26: Childhood diseases II

Question 1

pathogens of ascending infection

Answer 1

E. coli, BGS

herpes simplex II

Question 2

inflammations associated with an ascending infection

Answer 2

chorioamionitis, funisitis, placentitis, villitis

Question 3

consequences of ascending infection

Answer 3

preterm birth

Question 4

lymphocytic infilrate of the chorionic villi, associated with recurrent miscarriage and fetal growth restiriction

Answer 4

villitis, a perinatal ascending infection

Question 5

early onset neonatal sepsis (0-7 d)

Answer 5

GBS
gram negative

e. coli and klebsiella
pneumonia
meningitis

Question 6

late onset neonatal spesis (8 d- 3 mo)

Answer 6

staphylocci

h. influenzae
listeria
 chlamdia
mycoplasma
candida

Question 7

causes of Neonatal RDS

Answer 7

prematurity (60% of infants born less than 28 sks)

• lack of surfactant
• fetal head injury
• sedation
• aorta anomalies
• umbilical cord coiling
• amniotic fluid aspiration

Question 8

risk factors for neonatal sepsis

Answer 8

• previous infant with GBS disease
• GBS bacteriuria during pregnancy
• delivery before 37 wk gestation
• ruptured membranes > 18 h
• intrapartum temperature >38

Question 9

most common cause of neonatal RDs

Answer 9

hyaline membrane disease

Question 10

leading cause of mortality and morbidity in premature infants

Answer 10

hyaline membrane disease

Question 11

risk factors for hyaline membrane disease

Answer 11

• preterm AGA
• maternal diabetes
• cesarean section
• male gender

Question 12

• respiratory distress
• cyanosis
• hypoxemia
• hypercarbia
• metabolic acidosis

Answer 12

hyaline membrane disease clinical

Question 13

complications fo hyaline membrane disease

Answer 13

• intraventricular hemorrhage
• PDA
• necrotizing enterocolitis
• bronchopulmonary dysplasia
• retinopathy of prematurity

Question 14

occurs in preterm neonates treated oxygen therapy > 4 wks and postiive pressure ventialtion

Answer 14

bronchopulmonary dysplasia

• sponge-like lung radiology, interstitial fibrosis, epithelial hyperplasia, squamous metaplasia, reduced number of alveoli, predispostion to respiratory infection

Question 15

cobblestone exterior sufrace of lung due to scarringa nd alternating hyperinflation and collapse of the underlying parenchyma

Answer 15

bronchopulmonry dysplasia

Question 16

ischemia results in focal to confluent areas of bowel necrosis, most often in the terminal ileum

Answer 16

necrotizing enterocolitis

Question 17

gas in the bowel wall observed in abdomial radiographs

Answer 17

necrotizing enterocolitis

Question 18

edema in fetus

Answer 18

fetal hydrops

generalized- hydrops fetalis
localized- cystic hygroma

Question 19

immune hydrops

Answer 19

blood group incompatibility

a cause of fetal hydrops

Question 20

nonimmune hydrops

Answer 20

cause of fetal hydrops

infections, chromosmal anomalies, twin pregnancy, cardiovascular defects

Question 21

pathogenesis of immune hydrops fetalis

Answer 21

mother Rh D-; father Rh D+

maternal immunization to Rh D antigen, transplacental passage of maternal anti-D IfF antibodies

• binding anti-D IfF to fetal Rh+ RBC
• destruction of anti-D IgG RBC complex

Question 22

observe: heart failure, liver failure, and hydrops fetalis

Answer 22

hemolytic anemia

Question 23

observe: jaundice, kernicterus

Answer 23

hyperbilirubinemia

Question 24

what is kernicterus?

Answer 24

prominent yellow staining of specific regions in the brain

Question 25

unexplained death under 1 yr of age

Answer 25

SIDS

90% of cases infant is less than 6 mo

Question 26

environmental SIDS risk factors

Answer 26

prone sleep position

sleeping on soft surfaces

hyperthermia

postnatal passive smoking

Question 27

paternal risk factors for SIDS

Answer 27

young mom 
smoking
drug abuse 
lacking prenatal care
short intergestational inervals

Question 28

infant risk factors for SIDS

Answer 28

abnormal brain stem

prematurity

Male

antecedent respiratory infections

multiple birth pregnancy

Question 29

pathology of SIDS (4)

Answer 29

• multiple petechiae (80% of cases)
• lungs congestion w. vascular engorgement
• hypoplasia of arcuate nucleus
• decreased brain stem neuronal populations

Question 30

most fibrous tumors are benign except…

Answer 30

firbosarcoma - malignant

Question 31

most common tumor in infants

Answer 31

hemangioma

Question 32

strawberry type hemangioma

Answer 32

capillary hemangioma (juvenile hemangioma)

Question 33

describe cavernous hemangiomas

Answer 33

a component of VHL disease – cavernous hemangiomas can be in cerebellum, brain stem, pancreas, liver

Question 34

what is funisitis?

Answer 34

inflammation of the umbilicus

Question 35

explain the malicious circle concerning decreased alveolar surfactant

Answer 35

decreased alveolar surfactant –> atelactasis –> hypoxemia and CO2 retentiion –> acidosis –> vasoconstriciton –> hypoperfusion –> endothelial and epithelial damage

**both hypoxemia and acidosis can lead to additionally reduced surfactat synthesis

Question 36

observe: alternating atelectatic alveoli and alveoar ducts dilated and lined by eosinophilic fibrin-rich thick hyaline

Answer 36

hyaline membrane disease

Question 37

sponge-like lung radiology

Answer 37

bronchopulmonary dysplasia