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Human Development Flashcards

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1
Q

When is further growth assessment needed in babies?

A

Drop of 2 weight centiles

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2
Q

When is further growth assessment needed in kids and teens?

A

Weight, height or BMI below 0.4 centile

Height more than 3 centiles below mid-parental height

Drop in height centile more than 2 centiles

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3
Q

How can we classify BMI on growth charts?

A

BMI above 91st centile –> overweight

BMI above 98th centile –> obese

BMI below 2nd centile –> underweight

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4
Q

What is failure to grow in utero caused by?

A 
Poor nutrition
Poor O2 supply
Diabetes
Drugs, alcohol, smoking
Long term maternal conditions 
Pre-eclampsia 
Chromosomal abnormalities
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5
Q

How is small for gestational age defined?

A

Weight, length or head circumference below 10th centile

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6
Q

What are causes of SGA?

A 
Small parents
Genetic abnormalities
Infection
Placental problems
Maternal factors
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7
Q

How is large for gestational age defined?

A

Weight, length or head circumference above 90th centile

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8
Q

What is macrosomia?

A

Birth weight > 4.5kg

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9
Q

What are causes for LGA?

A

Maternal diabetes and obesity

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10
Q

What are the developmental domains?

A
  1. Gross motor
  2. Fine motor and vision
  3. Language and speech
  4. Social
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11
Q

What are key parts in gross motor development?

A

Sits without support by 9 months

Walks by 18 months

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12
Q

What are key parts in fine motor and vision development?

A

Follows objectts by turning head by 3 months

Mature pincer grip by 12 months

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13
Q

What are key parts in speech and language development?

A

Babbles at 7 months

A few words by 12 months

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14
Q

What are key parts in social development?

A

Social smile by 8 weeks

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15
Q

What is abnormally early puberty for girls?

A

< 8 years (often benign)

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16
Q

What is abnormally early puberty for boys?

A

< 9 years (often concerning)

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17
Q

What are causes of precocious puberty?

A
  1. Gonadotrophin-dependent (central) - activation of HPG axis; normally benign
  2. Gonadotrophin-independent - due to increased sex hormone production without maturation of axis; congenital adrenal hyperplasia, tumours
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18
Q

What is abnormally late puberty for girls?

A

No breasts by 13 or primary amenorrhoea at 15

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19
Q

What is abnormally late puberty for boys?

A

No testicular development by 14

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20
Q

What are causes for delayed puberty?

A
  1. Constitutional delay
  2. Chronic illness or malnutrition
  3. Excessive exercise
  4. Tumours
  5. Congenital abnormalities
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21
Q

What is the genetic profile for Turner?

A

45 X

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22
Q

What does Klinefelter cause?

A

Infertility

Small, poorly functioning testicles

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23
Q

What is Klinefelter?

A

47 XXY

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24
Q

What does Turner cause?

