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All Subjects In One > 2012-2018 and Subject Reviews All together - In CSV form - Sheet1 > Flashcards

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

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1
Q

What is type 1 error?

A

Rejecting the null when you shouldn’t have

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2
Q

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

A

ToF

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3
Q

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

A

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

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4
Q

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

A

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

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5
Q

Which uterine anomaly has the highest risk of PTL?

A 
#1. Didelphys 
 #2. Bicornuate 
 #3. Septate
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6
Q

What is the most common maternal complication of malaria?

A

Anemia

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7
Q

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

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

A

Hypothermia does not

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8
Q

Mitral stenosis worsens with?

A

Increased Preload

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9
Q

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

A

Levonorgesterol IUD

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10
Q

Minipres mode of action?

A

Alpha blocker

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11
Q

Which screening is recommended for Ashkenazi Jewish population?

A

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

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12
Q

Where is PGF2apha produced mainly?

A

Decidua

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13
Q

Most drugs cross the placenta by what method?

A

Simple diffusion

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14
Q

HLA is not expressed on which?

Syncytiotrophoblast or cytotrophoblast

A

The Syncytiotrophoblast -has NO Antigens

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15
Q

What is the most common complication of malarial infection?

A

Anemia

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16
Q

Least likely to be transmitted in banked breast milk?

A

CMV

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17
Q

Multiple intraabdominal echogenecities are least associated with which condition?

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

Parvo

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18
Q

Where does fetus make blood throughout pregnancy?

A

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

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19
Q

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

A

Breast Cancer

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20
Q

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

A

Cardiac defects

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21
Q

Which is most associated with fetal risk?

Thyroid stimulating antibodies, TSH?

A

TSI’s

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22
Q

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

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

Mom 10-15%

Dad: <5%

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23
Q

What is the worst complication of halothane?

A

Hepatotoxicity

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24
Q

Which Coagulation factors decrease with pregnancy?

