MedU Clipp Cases 1 and 2 Flashcards
1
Q
Infants born to adolescent mothers are at greater risk for?
A
- Lower birth weight
- Vertically acquired STIs (high inidence rate)
- Poorer developmental outcomes
- Increased risk of Fetal death
- Additionally, pregnant teenager has an increased risk of premature death compared to her non-pregnant peers
2
Q
HEEADSSS Questions?
A
- Home
- Education / Employment
- Eating disorder screening
- Activities / Affiliations / Aspirations
- Drugs (EtOH, Tobacco, Steroids)
- Sexuality (abuse, fights, weapons, seatbelts)
- Suicide (depression, mental health)
3
Q
Prenatal Effects of Tobacco?
A
- Low birth weight in the Fetus
- Characteristic facies
4
Q
Prenatal Effects of Alcohol?
A
- No “Safe” amount of alcolhol during pregnancy
- FAS is a distinct pattern of facial abnormalitis, growth defeciencies, CNS dysfunction
- Poor Motor skills
- Poor Eye Hand Coordination
- Learning Problems
- Difficulties w/ Memory
- Attention
- Judgment
5
Q
Prenatal Effects of Marijuana?
A
- Distinctive effects of Marijuana have not been identified
6
Q
Prenatal Effects of Cocaine?
A
- Vasoconstriction
- -> Placental insufficiency
- -> Low Birth Weight
- Deficits:
- Cognitive performance
- Information-processing
- Attention to tasks
7
Q
Maternal Factors Limiting Fetal Growth in Utero?
A
- Poor weight gain in the 3rd Trimester
- Preeclampsia
- Maternal Prescription
- Illicit Drug use
- Maternal Infections
- Uterine Abnormalities
8
Q
Placental Factors Limiting Fetal Growth in Utero?
A
- Placenta Previa
- Placental abruptions
- Abnormal Umbilical Vessel Insertions
9
Q
Fetal Abnormalities Limiting Fetal Growth in Utero?
A
- Fetal Malformations
- Metaboic Disease
- Chromosomal Abnormalities
- Congenital Infections
10
Q
Prenatal Lab Screening?
A
- Serelogical screening for Infections
- HIV
- Rubella
- Hepatitis B
- Blood Type and Rh
- Urine Drug screen
11
Q
Factors that Increase Risk of HIV Transmission
from Mother to Infant?
A
- Frequent, unprotected sex during pregnancy
- Advanced maternal HIV disease (High Viral Load)
- Membrane rupture > 4 hours prior to delivery if mother is not on anti-retroviral therapy
- Vaginal Delivery
- Breastfeeding
- Premature delivery ( < 37 weeks)
12
Q
GBS intrapartum antimicrobial prophylaxis?
A
- < 37 weeks
- Ruptured > 18 hours
- Temp > 100.4 F (38 C)
- Positive for GBS
- Previous infant w/ GBS
- GBS bacturia during any trimester
- Positive GBS vaginal-rectal screening in late gestation
- Unknown GBS status w/ onset of Labor
13
Q
Steps used to decrease risk of HIV Transmission?
A
- Treatment of anti-retroviral therapy if viral load > 1000 copies/mL
- Cessarian delivery preferred
- Formula feed infants (NO Breastfeeding)
14
Q
Methods to Stabilize a Infant’s Tempature?
A
- Skin-to-Skin contact
- Radiant warmer
- Incubator
15
Q
Elements of APGAR score?
A
- Apprearance (skin color)
- Pulse (heart rate)
- Grimace (reflex irritability)
- Activity (muscle tone)
- Respirations
16
Q
What percentalie is Small for Gestational Age (SGA)?
A
- Weight < 10th Percentile for Gestational Age
17
Q
What Percentage is Microcephalic?
A
- Head circumference < 10th Percentile for Gestational Age
18
Q
Hypoglycemia in Newborns?
A
- Decreased Glycogen storage
- Heat Loss
- Hypoxia
- Decreased Gluconeogenesis
19
Q
Hypothermia in Newborns?
A
- Cold stress
- Hypoxia
- Hypoglycemia
- Increased Surface Area
- Decreased Subcutaneous Insulation
20
Q
Polycythemia in Newborns?
A
- Chronic Hypoxia
- Maternal-fetal Transfusion
21
Q
DDx of Microcephaly and Purpuric Rash?
A
- TORCH infection
- Fetal Alcohol Syndrome
- Chromosomal Abnormality
- Prenatal Tobacco Exposure
- HIV Infection
22
Q
What does the O in TORCH stand for?
A
- Other Transplacental Infections
- HIV
- Hepatitis B
- Human Parvovirus
- Syphilis
23
Q
What Labs do you order for TORCH testing?
