Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - Reproductive and Sexual Health (DP) > Neonatology > Flashcards

Neonatology Flashcards

1
Q

What are the three shunts of the foetal circulation?

A

Ductus venosus
Foramen ovale
Ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How much of the foetal circulation does via the lungs?

A

7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does the foetus prepare during the 3rd trimester?

A 
Surfactant production
Accumulation of glycogen in liver, muscle and heart
Accumulation of brown fast:
- Between scapulae
- Around internal organs
Accumulation of S/C fat
Swallowing amniotic fluid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens to catecholamines and cortisol at the onset of labour?

A

Levels increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens to the synthesis of lung fluid at labour?

A

Stops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What effect does vaginal delivery have on foetal lungs?

A

Squeezes them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does the baby appear during the first few seconds after birth?

A

Initially blue
Starts to breathe and turns pink
Cries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens to vascular resistance after birth?

A

Pulmonary resistance drops

Systemic resistance increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens to oxygen tension after birth?

A

Increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What happens to circulating prostaglandins in the foetus after birth?

A

Drop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When the ductus constricts, what happens?

A

Increased pO2

Reduced flow and prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does the ductus arteriosus become normally?

A

Ligamentum arteriosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is a patent ductus arteriosus treated in preterm infant?

A

Indometacin
OR
Ibuprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does the ductus venosus become?

A

Ligamentum teres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A baby is born with signs of asphyxia. She is tachypnoeic and has a loud S2 and harsh systolic murmur (tricuspid regurgitation). Her Apgar scores are persistently low. There is some meconium staining. The baby is cyanosed, with a low systemic BP. Signs of shock.

A

Persistent Pulmonary Hypertension of the Newborn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is Persistent Pulmonary Hypertension of the Newborn managed?

A 
Ventilation
Oxygen
NO
Sedation
Inotropes
Extracorporeal Life Support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What physiological changes happen in the first few hours of life?

A

Thermoregulation
Glucose homeostasis
Nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the main method of heat generation following birth?

A

Non-shivering thermogenesis:

- Breakdown of stored brown adipose tissue to catacholamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Why do neonates need help with maintaining temperature?

A 
Wet when born
Large surface area;body mass ratio
No shivering
Non-shivering thermogenesis is not efficient in first 12 hours
Peripheral vasoconstriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What infants are at increased risk of hypothermia?

A

Low stores of brown fat
Little S/C fat
Large SA;Vol. ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is glucose homeostasis following birth?

A

Drop in insulin; increase in glycogen
Mobilisation of hepatic glycogen stores for gluconeogenesis
Ability to use ketones as brain fuel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can hypoglycaemia arise due to increased energy demands?

A

Unwell

Hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What effect does an increase in 2,3-diphosphoglycerate do to the Hb dissociation curve?

A

Shifts it right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where does haematopoeisis shift to after birth?

A

Bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why is there a physiological anaemic following birth? When does it resolve?

A

Adult Hb synthesised sslower than foetal Hb broken down

Nadir at 8-10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What cause physiological jaundice?

A

Breakdown of foetal Hb
Conjugating pathways immature
Increase in circulating unconjugated bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When does physiological jaundice usually occur?

A

1-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When is jaundice pathological?

A

<24 hours after birth
OR
Lasting longer than >14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What does ineffective attachment result in?

A

Pain and damage to nipples
Breastmilk not removed effectively
Apparent poor milk supply
Breast milk production declines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What can the following cause:

  • Poor positioning and incorrect attachment
  • Mechanical pumping
  • Tearing the nipple/areolar junction
  • Detaching baby or pump incorrectly
A

Sore/Cracked nipples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the signs/symptoms of sore/cracked nipples?

A 
Pain (specific to nipple)
Worsens at start of feeding
Nipple is wedge-shaped after feeding
Engorgement
Redness, blisters, bleeding and scabs
Baby may vomit blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What can cause breast engorgement?

