive women
    • All Rhesus-negative women
  14. In Rhesus haemolytic disease the mothers blood group may be:
    • O –ve
    • O +ve
    • A +ve
    • B +ve
  15. Rhesus haemolytic disease must be suspected if:
    • An infant is jaundiced in the first 24 hours of life.
    • An infant has an elevated haemoglobin.
    • The Coomb’s test on the cord blood is negative.
    • The infant is a male.
  16. Bilirubin encephalopathy (kernicterus) causes:
    • Liver failure
    • Green staining of the skin called bronzing
    • Mental retardation
    • No clinical problems
  17. Phototherapy acts by:
    • Making unconjugated bilirubin water soluble
    • Conjugating bilirubin
    • Stimulating the liver
    • Changing bilirubin to stercobilin
  18. During phototherapy the serum bilirubin concentration is lowered by exposing the infant to:
    • Ultraviolet light
    • Visible light
    • Infrared light
    • Heat
  19. What treatment should be given to an infant if the total serum bilirubin concentration is above 400 µmol/l?
    • Phototherapy alone
    • Exchange transfusion
    • Oral phenobarbitone
    • Frequent feeds
  20. What is the normal range of packed cell volume (PCV) at birth?
    • 10–25%
    • 25–45%
    • 45–65%
    • 65–75%