HD EOYS3

Question 1

What % [1] and L/min [1] of O2 would you prescribe a mother with IUGR? [1]

Answer 1

55% at 8L/min

Question 2

A lag of symphysio-fundal height of how many weeks is suggestive of IUGR?

2 weeks
3 weeks
4 weeks
5 weeks

Answer 2

A lag of symphysio-fundal height of how many weeks is suggestive of IUGR?

2 weeks
3 weeks
4 weeks
5 weeks

Question 3

Which disease increases the liklihood the pathology depicted of a neonate? [1]

Answer 3

Respiratory distress syndrome

Question 4

What birthweight of less than how many grams increases the liklihood of this pathology of a neonate? [1]

Answer 4

> 1500g

Question 5

A death in second week of life would be classfied as:

Miscarriage
Still born
Early neonate death
Late neonate death
Infant death

Answer 5

A death in second week of life would be classfied as:

Miscarriage
Still born
Early neonate death
Late neonate death
Infant death

Question 6

A death in day 5 of life would be classfied as:

Miscarriage
Still born
Early neonate death
Late neonate death
Infant death

Answer 6

A death in day 5 of life would be classfied as:

Miscarriage
Still born
Early neonate death: 0-7 days
Late neonate death: 7-28 days
Infant death 29-1yr

Question 7

This cast of the bronchial tree is formed of inspissated mucus and was coughed up by a patient with what pathology? [1]

Answer 7

Asthma:

The outpouring of mucus from hypertrophied bronchial submucosal glands, the bronchoconstriction, and dehydration all contribute to the formation of mucus plugs that can block airways in asthmatic patients.

Question 8

What does this arrow depict? [1]

Answer 8

Ghon complex

Question 9

Which pathogen causes this diease? [1]

Answer 9

TB: ghon complex

Question 10

Which pathogen cause this histopathological slide

CMV
T. gondii
Parvovirus B19
Listeria
TB

Answer 10

Which pathogen cause this histopathological slide

CMV
T. gondii
Parvovirus B19

The pink intranuclear inclusions in the erythroid precursors seen here are characteristic for parvovirus infection. Parvovirus, or “fifth disease” is a self-limited infection that can produce a “slapped cheek” appearance of a rash in children, and often goes unnoticed in adults. However, pregnant mothers can pass the virus to the fetus, and a severe anemia with fetal hydrops and intrauterine demise can result.

Question 11

Which pathogen cause this histopathological slide

CMV
T. gondii
Parvovirus B19
Listeria
TB

Answer 11

Which pathogen cause this histopathological slide

CMV

Question 12

Which pathogen cause this histopathological slide

CMV
T. gondii
Parvovirus B19
Listeria
TB

Answer 12

Which pathogen cause this histopathological slide

T. gondii

Question 13

Which nucleus is underdeveloped in SIDs? [1]

Answer 13

Arcuate nucleus

Question 14

What is this pathology?

omphalocele
gastroschisis
bowel atresia
duodenal atresia

Answer 14

What is this pathology?

omphalocele
gastroschisis
bowel atresia
duodenal atresia

Question 15

Growth rate of normal fetus: Weight gain is:
[] per day at 14-15 weeks of gestation
[] per day at 20 weeks
[] per day at 32-34 weeks
Then growth rate decrease

Answer 15

Weight gain
5g per day at 14-15 weeks of gestation
10g per day at 20 weeks
30-35g per day at 32-34 weeks
Then growth rate decrease

Question 16

Which maternal mesaurement (height) height approx increases at 1cm per week between 14 and 32 weeks? [1]

How does abdominal girth change after 30 weeks, per week? [1]

Answer 16

Symphysiofundal height increases approx 1cm per week between 14 and 32 weeks

BUT if have polyhydramnios then this would cause inaccurate readings

After 30 weeks - increases by 2.5 cm per week

Question 17

Explain the pathology behind Type 1 IUGR:

• Is it caused by problem with mother or fetus? [1]
• Is it symmetrical or asymmetrical? [1]
• Between which weeks during pregnancy does it normally occur? [1]

Answer 17

Type 1 IUGR:

• Problem with fetus growth during week 4-20 (when most of mitosis is occuring)
• Everything is symmetrical / normal ration: but all parameters are below 10th percentile for gestational age

Question 18

What are causes of type 1 IUGR? [4]

Answer 18

Etiology:
* Genetic: associated with trisomy 21, 18 and 13
* Infection (intrinsic to fetus; CMV)
* Multiple gestation
* Environmental toxins: fetal alcohol syndrome

Question 19

• Explain pathophysiology of Type 2 IUGR [1] Which maternal pathologies is it associated with? [3]
• When does in pregnancy does it usually occur? [1]
• How do neonates appear? [1]
• WHat do neonates have reduced growth in? [2]

Answer 19

• Caused by uteroplacental insufficiency: uterus not providing enough nutrition for fetus. Associated with: maternal HTN / pre-eclampsia; renal disease; vasculapathies
• Growth restriction begins after week 28 in stage of hypertrophy : Fetus has near normal cell number but size reduced
• Asymmetry seen: head sized normal, but redistribution of fetal CO causes reduced abdomen and splachnic growth, whilst brain is spared.