A
- Toxoplasma - Infant Toxoplasma Titer
- Other
- Rubella - Maternal and Infant Rubella Titer
- CMV - Infant Urine Culture
- Hepatitis B - Maternal Hepatitis B Surface Antigen (HBsAg)
24
Q
What are the Routine Newborn Medications?
A
- Vitamin K
- prevent Hemorrhagic disease (Vit. K def.)
- Hepatitis B vaccine
- > 2000 grams
- HBIG - vertical transmission of Hep. B
- Erythromycin (also Tetracycline or Silver Nitrate)
- Gonococcal conjunctivitis
- Chlamydia trachomatis conjunctivitis presents with a stachato cough 7 - 14 days later and neonatal prophylaxis does little to prevent Chlamydia conjunctivitis
25
Neurological CMV findings?
* Intracranial calcifications
* Diminished number of Gyri
* Abnormally thick Cortex (Lissencephaly or Agyria-pachygyria)
* Enlarged Ventricles
26
Sequelae of Congenital CMV?
* Hearing Loss (progressive)
* Microcephaly
* Intracranial Calcifications
* Hepatosplenomegally
* Rash
27
What is the Treatment for Congenital CMV?
* 6 months Therapy:
* Ganciclovir or Oral Valganciclovir
28
Absolute Contraindictations for Breastfeeding?
* Maternal HIV
* Active Herpes Simplex lesions on the Breats
* Active TB
* Drug use and abuse
* Infants w/ Galactosemia
29
Signs and Symptoms of Metabolic Disorders?
* Anorexia
* Lethargy
* Vomiting
* Seizures
* Metabolic Acidosis
* Unusual Odors
30
Anticonvulsants during pregnancy?
* Leads to Cardiac Defects
* Dysmorphic Craniofacial features
* Hypoplastic nails
* Distal phalanges
* IUGR
* Microcephaly
* Mental Retardation
31
Opiate use during pregancy appears as?
* CNS Findings
* Irritability
* Hyperactivity
* Hypertonicity
* High-pitched Cry
* Tremors
* Seizures
* GI (vomiting, diarrhea, weight loss, hunger, salvation)
* Respiratory (nasal stiffness, sneezing, yawning)
32
Fetal Alcohol Syndrom Facial Features?
* Smooth Philtrum
* Thinning of the Upper lip
* Small Palpebral fissures
33
Clinical features of PKU?
| (Phenylketonuria)
* Vomitting
* Hypotonia
* Musty Odor
* Developmental delay
* Decreased Pigmentation of the Hair and Eyes
* Phenylalanine-restricted diet is necessary
34
Caloric requirement of Term Infant?
100 - 120 cal/kg/day
35
Caloric requirement for Preterm Infant?
115 - 130 cal/kg/day
36
Caloric requiremtn for VLBW infants?
| (Very Low Birth Weight)
up to 150 cal/kg/day
37
Car Safety Guidelines for Kids?
* Children \< 13 y.o. should not sit in Front Seat
* Until 2 y.o. --\> Face rearward
* Middle of Backseat is most protected position
* Most effective seat is a 5-point harness
38
2 month immunizations?
* DTaP
* Hib
* IPV
* PCV13
* RotaV
* HepB - 2nd dose
39
What age should an infant double and tripple
their birth weight?
* Double - 5 months
* Triple - 12 months
40
What age will children double their birth length?
4 years
41
Absence of Red Reflex in infants suggests?
* Cataracts
* Glaucoma
* Retinoblastoma
* Chorioretinitis
42
6 month milestones?
* Gross Motor
* Rolls over, Sits unsupported, No Head lag pull to sit
* Fine Motor
* Reaches for objects, Looks at dropped items
* Language
* Turns toward voice, Babbles
* Social / Adaptive
* Feeds self, Stranger recognition
43
12 Month Milestones?
* Gross Motor
* Stands alone (many can walk well)
* Fine Motor
* Pincer Grasp
* Language
* Mama, Dada, and 1 or 2 other words
* Social / Adaptive
* Hands parents book wants to read
* Points when wants something
* Plays ball with examiner
44
18 months old milestones?
* Walk Backward
* Run
* Scribble
* 2 Block Tower
* 3 - 6 words
* Can help remove Garments
45
Wilm's Tumor?
* A/w Beckwith-Wiedemann Syndrome
* Genetic overgrowth syndrome
* Omphalocele
* Hemihypertrophy
* Hypoglycemia
* Large for Gestational Age
* Dysmorphic Features
46
What is a favorable characterristic for Neuroblastoma?
Non-ampliffication of the N-myc gene
