2012-2018 and Subject Reviews All together - In CSV form - Sheet1 Flashcards
What is type 1 error?
Rejecting the null when you shouldn’t have
In a patient with DiGeorge, what is the most common cardiac anomaly?
ToF
Fasting levels of what causes NTD? When might you see it?
Homocysteine, With Folic Acid antagonists blocking folate acid synthesis and back up results in increased homocysteine.
Best test to compare continuous variable in patients before and after treatment with experimental med .
paired t-test (best for one group before and after an intervention).
Which uterine anomaly has the highest risk of PTL?
#1. Didelphys #2. Bicornuate #3. Septate
What is the most common maternal complication of malaria?
Anemia
A mother has diabetes, which is the least likely complication to the fetus?
a) Hypoglycemia
b) Hypocalcemia
c) Hypothermia
d) Polycythemia
Hypothermia does not
Mitral stenosis worsens with?
Increased Preload
What is the best contraception option for a women with DVT in pregnancy?
Levonorgesterol IUD
Minipres mode of action?
Alpha blocker
Which screening is recommended for Ashkenazi Jewish population?
Familial Dysautonomia
Cystic Fibrosis
Canavan: Aspartocyclase
Tay Sachs: Hexosaminidase A
Where is PGF2apha produced mainly?
Decidua
Most drugs cross the placenta by what method?
Simple diffusion
HLA is not expressed on which?
Syncytiotrophoblast or cytotrophoblast
The Syncytiotrophoblast -has NO Antigens
What is the most common complication of malarial infection?
Anemia
Least likely to be transmitted in banked breast milk?
CMV
Multiple intraabdominal echogenecities are least associated with which condition?
- CF
- Aneuploidy
- Toro
- Parvo
- Meconium peritonitis
Parvo
Where does fetus make blood throughout pregnancy?
Yolk sac: 3-8 weeks
Liver: 6 weeks -> birth
Spleen: 8 weeks -> 28 weeks
Bone marrow: 18 weeks -> adult
OCP’s have the least beneficial effect in preventing which cancer?
Breast Cancer
What is the most common associated anomaly with single umbilical artery?
Cardiac defects
Which is most associated with fetal risk?
Thyroid stimulating antibodies, TSH?
TSI’s
Which situation is most likely to result in a fetus having T21?
- mom 45XX rob(14;21)
- dad 45XX rob(14:21)
Mom 10-15%
Dad: <5%
What is the worst complication of halothane?
Hepatotoxicity
Which Coagulation factors decrease with pregnancy?
Factor XIII, XI, Protein S and Platelets
Most common cause of mortality in setting of epidural placed for C-S?
Local toxicity
Which of the following have associations with advanced paternal age?
Marfan, Achondroplasia, Neurofibromatosis (MAN)
What happens to beta cells in pregnancy?
Beta cell islet hypertrophy
Which Swan values are calculated?
MAP, SV, SVR, PVR, LVSW
Low MCV, HbA2 3.9% Normal Iron Studies, Dx?
Beta Thalassemia
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
Which chromosome is oxytocin receptor on?
3
Early amniocentesis at 14 weeks is associated with?
It is associated with: fetal loss, club foot, failed procedure, PROM
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
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
What is used to measure inter-observer variability?
Kappa Score
What infection is most likely to be transmitted with breast feeding?
a. Hep B
b. Hep C
c. CMV
d. Herpes
CMV
Lasix mode of action?
Loop diuretic
What enzym is deficient in Gaucher?
Glucocerebrosidase
How does IgG cross the placenta?
Pinocytosis / endocytosis
What is the Barker hypothesis on fetal programming saying for IUGR fetuses?
They will develop Type 2 Diabetes later in life or metabolic syndrome
What are the MOST likely symptoms of multiple sclerosis during pregnancy ?
Variable Course, usually improves
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)
Injury to what nerve causes numbness to medial thigh and labia?
Ilioinguinal
Which coagulation factor is decreased in pregnancy?
Protein S, Factor XI, Factor XIII, Platelets
Newborn with nose hypoplasia, stippled epiphyses, and limb hypoplasia, dx?
Warfarin embryopathy
Most common complication of IUD in pregnancy?
Abortion
How do you treat MAI if CD4 is 50?
Azithromycin
Most likely to be helpful for treatment of mitral stenosis intrapartum?
Propranolol (Beta blocker)
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)
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
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%)
What is the most likely obstetrical complication related to obesity?
Increased Cesarean Delivery
What is Combivir?
Zidovudine (AZT) + Lamivudine
What cardiac lesions should be deliverd by cesarean?
Dilated Aortic Root >40mm Aortic Aneurysm Recent MI Acute Severe CHF Severe Symptomatic AS
How do you make the diagnosis of Von Willibrands?
Ristocetin test
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
Which anesthetic is the MOST cardiotoxic?
Bupivicaine
What is LEAST appropriate for testing for PKU?
Amnio for enzyme activity
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.
How is Fragile X inherited?
X linked dominant
<p>Most common non cardiac cause of maternal mortality</p>
<p>Infection</p>
Which is not true with preeclampsia at induction of anesthesia?
decreased vasoresponsiveness to pressors
decreased plasma volume
increased coagulopathy
decreased vasoresponsiveness to pressors
Which anesthetic has a risk of CAUSING withdrawal? Why?
Stadol (Butorphanol), it’s a mixed mu-agonist antagonist
Which is best test if using multiple variables to assess surival?
cox regression
What does PCWP approximate/indicate?
LV preload / filling
Most likely cause of a nonreative tracing in a term fetus
Sleep cycle
Which of the thyroid related substances crosses the placenta most rapidly?
Thyroid stimulating antibodies/immunoglobulins
Which seizure medication is most affected by maternal liver failure?
Dilantin (Phenytoin)
Which ultrasound parameter predicts placenta accreta most accurately?
Lacunae
Aldomet Mode of action?
Central alpha blocker
Which infection is a transplant patient least susceptible to compared with non-transplant patients?
E. coli, CMV, Chlamydia?
Chlamydia
Which statistic test is used to differentiate between dependent and independent variables?
Logistic Regression
At 30 seconds of resuscitation of a neonate, the HR is still low, Next step?
PPV
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%)
Choroid plexus cysts are most commonly associated with which aneuploidy?
- T21
- T13
- T18
T18
30-50% of T18 have CPC
What are the two AF molecules elevated with aplasia cutis?
AFP and Acetylcholinesterase
- elevated with all open wall defects
At which phase do type 2 pneumocytes appear?
Cannalicular
Aneuploidy with duodenum abnormality?
T21 in 30%
What drug is commonly associated with microotia?
Isoretinoin
Which IL is antiinflammatory?
IL10
Levels of which drug are least effected by liver metabolism?
Lovenox, Warfarin, Dylantin?
Lovenox
How do you treat a patient with Pulmonary hypertension, and you want to give general anesthesia.
Viagra
Which HIV medication should be avoided in first trimester?
Efavirenz (NNRTI)
Best medication for anticoagulation in pregnancy?
Lovenox
Which translocation most likley to result in fetus with T21?
21:21 Homologous 21 translocation
Which fetal vessel has the lowest PO2?
Umbilical Artery
Which thombophilia is the most common?
Factor V leiden
What are the criteria for pre-eclpamsia with severe features?
- BP: >160 systolic or >110 diastolic x 2, atleast 4 hours apart
- Plt <100,000
- ↑ 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
Which inheritance pattern is most associated with variable penetrance?
Autosomal Dominant
What is not associated with placental thickening?
a) Syphilis
b) Rh Issoimmunization
c) Non-immune hydrops
d) Listeriosis
Listeriosis
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
Doppler studies reflect what parameter?
Velocity
What is the risk of NAIT in a subsequent pregnancy?
If father’s antigen zygosity determines he is homozygous: 100% risk
Heterozygous: 50% risk
What is the most likely cause of pain from a Wet tap?
Traction of nerves from CSF leak
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)
CVS cannot diagnose which conditions?
NTD
Fragile X
Woman with MCV of 62, normal ferritin, HgbA2 4.2%. Most likely cause:
Beta Thalassemia
- Which anomaly is LEAST associated with very ill neonate after birth
a. Interrupted aortic arch
b. AV canal
c. Other CHD
AVSD
Triple screen shows a normal AFP, normal HCG and a low E3. What condition is this associated with?
X-linked icthyoses and SLOS
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
pCO269, HCO3 20, BE -2
Mixed
What is the heart ultrasound finding most commonly associated with DiGeorge?
Interrupted Aortic Arch
The most accurate description of Standard error is?
The same as standard deviation
GnRH is made in which tissue?
Cytotrophoblast and Decidua
Betamethasone decreasese what in fetuses?
Fetal Breathing and movement
Most likley diagnosis with fetal unilateral pleural effusion?
Hydrothorax
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
Mechanism of anemia in parvovirus?
hemolytic effect, viral effect on erythroid precursors?
Effect on erythroid precursors
Gaucher’s disease is a disorder of:
Glucocerebrosidase
What is the most common trisomy in first trimester abortuses?
Trisomy 16
What maternal cardiac disease is associated with a poor prognosis?
VSD with R-> L shunt (Eisenmenger)
What is the most common adverse effect of general anesthesia?
Nausea and vomiting
What is the mutation in Osteogenesis Imperfecta? Inheritance?
COL1A1 and COL1A2 (autosomeal dominant)
What is most likely diagnosis of ambiguous genitalia?
CAH
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
What type of inheritence is associated wuth Leber’s optic atrophy?
Mitochondrial
Which of the following syndromes is caused by uniparental disomy?
Angelman
Beckwith
Prader- Willi
Maternal death is most associated with?
