2012-2018 and Subject Reviews All together - In CSV form - Sheet1

Question 1

What is type 1 error?

Answer 1

Rejecting the null when you shouldn’t have

Question 2

In a patient with DiGeorge, what is the most common cardiac anomaly?

Answer 2

ToF

Question 3

Fasting levels of what causes NTD? When might you see it?

Answer 3

Homocysteine, With Folic Acid antagonists blocking folate acid synthesis and back up results in increased homocysteine.

Question 4

Best test to compare continuous variable in patients before and after treatment with experimental med .

Answer 4

paired t-test (best for one group before and after an intervention).

Question 5

Which uterine anomaly has the highest risk of PTL?

Answer 5

#1. Didelphys 
 #2. Bicornuate 
 #3. Septate

Question 6

What is the most common maternal complication of malaria?

Answer 6

Anemia

Question 7

A mother has diabetes, which is the least likely complication to the fetus?

a) Hypoglycemia
b) Hypocalcemia
c) Hypothermia
d) Polycythemia

Answer 7

Hypothermia does not

Question 8

Mitral stenosis worsens with?

Answer 8

Increased Preload

Question 9

What is the best contraception option for a women with DVT in pregnancy?

Answer 9

Levonorgesterol IUD

Question 10

Minipres mode of action?

Answer 10

Alpha blocker

Question 11

Which screening is recommended for Ashkenazi Jewish population?

Answer 11

Familial Dysautonomia
Cystic Fibrosis
Canavan: Aspartocyclase
Tay Sachs: Hexosaminidase A

Question 12

Where is PGF2apha produced mainly?

Answer 12

Decidua

Question 13

Most drugs cross the placenta by what method?

Answer 13

Simple diffusion

Question 14

HLA is not expressed on which?

Syncytiotrophoblast or cytotrophoblast

Answer 14

The Syncytiotrophoblast -has NO Antigens

Question 15

What is the most common complication of malarial infection?

Answer 15

Anemia

Question 16

Least likely to be transmitted in banked breast milk?

Answer 16

CMV

Question 17

Multiple intraabdominal echogenecities are least associated with which condition?

1. CF
2. Aneuploidy
3. Toro
4. Parvo
5. Meconium peritonitis

Answer 17

Parvo

Question 18

Where does fetus make blood throughout pregnancy?

Answer 18

Yolk sac: 3-8 weeks
Liver: 6 weeks -> birth
Spleen: 8 weeks -> 28 weeks
Bone marrow: 18 weeks -> adult

Question 19

OCP’s have the least beneficial effect in preventing which cancer?

Answer 19

Breast Cancer

Question 20

What is the most common associated anomaly with single umbilical artery?

Answer 20

Cardiac defects

Question 21

Which is most associated with fetal risk?

Thyroid stimulating antibodies, TSH?

Answer 21

TSI’s

Question 22

Which situation is most likely to result in a fetus having T21?

1. mom 45XX rob(14;21)
2. dad 45XX rob(14:21)

Answer 22

Mom 10-15%

Dad: <5%

Question 23

What is the worst complication of halothane?

Answer 23

Hepatotoxicity

Question 24

Which Coagulation factors decrease with pregnancy?

Answer 24

Factor XIII, XI, Protein S and Platelets

Question 25

Most common cause of mortality in setting of epidural placed for C-S?

Answer 25

Local toxicity

Question 26

Which of the following have associations with advanced paternal age?

Answer 26

Marfan, Achondroplasia, Neurofibromatosis (MAN)

Question 27

What happens to beta cells in pregnancy?

Answer 27

Beta cell islet hypertrophy

Question 28

Which Swan values are calculated?

Answer 28

MAP, SV, SVR, PVR, LVSW

Question 29

Low MCV, HbA2 3.9% Normal Iron Studies, Dx?

Answer 29

Beta Thalassemia

Question 30

What is the mechanism for a β-agonist?

Answer 30

Stim. B2 receptor (G membrane protein) -> activates adenylate
cyclase ↑ intracellular cAMP + activates PKA -> inhibits myosin light chain
phosphorylation -> ↓ intracellular calcium

Question 31

Which chromosome is oxytocin receptor on?

Answer 31

3

Question 32

Early amniocentesis at 14 weeks is associated with?

Answer 32

It is associated with: fetal loss, club foot, failed procedure, PROM

Question 33

What is the primary location of fetal hematopoesis at 20 weeks GA?

Answer 33

Yolk sac: 3-8 weeks
Liver: 6 weeks -> birth
Spleen: 8 weeks -> 28 weeks
Bone marrow: 18 weeks -> adult

Question 34

In patients with Aortic Stenosis, what changes after epidural can be problematic? How do you avoid this?

Answer 34

Decreased SVR -> Decreased Coronary Artery Perfusion –> MI. Avoid via slow epidural, narcotics only

Question 35

What is used to measure inter-observer variability?

Answer 35

Kappa Score

Question 36

What infection is most likely to be transmitted with breast feeding?

a. Hep B
b. Hep C
c. CMV
d. Herpes

Answer 36

CMV

Question 37

Lasix mode of action?

Answer 37

Loop diuretic

Question 38

What enzym is deficient in Gaucher?

Answer 38

Glucocerebrosidase

Question 39

How does IgG cross the placenta?

Answer 39

Pinocytosis / endocytosis

Question 40

What is the Barker hypothesis on fetal programming saying for IUGR fetuses?

Answer 40

They will develop Type 2 Diabetes later in life or metabolic syndrome

Question 41

What are the MOST likely symptoms of multiple sclerosis during pregnancy ?

Answer 41

Variable Course, usually improves

Question 42

Carrier frequency of AR gene if prevalence is 1/6400?

Answer 42

~1/40 q^2 = 1 6400, q = 1/80 p = 79/80, (carrier rate = 2PQ = 2* 79/80 * 1/80)

Question 43

Injury to what nerve causes numbness to medial thigh and labia?

Answer 43

Ilioinguinal

Question 44

Which coagulation factor is decreased in pregnancy?

Answer 44

Protein S, Factor XI, Factor XIII, Platelets

Question 45

Newborn with nose hypoplasia, stippled epiphyses, and limb hypoplasia, dx?

Answer 45

Warfarin embryopathy

Question 46

Most common complication of IUD in pregnancy?

Answer 46

Abortion

Question 47

How do you treat MAI if CD4 is 50?

Answer 47

Azithromycin

Question 48

Most likely to be helpful for treatment of mitral stenosis intrapartum?

Answer 48

Propranolol (Beta blocker)

Question 49

On QUAD screen if estriol is low (0.1MoM), what is the most likely diagnosis?

Answer 49

Icthyoses (placental sulfatase deficiency), less likely Smith-Lemli Opitz (deficiency in 7 dehydrocholesterol reductase)

Question 50

Patient with SLE that has normal fetal anatomy but fetal heart rate noted in 60s. What is the likely cause?

Answer 50

Congenital heart block - from SSA and SSB antibodies

Question 51

Pregnancy after endometrial ablation is associated with what outcome most frequently?
 S Ab
 PTD
 Malpresentation
 Placenta Accreta

Answer 51

Malpresentation (39%)
Morbidly adherent placenta (26%)
PTD (20%)
Sab (12%)

Question 52

What is the most likely obstetrical complication related to obesity?

Answer 52

Increased Cesarean Delivery

Question 53

What is Combivir?

Answer 53

Zidovudine (AZT) + Lamivudine

Question 54

What cardiac lesions should be deliverd by cesarean?

Answer 54

Dilated Aortic Root >40mm
 Aortic Aneurysm
 Recent MI
 Acute Severe CHF
 Severe Symptomatic AS

Question 55

How do you make the diagnosis of Von Willibrands?

Answer 55

Ristocetin test

Question 56

Which crossed placenta most readily?

T3, T4, TSH, TRH, TSI?

Answer 56

TSI is the most, followed by TRH and Iodine.

There is some T3 and T4 crossing and TSH Tcannot cross the placenta

Question 57

Which anesthetic is the MOST cardiotoxic?

Answer 57

Bupivicaine

Question 58

What is LEAST appropriate for testing for PKU?

Answer 58

Amnio for enzyme activity

Question 59

What is least advised in pregnancy if mom has known PKU?
 amnio for enzyme
 paternal PKU testing 
 dietary restrictions
 fetal echo

Answer 59

Amnio for enzyme, it is only found in the liver so amniocentesis to look for enzyme isnt helpful, would need to do molecular testing to identify recessive genes.

Question 60

How is Fragile X inherited?

Answer 60

X linked dominant

Question 61

<p>Most common non cardiac cause of maternal mortality</p>

Answer 61

<p>Infection</p>

Question 62

Which is not true with preeclampsia at induction of anesthesia?
decreased vasoresponsiveness to pressors
decreased plasma volume
increased coagulopathy

Answer 62

decreased vasoresponsiveness to pressors

Question 63

Which anesthetic has a risk of CAUSING withdrawal? Why?

Answer 63

Stadol (Butorphanol), it’s a mixed mu-agonist antagonist

Question 64

Which is best test if using multiple variables to assess surival?

Answer 64

cox regression

Question 65

What does PCWP approximate/indicate?

Answer 65

LV preload / filling

Question 66

Most likely cause of a nonreative tracing in a term fetus

Answer 66

Sleep cycle

Question 67

Which of the thyroid related substances crosses the placenta most rapidly?

Answer 67

Thyroid stimulating antibodies/immunoglobulins

Question 68

Which seizure medication is most affected by maternal liver failure?

Answer 68

Dilantin (Phenytoin)

Question 69

Which ultrasound parameter predicts placenta accreta most accurately?

Answer 69

Lacunae

Question 70

Aldomet Mode of action?

Answer 70

Central alpha blocker

Question 71

Which infection is a transplant patient least susceptible to compared with non-transplant patients?
E. coli, CMV, Chlamydia?

Answer 71

Chlamydia

Question 72

Which statistic test is used to differentiate between dependent and independent variables?

Answer 72

Logistic Regression

Question 73

At 30 seconds of resuscitation of a neonate, the HR is still low, Next step?

Answer 73

PPV

Question 74

What is the most likely outcome with AS?

a. Arrhythmia
b. Stroke
c. MI
d. Heart failure
e. Maternal death

Answer 74

Heart Failure (7-17%)
 Arrhythmia (3-33%)

Question 75

Choroid plexus cysts are most commonly associated with which aneuploidy?

1. T21
2. T13
3. T18

Answer 75

T18

30-50% of T18 have CPC

Question 76

What are the two AF molecules elevated with aplasia cutis?

Answer 76

AFP and Acetylcholinesterase

- elevated with all open wall defects

Question 77

At which phase do type 2 pneumocytes appear?

Answer 77

Cannalicular

Question 78

Aneuploidy with duodenum abnormality?

Answer 78

T21 in 30%

Question 79

What drug is commonly associated with microotia?

Answer 79

Isoretinoin

Question 80

Which IL is antiinflammatory?

Answer 80

IL10

Question 81

Levels of which drug are least effected by liver metabolism?

Lovenox, Warfarin, Dylantin?

Answer 81

Lovenox

Question 82

How do you treat a patient with Pulmonary hypertension, and you want to give general anesthesia.

Answer 82

Viagra

Question 83

Which HIV medication should be avoided in first trimester?

Answer 83

Efavirenz (NNRTI)

Question 84

Best medication for anticoagulation in pregnancy?

Answer 84

Lovenox

Question 85

Which translocation most likley to result in fetus with T21?

Answer 85

21:21 Homologous 21 translocation

Question 86

Which fetal vessel has the lowest PO2?

Answer 86

Umbilical Artery

Question 87

Which thombophilia is the most common?

Answer 87

Factor V leiden

Question 88

What are the criteria for pre-eclpamsia with severe features?

Answer 88

1. BP: >160 systolic or >110 diastolic x 2, atleast 4 hours apart
2. Plt <100,000
3. ↑ LFTs + severe RUQ/epigastric pain 4. Cr > 1.1 or doubled 5. Pulmonary edema 6. New-onset headache not responsive to meds 7. Visual distubances

Question 89

Which inheritance pattern is most associated with variable penetrance?

Answer 89

Autosomal Dominant

Question 90

What is not associated with placental thickening?

a) Syphilis
b) Rh Issoimmunization
c) Non-immune hydrops
d) Listeriosis

Answer 90

Listeriosis

Question 91

Who should receive prophylaxis for endocarditis?

Answer 91

Previous infective endocarditis
Unrepaired Cyanotic defect
Defects repaired with prosthetic material (first 6 months)
Defects reapired with prosthetic material with residual defect at repair site
Infection and a prosthetic valve

Question 92

Doppler studies reflect what parameter?

Answer 92

Velocity

Question 93

What is the risk of NAIT in a subsequent pregnancy?

Answer 93

If father’s antigen zygosity determines he is homozygous: 100% risk
Heterozygous: 50% risk

Question 94

What is the most likely cause of pain from a Wet tap?

Answer 94

Traction of nerves from CSF leak

Question 95

All of the following diseases are associated with DNA repeats except:
 Fragile X
 Huntington's 
 CF
 Myotonic Dystrophy

Answer 95

Cystic Fibrosis 
 Repeats:
 FraGile X (CGG)
 Huntingtons (CAG)
 MyoTonic Dystrophy (CTG)

Question 96

CVS cannot diagnose which conditions?

Answer 96

NTD

Fragile X

Question 97

Woman with MCV of 62, normal ferritin, HgbA2 4.2%. Most likely cause:

Answer 97

Beta Thalassemia

Question 98

1. Which anomaly is LEAST associated with very ill neonate after birth
   a. Interrupted aortic arch
   b. AV canal
   c. Other CHD

Answer 98

AVSD

Question 99

Triple screen shows a normal AFP, normal HCG and a low E3. What condition is this associated with?

Answer 99

X-linked icthyoses and SLOS

Question 100

Fetus with thyrotoxicosis/hyperthyroidism will have the following issues:

Answer 100

Issues with fetal hyperthyroid are - Heart rate greater than 160, growth retardation, advanced bone age, craniosyostosis
Occasionally Hydrops

Question 101

pCO269, HCO3 20, BE -2

Answer 101

Mixed

Question 102

What is the heart ultrasound finding most commonly associated with DiGeorge?

Answer 102

Interrupted Aortic Arch

Question 103

The most accurate description of Standard error is?

Answer 103

The same as standard deviation

Question 104

GnRH is made in which tissue?

Answer 104

Cytotrophoblast and Decidua

Question 105

Betamethasone decreasese what in fetuses?

Answer 105

Fetal Breathing and movement

Question 106

Most likley diagnosis with fetal unilateral pleural effusion?

Answer 106

Hydrothorax

Question 107

Which of the following is not a uterotonin?

a) Endothelin-1
b) Prostaglandins
c) Oxytocin
d) Calcium

Answer 107

Calcium , its needed for contractions, but isnt a factor that causes them like Endothelin, PG and Oxytocin

Question 108

Mechanism of anemia in parvovirus?

hemolytic effect, viral effect on erythroid precursors?

Answer 108

Effect on erythroid precursors

Question 109

Gaucher’s disease is a disorder of:

Answer 109

Glucocerebrosidase

Question 110

What is the most common trisomy in first trimester abortuses?

Answer 110

Trisomy 16

Question 111

What maternal cardiac disease is associated with a poor prognosis?

Answer 111

VSD with R-> L shunt (Eisenmenger)

Question 112

What is the most common adverse effect of general anesthesia?

Answer 112

Nausea and vomiting

Question 113

What is the mutation in Osteogenesis Imperfecta? Inheritance?

Answer 113

COL1A1 and COL1A2 (autosomeal dominant)

Question 114

What is most likely diagnosis of ambiguous genitalia?

Answer 114

CAH

Question 115

If a prior infant born with severe thrombocytopenia, what is the first step for testing in current pregnancy?

Answer 115

Maternal platelet antibody testing
If mom +: do maternal/paternal platelet antigen testing
If mom and dad are different for significant alleles and dad is homozygous then 100% risk of recurrence, if dad is heterozygous then 50% risk of recurrence

Question 116

What type of inheritence is associated wuth Leber’s optic atrophy?

Answer 116

Mitochondrial

Question 117

Which of the following syndromes is caused by uniparental disomy?

Answer 117

Angelman
Beckwith
Prader- Willi

Question 118

Maternal death is most associated with?

Answer 118

Cardiac Disease

Question 119

How long should you use Iodide for?

Answer 119

No more than 2 weeks as it increases the risk of fetal goiter (due to lack of release of the stored thyroid hormone)

Question 120

What defines Stage 3 TTTS?

Answer 120

Doppler abormalities (AEDF, REDF) 
 Stage 1: Poly/oli
 Stage 2: Absent bladder
 Stage 3: Doppler AEDF or REDF
 Stage 4: Hydrops
 Stage 5: Death

Question 121

What is the mechanism of fetal anemia caused by parvovirus?

