1. Describe the embryology and the approximate time of development of the morula,
blastocyst, blastoderm, and trophoblast.
2. Identify the three germ layers and the body structures that evolve
from each.
3. Identify the four periods of embryonic lung growth and describe the
major milestones of each period.
4. Regarding fetal lung fluid, describe the following:
a. Composition
b. Function
c. The hazards of lung fluid retention
5. Describe the embryological development of the heart including:
a. Development of the cardiac chambers
b. Formation of major vessels and cardiac valves
6. Describe and explain:
a. The cause of pressure differences between the right and left heart
b. The flow of blood from the placenta, through the body and back to the placenta
c. Each shunt that is encountered with the approximate amount of blood that passes each
shunt
7. Explain the function of the amniotic fluid and define the following:
a. polyhydramnics
b. oligohyframnios
Reading Assignment: Whitaker, pp. 3-10 , 17-27.
The High Risk Pregnancy Assessment of Fetal Growth and Development
1. Given an appropriate history, determine whether a pregnancy is high risk
2. Discuss the effects of maternal age on pregnancy risk.
3. Describe the features of toxemia of pregnancy.
4. List the conditions related to uteroplacental insufficiency.
5. Describe the possible results of uteroplacental insufficiency.
6. Explain the possible effects of maternal diabetes on fetal
development in general and on
lung maturation in particular.
7. Define Teratogenesis. Describe the effects of the abuse of such
teratogens as tobacco, marijuana, cocaine, and alcohol.
8. Describe the possible effects of maternal infection with rubella, toxoplasmosis,
herpes, cytomegalovirus, and syphilis on the fetus.
9. List and describe maternal anatomic abnormalities which may increase fetal risk.
10. Describe how ultrasonography is used to assess fetal status.
11. Define amniocentesis and describe the role of each of the following:
a ) L/S ratio
b) Determination of alpha-fetoprotein
c) Bilirubin level
d) Creatinine level
e) Identification of meconium staining
f) Cytologic examination of cells
12. List and describe the different methods of measuring fetal heart rates and
describe the cause and characteristics of the following:
a) Baseline heart rate
b) Bradycardia
c) Tachycardia
d) Beat-to-beat variability
e) Accelerations
f) Deceleration
13. Explain how fetal scalp pH is used to assess fetal asphyxia.
14. List and describe the five methods used to estimate the date of
delivery.
15. Compare and contrast the contraction stress test to the non-stress test. Describe
how each is performed and the advantages and disadvantages.
16. Describe the use of acoustic stimulation and fetal movements as
methods of assessing fetal well-being.
17. Describe the six tests used in the biophysical profile.
18. Discuss the implications of meconium stained amniotic fluid in
assessing fetal well being.
Reading Assignment: Koff, Chapter 2.
Whitaker, Chapter 3, "Labor, Delivery, and Physiologic Changes
After Birth," pp. 57-78.
Labor, Delivery, and Physiologic Changes After Birth
- Stages of Normal Labor and Delivery
- Abnormal Labor and Delivery
- Adaptation to Extrauterine Life
1. Describe the basic process of cervical dilatation and
effacement. Identify the most common presentation.
2. Define station and how it is expressed. Describe the sequence of events that lead to
the descent and delivery of the fetus.
3. Define tocolysis and describe the various methods used to achieve
tocolysis.
4. Define dystocia and describe the three etiological factors that cause it.
5. Describe each of the following types of presentation:
a. Complete breech
b. Incomplete or footling breech
c. Frank breech
d. Face presentation
e. Transverse lie
f. Prolapse of the umbilical cord and occult cord compression
6. Identify and describe the three types of placenta previa.
7. Describe the three categories of abruptio placentae and discuss the treatment.
8. Discuss the issues and risks associated with premature rupture of membranes (PROM).
9. List the indications for a cesarean birth.
10. Discuss the problem of multiple gestations in high-risk pregnancies.
Explain what occurs in discordant and parabiotic twinning.
11. List the factors that are responsible for the first breath.
12. Describe the importance of overcoming surface forces in adapting to extrauterine
life.
13. Identify and describe factors that cause the change from the fetal to the adult
circulation.
14. Identify the normal values for functional residual capacity (FRC), pulmonary
compliance, airway resistance, tidal volume, minute ventilation, deadspace, and alveolar
ventilation of the term newborn. Explain how these values change with age.
15. Explain what is meant by time constants and the consequences of decreased
expiratory time.
16. Explain the effects of decreased compliance and increased airway resistance on
tidal volume and respiratory rate in the newborn.
17. Describe the differences between the adult and the newborn infant with regard to
ventilation/perfusion ratio, diffusing capacity, and hemoglobin type.
18. Discuss the consequences of increased fetal risk and identify the extrapulmonary
complications of prematurity in the neonate. Discuss IUGR and distinguish between the two
types.