A 
Delay in first feed
Poor positioning and attachment
Restricted feeding
Ineffective emptying
Supplementation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the signs/symptoms of breast engorgement?

A 
Breasts shiny (due to oedema)
Pain
Poor flow due to increased pressure
Redness
Fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What can cause mastitis?

A 
Plugged milk duct
Breast infection
Poor positioning and attachment
Infrequent feeds
Consistent breast pressure
Dummies
Supplementation
Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How does a blocked duct present?

A

Tender spot
Redness
Sore lump without fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does a breast infection present?

A

Tender spot/lump

Low grade fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What may an infective mastitis present with?

A

Cracked nipple
Pus and blood in milk
Red streaks from site back into breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What antibiotics can treat mastitis?

A

Flucloxacillin 1g qid
OR
Clindamycin 450mg tds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

When is the prevalence of breast thrush minimal?

A

First 6 weeks following birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the signs/symptoms of breast thrush?

A 
Agonising pain in BOTH breasts:
- Pain equal in both
Pain after every feed
No change in nipple colour
No change in nipple shape
Oral swab positive for candida
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is superficial breast thrush treated?

A

Miconazole cream 2% for 1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How is deep breast thrush treated?

A

Fluconazole 300mg loading dose

Then 150mg daily for at least 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How is infantile thrush treated?

A

Younger than 4 months:
- Nystatin oral suspension for 1 week
Older than 4 months:
- Miconazole oral gel 24mg/ml qid for 1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

If there is no improvement in how many days, when should the diagnosis of breast thrush be reconsidered?

A

10 days (with combined therapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How much does the average male weigh at 28 weeks?

A

1150g (3.5% fat)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How much does the average male weigh at term?

A

3550g (15% fat)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the average daily weight gain?

A

24g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

When is a birth deemed term?

A

After 37 weeks completed gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

When is a birth deemed post-term?

A

After 41 weeks completed gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is a normal birth weight?

A

2.5-4kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What hormones enhance foetal adaptation?

A

Cortisol

NA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What effect does prolonged labour have on the foetus?

A

Reduced foetal reserves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

In APGAR, what does the first A stand for and what possible scores are available?

A

A is Appearance (Skin colour):

  • 0 points = Blue/pale all over
  • 1 point = Blue at extremities; body is pink
  • 2 points = No cyanosis; body/extremities pink
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

In APGAR, what does the P stand for and what possible scores are available?

A

P is Pulse rate:

  • 0 points = Absent
  • 1 point = <100
  • 2 points = >100
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

In APGAR, what does the G stand for and what possible scores are available?

A

G is Grimace (reflex irritability):

  • 0 points = None
  • 1 point = On aggressive stimulation/suction
  • 2 points = Cries on stimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

In APGAR, what does the second A stand for and what possible scores are available?

A

A is Activity:

  • 0 points = None
  • 1 point = Some flexion
  • 2 points = Flexed arms and legs that resist extension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

In APGAR, what does the second R stand for and what possible scores are available?

A

R is Respiratory effort:

  • 0 points = Absent
  • 1 point = Weak, irregular gasping
  • 2 points = Strong, robust cry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is a normal APGAR score?

A

> =8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the incidence of Haemolytic Disease of the Newborn?

A

~2/1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How can Haemolytic Disease of the Newborn be prevented?

A

Vitamin K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What vaccination can be given at birth?

A

Hep B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What vaccination can be given in the first month?

A

BCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

When are the first routine vaccinations given?

A

8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What maternal vaccines are given?

A

Pertussis

Flu

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What screening tests are done after birth?

A 
Universal hearing
Hip:
- Clinical
- USS
CF
Metabolic:
- Thyroid
- MCCAD
- PKU
- Haemoglobinopathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Who carries out the top to toe examination following delivery?

A

Midwife

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

When is the formal newborn examination carried out and by who?

A

24 hours after birth

A variety of different staff groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What should the newborn heart rate be?

A

120-140 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What should the newborn respiratory rate be?

A

40-60/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What bacterial infections are common in newborns?

