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Pathology > Childhood Diseases II > Flashcards

Childhood Diseases II Flashcards

1
Q

What are the common bacterial (2) and viral (1) causes of ascending infections?

A

Bacterial: GBS, E.coli
Viral: HSV II

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2
Q

What is the consequence of perinatal infx?

A

Preterm birth

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3
Q

What is the time scale for early onset neonatal sepsis? late?

A 
Early = 0-7 days
Late = 8 days - 3 months
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4
Q

What are the inflammations that can occur with transplacental infx?

A

Chorioamnionitis
Funisitis
Placentitis
VIllitis

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5
Q

What is the consequence of perinatal infx?

A

Preterm birth

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6
Q

What is the time scale for early onset neonatal sepsis? late?

A 
Early = 0-7 days
Late = 8 days - 3 months
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7
Q

What are the causes of Early onset sepsis? (2)

A 
GBS
Gram negative (e.coli, Klebsiella)
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8
Q

What are the causes of late onset neonatal sepsis? (6)

A 
Staph
H. Influenzae
Listeria
Chlamydia
Mycoplasma
Candida
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9
Q

What are the risk factors for early onset neonatal sepsis?

A
  1. Previous GBS disease
  2. GBS bacteriuria during pregnancy
  3. Delivery before 37 weeks
  4. Ruptured membranes >18 hrs
  5. Intrapartum temp > 38C
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10
Q

What are the histological characteristics of neonatal pneumonia?

A

Many PMNs filling the immature bronchioles (multiple nuclei)

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11
Q

Neonatal RDS occur how often with prematures infants under 28 weeks?

A

60%

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12
Q

What is the most common cause of neonatal RDS?

A

Hyaline membrane disease

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13
Q

What is the period of time that surfactant is produce? What are the cells that produce it?

A

26-32 weeks, there is a sharp increase in type II pneumocytes

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14
Q

What are the causes of NRDS besides lack of surfactant?

A 
Fetal head injury
Sedation
Aorta anomalies
Umbilical cord coiling
Amniotic fluid aspiration
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15
Q

What is hyaline membrane disease?

A

a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs (now called IRDS)

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16
Q

What type of baby gets hyaline membrane disease? (4 risk factors)

A
  1. Preterm
  2. Maternal DM
  3. Male
  4. Cesarean section
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17
Q

What is the consequence of atelectasis in hyaline membrane disease? (4 steps)

A
  1. Hypoxemia/CO2 retention
  2. Acidemia
  3. endothelial/epithelial cell damage, plasma leaks into alveolus
  4. fibrin deposition
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18
Q

What is hyaline membrane disease?

A

Deficient surfactant production leads to atelectasis

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19
Q

What is the clinical presentation of hyaline membrane disease? (5)

A
  1. Respiratory distress
  2. Cyanosis
  3. Hypoxemia
  4. Hypercarbia
  5. Mixed acidosis
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20
Q

What type of baby gets hyaline membrane disease?

A
  1. Preterm
  2. Maternal DM
  3. Male
  4. Cesarean section
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21
Q

What is the consequence of atelectasis in hyaline membrane disease? (4 steps)

A

Hypoxemia/CO2 retention»
Acidemia»
endothelial/epithelial cell damage»plasma leaks into alveolus»fibrin deposition

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22
Q

What are the histological characteristics of hyaline membrane disease? (3)

A

Hyaline deposition in the alveoli

Atelectatic alveoli

Necrotic/inflammatory cells

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23
Q

What is the clinical presentation of hyaline membrane disease? (5)

A
  1. Respiratory distress
  2. Cyanosis
  3. Hypoxemia
  4. Hypercarbia
  5. Metabolic acidosis
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24
Q

What are the complications of hyaline membrane disease?

A
  1. Intraventricular hemorrhage
  2. PDA
  3. Necrotizing enterocolitis
  4. Bronchopulmonary dysplasia
  5. Retinopathy
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25
Q

In whom does bronchopulmonary disease occur in?

A

Preterm neonates treated with oxygen therapy >4 weeks and positive pressure ventilation

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26
Q

What are the risk factors for necrotizing enterocolitis? (2)

A

Premature

Low birth weight

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27
Q

What causes bronchopulmonary disease?

A

Preterm neonates treated with oxygen therapy >4 weeks and positive pressure ventilation

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28
Q

What are the radiologic characteristics of bronchopulmonary dysplasia?

A

Sponge-like

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29
Q

Gas in the bowel wall of an infant= ?

A

Necrotizing enterocolitis

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30
Q

What are the complications of necrotizing enterocolitis? (2)

A
  1. Perforation

2. Stricture (stenosis)

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31
Q

What is the histological characteristics of necrotizing enterocolitis?

A

Hemorrhagic necrosis from the mucosa and extending to involve the muscular wall

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32
Q

What are the histological characteristics of bronchopulmonary dysplasia? (4)

A

Interstitial fibrosis
Epithelial Hyperplasia
Reduced alveoli
Squamous metaplasia

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33
Q

Cobblestone exterior surface of a lung = ?

