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Flashcards in Week 5 Deck (154):
1

What is the connection between the pulmonary artery and aorta in a fetus

Ductus arteriosum

2

Where does the fetus get oxygen from

Placenta
Maternal circulation

3

From placenta to fetal hearth, what is involved

Umbilical vein --> Ductus venosus -->
Inferior vena cava --> Right atrium

4

What is the blood distribution from Right atrium in fetus

Some into Left atrium, some into Right ventricle

5

How does the blood get from Right to Left Atrium in fetus

Oval foramen

6

What is the distribution from Right ventricle in fetus

Pulmonary trunk --> Pulmonary arteries AND Ductus arteriosus to the descending aorta

7

When does the foramen ovale functionally close

By 3 months of age

8

When does Ductus arteriosus functionally close

10-15h post birth

9

What closes ductus arteriosus

Oxygen and pressure

10

What opens the ductus arteriosus

Prostaglandins

11

What is presenting symptoms of failed adaptation of fetus

Feeding difficulties
Fast breathing rate
Cyanotic episodes

12

What is atrial septal defect

The Oval foramen has not closed, leaking blood from Left to Right Atrium

13

What can happen with Ventricular Septal defect

Pulmonary hypertension, fluid leakage in lungs

14

What is aortic stenosis

Narrowing of the aortic valve

15

What is pulmonary atresia

Non-functional pulmonary valve

16

What is tetralogy of Fallot

Large ventricular septal defect
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta

17

What is it called when the aorta and pulmonary trunk are swapped

Transposition of the great arteries

18

Definition of Extremely preterm

Week 27 or before

19

Definition of Very Preterm

Week 31 or before

20

Definition of Preterm

Week 36 or before

21

Definition of Term baby

Week 37-41

22

Definition of Post term

Week 42 or later

23

Normal birth weight

2.5kg - 4kg

24

Definition of Large for gestational age at birth

>4kg

25

Defintion of small for gestational age at birth

26

What enhances baby adaption after birth

Cortisol and Adrenaline

27

What is hemolytic disease of the newborn

Alloimmune disease that breaks down RBC in the fetus

28

Why is Vitamin K given to newborns

To stop Hemorrhagic disease of the newborn casued by Vitamin K deficiency

29

What infections are screened for in infants

Hep B and C, HIV, TB, Group B Strep, Syphilis, Gonococcus

30

What vaccination is given at birth

Hep B

31

What vaccination is given first month of life if riskfactors are there

BCG vaccine
TB vaccine

32

When is routine vaccinations given

8 weeks

33

What Screening tests are done on infants

Universal hearing screen
Hip screen
Metabolic (Blood test)

34

Newborn examination: Head

OFC
Moulding
Overlapping sutures
Fontanelles
Cephalohematoma
Caput succedaneum
Ventouse/forceps marks

35

What is hemorrhage between skull and periosteum in a newborn called

Cephalhematoma

36

What is swelling of infants scalp called

Caput succedaneum

37

Newborn examination: Eyes

Size
Red reflex
Conjunctival hemorrhage
Squints

38

Newborn examination: Ears

Position
External auditory canal
FH of hearing loss
Tags/pits

39

Newborn examination: Mouth

Shape -- Philtrum -- Tongue tie -- Palate -- Neonatal teeth -- Ebsteins pearls -- Sucking/rooting reflex

40

What are Epstein pearls

Whitish-yellow cysts that form on the gums and roof of mouth.
Harmless

41

Newborn examination: Face

Facial palsy
Dysmorphism

42

Newborn examination: Respiratory

Chest shape
Nasal flaring
Grunting
Tachypnea
In-drawing
Breath sounds

43

Newborn examination: Cardiovascular

Color -- Saturation -- Femoral pulse -- Apex/thrills -- Heart sounds

44

Newborn examination: Abdominal

Moves with respiration
Distention
Bile stained vomiting
Passage of meconium
Anus

45

Newborn examination: Genitourinary

Normal passage of urine
Normal genitalia
Undescended testes
Hypospadius

46

Newborn examination: MSK

Limbs and digits
Movement
Contractures
Spine
Sacral dimples
Hip examination

47

What are the two Hip examinations called in newborns

Ortolani/Barlow

48

Newborn examination: Neurological

Posture
Tone
Movement
Reflexes

49

What is the reflex that newborns have when they fall backwards called

Moro

50

Newborn examination: Skin

Dryness/cracking
Milia
Birth marks
Erythema toxicum

51

Causes of preterm birth

Spontaneous
Multiple pregnancy
Preterm prelabor rupture of membranes
Cervical incompetence
And more

52

Risk factors of preterm labor

Multiple pregnancy (x9)
Smoking, alcohol and drugs
In vitro fertilisation

53

What is a good tool to assess preterm babies

Pulse oximetry
Lungs are immature

54

When should umbilical cord be clamped

If the baby is ok and can be kept warm, pause for a minute before clamping

55

How is a preterm baby kept warm

Keep baby in plastic bag under a radiant heater

56

Consideration with preterm lungs

Lungs are fragile and susceptible to over-inflation

57

When should growth charts be used with Gestational correction

Preterm babies

58

How long should Gestational correction be used

1 year for infants born week 32-36
2years for infants born before 32 weeks

59

Most commong Organism of neonatal sepsis

Group B strep

60

What is Respiratory distress syndrome

Syndrome that happens when newborn lungs can't sufficiently provide enough oxygen