A 
Group B Strep.
E. coli
Listeria myocytogenes
Staphylococcus aureus
Staph. epidermidis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What viral infections are common in newborns?

A

CMV
Parvovirus
Herpes
Enteroviruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What other viral infections can occur in newborns?

A

Toxoplasma gondii
HIV
Treponema pallidum
TORCH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What causes Hypoxic Ischaemic Encephalopathy?

A

Multi-organ damage due to tissue hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the signs of Hypoxic Ischaemic Encephalopathy?

A

Poor Apgar scores:
- Active resuscitation required
Neurodevelopmental sequelae:
- Variable prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What respiratory conditions can occur after birth?

A

Transient Tachypnoea of the New born
Pneumothorax:
- Spontaneous vs Secondary to active resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What congenital heart diseases can present at birth?

A 
Tetralogy of Fallot
Transposition of great arteries
Coarctation of aorta
TAPVD
Hypoplastic heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What congenital respiratory diseases can present at birth?

A

Tracheo-oesophageal fistul

Diaphragmatic hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What congenital neurlogical diseases can present at birth?

A

Microcephaly

Spina bifida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What congenital renal disease can present at birth?

A

Potters Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What congenital musculoskeletal disease can present at birth?

A

Myotonic Dystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are some risk factors for preterm birth?

A

> 2 preterm deliveries (Increases risk by 70%)
Abnormally shaped uterus
Multiple pregnancy (9x risk)
Interval of <6 months between pregnancies
IVF
Smoking/Alcohol/Illicit drugs
Poor nutrition/High BP/DM/Multipel miscarriages or abortions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

When can cord clamping be delayed?

A

If baby is okay and can be kept warm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How long can cord clamping be delayed for?

A

1 minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What does delaying cord clamping do?

A

Allows placental transfusion resulting in better circulatory stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What happens in a newborns lungs are overinflated?

A

Damage
Inflammation
Bronchopulmonary dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is gestational correction?

A

Adjusts the plot of a measurement to account for number of weeks born early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

When is gestational correction not used?

A

In term infants (37+ weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

When should gestational correction be continued until?

A

1 year for infants born 32-36 weeks

2 years for infants born <32 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What causes early onset of neonatal sepsis?

A

Bacteria acquired before and during delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What causes late onset of neonatal sepsis?

A

Acquired after delivery:

  • Nosocomial
  • Community
91
Q

What gram negatives can cause neonatal sepsis?

A

Klebsiella
E. coli
Psuedomonas
Salmonella

92
Q

What gram positives can cause neonatal sepsis?

A

Staph. aureus
Coagulase nehative Strep.
Strep. pneumoniae
Strep. pyogenes

93
Q

What is the commonest cause of neontal sepsis?

A

Group B Strep.

94
Q

What is the primary pathology of Infant Respiratory Distress Syndrome?

A

Surfactant deficiency

Structural immaturity

95
Q

What is the secondary pathology of Infant Respiratory Distress Syndrome?

A

Alveolar damage
Formation of exudate from leaky capillaries
Inflammation
Repair

96
Q

What is the incidence of Infant Respiratory Distress Syndrome in infants born before 29 weeks?

A

75%

97
Q

What is the incidence of Infant Respiratory Distress Syndrome in infants born after 32 weeks?

A

10%

98
Q

What are the clinical features of Infant Respiratory Distress Syndrome?

A 
Tachypnoea
Grunting
Intercostal recessions
Nasal flaring
Cyanosis
Worsens over minutes to hours
99
Q

When does Infant Respiratory Distress Syndrome worsen until?

A

Days 2-4 (nadir)

100
Q

How is Infant Respiratory Distress Syndrome managed?

A 
Maternal steroid
Surfactant
Ventilation:
- Invasive
- Non-invasive
101
Q

Where does bleeding initially occur in intraventricular haemorrhage?

A

Germinal matrix

102
Q

How can prematurity increase the risk of intraventricular haemorrhage?