A

Bronchopulmonary dysplasia

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34
Q

What is necrotizing enterocolitis?

A

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

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35
Q

What are the causes of necrotizing enterocolitis?

A

Multifactorial, ischemia, infx

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36
Q

What are the risk factors for necrotizing enterocolitis?

A

Premature

Low birth weight

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37
Q

What are the symptoms of necrotizing enterocolitis? (3)

A

Hematochezia
Abdominal distension
Ileus

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38
Q

What causes hydrops fetalis?

A

Maternal immunization to RhD antigen (she is Rh -, but father/fetus is Rh +)

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39
Q

Bloody stool in a neonate = ?

A

Necrotizing enterocolitis

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40
Q

What antibodies are involved in hydrops fetalis?

A

IgG antibodies to Rh complex

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41
Q

Why is it that the first pregnancy is not susceptible to hydrops fetalis?

A

Not enough maternal B cells producing IgG to cross the placenta

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42
Q

Gas in the bowel wall = ?

A

Necrotizing enterocolitis

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43
Q

What are the complications of necrotizing enterocolitis? (2)

A
  1. Perforation

2. Stricture

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44
Q

What does the hemolytic anemia in a fetus with erythroblastosis fetalis cause?

A

Heart failure
Liver failure
Hydrops fetalis

45
Q

What causes the distended abdomen in an infant born with erythroblastosis fetalis?

A

Hepatomegaly and massive ascites

This causes hypoplastic lungs

46
Q

What is the histological characteristics of necrotizing enterocolitis?

A

Hemorrhagic necrosis from the mucosa and extending to involve the muscular wall

47
Q

RBCs in a histological sample of the intestines = ?

A

Necrotizing enerocolitis

48
Q

What is fetal hydrops?

A

Edema in fetus

49
Q

What is the generalized edema in a fetus?

A

Hydrops fetalis

50
Q

What is cystic hygroma?

A

Localized edema in a fetus

51
Q

What is the cause of immune hydrops?

A

Blood group incompatibility

transplacental passage of anti-D IgG antibodies

52
Q

What are the causes of nonimmune hydrops?

A
  1. Infxs
  2. Chromosomal anomalies
  3. Twin pregnancy
  4. Cardio defects
53
Q

What causes hydrops fetalis?

A

Maternal immunization to RhD antigen (she is Rh -, but father is Rh +)

54
Q

What is the most common type of Rh type?

A

D

55
Q

What is a teratoma?

A

a tumor with tissue or organ components resembling normal derivatives of more than one germ layer

56
Q

What antibodies are involved in hydrops fetalis?

A

IgG antibodies to Rh complex

57
Q

Why is it that the first pregnancy is not susceptible to hydrops fetalis?

A

Not enough maternal B cells producing IgG

58
Q

What are cavernous hemangiomas?

A

A type of blood vessel malformation or hemangioma, where a collection of dilated blood vessels form a tumor/ Hemorrhage from these vessels cause symptoms.

59
Q

What is erythroblastosis fetalis?

A

Antibodoes + complement activation in the baby d/t maternal anti Rh + IgG

60
Q

What is kernicterus?

A

a bilirubin-induced brain dysfunction. Can be caused by erythroblastosis fetalis

61
Q

What causes the distended abdomen in an infant born with erythroblastosis fetalis?

A

Hepatomegaly and massive ascites

This causes hypoplastic lungs

62
Q

Kernicterus = what disease?

A

Erythroblastosis fetalis

63
Q

What is SIDS?

A

Unexplained death under 1 years of age

64
Q

How many cases of SIDS occurs in children in less than 6 months?

A

90%

65
Q

What are the maternal risk factors for SIDS? (5)

A
  1. Young maternal age
  2. Smoking
  3. Drug abuse
  4. Late/no prenatal care
  5. Short intergestational intervals
66
Q

What are the four environmental risk factors for SIDS?

A
  1. Prone sleep position
  2. Sleeping on soft surfaces
  3. Hyperthermia
  4. Postnatal passive smoking
67
Q

What are the infant risk factors for SIDS? (3)

A

Brain stem abnormalities
Male
Premature

68
Q

What are the two types of developmental vascular anomalies?

A
  1. Hemangioma

2. Vascular malformation

69
Q

What are the two types of lymphatic tumors in infancy?

A
  1. Lymphangioma

2. Lymphangiectasis

70
Q

What is the most benign tumor found in infancy?

A

Fibrous tumor

71
Q

What is the most common tumor in infants?

A

Hemangioma

72
Q

What are capillary hemangiomas called?

A

Strawberry hemangiomas

73
Q

What are cavernous hemangiomas?

A

A component of VHL disease–these can occur in cerebellum, brain stem, pancreas, liver

74
Q

What are hemangiomas?

A

A hemangioma is a benign and usually self-involuting tumor (swelling or growth) of the endothelial cells that line blood vessels, and is characterised by increased number of normal or abnormal vessels filled with blood. It usually appears in the first weeks of life and grows most rapidly over the first six months.