A

Factor XIII, XI, Protein S and Platelets

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25
Most common cause of mortality in setting of epidural placed for C-S?
Local toxicity
26
Which of the following have associations with advanced paternal age?
Marfan, Achondroplasia, Neurofibromatosis (MAN)
27
What happens to beta cells in pregnancy?
Beta cell islet hypertrophy
28
Which Swan values are calculated?
MAP, SV, SVR, PVR, LVSW
29
Low MCV, HbA2 3.9% Normal Iron Studies, Dx?
Beta Thalassemia
30
What is the mechanism for a β-agonist?
Stim. B2 receptor (G membrane protein) -> activates adenylate cyclase ↑ intracellular cAMP + activates PKA -> inhibits myosin light chain phosphorylation -> ↓ intracellular calcium
31
Which chromosome is oxytocin receptor on?
3
32
Early amniocentesis at 14 weeks is associated with?
It is associated with: fetal loss, club foot, failed procedure, PROM
33
What is the primary location of fetal hematopoesis at 20 weeks GA?
Yolk sac: 3-8 weeks Liver: 6 weeks -> birth Spleen: 8 weeks -> 28 weeks Bone marrow: 18 weeks -> adult
34
In patients with Aortic Stenosis, what changes after epidural can be problematic? How do you avoid this?
Decreased SVR -> Decreased Coronary Artery Perfusion --> MI. Avoid via slow epidural, narcotics only
35
What is used to measure inter-observer variability?
Kappa Score
36
What infection is most likely to be transmitted with breast feeding? a. Hep B b. Hep C c. CMV d. Herpes
CMV
37
Lasix mode of action?
Loop diuretic
38
What enzym is deficient in Gaucher?
Glucocerebrosidase
39
How does IgG cross the placenta?
Pinocytosis / endocytosis
40
What is the Barker hypothesis on fetal programming saying for IUGR fetuses?
They will develop Type 2 Diabetes later in life or metabolic syndrome
41
What are the MOST likely symptoms of multiple sclerosis during pregnancy ?
Variable Course, usually improves
42
Carrier frequency of AR gene if prevalence is 1/6400?
~1/40 q^2 = 1 6400, q = 1/80 p = 79/80, (carrier rate = 2PQ = 2* 79/80 * 1/80)
43
Injury to what nerve causes numbness to medial thigh and labia?
Ilioinguinal
44
Which coagulation factor is decreased in pregnancy?
Protein S, Factor XI, Factor XIII, Platelets
45
Newborn with nose hypoplasia, stippled epiphyses, and limb hypoplasia, dx?
Warfarin embryopathy
46
Most common complication of IUD in pregnancy?
Abortion
47
How do you treat MAI if CD4 is 50?
Azithromycin
48
Most likely to be helpful for treatment of mitral stenosis intrapartum?
Propranolol (Beta blocker)
49
On QUAD screen if estriol is low (0.1MoM), what is the most likely diagnosis?
Icthyoses (placental sulfatase deficiency), less likely Smith-Lemli Opitz (deficiency in 7 dehydrocholesterol reductase)
50
Patient with SLE that has normal fetal anatomy but fetal heart rate noted in 60s. What is the likely cause?
Congenital heart block - from SSA and SSB antibodies
51
``` Pregnancy after endometrial ablation is associated with what outcome most frequently? S Ab PTD Malpresentation Placenta Accreta ```
Malpresentation (39%) Morbidly adherent placenta (26%) PTD (20%) Sab (12%)
52
What is the most likely obstetrical complication related to obesity?
Increased Cesarean Delivery
53
What is Combivir?
Zidovudine (AZT) + Lamivudine
54
What cardiac lesions should be deliverd by cesarean?
``` Dilated Aortic Root >40mm Aortic Aneurysm Recent MI Acute Severe CHF Severe Symptomatic AS ```
55
How do you make the diagnosis of Von Willibrands?
Ristocetin test
56
Which crossed placenta most readily? | T3, T4, TSH, TRH, TSI?
TSI is the most, followed by TRH and Iodine. | There is some T3 and T4 crossing and TSH Tcannot cross the placenta
57
Which anesthetic is the MOST cardiotoxic?
Bupivicaine
58
What is LEAST appropriate for testing for PKU?
Amnio for enzyme activity
59
``` What is least advised in pregnancy if mom has known PKU? amnio for enzyme paternal PKU testing dietary restrictions fetal echo ```
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.
60
How is Fragile X inherited?
X linked dominant
61

Most common non cardiac cause of maternal mortality

Infection

62
Which is not true with preeclampsia at induction of anesthesia? decreased vasoresponsiveness to pressors decreased plasma volume increased coagulopathy
decreased vasoresponsiveness to pressors
63
Which anesthetic has a risk of CAUSING withdrawal? Why?
Stadol (Butorphanol), it’s a mixed mu-agonist antagonist
64
Which is best test if using multiple variables to assess surival?
cox regression
65
What does PCWP approximate/indicate?
LV preload / filling
66
Most likely cause of a nonreative tracing in a term fetus
Sleep cycle
67
Which of the thyroid related substances crosses the placenta most rapidly?
Thyroid stimulating antibodies/immunoglobulins
68
Which seizure medication is most affected by maternal liver failure?
Dilantin (Phenytoin)
69
Which ultrasound parameter predicts placenta accreta most accurately?
Lacunae
70
Aldomet Mode of action?
Central alpha blocker
71
Which infection is a transplant patient least susceptible to compared with non-transplant patients? E. coli, CMV, Chlamydia?
Chlamydia
72
Which statistic test is used to differentiate between dependent and independent variables?
Logistic Regression
73
At 30 seconds of resuscitation of a neonate, the HR is still low, Next step?
PPV
74
What is the most likely outcome with AS? a. Arrhythmia b. Stroke c. MI d. Heart failure e. Maternal death
``` Heart Failure (7-17%) Arrhythmia (3-33%) ```
75
Choroid plexus cysts are most commonly associated with which aneuploidy? 1. T21 2. T13 3. T18
T18 | 30-50% of T18 have CPC
76
What are the two AF molecules elevated with aplasia cutis?
AFP and Acetylcholinesterase | - elevated with all open wall defects
77
At which phase do type 2 pneumocytes appear?
Cannalicular
78
Aneuploidy with duodenum abnormality?
T21 in 30%
79
What drug is commonly associated with microotia?
Isoretinoin
80
Which IL is antiinflammatory?
IL10
81
Levels of which drug are least effected by liver metabolism? | Lovenox, Warfarin, Dylantin?
Lovenox
82
How do you treat a patient with Pulmonary hypertension, and you want to give general anesthesia.
Viagra
83
Which HIV medication should be avoided in first trimester?
Efavirenz (NNRTI)
84
Best medication for anticoagulation in pregnancy?
Lovenox
85
Which translocation most likley to result in fetus with T21?
21:21 Homologous 21 translocation
86
Which fetal vessel has the lowest PO2?
Umbilical Artery
87
Which thombophilia is the most common?
Factor V leiden
88
What are the criteria for pre-eclpamsia with severe features?
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
89
Which inheritance pattern is most associated with variable penetrance?
Autosomal Dominant
90
What is not associated with placental thickening? a) Syphilis b) Rh Issoimmunization c) Non-immune hydrops d) Listeriosis
Listeriosis
91
Who should receive prophylaxis for endocarditis?
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
92
Doppler studies reflect what parameter?
Velocity
93
What is the risk of NAIT in a subsequent pregnancy?
If father's antigen zygosity determines he is homozygous: 100% risk Heterozygous: 50% risk
94
What is the most likely cause of pain from a Wet tap?
Traction of nerves from CSF leak
95
``` All of the following diseases are associated with DNA repeats except: Fragile X Huntington's CF Myotonic Dystrophy ```
``` Cystic Fibrosis Repeats: FraGile X (CGG) Huntingtons (CAG) MyoTonic Dystrophy (CTG) ```
96
CVS cannot diagnose which conditions?
NTD | Fragile X
97
Woman with MCV of 62, normal ferritin, HgbA2 4.2%. Most likely cause:
Beta Thalassemia
98
1. Which anomaly is LEAST associated with very ill neonate after birth a. Interrupted aortic arch b. AV canal c. Other CHD
AVSD
99
Triple screen shows a normal AFP, normal HCG and a low E3. What condition is this associated with?
X-linked icthyoses and SLOS
100
Fetus with thyrotoxicosis/hyperthyroidism will have the following issues:
Issues with fetal hyperthyroid are - Heart rate greater than 160, growth retardation, advanced bone age, craniosyostosis Occasionally Hydrops
101
pCO269, HCO3 20, BE -2
Mixed
102
What is the heart ultrasound finding most commonly associated with DiGeorge?
Interrupted Aortic Arch
103
The most accurate description of Standard error is?
The same as standard deviation
104
GnRH is made in which tissue?
Cytotrophoblast and Decidua
105
Betamethasone decreasese what in fetuses?
Fetal Breathing and movement
106
Most likley diagnosis with fetal unilateral pleural effusion?
Hydrothorax
107
Which of the following is not a uterotonin? a) Endothelin-1 b) Prostaglandins c) Oxytocin d) Calcium
Calcium , its needed for contractions, but isnt a factor that causes them like Endothelin, PG and Oxytocin
108
Mechanism of anemia in parvovirus? | hemolytic effect, viral effect on erythroid precursors?
Effect on erythroid precursors
109
Gaucher's disease is a disorder of:
Glucocerebrosidase
110
What is the most common trisomy in first trimester abortuses?
Trisomy 16
111
What maternal cardiac disease is associated with a poor prognosis?
VSD with R-> L shunt (Eisenmenger)
112
What is the most common adverse effect of general anesthesia?
Nausea and vomiting
113
What is the mutation in Osteogenesis Imperfecta? Inheritance?
COL1A1 and COL1A2 (autosomeal dominant)
114
What is most likely diagnosis of ambiguous genitalia?
CAH
115
If a prior infant born with severe thrombocytopenia, what is the first step for testing in current pregnancy?
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
116
What type of inheritence is associated wuth Leber's optic atrophy?
Mitochondrial
117
Which of the following syndromes is caused by uniparental disomy?
Angelman Beckwith Prader- Willi
118
Maternal death is most associated with?
Cardiac Disease
119
How long should you use Iodide for?
No more than 2 weeks as it increases the risk of fetal goiter (due to lack of release of the stored thyroid hormone)
120
What defines Stage 3 TTTS?
``` Doppler abormalities (AEDF, REDF) Stage 1: Poly/oli Stage 2: Absent bladder Stage 3: Doppler AEDF or REDF Stage 4: Hydrops Stage 5: Death ```
121
What is the mechanism of fetal anemia caused by parvovirus?
Cytotoxic to erythrocyte precursors
122
``` Which PG is not associated with labor? PGE 1 PGE 2 PGE 3 prostacyclin thromboxane ```
Prostacyclin
123
Why is there increased placental transport of Meperidine (aka Demerol) in the acidotic fetus?
Ion Trapping because demerol is a basic drug (Decreased Isoelectric point)
124
What mechanism does cAMP work in B-mimmetic?
↑ intracellular cAMP-> activates PKA -> Phosphorylates myosin light chain Kinase (Which inactivates it) -> ↓ intracellular calcium and Muscle Relaxation
125
What is associated with pancytopneia and absent radius?
Fanconi's anemia
126
What enzyme deficiency is seen with hydantoin syndrome?
Epoxide hydralase
127
What is the most likely cause of low estriol levels?
Placental sulfatase deficiency (XLI) or SLOS
128
What is the most common fetal anaomaly in obese patients?
Neural tube defects / Spina Bifida
129
What is an obligate precursor for NO?
L-arginine
130
What is an early sign of TTTS?
NT and CRL discordance
131
Low MCV, HbA2 2.2% Low Iron Studies, Dx?
Iron deficiency anemia
132
What is the most common reason for birth defects?
Genetic
133
What syndrome has coarctation of the aorta?
Turners
134
Which is the stats term used for inter-observer agreement?
kappa (intra observer variability / agreement)
135
What is the most common presentation of neonatal lupus?
Rash and second thrombocytopenia
136
Chorioangioma – most likely complication?
Polyhydramnios in 60% vs FGR in 20%
137
What physical finding on a baby is associated with a term birth?
Scrotal Rugae
138
Which ashkenazi disease is treatable with enzyme replacement?
Gauchers
139
What crosses the placenta via Simple Diffusion?
COKED - CO2, O2, Ketones, Electrolytes, Drugs (most)
140
What does Barker theory of fetal programming say about IUGR fetus at most risk of?
1. Metabolic syndrome
141
Very Low Estriol levels are most commonly associated with what?
Placental Sulfatase Deficiency, X linked icthyoses, SLOS
142
What mutation happens in Duchenne Muscular Dystrophy?
Deletion of Exons (X-L-Recessive)
143
Diazoxide mode of action?
Thiazide analog (non-diuretic, vasodilator)
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
Prematurity
145
What does CVP approximate/indicate?
RV Preload / filling
146
Atenolol mode of action?
Beta blocker
147
A normal woman has a homozygoous 21/21 translocation. What percent of her offspring will have Down syndrome?
100%
148
Which disease is AD and is associated with telengiectasia, ataxia, thrombocytopenia?
Osler Weber Rendu
149
Which of the following is LEAST associated with an enlarged placenta: a) listeria b) Parvo c) NIH d) syphilis e) toxo
Toxoplasmosis, syphilis, and parvo can all cause non-immune hydrops, which has placentamegaly as a feature.
150
Which headache gets worse with sitting standing and better with laying flat?
Spinal Headache
151
Fetal thyrotoxicosis with heart failure in a mom with s/p thyroid ablation, whats the likely diagnosis and treatment?
Maternal Graves (TSI antibodies still present despite ablation), PTU
152
Prophlyaxis for mycobacterium avium with CD4 count 45 is?
Azithromycin when CD4 < 50
153
Least likely symptom with H1N1? | Nausea/Vomitting, Cough, Fever, Sore Throat?
Nausea/Vomitting
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
Amnio for toxo PCR (immature fetal immune system so less likely to make Antibodies and IgG may be moms)
155
What US findings are associated with Meckel Gruber?
Multicystic dysplastic Kidney, Encephalocele, Postaxial Polydactyly
156
Patient has an MCV of 69 and Hgb A2 of 4% on electropheresis, what is the MOST likely diagnosis?
Beta thalassemia
157
What is the most common genetic cause of mental retardation?
Fragile X
158
What is the reason for maternal hypoxia at time of induction of general anesthesia?
Decreased Functional Residual Capacity
159
Microtia associated with other drugs then isotretinoin?
Thalidomide, Mycophenolate
160
Greatest risk with lupus nephritis?
Preeclampsia
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
Multicsystem organ failure
