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487 Cards in this Set
- Front
- Back
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Li Fraumeni
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many diff types of CA in same family
in kids TP53 on Chr 17 |
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Cowden Syndrome
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PTEN on Chr 10
Breast, thyroid, endometrium Papillomas are hallmark Mutated PTEN = no phosphorylation |
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HNPCC
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Lynch syndrome
I = Rt sided mult tumors II = I + extracolonic colorectal cancer microsatellite instability |
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BRCA2
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AD
Male breast cancer Chr 1310-3-% of breast cancer |
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BRCA1
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AD
Chr 17 BRCT domain at C-terminus 20-40% of genetic breast cancer |
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SRY gene
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GC-rich in 5' region
2 Zn finger rich recognition sites for Sp1 |
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SOX9 mutations
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camptomelia dysplasia
SOX9 target is AMH No SOX9 = no mullerian duct degen. Ovary development occurs |
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Androgen insensitivity
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XY sex
look like girl, large breasts, juvenile nipples F external genitalia, blind-ending vagina absent/scanty sexual hair normal M testosterone levels hi FSH, LH, hCG |
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Cholesterol synthesis defects
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Smith Lemli Opitz Syndrome
def of 7 DHC Sx: growth retardation, microcephaly, mental retardation, malformations |
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17B-Hydroxysteroid dehyrogenase def
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46,XY
F external genitalia Substances shunted down = hi E virilization at puberty |
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5-alpha reductase deficiency
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Def conversion of T to DHT
in F: genitalia normal, delayed menarche external genitalis appear F at birth hypospadic microphallus blind vaginal pouch **normal serum T, high T:DHT ratio** |
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Klinefelter
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47,Y+extra X's
tall, skinny, small testes high FSH, LH, E:T ratio low T delayed puberty |
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Noonan Syndrome
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AD
mutations in PTPN11 gene KRAS more severe RAF heart problems delayed puberty, down-slanting eyes small penis, undescended testes unusal chest shape webbed and short-appearing neck Looks like Turner's but is autosomal, can be in males, and is inherited |
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Breast cancer risk factors
(Bjerke) |
Age
HRT Alcohol consumption 1.5x risk for 5 drinks/day BCP (LCIS 8-11x) BRCA1, 2 Sex F>M Late 1st baby (>30) Late menopause (>55) |
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characteristics of Fibroadenoma
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common < 30 (surgery) 15-25 (wootton) < 25 (FA)
1-3 cm size freely mobile, firm mass with sharp edges discreet round mass made of fibrous and glandular tissue pregnancy can stimulate growth (inc E) not a precursor to cancer |
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Mastalgia
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HRT, Danzol
Deep voice hirsuit can be aspirated |
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Nipple discharge
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duct ectasia common
single duct bloody drainage 10-15% malignancy more commonly intraductal papilloma (benign) 4th/5th decdes |
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Thoracodorsal
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Lat dorsi
Adducts, extends arm |
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Long thoracic
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serratus anterior
Abducts scapula (winged scapula) |
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Local recurrence BC
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mastectomy
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Local recurrence BC after mastectomy Tx
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excision with radiation
systemic chemo |
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Metastatic BC Tx
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brain mets = radiation
bone mets = radiation & surgical fixation |
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Most common type of BC
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Infiltrating ductal
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Benign condition that is a marker for invasive BC
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LCIS
Paget's |
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Will Roger's Phenomenon
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obtained when moving an element from one set to another set, raises the avg values of both sets
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Mastitis
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lactating women
staph or strep CAN breastfeed |
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BAD mammo characteristics
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pleomorphic, linear, branching
clusters of calcification "come to ea other" different looking irregular, ill0defined projections shadowing |
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GOOD mammo characteristics
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large, round
oval, lobular well-defined margin |
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1st line breast imaging < 25
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US
used if requested by mammo findings or if palpable nodules |
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3 predominant features of fibrocystic breast dz
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cyst formation
fibrosis adenosis |
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MC solid benign tumor in young women
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fibroadenoma
not a/w inc cancer risk |
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indications of benign BC on US
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wider than tall
(like elongated since it's not growing to skin or wall) |
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1st workup for gynecomastia
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mammo
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most important risk factor for BC
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bein' a lady
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MC cancer detected in US women
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breast
(melanoma 1st) |
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MC cancer in women
2nd MC cancer in women |
lung
breast |
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Start yearly mammo at age...?
(Dykstra) |
40
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Linguine Sign
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snakey lines seen w/ rupture of implant
use MRI |
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Ataxia-Telangiectasia defect
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defect in DNA repair enzymes
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triad of sx: ataxia-telangiectasia
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cerebellar defects (ataxia)
spider angiomas (telangiectasia) IgA deficiency |
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percentage of F who have no risk factors for BC except gender and older age
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70%
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What to supplement in breastfed babies
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vit D
Fe |
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when to use nipple shields
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flat or inverted nipples, pre-term
NOT for babies who will no latch |
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when to use breast pump
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poor stimulation
baby has poor suck etc (NOT if nursing well + no risk factors) |
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correct sucking pattern
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tongue:
-curves around finger -is beneath finger -is over gum line Complete seal formed around finger neg pressure rhythmic pattern of suck |
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most important time to breastfeed
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in delivery room
(are alert and eager from birth-2 hrs: PUT TO BREAST) |
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how many times should baby nurse in 1st 24 hours?
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at least 8x
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criteria for assessment of breast feeding
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alignment
areolar grasp areolar compression audible swallowing total seal around breast |
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indications of sufficient breast milk intake
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6+ voids/24 hrs
4+ stools/24 hrs content after feeds wakes to be fed |
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normal infant weight gain
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5-7 oz/weeks
or 1 lb/2 days (WTF? This IS what the slide says. Internet says: 1 oz per day for the first month, and about 1-2 lbs a month until month 6) |
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# of voids baby should have by day 5
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6+ (most critical voids/day to achieve)
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initial and most effective eval of newborn
(Magie) |
hands and stethoscope OFF
use eyes and ears |
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grayish hue/color of newborn
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severe acidosis
poor outcome seen with severe infections, cardiac dz |
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acrocyanosis in newborns is normal for how long?
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1st 24 hrs
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how should term babies lay on the bed?
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all extremities held off bed
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mottling in newborn
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cold
stress indicator of significant systemic illness -worry if stays when warm (cardiac or acidosis d/t infection) |
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pallor in newborns
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never normal
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normal diameter of newborn cornea
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10mm
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normal newborn HR
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100-160
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PMI of newborn
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left lower sternal border
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describe S2 of newborn
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upper left sternal border
normally split absence of split = pathology |
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disappearance of a murmur in a clinically deteriorating newborn is indicative of?