Reading Assignment: Whitaker. pp. 380-381;446-447;370-374
Assorted Handout (posted) Materials
Respiratory Distress Syndrome
Surfactant: Endogenous and Exogenous
1. Define surface tension and describe the following
a. How it is developed
b. Laplace's Law
c. Application to alveolar mechanics
2. Discuss the role of surfactant in pulmonary physiology-
3. Identify the major components of pulmonary surfactant and explain their functions.
4. Discuss the risk factors associated with the development of respiratory
distress syndrome (RDS).
5. List and describe the six abnormalities typically associated with RDS.
6. Describe the pathophysiology of RDS. Explain why alveolar hyaline membranes are
formed. Describe the vicious cycle which contributes to the deteriorating clinical
condition of the infant with RDS.
7. Outline the clinical features of RDS and describe the usual clinical course.
8. Given a case description of a patient with typical but severe case of RDS, identify
key steps in the proper treatment and management.
9. List the disorders which frequently accompany RDS or are complications of treatment.
10. Describe the essential features of an effective exogenous surfactant.
Reading Assignment: Whitaker, pp. 10-13 Surface Forces and the Role of Surfactant
pp. 350-355 Respiratory Distress Syndrome
Koff pp. 5-8
Respiratory Diseases in the Neonate:
- Transient Tachypnea of the Newborn - Pneumonia
- Meconium Aspiration
1. Discuss the etiology of transient tachypnea of the newborn
(TTN) and identify the types of neonates and the perinatal
situations which give rise to this problem.
2. Describe the typical presentation and progression of TTN.
3. Explain how TTN is diagnosed. Describe the typical chest x-
ray findings.
4. Given a typical TTN case, discuss how the patient should be managed.
5. Distinguish between early onset and late onset neonatal pneumonia. Compare the two
types' response to treatment. Explain the ways in which transmission of pathogens can
occur in the neonate.
6. Identify the most common causative organism for neonatal pneumonia. Identify the
complications that occur with this pneumonia. Identify other transplacental and
perinatally acquired organisms.
7. Identify causative organisms for late onset pneumonia. Discuss the ways in which
pathogens are transmitted.
8. Describe the clinical presentation, the most frequently encountered clinical issues,
the typical x-ray findings, and the general management of the neonate with pneumonia.
9. Identify the conditions which predispose a neonate to the meconium aspiration
syndrome (MAS). Describe the meconium material.
10. Discuss the do's and don'ts for the delivery room management of the meconium
stained infant.
11. Identify key areas in the management of the MAS infant. Contrast the various
clinical scenarios that could occur with MAS. Explain the limitations of conventional
interventions and why they sometimes fail.
Reading Assignment: Whitaker. pp. 380-381;446-447;370-374
MID-TERM EXAM
Complications and Issues of Prematurity
1. Define retinopathy of prematurity (ROP) and explain in general terms the nature of
this disease. Identify the risk factors for developing ROP.
2. Describe the process by which ROP develops. Describe the five stages of ROP.
Identify the ways in which the disease is treated.
3. Distinguish between intracranial and intraventricular hemorrhage in terms of the
gestational ages they affect and the area of the brain in which they are present.
4. Summarize the physiological reasons by which intracranial and intraventricular
hemorrhages develop. List the contributory factors of intraventricular hemorrhage.
5. Outline the clinical signs that may be present in the neonate who is developing an
intraventricular hemorrhage (IVH). Describe the grading scale of IVH.
6. Explain how long-lasting complications from IVH are managed. Explain how the
condition known as post hemorrhagic hydrocephalus (PHH) develops and how it is treated.
7. Identify the infant who is at risk for necrotizing enterocolitis (NEC). Explain
how NEC is diagnosed and how the infant on "NEC watch" is managed.
8. Describe the pathophysiology of NEC and the treatment.
Reading Assignment: Whitaker, pp. 359-367; pp. 268-270
Additional Issues in Prematurity:
- Air Leak Syndromes
- Neonatal Jaundice
1. List the types of air leak syndromes that occur frequently in
the neonate. Explain the pathophysiology of each of the types.
2. Identify the two types of pulmonary interstitial emphysema (PIE). Explain how
PIE develops and how it can be prevented or minimized. Describe the pathophysiology.
3. Explain ways in which pneumothorax can develop. Discuss the difference between
spontaneous pneumothorax and tension pneumothorax.
4. Discuss how pneumothorax can be diagnosed. Describe the signs and symptoms. Explain
how the transilluminator is used to diagnose pneumothorax.
S. Describe the emergency and non-emergency treatment of pneumothorax.
6. Differentiate pneumomediastinum from pneumothorax and discuss
the treatment.
7. Define neonatal jaundice and discuss its prevalence in the newborn population.
Explain in basic terms why neonatal jaundice is problematic, differentiating between
physiologic and non-physiologic jaundice.
8. Identify the source of bilirubin and explain in basic terms how unconjugated
bilirubin becomes conjugated. Explain what can happen to allow persistently high serum
levels of unconjugated bilirubin.
9. List the common issues that occur in the neonate that can lead to
hyperbilirubinemia.
