Peds Gestation And Birth

Front 1

main source of energy for growing fetus

Back 1

carbohydrates

Front 2

Most common congenital heart defects

Back 2

Bicuspid aortic valve and VSD

Front 3

Embryology Week 1

Back 3

fertilization in fallopian tube ampulla, implantation begins

Front 4

Embryology Week 2

Back 4

implantation complete; endoderm and ectoderm form (bilaminar embryo)

Front 5

Embryology Week 3

Back 5

Mesoderm formed (trilaminar embryo)

Front 6

Embryology Week 5

Back 6

subdivisions of forebrain, midbrainand hindbrain are formed

Front 7

Embryology Week 7

Back 7

Heart formed

Front 8

Embryology Week 8

Back 8

primary organogenesis complete; placentation occurs

Front 9

Embryology Week 9

Back 9

permanent kidneys begin functioning

Front 10

Embryology Week 10

Back 10

midgut returns from umbilical cord, where it was developing, to abdominal cavity, while undergoing counterclockwise

Front 11

Embryology Week 24

Back 11

primitive alveoli are formed and surfactant production begins

Front 12

Embryology Week 26

Back 12

testicles descend

Front 13

Describe embryology of the heart

Back 13

Week 3: paired heart tubes begin to work
Week 4: Primordial atrium is divided into left and right by septa primum and secundum; Septum primum forms the valve of the foramen ovale, which closes about 3 months after birth.; failure of the foramen ovale to close results in an atrial septal defect (ASD)
Week 7: The single ventricle is divided into left and right; prior to that the interventricular foramen communicates between left and right sides.; failure of the interventricular foramen to close results in a ventricular septal defect (VSD)

Front 14

Describe the fetal circulation

Back 14

placenta-> umbilical vein->ductus venous->IVC->RA->foramen ovale->aorta

Front 15

How is the closure of the ductus arteriosus prevented and facilitated

Back 15

prevented by prostaglandin E1
facilitated by indomethacin by inhibition of prostaglandin synthesis

Front 16

failure of the kidneys to develop results in what

Back 16

oligohydramnios - decrease fluid in the amniotic cavity

Front 17

failure of the kidney to migrate results in what

Back 17

ectopic kidneys

Front 18

A horseshoe kidney gets caught on what during its ascent

Back 18

inferior mesenteric artery (IMA)

Front 19

Failure of testicles to descend results in what

Back 19

cryptorchidism, may need to be corrected surgically to prevent progressive dysplasia and may affect fertility

Front 20

Where and when does fetal erythropoiesis occur

Back 20

yolk sac (3-8 wks)
liver (6-8 wks)
spleen (9-28 wks)
bone marrow (28 weeks onward)

Front 21

What are metanephri and when do they start functioning

Back 21

permanent kidneys; start functioning at 9 weeks; urine is excreted into amniotic cavity

Front 22

What forms the Placenta

Back 22

fetal portion of placenta is formed from chorionic sac
maternal portion is derived from endometrium

Front 23

What does the placenta synthesize

Back 23

glycogen and cholesterol

Front 24

what does the placenta transport

Back 24

- nutrients, electrolytes, water, and gases are diffused or transported across the placenta
- most drugs pass through placenta and can be detected in fetal plasma
- a few substances cannot pass because of their size or charge (heparin); protein hormones (insulin) do not cross the placenta

Front 25

Maternal alpha fetoprotein (AFP) is high in what

Back 25

- multiple gestations (most common)
- fetal neural tube defects
- Gastroschisis

Front 26

Which supplements during pregnancy reduce incidence of neural tube defects

Back 26

folic acid

Front 27

What is the placenta's endocrine functions

Back 27

produces beta HCG, ACTH, human placental lactogen human chorionic somatomammotropin

Front 28

What allows for early detection of pregnancy

Back 28

testing urine for Beta hCG

Front 29

Describe the CNS embryo development

Back 29

- during week 3, the neural tube is formed on the ectodermal surfaces
- neural tube openings are closed by 25-27 days
- by week 5, subdivisions of forebrain, midbrain and hindbrain are formed

Front 30

What results if the neural tube fails to close

Back 30

-failure of caudal neural tube to close completely can result in spina bifida
-failure of the rostral neural tube to close can result in anencephaly

Front 31

When are the lungs formed

Back 31

by 24 weeks, primitive alveoli are formed and surfactant production is begun

Front 32

What is given to infants if they are born prior to 30 weeks? why?