Cardiac Disease
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)
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
What is the mechanism of fetal anemia caused by parvovirus?
Cytotoxic to erythrocyte precursors
Which PG is not associated with labor? PGE 1 PGE 2 PGE 3 prostacyclin thromboxane
Prostacyclin
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)
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
What is associated with pancytopneia and absent radius?
Fanconi’s anemia
What enzyme deficiency is seen with hydantoin syndrome?
Epoxide hydralase
What is the most likely cause of low estriol levels?
Placental sulfatase deficiency (XLI) or SLOS
What is the most common fetal anaomaly in obese patients?
Neural tube defects / Spina Bifida
What is an obligate precursor for NO?
L-arginine
What is an early sign of TTTS?
NT and CRL discordance
Low MCV, HbA2 2.2% Low Iron Studies, Dx?
Iron deficiency anemia
What is the most common reason for birth defects?
Genetic
What syndrome has coarctation of the aorta?
Turners
Which is the stats term used for inter-observer agreement?
kappa (intra observer variability / agreement)
What is the most common presentation of neonatal lupus?
Rash and second thrombocytopenia
Chorioangioma – most likely complication?
Polyhydramnios in 60% vs FGR in 20%
What physical finding on a baby is associated with a term birth?
Scrotal Rugae
Which ashkenazi disease is treatable with enzyme replacement?
Gauchers
What crosses the placenta via Simple Diffusion?
COKED - CO2, O2, Ketones, Electrolytes, Drugs (most)
What does Barker theory of fetal programming say about IUGR fetus at most risk of?
- Metabolic syndrome
Very Low Estriol levels are most commonly associated with what?
Placental Sulfatase Deficiency, X linked icthyoses, SLOS
What mutation happens in Duchenne Muscular Dystrophy?
Deletion of Exons (X-L-Recessive)
Diazoxide mode of action?
Thiazide analog (non-diuretic, vasodilator)
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
What does CVP approximate/indicate?
RV Preload / filling
Atenolol mode of action?
Beta blocker
A normal woman has a homozygoous 21/21 translocation. What percent of her offspring will have Down syndrome?
100%
Which disease is AD and is associated with telengiectasia, ataxia, thrombocytopenia?
Osler Weber Rendu
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.
Which headache gets worse with sitting standing and better with laying flat?
Spinal Headache
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
Prophlyaxis for mycobacterium avium with CD4 count 45 is?
Azithromycin when CD4 < 50
Least likely symptom with H1N1?
Nausea/Vomitting, Cough, Fever, Sore Throat?
Nausea/Vomitting
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)
What US findings are associated with Meckel Gruber?
Multicystic dysplastic Kidney, Encephalocele, Postaxial Polydactyly
Patient has an MCV of 69 and Hgb A2 of 4% on electropheresis, what is the MOST likely diagnosis?
Beta thalassemia
What is the most common genetic cause of mental retardation?
Fragile X
What is the reason for maternal hypoxia at time of induction of general anesthesia?
Decreased Functional Residual Capacity
Microtia associated with other drugs then isotretinoin?
Thalidomide, Mycophenolate
Greatest risk with lupus nephritis?
Preeclampsia
What is least associated with cerebral palsy?
- ph<7 BE>-12
- early onset encephalopathy
- neonatal seizures
- Apgar score of <3 at 5 minutes
- Multi system organ failure
- Spastic quadriplegia
Multicsystem organ failure
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)
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.
What condition results from pituitary deficiency? acromegaly diabetes insipidus addisons cushings
Diabetes Insipidus (Decreased ADH from Posterior pituitary)
Most common outcome if NT is increased?
Normal
Neonate with limb and muscle hypoplasia, derm and
eye finding, Diagnosis?
Congenital Varicella
Which Aneuploidy is most common with CDH?
T18
Discrepancy in which is best for TTTS diagnosis?
Amniotic Fluic (Poly/Oli)
Which medication increases cardiac contractility?
Beta agonist
Which is helpful for treatment of HIE?
Cooling
Which fetal organ system is subject to malformations the longest?
Nervous system
In a retrospective study, do you use Odds ratio or relative risk?
Odds Ratio
Weight of the uterus at term? Non pregnant?
The uterus weighs 1100-1200 g at term. Non-pregnancy <100g.
Best outcome following in utero repair of myelomeningocele is seen with?
Lower limb muscle strength
Management of Acute Fatty Liver of Pregnancy?
Delivery despite gestational age
Treatment of NAIT should be? At what gestational age?
IVIG, starting at 12 weeks
Which is least likely with listeria?
preterm labor, chorioamnionitis, hydrops?
Hydrops (one of the less common etiologies of hydrops)
What is FGR at 20 weeks most associated with?
Triploidy, If >26 weeks probably Trisomy 18
Which Coagulation factors increase in pregnancy?
Fibrinogen, Factor VII, Factor X, vwF:Roc
At term which fetal organs get the most blood flow?
#1 Placenta #2 Brain #3 Lungs
Which maternal cardiac lesion most associated with fetal hypoxia?
Pulmonary Hypertension
Surfactant treatment of a 28 week newborn will help decrease what the most?
Neonatal Mortality
What is the first line medication when there is uterine inversion?
Terbutaline , second line Nitroglycerine
What are the features of Warfarin Embryopathy?
SLIMNECk Stippled Epiphysis Limb Defects IUGR MR Nasal Hypoplasia Eye Defects CNS k - Vit K Antagonist Warfarin
What does a class 1 MHC get attacked by?
Cytotoxic T cells
What is more convincing situation to intubate, hypoxemia or hypercapnea?
Hypercapnea
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)
Which IL is a regular component of amniotic fluid?
IL8
Which disease is most transmittable in breastfeeding?
CMV
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
Pfannestial incision opening rectus muscles, what vessels are most likely injured?
Epigastric vessels
Which anesthetic has the shortest halflife?
Chloroprocaine
Which patient with thrombophilia can you give OCPs to post partum?
- Prothrombin mutation
- APLS
- MTHFR homozygous
- Protein C/S deficiency
- Factor V Leiden
MTHFR
Which artery can be injured when separating the rectus muscles during a c-section?
Inferior epigastric
Which is the MOST diagnostic of primary adrenal insufficiency in pregnancy?
They develop hypotension from HYPONATREMIC volume contraction
What influences the volume of AF the least in pregnancy?
a. Swallowing
b. Urine production
c. Maternal weight
d. Dehydration
e. Transudation
Maternal weight
Which anesthetic has the fastest onset of action?
Lidocaine
Most severe manifestation In listeria is?
The main manifestation of Listeria is stillbirth.
What is pulmonary capillary wedge pressure (PCWP) reflects?
Left Ventricular Preload
NTD is associated with what intercranial findings?
Banana sign
Lemon sign
Ventriculomegaly
Small cisterna magna
Which of the following are findings in BV?
pH>4.5
+Whiff test
Thin homogeneous discharge
>20% clue cells
Which parameters are directly measured by Swan?
HR CVP Pulmonary artery systolic and diastolic pressure PCWP Cardiac output
What aneuploidy is seen with holoprosencephaly and midline facial defects?
Trisomy 13
Which of the following is the action of platelet activating factor on myometrial cells?
Increases intracellular Calcium
IUGR is most associated with what later in life?
metabolic syndrome / dm2
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.
Patient presents postpartum with fever, renal failure, anemia. Dx? Tx?
TTP, Plasmapheresis
Why does creatinine decrease in pregnancy?
Increased renal perfusion and renal plasma flow (GFR)
Pattern of glucose levels by time of day in pregnancy?
Decreased fasting levels, Increased postprandials
Precursor for Fetal Steroid Synthesis?
Maternal LDL
What is the most common finding with Trisomy 21 on sono at 18-20 weeks?
Nuchal Fold
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
What is the most common non-infectious, non-genetic cause of MR?
Fetal alcohol syndrome
Which lab measuring cardiac ischemia/function can be increased after vaginal delivery?
CKMB - found not only in myocardium but also in uterus and placenta.
Which statistical test will account for survival accounting for multiple variables?
Cox Regression
What is a unilateral pleural effusion in a fetus is most likely due?
Hydrothorax
Which ethical principle explains a Dr/Patient relationship?
Beneficence
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)
Evaluate the effect of Smoking on Lung Cancer, what type of study?
Case Control
Facial nerve palsy is a complication of which Operative delivery method?
Forceps
Which adrenergic receptors are present on the myometrium?
- α1: ↑ Phospholipase C -> ↑Protein Kinase C & Calsium 2. β2: ↑ Adenylyl Cyclase -> ↑ CAMP –> ↑ Protein Kinase A
Risk of NTD with valproic acid?
1-2%
When a CVS result is mosaic, what is the most likely outcome?
Confined placental mosaicism
After cardiac arrest, when should delivery ideally occur ?
Within 5 minutes (If spontaneous circulation does not occur within 4 mins of effective CPR)
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
Most common location of brain bleed in premature infant?
Germinal Matrix
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
What does wedge pressure measure?
LV filling pressure
Most common obstetric fistula?
rectovaginal fistula
Karyotype shows 45XX t(14;21). What is the phenotype?
Normal
Balanced translocation
How can you distinguish preeclampsia from lupus flare?
Increased Urine Sediment, Decreased CH50 activity, Anti DsDNA
What is another name for Bupivicaine?
Marcaine
Swan readings for PE?
Increase: Pulmonary artery pressure
Pregnant patient with ab pain and bloody stool?
Stool culture
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
What is associated with fetal abdominal calcifications?
CMV
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 )
Which TB treatment is teratogenic? What does it do?
Streptomycin is contraindicated - as it is associated with hearing loss
Which Respiratory functions don’t change in pregnancy?