Question 20

Mothers more at risk of giving birth to a IUGR baby have what wrong with them? [5]

Answer 20

Poor maternal nutrition: Low BMI at conception; Poor maternal weight gain during pregnancy

Pre-eclampsia

Renal disorders

Diseases causing vascular insufficiency

Infections (TORCH)

Question 21

What measurement would use clinically to diagnosis IUGR? [1]

What is normal growth of ^? [1]
What would indicate IUGR? [1]
What would indicate severe IGR? [1]

Answer 21

Symphysio-fundal height:

• Lag in fundal height of 4 weeks suggestive of IUGR
• Lag of >6 weeks is suggestive of severe IUGR

Question 22

Using a ultrasound to diagnose IUGR, what would you investigate? [3]

Answer 22

Head circumference
Abdominal circumference (AC) - AC highest sensitivity and greatest predictive value for diagnosis of IUGR
Amntiotic fluid volume

Can assess if type 1 or 2 by assessing differences in head vs abdomen

Question 23

What complications of IUGR would you expect in antepartum period? [2]

Answer 23

• Increased incidence of still births (52% of unexplained still births – die in utero)
• Oligohydramnios (esp. type 2 - kidneys haven’t formed properly)

Question 24

What complications of IUGR would you expect in intrapartum period? [2]

Answer 24

Higher incidence of meconium aspiration:: Fetal distress

Intrapartum fetal death

Question 25

What complications of IUGR would you expect in neonatal period? [5]

Answer 25

• Increased incidence of hypoxic ischemic encephalopathy: heart not developed so o2 to brain is insufficient
• Persistent fetal circulation insufficiency (patent ductus arteriosus - all O2 blood is mixed with deO2 - leads to hypoxia)
• Difficulty in temperature regulation: Absent brown fat and small body mass to surface area in type 2
• Poor glycogen stores may predispose to hypoglycemia
• Chronic intrauterine hypoxia lead to polycythemia, necrotizing enterocolitis, other metabolic abnormalities

Question 26

What is normal v abnormal cerebral: placenta ratio? [2]

What does this indicate? [1]

Answer 26

cerebroplacental ratio: >1:1 is normal and <1:1 is abnormal
<1 = abnormal

Indicates more flow to cerebral atery than placenta (and therefore brain sparing)

Question 27

Explain how you manage IUGR [5]

• Maternal oxygen therapy? [1]
• Bed rest position? [1]
• Drugs? [1]

Answer 27

Identify etiology of IUGR then treatment of underlying cause:

Stop smoking, alcohol, protein energy supplementation, hypertension

Bed rest in left lateral position increases uteroplacental blood flow

Maternal oxygen therapy
55% O2 at 8L/min round the clock decreases perinatal mortality rate

No pharmacological therapy which can reverse IUGR
Delivery

Risk of prematurity versus risk of intrauterine death has to be judged

Antenatal steroids reduces incidence of respiratory distress syndrome, intraventricular hemorrhage and death for fetus of <1500g

Question 28

Adequate vitamin D reduces which pathologies? [3]

Answer 28

Adequate vitamin D reduces:
- sepsis
- ROP
- delayed retinal maturation

Question 29

Describe the pathology of Intraventricular hemorrhage / periventricular leukomalacia:

What birth weight babies most likely? [1]
What is pathophysiology? [1]
Which disease is a risk factor for this? [1]

Answer 29

Intraventricular hemorrhage / periventricular leukomalacia:

• VLBW (less than 1500g) at greatest risk
• Resp. distress syndrome 4x more likely
• Pathology: blood vessels in the preterm may be more fragile and immature and cause small to large bleeds in brain ventricles

Question 30

What does Intraventricular hemorrhage / periventricular leukomalacia look like on ultrasound? [1]

Answer 30

Honeycombed

Question 31

Describe physiology of retinal blood vessels in normal fetus:

• when does it normally start & complete by? [2]
• Which directions do the retinal blood vessels grow? [1]
• What condition within the eye controls normal retinal development? [1]

Answer 31

Retinal blood vessel development starts at around 16 weeks and is complete by 37 – 40 weeks gestation.

The blood vessels grow from the middle of the retina to the outer area.