61

Signs and symptoms of Respiratory distress syndrome

Tachypnoea
Grunting
Intercostal recessions
Nasal flaring
Cyanosis

62

How is Respiratory distress syndrome managed

Maternal steroids
Surfactants
Ventilation (invasive or non invasive)

63

What are cardiovascular concerns in preterm infants

Patent ductus arteriosus
Systemic hypotension

64

What is intraventricular hemorrhage

A form of intracranial hemorrhage that occurs in preterm infants, which begins with bleeding into the germinal matrix

65

What are the risk factors for Intraventricular hemorrhage

Prematurity
Respiratory distress syndrome

66

What are the grades of Intraventricular hemorrhage

Grade 1-4
1 being best outcome

67

What is Necrotizing enterocolitis

Widespread necrosis in the small and large intestine

68

Most common Bacterial infections in neonates

Group B strep
E. Coli
Listeria myogenes
Staphylococcus aureus
Staphylococcus epidermidis

69

Common Viral infections in neonates

Cytomegalovirus
Parovirus
Herpes virus
Enteroviruses

70

What is Transient tachypnoea of the newborn (TTN)

Self-limited disease caused by problems of fluid clearance of the lungs. Presents at first few hours of life.

71

Tetralogy of Fallot is

-Pulmonary valve stenosis
-Overriding aorta
-Ventricular Septal Defect
-Right ventricular hypertrophy

72

What is Total Anomalous Pulmonary Venous Drainage (TAPVD)

Congenital cyanotic malformation where all pulmonary vessels are malformed and return blood to venous system rather than the left atrium.

73

What is hypoplastic heart

Congenital disease where part of the heart does not form properly causing cyanotic condition

74

What is Potter's syndrome

Congenital disease where the kidneys are not developed properly causing lack of amniotic fluid and kidney failure.

75

What is Spina bifida

Congenital neural tube defect. The spine is not formed properly and the spinal canal is exposed. Severity depends if the skin close over or not.

76

What are the sections of the Apgar Score

Heart Rate -- Resp.effort -- Tone -- Color -- Response

77

What is the highest APGAR score

10

78

What is normal Resp rate of newborn

40-60/minute

79

What is normal heart rate of newborn

120-140/minute

80

What was the anti-emetic drug that caused severe birth defects and is now banned

Thalidomide

81

Green puke in infants mean

Malrotation with volvus until proven otherwise. Medical emergency

82

Does Heparin cross the placenta

No, it is a large molecular weight drug

83

Pharmokinetics during pregnancy, what happens to Absorption

May be affected by morning sickness

84

Pharmokinetics during pregnancy, what happens to Distribution

Increased plasma volume, decreased protein binding and fat stores alters the distribution.

85

Pharmokinetics during pregnancy, what happens to Metabolism

Increased liver metabolism of some drugs

86

Pharmokinetics during pregnancy, what happens to Elimination

Renally excreted drug elimination increases due to increased GFR

87

What teratogenic effect does ACE inhibitors/ARB have

Renal hypoplasia

88

What teratogenic effect does Lithium have

Cardiovascular defects

89

What teratogenic effect does Warfarin have

Limb and fascial defects

90

What teratogenic effect does Methotrexate have

Skeletal defects

91

Which Epileptic drugs should be avoided in pregnancy

Valproate and Phenytoin

92

Which diabetes drugs should be avoided in pregnancy

Sulfonylureas

93

Which anti-hypertensive drugs should be used in pregnancy

Labetalol
Methyldopa
Nifedipine

94

Which anti-hypertensive drugs should be avoided in pregnancy

ACE inhibitors
ARB
Most betablockers in late prgnancy

95

Which anti emetic is safe in pregnancy

Cyclizine

96

Which drugs are used in UTI in pregnancy

Amoxicillin or Cefalexin

97

Which pain reliever is used in pregnancy

Paracetamol
Avoid NSAIDs

98

Which drugs especially enters breast milk

Small molecules
Fat soluble

99

26y women, 28week pregnany, presents with swollen right leg. Differential diagnosis.

DVT

100

26y women, 28 week pregnancy, presents with swollen right leg. DVT confirmed on USS. Treatment?

LMWH- Low molecular weight Heparin

101

Which antibiotic during pregnancy or in early childhood may cause darkening of teeth

Tetracycline - Casue staining of bones and teeth

102

Which antiepileptic drug is associated with Cleft palate

Phenytoin

103

Discriminating facial features of Fetal alcohol syndrome

Flat midline -- Short nose -- Indistinct philtrum -- Thin upper lip

104

Which antiepileptic drug is associated with neural tube defects

Valporate

105

What is population attributable risk

What proportion of this disease is attributable to this risk factor?