- Vital Capacity
- Respiratory Rate
- FEV1
What confers the worst neonatal prognosis in CMV?
Microcephaly
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?
Which bacterial enzyme is most associated with preterm birth?
Phospholipase a2
Which condition is most likely associated with aneuploidy?
- Cardiac
- Omphalocele
Omphalocele
Baby delivered and tried to resuscitate, Post ductal O2: 70%, Preductal 90%, likely diagnosis?
Persistent fetal circulation
Patient with elevated HbA1c (10%), what is the most likely finding on ultrasound?
Normal
NTDs are usually:
a) Due to single gene defects
b) Caused by teratogens
c) Multifactorial
d) Aneuploidy
Multifactorial
Preload and afterload fixed, what increases CO?
beta adrenergic (dobutamine)
What is the most predictive of transmission of HIV to baby?
Viral load/HIV RNA
What does a ROC curve represent?
Compares sensitivity and specificity
y = sensitivity
x = 1-specificity
What is the ethical principal which states a physician must refrain from providing ineffective treatments or acting with malice toward patients
Non-maleficence
What is the positive predictive value of an NST for cerebral palsy?
<1%
Algorithm for managing SVT?
#1) Vagal maneuvers (holding breath, valsalva) #2) Carotid Massage #3) Adenosine #4) Verapamil #5) Beta blocker
Which medication is contraindicated in women with chronic hepatitis for HIV treatment?
Nevirapine, less so Lopinavir/Ritonavir (Kaletra)
Which error is failing to reject the null hypothesis when its false?
Type 2 Error (failed “2” reject the null)
What Ultrasound finding is agenesis of the corpus callosum most associated with?
Absent CSP
Also colpocephaly
What is the best way to monitor improvement in metabolic acidosis in DKA?
Anion gap
Most common complication with general anesthesia?
Failed Intubation
Why does T4 demand increase in pregnancy?
Increased TBG, to maintain adequate free T3 T4 there is increased production
Which is true regarding oxygen dissociation curve?
A fetus has higher O2 saturation at any PO2 than mom
Which maternal cardiac lesion is associated with the greatest fetal oxygenation risk?
Pulmonary Hypertension
Patient meets clinical criteria for antiphospholipid syndrome. Recommended testing?
Lupus Anticoagulant (Kaolin, Dilute russelll venom viper test, B2 Glycoprotein, Anti Cardiolipin Antibody
What is the principal substrate for oxidative metabolism in the placenta?
Glucose
Patient can’t dorsiflex after forceps delivery, which nerve injured
Common Peroneal
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)
Most likely genetic cause of early IUGR?
<26 weeks think Triploidy
> 26 weeks think T18
Newborn with Thrombocytopenia and Interventricular Hemorrhage, likely Diagnosis?
Alloimmune thrombocytopenia
Which maternal cardiac lesion most likely transmitted to fetus?
IHSS (autosomal dominant)
Patient with 8 week IUP has IUD in place, develops fever, chills, abdominal pain. What should you do next?
- Remove IUD, then evaluate for other causes of abdominal pain / fever and check for signs of septic abortion.
Which fetal anomaly has highest risk of malignancy?
CCAM (Pleuropulmonary blastoma and bronchoalveolar carcinoma )
What is the most common Adverse effect of AZT?
Anemia (next is neutropenia)
Baby with transposition, cleft lip and facial abnormality. Diagnosis?
DiGeorge
What represents a thyroid profile of first trimester?
TSH decreases slightly
FT4 remains same
Which nerve injury causes decreased mons sensation?
iliohypogastric
What does maternal blood come into direct contact with in the intervillous space of placenta?
Syncytiotrophoblasts
Which tests are positive if you are chronically infected with Hep B?
Surface antigen and core antibody (anti-HBc)
What is a prolonged aPTT in a patient with pre-eclampsia is most likely due?
APLS
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%)
When is CVS not recommended?
In cases of Isoimmunizatio/Alloimmunization (NAIT, Kell, Rh)
What is the best way to determine chorionicity in twin gestations?
Twin peak sign
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
What is the precursor for fetal steroid synthesis?
LDL
If a CVS shows balanced translocation, what should you do next?
Maternal karyotype
Ultrasound findings would increase the risk of Down syndrome, except: Duodenal atresia Increased Nuchal Fold Cardiac anomaly Short femur Sandal gap
Sandal gap
What is not covered by Cephalosporins?
a) Enterococcus
b) Group A Strep
c) Group B Strep
Enterococcus
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)
Which syndrome is associated with fetal thrombocytopenia?
- Absent radius
- Gestational thrombocytopenia
- Erythroblastosis fetalis
- Bernard Soulier syndrome
TAR Syndrome - Thrombocytopenia, Abset radius syndrome (but thumb present)
Which can also pretsent with Kidney or Heart issues
Anomaly of what system is most commonly seen with diaphragmatic hernia ?
Cardiac
What is the most common problem for a term IUGR infant?
Hypoglycemia
What is the treatmet for TB?
- Rifampin
- Isonoazid
- Pyrazinamide
- Ethambutal
Which of the following is most associated with aneuploidy in isolation?
cleft lip, gastroschisis, EIF, hydronephrosis, or ventriculomegaly?
Ventriculomegaly (3.81X LR)
What is the most likely complication of pregnancy conceived with IUD in place?
SAB - 3x more likely (50%)
Which ethical concept is informed consent most closely tied to?
Autonomy
What are the findings of Neonatal Myasthenia Gravis?
Poor cry, decreased muscle tone, respiratory muscle weakness
What does treatment of GDM improve?
Lower rates of macrosomia
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)
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
Which is the best way to randomize?
table of generated numbers with block randomization
What does not get absorbed in patient with Roux-En-Y bypass vs. gastric banding?
B12 Deficiency
What is the most common complication of SLE on pregnancy?
- Pre-eclampsia (8-20%) 2. PTL (spont and indicated - 20-50%)
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)
Foot drop is associated with what nerve injury:
Peroneal
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)
Most associated with placental insufficiency?
Low Papp-A, High Papp-A, HcG?
Low Papp-a
Which study type is ideal for studying rare outcomes/diseases?
Case-Control Study
Twins, when do you not do a CVS?
With Alloimmunication
What is the most likely cause of fetal Macrosomia?
Prepregnancy obesity
39 week patient with a DVT, management?
Therapeutic Heparin
Most common presentation of Turners syndrome?
Short Stature
Which congenital cardiac lesion is most likely to result in a clinically stable infant immediately postpartum?
Complete AV canal
What is most resistant to GBS?
a) Erythromycin
b) Clindamycin
c) Penicillin
d) Azithromycin
Erythromycin
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%
Which infection poses the greatest risk for maternal mortality?
Varicella (likely #1), maybe H1N1 if no varicella
Which fish should be avoided in pregnancy?
King Mackeral
Triple screen with nl HCG, AFP but very low estriol, think?
X-linked iccthyosis(Placental sulfatase deficiency) and SLOS
What is the most likely risk from regional anesthesia?
Toxicity from local anesthetic
How do you differentiate between CCAM and CHAOS?
In Chaos you have inverted diaphragm
What is the most likely to have a low estriol?
a. IUFD
b. Trisomy 21
c. Placental sulfatase deficiency
Placental Sulfatase Deficiency
Complications associated with Herpes Gestationis?
PTD, IUGR, increased neonatal mortality
Which cardiac lesion is most specific with T21?
AV Canal defect
Which situation allows you to override patient confidentiality?
someone in serious danger
Findings in autonomic dysreflexia?
Hypertension, Bradycardia, Flushing
Which enzyme deficiency is a concern with chloroprocaine?
Pseudocholinesterase
Which lab result is most indicative of recurrent CMV infection?
IgM: +
IgG: +
High IgG avidity
What is the disease characterized by a deficiency in aspartoacylase?
Canavans
Which is the most likely neonatal complication with PKU?
Mental Retardation
Which medicine is NOT associated with PPHN?
Keppra, NSAIDs, SSRIs
Keppra
What crosses the placenta via active transport?
PICA - Phosphorous, Iron, Calcium, Amino Acids
Multiple Sclerosis is most associated with which pregnancy complication?
IUGR (MS = Mighty Small)
How do you monitor improvement of metabolic acidosis in DKA?
Follow anion gap
When can a physician override refusal of treatment?
Lack of capacity
What is the prevalence of asymptomatic bacteriuria in pregnancy?
a) 5%
b) 15%
c) 25%
5%
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
What pattern of inheritance is passed through maternal only?
Mitochondrial
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.
Which rate of dopamine infusion improves renal blood flow?
Low dose, <5ug/kg/min for renal blood flow
Why does NPH stay longer in body than aspart?
Increased halflife due to protamine and pH
Best Rx for mom with dyspnea, cyanosis, large VSD and R to L shunt at 28 weeks?
Viagra
What crosses the placenta via Endocytosis?
IgG, LDL, Insulin (If IgG), Transferrin
TTTS is best diagnosed with a discrepency in what ?
Amniotic fluid volumes
Which affects fetal growth the most?
Fetal Insulin, HPL (aka human somatomammotropin)
What increases alveolirization in the lungs?
Thyroxine or Vitamin A
The fetal organ that receives the highest proportion of cardiac output:
Placenta
Most common complication with insulin pump?
Site infection, asymptomatic hypoglycemia
What is the most likely reason to intubate a pregnant lady?
Respiratory acidosis
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.
What are the key abnormalities with Meckel Gruber?
Post-axial Polydactyly
Multicystic Dysplastic Kidneys
Encephalocele
Which cells are the innate immune cells?
Which are the adaptive immune cells?
Innate: NK, Monocytes, macrophages, trophoblasts
Adaptive: B cells and T cells
3+ groups which statistical test?