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ductal dependent lesion
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most common abd mass in newborn
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hydronephrosis or cystic kidney disease
(kidneys are normally palpable in newborn) |
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BCG
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TB immunization
don't use in USA bc doesn't protect against pulmonary dz |
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fever 103-105, 5-7 days
H/A pneumonitis unusual rash (often petechial) extremity swelling |
measles
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Hep B is what type of vaccine?
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recombinant DNA
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CI's to vaccines
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ANY allergic rxn EVER: don't give again
Rotavirus: not if have SCID Tdap: don't give if encephalopathy Hib: don't give < 6 wks old MMR: no if pregnant or known severe immunodeficiency Varicella: same as MMR |
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Who is required to report child abuse:
KS MO |
KS: persons licensed to practice the healing arts or dentistry
MO: physician (including residents and interns) Both: nurses, chiropractors, podiatrists, psychologists, anyone else who cares for kids |
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presence of IgM in newborn indicates?
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likelihood of infection with that organism
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presence of IgG and absence of IgM in newborn indicates?
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may reflect passive transfer of maternal Ab to baby
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how is baby infected with vaginal flora after ROM?
delayed v. "shortly after" delivery |
bacteria ascends
v. baby is colonized during passage down birth canal |
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MC congenital infection
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CMV
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Toxoplasma gondii mode of transmission
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cat poo
ingestion of undercooked meat |
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triad of neonatal manifestations: Toxoplasma
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chorioretinitis
hydrocephalus intracranial calcifications |
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triad of neonatal manifestations: rubella
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PDA (or pulmonary a. hypoplasia)
cataracts deafness +/- blueberry muffin rash |
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neonatal manifestations: CMV
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hearing loss
seizures petechial rash microcephalus periventricular calcification |
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neonatal manifestations: HSV
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vesicular lesions
keratoconjunctivitis temporal encephalitis |
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neonatal manifestations: HIV
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severe thrush
failure to thrive recurrent bacterial infections calcification of the basal ganglia chronic diarrhea |
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neonatal manifestations: treponema palladium
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bullous, macular, and eczematous skin lesions
osteochrondritis and periostitis |
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characteristics of intraductal papilloma
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more common post-menopause
small tumor in the lactiferous ducts typically beneath areola MCC of spontaneous nipple d/c in < 50 y/o bloody/serous/turbid nipple d/c slight inc risk for carcinoma |
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tx of intraductal papilloma
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excision of lesion and involved duct
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tx of fibroadenoma
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excised when 2-4 cm (cosmetic reasons)
if > 15 cm then have malignant potential and should be excised |
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characteristics of galactocele
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cystic dilation of duct filled with milk
found during or shortly after lactation usually d/t some form of occlusion secondary Ix can cause mastitis or abscess |
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tx of galactocele
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needle aspiration
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characteristics of hyperplasia (aka fibrocystic breast dz)
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when a/w cellular atypia = inc risk of cancer
though to be d/t dec P, inc E lesions usually b/l and multiple pain & tenderness tend to be cyclic |
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tx of breast hyperplasia
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depends on age, severity, risk of CA, etc
may need imaging if suspicious can aspirate cyts to relieve pain |
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tx of mastalgia
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symptomatic:
avoid caffeine low fat diet good support bra evening of primrose oil OCP's may improve cyclic pain |
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principle hormone for synthesis of milk and maintenance of lactation
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PRL
(ant pit and mammary gland) |
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responsible for release of stored milk
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oxytocin
(post pit) |
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immunoglobulin in breast milk
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IgA
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components unique to breast milk
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casein
lactalbumin beta-lactoglobulin |
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typical bug in mastitis
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staph aureus from baby's mouth
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tx for mastitis
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penicillinase resistant ATBX like dicloxacillin
DO NOT need to discontinue feeding |
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how to suppress lactation
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NO MEDS
tight bra analgesics like tylenol ice avoid stimulation |
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produced on day 2 of breastfeeding
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colostrum: proteins, fat, minerals, IgA
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colostrum is replaced by mature milk on day(s) ______? (after delivery)
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3-6
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what does the Clear Blue Monitor detect?
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detects metabolite estrogen in first few days of fertile phase
also LH surge |
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what pattern of cervical mucus marks the fertile window
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"sperm pattern"
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best type of natural planning
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symptothermal
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relationship effects of NFP
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helpful to marriage
lowers divorce rate (says the pope) |
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def of 1st stage of labor
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onset of labor to complete dilation and effacement
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def of latent/early phase of labor
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1-3 cm
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def of active/late phase of labor
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intense labor
4-10 cm |
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remedial tx for uterine hyperstimulation
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1. Stop pitocin immediately
2. Increase IV fluids 3. Administer O2 at 6L/min 4. Turn patient on left side |
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CI's to induction
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1. Transverse fetal lie
2. Vasa previa (cord over os) or complete placental previa 3. Umbilical cord prolapse 4. Previous trasfundal uterine surgery |
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def of presentation (delivery)
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presenting part of fetal body which is foremost in the birth canal
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def of station
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descent of fetus in 2nd stage, eval by measuring relationship of boeny portion of fetal head to the level of the maternal ischial spines
zero: at spines neg: above pos: below |
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normal baby birth position
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OA
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4 degrees of Perineal Lacerations
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1. 1st—tear of vagina or perineal skin
2. 2nd—extending into the subepi of vagina or perineum 3. 3rd –tear involving anal sphincter 4. 4th—involve rectal mucosa |
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what should you do when baby's head is coming out?
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control it!
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length of 3rd stage of labor should be?
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0-30 min
> 20, start to worry about hemorrhage |
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cardinal movements in labor
|
engagement
flexion (chin tucked, = attitude) descent int rotation (nose to post) extension est rot (restitution) |
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duration of stage 2 labor
primapara multipara w/ and w/o epidural |
prima: 2 hrs, 3 w/ epidural
multi: 10 min-1 hr, 2 w/ epidural |
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duration of stage 1 of labor
primapara multipara |
prima: 6-18 hrs
multi: 2-10 hrs |
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rate of cervical dilation should be? (1st stage)
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1 cm/hr primapara
1.2 cm/hr multwipara |
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when to admit laboring mom to hosp
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cervix dilated approx 3-4 cm, 50% effaced or showing change
ANY heavy bleeding! contracting ~ every 3-5 min for ! 45 sec |
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where to insert epidural
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L2-3
L3-4 L4-5 |
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epidural does not....?
