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156 Cards in this Set
- Front
- Back
main source of energy for growing fetus
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carbohydrates
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Most common congenital heart defects
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Bicuspid aortic valve and VSD
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Embryology Week 1
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fertilization in fallopian tube ampulla, implantation begins
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Embryology Week 2
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implantation complete; endoderm and ectoderm form (bilaminar embryo)
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Embryology Week 3
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Mesoderm formed (trilaminar embryo)
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Embryology Week 5
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subdivisions of forebrain, midbrainand hindbrain are formed
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Embryology Week 7
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Heart formed
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Embryology Week 8
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primary organogenesis complete; placentation occurs
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Embryology Week 9
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permanent kidneys begin functioning
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Embryology Week 10
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midgut returns from umbilical cord, where it was developing, to abdominal cavity, while undergoing counterclockwise
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Embryology Week 24
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primitive alveoli are formed and surfactant production begins
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Embryology Week 26
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testicles descend
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Describe embryology of the heart
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Week 3: paired heart tubes begin to work
Week 4: Primordial atrium is divided into left and right by septa primum and secundum; Septum primum forms the valve of the foramen ovale, which closes about 3 months after birth.; failure of the foramen ovale to close results in an atrial septal defect (ASD) Week 7: The single ventricle is divided into left and right; prior to that the interventricular foramen communicates between left and right sides.; failure of the interventricular foramen to close results in a ventricular septal defect (VSD) |
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Describe the fetal circulation
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placenta-> umbilical vein->ductus venous->IVC->RA->foramen ovale->aorta
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How is the closure of the ductus arteriosus prevented and facilitated
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prevented by prostaglandin E1
facilitated by indomethacin by inhibition of prostaglandin synthesis |
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failure of the kidneys to develop results in what
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oligohydramnios - decrease fluid in the amniotic cavity
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failure of the kidney to migrate results in what
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ectopic kidneys
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A horseshoe kidney gets caught on what during its ascent
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inferior mesenteric artery (IMA)
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Failure of testicles to descend results in what
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cryptorchidism, may need to be corrected surgically to prevent progressive dysplasia and may affect fertility
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Where and when does fetal erythropoiesis occur
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yolk sac (3-8 wks)
liver (6-8 wks) spleen (9-28 wks) bone marrow (28 weeks onward) |
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What are metanephri and when do they start functioning
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permanent kidneys; start functioning at 9 weeks; urine is excreted into amniotic cavity
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What forms the Placenta
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fetal portion of placenta is formed from chorionic sac
maternal portion is derived from endometrium |
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What does the placenta synthesize
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glycogen and cholesterol
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what does the placenta transport
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- nutrients, electrolytes, water, and gases are diffused or transported across the placenta
- most drugs pass through placenta and can be detected in fetal plasma - a few substances cannot pass because of their size or charge (heparin); protein hormones (insulin) do not cross the placenta |
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Maternal alpha fetoprotein (AFP) is high in what
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- multiple gestations (most common)
- fetal neural tube defects - Gastroschisis |
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Which supplements during pregnancy reduce incidence of neural tube defects
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folic acid
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What is the placenta's endocrine functions
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produces beta HCG, ACTH, human placental lactogen human chorionic somatomammotropin
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What allows for early detection of pregnancy
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testing urine for Beta hCG
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Describe the CNS embryo development
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- during week 3, the neural tube is formed on the ectodermal surfaces
- neural tube openings are closed by 25-27 days - by week 5, subdivisions of forebrain, midbrain and hindbrain are formed |
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What results if the neural tube fails to close
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-failure of caudal neural tube to close completely can result in spina bifida
-failure of the rostral neural tube to close can result in anencephaly |
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When are the lungs formed
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by 24 weeks, primitive alveoli are formed and surfactant production is begun
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What is given to infants if they are born prior to 30 weeks? why?