162
How do you diagnose NAIT?
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)
163
What happens to gluconeogenesis with persistent fasting in pregnancy?
Gluconeogenesis is not increased, as would be expected. | Prolonged fasting in pregnancy is accompanied by exaggerated hypoglycemia, hypoinsulinism, and hyperketonemia.
164
``` What condition results from pituitary deficiency? acromegaly diabetes insipidus addisons cushings ```
Diabetes Insipidus (Decreased ADH from Posterior pituitary)
165
Most common outcome if NT is increased?
Normal
166
Neonate with limb and muscle hypoplasia, derm and | eye finding, Diagnosis?
Congenital Varicella
167
Which Aneuploidy is most common with CDH?
T18
168
Discrepancy in which is best for TTTS diagnosis?
Amniotic Fluic (Poly/Oli)
169
Which medication increases cardiac contractility?
Beta agonist
170
Which is helpful for treatment of HIE?
Cooling
171
Which fetal organ system is subject to malformations the longest?
Nervous system
172
In a retrospective study, do you use Odds ratio or relative risk?
Odds Ratio
173
Weight of the uterus at term? Non pregnant?
The uterus weighs 1100-1200 g at term. Non-pregnancy <100g.
174
Best outcome following in utero repair of myelomeningocele is seen with?
Lower limb muscle strength
175
Management of Acute Fatty Liver of Pregnancy?
Delivery despite gestational age
176
Treatment of NAIT should be? At what gestational age?
IVIG, starting at 12 weeks
177
Which is least likely with listeria? | preterm labor, chorioamnionitis, hydrops?
Hydrops (one of the less common etiologies of hydrops)
178
What is FGR at 20 weeks most associated with?
Triploidy, If >26 weeks probably Trisomy 18
179
Which Coagulation factors increase in pregnancy?
Fibrinogen, Factor VII, Factor X, vwF:Roc
180
At term which fetal organs get the most blood flow?
``` #1 Placenta #2 Brain #3 Lungs ```
181
Which maternal cardiac lesion most associated with fetal hypoxia?
Pulmonary Hypertension
182
Surfactant treatment of a 28 week newborn will help decrease what the most?
Neonatal Mortality
183
What is the first line medication when there is uterine inversion?
Terbutaline , second line Nitroglycerine
184
What are the features of Warfarin Embryopathy?
``` SLIMNECk Stippled Epiphysis Limb Defects IUGR MR Nasal Hypoplasia Eye Defects CNS k - Vit K Antagonist Warfarin ```
185
What does a class 1 MHC get attacked by?
Cytotoxic T cells
186
What is more convincing situation to intubate, hypoxemia or hypercapnea?
Hypercapnea
187
These drugs should not be used in patients with myasthenia gravis except: a) Curare b) Magnesium c) Gentamicin d) Mestinon
Mestinon (used to treat Myasthenia gravis)
188
Which IL is a regular component of amniotic fluid?
IL8
189
Which disease is most transmittable in breastfeeding?
CMV
190
What is NOT seen with hyperparathyroidism or an increase in maternal calcium? a. Hypercalcemia b. Htn c. Fetal intracranial calcification d. Neonatal hypocalcemia
Fetal intracranial calcification
191
Pfannestial incision opening rectus muscles, what vessels are most likely injured?
Epigastric vessels
192
Which anesthetic has the shortest halflife?
Chloroprocaine
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
MTHFR
194
Which artery can be injured when separating the rectus muscles during a c-section?
Inferior epigastric
195
Which is the MOST diagnostic of primary adrenal insufficiency in pregnancy?
They develop hypotension from HYPONATREMIC volume contraction
196
What influences the volume of AF the least in pregnancy? a. Swallowing b. Urine production c. Maternal weight d. Dehydration e. Transudation
Maternal weight
197
Which anesthetic has the fastest onset of action?
Lidocaine
198
Most severe manifestation In listeria is?
The main manifestation of Listeria is stillbirth.
199
What is pulmonary capillary wedge pressure (PCWP) reflects?
Left Ventricular Preload
200
NTD is associated with what intercranial findings?
Banana sign Lemon sign Ventriculomegaly Small cisterna magna
201
Which of the following are findings in BV?
pH>4.5 +Whiff test Thin homogeneous discharge >20% clue cells
202
Which parameters are directly measured by Swan?
``` HR CVP Pulmonary artery systolic and diastolic pressure PCWP Cardiac output ```
203
What aneuploidy is seen with holoprosencephaly and midline facial defects?
Trisomy 13
204
Which of the following is the action of platelet activating factor on myometrial cells?
Increases intracellular Calcium
205
IUGR is most associated with what later in life?
metabolic syndrome / dm2
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
Coumadin is the most appropriate medication for long-term anticoagulation and is compatible with breastfeeding.
207
Patient presents postpartum with fever, renal failure, anemia. Dx? Tx?
TTP, Plasmapheresis
208
Why does creatinine decrease in pregnancy?
Increased renal perfusion and renal plasma flow (GFR)
209
Pattern of glucose levels by time of day in pregnancy?
Decreased fasting levels, Increased postprandials
210
Precursor for Fetal Steroid Synthesis?
Maternal LDL
211
What is the most common finding with Trisomy 21 on sono at 18-20 weeks?
Nuchal Fold
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
Decreased variability
213
What is the most common non-infectious, non-genetic cause of MR?
Fetal alcohol syndrome
214
Which lab measuring cardiac ischemia/function can be increased after vaginal delivery?
CKMB - found not only in myocardium but also in uterus and placenta.
215
Which statistical test will account for survival accounting for multiple variables?
Cox Regression
216
What is a unilateral pleural effusion in a fetus is most likely due?
Hydrothorax
217
Which ethical principle explains a Dr/Patient relationship?
Beneficence
218
What karyotype is suggestive of uniparental disomy?
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)
219
Evaluate the effect of Smoking on Lung Cancer, what type of study?
Case Control
220
Facial nerve palsy is a complication of which Operative delivery method?
Forceps
221
Which adrenergic receptors are present on the myometrium?
1. α1: ↑ Phospholipase C -> ↑Protein Kinase C & Calsium 2. β2: ↑ Adenylyl Cyclase -> ↑ CAMP --> ↑ Protein Kinase A
222
Risk of NTD with valproic acid?
1-2%
223
When a CVS result is mosaic, what is the most likely outcome?
Confined placental mosaicism
224
After cardiac arrest, when should delivery ideally occur ?
Within 5 minutes (If spontaneous circulation does not occur within 4 mins of effective CPR)
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?
.1/50
226
Most common location of brain bleed in premature infant?
Germinal Matrix
227
What are the main features of Fetal Alcohol Syndrome?
``` Mental retardation Cardiac Septal Defects Growth Restriction Smooth Filtrum Small upper lip Small Palpebral fissures Kidney Abnormalities ```
228
What does wedge pressure measure?
LV filling pressure
229
Most common obstetric fistula?
rectovaginal fistula
230
Karyotype shows 45XX t(14;21). What is the phenotype?
Normal | Balanced translocation
231
How can you distinguish preeclampsia from lupus flare?
Increased Urine Sediment, Decreased CH50 activity, Anti DsDNA
232
What is another name for Bupivicaine?
Marcaine
233
Swan readings for PE?
Increase: Pulmonary artery pressure
234
Pregnant patient with ab pain and bloody stool?
Stool culture
235
What is the best study design to look at a disease and link to a risk factor? Example: smoking and cancer
Case control: | Compares a group with disease to a group without and looks back at risk factor
236
What is associated with fetal abdominal calcifications?
CMV
237
How do you differentiate betweem TTTS and TAPS?
MCA Dopplers (MCA PSV >1.5MoM in one twin and <0.8 MoM in the other twin )
238
Which TB treatment is teratogenic? What does it do?
Streptomycin is contraindicated - as it is associated with hearing loss
239
Which Respiratory functions don’t change in pregnancy?
1. Vital Capacity 2. Respiratory Rate 3. FEV1
240
What confers the worst neonatal prognosis in CMV?
Microcephaly
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
Chi squared?
242
Which bacterial enzyme is most associated with preterm birth?
Phospholipase a2
243
Which condition is most likely associated with aneuploidy? 1. Cardiac 2. Omphalocele
Omphalocele
244
Baby delivered and tried to resuscitate, Post ductal O2: 70%, Preductal 90%, likely diagnosis?
Persistent fetal circulation
245
Patient with elevated HbA1c (10%), what is the most likely finding on ultrasound?
Normal
246
NTDs are usually: a) Due to single gene defects b) Caused by teratogens c) Multifactorial d) Aneuploidy
Multifactorial
247
Preload and afterload fixed, what increases CO?
beta adrenergic (dobutamine)
248
What is the most predictive of transmission of HIV to baby?
Viral load/HIV RNA
249
What does a ROC curve represent?
Compares sensitivity and specificity y = sensitivity x = 1-specificity
250
What is the ethical principal which states a physician must refrain from providing ineffective treatments or acting with malice toward patients
Non-maleficence
251
What is the positive predictive value of an NST for cerebral palsy?
<1%
252
Algorithm for managing SVT?
``` #1) Vagal maneuvers (holding breath, valsalva) #2) Carotid Massage #3) Adenosine #4) Verapamil #5) Beta blocker ```
253
Which medication is contraindicated in women with chronic hepatitis for HIV treatment?
Nevirapine, less so Lopinavir/Ritonavir (Kaletra)
254
Which error is failing to reject the null hypothesis when its false?
Type 2 Error (failed "2" reject the null)
255
What Ultrasound finding is agenesis of the corpus callosum most associated with?
Absent CSP | Also colpocephaly
256
What is the best way to monitor improvement in metabolic acidosis in DKA?
Anion gap
257
Most common complication with general anesthesia?
Failed Intubation
258
Why does T4 demand increase in pregnancy?
Increased TBG, to maintain adequate free T3 T4 there is increased production
259
Which is true regarding oxygen dissociation curve?
A fetus has higher O2 saturation at any PO2 than mom
260
Which maternal cardiac lesion is associated with the greatest fetal oxygenation risk?
Pulmonary Hypertension
261
Patient meets clinical criteria for antiphospholipid syndrome. Recommended testing?
Lupus Anticoagulant (Kaolin, Dilute russelll venom viper test, B2 Glycoprotein, Anti Cardiolipin Antibody
262
What is the principal substrate for oxidative metabolism in the placenta?
Glucose
263
Patient can't dorsiflex after forceps delivery, which nerve injured
Common Peroneal
264
Genetic screen test shows a normal AFP, normal hCG, and a low E3. What condition is this associated with?
X-linked Ichthyosis (placental sulfatase deficience) or SLOS (DHCR7 deficiency)
265
Most likely genetic cause of early IUGR?
<26 weeks think Triploidy | > 26 weeks think T18
266
Newborn with Thrombocytopenia and Interventricular Hemorrhage, likely Diagnosis?
Alloimmune thrombocytopenia
267
Which maternal cardiac lesion most likely transmitted to fetus?
IHSS (autosomal dominant)
268
Patient with 8 week IUP has IUD in place, develops fever, chills, abdominal pain. What should you do next?
1. Remove IUD, then evaluate for other causes of abdominal pain / fever and check for signs of septic abortion.
269
Which fetal anomaly has highest risk of malignancy?
CCAM (Pleuropulmonary blastoma and bronchoalveolar carcinoma )
270
What is the most common Adverse effect of AZT?
Anemia (next is neutropenia)
271
Baby with transposition, cleft lip and facial abnormality. Diagnosis?
DiGeorge
272
What represents a thyroid profile of first trimester?
TSH decreases slightly | FT4 remains same
273
Which nerve injury causes decreased mons sensation?
iliohypogastric
274
What does maternal blood come into direct contact with in the intervillous space of placenta?
Syncytiotrophoblasts
275
Which tests are positive if you are chronically infected with Hep B?
Surface antigen and core antibody (anti-HBc)
276
What is a prolonged aPTT in a patient with pre-eclampsia is most likely due?
APLS
277
Greatest finding of the MOMS trial?
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%)
278
When is CVS not recommended?
In cases of Isoimmunizatio/Alloimmunization (NAIT, Kell, Rh)
279
What is the best way to determine chorionicity in twin gestations?
Twin peak sign
280
Delayed cord clamping improves which outcome in preterm infants? What about in term infants?
Preterm: Decreased: Necrotizing Enterocolitis, IVH, need for transfusion Term: Increased Hb and Iron stores
281
What is the precursor for fetal steroid synthesis?
LDL
282
If a CVS shows balanced translocation, what should you do next?
Maternal karyotype
283
``` Ultrasound findings would increase the risk of Down syndrome, except: Duodenal atresia Increased Nuchal Fold Cardiac anomaly Short femur Sandal gap ```
Sandal gap
284
What is not covered by Cephalosporins? a) Enterococcus b) Group A Strep c) Group B Strep
Enterococcus
285
When should you treat potential fetal CAH and with what medication?
7-8 weeks, Dexamethasone to prevent virilization (CVS, if male stop treatment, if female continue)
286
Which syndrome is associated with fetal thrombocytopenia? 1. Absent radius 2. Gestational thrombocytopenia 3. Erythroblastosis fetalis 4. Bernard Soulier syndrome
TAR Syndrome - Thrombocytopenia, Abset radius syndrome (but thumb present) Which can also pretsent with Kidney or Heart issues
287
Anomaly of what system is most commonly seen with diaphragmatic hernia ?
Cardiac
288
What is the most common problem for a term IUGR infant?
Hypoglycemia
289
What is the treatmet for TB?
1. Rifampin 2. Isonoazid 3. Pyrazinamide 4. Ethambutal
290
Which of the following is most associated with aneuploidy in isolation? cleft lip, gastroschisis, EIF, hydronephrosis, or ventriculomegaly?
Ventriculomegaly (3.81X LR)
291
What is the most likely complication of pregnancy conceived with IUD in place?
SAB - 3x more likely (50%)
292
Which ethical concept is informed consent most closely tied to?
Autonomy
293
What are the findings of Neonatal Myasthenia Gravis?
Poor cry, decreased muscle tone, respiratory muscle weakness
294
What does treatment of GDM improve?
Lower rates of macrosomia
295
