Pediatric Pathology

Question 1

Developmental age

Answer 1

age from date of fertilization to date of intrauterine death or live birth

Question 2

Gestational age

Answer 2

2 weeks more than developmental age

age from LMP to expulsion or removal of conceptus

Question 3

Embryonal period vs fetal period

Answer 3

period of development of major organ systems - conception to end of 8th developmental week, fetal period is from 9th week to birth

Question 4

perinatal period

Answer 4

28+ weeks GA - to first week after birth

Question 5

Spontaneous abortion applies to

Answer 5

fetuses <20 weeks GA, NOT dev age

Question 6

Still birth

Answer 6

> 20 weeks GA OR fetus >500g
AND
NO sign of life

Question 7

Causes of spontaneous abortions

Answer 7

1) chromosomal - 50%
2) Implantation - luteal phase deficiency/ectopic
3) infection - chorioamnionitis
4) incompatibility - MHC homozygosity
5) maternal illness
6) placental pathology -

Question 8

causes of stillbirth

Answer 8

• NOT identified in 50% of cases
• Intrauterine asphyxia
• maternal causes
• placental causes
• Fetal factors - hydrops

Question 9

Intrauterine asphyxia with fetal demise results in

Answer 9

1- thoracic petechiae
2- visceral congestion
3- Hypoxic ischemic injury

Question 10

Intrauterine asphyxia with fetal demise results in

Answer 10

1- thoracic petechiae
2- visceral congestion
3- Hypoxic ischemic injury

Question 11

Intrauterine asphyxia with survival leads to

Answer 11

Hypoxic ischemic encephalopathy -

Question 12

Toxemia of pregnancy includes

Answer 12

• preeclapmsia
• eclampsia
  HELLP syndrome
  pregnancy induced hypertension

Question 13

Shared circulation is the case for

Answer 13

monochorionic diamnionic,

monochorionic monoamnionic

Question 14

Acute chorioamnionitis is due to

Answer 14

blood-borne infection in mother, causes chronic villitis, due to TORCH organisms
MATERNAL RESPONSE to infection

Question 15

placental abruption is due to

Answer 15

.damage to the maternal spiral arteries

Question 16

Preeclampsia most common in

Answer 16

3rd trimester

Question 17

Kleihauer Betke test

Answer 17

estimates the volume of HbF RBCs in maternal circulation

Question 18

2 most common routes of infection

Answer 18

1. maternal hematogenous

2. ascending amniotic

Question 19

Greatest risk for fetal consequences if infected with rubella

Answer 19

First trimester

Question 20

Premature
term mature
post-mature

Answer 20

42

Question 21

Neonatal period is from

Answer 21

birth to one month of age

Question 22

Neonatal mortality is inversely related to

Answer 22

gestational age

Question 23

Most contributing factor for neonatal mortality is

Answer 23

prematurity/LBW and congenital/genetic anomalies

Question 24

Alveolar collapse is prevented by

Answer 24

residual air -40% of volume and

a marked increase in pulmonary blood flow

Question 25

surfactant produced by

Answer 25

Type 2 pneumocyte

Question 26

When does surfactant appear?

Answer 26

28-32 weeks GA, mature levels at 35

Question 27

Normal levels of surfactant when

Answer 27

lecithin/sphingomyelin ratio > 2

Question 28

Prematurity causes

Answer 28

1) premature rupture of membranes 2) Chorioamnionitis - 25% of prems 3) placenta previa /multiple gestation

Question 29

Hyaline membrane disease is

Answer 29

acute injury to alveoli and bronchioles - epithelial necrosis, losing fluid - form membranes lining distal air space

Question 30

Highest incidence of HMD is

Answer 30

in GA <28 weeks

Question 31

causes of hyaline membrane disease

Answer 31

1- deficiency of surfactant - congenital pneumonia/sepsis group B strep - etc

Question 32

Pathology of bronchopulmonary dysplasia

Answer 32

- pulmonary fibrosis - arrest in acini development - squamous metaplasia of resp epithelium - smooth muscle hyperplasia

Question 33

Prognosis of HMD dependant on

Answer 33

dependent on GA and birth weight

Question 34

causes of NEC

Answer 34

- poor perfusion - congenital heart defect | - bacterial invasion through damaged mucosa

Question 35

Pathology of NEC

Answer 35

1- begins at bowel mucosa - goes full thickness 2- mucosa bleeds - pass bloody stool 3- bubbles of gas from invading bact- pneumatosis intestinalis 4- necrosis - > bowel perforattion, peritonitis and bacteria

Question 36

Pathogenesis of HMD

Answer 36

1- decreased surfactant (increased surface tension and atelectasis) 2- Hypoxemia CO2 retention 3- acidosis 4- vasoconstrction and hypoperfusion - endothelial and epithelial cell damage - - plasma leak into alveoli -> fibrin and necrotic cells

Question 37

Risk factors for SIDS

Answer 37

``` .prone or side sleep - soft surface/loose bedding maternal smoking overheating late or no prenatal care young maternal age prematurity male gender ```

Question 38

causes of cholestasis

Answer 38

1) anatomic abnormality of liver/biliary system 2) metabolic disoder 3) infection - TORCH 4) genetic 5) toxic injury 6) hypoxic/ischemic 7) idiopathic/neonatal

Question 39

clinical presentation of biliary atresia

Answer 39

jaundice at 4-8 weeks (perinatal form) | jaundice from birth (20% fetal form)

Question 40

Pathology of biliary atresia

Answer 40

inflammation, necrosis, fibrosis

Question 41

Prognosis and treatment of biliary atresia

Answer 41

.resection and reconstruction or liver transplant

Question 42

SIDS

Answer 42

- under 12 months of age - occurs during sleep - unexplained - most common 1-12 months cause of death

Question 43

most common causes of sustained cholestasis

Answer 43

1) biliary atrsia 2) idiopathic neonatal hepatitis 3) a1-antitrypsin deficiency