A

Germinal matrix still resent

Cerebral autoregulation immature

103
Q

How can Infant Respiratory Distress Syndrome increase the risk of intraventricular haemorrhage?

A

Hypoxia; Acidosis; Hypotension

Results in unstable cerebral circulation

104
Q

90% of intraventricular haemorrhages occur in what time period?

A

First 72 hours

105
Q

How can intraventricular haemorrhage be prevented?

A

Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability

106
Q

What must be avoided to prevent intraventricular haemorrhage?

A

Hypoxia
Hypercapnia
Hyperoxia
Hypocapnia

107
Q

What are grades 1 and 2 of intraventricular haemorrhage?

A

Germinal matrix haemorrhage
OR
IVH with no enlargement

108
Q

What are grades 3 and 4 of intraventricular haemorrhage?

A

IVH with enlargement

+/- extension into brain

109
Q

What is the most common neonatal surgical emergency?

A

Necrotising enterocolitis

110
Q

What is necrotising enterocolitis?

A

Widespread necrosis in small and large intestine

111
Q

What is the clinical picture of necrotising enterocolitis?

A 
Usually after recovering from respiratory distress syndrome
Early signs:
- Lethargy
- Gastric residuals
Blood stool
Temperature instability
Apnoea
Bradycardia
112
Q

When does retinopthy of prematurity occur?

A

Usually 6-8 weeks after delivery

113
Q

What is Grade 0 of the Modified Oxford Scale mean? (And its ICS equivalent)

A

No discernible contraction of pelvic floor

ICS - Absent

114
Q

What is Grade 1 of the Modified Oxford Scale mean? (And its ICS equivalent)

A

Flicker

ICS - Weak

115
Q

What is Grade 2 of the Modified Oxford Scale mean? (And its ICS equivalent)

A

Weak contraction

ICS - Weak

116
Q

What is Grade 3 of the Modified Oxford Scale mean? (And its ICS equivalent)

A

Moderate contraction

ICS - Normal

117
Q

What is Grade 4 of the Modified Oxford Scale mean? (And its ICS equivalent)

A

Good contraction

ICS - Normal

118
Q

What is Grade 5 of the Modified Oxford Scale mean? (And its ICS equivalent)

A

Strong contraction against max. resistance

ICS - Strong

119
Q

What lifestyle factors can help in gynaecological disorders?

A 
Healthy BMI
Avoid constipation
Smoking cessation
Avoid heavy lifting
Reduce caffeine
120
Q

What lifestyle factors can manage bladder symptoms?

A 
Reduce caffeine
Bladder training
Voiding/Double voiding techniques
Pelvic floor exercises
Constipation reduction
121
Q

What lifestyle factors can manage bowel symptoms?

A 
Regulate stool
Pelvic floor exercises
Difficulty wiping clean:
- Lepicol
Urge:
- Holding on programme
Frequency:
- Holding on programme
- Caffeine reduction
122
Q

How often are pelvic floor muscle exercises carried out?

A

Performed until fatigue several times a day

Practised for 15-20 weeks

123
Q

What enzyme breaks down Haem and into what?

A

Haem oxygenase (NADPH and Oxygen):

  • Iron
  • CO
  • Biliverdin
124
Q

What enzyme converts Biliverdin into Bilirubin?

A

Biliverdin Reductase (NADH or NADPH)

125
Q

How much conjugated bilirubin is produced by the liver per day?

A

260mg

126
Q

Where does conjugated bilirubin move to after leaving the liver?

A

Small intestine -> Colon

127
Q

What is conjugated bilirubin converted to in the intestines and colon?

A

Urobilinogen

128
Q

What happens to urobilinogen?

A

Enterohepatic recycling

129
Q

What happens to urobiliogen that returns to the liver?

A

Enters systemic circulation
Then enters the kidney
Excreted as urinary urobilinogen (0-4mg/day)

130
Q

How much faecal urobilinogen is excreted per day?