Physical Signs of fetal immaturity
``` 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) ```
296
What enzyme is associated with Hydantoin syndrome?
Epoxide Hydrolase. Teratogenicity of several anticonvulsant medications is associated with elevated level of oxidative metabolites normally eliminated by epoxide hydrolase
297
Which is the best way to randomize?
table of generated numbers with block randomization
298
What does not get absorbed in patient with Roux-En-Y bypass vs. gastric banding?
B12 Deficiency
299
What is the most common complication of SLE on pregnancy?
1. Pre-eclampsia (8-20%) 2. PTL (spont and indicated - 20-50%)
300
MCA is not helpful for which of the following? | Sickle cell, kell, Anti-D
Sickle Cell (they have Fetal Hb, so no bad anemia in utero)
301
Foot drop is associated with what nerve injury:
Peroneal
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 –
colpocephaly (tear drop ventricles)
303
Most associated with placental insufficiency? | Low Papp-A, High Papp-A, HcG?
Low Papp-a
304
Which study type is ideal for studying rare outcomes/diseases?
Case-Control Study
305
Twins, when do you not do a CVS?
With Alloimmunication
306
What is the most likely cause of fetal Macrosomia?
Prepregnancy obesity
307
39 week patient with a DVT, management?
Therapeutic Heparin
308
Most common presentation of Turners syndrome?
Short Stature
309
Which congenital cardiac lesion is most likely to result in a clinically stable infant immediately postpartum?
Complete AV canal
310
What is most resistant to GBS? a) Erythromycin b) Clindamycin c) Penicillin d) Azithromycin
Erythromycin
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?
1% Recurrent risk: 1-2% Primary infection: 40-50%
312
Which infection poses the greatest risk for maternal mortality?
Varicella (likely #1), maybe H1N1 if no varicella
313
Which fish should be avoided in pregnancy?
King Mackeral
314
Triple screen with nl HCG, AFP but very low estriol, think?
X-linked iccthyosis(Placental sulfatase deficiency) and SLOS
315
What is the most likely risk from regional anesthesia?
Toxicity from local anesthetic
316
How do you differentiate between CCAM and CHAOS?
In Chaos you have inverted diaphragm
317
What is the most likely to have a low estriol? a. IUFD b. Trisomy 21 c. Placental sulfatase deficiency
Placental Sulfatase Deficiency
318
Complications associated with Herpes Gestationis?
PTD, IUGR, increased neonatal mortality
319
Which cardiac lesion is most specific with T21?
AV Canal defect
320
Which situation allows you to override patient confidentiality?
someone in serious danger
321
Findings in autonomic dysreflexia?
Hypertension, Bradycardia, Flushing
322
Which enzyme deficiency is a concern with chloroprocaine?
Pseudocholinesterase
323
Which lab result is most indicative of recurrent CMV infection?
IgM: + IgG: + High IgG avidity
324
What is the disease characterized by a deficiency in aspartoacylase?
Canavans
325
Which is the most likely neonatal complication with PKU?
Mental Retardation
326
Which medicine is NOT associated with PPHN? | Keppra, NSAIDs, SSRIs
Keppra
327
What crosses the placenta via active transport?
PICA - Phosphorous, Iron, Calcium, Amino Acids
328
Multiple Sclerosis is most associated with which pregnancy complication?
IUGR (MS = Mighty Small)
329
How do you monitor improvement of metabolic acidosis in DKA?
Follow anion gap
330
When can a physician override refusal of treatment?
Lack of capacity
331
What is the prevalence of asymptomatic bacteriuria in pregnancy? a) 5% b) 15% c) 25%
5%
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
Lower O2 than uterine vein
333
What pattern of inheritance is passed through maternal only?
Mitochondrial
334
``` Postpartum thyroiditis has all the following symptoms except? Depression Tachycardia HTN Diarrhea ```
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.
335
Which rate of dopamine infusion improves renal blood flow?
Low dose, <5ug/kg/min for renal blood flow
336
Why does NPH stay longer in body than aspart?
Increased halflife due to protamine and pH
337
Best Rx for mom with dyspnea, cyanosis, large VSD and R to L shunt at 28 weeks?
Viagra
338
What crosses the placenta via Endocytosis?
IgG, LDL, Insulin (If IgG), Transferrin
339
TTTS is best diagnosed with a discrepency in what ?
Amniotic fluid volumes
340
Which affects fetal growth the most?
Fetal Insulin, HPL (aka human somatomammotropin)
341
What increases alveolirization in the lungs?
Thyroxine or Vitamin A
342
The fetal organ that receives the highest proportion of cardiac output:
Placenta
343
Most common complication with insulin pump?
Site infection, asymptomatic hypoglycemia
344
What is the most likely reason to intubate a pregnant lady?
Respiratory acidosis
345
# Choose the highest risk of contracting hepatitis B. a) Whole blood b) Cryoprecipitate c) Albumin
Cryoprecipitate is pooled from multiple donors, thereby increasing the risk for Hepatitis B infection.
346
What are the key abnormalities with Meckel Gruber?
Post-axial Polydactyly Multicystic Dysplastic Kidneys Encephalocele
347
Which cells are the innate immune cells? | Which are the adaptive immune cells?
Innate: NK, Monocytes, macrophages, trophoblasts | Adaptive: B cells and T cells
348
3+ groups which statistical test?
ANOVA
349
Does obesity increase risk of NTDs?
YES
350
Which is the usual cause of hemodynamic decompensation with mitral stenosis peripartum?
Increased Preload
351
Discrepancy between cfDNA and fetal Karyotype, what can cause this?
Confined placental mosaicism
352
What molecule gets degraded most by the placenta?
Prednisone/Prednisolone - by 11 β-hydroxysteroid dehydrogenase Type 2
353
Name 3 diseases that can be treated with IVIG?
IVIG is a proven treatment for myasthenia, NAIT, and ITP.
354
What clinical scenario should cause you to test for Antiphospholipid Antibodies?
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)
355
Mom with uncontrolled hyperthyroidism, what are the most common pregnancy complications?
``` #1: Preeclampsia #2: Growth Restriction #3: Preterm delivery ```
356
Which maternal karyotype has the highest risk of Down syndrome?
21:21 Translocation (100% of live babies are T21, but of total gametes 50% would be monosomy 21)
357
Nuchal translucency is 5.4mm. Next best step?
CVS (genetic testing)
358
What are the branches of the Internal Iliac Artery?
``` 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
359
How does iodide treatment work?
Decreases the circulating supply of T4 and T3 by inhibiting release of stored thyroid hormone.
360
A patient has mitral stenosis, what do you give to block intubation reflex hypertension?
Nitroprusside, In patients in whom hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation.
361
In Mono-Di twins, at what day does cleavage occur?
4-8 days
362
16. Which causes a recurring fever? a. Listeriosis b. Syphilis c. Lyme dz d. Others
Lyme Disease, Brucellosis also
363
Which medication decreases OCP efficacy?
Carbamezapine, Phenytoin, Rifampin
364
If a patient refuses CD for fetal indications, what should you do?
Continue taking care of patient and don't proceed with CD. Respect patient wishes
365
Patient presents with IUFD, severe iugr + omphalocele, + large kidneys, what lab should you send?
Karyotype and Microarray
366
Antihypertensive with most evidence for association with IUGR?
Atenolol
367
Swan readings for pulmonary edema?
Increase: PCWP > 18, CVP
368
A patient is newly diagnosed with HIV not previously on any medication. What is the best way to prevent HIV transmission?
AZT (zidovudine)
369
What is the precursor to estriol?
C9 Precursor DHEAS (from the fetal adrenal, fetal zone)
370
If a preterm baby develops respiratory distress after delivery and Preductal SpO2: 90%, post ductal: 70%. What is the diagnosis?
Persistent fetal circulation (Ductus arteriosus) or PPHN (same thing)
371
``` Which would decrease drug transport across placenta? increased lipid solubility increased protein binding decreased ionization placental degradation ```
Increased protein binding
372
What is the best treatment for in utero CAH?
Dexamthasone, starting at 7-8 weeks. To prevent virilization of female fetus
373
What should the work up of a woman with a Spontaneous Abortion at 12 weeks include?
Antiphospholipid Antibodies
374
Most common cause of Polyhydramnios?
Idiopathic
375
Most common complication of PKU? | What is the most common structural complication in PKU?
Mental retardation = most common | Cardiac (hence we do echo's on these fetuses) = most common structural
376
Most direct biochemical cause of a myometrial contraction?
Myosin Light Chain Kinase
377
What mechanisms result in uniparental disomy?
2 chromosomes inherited from one parent, trisomic rescue | Ex: Beckwith, Angelman, Prader-Willi
378
Treatment for HIV+ women with Viral load > 1000 near term?
Cesarean at 38 weeks, Continue ART therapy, and start AZT 3 hours prior to cesarean
379
``` Which of the following is not associated with AMA? T21 T13 T18 45XO ```
45 XO
380

What percentage of Rh negative patients who do not receive Rhogam will be sensitized?

15%

381
What affects positive predictive value (PPV) the MOST?
Prevalence
382
Physiology of late decelerations?
Chemoreceptor reflex
383
What is the most common complication of SLE on pregnancy?
1. Pre-eclampsia (8-20%) | 2. PTD (spont and indicated - 20-50%) - Not spontaneous PTB
384
Which cancer do OCPs decrease the least?
Breast Cancer
385
In which patients can you give OCPs? 1. Hx of DVT 2. Migraine with aura 3. Type 1 DM 4. Active viral hepatitis
Type 1 DM
386
What is the definition of imprinting?
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)
387
Which is not associated with IUGR? | Hyperthyroidism, sickle cell, parvo
Parvovirus (anemia and heart failure, not usually FGR)
388
Most common complication of SSRI used in pregnancy used in a neonate?
Neonatal Abstinence
389
If maternal thyroid function is well controlled but fetus develops goiter. What test should you do?
Check maternal Thyroid Peroxidase Antibody; Thyroglobulin Antibody; Thyroid Stimulating Hormone Receptor Antibody (All synonyms for TSI)
390
What is the risk of cystic fibrosis if fathers sister has CF and carrier rate is 1/25?
1/150
391
Greatest contraindication to postpartum combined OCP's hemorrhagic stroke w/ eclampsia sagittal vein thrombosis ovarian vein thrombosis
Sagittal Vein Thrombosis
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
Nevirapine (in combination with AZT or if AZT is unavailable)
393
What are the features that make a drug more likely to cross the placenta?
Low molecular weight Lipophilic (soluble) Nonpolar (not ionized) Unbound to protein
394
Which cell is not part of innate immunity?
Monocyte
395
Best Treatment for a Pheochromocytoma
Phenoxybenzamine (Alpha Blocker)
396
Baby has an amniotic band, do you remove them?
Yes if it is wrapped around a limb and there is some sort of blood flow disruption in post band vs. pre band.
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 ```
Increased BPD
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
Amniotic Fluid IL6
399
Histologic Chorioamnionitis without clinical signs of infection is associated with what neonatal complications?
Interventricular hemorrhage, periventricular leukomalacia and Cerebral palsy
400
What is Methadone LEAST likely to result in?
Congenital anomalies
401
What drug is impermeable to the placenta?
Insulin, except if IgG bound
402
Holoprosencephaly is most commonly associated with which of the following chromosomal abnormalities?
Trisomy 13
403
What hormone decreases after delivery to allow for lactation?
Estrogen
404
Which mode of inheritance applies to penetrance and variable expressivity?
Autosomal Dominant
405
What lab value are features of DKA?
PH: <7.3 HCO3: <15 AG: >12 +Ketones
406
What is Alpha Error?
Type 1 error (False Positive, rejecting the null when we should have kept it)
407
Which finding is the MOST common in Meckel-Gruber syndrome?
Multicystic dysplastic Kidneys (100%)
408
Placenta degrades _____ the most: a. Betamethasone b. Prednisone c. Insulin d. Heparin
Prednisone
409
CDH, IUGR, VSD , most likely diagnosis?
T18
410
How is calcium transported across placenta?
Active transport
411
Most common complication of neontatal thrombocytopenia?
Rash more than thrombocytopenia
412
Neonate has apnea and bradycardia after 60 seconds with PPV, what is next BEST step ?
``` 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) ```
413
Which infertility treatment is associated with hypospadias ?
ICSI
414
What cardiac anomaly cannot be identified with 4 chamber view ?
TGA Coarctation VSD
415
Marfan Aortic root recommendations?
Recommend beta blockers, cesarean delivery for aortic root >5. Recommend repair prior to pregnancy for aortic root >4
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?
.1/24
417
The main factor that influences fetal growth?
Insulin, HPL
418
If a mom is exposed to parvovirus 3 days ago at 18 weeks GA, what is the most appropriate testing at this time?
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)
419
What is the main source of PGI2 in pregnancy?
The Myometrium
420
Which hepatitis can cause chronic active hepatitis and cirrhosis?
Hep C
421
Formula for odds ratio is?
AD/BC, ratio of exposed cases to unexposed cases divided by ratio of exposed controls to unexposed controls (The wording really was this convoluted)
422
What stage is a fetus with abnormal Dopplers?
Stage 3
423
What is the most likely outcome with demise of one twin in a MCDA pair?
Neurologic Sequelae in the surviving twin (15-25%)
424
When does Relaxin peak?
8-12 weeks
425
What condition with CF carries a poor prognosis?
Cor Pulmonale
426
NO reacts with what to produce cGMP?
Iron
427
External Genitalia differentiation stimulated by what hormone?
LH which stimulates testosterone
428
What is the risk of transmission in the first trimester with primary CMV infection
40%
429
What dictates delivery mode in patients with ITP?
Obstetrical reasons
430
What crosses placenta via Facilitated diffusion?
Glucose
431
A woman with a prolactinoma wants to breast feed, you advise?
Okay for microadenoma prolactinoma to breast feed