Answer 121

Cytotoxic to erythrocyte precursors

Question 122

Which PG is not associated with labor?
 PGE 1
 PGE 2 
 PGE 3 
 prostacyclin 
 thromboxane

Answer 122

Prostacyclin

Question 123

Why is there increased placental transport of Meperidine (aka Demerol) in the acidotic fetus?

Answer 123

Ion Trapping because demerol is a basic drug (Decreased Isoelectric point)

Question 124

What mechanism does cAMP work in B-mimmetic?

Answer 124

↑ intracellular cAMP-> activates PKA -> Phosphorylates myosin light chain
Kinase (Which inactivates it) -> ↓ intracellular calcium and Muscle Relaxation

Question 125

What is associated with pancytopneia and absent radius?

Answer 125

Fanconi’s anemia

Question 126

What enzyme deficiency is seen with hydantoin syndrome?

Answer 126

Epoxide hydralase

Question 127

What is the most likely cause of low estriol levels?

Answer 127

Placental sulfatase deficiency (XLI) or SLOS

Question 128

What is the most common fetal anaomaly in obese patients?

Answer 128

Neural tube defects / Spina Bifida

Question 129

What is an obligate precursor for NO?

Answer 129

L-arginine

Question 130

What is an early sign of TTTS?

Answer 130

NT and CRL discordance

Question 131

Low MCV, HbA2 2.2% Low Iron Studies, Dx?

Answer 131

Iron deficiency anemia

Question 132

What is the most common reason for birth defects?

Answer 132

Genetic

Question 133

What syndrome has coarctation of the aorta?

Answer 133

Turners

Question 134

Which is the stats term used for inter-observer agreement?

Answer 134

kappa (intra observer variability / agreement)

Question 135

What is the most common presentation of neonatal lupus?

Answer 135

Rash and second thrombocytopenia

Question 136

Chorioangioma – most likely complication?

Answer 136

Polyhydramnios in 60% vs FGR in 20%

Question 137

What physical finding on a baby is associated with a term birth?

Answer 137

Scrotal Rugae

Question 138

Which ashkenazi disease is treatable with enzyme replacement?

Answer 138

Gauchers

Question 139

What crosses the placenta via Simple Diffusion?

Answer 139

COKED - CO2, O2, Ketones, Electrolytes, Drugs (most)

Question 140

What does Barker theory of fetal programming say about IUGR fetus at most risk of?

Answer 140

1. Metabolic syndrome

Question 141

Very Low Estriol levels are most commonly associated with what?

Answer 141

Placental Sulfatase Deficiency, X linked icthyoses, SLOS

Question 142

What mutation happens in Duchenne Muscular Dystrophy?

Answer 142

Deletion of Exons (X-L-Recessive)

Question 143

Diazoxide mode of action?

Answer 143

Thiazide analog (non-diuretic, vasodilator)

Question 144

What is the most common cause of a low apgar score in a preterm infant?

a) Prematurity
b) Acidosis
c) Sepsis
d) Chromosome abnormality

Answer 144

Prematurity

Question 145

What does CVP approximate/indicate?

Answer 145

RV Preload / filling

Question 146

Atenolol mode of action?

Answer 146

Beta blocker

Question 147

A normal woman has a homozygoous 21/21 translocation. What percent of her offspring will have Down syndrome?

Answer 147

100%

Question 148

Which disease is AD and is associated with telengiectasia, ataxia, thrombocytopenia?

Answer 148

Osler Weber Rendu

Question 149

Which of the following is LEAST associated with an enlarged placenta:

a) listeria
b) Parvo
c) NIH
d) syphilis
e) toxo

Answer 149

Toxoplasmosis, syphilis, and parvo can all cause non-immune hydrops, which has placentamegaly as a feature.

Question 150

Which headache gets worse with sitting standing and better with laying flat?

Answer 150

Spinal Headache

Question 151

Fetal thyrotoxicosis with heart failure in a mom with s/p thyroid ablation, whats the likely diagnosis and treatment?

Answer 151

Maternal Graves (TSI antibodies still present despite ablation), PTU

Question 152

Prophlyaxis for mycobacterium avium with CD4 count 45 is?

Answer 152

Azithromycin when CD4 < 50

Question 153

Least likely symptom with H1N1?

Nausea/Vomitting, Cough, Fever, Sore Throat?

Answer 153

Nausea/Vomitting

Question 154

Which is the most sensitive test to determine whether the fetus is infected with toxo

a) amnio for toxo PCR
b) PUBS for fetal IgM
c) PUBS for fetal IgG

Answer 154

Amnio for toxo PCR (immature fetal immune system so less likely to make Antibodies and IgG may be moms)

Question 155

What US findings are associated with Meckel Gruber?

Answer 155

Multicystic dysplastic Kidney, Encephalocele, Postaxial Polydactyly

Question 156

Patient has an MCV of 69 and Hgb A2 of 4% on electropheresis, what is the MOST likely diagnosis?

Answer 156

Beta thalassemia

Question 157

What is the most common genetic cause of mental retardation?

Answer 157

Fragile X

Question 158

What is the reason for maternal hypoxia at time of induction of general anesthesia?

Answer 158

Decreased Functional Residual Capacity

Question 159

Microtia associated with other drugs then isotretinoin?

Answer 159

Thalidomide, Mycophenolate

Question 160

Greatest risk with lupus nephritis?

Answer 160

Preeclampsia

Question 161

What is least associated with cerebral palsy?

1. ph<7 BE>-12
2. early onset encephalopathy
3. neonatal seizures
4. Apgar score of <3 at 5 minutes
5. Multi system organ failure
6. Spastic quadriplegia

Answer 161

Multicsystem organ failure

Question 162

How do you diagnose NAIT?

Answer 162

In a baby with unexplained ICH or thrombocytopenia
1. test mom for platelet antibodie
2. if positive, test maternal and paternal antigens
NAIT = If Mom is antibody positive and dad is homozygous positive for that antigen
or if dad is heterozygous (test the fetus)

Question 163

What happens to gluconeogenesis with persistent fasting in pregnancy?

Answer 163

Gluconeogenesis is not increased, as would be expected.

Prolonged fasting in pregnancy is accompanied by exaggerated hypoglycemia, hypoinsulinism, and hyperketonemia.

Question 164

What condition results from pituitary deficiency?
 acromegaly
 diabetes insipidus 
 addisons 
 cushings

Answer 164

Diabetes Insipidus (Decreased ADH from Posterior pituitary)

Question 165

Most common outcome if NT is increased?

Answer 165

Normal

Question 166

Neonate with limb and muscle hypoplasia, derm and

eye finding, Diagnosis?

Answer 166

Congenital Varicella

Question 167

Which Aneuploidy is most common with CDH?

Answer 167

T18

Question 168

Discrepancy in which is best for TTTS diagnosis?

Answer 168

Amniotic Fluic (Poly/Oli)

Question 169

Which medication increases cardiac contractility?

Answer 169

Beta agonist

Question 170

Which is helpful for treatment of HIE?

Answer 170

Cooling

Question 171

Which fetal organ system is subject to malformations the longest?

Answer 171

Nervous system

Question 172

In a retrospective study, do you use Odds ratio or relative risk?

Answer 172

Odds Ratio

Question 173

Weight of the uterus at term? Non pregnant?

Answer 173

The uterus weighs 1100-1200 g at term. Non-pregnancy <100g.

Question 174

Best outcome following in utero repair of myelomeningocele is seen with?

Answer 174

Lower limb muscle strength

Question 175

Management of Acute Fatty Liver of Pregnancy?

Answer 175

Delivery despite gestational age

Question 176

Treatment of NAIT should be? At what gestational age?

Answer 176

IVIG, starting at 12 weeks

Question 177

Which is least likely with listeria?

preterm labor, chorioamnionitis, hydrops?

Answer 177

Hydrops (one of the less common etiologies of hydrops)

Question 178

What is FGR at 20 weeks most associated with?

Answer 178

Triploidy, If >26 weeks probably Trisomy 18

Question 179

Which Coagulation factors increase in pregnancy?

Answer 179

Fibrinogen, Factor VII, Factor X, vwF:Roc

Question 180

At term which fetal organs get the most blood flow?

Answer 180

#1 Placenta
 #2 Brain
 #3 Lungs

Question 181

Which maternal cardiac lesion most associated with fetal hypoxia?

Answer 181

Pulmonary Hypertension

Question 182

Surfactant treatment of a 28 week newborn will help decrease what the most?

Answer 182

Neonatal Mortality

Question 183

What is the first line medication when there is uterine inversion?

Answer 183

Terbutaline , second line Nitroglycerine

Question 184

What are the features of Warfarin Embryopathy?

Answer 184

SLIMNECk
 Stippled Epiphysis
 Limb Defects
 IUGR
 MR
 Nasal Hypoplasia
 Eye Defects
 CNS
 k - Vit K Antagonist Warfarin

Question 185

What does a class 1 MHC get attacked by?

Answer 185

Cytotoxic T cells

Question 186

What is more convincing situation to intubate, hypoxemia or hypercapnea?

Answer 186

Hypercapnea

Question 187

These drugs should not be used in patients with myasthenia gravis except:

a) Curare
b) Magnesium
c) Gentamicin
d) Mestinon

Answer 187

Mestinon (used to treat Myasthenia gravis)

Question 188

Which IL is a regular component of amniotic fluid?

Answer 188

IL8

Question 189

Which disease is most transmittable in breastfeeding?

Answer 189

CMV

Question 190

What is NOT seen with hyperparathyroidism or an increase in maternal calcium?

a. Hypercalcemia
b. Htn
c. Fetal intracranial calcification
d. Neonatal hypocalcemia

Answer 190

Fetal intracranial calcification

Question 191

Pfannestial incision opening rectus muscles, what vessels are most likely injured?

Answer 191

Epigastric vessels

Question 192

Which anesthetic has the shortest halflife?

Answer 192

Chloroprocaine

Question 193

Which patient with thrombophilia can you give OCPs to post partum?

1. Prothrombin mutation
2. APLS
3. MTHFR homozygous
4. Protein C/S deficiency
5. Factor V Leiden

Answer 193

MTHFR

Question 194

Which artery can be injured when separating the rectus muscles during a c-section?

Answer 194

Inferior epigastric

Question 195

Which is the MOST diagnostic of primary adrenal insufficiency in pregnancy?

Answer 195

They develop hypotension from HYPONATREMIC volume contraction

Question 196

What influences the volume of AF the least in pregnancy?

a. Swallowing
b. Urine production
c. Maternal weight
d. Dehydration
e. Transudation

Answer 196

Maternal weight

Question 197

Which anesthetic has the fastest onset of action?

Answer 197

Lidocaine

Question 198

Most severe manifestation In listeria is?

Answer 198

The main manifestation of Listeria is stillbirth.

Question 199

What is pulmonary capillary wedge pressure (PCWP) reflects?

Answer 199

Left Ventricular Preload

Question 200

NTD is associated with what intercranial findings?

Answer 200

Banana sign
Lemon sign
Ventriculomegaly
Small cisterna magna

Question 201

Which of the following are findings in BV?

Answer 201

pH>4.5
+Whiff test
Thin homogeneous discharge
>20% clue cells

Question 202

Which parameters are directly measured by Swan?

Answer 202

HR
 CVP
 Pulmonary artery systolic and diastolic pressure
 PCWP
 Cardiac output

Question 203

What aneuploidy is seen with holoprosencephaly and midline facial defects?

Answer 203

Trisomy 13

Question 204

Which of the following is the action of platelet activating factor on myometrial cells?

Answer 204

Increases intracellular Calcium

Question 205

IUGR is most associated with what later in life?

Answer 205

metabolic syndrome / dm2

Question 206

What is the most appropriate to give a patient for long-term anticoagulation and breast-feeding?

a) LMWH
b) Full dose heparin
c) Coumadin
d) Mini-heparin
e) ASA

Answer 206

Coumadin is the most appropriate medication for long-term anticoagulation and is compatible with breastfeeding.

Question 207

Patient presents postpartum with fever, renal failure, anemia. Dx? Tx?

Answer 207

TTP, Plasmapheresis

Question 208

Why does creatinine decrease in pregnancy?

Answer 208

Increased renal perfusion and renal plasma flow (GFR)

Question 209

Pattern of glucose levels by time of day in pregnancy?

Answer 209

Decreased fasting levels, Increased postprandials

Question 210

Precursor for Fetal Steroid Synthesis?

Answer 210

Maternal LDL

Question 211

What is the most common finding with Trisomy 21 on sono at 18-20 weeks?

Answer 211

Nuchal Fold

Question 212

Which is most likely associated with significant neonatal respiratory depression from narcotic analgesia given to a mom in labor

a. Bradycardia
b. Variable decels
c. Reduced variability
d. Early decels

Answer 212

Decreased variability

Question 213

What is the most common non-infectious, non-genetic cause of MR?

Answer 213

Fetal alcohol syndrome

Question 214

Which lab measuring cardiac ischemia/function can be increased after vaginal delivery?

Answer 214

CKMB - found not only in myocardium but also in uterus and placenta.

Question 215

Which statistical test will account for survival accounting for multiple variables?

Answer 215

Cox Regression

Question 216

What is a unilateral pleural effusion in a fetus is most likely due?

Answer 216

Hydrothorax

Question 217

Which ethical principle explains a Dr/Patient relationship?

Answer 217

Beneficence

Question 218

What karyotype is suggestive of uniparental disomy?

Answer 218

From any trisomy as a trisomic rescue
( i.e you have trisomy 13 on CVS, the fetus tries to save itself by losing chromosome 13 but loses the wrong one and gets a uniparental disomy)

Question 219

Evaluate the effect of Smoking on Lung Cancer, what type of study?

Answer 219

Case Control

Question 220

Facial nerve palsy is a complication of which Operative delivery method?

Answer 220

Forceps

Question 221

Which adrenergic receptors are present on the myometrium?

Answer 221

1. α1: ↑ Phospholipase C -> ↑Protein Kinase C & Calsium 2. β2: ↑ Adenylyl Cyclase -> ↑ CAMP –> ↑ Protein Kinase A

Question 222

Risk of NTD with valproic acid?

Answer 222

1-2%

Question 223

When a CVS result is mosaic, what is the most likely outcome?

Answer 223

Confined placental mosaicism

Question 224

After cardiac arrest, when should delivery ideally occur ?

Answer 224

Within 5 minutes (If spontaneous circulation does not occur within 4 mins of effective CPR)

Question 225

A couple wants to know the likelihood of their baby being affected with PKU. The father has PKU (disorder frequency 1/10,000). What is the likelihood the mother is a carrier?

Answer 225

.1/50

Question 226

Most common location of brain bleed in premature infant?

Answer 226

Germinal Matrix

Question 227

What are the main features of Fetal Alcohol Syndrome?

Answer 227

Mental retardation
 Cardiac Septal Defects
 Growth Restriction
 Smooth Filtrum
 Small upper lip
 Small Palpebral fissures
 Kidney Abnormalities

Question 228

What does wedge pressure measure?

Answer 228

LV filling pressure

Question 229

Most common obstetric fistula?

Answer 229

rectovaginal fistula

Question 230

Karyotype shows 45XX t(14;21). What is the phenotype?

Answer 230

Normal

Balanced translocation

Question 231

How can you distinguish preeclampsia from lupus flare?

Answer 231

Increased Urine Sediment, Decreased CH50 activity, Anti DsDNA

Question 232

What is another name for Bupivicaine?

Answer 232

Marcaine

Question 233

Swan readings for PE?

Answer 233

Increase: Pulmonary artery pressure

Question 234

Pregnant patient with ab pain and bloody stool?

Answer 234

Stool culture

Question 235

What is the best study design to look at a disease and link to a risk factor? Example: smoking and cancer

Answer 235

Case control:

Compares a group with disease to a group without and looks back at risk factor

Question 236

What is associated with fetal abdominal calcifications?

Answer 236

CMV

Question 237

How do you differentiate betweem TTTS and TAPS?

Answer 237

MCA Dopplers (MCA PSV >1.5MoM in one twin and <0.8 MoM in the other twin )

Question 238

Which TB treatment is teratogenic? What does it do?

Answer 238

Streptomycin is contraindicated - as it is associated with hearing loss

Question 239

Which Respiratory functions don’t change in pregnancy?

Answer 239

1. Vital Capacity
2. Respiratory Rate
3. FEV1

Question 240

What confers the worst neonatal prognosis in CMV?

Answer 240

Microcephaly

Question 241

What to do to compare 2 groups, nl distribution and nominal outcome (ie histology)

a. Chi sq table
b. Anova
c. Ttest
d. others

Answer 241

Chi squared?