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impede progress of labor of inc operative delivery rate
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painless vaginal bleeding in pregnancy
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placenta previa
hemorrhage secondary to placental tearing do NOT do digital exam can do US/speculum (gentle!) usually PAINLESS ONSET |
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placenta accreta
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through the uterine myometrium as result of defective decidula formation
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placenta increta
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through uterine muscle
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placenta percreta
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extends to uterine serosa, can go to bladder
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clinical presentation of placental abruption
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vag bleeding
ABDOMINAL PAIN tachysystole non reassuring FHR BLEEDING CAN BE CONCEALED! |
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5 steps to assess bleeding in pregnancy
|
1. assemble team, use "trauma protocol"
2. initiate 2 large bore IV 3. obtain freq vitals (ABC's!) 4. obtain history, r/o placenta previa, vasa previa (SONOGRAM), ask about blood clotting disorders 5. check CBC, coag panel, fibrinogen |
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4 T's of hemorrhage
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Tone
Tissue retained Trauma lacs and uterine rupture Thrombin |
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causes 75-85% of hemorrhage after birth
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uterine atony
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tx of uterine hemorrhage
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bimanual massage
methylergonovine (methergine) |
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microorganisms of postpartum endometritis
|
"normal" vag bugs
Group B strep **anaerobic streptococci** - (peptostrepto) aerobic G- (EC, Kleb, Proteus) anaerobic G+ (bacteroides, prevotella) |
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what to do w/ uterine inversion
|
emergency!
high morbidity and mortality get help act rapidly atropine if brady push center of uterus before cervical contraction ring develops |
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presentation of uterine inversion
|
blue-gray mass protruding from vag
copious bleeding hypotension worsened by vasovagal reaction |
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tx of uterine rupture
|
surgical intervention
emergency usually occurs in active labor |
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average blood loss in vaginal delivery
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500 mL
> means hemorrhage |
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average blood loss in abdominal delivery
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1000 mL
greater means hemorrhage |
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signs of postpartum hemorrhage
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hypotension
tachy pain watch out for slow bleeds! most death occurs after 5 hrs following delivery |
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external fetal monitoring assesses what?
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freq and duration
NOT intensity |
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internal fetal monitoring assesses what?
|
strength and pressure of contractions
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normal baseline FHR
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110-160
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FHR brady = ?
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< 110
3rd degree heart block |
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FHR tachy
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> 160
see a lot in maternal fever (think chorioamnionitis) |
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variability:
absent minimal moderate marked |
absent: undetectable
minimal: > undetectable, < 5 bpm moderate: 6-25 bpm marked: > 25 bpm |
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how to uterine contractions affect FHR?
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blood flow from mother to baby initially ceases, then resumes as contraction ends
can inc or dec |
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influence FHR via vagus in response to change in fetal BP
|
baroreceptors
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produce FHR tachy in response to hypoxia
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chemoreceptors
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baseline variability of FHR should be?
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vary by at least 5-25 beat over period of 1 min
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causes of FHR brady
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late sign hypoxia
pitocin heart block fetal position OP: occular pressure |
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FHR tachy causes
|
early sign hypoxia
terbutaline intrauterine infection |
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dec variability in fetal heart monitoring indicates what?
|
possible stress
hypoxia/acidosis CNS depressant meds prematurity fetal sleep |
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tx of non reassuring FHR
|
mom left side
stop oxytocin inc O2 inc IV fluid |
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late decels in FHR look like...?
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gradual dec in FHR with gradual return to baseline after contraction
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etiology of late decels in FHR
|
uteroplacental insufficiency
always worrisome |
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what do early decels on FHR look like?
|
begins at onset of contraction adn end with end of contraction
mirror image of contractions |
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etiology of early decel in FHR
|
vagal stimulation from head compression
|
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accelerations in FHR should....?
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start before contraction
be greater 15 bpm x 15 secs if < 32 weeks 10 x 10 reassuring! |
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2 accelerations in 20 mins on fetal monitor
|
reactive trace
|
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when to give Rhogam
|
28 weeks
anytime they experience bleeding during pregnancy and postpartum |
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when can you detect hCG in serum
|
6-8 days after ovulation
<5 IU/L is negative > 25 IU/L is positive |
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how does AST/ALT change during pregnancy?
|
doesn't (HAH!)
if rises, think preeclampsia, fatty liver, etc |
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when to do crown-rump length
|
between 6-11 weeks
can determine due date within 7 days |
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how to determine due date when between 12-20 weeks
|
can determine due date within 10 days using femur length, biparietal diameter, and abd circumference
|
|
|
incidence of Downs between ages 40-45
|
1:80
(normally 1:800) |
|
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Downs is due to what meiotic error?
|
nondisjunctional events leading to 47 Chr with an extra 21 Chr
|
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2nd MC form of mental retardation
|
Fragile X
(MC inherited form) |
|
|
supplementation reduces risk of NTD's
|
folic acid
|
|
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hallmark of AD disorders
|
variability
|
|
|
most common gene defect carried in NAmer whites
|
CF
1:25 |
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inc maternal serum AFP indicates what?
|
open NTD
|
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if inc maternal AFP then do what?
|
US to r/o mult gestation, fetal demise, inaccurate GA
|
|
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if high AFP, and r/o mult gestation, fetal demise, inaccurate GA, then do what?
|
amnio
look for acetylcholinesterase (present only with NTD) |
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maternal
low AFP, high hCG, low estriol |
Downs
(can add inhibin to panel) |
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maternal
low AFP, low hCG, low estriol |
Trisomy 18
|
|
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most vulnerable stage of fetal development
|
days 17-56 postconception
(31-81 by GA) period of organogenesis |
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3 classes of teratogenic agents
|
drugs
infectious agents radiation |
|
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heparin ok for pregnant moms?
|
yes, does not cross placenta
|
|
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coumadin ok for pregnant moms?
|
NO
badbadbad |
|
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smoking in pregnancy causes what?
|
interferes with fetal growth
weight, length, head circum inc risk: spontaneous abortion, fetal death, neonatal death, prematurity |
|
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critical period for fetal radiation exposure
|
2-6 weeks
|
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limit for fetal radiation exposure
|
< 5 rads
|
|
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can travel until what week of prenancy?
|
34
|
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when to screen for group B strep carrier in pregnancy
|
35-37 weeks (vag culture)
treat in labor if (+) |
|
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fetus should move how often?
|
10 movements in 1 hour
|
|
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frequency of pregnancy dr visits should be?
|
every 4 weeks till 28 weeks
every 2 weeks from 28-36 weeks weekly until delivery |
|
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etiology of heartburn in pregnancy
|
relations of esophageal sphincter by progesterone
|
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def of HTN in pregnancy
|
sustained BP over 140/90
|
|
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DOC for severe chronic HTN in preg
|
methyldopa
|
|
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can you give ACEI's to pregnant moms?
|
NO
|
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def of gestational HTN
|
HTN w/o proteinuria
|
|
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dx of gestational HTN is made how?
