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Peds Shelf > Gestation and Birth > Flashcards

Gestation and Birth Flashcards

1
Q

What is the main source of energy for a growing fetus?

A

Carbs - preterm babies don’t have time to build glycogen stores - more likely to be hypoglycemic

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2
Q

Week 1 of development

A

Fertilization - fallopian tube ampulla

Implantation begins

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3
Q

Week 2 of development

A

Implantation complete

Endoderm & Ectoderm form

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4
Q

Week 3 of development

A

Mesoderm formed = “tri” laminar embryo

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5
Q

Week 5 of development

A

Forebrain, midbrain and hindbrain

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6
Q

Week 7 of development

A

Heart formed

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7
Q

Week 8 of development

A

Organogenesis complete

Placentation

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8
Q

Week 9 of development

A

Permanent kidneys (metanephri) begin functioning

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9
Q

Week 10 of development

A

Midgut returns (counterclockwise rotation)

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10
Q

Week 24 of development

A

Primary alveoli are formed and surfactant production begins

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11
Q

Week 26 of development

A

Testicles descend

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12
Q

What is the CNS/PNS, sensory epithelia of ear/eye/nose, epidermis, mammary glands, pituitary gland, and tooth enamel formed from?

A

Ectoderm

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13
Q

What are the spinal nerves, CN, autonomic ganglia, adrenal medulla, meninges, pigment and peripheral glial cells formed from?

A

Neural Crest (Ectoderm)

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14
Q

What forms the CT, bone, striated and smooth muscle, blood/lymph, gonads, spleen, adrenal cortex and serous membranes lining body cavities?

A

Mesoderm

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15
Q

What forms the epithelial lining of the GI tract/Resp tract/ and middle ear, thymus, parathyroid/thyroid, liver, and pancreas?

A

Endoderm

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16
Q

What forms the valve of the foramen ovale?

A

Septum primum

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17
Q

What is the path of O2 from mom to fetus?

A

Umbilical vein - ductus venosus - IVC - *RA - foramen ovale - aorta

or *RV - pulmonary trunk - ductus arterosus - aorta

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18
Q

Where does fetal erythropoiesis occur?

A

3-8 wks = Yolk sac

6-8 wks = Liver

9-28 wks = Spleen

28 + wks = Bone Marrow

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19
Q

What induces primary male sex cords to develop into male gonads?

A

Testis-determining factor

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20
Q

Failure of the neural tube to close can result in __________.

A

Spina bifida = unfused spinal arch +/- unfused dura and spinal cord

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21
Q

What ratio of lecithin to sphingomyelin in the amniotic fluid indicates fetal lung maturity?

A

> 3

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22
Q

When is maternal α-fetoprotein high?

A

Multiple gestation

Fetal neural tube defects

Gastroschisis

**Incorrect dating**

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23
Q

Maternal α-fetoprotein is low in what 2 disease?

A

Trisomy 21 and 18

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24
Q

What is the most common cause for abnormal AFP?

A

Incorrect Dates!!!

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25
Q

What intrauterine infection leads to microcephaly, hydrocephalus, intracranial calcifications, chorioretinitis, and seizures?

A

Toxoplasmosis

Cats!

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26
Q

What intrauterine infection can lead to meningoencephalitis, microcephaly, cataracts, sensorineural deafness, and PDA or pulmonary artery stenosis?

A

Rubella - rare post-vaccine

27
Q

IURG, low birth weight, jaundice, HSmegaly, chorioretinitis and intracranial calcifications can be caused by what?

A

CMV

28
Q

What are causes of IUGR? (5)

A

Renal agenesis

Maternal vascular disease

Alcohol/Cocaine/Narcotics/Phenytoin

PPROM

CMV

29
Q

What does this baby have?

A

Fetal Alcohol Syndrome

30
Q

What does a newborn receive for ppx?

A

GC/CT eye ppx - 1% silver nitrate and erythromycin

Hemorrhagic disease of the newborn - Vitamin K

31
Q

When does the anterior fontanelle close?

A

9-12 months

32
Q

True or False: Acrocyanosis (blue hands and feet) is always pathologic in a newborn?

A

False, can be normal

33
Q

A bulging fontanelle can indicate what?

A

Increased intracranial pressure

Hydrocephalus

Meningitis (Late-onset GBS)

34
Q

Symmetrically small babies =

Normal HC, small body =

A

Early onset (<28wks): HTN, renal disease, ch. abnormalities

Late onset (>28 wks): Multiple gestation, preeclampsia

35
Q

What is the most common bone fractured during delivery?

A

Clavicle

36
Q

What is the most common cause of an abdominal mass in a newborn?