Question 242

Which bacterial enzyme is most associated with preterm birth?

Answer 242

Phospholipase a2

Question 243

Which condition is most likely associated with aneuploidy?

1. Cardiac
2. Omphalocele

Answer 243

Omphalocele

Question 244

Baby delivered and tried to resuscitate, Post ductal O2: 70%, Preductal 90%, likely diagnosis?

Answer 244

Persistent fetal circulation

Question 245

Patient with elevated HbA1c (10%), what is the most likely finding on ultrasound?

Answer 245

Normal

Question 246

NTDs are usually:

a) Due to single gene defects
b) Caused by teratogens
c) Multifactorial
d) Aneuploidy

Answer 246

Multifactorial

Question 247

Preload and afterload fixed, what increases CO?

Answer 247

beta adrenergic (dobutamine)

Question 248

What is the most predictive of transmission of HIV to baby?

Answer 248

Viral load/HIV RNA

Question 249

What does a ROC curve represent?

Answer 249

Compares sensitivity and specificity
y = sensitivity
x = 1-specificity

Question 250

What is the ethical principal which states a physician must refrain from providing ineffective treatments or acting with malice toward patients

Answer 250

Non-maleficence

Question 251

What is the positive predictive value of an NST for cerebral palsy?

Answer 251

<1%

Question 252

Algorithm for managing SVT?

Answer 252

#1) Vagal maneuvers (holding breath, valsalva)
 #2) Carotid Massage
 #3) Adenosine
 #4) Verapamil
 #5) Beta blocker

Question 253

Which medication is contraindicated in women with chronic hepatitis for HIV treatment?

Answer 253

Nevirapine, less so Lopinavir/Ritonavir (Kaletra)

Question 254

Which error is failing to reject the null hypothesis when its false?

Answer 254

Type 2 Error (failed “2” reject the null)

Question 255

What Ultrasound finding is agenesis of the corpus callosum most associated with?

Answer 255

Absent CSP

Also colpocephaly

Question 256

What is the best way to monitor improvement in metabolic acidosis in DKA?

Answer 256

Anion gap

Question 257

Most common complication with general anesthesia?

Answer 257

Failed Intubation

Question 258

Why does T4 demand increase in pregnancy?

Answer 258

Increased TBG, to maintain adequate free T3 T4 there is increased production

Question 259

Which is true regarding oxygen dissociation curve?

Answer 259

A fetus has higher O2 saturation at any PO2 than mom

Question 260

Which maternal cardiac lesion is associated with the greatest fetal oxygenation risk?

Answer 260

Pulmonary Hypertension

Question 261

Patient meets clinical criteria for antiphospholipid syndrome. Recommended testing?

Answer 261

Lupus Anticoagulant (Kaolin, Dilute russelll venom viper test, B2 Glycoprotein, Anti Cardiolipin Antibody

Question 262

What is the principal substrate for oxidative metabolism in the placenta?

Answer 262

Glucose

Question 263

Patient can’t dorsiflex after forceps delivery, which nerve injured

Answer 263

Common Peroneal

Question 264

Genetic screen test shows a normal AFP, normal hCG, and a low E3. What condition is this associated with?

Answer 264

X-linked Ichthyosis (placental sulfatase deficience) or SLOS (DHCR7 deficiency)

Question 265

Most likely genetic cause of early IUGR?

Answer 265

<26 weeks think Triploidy

> 26 weeks think T18

Question 266

Newborn with Thrombocytopenia and Interventricular Hemorrhage, likely Diagnosis?

Answer 266

Alloimmune thrombocytopenia

Question 267

Which maternal cardiac lesion most likely transmitted to fetus?

Answer 267

IHSS (autosomal dominant)

Question 268

Patient with 8 week IUP has IUD in place, develops fever, chills, abdominal pain. What should you do next?

Answer 268

1. Remove IUD, then evaluate for other causes of abdominal pain / fever and check for signs of septic abortion.

Question 269

Which fetal anomaly has highest risk of malignancy?

Answer 269

CCAM (Pleuropulmonary blastoma and bronchoalveolar carcinoma )

Question 270

What is the most common Adverse effect of AZT?

Answer 270

Anemia (next is neutropenia)

Question 271

Baby with transposition, cleft lip and facial abnormality. Diagnosis?

Answer 271

DiGeorge

Question 272

What represents a thyroid profile of first trimester?

Answer 272

TSH decreases slightly

FT4 remains same

Question 273

Which nerve injury causes decreased mons sensation?

Answer 273

iliohypogastric

Question 274

What does maternal blood come into direct contact with in the intervillous space of placenta?

Answer 274

Syncytiotrophoblasts

Question 275

Which tests are positive if you are chronically infected with Hep B?

Answer 275

Surface antigen and core antibody (anti-HBc)

Question 276

What is a prolonged aPTT in a patient with pre-eclampsia is most likely due?

Answer 276

APLS

Question 277

Greatest finding of the MOMS trial?

Answer 277

Trial stopped early because of efficacy. Need for shunt placement during first year of life was lower in fetal surgery group (40% vs 82%). Ambulation fetal (45%) vs postnatal repair (24%)

Question 278

When is CVS not recommended?

Answer 278

In cases of Isoimmunizatio/Alloimmunization (NAIT, Kell, Rh)

Question 279

What is the best way to determine chorionicity in twin gestations?

Answer 279

Twin peak sign

Question 280

Delayed cord clamping improves which outcome in preterm infants? What about in term infants?

Answer 280

Preterm: Decreased: Necrotizing Enterocolitis, IVH, need for transfusion
Term: Increased Hb and Iron stores

Question 281

What is the precursor for fetal steroid synthesis?

Answer 281

LDL

Question 282

If a CVS shows balanced translocation, what should you do next?

Answer 282

Maternal karyotype

Question 283

Ultrasound findings would increase the risk of Down syndrome, except: 
 Duodenal atresia
 Increased Nuchal Fold
 Cardiac anomaly
 Short femur
 Sandal gap

Answer 283

Sandal gap

Question 284

What is not covered by Cephalosporins?

a) Enterococcus
b) Group A Strep
c) Group B Strep

Answer 284

Enterococcus

Question 285

When should you treat potential fetal CAH and with what medication?

Answer 285

7-8 weeks, Dexamethasone to prevent virilization (CVS, if male stop treatment, if female continue)

Question 286

Which syndrome is associated with fetal thrombocytopenia?

1. Absent radius
2. Gestational thrombocytopenia
3. Erythroblastosis fetalis
4. Bernard Soulier syndrome

Answer 286

TAR Syndrome - Thrombocytopenia, Abset radius syndrome (but thumb present)
Which can also pretsent with Kidney or Heart issues

Question 287

Anomaly of what system is most commonly seen with diaphragmatic hernia ?

Answer 287

Cardiac

Question 288

What is the most common problem for a term IUGR infant?

Answer 288

Hypoglycemia

Question 289

What is the treatmet for TB?

Answer 289

1. Rifampin
2. Isonoazid
3. Pyrazinamide
4. Ethambutal

Question 290

Which of the following is most associated with aneuploidy in isolation?
cleft lip, gastroschisis, EIF, hydronephrosis, or ventriculomegaly?

Answer 290

Ventriculomegaly (3.81X LR)

Question 291

What is the most likely complication of pregnancy conceived with IUD in place?

Answer 291

SAB - 3x more likely (50%)

Question 292

Which ethical concept is informed consent most closely tied to?

Answer 292

Autonomy

Question 293

What are the findings of Neonatal Myasthenia Gravis?

Answer 293

Poor cry, decreased muscle tone, respiratory muscle weakness

Question 294

What does treatment of GDM improve?

Answer 294

Lower rates of macrosomia

Question 295

Physical Signs of fetal immaturity

Answer 295

Poor tone
 Smooth, transparent skin
 Sparse lanugo, fine and fuzzy scalp hair
 no sole creases, NOT PALMAR creases (theyre not included), lack of rugae
 Small breast nodules
 Pliable ear lobe with no cartilage
 No scrotal rugae
 (BERT
 Breast Nodules
 Ear is pliable
 Rugae (scrotal and soles)
 Tone is low)

Question 296

What enzyme is associated with Hydantoin syndrome?

Answer 296

Epoxide Hydrolase. Teratogenicity of several anticonvulsant medications is associated with elevated level of oxidative metabolites normally eliminated by epoxide hydrolase

Question 297

Which is the best way to randomize?

Answer 297

table of generated numbers with block randomization

Question 298

What does not get absorbed in patient with Roux-En-Y bypass vs. gastric banding?

Answer 298

B12 Deficiency

Question 299

What is the most common complication of SLE on pregnancy?

Answer 299

1. Pre-eclampsia (8-20%) 2. PTL (spont and indicated - 20-50%)

Question 300

MCA is not helpful for which of the following?

Sickle cell, kell, Anti-D

Answer 300

Sickle Cell (they have Fetal Hb, so no bad anemia in utero)

Question 301

Foot drop is associated with what nerve injury:

Answer 301

Peroneal

Question 302

Which of the following is most likely to be seen with agenesis of the corpus collosum?

a. Depression of the third ventricle
b. Colopocephaly
c. Some other choices –

Answer 302

colpocephaly (tear drop ventricles)

Question 303

Most associated with placental insufficiency?

Low Papp-A, High Papp-A, HcG?

Answer 303

Low Papp-a

Question 304

Which study type is ideal for studying rare outcomes/diseases?

Answer 304

Case-Control Study

Question 305

Twins, when do you not do a CVS?

Answer 305

With Alloimmunication

Question 306

What is the most likely cause of fetal Macrosomia?

Answer 306

Prepregnancy obesity

Question 307

39 week patient with a DVT, management?

Answer 307

Therapeutic Heparin

Question 308

Most common presentation of Turners syndrome?

Answer 308

Short Stature

Question 309

Which congenital cardiac lesion is most likely to result in a clinically stable infant immediately postpartum?

Answer 309

Complete AV canal

Question 310

What is most resistant to GBS?

a) Erythromycin
b) Clindamycin
c) Penicillin
d) Azithromycin

Answer 310

Erythromycin

Question 311

A mother has a history of 3 episodes of genital HSV, now presents in labor with a lesion. What is the risk of transmission to the neonate?

Answer 311

1%
Recurrent risk: 1-2%
Primary infection: 40-50%

Question 312

Which infection poses the greatest risk for maternal mortality?

Answer 312

Varicella (likely #1), maybe H1N1 if no varicella

Question 313

Which fish should be avoided in pregnancy?

Answer 313

King Mackeral

Question 314

Triple screen with nl HCG, AFP but very low estriol, think?

Answer 314

X-linked iccthyosis(Placental sulfatase deficiency) and SLOS

Question 315

What is the most likely risk from regional anesthesia?

Answer 315

Toxicity from local anesthetic

Question 316

How do you differentiate between CCAM and CHAOS?

Answer 316

In Chaos you have inverted diaphragm

Question 317

What is the most likely to have a low estriol?

a. IUFD
b. Trisomy 21
c. Placental sulfatase deficiency

Answer 317

Placental Sulfatase Deficiency

Question 318

Complications associated with Herpes Gestationis?

Answer 318

PTD, IUGR, increased neonatal mortality

Question 319

Which cardiac lesion is most specific with T21?

Answer 319

AV Canal defect

Question 320

Which situation allows you to override patient confidentiality?

Answer 320

someone in serious danger

Question 321

Findings in autonomic dysreflexia?

Answer 321

Hypertension, Bradycardia, Flushing

Question 322

Which enzyme deficiency is a concern with chloroprocaine?

Answer 322

Pseudocholinesterase

Question 323

Which lab result is most indicative of recurrent CMV infection?

Answer 323

IgM: +
IgG: +
High IgG avidity

Question 324

What is the disease characterized by a deficiency in aspartoacylase?

Answer 324

Canavans

Question 325

Which is the most likely neonatal complication with PKU?

Answer 325

Mental Retardation

Question 326

Which medicine is NOT associated with PPHN?

Keppra, NSAIDs, SSRIs

Answer 326

Keppra

Question 327

What crosses the placenta via active transport?

Answer 327

PICA - Phosphorous, Iron, Calcium, Amino Acids

Question 328

Multiple Sclerosis is most associated with which pregnancy complication?

Answer 328

IUGR (MS = Mighty Small)

Question 329

How do you monitor improvement of metabolic acidosis in DKA?

Answer 329

Follow anion gap

Question 330

When can a physician override refusal of treatment?

Answer 330

Lack of capacity

Question 331

What is the prevalence of asymptomatic bacteriuria in pregnancy?

a) 5%
b) 15%
c) 25%

Answer 331

5%

Question 332

Which is true about the Umbilical vein?

a) lower O2 than uterine vein
b) lower pH than umbilical artery
c) higher CO2 than umbilical artery
d) lower hemoglobin than uterine artery

Answer 332

Lower O2 than uterine vein

Question 333

What pattern of inheritance is passed through maternal only?

Answer 333

Mitochondrial

Question 334

Postpartum thyroiditis has all the following symptoms except? 
 Depression 
 Tachycardia 
 HTN 
 Diarrhea

Answer 334

HTN is not
Symptoms of the hyperthyroid phase include heat intolerance, fatigue, palpitations, nervousness and diarrhea. HTN is not a component of this. Hypothyroid phase is marked by depression, cold intolerance, hair loss, fatigue, dry skin, impaired concentration.

Question 335

Which rate of dopamine infusion improves renal blood flow?

Answer 335

Low dose, <5ug/kg/min for renal blood flow

Question 336

Why does NPH stay longer in body than aspart?

Answer 336

Increased halflife due to protamine and pH

Question 337

Best Rx for mom with dyspnea, cyanosis, large VSD and R to L shunt at 28 weeks?

Answer 337

Viagra

Question 338

What crosses the placenta via Endocytosis?

Answer 338

IgG, LDL, Insulin (If IgG), Transferrin

Question 339

TTTS is best diagnosed with a discrepency in what ?

Answer 339

Amniotic fluid volumes

Question 340

Which affects fetal growth the most?

Answer 340

Fetal Insulin, HPL (aka human somatomammotropin)

Question 341

What increases alveolirization in the lungs?

Answer 341

Thyroxine or Vitamin A

Question 342

The fetal organ that receives the highest proportion of cardiac output:

Answer 342

Placenta

Question 343

Most common complication with insulin pump?

Answer 343

Site infection, asymptomatic hypoglycemia

Question 344

What is the most likely reason to intubate a pregnant lady?

Answer 344

Respiratory acidosis

Question 345

Choose the highest risk of contracting hepatitis B.

a) Whole blood
b) Cryoprecipitate
c) Albumin

Answer 345

Cryoprecipitate is pooled from multiple donors, thereby increasing the risk for Hepatitis B infection.

Question 346

What are the key abnormalities with Meckel Gruber?

Answer 346

Post-axial Polydactyly
Multicystic Dysplastic Kidneys
Encephalocele

Question 347

Which cells are the innate immune cells?

Which are the adaptive immune cells?

Answer 347

Innate: NK, Monocytes, macrophages, trophoblasts

Adaptive: B cells and T cells

Question 348

3+ groups which statistical test?

Answer 348

ANOVA

Question 349

Does obesity increase risk of NTDs?

Answer 349

YES

Question 350

Which is the usual cause of hemodynamic decompensation with mitral stenosis peripartum?

Answer 350

Increased Preload

Question 351

Discrepancy between cfDNA and fetal Karyotype, what can cause this?

Answer 351

Confined placental mosaicism

Question 352

What molecule gets degraded most by the placenta?

Answer 352

Prednisone/Prednisolone - by 11 β-hydroxysteroid dehydrogenase Type 2

Question 353

Name 3 diseases that can be treated with IVIG?

Answer 353

IVIG is a proven treatment for myasthenia, NAIT, and ITP.

Question 354

What clinical scenario should cause you to test for Antiphospholipid Antibodies?

Answer 354

Any of the following:

(a) 1+ episode of vascular thrombosis
(b) 1+ death of morphologically normal fetus at 10+ weeks
(c) 1+ birth before 34 weeks due to preeclampsia/eclampsia or features associated with placental insufficiency
(d) 3+ unexplained pregnancy losses before 10 weeks (after maternal/paternal genetic and anatomic/hormonal causes excluded)

Question 355

Mom with uncontrolled hyperthyroidism, what are the most common pregnancy complications?

Answer 355

#1: Preeclampsia
 #2: Growth Restriction
 #3: Preterm delivery

Question 356

Which maternal karyotype has the highest risk of Down syndrome?

Answer 356

21:21 Translocation (100% of live babies are T21, but of total gametes 50% would be monosomy 21)

Question 357

Nuchal translucency is 5.4mm. Next best step?

Answer 357

CVS (genetic testing)

Question 358

What are the branches of the Internal Iliac Artery?

