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356 Cards in this Set

  • Front
  • Back
What is a placental site trophoblastic tumor?
neoplasm of intermediate trophoblasts
remains localized to uterus
Larger cells
What is the karyotype of a complete hydatidiform mole?
46,XX
46, XY
All chromosomes of paternal origin
What is the presentation of complete mole?
Vaginal discharge
Uterus too large for dates
Hyperemesis
VERY high hCG
What is the presentation of partial mole?
Vaginal discharge
Uterus small for dates
bhCG high
What is the appearance of a complete mole?
Hydropic change & trophoblastic proliferation of all villi
No fetal development
What is the karyotype of a partial mole?
69, XXX; 69, XXY; 69XYY; can be tetraploid
Fertilizaton of an egg by 2 sperms or by 1 sperm w/duplicated DNA
What is particularly associated with gestational choriocarcinoma?
Complete mole (50%)
Define gestational choriocarcinoma.
Malignant neoplasm made of cytotrophoblast & syncytiotrophoblasts which do NOT form villi
Describe the typical presentation of gestation choriocarcinoma.
Presents following pregnancy w/vaginal bleeding or distant metastases
What metastases are commonly found w/choriocarcinoma?
Lung
CNS
What is the treatment for gestation choriocarcinoma?
Chemo
Define malformation.
Morphologic defect resulting from an intrinsically abnormal developmental process
Define disruption.
Morphologic defect resulting from an extrinsic disturbance of previously normal developmental process.
NOT heritable
Define deformation.
Abnormal shape resulting from mechanical forces such as uterine compression or oligohydramnios
Define sequence.
Cascade of anomalies triggered by 1 initiating aberration
Define syndrome.
Group of anomalies thought to be pathogenetically related but not explained on basis of 1 single, localized, initiating defect
Clinodactyly is related to what abnormality?
Trisomy 21
Patau syndrome is another name for what?
Trisomy 13
Cleft lip/palate is related to what trisomy?
13
Micrognathia, low set ears, and overlapping fingers are associated with what karyotypic abnormality?
Trisomy 18
Edwards syndrome is another name for what?
Trisomy 18
What is the major factor associated with fetal growth restriction (IUGR)?
Preterm premature rupture of placental membranes (PPROM)
What are the most common risk factors for PPROM?
Maternal smoking
Prior Hx of preterm delivery
Vaginal bleeding during pregnancy
What are organisms can commonly cause intrauterine infection?
Ureaplasma
Mycoplasma hominis
Gardenella vaginalis
Trichomonas
Gonorrhea
Chlamydia
Fetal factors resulting in IUGR result in what type of IUGR?
Symmetric growth restriction
Placental factors resulting in IUGR result in what type of IUGR?
Asymmetric IUGR-->normal head, small body
Maternal factors resulting in IUGR result in what type of IUGR?
Disproportionate IUGR by affecting the placenta
What are the most common factors affecting SGA infants?
Maternal factors
What are the six types of birth trauma injuries in descending order of frequency?
Clavicular fx
Facial n. injury
Brachial plexus injury
Intracranial injury
Humeral fx
Lacerations
What is caput succedanum?
Interstitial fluid in scalp
What is a cephalhematoma?
Subperiosteal skull hemorrhage
Close association w/skull fx
What factors are strongly associated with RDS?
Preterm, SGA infants
Male gender, maternal diabetes, delivery by C-section
What is a bad consequence of RDS?
Retinopathy of prematurity d/t oxygen toxicity (retrolental fibroplasias)
Describe the triple risk model of SIDS.
Vulnerable infant
Critical developmental period in homeostatic control
Exogenous stressors
When do most cases of SIDS occur?
90% in 1st 6 months of life
What are some infant-related risk factors for SIDS?
Male gender
Brain stem abnormalities
Product of multiple birth
SIDS in prior sibling
Prematurity
What are some parental risk factors for SIDS?
Young maternal age
Maternal smoking during pregnancy
Drug abuse in either parent
Short intergestational intervals
Low socioeconomic group
What pathology is found in an infant who has died of SIDS?
