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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 |
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|
What is the karyotype of a complete hydatidiform mole?
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46,XX
46, XY All chromosomes of paternal origin |
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What is the presentation of complete mole?
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Vaginal discharge
Uterus too large for dates Hyperemesis VERY high hCG |
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What is the presentation of partial mole?
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Vaginal discharge
Uterus small for dates bhCG high |
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What is the appearance of a complete mole?
|
Hydropic change & trophoblastic proliferation of all villi
No fetal development |
|
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What is the karyotype of a partial mole?
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69, XXX; 69, XXY; 69XYY; can be tetraploid
Fertilizaton of an egg by 2 sperms or by 1 sperm w/duplicated DNA |
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What is particularly associated with gestational choriocarcinoma?
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Complete mole (50%)
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Define gestational choriocarcinoma.
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Malignant neoplasm made of cytotrophoblast & syncytiotrophoblasts which do NOT form villi
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Describe the typical presentation of gestation choriocarcinoma.
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Presents following pregnancy w/vaginal bleeding or distant metastases
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What metastases are commonly found w/choriocarcinoma?
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Lung
CNS |
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What is the treatment for gestation choriocarcinoma?
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Chemo
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Define malformation.
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Morphologic defect resulting from an intrinsically abnormal developmental process
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Define disruption.
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Morphologic defect resulting from an extrinsic disturbance of previously normal developmental process.
NOT heritable |
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Define deformation.
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Abnormal shape resulting from mechanical forces such as uterine compression or oligohydramnios
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Define sequence.
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Cascade of anomalies triggered by 1 initiating aberration
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Define syndrome.
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Group of anomalies thought to be pathogenetically related but not explained on basis of 1 single, localized, initiating defect
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Clinodactyly is related to what abnormality?
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Trisomy 21
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Patau syndrome is another name for what?
|
Trisomy 13
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Cleft lip/palate is related to what trisomy?
|
13
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Micrognathia, low set ears, and overlapping fingers are associated with what karyotypic abnormality?
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Trisomy 18
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Edwards syndrome is another name for what?
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Trisomy 18
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What is the major factor associated with fetal growth restriction (IUGR)?
|
Preterm premature rupture of placental membranes (PPROM)
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What are the most common risk factors for PPROM?
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Maternal smoking
Prior Hx of preterm delivery Vaginal bleeding during pregnancy |
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What are organisms can commonly cause intrauterine infection?
|
Ureaplasma
Mycoplasma hominis Gardenella vaginalis Trichomonas Gonorrhea Chlamydia |
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Fetal factors resulting in IUGR result in what type of IUGR?
|
Symmetric growth restriction
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Placental factors resulting in IUGR result in what type of IUGR?
|
Asymmetric IUGR-->normal head, small body
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Maternal factors resulting in IUGR result in what type of IUGR?
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Disproportionate IUGR by affecting the placenta
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What are the most common factors affecting SGA infants?
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Maternal factors
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What are the six types of birth trauma injuries in descending order of frequency?
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Clavicular fx
Facial n. injury Brachial plexus injury Intracranial injury Humeral fx Lacerations |
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What is caput succedanum?
|
Interstitial fluid in scalp
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What is a cephalhematoma?
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Subperiosteal skull hemorrhage
Close association w/skull fx |
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What factors are strongly associated with RDS?
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Preterm, SGA infants
Male gender, maternal diabetes, delivery by C-section |
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What is a bad consequence of RDS?
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Retinopathy of prematurity d/t oxygen toxicity (retrolental fibroplasias)
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Describe the triple risk model of SIDS.
|
Vulnerable infant
Critical developmental period in homeostatic control Exogenous stressors |
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When do most cases of SIDS occur?
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90% in 1st 6 months of life
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What are some infant-related risk factors for SIDS?
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Male gender
Brain stem abnormalities Product of multiple birth SIDS in prior sibling Prematurity |
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What are some parental risk factors for SIDS?
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Young maternal age
Maternal smoking during pregnancy Drug abuse in either parent Short intergestational intervals Low socioeconomic group |
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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 |
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What chromosome is the mutation for CF found?
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7
CFTR gene |
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What is the inheritance pattern of CF?
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AR
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What is the most common lethal genetic disorder affecting Caucasians?
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CF
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What infections common kill patients w/CF?
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Staph
Pseudomonas |
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What is the most common type of cancer in kids?
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Leukemia/lymphoma
-Lymphomas increase over leukemias w/age |
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Most common benign tumor of infancy is...
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Hemangioma
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N-myc amplication is associated with...
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Neuroblastoma
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C-myc & lg loci translocations are associated with...