Answer 358

Midline structures and GiOPi
 Gluteal (Inferior)
 Obturator
 Pudendal (internal)
 Vagina
 Uterus
 Vesical
 Rectal (middle)
 Umbilical

Posterior Division: I love sex
Iliolumbar
Lateral Sacral
Superior Gluteal

Question 359

How does iodide treatment work?

Answer 359

Decreases the circulating supply of T4 and T3 by inhibiting release of stored thyroid hormone.

Question 360

A patient has mitral stenosis, what do you give to block intubation reflex hypertension?

Answer 360

Nitroprusside, In patients in whom hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation.

Question 361

In Mono-Di twins, at what day does cleavage occur?

Answer 361

4-8 days

Question 362

16. Which causes a recurring fever?
    a. Listeriosis
    b. Syphilis
    c. Lyme dz
    d. Others

Answer 362

Lyme Disease, Brucellosis also

Question 363

Which medication decreases OCP efficacy?

Answer 363

Carbamezapine, Phenytoin, Rifampin

Question 364

If a patient refuses CD for fetal indications, what should you do?

Answer 364

Continue taking care of patient and don’t proceed with CD. Respect patient wishes

Question 365

Patient presents with IUFD, severe iugr + omphalocele, + large kidneys, what lab should you send?

Answer 365

Karyotype and Microarray

Question 366

Antihypertensive with most evidence for association with IUGR?

Answer 366

Atenolol

Question 367

Swan readings for pulmonary edema?

Answer 367

Increase: PCWP > 18, CVP

Question 368

A patient is newly diagnosed with HIV not previously on any medication. What is the best way to prevent HIV transmission?

Answer 368

AZT (zidovudine)

Question 369

What is the precursor to estriol?

Answer 369

C9 Precursor DHEAS (from the fetal adrenal, fetal zone)

Question 370

If a preterm baby develops respiratory distress after delivery and Preductal SpO2: 90%, post ductal: 70%. What is the diagnosis?

Answer 370

Persistent fetal circulation (Ductus arteriosus) or PPHN (same thing)

Question 371

Which would decrease drug transport across placenta? 
 increased lipid solubility
 increased protein binding
 decreased ionization
 placental degradation

Answer 371

Increased protein binding

Question 372

What is the best treatment for in utero CAH?

Answer 372

Dexamthasone, starting at 7-8 weeks. To prevent virilization of female fetus

Question 373

What should the work up of a woman with a Spontaneous Abortion at 12 weeks include?

Answer 373

Antiphospholipid Antibodies

Question 374

Most common cause of Polyhydramnios?

Answer 374

Idiopathic

Question 375

Most common complication of PKU?

What is the most common structural complication in PKU?

Answer 375

Mental retardation = most common

Cardiac (hence we do echo’s on these fetuses) = most common structural

Question 376

Most direct biochemical cause of a myometrial contraction?

Answer 376

Myosin Light Chain Kinase

Question 377

What mechanisms result in uniparental disomy?

Answer 377

2 chromosomes inherited from one parent, trisomic rescue

Ex: Beckwith, Angelman, Prader-Willi

Question 378

Treatment for HIV+ women with Viral load > 1000 near term?

Answer 378

Cesarean at 38 weeks, Continue ART therapy, and start AZT 3 hours prior to cesarean

Question 379

Which of the following is not associated with AMA?
 T21
 T13
 T18
 45XO

Answer 379

45 XO

Question 380

<p>What percentage of Rh negative patients who do not receive Rhogam will be sensitized?</p>

Answer 380

<p>15%</p>

Question 381

What affects positive predictive value (PPV) the MOST?

Answer 381

Prevalence

Question 382

Physiology of late decelerations?

Answer 382

Chemoreceptor reflex

Question 383

What is the most common complication of SLE on pregnancy?

Answer 383

1. Pre-eclampsia (8-20%)

2. PTD (spont and indicated - 20-50%) - Not spontaneous PTB

Question 384

Which cancer do OCPs decrease the least?

Answer 384

Breast Cancer

Question 385

In which patients can you give OCPs?

1. Hx of DVT
2. Migraine with aura
3. Type 1 DM
4. Active viral hepatitis

Answer 385

Type 1 DM

Question 386

What is the definition of imprinting?

Answer 386

gamete specific gene silencing where only the gene from the mother or father is expressed (Ex: Prader Willi - no dad’s CH 15, so maternal uniparental disomy)

Question 387

Which is not associated with IUGR?

Hyperthyroidism, sickle cell, parvo

Answer 387

Parvovirus (anemia and heart failure, not usually FGR)

Question 388

Most common complication of SSRI used in pregnancy used in a neonate?

Answer 388

Neonatal Abstinence

Question 389

If maternal thyroid function is well controlled but fetus develops goiter. What test should you do?

Answer 389

Check maternal Thyroid Peroxidase Antibody; Thyroglobulin Antibody; Thyroid Stimulating Hormone Receptor Antibody (All synonyms for TSI)

Question 390

What is the risk of cystic fibrosis if fathers sister has CF and carrier rate is 1/25?

Answer 390

1/150

Question 391

Greatest contraindication to postpartum combined OCP’s
hemorrhagic stroke w/ eclampsia
sagittal vein thrombosis
ovarian vein thrombosis

Answer 391

Sagittal Vein Thrombosis

Question 392

A mother who is HIV positive who took no meds during the pregnancy what is given in labor to decrease transmission?

a) Acyclovir
b) Lamivudine
c) Nevirapine

Answer 392

Nevirapine (in combination with AZT or if AZT is unavailable)

Question 393

What are the features that make a drug more likely to cross the placenta?

Answer 393

Low molecular weight
Lipophilic (soluble)
Nonpolar (not ionized)
Unbound to protein

Question 394

Which cell is not part of innate immunity?

Answer 394

Monocyte

Question 395

Best Treatment for a Pheochromocytoma

Answer 395

Phenoxybenzamine (Alpha Blocker)

Question 396

Baby has an amniotic band, do you remove them?

Answer 396

Yes if it is wrapped around a limb and there is some sort of blood flow disruption in post band vs. pre band.

Question 397

All of the following US findings would be present in a fetus with a neural tube defect EXCEPT:
 Small cisterna
 Scalloped cerebellum
 Incavatated cranium
 Ventrculomegaly
 Increased BPD

Answer 397

Increased BPD

Question 398

What increases the risk of preterm birth

a. IL-6 maternal serum
b. IL-6 amniotic fluid
c. IL-10 maternal serum
d. IL-10 amniotic fluid

Answer 398

Amniotic Fluid IL6

Question 399

Histologic Chorioamnionitis without clinical signs of infection is associated with what neonatal complications?

Answer 399

Interventricular hemorrhage, periventricular leukomalacia and Cerebral palsy

Question 400

What is Methadone LEAST likely to result in?

Answer 400

Congenital anomalies

Question 401

What drug is impermeable to the placenta?

Answer 401

Insulin, except if IgG bound

Question 402

Holoprosencephaly is most commonly associated with which of the following chromosomal abnormalities?

Answer 402

Trisomy 13

Question 403

What hormone decreases after delivery to allow for lactation?

Answer 403

Estrogen

Question 404

Which mode of inheritance applies to penetrance and variable expressivity?

Answer 404

Autosomal Dominant

Question 405

What lab value are features of DKA?

Answer 405

PH: <7.3
HCO3: <15
AG: >12
+Ketones

Question 406

What is Alpha Error?

Answer 406

Type 1 error (False Positive, rejecting the null when we should have kept it)

Question 407

Which finding is the MOST common in Meckel-Gruber syndrome?

Answer 407

Multicystic dysplastic Kidneys (100%)

Question 408

Placenta degrades _____ the most:

a. Betamethasone
b. Prednisone
c. Insulin
d. Heparin

Answer 408

Prednisone

Question 409

CDH, IUGR, VSD , most likely diagnosis?

Answer 409

T18

Question 410

How is calcium transported across placenta?

Answer 410

Active transport

Question 411

Most common complication of neontatal thrombocytopenia?

Answer 411

Rash more than thrombocytopenia

Question 412

Neonate has apnea and bradycardia after 60 seconds with PPV, what is next BEST step ?

Answer 412

Chest Compressions
 NRP
 (@30 seconds, if HR < 100 or Apnea --> PPV)
 (@60 HR < 60 --> Chest compressions
  HR 60-100 --> Continue PPV)
 (@90 HR <60 --> Epi and Intubate)

Question 413

Which infertility treatment is associated with hypospadias ?

Answer 413

ICSI

Question 414

What cardiac anomaly cannot be identified with 4 chamber view ?

Answer 414

TGA
Coarctation
VSD

Question 415

Marfan Aortic root recommendations?

Answer 415

Recommend beta blockers, cesarean delivery for aortic root >5. Recommend repair prior to pregnancy for aortic root >4

Question 416

Mom presents with acute chest syndrome due to HbSS. Dad not tested. But carrier rate is 1/12. What is the risk of an affected fetus?

Answer 416

.1/24

Question 417

The main factor that influences fetal growth?

Answer 417

Insulin, HPL

Question 418

If a mom is exposed to parvovirus 3 days ago at 18 weeks GA, what is the most appropriate testing at this time?

Answer 418

Maternal blood for Parvo PCR
(It takes 10 days for IgM to develop)
If positive Serial ultrasound should be performed every 1-2 weeks after exposure for 8-12 weeks. (Peak hydrops risk as at 4-6 weeks after maternal infection)

Question 419

What is the main source of PGI2 in pregnancy?

Answer 419

The Myometrium

Question 420

Which hepatitis can cause chronic active hepatitis and cirrhosis?

Answer 420

Hep C

Question 421

Formula for odds ratio is?

Answer 421

AD/BC, ratio of exposed cases to unexposed cases divided by ratio of exposed controls to unexposed controls (The wording really was this convoluted)

Question 422

What stage is a fetus with abnormal Dopplers?

Answer 422

Stage 3

Question 423

What is the most likely outcome with demise of one twin in a MCDA pair?

Answer 423

Neurologic Sequelae in the surviving twin (15-25%)

Question 424

When does Relaxin peak?

Answer 424

8-12 weeks

Question 425

What condition with CF carries a poor prognosis?

Answer 425

Cor Pulmonale

Question 426

NO reacts with what to produce cGMP?

Answer 426

Iron

Question 427

External Genitalia differentiation stimulated by what hormone?

Answer 427

LH which stimulates testosterone

Question 428

What is the risk of transmission in the first trimester with primary CMV infection

Answer 428

40%

Question 429

What dictates delivery mode in patients with ITP?

Answer 429

Obstetrical reasons

Question 430

What crosses placenta via Facilitated diffusion?

Answer 430

Glucose

Question 431

A woman with a prolactinoma wants to breast feed, you advise?

Answer 431

Okay for microadenoma prolactinoma to breast feed

Question 432

If a patient tests IgM positive at 20 weeks for parvovirus, how long should the pregnancy be monitored?

Answer 432

Serial ultrasound should be performed every 1-2 weeks after exposure for 8-12 weeks. (Peak hydrops risk as at 4-6 weeks after maternal infection)

Question 433

A normal woman has a homozygoous 21/21 translocation. What percent of her conceptuses will have monosomy 21?

Answer 433

50%

Question 434

Patient’s husbands sister died of CF; carrier rate is 1/25, what is the risk to the fetus?
1/50 1/100 1/150

Answer 434

1/150

Question 435

Which hormone decreases surfactant synthesis?

Answer 435

Insulin - delays surfactant production

Question 436

The benefit of doing a multivariate analysis in a cohort study is?

Answer 436

Decrease confounding

Question 437

What is increased in the fasting state in pregnancy?

Answer 437

Cholesterol, depends on this for energy NOT gluconeogenesis

Question 438

What effects on lipids does Depot Provera have?

Answer 438

↑ LDL

↓ HDL No change in triglycerides

Question 439

What is the origin of cell free dna?

Answer 439

apoptosis of placental cells (syncytiotrophoblast)

Question 440

Which medication is the best anticoagulant to prevent clot in pregnancy:

Answer 440

Lovenox

Question 441

What is MOA of iodine in maternal thyroid function?

Answer 441

Blocks release of thyroid hormone from the gland

Question 442

What is associated with graft versus host?

Answer 442

Erythema multiforme

Question 443

What medications can decrease the effectiveness of OCP’s

Answer 443

Phenytoin, Carbamezapine, Rifampin

Question 444

Most common Uterine Anomaly with Pregnancy loss?

Answer 444

Septate Uterus

Question 445

Which anesthetic has greatest cardiac risk?

Answer 445

Bupivacaine (Marcaine)

Question 446

If the father has a balanced translocation how does that change the risk to child compared to a mother?

Answer 446

Decreased risk with father (<5%) compared to mother (1/6)

Question 447

In a patient with T2DM and an elevated HbA1c, what is the most common finding on US?

Answer 447

Normal Ultrasound

Question 448

When does cardiac output increase the most?

Answer 448

Immediately postpartum

Question 449

Benefit of a SNP Array over CGH Array?

Answer 449

SNP Array can detect Triploidy

Question 450

Which medication is LEAST likely a teratogen?

Azathioprine, Cyclophosphamide, Cyclosporine

Answer 450

Azathioprine

Question 451

What is the most common location of an arachnoid cyst?

Answer 451

Middle Cranial Fossa

Question 452

Which local anesthesic is least likely to cause neurotoxicity if given IV?

Answer 452

Lidocaine wont cause it,
Chloroprocaine will
and bupivicaine will but more cardiotoxic

Question 453

Which is predictive of cerebral palsy? 
 neonatal seizures
 low pH / high base excess
 multi-organ dysfunction 
 10 min Apgar =3
 early onset encephalopathy

Answer 453

Neonatal Seizures, Low pH (high BE), 10 min apgar<=3, Early encephalopathy

Question 454

What are the last 5 phases of lung development? At what weeks do they occur?

Answer 454

Embryonic -3 - 7
 Pseudoglandular - 5-17
 Canalicular - 16-26
 Saccular - 26- 36
 Alveolar - 36+

Question 455

Steroids are least likely to help

a. IVH
b. RDS
c. BPD
d. NEC

Answer 455

BPD - no effect

Question 456

After an overnight fast, what is most likely decreased in the morning?

Answer 456

Glucose

Question 457

Hyperparathyroidism is most associated with:

a. Neonatal hypocalcemia
b. IUGR
c. PTL
d. SAB

Answer 457

50% risk of neonatal hypocalcemia (over production of calcium suppresses babies PTH and then when delivered he cant raise Ca2+ levels once he loses the moms calcium)
~10 % SAB rate

Question 458

Swan readings for Hemorrhage?

Answer 458

Decrease: CO, PCWP and CVP

Increase: SVR

Question 459

How many asymptomatic bacteriuria pregnant women would develop symptomatic infection if untreated vs. treated?

Answer 459

20-35% compared to <4% if treated

Question 460

Which Prostaglandin causes muscle relaxation?

Answer 460

Prostacyclin (PGI2)

Question 461

What is a sentinel event?

Answer 461

unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient’s illness.

Question 462

Which HIV medication is worst for liver toxicity?

Answer 462

Nevirapine (most), Ritonavir/lopinavir (if its not there)

Question 463

What is the mutation in Spinal Muscular Atrophy? Inheritance?

Answer 463

SMN1

Question 464

What is gap junction protein?

Answer 464

Connexin

Question 465

What is the management hydrocephaly?

Answer 465

US, infectious and genetic workup

Question 466

Aspartoacylase deficiency is associated with?

Answer 466

Canavan disease

Question 467

What is the most important factor affecting Positive Predictive Value?

Answer 467

Prevalence of disease

Question 468

Obese patient comes to you with complaint sof fatigue and forgetfulness, what test should you order?

Answer 468

Sleep Study

Question 469

A mother who is HIV positive who took no meds during the pregnancy. What is given in labor to MOST likely decrease transmission?

Answer 469

Zidovudine or Lamivudine (if azt not an option)

Question 470

When you open the broad ligament, where is the ureter located?

Answer 470

Crosses over the common iliac artery

Question 471

If a patient becomes hypotensive after mag bolus, what medication do you give?

Answer 471

Calcium Gluconate

Question 472

Most likely complication of pyelo in pregnancy?

a) Urosepsis
b) ARDS
c) Preterm delivery
d) Anemia
e) Decreased creatinine clearance

Answer 472

Anemia (33%)

Question 473

What added step should you do in a cesarean section of a Morbidly obese patient?

Answer 473

Closed Subcutaneous layer

Question 474

What is the gestational age at which fetal lung alveolarization occurs?

Answer 474

36 weeks

Question 475

Which blood product increases fibrinogen the MOST?

Answer 475

Cryo

Question 476

What is the most common feature of turners syndrome?

Answer 476

Short stature

Question 477

Which part of the biophysical profile is most associated with an acidemic fetus?