A

125-130mg/day

131
Q

What are the pathological causes of jaundice?

A 
Blood group incompatibility
Other haemolytic disorders (eg. G6PD deficiency)
Sepsis
Liver disease
Metabolic disorders
132
Q

Why does physiological jaundice develop?

A 
Increased production
Reduced uptake and hepatocyte binding
Reduced conjugation (most important)
Reduced excretion
Increased enterohepatic circulation of bilirubin
133
Q

When is ‘too early’ jaundice?

A

<24 hours

134
Q

What usually causes jaundice in neonates <24 hours?

A

Haemolysis resulting in increased bilirubin

135
Q

What are the causes of early jaundice? (most common ones in descending order)

A

ABO incompatibility
Rh immunisation
Sepsis

136
Q

What are the rarer causes of early jaundice?

A

Other blood group incompatibilites
Red cell enzyme defects (eg. G6PD deficiency)
Red cell membrane defects (eg. Hereditary spherocytosis)

137
Q

When should hepatitis be considered as a cause of early jaundice? What may it occur in?

A

If substantial increase in conjugated bilirubin (>15% of total)
May occur in Rh babies +/- in-utero transfusions

138
Q

How is early pathological jaundice investigated?

A 
Total and conjugated [bilirubin]
Maternal blood group and Ab titres (if Rh -ve)
Baby's blood group
Direct Coombs Test and elution test:
- Detects anti-A/B
Full blood exam:
- Evidence of haemolysis
- Unusually shaped RBCs
- Infection
CRP
139
Q

When does ‘too high’ jaundice occur?

A

24 hours - 10 days

140
Q

What can be considered ‘too high’ jaundice?

A

If serum [bilirubin] is high requiring treatment

141
Q

What can cause ‘too high’ jaundice?

A 
Dehydration/Poor milk supply
Haemolysis
Breakdown of extravasated blood
Polycythaemia
Infection (more likely)
Increased enterohepatic circulation (gut obstruction)
142
Q

What is ‘too long’ jaundice?

A

> 10 days of age

Esp. >2 weeks

143
Q

What must be assessed in ‘too long’ jaundice?

A

Is the elevated bilirubin:

  • Mostly unconjugated (>85%)
  • Consisting of substantially increased conjugated (>15%)
144
Q

What can cause persistent unconjugated hyperbilirubinaemia?

A 
Breast milk jaundice (diagnosis of exclusion)
Continued poor milk intake
Haemolysis:
- Severe is usual
- G6PD deficiency
Infection
Hypothyroidism
145
Q

Who is G6PD deficiency more common in?

A

Mediterranean
Asian
African
Males (X-linked)

146
Q

What are some causes of persistent conjugated hyperbilirubinaemia?

A 
Hepatitis:
- Infectious
- Metabolic disorder (eg. Galactosaemia)
Biliary atresia:
- Obstructive jaundice
- Pale (clay) colour stools
- Dark urine
- Fatal if untreated
147
Q

What happens if unconjugated bilirubin crosses the BBB?

A 
Kernicterus - Death of brain cells
Yellow staining (particularly in grey matter)
148
Q

What do the following describe:

  • Lethargy
  • Poor feeding
  • Temperature instability
  • Hypotonia
  • Opisthotonus (head, neck and back arching)
  • Spasticity
  • Seizures
  • Jaundice
A

Acute bilirubin encephalopathy

149
Q

What increases the risk of developing kernicterus?

A 
Increased unconjugated bilirubin:
- Conc >340 micro-mol/L
Preterm at lower conc. (300 micro-mol/L)
Asphyxia
Acidosis
Hypoxia
Hypothermia
Meningitis
Sepsis
Reduced albumin binding
150
Q

When would IV Ig be used in jaundice?

A

If isoimmune haemolytic disease and rising bilirubin despite phototherapy
Indicated for Rh/ABO disease if SBR rises by >8.5 micro=mol/L OR bilirubin within 30-50 micro-mol of exchange transfusion

151
Q

How can evidence of traction birth injury (eg. Erb’s palsy) be checked?

