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PHY V > Neonatal & Geriatrics Physio > Flashcards

Neonatal & Geriatrics Physio Flashcards

1
Q

How many % of babies delivered require aggressive resuscitation?

A

10%

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2
Q

When the baby is out what do you do?

A

Dry thoroughly to avoid hypothermia caused by cold stress. Next, lay on top of the mother for skin to skin contact (for themoregulation and bonding). Cut the cord when the pulse of the cord stops.

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3
Q

When does the fetus gain so much weight and length?

A

2nd and 3rd trimester

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4
Q

Describe the air sacs of the fetus in utero?

A

Filled with fetal lung fluid

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5
Q

T or F. The arterioles in the fetal lungs are dilated to allow better O2 for delivery to other organs.

A

F!!! Arterioles are constricted because the blood flow is not preferentially passing through the pulmonary circulation. Thus, the resistance is high, flow is diminished, and the blood will be diverted to a shunt called ductus arteriosus.

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6
Q

The cord is made up of how many vessels?

A

3! 2 deoxygenated arteries and 1 oxygenated vein.

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7
Q

What is the direct link between maternal and fetal capillaries?

A

NONE! HAHA. Trick question.

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8
Q

Where does the exchange of gases and substrates occur?

A

Intervillous spaces.

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9
Q

In utero, which structures allow the mixture of blood? Describe.

A

Shunts! We have 3. Sometimes, referred to as 4.

  1. Ductus Venosus
    - within the hepatic circulation
    - shunt that will combine or receive blood coming from umbilical vein and IVC towards the RA
  2. Foramen Ovale
    - window between RA and LA
    - seen as remnant
  3. Ductus Arteriosus
    - extra vessel there
    - like a detour blood from the pulmonary artery to the aorta
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10
Q

Why is blood flowing freely to the placenta?

A

Because it is a low resistance vessel!

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11
Q

T or F. The placenta is as efficient as the lungs in terms of being an oxygen exchange organ.

A

F!!! No. However, in utero, the O2 tension is low so it is enough to supply the baby still.

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12
Q

What fetal structure has the highest PO2?

A

Umbilical vein

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13
Q

Fetal circulation

A

Umbilical vein -> ductus venosus -> IVC -> RA -> foramen ovale (preferentially) -> LA -> LV -> Aorta -> Ascending arch (Preferentially supplying the organs at the higher center)
*higher O2 content

What happens now?
Drainage from the upper part of the body will go to SVC -> RA -> RV -> Pulmonary artery
—> (8-10%) Lungs
—> (rest/90%) Ductus arteriosus -> Descending aorta -> supplies the rest of the body
*lesser O2 content

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14
Q

The ductus arteriosus remains patent due to?

A

Presence of high PGs in utero

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15
Q

Fetal output =

A

Combined output of the left and right ventricles

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16
Q

What happens if you have problems in the fetal CO?

A

Can’t compensate by increasing stroke volume because the myocardium is not yet mature. So when HR decreases, the initial reaction will be tachycardia (sign of fetal distress) -> bradycardia -> death

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17
Q

Why is the pulmonary blood flow low?

A

Because it traverses the ductus arteriosus, the rest just passes through the vessels of the lungs for its nutritional requirement for lung growth (8-10%)

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18
Q

Why are you slapped in the butt or pinched by the OB once delivered?

A

To facilitate very effective breathing enough to allow gas to go in -> open up the alveoli -> allow fluid clearance

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19
Q

Why will the foramen ovale close once born?

A

Due to the pulmonary venous return which will cause the pressure on the left be higher than the right side. Thus, closing the foramen ovale shunt.

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20
Q

What happens if your DA will not close after birth?

A

Leads to L->R shunt & not most of the blood will pick up O2

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21
Q

What causes the closure of ductus arteriosus?

A

Increased arterial O2 saturation

High pulmo O2 tension

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22
Q

What initiates closure of the ductus venosus?

A

Removal of the placenta.

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23
Q

What is PPHN? Treatment?

A

Persistent Pulmonary Hypertension of the Newborn
-Did not proceed all to transition or neonatal circulation
Failure to achieve and maintain the decrease in PVR that normally occurs after birth. Thus, you reduce pulmonary blood flow -> reduced O2 -> hypoxia -> reduced systemic delivery of substrates

> Even if you give O2, no use because the vessels are closed! So give vasodilators (NO gas, alkalinize, vasodilators)

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24
Q

What is CHD with Large Communications at the Ventricular or Great Vessels? Tx?

A

There is delayed fall in PVR in the presence of increased pulmonary blood flow or pressure -> leads to endothelial injury

What’ll happen?
You won’t survive because deoxygenated blood goes to your circulation.

