2012 - Final XLS in CSV form - Sheet1 Flashcards
1
Q
Which medication is contraindicated in women with chronic hepatitis for HIV treatment?
A
Nevirapine, less so Lopinavir/Ritonavir (Kaletra)
2
Q
What is a unilateral pleural effusion in a fetus is most likely due?
A
Hydrothorax
3
Q
What does a ROC curve represent?
A
Compares sensitivity and specificity
y = sensitivity
x = 1-specificity
4
Q
Which infection poses the greatest risk for maternal mortality?
A
Varicella (likely #1), maybe H1N1 if no varicella
5
Q
Which cardiac lesions tolerates a decrease in SVR the least?
A
Eisenmenger - right to left shunting of blood
6
Q
Which of the thyroid related substances crosses the placenta most rapidly?
A
Thyroid stimulating antibodies/immunoglobulins
7
Q
What hormone is the placental precursor to estrogens, where does it come from?
A
C19 precursor DHEAS from the fetal zone of the fetal adrenals
8
Q
What factor is the worst prognosticator for CDH?
A
LHR <1 is worst
Liver is bad but not the worst
9
Q
What is Prader Willi most likely due to?
A
Deletion of paternally derived Ch 15
10
Q
When is CVS contraindicated ?
A
Isoimmunization (Kell/Rh/etc.)
11
Q
What is LEAST appropriate for testing for PKU?
A
Amnio for enzyme activity
12
Q
Which structural anomaly is most common with PKU? What about most common complication?
A
Structural: Cardiac (10-15%)
Complication: Mental Retardation (80-90%)
13
Q
What is the best intrapartum treatment of Mitral Stenosis?
A
Beta Blockers
14
Q
What is post partum decompensation of Mitral stenosis due to?
A
Hypervolemia (keep em dry)
15
Q
What is post partum decompensation in Aortic stenosis due to?
A
Hypovolemia (keep em wet)
16
Q
What is the PO2 in the umbilical artery?
A
20
17
Q
At 37 degrees Celsius and pH of 7.4, fetal hemoglobin oxygen dissociation curve means?
A
This means that for any given PO2, fetal O2 saturation is higher
18
Q
What is Methadone LEAST likely to result in?
A
Congenital anomalies
19
Q
Which antidepressant is most associated with cardiac anomalies?
A
Paxil (Paroxetine)
20
Q
What does Barker theory of fetal programming say about IUGR fetus at most risk of?
A
- Metabolic syndrome
21
Q
What stage is a fetus with abnormal Dopplers?
A
Stage 3
22
Q
Which type of anatamosis is protective for TTTS?
A
Artery - Artery
23
Q
What is the mechanism of AZT?
A
Nucleoside Reverse transcriptase inhibitor
24
Q
What is the most common Adverse effect of AZT?
A
Anemia (next is neutropenia)
25
Which HIV medication should be avoided in first trimester?
Efavirenz (NNRTI)
26
What are the Ashkenzi panel enzyme deficiencies?
Familial Dysautonomia
Cystic Fibrosis
Canavan: Aspartocyclase
Tay Sachs: Hexosaminidase A
27
What is the mechanism LMWH causes anticoagulation?
1. Inhibits Prothrombin
| 2. Binds ATIII and inhibits thrombin formation
28
Which seizure medication is most affected by maternal liver failure?
Dilantin (Phenytoin)
29
Which patient with thrombophilia can you give OCPs to post partum?
1. Prothrombin mutation
2. APLS
3. MTHFR homozygous
4. Protein C/S deficiency
5. Factor V Leiden
MTHFR
30
In which patients can you give OCPs?
1. Hx of DVT
2. Migraine with aura
3. Type 1 DM
4. Active viral hepatitis
Type 1 DM
31
Which medications decreases the level of OCPs?
Rifampin, Carbamezapine, Phenytoin
32
OCPs are not associated with a decreased risk of which cancer?
Breast Cancer
33
What is the best contraception option for a women with DVT in pregnancy?
Levonorgesterol IUD
34
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
35
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)
36
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
37
Which lab result is most indicative of recurrent CMV infection?
IgM: +
IgG: +
High IgG avidity
38
Injury to what nerve causes numbness to medial thigh and labia?
Ilioinguinal
39
What is a decrease in Urine calcium associated with in pregnancy?
Preeclampsia
40
What nerves is second stage labor pain due to?
Pudendal nerve S2-S4
41
Which fetal organ system is subject to malformations the longest?
Nervous system
42
What does maternal blood come into direct contact with in the intervillous space of placenta?
Syncytiotrophoblasts
43
Which is the MOST diagnostic of primary adrenal insufficiency in pregnancy?