A

Enlarged kidney

37
Q

Caput Succedaneum

A

Area of edema over presenting portion of scalp during vertex delivery

+/- bruising petechiae

38
Q

Cephalohematoma

A

Bleeding below periosteum of parietal bone - usually

5-10% have skull fractures

39
Q

“Claw Hand” deformity is caused by traction on what nerve roots?

A

C7 - C8

**Often seen with Horner’s Syndrome**

40
Q

Erbs Palsy

A

C5-C6

“Waiter’s Tip”

41
Q

How can you tell the difference between caput succedaneum and a cephalohematoma?

A

Caput = external to periosteum, crosses midline/suture lines

Cephalohematoma = below periosteium, doesn’t cross lines

42
Q

What are risk factors for perinatal infections?

A

ROM > 18 hrs

Age < 37 wks

Chorio

Maternal fever

Maternal GBS+

43
Q

What drug combos are used for neonatal sepsis?

A

Amp and Gent (Amp for listeria)

or

Amp and Cefotaxime

44
Q

3 wk infant presents with paroxysmal cough and tachypnea, bilateral diffuse crackles, hyperinflation and patchy infiltrates on CXR. Had conjunctivitis at 10 days.

A

Chlamydia pneumonia

PO erythromycin for 2 wks

45
Q

+Ortolani and Barlow tests indicate what?

A

Developmental Dysplasia of the hip

*Female, white, breech*

unilateral, left, short affected leg

46
Q

What is the most common presentation of CF in the neonatal period?

A

Meconium Ileus

*Failure to pass stool, abdominal distention, vomiting*

47
Q

How do you diagnose and treat Developmental Dysplasia of the Hip?

A

US

Pavlik harness or casting

48
Q

What other problems can be seen with a diaphragmatic hernia?

A

Chromosomal abnormalities

LBW/IUGR

49
Q

True or False: High indirect serum bilirubin in the first 24 hours of life is always pathologic.

A

True

A/O or B/O incompatibility

Rh iso-immunization

Infection

Liver disease

50
Q

What is the cause of physiologic jaundice? When do you see it?

A

Inc. bilirubin 2/2 increased enterohepatic circulation

Starts at 24hrs

Peaks at 3 days

Resolves within 2 weeks

51
Q

Kernicterus

A

Bilirubin neurotoxicity - deposits in basal ganglia

Deaf, encephalopathy, death

52
Q

At what bilirubin do you treat with phototherapy? Exchange transfusion?

A

12-20

20-25

53
Q

Premature infant

A

< 37 weeks

54
Q

Low-birth-weight infant

Very-low-birth-weight infant

A

<2500 grams

<1500 grams

55
Q

RDS of the newborn is caused by what? How do you diagnose it?

A

2/2 insufficiency of lung surfactant - alveoli don’t stay open

Fine, diffuse reticulogranular “ground glass” and air bronchograms

56
Q

If an infant needs supplemental O2 > 28 days what do they have?

A

Bronchopulmonary Dysplasia - squamous metaplasia/hypertrophy of small airways

**Can be wheezing**

57
Q

What causes Bronchopulmonary Dysplasia? (4) How do you treat it? (3)

A

Immature lung

Prolonged ventilation/Barotrauma

Oxygen toxicity to the lungs

O2 - PO steroids - bronchodilators

58
Q

An infant that is intolerant of feeds - bilious vomit - with abdominal distention, temp instability, RDS, sepsis, etc has what?

A

Necrotizing Enterocolitis

**Bowel ischemia and bacterial invasion of intestinal wall**

59
Q

Impression: Distended loops of bowel and pneumatosis intestinalis

What is it, how do you treat it?

A

Necrotizing enterocolitis

d/c feeds, ng tube, IV fluids, antibiotics, surgery

60
Q

What causes retinopathy of prematurity?

A

Proliferation of immature retinal vessels 2/2 excessive O2 use in premie

61
Q

Intraventricular Hemorrhage

A

Rupture of germinal matrix bv 2/2 hypoxic/hypotensive injury

dx w/ cranial US

*Correct underlying problem*

62
Q

How do you diagnose Rickets of Prematurity?

A

XR: Cupping/fraying of metaphyses, osteopenia, subperiosteal new bone formation

63
Q

What does an infant with the following have? How do you treat

  • Hypotonia
  • Craniotabes - occipital flattening
  • Harrison’s Groove - rib indentation at the diaphragm
  • Rachitic rosary - swelling of costochondral junction

​

A

Ricket’s of Prematurity - Ca/Phos occurs during 3rd trim.

Vitamin D and Calcium

**AlkPhos will also be inc.**

64
Q

Do you give vaccinations based on postnatal or gestational age?

A

Postnatal

Peds Shelf (11 decks)

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