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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
In whom does bronchopulmonary disease occur in?
Preterm neonates treated with oxygen therapy >4 weeks and positive pressure ventilation
26
What are the risk factors for necrotizing enterocolitis? (2)
Premature | Low birth weight
27
What causes bronchopulmonary disease?
Preterm neonates treated with oxygen therapy >4 weeks and positive pressure ventilation
28
What are the radiologic characteristics of bronchopulmonary dysplasia?
Sponge-like
29
Gas in the bowel wall of an infant= ?
Necrotizing enterocolitis
30
What are the complications of necrotizing enterocolitis? (2)
1. Perforation | 2. Stricture (stenosis)
31
What is the histological characteristics of necrotizing enterocolitis?
Hemorrhagic necrosis from the mucosa and extending to **involve the muscular wall**
32
What are the histological characteristics of bronchopulmonary dysplasia? (4)
Interstitial fibrosis Epithelial Hyperplasia Reduced alveoli Squamous metaplasia
33
Cobblestone exterior surface of a lung = ?
Bronchopulmonary dysplasia
34
What is necrotizing enterocolitis?
**ischemia** results in focal to confluent areas of bowel necrosis, most often in the terminal ileum
35
What are the causes of necrotizing enterocolitis?
Multifactorial, ischemia, infx
36
What are the risk factors for necrotizing enterocolitis?
Premature | Low birth weight
37
What are the symptoms of necrotizing enterocolitis? (3)
Hematochezia Abdominal distension Ileus
38
What causes hydrops fetalis?
Maternal immunization to RhD antigen (she is Rh -, but father/fetus is Rh +)
39
Bloody stool in a neonate = ?
Necrotizing enterocolitis
40
What antibodies are involved in hydrops fetalis?
**IgG** antibodies to Rh complex
41
Why is it that the first pregnancy is not susceptible to hydrops fetalis?
Not enough maternal B cells producing IgG to cross the placenta
42
Gas in the bowel wall = ?
Necrotizing enterocolitis
43
What are the complications of necrotizing enterocolitis? (2)
1. Perforation | 2. Stricture
44
What does the hemolytic anemia in a fetus with erythroblastosis fetalis cause?
Heart failure Liver failure Hydrops fetalis
45
What causes the distended abdomen in an infant born with erythroblastosis fetalis?
Hepatomegaly and massive ascites This causes hypoplastic lungs
46
What is the histological characteristics of necrotizing enterocolitis?
Hemorrhagic necrosis from the mucosa and extending to involve the muscular wall
47
RBCs in a histological sample of the intestines = ?
Necrotizing enerocolitis
48
What is fetal hydrops?
Edema in fetus
49
What is the generalized edema in a fetus?
Hydrops fetalis
50
What is cystic hygroma?
Localized edema in a fetus
51
What is the cause of immune hydrops?
Blood group incompatibility | transplacental passage of anti-D IgG antibodies
52
What are the causes of nonimmune hydrops?
1. Infxs 2. Chromosomal anomalies 3. Twin pregnancy 4. Cardio defects
53
What causes hydrops fetalis?
Maternal immunization to RhD antigen (she is Rh -, but father is Rh +)
54
What is the most common type of Rh type?
D
55
What is a teratoma?
a tumor with tissue or organ components resembling normal derivatives of more than one germ layer
56
What antibodies are involved in hydrops fetalis?
IgG antibodies to Rh complex
57
Why is it that the first pregnancy is not susceptible to hydrops fetalis?
Not enough maternal B cells producing IgG
58
What are cavernous hemangiomas?
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
What is erythroblastosis fetalis?
Antibodoes + complement activation in the baby d/t maternal anti Rh + IgG
60
What is kernicterus?
a bilirubin-induced brain dysfunction. Can be caused by erythroblastosis fetalis
61
What causes the distended abdomen in an infant born with erythroblastosis fetalis?
Hepatomegaly and massive ascites This causes hypoplastic lungs
62
Kernicterus = what disease?
Erythroblastosis fetalis
63
What is SIDS?
Unexplained death under 1 years of age
64
How many cases of SIDS occurs in children in less than 6 months?
90%
65
What are the maternal risk factors for SIDS? (5)
1. Young maternal age 2. Smoking 3. Drug abuse 4. Late/no prenatal care 5. Short intergestational intervals
66
What are the four environmental risk factors for SIDS?
1. Prone sleep position 2. Sleeping on soft surfaces 3. Hyperthermia 4. Postnatal passive smoking
67
What are the infant risk factors for SIDS? (3)
Brain stem abnormalities Male Premature
68
What are the two types of developmental vascular anomalies?
