Module 2 Flashcards
genetic diseases, women's reprocuctive health, men's health, STIs
What family hx elements should be included when considering a genetic syndrome?
- the age and sex of family members
- when family members were affected by disease or when they died
- the ethnic background
- If there is consanguinity
What is the most common chromosomal abnormality?
Down syndrome
The underlying karyotype for Down Syndrome
95% nonfamilial trisomy 21 (47 total chromosomes),
3% to 4% unbalanced translocation
1% to 2% genetic mosaicism
Birth rates are highest among who?
mothers of advanced maternal age (one in 400 at 35 years of age, one in 105 at 40 years of age, one in 12 at 45 years of age); however, 80% of all children with Down syndrome are born to mothers younger than 35 years.
Risk Factors for Down Syndrome
maternal age > 35
Previous child with Down Syndrome
What are the common features of a baby with Down syndrome?
Flattened nasal bridge, small head, epicanthal folds, thick tongue, small ears, short neck
Non Pharm Mgmt for Down Syndrome
Annual eye and ear exams
Monitor for sleep apnea, GER, celiac disease and dysphagia
Annual thyroid testing
Monitor for the development of leukemia, heart disease, HTN, myelopathy
syndrome characterized by the partial or complete absence of one X chromosome (45,X karyotype)
Turner syndrome
Patients with Turner syndrome are at risk for
congenital heart defects (and may have progressive aortic root dilatation or dissection)
congenital lymphedema
renal malformation
sensorineural hearing loss
osteoporosis
obesity
diabetes
and atherogenic lipid profile
Physical manifestations in Turner’s syndrome
Physical manifestations may be subtle but can include misshapen ears, a webbed neck, a broad chest with widely spaced nipples, and cubitus valgus.
When should a Turner syndrome diagnoses be considered?
Turner syndrome diagnosis should be considered in girls with short stature or primary amenorrhea.
Klinefelter syndrome
boys born with an additional X chromosome
Symptoms of Klinefelter syndrome
infertility, small testes, decreased facial hair, gynecomastia, decreased pubic hair, and a small penis. Because of their long legs, men with Klinefelter syndrome often are taller than predicted based on parental height.
Tay-Sachs disease
a rare inherited disorder that progressively destroys nerve cells (neurons) in the brain and spinal cord
When does the most common form of Tay-Sachs disease become apparent?
In infancy
At 3 to 6 months, when their development slows and muscles used for movement weaken.
Affected infants lose motor skills such as turning over, sitting, and crawling. They also develop an exaggerated startle reaction to loud noises.
What abnormality is characteristic of Tay-Sachs disease?
An eye abnormality called a cherry-red spot, which can be identified with an eye examination, is characteristic of this disorder.
What distinctive facial features may infants with Tay Sachs have?
Affected infants may have distinctive facial features including almond-shaped eyes, a thin upper lip, a downturned mouth, a narrow bridge of the nose, a narrow forehead, and a disproportionately long, narrow head (dolichocephaly).
Distinctive facial features can be noticeable shortly after birth or may develop slowly over time.
Why are children with Tay Sachs diesase prone to obesity?
Between 4.5-8 years old, appetite and caloric intake usually increases, often thereafter developing a need to eat an extraordinarily large amount of food (hyperphagia) usually because they do not feel satisfied after completing a meal (satiety).
In addition, there is a decreased calorie requirement in people with PWS due to low muscle, decreased metabolism and decreased physical activity if not treated with growth hormone replacement. Consequently, overeating, rapid weight gain, and morbid obesity occurs if not controlled by others.
Are males or females more affected by Fragile X Syndrome
error is on the X chromosome, so males are affected more and more severely than women
Craniofacial features of Fragile X Syndrome
Large protruding ears
Elongated face/forehead
High, arched palate
What is involved in the care of the pregnant patient in the 3rd trimester?
Managing:
premature labor vs Braxton Hicks
premature rupture of membranes
gestational diabetes
urinary frequency
swelling
What is involved in the care of the pregnant patient in the 2nd trimester?
weight mgmt and healthy eating
assessing fetal heart tones, fundal height, fetal movement
screening for anemia and gestational diabetes
begin prep for childbirth and breastfeeding
What is involved in the care of the pregnant patient in the 1st trimester?
Hx and physical
Mgmt of chronic disease
education, diet, exercise
prenatal vitamin with iron
Screening for HIV, STI, UTI, anemia
Domestic violence
When the fertilized egg grows inside the tube or other extrauterine site
Ectopic pregnancy
Treatment for ectopic pregnancy
If diagnosed early, methotrexate is prescribed to stop the growth of fetal tissue. Otherwise, the patient will require surgical removal
What does estrogen cause during the 2nd trimester?
estrogen causes growth of of blood supply to things such as moles, warts and gums
abruptio placenta
occure when placenta separates prematurely from the uterus
signs: decreased fetal movement, bleeding, hemmorhage, dizziness, shock, contractions
preeclampsia
pregnancy induced endothelial malfunction accompanied by vasospasm
occurs after 20 weeks and up to 6 weeks post partum
elevated BP
proteinuria of 3+ or greater
headache, scotoma
Eclampsia = seizures
What leads to gestational diabetes?
hyperinsulinemia and rapid weight gain
Causes of premature labor
infection
uterine abnormality
smoking
drug abuse
HTN
Care of the patient in the 3rd trimester
screening for infx, Broup B strep
What is a cerclage?
the use of suture to hold the cervical os closed
What are the characteristics of all hormonal methods?
All effect ovulation, the endometrial lining, thickness of the cervical mucus, change the production of FSH and LH (preventing egg recruitment and release).
Role of estrogen
decreases FSH
Prevents release of egg
stablizes the thickness of endometyrium, prevents shedding
NOT necessary to ptevent pregnancy
NOT a conctraceptive
What can high levels of estrogen cause?
gestational diabetes
can alo interfere with latation
What is a POP?
A progestin only pill - no estrogen
Good for breastfeeding mother, some headache patients
Need to start while bleeding
Take at SAME TIME EVERY DAY
Causes irregular menses
Role of Progesterone
prevents LH surge, thickens cervical mucus, thins endometrium
Women with migraines may more sensitive to the combined or estrogen only pill, may want to use progestin only
Periods will not be regular on Progestin only pill
Progestin slows GI motility
What is a COC?
“combined oral contraceptive”
contains noth estrogen and progestin
Starting OCs
Same day/quick start - pregnancy test is negative
Sunday start - pregnancy test is negative, not likeley to be pregnant. Start next Sunday (period free weekends)
1st day start - start on 1st day of next menstrual period
Contraindications of OCs
History of:
MI, CVA, or clot
Active breast or uterine cancer
Undiagnosed vaginal bleeding
Liver disease ot liver cancer
Treatment for BPH
Alpha blockers
5-alpha reductase inhibitors
tadalafil
Gold standard for vasomotor symptoms
HRT