Back 32

exogenous surfactant to prevent respiratory distress syndrome

Front 33

How is lung maturity determined

Back 33

lecithin to sphingomyelin ratio in the amniotic fluid is greater than 3

Front 34

What is gastroschisis

Back 34

failure of the intestine to return to the abdominal cavity with intestinal contents remaining at the base of the umbilical cord; it is a abdominal wall defect with extruded intestine

Front 35

What is a TE fistula

Back 35

incomplete separation of foregut and primitive airway

Front 36

What happens to the GI tract at week 10

Back 36

midgut returns from the umbilical cord, where it was developing, to the abdominal cavity, while undergoing counterclockwise rotation

Front 37

When do morphologic sexual characteristics develop

Back 37

week 7 gestation

Front 38

When does testosterone production begin in males? What does this lead to?

Back 38

in males, testis determining factor induces primary sex cords to develop as male gonads, with testosterone production by week 8

Front 39

Describe the testicles development

Back 39

testicles develop intra-abdominally and then descend through inguinal canals into teh scrotum by 26 weeks

Front 40

How does cocaine affect the fetus

Back 40

placental abruption

Front 41

When is the maternal AFP low

Back 41

trisomies 21 (Down Syndrome) and 18

Front 42

what is the most common cause for abnormal AFP

Back 42

incorrect dates

Front 43

Why shouldn't pregnant women change a cat's litter box

Back 43

risk of toxoplasmosis

Front 44

Infants who have experienced an intra-uterine infection have a higher than average risk of what

Back 44

- being small for gestation age
-hepatosplenomegaly
-congenital defects
-microcephaly
-intracranial calcifications

Front 45

What are the clinical features of Toxoplasmosis ingestion

Back 45

-microcephaly
-hydrocephalus
-intracranial calcifications
-chorioretinitis
-seizures

Front 46

Describe Maternal infection of toxoplasmosis

Back 46

-is due to ingestion of oocytes from feces of infected cats
-mother is asymptomatic

Front 47

What are clinical features of congenital rubella

Back 47

meningoencephalitis
microcephaly
cataracts
hearing loss
congential heart disease (patent ductus arteriosus, pulmonary artery stenosis)

Front 48

What are clinical features of CMV

Back 48

-intrauterine growth retardation (IUGR)
-low birth weight
-petechiae and purpura
-jaundice
-hepatosplenomegaly
-microcephaly
-chorioretinitis
-intracranial calcifications

Front 49

What are the late manifestations of CMV

Back 49

learning and hearing deficits can occur in 10% of infected

Front 50

What are narcotics like heroin and methadone associated with

Back 50

IUGR, SIDS, infant narcotic withdrawal syndrome

Front 51

Smoking is associated with

Back 51

decreased birth weight

Front 52

Phenytoin is assoicated with

Back 52

fetal hydantoin syndrome (includes IUGR, mental retardation, dysmorphic facies, and hypoplasia of nails and distal phalanges)

Front 53

What does tetracycline cause

Back 53

tooth discoloration and inhibits bone formation

Front 54

What is Isotretinoin (Accutane) associated with

Back 54

hydrocephalus, microtia, micrognathia, aortic arch abnormalities

Front 55

what is Warfarin associated with

Back 55

abnormal cartilage development
mental retardation
deafness
blindness
** instead use low molecular weight heparin which has fewer side effects