Astrogliosis of brain stem & cerebellum
Persistant hepatic extramedullary hematopoiesis & periadrenal brown fat
Petechiae
Pulmonary congestion &edema
What chromosome is the mutation for CF found?
7
CFTR gene
What is the inheritance pattern of CF?
AR
What is the most common lethal genetic disorder affecting Caucasians?
CF
What infections common kill patients w/CF?
Staph
Pseudomonas
What is the most common type of cancer in kids?
Leukemia/lymphoma
-Lymphomas increase over leukemias w/age
Most common benign tumor of infancy is...
Hemangioma
N-myc amplication is associated with...
Neuroblastoma
C-myc & lg loci translocations are associated with...
Burkitt lymphoma
t(8;14) is associated with...
Burkitt lymphoma
Parental isodisomy of chromosome 11p15.5 is associated with...
Embryonal Rhabdomyosarcoma
t(11;22) is associated with...
Ewing's sarcoma/PTEN
11p13 deletion or mutation is associated with...
Wilms tumor
Neuroblastic tumors derive from...
primordial neural crest cells of the sympathetic ganglia & adrenal medulla
What is the most common extracranial solid malignancy of childhood?
Neuroblastoma
Where do most neuroblastomas arise?
Adrenal medulla
How do neuroblastomas present?
Abdominal mass, fever, weight loss in an infant
What is the most common age @ diagnosis for neuroblastoma?
18mos
VMA & HVA in the urine indicates what tumor?
Neuroblastoma
Homer-Wright pseudorosettes are associated with what tumor?
Neuroblastoma
What are the most important determinants of outcome of a neuroblastoma?
Age & stage
What is the most common primary renal tumor of chidlhood?
Wilms tumor
How may Wilms tumor present?
Child with abdominal mass & pulmonary metastases
What is the histology of Wilms tumor?
Triphasic:
Blastema: small blue cells
Epithelial: tubular & glomeruloid
Mesenchymal: spindled mesenchymal tissue & mesenchymal elements like mature striated muscle
What is the histology of neuroblastoma?
Small round blue cells
Pink fibrillary material (neuropil)
Homer-Wright pseudorosettes
Anaplasia is a particularly poor prognostic factor for what cancer of childhood?
Wilms tumor
What chromosome are the mutations for Wilms tumor found?
11
WAGR syndrome consists of what elements & is caused by what mutation?
Wilms tumor Aniridia Genitourinary malformations Retardation
Deletion of 11p13
What is the risk of developing Wilms tumor if you have WAGR syndrome?
33%
What is Denys Drash?
Gonadal dysgenesis & Wilms tumor
What is the risk of developing Wilms tumor if you have Denys Drash?
90%
What is Beckwith Wiedemann syndrome?
Enlargement of body organs
Hemihypertrophy
Renal medullary cysts
Adrenal cytomegaly
Increased risk for: wilms tumor, hepatoblastoma, pancreatoblastoma, adrenocortical tumor, rhabdomyosarcoma
What are precursor lesions to Wilms tumor?
Nephroblastomatosis w/nephrogenic rests
Need radiology to determine if it is Wilms tumor or nephroblastomatosis b/c Wilms tumor & neprhoblastomatosis look similar on biopsy
When does cardiac output peak during pregnancy?
20-24 weeks
How is cardiac output increased during pregnancy?
Early pregnancy: increased in SV
Late pregnancy: increase in HR
What ECG changes are noted during pregnancy?
15 degree left axis deviation
Other: ST depression, benign unifocal PVCs, supraventricular tachyarrhythmias
What auscultatory changes are heard during pregnancy?
Exaggerated S1 split as mitral valve closes earlier secondary to increased cardiac output
Early systolic murmur @ 18 weeks
S3 gallop near term
What happens to BP during pregnancy?
Drops d/t decreased peripheral vascular resistance than increases to normal
Does pulmonary artery pressure change during pregnancy?
NO
When does plasma volume begin to increase & when does it plateau?
Begins @ 10 weeks
Plateaus @ 30-40 weeks
Increases 50%
When does RBC volume begin increasing?
