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Block 3 > Week 8 > Flashcards

Week 8 Flashcards

1
Q

What is the APGAR score?

A
  • evaluate at birth and 10 minutes
  • Activity
    • muscle tone
  • Pulse
  • Grimace
    • reflex irritability
  • Appearance
    • Skin Color
  • Respiration
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2
Q

How can a childs height be estimated?

A
  • midparental height
    • female: MH + (PH- 13)/2
    • male: (MH + 13) + PH/2
  • parental pubertal history
  • bone age
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2
Q

What are the symptoms of tall stature?

A
  • rarely referred
  • symptoms
    • exogenous obesity
    • precocious puberty
    • symdromes (marfan’s, Soto’s, klinefelters)
  • GH secreting tumor extremely rare in children
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3
Q

How much calcium and phoshate is absorbed by the fetus and what weeks does this happen?

A
  • 23 g of calcium and 14 g of phosphate
    • half of total amount accumulated happens in the last 4 weeks
    • accumulation will start between weeks 16-20
  • Ca2+ is about 1/50th of maternal bone content
    • if there not adequate amounts of Ca2+ in the mother’s diet then it will pull it from the mother’s bones
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3
Q

How long does the mother inherited immunity and what does it protect against?

A
  • protects an infant for 6 months
  • against
    • diphtheria
    • measles
    • polio
  • allergies appear when teh infant begins to form its own antibodies
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4
Q

What effects height more than weight?

A
  • Generally constitutional
  • endocrine/syndromic
  • renal
  • metabolic
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4
Q

What are the weight and length changes in a fetus?

A
  • first 2-3 weeks microscopic and weight is so small during first 12 weeks
  • most weight gain happens last 2 months
  • ~2 lbs/month
  • length is pretty steady
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5
Q

What is russell-silver syndrome?

A
  • type of drawfism
  • symptoms
    • macocephally
    • micrognathia
    • asymmetric limbs
    • precocious puberty
    • hypoglycemia
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5
Q

What is the fetal development of the kidneys?

A
  • start developing at week 5
  • start to excrete urine sometime between the 1st and 2nd trimester
    • urine contributes to amniotic fluid
  • fluid regulation and acid-base balance isnt fully developed until months after birth
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6
Q

What makes the weight more affected than height?

A
  • GI
  • Nutritional
  • Renal
  • Metabolic
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7
Q

How does estrogen effects the skeleton?

A
  • stimulates bone growth
  • unite epiphyses with shafts of long bones
    • estrogen >>testosterone, girls stop growing earlier
  • after menopause estrogen levels drop
    • increased osteoclastic activity
    • descrease bone matrix and mineralization
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7
Q

What cells makes up the placental membrane barrier at the end of 4th week?

A
  • syncytium
  • cytotrophoblast
  • CT
  • Endothelium
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7
Q

How is vitamin E used in a growing fetus?

A
  • maintains normal development in early embryo
  • spontaneous abortions with deficiencies
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7
Q

What is respiratory distress syndrome?

A
  • occurs in premature infants or those born to diabetic mothers
  • hyaline membrane disease causing collapsed alveoli and pulmonary edema
    • lack of surfactant
    • Type II alveolar epithelial cells dont produce util last 3 months
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8
Q

What is noonans syndrome?

A
  • short stature
  • right sided cardiac defects
  • neck webbing
  • hypogonadism
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9
Q

Where and when are nucleated blood cells formed?

A
  • nucleated blood cells form in
    • yolk sac
    • mesothelial layer of placenta
  • Happens during first 3 weeks of development
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9
Q

How much iron is accumlated by the fetus and when does this happen?

A
  • Iron accumaltes fast 250mg
    • starts around week 12 and ramps up the last month
  • Most of the iron is incorporated into hemoglobin which starts 3 weeks after fertilization
  • 1/3 of iron in a full term fetus is stored in the liver for future formation of hemoglobin
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10
Q

When does the first heart beat and what is the heart rate?

A
  • starts beating at day 26
  • HR will start at 65 bpm and increase to 140 bpm just before delivery
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11
Q

What are the risk factors for respiratory distress syndrome?

A
  • male sex
  • premature birth
  • second born twin
  • perinatal asphyxia
  • maternal diabetes
  • Lecithin/sphingomyelin ration
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12
Q

What happens to trophoblast on day 11 and 12?

A
  • establishment of uteroplacental circulation
  • trophoblast lucunae <> maternal sinusoids > maternal blood enters lacunar system
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13
Q

Why refer somone for growth abnormalities?

A
  • unexplained hypoglycemia
  • unexplained abnormally slow or fast growth
  • 95th%
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14
Q

What are the different types of food allergies tests?

A

Need test based on history of the allergen

  • skin tests
    • quick, convenient, but high false positive
  • RAST tests (blood)
    • very high false positive
  • Patch tests
    • diffucult to administer
  • Food challenges
    • incremental challenge
    • double blind, placebo
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15
Q

What is eosinophilic esophagitis?