Front 56

What does elevated maternal glucose cause

Back 56

elevated fetal glucose->fetal hyperinsulinism, which can -> hypoglycemia in the newborn

Front 57

What is maternal diabetes associated with

Back 57

-macrosomia (wt >4kg), which can cause birth related injury
-metabolic disorders
-respiratory distress syndrome
-hyperbilirubinemia
-polycythemia and hyperviscosity
-congenital malformations including cardiac, renal, GI, neuro and skeletal defects

Front 58

maternal lupus is associated with

Back 58

first degree AV block in affected infants

Front 59

What are maternal HTN and renal and cardiac disease associated with in infants

Back 59

small for gestational age babies and prematurity

Front 60

vascular disease of placenta, caused by maternal illnesses such as diabetes or lupus can cause

Back 60

insufficient supply of nutrients to fetus and IUGR

Front 61

Most common teratogen

Back 61

alcohol

Front 62

What nationality has the highest incidence of fetal alcohol syndrome? Why?

Back 62

Native americans because alcoholism is higher in this population

Front 63

Clinical manifestations of fetal alcohol syndrome

Back 63

microcephaly, mental retardation, IUGR, facial dysmorphism(shortened nasal philum), renal and cardiac defects, hypospadias

Front 64

what is cocaine associated with

Back 64

higher risk of spontaneous abortion, placental abruption, fetal distress, meconium staining, preterm birth, IUGR, low APGAR scores at birth, intracranial hemorrhage, necrotizing enterocolitis, increase incidence of SIDS

Front 65

What affect does cocaine have on the infant

Back 65

causes maternal HTN and constriction of placental circulation-> decrease uterine blood flow and fetal hypoxia

Front 66

What is cocaine withdrawal associated with

Back 66

irritability, increase tremulousness, and poor feeding, increase incidence of learning difficulties and attention and concentration deficits later on

Front 67

What can the cord blood be used for

Back 67

-blood gas study if fetal distress is present
-test for infants blood type
-rich in stem cells, which are pleuripotential cells that have potential use in malignancies and gene therapy

Front 68

Which prophylaxis is given in the delivery room to the baby

Back 68

-gonococcal and chlamydial eye infection prophylaxis is with erythromycin or tetracycline
- vitamin K is given intramuscularly to prevent hemorrhagic disease of the newborn

Front 69

What are the steps that occur during childbirth

Back 69

1. once the head is delivered, the nose and mouth are suctioned
2. once the whole body is delivered, the newbornis heldat the level of the table and the umbilical cord is clamped
3. Newborn is then placed under radiant warmer and is dried with warm towels
4. mouth and nose are gently suctioned
5. gentle rubbing of the back or flicking of the soles of the feet, if needed to stimulate breathing
6. when the umbilical cord is clamped and cut, absent blood flow within the umbilical vein -> the closure of the ductus venosus

Front 70

What is the APGAR score

Back 70

-practical method of assessing newborn infants immediately after birth to help identify those requiring resuscutation
- assessment at 1 and 5 mins

Front 71

What prenatal infections most commonly cause birth defects

Back 71

TORCH
-Toxoplasmosis
-Other (hepatitis B, syphilis, varicella-zoster virus)
-Rubella -CMV -Herpes simplex virus/HIV

Front 72

When is a bulging fontanelle seen

Back 72

increase intracranial pressure, hydrocephalus, meningitis

Front 73

early onset small for gestation age associations

Back 73

-insult begin before 28 wks gestational age
-head circumference and height both small (symmetric)
-seen in infants born to mothers with severe vascular dz w/ HTN, renal dz, congential anomalies, infections, chromosomal abnormalities

Front 74

late onset small for gestational age

Back 74

-occurs with an insult after 28 wks gestational age
- sparing the head circumference (asymetric IUGR)
-occur with multiple gestations and preeclampsia