10 weeks, continues to term
30% overal increase
When does the maternal increase in HbF peak?
18-22 weeks
When does Hct reach its nadir?
30-34 weeks
What happens to the oxygen dissociation curve during pregnancy & why?
Right shift
Increased 2,3DPG levels
What form must Fe be in to be absorbed?
Divalent (ferrous)
What is the best predictor of Fe-deficiency anemia?
Serum ferritin
Where is Fe stored?
As ferritin in liver & spleen
Which pregnancy patients need extraextra folate?
Those on phenytoin
Hemoglobinopathies
Multiple gestation
What happens to B12 during pregnancy?
Levels fall but remain in normal range
Transcobaliamine II increases
Why does ESR increase during pregnancy?
The absolute amount of fibrinogen doubles during pregnancy
Which coagulation factors increase during pregnancy?
1, 7, 8, 9, 10
Which coagulation factors decrease during pregnancy?
11, 14
Which coagulation factors remain unchanged during pregnancy?
2, 5, 12
What is the normal WBC differential?
5000-10,000
Neutrophils: 65-75%
Lymphocytes:20-30%
What is a "right" shift in WBCs?
more lymphocytes
indicates viral infection
What is a "left" shift in WBCs?
more neutrophils
indicates bacterial infection
What happens to WBCs during pregnancy?
WBCs increase to 15,000-20,000
But differential does not change
What happens to platelets during pregnancy?
Platelet count falls but remains w/in physiologic range
Pathologic drop<100,000/mm3
Which lung volumes remain unchanged during pregnancy?
Respiratory rate
Vital capacity
Inspiratory reserve volume
Which lung volumes increase during pregnancy?
Inspiratory capacity
Tidal volume
Which lung volumes decrease during pregnancy?
Functional residual capacity
Expiratory reserve capacity
Residual volume
What happens in minute volume in pregnancy?
Increases
What kind of acid-base imbalance occurs during pregnancy?
Compensated respiratory alkalosis
What causes the acid-base imbalance encountered during pregnancy?
Progesterone
What causes the renal enlargement seen in pregnancy?
Progesterone
How much does RPF increase by?
75%
When does RPF reach its zenith?
16 weeks
When does GFR begin rising?
5-7 weeks
When does GFR plateau?
end of 1st trimester
What happens to filtration fraction during pregnancy?
Decreases in early pregnancy
Rises to non-pregnant levels in late pregnancy when RPF falls again
What happens to uric acid levels during pregnancy?
Fall to a nadir @ 24 weeks then rise
Rise is secondary to increased tubular reabsorption in 3rd trimester
What happens to sodium in pregnancy?
Large increase in renal reabsorption of sodium
What promotes Na reabsorption during pregnancy?
Progesterone, aldosterone, deoxycorticosterone
What happens to angiotensin & renin levels during pregnancy?
Renin levels increase 5-10x
Angiotensin levels increase 4-5x
What happens to the renin produced by the uterus?
Found only in uterus & amniotic fluid
What happens to thyroid function during pregnancy?
TSH decreases a tiny bit
Hepatic TBG synthesis increases
Total T4 rises
Free T4 & T3 remain unchanged
When do TBG levels reach their zenith during pregnancy?
12 weeks
When does PTH appear in the fetus?
10 weeks
What causes the LH surge?
Estrogen
What increases basal body temperature during the menstrual cycle?
Progesterone
Describe the phases of sperm transport.
Rapid phase: prostaglandins help muscle contractions to propel sperm to oviduct
Delayed phase: some sperm reach oviduct after storage in cervical crypts after several hours
Describe the acrosome reaction.
Sperm encounters the zona pellucida which contains sperm receptors ZP3
Acrosome reaction triggers release of proteolytic enzymes from acrosome
Describe the cortical reaction.
Triggered by sperm contacting the plasma membrane of the egg
Cortical granules fuse w/egg membrane-->zona pellucida hardens
What prevents polyspermy?
Cortical reaction
What is syngamy?
Fusion of male & female nuclei
When does the 1st division of cells occur after fertilization?
30 hours after fertilization
How long does transportation of the fertilized embyro to the uterus take?