|
true dx is in retrospect
|
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def of preeclampsia (diagnosis)
|
HTN
proteinuria (> 300g/24 hrs, severe = > 500g/24hrs) edema |
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sx of preeclampsia (patient will complain of)
|
scotoma (change in vision)
blurred vision epigastric/RUQ pain h/a |
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def of mild chronic HTN in pregnancy
|
less than 150/100
present before or during 1st half pregnancy |
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def of mild preeclampsia
|
BP > 140/90, < 160/110
proteinuria > 300 g/24 hrs, < 500 g/24hrs asymptomatic |
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def of severe preeclampsia
|
BP sys > 160 or dias > 110
proteinura > 500 g/24 hrs or 3+ on 2 random u-dips at least 4 hrs aparts oliguria (< 500 mL/24 hrs) symptomatic |
|
|
management of severe preeclampsia
|
immed hospitalization
delivery if > 34 weeks manage HTN: hydralizine, labetalol, nifedipine |
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|
HELLP syndrome
|
Hemolysis
Elevated Liver enzymes Low Platelets |
|
|
toxicity of magnesium sulfate causes?
|
resp compromise and cardiac arrest
|
|
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give what to reverse magnesium sulfate?
|
calcium gluconate
|
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first tx of ecclampsia
|
protect airway!
may need diazepam or lorazepam mag sulfate |
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tx of HELLP
|
immediate delivery
|
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management of mild preeclampsia < 37 weeks
|
bed rest
twice week testing fetal growth US every 2-4 weeks office/lab evals possible hospitalization |
|
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tx of mild preeclampsia between 37-40 weeks
|
deliver!
if favorable cervix-induct if unfavorable cervix- use cervical ripening agent to begin induction |
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etiology of liver pain in pregnancy (RUQ pain)
|
stretching of Glisson's capsule
|
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when to screen for GDM
|
between 24-28 weeks
|
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how to test for GDM
|
50 gm one hour oral load glucose challenge
if abnormal follow w/ 3 hr, 100 gm oral load glucose tolerance test |
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meds for hyperthyroid in preg
|
PTU
MTZ |
|
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etiology of neonatal thryotoxicosis
|
transplacental transfer of thyroid stimulating Ab's
|
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indications for operative vaginal deliveries
|
non reassuring FHR
prolonged 2nd stage labor (prima = > 2 hrs, > 3 hrs w/ epidural, multi = > 1 hr, or >2 w/ epidural) |
|
|
requirements for operative vag delivery
|
**adequate analgesia**
lithotomy position empty bladder adequate pelvimetry consent |
|
|
describe classic forceps
|
cephalic curvature and pelvic curve to yield concave longitudinal axis
not for rotation of head |
|
|
how to apply traction with forceps
|
in plane of least resistance and follow pelvic curve
if doesn't come easy = STOP |
|
|
what must you be positive of before using forceps?
|
position of baby's head
|
|
|
what to do if forceps don't articulate easily
|
reapply
if still don't articulate DON'T reapply |
|
|
what should you check before applying traction to forceps
|
position
|
|
|
where should forceps be placed on fetus?
|
against head so that they cover space between the orbits and ears
|
|
|
what are forceps used for?
|
assist w/ delivery of fetal head
expedite delivery helps advance fetal head through (traction) pelvis (assist w/ rotation) |
|
|
3 checks when using vacuum
|
1. no tissue trapped
2. cup placed in midline of sagittal suture 3. vacuum port of suction cup points toward occiput |
|
|
how many pop-offs allowed when using vacuum?
|
2, no more
|
|
|
complications of vacuum compared to forceps
|
more failed deliveries
less perineal injuries inc incidence fetal cephalohematoma inc scalp lacs and bruising |
|
|
how to apply vacuum
|
do 3 checks
place cup on head ensure free of tissue inc P to 600 mmHg w/ contraction traction along pelvic axis |
|
|
advantage of vacuum
|
can be achieved w/ little maternal analgesia
|
|
|
CI's to vacuum
|
GA < 34 weeks
suspected fetal coag disorder suspected macrosomia breech |
|
|
MC hospital based procedure in US
|
C/S
|
|
|
what tx of hyperthyroidism is CI in pregnancy
|
radioactive iodine
|
|
|
how to dx maternal hyperthyroidism
|
difficult d/t vague sx
elevated free T4 and suppressed TSH |
|
|
sx of maternal thyroid storm
|
hyperthermia
tachy sweating high output cardiac failure high maternal mortality! |
|
|
tx of maternal thyroid storm
|
BB: propranolol
block thyroid hormone: sodium iodide stop syn of thyroid hormone: PTU halt peripheral conversion T4 to T3: dexamethasone replace fluid losses bring temp down |
|
|
tx of maternal hypothyroidism
|
thyroid replacement i.e. levothyroxine
monitor TSH and free T3/T4 monthly |
|
|
indication of GDM c-section delivery of baby
|
> 4250 grams
|
|
|
MC lesion of rheumatic heart disease
|
mitral stenosis
|
|
|
a "must" for management of pregnant cardiac pts
|
co-manage with cardiologist
|
|
|
sx of postpartum cardiomyopathy
|
significant SOB
cardiomyopathies postpartum no more pregnancies mortality rate ~20% |
|
|
tx of cardiac pregnant pts
|
EKG/echo
low sodium diet rest on left side adequate sleep **avoid strenuous activity** prevent anemia (protect work of heart) anticoag's with mech valves and a-fib |
|
|
Mendelson's syndrome in pregnancy is also known as?
|
acid aspiration syndrome
|
|
|
what can Mendelson's syndrome in pregnancy result in?
|
adult respiratory distress syndrome
|
|
|
why are pregnant women at higher risk for Mendelson's syndrome?
|
delayed gastric emptying, inc intra-abdominal and intra-gastric P
|
|
|
prevention and tx of Mendelson's
|
prevent: dec acid, do not feed in labor
tx: supplemental O2, maintain airway, treatment for acute resp failure |
|
|
definition/dx of cholestasis in pregnancy
|
cholestasis and pruritis in 2nd half of pregnancy not a/w liver enzyme elevations
|
|
|
sx of cholestasis in pregnancy
|
itching w/o abd pain or rash
elevated serum bile acids |
|
|
lab findings of acute fatty liver of prenancy
|
inc PT, PTT, elevated bili, ammonium, uric acid, elevation of liver transaminases
tx = have baby! |
|
|
signs of PE in pregnancy
|
*tachypnea
*tachycardia low grade fever pleural friction rub chest splinting |
|
|
typical instigating factor of PE in preg
|
DVT
|
|
|
dx of DVT in preg
tx of DVT in preg |
dx: 50% asymptomatic, compression US, may use MRI
tx: heparin |
|
|
DVT in preg is more common in which leg?
|
left
|
|
|
Homan's sign
|
pain in calf with dorsiflexion
|
|
|
MC arrhythmia in preg
|
supraventricular tachy (usually benign)
|
|
|
describe birth rate of monozygotic twins worldwide
|
constant at 1/250
NO GENETIC PREDISPOSITION |
|
|
def of dizygotic/fraternal gestations
|
twin fetuses resulting from the fertilization of two separate ova
|
|
|
**in this type of twin each has own amnion (thick membranes), chorion, and placenta
|
dizygotic
|
|
|
how do you confirm twins?