ANOVA
Does obesity increase risk of NTDs?
YES
Which is the usual cause of hemodynamic decompensation with mitral stenosis peripartum?
Increased Preload
Discrepancy between cfDNA and fetal Karyotype, what can cause this?
Confined placental mosaicism
What molecule gets degraded most by the placenta?
Prednisone/Prednisolone - by 11 β-hydroxysteroid dehydrogenase Type 2
Name 3 diseases that can be treated with IVIG?
IVIG is a proven treatment for myasthenia, NAIT, and ITP.
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)
Mom with uncontrolled hyperthyroidism, what are the most common pregnancy complications?
#1: Preeclampsia #2: Growth Restriction #3: Preterm delivery
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)
Nuchal translucency is 5.4mm. Next best step?
CVS (genetic testing)
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
How does iodide treatment work?
Decreases the circulating supply of T4 and T3 by inhibiting release of stored thyroid hormone.
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.
In Mono-Di twins, at what day does cleavage occur?
4-8 days
- Which causes a recurring fever?
a. Listeriosis
b. Syphilis
c. Lyme dz
d. Others
Lyme Disease, Brucellosis also
Which medication decreases OCP efficacy?
Carbamezapine, Phenytoin, Rifampin
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
Patient presents with IUFD, severe iugr + omphalocele, + large kidneys, what lab should you send?
Karyotype and Microarray
Antihypertensive with most evidence for association with IUGR?
Atenolol
Swan readings for pulmonary edema?
Increase: PCWP > 18, CVP
A patient is newly diagnosed with HIV not previously on any medication. What is the best way to prevent HIV transmission?
AZT (zidovudine)
What is the precursor to estriol?
C9 Precursor DHEAS (from the fetal adrenal, fetal zone)
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)
Which would decrease drug transport across placenta? increased lipid solubility increased protein binding decreased ionization placental degradation
Increased protein binding
What is the best treatment for in utero CAH?
Dexamthasone, starting at 7-8 weeks. To prevent virilization of female fetus
What should the work up of a woman with a Spontaneous Abortion at 12 weeks include?
Antiphospholipid Antibodies
Most common cause of Polyhydramnios?
Idiopathic
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
Most direct biochemical cause of a myometrial contraction?
Myosin Light Chain Kinase
What mechanisms result in uniparental disomy?
2 chromosomes inherited from one parent, trisomic rescue
Ex: Beckwith, Angelman, Prader-Willi
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
Which of the following is not associated with AMA? T21 T13 T18 45XO
45 XO
<p>What percentage of Rh negative patients who do not receive Rhogam will be sensitized?</p>
<p>15%</p>
What affects positive predictive value (PPV) the MOST?
Prevalence
Physiology of late decelerations?
Chemoreceptor reflex
What is the most common complication of SLE on pregnancy?
- Pre-eclampsia (8-20%)
2. PTD (spont and indicated - 20-50%) - Not spontaneous PTB
Which cancer do OCPs decrease the least?
Breast Cancer
In which patients can you give OCPs?
- Hx of DVT
- Migraine with aura
- Type 1 DM
- Active viral hepatitis
Type 1 DM
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)
Which is not associated with IUGR?
Hyperthyroidism, sickle cell, parvo
Parvovirus (anemia and heart failure, not usually FGR)
Most common complication of SSRI used in pregnancy used in a neonate?
Neonatal Abstinence
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)
What is the risk of cystic fibrosis if fathers sister has CF and carrier rate is 1/25?
1/150
Greatest contraindication to postpartum combined OCP’s
hemorrhagic stroke w/ eclampsia
sagittal vein thrombosis
ovarian vein thrombosis
Sagittal Vein Thrombosis
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)
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
Which cell is not part of innate immunity?
Monocyte
Best Treatment for a Pheochromocytoma
Phenoxybenzamine (Alpha Blocker)
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.
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
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
Histologic Chorioamnionitis without clinical signs of infection is associated with what neonatal complications?
Interventricular hemorrhage, periventricular leukomalacia and Cerebral palsy
What is Methadone LEAST likely to result in?
Congenital anomalies
What drug is impermeable to the placenta?
Insulin, except if IgG bound
Holoprosencephaly is most commonly associated with which of the following chromosomal abnormalities?
Trisomy 13
What hormone decreases after delivery to allow for lactation?
Estrogen
Which mode of inheritance applies to penetrance and variable expressivity?
Autosomal Dominant
What lab value are features of DKA?
PH: <7.3
HCO3: <15
AG: >12
+Ketones
What is Alpha Error?
Type 1 error (False Positive, rejecting the null when we should have kept it)
Which finding is the MOST common in Meckel-Gruber syndrome?
Multicystic dysplastic Kidneys (100%)
Placenta degrades _____ the most:
a. Betamethasone
b. Prednisone
c. Insulin
d. Heparin
Prednisone
CDH, IUGR, VSD , most likely diagnosis?
T18
How is calcium transported across placenta?
Active transport
Most common complication of neontatal thrombocytopenia?
Rash more than thrombocytopenia
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)
Which infertility treatment is associated with hypospadias ?
ICSI
What cardiac anomaly cannot be identified with 4 chamber view ?
TGA
Coarctation
VSD
Marfan Aortic root recommendations?
Recommend beta blockers, cesarean delivery for aortic root >5. Recommend repair prior to pregnancy for aortic root >4
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
The main factor that influences fetal growth?
Insulin, HPL
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)
What is the main source of PGI2 in pregnancy?
The Myometrium
Which hepatitis can cause chronic active hepatitis and cirrhosis?
Hep C
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)
What stage is a fetus with abnormal Dopplers?
Stage 3
What is the most likely outcome with demise of one twin in a MCDA pair?
Neurologic Sequelae in the surviving twin (15-25%)
When does Relaxin peak?
8-12 weeks
What condition with CF carries a poor prognosis?
Cor Pulmonale
NO reacts with what to produce cGMP?
Iron
External Genitalia differentiation stimulated by what hormone?
LH which stimulates testosterone
What is the risk of transmission in the first trimester with primary CMV infection
40%
What dictates delivery mode in patients with ITP?
Obstetrical reasons
What crosses placenta via Facilitated diffusion?
Glucose
A woman with a prolactinoma wants to breast feed, you advise?
Okay for microadenoma prolactinoma to breast feed
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)
A normal woman has a homozygoous 21/21 translocation. What percent of her conceptuses will have monosomy 21?
50%
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
Which hormone decreases surfactant synthesis?
Insulin - delays surfactant production
The benefit of doing a multivariate analysis in a cohort study is?
Decrease confounding
What is increased in the fasting state in pregnancy?
Cholesterol, depends on this for energy NOT gluconeogenesis
What effects on lipids does Depot Provera have?
↑ LDL
↓ HDL No change in triglycerides
What is the origin of cell free dna?
apoptosis of placental cells (syncytiotrophoblast)
Which medication is the best anticoagulant to prevent clot in pregnancy:
Lovenox
What is MOA of iodine in maternal thyroid function?
Blocks release of thyroid hormone from the gland
What is associated with graft versus host?
Erythema multiforme
What medications can decrease the effectiveness of OCP’s
Phenytoin, Carbamezapine, Rifampin
Most common Uterine Anomaly with Pregnancy loss?
Septate Uterus
Which anesthetic has greatest cardiac risk?
Bupivacaine (Marcaine)
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)
In a patient with T2DM and an elevated HbA1c, what is the most common finding on US?
Normal Ultrasound
When does cardiac output increase the most?
Immediately postpartum
Benefit of a SNP Array over CGH Array?
SNP Array can detect Triploidy
Which medication is LEAST likely a teratogen?
Azathioprine, Cyclophosphamide, Cyclosporine
Azathioprine
What is the most common location of an arachnoid cyst?
Middle Cranial Fossa
Which local anesthesic is least likely to cause neurotoxicity if given IV?
Lidocaine wont cause it,
Chloroprocaine will
and bupivicaine will but more cardiotoxic
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
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+
Steroids are least likely to help
a. IVH
b. RDS
c. BPD
d. NEC
BPD - no effect
After an overnight fast, what is most likely decreased in the morning?
Glucose
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
Swan readings for Hemorrhage?
Decrease: CO, PCWP and CVP
Increase: SVR
How many asymptomatic bacteriuria pregnant women would develop symptomatic infection if untreated vs. treated?
20-35% compared to <4% if treated
Which Prostaglandin causes muscle relaxation?
Prostacyclin (PGI2)
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.
Which HIV medication is worst for liver toxicity?
Nevirapine (most), Ritonavir/lopinavir (if its not there)
What is the mutation in Spinal Muscular Atrophy? Inheritance?
SMN1
What is gap junction protein?
Connexin
What is the management hydrocephaly?
US, infectious and genetic workup
Aspartoacylase deficiency is associated with?
Canavan disease
What is the most important factor affecting Positive Predictive Value?
Prevalence of disease
Obese patient comes to you with complaint sof fatigue and forgetfulness, what test should you order?
Sleep Study
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)
When you open the broad ligament, where is the ureter located?
Crosses over the common iliac artery
If a patient becomes hypotensive after mag bolus, what medication do you give?
Calcium Gluconate
Most likely complication of pyelo in pregnancy?
a) Urosepsis
b) ARDS
c) Preterm delivery
d) Anemia
e) Decreased creatinine clearance
Anemia (33%)
What added step should you do in a cesarean section of a Morbidly obese patient?
Closed Subcutaneous layer
What is the gestational age at which fetal lung alveolarization occurs?
36 weeks
Which blood product increases fibrinogen the MOST?
Cryo
What is the most common feature of turners syndrome?