3-4 days
What is a morula?
Exists when embyro has reached the uterus
Too many cells to count
What is a blastocyst?
5-6 days
NO zona pellucida
2 different cell layers are visible: trophoblast (makes hCG, becomes the chorion) & embryoblast (inside the trophoblast, becomes the embryo, gives rise to the amnion)
What cell layer does the amnion derive from?
Embryoblast
What cell layer does the chorion derive form?
Trophoblast
What becomes the fetal component of the placenta?
Chorion
What is the decidual reaction?
Response of uterus to attaching blastocyst: requires sequence of estrogen priming FOLLOWED BY progesterone priming
Causes dilation of blood vessels, increased capillary permeability, and proliferation of glandular & epithelial cells
What must have happened for implantation to occur?
Egg must have hatched from zona pellucida
Endometrium must have been primed by estrogen THEN progesterone
What forms the blood-placental barrier?
Epithelial lining of chorionic villi
What is the maternal component of the placenta?
Decidua basalis
What becomes the fetal compartment of the placenta?
Chorionic plate
What does the chorionic plate become?
Chorionic villi
What line the chorionic villi?
Cytotrophoblsts
Syncytiotrophoblasts
What is produced by the cytotrophoblasts?
GnRH
What is produced by the syncytiotrophoblasts?
hCG
Progesterone
Estogen
hPL
Relaxin
What are Hoffbauer cells?
Resident macrophages of the chorionic villi
What is the configuration of the amnion & chorion if the split of monozygotic twins occurs at the morula stage?
Dichorionic/diamniotic
What is the configuration of the amnion & chorion if the split of monozygotic twins occurs at the blastocyst stage?
Monochorionic/diamniotic
What is the configuration of the amnion & chorion if the split of monozygotic twins occurs between days 4-8?
Monochorionic/diamniotic
Blastocyst stage
What is the configuration of the amnion & chorion if the split of monozygotic twins occurs during days 8-13?
monochorionic/monoamniotic
Implanted blastocyst
What is the configuration seen in twin-twin transfusion?
monochorionic/diamniotic
What is the configuration of the amnion & chorion if the split of monozygotic twins occurs during days 13-15?
Conjoined twins
What rescues the corpus luteum when pregnancy occurs?
hCG
What are the roles of progesterone during pregnancy?
Maintenance of decidual lining
Suppression of maternal immunologic response to fetus
Stimulation of glandular secretion of nutrients
Maintains quiescence of myometrium
What is the luteal-placental shift?
Shift of production of progesterone from the corpus luteum-->placenta
Occurs @ 7-10 weeks
What hormone maintains uterine quiescence during pregnancy?
Progesterone
What hormone induces oxytocin & progesterone receptors?
Estrogen
What is hPL?
Human placental lactogen
Alterals fuel availability by antagonizing maternal glucose
What inhibits lactation during pregnancy?
High levels of estrogen & progesterone
What is the role of relaxin during pregnancy?
With estrogen-->softens cervix
With progesterone-->maintains uterine quiescence
What is the source of relaxin?
Both placenta & corpus luteum
What is the fetal source of progesterone?
Placenta
Where does formation of 16-hydroxyDHEA-S occur?
Fetal liver by 16-hydroxylation of DHEA-S
Where is estriol formed?
In the placenta
Which hormones antagonize insulin action during pregnancy?
GH
Prolactin
hPL
What is meant by "progesterone block"?
Maintenance of uterine quiescence by progesterone during pregnancy
What can be used to induce labor?
Progesterone antagonist
What is the role of prostaglandins in labor?
Stimulate uterine contractions
What contributes to parturition?
Increased E or decreased P/E ratio increases oxytocin receptors in the myometrium
What stimulates the growth & branching of mammary ducts?
Estrogen
What stimulates milk synthesis?
Prolactin
What stimulates contraction of myoepithelial cells for milk ejection?
Oxytocin
Define lactation.
Secretion of milk by mammary glands
Define lactogenesis.
Milk synthesis
Describe the stimulation of lactogenesis.