A

Short stature
Premature ovarian failure
Neck webbing

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25
When are the breasts ready to produce milk?
Month 5-6
26
What triggers milk production?
High levels of progesterone prevent milk production Delivery of placenta causes progesterone drop and the high prolactin means milk production
27
What is the first milk?
Colostrum (high IgA to help develop GI system)
28
What happens in the follicular phase?
FSH stimulates 10-20 follicles to grow, as they grow they produce more oestrogen
29
What happens in the ovulatory phase?
one follicle will continue to grow, and produce more oestrogen, at particular level of oestrogen pituitary gland signalled to release LH, LH signals for egg to rupture and enter uterine tubes, oocyte propelled by cilia and uterine tube contractions
30
What happens in the luteal phase?
haemorrhage into remains of follicle, corpus luteum formed and persists if fertilsiation occurs and acts to secrete progesterone
31
When is primordial follicle arrested?
Prophase I meoisis I
32
When is the secondary oocyte arrested?
Matephase II of meisosis II
33
What is menopause?
One year of amenorrhoea (typically late 40s, early 50s)
34
What are symptoms of menopause?
Hot flushes, palpitations, night sweats, vaginal atrophy and prolapse
35
How is menopause diagnosed?
> 45years–no tests and based on symptoms alone < 45 years – high FSH levels with low oestrogen
36
What are the consequences of menopause?
CVD Osteoporosis Vaginal dryness Atrophy
37
Why does menopause occur?
Menopause occurs due to a limited pool of oocytes, that decrease over time, reduced number of granulosa cells therefore reduced oestrogen and lack of ovulation, FSH increases due to lack of negative feedback leading to anovulatory cycles and physiological + physical changes
38
What is the underlying mechanism of menopause osteoporosis?
Oestrogens crucial for maintaining bone mass by acting to suppress bone resorption by osteoclasts and to promote bone formation by osteoblasts- management; weight bearing exercise, vitamin D + oestrogen
39
What is the management of menopause?
HRT; replacing oestrogen, progesterone given to protect endometrium if uterus present (protection against endometrial hyperplasia), testosterone given to increase overall energy + sexual drive. Risks; increased breast and endometrial cancer risk
40
What do Sertoli cells do?
Facilitate spermatogenesis and spermiogenesis Provide nutrition Secrete inhibin which regulates FSH through negative feedback Secretes ABP required for sperm cells maturation
41
What do Leydig cells do?
Drives spermatogenesis via testosterone secretion which acts on Sertoli cells to create a suitable environment allowing progression of germ cells into mature sperm
42
What is secondary infertility?
Someone has already been pregnant before
43
What are causes for subfertility?
``` Male factor Anovulation Tubal factor Age over 35 History of STD Smoking Excessive alcohol Low BMI ```
44
What is premature ovarian insufficiency?
Cessation of menses for more than 1 year < 40 yo
45
What are risk factors for premature ovarian insufficiency?
Family history Exposure to chemotherapy or radiation Autoimmune disease
46
What investigations are needed for premature ovarian insufficiency?
LH and FSH levels (usually FSH > 30 on 2 occasions) Serum estradiol AMH level
47
What is a treatment for for premature ovarian insufficiency?
HRT
48
What are diagnostic factors for for premature ovarian insufficiency?
``` Hot flushes Sleep disturbances Irritability Vaginal dryness Infertility Vaginal atrophy Small uterus with non-palpable ovaries ```
49
What are signs and symptoms of PCOS?
Irregular menstruation Infertility Hirsutism Acne
50
What are risk factors for POCS?
Family history Obesity Premature or early adrenache
51
What are investigations for PCOS?
``` Serum 17-hydroxyprogesterone Serum prolactin Serum TSH Oral glucose tolerance Serum LH Serum FSH ```
52
What is treattment for PCOS?
1. Weight loss 2. Non-steroidal anti-oestrogen 3. Oral contraceptive + weight loss
53
What is the folic acid recommendation?
400 micrograms per day
54
When are women offered a scan for chromosomal abnormalities?
11+0 weeks | 13+6 weeks
55
When is the first antenatal visit?
10-12 weeks
56
What is done during the first antenatal visit?
``` FBC Blood type, Rh Rubella screen STD screen Hep B Dating ultrasound ```
57
When is the first ultrasound?
11-13 weeks
58
When is the fetal anatomy ultrasound?
18-20 weeks
59
When is the quadruple marker serum screening and amniocentesis for chromosomal abnormalities?
15-22 weeks
60
What are cardiovascular changes that occur during pregnancy?
Increase blood volume Increase RBC and WBC Increased stroke volume BP falls in first 2 trimesters but increases in 3rd
61
What are respiratory changes that occur during pregnancy?
Increase in RR Reduction in functional residual capacity Respiratory alkalosis
62
What are urinary and digestive changes that occur during pregnancy?
Increase in kidney size and renal blood flow
63
What are risk factors for ectopic pregnancies?
History of one IUD Smoking Multiple sexual partners
64
What are signs and symptoms of an ectopic pregnancy?
Abdominal pain Vaginal bleeding Abdominal tenderness Amonerrhoea
65
How would you investigate an ectopic pregnancy?
Urine/serum pregnancy test | Transvaginal ultrasound
66
What are risk factors for pre-eclampsia?
``` Multiple gestations Age > 35 DM Obesity Family history ```
67
What are the key factors in pre-eclampsia?
New onset hypertension | Proteinuria
68
What is the prevalence of gestational diabetes?
5-10%
69
What are risk factors for gestational diabetes?
``` Previous GDM Previous macrosomia babies Increased BMI >40 yo PCOS Family history of DM ```
70
How would you test for GDM?
7/11 rule >7mmol/L fasting plasma glucose >11mmol/L random blood glucose level
71
What is considered premature?
<37 weeks
72
What are the three stages of labour?
1. Dilation up to 4 cm --> active phase up to 10cm 2. Full cervical dilation up to birth of the baby (less than 3 hours) 3. Placental delivery

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