|
US to determine # of fetuses and gestation sac
will help determine chorionicity if done aroud 14 weeks gestation |
|
|
when to suspect multiple gestation
|
large uterine size
high chorionic gonadotropin in plasma and urine high AFP |
|
|
maternal complaints in multi gestation
|
excessive weight gain
hyperemesis gravidum sensation of > 1 fetus moving (duh) |
|
|
twins born < 35 weeks gestation are 2x as likely to develop what?
|
**hyaline membrane disease
|
|
|
tx of twin-twin transfusion
|
**send pt to tertiary and laser ablation of vessels to make anastomoses go away
|
|
|
adequate nutrition for multi gest mothers
|
inc caloric intake 300 cals
**double iron and folic acid |
|
|
deliver multifetal pregnancies by week?
|
36
|
|
|
multifetal preg considered postdate at week?
|
**38
**consider induction |
|
|
etiology of breech presentation
|
**prematurity
**uterine anomalies |
|
|
severe TTTS can cause?
|
polyhydramnios in recipient
oligo in donor must treat or one will die develops early in 2nd trimester |
|
|
moderate TTTS can cause?
|
discrepancy in size, no amniotic amount problems
hydrops can develop in either twin develops late in 2nd trimester |
|
|
mild TTTS can cause?
|
size and Hb differ
develops in 3rd trimester |
|
|
length of latent phase in nulliparous
|
**20 hours or less
|
|
|
length of latent phase in multiparous
|
**14 hours or less
|
|
|
def of labor
|
cervical change accopmanied by regualr uterine contraction
|
|
|
def of latent phase
|
initial part of labor, most effacement
|
|
|
def of active phase
|
portion of labor where dilation occurs more rapidly, usually when cervix > 4 cm
|
|
|
def of protraction disorder of active phase of labor
|
< 1.0 cm in prima, < 1.2 in multi
(ie less change than expected) |
|
|
def of cephalopelvic disproportion
|
**if maternal bony pelvis is not of sufficient size/shape to allow passage of fetal head
|
|
|
def of relative cephalopelvic disproportion
|
**fetal head in abnormal position, if baby's head is OP, get C/S
next baby could be vag delivery |
|
|
def of macrosomia
|
**fetus > 4500 gm
|
|
|
tx of shoulder dystocia
|
**CALL FOR HELP!!
**McRobert's (hyperF and aBduction of hips) suprapubic pressure episiotomy direct fetal manipulation |
|
|
def of arrest of dilatation
|
no progress in active phase of labor for 2 or more hours
|
|
|
how do you approach pregnant pt with surgical emergency?
|
**same as non-pregnant patient
|
|
|
def of 1st trimester, 2nd, 3rd
|
conception to 14 wks
14-28 28-40 |
|
|
GA of viable baby
|
23+ weeks
|
|
|
GA of preterm labor
|
20-37 weeks
|
|
|
GA term baby
|
** 38 weeks ("just term")
|
|
|
GA of post-term
|
** > 42 weeks
|
|
|
GA of spontaneous abortion
|
** < 20 weeks
|
|
|
#1 risk factor for preterm delivery
|
**prior preterm delivery
(also infection/chorioamnionitis, teen pregnancy) |
|
|
tx to reduce preterm delivery
|
progesterone
|
|
|
where to sample fetal fibronectin?
|
posterior cervical fornix
|
|
|
what invalidates fetal fibronectin sample?
|
**bleeding, recent sex, recent check of cervix
|
|
|
neg predictive value of fetal fibronectin
|
**neg predictive value = > 95% won't deliver w/in 2 weeks (22-35 weeks)
|
|
|
fetal fibronectin test decreases what?
|
high rate of false positive dx of preterm labor
|
|
|
in what percentage of cases is NO reason for preterm labor discovered?
|
50%
|
|
|
when do you treat (try to suppress) preterm labor?
|
**24-34 weeks
**EFW 600-2500 grams (1 lb 5 oz - 5 lb 8 oz) < 24 weeks must try to suppress 34-37 weeks expectant management |
|
|
when do you administer corticosteroids to fetus?
|
**if b/w 24-34 weeks and will deliver w/in 7 days
|
|
|
which pneumocytes make surfactant?
|
**Type II
|
|
|
typical protocol for fetal corticosteroid administration
|
betamethasone 12 mg IM q 24 hrs to stimulate type II pneumocytes
DO NOT repeat protocol (most of the time) |
|
|
MOA of beta mimetic adrendergic agents to cause tocolysis
SE's |
act on B2 receptors to relax uterus and uterine vessels
SE's: pulmonary edema, hypotension, tachy, chest pain, tremors |
|
|
MOA of mag sulfate for preterm labor and preeclampsia
|
**acts at cellular lever by competing with Ca for entry into cell at time of depolarization
use to stop contractions |
|
|
when to test for group B strep in preterm labor?
|
**always (ampicillin)
bc probably haven't tested/cultured yet |
|
|
def of PROM
|
**spontaneous rupture of membranes before the onset of labor at any gestational age
|
|
|
how to check for PROM?
|
**use sterile spec to look for vaginal pooling
**nitrazine test: paper turns blud if amniotic fluid (pH 7-7.5) **ferning: fernlike patter of xstallization on microscope of dry vaginal fluid |
|
|
(rare) assessment of PROM
|
**inserted indigo carmine into amniotic fluid, look to see if appears on pad/tampon
|
|
|
when to check for fetal lung maturity? (what stage of pregnancy)
|
usually 3rd trimester
|
|
|
which stage of pregnancy to check for Chr abnormalities?
|
1st trimester (or 2nd)
|
|
|
ATBX tx of PROM
|
GA 24-32 weeks
**erythromycin **ampicillin amoxicillin |
|
|
sx of chorioamnionitis
|
****
fetal/maternal tachy fever uterine tenderness (also foul smelling fluid, maternal leukocytosis) |
|
|
tx of chorioamnionitis
|
**deliver!
|
|
|
def of fetal demise
|
20 weeks but before onset of labor
|
|
|
cutoff GA for tocolytic therapy?
|
**typically not used after 34 weeks or after steroid complete
exception: severe heart anomaly |
|
|
MC surgical emergency in pregnancy
|
**appy
|
|
|
sx of adnexal torsion
|
**sudden onset of severe intermittent abd pain
**may radiate to flank or down ant thigh |
|
|
MCC of abdominal trauma in pregnancy
|
**MVC
|
|
|
why is there an increase in cholecystitis and cholelithiasis in pregnancy?
