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Y5 Paediatrics > perinatal medicine > Flashcards

perinatal medicine Flashcards

1
Q

What is perinatal mortality rate=?

A

stillbirth + death within the first week per 1000 births

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2
Q

What is neonatal mortality rate?

A

deaths of live born infant within 4 weeks after birth per 1000 births

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3
Q

What is a neonate?

A

Child <28 days old

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4
Q

What is low birth weight?

A

<2500

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5
Q

What is very low birth weight?

A

<1500

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6
Q

What is extremely low birth weight?

A

<1000

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7
Q

What is small for gestational age?

A

birthweight <10th centile for gestational age

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8
Q

What is large for gestational age?

A

birthweight >90th centile for gestational age

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9
Q

What are symptoms of foetal hyperthyropidism?

A

foetal tachy on CTG trace

foetal goitre on USS

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10
Q

What does anti phospholipid syndrome cause?

A 
recurrent miscarriage 
IUGR 
PET 
placental abruption 
preterm delivery
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11
Q

Why does maternal Graves affect the foetus?

A

Because the thyroid stimulating antibodies cross the placenta
They stimulate the foetal thyroid

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12
Q

What are symptoms of foetal alcohol syndrome?

A

Saddle shaped nose
Maxillary hyperplasia
absent philtrum
short upper lip

growth restriction
developmental delay
cardiac defect

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13
Q

What can an epidural cause to the mother during labour?

A

it can cause a fever

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14
Q

What do vitamin A/retinoids cause on the foetus?

A

increased spontaneous abortion

abnormal face

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15
Q

What does warfarin cause on the foetus?

A

interferes with cartilage formation (nasal hypoplasia)
cerebral haemorrhage
microcephaly

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16
Q

What are the risks to the foetus with drug abuse?

A

prematurity
growth restriction
drug withdrawal
cocaine: placental abruption, preterm delibery, cerebral infarction
IVDU: increased risk of contracting Hep B, C, HIBV

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17
Q

What is the effect of rubella on the newborn?

A

TRIAD:

  • cataracts
  • deafness
  • congenital heart disease
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18
Q

How does the effect of rubella on the foetus change based on gestation time?

A

infection < 8 wks : cataracts, deafness, heart disease in 80%
13-16 weeks: impaired hearing in 30%
>20 weeks: no consequence

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19
Q

How do you manage rubella infection in pregnancy?

A

Notify health protection unity
Test for Parvovirus 19
NO TREATMENT - advise rest and paracetamol for sx relief
Advise to avoid contact with pregnant women for 6 days since rash onset
Refer urgently to obstetrics for risk assessment and counselling

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20
Q

What is the most common congenital infection ?

A

CMV

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21
Q

What occurs to each proportion of foetuses affected with CMV, and how?

A

90% are fine
5% have clinical features at birth (hepatosplenomeg, petechiae), neurodevelopmental disabilityes
5% develop problems in later life (sensorineural hearing loss)

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22
Q

What is screenign and vaccination like for CMV?

A

NONE

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23
Q

What is management of newborns with CMV?

A

IV ganciclovir

or IV vanganciclovir

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24
Q

How do mothers get infected with toxoplasma?

A

COntact with faeces from infected cat
OR
undercooked meat

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25
Q

What clinical features will a foetus develop from toxoplasma?

A

retinopathy
cerebral calcification
hydrocephalus

> > long term neuro disabilities

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26
Q

What is mx of newborns with toxo?

A

pyrimethamine + sulfadiazine + calcium folinate

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27
Q

When is risk of VZV passing from mother to foetus highest?

A

Around labout (five days pre to 2 days post)

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28
Q

How do you manage VZV in newborn?

A

VZIG to mother if within 10 days from exposure

acyclovir tx

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29
Q

How do you manage a mother with syphilis

A

ensure complete treatment 1 month prior to delivery

if in doubt treat foetus with penicillin

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30
Q

What is asphyxia?