Short stature
Which part of the biophysical profile is most associated with an acidemic fetus?
tone
Which antibiotic has the ability to potentiate the neurmuscular blocking ability of magnesium sulfate?
Unasyn
Gentamicin
Erythromycin
Gentamicin
What is the most likely outcome for patient on dialysis?
Preterm Delivery (50-80%)
Polyhydramnios (40%)
Anemia (100%)
Hypertension (100%)
Maternal risk of Varicella?
30% pneumonia which has a 30% mortality.
Which is LEAST likely a finding in pseudotumor cerebri?
Ventriculomegaly
Which is least associated with pregnancy loss after amniocentesis?
Tenting, multiple attempts, needle gauge, transplacental stick?
Tenting
What is the most reliable ultrasound criteria for dating?
Cerebellum
Foot length
What is the cause of a post regional headache?
traction of pain sensing cranial structures
Which is the thrombophilia with the worst prognosis?
Antithrombin III
Most likely complication for patients with aortic stenosis in the peripartum period?
Arrhythmias
What is the precursor of fetal steroid synthesis?
LDL
At what CD4 Count are you at risk of pneumocystic pneumonia?
<200
Patient has a fetus with T21, what is the risk of recurrence?
1%, or age related risk whichever is higher
Which artery most likely to cause vulvar hematoma?
Branches of pudendal artery
What are the last 3 phases of lung development? At wat weeks do they occur?
Cannalicular - 16-26
Saccular - 26- 36
Alveolar - 36+
Maternal blood comes into direct contact with what?
Syncytiotrophoblasts
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
Which structural anomaly is most common with PKU? What about most common complication?
Structural: Cardiac (10-15%)
Complication: Mental Retardation (80-90%)
What is the PO2 in the umbilical artery?
20
Most likely diagnosis of echogenic bowel at 20 weeks?
Normal
What is Prader Willi most likely due to?
Deletion of paternally derived Ch 15
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)
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
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)
Cerebal palsy is a diseas of what part of the nervous cystem?
upper motor neuron disease due to damage of white matter.
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)
What is a decrease in Urine calcium associated with in pregnancy?
Preeclampsia
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)
What is mode of inheritance of Fragile X?
X linked dominant
Renal dose of Dopamine?
<4mcg/kg/min
What is the best way to test for a fetus having CAH?
Direct gene testing
Which autoimmune disorder is more likely to improve during pregnancy?
Rheumatoid Arthritis improves in 50-70% of cases in pregnancy
Which medication relieves symptoms of cholestasis?
Ursodiol
Diabetic nephropathy most common pregnancy complications?
Preeclampsia (53%)
Preterm delivery (51%)
IUGR (11%)
Which anesthetic has the fastest onset?
Lidocaine
In TRAP what is found in the acardiac twins’s Dopplers?
Pulsatile flow in UA
Continuous flow in UV
Features of Fetal Varicella?
Mental Retardation, Limb Hypoplasia, Scarring of Skin, Eye
What enzyme is deficient in Tay Sachs?
Hexosaminidase A
Large c-section incision injures iliohypogastric/ilioinguinal nerve, what is the most likely result?
Paresthesia/Pain at mons (hypogastric)
ilioinguinal more labia
Swan readings for septic shock?
Decrease: SVR
Increase: Co
What to use for malignant hyperthermia at >36 wks with contractions
a. Epidural
b. Spinal
c. Mag tocolysis
d. others
Epidural
CVS is most contraindicated in?
Existing Rh isoimmunization is a contraindication to CVS
Most likely diagnosis with a cystic hygroma?
40% T21, 30% Turners
Recurrence risk with spina bifida?
1.5% if one effected chlid, 7% if 2
What drug increases the motor blockade with magnesium sulfate?
Calcium Channel Blocker
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)
Which part of the BPP is most closely correlated with Acidosis?
Loss of tone
Which rash is associated with the worst fetal/neonatal outcomes?
Pemphigoid AKA Herpes Gestationalis
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)
Preeclampsia - most common finding on pathology of placenta?
Parenchymal infarction
What hormone is the placental precursor to estrogens, where does it come from?
C19 precursor DHEAS from the fetal zone of the fetal adrenals
What is the treatment for NAIT?
IVIG
Which antidepressant is most associated with cardiac anomalies?
Paxil (Paroxetine)
Which R-A-S component increases and then decreases?
Renin peaks at 12 weeks then declines in 3rd trimester
Most specific finding to distinguish TTP from HELLP
LDH to AST ratio (elevated in TTP)
Where does a sub-galeal hemorrhage happen?
Between skull periosteum and the scalp galea aponeurosis
Increased Fluid is most beneficial for what lesion?
Aortic Stenosis
Which hormone drops to allow breastfeeding?
Estrogen
Uncorrected ASD, increases the risk of?
Stroke (increased risk of emboli from arrhythmias)
Pregnancy patient with joint pain + pustular rash on hands, most likely has which infection?
Gonorrhea
Which malfomation has the greatest risk of underlying aneuploidy? CHD Gastroschesis Omphalocele Clubbed foot
Omphalocele
What are the ultrasound findings of holoprosencephaly?
Single ventricle
Absent corpus callosum
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.
What are the features of Fetal Hydantoin Syndrome?
IUGR, MR, Nail/Digit hypoplasia, Hypertelorism, low set ears, short nose / flat nasal bridge
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.
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
What is the most likely diagnosis of fetus with enlarged bladder?
Posterior uretheral valves is most common cause of bladder outlet obstruction
Which complication is not associated with SSRI use in pregnancy?
Gastroschisis
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
What does wedge pressure represent?
LV preload
Why are pregnant patients more susceptible of hypoxia during intubation?
Decreased functional reserve
Pt presents at 36 weeks history of T6 spinal cord injury with UC’s, hypertension, flushing what is best treatment?
Epidural
What is the Fetal Cardiac Output at term?
500mL/kg/min
Which phospholipid is the largest percentage in the fetal lungs?
Phosphatidylcholine
What is the mechanism of AZT?
Nucleoside Reverse transcriptase inhibitor
A physician practices evidence-based medicine. This represents
Integrity
What would be the pattern on QUAD screen of a fetus with Down syndrome?
High: HCG & Inhibin
Low: Estriol, AFP
Best way to prevent a retained sponge after a vaginal delivery?
Debriefing (via sponge count)
Why is ROC a good test?
sensitivity = y , 1- specificity = x allows to balance between them
What is the risk of Down syndrome with a prior afected child?
1% or the age related risk, whichever is higher
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
If an amnio showed 45XX+14,21. What kind of mutation is that?
Balanced translocation
Where can you find the ureter?
Over the bifurcation of the iliac artery
What is the most common complication of AZT?
Bone marrow suppression
Prostaglandin dehydrogenase is found where?
Chorion
What enzyme causes prostaglandin inactivation? Where is it found?
Prostaglandin Dehydrogenase, Chorion
What is the most effective anticoagulation for patients with mechanical heart valves?
Warfarin
How do you test for familial dysautonomia?
DNA analysis
Which of these is a more common surgical complication of c hyst? Ureteral injury Cystotomy Fistula Bowel Injury
Cystotomy
Decreased Urinary Calcium is associated with what pregnancy disorder?
Preeclampsia
<p>Which of the following valve lesions as the highest risk of mortality for the mother?
<br></br> AS, AR, MS, MR?</p>
<p>Aortic Stenosis</p>
Where are the different Prostaglandins made?
PGI2: Myometrium
PGE2: Decidua and Amnion
PGF2alpha: Decidua
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
The PO2 is lowest in which vessel?
UmbA, Umb V, Uter A , Uter V
Umbilical Artery
If preload and afterload are already optimized, what is the best way to increase cardiac output?
Beta adrenergic
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
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
Which drug prevents IVH?
BMZ - also decreases RDS, NEC and neonatal mortality
What percent of omphaloceles will have a chromosomal aneuploidy?
30 - 40%
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))
A normal pregnant patient in the third trimester what would her glucose levels do, Fasting and Postprandial?
Fasting ↓ Postprandial ↑
What dose of folic acid do patients with sickle cell require?
4mg
Most likely cause of hypoxia post c-section in obese class II patient?
Apnea
Type I CPAM with Hydrops, what is the treatment?
Shunt for Drainage of Cyst
When in pregnancy is the Cardiac output at its highest?
Immediately after delivery (autotransfusion of blood = 50% increase in CO)
When should you only use a one tailed test?
When results can only go in one direction
What nerve causes foot drop?
Common peroneal
Discussion of mode of delivery in a pregnancy with a lethal anomaly involves which ethical principal?
Autonomy
Fetus has cleft lip/palate, VSD, holoprosencephay. What is the most likely diagnosis?
T13
What are the abnormalities with acute fatty liver of pregnancy?
↑ LFTs, uric acid, billirubin , Ammonia
↓ Platelets, ↓ Glucose
What is the preferred mode of delivery for Omphalocele?
Vaginal unless >5cm or liver is out
Which medication needs adjustment for Increased GFR?
Digoxin
Simulation training has helped improve outcomes most in?
Brachial Plexus Injury (reduction by 60-90%)
What happens to thyroid hormones in the first trimester?
TBG increases, Total T4 Increases, Free T4 Increases, TSH Decreases
What pregnancy complications are associated with Multiple Sclerosis?
Increased risk of Growth restriction (and of C/section, but less than IUGR)
Who is the best candidate for an IUD?
a. Uterine anomaly
b. Benign ovarian tumors
c. AIDS
d. Active chlamydia
AIDS
In what setting is Down Syndrome most likely?
- brachycephaly
- Hypoplasia of mid phalangeal joint of 5th digit
- normal humerus
Hypoplasia of the midphalanx of the fifth digit
What is the most likely diagnosis if NT > 4mm?