A

Neck
Shoulders
Clavicles

152
Q

What may a single palmar crease indicate?

A

Down’s syndrome

153
Q

What may a hyperdynamic pulse in a newborn indicate?

A

Patent ductus arteriosus

154
Q

How may spina bidifa occulta or sinus be hidden?

A

Flesh creases
Dimples
Hair tufts

155
Q

At what gestation can a cardiac anomaly scan be done?

A

12-20 weeks

156
Q

At what gestation can a microcephaly scan be done?

A

Usually after 22 weeks

157
Q

At what gestation can a short limb scan be done?

A

Usually after 22 weeks

158
Q

How long does PCR DNA testing take?

A

2-3 days

159
Q

How long does southern blotting DNA testing take?

A

2-3 weeks

160
Q

In FISH sex-determination, what chromosome is used as a control?

A

18

161
Q

In what parental chromosome abnormalities may a preimplantation genetic diagnosis be recommended?

A

Robertsonian translocation

Reciprocal translocation

162
Q

In what X-linked disorder may a preimplantation genetic diagnosis be recommended?

A

For reimplantation of female embryos

163
Q

In what single gene disorders may a preimplantation genetic diagnosis be recommended?

A

Spinal muscular dystrophy
CF
Huntington’s disease

164
Q

What drugs do not cross the placenta?

A

Large molecular weight:

- eg. Unfractioned heparin

165
Q

What drugs cross the placenta more quick;y?

A

Small

Lipid-soluble

166
Q

How do plasma volume and fat stores affect pharmacokinetics?

A

Both increased so increase volume of distribution

167
Q

How does protein binding affect pharmacokinetics?

A

Reduced in pregnancy so increased free drug

168
Q

How does liver metabolism of some drugs (eg. Phenytoin) affect pharmacokinetics?

A

Increased metabolism in pregnancy

169
Q

How does increased GFR affect pharmacokinetics?

A

Increased elimination of renally-excreted drugs

170
Q

What drug concentrations and doses should be altered during pregnancy and after delivery?

A

Lithium

Digoxin

171
Q

During the second trimester, what may pregnancy women be more sensitive to?

A

Anti-hypertensives can result in hypotension

172
Q

When and how much folic acid is given?

A

400micrograms daily for 3 months prior to and during the first 3 months of pregnancy

173
Q

When is the risk of the greatest teratogenicity?

A

During weeks 4-11

174
Q

When does organogenesis occur?

A

1st trimester

175
Q

What can ACEi/ARBs teratogenicity cause?

A

Renal hypoplasia

176
Q

What can androgen teratogenicity cause?

A

Virilisation of female foetus

177
Q

What can antiepileptic teratogenicity cause?

A

Cardiac, facial, limb and neural tube defects

178
Q

What can cytotoxic teratogenicity cause?

A

Multiple defects

Abortion

179
Q

What can lithium teratogenicity cause?

A

Cardiovascular defects

180
Q

What can methotrexate teratogenicity cause?

A

Skeletal defects

181
Q

What can retinoid teratogenicity cause?

A

Ear, cardiovascular and skeletal defects

182
Q

What can warfarin teratogenicity cause?

A

Limb and facial defects

183
Q

What drugs can depress the respiratory system?

A

Opiates

184
Q

Withdrawal symptoms can occur after birth in the neonate from what drugs?

A

Opiates

SSRIs

185
Q

What can frequent seizures during pregnancy result in?

A 
Reduced verbal IQ
Hypoxia
Bradycardia
Antenatal death
Maternal death
186
Q

What foetal defects can phenytoin cause?

A

Cleft lip and palate

187
Q

Is insulin safe in pregnancy?

A

Yes

188
Q

What does poor diabetic control increase the risk of?

A

Congenital malformations

IUD

189
Q

What hypoglycaemics are not safe in pregnancy?

A

Sulfonylureas (switch to insulin)

190
Q

How is hypertension in pregnancy treated?

