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Clin Med Fall 2015 > Developmental Disorders 3 Test 1 > Flashcards

Developmental Disorders 3 Test 1 Flashcards

1
Q

Development

A

conception through adolescence

  • prenatal
  • perinatal
  • postnatal
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2
Q

Congenital Infections

A 
passed from mother to child while pregnant-STORCH
S=syphilis
T=toxoplasmosis
O=other ( HIV)
R=rubella
C=cytomegalic inclusion disease
H=herpes (active genital)
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3
Q

Pathophisology of Syphilis

A
  • sexually transmitted bacteria ( Trepnema Pallidum)

- untreated syphilis transmitted from mother to fetus via placenta

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4
Q

Incidence of Syphilis

A

dependent on incidence of untreated syphilis in pregnant women

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5
Q

Clinical Picture of Syphilis

A

25% fetal death by 2nd trimester and 25% die soon after birth
Of the 50% survive past first few weeks;
- 25% show signs of jaundice, anemia, pneumonia, skin rash, and bone inflammtion
-75% show no signs at birth but later manifest abnormalties in teeth, blindness, skeletal anomalies , mental retardation (MR), sensorineural deafness
- can be born w/ active syphilis lesions on body

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6
Q

Diagnosis of Syphilis and medical mangement

A
  • blood test

- antibodics(penicillin)

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7
Q

Toxoplasmosis pathophysiology

A

-protozoan (Toxplasma gondii) present in cat feces

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8
Q

Incidence of Toxoplasmosis

A

1-2: 1,000 live births

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9
Q

Clinical picture of Toxoplasmosis

A

may pass through placenta of mother and cause spontaneous abortion or premature delivery
-affected infants are characterized as LBW, enlarged liver/spleen, jaundice anemia

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10
Q

Infants with Toxoplasmosis

A

may present with:

hydrocephalus, microcephaly, calcification in the brain, MR, seizures, CP, diseases of retina causing blindness

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11
Q

Diagnosis of Toxoplasmosis

A
  • Suspect in any infant showing signs of congenital infection
  • confirmed by blood test
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12
Q

Medical Management of Toxoplasmosis

A

Anti-protozoan medication (efficacy not proven) used during newborn period may prevent further damage by organism

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13
Q

HIV pathophysiology

A

infection by human immunodeficiency virus

80% of kids with aids acquired the virus in utero via transplacental transfer the other 20% from breast milk

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14
Q

Clinical picture of infants with AIDS

A

Opportunistic infections, pneumonitis, microcephaly, neurological abnormalities (90% show signs of static or progressive encephalopathy)

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15
Q

Diagnosis and medical management of HIV

A
  • blood test

- variety of drug therapies to address HIV and other meds to address opportunistic infections

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16
Q

Rubella pathophysiology

A

Togavirus which multiples in upper respiratory tract and passes into blood stream via cervical lymph nodes

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17
Q

Incidence of Rubella

A

.1-.7: 1,000 live births

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18
Q

Clinical picture of Rubella

A
  • may cause spontaneous abortion
  • blindness, deafness, MR, LBW, rash
  • Heart defects, enlarged liver/spleen, microcephaly, cataracts, micropthlamia (small eyes)
  • newborn: lethargic, inactive, opisthotonic posturing, seizures, thyroid disease, diabetes
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19
Q

Rubella Diagnosis

A
  • Suspect in any infant showing signs of congenital infection
  • isolated by blood test
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20
Q

medical management for rubella

A

non-specific treatment except prevention by immunization

21
Q

Pathophysiology of Cytomegalic Inclusion Disease

A

cytomegalo virus (CMV) transmitted through intimate contact or droplet contamination (sneezing/coughing)

22
Q

Incidence of Cytomegalic Inclusion Disease

A

10-20: 1,000 live births

23
Q

Clinical picture of Cytomegalic Inclusion Disease

A
  • may cause uterine death or premature death
  • LBW, jaundice, rash, micropthalmia, diseases of retina, deafness, developmental delay
  • 90% newborns with CMV are asymptomatic
  • some develop long-term problems
24
Q

Diagnosis and Medical Management for Cytomegalic Inclusion Disease

A
  • blood test

- antiviral meds under investigation.. currently no specific treatment

25
Q

Pathophysiology of Herpes

A
  • herpes simplex virus
  • transmission to fetus is neonatal rather than congenital (through the placenta)
  • most often transmitted during birth when mother has active genital herpes
26
Q

Incidence of Herpes

A

.03-.3: 1,000 live births

27
Q

Clinical Picture of Herpes

A
  • mild disease of skin and mucous membranes of eyes and mouth
  • severe- involves all body organs including brain, microcephaly, retinal diseases, developmental delay
28
Q