|
rising cholesterol and lipid levels as well as biliary stasis
|
|
|
MC type gallstones in pregnancy
|
cholesterol
|
|
|
when do you remove ovarian tumors in pregnancy?
|
**remove: if persists or grows
**prefer to wait till 2nd trimester |
|
|
tx of cholecystitis/stasis in pregnancy
|
IV fluids
gastric decompression analgesia as appropriate diet |
|
|
sx cholecystitis and cholelithiasis
|
N, V, RUQ pain, increased WBC & bili, jaundice, increase thickness of GB wall on US
|
|
|
sx of pancreastitis
|
severe non-colicky epigastric pain radiating to back
N, V elevated serum amylase |
|
|
material causation of disparity
|
physical or financial resources
|
|
|
semiotic causation of disparity
|
symbolic understandings and resulting expectations
|
|
|
we talked about disparities in health care with what 3 things?
|
internal cardiac defib
drug eluting stents steroid inhalers |
|
|
how does the diffusion of innovation through society?
|
in predictable manner, according to socio economic strata, is not random
advantages and disadvantages to certain groups (class/race) |
|
|
who is last to benefit from new technology?
|
minority children
|
|
|
how is our society structured?
(crappy question, I know) |
there is a hierarchical structure to our society that is layered and one way it is layered is according to race/class which gives advantages in receiving health care
|
|
|
what plays a role in access to health care?
|
both material and semiotic influences
|
|
|
what is critical to engage disparities in clinical practice?
|
the sociological imagination: being able to see "personal troubles" in "public issues"
|
|
|
describe sociological imagination
|
individual can understand his own experience and gauge his own fate by locating himself within his period that he can know his own changes in life only by becoming aware of those of all individuals in his circumstances
|
|
|
principle estrogen of pregnancy
|
estriol
|
|
|
progesterone's actions during pregnancy
|
prep of endometrium con't
maintains endometrium *inhibits uterine contraction stimulates development of lobules and proliferation of alveoli in breasts |
|
|
which hormone is required to maintain pregnancy?
|
progesterone
|
|
|
which hormones block lactation during pregnancy?
|
progesterone and estrogen
(mostly P) |
|
|
which hormone supresses fertility while breastfeeding?
|
PRL
|
|
|
which hormone is responsible for milk ejection/let-down?
|
oxytocin
|
|
|
which hormone stimulates contraction fo uterus at delivery?
|
oxytocin
|
|
|
consequences of iron deficiency in pregnancy?
|
Fe def anemia
preterm labor late-spontaneous abortion |
|
|
which hormone is produced by fetal tissues and facilitates calcium transfer across the placenta?
|
PTH-rP
|
|
|
how does maternal cardiovascular function change in pregnancy?
|
CO inc 30-40%, stroke V first, then HR
blood V inc 30-40% |
|
|
are maternal heart murmurs ok during systole?
|
yes, common and benign
late systolic and ejection |
|
|
are diastolic murmurs ok during pregnancy?
|
no, serious, perhaps pathologic
|
|
|
maternal pulmonary changes during pregnancy?
|
total ventilation inc 30-40%
PCO2 dec from pre-pregnancy respirations more diaphragmatic |
|
|
where do hCS and hCG come from?
|
syncytiotrophoblast
|
|
|
function of hCG?
|
maintain corpus luteum
|
|
|
function of hCS?
|
GH-like
|
|
|
how does fetal arterial O2 compare to adults?
|
lower
|
|
|
why is it ok that fetal arterial O2 is lower than adults?
|
Hb has high affinity
low capacity to deal with free radicals |
|
|
how do nutrients move across the placenta?
|
mostly facilitated diffusion
some simple diffusion |
|
|
what happens to fetal respiration during periods of hypoxia/asphyxia?
|
suppressed
|
|
|
where does the highest PO2 blood go in the fetus?
|
head/brain and heart
|
|
|
how does fetal CO compare to adult and why?
|
higher (d/t low resistance of placental vascular bed, inc size of placenta compared to fetus, low PO2, and relative vasodilation of peripheral vasculature until development of baroreceptor reflex)
|
|
|
what is the major GH in the fetus and what is its primary receptor?
|
insulin
IGF-2 |
|
|
what is GH responsible in the fetus
|
general growth and major role in organ growth
|
|
|
what is released (and can be measured) in the fetus in response to stress?
|
epi
|
|
|
describe early fetal movements
|
involve whole body rather than specific limbs
|
|
|
why are premature babies very sensitive to afferent stimuli?
|
too many synapses are formed during fetal development and are pruned during the third trimester and post-natally
|
|
|
describe blood flow to fetal nephrons
|
deep cortical nephrons get the majority of flow before birth, outer cortical nephrons get more after birth
|
|
|
how is most of ion regulation accomplished in the fetus?
|
"passively" at the placenta, regulated by the maternal ECF
|
|
|
what is the purpose of respiratory motion in the fetus?
|
do NOT bring in O2 or remove CO2
only inc O2 consumption and CO2 production function to expand the chest wall and allow for normal development |
|
|
what is the early fetal CV response to hypoxia?
|
peripheral chemoreceptors cause tachycardia, cessation of resp movements, and inc CO (therefore inc BP), also vasoconstriction everywhere but brain
|
|
|
what is the late fetal CV response to hypoxia?
|
inc BP activates baroreceptors which causes the net effect of dec HR and the hypoxia directly affects the myocardium
|
|
|
where is HLA-G protein expression restricted to?
|
immune privileged sites such as the placenta and thymus
|
|
|
what is the function of HLA-G in pregnancy?
|
placental immunosuppression
|
|
|
what does indoleamine 2,3-dioxygenase (IDO) control?
|
metabolism of tryptophan
|
|
|
which immunosuppressors does the placenta express?
|
Th2 cytokines: IL-10 and TGF-beta
PGE-2 |
|
|
which hormone induces the secretion of RTF and PIBF (potent immunoregulators) in pregnancy?
|
high progesterone
|
|
|
what is the function of RTF in pregnancy?
|
upregulates IL-10, interferes with IL-2 to block Th1 and promote Th2
|
|
|
what is the function of PIBF in pregnancy?
|
inhibits NK cells, stimulates IL-3, 4, 10 (Th2), and inhibits INF, TNF-alpha, and IL-2, in B-cells induces production of non-cytotoxic Ab's which do not fix complement
|
|
|
how does RU-486/Mifeprisone function in terms of immunology?
|
blocks Pg receptors and prevents PIBF production, linked with surge in TNF-alpha
|
|
|
what is the function of membrane cofactor protein (MCP) in pregnancy?
|
blocks C3b and C4b
|
|
|
what is the function of decay accelerating factor (DAF) in pregancy?
|
prevents assembly of C3bBb complex or accelerates disassembly of preformed convertase
|
|
|
which ligand do trophoblasts express and what is it's function?