10. Discuss the dangers and complications of jaundice. Explain what is meant by
kernicterus. Outline the basic treatments.
Reading Assignment: Whitaker, pp. 183-185; 264-268; 381-385; 402-406; 449-452
Koff, pp. 165-137; 179-195
Disorders in the Newborn
- Congenital Anomalies Involving the Airway
- Infectious Disease Involving the Airway
1. Explain what is meant by apnea of prematurity. List the three types of apnea.
2. Describe the mechanism to which the cause of apnea of prematurity is attributed.
3. Explain when most episodes of apnea occur. Identify the common disorders which are
reported to precipitate apnea of prematurity.
4. Explain how the infant who is prone to apnea spells is cared for and
monitored. State the target the Theophilline level range.
5. Describe the type of child who has obstructive sleep apnea. Discuss some of the
major treatments for this problem.
6. Define sudden infant death syndrome (SIDS) and identify the age group affected.
Explain how a diagnosis is made.
7. Explain why SIDS is sometimes called a development disorder. Identify the major risk
factors for the syndrome. Explain how the risks for SIDS can be minimized. Discuss the
"prone position" theory.
8. Explain what is meant by an ALTE and how a patient affected by SIDS can become an
intensive care admission.
9. Discuss the types of congenital tracheoesophageal fistulas. Explain what is meant by
esophageal atresia. Describe the signs seen in the newborn that may lead to a suspicion
TEF. Explain how the infant with TEF should be positioned.
10. Discuss the signs of choanal atresia and explain how the affected infant should be
managed before surgical repair.
11. Identify the major congenital anomalies which produce airway obstruction.
12. Explain how stridor is produced. Explain how the character of stridor differs with
partial obstructions at different locations in the airways.
13. In the child with laryngomalacia describe the structural abnormalities and discuss
the prognosis and management.
14. In the child affected by vocal cord paralysis, explain under what conditions
airway obstruction is likely. Discuss the potential causes of vocal cord paralysis and the
treatment and prognosis.
15 . Identify the causes and describe the basic abnormalities found in subglottic
stenosis, tracheal stenosis, and tracheomalacia. Discuss the management of patients
affected by these problems.
16. Identify the airway structures that are affected by epiglottitis. Explain how this
disease is diagnosed. Explain how an airway emergency can arise from this problem. Discuss
the cause, presentation, and treatment of epiglottitis.
17. Distinguish between croup and epiglottitis. Identify the three types of croup.
18. In discussing the three types of croup, identify the presumed causes of this
disease. Discuss the patient history for each type and explain how a diagnosis is made.
Discuss
Reading Assignment: Koff, pp: 138-153; 198-184
Whitaker, pp. 381-385; 402-406; 183-185; .449-452
Surgical Disorders in the Newborn and Child
1 . For each of the following pulmonary lesions, explain exactly what they are and
discuss the potential causes, potential complications, and treatment issues:
a) congenital adenomatoid malformation (CAM)
b) bronchogenic cysts
c) congenital lobar emphysema
d) sequestration
e) congenital diaphragmatic hernia (CDH)
2. Describe congenital diaphragmatic hernia and define the paradigm. Explain how and to
what degree ventilation is compromised in CDH.
3. Discuss the diagnosis and delivery room management of CDH. Describe the ventilation
strategies used in treating CDH.
4. Describe additional treatment measures for CDH in addition to or beyond mechanical
ventilation.
Reading Assignment: Whitaker, pp. 173-4; 405-406
Reading Assignment: Whitaker, pp. 437-439; 444-446; 432-437
Cardiac Anomalies: Defects that Decrease Pulmonary Blood Flow
1. Identify the major cardiac anomalies that produce hypoxemia by impairing pulmonary
blood flow. For each of the anomalies, describe the basic defective physiology.
2. Discuss and justify the most common medical interventions and
surgical procedures that are used to correct defects in pulmonary blood flow.
Distinguish between medical, palliative, and corrective interventions.
Reading Assignment: Whitaker, pp. 410-411; 414
Cardiac Anomalies: Defects that Increase Pulmonary Blood Flow
1. Identify the major cardiac anomalies that alter pulmonary/systemic hemodynamics. For
each of the anomalies, describe the basic defect in anatomy and its effect on
hemodynamics.
2. Discuss signs and symptoms of infants affected by cardiac defects that
increase pulmonary blood flow. Discuss the challenges to respiratory management.
3. Discuss and justify the most common medical interventions and surgical procedures
that are used to correct defects in pulmonary blood flow. Distinguish between medical,
palliative, and corrective interventions.
Cardiac Anomalies: Transposition of the Great Arteries (TGA)
1. Describe the abnormalities in cardiac structure and blood flow in the patient
with transposition of the great arteries (TGA). Discuss the physiological effects
of the abnormal structure.
2. Discuss signs and symptoms of infants affected by TGA. Explain how the chest x-ray
would appear.
3. Describe how the TGA patient is medically managed. Explain what interventions might
be appropriate in the Cath Lab. Describe the structural and blood flow changes that
surgically.