45X - Turners , most common with very increased NT
What is the main source of estriol?
C19 adrenal steroids (DHEAS from fetal adrenals)
What is the mechanism of insulin resistance in pregnancy?
HPL and Human Placental Growth Hormone reduce insulin receptor sites
What effect does medroxyprogesterone have postpartum?
Decreased bone mineral density long term use
Which of the following is associated with coarctation of the aorta?
45 XO
Which medication increases cardiac output when preload and afterload are optimized?
Dobutamine (B agonist)
What is the mechanism of action of LMWH?
- Inhibits Prothrombin
2. Binds ATIII and inhibits thrombin formation
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)
What enzyme is deficient in Canavans?
Aspartoacylase
Stillbirth in setting of cholestasis, most likely finding?
Meconium stained amniotic fluid
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
Clenched fists are associated with which chromosomal abnormality?
T18
What is the #1 cause of low maternal estriol?
Placental sulfatase deficiency , SLOS, X linked Icthyoses
Prophylaxis for PCP in CD4 < 200?
Bactrim
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
For which of the following is plasmapharesis 1st line Rx?
TTP
Which disorder is associated with UPD? Cri du chat Williams Prader Willi Hydantoin
Prader Willi
Why do we not use Rapid GBS?
Low Sensitivity
How does dialysis change with pregnancy?
- Longer sessions
- More frequent sessions
- Add less calcium to dialysate
- Add more HCO3 to dialysate
Longer sessions
What statistic would you use to compare three means?
ANOVA
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
Where does a subgaleal hemorrhage occur?
Between skull periosteum and scalp galea aponeurosis
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)
What is mode of inheritene of IHSS?
Hypertrophic cardiomyopathy is also called IHSS.
Autosomal Dominant
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)
What is fastest onset anesthetic medication?
Lidocaine : 1-2 mins
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
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
What medication causes reversible hearing loss in the fetus?
Streptomycin
What are the causes of non-immune hydrops?
Idiopathic Cardiovascular Chromosomal - Turners Infections CCAM, Sacrococcygeal teratoma
Which uterine structural anomaly has the highest miscarriage rate?
#1. Septate #2. Unicornuate #3. Bicornuate
At which phase do type 2 pneumocytes appear?
Canalicular
Difference in allele inheritance based on maternal and paternal genes best describes:
Imprinting
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
Which condition does plasmapheresis treat?
TTP
What is the term that means it matters from which parent an allele was inherited?
imprinting
Mechanism of Progesterone IUD?
Cervical Mucous(most correct). Anovulation. Affecting Sperm Motility, preventing implantation
Which cytokine is anti-inflammatory?
IL-10
What drug stays around in the maternal system for 2-3 years?
Etretinate
What is the most common trisomy in abortuses?
Trisomy 16
Increased nuchal fold is associated the most with what aneploidy?
T21
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)
Features of Congenital Rubella?
Blueberry Muffin, Cardiac issues, Cataracts, CNS and Deafness.
Fetus with posterior urethral valves, what findings signify renal impairment?
Increases in Ca, Cl, Na, Microglobulin or OsmolaRity
What test do you use for evaluation of Means?
t-test
Which part of the Choirion is avascular?
Chorion Laeve
Which SSRI most associated with increased fetal cardiac risk
Paxil (ASD, or outflow tract obstruction)
How do you diagnosis Von Willebrand’s disease?
Ristocetin cofactor activity
What is the best intrapartum treatment of Mitral Stenosis?
Beta Blockers
Which is most associated with enlarged placenta, pale placenta, hydrops?
Syphillis
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
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
Which fetal lung lesion is MOST associated with malignant transformation
CCAM
Highest risk of Preterm birth is in what uterine anomaly? What about miscarriages?
PTD: Bicornuate uterus 60-70%
Sab: Septate
Which antibody is positive if you have been vaccinated for Hep B?
Hep B surface antibody (anti-HBs)
What enable increased fetal calcium?
Increased intestinal absorption of calcium from mother
Which nerve fibers contribute to pain in 2nd stage of labor?
Pudendal nerve (S2-4)
Which maternal cardiac lesion is associated with the greatest fetal risk of transmission?
- AS
- MS
- VSD
- TOF
Aortic stenosis (15-18% risk of fetal transmission)
IHSS: 50%
Coarctation: 14%
Low MCV, HbA2 2.2% Normal Iron Studies, Dx?
Alpha Thalassemia
Why is Randomization good practice?
Helps decrease confounding
What is the follow-up for 6 mm bilateral pyelectasis and normal karyotype?
Repeat at 32 weeks
Pt. had a CVS w/ Mosaic result, what can explain the birth of a normal baby?
Confined placental mosaicism
What is the most common finding of a term infant with Down syndrome?
- Simian crease
- Hypotonia
- LBW <2500gm
Hypotonia
After a Fontan procedure, what does cardiac output depend most on?
Preload or SV
(HR plays a negligable role In a fontan circulation)
Least associated with embryopathy?
Azathioprine, warfarin, hydantoin
Azathioprine (not associated with major anomalies)
Which stage of lung development is surfactant produced?
Saccular phase
Most common mode of transmission for Hep B worldwide?
Vertical Transmission from mother to baby
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)
What genetic principle explains a mom with tuberous sclerosus who has a child with heart problems, neurological lesion?
Variable Expressivity
Which type of anatamosis is protective for TTTS?
Artery - Artery
What enzyme is deficient in Smith Lemli Optiz?
Dehydrocholesterol Reductase (DHCR7)
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)
What is the mechanism LMWH causes anticoagulation?
- Inhibits Prothrombin
2. Binds ATIII and inhibits thrombin formation
Which medication is contraindicated in women with liver failure for HIV treatment?
Nevirapine, less so Lopinavir/Ritonavir (Kaletra)
When is breastfeeding contraindicated?
HIV
Untreated Active TB
HSV Lesion Breast
Infants with classic galactosemia
What is the most common cause of CAH?
21 alpha hydroxylase deficiency
What is post partum decompensation in Aortic stenosis due to?
Hypovolemia (keep em wet)
What can explain a discrepancy between amniocentesis results and CVS results?
Confined placental mosaicism
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.
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
Which has the lowest O2 content?
umbilical artery, umbilical vein, uterine artery, uterine vein
Umbilical Artery
What is treated with spiramycin?
Intrauterine Toxoplasmosis
Which of the following is not associated with paternal age >50?
Achondroplasia, NF, Marfans, Klinefelters?
Klienfelter’s
What is the inheritance pattern of PKU?
Autosomal Recessive
Genetic diagnosis most associated with a mom that has preeclampsia?
Trisomy 13
What is the LEAST useful sonographic measurement to differentiate between IUGR and wrong dates?
AC
Most common cause of mortality with anesthesia?
Failed intubation
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
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%
Early Varicella Infection, whats the most common finding of baby?
Skin Scars
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
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)
What is the most common enzyme deficiency in CAH?
21 α Hydroxylase deficiency
What causes virilization of a female fetus? Luteoma of pregnancy Cystadenoma Prolactinoma OCPs
Luteoma of pregnancy
When is cardiac output the highest?
Immediately after delvery due to autotransfusion
Which steroid influences sodium reabsorption?
a. Fludrocortisone
b. Hydrocortisone
c. Betamethasone
d. Cortisol
Fludrocortisone (Mineralocorticoid)
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
What is the ethical principal which states that action is done for the benefit of others?
Beneficence
OCPs are not associated with a decreased risk of which cancer?
Breast Cancer
Microtia is associated with what medication?
Microtia - Undeveloped external ear, happens from isotretinoin (accutane)
Baby with nasal hypoplasia and limb defects?
Warfarin embryopathy
What would a biopsy of a pre-eclamptic patient show?
Glomeruloendotheliosis in Nulligravidas
Normal histologic appearance in multigravidas
Which ultrasound finding in gastroschisis is most associated with intestinal atresia ?
Bowel dilation (>14mm strongly predicts atresia)
Smoking is least likely associated with an incease in which pregnancy associated condition?
Preeclampsia
Which HIV Medication shouldnt be used In the first trimester?
Efavirenz (Increased Myelomeningocele risk)
Which rash is associated with the worst neonatal / fetal complications?
Pemphigus Gestationalis (prematurity, SGA)
Injury with brachial plexus injury resulting in Erb’s palsy is at what level?
C5-6
If a patient has class F diabetes, what are they at most risk of?
diabetic nephropathy #1Pre-eclampsia #2 PTD #3 Growth Restriction
What is the sensitivity of Quad screen in detecting T21 in a patient <35 years?
75%
Which does not express MHC?
Syncytiotrophoblasts
Which coagulation factor decreases in pregnancy?
Protein S, Factor XI, XIII and platelets
Fetus at 28 weeks with CCAM type I lesion and hydrops. Management?
Thoracoamniotic shunt
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.
What is the best way to decrease complications of shoulder dystocia?
Send staff for training, simulation
When do you prophylax and with what for CD4 counts in HIV?
<200 : PCP : Bactrim
<100 : Toxo : Bactrim
<50 : MAI : Azithro
Omphalocele is associated with which genetic syndrome?
Beckwith wiedemann, kartagener, meckel gruber?
Beckwith Wiedemann
What condition with cystic fibrosis carries a poor prognosis?
Right heart failure (Cor Pulmonale)
Which most explains decreased 2nd tri BP?
increased cardiac output
increased renal blood flow
decreased angiotensin sensitivity
Decreased Angiotensin Sensitivity
What is the best way to perform randomization?
Random number block permutation
What is not associated with intraabdominal calficiations?
CMV, Toxo, Parvo, CF, Meconium Peritonitis?
Parvovirus
What is the initial treatment of pheochromocytoma in pregnancy?