A

lack of oxygen to foetus during labour / delivery

can cause brain injury / death

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31
Q

What is primary apnoea?

A

Once the foetus is deprived of oxygen in utero, it will attempt to breathe
This is unsuccessful as still in utero
Heart rate is maintained

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32
Q

What is secondary apnoea?

A

The period that follows primary apnoea and irregular gasping
HR and BP drop

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33
Q

What does a foetus delivered in secondary apnoea need help with?

A

lung expansion > positive pressure ventilation / tracheal tube

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34
Q

What are causes of continous apnoea?

A

Placental abruption, cord prolapse

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35
Q

Is asphyxia in utero common?

A

yes, during labour and delivery

but it is intermittent, due to frequent uterine contractions

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36
Q

What is the Apgar score used for?

A

To describe baby’s condition at 1 and 5 minutes after delivery
or every 5 minutes if condition is poor

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37
Q

What ate the 5 components of the apgar score’

A 
HR 
Resp effort
muscle tone 
reflex irritability 
colour
38
Q

What numbering is the apgar score out of

A

0-2 for each section

39
Q

What are patterns of growth restriction?

A

Asymmetrical

or

symmetrical

40
Q

what are causes for LGA baby?

A

gestational diabetes
congenital (beckwith Wiedeman syndrome)
physiologically large

41
Q

What are consequences for the baby of being LGA?

A 
Birth asphyxia 
Breathing difficulty from an enlarged tongue 
Birth trauma (shoulder dystocia) 
Hypoglycaemia (due to hyperinsulinism) 
Polycythaemia
42
Q

When is the routine examination of newborn performed?

A

24h after birth

43
Q

What is a post-wine stain (naevus flammus)?

A

vascualr malformation of capillaries in the dermis

44
Q

What is a strawberry naevus?

A 
a CAVERNOSUS HAEMANGIOMA 
appears in 1st month of life (not at birth) 
may be mutliple 
gradually regresses 
no treatment
45
Q

Why must midline abnormalty over spine e.g. hair tuft be checked?

A

may indicate abnormality of CNS

46
Q

What is DDH?

A

Developmental dysplasia of the hip

Abnormality of hip joint where acetabulum does not fully cover the femoral head
This results in risk of hip dislocation

47
Q

What are RF for DDH?

A

girls

breech

48
Q

What are two tests for DDH?

A 
Barlow maneuvre (dislocate hip posteriorly) 
Ortolani maneuvre (relocate dislocated hip back into acetabulum)
49
Q

How do you manage DDH?

A

splint with Pavlik harness

50
Q

What does Vit K deficiency cause?

A

haemorrhagic disease of the newborn

51
Q

What is haemorrhagic disease of the newbortn?

A

In most infants, mild bleeding (bruising, haematemesis, melaena)
In some: intracranial haemorrhage

52
Q

What are RF for haemorrhagic disease of newborn?

A

breast feeding (poor source of vit K compared to formula)

Anticonvulsants (impair vit K synthesis)

53
Q

How must you administer sufficient vitamin K to foetus?

A

Give IM vit K at birth

Overall 3 doses in first 4 qeeks of life

54
Q

What does Guthrie test screen for?

A 
Phenylketonuria 
Hypothyroidism 
Sickle cell and thalassaemia 
Cystic fibrosis 
MCAD deficiency
55
Q

What is the maternal mortality rate?

A

death in pregnancy + labour + 6 weeks postnatal

56
Q

How do you rate an apgar score

A

0-3 very low
4-6 moderately low
7-10 good

57
Q

What do mongolian blue spots look like

A

blue / black macular discoloration at the base of the spine and on the buttocks

Commonly in afrocaribbean / asian babies

58
Q

How do you manage mongolian blue spots

A

None

Fade slowly over first few yeara

59
Q

What are milia?