432
If a patient tests IgM positive at 20 weeks for parvovirus, how long should the pregnancy be monitored?
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)
433
A normal woman has a homozygoous 21/21 translocation. What percent of her conceptuses will have monosomy 21?
50%
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
1/150
435
Which hormone decreases surfactant synthesis?
Insulin - delays surfactant production
436
The benefit of doing a multivariate analysis in a cohort study is?
Decrease confounding
437
What is increased in the fasting state in pregnancy?
Cholesterol, depends on this for energy NOT gluconeogenesis
438
What effects on lipids does Depot Provera have?
↑ LDL | ↓ HDL No change in triglycerides
439
What is the origin of cell free dna?
apoptosis of placental cells (syncytiotrophoblast)
440
Which medication is the best anticoagulant to prevent clot in pregnancy:
Lovenox
441
What is MOA of iodine in maternal thyroid function?
Blocks release of thyroid hormone from the gland
442
What is associated with graft versus host?
Erythema multiforme
443
What medications can decrease the effectiveness of OCP's
Phenytoin, Carbamezapine, Rifampin
444
Most common Uterine Anomaly with Pregnancy loss?
Septate Uterus
445
Which anesthetic has greatest cardiac risk?
Bupivacaine (Marcaine)
446
If the father has a balanced translocation how does that change the risk to child compared to a mother?
Decreased risk with father (<5%) compared to mother (1/6)
447
In a patient with T2DM and an elevated HbA1c, what is the most common finding on US?
Normal Ultrasound
448
When does cardiac output increase the most?
Immediately postpartum
449
Benefit of a SNP Array over CGH Array?
SNP Array can detect Triploidy
450
Which medication is LEAST likely a teratogen? | Azathioprine, Cyclophosphamide, Cyclosporine
Azathioprine
451
What is the most common location of an arachnoid cyst?
Middle Cranial Fossa
452
Which local anesthesic is least likely to cause neurotoxicity if given IV?
Lidocaine wont cause it, Chloroprocaine will and bupivicaine will but more cardiotoxic
453
``` Which is predictive of cerebral palsy? neonatal seizures low pH / high base excess multi-organ dysfunction 10 min Apgar =3 early onset encephalopathy ```
Neonatal Seizures, Low pH (high BE), 10 min apgar<=3, Early encephalopathy
454
What are the last 5 phases of lung development? At what weeks do they occur?
``` Embryonic -3 - 7 Pseudoglandular - 5-17 Canalicular - 16-26 Saccular - 26- 36 Alveolar - 36+ ```
455
Steroids are least likely to help a. IVH b. RDS c. BPD d. NEC
BPD - no effect
456
After an overnight fast, what is most likely decreased in the morning?
Glucose
457
Hyperparathyroidism is most associated with: a. Neonatal hypocalcemia b. IUGR c. PTL d. SAB
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
458
Swan readings for Hemorrhage?
Decrease: CO, PCWP and CVP | Increase: SVR
459
How many asymptomatic bacteriuria pregnant women would develop symptomatic infection if untreated vs. treated?
20-35% compared to <4% if treated
460
Which Prostaglandin causes muscle relaxation?
Prostacyclin (PGI2)
461
What is a sentinel event?
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.
462
Which HIV medication is worst for liver toxicity?
Nevirapine (most), Ritonavir/lopinavir (if its not there)
463
What is the mutation in Spinal Muscular Atrophy? Inheritance?
SMN1
464
What is gap junction protein?
Connexin
465
What is the management hydrocephaly?
US, infectious and genetic workup
466
Aspartoacylase deficiency is associated with?
Canavan disease
467
What is the most important factor affecting Positive Predictive Value?
Prevalence of disease
468
Obese patient comes to you with complaint sof fatigue and forgetfulness, what test should you order?
Sleep Study
469
A mother who is HIV positive who took no meds during the pregnancy. What is given in labor to MOST likely decrease transmission?
Zidovudine or Lamivudine (if azt not an option)
470
When you open the broad ligament, where is the ureter located?
Crosses over the common iliac artery
471
If a patient becomes hypotensive after mag bolus, what medication do you give?
Calcium Gluconate
472
Most likely complication of pyelo in pregnancy? a) Urosepsis b) ARDS c) Preterm delivery d) Anemia e) Decreased creatinine clearance
Anemia (33%)
473
What added step should you do in a cesarean section of a Morbidly obese patient?
Closed Subcutaneous layer
474
What is the gestational age at which fetal lung alveolarization occurs?
36 weeks
475
Which blood product increases fibrinogen the MOST?
Cryo
476
What is the most common feature of turners syndrome?
Short stature
477
Which part of the biophysical profile is most associated with an acidemic fetus?
tone
478
Which antibiotic has the ability to potentiate the neurmuscular blocking ability of magnesium sulfate? Unasyn Gentamicin Erythromycin
Gentamicin
479
What is the most likely outcome for patient on dialysis?
Preterm Delivery (50-80%) Polyhydramnios (40%) Anemia (100%) Hypertension (100%)
480
Maternal risk of Varicella?
30% pneumonia which has a 30% mortality.
481
Which is LEAST likely a finding in pseudotumor cerebri?
Ventriculomegaly
482
Which is least associated with pregnancy loss after amniocentesis? Tenting, multiple attempts, needle gauge, transplacental stick?
Tenting
483
What is the most reliable ultrasound criteria for dating?
Cerebellum | Foot length
484
What is the cause of a post regional headache?
traction of pain sensing cranial structures
485
Which is the thrombophilia with the worst prognosis?
Antithrombin III
486
Most likely complication for patients with aortic stenosis in the peripartum period?
Arrhythmias
487
What is the precursor of fetal steroid synthesis?
LDL
488
At what CD4 Count are you at risk of pneumocystic pneumonia?
<200
489
Patient has a fetus with T21, what is the risk of recurrence?
1%, or age related risk whichever is higher
490
Which artery most likely to cause vulvar hematoma?
Branches of pudendal artery
491
What are the last 3 phases of lung development? At wat weeks do they occur?
Cannalicular - 16-26 Saccular - 26- 36 Alveolar - 36+
492
Maternal blood comes into direct contact with what?
Syncytiotrophoblasts
493
What hormone does the placenta lack / is "inactive" that the fetus has / is "active"?
17-alpha-hydroxylase, it breaks down progesterone, which we don’t want the placenta to be able to do
494
Which structural anomaly is most common with PKU? What about most common complication?
Structural: Cardiac (10-15%) | Complication: Mental Retardation (80-90%)
495
What is the PO2 in the umbilical artery?
20
496
Most likely diagnosis of echogenic bowel at 20 weeks?
Normal
497
What is Prader Willi most likely due to?
Deletion of paternally derived Ch 15
498
Hypoxic-ischemic–encephalopathy is most associated with? a. chorioamnionitis b. demise of one monochorionic twin c. prematurity <28 weeks d. pH = 7.0
pH 7.0 (acidemia)
499
What would make a medication most likely to cross in to breast milk?
Lipid Solube, Not bound to protein, non ionized, small/low molecular weight
500
Mom has sickle cell anemia, dad not tested, carrier rate 1/12, what is the risk of an affected fetus?
1/24 (1 x ½ x 1/12)
501
Cerebal palsy is a diseas of what part of the nervous cystem?
upper motor neuron disease due to damage of white matter.
502
``` Which initiates preterm labor? Prostaglandin dehydrogenase (PGDH) phospholipase A2 metalloproteinases prostaglandin synthase ```
Phospholipase a2 (Phospholipase A2 is associated with the arachidonic acid pathway to production of prostaglandins. Prostaglandins are associated with labor induction/progression)
503
What is a decrease in Urine calcium associated with in pregnancy?
Preeclampsia
504
``` The 4 chamber view is not sensitive for detecting which cardiac anomaly? HLHS TGA Ebsteins Anomaly VSD ```
Transposition of great arteries (also bad for Coarctation)
505
What is mode of inheritance of Fragile X?
X linked dominant
506
Renal dose of Dopamine?
<4mcg/kg/min
507
What is the best way to test for a fetus having CAH?
Direct gene testing
508
Which autoimmune disorder is more likely to improve during pregnancy?
Rheumatoid Arthritis improves in 50-70% of cases in pregnancy
509
Which medication relieves symptoms of cholestasis?
Ursodiol
510
Diabetic nephropathy most common pregnancy complications?
Preeclampsia (53%) Preterm delivery (51%) IUGR (11%)
511
Which anesthetic has the fastest onset?
Lidocaine
512
In TRAP what is found in the acardiac twins's Dopplers?
Pulsatile flow in UA | Continuous flow in UV
513
Features of Fetal Varicella?
Mental Retardation, Limb Hypoplasia, Scarring of Skin, Eye
514
What enzyme is deficient in Tay Sachs?
Hexosaminidase A
515
Large c-section incision injures iliohypogastric/ilioinguinal nerve, what is the most likely result?
Paresthesia/Pain at mons (hypogastric) | ilioinguinal more labia
516
Swan readings for septic shock?
Decrease: SVR | Increase: Co
517
What to use for malignant hyperthermia at >36 wks with contractions a. Epidural b. Spinal c. Mag tocolysis d. others
Epidural
518
CVS is most contraindicated in?
Existing Rh isoimmunization is a contraindication to CVS
519
Most likely diagnosis with a cystic hygroma?
40% T21, 30% Turners
520
Recurrence risk with spina bifida?
1.5% if one effected chlid, 7% if 2
521
What drug increases the motor blockade with magnesium sulfate?
Calcium Channel Blocker
522
What is the most likely US finding for a fetus if mom has an HbA1c of >10%.
Normal (only 10-20% increased risk of anomaly, so the majority will be normal)
523
Which part of the BPP is most closely correlated with Acidosis?
Loss of tone
524
Which rash is associated with the worst fetal/neonatal outcomes?
Pemphigoid AKA Herpes Gestationalis
525
``` What is the least common with myxedema? hypothermia hypoglycemia bradycardia hypocapnia ```
Hypocapnea In Myxedematous coma patients have (Low blood sugar, low blood pressure, hyponatremia, hypercapnia, hypoxia, slowed heart rate, and hypoventilation)
526
Preeclampsia - most common finding on pathology of placenta?
Parenchymal infarction
527
What hormone is the placental precursor to estrogens, where does it come from?
C19 precursor DHEAS from the fetal zone of the fetal adrenals
528
What is the treatment for NAIT?
IVIG
529
Which antidepressant is most associated with cardiac anomalies?
Paxil (Paroxetine)
530
Which R-A-S component increases and then decreases?
Renin peaks at 12 weeks then declines in 3rd trimester
531
Most specific finding to distinguish TTP from HELLP
LDH to AST ratio (elevated in TTP)
532
Where does a sub-galeal hemorrhage happen?
Between skull periosteum and the scalp galea aponeurosis
533
Increased Fluid is most beneficial for what lesion?
Aortic Stenosis
534
Which hormone drops to allow breastfeeding?
Estrogen
535
Uncorrected ASD, increases the risk of?
Stroke (increased risk of emboli from arrhythmias)
536
Pregnancy patient with joint pain + pustular rash on hands, most likely has which infection?
Gonorrhea
537
``` Which malfomation has the greatest risk of underlying aneuploidy? CHD Gastroschesis Omphalocele Clubbed foot ```
Omphalocele
538
What are the ultrasound findings of holoprosencephaly?
Single ventricle | Absent corpus callosum
539
Patient has nose bleeds with a platelet count of 20,000, treatment? When do you treat thrombocytopenia?
Steroids, plt<30,000 or if symptomatic, or consider Transfusion if preparing for surgery.
540
What are the features of Fetal Hydantoin Syndrome?
``` IUGR, MR, Nail/Digit hypoplasia, Hypertelorism, low set ears, short nose / flat nasal bridge ```
541
Malaria, which more likely to have PROM(?)?
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.
542
Baby delivered at 35 weeks. 30 minutes after delivery, develops severe respiratory distress. Preductal O2sat = 70%. Postductal O2sat = 90%. CXR normal. Diagnosis?
Postductal > Preductal, think TGA
543
What is the most likely diagnosis of fetus with enlarged bladder?
Posterior uretheral valves is most common cause of bladder outlet obstruction
544
Which complication is not associated with SSRI use in pregnancy?
Gastroschisis
545
Which changes least in pregnancy? | CVP, CO, SVR, PVR
CVP does not change in preg. Increase: CO, HR Decrease: SVR, PVR, COP go down Stays Same: PCWP, CVP
546
What does wedge pressure represent?
LV preload
547
Why are pregnant patients more susceptible of hypoxia during intubation?
Decreased functional reserve
548
Pt presents at 36 weeks history of T6 spinal cord injury with UC’s, hypertension, flushing what is best treatment?
Epidural
549
What is the Fetal Cardiac Output at term?
500mL/kg/min
550
Which phospholipid is the largest percentage in the fetal lungs?
Phosphatidylcholine
551
What is the mechanism of AZT?
Nucleoside Reverse transcriptase inhibitor
552
A physician practices evidence-based medicine. This represents
Integrity
553
What would be the pattern on QUAD screen of a fetus with Down syndrome?
High: HCG & Inhibin | Low: Estriol, AFP
554
Best way to prevent a retained sponge after a vaginal delivery?
Debriefing (via sponge count)
555
Why is ROC a good test?
sensitivity = y , 1- specificity = x allows to balance between them
556
What is the risk of Down syndrome with a prior afected child?
1% or the age related risk, whichever is higher
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?
1/6 = 16.7% of all gametes | 1/3 if only living child
558
If an amnio showed 45XX+14,21. What kind of mutation is that?
Balanced translocation
559
Where can you find the ureter?
Over the bifurcation of the iliac artery
560
What is the most common complication of AZT?
Bone marrow suppression
561
Prostaglandin dehydrogenase is found where?
Chorion
562
What enzyme causes prostaglandin inactivation? Where is it found?
Prostaglandin Dehydrogenase, Chorion
563
What is the most effective anticoagulation for patients with mechanical heart valves?
Warfarin
564
How do you test for familial dysautonomia?
DNA analysis
565
``` Which of these is a more common surgical complication of c hyst? Ureteral injury Cystotomy Fistula Bowel Injury ```
Cystotomy
566
Decreased Urinary Calcium is associated with what pregnancy disorder?
Preeclampsia
567