Tx: Catch ductus not closing. (What will now close ductus? PGE and low O2) So PGE then surgery to switch back

25
Q

What happens to these structures within seconds after birth

  1. Fluid in the alveoli
  2. Umbilical vessels
  3. Blood vessels in the lung tissue
A
  1. Absorbed
  2. Constricted or eliminated
  3. Relaxed
26
Q

Fetal vs. Neonatal Circulation in terms of:

  1. Type of circulation
  2. Shunts
  3. PVR
  4. CO
  5. Gas exchange site (major)
A

1.
Fetal: Parallel
Neonatal: Series

  1. Fetal: Intracardiac shunts
    Neonatal: NO IC shunts

3.
Fetal: High PVR
Neonatal: Low PVR

4.
Fetal: Relatively low CO
Neonatal: Relatively high CO

5.
Fetal: Placenta
Neonatal: Lungs

27
Q

Five Stages of Lung Development

A
  1. Embryonic
    - 1st 6 weeks
    - Can’t survive. Lungs: Just conducting aiways (1’ and 2 main stem bronchus only)
  2. Pseudoglandular
    - Week 6-16
    - You now have cartilage smooth ms but devt is still up until terminal bronchioles; no gas exchange
    - Won’t survive even w/ surfactants given
  3. Canalicular
    - Week 16 -28
    - Respiratory bronchioles start to develop
    - At later part (Wk 24-28), you have air sacs producing immature surfactants
    - CAN SURVIVE
  4. Saccular
    - Week 28 - 36
    - Continue to develop immature surfactants
  5. Alveolar
    - Week 36 - term
    - Mature surfactant
28
Q

When prematurely contracting mothers go to OB, what is done?

A

Inject steroids to stimulate pneumocyte type II cell fibroblast to produce surfactant needed

29
Q

Why is delivering vaginally better

A

You increase the Na/K ATPase activity in type II alveolar cells which will now enhance the lung function.

30
Q

Respiration

  1. Does it occur during fetal life?
  2. When do attempted respiratory movements occur?
  3. What stimulates attempted respiratory movements?
A
  1. No! But there are breathing movements which promotes lung growth.
  2. Starting at the end of the 1st trimester
  3. Tactile stimuli and fetal asphyxia
31
Q

Can the baby poo even before birth?

A

Yes, meconium can pass if motilin, a hormone enhancing gut motility and meconium passage, is incited by hypoxia (Flow in the cord is interrupted).

32
Q

How do you clear the fetal lung fluid?

A

As it passes through the vaginal canal, the squeezing effect benefits for lung fluid clearance. It will be reabsorbed by the epithelium in the lungs to the vessel (veins and lymphatics) -> urine

33
Q

Role of extrauterine respiratory function?

A

Primarily to eliminate the fluid and establish functional residual capacity.

34
Q

When you establish respiration, what happens to the ff:

  1. Pulmonary vascular resistance
  2. Alveolar surface tension
  3. Interstitial Pressure
  4. Pulmonary Vascular Volume
  5. Oxygenation
A
  1. Dec due to inc PaO2
  2. Dec due to surfactants
  3. Dec
    4, 5. Increased
35
Q

What opposes first breath?

A
  1. Viscosity of the lung fluid
  2. Degree of lung compliance
  3. Materials in the amniotic fluid that can obstruct fluid clearance: mucus, blood, meconium, amniotic fluid, etc.
36
Q

What does the silver tsunami state?

A

Dictate the increase in the number of elderly people. (By the year 2050, there are more elderly than younger ones, accdg to the prediction)

37
Q

Three types of survivorship curves. Where do we belong?

A

Type I

  • high survivorship but at the time you reach old age, becomes very low/increase in death rate of the elderly
  • large mammals

Type II

  • Steady survivorship
  • constant mortality and survivorship all throughout their life expectancy

Type III

  • Low survivorship then high survivorship after (high death rate, low survivorship at first)
  • small mammals
38
Q

What do population pyramids show?

A
  • Information about the age and gender of people in a specific country.
  • A way of projecting the population
39
Q

Aging Theories

A
  • Evolutionary theory
  • Programmed theories
  • Damaged theories
  • General formulations
  • Individual mechanisms
  • etc.
40
Q

What is homeostenosis?

A

Homeostenosis

  • Refers to the concept that from maturity to senescence, there will be a decrease in your physiologic reserves. Thus, it’ll be harder for you to cope with challenges being offered by the environment.
  • This will narrow/decrease your reserves and capability to reproduce, as well.
  • End result: Frailty
41
Q

Diagnosis for Frailty Syndrome

A 
Must have 3 or more of the ff symptoms:
Weakness
Slow walking speed
Self-reported exhaustion
Low lvl of PA
Unintentional weight loss
42
Q

What happens to the ff things in the brain as you age:

  1. Volume
  2. Weight
  3. Connections
  4. Action Potential
  5. Synthesis of NTs and neuromodulator substances
  6. Amount of pigments (lipofuscin), cal-protein, amyloid flocks, neurofibrillary
A
  1. Decrease
  2. Decrease
  3. Decrease/Lose connections
  4. Slower
  5. Decrease
  6. Increase
43
Q

Types of Cognitive Impairment?

A
  1. Pre-clinical
    >Not clinically testable yet
    >You’re the only one who notices it
  2. Mild Cognitive Impairment (MCI)
    >Cognitive changes are of concern to individual and/or family
    >Preserved activities of daily living
  3. Dementia
    >CI severe enough to interfere w/ everyday activities
    >Classified as mild, moderate, moderately severe, severe
44
Q

What is the test you perform to test for cognitive impairment/dementia?