A

White pimples on nose and cheeks from retention of keratin and sebaceous material

60
Q

What is an umbilical hernia epidemiology?

A

Common in children, likely found on newborn exam

Should close by the age of 5

61
Q

HOw does an umbilical hernia occur

A

due to weakness of the umbilical ring
The umbilical ring allows passage of vessels through abdo wall muscle between the mother and the foetus
After birth, the ring remains, with spontaneous closure at 5 years old

62
Q

How does an umbilical hernia present

A

Reducible, painless bulge at umbilicus

Prominent on strain

63
Q

How do you manage infant with umbilical hernia

A

if <3 years old and healthy: no tx required, should resolve, safety net parents

If >3 yo: refer to surgeon for elective repair

** do not attempt to tape things over it to close the hernia

64
Q

What is failure to thrive?

A

Weight below 5th centile on multiple occasions OR weight decelaration across 2 major percentile lines

65
Q

What is oesophageal atresia?

A

congenital defect in which upper oesophagus ends blindly and is not connected to the lower oesophagus

66
Q

Why does oesophageal atresia occur

A

due to abnormal debeòlopment of the tracheoesophageal septum

67
Q

How do you classify oesophageal atresia

A

Gross Classification (A-E)

68
Q

What is the most common type of oesophageal atrasia

A

Type C - oesophageal atresia with fistula which connects to trachea distally

69
Q

How does oesophageal atresia present

A

Cyanotic attack
Foaming at mouth
Cough
Depending on type- aspiration pneumonia, gastric distension

70
Q

How do you investigate oesophageal atresia

A

Feeding tube cannot pass

X ray

71
Q

What do you see on x ray of oesophageal atresia

A

air filled pouch at T3

72
Q

How does oesophageal atresia present in utero

A

POLYHYDRAMNIOS

73
Q

How do you manage oesophageal atresia

A

Do NOT feed orally
Suction tube in oesophagus
Antibiotics if aspirating

SURGERY WITHIN 24h

74
Q

What other things must you be aware of in baby with oesopahgeal atrasia

A

Likelyhood of other congenital malformations VACTERL

75
Q

What does VACTERL stand for

A

Vertebral, Anorectal, Cardiac, Trachea-Oesophageal, Renal, Radial LImb

76
Q

When will small bowel obstruction vomiting NOT be bile stained

A

When obstruction is BEFORE ampulla of vater

77
Q

What are causes of small bowel obstruction

A

Duodenal / Jejunal / Ileum - atresia / stenosis (Down’s)
Malrotation with volvulus
Meconium ileus
Meconium plug

78
Q

What is meconium ileus

A

thick insippated meconium

becomes impacted on lower ileum

79
Q

What is the single biggest RF for meconium ileus

A

CF

80
Q

What is meconium plyg

A

COngealed meconium causing lower intestinal obstruction

81
Q

How do you manage meconium plug

A

passes spontaneously

82
Q

How do you manage a meconium ileus

A

Dislodge Using Gastrograffin contrast medium

83
Q

What are two key causes to laarge bowel obstruction in neonates

A

Hirschprung / Rectal atresi

84
Q

What is another name for exomphalos

A

omphalocele

85
Q

What is exomphalos

A

Abdominal contents protrude through umbilical ring

Coevred. by transparent sac (amniotic membrane + peritoneum)

86
Q

What is exomphalos associarted with

A

Major congenital abnormalities

e.g. Down, Beckwith Wiederman

87
Q

How do you manage exomphalos

A

ECS + staged repair

88
Q

What is gastroschisis

A

Bowel protrudes through defect in anterior abdominal w all

NO covering sac

89
Q

What is gastroscisis associated with

A

NOTHING

No association with congenital abnormalities

90
Q

WHat is the risk in gastroscisis

A

dehydration.

protein loss q

91
Q

How do you manage gastroscisis

A

vaginal delivery

immediate repair

Y5 Paediatrics (30 decks)

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