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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
Pathophysiology of Herpes
- 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
Incidence of Herpes
.03-.3: 1,000 live births
27
Clinical Picture of Herpes
- mild disease of skin and mucous membranes of eyes and mouth - severe- involves all body organs including brain, microcephaly, retinal diseases, developmental delay
28
Diagnosis of Herpes
- isolation of virus and other lab tests | - Infants show signs of infection 5-9 days after birth
29
Medical Management of Herpes
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
Environmental Teratogens | -Prenatal drug exposure
- pathophysiology depends on the type of teratogenic agent | - substance in environment that negatively effects the developing fetus in utero
31
Types of Teratogens (Drugs)
narcotics, cocaine, PCP, heroin, methadone
32
Clinical picture of prenatal drug exposure
- LBW, intrauterine growth retardation (IGR), premature birth - hemorraghic infarctions - withdrawl symptoms; jitteriness, irritability, vigorous sucking - increased obstetric complications
33
Thalidomide (prenatnal drug exposure)
- 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
Acutain
- 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
Fetal alcohol syndrome (FAS)
-constellation of abnormalities directly related to alcohol ingestion during pregnancy
36
FAS pathophysiology
-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
FAS incidence
- 3-6: 1,000 live birhts | - 50-75% of infants of chronic alcoholics have FAS
38
FAS clinical picture
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
FAS diagnostic criteria
Must present with 3 criteria: 1. characteristic facial features 2. growth retardation (unexplained by nutrition) 3. central nervous system neurodevelopmental abnormalities
40
FAS characteristic facial features criteria
- a flattened midface - thin upper lip - indistinct/absent philtrum - short eye slits
41
FAS growth retardation criteria
- lower birth weight - disporportional weight not due to nutrition - height and/or weight below the 5th percentile
42
FAS CNS neurodevelopmental abnormalities criteria
- 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
FAS medical management
none- can't fix damage | -supportive care to issues presented to increase function
44
neonatal abstinence syndrome
Prenatal cocaine exposure - marijuna, tranquilizers, anticonvulsants (anti-seizure meds), oral contraceptives may also cause damage to developing fetus
45
Maternal Diabetes pathophysiology
- diaebetes mellitus in mother carries high risk to developing fetus and mother - incidence : related to incidence of diabetes and pregnancy
46
Maternal Diabetes clinical picture
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
Maternal Diabetes diagnosis
monitoring of glucose levels throughout pregnancy (urine and blood)
48
Maternal Diabetes medical management
- 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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