Answer 477

tone

Question 478

Which antibiotic has the ability to potentiate the neurmuscular blocking ability of magnesium sulfate?
Unasyn
Gentamicin
Erythromycin

Answer 478

Gentamicin

Question 479

What is the most likely outcome for patient on dialysis?

Answer 479

Preterm Delivery (50-80%)
Polyhydramnios (40%)
Anemia (100%)
Hypertension (100%)

Question 480

Maternal risk of Varicella?

Answer 480

30% pneumonia which has a 30% mortality.

Question 481

Which is LEAST likely a finding in pseudotumor cerebri?

Answer 481

Ventriculomegaly

Question 482

Which is least associated with pregnancy loss after amniocentesis?
Tenting, multiple attempts, needle gauge, transplacental stick?

Answer 482

Tenting

Question 483

What is the most reliable ultrasound criteria for dating?

Answer 483

Cerebellum

Foot length

Question 484

What is the cause of a post regional headache?

Answer 484

traction of pain sensing cranial structures

Question 485

Which is the thrombophilia with the worst prognosis?

Answer 485

Antithrombin III

Question 486

Most likely complication for patients with aortic stenosis in the peripartum period?

Answer 486

Arrhythmias

Question 487

What is the precursor of fetal steroid synthesis?

Answer 487

LDL

Question 488

At what CD4 Count are you at risk of pneumocystic pneumonia?

Answer 488

<200

Question 489

Patient has a fetus with T21, what is the risk of recurrence?

Answer 489

1%, or age related risk whichever is higher

Question 490

Which artery most likely to cause vulvar hematoma?

Answer 490

Branches of pudendal artery

Question 491

What are the last 3 phases of lung development? At wat weeks do they occur?

Answer 491

Cannalicular - 16-26
Saccular - 26- 36
Alveolar - 36+

Question 492

Maternal blood comes into direct contact with what?

Answer 492

Syncytiotrophoblasts

Question 493

What hormone does the placenta lack / is “inactive” that the fetus has / is “active”?

Answer 493

17-alpha-hydroxylase, it breaks down progesterone, which we don’t want the placenta to be able to do

Question 494

Which structural anomaly is most common with PKU? What about most common complication?

Answer 494

Structural: Cardiac (10-15%)

Complication: Mental Retardation (80-90%)

Question 495

What is the PO2 in the umbilical artery?

Answer 495

20

Question 496

Most likely diagnosis of echogenic bowel at 20 weeks?

Answer 496

Normal

Question 497

What is Prader Willi most likely due to?

Answer 497

Deletion of paternally derived Ch 15

Question 498

Hypoxic-ischemic–encephalopathy is most associated with?

a. chorioamnionitis
b. demise of one monochorionic twin
c. prematurity <28 weeks
d. pH = 7.0

Answer 498

pH 7.0 (acidemia)

Question 499

What would make a medication most likely to cross in to breast milk?

Answer 499

Lipid Solube, Not bound to protein, non ionized, small/low molecular weight

Question 500

Mom has sickle cell anemia, dad not tested, carrier rate 1/12, what is the risk of an affected fetus?

Answer 500

1/24 (1 x ½ x 1/12)

Question 501

Cerebal palsy is a diseas of what part of the nervous cystem?

Answer 501

upper motor neuron disease due to damage of white matter.

Question 502

Which initiates preterm labor? 
 Prostaglandin dehydrogenase (PGDH) 
 phospholipase A2
 metalloproteinases
 prostaglandin synthase

Answer 502

Phospholipase a2 (Phospholipase A2 is associated with the arachidonic acid pathway to production of prostaglandins. Prostaglandins are associated with labor induction/progression)

Question 503

What is a decrease in Urine calcium associated with in pregnancy?

Answer 503

Preeclampsia

Question 504

The 4 chamber view is not sensitive for detecting which cardiac anomaly?
 HLHS
 TGA
 Ebsteins Anomaly
 VSD

Answer 504

Transposition of great arteries (also bad for Coarctation)

Question 505

What is mode of inheritance of Fragile X?

Answer 505

X linked dominant

Question 506

Renal dose of Dopamine?

Answer 506

<4mcg/kg/min

Question 507

What is the best way to test for a fetus having CAH?

Answer 507

Direct gene testing

Question 508

Which autoimmune disorder is more likely to improve during pregnancy?

Answer 508

Rheumatoid Arthritis improves in 50-70% of cases in pregnancy

Question 509

Which medication relieves symptoms of cholestasis?

Answer 509

Ursodiol

Question 510

Diabetic nephropathy most common pregnancy complications?

Answer 510

Preeclampsia (53%)
Preterm delivery (51%)
IUGR (11%)

Question 511

Which anesthetic has the fastest onset?

Answer 511

Lidocaine

Question 512

In TRAP what is found in the acardiac twins’s Dopplers?

Answer 512

Pulsatile flow in UA

Continuous flow in UV

Question 513

Features of Fetal Varicella?

Answer 513

Mental Retardation, Limb Hypoplasia, Scarring of Skin, Eye

Question 514

What enzyme is deficient in Tay Sachs?

Answer 514

Hexosaminidase A

Question 515

Large c-section incision injures iliohypogastric/ilioinguinal nerve, what is the most likely result?

Answer 515

Paresthesia/Pain at mons (hypogastric)

ilioinguinal more labia

Question 516

Swan readings for septic shock?

Answer 516

Decrease: SVR

Increase: Co

Question 517

What to use for malignant hyperthermia at >36 wks with contractions

a. Epidural
b. Spinal
c. Mag tocolysis
d. others

Answer 517

Epidural

Question 518

CVS is most contraindicated in?

Answer 518

Existing Rh isoimmunization is a contraindication to CVS

Question 519

Most likely diagnosis with a cystic hygroma?

Answer 519

40% T21, 30% Turners

Question 520

Recurrence risk with spina bifida?

Answer 520

1.5% if one effected chlid, 7% if 2

Question 521

What drug increases the motor blockade with magnesium sulfate?

Answer 521

Calcium Channel Blocker

Question 522

What is the most likely US finding for a fetus if mom has an HbA1c of >10%.

Answer 522

Normal (only 10-20% increased risk of anomaly, so the majority will be normal)

Question 523

Which part of the BPP is most closely correlated with Acidosis?

Answer 523

Loss of tone

Question 524

Which rash is associated with the worst fetal/neonatal outcomes?

Answer 524

Pemphigoid AKA Herpes Gestationalis

Question 525

What is the least common with myxedema?
 hypothermia
 hypoglycemia
 bradycardia
 hypocapnia

Answer 525

Hypocapnea
In Myxedematous coma patients have (Low blood sugar, low blood pressure, hyponatremia, hypercapnia, hypoxia, slowed heart rate, and hypoventilation)

Question 526

Preeclampsia - most common finding on pathology of placenta?

Answer 526

Parenchymal infarction

Question 527

What hormone is the placental precursor to estrogens, where does it come from?

Answer 527

C19 precursor DHEAS from the fetal zone of the fetal adrenals

Question 528

What is the treatment for NAIT?

Answer 528

IVIG

Question 529

Which antidepressant is most associated with cardiac anomalies?

Answer 529

Paxil (Paroxetine)

Question 530

Which R-A-S component increases and then decreases?

Answer 530

Renin peaks at 12 weeks then declines in 3rd trimester

Question 531

Most specific finding to distinguish TTP from HELLP

Answer 531

LDH to AST ratio (elevated in TTP)

Question 532

Where does a sub-galeal hemorrhage happen?

Answer 532

Between skull periosteum and the scalp galea aponeurosis

Question 533

Increased Fluid is most beneficial for what lesion?

Answer 533

Aortic Stenosis

Question 534

Which hormone drops to allow breastfeeding?

Answer 534

Estrogen

Question 535

Uncorrected ASD, increases the risk of?

Answer 535

Stroke (increased risk of emboli from arrhythmias)

Question 536

Pregnancy patient with joint pain + pustular rash on hands, most likely has which infection?

Answer 536

Gonorrhea

Question 537

Which malfomation has the greatest risk of underlying aneuploidy?
 CHD
 Gastroschesis
 Omphalocele
 Clubbed foot

Answer 537

Omphalocele

Question 538

What are the ultrasound findings of holoprosencephaly?

Answer 538

Single ventricle

Absent corpus callosum

Question 539

Patient has nose bleeds with a platelet count of 20,000, treatment? When do you treat thrombocytopenia?

Answer 539

Steroids, plt<30,000 or if symptomatic, or consider Transfusion if preparing for surgery.

Question 540

What are the features of Fetal Hydantoin Syndrome?

Answer 540

IUGR, 
 MR, 
 Nail/Digit hypoplasia,
  Hypertelorism, 
 low set ears, 
 short nose / flat nasal bridge

Question 541

Malaria, which more likely to have PROM(?)?

Answer 541

Malaria is worse in primigravid women, and also worse in areas with less malaria (i.e. because less prior exposure to it). Sickle trait provides protection against malaria. Thus I assume the correct answer is A, primip without hx of malaria.

Question 542

Baby delivered at 35 weeks. 30 minutes after delivery, develops severe respiratory distress. Preductal O2sat = 70%. Postductal O2sat = 90%. CXR normal. Diagnosis?

Answer 542

Postductal > Preductal, think TGA

Question 543

What is the most likely diagnosis of fetus with enlarged bladder?

Answer 543

Posterior uretheral valves is most common cause of bladder outlet obstruction

Question 544

Which complication is not associated with SSRI use in pregnancy?

Answer 544

Gastroschisis

Question 545

Which changes least in pregnancy?

CVP, CO, SVR, PVR

Answer 545

CVP does not change in preg.
Increase: CO, HR
Decrease: SVR, PVR, COP go down
Stays Same: PCWP, CVP

Question 546

What does wedge pressure represent?

Answer 546

LV preload

Question 547

Why are pregnant patients more susceptible of hypoxia during intubation?

Answer 547

Decreased functional reserve

Question 548

Pt presents at 36 weeks history of T6 spinal cord injury with UC’s, hypertension, flushing what is best treatment?

Answer 548

Epidural

Question 549

What is the Fetal Cardiac Output at term?

Answer 549

500mL/kg/min

Question 550

Which phospholipid is the largest percentage in the fetal lungs?

Answer 550

Phosphatidylcholine

Question 551

What is the mechanism of AZT?

Answer 551

Nucleoside Reverse transcriptase inhibitor

Question 552

A physician practices evidence-based medicine. This represents

Answer 552

Integrity

Question 553

What would be the pattern on QUAD screen of a fetus with Down syndrome?

Answer 553

High: HCG & Inhibin

Low: Estriol, AFP

Question 554

Best way to prevent a retained sponge after a vaginal delivery?

Answer 554

Debriefing (via sponge count)

Question 555

Why is ROC a good test?

Answer 555

sensitivity = y , 1- specificity = x allows to balance between them

Question 556

What is the risk of Down syndrome with a prior afected child?

Answer 556

1% or the age related risk, whichever is higher

Question 557

A woman has recurrent SABs, her karyotype reveals a balanced translocation. Phenotypic trisomy 21 will be present in what percentage of subsequent surviving pregnancies?

Answer 557

1/6 = 16.7% of all gametes

1/3 if only living child

Question 558

If an amnio showed 45XX+14,21. What kind of mutation is that?

Answer 558

Balanced translocation

Question 559

Where can you find the ureter?

Answer 559

Over the bifurcation of the iliac artery

Question 560

What is the most common complication of AZT?

Answer 560

Bone marrow suppression

Question 561

Prostaglandin dehydrogenase is found where?

Answer 561

Chorion

Question 562

What enzyme causes prostaglandin inactivation? Where is it found?

Answer 562

Prostaglandin Dehydrogenase, Chorion

Question 563

What is the most effective anticoagulation for patients with mechanical heart valves?

Answer 563

Warfarin

Question 564

How do you test for familial dysautonomia?

Answer 564

DNA analysis

Question 565

Which of these is a more common surgical complication of c hyst?
 Ureteral injury
 Cystotomy
 Fistula
 Bowel Injury

Answer 565

Cystotomy

Question 566

Decreased Urinary Calcium is associated with what pregnancy disorder?

Answer 566

Preeclampsia

Question 567

<p>Which of the following valve lesions as the highest risk of mortality for the mother?
<br></br> AS, AR, MS, MR?</p>

Answer 567

<p>Aortic Stenosis</p>

Question 568

Where are the different Prostaglandins made?

Answer 568

PGI2: Myometrium
PGE2: Decidua and Amnion
PGF2alpha: Decidua

Question 569

What is least useful with SC disease?

a) FeSO4
b) Folic acid
c) Pneumovax
d) Antibiotics for suppression

Answer 569

FeSO4, can lead to hemochromatosis if patient is not iron deficient

Question 570

The PO2 is lowest in which vessel?

UmbA, Umb V, Uter A , Uter V

Answer 570

Umbilical Artery

Question 571

If preload and afterload are already optimized, what is the best way to increase cardiac output?

Answer 571

Beta adrenergic

Question 572

Beta mimetics (agonist) relax smooth muscle by what mechanism?

Answer 572

Stim. B2 receptor (G membrane protein) -> activates adenylate
cyclase ↑ intracellular cAMP + activates PKA -> inhibits myosin light chain
phosphorylation -> ↓ intracellular calcium

Question 573

If O2 is decreased, which fetal organ gets less blood flow?
 Lungs
 Brain
 Adrenals
 Myocardium

Answer 573

Lungs,

Fetus will maintain flow to Brain and Adrenals and Myocardium

Question 574

Which drug prevents IVH?

Answer 574

BMZ - also decreases RDS, NEC and neonatal mortality

Question 575

What percent of omphaloceles will have a chromosomal aneuploidy?

Answer 575

30 - 40%

Question 576

What is most likely outcome with amnio 45, XX der (13,21)?

Answer 576

Normal (no extra 13 or 21, just 1x13, 1x21 and 1x13-21 together))

Question 577

A normal pregnant patient in the third trimester what would her glucose levels do, Fasting and Postprandial?

Answer 577

Fasting ↓ Postprandial ↑

Question 578

What dose of folic acid do patients with sickle cell require?

Answer 578

4mg

Question 579

Most likely cause of hypoxia post c-section in obese class II patient?

Answer 579

Apnea

Question 580

Type I CPAM with Hydrops, what is the treatment?

Answer 580

Shunt for Drainage of Cyst

Question 581

When in pregnancy is the Cardiac output at its highest?

Answer 581

Immediately after delivery (autotransfusion of blood = 50% increase in CO)

Question 582

When should you only use a one tailed test?

Answer 582

When results can only go in one direction

Question 583

What nerve causes foot drop?

Answer 583

Common peroneal

Question 584

Discussion of mode of delivery in a pregnancy with a lethal anomaly involves which ethical principal?

Answer 584

Autonomy

Question 585

Fetus has cleft lip/palate, VSD, holoprosencephay. What is the most likely diagnosis?

Answer 585

T13

Question 586

What are the abnormalities with acute fatty liver of pregnancy?

Answer 586

↑ LFTs, uric acid, billirubin , Ammonia

↓ Platelets, ↓ Glucose

Question 587

What is the preferred mode of delivery for Omphalocele?

Answer 587

Vaginal unless >5cm or liver is out

Question 588

Which medication needs adjustment for Increased GFR?

Answer 588

Digoxin

Question 589

Simulation training has helped improve outcomes most in?

Answer 589

Brachial Plexus Injury (reduction by 60-90%)

Question 590

What happens to thyroid hormones in the first trimester?

Answer 590

TBG increases, Total T4 Increases, Free T4 Increases, TSH Decreases

Question 591

What pregnancy complications are associated with Multiple Sclerosis?

Answer 591

Increased risk of Growth restriction (and of C/section, but less than IUGR)

Question 592

Who is the best candidate for an IUD?

a. Uterine anomaly
b. Benign ovarian tumors
c. AIDS
d. Active chlamydia

Answer 592

AIDS

Question 593

In what setting is Down Syndrome most likely?

1. brachycephaly
2. Hypoplasia of mid phalangeal joint of 5th digit
3. normal humerus

Answer 593

Hypoplasia of the midphalanx of the fifth digit

Question 594

What is the most likely diagnosis if NT > 4mm?

Answer 594

45X - Turners , most common with very increased NT

Question 595

What is the main source of estriol?

Answer 595

C19 adrenal steroids (DHEAS from fetal adrenals)

Question 596

What is the mechanism of insulin resistance in pregnancy?

Answer 596

HPL and Human Placental Growth Hormone reduce insulin receptor sites

Question 597

What effect does medroxyprogesterone have postpartum?

Answer 597

Decreased bone mineral density long term use

Question 598

Which of the following is associated with coarctation of the aorta?