1. Decreased dopamine & increased PRF from hypothalamus-->increased prolactin from anterior pituitary
2. Dopamine agonists can stop milk production
Describe the source of oxytocin.
Posterior pituitary
Stimulated by suckling for milk ejection
How does suckling produce a contraceptive effect?
Suckling stimulates GnRH release from hypothalamus
GnRH inhibits FSH/LH release from anterior pituitary
What is the upper limit on dilatation & curettage as an abortion method?
14 weeks
What medications are used to soften the cervix prior to surgical abortion?
Laminaria, mifeprisone, misoprostol
What are potential complications of medical abortion?
Nausea, vomiting, bleeding
What are the potential complications of 1st trimester surgical abortion?
Infection, sepsis, uterine perforation, hemorrhage, death
What are the two methods of 2nd trimester abortion?
Dilatation & evacuation
Induction of labor
What agents are used to induce labor for abortion?
Oxytocin
PGF-2 antagonists
Misoprostol
PGE2
What are contraindications for a vasectomy?
Varicocele
Infection
Scrotal abnormalities
What is late vasectomy failure?
Reappearance of sperm after 4 months
What is early vasectomy failure?
Persistence of motile sperm for 4 months or 20 ejaculations
What are contraindications for tubal ligation?
Medical for surgery
Known tubal pathology
What tubal ligation technique has the highest failure rate?
Bipolar coagulation
What is transcervical sterilization?
insertion of device-->scarring produces infertility
PERMANENT
What are complications of transcervical sterilization?
Perforation of tube
Failure to place
Expulsion
What are the side effects of the copper IUD?
Heavy menses & dysmenorrhea
How long can 1 copper IUD be used?
10 years
How long can 1 levonorgestrel IUD be used?
5 years
What are the side effects of levonorgestrel IUD?
Irregular menses & less menstrual blood loss
What are contraindications for IUDs?
Pelvic infections or recent STD hx
Non-monogamous relationship
Abnormal uterine shape
Copper IUD only: Wilsons dz, bleeding disorders
What are the s/e of DepoProvera?
Irregular bleeding & amenorrhea
headaches
weight gain
reversible bone loss
delay in conception 9 months
What is the active ingredient in current implantable contraception?
etonogestrel
How does DepoProvera work?
Blocks LH surge
How does the implantable contraception work?
Inhibits ovulation (blocks LH surge)
How long is the implantable contraception good for?
3 years
What are the s/e of the progesin-only OCPs?
irregular bleeding
functional ovarian cysts
acne
vaginal dryness
What kind of contraception is needed in a lactating woman?
Progestin only (Depo)
Desogestrel is found in which contraceptive options?
Pill & vaginal ring
Norgestimate is found in which contraceptive options?
Pill & patch
What are the benefits of combined OCPs?
Lower incidence of ovarian & endometrial CA
Less dysmenorrhea
Less blood loss w/menstruation
Lower incidence of benign breast disease
Lower risk of PID
What are common s/e of combined OCPs?
BTB
Nausea
Breast tenderness
Headache
Women with classic migraines should not receive which medications?
Combined OCPs==>STROKE
Describe the use of the vaginal ring.
Leave ring in place for 3 weeks
Out 1 week
Replace
Describe the use of the contraceptive patch.
Apply weekly for 3 weeks, 1 week off.
What is in the vaginal ring?
Etonogestrel & ethinyl estradiol
What is in the transdermal patch?
Norelgesrommin & ethinyl estradiol
What is the active ingredient in spermicide?
nonoxyl-9
What is Plan B?
0.75 mg levonorgestrel
What are the low-dose OCP equivalents of emergency contraception?
4 pills of LoOvral, Nordette or Levelen
What is the effectiveness of emergency contraception?
75%
What are the most effective contraceptive methods?
Male/Female sterilization
IUD/IUS
Implants
What are the 91-99% effective contraception methods?
Pills
Injectables
Ring
Patch
What are the 81-90% effective contraception methods?
Male/Female condom
Sponge
Diaphragm
What are the up to 80% effective contraception methods?
Fertility awareness
Cervical cap
Spermicide
When is the seminiferous cord apparent in male development?