106

What is the BMI requirements for IVF

>18.5

107

What is the smoking requirement for IVF

Non smoker for >3 months
Both partners

108

What is the methadone requirement for IVF

Methadone free for at least one year prior to treatment

109

What is the alcohol requirement for IVF

Neither partner should drink alcohol

110

Can a couple receive IVF if they have undergone voluntary sterilization

No
Even if they reversed it, (self funded)

111

What causes breast engorgement

Delay in first feed
Ineffective positioning and attachment
Restricted feeding
Ineffective emptying
Supplmentation

112

Appareance of breast in breast engorgement

Stretched shiny skin, edma.
May be red

113

Management of Engorgement

Warm baths or warm compress prior to feed --
Cold compress after feed to reduce edema --
Mild analgesia (paracetamol or Ibruprofen) --
Express milk if feed is not sufficient to reduce pressure

114

Poor management of engorgement may lead to

Mastitis

115

What causes Mastitis

Plugged milk duct -- breast infection -- poor position and attachment -- infrequent feeds -- consistent breast pressure -- Dummies -- Supplementation -- Trauma

116

Signs and Symptoms of Mastitis (blocked duct)

Tender spot, redness, sore lump without fever

117

Signs and Symptoms of Mastitis (breast infection)

A tender spot or lump and a low grade fever

118

Signs and symptoms of Infective mastitis

Cracked nipple
Pus and blood in milk
Red streaks from site back into breast

119

Treatment of mastitis

Continue breastfeeding
Express milk if needed
Anti-inflammatory medication
Antibiotics if no improvement

120

What is the order of events in mastitis

Blocked duct --> Localized inflammation --> systemic response

121

Mastitis can lead to what if untreated

Abscess

122

Antibiotic treatment for Mastitis

Flucloxacillin
Clindamycin if Penicillin allergy

123

When is the prevalence of breast thrush low and other causes of breast pain should be considered

First 6 weeks after birth

124

Sign and symptoms of Breast thrush

Agonsing pain in BOTH breasts
Pain is equal in BOTH breasts
Pain AFTER feed
Position and attachement is normal. No change in nipple color or shape after feed.
+ve oral swab for Candida albicans

125

What is Frenotomy

When the linguinal frenulum is cut. Done when baby has tounge-tie

126

What causes Breast Thrush

Candida Albicans

127

Signs of Thrush in infant

Nappy rash
Oral thrush
Baby pulling of breast while feeding
Baby windy, fretful or difficult to settle

128

Management of Breast Thrush

Observe breast and breastfeed --
Boil dummies and teats 20min/day
Wash towels and bras in hot water
CONTINUE FEEDING

129

Treatment of Superficial breast thrush

Miconazole cream

130

Treatment of Deep breast thrush

Fluconazole
300mg loading dose + 150mg daily for at least 10days

131

Treatment of Thrush in infant

Nyastin oral suspension

132

Treatment of Thrush in infant >4months

Miconazole oral gel

133

Bound anteriorally by the symphysis pubis, laterally by the iliopectineal lines, and posteriorly by the sacral promiotry

Pelvic inlet

134

Bound anteriorally by the pubic arch, laterally by the ischial tuberosities and posteriorly by the coccyx

Pelvic outlet

135

Woman presenting with multiple small painful ulcers on her genitalia and a flu-like illness. She is unable to urinate due to discomfort. Diagnosis

Herpes Simplex

136

Non-sexually active woman presents with a frothy brownish vaginal discharge, which has an offensive smell

Bacterial vaginosis

137

Woman presents with vulval irritation and a white discharge

Candida albicans

138

At what stage of development is embryo transfer most successful

Blastocyst

139

LH surge occurs at what duration prior to ovulation

24-36h

140

Changes in the Endometrium in the luteal phase are direct effect of which hormone

Progesterone

141

What is Clomifene

Non-steroidal infertility medication
Used to induce ovulation in polycystic ovarian syndrome.

142

Oligoasthenospermia menas

Low count and low motility

143

Teratoasthenospermia means

Abnormal form and low motility

144

Where does spermatogenesis occur in the testicle

Seminiferous tubules

145

Where is testosterone secreted from in a male

Leydig cells

146

7 week gestation, heavy vaginal bleed and abdominal pain. Cervix is slightly open with tissue visible. USS shows fetal heart beat. Diagnosis

Inevitable miscarriage

147

Most lymph (>75%) from the breast initially drains to the

Axillary lymph nodes

148

32y old lady has been seen in the unplanned pregnancy assessment clinic. Report shows an intrauterine sac measuring 40x32x25mm. Most likely diagnosis is

Delayed miscarriage

149

Antibiotic treatment for Chlamydia

Arithromycin

150

Preferred test for Chlamydia in an asymptomatic female is

First void urine NAAT

151

Main artery to the anterior abdominal wall

Inferior epigastric

152

In Down's syndrome screening, nuchal thickness is measured by ultrasound at what time

11-14weeks

153

When can the fundus first be palpable in singelton pregnancy

12week

154

Week 5 lecture done

yes