This vessel formation is stimulated byhypoxiawhich is a normal condition in the retina during pregnancy

Question 32

Which nutritional things would you screen for in pre-term babies? [2]

Answer 32

Hyperglycemia (poorly developed pancreas; immature insulin secretion)

Osteopenia (limited Ca & P in parentral nutrition)

Question 33

Treatment of necrotising enterocolitis? [3]

Answer 33

• Stop oral feeding
• Broad spectrum antibiotics covering both aerobic and anaerobic species
• Surgery to remove perforated sections

Question 34

Compare the flow between A & C of this doppler ultrasound.

Answer 34

A: showing normal flow

C: severely reduced flow with severe notch (see arrows).

Question 35

What does the pulsatility index (PI) of doppler ultrasound show [1] and measure? [1]

How does the PI differ between the MCA and umbilical artery in a normal & IUGR fetus? [2]

Answer 35

Pulsatility Index (PI):
* the difference between the peak systolic flow and minimum diastolic flow velocity, divided by the mean velocity recorded throughout the cardiac cycle.
* It is a non-invasive method of assessing vascular resistance with the use of Doppler ultrasonography.

Healthy fetus:
* PI of MCA greater than umbilical artery
* Creates ratio >1

IUGR:
* PI of MCA less than umbilical artery

Question 36

What does prescence of uterine artery notch after 22 weeks indicate? [1]

Answer 36

The presence of a notch after 22 weeks indicates increased uterine vascular resistance and warrants monitoring of the patient.

Question 37

How does the A-wave in a ductus venosus doppler ultrasound present in a normal and IUGR fetus? [2]

Answer 37

Normally ductus venosus shows positive A wave.

Reversal of the A wave may be seen in severe intrauterine growth restriction as well as in tricuspid regurgitation.

Question 38

What is the definiton of miscarriage? [1]

What is the definiton of stillbirth? [1]

What is early and late neonatal death? [2]

What is infant death? [1]

Answer 38

Miscarriage: pregnancy loss <24 weeks

Stillbirth: baby born >24 weeks with no signs of life

Neonatal death: baby born live but dies in first 28 days of life
- Early neonatal: 0-7 days death
- Late neonatal: 7-28 days death

Infant death: anytime in first year

Question 39

Which viruses is hand, foot and mouth disease commonly caused by? [3]

Describe pathology

Answer 39

Enterovirus 71 Virus
Coxsackie virus
Kawasaki virus

Causes neurological or cardiac complications including death

Kawasaki disease causes medium vessel vasculitis of children that can cause coronary artery aneursym

Question 40

Explain pathophysiology of Marfans syndrome causing sudden death (include gene mutation) [2]

Answer 40

Lack of Fibrillin covering elastin due to mutation in FBN1 gene.

Can cause aortic aneurysm which burst

Question 41

Non-specific post mortem findings in SIDS? [8]

Answer 41

• Thymus with petechiae (round spots that appear on the skin as a result of bleeding)
• Petechiae in pleura
• Epicardial petechiae
• Full expansion of lungs
• Liquid heart blood
• Empty bladder
• Prominent lymph nodes & Peyer’s patches

Question 42

Explain pathology behind shaken baby syndrome (caused by a triad off..) [3]

Answer 42

Caused by
* sub-dural hematoma - most common
* encephalopathy;
* retinal haemorrhages

Question 43

Explain the brain anomalies that are common in SIDs pathology:

• Which nucleus can become underdeveloped? [1]

Answer 43

• Alterations (decreases) in serotonin signalling
• causes disturbances in medulla and ANS:
• leads to underdevelopment of arcuate nucleus which controls neuroendrocine & physiological functions
• Platelets carry around serotonin. More serotonin in platelets increases the stickiness.

Question 44

Explain subset of SIDS infants related to serum platelet anomolies

Answer 44

Subset of SIDS infants have elevated serum serotonin platelets carry >98% of 5HT in blood:

Causes constriction of damaged blood vessels and enhances platelet aggregation

Question 45

What type of virus caused this lung infection? [1]

Answer 45

RSV

. Multinucleated giant cell (MNGC) of respiratory syncytial virus infection
demonstrating a large intracytoplasmic inclusion (arrow); (H&E, 1000 ). MNGCs
are more commonly seen within alveoli than within bronchioles.

Question 46

What is the most common bacterial [1] and viral [1] cause of pneumonia in neonates? [2]

Answer 46

Respiratory syncytial virus (RSV)
streptococcus pneumoniae

Question 47

What is the causative agent of this CSF infection? [1]

Answer 47

Group B streptococcus

Question 48

What is the most likely cause of this neonatal pathology? [1]

Answer 48

Osteogenesis imperfecta

Question 49

IUGR is associated with which congenital heart defect in neonates? [1]

Answer 49

Patent ductus ateriosus - causes hypoxia

Question 50

What pathology is depcited here? [1]

Answer 50

Duodenal atresia [1]