They develop hypotension from HYPONATREMIC volume contraction
44
What effect does medroxyprogesterone have postpartum?
Decreased bone mineral density long term use
45
What is the most likely cause of low estriol levels?
Placental sulfatase deficiency (XLI) or SLOS
46
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)
47
A patient with SLE nephritis will MOST liekly have which outcome?
Pre-eclampsia
48
What is the best way to determine chorionicity in twin gestations?
Twin peak sign
49
Pregnancy patient with joint pain + pustular rash on hands, most likely has which infection?
Gonorrhea
50
Which congenital cardiac lesion is most likely to result in a clinically stable infant immediately postpartum?
Complete AV canal
51
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
52
Which antibody is most responsible for immunity passed to infant through breast milk?
IgA
53
Patient has an MCV of 69 and Hgb A2 of 4% on electropheresis, what is the MOST likely diagnosis?
Beta thalassemia
54
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.
55
Where does a subgaleal hemorrhage occur?
Between skull periosteum and scalp galea aponeurosis
56
Which medication relieves symptoms of cholestasis?
Ursodiol
57
What is the most effective treatment for steroid resistant lupus in pregnancy?
Azathoprine
58
What are the MOST likely symptoms of multiple sclerosis during pregnancy ?
Variable Course, usually improves
59
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)
60
What is the initial treatment of pheochromocytoma in pregnancy?
Phenoxybenzamine (Alpha blocker)
61
Which finding is the MOST common in Meckel-Gruber syndrome?
Multicystic dysplastic Kidneys (100%)
62
Which mode of inheritance applies to penetrance and variable expressivity?
Autosomal Dominant
63
Which is LEAST likely a finding in pseudotumor cerebri?
Ventriculomegaly
64
Which blood product has the MOST of Factors V, VII and X?
FFP (has fibrinogen, factors 2, 5, 7, 9, 10, 11)
65
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)
```
66
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)
```
67
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
```
68
Which medication decreases OCP efficacy?
Carbamezapine, Phenytoin, Rifampin
69
How do you treat MAI if CD4 is 50?
Azithromycin
70
Which anesthetic is the MOST cardiotoxic?
Bupivicaine
71
What is the most likely risk from regional anesthesia?
Toxicity from local anesthetic
72
What is the cause of a post regional headache?
traction of pain sensing cranial structures
73
PVL is associated with which maternal infection?
Chorioamnionitis
74
What is the most predictive of transmission of HIV to baby?
Viral load/HIV RNA
75
What is the most common trisomy in first trimester abortuses?
Trisomy 16
76
Which cancer do OCPs decrease the least?
Breast Cancer
77
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)
78
What is the precursor for fetal steroid synthesis?
LDL
79
Most drugs cross the placenta by which mechanism?
Simple Diffusion
80
How does IgG cross the placenta?
Pinocytosis / endocytosis
81
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)
82
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)
83
What is the risk of cystic fibrosis if fathers parents has CF and carrier rate is 1/25?
1/100
84
What is the risk of cystic fibrosis if fathers sister has CF and carrier rate is 1/25?
1/150
85
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)
86
If a patient becomes hypotensive after mag bolus, what medication do you give?
Calcium Gluconate
87
A normal pregnant patient in the third trimester what would her glucose levels do, Fasting and Postprandial?
Fasting ↓ Postprandial ↑
88
What enzyme deficiency is seen with hydantoin syndrome?
Epoxide hydralase
89
What drug stays around in the maternal system for 2-3 years?
Etretinate
90
What drug is commonly associated with microotia?
Isoretinoin
91
What condition with cystic fibrosis carries a poor prognosis?
Right heart failure (Cor Pulmonale)
92
What maternal cardiac disease is associated with a poor prognosis?
VSD with R-> L shunt (Eisenmenger)
93
The use of valproic acid carries what risk of NTD?
1-2%
94
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
95
What is the most common presentation of neonatal lupus?
Rash and second thrombocytopenia
96
How do you make the diagnosis of Von Willibrands?
Ristocetin test
97
Which coagulation factor decreases in pregnancy?
Protein S, Factor XI, XIII and platelets
98
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)
99
What nerve is affected if the mother’s legs are hyperflexed during delivery?
Femoral nerve (Diffficulty with kicking motion)
100
What is the LEAST useful sonographic measurement to differentiate between IUGR and wrong dates?
AC
101
Which antihypertensive INCREASES maternal cardiac output?
Hydralazine
102
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
103
Why are pregnant patients more susceptible of hypoxia during intubation?
Decreased functional reserve
104
What is the mechanism of fetal anemia caused by parvovirus?
Cytotoxic to erythrocyte precursors
105
Which disease is associated with increased paternal age?