|
express Fas ligand (FasL) (which normally induces T cell apoptosis upon immune withdrawal), here it guards and induces apoptosis of infiltrating T cell to maintain immune privilege
|
|
|
which cytokines are Th1 in pregnancy?
|
IL-2, IL-12, INF-gamma, TNF
|
|
|
which cytokines are Th2 in pregnancy?
|
IL-3, 4, 5, 6, 10, 13
|
|
|
what are the major APC's in the female reproductive tract?
|
macrophages and DC's
|
|
|
what forms the blood-testis barrier in males?
|
tight junctions between sertoli cells (immune privileged site)
|
|
|
how does PID create infertility in regards to immunology?
|
response occurs with a concurrent infection where sperm cells become "innocent bystanders"
W with PID have hi incidence of ASA's |
|
|
what is the immune response to sperm in fertile women?
|
ASA elicit the production of anti idiotypic Ab's which neutralize ASA reponse
|
|
|
what is the immune response to sperm in infertile women?
|
anti-idiotypic Ab production is weak/absent
|
|
|
suppressing factors in immunology of pregnancy?
|
seminal plasma (prostaglandins, TGF-beta, etc)
sperm surface molecules idiotypic Ab network immune suppressor cells in tract |
|
|
stimulating factors in immunology of pregnancy?
|
infectious agents, inflammatory cells, cytokines in semen
infection/inflamm/trauma in tract dec immunosuppressive factors in semen ASA sperm activation of macrophages and immune cells immune sys def (lack of idiotypic Ab's, lack of suppressor T cell response) |
|
|
why are there more cancers in the upper outer quadrant of the breast?
|
most massive part of breast (basically the size of it)
|
|
|
what do you use to stain for myoepithelium in the breast?
|
smooth-muscle-actin or S100
|
|
|
what composes one "lobule" in the breast?
|
one collecting duct, and its terminal ductules and acini, plus the accompanying stroma
|
|
|
describe the pathology of fat necrosis of the breast
|
trauma
necrotic fat cells surrounded by mixed inflammation, later with calcification, foreign body rxn, scarring |
|
|
what is mondor's disease?
|
thrombosis of subcu vein of breast, usually harmless
|
|
|
what 3 pattern occur in fibrocystic change of the breast?
|
fibrosis
cyst formation adenosis |
|
|
does proliferative breast dx have an extra cancer risk?
|
yes
|
|
|
does fibrocystic change of the breast put a woman at an extra risk for cancer?
|
no
|
|
|
what are the 3 categories of proliferative breast disease?
|
epithelial hyperplasia
sclerosing adenosis small duct papillomas |
|
|
3 tips that mean sclerosing adenosis, and not cancer
|
always myoepithelium
normal lobular architecture is preserved (although may be expanded) hard, but never cuts "gritty" |
|
|
which 3 mutations confer a large risk for breast cancer?
|
BRCA1, BRCA2, TP53
|
|
|
how does breast cancer usually present?
|
dominant, painless mass
|
|
|
what percentage of breast cancers do not show up on mammo?
|
10%
|
|
|
is smoking a risk factor for breast cancer?
|
no
|
|
|
what inflammatory cell is abundant in medullary carcinoma?
|
lymphocytes
(cells express HLA-DR) |
|
|
which breast carcinoma has the best prognosis and is star shaped?
|
tubular carcinoma
|
|
|
describe histo of invasive lobular carcinoma
|
cells in indian file
signet ring cells loss of e-cadherin expression |
|
|
what do you stain the sentinel lymph node of the breast with to spot cancer cells?
|
cytokeratin 19 and/or mammaglobin
|
|
|
what is the key to surviving breast cancer?
|
early dx
|
|
|
what type of cancer is carcinoma of the male breast?
|
infiltrating ductal carcinoma
|
|
|
most important change/factor in breasts in pregnancy?
|
glandular hyperplasia
|
|
|
increase of breast size during adolescence is due to?
|
proliferation of stroma
|
|
|
what can inverted nipples easily be confused with?
|
inversion of nipples d/t cancer, but inverted nipple can be normal for that woman
|
|
|
what best characterizes fibrocystic disease?
|
multicentric origin
|
|
|
most important prognostic indicator in breast cancer
|
presence of absence of metastatic tumor in axillary lymph nodes
|
|
|
is hormone production characteristic of breast cancer?
|
no
|
|
|
which breast lesion is characteristically b/l?
|
lobular carcinoma in situ
|
|
|
mean age for dx of carcinoma of breast?
|
55
|
|
|
mean age for dx of fibroadenoma of breast?
|
20
|
|
|
is presence of E receptor in BC a good or bad sign?
|
good
|
|
|
a few fibrotic cotyledons on maternal surface of placenta
old or new infarct? |
**old
|
|
|
a few red cotyledons on maternal surface of placenta
old or new infarct? |
**new
|
|
|
vernix caseosa embedded in the amnion, usually w/ oligohydramnios
|
**amnion nodosum (likely on practical)
|
|
|
how long can you detect CMV in the urine of the newborn?
|
**up to 24 hours
|
|
|
how many vessels should be in the umbilical cord?
|
**two arteries and one vein
|
|
|
what is the greatest risk for preeclampsia?
|
previous pregnancy with preeclampsia with the same father
|
|
|
what appears to be the key molecule in toxemia of pregancy?
|
sFIt1
|
|
|
is preeclampsia preventable?
|
no, but eclampsia can be staved off
|
|
|
what is the morphology of eclampsia in the liver?
|
**bleeds in the liver and under its capsule, patches of necrosis, mostly adjacent to the portal area
|
|
|
what is the morphology of acute fatty liver of pregnancy and what condition is it a/w?
|
**periportal necrosis and ecclampsia
|
|
|
what precludes giving Rhogam to Rh (-) women after delivery? (ERF)
|
low levels of anti-Rho D in her serum
|
|
|
what is the cause of fetal growth retardation associated with prolonged pre-eclampsia?
|
obstructive lesions in the spiral arteries
|
|
|
an intra-abdominal mass in a newborn is most likely to be a(n)?
|
multicystic kidney
|
|
|
AD disorder
Affects intelligence Unibrow, long eyelash, long philthrum |
Cornelia de Lange syndrome
|
|
|
Small jaw, malformed face
Airway defect 1st branchial arch issue Normal intelligence |
Treacher Collins
|
|
|
Alligator skin
|
Lamellar ichtyosis
Mild variance (AD; Tx w/ Laminin) |
|
|
No sweat glands
Pointy or peg-shaped teeth “Leave in a hot room and they die!!” |
Ectodermal dysplasia
|
|
|
AR disorder; pale-skinned (loss of melanocytes)
Microtubule defect Granules of neutrophils clumped together |
Chediak-Higashi
|
|
|
Mermaid baby
Usually die |
sirenomelia
|
|
|
Nose and ears flattened
Club-foot Oligohydramnios due to renal agenesis |
Potter's
|
|
|
Ash-leaf spots (depigmented on the longitudinal axis or dermatomes)
“Zits, fits and nitwits” Adenoma sebaceum (facial angiofibromas made of blood vessels and fibrous tissue) Seizures Mentally retarded |
Tuberous sclerosis
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NO hemidesmosomes (one subtype of E.B.... there are others with defects in keratin or collagen)
You touch them and their skin peels |
Epidermolysis Bullosa
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Mutated VG5Q
Port-wine stain Thrombocytopenia Varicose veins Telangiectasias Bone and soft tissue hypertrophy Blood and lymph vessels fail to form |
Klippel Trenaunay Weber syndrome
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during which phase of the menstrual cycle does implantation occur?
