FINAL FALL 2019 MCN568 Flashcards
Amnion Nodosum in the placenta?
are nodules found on the amnion, and is frequently present in oligohydramnios
Is DNA random?
TRUE
What cells produce testosterone?
Leydig cells
S&S of polyhydramnios?
malformations of esophagus and upper GI, inhibited fetal swallowing, aneuploidy, intermittent renal obstruction, MD, TTTS
Chronic Villi Sampling risk?
limb abnormalities
what is the difference between DNA, gene, chromosome?
DNA-double stranded nucleoid acid build of nucleotides (A, T, G, C) and sugar deoxyribose
Chromosome- structural unit composed of DNA on a framework of proteins, carry genetic information, each human cell has 23 chromosomes
Gene-a sequence of chromosomal DNA that can specify the sequence of amino acids in a particular polypeptide
Chromosome carries genes
genes carry DNA
maternal DM causes what?
TGA, VSD, cardiomyopathy, renal abnormalities, NTDs
who has Wolf and Mull ducts?
Wolffian and Müllerian ducts, also known as mesonephric and paramesonephric ducts, respectively. The Wolffian duct remains in males and the Müllerian duct persists in females
variable decels are caused by?
compression of the umbilical cord and represent physiologic changes in response to alternations in vascular resistance and preload
Turner S&S?
mosaicisms in 25%
ovarian dysgenesis (hypoplasia to absence)
broad shield-like chest with wide nipples
congenital lymphedema (puffy hands and feet)
anomalous auricles
renal anomalities
webbed posterior neck
low posterior hair line
teratogen definition
anything external to the fetus that causes a structural or functional disability in prenatal and postnatal life
meds, maternal conditions, infections, environmental factors
zygotic development pattern
cranio-caudal?
best predictor of premature labor
cervical length
Fetal fibronectin fFN
noise exposure for the fetus
both low and high frequency might produce physiologic changes; increase fetal HR and movement; congenital anomalies, prematurity, low birth weight; avid exposure above 65dB
twin pregnancies
dizygotic-two eggs monozygotic-one egg dichorionic-two sacks monochorionic-one sac monoamniotic diamniotic
newborn screening program tests for what?
metabolic and genetic disorders
epigenics and genomic imprinting syndromes
Angelman, Prader-Willi, Beckwith-Wiedemann
what is hypospadias?
the urethral orifice is situated on the ventrical aspect of the penis at the site proximal to the normal opening
epigenetics and genomic imprinting syndromes
Angelman, Prader-Willi, Beckwith-Wiedemann
Turner S&S?
mosaicisms in 25% female x-linked disorder
ovarian dysgenesis (hypoplasia to absence)
broad shield-like chest with wide nipples
congenital lymphedema (puffy hands and feet)
anomalous auricles
renal abnormalities
webbed posterior neck
low posterior hairline
Dubowitz assessment/Ballard Scores
skin texture, lanugo, plantar creases, breast, eyes and ears, genitals male and female
most common NTDs?
myelomeningocele, prevention Folic Acid
Achondroplasia
associated with advanced paternal age, form of short-limb dwarfism
Cornelia De Lange
synophrys- fusion of the eyebrows in the midline
Pyloric Stenosis S&S?
projectile nonbilious vomiting
firm non-tender olive
Dubowitz assessment/Ballard Scores
skin texture, lanugo, plantar creases, breast, eyes and ears, genitals male and female
DiGeorge Syndrome S&S
macrostomia- large mouth
CHD
hypocalcemia
Amniotic band sequence
group of birth defects that result when strands of the amniotic sac detach and wrap around parts of the baby in the womb. The defects may affect the face, arms, legs, fingers, or toes
Beckwith-Wiedemann syndrome S&S
LGA
refractory hypoglycemia
macroglossia- enlarged protruding tongue
omphalocele- abdominal contents protrude through the umbilical opening
DiGeorge Syndrome S&S
macrostomia- large mouth defect of thymus hypoparathyroidism CHD truncus arteriosus or aourtic arch anomality hypocalcemia
metabolism
require conversion to more water-soluble metabolites for efficient elimination from the body
liver phase I and Phase II
P450
excretion
renal: kidneys
Neonates often have a larger volume of distribution but delayed excretion compared to older children or adults, resulting in the need for higher mg/kg doses of medications with potentially longer dosing intervals
absorbtion
the passage of a drug from its site of administration into the circulation
distribution
drug into the extravascular tissues is largely influenced by body composition, which is much different in a neonate compared with an older infant or adult.
