Study Guide for Midterm 1

STUDY QUESTIONS:

Lecture 10/5

1. What factors push delivery to occur?
2. What is the ideal length of pregnancy? How long is a pregnancy or how much does a neonate weight that is considered premature?
3. What does "small-for-date" mean? What does it indicate when such a baby is born?
4. How long is a pregnancy that is considered postmature? Is this more or less common than prematurity? What main problem makes the state of postmaturity precarious for the infant?
5. Is neonatal mortality a problem? Where?
6. What are the 3 major steps of parturition?
7. What signals does the fetus give that it is time for delivery (know at least 3)?
8. Where is oxytocin made? From where is it secreted into the bloodstream?
9. Understand the circular interaction between cervical stretch, oxytocin release, and uterine contractions that leads to delivery. What makes this loop stop?
10. Why isnıt oxytocin making the uterus contract throughout pregnancy? What is the relationship between the readiness of the uterus, estrogen levels, and the uterine response to oxytocin?
11. Where is relaxin produced? What are its main functions (know 2 that are related to delivery).

Lecture 10/8

1. What does the term "teratology" mean?
2. What is teratogenesis? What are teratogens?
3. What is the definition of "congenital malformation"? Are they always detrimental to the person with them?
4. How common are birth defects?
5. What are four types of birth defect (general categories)?
6. What congenital problem must be recognized at birth or will lead to Cretinism?
7. Give an example of a genetic birth defect. What is meant by X-linked?
8. What is the primary defect (in general terms) that occurs in hemophilia?
9. Give an example of a birth defect that is understood to have a multifactorial basis.
10. Give 4 examples of fatal genetic diseases that are hoped to be curable with stem cell therapies.
11. Since she referred you to p. 40, 55-56, and 57-58 ŭ you should what fundamental defect is involved in hemophilia, sickle cell, and PKU (phenylketonuria), but do not labor over the details.
12. In the context of birth defects, why is it so important that a woman know she is pregnant early on? --think about critical periods
13. Know the known human teratogens.

Lecture 10/10

1. What is Cretinism?
2. Why is the neonate not terribly worried about eating just after birth? What other considerations are more pressing?
3. What substance must be present in the lungs in order for them to expand during the first breath attempt?
4. What muscle must be ready in order for the infant to breath on its own? How is it that this muscle is strong enough at birth?
5. What is the main stimulus for breathing in humans? What part of the brain responds to this stimulus? What factors make that part of the brain excitable enough for it to begin initiating breathing?
6. Understand the 3 cardiovascular changes that occur after birth and what factors mediate those changes.

Lecture 10/12

1. Why is it so difficult for the newborn to take its first breath? How does surfactant help?
2. Fill in the following table:

   	Adult/Newborn	Fetus
   Carries oxygenated blood to the heart	_______________________________	_______________________________
   Carries venous blood to gas exchange organ	_______________________________	_______________________________
   Gas exchange organ	_______________________________	_______________________________
   Moves gas to be exchanged	_______________________________	_______________________________

3. Give 3 mechanisms in the newborn that contribute to quickly pulling fluid out of the air spaces after delivery (other than coughing up fluid).
4. Know how to calculate an infantıs Apgar score. Why would you be hesitant to resuscitate a baby with an Apgar score of zero? What is the usual Apgar score of a healthy baby?
5. What is the biggest different between primary and secondary apnea in a newborn? In which case must you intervene? Why does apnea occur in newborns? What does it indicate? Does apnea occur in healthy babies? What is the significance of a low heart rate in an infant who is apneic?
6. Name 3 procedures done to infants just after birth (at least in this country).
7. What is jaundice?
8. What is meant by the phrase "A good baby is a sick baby!"?
9. Name 3 things that cause fetal distress.
10. What happens if the mother has diabetes during her pregnancy? What are 2 important features of the baby that results? Answer the same questions for a preeclampsic mother.
11. What is the relationship between birth weight, IQ, and cardiovascular disease?

Lecture 10/15

1. How is cocaine an intrauterine toxin?
2. What is the relationship between interpregnancy interval and a womanıs risk for having a premature baby?
3. What problems are caused by maternal infections during pregnancy?
4. Why are premature infants at increased for stroke?
5. What is the minimum age of a newborn that is viable? Will these children have normal IQs?
6. What medical intervention in neonatal life causes bronchopulmonary dysplasia (BPD)? What is the result of this condition?

Lecture 10/17

1. What 3 factors determine how fast a person loses heat?
2. How does the fetus get rid of excess heat while in the uterus?
3. Why do infants lose body head 5 times as fast as adults?
4. What is the thermoneutral zone?
5. What happens to the bodyıs metabolism level as the external temperature drops?
6. What is meant by "nonshivering thermogenesis"? Understand how this process works. For example, know how hypoxia effects body temperature.
7. Where in the brain is information about body temperature processes?
8. Understand the four ways that infants lose heat, and know of ways you could reduce each. What is the largest source of heat loss in infants?