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Burkitt lymphoma
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t(8;14) is associated with...
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Burkitt lymphoma
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Parental isodisomy of chromosome 11p15.5 is associated with...
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Embryonal Rhabdomyosarcoma
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t(11;22) is associated with...
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Ewing's sarcoma/PTEN
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11p13 deletion or mutation is associated with...
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Wilms tumor
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Neuroblastic tumors derive from...
|
primordial neural crest cells of the sympathetic ganglia & adrenal medulla
|
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What is the most common extracranial solid malignancy of childhood?
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Neuroblastoma
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Where do most neuroblastomas arise?
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Adrenal medulla
|
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How do neuroblastomas present?
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Abdominal mass, fever, weight loss in an infant
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What is the most common age @ diagnosis for neuroblastoma?
|
18mos
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VMA & HVA in the urine indicates what tumor?
|
Neuroblastoma
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Homer-Wright pseudorosettes are associated with what tumor?
|
Neuroblastoma
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What are the most important determinants of outcome of a neuroblastoma?
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Age & stage
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What is the most common primary renal tumor of chidlhood?
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Wilms tumor
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How may Wilms tumor present?
|
Child with abdominal mass & pulmonary metastases
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What is the histology of Wilms tumor?
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Triphasic:
Blastema: small blue cells Epithelial: tubular & glomeruloid Mesenchymal: spindled mesenchymal tissue & mesenchymal elements like mature striated muscle |
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What is the histology of neuroblastoma?
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Small round blue cells
Pink fibrillary material (neuropil) Homer-Wright pseudorosettes |
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Anaplasia is a particularly poor prognostic factor for what cancer of childhood?
|
Wilms tumor
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What chromosome are the mutations for Wilms tumor found?
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11
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WAGR syndrome consists of what elements & is caused by what mutation?
|
Wilms tumor Aniridia Genitourinary malformations Retardation
Deletion of 11p13 |
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What is the risk of developing Wilms tumor if you have WAGR syndrome?
|
33%
|
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What is Denys Drash?
|
Gonadal dysgenesis & Wilms tumor
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What is the risk of developing Wilms tumor if you have Denys Drash?
|
90%
|
|
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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 |
|
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What are precursor lesions to Wilms tumor?
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Nephroblastomatosis w/nephrogenic rests
Need radiology to determine if it is Wilms tumor or nephroblastomatosis b/c Wilms tumor & neprhoblastomatosis look similar on biopsy |
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When does cardiac output peak during pregnancy?
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20-24 weeks
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How is cardiac output increased during pregnancy?
|
Early pregnancy: increased in SV
Late pregnancy: increase in HR |
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What ECG changes are noted during pregnancy?
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15 degree left axis deviation
Other: ST depression, benign unifocal PVCs, supraventricular tachyarrhythmias |
|
|
What auscultatory changes are heard during pregnancy?
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Exaggerated S1 split as mitral valve closes earlier secondary to increased cardiac output
Early systolic murmur @ 18 weeks S3 gallop near term |
|
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What happens to BP during pregnancy?
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Drops d/t decreased peripheral vascular resistance than increases to normal
|
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Does pulmonary artery pressure change during pregnancy?
|
NO
|
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When does plasma volume begin to increase & when does it plateau?
|
Begins @ 10 weeks
Plateaus @ 30-40 weeks Increases 50% |
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When does RBC volume begin increasing?
|
10 weeks, continues to term
30% overal increase |
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When does the maternal increase in HbF peak?
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18-22 weeks
|
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When does Hct reach its nadir?
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30-34 weeks
|
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What happens to the oxygen dissociation curve during pregnancy & why?
|
Right shift
Increased 2,3DPG levels |
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What form must Fe be in to be absorbed?
|
Divalent (ferrous)
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What is the best predictor of Fe-deficiency anemia?
|
Serum ferritin
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Where is Fe stored?
|
As ferritin in liver & spleen
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Which pregnancy patients need extraextra folate?
|
Those on phenytoin
Hemoglobinopathies Multiple gestation |
|
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What happens to B12 during pregnancy?
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Levels fall but remain in normal range
Transcobaliamine II increases |
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Why does ESR increase during pregnancy?
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The absolute amount of fibrinogen doubles during pregnancy
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Which coagulation factors increase during pregnancy?
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1, 7, 8, 9, 10
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Which coagulation factors decrease during pregnancy?
|
11, 14
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Which coagulation factors remain unchanged during pregnancy?