Front 75

What does absent breath sounds indicate

Back 75

tension pneumothorax or atelectasis

Front 76

what does bowel sounds in the thorax indicate

Back 76

congenital diaphragmatic hernia

Front 77

What does diminished femoral pulses indicate

Back 77

coartation of the aorta

Front 78

Which infants are at risk for being Large for gestational age

Back 78

-born to diabetic mother, postmature infant, Beckwith-Wiedemann syndrome

Front 79

what is the most common cause of an abdominal mass in a newborn

Back 79

enlarged kidney

Front 80

What are the layers of the skull

Back 80

SCALP
-skin, cutaneous tissue, aponeurosis, loose areolar tissue, periosteum

Front 81

Circumcision should be avoided in which boys

Back 81

boys with hypo or epispadias, as foreskin can be used to repair these defects later

Front 82

what is the most common bone fracture during delivery

Back 82

clavicular fracture

Front 83

What is caput seccedaneum

Back 83

-area of edema over the presenting portion of the scalp during a vertex delivery
-associated with bruising and petechiae
-can cross suture lines

Front 84

What are the neonatal screening test? Where does it occur?

Back 84

-heel is punctured
-hypothyroidism, galactosemia, adrenal hyperplasia, cystic fibrosis, PKU,

Front 85

What are the types of newborn screening tests

Back 85

neonatal screening and auditory screening

Front 86

What can improve the intellectual outcome in infants born with hypothyroidism

Back 86

early diagnosis and Tx with thyroid hormone prior to 3 mths of age

Front 87

what is a cephalohematoma

Back 87

-caused by bleeding that occurs below the periosteum of the overlying bone (usually the parietal)
-associated with skull fractures
-contained within periosteum: does not cross suture lines

Front 88

What should occur with all macrosomic infants

Back 88

they should be examined for signs of birth trauma and checked for hypoglycemia

Front 89

what does a complete clavicular fracture cause

Back 89

absence of Moro reflex

Front 90

what is molding

Back 90

temporary asymmetry of the skull from the overlapping of bones that occurs following prolonged labor and vaginal deliveries. Normal head shape returns in several weeks

Front 91

what is Klumpke palsy

Back 91

-involves the lower arm and affects the 7th and 8th cervical and first thoracic nerve root
- the hands are paralyzed and has absent grasp reflex, causing "claw hand"

Front 92

What is the most common type of Erb palsy

Back 92

Erb-Duchenne (involves the upper arm)

Front 93

What is Erb palsy

Back 93

-involves the fifth and sixth cervical roots
-arm is adducted and internally rotated, but the grasp reflex is intact

Front 94

Delivery room management of a meconium stained infant

Back 94

nasopharyngeal suctioning before the delivery of the thorax. Infants with respiratory depression require intubation and tracheal suctioning

Front 95

Problems with full-term infants

Back 95

-developmental dysplasia of the hip
-hypoxic/ischemic encephalopathy
-congenital diaphragmatic hernia
-jaundice

Front 96

what are the signs of developmental dysplasia of the hip

Back 96

-asymmetry of the skin folds int the groin and shortening of the affected leg
-more likely unilateral and involve the left hip

Front 97

Dx of developmental dysplasia of the hip

Back 97

confirmed by ultrasound

Front 98

Tx for developmental dysplasia of the hip

Back 98

special brace (Pavlik harness) or sometimes casting

Front 99

Who do developmental dysplasia of the hip more likely occur in

Back 99

white females with breech presentation

Front 100

What is meconium

Back 100

first intestional discharge of a newborn infant and is composed of epithelial cells, fetal hair, mucus and bile

Front 101

Meconium ileus is the most common presentation of what disease

Back 101

cystic fibrosis in the neonatal period

Front 102

When do most full term infants pass their first stool

Back 102

within the first 24 hrs of life

Front 103

What should infants with meconium ileus be tested for

Back 103

cystic fibrosis

Front 104

What is meconium ileus

Back 104

occurs when meconium becomes obstructed in the terminal ileum

Front 105

How does an infant with meconium ileus present

Back 105

failure to pass stool, abdominal distention and vomiting

Front 106

what is meconium aspiration syndrome? When does it occur?

