ID and Endo Flashcards
MCC of EOS and LOS in term? EOS in VLBW?
- EOS: GBS, E. Coli, strep
- LOS: CONS, E. Coli, staph
- VLBW: E. Coli
Chocolate like amniotic fluid?
What does placenta have?
What other associated physical findings?
Listeriosis
micro-abscesses
discoloration/jaundice around umbilicus, granulomatosis infantisepticum
What is the rubella triad?
Late manifestations of rubella?
bones and eyes?
- cataracts, hearing loss, and CHD (PPS or PDA)
- thyroid disease, DM, and immunodeficiency
- celery stalking of bones and salt and pepper retinopathy
Classic triad for toxo?
Transmission during pregnancy?
When do they present?
Treatment?
- chorioretinitis, intracranial calcifications, and hydrocephalus
- Risk of transmission greatest in later pregnancy, but disease is worse if transmitted early
- preterm infants at ~3 months, term later
- pyrimethamine and sulfadiazine AND folate x1 year
Treatment for omphalitis?
vancomycin and cefotaxime
When does T4 synthesis begin in fetus?
14 weeks (T4 14)
When does the fetal thyroid begin to take up iodine?
10 weeks (10dine)
What is the most common system involved with hypothyrodism?
cardiac
About what % of infants affected with toxo will have visual/learning disabilities?
80%
When is C-section indicated for HIV+ mom?
viral load >1000
When does TSH peak?
30 minutes after birth?
Primary thyroid hormone in fetus?
rT3
When does PTH peak?
48 hours (follows calcium decrease after delivery, nadirs at 24 hours of life)
Which 2 adrenal hormones are not produced by the fetus?
3B-HSD and aromatase are produced by the placenta
- limited cortisol production before 30 weeks
- if placenta is deficient in aromatase and fetus is female, they have ambiguous genitalia d/t too much testosterone –> mother gets hirsuitism
Which of the following is NOT used to monitor hydrocort/fludrocort dosing in CAH?
- blood pressure, linear growth, bone age, hand/wrist X-rays, renin, aldosterone, ACTH, andostenedione
ACTH
What two lesions will culture negative
Chlamydia and SSSS
In what infectious condition do you give steroids as an adjunct for meningitis treatment?
TB
electrolyte abnormality with ampho B?
hypomagnesemia (think of it if you start ampho B after SIP and see seizures)
What are 4 causes of undervirilized male? 4 causes of overvirilized female?
male: 3 beta, 5 alpha, 17 (both alpha and beta), AIS
female: 3 beta, 11 beta, 21 alpha, aromatase deficiency
What viruses are dsDNA? ssDNA?
dsDNA: CMV, HBV, HSV, VZV
ssDNA: parvo
everything else is ssRNA
Which of the following is increased in preterm compared to term: T4, T3, TBG, thyroglobulin?
thyroglobulin
- What stimulates Wolffian duct differentiation?
- What stimulates Mullerian duct regression?
- What stimulates formation of scrotum and penis in 1st trimester?
- What stimulates phallic enlargement and testicular descent in 2nd trimester?
- Testosterone (formed by leydig cells and driven by placental hcg)
- MIS
- hCG (1st trimester)
- LH (2nd trimester)
Which one of the following is NOT used to evaluate an undervirilized male:
MIS, testosterone, DHT, LH, FSH, renin
renin (use in CAH)
Where does the wolffian duct come from?
Where does the mullerian duct come from?
Wolf: mesonephros
Muller: paramesonephric duct
MCC of conjunctivitis in the first month of life?
chlamydia
Between gonorrhea and chlamydia:
- which one is prevented with erythro ppx?
- which one presents earlier?
- how to treat each?
- gonorrhea is prevented with erythro
- gonorrhea at 2-5 days, chlamydia 5-14 days
- gonorrhea: CTX IV
chlamydia: erythromycin PO
gram pos/neg cocci/rod?
- clostridium
- TB
- GBS
- Listeria
- pseudomonas
- clostridium: gram positive rod
- TB: acid-fast rod
- GBS: gram positive diplococci
- Listeria: gram positive rod
- pseudomonas: gram negative rod
what radiographs do you do for vitamin D deficiency?
anterior knee less than three
hand/wrist if >4 years
25 hydroxy vs. 1,25 dihydroxy - what is low in vitamin D deficiency?
25 hydroxy
syphilis tests
Non-treponemal tests: RPR/VDRL
- Sensitive not specific
- Need to be confirmed with treponemal tests
- Quantitative - assess activity, medications response
Treponemal tests - MHA-TP, FTS-ABS
- Confirmatory: identify spirochete in skin lesions, placenta, umbilical cord, snuffles at autopsy
- Qualitative - once+ always+
- Presumptive dx - CSF+ VDRL, RPR/VDRL > 4 times maternal titer, IgM+, clinical symptoms
why do DiGeorge infants have hypocalcemia?
they have absent parathyroid glands –> low PTH –> low calcium
How is the RAA pathway stimulated?
decreased blood volume –> decreased blood flow to kidney –> juxtaglomerular cells sense decrease –> increase in renin
What are calcium, phos, and 1,25OH levels in MBD?
normal Ca/Phos, elevated 1,25OH
What is most threatening symptom of enterovirus
myocarditis
Liver hemangioma can cause what?
consumptive hypothyroidism (converts T3 back to rT3)
Hyperinsulinism treatment?
Diazoxide (monitor for pulm edema and neutropenia)
HSV:
- what L&D intervention increases risk?
- What type is most common, less common, least common?
- When does each present?
Fetal scalp monitor increases risk
Disseminated 7-10 days (least common)
SEM presents 5-14 days (most common)
CNS 15-21 days (less common)
CNS has retinitis and encephalitis
Testosterone is made in ______, stimulated by these two things
made in leydig cells, stimulated by hcg and LH
Rubella, syphilis, toxo infectious patterns?
Rubella: U-shaped (worse at beginning and at end)
Toxo and syphilis: worse if acquired at beginning, more common to be acquired at the end