Phenoxybenzamine (Alpha blocker)
What is the PO2 in the Umbilical artery?
20
Most likely to decrease breast milk flow?
OCP’s IUD Depo-provera
OCP’s
Which is consistent with prerenal oliguria?
Osmolality>450
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)
What is the most appropriate US surveillance for MCDA twins?
US every other week at 16 weeks
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.
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
Action of PGI2
Prostacyclin is a potent vasodilator. It is produced in endothelial cells & the myometrium. It is also a uterine relaxing agent.
What is the mode of inheritance of familial hypertrophic cardiomyopathy?
Autosomal Dominant
Umbilical vein has what O2 compared to uterine vein?
lower O2 than uterine vein
Which is most associated with aneuploidy?
EIF, short humerus, echogenic bowel , pyelectasis?
Echogenic bowel (1.65X LR)
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)
Which Anastomoses protect against TTTS?
A-A
Most common ovarian cancer found in pregnancy?
Dysgerminoma (30% of ovarian cancers found in pregnancy)
What is the most common symptom after a lumbar puncture ?
Headache that gets worse with standing/sitting and better with laying flat
Which is not related to non-disjunction in the mother?
- Turners
- Klienfelters
- XXX
Turners
The single X is maternal in origin in 70% of cases. Paternal is lost
Most likely ultrasound finding in a patient baby with Myotonic Dystrophy?
Polyhydramnios
What is hormones are HPL most like?
Prolactin and GH
Treatment for toxoplasma in pregnant women?
Spiramycin
Short bent femurs, humerus, radii, and thoracic circumference <5%. Normal ossification of cranuim and spine. What is the most likely diagnosis?
Thanatophoric Dysplasia
Which chromosomal abnormality is not increased in offspring of AMA females?
Turner Syndrome
Initial symptom of Intravascular Lidocaine injection?
Tinnitus
What hormone can increase maturation of lungs?
Betamethasone/Dexamethasone, Thyroxine, Vitamin A
What is a premutation of fragile X (how many repeats)?
Between 55-200 (premutation)
Treacher collins is associated with impairment in what structure?
The mandible
Which Doppler finding is the worst?
Reversed A wave in DV
Amino acids cross the placenta via what type of movement?
Active Transport
Which of the following is important for PGE2 creation?
Arachidonic acid or Prostacyclin
Arachidonic acid
Least likely with hyperparathyroidism? Pancreatitis HTN kidney stones cranial califications neonatal hypocalcemia
Cranial Calcifications
What is the most likely cause for an LGA Fetus?
Maternal Obesity
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
Best treatment for Neisseria Gonorrhea in pregnancy?
Ceftriaxone
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
What is the primary source of precursor estrogen synthesis in the placenta?
C19 Precursor DHEAS from the Fetal Adrenal (Fetal Zone)
How to control for a variable in survival analysis?
Cox-regression
Which karyotype is the result of a uniparental disomy?
A Trisomy - results in UPD from trisomic rescue
Which is not helpful for identifying lupus anticoagulant?
Dilute russell venom, Kaolin, Prolonged PTT, ANA?
ANA
Why do you explain informed consent?
Autonomy
What pregnancy outcomes does bariatric surgery improve?
Gestational Diabetes
Less Macrosomia
A women has preeclampsia and oliguria. What is indicative of pre-renal process?
Osm >550
What antihypertensive medication increases cardiac output?
Hydralazine
What is the most common placental mass?
Chorioangioma - has color flow , associated with Polyhydramnios (60%) and IUGR (20%)
Most likely to cause neonatal cushingoid syndrome in pregnancy?
Repeated steroid doses (though this looks like it has fallen out of favor)
Duodenal Atresia in baby with Polyhydramnios. How does the amniotic fluid get absorbed if the baby has an obstruction?
Intramembranous absorption
18 weeks pregnant with Non-Hodgkins Lymphoma, best treatment?
Combination Chemotherapy
Both parents have normal stature, but both kids have achondroplasia, most likely reason?
Gonadal mosaicism
Which is not associated with hydrops
listeria, syphillis, parvo, cmv, toxo
All of them are, Listeria is probably the least
When should you get the flu vaccine in pregnancy?
As early as possible
Patient Is 8 weeks pregnant with an IUD in place, strings are visible. You should?
Pull string
Why are basic drugs like demerol concentrated in an acidemic fetus?
Ion trapping from a decreased isoelectric point
Prerenal Azotemia with Preeclampsia,what lab is suggestive of this?
Urine osmolality >450
When should you use a one tailed t-test?
results can only go in one direction
Most common cause of non-hereditary deafness?
CMV (but remember 85% of congenital CMV are asymptomatic)
What nerve injury causes decreased labial sensation?
Illioinguinal
Most likely fetal outcome of radiation exposure in the first trimester?
Microcephaly - (also growth restriction and intellectual disability)
Medications for SBE prevention?
Ampicillin or Cephalosporin
Which antihypertensive INCREASES maternal cardiac output?
Hydralazine
What is the best megahertz to assess abdominal circumference at 20 weeks?
3.5 mHz
Hypospadias and congenital anomalies are increased with what REI?
IVF with ICSI
Which is NOT associated with autonomic hyperreflexia?
Hypotension
Which HIV drug should you avoid in first trimester?
Efavirenz due to concern for NTD
Longest lasting anesthetic for an epidural?
Bupivicaine
Which disease is associated with increased paternal age?
Achondroplasia
Neurfibromatosis Marfans
What is the odds ratio formula?
AD/BC ratio of exposed cases to unexposed cases divided by ratio of exposed controls to unexposed controls
What is most associated with ARDS in pregnancy?
PE, Infection?
Infection
Which anomaly is associated with the highest risk of aneuploidy?
- Omphalocele
- Cardiac defects
- Gastroschisis
Omphalocele
At what gestational age is Warfarin exposure at greatest risk for causing warfarin embryopathy?
6-9 weeks
Which factors move the Oxygen dissociation curve to the left?
Left means: Higher affinity of Hb-O2
- Fetal Hb
- Lower CO2
- Higher pH
- Lower temperature
- Lower 2-3 DPG
What is the most common aneuploidy found in first trimester abortions?
Trisomy 16
Erb’s palsy is damage to which nerve roots?
C5-C6
What is the most common complication of Chorioangioma?
Polyhydramnios
What type of virus is HIV?
RNA Retrovirus
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
What nerves is second stage labor pain due to?
Pudendal nerve S2-S4
Treatment for IHSS?
Beta blocker (propranolol), controls the heart rate so more time for ventricular filling
Which disease other than SLE has +SSA/SSB antibodies?
Sjogren’s
Which blood product has the MOST of Factors V, VII and X?
FFP (has fibrinogen, factors 2, 5, 7, 9, 10, 11)
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
Which Interleukin is Anti-inflammatory
IL-10
Bullous lesions with biopsy showing C3 deposition in the basement membrane: Diagnosis?
Herpes gestationis (Aka Pemphigoid gestationis))
Which genetic condition should you consider in a Fetus with Increased Nuchal Translucency, but normal karyotype?
Noonan syndrome (10% of euploid with increased NT)
What is the best method to determine heart rate in the first trimester?
M- Mode
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
What is post partum decompensation of Mitral stenosis due to?
Hypervolemia (keep em dry)
What is the most common presentation of AFE?
- Hypoxia/Hypotension
2. Coagulopathy
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)
Which antibody is most responsible for immunity passed to infant through breast milk?
IgA
Most common risk with AZT?
Anemia (Marrow Suppression) - most common adverse reaction
But Nausea.vomitting, more common / less specific.
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
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.
What is used in the treatment of Lyme in pregnancy?
a) Penn
b) Doxy
c) Vancomycin
d) Clindamycin
e) Cephalosporin
Cephalosporin (Or amoxicillin)
SSA and SSB antibodies are most associated with?
Neonatal Lupus (25%), Heart block ( 1-3%), Normal pregnancy most likely
PVL is associated with which maternal infection?
Chorioamnionitis
Patient with uncontrolled hyperthyroidism most likely to present with:
#1: Preeclampsia #2: Growth Restriction #3: Preterm delivery
In a mother that is Rh sensitized but has a low titer, what is the next step in management?
Continue to follow titers
Mutation in Sickle Cell?
can detect valine to glutamine at 6 position of beta chain on chromosome 11
At what gestational age woud you deliver a patient with a subchorionic hemorrhage?
At term
Folic Acid antagonist use is associated with?
Neural Tube Defects, Cardiac Defects and Oral Clefts
Which is the bad malaria in pregnancy?
Falciparum
Which condition is most likely to transmit to the fetus?
- ASD
- VSD
- Coarctation
- TOF
Coarctation
What is the most effective treatment for steroid resistant lupus in pregnancy?
Azathoprine
Common findings in congenital toxoplasmosis?
Chorioretinitis, hepatosplenomegaly, periventricular calfications, ventriculomegaly, disseminated purpuric rash
Which part of the fetal adrenal gland makes DHEAS?
Fetal zone
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!
What factors are most important in oxygen delivery to tissue?
CO x PaO2 (Oxygen delivery = CO x arterial oxygen content )
Amniotic fluid acetylcholinesterase is least helpful with what condition?
- Omphalocele
- Gastroschisis
- Congenital nephrosis
- Anencephaly
Congenital nephrosis
Which has clinically significant levels of Factor X?
FFP or cryo?
FFP - has fibrinogen, factors 2, 5, 7, 9, 10, 11
What is the most specific finding of NEC?
Pneumatosis - diagnosis of NEC is confirmed with gas in bowel wall on Xray
Most likely finding of fetus in mom with hyperparathyroidism:
Neonatal Hypocalcemia
Most common complication after narcotic anesthesia?