7 weeks
What becomes the seminiferous tubule?
Primary sex cords
Male internal genitalia derives from what?
Wolffian duct system (mesonephric)
What is the ovary derived from?
Cortex
Female fallopian tubes, uterus, and upper 1/3 of vagina is derived from what?
Mullerian ducts (paramesonephric ducts)
What is responsible for the differentiation of male external genitalia?
DHT & 5alpha-reductase
In the male, what derives from the urogenital sinus?
Prostate & urethra
In the male, what derives from the genital tubercle?
glans penis
In the male, what derives from the genital swelling?
Scrotum
In the male, what derives from the urethral genital folds?
Body of the penis
In the female, what derives from the urogenital sinus?
Lower vagina
urethra
In the female, what derives from the genital tubercle?
Clitoris
In the female, what derives from the genital swelling?
Labia majora
In the female, what derives from the urethral genital folds?
Labia minora
What prevents the differentiation of the Mullerian duct system in males?
AMH from Sertoli cells
The SRY on the Y chromosome codes for what? What does it do?
SRY codes for TDF
TDF stimulates proliferation of primary sex cords
What stimulates the differentiation of the Wolffian duct system?
Testosterone from Leydig cells
How does the Mullerian system differentiate in the female?
Absence of AMH-->Mullerian system can differentiate
Wolffian system regresses
What are the most common mutations causing CAH?
21-hydroxylase deficiency
11beta-hydroxylase deficiency
What causes the adrenal hyperplasia of CAH?
No cortisol produced-->no negative feedback on ACTH release-->increased ACTH release-->increased stimulation of adrenal synthesis
A baby is born with ambiguous genitalia and is raised as a girl. 12 years later, she develops a penis. What is this disorder?
5alpha-reductase deficiency
What is the karyotype of Klinefelter syndrome?
47,XXY
What is the karyotype of Turner syndrome?
45,X
What is gonadal dysgenesis?
Incomplete differentiation of the gonads
What is pseudohermaphrodism?
1 type of gonad, differing degree of sexuality of opposite type
What is the phenotype of androgen insensitivity syndrome?
Female (testicles undescended)
What are some disorders that can cause pseudohermaphrodism?
CAH, 5alpha-reductase def., androgen insensitivity syndrome
What is seen in true hermaphrodism?
Both scrotum & ovaries
How is gestational age measured?
beginning of 1st day of last menstrual period (LMP)
280 days (40 weeks) is full term
What is Nagele's rule?
Calculation for due date
Due date=LMP+7 days-3 months
How is conceptional age measured?
Begins w/date of conception
Important for fetal measurements
When is the embryo stage of development?
1st 8 weeks in the womb
When is the embryo most sensitive to teratogens?
1st 8 weeks
When is the fetal stage of development?
8 weeks-term
When does a fetus become very photosensitive?
28 weeks
When can a baby react to local stimuli?
10 weeks
When does the fetal tone center in the cortex begin to function in neck & trunk?
7.5-8.5 weeks
When is the fetal movement center in the cortex-nuclei completely functional?
9 weeks
When does baby begin to have breathing movements?
14-16 weeks
When does a baby begin sucking?
24 weeks
When can a baby hear?
24-26 weeks
When are the eyes & ears most sensitive to malformation?
4th-6th weeks
When do the lacrimal glands become functional?
6 weeks after delivery
What is the 2nd most common fetal anomaly?
NTD
What is the anomaly most commonly associated with hydrocephalus?
Congenital aqueduct stenosis
Where does most erythropoiesis occur during the 1st 8 weeks?
Yolk sac
Where does most erythropoiesis occur during weeks 8-24?
Liver
Where does most erythropoiesis occur during weeks 24-40?
Bone marrow
When is a heart beat audible in a fetus?
End of week 4
Describe the circulation pathway of blood in a fetus.
Well-oxygenated blood-->placenta-->single umbilical vein-->ductus venosus-->IVC-->LV
What is the most common congenital heart defect?
VSD
What is the most common fetal anomaly?
Congenital heart defects
What sort of shunt results from a VSD?
L-->R
What are 3 shunts that shut down soon after birth?