protein binding
steady state
the result of maternal drug disposition
ultimately determines the amount of the drug available for distribution to the fetal compartment
half-life
the time required for any specified property (e.g. the concentration of a substance in the body) to decrease by half
Methylxanthines
caffeine and theophylline, are a mainstay in the treatment and prevention of AOP
pulmonary vasodilators
bosentan
sildenafil and tadalafil
RX: acute and chronic PPHN
nitric oxide
surfactant
RDS
therapeutic drug monitoring
aminoglycosides, vancomycin, phenobarbital, digoxin
erythema toxicum
newborn rash; small white or yellow papules or vesciles with erythematous bases
milia
multiple yellow or pearly white papules 1mm
brow, cheeks and nose
Ebstein pearls
Bohn nodules
miliaria
heat rash
sebaceous nevus
immature hair follicles and sebaceous gland
mongolian spot
hyperpigmented macule
buttock, flanks, shoulders
gray or blue green in color; bruising? NOT
cafe au lait patch
tan or light-brown, oval-shaped macule with a well-defined border
six or more patches greater than 0.5 cm in length may indicate cutaneous neurofibromatosis
subcutaneous Fat necrosis
a subcutaneous nodule or nodules that are hard, nonpitting, and sharply circumscribed
red or purplish color
term newborns and are thought to be caused by trauma, cold, or asphyxia
nevus simplex
salmon patch or stork bite
vascular birthmark
nape of the neck, upper eyelids, bridge of the nose, upper lip
port wine nevus
flat pink or reddish-purple lesion consisting of dilated, congested capillaries directly beneath the epidermis
sharply delineated edges and does not blanch with pressure
Infantile hemangioma
strawberry mark
bright-red, raised, lobulated tumor that occurs on the head, neck, trunk, or extremities. It is soft and compressible, with sharply demarcated margins
aplasia cutis congenita ACC
congenital abnormality characterized by the absence of some or all layers of the skin
scalp
caput succedaneum
edema of the presenting part of the scalp
usually crosses suture line
resolves in days
cephalhematoma
collection of blood between the periosteum and the skull
resolves in weeks
clearly demarcated edges confined by suture lines
subgaleal hemorrhage
galea aponeurotica or subaponeurotic space
head size
33-37cm avarege 35cm
hypo-hyper telorism
how wide are the eyes
cystic hygroma
neck mass,
development of sequestered lymph channels, which dilate into large cyst
Ortolani maneuver
test for hip reduction
means that the hip is “out.” The maneuver is used to place the hip back into a normal position.
positive Ortolani maneuver is produced when a palpable “clunk” is noted, indicating that the femoral head has slipped from a dislocated position into the acetabulum
positive Ortolani sign (hip dislocated, but reducible
Barlow maneuver
determines whether the femoral head can be dislocated from the acetabulum
positive Barlow maneuver (hip reduced but dislocatable)
cryptorchidism
Bilateral undescended testes; should descend by 36 weeks
newborn behavioral states
deep sleep, light sleep, drowsiness, quiet alert, active alert, crying
habituation
infant’s ability to decrease a response to a repeated stimulus
retractions
negative intrapleural pressure generated by the contraction of the diaphragm and other respiratory muscles and the mechanical properties of the lungs and chest wall
stiff lungs cause more retractions
lung developmental stages
EMBRYONIC: 4-7weeks, elongation, anatomic framework; 6 branchial arches and breathing structures
PSEUDOGLANDURAL: 6-16weeks: branching, lung components complete
CANALICULAR:16-26: primitive type I and II
SACCULAR: 24-36 alveolar sacs, gas exchange: type I and II; surfactant synthesis,
ALVEOLAR: 32-8 years saccular septation
pulmonary vasculature
caudal
angiogenesis, vasculogenesis, fucion
surfactant composition
phospholipids, proteins A and D-host defense immune system; B amd C disbursement of surfactant within the alveolus, fats
decreased affinity to oxygen
shift to the right usually happens in postnatal period
less oxygen will remain bound to hemoglobin in the lungs as more is released to the tissues
blood gases values
pH 7.25-7.45 pO2 55-95 pCO2 27-45 HCO3 17-24 base -5/5+ FiO2 88-95%
Congenital Lobar Emphysema
Cystic Lung Lesion; lobar overilflation; results in air trapping, mediastinal shift and compression of surroundings
long term: wheezing
RDS patho
surfactant deficiency; atelectatic alveoli recult in ventilation to perfusion mismatch causing: cyanosis, impaired )2/CO2 exchange, increased pulmonary pressures, delay in
adaptation
xray: round glass, air bronchograms
MAS patho
a ball-valve effect of obstruction by particulate meconium in the distal airways of the lung, inactivation of surfactant, and development of pneumonitis. Alveolar overdistension and gas trapping caused by meconium particles blocking the distal airways during expiration increases the risk of air leaks and may result in an increased anterior-to-posterior diameter, or barrel-chest appearance
apnea types
the cessation of breathing for greater than 15-20 seconds.
central
obstructive
mixed