Back 106

intrauterine stress may cause passage of meconium into the amniotic fluid, which can cause airway obstruction and a severe inflammatory response, which cause severe respiratory distress known as meconium aspiration syndrome

Front 107

What are the neurological manifestations of hypoxic/ischemic encephalopathy

Back 107

hypotonia, coma, seizures

Front 108

What are the outcomes of hypoxic/ischemic encephalopathy

Back 108

death, cerebral palsy, mental retardation

Front 109

What is hypoxic ischemic encephalopathy

Back 109

important cause of permanent damage to the cells of the CNS that occurs secondary to hypoxia (decrease oxygen delivery) and ischemia (decrease blood flow)

Front 110

What are the causes for hypoxic ischemic encephalopathy

Back 110

maternal conditions (HTN), placental insufficiency, severe neonatal blood loss, overwhelming infection

Front 111

What are congenital diaphragmatic hernias associated with

Back 111

c-some abnormalities, low birth weight, IUGR

Front 112

What is the cardinal sign in neonates with congenital diaphragmatic hernia

Back 112

respiratory distress

Front 113

Dx of congenital diaphragmatic hernia

Back 113

prenatal ultrasound btw 16-24 weeks

Front 114

What are the signs of congenital diaphragmatic hernia

Back 114

respiratory distress immediately on delivery, tachypnea, poor breath sounds over affected side of chest (most commonly left), and scaphoid abdomen

Front 115

Tx for congenital diaphragmatic hernia

Back 115

ex-utero intrapartum treatment (EXIT) procedure, where neonatologists and surgeons are present at delivery and infant is intubated and central extracorporeal membrane oxygenation (ECMO) catheters placed at the delivery of the head and neck

Front 116

When does physiologic hyperbilirubinemia occur, peak and resolve

Back 116

seen after first 24 hrs of life, peaks at 3 days, and resolves over 2 weeks

Front 117

what is kernicterus

Back 117

bilirubin neurotoxicity secondary to persistently elevated bilirubin levels, which exceed albumin-binding capacity of the blood resulting in deposition of bilirubin in the basal ganglia

Front 118

what does kernicterus result in

Back 118

neurologic deficits, hearing loss, profound encephalopathy and death

Front 119

Tx for Kernicterus

Back 119

-phototherapy with blue-green light converts bilirubin in skin to nontoxic isomers that are excreted without conjugation
-elevated bilirubin levels (12-20 mg/dL) are usually treated with phototherapy
-exchange transfusion should be considered at higher levels (20-25 mg/dL)

Front 120

what types of injuries occur during birth

Back 120

brachial plexus injuries

Front 121

what are the perinatal infection risk factors

Back 121

-rupture of amniotic membranes for 18 hrs or more
-chorioamnionitis
-intrapartum maternal fever
-maternal group B strep
-prematurity
-maternal UTI w/ gram negative organisms is emerging as the common cause due to perinatal GBS prophylaxis

Front 122

What percentage of pregnant women are colonized with GBS

Back 122

20%

Front 123

what is the recommended screening for pregnant women for GBS

Back 123

all pregnant women be screened (vaginal, rectal swab) at 35-37 wks of gestation

Front 124

what is the most important route of transmission of group B strep

Back 124

vertical transmission

Front 125

what are the 2 patterns of disease for group B strep

Back 125

early onset disease- < 1 wk
late onset disease- 1 -12 wks

Front 126

How does early onset Group B strep present

Back 126

presents shortly after birth as sepsis, pneumonia, or meningitis

Front 127

What is early onset Group B strep associated with

Back 127

persistent pulmonary HTN of the newborn

Front 128

How does late onset Group B strep present

Back 128

bacteremia, meningitis, bulging fontanelle, lethargy, irritability, vomiting, seizures