Diagnosis of Herpes

A
  • isolation of virus and other lab tests

- Infants show signs of infection 5-9 days after birth

29
Q

Medical Management of Herpes

A

antiviral meds reduce number of deaths, but severe brain damage occurs even with treatment
- identify herpes prior to labor and delivery and attempt c-section

30
Q

Environmental Teratogens

-Prenatal drug exposure

A
  • pathophysiology depends on the type of teratogenic agent

- substance in environment that negatively effects the developing fetus in utero

31
Q

Types of Teratogens (Drugs)

A

narcotics, cocaine, PCP, heroin, methadone

32
Q

Clinical picture of prenatal drug exposure

A
  • LBW, intrauterine growth retardation (IGR), premature birth
  • hemorraghic infarctions
  • withdrawl symptoms; jitteriness, irritability, vigorous sucking
  • increased obstetric complications
33
Q

Thalidomide (prenatnal drug exposure)

A
  • medication used in the 1960s as a sleeping pill/sedative
  • withdrawn from use due to potential for teratogenic effects if taken during pregnancy
  • Phocomelia: developmental anomaly of absence of upper portion of one or more limbs
  • feet or hands are attached to trunk by short irregular shaped stumps resembling fins of a seal (no humerus or femur, webbed or no individual digits)
34
Q

Acutain

A
  • medication used for cystic acne (vitamin A derivative)
  • when taken during pregnancy it causes brain and craniofacial anomalies or death
  • 33% fetal death, 25% congenital anomalies and neural crest anomalies
35
Q

Fetal alcohol syndrome (FAS)

A

-constellation of abnormalities directly related to alcohol ingestion during pregnancy

36
Q

FAS pathophysiology

A

-direct effect of alcohol on developing organs
- genetic predisposition or poor nutrition may be contributing factors
- may damage fetus anytime during pregnancy
- currently no established amount of alcohol w/ prego women can safely consume
(chronic use of alcoholism- not just once by mistake)

37
Q

FAS incidence

A
  • 3-6: 1,000 live birhts

- 50-75% of infants of chronic alcoholics have FAS

38
Q

FAS clinical picture

A

Pre and post natal growth deficiency
-LBW or VLBW & intrauterine growth retardation (IGR)
Facial dysmorphology:
-microcephaly, small wide set eyes (hypertelorism-wide set), thin upper lip
- shortened upturned nose, receding chin (micognathia), drooping eyelids, epicanthal folds ( flap over conjuctiva-also present in Downs Syn.)
- cleft palate( varying severity), small mouth, wide space b/t nose and upper lip (philtrum)
Muscle changes (not present or smaller than typical), visual disturbances, congenital heart disease, behavior problems

39
Q

FAS diagnostic criteria

A

Must present with 3 criteria:

  1. characteristic facial features
  2. growth retardation (unexplained by nutrition)
  3. central nervous system neurodevelopmental abnormalities
40
Q

FAS characteristic facial features criteria

A
  • a flattened midface
  • thin upper lip
  • indistinct/absent philtrum
  • short eye slits
41
Q

FAS growth retardation criteria

A
  • lower birth weight
  • disporportional weight not due to nutrition
  • height and/or weight below the 5th percentile
42
Q

FAS CNS neurodevelopmental abnormalities criteria

A
  • impaired fine motor skills
  • learning disabilities
  • behavior disorders or a mental handicap (the latter of which is found in approx 50% of those with FAS)
  • often not diagnosed until 2-4 y/o (NOT at birth) due to other skill sets being delayed
43
Q

FAS medical management

A

none- can’t fix damage

-supportive care to issues presented to increase function

44
Q

neonatal abstinence syndrome

A

Prenatal cocaine exposure
- marijuna, tranquilizers, anticonvulsants (anti-seizure meds), oral contraceptives may also cause damage to developing fetus

45
Q

Maternal Diabetes pathophysiology

A
  • diaebetes mellitus in mother carries high risk to developing fetus and mother
  • incidence : related to incidence of diabetes and pregnancy
46
Q

Maternal Diabetes clinical picture

A

high risk of intrauterine fetal death, maternal mortality 0CVA, toxemia (high spikes in BP -> stroke), coma), renal failure, perinatal fetal mortality, abruptio placenta(prematurely detached placenta), hydroaminos (low amt of amniotic fluid), premature labor, congenital abnormalities
-post-natally infants may have problems in multiple systems

47
Q

Maternal Diabetes diagnosis

A

monitoring of glucose levels throughout pregnancy (urine and blood)

48
Q

Maternal Diabetes medical management

A
  • strict maternal diet (control BP, decreased risk to fetus)
  • at birth treated as high risk infant regardless of gestational age or birth weight ( increased US, appointments and BP checks)

Clin Med Fall 2015 (10 decks)

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