Quiz 1 Flashcards
Gestational age
Time elapsed since 1st day of LMP
Ovulation age
2 weeks from 1st day of LMP
Time frame of “embryo”
3-8 weeks
Time frame of “fetus”
> 8 weeks
Most sensitive period of gestation for teratogenicity
3-8 weeks
How many weeks is full term
39-40 weeks
When is a fetus considered viable
Week 24
Why does physiologic anemia occur during pregnancy
Greater increase in plasma volume (30-50%) compared to RBC mass increase (20-30%)
When is first prenatal visit and what is its purpose
6-8 weeks GA;
Date pregnancy
When is the second prenatal visit and what is its purpose
15-16 weeks GA;
Quad screen
Who is Rhogam indicated for and when is it given
Indicated for Rh- mothers;
Given at 28 weeks GA
When should Group B Strep culture be done
35-37 weeks GA
Primitive reflexes in an infant
Rooting, sucking, grasping, Moro
Postural reflexes in an infant
Head up, parachute, maintain balance
Locomotor reflexes in an infant
Crawling, stepping, swimming
What is assimilation in an infant
New information being brought into existing scheme
What is accommodation in an infant
Modification of old scheme or creating a new one
Are the following stats increasing or decreasing?
Preterm births; LBW infants; Infant mortality rate
Decreasing, increasing (particularly ELBW infants), decreasing (bc of ventilators, surfactant, and antenatal steroids)
Common complications of infant of diabetic mothers (IDM)
Macrosomia, respiratory distress syndrome (hyperinsulinemia inhibits cortisol = decreases surfactant), hypertrophic cardiomyopathy, cardiac malformation, lumbar neural tube defect, caudal regression, unilateral renal agenesis/renal vein thrombosis -> polycythemia, hypoglycemia -> seizures
Common complications of extremely premature infant
Multi-system failure with prolonged hospital stay ($1.5 million for initial hospitalization);
Intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis
Multiple genes with additive effect that can be influenced by environment
Polygenic genes
Genes that have small quantitative effect on level of expression of another gene
Modifier genes
Epigenetics: definition and mechanisms
Def: transmission of info from cell to descendent without info encoded in nucleotide sequence;
Mechs: X-inactivation, imprinting, DNA methylation, histone/chromatin modification, RNA-modifiers
Different genes at different loci producing same phenotype
Genetic (locus) heterogeneity
What increases recurrence risk of multifactorial inheritance?
Increased recurrence risk if proband is of the less commonly affected sex
Polygenic condition
Offspring tend to be average of parents
Congenital viral pathogens
Toxoplasma, Rubella, CMV, HIV, Herpes, Syphilis (ToRCHHeS)
Path of congenital infections in newborn
Stillbirth, congenital malformation, preterm birth, long-term hearing/neurobehavioral disability
Pathogen that causes early onset neonatal sepsis (48-72 hours)
GBS, E. coli
Pathogen that causes late onset neonatal sepsis (3-7 days)
GBS, S. aureus
Diagnosis of neonatal sepsis
LP to look for meningitis
Clinical findings of respiratory distress syndrome
Premature baby
Radiographic findings in respiratory distress syndrome
reticulo-granular pattern (“groundglass”); symmetrical low lung volume
Pathophys of respiratory distress syndrome
hyaline membranes blocking gas exchange
Treatment of respiratory distress syndrome
Surfactant
Clinical findings of meconium aspiration syndrome
Term baby with fluid stained with meconium
Radiographic findings in meconium aspiration syndrome
Coarse markings, asymmetrical areas of hyperinflation
Pathophys of meconium aspiration syndrome
Mechanical obstruction, chemical inflammation (acidic), surfactant inactivation -> decreases compliance, decreases alveolar ventilation, increases pulmonary vascular resistance