A
  • symptoms very with age
    • failure to thrive - infants
    • vomiting - infants
    • GERD - school age
    • food impaction - teenagers/adults
  • strongly associated with allergies
  • biopsy of esophagus so its filled with IgE and eosinophils
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17
Q

What is menopausal syndrome?

A
  • Hot flushes
  • psychic sensation of dyspnea
  • irritability
  • fatigue
  • anxiety
  • decreased strength and calcification of bones
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18
Q

What is the RBC and WBC count in a fetus?

A
  • 3x10^6 or (3.75 if umbilical cord stripped)
  • 45,000/microliter at birth
    • 5x the adult values
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19
Q

What are the effects of progesterone on the uterus, fallopian tubes, breasts?

A
  • uterus
    • promote secretory changes
    • descrease frequency and intensity of uterine contraction
  • fallopian tubes
    • promote secretion of peg cells
  • breasts
    • development of lobules and alveoli for secreotyr status
    • no milk production without prolactin
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20
Q

What affects Occipital Frontal circumference?

A
  • neurological
  • genetic
20
Q

What are the fetal shunts?

A
  • Ductus venosus
    • shunts off the liver
  • Foramen Ovale
    • right to left shunt to off the lungs
    • fossa ovalis
  • Ductus arteriosus
    • further shunting from the lungs to the ascending aorta
22
Q

What occurs because of structural abnormalities to cause female infertility?

A
  • ovarian anatomic abnormailites
  • Endometriosis
    • endometrial tissue surround uterus, fallopian tubes, and ovaries, can menstrate causing fibrosis throughout pelvis
23
Q

What pressures are needed to open the lungs?

A
  • 25 mmHg negative pressure needed to open lungs
  • first inspirations can produce up to 60 mmHg negative pressure in intrapleural space
  • second breath much easier
24
Q

How does estrogen effect the uterus and external sex organs?

A
  • increase size
    • internal: ovaries, fallopian tubes, uterus
    • external: vagina, fat deposits in mons pubis and labia major, enlargement of labia minora
  • vaginal epithelium
    • cubuidal > stratified
    • more resistant to trauma and infection
  • uterus
    • 2-3 fold bigger
    • proliferation of endometrial stroma
    • development of endmetrial glands
24
Q

What is arterial pressure at birth?

A
  • averages 70/50 at birth
    • increases over several months to 90/60
  • BP then slowly increase to adolescant vaules of 115/70
25
Q

What is the development of respiratory system?

A
  • respiratory movements take place during 1st trimester then is inhibited during last 3-4 months
    • inhibition prevents debris from entering the lungs
  • fluids secreted by alveolar epithelium to keep airways clean
25
Q

What is the liver function in a newborn?

A
  • reduction in bilirubin excretion
    • can result in jaundice
  • reduced plasma protein formation
  • hypoglycemia
  • blood coagulation factors
27
Q

What happens to trophoblast on day 8?

A
  • formation of 2 layers
    • cytotrophoblast - inner
    • syncytiotrophoblast - outer
28
Q

What is a food allergen and what are the known food allergens?

A
  • water soluble glycoproteins ressitnat to heat and proteolysis
    • helps across mucosal surfaces
  • Known allergens
    • peanut
    • soybean
    • fish/shrimp
    • chicken egg whites
30
Q

What is the function of the placenta?

A
  • exchanges of
    • gases
    • nutrients
    • electrolytes
  • transmission of maternal antibodies
  • hormone production
    • progesterone, estrogen, hCG, somatomammotropin (placental lactogen)
32
Q

How is vitamin K used in a growing fetus?

A
  • formation of blood coagulation factors in liver
  • provided by mother
    • since formed by bacterial action in colon
  • prevents hemorrhage
33
Q

What is food protein-induced enterocolitis syndrome?

A
  • severe, cell mediated GI food hypersensitivity that can be brought on by
    • cow’s milk, soy, grains, veggies or poultry
  • symptoms
    • vomiting, diarreha, letheragy/dehydration
    • usually diagnosed for sepsis
34
Q

What is fetal development of the GI tract?

A
  • at 4.5 months of gestation, fetus ingests large quantities of amniotic fluid
  • months 6-9 GI becomes as functional as it will be in a newborn infant
  • Meconium is excreted by the fetus
36
Q

What are the effects of progesterone on the female?

A
  • initiates conversion from proliferative uterus to secretory uterus for implantation
  • maintains uterus in secretory phase
  • inhibits LH production
37
Q

When does the bone marrow start to produce blood cells?

A
  • 3rd or 4th month to bone marrow forms red and white blood cells
  • After birth bone marrow is the only source of RBCs and WBCs
38
Q

What are common nutrition defiencies in newborns?

A
  • Calcium and vitamin D
    • for bones
  • Iron
    • needed for RBC development
40
Q

What occurs during growth hormone deficiency?