Answer 598

45 XO

Question 599

Which medication increases cardiac output when preload and afterload are optimized?

Answer 599

Dobutamine (B agonist)

Question 600

What is the mechanism of action of LMWH?

Answer 600

1. Inhibits Prothrombin

2. Binds ATIII and inhibits thrombin formation

Question 601

Characteristic of Med to freely pass into breast milk?

Answer 601

Non protein bound, Lipid soluble, Non-ionized, Low molecular weight
(All the same things for crossing placenta)

Question 602

What enzyme is deficient in Canavans?

Answer 602

Aspartoacylase

Question 603

Stillbirth in setting of cholestasis, most likely finding?

Answer 603

Meconium stained amniotic fluid

Question 604

Mother refuses a CS for fetal decelerations remote from delivery, what do you do?

Answer 604

Continue to manage her do not do cesarean against her will

Question 605

Clenched fists are associated with which chromosomal abnormality?

Answer 605

T18

Question 606

What is the #1 cause of low maternal estriol?

Answer 606

Placental sulfatase deficiency , SLOS, X linked Icthyoses

Question 607

Prophylaxis for PCP in CD4 < 200?

Answer 607

Bactrim

Question 608

At 37 degrees Celsius and pH of 7.4, fetal hemoglobin oxygen dissociation curve means?

Answer 608

This means that for any given PO2, fetal O2 saturation is higher

Question 609

For which of the following is plasmapharesis 1st line Rx?

Answer 609

TTP

Question 610

Which disorder is associated with UPD?
 Cri du chat
 Williams
 Prader Willi
 Hydantoin

Answer 610

Prader Willi

Question 611

Why do we not use Rapid GBS?

Answer 611

Low Sensitivity

Question 612

How does dialysis change with pregnancy?

1. Longer sessions
2. More frequent sessions
3. Add less calcium to dialysate
4. Add more HCO3 to dialysate

Answer 612

Longer sessions

Question 613

What statistic would you use to compare three means?

Answer 613

ANOVA

Question 614

What is the highest complication associated for 10 rads exposure at 15 weeks?

Answer 614

prior to 2 weeks: sab (all or none)
2-8 weeks: growth restriction/anomalies
8-15weeks: Intellectual Disability

Question 615

Where does a subgaleal hemorrhage occur?

Answer 615

Between skull periosteum and scalp galea aponeurosis

Question 616

Balanced translocation 14:21, what are the possible outcomes of baby?

Answer 616

1) 21,14 (normal)
2) 21:14 (balanced translocation like mom)
3) 21:14 (translocation + normal 21 (tri 21)
4) 21:14 (translocation + normal 14 (tri 14 - SAB)
5) Monosomy 14 (Sab)
6) Monosomy 21 (Sab)

Question 617

What is mode of inheritene of IHSS?

Answer 617

Hypertrophic cardiomyopathy is also called IHSS.

Autosomal Dominant

Question 618

How would you investigate whether there is an association between smoking and bladder cancer?

Answer 618

Case control study (Compares a group with disease to a group without and looks back at risk factor)

Question 619

What is fastest onset anesthetic medication?

Answer 619

Lidocaine : 1-2 mins

Question 620

Which is LEAST likely in the first 24 hours after birth?

Answer 620

Closure of DV (occurs within 1 week)

Closure of DA - approx few days
Closure of foramen ovale - early
Increased pulmonary resistance

Question 621

Which of the following fetal cardiac anomaly is least likely to result in a critically ill newborn?
 TGA 
 HLHS 
 AVSD
 TOF w pulm atresia

Answer 621

AVSD

Question 622

What medication causes reversible hearing loss in the fetus?

Answer 622

Streptomycin

Question 623

What are the causes of non-immune hydrops?

Answer 623

Idiopathic
 Cardiovascular
 Chromosomal - Turners
 Infections
 CCAM, Sacrococcygeal teratoma

Question 624

Which uterine structural anomaly has the highest miscarriage rate?

Answer 624

#1. Septate 
 #2. Unicornuate 
 #3. Bicornuate

Question 625

At which phase do type 2 pneumocytes appear?

Answer 625

Canalicular

Question 626

Difference in allele inheritance based on maternal and paternal genes best describes:

Answer 626

Imprinting

Question 627

What is a contraindication to breast feeding?

a. CMV
b. HCV
c. HBV
d. Genital HSV
e. Active TB

Answer 627

Active untreated TB, or HSV on breast (not genitals), HIV

Question 628

Which condition does plasmapheresis treat?

Answer 628

TTP

Question 629

What is the term that means it matters from which parent an allele was inherited?

Answer 629

imprinting

Question 630

Mechanism of Progesterone IUD?

Answer 630

Cervical Mucous(most correct). Anovulation. Affecting Sperm Motility, preventing implantation

Question 631

Which cytokine is anti-inflammatory?

Answer 631

IL-10

Question 632

What drug stays around in the maternal system for 2-3 years?

Answer 632

Etretinate

Question 633

What is the most common trisomy in abortuses?

Answer 633

Trisomy 16

Question 634

Increased nuchal fold is associated the most with what aneploidy?

Answer 634

T21

Question 635

What hormone causes insulin resistance at 4-7AM? 
 cortisol 
 GH 
 PRL 
 progesterone
  androstenedione

Answer 635

GH, (Human placental Growth Hormone causes insulin resistance via decreasing insulin receptor sites)

Question 636

Features of Congenital Rubella?

Answer 636

Blueberry Muffin, Cardiac issues, Cataracts, CNS and Deafness.

Question 637

Fetus with posterior urethral valves, what findings signify renal impairment?

Answer 637

Increases in Ca, Cl, Na, Microglobulin or OsmolaRity

Question 638

What test do you use for evaluation of Means?

Answer 638

t-test

Question 639

Which part of the Choirion is avascular?

Answer 639

Chorion Laeve

Question 640

Which SSRI most associated with increased fetal cardiac risk

Answer 640

Paxil (ASD, or outflow tract obstruction)

Question 641

How do you diagnosis Von Willebrand’s disease?

Answer 641

Ristocetin cofactor activity

Question 642

What is the best intrapartum treatment of Mitral Stenosis?

Answer 642

Beta Blockers

Question 643

Which is most associated with enlarged placenta, pale placenta, hydrops?

Answer 643

Syphillis

Question 644

Expansion of a vulvar hematoma is limited by?

a. Inguinal ligament
b. Levator ani muscles
c. Colles fascia

Answer 644

Colles Fascia, Urogenital Diaphragm, and Anal fascia

Question 645

Best way to differentiate a lupus flare from Preeclampsia?

Answer 645

Measurement of ANA, anti-dsDNA, decreased CH50, and active urinary sediment(cellular casts, aseptic leukocyturia, and hematuria) may help distinguish SLE nephritis flare

Question 646

Which fetal lung lesion is MOST associated with malignant transformation

Answer 646

CCAM

Question 647

Highest risk of Preterm birth is in what uterine anomaly? What about miscarriages?

Answer 647

PTD: Bicornuate uterus 60-70%

Sab: Septate

Question 648

Which antibody is positive if you have been vaccinated for Hep B?

Answer 648

Hep B surface antibody (anti-HBs)

Question 649

What enable increased fetal calcium?

Answer 649

Increased intestinal absorption of calcium from mother

Question 650

Which nerve fibers contribute to pain in 2nd stage of labor?

Answer 650

Pudendal nerve (S2-4)

Question 651

Which maternal cardiac lesion is associated with the greatest fetal risk of transmission?

1. AS
2. MS
3. VSD
4. TOF

Answer 651

Aortic stenosis (15-18% risk of fetal transmission)
IHSS: 50%
Coarctation: 14%

Question 652

Low MCV, HbA2 2.2% Normal Iron Studies, Dx?

Answer 652

Alpha Thalassemia

Question 653

Why is Randomization good practice?

Answer 653

Helps decrease confounding

Question 654

What is the follow-up for 6 mm bilateral pyelectasis and normal karyotype?

Answer 654

Repeat at 32 weeks

Question 655

Pt. had a CVS w/ Mosaic result, what can explain the birth of a normal baby?

Answer 655

Confined placental mosaicism

Question 656

What is the most common finding of a term infant with Down syndrome?

1. Simian crease
2. Hypotonia
3. LBW <2500gm

Answer 656

Hypotonia

Question 657

After a Fontan procedure, what does cardiac output depend most on?

Answer 657

Preload or SV

(HR plays a negligable role In a fontan circulation)

Question 658

Least associated with embryopathy?

Azathioprine, warfarin, hydantoin

Answer 658

Azathioprine (not associated with major anomalies)

Question 659

Which stage of lung development is surfactant produced?

Answer 659

Saccular phase

Question 660

Most common mode of transmission for Hep B worldwide?

Answer 660

Vertical Transmission from mother to baby

Question 661

If a parent has a robertsonian translocation 45XXder(14:21)(10q:10q) What is the chance that offspring will have phenotype of T21?

Answer 661

1/6 chance that baby is T21, but 3/6 of babies will be miscarriage so depends on if question asks about liveborn or just whether they’ll have trisomy 21. (Because 1/3 of the live births will be T21, but 1 in 6 possible outcomes of which 3 are miscarriage)

Question 662

What genetic principle explains a mom with tuberous sclerosus who has a child with heart problems, neurological lesion?

Answer 662

Variable Expressivity

Question 663

Which type of anatamosis is protective for TTTS?

Answer 663

Artery - Artery

Question 664

What enzyme is deficient in Smith Lemli Optiz?

Answer 664

Dehydrocholesterol Reductase (DHCR7)

Question 665

Local anesthetic epidural anesthesia is LEAST associated with

a) hypotension
b) FHR abnormalities
c) pruritis
d) spinal headache

Answer 665

Pruritus (that is for Narcotic epidurals, not local anesthetic)

Question 666

What is the mechanism LMWH causes anticoagulation?

Answer 666

1. Inhibits Prothrombin

2. Binds ATIII and inhibits thrombin formation

Question 667

Which medication is contraindicated in women with liver failure for HIV treatment?

Answer 667

Nevirapine, less so Lopinavir/Ritonavir (Kaletra)

Question 668

When is breastfeeding contraindicated?

Answer 668

HIV
Untreated Active TB
HSV Lesion Breast
Infants with classic galactosemia

Question 669

What is the most common cause of CAH?

Answer 669

21 alpha hydroxylase deficiency

Question 670

What is post partum decompensation in Aortic stenosis due to?

Answer 670

Hypovolemia (keep em wet)

Question 671

What can explain a discrepancy between amniocentesis results and CVS results?

Answer 671

Confined placental mosaicism

Question 672

Which is most likely to be abnormal with fetal acidemia
Absent accelerations
decreased fetal tone
decreased fetal breathing

Answer 672

First lose accelerations, then breathing then movement then tone.

Question 673

Which 8 cardiac lesions are considered the highest risk in pregnancy?

Answer 673

(1) Pulmonary artery hypertension
(2) Previous peripartum cardiomyopathy with any residual impairment
(3) Severe Left Venricle Dysfunction (EF<30%)
(4) Severe MS
(5) Severe symptomatic AS
(6) Marfan (Aortic Root >45mm)
(7) Aorta > 50mm in bicuspid valve aortopathy
(8) Native Severe Coarctation

Question 674

Which has the lowest O2 content?

umbilical artery, umbilical vein, uterine artery, uterine vein

Answer 674

Umbilical Artery

Question 675

What is treated with spiramycin?

Answer 675

Intrauterine Toxoplasmosis

Question 676

Which of the following is not associated with paternal age >50?
Achondroplasia, NF, Marfans, Klinefelters?

Answer 676

Klienfelter’s

Question 677

What is the inheritance pattern of PKU?

Answer 677

Autosomal Recessive

Question 678

Genetic diagnosis most associated with a mom that has preeclampsia?

Answer 678

Trisomy 13

Question 679

What is the LEAST useful sonographic measurement to differentiate between IUGR and wrong dates?

Answer 679

AC

Question 680

Most common cause of mortality with anesthesia?

Answer 680

Failed intubation

Question 681

What is the mechanism of action of b-mimetics?

Answer 681

Stim. B2 receptor (G membrane protein) -> activates adenylate
cyclase ↑ intracellular cAMP + activates PKA -> decreases intracellular calcium which –> inhibits myosin light chain kinase –> so no phosphorylation of myosin and therefore muscle relaxation

Question 682

A woman has a history of 5 recurrent miscarriages. She has a 45XX: (t21,22) karyotype, her husbands’, karyotype is 46XY. What is the chance that their next offspring will be affected with Down Syndrome?

Answer 682

33%

Question 683

Early Varicella Infection, whats the most common finding of baby?

Answer 683

Skin Scars

Question 684

Which of the following is the LEAST likely diagnosis with micromelia and hypocalcification of the skull are seen or ultrasound?
 OI
 Achondrogenesis
 Hypophosphatemia
 Thanatophoric dysplasia

Answer 684

Thanatophoric dysplasia

Question 685

Patient at 35 weks with C6 spinal cord lesion admitted with severe hypertension, flushing with contractions. What is next best step in management ?

Answer 685

Epidural anesthesia (autonomic dys/hyperreflexia)

Question 686

What is the most common enzyme deficiency in CAH?

Answer 686

21 α Hydroxylase deficiency

Question 687

What causes virilization of a female fetus?
 Luteoma of pregnancy
 Cystadenoma
 Prolactinoma
 OCPs

Answer 687

Luteoma of pregnancy

Question 688

When is cardiac output the highest?

Answer 688

Immediately after delvery due to autotransfusion

Question 689

Which steroid influences sodium reabsorption?

a. Fludrocortisone
b. Hydrocortisone
c. Betamethasone
d. Cortisol

Answer 689

Fludrocortisone (Mineralocorticoid)

Question 690

Of the following which is most associated with aneuploidy:

a. Thickened nuchal fold
b. Short humerus
c. Echogenic bowel
d. EIF

Answer 690

Thickened Nuchal Fold
 #1 Absent Nasal Bone
 #2 Nuchal fold
 #3 AND 4, NOT SURE THE ORDER - Echogenic bowel and Ventriculomegaly

Question 691

What is the ethical principal which states that action is done for the benefit of others?

Answer 691

Beneficence

Question 692

OCPs are not associated with a decreased risk of which cancer?

Answer 692

Breast Cancer

Question 693

Microtia is associated with what medication?

Answer 693

Microtia - Undeveloped external ear, happens from isotretinoin (accutane)

Question 694

Baby with nasal hypoplasia and limb defects?

Answer 694

Warfarin embryopathy

Question 695

What would a biopsy of a pre-eclamptic patient show?

Answer 695

Glomeruloendotheliosis in Nulligravidas

Normal histologic appearance in multigravidas

Question 696

Which ultrasound finding in gastroschisis is most associated with intestinal atresia ?

Answer 696

Bowel dilation (>14mm strongly predicts atresia)

Question 697

Smoking is least likely associated with an incease in which pregnancy associated condition?

Answer 697

Preeclampsia

Question 698

Which HIV Medication shouldnt be used In the first trimester?

Answer 698

Efavirenz (Increased Myelomeningocele risk)

Question 699

Which rash is associated with the worst neonatal / fetal complications?

Answer 699

Pemphigus Gestationalis (prematurity, SGA)

Question 700

Injury with brachial plexus injury resulting in Erb’s palsy is at what level?

Answer 700

C5-6

Question 701

If a patient has class F diabetes, what are they at most risk of?

Answer 701

diabetic nephropathy
 #1Pre-eclampsia
 #2 PTD
 #3 Growth Restriction

Question 702

What is the sensitivity of Quad screen in detecting T21 in a patient <35 years?

Answer 702

75%

Question 703

Which does not express MHC?

Answer 703

Syncytiotrophoblasts

Question 704

Which coagulation factor decreases in pregnancy?

Answer 704

Protein S, Factor XI, XIII and platelets

Question 705

Fetus at 28 weeks with CCAM type I lesion and hydrops. Management?

Answer 705

Thoracoamniotic shunt

Question 706

What is the best medication to alleviate hypertension in a preeclamptic patient at time of general anesthesia induction?

Answer 706

Nitroglycerin, In patients in whom hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation.

Question 707

What is the best way to decrease complications of shoulder dystocia?

Answer 707

Send staff for training, simulation

Question 708

When do you prophylax and with what for CD4 counts in HIV?

Answer 708

<200 : PCP : Bactrim
<100 : Toxo : Bactrim
<50 : MAI : Azithro

Question 709

Omphalocele is associated with which genetic syndrome?

Beckwith wiedemann, kartagener, meckel gruber?

Answer 709

Beckwith Wiedemann

Question 710

What condition with cystic fibrosis carries a poor prognosis?