Treatment of meconium aspiration syndrome
Suction of trachea
Clinical findings in persistent pulmonary hypertension of the newborn
Term baby; cyanosis from R -> L shunt = severe hypoxia
Pathophys of persistent pulmonary hypertension of the newborn
maladaption (increased pulmonary vascular resistance from hypoxia), maldevelopment (pulmonary vascular bed is abnormal from hypoplasia)
Clinical findings of cyanotic congenital heart disease
Unrelieved by 100% O2
Pathophys of cyanotic congenital heart disease
transposition of great vessels, truncus arteriosus (persistent), triscuspid atresia, tetralogy of Fallot, total anomalous pulmonary venous return
Radiographic findings in cyanotic congenital heart disease
Heart is too big for ribcage
Radiographic findings in congenital diaphragmatic hernia
Bowel seen above diaphragm
Treatment of congenital diaphragmatic hernia
Surgical repair once stable
Radiographic findings in bronchopulmonary dysplasia
Distortion of pulmonary architecture, cystic space, interstitial fibrosis, hyperinflation, atelectasis
Pathophys of bronchopulmonary dysplasia
Prolonged O2 requirement
Treatment of bronchopulmonary dysplasia
Gentle ventilation
Radiographic findings of surfactant deficiency
Diffuse, “ground glass” or finely granular appearance, air bronchograms, hypoventilation
When do clinical findings of surfactant deficiency present
1st 24 hours after birth
Radiographic findings of necrotizing enterocolitis
Pneumatosis intestinalis, pneumoperitoneum, portal venous gas
Clinical findings of necrotizing enterocolitis
Premature, ab distention, increased residuals, blood in stool, apnea, bradycardia, acidosis
Grade I germinal matrix hemorrhage
Caudo-thalamic groove
Grade II germinal matrix hemorrhage
Intraventricular hemorrhage with normal size
Grade III germinal matrix hemorrhage
Intraventricular hemorrhage with dilation
Grade IV germinal matrix hemorrhage
Parenchymal hemorrhage
Clinical findings of germinal matrix hemorrhage
Only occurs in preterm infants (GM is gone by 35 weeks)
Risk factors of germinal matrix hemorrhage
Low birth weight, cyanotic congenital heart dz, prolonged labor, multifetal preg
Sequelae of germinal matrix hemorrhage
Post-hemorrhagic hydrocephalus, cyst formation, periventricular leukomalacia
Compared to adults, newborns clear drugs more slowly or quickly? Toddlers? Adolescents?
Newborns clear drugs more slowly;
Toddlers clear drugs more rapidly;
Adolescents have a similar drug clearance
What are the FDA indications of treating children
There are none; must be treated “off label”
Maternal causes of preterm labor
Severe illness, uteroplacental underperfusion, uterine fundal and cervial abnormalities, UTI/pyelonephritis
Placental causes of preterm labor
Early rupture of membranes (NOS), infection, vascular thrombotic/bleeding problems
Indications for preterm delivery
Severe maternal HTN, severe DM, placental abruption, abnormalities of fetal growth
Pathophys of respiratory distress syndrome
Decreased synthesis, storage, release of surfactant by Type 2 pneumocytes: alveoli collapse easier -> hypoxia -> alveolar damage -> endothelial damage -> hyaline a/w developing PDA, intraventricular hemorrhage, NEC;
Corticosteroids increase surfactant formation;
Insulin decreases surfactant secretion
Tx of RDS
prophylactic surfactant, glucocorticoids, O2 (but increase risk of retinopathy of prematurity and bronchopulmonary dysplasia)
Clinical findings in necrotizing enterocolitis
Premature baby, PAF increase enterocyte apoptosis, pneumatosis intestinalis, death
Radiograph findings in necrotizing enterocolitis
Air trapping
Pathophys of germinal matric hemorrhage
Intraventricular bleed at anterior horn of lateral ventricle due to vascular bed immaturity
Neonatal sepsis
Infants
Risk factors for neonatal sepsis