75
Q

What is the most common site of cavernous hemangioma?

A

Brain

76
Q

What are the histological differences between cavernous and capillary hemangiomas?

A

Cavernous has “caverns”, separated by thick CT stroma.

Capillary hemangiomas = thin walled capillaries with SCANT stroma

77
Q

How long do membranes have to be ruptured for to be considered a risk factor for neonatal sepsis?

A

> 18 hours

78
Q

What intrapartum temperature is considered to be a risk factor for early neonatal sepsis?

A

> 38 C

79
Q

Delivery before how many weeks is considered to be a risk factor for early onset neonatal sepsis?

A

37 weeks

80
Q

What are the two GBS indications that are categorized as risk factors for early onset neonatal sepsis?

A

Previous infant with GBS

GBS bacteriuria during pregnancy

81
Q

What is the effect of the acidosis caused by hyaline membrane disease on surfactant production? What is the consequence of this?

A

Decreases surfactant production, leading to increased CO2, more acidosis etc

82
Q

What is the effect of the acidosis caused by hyaline membrane disease on surfactant production and O2 absorption? What is the consequence of this?

A

Decreases surfactant production, leading to increased CO2, more acidosis etc

83
Q

What part of the intestines is most susceptible to necrotizing enterocolitis?

A

Ileum

84
Q

What are lymphangiomas?

A

malformations of the lymphatic system characterized by lesions that are thin-walled cysts; these cysts can be macroscopic, as in a cystic hygroma, or microscopic

85
Q

What is a major predisposing factor to perinatal infections?

A

PROM 12-24 hours before birth

86
Q

What are the usual complications of GBS infx in infants?

A

Pneumonia

Meningitis

87
Q

How do you diagnose IRDS?

A

at maturity the amniotic fluid lecithin/sphingomyelin ratio is >2 and phosphatidylglycerol is present

88
Q

WHat is the treatment for IRDS? (3)

A

steroids, surfactant therapy, oxygen

89
Q

What are the long term complications of IRDS and its treatment (2)?

A

oxygen toxicity causes bronchopulmonary dysplasia and retrolental fibroplasia (retinopathy of prematurity).

90
Q

At what level of alveolar septation/development does bronchopulmonary dysplasia block?

A

Saccular stage

91
Q

Pneumatosis intestinalis (gas in the intestinal wall) in an infant = ?

A

necrotizing enterocolitis

92
Q

What are the symptoms of IMMUNE hydrops fetalis?

A

Ascites and pericardial effusion are considered to be the early signs followed by skin edema and placental thickening, and eventually by pleural effusion in the preterminal stage of disease

93
Q

What are the symptoms of NON-IMMUNE hydrops fetalis?

A

pleural effusion is a common finding in combination with the usually present fluid collections in other body compartments.

94
Q

What is the pathogenesis of immune hydrops fetalis?

A

Maternal IgG antibodies to Rh, A, or B causes hemolytic anemia in the fetus.

95
Q

What is the clinical finding of immune hydrops fetalis?

A

Nucleated (immature) RBCs in fetal circulation

Hyperbilirubinemia

96
Q

What are the common causes of nonimmune hydrops fetalis?

A

Intrinsic RBC disorders (thalassemia etc)

97
Q

Human parvovirus B19 tropism is for what type of cells? What is the consequence of infection of this while prego?

A

Erythroid progenitor cells

Nonimmune hydrops fetalis d/t anemia

98
Q

What are “port-wine stains”?

A

Cavernous hemangiomas that do not regress

99
Q

What is the most common cause of lymphangiomas?

A

Cystic hygromas, a cavernous lymphangioma of the neck/axilla

100
Q

What is Lymphangiectasis?

A

dilated lymph channels presenting as a diffuse non-progressive swelling of an extremity with cosmetic consequences.

101
Q

What is the most prevalent fibrous tumor of infancy?

A

Infantile Myofibromatosis

102
Q

What is myofibromatosis?

A

solitary or generalized soft tissue tumors that may be located in the skin, muscle, bone or viscera

103
Q

When is myofibromatosis problematic?

A

The multicentric form with visceral involvement produces varied symptoms and death within the first 4 months of life.

104
Q

What is fibromatosis?

A

a condition characterized by the occurrence of multiple fibromas, subcutaneous nodules that sometimes may grow rapidly

105
Q

What is the marker of fibromatosis?

A

Muscle-specific Actin

106
Q

What causes the hyaline membrane formation in hyaline membrane disease?

A

Inflammation of endothelial/epithelial cells allow fibrin to leak into the alveoli, leading to deposiion

107
Q

What are the two heart complications of hyaline membrane disease?

A

Intraventricular hemorrhage

PDA

108
Q

What is the intestinal complication associated with hyaline membrane disease?

A

Necrotizing enterocolitis

109
Q

What is the ocular complication of hyaline membrane disease?

A

Retinopathy

Pathology (32 decks)

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