Ductus arteriosus
Ductus venosus
Foramen ovale
What two structures receive most of the fetal cardiac output?
Placenta & brain
List the structures receiving cardiac output from the fetus in descending order.
Placenta
Brain
GI
Heart
Kidney, liver
Describe the affinities of HbF.
Increased O2 affinity
Decreased 2,3DPG affinity
What kind of antibodies are responsible for Rh(d) alloimmunization?
IgG
What are the causes of hydrops fetalis?
Immune: Rh disease
Nonimmune: cardiovascular, chromosomal, infections, thoracic, twin-twin transfusion
What is hemoglobin barts?
NO HbF-->leads to fetal death
When is there the first evidence of immune competence in a fetus?
13 weeks
When is the IgM immune response mature?
9 months
When is a child's immune system mature?
3 years
When do B lymphocytes appear?
Liver by 9 weeks
Bone marrow by 12 weeks
What is DiGeorge syndrome?
Thymic hypoplasia or absence
Deletion of 22q11
Craniofacial, cardiac, parathyroid abnormalities
What cells are missing in patients w/DiGeorge syndrome?
T lymphocytes
List the stages of fetal lung development in order with timing.
Embryonic (4th-6th weeks)
Glandular (7th-16th week)
Canalicular (16th-24th week)
Terminal sac or alveolar (24th week-term)
What happens in the embryonic stage of lung development?
Lung buds & diaphragm form
What develops in the lungs in the glandular stage?
airways, mucus glands, cilia
What develops in the lungs in the canalicular stage?
distal airways, type II cells differentiate
What develops in the lungs in the alveolar stage?
type 1 cells thin, type II cells proliferate
Which lung cells produce surfactant?
Type II alveolar cells
How is alveolar surfactant packaged?
Lamellar bodies
What pulmonary changes occur @ birth?
Lung fluid is expulsed during labor
First breath triggered by temperature change, light stimulation, physical sitmulation, cord clamping, negative P in chest cavity
What is a congenital diaphragmatic hernia?
Herniation of viscera into thorax
What is congenital cystic adenomatoid malformation?
Multicystic mass of pulmonary tissue
When do the kidneys being producing urine in fetal development?
12 weeks
What are the contents of fetal urine?
Urea, creatinine, uric acid
What can cause fetal hydronephrosis?
Ureteropelvic, ureterovesical, infravesical, urethral obstruction
What is the most common cause of fetal hydronephrosis in males?
posterior urethral valves
What is potter sequence?
Abnormal facies & hypoplastic lungs d/t decreased amniotic fluid d/t lack of kidney function
Describe the bowel herniation movements.
Rotates out of tummy & 90degrees clockwise around SMA
Returns to abdomen @ 12 weeks & rotates 180degrees clockwise
What is in the meconium?
Undigested debris: glycerophospholipids, desquamated cells, ianugo, scalp hair, vernix, biliverdin
When is meconium seen in a lot of deliveries?
after 42 weeks
What is the main blood supply to the fetal liver?
Umblical vein
What is omphalocele?
Intra-abdominal contents extrude into base of umbilical cord & are covered by amnioperitoneal membrane
high risk of aneuploidy
What is gastroschisis?
Full-thickness para-umbilical defect w/evisceration of fetal intestine
low risk of aneuploidy
What is the 1st fetal gland to develop?
Thyroid
When do T4 levels begin to increase?
20 weeks
What is the origin of the pancreas?
Duodenal endoderm
When is insulin 1st produced by beta cells in the fetus?
12 weeks
What is the main hormone regulating fetal growht?
Insulin
What are the features of fetal hypothyroidism?
Coarse facial features
Macroglossia
Large fontanelles
Umbilica hernia
Myxedema
Goiter
When doe the thyroid have a bilobed shape?
7 weeks
When does the fetal thyroid begin to trap iodine?
8-10 weeks
What is polyhydramnios?
Too much amniotic fluid
What is oligohydramnios?
Too little amniotic fluid
What is the folate supplement recommendation for pregnant moms?
0.4mg
Why is 35 a big number when talking about defects?