A
  • Most common isolated deficiency
  • IGF-1 and BP-3 low
  • Growth velocity slow, bone age delay
  • symptoms
    • hypoglycemia, fatigue, slow mentation
42
Q

What occurs during an endocrine abnormaility to cause female infertility?

A
  • cycle without ovulation (anovulation) due to hyposecretion of gonadotropins
  • Treatments: HCG, ovulation from multiple follicles, multiple births
43
Q

What are the nutrition limitations in a newborn?

A
  • low levels of pancreatic amylase so they cant digest starches
  • reduced fat absorption
  • unstable/low blood glucse levels
  • GOOD AA utilization
45
Q

How does estrogen effect the breasts?

A
  • initiation of growth of breasts of the lactiferous ducts, stroma and fat
  • further growth and function depends on progesterone and prolactin
46
Q

What cells make up the placental membrane by the end of the 4th month?

A
  • syncytium
  • endothelium
47
Q

What is the fetal development of the nervous system?

A
  • Nervous system starts to develop at week 3
    • skin relexes start at months 3-4
  • higher function of cerebral cortex are underdeveloped at birth
  • myelinization takes up to a year
  • brain mass is only 1/4 of adult at birth
48
Q

What is the kidney function in a newborn?

A
  • newborns are susceptible to dehydration, overhydration and acidosis
  • fluid intake/excretion is 7x more than an adult
  • kidneys are fully developed after 1 month after birth
  • concentrate urine by 1.5x instead of 3-4x
    • metabolism is 2x higher than adult so slightly acidotic
49
Q

What systems are not fully developed at birth?

A
  • nervous system
  • kidneys
  • liver

organ systems dont develop within first month

50
Q

What is cushings syndrome?

A
  • extremely rare
  • exogenous steriod use is more common but not cushings
  • symptoms
    • short stature
    • rapid weight gain
    • buffalo hump
    • hypertensive
51
Q

What happens to trophoblast on day 9?

A
  • Fibrin coagulum - closure of penetration defect
  • lucunar state
  • primitive yolk sac
52
Q

How is vitamin C used in a growing fetus?

A
  • Bone matrix and CT fiber formation
53
Q

What is physiologic hyperbiliruinemia?

A
  • occurs in new borns because the liver is only marginally functional
  • bilirubin rises
55
Q

What is hypogonadonism in females?

A
  • causes irregularity of menses and amenorrhea
    • estrogen levels must reach certain points to have normal cycle
  • lack or nonfunctional ovaries at birth
    • lack of 2nd sexual characteristics, sex organs never mature
    • taller
  • removal of ovaries
    • regression of sex organs
    • similar to menopause
56
Q

What happens to trophoblast on day 13?

A
  • primary villi formation
    • cytotrophoblastic cell proliferation > penetration into syntiotrophoblast > cellular columns > villi formation
57
Q

How do you treat eosinophilic esophagitis?

A
  • stay away from specific food allergen
  • systemic corticosteriods: prenisone
  • topical corticosteroids: swallowed fluticasone
  • allergy shots
58
Q

What is food anaphylaxis?

A
  • angioedema
  • difficulty breathing, weezing
  • hypotension
  • nausea, vomiting

requires epinephrine injectioins cant use benadryl

59
Q

What is IgE mediated food allergies?

A
  • IgE antibodies made to specific epitopes of food allergen
    • second exposure creates crosslinked IgEs causing the release of histamine, prostaglandins, leukotrienes, cytokins
  • causes
    • vasodilatation
    • SM contraction
    • mucus secretion
    • food anaphylaxis
61
Q

What is turner syndrome?

A
  • missing one X chromosome 45 that affects females
  • 1/2500 births
  • symptoms
    • left side cardiac defects
    • renal abnormalities
    • short stature
    • neck webbing
62
Q

What contributes to normal growth?

A
  • Hormones
    • GH, TH, cortisol, pubertal hormones
  • Nutrition
    • protein defiency
  • GI abnormalities
    • celiac, IBD, prancreatic insufficiency
  • Genetics
  • Environment
    • meds, sleep, stress
63
Q

What are the three types of estrogen?

A
  • in order from most potent to least
    • beta-estradiol - from ovaries
    • estrone - peripheral tissues
    • estriol - weak estrogen, made from estradiol and estrone in liver
64
Q

After week 4 where are non-nucleated RBCs made?

A
  • Begin form in liver then spleen
    • week 3 for spleen
    • liver has been producing RBCs but it takes over in week 3
65
Q

What is erythroblastosis fetalis?

A
  • produced by Rh incompatibility between mother and fetus
  • mother makes antibodies angainst fetal RBCs
  • large amounts of bilirubin released into plasma
66
Q

What are complications related to a baby who becomes hypoxic?

A
  • serious depression of respiratory center
  • development of lesions of the inferior coliculi, thalamus other parts of the brain stem
    • impairs motor functions

Block 3 (8 decks)

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