Which of the following valve lesions as the highest risk of mortality for the mother?
AS, AR, MS, MR?

Aortic Stenosis

568
Where are the different Prostaglandins made?
PGI2: Myometrium PGE2: Decidua and Amnion PGF2alpha: Decidua
569
What is least useful with SC disease? a) FeSO4 b) Folic acid c) Pneumovax d) Antibiotics for suppression
FeSO4, can lead to hemochromatosis if patient is not iron deficient
570
The PO2 is lowest in which vessel? | UmbA, Umb V, Uter A , Uter V
Umbilical Artery
571
If preload and afterload are already optimized, what is the best way to increase cardiac output?
Beta adrenergic
572
Beta mimetics (agonist) relax smooth muscle by what mechanism?
Stim. B2 receptor (G membrane protein) -> activates adenylate cyclase ↑ intracellular cAMP + activates PKA -> inhibits myosin light chain phosphorylation -> ↓ intracellular calcium
573
``` If O2 is decreased, which fetal organ gets less blood flow? Lungs Brain Adrenals Myocardium ```
Lungs, | Fetus will maintain flow to Brain and Adrenals and Myocardium
574
Which drug prevents IVH?
BMZ - also decreases RDS, NEC and neonatal mortality
575
What percent of omphaloceles will have a chromosomal aneuploidy?
30 - 40%
576
What is most likely outcome with amnio 45, XX der (13,21)?
Normal (no extra 13 or 21, just 1x13, 1x21 and 1x13-21 together))
577
A normal pregnant patient in the third trimester what would her glucose levels do, Fasting and Postprandial?
Fasting ↓ Postprandial ↑
578
What dose of folic acid do patients with sickle cell require?
4mg
579
Most likely cause of hypoxia post c-section in obese class II patient?
Apnea
580
Type I CPAM with Hydrops, what is the treatment?
Shunt for Drainage of Cyst
581
When in pregnancy is the Cardiac output at its highest?
Immediately after delivery (autotransfusion of blood = 50% increase in CO)
582
When should you only use a one tailed test?
When results can only go in one direction
583
What nerve causes foot drop?
Common peroneal
584
Discussion of mode of delivery in a pregnancy with a lethal anomaly involves which ethical principal?
Autonomy
585
Fetus has cleft lip/palate, VSD, holoprosencephay. What is the most likely diagnosis?
T13
586
What are the abnormalities with acute fatty liver of pregnancy?
↑ LFTs, uric acid, billirubin , Ammonia | ↓ Platelets, ↓ Glucose
587
What is the preferred mode of delivery for Omphalocele?
Vaginal unless >5cm or liver is out
588
Which medication needs adjustment for Increased GFR?
Digoxin
589
Simulation training has helped improve outcomes most in?
Brachial Plexus Injury (reduction by 60-90%)
590
What happens to thyroid hormones in the first trimester?
TBG increases, Total T4 Increases, Free T4 Increases, TSH Decreases
591
What pregnancy complications are associated with Multiple Sclerosis?
Increased risk of Growth restriction (and of C/section, but less than IUGR)
592
Who is the best candidate for an IUD? a. Uterine anomaly b. Benign ovarian tumors c. AIDS d. Active chlamydia
AIDS
593
In what setting is Down Syndrome most likely? 1. brachycephaly 2. Hypoplasia of mid phalangeal joint of 5th digit 3. normal humerus
Hypoplasia of the midphalanx of the fifth digit
594
What is the most likely diagnosis if NT > 4mm?
45X - Turners , most common with very increased NT
595
What is the main source of estriol?
C19 adrenal steroids (DHEAS from fetal adrenals)
596
What is the mechanism of insulin resistance in pregnancy?
HPL and Human Placental Growth Hormone reduce insulin receptor sites
597
What effect does medroxyprogesterone have postpartum?
Decreased bone mineral density long term use
598
Which of the following is associated with coarctation of the aorta?
45 XO
599
Which medication increases cardiac output when preload and afterload are optimized?
Dobutamine (B agonist)
600
What is the mechanism of action of LMWH?
1. Inhibits Prothrombin | 2. Binds ATIII and inhibits thrombin formation
601
Characteristic of Med to freely pass into breast milk?
Non protein bound, Lipid soluble, Non-ionized, Low molecular weight (All the same things for crossing placenta)
602
What enzyme is deficient in Canavans?
Aspartoacylase
603
Stillbirth in setting of cholestasis, most likely finding?
Meconium stained amniotic fluid
604
Mother refuses a CS for fetal decelerations remote from delivery, what do you do?
Continue to manage her do not do cesarean against her will
605
Clenched fists are associated with which chromosomal abnormality?
T18
606
What is the #1 cause of low maternal estriol?
Placental sulfatase deficiency , SLOS, X linked Icthyoses
607
Prophylaxis for PCP in CD4 < 200?
Bactrim
608
At 37 degrees Celsius and pH of 7.4, fetal hemoglobin oxygen dissociation curve means?
This means that for any given PO2, fetal O2 saturation is higher
609
For which of the following is plasmapharesis 1st line Rx?
TTP
610
``` Which disorder is associated with UPD? Cri du chat Williams Prader Willi Hydantoin ```
Prader Willi
611
Why do we not use Rapid GBS?
Low Sensitivity
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
Longer sessions
613
What statistic would you use to compare three means?
ANOVA
614
What is the highest complication associated for 10 rads exposure at 15 weeks?
prior to 2 weeks: sab (all or none) 2-8 weeks: growth restriction/anomalies 8-15weeks: Intellectual Disability
615
Where does a subgaleal hemorrhage occur?
Between skull periosteum and scalp galea aponeurosis
616
Balanced translocation 14:21, what are the possible outcomes of baby?
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)
617
What is mode of inheritene of IHSS?
Hypertrophic cardiomyopathy is also called IHSS. | Autosomal Dominant
618
How would you investigate whether there is an association between smoking and bladder cancer?
Case control study (Compares a group with disease to a group without and looks back at risk factor)
619
What is fastest onset anesthetic medication?
Lidocaine : 1-2 mins
620
Which is LEAST likely in the first 24 hours after birth?
Closure of DV (occurs within 1 week) Closure of DA - approx few days Closure of foramen ovale - early Increased pulmonary resistance
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 ```
AVSD
622
What medication causes reversible hearing loss in the fetus?
Streptomycin
623
What are the causes of non-immune hydrops?
``` Idiopathic Cardiovascular Chromosomal - Turners Infections CCAM, Sacrococcygeal teratoma ```
624
Which uterine structural anomaly has the highest miscarriage rate?
``` #1. Septate #2. Unicornuate #3. Bicornuate ```
625
At which phase do type 2 pneumocytes appear?
Canalicular
626
Difference in allele inheritance based on maternal and paternal genes best describes:
Imprinting
627
What is a contraindication to breast feeding? a. CMV b. HCV c. HBV d. Genital HSV e. Active TB
Active untreated TB, or HSV on breast (not genitals), HIV
628
Which condition does plasmapheresis treat?
TTP
629
What is the term that means it matters from which parent an allele was inherited?
imprinting
630
Mechanism of Progesterone IUD?
Cervical Mucous(most correct). Anovulation. Affecting Sperm Motility, preventing implantation
631
Which cytokine is anti-inflammatory?
IL-10
632
What drug stays around in the maternal system for 2-3 years?
Etretinate
633
What is the most common trisomy in abortuses?
Trisomy 16
634
Increased nuchal fold is associated the most with what aneploidy?
T21
635
``` What hormone causes insulin resistance at 4-7AM? cortisol GH PRL progesterone androstenedione ```
GH, (Human placental Growth Hormone causes insulin resistance via decreasing insulin receptor sites)
636
Features of Congenital Rubella?
Blueberry Muffin, Cardiac issues, Cataracts, CNS and Deafness.
637
Fetus with posterior urethral valves, what findings signify renal impairment?
Increases in Ca, Cl, Na, Microglobulin or OsmolaRity
638
What test do you use for evaluation of Means?
t-test
639
Which part of the Choirion is avascular?
Chorion Laeve
640
Which SSRI most associated with increased fetal cardiac risk
Paxil (ASD, or outflow tract obstruction)
641
How do you diagnosis Von Willebrand's disease?
Ristocetin cofactor activity
642
What is the best intrapartum treatment of Mitral Stenosis?
Beta Blockers
643
Which is most associated with enlarged placenta, pale placenta, hydrops?
Syphillis
644
Expansion of a vulvar hematoma is limited by? a. Inguinal ligament b. Levator ani muscles c. Colles fascia
Colles Fascia, Urogenital Diaphragm, and Anal fascia
645
Best way to differentiate a lupus flare from Preeclampsia?
Measurement of ANA, anti-dsDNA, decreased CH50, and active urinary sediment(cellular casts, aseptic leukocyturia, and hematuria) may help distinguish SLE nephritis flare
646
Which fetal lung lesion is MOST associated with malignant transformation
CCAM
647
Highest risk of Preterm birth is in what uterine anomaly? What about miscarriages?
PTD: Bicornuate uterus 60-70% | Sab: Septate
648
Which antibody is positive if you have been vaccinated for Hep B?
Hep B surface antibody (anti-HBs)
649
What enable increased fetal calcium?
Increased intestinal absorption of calcium from mother
650
Which nerve fibers contribute to pain in 2nd stage of labor?
Pudendal nerve (S2-4)
651
Which maternal cardiac lesion is associated with the greatest fetal risk of transmission? 1. AS 2. MS 3. VSD 4. TOF
Aortic stenosis (15-18% risk of fetal transmission) IHSS: 50% Coarctation: 14%
652
Low MCV, HbA2 2.2% Normal Iron Studies, Dx?
Alpha Thalassemia
653
Why is Randomization good practice?
Helps decrease confounding
654
What is the follow-up for 6 mm bilateral pyelectasis and normal karyotype?
Repeat at 32 weeks
655
Pt. had a CVS w/ Mosaic result, what can explain the birth of a normal baby?
Confined placental mosaicism
656
What is the most common finding of a term infant with Down syndrome? 1. Simian crease 2. Hypotonia 3. LBW <2500gm
Hypotonia
657
After a Fontan procedure, what does cardiac output depend most on?
Preload or SV | (HR plays a negligable role In a fontan circulation)
658
Least associated with embryopathy? | Azathioprine, warfarin, hydantoin
Azathioprine (not associated with major anomalies)
659
Which stage of lung development is surfactant produced?
Saccular phase
660
Most common mode of transmission for Hep B worldwide?
Vertical Transmission from mother to baby
661
If a parent has a robertsonian translocation 45XXder(14:21)(10q:10q) What is the chance that offspring will have phenotype of T21?
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)
662
What genetic principle explains a mom with tuberous sclerosus who has a child with heart problems, neurological lesion?
Variable Expressivity
663
Which type of anatamosis is protective for TTTS?
Artery - Artery
664
What enzyme is deficient in Smith Lemli Optiz?
Dehydrocholesterol Reductase (DHCR7)
665
Local anesthetic epidural anesthesia is LEAST associated with a) hypotension b) FHR abnormalities c) pruritis d) spinal headache
Pruritus (that is for Narcotic epidurals, not local anesthetic)
666
What is the mechanism LMWH causes anticoagulation?
1. Inhibits Prothrombin | 2. Binds ATIII and inhibits thrombin formation
667
Which medication is contraindicated in women with liver failure for HIV treatment?
Nevirapine, less so Lopinavir/Ritonavir (Kaletra)
668
When is breastfeeding contraindicated?
HIV Untreated Active TB HSV Lesion Breast Infants with classic galactosemia
669
What is the most common cause of CAH?
21 alpha hydroxylase deficiency
670
What is post partum decompensation in Aortic stenosis due to?
Hypovolemia (keep em wet)
671
What can explain a discrepancy between amniocentesis results and CVS results?
Confined placental mosaicism
672
Which is most likely to be abnormal with fetal acidemia Absent accelerations decreased fetal tone decreased fetal breathing
First lose accelerations, then breathing then movement then tone.
673
Which 8 cardiac lesions are considered the highest risk in pregnancy?
(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
674
Which has the lowest O2 content? | umbilical artery, umbilical vein, uterine artery, uterine vein
Umbilical Artery
675
What is treated with spiramycin?
Intrauterine Toxoplasmosis
676
Which of the following is not associated with paternal age >50? Achondroplasia, NF, Marfans, Klinefelters?
Klienfelter's
677
What is the inheritance pattern of PKU?
Autosomal Recessive
678
Genetic diagnosis most associated with a mom that has preeclampsia?
Trisomy 13
679
What is the LEAST useful sonographic measurement to differentiate between IUGR and wrong dates?
AC
680
Most common cause of mortality with anesthesia?
Failed intubation
681
What is the mechanism of action of b-mimetics?
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
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?
33%
683
Early Varicella Infection, whats the most common finding of baby?
Skin Scars
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 ```
Thanatophoric dysplasia
685
Patient at 35 weks with C6 spinal cord lesion admitted with severe hypertension, flushing with contractions. What is next best step in management ?
Epidural anesthesia (autonomic dys/hyperreflexia)
686
What is the most common enzyme deficiency in CAH?
21 α Hydroxylase deficiency
687
``` What causes virilization of a female fetus? Luteoma of pregnancy Cystadenoma Prolactinoma OCPs ```
Luteoma of pregnancy
688
When is cardiac output the highest?
Immediately after delvery due to autotransfusion
689
Which steroid influences sodium reabsorption? a. Fludrocortisone b. Hydrocortisone c. Betamethasone d. Cortisol
Fludrocortisone (Mineralocorticoid)
690
Of the following which is most associated with aneuploidy: a. Thickened nuchal fold b. Short humerus c. Echogenic bowel d. EIF
``` Thickened Nuchal Fold #1 Absent Nasal Bone #2 Nuchal fold #3 AND 4, NOT SURE THE ORDER - Echogenic bowel and Ventriculomegaly ```
691
What is the ethical principal which states that action is done for the benefit of others?
Beneficence
692