Pruritus
Patient with recurrent cholelithiasis, management?
Lap Cholecystectomy
Recurrent achondroplasia in a couple who are not affected are most likely associated with:
Germline Mutation AKA Gonadal Mosaicism
Best contraceptive option for patient with Hepatitis C and liver disease
Copper IUD
What causes diabetic retinopathy?
Chronic hyperglycemia - elevated HBA1c
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
What is the form of the source of metabolic fuel for the fetal myocardium?
Glucose
Which disease is NOT associated with relapsing/remitting fevers? Brucella Lyme Malaria Listeria
Listeria
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
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
Most drugs cross the placenta by which mechanism?
Simple Diffusion
Betamethasone is metabolized in the placenta by:
11β-hydroxysteroid dehydrogenase type 2
Which enzymes catalyzes the degradation of endothelin-1?
Enkephalinase
What nerve is affected if the mother’s legs are hyperflexed during delivery?
Femoral nerve (Diffficulty with kicking motion)
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)
Which fetal organ system is most susceptible to teratogens earlier and for the longest time?
Brain
What does giving betamethasone due to biophysical profile?
Decreases breathing and Movement
Most likely outcome with Fragile X?
Mental Retardation
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.
A pt. has Epistaxis, Telangiectasia. Diagnosis? Mode of inheritance?
Ossler Webber Rondu (AD)
Low level of which hormone is most associated with placental insufficiency?
low PAPP-A
Anemia, Thrombocytopenia and Renal Failure, Diagnosis?
HUS
Most likely antibody to result from transfusion?
a) D
b) C
c) E
d) Kell
e) N
Kell
Which drug sticks around in the body for 2 years?
Etretinate
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
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)
Which is not associated with SSRI?
a. Congenital heart defect
b. NTD
c. Neonatal withdrawal
d. PPHN
NTD
The most common symptom of appendicitis in pregnancy is?
Abdominal pain
Which antiseizure drug has the highest risk of NTD?
Valproic acid 1-2%
What drug doesn’t cross the placenta
Heparin, and maybe insulin unless IgG bound.
The use of valproic acid carries what risk of NTD?
1-2%
Treatment for fetal thyrotoxisocis / hyperthyroidism?
Maternal PTU
Cord Blood Gases – You have table, what is it?
Respiratory, metabolic, mixed?
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
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.
As a class, what is the most common etiology for fetal malformations?
Genetic
Which Immunoglobin associated with mucosal defense in
breast milk?
IgA
Which disease is most commonly associated with Ro and La Antibodies?
Sjogrens syndrome (SSA and SSB) - 80-90% only in 30% of Lupus patients
Prior neonate with ambiguous genitalia & neonatal death. What is the most likely cause of neonatal death?
CAH - salt wasting
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)
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
What antibody pattern is consistent with Recurrent CMV?
ERROR!
20 yo Asian woman with low MCV, HgbA2 2.4%. Most likely cause:
Alpha Thalassemia
What effeect will glucose have on BPP?
Increased Breathing (not movement)
Standard Error is interchangeable with Standard Deviation?
YES. Standard error is the estimation of the standard deviation
Treatment for malignant hyperthermia?
Dantrolene
Which cardiac anomaly most associated with DiGeorge ?
Interrupted aortic arch
What should you do if cord insertion at 8 weeks is abnormal?
Repeat ultrasound because of physiologic herniation
Which procedure has the greatest risk of alloimmunziation?
Amnio, CVS or Cordocentesis?
Cordocentesis (close to 40%)
HIV patient not on meds, presents in labor, best single agent?
Zidovudine / Lamivudine
What enzyme is the rate-limiting step in synthesis of prostaglandin?
Phospholipid converstion by Phospholipase A2 to Arachidonic acid
Most common mutation in Osteogenesis Imperfecta?
ColA1,2
What bacteria is associated with Alkaline Urine UTI’s?
Proteus Mirabilis
What vitamin must you supplement in vegans?
B12
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
What is the minimal PO2 needed to maintain maternal SaO2 >90%?
60
What is the major component of surfactant?
Phosphotidylcholine
What enzyme is deficient in Niemann Pick?
Sphingomyelinase
How much of the screen should a cervix take up for a cervical length?
3/4 of screen
What statistical test do you use for evaluation of proportions?
Chi Square
Neonatal lupus most likely to present with which?
Rash (25%), Complete heart block (3%)
Thrombocytopenia (10%, but that was in one random BMJ article)
Elevated AF Acetylcholinesterase is NOT associated with which of the following? Apalsia Cutis Omphalocele Anencephaly Encephalocele Congenital nephrosis
Congenital nephrosis
Worst prognosis for neonatal CMV with?
Microcephaly
What do you use to compare two means that are normally distributed that are continuous:
T test
A man of normal height has 3 dwarf children with 3 different mothers, explanation?
Gonadal Moasaicism
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.
Where is PGE2 produced mostly?
Amnion
Patient with Preeclampsia with ruptured liver capsule, management?
- Correct Coagulopathies (likely DIC),
- For surgical management Pack and drain
- Improve surival with Hepatic Artery Embolization
Which infection is associated with Placental Microabscesses?
Listeria
Petechiae + hepatosplenomegaly at birth, which infectious etiology?
CMV
False positives for KB?
Anything that can be caused by anything that causes maternal HbF to be elevated – beta thal, sickle cell
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
Anemia, Thrombocytopenia, Renal Failure, Neurologic Abnormalities, and Fever
TTP
What do you use to Differentiate TTP and HELLP
LDH to AST, fever (less specific)
When does fetal movement increase the most in a 24 hour period?
At night
Which autoimmune diseases are associated with RA factor?
Scleroderama, SLE, Sjogrens, RA and Dermatomyositis
What is the management for a patient with Preterm Contractions but is closed?
Prolonged observation
What are the most common causes of maternal mortality?
#1 Cardio #2 Infection #3 Hemorrhage
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
Best Rx for type 1 Von Willebrand’s Disease?
Desmopressin, cryo, FFP
Desmopressin
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
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
In preeclampsia what happens to thromboxane and PGI2?
Thromboxane increases (normally it stsays the same) and PGI2 Decreases (normally it increases)
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
Fish highest in mercury content?
King Mackerel (Shark, Swordfish, Tilefish, Ahi Tuna also)
Kid got narcotic, what is the first sign of acidosis in tracing?
Loss of variability
Which organisms are most likely to cause Toxic Shock Syndrome?
Staph Aureus, Group A Strep
What factor is the worst prognosticator for CDH?
LHR <1 is worst
Liver is bad but not the worst
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
Which agents can potentially cause renal anomalies along with oligohydramnios?
ACE-inhibitors (-opril drugs)
Least likely in family hx affected by Fragile X? Premature ovarian failure Ataxia Family history MR Gonadal Cancer
Gonadal Cancer
Which Interleukin is antiinflammatory
IL10
What are the Ashkenzi panel enzyme deficiencies?
Familial Dysautonomia
Cystic Fibrosis
Canavan: Aspartocyclase
Tay Sachs: Hexosaminidase A
How do you treat the fetus is the mother has CAH?
Dexamthasone, starting at 7-8 weeks. To prevent virilization of female fetus
Risk of peripartum transmission for recurrent HSV
Low, 1%
A patient with SLE nephritis will MOST liekly have which outcome?
Pre-eclampsia
Which Cardiac Lesion is the worst in pregnancy?
VSD with R to L shunt
Which cardiac disease is associated with the highest mortality?
Pulmonary HTN with VSD and Eisenmengers (Right to Left Shunt)
Your primary ethical responsibilities to the patient are:
Beneficence and autonomy (more so than nonmaleficence)
Duodenal atresia is associated with what other findings?
Polyhydramnios
Best test to compare the mean in 3 groups?
ANOVA (used for comparing means in more than 2 groups)
When is CVS contraindicated ?
Isoimmunization (Kell/Rh/etc.)
What is the medication used for primary pulmonary hypertension?
Viagra
Least likely associated with mental retardation?
Only 0.4% of women with varicella in first trimester have affected children.
Which is associated with pre-renal oliguria?
Urine osm 550, Urine Na > 20, Serum BUN:Cr 1:1
Urine Osm >450
Which medications to treat SLE are teratogenic?
Mycophenolate Mofetil and Cyclophosphamide
Club foot after oligo is the best example of a:
Malformation, Deformation, Disruption?
Deformation
Fragile X inheritance is associated with what number of repeats? What are the repeat letters?
> 200
Most likely outcome of Meconium stained fluid with normal heart tracing?
Normal
What is the risk of cystic fibrosis if fathers parents has CF and carrier rate is 1/25?
1/100
What is the likelihood of poor neurological outcome after the death of one twin in a MCDA twin?
15-25%
What is the most common complication in pregnancy of women with Acromegaly?
Gestational Diabetes
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
A patient presents with bullous lesions in pregnancy and has positive complement deposition. What is the diagnosis?
Herpes/Pemphigoid Gestationalis
What is the structure of TRH?
Tripeptide
45XX, der(13,21)(q10q10) is associated with what?
Normal.
This is a balanced translocation on 13q;21q
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)
Which cardiac lesions tolerates a decrease in SVR the least?
Eisenmenger - right to left shunting of blood
Bleeding circ most likely associated with what deficiency
Factor XIII
What is the appropriate treatment for Non-Hodgkins lymphoma at 18 weeks?
Combination chemotherapy
Fetus with intraabdominal Calcifications, Hepatosplenomegaly, Differential Diagnosis?
CMV/Toxo
Which medications decreases the level of OCPs?
Rifampin, Carbamezapine, Phenytoin
Which drug can cause neonatal hypotermia?
Valium