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exogenous surfactant to prevent respiratory distress syndrome
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How is lung maturity determined
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lecithin to sphingomyelin ratio in the amniotic fluid is greater than 3
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What is gastroschisis
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failure of the intestine to return to the abdominal cavity with intestinal contents remaining at the base of the umbilical cord; it is a abdominal wall defect with extruded intestine
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What is a TE fistula
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incomplete separation of foregut and primitive airway
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What happens to the GI tract at week 10
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midgut returns from the umbilical cord, where it was developing, to the abdominal cavity, while undergoing counterclockwise rotation
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When do morphologic sexual characteristics develop
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week 7 gestation
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When does testosterone production begin in males? What does this lead to?
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in males, testis determining factor induces primary sex cords to develop as male gonads, with testosterone production by week 8
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Describe the testicles development
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testicles develop intra-abdominally and then descend through inguinal canals into teh scrotum by 26 weeks
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How does cocaine affect the fetus
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placental abruption
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When is the maternal AFP low
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trisomies 21 (Down Syndrome) and 18
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what is the most common cause for abnormal AFP
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incorrect dates
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Why shouldn't pregnant women change a cat's litter box
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risk of toxoplasmosis
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Infants who have experienced an intra-uterine infection have a higher than average risk of what
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- being small for gestation age
-hepatosplenomegaly -congenital defects -microcephaly -intracranial calcifications |
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What are the clinical features of Toxoplasmosis ingestion
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-microcephaly
-hydrocephalus -intracranial calcifications -chorioretinitis -seizures |
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Describe Maternal infection of toxoplasmosis
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-is due to ingestion of oocytes from feces of infected cats
-mother is asymptomatic |
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What are clinical features of congenital rubella
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meningoencephalitis
microcephaly cataracts hearing loss congential heart disease (patent ductus arteriosus, pulmonary artery stenosis) |
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What are clinical features of CMV
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-intrauterine growth retardation (IUGR)
-low birth weight -petechiae and purpura -jaundice -hepatosplenomegaly -microcephaly -chorioretinitis -intracranial calcifications |
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What are the late manifestations of CMV
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learning and hearing deficits can occur in 10% of infected
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What are narcotics like heroin and methadone associated with
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IUGR, SIDS, infant narcotic withdrawal syndrome
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Smoking is associated with
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decreased birth weight
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Phenytoin is assoicated with
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fetal hydantoin syndrome (includes IUGR, mental retardation, dysmorphic facies, and hypoplasia of nails and distal phalanges)
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What does tetracycline cause
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tooth discoloration and inhibits bone formation
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What is Isotretinoin (Accutane) associated with
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hydrocephalus, microtia, micrognathia, aortic arch abnormalities
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what is Warfarin associated with
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abnormal cartilage development
mental retardation deafness blindness ** instead use low molecular weight heparin which has fewer side effects |
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What does elevated maternal glucose cause
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elevated fetal glucose->fetal hyperinsulinism, which can -> hypoglycemia in the newborn
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What is maternal diabetes associated with
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-macrosomia (wt >4kg), which can cause birth related injury
-metabolic disorders -respiratory distress syndrome -hyperbilirubinemia -polycythemia and hyperviscosity -congenital malformations including cardiac, renal, GI, neuro and skeletal defects |
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maternal lupus is associated with
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first degree AV block in affected infants
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What are maternal HTN and renal and cardiac disease associated with in infants
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small for gestational age babies and prematurity
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vascular disease of placenta, caused by maternal illnesses such as diabetes or lupus can cause
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insufficient supply of nutrients to fetus and IUGR
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Most common teratogen
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alcohol
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What nationality has the highest incidence of fetal alcohol syndrome? Why?