35 has risk of complication for amniocentesis=risk fo ahving defect
What are the components of the triple screen?
Beta-hCG
AFP
unconjugated Estriol
What are the components of the quad screen
Beta-hCG
AFP
unconjugated Estriol (uE3)
Inhibin A
Inhibin A has no purpose in screening for what defect?
Trisomy 18
When is a quad screen done?
15-20 weeks
What are the tools available for 1st trimester genetic screening?
Serum tests: triple or quad screening
Nuchal translucency
Nasal bone: check for hypoplasia
What are the components of the penta screen?
Beta-hCG
AFP
unconjugated Estriol (uE3)
Inhibin A
Invasive trophoblast antigen (ITA)
Increased AFP is related to what birth defect?
NTD
Decreased AFP, decreased uE3, increased beta-hCG, and increased inhibin A are related with what defect?
Trisomy 21
Decreased AFP, decreased uE3, and decreased beta-hCG are related to what defect?
Trisomy 18
When can amniocentesis be done?
15 weeks
When can CVS be done?
10-12 weeks
Duodenal atresia is related to what birth defect?
Trisomy 21
Polycystic kidneys are found in what trisomy?
13
Clenched fists, low-set malformed ears, and a small chin indicate what?
Trisomy 18
What are the physical findings of Turner syndrome?
Lymphedema
Short stature
gonadal dysgenesis
Congenital heart disease
Increased nuchal translucency
What syndrome is related to coarctation of the aorta?
Turner syndrome
Acetylcholinesterase in the amniotic fluid is diagnostic of what defect?
NTD
The lemon sign indicates what?
NTD
The banana sign indicates what?
NTD
What is characteristic of a primary syphilitic lesion?
Painless, rolled edges, not purulent exudate
Heals in 4 weeks
When does the secondary syphilitic lesion appear?
4-6 weeks after primary lesion healed
What type of test is VDRL?
Non-treponemal antigen test for syphilis
Flocculation test
What is RPR?
Non-treponemal antigen test for syphilis
Agglutination
What is MHATP?
Microhemagglutination test for T. pallidum antibody
What does a secondary syphilitic lesion look like?
Can be generalized rash or can be condyloma lata
What is thought to be a reason for increased incidence of congenital syphilis?
Cocaine use
How is T. pallidum spread to a fetus?
Hematogenous
What happens to the placenta in congenital syphilis?
increased placenta:fetus weight ratio w/congested, edematous fetus
What test is done on fetal serum congenital syphilis?
IgM FTA
When is CSF analysis for congenital syphilis indicated?
Neuro involvement
Aoritits
High titers
Treatment failure
HIV +
What is the pathogenesis of N. gonorrhea?
Invasion of columnar & transitional epithelium
What does gonorrhea have some cross-reactivity with?
Meningococcus
What are the virulent strains of N. gonorrhea?
T1 & T2
How does gonorrhea facilitate other infections?
Lower pH
Allows for anaerobe proliferation
Gram negative intracellular bodies seen in a patient with an STD indicates what?
Chlamydia
What is Chlamydia trachomatis related to?
Chlamydia psittaci
What is the pathogenesis of C. trachomatis?
EB gains entry & differentiates to Reticulate Body (RB)
RB replicates-->eventually reforms EB
EBs overtake the RBs-->cell lysis
A bacterial intracellular pathogen invading the genitals is...
Chlamydia
A "heel cell" is indicative off..
Chlamydia
What kinds of lesions are seen in Chlamydia?
Uveitis
Arthritis
Skin lesions
Visceral lesions
What is the minimum criteria for diagnosis of PID?
lower abdominal tenderness
adnexal tenderness
cervical motion tenderness
What are additional criteria for PID dx?
Temp=101F
Abnormal cervical discharge
Elevated ESR & CRP
Proof of gonorrhea or chlamydia
What is the best treatment of gonorrhea?
Cephalosporins-->ceftriaxone
What are the levels of FSH & LH in Turner syndrome @ puberty age?
High-->postmenopausal levels
What is Mayer-Rokitansky-Kuster-Hauser syndrome?
Absence of vagina