Answer 710

Right heart failure (Cor Pulmonale)

Question 711

Which most explains decreased 2nd tri BP?
increased cardiac output
increased renal blood flow
decreased angiotensin sensitivity

Answer 711

Decreased Angiotensin Sensitivity

Question 712

What is the best way to perform randomization?

Answer 712

Random number block permutation

Question 713

What is not associated with intraabdominal calficiations?

CMV, Toxo, Parvo, CF, Meconium Peritonitis?

Answer 713

Parvovirus

Question 714

What is the initial treatment of pheochromocytoma in pregnancy?

Answer 714

Phenoxybenzamine (Alpha blocker)

Question 715

What is the PO2 in the Umbilical artery?

Answer 715

20

Question 716

Most likely to decrease breast milk flow?

OCP’s IUD Depo-provera

Answer 716

OCP’s

Question 717

Which is consistent with prerenal oliguria?

Answer 717

Osmolality>450

Question 718

What enzyme is missing in the placenta but fetus has?

Answer 718

17 α hydroxylase (which breaks down progesterone, we don’t want the placenta to be able to break down progesterone)

Question 719

What is the most appropriate US surveillance for MCDA twins?

Answer 719

US every other week at 16 weeks

Question 720

Which characteristic will increase passage into milk during lactogenesis

Answer 720

Lipid Soluble, Non Protein Bound, Non Ionized, Low Weight will increase passage into milk during lactogenesis.

Question 721

Which vessel has the highest fetal oxygenation?

a. IVC
b. Descending Aorta
c. RV
d. DA

Answer 721

IVC
UV -> DV -> IVC -> Left Heart –> Ascending Aorta –> Neck vessels –> Descending Aorta
Ductus Arteriosus < Descending Aora

Question 722

Action of PGI2

Answer 722

Prostacyclin is a potent vasodilator. It is produced in endothelial cells & the myometrium. It is also a uterine relaxing agent.

Question 723

What is the mode of inheritance of familial hypertrophic cardiomyopathy?

Answer 723

Autosomal Dominant

Question 724

Umbilical vein has what O2 compared to uterine vein?

Answer 724

lower O2 than uterine vein

Question 725

Which is most associated with aneuploidy?

EIF, short humerus, echogenic bowel , pyelectasis?

Answer 725

Echogenic bowel (1.65X LR)

Question 726

Neonate has apnea after 30 seconds, what is next best step?

Answer 726

Positive pressure ventilation
 NRP
 (@30 seconds, if HR < 100 or Apnea --> PPV)
 (@60 HR < 60 --> Chest compressions
  HR 60-100 --> Continue PPV)
 (@90 HR <60 --> Epi and Intubate)

Question 727

Which Anastomoses protect against TTTS?

Answer 727

A-A

Question 728

Most common ovarian cancer found in pregnancy?

Answer 728

Dysgerminoma (30% of ovarian cancers found in pregnancy)

Question 729

What is the most common symptom after a lumbar puncture ?

Answer 729

Headache that gets worse with standing/sitting and better with laying flat

Question 730

Which is not related to non-disjunction in the mother?

1. Turners
2. Klienfelters
3. XXX

Answer 730

Turners

The single X is maternal in origin in 70% of cases. Paternal is lost

Question 731

Most likely ultrasound finding in a patient baby with Myotonic Dystrophy?

Answer 731

Polyhydramnios

Question 732

What is hormones are HPL most like?

Answer 732

Prolactin and GH

Question 733

Treatment for toxoplasma in pregnant women?

Answer 733

Spiramycin

Question 734

Short bent femurs, humerus, radii, and thoracic circumference <5%. Normal ossification of cranuim and spine. What is the most likely diagnosis?

Answer 734

Thanatophoric Dysplasia

Question 735

Which chromosomal abnormality is not increased in offspring of AMA females?

Answer 735

Turner Syndrome

Question 736

Initial symptom of Intravascular Lidocaine injection?

Answer 736

Tinnitus

Question 737

What hormone can increase maturation of lungs?

Answer 737

Betamethasone/Dexamethasone, Thyroxine, Vitamin A

Question 738

What is a premutation of fragile X (how many repeats)?

Answer 738

Between 55-200 (premutation)

Question 739

Treacher collins is associated with impairment in what structure?

Answer 739

The mandible

Question 740

Which Doppler finding is the worst?

Answer 740

Reversed A wave in DV

Question 741

Amino acids cross the placenta via what type of movement?

Answer 741

Active Transport

Question 742

Which of the following is important for PGE2 creation?

Arachidonic acid or Prostacyclin

Answer 742

Arachidonic acid

Question 743

Least likely with hyperparathyroidism? 
 Pancreatitis 
 HTN 
 kidney stones
 cranial califications 
 neonatal hypocalcemia

Answer 743

Cranial Calcifications

Question 744

What is the most likely cause for an LGA Fetus?

Answer 744

Maternal Obesity

Question 745

The mother has a blood type of O+ and the baby has a blood type of A+. The baby has been breast-feeding and 2 days post partum is noticed to be jaundice. The mom has no antibodies but there is a + direct Coombs. What is the most likely cause?

a) Breast Feeding
b) ABO incompatibility
c) Rh Disease
d) Immature fetal liver enzymes

Answer 745

ABO incompatibility

Question 746

Best treatment for Neisseria Gonorrhea in pregnancy?

Answer 746

Ceftriaxone

Question 747

Which Heart finding is most specific for DiGeorge Syndrome?

Answer 747

Interrupted Aorta (They said is Correct- not sure bout that), Tetralogy of Fallot (26%), Interrupted Aortic Arch (10%), Pulmonary Atresia wit VSD (24%), VSD (19%) - I think what they meant was if you have Interrupted Aortic Arch you are at 50-89% likely to have DiGeorge, but overall it is rare

Question 748

What is the primary source of precursor estrogen synthesis in the placenta?

Answer 748

C19 Precursor DHEAS from the Fetal Adrenal (Fetal Zone)

Question 749

How to control for a variable in survival analysis?

Answer 749

Cox-regression

Question 750

Which karyotype is the result of a uniparental disomy?

Answer 750

A Trisomy - results in UPD from trisomic rescue

Question 751

Which is not helpful for identifying lupus anticoagulant?

Dilute russell venom, Kaolin, Prolonged PTT, ANA?

Answer 751

ANA

Question 752

Why do you explain informed consent?

Answer 752

Autonomy

Question 753

What pregnancy outcomes does bariatric surgery improve?

Answer 753

Gestational Diabetes

Less Macrosomia

Question 754

A women has preeclampsia and oliguria. What is indicative of pre-renal process?

Answer 754

Osm >550

Question 755

What antihypertensive medication increases cardiac output?

Answer 755

Hydralazine

Question 756

What is the most common placental mass?

Answer 756

Chorioangioma - has color flow , associated with Polyhydramnios (60%) and IUGR (20%)

Question 757

Most likely to cause neonatal cushingoid syndrome in pregnancy?

Answer 757

Repeated steroid doses (though this looks like it has fallen out of favor)

Question 758

Duodenal Atresia in baby with Polyhydramnios. How does the amniotic fluid get absorbed if the baby has an obstruction?

Answer 758

Intramembranous absorption

Question 759

18 weeks pregnant with Non-Hodgkins Lymphoma, best treatment?

Answer 759

Combination Chemotherapy

Question 760

Both parents have normal stature, but both kids have achondroplasia, most likely reason?

Answer 760

Gonadal mosaicism

Question 761

Which is not associated with hydrops

listeria, syphillis, parvo, cmv, toxo

Answer 761

All of them are, Listeria is probably the least

Question 762

When should you get the flu vaccine in pregnancy?

Answer 762

As early as possible

Question 763

Patient Is 8 weeks pregnant with an IUD in place, strings are visible. You should?

Answer 763

Pull string

Question 764

Why are basic drugs like demerol concentrated in an acidemic fetus?

Answer 764

Ion trapping from a decreased isoelectric point

Question 765

Prerenal Azotemia with Preeclampsia,what lab is suggestive of this?

Answer 765

Urine osmolality >450

Question 766

When should you use a one tailed t-test?

Answer 766

results can only go in one direction

Question 767

Most common cause of non-hereditary deafness?

Answer 767

CMV (but remember 85% of congenital CMV are asymptomatic)

Question 768

What nerve injury causes decreased labial sensation?

Answer 768

Illioinguinal

Question 769

Most likely fetal outcome of radiation exposure in the first trimester?

Answer 769

Microcephaly - (also growth restriction and intellectual disability)

Question 770

Medications for SBE prevention?

Answer 770

Ampicillin or Cephalosporin

Question 771

Which antihypertensive INCREASES maternal cardiac output?

Answer 771

Hydralazine

Question 772

What is the best megahertz to assess abdominal circumference at 20 weeks?

Answer 772

3.5 mHz

Question 773

Hypospadias and congenital anomalies are increased with what REI?

Answer 773

IVF with ICSI

Question 774

Which is NOT associated with autonomic hyperreflexia?

Answer 774

Hypotension

Question 775

Which HIV drug should you avoid in first trimester?

Answer 775

Efavirenz due to concern for NTD

Question 776

Longest lasting anesthetic for an epidural?

Answer 776

Bupivicaine

Question 777

Which disease is associated with increased paternal age?

Answer 777

Achondroplasia

Neurfibromatosis Marfans

Question 778

What is the odds ratio formula?

Answer 778

AD/BC ratio of exposed cases to unexposed cases divided by ratio of exposed controls to unexposed controls

Question 779

What is most associated with ARDS in pregnancy?

PE, Infection?

Answer 779

Infection

Question 780

Which anomaly is associated with the highest risk of aneuploidy?

1. Omphalocele
2. Cardiac defects
3. Gastroschisis

Answer 780

Omphalocele

Question 781

At what gestational age is Warfarin exposure at greatest risk for causing warfarin embryopathy?

Answer 781

6-9 weeks

Question 782

Which factors move the Oxygen dissociation curve to the left?

Answer 782

Left means: Higher affinity of Hb-O2

1. Fetal Hb
2. Lower CO2
3. Higher pH
4. Lower temperature
5. Lower 2-3 DPG

Question 783

What is the most common aneuploidy found in first trimester abortions?

Answer 783

Trisomy 16

Question 784

Erb’s palsy is damage to which nerve roots?

Answer 784

C5-C6

Question 785

What is the most common complication of Chorioangioma?

Answer 785

Polyhydramnios

Question 786

What type of virus is HIV?

Answer 786

RNA Retrovirus

Question 787

Which is not associatied with autonomic hyperreflexia? At what level injury is it seen in? How is it prevented?
Hypotension, bradycardia, piloerection

Answer 787

Hypotension (Hypertension happens), T6 and above, early epidural

Question 788

What nerves is second stage labor pain due to?

Answer 788

Pudendal nerve S2-S4

Question 789

Treatment for IHSS?

Answer 789

Beta blocker (propranolol), controls the heart rate so more time for ventricular filling

Question 790

Which disease other than SLE has +SSA/SSB antibodies?

Answer 790

Sjogren’s

Question 791

Which blood product has the MOST of Factors V, VII and X?

Answer 791

FFP (has fibrinogen, factors 2, 5, 7, 9, 10, 11)

Question 792

When are the periods with the highest risk of developing a hemorrhagic stroke in pregnancy?

Answer 792

Highest during the delivery period and up to 2 weeks postpartum

Question 793

Which Interleukin is Anti-inflammatory

Answer 793

IL-10

Question 794

Bullous lesions with biopsy showing C3 deposition in the basement membrane: Diagnosis?

Answer 794

Herpes gestationis (Aka Pemphigoid gestationis))

Question 795

Which genetic condition should you consider in a Fetus with Increased Nuchal Translucency, but normal karyotype?

Answer 795

Noonan syndrome (10% of euploid with increased NT)

Question 796

What is the best method to determine heart rate in the first trimester?

Answer 796

M- Mode

Question 797

What is the MOST specific marker for T21?

Answer 797

Absent nasal bone
 #1 Absent Nasal Bone
 #2 Nuchal fold
 #3 AND 4, NOT SURE THE ORDER - Echogenic bowel and Ventriculomegaly

Question 798

What is post partum decompensation of Mitral stenosis due to?

Answer 798

Hypervolemia (keep em dry)

Question 799

What is the most common presentation of AFE?

Answer 799

1. Hypoxia/Hypotension

2. Coagulopathy

Question 800

Which is the LEAST likely EKG finding in a normal pregnancy?

Answer 800

PR Interval increase (Normal findings: HR increases, PR interval decreases, Axis deviates left, ST and T wave changes)

Question 801

Which antibody is most responsible for immunity passed to infant through breast milk?

Answer 801

IgA

Question 802

Most common risk with AZT?

Answer 802

Anemia (Marrow Suppression) - most common adverse reaction

But Nausea.vomitting, more common / less specific.

Question 803

Which elevated value is the most predictive for poor kidney function?

a. Osmolality
b. Na
c. Chloride
d. B2-microglobulin

Answer 803

All are predictive if elevated

Question 804

Risk of Early onset GBS if not treated in labor and GBS positive?

Answer 804

1-2%
Per the CDC report, in the absence of intervention 1-2% of infants born to colonized mothers develop early-onset GBS sepsis. Prior to instituting universal screening, the incidence of GBS sepsis was 1.7/1000, now is 0.33/1000.

Question 805

What is used in the treatment of Lyme in pregnancy?

a) Penn
b) Doxy
c) Vancomycin
d) Clindamycin
e) Cephalosporin

Answer 805

Cephalosporin (Or amoxicillin)

Question 806

SSA and SSB antibodies are most associated with?

Answer 806

Neonatal Lupus (25%), Heart block ( 1-3%), Normal pregnancy most likely

Question 807

PVL is associated with which maternal infection?

Answer 807

Chorioamnionitis

Question 808

Patient with uncontrolled hyperthyroidism most likely to present with:

Answer 808

#1: Preeclampsia
 #2: Growth Restriction
 #3: Preterm delivery

Question 809

In a mother that is Rh sensitized but has a low titer, what is the next step in management?

Answer 809

Continue to follow titers

Question 810

Mutation in Sickle Cell?

Answer 810

can detect valine to glutamine at 6 position of beta chain on chromosome 11

Question 811

At what gestational age woud you deliver a patient with a subchorionic hemorrhage?

Answer 811

At term

Question 812

Folic Acid antagonist use is associated with?

Answer 812

Neural Tube Defects, Cardiac Defects and Oral Clefts

Question 813

Which is the bad malaria in pregnancy?

Answer 813

Falciparum

Question 814

Which condition is most likely to transmit to the fetus?

1. ASD
2. VSD
3. Coarctation
4. TOF

Answer 814

Coarctation

Question 815

What is the most effective treatment for steroid resistant lupus in pregnancy?

Answer 815

Azathoprine

Question 816

Common findings in congenital toxoplasmosis?

Answer 816

Chorioretinitis, hepatosplenomegaly, periventricular calfications, ventriculomegaly, disseminated purpuric rash

Question 817

Which part of the fetal adrenal gland makes DHEAS?

Answer 817

Fetal zone

Question 818

Which has lowest chance of MR in child? a) accutane in first trimester b) Rubella exposure first trimester c) varicella exposure first tri d) warfarin first trimester

Answer 818

VARICELLA TRANSMISSION IN FIRST TRIMESTER IS RARE!

Question 819

What factors are most important in oxygen delivery to tissue?

Answer 819

CO x PaO2 (Oxygen delivery = CO x arterial oxygen content )

Question 820

Amniotic fluid acetylcholinesterase is least helpful with what condition?

1. Omphalocele
2. Gastroschisis
3. Congenital nephrosis
4. Anencephaly

Answer 820

Congenital nephrosis

Question 821

Which has clinically significant levels of Factor X?

FFP or cryo?

Answer 821

FFP - has fibrinogen, factors 2, 5, 7, 9, 10, 11

Question 822

What is the most specific finding of NEC?

Answer 822

Pneumatosis - diagnosis of NEC is confirmed with gas in bowel wall on Xray

Question 823

Most likely finding of fetus in mom with hyperparathyroidism:

Answer 823

Neonatal Hypocalcemia

Question 824

Most common complication after narcotic anesthesia?

Answer 824

Pruritus

Question 825

Patient with recurrent cholelithiasis, management?

Answer 825

Lap Cholecystectomy

Question 826

Recurrent achondroplasia in a couple who are not affected are most likely associated with:

Answer 826

Germline Mutation AKA Gonadal Mosaicism

Question 827

Best contraceptive option for patient with Hepatitis C and liver disease

Answer 827

Copper IUD

Question 828

What causes diabetic retinopathy?

Answer 828

Chronic hyperglycemia - elevated HBA1c

Question 829

Who is microarray most appropriate for?

a. Abnormal integrated screen
b. VSD
c. Partner with Robertsonian translocation
d. CPC

Answer 829

VSD
microarray analysis helpful to reveal more than karyotype in
6.0% with a structural anomaly and
1.7% of AMA or positive serum screen

Question 830

What is the form of the source of metabolic fuel for the fetal myocardium?