Front 129

Dx of group B strep

Back 129

isolation from sterile body fluids (blood, CSF)

Front 130

What is the Tx the symptomatic and asymptomatic group B strep

Back 130

-symptomatic (apnea, low temp, feeding intolerance) Tx with ampicillin and gentamicin
-asymptomatic- monitor

Front 131

what are risk factors for E. coli infection in newborn

Back 131

maternal urinary tract infection during last month of pregnancy

Front 132

What are the clinical manifestations of of E. coli in newborn

Back 132

sepsis, meningitis, UTI, pneumonia

Front 133

Tx for E. coli in newborn

Back 133

third generation cephalosporin

Front 134

E coli infection in the infant is common in which infants

Back 134

infants with galactosemia

Front 135

E.coli is the principal cause of what conditions

Back 135

gram negative sepsis and meninigitis in newborn

Front 136

cesarean section is performed for women with what infection

Back 136

primary genital herpes and vaginal lesions in late gestation

Front 137

Tx for Herpes simplex

Back 137

acyclovir

Front 138

Dx of herpes simplex virus

Back 138

-HSV can be isolated in cell culture from skin lesions or nasopharyngeal swabs
-PCR is a sensitive for HSV detection

Front 139

what percentage of adults have genital herpes

Back 139

20%

Front 140

How is 90% of neonatal Herpes Simplex infection acquired

Back 140

infected secretions during birth

Front 141

What are the 3 distinct patterns of herpes simplex dz

Back 141

-cutaneous disease (skin, mouth, eyes)
-encephalitic disease
-disseminated dz

Front 142

When is chlamydia acquired in infants

Back 142

passage through birth canal of an infected mother

Front 143

what does chlamydia cause in newborns

Back 143

conjunctivitis (few days to several days) and pneumonia (3-19 wks)

Front 144

Tx for chlamydia in newborn

Back 144

erythromycin orally for 14 days

Front 145

Chlamydia Dx

Back 145

culture

Front 146

Erythromycin use is associated with what development

Back 146

pyloric stenosis

Front 147

Tx for syphilis

Back 147

penicillin G

Front 148

Dx for syphilis

Back 148

-rapid plasma reagin (RPR) titers and flourescent treponemal anti-body-absorption test (FTA-ABS)
-

Front 149

features of syphilis

Back 149

-intermittent fever, osteitis and osteochondritis, hepatosplenomegaly, lymphadenopathy, persistent rhinitis (snuffles), maculopapular rash involving the palms and the soles

Front 150

late manifestations of syphilis

Back 150

saddle nose deformity, saber shins, frontal bossing, Hutchison teeth and mulberry molars, sensorineural, and Clutton's joints (painless joint effusions)

Front 151

Dx of HIV

Back 151

detection of p24 antigen in peripheral blood, PCR to detect viral nucleic acid in peripheral blood, and ELISA for detection of antibodies

Front 152

Tx for HIV

Back 152

nutritional support, Pneumocystis jiroveci prophylaxis, antiviral therapy and anti-infective agents

Front 153

What reduces the transmission of HIV

Back 153

maternal Tx with zidovudine in the second trimester reduces the rate of transmission by >70%

Front 154

Clinical features of infant HIV

Back 154

persistent thrush, lymphadenopathy and hepatosplenomegaly, severe diarrhea, failure to thrive, and recurrent infections

Front 155

What are the strategies to reduce transmission of HIV to newborns

Back 155

-maternal Tx with ZDV during pregnancy
-consider elective C-section at 38 wks
-mothers who are HIV positive should be advised not to breast feed due to risk of transmission

Front 156

What percentage of pediatric HIV infection results from maternal fetal vertical transmission

Back 156

25%