1. Hemangioma | 2. Vascular malformation
69
What are the two types of lymphatic tumors in infancy?
1. Lymphangioma | 2. Lymphangiectasis
70
What is the most benign tumor found in infancy?
Fibrous tumor
71
What is the most common tumor in infants?
Hemangioma
72
What are capillary hemangiomas called?
Strawberry hemangiomas
73
What are cavernous hemangiomas?
A component of VHL disease--these can occur in cerebellum, brain stem, pancreas, liver
74
What are hemangiomas?
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
What is the most common site of cavernous hemangioma?
Brain
76
What are the histological differences between cavernous and capillary hemangiomas?
Cavernous has "caverns", separated by thick CT stroma. Capillary hemangiomas = thin walled capillaries with SCANT stroma
77
How long do membranes have to be ruptured for to be considered a risk factor for neonatal sepsis?
>18 hours
78
What intrapartum temperature is considered to be a risk factor for early neonatal sepsis?
>38 C
79
Delivery before how many weeks is considered to be a risk factor for early onset neonatal sepsis?
37 weeks
80
What are the two GBS indications that are categorized as risk factors for early onset neonatal sepsis?
Previous infant with GBS | GBS bacteriuria during pregnancy
81
What is the effect of the acidosis caused by hyaline membrane disease on surfactant production? What is the consequence of this?
Decreases surfactant production, leading to increased CO2, more acidosis etc
82
What is the effect of the acidosis caused by hyaline membrane disease on surfactant production and O2 absorption? What is the consequence of this?
Decreases surfactant production, leading to increased CO2, more acidosis etc
83
What part of the intestines is most susceptible to necrotizing enterocolitis?
Ileum
84
What are lymphangiomas?
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
What is a major predisposing factor to perinatal infections?
PROM 12-24 hours before birth
86
What are the usual complications of GBS infx in infants?
Pneumonia | Meningitis
87
How do you diagnose IRDS?
at maturity the amniotic fluid lecithin/sphingomyelin ratio is >2 and phosphatidylglycerol is present
88
WHat is the treatment for IRDS? (3)
steroids, surfactant therapy, oxygen
89
What are the long term complications of IRDS and its treatment (2)?
oxygen toxicity causes bronchopulmonary dysplasia and retrolental fibroplasia (retinopathy of prematurity).
90
At what level of alveolar septation/development does bronchopulmonary dysplasia block?
Saccular stage
91
Pneumatosis intestinalis (gas in the intestinal wall) in an infant = ?
necrotizing enterocolitis
92
What are the symptoms of IMMUNE hydrops fetalis?
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
What are the symptoms of NON-IMMUNE hydrops fetalis?
pleural effusion is a common finding in combination with the usually present fluid collections in other body compartments.
94
What is the pathogenesis of immune hydrops fetalis?
Maternal IgG antibodies to Rh, A, or B causes hemolytic anemia in the fetus.
95
What is the clinical finding of immune hydrops fetalis?
Nucleated (immature) RBCs in fetal circulation Hyperbilirubinemia
96
What are the common causes of nonimmune hydrops fetalis?
Intrinsic RBC disorders (thalassemia etc)
97
Human parvovirus B19 tropism is for what type of cells? What is the consequence of infection of this while prego?
Erythroid progenitor cells Nonimmune hydrops fetalis d/t anemia
98
What are "port-wine stains"?
Cavernous hemangiomas that do not regress
99
What is the most common cause of lymphangiomas?
Cystic hygromas, a cavernous lymphangioma of the neck/axilla
100
What is Lymphangiectasis?
dilated lymph channels presenting as a diffuse non-progressive swelling of an extremity with cosmetic consequences.
101
What is the most prevalent fibrous tumor of infancy?
Infantile Myofibromatosis
102
What is myofibromatosis?
solitary or generalized soft tissue tumors that may be located in the skin, muscle, bone or viscera
103
When is myofibromatosis problematic?
The multicentric form with visceral involvement produces varied symptoms and death within the first 4 months of life.
104
What is fibromatosis?
a condition characterized by the occurrence of multiple fibromas, subcutaneous nodules that sometimes may grow rapidly
105
What is the marker of fibromatosis?
Muscle-specific Actin
106
What causes the hyaline membrane formation in hyaline membrane disease?
Inflammation of endothelial/epithelial cells allow fibrin to leak into the alveoli, leading to deposiion
107
What are the two heart complications of hyaline membrane disease?
Intraventricular hemorrhage PDA
108
What is the intestinal complication associated with hyaline membrane disease?
Necrotizing enterocolitis
109
What is the ocular complication of hyaline membrane disease?
Retinopathy

Pathology (32 decks)

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