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secretory phase
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portion of the placenta underlying the implantation site and forming the maternal part of the placenta
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decidua basalis
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portion overlying the implanted embryo and separating it from the uterine cavity
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decidua capsularis
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which part of the placenta synthesizes most of the hormones released?
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syncytial trophoblast
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moles and choriocarcinomas are composed of what kind of tissue?
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trophoblastic tissue
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a mixture of malignant throphoblast and syncytiotrophoblast
elevated b-hCG |
choriocarcinoma
(Cole) |
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invasion into myometrium of edematous chorionic villi covered w/ layers of proliferative trophoblastic cells
b-hCG moderately elevated |
invasive moles
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tumore with absence of chorionic villi and proliferation of intermediate cytotrophoblasts
low positive b-hCG secretes hPL |
placental-site trophoblastic tumor
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46,XX paternal origin
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complete mole
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causes of oligohydramnios
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fetal urinary tract anomaly (i.e. b/l renal agenesis)
placental insufficiency PROM |
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causes of polyhydramnios
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decreased fetal swallowing
fetal GI tract obstruction |
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when does a secondary ovocyte complete its second meiotic division?
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at fertilization
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grape-like clusters of hydropic villi suggest what?
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complete mole
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what occurs immediately following the completion of meiosis II?
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formation of female pronucleus
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during which weeks of pregnancy is the embryo most susceptible to teratogenesis?
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weeks 3-8
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during which weeks of pregnancy is the embryo most susceptible to physiological defects and/or minor morphological abnormalities from teratogens?
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weeks 9-38
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what gives evidence of the beginning of gastrulation?
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formation of the primitive streak
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what are ectoderm, endoderm, and mesoderm derived from?
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the epiblast
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what functions as the primary inductor in the early embryo?
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notochord
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what are the 3 primary functions of the notochord?
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1. induce overlying ectoderm to differentiate into neuroectoderm and form the neural plate
2. induces formation of the vertebral bodies 3. forms the nucleus pulposus of each intervertebral disc |
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what is the MCC of mental retardation?
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fetal alcohol syndrom
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what does failure of the cranial neuropore to close cause?
is marked by high AFP |
anencephaly
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what is the MC congenital malformation in the world?
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cleft palate
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herniation of cerebellar vermis through the foramen magnum
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arnold-chiari malformation
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adult derivative of pharyngeal arch 1?
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external auditory meatus (only external derivative of pharyngeal arches)
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what produces FGF in order to stimulate mitosis?
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apical ectodermal ridge
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adult deriv. of truncus arteriosus?
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aorta
pulmonary trunk |
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adult deriv. of bulbus cordis?
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smooth part of RV, smooth part of LV
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adult deriv. of primitive ventricle?
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trabeculated part of RV and LV
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adult deriv. of primitive atrium?
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trabeculated part of RA and LA
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adult deriv. of sinus venosus?
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smooth part of RA, coronary sinus, oblique vein of LA
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what is the most common position abnormality of embryological development?
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dextrocardia
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what is the MC congenital heart defect?
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VSD
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what are most congenital CV defects related to in embryological development?
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abnormal formation of the heart's interior septae
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continuous murmur
2nd MC CV defect |
PDA
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what does incomplete separation of the tracheoesophageal septum cause?
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tracheoesophageal fistula
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what does failure of pleuroperitoneal membranes to fuse cause?
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congenital diaphragmatic hernia
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which branches of the aorta supply the:
foregut midgut hindgut |
celiac
sup. mesenteric inf. mesenteric |
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hypertrophy of pylorus musculature
a/w non bilious projectile vomiting |
pyloric stenosis
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what causes hirschsprung's disease in embryological development?
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defect of neural crest cell migration
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what forms the renal tubules?
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intermediate mesoderm forms the metanephric blastema which differentiates into the renal tubules
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what does the urinary bladder develop from?
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urogenital sinus (continuous with allantois, which normally degenerates)
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what does the ureteric bud give rise to?
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collecting duct, minor and major calyces, renal pelvis, and ureter
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what causes a urachal fistula?
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persistent allantois
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absence of an organ/body region d/t complete absence of its precursor
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agenesis
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absence of an organ/body region d/t failure of development of its precursor
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aplasia
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T/F:
bacteria play a significant role in congenital anomalies |
F
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causes fetal hydantoin syndrom
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diphenylhydantoin (phenytoin)
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MC preventable cause of mental retardation in the world?
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iodine deficiency
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what effects do androgenic agents have on embryo development?
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msaculinization of external genitalia in females
hypospadias in males increase in CV anomalies |
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what does cigarette smoking in pregnancy cause?
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IUGR, premature delivery
NOT linked to major birth defects |
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what effect does warfarin have on embryo development?
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chondrodysplasia, mental retardation, microcephaly, nasal malformations
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appropriate weight gain for mothers in 2nd and 3rd trimester:
obese/overweight? normal/underweight? |
1/2 lb/week
1 lb/week |
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extra calories in pregnancy:
1st trimester? 2nd T? 3rd T? |
0
340 450 |
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vegetarian and vegan mothers have increased risk of which nutrient?
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calcium (mainly)
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absolute CI's to exercise in pregnancy
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risk for preterm labor
vaginal bleeding PROM |
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which 2 nutrients should be taken together in pregnancy to increase absorption?
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Vit C and Iron
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what are the positive benefits for the fetus of exercising in pregnancy?
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increased HR variability, more fetal breathing movements (help lung development), cardioprotective
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presents with nipple discharge, nipple retraction, small subareolar mass
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intraductal papilloma (if multiple a/w increased risk of cancer)
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3 MC cancer KILLERS of women in the USA (ERF)
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1. lung
2. breast 3. colon-rectum (descending) |
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3 MC cancers of women in the USA (ERF)
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1. breast
2. lung 3. colon-rectum (descending) |
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soft, large, gelatinous breast tumor in an older woman
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colloid/mucinous carcinoma
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which viral vaccines are killed? (4)
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rabies
influenza polio (salk) Hep A |