OCPs are not associated with a decreased risk of which cancer?
Breast Cancer
693
Microtia is associated with what medication?
Microtia - Undeveloped external ear, happens from isotretinoin (accutane)
694
Baby with nasal hypoplasia and limb defects?
Warfarin embryopathy
695
What would a biopsy of a pre-eclamptic patient show?
Glomeruloendotheliosis in Nulligravidas | Normal histologic appearance in multigravidas
696
Which ultrasound finding in gastroschisis is most associated with intestinal atresia ?
Bowel dilation (>14mm strongly predicts atresia)
697
Smoking is least likely associated with an incease in which pregnancy associated condition?
Preeclampsia
698
Which HIV Medication shouldnt be used In the first trimester?
Efavirenz (Increased Myelomeningocele risk)
699
Which rash is associated with the worst neonatal / fetal complications?
Pemphigus Gestationalis (prematurity, SGA)
700
Injury with brachial plexus injury resulting in Erb's palsy is at what level?
C5-6
701
If a patient has class F diabetes, what are they at most risk of?
``` diabetic nephropathy #1Pre-eclampsia #2 PTD #3 Growth Restriction ```
702
What is the sensitivity of Quad screen in detecting T21 in a patient <35 years?
75%
703
Which does not express MHC?
Syncytiotrophoblasts
704
Which coagulation factor decreases in pregnancy?
Protein S, Factor XI, XIII and platelets
705
Fetus at 28 weeks with CCAM type I lesion and hydrops. Management?
Thoracoamniotic shunt
706
What is the best medication to alleviate hypertension in a preeclamptic patient at time of general anesthesia induction?
Nitroglycerin, In patients in whom hypertension during laryngoscopy could result in hypertensive crisis or cardiac decompensation, the anesthesiologist may administer anti-hypertensives during intubation.
707
What is the best way to decrease complications of shoulder dystocia?
Send staff for training, simulation
708
When do you prophylax and with what for CD4 counts in HIV?
<200 : PCP : Bactrim <100 : Toxo : Bactrim <50 : MAI : Azithro
709
Omphalocele is associated with which genetic syndrome? | Beckwith wiedemann, kartagener, meckel gruber?
Beckwith Wiedemann
710
What condition with cystic fibrosis carries a poor prognosis?
Right heart failure (Cor Pulmonale)
711
Which most explains decreased 2nd tri BP? increased cardiac output increased renal blood flow decreased angiotensin sensitivity
Decreased Angiotensin Sensitivity
712
What is the best way to perform randomization?
Random number block permutation
713
What is not associated with intraabdominal calficiations? | CMV, Toxo, Parvo, CF, Meconium Peritonitis?
Parvovirus
714
What is the initial treatment of pheochromocytoma in pregnancy?
Phenoxybenzamine (Alpha blocker)
715
What is the PO2 in the Umbilical artery?
20
716
Most likely to decrease breast milk flow? | OCP's IUD Depo-provera
OCP's
717
Which is consistent with prerenal oliguria?
Osmolality>450
718
What enzyme is missing in the placenta but fetus has?
17 α hydroxylase (which breaks down progesterone, we don’t want the placenta to be able to break down progesterone)
719
What is the most appropriate US surveillance for MCDA twins?
US every other week at 16 weeks
720
Which characteristic will increase passage into milk during lactogenesis
Lipid Soluble, Non Protein Bound, Non Ionized, Low Weight will increase passage into milk during lactogenesis.
721
Which vessel has the highest fetal oxygenation? a. IVC b. Descending Aorta c. RV d. DA
IVC UV -> DV -> IVC -> Left Heart --> Ascending Aorta --> Neck vessels --> Descending Aorta Ductus Arteriosus < Descending Aora
722
Action of PGI2
Prostacyclin is a potent vasodilator. It is produced in endothelial cells & the myometrium. It is also a uterine relaxing agent.
723
What is the mode of inheritance of familial hypertrophic cardiomyopathy?
Autosomal Dominant
724
Umbilical vein has what O2 compared to uterine vein?
lower O2 than uterine vein
725
Which is most associated with aneuploidy? | EIF, short humerus, echogenic bowel , pyelectasis?
Echogenic bowel (1.65X LR)
726
Neonate has apnea after 30 seconds, what is next best step?
``` 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) ```
727
Which Anastomoses protect against TTTS?
A-A
728
Most common ovarian cancer found in pregnancy?
Dysgerminoma (30% of ovarian cancers found in pregnancy)
729
What is the most common symptom after a lumbar puncture ?
Headache that gets worse with standing/sitting and better with laying flat
730
Which is not related to non-disjunction in the mother? 1. Turners 2. Klienfelters 3. XXX
Turners | The single X is maternal in origin in 70% of cases. Paternal is lost
731
Most likely ultrasound finding in a patient baby with Myotonic Dystrophy?
Polyhydramnios
732
What is hormones are HPL most like?
Prolactin and GH
733
Treatment for toxoplasma in pregnant women?
Spiramycin
734
Short bent femurs, humerus, radii, and thoracic circumference <5%. Normal ossification of cranuim and spine. What is the most likely diagnosis?
Thanatophoric Dysplasia
735
Which chromosomal abnormality is not increased in offspring of AMA females?
Turner Syndrome
736
Initial symptom of Intravascular Lidocaine injection?
Tinnitus
737
What hormone can increase maturation of lungs?
Betamethasone/Dexamethasone, Thyroxine, Vitamin A
738
What is a premutation of fragile X (how many repeats)?
Between 55-200 (premutation)
739
Treacher collins is associated with impairment in what structure?
The mandible
740
Which Doppler finding is the worst?
Reversed A wave in DV
741
Amino acids cross the placenta via what type of movement?
Active Transport
742
Which of the following is important for PGE2 creation? | Arachidonic acid or Prostacyclin
Arachidonic acid
743
``` Least likely with hyperparathyroidism? Pancreatitis HTN kidney stones cranial califications neonatal hypocalcemia ```
Cranial Calcifications
744
What is the most likely cause for an LGA Fetus?
Maternal Obesity
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
ABO incompatibility
746
Best treatment for Neisseria Gonorrhea in pregnancy?
Ceftriaxone
747
Which Heart finding is most specific for DiGeorge Syndrome?
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
748
What is the primary source of precursor estrogen synthesis in the placenta?
C19 Precursor DHEAS from the Fetal Adrenal (Fetal Zone)
749
How to control for a variable in survival analysis?
Cox-regression
750
Which karyotype is the result of a uniparental disomy?
A Trisomy - results in UPD from trisomic rescue
751
Which is not helpful for identifying lupus anticoagulant? | Dilute russell venom, Kaolin, Prolonged PTT, ANA?
ANA
752
Why do you explain informed consent?
Autonomy
753
What pregnancy outcomes does bariatric surgery improve?
Gestational Diabetes | Less Macrosomia
754
A women has preeclampsia and oliguria. What is indicative of pre-renal process?
Osm >550
755
What antihypertensive medication increases cardiac output?
Hydralazine
756
What is the most common placental mass?
Chorioangioma - has color flow , associated with Polyhydramnios (60%) and IUGR (20%)
757
Most likely to cause neonatal cushingoid syndrome in pregnancy?
Repeated steroid doses (though this looks like it has fallen out of favor)
758
Duodenal Atresia in baby with Polyhydramnios. How does the amniotic fluid get absorbed if the baby has an obstruction?
Intramembranous absorption
759
18 weeks pregnant with Non-Hodgkins Lymphoma, best treatment?
Combination Chemotherapy
760
Both parents have normal stature, but both kids have achondroplasia, most likely reason?
Gonadal mosaicism
761
Which is not associated with hydrops | listeria, syphillis, parvo, cmv, toxo
All of them are, Listeria is probably the least
762
When should you get the flu vaccine in pregnancy?
As early as possible
763
Patient Is 8 weeks pregnant with an IUD in place, strings are visible. You should?
Pull string
764
Why are basic drugs like demerol concentrated in an acidemic fetus?
Ion trapping from a decreased isoelectric point
765
Prerenal Azotemia with Preeclampsia,what lab is suggestive of this?
Urine osmolality >450
766
When should you use a one tailed t-test?
results can only go in one direction
767
Most common cause of non-hereditary deafness?
CMV (but remember 85% of congenital CMV are asymptomatic)
768
What nerve injury causes decreased labial sensation?
Illioinguinal
769
Most likely fetal outcome of radiation exposure in the first trimester?
Microcephaly - (also growth restriction and intellectual disability)
770
Medications for SBE prevention?
Ampicillin or Cephalosporin
771
Which antihypertensive INCREASES maternal cardiac output?
Hydralazine
772
What is the best megahertz to assess abdominal circumference at 20 weeks?
3.5 mHz
773
Hypospadias and congenital anomalies are increased with what REI?
IVF with ICSI
774
Which is NOT associated with autonomic hyperreflexia?
Hypotension
775
Which HIV drug should you avoid in first trimester?
Efavirenz due to concern for NTD
776
Longest lasting anesthetic for an epidural?
Bupivicaine
777
Which disease is associated with increased paternal age?
Achondroplasia | Neurfibromatosis Marfans
778
What is the odds ratio formula?
AD/BC ratio of exposed cases to unexposed cases divided by ratio of exposed controls to unexposed controls
779
What is most associated with ARDS in pregnancy? | PE, Infection?
Infection
780
Which anomaly is associated with the highest risk of aneuploidy? 1. Omphalocele 2. Cardiac defects 3. Gastroschisis
Omphalocele
781
At what gestational age is Warfarin exposure at greatest risk for causing warfarin embryopathy?
6-9 weeks
782
Which factors move the Oxygen dissociation curve to the left?
Left means: Higher affinity of Hb-O2 1. Fetal Hb 2. Lower CO2 3. Higher pH 4. Lower temperature 5. Lower 2-3 DPG
783
What is the most common aneuploidy found in first trimester abortions?
Trisomy 16
784
Erb's palsy is damage to which nerve roots?
C5-C6
785
What is the most common complication of Chorioangioma?
Polyhydramnios
786
What type of virus is HIV?
RNA Retrovirus
787
Which is not associatied with autonomic hyperreflexia? At what level injury is it seen in? How is it prevented? Hypotension, bradycardia, piloerection
Hypotension (Hypertension happens), T6 and above, early epidural
788
What nerves is second stage labor pain due to?
Pudendal nerve S2-S4
789
Treatment for IHSS?
Beta blocker (propranolol), controls the heart rate so more time for ventricular filling
790
Which disease other than SLE has +SSA/SSB antibodies?
Sjogren's
791
Which blood product has the MOST of Factors V, VII and X?
FFP (has fibrinogen, factors 2, 5, 7, 9, 10, 11)
792
When are the periods with the highest risk of developing a hemorrhagic stroke in pregnancy?
Highest during the delivery period and up to 2 weeks postpartum
793
Which Interleukin is Anti-inflammatory
IL-10
794
Bullous lesions with biopsy showing C3 deposition in the basement membrane: Diagnosis?
Herpes gestationis (Aka Pemphigoid gestationis))
795
Which genetic condition should you consider in a Fetus with Increased Nuchal Translucency, but normal karyotype?
Noonan syndrome (10% of euploid with increased NT)
796
What is the best method to determine heart rate in the first trimester?
M- Mode
797
What is the MOST specific marker for T21?
``` Absent nasal bone #1 Absent Nasal Bone #2 Nuchal fold #3 AND 4, NOT SURE THE ORDER - Echogenic bowel and Ventriculomegaly ```
798
What is post partum decompensation of Mitral stenosis due to?
Hypervolemia (keep em dry)
799
What is the most common presentation of AFE?
1. Hypoxia/Hypotension | 2. Coagulopathy
800
Which is the LEAST likely EKG finding in a normal pregnancy?
PR Interval increase (Normal findings: HR increases, PR interval decreases, Axis deviates left, ST and T wave changes)
801
Which antibody is most responsible for immunity passed to infant through breast milk?
IgA
802
Most common risk with AZT?
Anemia (Marrow Suppression) - most common adverse reaction | But Nausea.vomitting, more common / less specific.
803
Which elevated value is the most predictive for poor kidney function? a. Osmolality b. Na c. Chloride d. B2-microglobulin
All are predictive if elevated
804
Risk of Early onset GBS if not treated in labor and GBS positive?
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.
805
What is used in the treatment of Lyme in pregnancy? a) Penn b) Doxy c) Vancomycin d) Clindamycin e) Cephalosporin
Cephalosporin (Or amoxicillin)
806
SSA and SSB antibodies are most associated with?
Neonatal Lupus (25%), Heart block ( 1-3%), Normal pregnancy most likely
807
PVL is associated with which maternal infection?
Chorioamnionitis
808
Patient with uncontrolled hyperthyroidism most likely to present with:
``` #1: Preeclampsia #2: Growth Restriction #3: Preterm delivery ```
809
In a mother that is Rh sensitized but has a low titer, what is the next step in management?
Continue to follow titers
810
Mutation in Sickle Cell?
can detect valine to glutamine at 6 position of beta chain on chromosome 11
811
At what gestational age woud you deliver a patient with a subchorionic hemorrhage?
At term
812
Folic Acid antagonist use is associated with?
Neural Tube Defects, Cardiac Defects and Oral Clefts
813
Which is the bad malaria in pregnancy?
Falciparum
814
Which condition is most likely to transmit to the fetus? 1. ASD 2. VSD 3. Coarctation 4. TOF
Coarctation
815
What is the most effective treatment for steroid resistant lupus in pregnancy?
Azathoprine
816
Common findings in congenital toxoplasmosis?
Chorioretinitis, hepatosplenomegaly, periventricular calfications, ventriculomegaly, disseminated purpuric rash
817
Which part of the fetal adrenal gland makes DHEAS?
Fetal zone
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
VARICELLA TRANSMISSION IN FIRST TRIMESTER IS RARE!
819
What factors are most important in oxygen delivery to tissue?
CO x PaO2 (Oxygen delivery = CO x arterial oxygen content )
820
Amniotic fluid acetylcholinesterase is least helpful with what condition? 1. Omphalocele 2. Gastroschisis 3. Congenital nephrosis 4. Anencephaly