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2, 5, 12
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What is the normal WBC differential?
|
5000-10,000
Neutrophils: 65-75% Lymphocytes:20-30% |
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What is a "right" shift in WBCs?
|
more lymphocytes
indicates viral infection |
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What is a "left" shift in WBCs?
|
more neutrophils
indicates bacterial infection |
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What happens to WBCs during pregnancy?
|
WBCs increase to 15,000-20,000
But differential does not change |
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What happens to platelets during pregnancy?
|
Platelet count falls but remains w/in physiologic range
Pathologic drop<100,000/mm3 |
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Which lung volumes remain unchanged during pregnancy?
|
Respiratory rate
Vital capacity Inspiratory reserve volume |
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Which lung volumes increase during pregnancy?
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Inspiratory capacity
Tidal volume |
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Which lung volumes decrease during pregnancy?
|
Functional residual capacity
Expiratory reserve capacity Residual volume |
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What happens in minute volume in pregnancy?
|
Increases
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What kind of acid-base imbalance occurs during pregnancy?
|
Compensated respiratory alkalosis
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What causes the acid-base imbalance encountered during pregnancy?
|
Progesterone
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|
|
What causes the renal enlargement seen in pregnancy?
|
Progesterone
|
|
|
How much does RPF increase by?
|
75%
|
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When does RPF reach its zenith?
|
16 weeks
|
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When does GFR begin rising?
|
5-7 weeks
|
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When does GFR plateau?
|
end of 1st trimester
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What happens to filtration fraction during pregnancy?
|
Decreases in early pregnancy
Rises to non-pregnant levels in late pregnancy when RPF falls again |
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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
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What promotes Na reabsorption during pregnancy?
|
Progesterone, aldosterone, deoxycorticosterone
|
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What happens to angiotensin & renin levels during pregnancy?
|
Renin levels increase 5-10x
Angiotensin levels increase 4-5x |
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|
What happens to the renin produced by the uterus?
|
Found only in uterus & amniotic fluid
|
|
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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
|
|
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When does PTH appear in the fetus?
|
10 weeks
|
|
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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 |
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What prevents polyspermy?
|
Cortical reaction
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What is syngamy?
|
Fusion of male & female nuclei
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When does the 1st division of cells occur after fertilization?
|
30 hours after fertilization
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How long does transportation of the fertilized embyro to the uterus take?
|
3-4 days
|
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What is a morula?
|
Exists when embyro has reached the uterus
Too many cells to count |
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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) |
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What cell layer does the amnion derive from?
|
Embryoblast
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What cell layer does the chorion derive form?
|
Trophoblast
|
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What becomes the fetal component of the placenta?
|
Chorion
|
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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 |
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What must have happened for implantation to occur?
|
Egg must have hatched from zona pellucida
Endometrium must have been primed by estrogen THEN progesterone |
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What forms the blood-placental barrier?
|
Epithelial lining of chorionic villi
|
|
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What is the maternal component of the placenta?
|
Decidua basalis
|
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What becomes the fetal compartment of the placenta?
|
Chorionic plate
|
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What does the chorionic plate become?
|
Chorionic villi
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What line the chorionic villi?
|
Cytotrophoblsts
Syncytiotrophoblasts |
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What is produced by the cytotrophoblasts?
|
GnRH
|
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What is produced by the syncytiotrophoblasts?
|
hCG
Progesterone Estogen hPL Relaxin |
|
|
What are Hoffbauer cells?
|
Resident macrophages of the chorionic villi
|
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What is the configuration of the amnion & chorion if the split of monozygotic twins occurs at the morula stage?
|
Dichorionic/diamniotic
|
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What is the configuration of the amnion & chorion if the split of monozygotic twins occurs at the blastocyst stage?
|
Monochorionic/diamniotic
|
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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 |
|
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What is the configuration seen in twin-twin transfusion?
|
monochorionic/diamniotic
|
|
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What is the configuration of the amnion & chorion if the split of monozygotic twins occurs during days 13-15?
|
Conjoined twins
|
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|
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
|
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What hormone induces oxytocin & progesterone receptors?
|
Estrogen
|
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|
What is hPL?
|
Human placental lactogen
Alterals fuel availability by antagonizing maternal glucose |
|
|
What inhibits lactation during pregnancy?
|
High levels of estrogen & progesterone
|
|
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What is the role of relaxin during pregnancy?
|
With estrogen-->softens cervix
With progesterone-->maintains uterine quiescence |
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What is the source of relaxin?
|
Both placenta & corpus luteum
|
|
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What is the fetal source of progesterone?
|
Placenta
|
|
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Where does formation of 16-hydroxyDHEA-S occur?
|
Fetal liver by 16-hydroxylation of DHEA-S
|
|
|
Where is estriol formed?
|
In the placenta
|
|
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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 |
|
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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
|