Lecture 10/19

1. What demographic variables are related to a high frequency of breastfeeding?
2. From which embryonic layer of tissue do the mammary glands arise? (ectoderm, entoderm, or mesoderm?)
3. What hormone is involved in the canalization of new mammary ducts? Where is it produced?
4. What change take place in the female breast during puberty? During pregnancy?
5. What main hormone is responsible for stimulating milk production? What hormones keep milk production in check during pregnancy?
6. What is the neurohumoral reflex arc?
7. How does suckling result in the let-down of milk? What hormone is involved? What factors can inhibit that hormone?
8. Do women have menses during lactation? Why or why not?
9. What are the main constituents of breast milk? Which nutritional component of breast milk varies the most through the duration of breast-feeding?
10. What is the predominant sugar in breast milk?
11. Do women who are breast-feeding need to take vitamin supplements? What about calcium?
12. What components of the immune system are provided by breast milk?
13. Know the benefits of breastfeeding.
14. Know the complications of breastfeeding.

Lecture 10/22

1. What are the major functions of the digestive tract?
2. Is the digestive tract under voluntary control? Which portions of it are and are not?
3. Why are infections, irritations, and allergies of the intestinal wall so threatening to infants? What disorder of bowel function occurs if propulsion through the system is too fast? And what is the consequence of that condition?
4. Can the late term fetus carry on all enzymatically controlled metabolic reactions necessary for energy release and growth? If so, why is digestion still difficult for the newborn (think about those enzymes)?
5. She has referred you to p. 205 of the text, tables 12-1 and 12-2 on dentition ­ you should go back and look at that page
6. Why does the baby have to feed so often?
7. What is the meconium? How can it be dangerous to the fetus?
8. Is the infant capable of gastric acid secretion at birth?
9. What are the major functions of the liver? How does its function differ after birth from before?
10. What is the only function of the liver that is not in operation at birth?
11. What are the functions of bile?

Lecture 10/24

1. Bile, bilirubin, and jaundice were mentioned in at least 3 separate lectures --> you should understand this
   • Where does bilirubin come from?
   • What is the major source of a bilirubin load in an infant with benign jaundice of the newborn?
   • What is the function of the liver in relationship to bilirubin?
   • What are the causes of hyperbilirubinemia (high bilirubin in the blood)?
   • What is kernicterus? In what situation does it occur? Is it common? Why is it more severe with subsequent pregnancies?
2. Why is water balance so critical?
3. What are the functions of the kidney?
4. What are the organs of the urinary system?
5. How is blood flow to the kidney (renal blood flow) regulated?
6. Be familiar with the structure of the kidney. --> vascular structure, capsule, cortex, medulla, calyces
7. What is the function of the glomerulus?
8. What is the functional unit of the kidney? What are the components of that functional unit?
9. Know the basics of how the kidneys are formed in embryology (this is a very complex process, so donıt agonize over it‹just know the basic structures and know some features of the metanephros)
10. What further development does the kidney/nephron undergo after birth?

Lecture 11/26

1. Which has proportionately more water‹an adult or a child?
2. What are four sources of water loss from the body?
3. What are the 3 basic components of nephron function (hint: the first is filtration of plasma)?
4. Are there more of less functioning glomeruli in the infant than in the adult? What is the consequence of this?
5. Where on the nephron does ADH act? What is its function? Where is it made? From where is it secreted? What happens when there is an ADH insufficiency or lack (what is that condition called)?
6. What are the five factors that affect the ability of the nephron to concentrate the urine?
7. Which of these 5 are major limitations of young kidneys?
8. Why is urea low in the infant? What is the consequence of low urea in the kidney?
9. What is the normal pH of the body?
10. What two organs of the body are the main regulators of acid/base balance?
11. Understand the main mechanisms of urine acidification: 1) the actions of aldosterone, 2) the use of H2CO3 to shuttle H+ ions into the nephron (there are certainly other mechanisms, but focus on these).

Lecture 11/29

1. see figure 15-1 in text (p. 278) and understand it: What kind of curve is charted by growth versus age? What can you see in the chart that plots height gain versus age in years? How is this second curve different in girls and boys? What hormones are responsible for the growth spurt at puberty?
2. What is the definition of growth? (there are many variations on this)
3. What is the relationship between the speed of growth and differentiation?
4. What is the secular trend in stature? Why does this occur?
5. What is allometric growth? Give an example.
6. What is catch-up growth?
7. What is compensatory growth? Give an example.
8. What is the relationship between functional demand and the rate of growth of an organ?
9. Understand figure 15-11 p. 288. Be able to explain the growth curves for each of the organs listed.
10. What is gigantism? Is it more or less common that dwarfism? What are the causes of gigantism?
11. What is dwarfism?