A

Mini Mental State Examination

45
Q

What happens to vision as you age?

A

You lose the elasticity of the lens so the image will not fall directly into your retina.

Lose elasticity -> lose power of accommodation -> can’t see clearly (presbyopia)

46
Q

What is presbykosis?

  • Cause/s?
  • Type?
A

> Secondary to the atrophy of the hair cells which are sensory receptors for hearing found in the inner ear.

  • this kind of hearing loss is sensory neural but you may have mixed hearing problems
  • May be conducive in nature where you have an impacted cerumen
47
Q 
Taste and smell in the elderly
1. What happens in general?
2. What happens to the ff:
A. Salt detection
B. Bitter
C. Sweet
D. Chewing
E. Smell discrimination
A
  1. In general, there’s atrophy of olfactory bulbs and taste buds for smell and taste, respectively
2.
A. Decreased
B. Exaggerated
C. Unchanged
D. Has problems
F. Decreased
48
Q

The nature of the inc in adiposity in the elderly?

A

Centripetal

49
Q

1 problem in the elderly

A

Depression

50
Q

Effect of aging on the ff:

  1. Blood Function
  2. RBC lifespan
  3. Iron turnover
  4. Blood volume
  5. Colony size of WBCs
  6. Production of stimulating factors
  7. Function of the different WBCs
  8. Number of platelets
  9. Response to thrombotic stimulators
  10. NO and oxidative damage
  11. Bleeding time and inhibitors of plasminogen activators
A
  1. No change (N)
  2. N
  3. N
  4. N
  5. Dec bc 6. Dec so you also have 7. Dec/reduced
  6. N
  7. Inc
  8. Dec
  9. Dec
51
Q

What will happen to your heart as you age?
1. Size

  1. EDV
  2. Pacemaker cells
  3. Valves
A
  1. Enlarged left side (particularly LA)
    Why? You inc your afterload or pressure in the periphery for your arteries. Thus, more effort to push blood into the peripheral circulation.
  2. Left ventricular EDV is dec because of shortened diastolic filling time so dec CO
  3. Pacemaker cells may deteriorate making elderly prone to abnormal rhythms, most commonly atrial fibrillation.
  4. You have calcific deposits in your aortic and mitral valves. The sequela of having that, you may have stenosis or insufficiency in the closure and opening of the valves you hear in PE.
52
Q

Why do elderly people feel dizzy with sudden change in position?

A

Baroreceptors are true stretch receptors. Since there’s loss of compliance in elderly, they can’t stimulate the baroreceptor cells anymore.

53
Q

The Respiratory System in the Elderly. What happens to the ff:

  1. Alveolar ducts
  2. Surface Area for Gas Exchange
  3. Surfactant
  4. Alveolar fluid
  5. Ventilation/perfusion mismatching
  6. Inspiration and Expiration
  7. Stiffness of chest wall
  8. Diaphragm
A
  1. Enlarged due to loss of elastic tissue and collagen
  2. Dec
  3. Surfactant composition altered
  4. Alveolar fluid has greater amt of pro-inflammatory proteins
  5. Inc in areas which are better perfused than ventilated
  6. Weaker due to dec in neural stimulation of respiratory ms
  7. Inc
  8. Flattened
54
Q

What happens in your GIT as you age?
1. Oropharynx

  1. Salivary production
  2. Clearance of food from pharynx
  3. Myenteric ganglion cells
  4. Amplitude of peristalsis
  5. Gastric acid production
  6. Number and volume of the interstitial cells of Cajal
  7. Ghrelin and its signalin
  8. Gastrin
  9. Bacterial growth in small bowel
A
  1. W/ your oropharynx, you have mastication problems bc the gums recede and tooth cementum are exposed inc the risk for tooth decay/dental carries
  2. Dec
  3. Poor which may lead to aspiration
  4. Dec
  5. Dec so you can’t clear esophagus at once
  6. Dec
  7. Dec
  8. Dec
  9. Dec
  10. Dec
55
Q

Non peristaltic repetitive contraction of esophagus?

A

Presbyesophagus (won’t push food to the stomach)

56
Q

What happens to your renal system as you age?

  1. Renal mass
  2. Vascular resistance
  3. Total renal blood flow
  4. Tortuosity in the vasculature
  5. Number of glomerulus
  6. Collagen deposition
A
  1. Dec renal mass due to receding cortex
  2. Inc vascular resistance in afferent and efferent arterioles because of inc in intimal thickness and dec NO production = no vasodilator
  3. Dec total renal blood flow
  4. There may be tortuosity in the renal vasculature
  5. Dec
  6. Inc
57
Q

Why is there urinary incontinence as we age?

A
  1. Reduced Bladder Elasticity
  2. Poor Bladder Control
  3. Loss of Sphincteric Tone
58
Q

What is polypharmacy?

A

-The use of more than 5 medications per day

PHY V (12 decks)

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