Achondroplasia
| Neurfibromatosis Marfans
106
What is an obligate precursor for NO?
L-arginine
107
Which phospholipid is the largest percentage in the fetal lungs?
Phosphatidylcholine
108
Which is the best way to randomize?
table of generated numbers with block randomization
109
What is used to measure inter-observer variability?
Kappa Score
110
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
111
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%
112
Which maternal cardiac lesion is associated with the greatest fetal oxygenation risk?
Pulmonary Hypertension
113
A patient presents with bullous lesions in pregnancy and has positive complement deposition. What is the diagnosis?
Herpes/Pemphigoid Gestationalis
114
Which is consistent with prerenal oliguria?
Osmolality>450
115
Prostaglandin dehydrogenase is found where?
Chorion
116
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)
117
Which does not express MHC?
Syncytiotrophoblasts
118
Preload and afterload fixed, what increases CO?
beta adrenergic (dobutamine)
119
How to control for a variable in survival analysis?
Cox-regression
120
Which affects fetal growth the most?
Fetal Insulin, HPL (aka human somatomammotropin)
121
Renal dose of Dopamine?
<4mcg/kg/min
122
What statistic would you use to compare three means?
ANOVA
123
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)
124
What is the most common complication of AZT?
Bone marrow suppression
125
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)
126
Pt presents at 36 weeks history of T6 spinal cord injury with UC’s, hypertension, flushing what is best treatment?
Epidural
127
Which is NOT associated with autonomic hyperreflexia?
Hypotension
128
What is the odds ratio formula?
AD/BC ratio of exposed cases to unexposed cases divided by ratio of exposed controls to unexposed controls
129
What is the medication used for primary pulmonary hypertension?
Viagra
130
Umbilical vein has what O2 compared to uterine vein?
lower O2 than uterine vein
131
How do you monitor improvement of metabolic acidosis in DKA?
Follow anion gap
132
When should you use a one tailed t-test?
results can only go in one direction
133
What is the mechanism of insulin resistance in pregnancy?
HPL and Human Placental Growth Hormone reduce insulin receptor sites
134
What is the appropriate treatment for Non-Hodgkins lymphoma at 18 weeks?
Combination chemotherapy
135
Which medication is LEAST likely a teratogen?
| Azathioprine, Cyclophosphamide, Cyclosporine
Azathioprine
136
What is the most common maternal complication of malaria?
Anemia
137
Which disease other than SLE has +SSA/SSB antibodies?
Sjogren's
138
If an amnio showed 45XX+14,21. What kind of mutation is that?
Balanced translocation
139
What is most likely diagnosis of ambiguous genitalia?
CAH
140
Prior neonate with ambiguous genitalia & neonatal death. What is the most likely cause of neonatal death?
CAH - salt wasting
141
Which of the following is not associated with paternal age >50?
Achondroplasia, NF, Marfans, Klinefelters?
Klienfelter's
142
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)
143
Which part of the fetal adrenal gland makes DHEAS?
Fetal zone
144
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
145
Erb's palsy is damage to which nerve roots?
C5-C6
146
What is least associated with cerebral palsy?
1. ph<7 BE>-12
2. early onset encephalopathy
3. neonatal seizures
4. Apgar score of <3 at 5 minutes
5. Multi system organ failure
6. Spastic quadriplegia
Multicsystem organ failure
147
Which blood product increases fibrinogen the MOST?
Cryo
148
What does wedge pressure measure?
LV filling pressure
149
What does giving betamethasone due to biophysical profile?
Decreases breathing and Movement
150
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%
151
1. Which anomaly is LEAST associated with very ill neonate after birth
a. Interrupted aortic arch
b. AV canal
c. Other CHD
AVSD
152
Which fetal lung lesion is MOST associated with malignant transformation
CCAM
153
What to use for malignant hyperthermia at >36 wks with contractions
a. Epidural
b. Spinal
c. Mag tocolysis
d. others
Epidural
154
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?
155
Which part of the biophysical profile is most associated with an acidemic fetus?
tone
156
Physiology of late decelerations?
Chemoreceptor reflex
157
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
158
16. Which causes a recurring fever?
a. Listeriosis
b. Syphilis
c. Lyme dz
d. Others
Lyme Disease, Brucellosis also
159
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
160
Treatment for fetal thyrotoxisocis / hyperthyroidism?
Maternal PTU
161
In a retrospective study, do you use Odds ratio or relative risk?
Odds Ratio
162
Baby with transposition, cleft lip and facial abnormality. Diagnosis?
DiGeorge
163
Steroids are least likely to help
a. IVH
b. RDS
c. BPD
d. NEC
BPD - no effect
164
Bleeding circ most likely associated with what deficiency
Factor XIII