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Native americans because alcoholism is higher in this population
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Clinical manifestations of fetal alcohol syndrome
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microcephaly, mental retardation, IUGR, facial dysmorphism(shortened nasal philum), renal and cardiac defects, hypospadias
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what is cocaine associated with
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higher risk of spontaneous abortion, placental abruption, fetal distress, meconium staining, preterm birth, IUGR, low APGAR scores at birth, intracranial hemorrhage, necrotizing enterocolitis, increase incidence of SIDS
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What affect does cocaine have on the infant
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causes maternal HTN and constriction of placental circulation-> decrease uterine blood flow and fetal hypoxia
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What is cocaine withdrawal associated with
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irritability, increase tremulousness, and poor feeding, increase incidence of learning difficulties and attention and concentration deficits later on
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What can the cord blood be used for
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-blood gas study if fetal distress is present
-test for infants blood type -rich in stem cells, which are pleuripotential cells that have potential use in malignancies and gene therapy |
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Which prophylaxis is given in the delivery room to the baby
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-gonococcal and chlamydial eye infection prophylaxis is with erythromycin or tetracycline
- vitamin K is given intramuscularly to prevent hemorrhagic disease of the newborn |
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What are the steps that occur during childbirth
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1. once the head is delivered, the nose and mouth are suctioned
2. once the whole body is delivered, the newbornis heldat the level of the table and the umbilical cord is clamped 3. Newborn is then placed under radiant warmer and is dried with warm towels 4. mouth and nose are gently suctioned 5. gentle rubbing of the back or flicking of the soles of the feet, if needed to stimulate breathing 6. when the umbilical cord is clamped and cut, absent blood flow within the umbilical vein -> the closure of the ductus venosus |
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What is the APGAR score
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-practical method of assessing newborn infants immediately after birth to help identify those requiring resuscutation
- assessment at 1 and 5 mins |
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What prenatal infections most commonly cause birth defects
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TORCH
-Toxoplasmosis -Other (hepatitis B, syphilis, varicella-zoster virus) -Rubella -CMV -Herpes simplex virus/HIV |
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When is a bulging fontanelle seen
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increase intracranial pressure, hydrocephalus, meningitis
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early onset small for gestation age associations
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-insult begin before 28 wks gestational age
-head circumference and height both small (symmetric) -seen in infants born to mothers with severe vascular dz w/ HTN, renal dz, congential anomalies, infections, chromosomal abnormalities |
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late onset small for gestational age
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-occurs with an insult after 28 wks gestational age
- sparing the head circumference (asymetric IUGR) -occur with multiple gestations and preeclampsia |
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What does absent breath sounds indicate
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tension pneumothorax or atelectasis
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what does bowel sounds in the thorax indicate
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congenital diaphragmatic hernia
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What does diminished femoral pulses indicate
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coartation of the aorta
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Which infants are at risk for being Large for gestational age
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-born to diabetic mother, postmature infant, Beckwith-Wiedemann syndrome
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what is the most common cause of an abdominal mass in a newborn
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enlarged kidney
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What are the layers of the skull
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SCALP
-skin, cutaneous tissue, aponeurosis, loose areolar tissue, periosteum |
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Circumcision should be avoided in which boys
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boys with hypo or epispadias, as foreskin can be used to repair these defects later
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what is the most common bone fracture during delivery
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clavicular fracture
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What is caput seccedaneum
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-area of edema over the presenting portion of the scalp during a vertex delivery
-associated with bruising and petechiae -can cross suture lines |
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What are the neonatal screening test? Where does it occur?