A

Labetalol
Methyldopa
(Nifedipine MR)

191
Q

What effect can beta-blockers have in late pregnancy?

A

Growth restriction

192
Q

How can nausea and vomiting in pregnancy be treated?

A

Cyclizine

193
Q

How are UTIs treated in pregnancy?

A 
1st and 2nd trimester:
- Nitrofurantoin
- Cefalexin
3rd trimester:
- Trimethoprim
194
Q

How can pain be treated in pregnancy?

A

Paracetamol

195
Q

How can heartburn be treated in pregnancy?

A

Antacids

196
Q

What was diethylstilbestrol used for? What long term effects did it have?

A

Prevent recurrent miscarriages
Caused:
- Vaginal adenocarcinoma in girls aged 15-20
- Urological malignancy in boys

197
Q

How much more likely is VTE in pregnancy?

A

10x

198
Q

What is the leading cause of maternal death in pregnancy?

A

VTW

199
Q

What are the risk factors for VTE?

A 
Obesity
Age >35
Smoking
Parity >3
Previous DVT
C-section
200
Q

How many risk factors for VTE in pregnancy need to be present to warrant what therapy?

A

> =2

LMWH

201
Q

When is VTE prophylaxis given in pregnancy?

A

At delivery and up to 7 days post-partum

202
Q

How is DVT/PE treated in pregnancy?

A

LMWH

203
Q

Why is warfarin avoided in early pregnancy?

A

Teratogenic

204
Q

Why is warfarin avoided in late pregnancy?

A

Risk of haemorrhage during delivery

205
Q

What drugs are more likely to enter the breastmilk?

A

Small molecules

Lipophilic drugs

206
Q

What is foremilk rich in?

A

Proteins

207
Q

What is hindmilk richer in?

A

Fat

208
Q

What do longer feeds result in in terms of the constituents of breastmilk?

A

Higher amounts of fat soluble drunks

209
Q

What drugs are actively concentrated in the breast milk? What effect does this have?

A

Phenobarbitone/Phenobarbitol:

- Sucking difficulties

210
Q

What can breastmilk amiodarone cause?

A

Neonatal hypothyroidism

211
Q

What can breastmilk cytotoxics cause?

A

Bone marrow suppression

212
Q

What can breastmilk benzodiazepines cause?

A

Drowsiness

213
Q

What can breastmilk bromocriptine cause?

A

Suppress lactation

214
Q

How can foetal alcohol syndrome be suspected clinically?

A 
Short palpebral fissures
Flat midface
Short nose
Indistinct philtrum
Thin upper lip
215
Q

What features is foetal alcohol syndrome associated with?

A

Epicanthal folds
Low nasal bridge
Minor ear anomalies
Micrognathia

216
Q

What immunity benefits does breastfeeding provide?

A

Better vaccine response
Reduced childhood cancer
Fewer UTIs
Fewer ear infections

217
Q

What does cholesterol/fat in human milk promote?

A

Growth of nerve tissue - Higher IQ

218
Q

What mouth benefits does breastfeeding provide?

A

Less need for orthodontics

Increased facial muscle development

219
Q

What respiratory benefits does breastfeeding provide?

A

Fewer/less severe URTIs
Less wheezing
Less pneumonia and flu

220
Q

What GI benefits does breastfeeding provide?

A

Less diarrhoea
Fewer GI infections
Reduced risk of food allergies
Less risk of UC and CD

221
Q

What cardiac benefits does breastfeeding provide?

A

Lower cholesterol

Lower heart rate

222
Q

How does an increase in 2 BMI points affect the risk of breast cancer?

A

5% increase

223
Q

Why does obesity increase the risk of endometrial cancer?

A

?Hyperoestrogenaemia

224
Q

What other female cancers does obesity increase the risk of?

A

Oesophageal adenocarcinoma
Pancreatic
Breast (post-menopausal)

Year 3 - Reproductive and Sexual Health (DP) (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions