Week 8 Flashcards
(66 cards)
1
Q
What is the APGAR score?
A
- evaluate at birth and 10 minutes
-
Activity
- muscle tone
- Pulse
-
Grimace
- reflex irritability
-
Appearance
- Skin Color
- Respiration
2
Q
How can a childs height be estimated?
A
- midparental height
- female: MH + (PH- 13)/2
- male: (MH + 13) + PH/2
- parental pubertal history
- bone age
2
Q
What are the symptoms of tall stature?
A
- rarely referred
- symptoms
- exogenous obesity
- precocious puberty
- symdromes (marfan’s, Soto’s, klinefelters)
- GH secreting tumor extremely rare in children
3
Q
How much calcium and phoshate is absorbed by the fetus and what weeks does this happen?
A
- 23 g of calcium and 14 g of phosphate
- half of total amount accumulated happens in the last 4 weeks
- accumulation will start between weeks 16-20
- Ca2+ is about 1/50th of maternal bone content
- if there not adequate amounts of Ca2+ in the mother’s diet then it will pull it from the mother’s bones
3
Q
How long does the mother inherited immunity and what does it protect against?
A
- protects an infant for 6 months
- against
- diphtheria
- measles
- polio
- allergies appear when teh infant begins to form its own antibodies
4
Q
What effects height more than weight?
A
- Generally constitutional
- endocrine/syndromic
- renal
- metabolic
4
Q
What are the weight and length changes in a fetus?
A
- first 2-3 weeks microscopic and weight is so small during first 12 weeks
- most weight gain happens last 2 months
- ~2 lbs/month
- length is pretty steady
5
Q
What is russell-silver syndrome?
A
- type of drawfism
- symptoms
- macocephally
- micrognathia
- asymmetric limbs
- precocious puberty
- hypoglycemia
5
Q
What is the fetal development of the kidneys?
A
- start developing at week 5
- start to excrete urine sometime between the 1st and 2nd trimester
- urine contributes to amniotic fluid
- fluid regulation and acid-base balance isnt fully developed until months after birth
6
Q
What makes the weight more affected than height?
A
- GI
- Nutritional
- Renal
- Metabolic
7
Q
How does estrogen effects the skeleton?
A
- stimulates bone growth
- unite epiphyses with shafts of long bones
- estrogen >>testosterone, girls stop growing earlier
- after menopause estrogen levels drop
- increased osteoclastic activity
- descrease bone matrix and mineralization
7
Q
What cells makes up the placental membrane barrier at the end of 4th week?
A
- syncytium
- cytotrophoblast
- CT
- Endothelium
7
Q
How is vitamin E used in a growing fetus?
A
- maintains normal development in early embryo
- spontaneous abortions with deficiencies
7
Q
What is respiratory distress syndrome?
A
- occurs in premature infants or those born to diabetic mothers
- hyaline membrane disease causing collapsed alveoli and pulmonary edema
- lack of surfactant
- Type II alveolar epithelial cells dont produce util last 3 months
8
Q
What is noonans syndrome?
A
- short stature
- right sided cardiac defects
- neck webbing
- hypogonadism
9
Q
Where and when are nucleated blood cells formed?
A
- nucleated blood cells form in
- yolk sac
- mesothelial layer of placenta
- Happens during first 3 weeks of development
9
Q
How much iron is accumlated by the fetus and when does this happen?
A
- Iron accumaltes fast 250mg
- starts around week 12 and ramps up the last month
- Most of the iron is incorporated into hemoglobin which starts 3 weeks after fertilization
- 1/3 of iron in a full term fetus is stored in the liver for future formation of hemoglobin
10
Q
When does the first heart beat and what is the heart rate?
A
- starts beating at day 26
- HR will start at 65 bpm and increase to 140 bpm just before delivery
11
Q
What are the risk factors for respiratory distress syndrome?
A
- male sex
- premature birth
- second born twin
- perinatal asphyxia
- maternal diabetes
- Lecithin/sphingomyelin ration
12
Q
What happens to trophoblast on day 11 and 12?
A
- establishment of uteroplacental circulation
- trophoblast lucunae <> maternal sinusoids > maternal blood enters lacunar system
13
Q
Why refer somone for growth abnormalities?
A
- unexplained hypoglycemia
- unexplained abnormally slow or fast growth
- 95th%
14
Q
What are the different types of food allergies tests?
A
Need test based on history of the allergen
- skin tests
- quick, convenient, but high false positive
- RAST tests (blood)
- very high false positive
- Patch tests
- diffucult to administer
- Food challenges
- incremental challenge
- double blind, placebo
15
Q
What is eosinophilic esophagitis?
A
- symptoms very with age
- failure to thrive - infants
- vomiting - infants
- GERD - school age
- food impaction - teenagers/adults
- strongly associated with allergies
- biopsy of esophagus so its filled with IgE and eosinophils
17
Q
What is menopausal syndrome?
A
- Hot flushes
- psychic sensation of dyspnea
- irritability
- fatigue
- anxiety
- decreased strength and calcification of bones
18
What is the RBC and WBC count in a fetus?
* 3x10^6 or (3.75 if umbilical cord stripped)
* 45,000/microliter at birth
* 5x the adult values
19
What are the effects of progesterone on the uterus, fallopian tubes, breasts?
* uterus
* promote secretory changes
* descrease frequency and intensity of uterine contraction
* fallopian tubes
* promote secretion of peg cells
* breasts
* development of lobules and alveoli for secreotyr status
* no milk production without prolactin
20
What affects Occipital Frontal circumference?
* neurological
* genetic
20
What are the fetal shunts?
* Ductus venosus
* shunts off the liver
* Foramen Ovale
* right to left shunt to off the lungs
* fossa ovalis
* Ductus arteriosus
* further shunting from the lungs to the ascending aorta
22
What occurs because of structural abnormalities to cause female infertility?
* ovarian anatomic abnormailites
* Endometriosis
* endometrial tissue surround uterus, fallopian tubes, and ovaries, can menstrate causing fibrosis throughout pelvis
23
What pressures are needed to open the lungs?
* 25 mmHg negative pressure needed to open lungs
* first inspirations can produce up to 60 mmHg negative pressure in intrapleural space
* second breath much easier
24
How does estrogen effect the uterus and external sex organs?
* increase size
* internal: ovaries, fallopian tubes, uterus
* external: vagina, fat deposits in mons pubis and labia major, enlargement of labia minora
* vaginal epithelium
* cubuidal \> stratified
* more resistant to trauma and infection
* uterus
* 2-3 fold bigger
* proliferation of endometrial stroma
* development of endmetrial glands
24
What is arterial pressure at birth?
* averages 70/50 at birth
* increases over several months to 90/60
* BP then slowly increase to adolescant vaules of 115/70
25
What is the development of respiratory system?
* respiratory movements take place during 1st trimester then is inhibited during last 3-4 months
* inhibition prevents debris from entering the lungs
* fluids secreted by alveolar epithelium to keep airways clean
25
What is the liver function in a newborn?
* reduction in bilirubin excretion
* can result in jaundice
* reduced plasma protein formation
* hypoglycemia
* blood coagulation factors
27
What happens to trophoblast on day 8?
* formation of 2 layers
* cytotrophoblast - inner
* syncytiotrophoblast - outer
28
What is a food allergen and what are the known food allergens?
* water soluble glycoproteins ressitnat to heat and proteolysis
* helps across mucosal surfaces
* Known allergens
* peanut
* soybean
* fish/shrimp
* chicken egg whites
30
What is the function of the placenta?
* exchanges of
* gases
* nutrients
* electrolytes
* transmission of maternal antibodies
* hormone production
* progesterone, estrogen, hCG, somatomammotropin (placental lactogen)
32
How is vitamin K used in a growing fetus?
* formation of blood coagulation factors in liver
* provided by mother
* since formed by bacterial action in colon
* prevents hemorrhage
33
What is food protein-induced enterocolitis syndrome?
* severe, cell mediated GI food hypersensitivity that can be brought on by
* cow's milk, soy, grains, veggies or poultry
* symptoms
* vomiting, diarreha, letheragy/dehydration
* usually diagnosed for sepsis
34
What is fetal development of the GI tract?
* at 4.5 months of gestation, fetus ingests large quantities of amniotic fluid
* months 6-9 GI becomes as functional as it will be in a newborn infant
* Meconium is excreted by the fetus
36
What are the effects of progesterone on the female?
* initiates conversion from proliferative uterus to secretory uterus for implantation
* maintains uterus in secretory phase
* inhibits LH production
37
When does the bone marrow start to produce blood cells?
* 3rd or 4th month to bone marrow forms red and white blood cells
* After birth bone marrow is the only source of RBCs and WBCs
38
What are common nutrition defiencies in newborns?
* Calcium and vitamin D
* for bones
* Iron
* needed for RBC development
40
What occurs during growth hormone deficiency?
* Most common isolated deficiency
* IGF-1 and BP-3 low
* Growth velocity slow, bone age delay
* symptoms
* hypoglycemia, fatigue, slow mentation
42
What occurs during an endocrine abnormaility to cause female infertility?
* cycle without ovulation (anovulation) due to hyposecretion of gonadotropins
* Treatments: HCG, ovulation from multiple follicles, multiple births
43
What are the nutrition limitations in a newborn?
* low levels of pancreatic amylase so they cant digest starches
* reduced fat absorption
* unstable/low blood glucse levels
* GOOD AA utilization
45
How does estrogen effect the breasts?
* initiation of growth of breasts of the lactiferous ducts, stroma and fat
* further growth and function depends on progesterone and prolactin
46
What cells make up the placental membrane by the end of the 4th month?
* syncytium
* endothelium
47
What is the fetal development of the nervous system?
* Nervous system starts to develop at week 3
* skin relexes start at months 3-4
* higher function of cerebral cortex are underdeveloped at birth
* myelinization takes up to a year
* brain mass is only 1/4 of adult at birth
48
What is the kidney function in a newborn?
* newborns are susceptible to dehydration, overhydration and acidosis
* fluid intake/excretion is 7x more than an adult
* kidneys are fully developed after 1 month after birth
* concentrate urine by 1.5x instead of 3-4x
* metabolism is 2x higher than adult so slightly acidotic
49
What systems are not fully developed at birth?
* nervous system
* kidneys
* liver
organ systems dont develop within first month
50
What is cushings syndrome?
* extremely rare
* exogenous steriod use is more common but not cushings
* symptoms
* short stature
* rapid weight gain
* buffalo hump
* hypertensive
51
What happens to trophoblast on day 9?
* Fibrin coagulum - closure of penetration defect
* lucunar state
* primitive yolk sac
52
How is vitamin C used in a growing fetus?
* Bone matrix and CT fiber formation
53
What is physiologic hyperbiliruinemia?
* occurs in new borns because the liver is only marginally functional
* bilirubin rises
55
What is hypogonadonism in females?
* causes irregularity of menses and amenorrhea
* estrogen levels must reach certain points to have normal cycle
* lack or nonfunctional ovaries at birth
* lack of 2nd sexual characteristics, sex organs never mature
* taller
* removal of ovaries
* regression of sex organs
* similar to menopause
56
What happens to trophoblast on day 13?
* primary villi formation
* cytotrophoblastic cell proliferation \> penetration into syntiotrophoblast \> cellular columns \> villi formation
57
How do you treat eosinophilic esophagitis?
* stay away from specific food allergen
* systemic corticosteriods: prenisone
* topical corticosteroids: swallowed fluticasone
* allergy shots
58
What is food anaphylaxis?
* angioedema
* difficulty breathing, weezing
* hypotension
* nausea, vomiting
requires epinephrine injectioins cant use benadryl
59
What is IgE mediated food allergies?
* IgE antibodies made to specific epitopes of food allergen
* second exposure creates crosslinked IgEs causing the release of histamine, prostaglandins, leukotrienes, cytokins
* causes
* vasodilatation
* SM contraction
* mucus secretion
* food anaphylaxis
61
What is turner syndrome?
* missing one X chromosome 45 that affects females
* 1/2500 births
* symptoms
* left side cardiac defects
* renal abnormalities
* short stature
* neck webbing
62
What contributes to normal growth?
* Hormones
* GH, TH, cortisol, pubertal hormones
* Nutrition
* protein defiency
* GI abnormalities
* celiac, IBD, prancreatic insufficiency
* Genetics
* Environment
* meds, sleep, stress
63
What are the three types of estrogen?
* in order from most potent to least
* beta-estradiol - from ovaries
* estrone - peripheral tissues
* estriol - weak estrogen, made from estradiol and estrone in liver
64
After week 4 where are non-nucleated RBCs made?
* Begin form in liver then spleen
* week 3 for spleen
* liver has been producing RBCs but it takes over in week 3
65
What is erythroblastosis fetalis?
* produced by Rh incompatibility between mother and fetus
* mother makes antibodies angainst fetal RBCs
* large amounts of bilirubin released into plasma
66
What are complications related to a baby who becomes hypoxic?
* serious depression of respiratory center
* development of lesions of the inferior coliculi, thalamus other parts of the brain stem
* impairs motor functions