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-heel is punctured
-hypothyroidism, galactosemia, adrenal hyperplasia, cystic fibrosis, PKU, |
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What are the types of newborn screening tests
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neonatal screening and auditory screening
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What can improve the intellectual outcome in infants born with hypothyroidism
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early diagnosis and Tx with thyroid hormone prior to 3 mths of age
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what is a cephalohematoma
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-caused by bleeding that occurs below the periosteum of the overlying bone (usually the parietal)
-associated with skull fractures -contained within periosteum: does not cross suture lines |
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What should occur with all macrosomic infants
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they should be examined for signs of birth trauma and checked for hypoglycemia
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what does a complete clavicular fracture cause
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absence of Moro reflex
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what is molding
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temporary asymmetry of the skull from the overlapping of bones that occurs following prolonged labor and vaginal deliveries. Normal head shape returns in several weeks
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what is Klumpke palsy
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-involves the lower arm and affects the 7th and 8th cervical and first thoracic nerve root
- the hands are paralyzed and has absent grasp reflex, causing "claw hand" |
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What is the most common type of Erb palsy
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Erb-Duchenne (involves the upper arm)
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What is Erb palsy
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-involves the fifth and sixth cervical roots
-arm is adducted and internally rotated, but the grasp reflex is intact |
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Delivery room management of a meconium stained infant
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nasopharyngeal suctioning before the delivery of the thorax. Infants with respiratory depression require intubation and tracheal suctioning
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Problems with full-term infants
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-developmental dysplasia of the hip
-hypoxic/ischemic encephalopathy -congenital diaphragmatic hernia -jaundice |
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what are the signs of developmental dysplasia of the hip
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-asymmetry of the skin folds int the groin and shortening of the affected leg
-more likely unilateral and involve the left hip |
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Dx of developmental dysplasia of the hip
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confirmed by ultrasound
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Tx for developmental dysplasia of the hip
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special brace (Pavlik harness) or sometimes casting
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Who do developmental dysplasia of the hip more likely occur in
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white females with breech presentation
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What is meconium
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first intestional discharge of a newborn infant and is composed of epithelial cells, fetal hair, mucus and bile
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Meconium ileus is the most common presentation of what disease
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cystic fibrosis in the neonatal period
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When do most full term infants pass their first stool
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within the first 24 hrs of life
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What should infants with meconium ileus be tested for
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cystic fibrosis
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What is meconium ileus
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occurs when meconium becomes obstructed in the terminal ileum
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How does an infant with meconium ileus present
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failure to pass stool, abdominal distention and vomiting
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what is meconium aspiration syndrome? When does it occur?
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intrauterine stress may cause passage of meconium into the amniotic fluid, which can cause airway obstruction and a severe inflammatory response, which cause severe respiratory distress known as meconium aspiration syndrome
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What are the neurological manifestations of hypoxic/ischemic encephalopathy
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hypotonia, coma, seizures
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What are the outcomes of hypoxic/ischemic encephalopathy
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death, cerebral palsy, mental retardation
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What is hypoxic ischemic encephalopathy
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important cause of permanent damage to the cells of the CNS that occurs secondary to hypoxia (decrease oxygen delivery) and ischemia (decrease blood flow)
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What are the causes for hypoxic ischemic encephalopathy
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maternal conditions (HTN), placental insufficiency, severe neonatal blood loss, overwhelming infection
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What are congenital diaphragmatic hernias associated with
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c-some abnormalities, low birth weight, IUGR
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What is the cardinal sign in neonates with congenital diaphragmatic hernia
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respiratory distress
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Dx of congenital diaphragmatic hernia
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prenatal ultrasound btw 16-24 weeks
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What are the signs of congenital diaphragmatic hernia
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respiratory distress immediately on delivery, tachypnea, poor breath sounds over affected side of chest (most commonly left), and scaphoid abdomen
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Tx for congenital diaphragmatic hernia
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ex-utero intrapartum treatment (EXIT) procedure, where neonatologists and surgeons are present at delivery and infant is intubated and central extracorporeal membrane oxygenation (ECMO) catheters placed at the delivery of the head and neck
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When does physiologic hyperbilirubinemia occur, peak and resolve
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seen after first 24 hrs of life, peaks at 3 days, and resolves over 2 weeks
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what is kernicterus
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bilirubin neurotoxicity secondary to persistently elevated bilirubin levels, which exceed albumin-binding capacity of the blood resulting in deposition of bilirubin in the basal ganglia
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what does kernicterus result in
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neurologic deficits, hearing loss, profound encephalopathy and death
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Tx for Kernicterus