Answer 830

Glucose

Question 831

Which disease is NOT associated with relapsing/remitting fevers?
 Brucella
 Lyme
 Malaria
 Listeria

Answer 831

Listeria

Question 832

How do you treat pregnancies at risk of NAIT?

And when do you deliver?

Answer 832

If previously affected with Thrombocytopenia and ICH IVIG @ 12 weeks - Del @ 35-36
If previously affected with thrombocytopenia but NO ICH @ 20 weeks Del @ 37-38
De

Question 833

Baby delivered at 35 weeks. 30 minutes after delivery, develops severe respiratory distress. Preductal O2sat = 90%. Postductal O2sat = 70%. CXR normal. Diagnosis?

Answer 833

PPHN, Persisent fetal circulation

Question 834

Most drugs cross the placenta by which mechanism?

Answer 834

Simple Diffusion

Question 835

Betamethasone is metabolized in the placenta by:

Answer 835

11β-hydroxysteroid dehydrogenase type 2

Question 836

Which enzymes catalyzes the degradation of endothelin-1?

Answer 836

Enkephalinase

Question 837

What nerve is affected if the mother’s legs are hyperflexed during delivery?

Answer 837

Femoral nerve (Diffficulty with kicking motion)

Question 838

What is anticipation? Give an example?

Answer 838

Genetic condition passed on to next generation where symptoms worsen and come on early in the next generation, trinucleotide repeats (Huntingtons, Fragile X)

Question 839

Which fetal organ system is most susceptible to teratogens earlier and for the longest time?

Answer 839

Brain

Question 840

What does giving betamethasone due to biophysical profile?

Answer 840

Decreases breathing and Movement

Question 841

Most likely outcome with Fragile X?

Answer 841

Mental Retardation

Question 842

Risk of CP with APGAR score of <=3 at 5 minutes?

What about at 15-20 minutes?

Answer 842

An apgar score <=3 at 5 minutes is associated with 5% risk of CP. Becomes 50% when Apgar <=3 persists at 15-20 minutes.

Question 843

A pt. has Epistaxis, Telangiectasia. Diagnosis? Mode of inheritance?

Answer 843

Ossler Webber Rondu (AD)

Question 844

Low level of which hormone is most associated with placental insufficiency?

Answer 844

low PAPP-A

Question 845

Anemia, Thrombocytopenia and Renal Failure, Diagnosis?

Answer 845

HUS

Question 846

Most likely antibody to result from transfusion?

a) D
b) C
c) E
d) Kell
e) N

Answer 846

Kell

Question 847

Which drug sticks around in the body for 2 years?

Answer 847

Etretinate

Question 848

periventricular leukomalacia is most commonly associated with what pregnancy complication?
Why does it happen?

Answer 848

Intra-amniotic Infection/Chorioamnionitis

Proinflammatory cytokines damage the white matter of the brain

Question 849

Why do you treat a fetus at risk for CAH, When do you start and what is the treatment? (mother has CAH)

Answer 849

7-8 weeks, Dexamethasone to prevent virilization (CVS, if male stop treatment, if female continue)

Question 850

Which is not associated with SSRI?

a. Congenital heart defect
b. NTD
c. Neonatal withdrawal
d. PPHN

Answer 850

NTD

Question 851

The most common symptom of appendicitis in pregnancy is?

Answer 851

Abdominal pain

Question 852

Which antiseizure drug has the highest risk of NTD?

Answer 852

Valproic acid 1-2%

Question 853

What drug doesn’t cross the placenta

Answer 853

Heparin, and maybe insulin unless IgG bound.

Question 854

The use of valproic acid carries what risk of NTD?

Answer 854

1-2%

Question 855

Treatment for fetal thyrotoxisocis / hyperthyroidism?

Answer 855

Maternal PTU

Question 856

Cord Blood Gases – You have table, what is it?

Answer 856

Respiratory, metabolic, mixed?

Question 857

Which is likely to present for the first time during pregnancy?

a) Hg SC disease
b) Hg S-thal
c) Hg SS

Answer 857

Hb SC disease

Question 858

Which enzyme that the fetus lacks does the placenta have and what is its function?

Answer 858

3 Beta - Hydroxysteroid Dehydrogenase

It converts Pregnenalone to Progesterone which is the primary source of progesterone.

Question 859

As a class, what is the most common etiology for fetal malformations?

Answer 859

Genetic

Question 860

Which Immunoglobin associated with mucosal defense in

breast milk?

Answer 860

IgA

Question 861

Which disease is most commonly associated with Ro and La Antibodies?

Answer 861

Sjogrens syndrome (SSA and SSB) - 80-90%
 only in 30% of Lupus patients

Question 862

Prior neonate with ambiguous genitalia & neonatal death. What is the most likely cause of neonatal death?

Answer 862

CAH - salt wasting

Question 863

Baby delivers, meconium, develops respiratory problems after birth, CXR is clear, preductal O2 90%, postductal O2 70%?

Answer 863

Persistent fetal circulation (if cxr wassnt clear, possibly meconium aspiration)

Question 864

What are good prognosis findings in fetal urine?

Answer 864

Sodium (Na) Less than 100 mEq per liter
Chloride (Cl) Less than 90 mEq per liter
Osmolarity (Osm) Less than 210 mEq per liter
Calcium (Ca) Less than 2 mmol per liter
Beta-2 microglobulin Less than 2 mg per liter

Question 865

What antibody pattern is consistent with Recurrent CMV?

Answer 865

ERROR!

Question 866

20 yo Asian woman with low MCV, HgbA2 2.4%. Most likely cause:

Answer 866

Alpha Thalassemia

Question 867

What effeect will glucose have on BPP?

Answer 867

Increased Breathing (not movement)

Question 868

Standard Error is interchangeable with Standard Deviation?

Answer 868

YES. Standard error is the estimation of the standard deviation

Question 869

Treatment for malignant hyperthermia?

Answer 869

Dantrolene

Question 870

Which cardiac anomaly most associated with DiGeorge ?

Answer 870

Interrupted aortic arch

Question 871

What should you do if cord insertion at 8 weeks is abnormal?

Answer 871

Repeat ultrasound because of physiologic herniation

Question 872

Which procedure has the greatest risk of alloimmunziation?

Amnio, CVS or Cordocentesis?

Answer 872

Cordocentesis (close to 40%)

Question 873

HIV patient not on meds, presents in labor, best single agent?

Answer 873

Zidovudine / Lamivudine

Question 874

What enzyme is the rate-limiting step in synthesis of prostaglandin?

Answer 874

Phospholipid converstion by Phospholipase A2 to Arachidonic acid

Question 875

Most common mutation in Osteogenesis Imperfecta?

Answer 875

ColA1,2

Question 876

What bacteria is associated with Alkaline Urine UTI’s?

Answer 876

Proteus Mirabilis

Question 877

What vitamin must you supplement in vegans?

Answer 877

B12

Question 878

Which syndrome has absent radius, polyhydramnios and hydronephrosis?

Answer 878

Thrombocytopenia absent radius (TAR) Syndrome

• can have kidney, heart and thrombocytopenia with absent radius
• both radii are missing but thumbs are present

Question 879

What is the minimal PO2 needed to maintain maternal SaO2 >90%?

Answer 879

60

Question 880

What is the major component of surfactant?

Answer 880

Phosphotidylcholine

Question 881

What enzyme is deficient in Niemann Pick?

Answer 881

Sphingomyelinase

Question 882

How much of the screen should a cervix take up for a cervical length?

Answer 882

3/4 of screen

Question 883

What statistical test do you use for evaluation of proportions?

Answer 883

Chi Square

Question 884

Neonatal lupus most likely to present with which?

Answer 884

Rash (25%), Complete heart block (3%)

Thrombocytopenia (10%, but that was in one random BMJ article)

Question 885

Elevated AF Acetylcholinesterase is NOT associated with which of the following?
 Apalsia Cutis
 Omphalocele
 Anencephaly
 Encephalocele
 Congenital nephrosis

Answer 885

Congenital nephrosis

Question 886

Worst prognosis for neonatal CMV with?

Answer 886

Microcephaly

Question 887

What do you use to compare two means that are normally distributed that are continuous:

Answer 887

T test

Question 888

A man of normal height has 3 dwarf children with 3 different mothers, explanation?

Answer 888

Gonadal Moasaicism

Question 889

Mechanism of Uterine Contraction?

Answer 889

phospholipase C converts phospatidylinositol triphosphate to inositol triphosphate, which release calcium from the sarcoplasmic reticulum. Calcium then binds to calmodulin; the calcium-calmodulin complex then activates myosin light chain kinase. Myosin light chain kinase phosphorylates myosin light chain, which enables the ATPase activity & causes sliding of myosin over actin fibrils.

Question 890

Where is PGE2 produced mostly?

Answer 890

Amnion

Question 891

Patient with Preeclampsia with ruptured liver capsule, management?

Answer 891

• Correct Coagulopathies (likely DIC),
  
  • For surgical management Pack and drain
  • Improve surival with Hepatic Artery Embolization

Question 892

Which infection is associated with Placental Microabscesses?

Answer 892

Listeria

Question 893

Petechiae + hepatosplenomegaly at birth, which infectious etiology?

Answer 893

CMV

Question 894

False positives for KB?

Answer 894

Anything that can be caused by anything that causes maternal HbF to be elevated – beta thal, sickle cell

Question 895

Mom has sickle cell (hgb SS), dad unknown but carrier rate is 1/12, what is chance fetus will have hgb SS?

Answer 895

1/24,

1/12 chance hes a carrier x 1/2 risk of passing on the bad one

Question 896

Anemia, Thrombocytopenia, Renal Failure, Neurologic Abnormalities, and Fever

Answer 896

TTP

Question 897

What do you use to Differentiate TTP and HELLP

Answer 897

LDH to AST, fever (less specific)

Question 898

When does fetal movement increase the most in a 24 hour period?

Answer 898

At night

Question 899

Which autoimmune diseases are associated with RA factor?

Answer 899

Scleroderama, SLE, Sjogrens, RA and Dermatomyositis

Question 900

What is the management for a patient with Preterm Contractions but is closed?

Answer 900

Prolonged observation

Question 901

What are the most common causes of maternal mortality?

Answer 901

#1 Cardio
 #2 Infection
 #3 Hemorrhage

Question 902

Freq of an autosomal recessive disease is 1/6400, what is the carrier frequency?

Answer 902

q² = 1/6400
q = 1/80
2pq = 2 x 1/80 = 1/40

Question 903

Best Rx for type 1 Von Willebrand’s Disease?

Desmopressin, cryo, FFP

Answer 903

Desmopressin

Question 904

Spinal anesthesia resulting in sympathetic blockade is worst for?
Aortic stenosis, mitral stenosis, IHSS, Pulm HTN

Answer 904

Pulmonary Hypertension, Decreased SVR results in drop in preload which would result in inability to perfuse the pulmonary vascular bed

Question 905

If disease frequency for PKU is 1/10,000, then what is carrier frequency?

Answer 905

PKU: Autosomal Recessive

q² = 1/10,000 q = 1/100, p is always 1 2pq = 2x1/100 = 1/50

Question 906

In preeclampsia what happens to thromboxane and PGI2?

Answer 906

Thromboxane increases (normally it stsays the same) and PGI2 Decreases (normally it increases)

Question 907

The difference between quality and safety is:

Answer 907

Quality measures efficient effective care that gets the right job done at the right cost (doing things well), safety is preventing harm

Question 908

Fish highest in mercury content?

Answer 908

King Mackerel (Shark, Swordfish, Tilefish, Ahi Tuna also)

Question 909

Kid got narcotic, what is the first sign of acidosis in tracing?

Answer 909

Loss of variability

Question 910

Which organisms are most likely to cause Toxic Shock Syndrome?

Answer 910

Staph Aureus, Group A Strep

Question 911

What factor is the worst prognosticator for CDH?

Answer 911

LHR <1 is worst

Liver is bad but not the worst

Question 912

What product (of Aldosterone and testosterone) is increased in 21 hydroxylase deficiency, 17 hydroxylase deficiency and 11 hydroxylase deficiency

Answer 912

Follow the 1’s 1 = increase, BP - T
21 = BP down, Testosterone Up
17 = BP up, Testosterone down
11 = BP up, Testosterone up

Question 913

Which agents can potentially cause renal anomalies along with oligohydramnios?

Answer 913

ACE-inhibitors (-opril drugs)

Question 914

Least likely in family hx affected by Fragile X?
 Premature ovarian failure
 Ataxia 
 Family history MR 
 Gonadal Cancer

Answer 914

Gonadal Cancer

Question 915

Which Interleukin is antiinflammatory

Answer 915

IL10

Question 916

What are the Ashkenzi panel enzyme deficiencies?

Answer 916

Familial Dysautonomia
Cystic Fibrosis
Canavan: Aspartocyclase
Tay Sachs: Hexosaminidase A

Question 917

How do you treat the fetus is the mother has CAH?

Answer 917

Dexamthasone, starting at 7-8 weeks. To prevent virilization of female fetus

Question 918

Risk of peripartum transmission for recurrent HSV

Answer 918

Low, 1%

Question 919

A patient with SLE nephritis will MOST liekly have which outcome?

Answer 919

Pre-eclampsia

Question 920

Which Cardiac Lesion is the worst in pregnancy?

Answer 920

VSD with R to L shunt

Question 921

Which cardiac disease is associated with the highest mortality?

Answer 921

Pulmonary HTN with VSD and Eisenmengers (Right to Left Shunt)

Question 922

Your primary ethical responsibilities to the patient are:

Answer 922

Beneficence and autonomy (more so than nonmaleficence)

Question 923

Duodenal atresia is associated with what other findings?

Answer 923

Polyhydramnios

Question 924

Best test to compare the mean in 3 groups?

Answer 924

ANOVA (used for comparing means in more than 2 groups)

Question 925

When is CVS contraindicated ?

Answer 925

Isoimmunization (Kell/Rh/etc.)

Question 926

What is the medication used for primary pulmonary hypertension?

Answer 926

Viagra

Question 927

Least likely associated with mental retardation?

Answer 927

Only 0.4% of women with varicella in first trimester have affected children.

Question 928

Which is associated with pre-renal oliguria?

Urine osm 550, Urine Na > 20, Serum BUN:Cr 1:1

Answer 928

Urine Osm >450

Question 929

Which medications to treat SLE are teratogenic?

Answer 929

Mycophenolate Mofetil and Cyclophosphamide

Question 930

Club foot after oligo is the best example of a:

Malformation, Deformation, Disruption?

Answer 930

Deformation

Question 931

Fragile X inheritance is associated with what number of repeats? What are the repeat letters?

Answer 931

> 200

Question 932

Most likely outcome of Meconium stained fluid with normal heart tracing?

Answer 932

Normal

Question 933

What is the risk of cystic fibrosis if fathers parents has CF and carrier rate is 1/25?

Answer 933

1/100

Question 934

What is the likelihood of poor neurological outcome after the death of one twin in a MCDA twin?

Answer 934

15-25%

Question 935

What is the most common complication in pregnancy of women with Acromegaly?

Answer 935

Gestational Diabetes

Question 936

What are the main features of Fetal Alcohol Syndrome?

Answer 936

Mental retardation
 Cardiac Septal Defects
 Growth Restriction
 Smooth Filtrum
 Small upper lip
 Small Palpebral fissures
 Kidney Abnormalities

Question 937

A patient presents with bullous lesions in pregnancy and has positive complement deposition. What is the diagnosis?

Answer 937

Herpes/Pemphigoid Gestationalis

Question 938

What is the structure of TRH?

Answer 938

Tripeptide

Question 939

45XX, der(13,21)(q10q10) is associated with what?

Answer 939

Normal.

This is a balanced translocation on 13q;21q

Question 940

Why is it a bad plan to give I131 in pregnancy?

Answer 940

It will destroy the fetal thyroid (because it concentrates there startingat 10-12 weeks)

Question 941

Which cardiac lesions tolerates a decrease in SVR the least?

Answer 941

Eisenmenger - right to left shunting of blood

Question 942

Bleeding circ most likely associated with what deficiency

Answer 942

Factor XIII

Question 943

What is the appropriate treatment for Non-Hodgkins lymphoma at 18 weeks?

Answer 943

Combination chemotherapy

Question 944

Fetus with intraabdominal Calcifications, Hepatosplenomegaly, Differential Diagnosis?

Answer 944

CMV/Toxo

Question 945

Which medications decreases the level of OCPs?

Answer 945

Rifampin, Carbamezapine, Phenytoin

Question 946

Which drug can cause neonatal hypotermia?

Answer 946

Valium