The cause of Symmetric IUGR! - USMLE Forums
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  #1  
Old 06-25-2012
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Pediatrics The cause of Symmetric IUGR!

A 21-year-old female, gravida 1 , para 0, who recently emigrated from Zimbabwe presents for prenatal
counseling in her 341h week of pregnancy. She received no prenatal care. Ultrasound evaluation reveals
lower-than-normal fetal length and markedly reduced fetal head size. Which of the following could have
prevented this condition?
A. Folic acid supplementation
B. MMR vaccination
C. Zidovudine treatment
D. Malaria prophylaxis
E. Smoking cessation
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Old 06-25-2012
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A. Folic acid supplementation

just guessed..........
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  #3  
Old 06-25-2012
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Its .........E.........

smoking is the most common cause of IUGR .

folic acid for neural tube defects

MMR specially for rabies , rabies causes cataracts , deafness , microcephaly but here the over all length is decreased so its IUGR

HIV and malaria can cause IUGR but not as common as smoking .
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Old 06-25-2012
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The question specifies SYMMETRICAL IUGR. So, it is not a maternal problem. Symmetrical is secondary to fetal problems. Most likely a congenital infection, which could have been prevented by MMR vaccination.
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Old 06-25-2012
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Agree with Hitman..

E.

I think incidence of smoking is much higher in pregnant women vs. contracting Rubella during pregnancy.
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Old 06-25-2012
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Quote:
Originally Posted by patelMD View Post
Agree with Hitman..

E.

I think incidence of smoking is much higher in pregnant women vs. contracting Rubella during pregnancy.
NO. Read the question.

"lower-than-normal fetal length and markedly reduced fetal head size."

That is SYMMETRICAL IUGR. Symmetrical IUGR are secondary to FETAL CAUSES.

And the most common causes are CONGENITAL INFECTIONS such as the TORCH infections, chromosomal abnormalities, etc.
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Old 06-25-2012
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Quote:
Originally Posted by Merrily View Post
NO. Read the question.

"lower-than-normal fetal length and markedly reduced fetal head size."

That is SYMMETRICAL IUGR. Symmetrical IUGR are secondary to FETAL CAUSES.

And the most common causes are CONGENITAL INFECTIONS such as the TORCH infections, chromosomal abnormalities, etc.

It can be smoking , a much more common cause .

http://www.gpnotebook.co.uk/simplepa...ID=-1845100489
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Old 06-25-2012
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Red flags for congenital infections:

A 21-year-old female, gravida 1 , para 0, who recently emigrated from Zimbabwe presents for prenatal counseling in her 341h week of pregnancy. She received no prenatal care. Ultrasound evaluation reveals
lower-than-normal fetal length and markedly reduced fetal head size. Which of the following could have
prevented this condition?
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  #9  
Old 06-25-2012
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B- MMR caccination??
microcephaly is a feature of toxo, CMV and rubella
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Old 06-25-2012
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Correct Answer MMR

No prenatal, symmetrical Iugr, Zimbabwe
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Old 06-25-2012
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merrily thought matches most with qbank expln...

here is qbank

The woman described has emigrated from a geographic region with numerous public health issues including
inadequate vaccination, and has not received prenatal care. The absence of MMR (measles, mumps, and
rubella) vaccination provides a likely explanation for the baby's reduced head size. Standard prenatal care for
high risk women in the United States includes screening for infection with syphilis, chlamydia, gonorrhea, and
HIV, as well as screening for rubella and hepatitis B immunity. Early screening for these diseases is
important because fetal infection in the first trimester can have serious consequences. Rubella is one of the
TORCH infections, which collectively are characterized by symptoms including hepatosplenomegaly,
deafness, microcephaly, growth retardation, chorioretinitis and thrombocytopenia. Other TORCH infections
include toxoplasmosis, syphilis, CMV and HSV. Classic symptoms specific to congenital rubella infection
include sensorineural hearing loss and a "blueberry muffin" appearance caused by purpura.
(Choice A) Folic acid supplementation prior to conception is important in order to prevent neural tube defects
such as spina bifida and anencephaly.
(Choice C) Zidovudine treatment early in pregnancy in women with confirmed HIV infection can reduce the
risk of vertical transmission of HIV to the fetus. Caesarian delivery also reduces vertical transmission.
(Choice D) During pregnancy, malarial infection can cause maternal anemia. It also increases the risks of
fetal loss and intrauterine growth retardation. Microcephaly is not associated with malarial infection during
pregnancy.
(Choice E) Smoking during pregnancy carries a risk of intrauterine growth retardation, as well as neurologic
and developmental defects. Microcephaly is not a feature.

this is from uworld i thought smoking causes symmetrical iugr, if it does then patient should have microcephaly....
thoughts?
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  #12  
Old 06-25-2012
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Smoking causes asymmetric IUGR
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  #13  
Old 06-25-2012
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MMR, external factors are thecause of asymmetrical IUGR
Fetal anomalies cause symmetric IUGR
Source: kaplan gyn 2011
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Old 06-26-2012
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Quote:
Originally Posted by Hitman View Post
Its .........E.........

smoking is the most common cause of IUGR .

folic acid for neural tube defects

MMR specially for rabies , rabies causes cataracts , deafness , microcephaly but here the over all length is decreased so its IUGR

HIV and malaria can cause IUGR but not as common as smoking .


I think u meant MMR specially for Rubella
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Old 06-26-2012
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Quote:
Originally Posted by mayursn39 View Post


I think u meant MMR specially for Rubella
yes , thank you for the correction .......
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  #16  
Old 06-26-2012
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B.i also go with MMR..
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  #17  
Old 06-28-2012
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I go with MMR vaccination
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Old 06-28-2012
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Quote:
Originally Posted by tyagee View Post
A 21-year-old female, gravida 1 , para 0, who recently emigrated from Zimbabwe presents for prenatal
counseling in her 341h week of pregnancy. She received no prenatal care. Ultrasound evaluation reveals
lower-than-normal fetal length and markedly reduced fetal head size. Which of the following could have
prevented this condition?
A. Folic acid supplementation
B. MMR vaccination
C. Zidovudine treatment
D. Malaria prophylaxis
E. Smoking cessation
A- folic acid supplementation! He has Anencephaly so reduced head size! just kiddin ))))
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  #19  
Old 05-08-2013
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mmr vaccination so obvious
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  #20  
Old 06-01-2013
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I think the main thing to think about in this question is what they are actually asking about. I don't think its actually asking about IUGR. Its more a question about the causes of microcephaly. With that in mind its easier to answer.
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Quote:
Originally Posted by afridi123 View Post
mmr vaccination so obvious
- There is a similar question in the USMLE world Step2 CK and the answer is TORCHS
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