Congenital nephrosis
821
Which has clinically significant levels of Factor X? | FFP or cryo?
FFP - has fibrinogen, factors 2, 5, 7, 9, 10, 11
822
What is the most specific finding of NEC?
Pneumatosis - diagnosis of NEC is confirmed with gas in bowel wall on Xray
823
Most likely finding of fetus in mom with hyperparathyroidism:
Neonatal Hypocalcemia
824
Most common complication after narcotic anesthesia?
Pruritus
825
Patient with recurrent cholelithiasis, management?
Lap Cholecystectomy
826
Recurrent achondroplasia in a couple who are not affected are most likely associated with:
Germline Mutation AKA Gonadal Mosaicism
827
Best contraceptive option for patient with Hepatitis C and liver disease
Copper IUD
828
What causes diabetic retinopathy?
Chronic hyperglycemia - elevated HBA1c
829
Who is microarray most appropriate for? a. Abnormal integrated screen b. VSD c. Partner with Robertsonian translocation d. CPC
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
830
What is the form of the source of metabolic fuel for the fetal myocardium?
Glucose
831
``` Which disease is NOT associated with relapsing/remitting fevers? Brucella Lyme Malaria Listeria ```
Listeria
832
How do you treat pregnancies at risk of NAIT? | And when do you deliver?
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
833
Baby delivered at 35 weeks. 30 minutes after delivery, develops severe respiratory distress. Preductal O2sat = 90%. Postductal O2sat = 70%. CXR normal. Diagnosis?
PPHN, Persisent fetal circulation
834
Most drugs cross the placenta by which mechanism?
Simple Diffusion
835
Betamethasone is metabolized in the placenta by:
11β-hydroxysteroid dehydrogenase type 2
836
Which enzymes catalyzes the degradation of endothelin-1?
Enkephalinase
837
What nerve is affected if the mother’s legs are hyperflexed during delivery?
Femoral nerve (Diffficulty with kicking motion)
838
What is anticipation? Give an example?
Genetic condition passed on to next generation where symptoms worsen and come on early in the next generation, trinucleotide repeats (Huntingtons, Fragile X)
839
Which fetal organ system is most susceptible to teratogens earlier and for the longest time?
Brain
840
What does giving betamethasone due to biophysical profile?
Decreases breathing and Movement
841
Most likely outcome with Fragile X?
Mental Retardation
842
Risk of CP with APGAR score of <=3 at 5 minutes? | What about at 15-20 minutes?
An apgar score <=3 at 5 minutes is associated with 5% risk of CP. Becomes 50% when Apgar <=3 persists at 15-20 minutes.
843
A pt. has Epistaxis, Telangiectasia. Diagnosis? Mode of inheritance?
Ossler Webber Rondu (AD)
844
Low level of which hormone is most associated with placental insufficiency?
low PAPP-A
845
Anemia, Thrombocytopenia and Renal Failure, Diagnosis?
HUS
846
Most likely antibody to result from transfusion? a) D b) C c) E d) Kell e) N
Kell
847
Which drug sticks around in the body for 2 years?
Etretinate
848
periventricular leukomalacia is most commonly associated with what pregnancy complication? Why does it happen?
Intra-amniotic Infection/Chorioamnionitis | Proinflammatory cytokines damage the white matter of the brain
849
Why do you treat a fetus at risk for CAH, When do you start and what is the treatment? (mother has CAH)
7-8 weeks, Dexamethasone to prevent virilization (CVS, if male stop treatment, if female continue)
850
Which is not associated with SSRI? a. Congenital heart defect b. NTD c. Neonatal withdrawal d. PPHN
NTD
851
The most common symptom of appendicitis in pregnancy is?
Abdominal pain
852
Which antiseizure drug has the highest risk of NTD?
Valproic acid 1-2%
853
What drug doesn’t cross the placenta
Heparin, and maybe insulin unless IgG bound.
854
The use of valproic acid carries what risk of NTD?
1-2%
855
Treatment for fetal thyrotoxisocis / hyperthyroidism?
Maternal PTU
856
Cord Blood Gases – You have table, what is it?
Respiratory, metabolic, mixed?
857
Which is likely to present for the first time during pregnancy? a) Hg SC disease b) Hg S-thal c) Hg SS
Hb SC disease
858
Which enzyme that the fetus lacks does the placenta have and what is its function?
3 Beta - Hydroxysteroid Dehydrogenase | It converts Pregnenalone to Progesterone which is the primary source of progesterone.
859
As a class, what is the most common etiology for fetal malformations?
Genetic
860
Which Immunoglobin associated with mucosal defense in | breast milk?
IgA
861
Which disease is most commonly associated with Ro and La Antibodies?
``` Sjogrens syndrome (SSA and SSB) - 80-90% only in 30% of Lupus patients ```
862
Prior neonate with ambiguous genitalia & neonatal death. What is the most likely cause of neonatal death?
CAH - salt wasting
863
Baby delivers, meconium, develops respiratory problems after birth, CXR is clear, preductal O2 90%, postductal O2 70%?
Persistent fetal circulation (if cxr wassnt clear, possibly meconium aspiration)
864
What are good prognosis findings in fetal urine?
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
865
What antibody pattern is consistent with Recurrent CMV?
#ERROR!
866
20 yo Asian woman with low MCV, HgbA2 2.4%. Most likely cause:
Alpha Thalassemia
867
What effeect will glucose have on BPP?
Increased Breathing (not movement)
868
Standard Error is interchangeable with Standard Deviation?
YES. Standard error is the estimation of the standard deviation
869
Treatment for malignant hyperthermia?
Dantrolene
870
Which cardiac anomaly most associated with DiGeorge ?
Interrupted aortic arch
871
What should you do if cord insertion at 8 weeks is abnormal?
Repeat ultrasound because of physiologic herniation
872
Which procedure has the greatest risk of alloimmunziation? | Amnio, CVS or Cordocentesis?
Cordocentesis (close to 40%)
873
HIV patient not on meds, presents in labor, best single agent?
Zidovudine / Lamivudine
874
What enzyme is the rate-limiting step in synthesis of prostaglandin?
Phospholipid converstion by Phospholipase A2 to Arachidonic acid
875
Most common mutation in Osteogenesis Imperfecta?
ColA1,2
876
What bacteria is associated with Alkaline Urine UTI's?
Proteus Mirabilis
877
What vitamin must you supplement in vegans?
B12
878
Which syndrome has absent radius, polyhydramnios and hydronephrosis?
Thrombocytopenia absent radius (TAR) Syndrome - can have kidney, heart and thrombocytopenia with absent radius - both radii are missing but thumbs are present
879
What is the minimal PO2 needed to maintain maternal SaO2 >90%?
60
880
What is the major component of surfactant?
Phosphotidylcholine
881
What enzyme is deficient in Niemann Pick?
Sphingomyelinase
882
How much of the screen should a cervix take up for a cervical length?
3/4 of screen
883
What statistical test do you use for evaluation of proportions?
Chi Square
884
Neonatal lupus most likely to present with which?
Rash (25%), Complete heart block (3%) | Thrombocytopenia (10%, but that was in one random BMJ article)
885
``` Elevated AF Acetylcholinesterase is NOT associated with which of the following? Apalsia Cutis Omphalocele Anencephaly Encephalocele Congenital nephrosis ```
Congenital nephrosis
886
Worst prognosis for neonatal CMV with?
Microcephaly
887
What do you use to compare two means that are normally distributed that are continuous:
T test
888
A man of normal height has 3 dwarf children with 3 different mothers, explanation?
Gonadal Moasaicism
889
Mechanism of Uterine Contraction?
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.
890
Where is PGE2 produced mostly?
Amnion
891
Patient with Preeclampsia with ruptured liver capsule, management?
- Correct Coagulopathies (likely DIC), - For surgical management Pack and drain - Improve surival with Hepatic Artery Embolization
892
Which infection is associated with Placental Microabscesses?
Listeria
893
Petechiae + hepatosplenomegaly at birth, which infectious etiology?
CMV
894
False positives for KB?
Anything that can be caused by anything that causes maternal HbF to be elevated – beta thal, sickle cell
895
Mom has sickle cell (hgb SS), dad unknown but carrier rate is 1/12, what is chance fetus will have hgb SS?
1/24, | 1/12 chance hes a carrier x 1/2 risk of passing on the bad one
896
Anemia, Thrombocytopenia, Renal Failure, Neurologic Abnormalities, and Fever
TTP
897
What do you use to Differentiate TTP and HELLP
LDH to AST, fever (less specific)
898
When does fetal movement increase the most in a 24 hour period?
At night
899
Which autoimmune diseases are associated with RA factor?
Scleroderama, SLE, Sjogrens, RA and Dermatomyositis
900
What is the management for a patient with Preterm Contractions but is closed?
Prolonged observation
901
What are the most common causes of maternal mortality?
``` #1 Cardio #2 Infection #3 Hemorrhage ```
902
Freq of an autosomal recessive disease is 1/6400, what is the carrier frequency?
q² = 1/6400 q = 1/80 2pq = 2 x 1/80 = 1/40
903
Best Rx for type 1 Von Willebrand's Disease? | Desmopressin, cryo, FFP
Desmopressin
904
Spinal anesthesia resulting in sympathetic blockade is worst for? Aortic stenosis, mitral stenosis, IHSS, Pulm HTN
Pulmonary Hypertension, Decreased SVR results in drop in preload which would result in inability to perfuse the pulmonary vascular bed
905
If disease frequency for PKU is 1/10,000, then what is carrier frequency?
PKU: Autosomal Recessive | q² = 1/10,000 q = 1/100, p is always 1 2pq = 2x1/100 = 1/50
906
In preeclampsia what happens to thromboxane and PGI2?
Thromboxane increases (normally it stsays the same) and PGI2 Decreases (normally it increases)
907
The difference between quality and safety is:
Quality measures efficient effective care that gets the right job done at the right cost (doing things well), safety is preventing harm
908
Fish highest in mercury content?
King Mackerel (Shark, Swordfish, Tilefish, Ahi Tuna also)
909
Kid got narcotic, what is the first sign of acidosis in tracing?
Loss of variability
910
Which organisms are most likely to cause Toxic Shock Syndrome?
Staph Aureus, Group A Strep
911
What factor is the worst prognosticator for CDH?
LHR <1 is worst | Liver is bad but not the worst
912
What product (of Aldosterone and testosterone) is increased in 21 hydroxylase deficiency, 17 hydroxylase deficiency and 11 hydroxylase deficiency
Follow the 1's 1 = increase, BP - T 21 = BP down, Testosterone Up 17 = BP up, Testosterone down 11 = BP up, Testosterone up
913
Which agents can potentially cause renal anomalies along with oligohydramnios?
ACE-inhibitors (-opril drugs)
914
``` Least likely in family hx affected by Fragile X? Premature ovarian failure Ataxia Family history MR Gonadal Cancer ```
Gonadal Cancer
915
Which Interleukin is antiinflammatory
IL10
916
What are the Ashkenzi panel enzyme deficiencies?
Familial Dysautonomia Cystic Fibrosis Canavan: Aspartocyclase Tay Sachs: Hexosaminidase A
917
How do you treat the fetus is the mother has CAH?
Dexamthasone, starting at 7-8 weeks. To prevent virilization of female fetus
918
Risk of peripartum transmission for recurrent HSV
Low, 1%
919
A patient with SLE nephritis will MOST liekly have which outcome?
Pre-eclampsia
920
Which Cardiac Lesion is the worst in pregnancy?
VSD with R to L shunt
921
Which cardiac disease is associated with the highest mortality?
Pulmonary HTN with VSD and Eisenmengers (Right to Left Shunt)
922
Your primary ethical responsibilities to the patient are:
Beneficence and autonomy (more so than nonmaleficence)
923
Duodenal atresia is associated with what other findings?
Polyhydramnios
924
Best test to compare the mean in 3 groups?
ANOVA (used for comparing means in more than 2 groups)
925
When is CVS contraindicated ?
Isoimmunization (Kell/Rh/etc.)
926
What is the medication used for primary pulmonary hypertension?
Viagra
927
Least likely associated with mental retardation?
Only 0.4% of women with varicella in first trimester have affected children.
928
Which is associated with pre-renal oliguria? | Urine osm 550, Urine Na > 20, Serum BUN:Cr 1:1
Urine Osm >450
929
Which medications to treat SLE are teratogenic?
Mycophenolate Mofetil and Cyclophosphamide
930
Club foot after oligo is the best example of a: | Malformation, Deformation, Disruption?
Deformation
931
Fragile X inheritance is associated with what number of repeats? What are the repeat letters?
>200
932
Most likely outcome of Meconium stained fluid with normal heart tracing?
Normal
933
What is the risk of cystic fibrosis if fathers parents has CF and carrier rate is 1/25?
1/100
934
What is the likelihood of poor neurological outcome after the death of one twin in a MCDA twin?
15-25%
935
What is the most common complication in pregnancy of women with Acromegaly?
Gestational Diabetes
936
What are the main features of Fetal Alcohol Syndrome?
``` Mental retardation Cardiac Septal Defects Growth Restriction Smooth Filtrum Small upper lip Small Palpebral fissures Kidney Abnormalities ```
937
A patient presents with bullous lesions in pregnancy and has positive complement deposition. What is the diagnosis?
Herpes/Pemphigoid Gestationalis
938
What is the structure of TRH?
Tripeptide
939
45XX, der(13,21)(q10q10) is associated with what?
Normal. | This is a balanced translocation on 13q;21q
940
Why is it a bad plan to give I131 in pregnancy?
It will destroy the fetal thyroid (because it concentrates there startingat 10-12 weeks)
941
Which cardiac lesions tolerates a decrease in SVR the least?
Eisenmenger - right to left shunting of blood
942
Bleeding circ most likely associated with what deficiency
Factor XIII
943
What is the appropriate treatment for Non-Hodgkins lymphoma at 18 weeks?
Combination chemotherapy
944
Fetus with intraabdominal Calcifications, Hepatosplenomegaly, Differential Diagnosis?
CMV/Toxo
945
Which medications decreases the level of OCPs?
Rifampin, Carbamezapine, Phenytoin
946
Which drug can cause neonatal hypotermia?
Valium

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