Diseases of Infancy and Childhood II

Question 1

fetal causes of FGR

Answer 1

chromosomal disorders
congenital anomalies
congenital infections (TORCH group)

Question 2

TORCH infections

Answer 2

toxoplasmosis
rubella
cytomegalovirus
herpesvirus

Question 3

proportionate FGR

Answer 3

symmetric growth restriction

-often due to fetal factor

Question 4

placental causes of FGR

Answer 4

unbilical-placental vascular anomalies

placenta abruption, previa, thrombosis, infection, etc.

Question 5

asymmetric FGR

Answer 5

disproportionate growth retardation
-sparing of brain

often due to placental FGR

Question 6

placental mosaicism

Answer 6

mutations at first or second postzygotic division - fetus and placenta

mutation in trophoblast or inner cell mass - placental only

often trisomy 7

Question 7

maternal causes of FGR

Answer 7

most common*

preeclampsia and HTN
inheritied thrombophilias
-factor V mutation

narcotic, alcohol, cigarettes

Question 8

nRDS

Answer 8

neonatal respiratory distress syndrome

• surfactant low**
• hyaline membrane disease

male
maternal diabetes
C section

Question 9

nRDS presentation

Answer 9

after delivery - breathing difficulty and cyanosis

rales in lungs

with therapy, good prognosis

Question 10

surfactant production

Answer 10

type II pneumocytes

Question 11

risk factors for nRDS

Answer 11

male
maternal diabetes
-bc insulin inhibits production
C section

Question 12

glucocorticoids and surfactant

Answer 12

increase its production

Question 13

atelactasis

Answer 13

lung collapse

-seen with nRDS

Question 14

histology of nRDS

Answer 14

stiff lungs lead to protein and fibrin exudate in alveolar spaces
-formation of hyaline membranes

barriers to gas exchange

Question 15

O2 treatmnet of nRDS

Answer 15

oxygen toxicity

• retrolental fibroplasia
• bronchopulmonary dysplasi

Question 16

retrolental fibroplasia

Answer 16

oxygen toxicity in Tx of nRDS

hyperoxic - VEGF decrease with treatment

endothelial apoptosis

VEGF increases with return to room oxygen - retinal vessel proliferation
-causes lesions in retina

Question 17

bronchopulmonary dysplasia

Answer 17

oxygen toxicity in Tx of nRDS

airway hyperplasia
-squamous metaplasia, interstitial fibrosis

Question 18

risk for infants with RDS

Answer 18

patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis

Question 19

type II pneumocytes

Answer 19

produce surfactant

• can regenerate
• necrotic in nRDS

Question 20

type I pneumocytes

Answer 20

cannot regenerate

Question 21

Tx of nRDS

Answer 21

oxygen
surfactant
steroids

Question 22

necrotizing enterocolitis

Answer 22

low birth weight infants

• associated with enteral feeding
• introduction of bacteria

Question 23

inflammatory mediator with NEC

Answer 23

PAF - increases mucosal permeability

Question 24

presentation of NEC

Answer 24

blood stools
abdomen distension
circulatory collapse

gas in intestinal wall
-pneumatosis intestinalis

Question 25

location of NEC

Answer 25

right side

-terminal ileum, cecum, right colon

Question 26

Tx for NEC

Answer 26

severe cases require resection

• of necrotic bowel
• often develop post-NEC strictures

Question 27

transcervical infection

Answer 27

ascending

most bacterial and few viral (herpes I)

inhalation of amniotic fluid
-or infected birth canal

pneumonia, sepsis, meningitis

Question 28

transplacental infection

Answer 28

hematologic

most parasitic and viral infections
few bacteria (listeria, treponema)

via chorionic villi

Question 29

parvovirus B19

Answer 29

causes erythema infectiosum

attacks erythroid cells
-diagnostic viral inclusions form

Question 30

TORCH infections

Answer 30

fever
encephalitis
chorioretinitis
hepatosplenomegaly
pneumonitis
myocarditis
hemolytic anemia
skin lesions

Question 31

pneumatosis intestinalis

Answer 31

with NEC

-multiple cysts

Question 32

early onset sepsis

Answer 32

group B strep

Question 33

group B strep

Answer 33

early onset sepsis - within first 7 days

Question 34

late onset sepsis

Answer 34

listeria and candida

Question 35

listeria and candida

Answer 35

late onset sepsis - after first 7 days

Question 36

infection acquired during vaginal delivery

Answer 36

HIV
Hep B
herpes

Question 37

immune fetal hydrops

Answer 37

Rh incompatability
-rhogam has decreased this significantly

may be blocked by ABO blood grouping (anti-A and anti-B IgM)

Question 38

primary fetal hydrops

Answer 38

non-immune

Question 39

hydrops fetalis

Answer 39

generalized edema of newborn

Question 40

path of Rh incompatability

Answer 40

Rh-negative mother immunized against Rh-positive fetal red cells

antibodies pass free across placenta

anemia and Hg degradation

• lead to cardiac decompensation and bilirubin
• lead to hydrops, jaundice, kernicterus

Question 41

IgM antibodies

Answer 41

don’t cross placenta

Question 42

IgG antibodies

Answer 42

cross placenta

-formed during second pregnancy

Question 43

common antigen in Rh incompatability

Answer 43

D-antigen

Question 44

anemia in Rh incompatability

Answer 44

hypoxic injury to heart and liver

decreased plasma protein production

generalized edema

Question 45

jaundice in Rh incompatability

Answer 45

hemolysis produces unconjugated bilirubin

-binds lipids in brain - kernicterus

Question 46

nonimmune hydrops

Answer 46

cardiovascular defects
chromosomal anomalies
fetal anemia - alpha thalassemia

Question 47

chromosomal hydrops

Answer 47

45,X (turner)

trisomy 21 and 18

Question 48

turner and hydrops

Answer 48

abnormal lymph drainage

• cystic hygromas
• postnuchal fluid

Question 49

parvovirus B19

Answer 49

can cause hydrops

destruction and decrease in RBCs

Question 50

most serious threat in hydrops fetalis

Answer 50

kernicterus

Question 51

cystic hygroma

Answer 51

edema around neck