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-phototherapy with blue-green light converts bilirubin in skin to nontoxic isomers that are excreted without conjugation
-elevated bilirubin levels (12-20 mg/dL) are usually treated with phototherapy -exchange transfusion should be considered at higher levels (20-25 mg/dL) |
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what types of injuries occur during birth
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brachial plexus injuries
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what are the perinatal infection risk factors
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-rupture of amniotic membranes for 18 hrs or more
-chorioamnionitis -intrapartum maternal fever -maternal group B strep -prematurity -maternal UTI w/ gram negative organisms is emerging as the common cause due to perinatal GBS prophylaxis |
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What percentage of pregnant women are colonized with GBS
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20%
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what is the recommended screening for pregnant women for GBS
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all pregnant women be screened (vaginal, rectal swab) at 35-37 wks of gestation
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what is the most important route of transmission of group B strep
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vertical transmission
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what are the 2 patterns of disease for group B strep
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early onset disease- < 1 wk
late onset disease- 1 -12 wks |
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How does early onset Group B strep present
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presents shortly after birth as sepsis, pneumonia, or meningitis
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What is early onset Group B strep associated with
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persistent pulmonary HTN of the newborn
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How does late onset Group B strep present
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bacteremia, meningitis, bulging fontanelle, lethargy, irritability, vomiting, seizures
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Dx of group B strep
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isolation from sterile body fluids (blood, CSF)
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What is the Tx the symptomatic and asymptomatic group B strep
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-symptomatic (apnea, low temp, feeding intolerance) Tx with ampicillin and gentamicin
-asymptomatic- monitor |
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what are risk factors for E. coli infection in newborn
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maternal urinary tract infection during last month of pregnancy
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What are the clinical manifestations of of E. coli in newborn
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sepsis, meningitis, UTI, pneumonia
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Tx for E. coli in newborn
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third generation cephalosporin
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E coli infection in the infant is common in which infants
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infants with galactosemia
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E.coli is the principal cause of what conditions
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gram negative sepsis and meninigitis in newborn
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cesarean section is performed for women with what infection
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primary genital herpes and vaginal lesions in late gestation
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Tx for Herpes simplex
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acyclovir
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Dx of herpes simplex virus
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-HSV can be isolated in cell culture from skin lesions or nasopharyngeal swabs
-PCR is a sensitive for HSV detection |
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what percentage of adults have genital herpes
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20%
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How is 90% of neonatal Herpes Simplex infection acquired
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infected secretions during birth
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What are the 3 distinct patterns of herpes simplex dz
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-cutaneous disease (skin, mouth, eyes)
-encephalitic disease -disseminated dz |
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When is chlamydia acquired in infants
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passage through birth canal of an infected mother
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what does chlamydia cause in newborns
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conjunctivitis (few days to several days) and pneumonia (3-19 wks)
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Tx for chlamydia in newborn
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erythromycin orally for 14 days
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Chlamydia Dx
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culture
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Erythromycin use is associated with what development
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pyloric stenosis
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Tx for syphilis
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penicillin G
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Dx for syphilis
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-rapid plasma reagin (RPR) titers and flourescent treponemal anti-body-absorption test (FTA-ABS)
- |
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features of syphilis
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-intermittent fever, osteitis and osteochondritis, hepatosplenomegaly, lymphadenopathy, persistent rhinitis (snuffles), maculopapular rash involving the palms and the soles
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late manifestations of syphilis
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saddle nose deformity, saber shins, frontal bossing, Hutchison teeth and mulberry molars, sensorineural, and Clutton's joints (painless joint effusions)
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Dx of HIV
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detection of p24 antigen in peripheral blood, PCR to detect viral nucleic acid in peripheral blood, and ELISA for detection of antibodies
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Tx for HIV
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nutritional support, Pneumocystis jiroveci prophylaxis, antiviral therapy and anti-infective agents
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What reduces the transmission of HIV
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maternal Tx with zidovudine in the second trimester reduces the rate of transmission by >70%
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Clinical features of infant HIV
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persistent thrush, lymphadenopathy and hepatosplenomegaly, severe diarrhea, failure to thrive, and recurrent infections
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What are the strategies to reduce transmission of HIV to newborns
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-maternal Tx with ZDV during pregnancy
-consider elective C-section at 38 wks -mothers who are HIV positive should be advised not to breast feed due to risk of transmission |
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What percentage of pediatric HIV infection results from maternal fetal vertical transmission
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25%
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