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JFNG > 2012 - Final XLS in CSV form - Sheet1 > Flashcards

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)

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2
Q

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

A

Hydrothorax

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3
Q

What does a ROC curve represent?

A

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

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4
Q

Which infection poses the greatest risk for maternal mortality?

A

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

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5
Q

Which cardiac lesions tolerates a decrease in SVR the least?

A

Eisenmenger - right to left shunting of blood

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6
Q

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

A

Thyroid stimulating antibodies/immunoglobulins

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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

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8
Q

What factor is the worst prognosticator for CDH?

A

LHR <1 is worst

Liver is bad but not the worst

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9
Q

What is Prader Willi most likely due to?

A

Deletion of paternally derived Ch 15

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10
Q

When is CVS contraindicated ?

A

Isoimmunization (Kell/Rh/etc.)

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11
Q

What is LEAST appropriate for testing for PKU?

A

Amnio for enzyme activity

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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%)

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13
Q

What is the best intrapartum treatment of Mitral Stenosis?

A

Beta Blockers

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14
Q

What is post partum decompensation of Mitral stenosis due to?

A

Hypervolemia (keep em dry)

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15
Q

What is post partum decompensation in Aortic stenosis due to?

A

Hypovolemia (keep em wet)

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16
Q

What is the PO2 in the umbilical artery?

A

20

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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

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18
Q

What is Methadone LEAST likely to result in?

A

Congenital anomalies

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19
Q

Which antidepressant is most associated with cardiac anomalies?

A

Paxil (Paroxetine)

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20
Q

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

A
  1. Metabolic syndrome
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21
Q

What stage is a fetus with abnormal Dopplers?

A

Stage 3

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22
Q

Which type of anatamosis is protective for TTTS?

A

Artery - Artery

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23
Q

What is the mechanism of AZT?

A

Nucleoside Reverse transcriptase inhibitor

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24
Q

What is the most common Adverse effect of AZT?

A

Anemia (next is neutropenia)

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25
Q

Which HIV medication should be avoided in first trimester?

A

Efavirenz (NNRTI)

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26
Q

What are the Ashkenzi panel enzyme deficiencies?

A

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

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27
Q

What is the mechanism LMWH causes anticoagulation?

A
  1. Inhibits Prothrombin

2. Binds ATIII and inhibits thrombin formation

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28
Q

Which seizure medication is most affected by maternal liver failure?

A

Dilantin (Phenytoin)

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29
Q

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
A

MTHFR

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30
Q

In which patients can you give OCPs?

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

Type 1 DM

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31
Q

Which medications decreases the level of OCPs?

A

Rifampin, Carbamezapine, Phenytoin

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32
Q

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

A

Breast Cancer

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33
Q

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

A

Levonorgesterol IUD

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34
Q

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

A

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

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35
Q

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

A

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)

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36
Q

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

A

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

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37
Q

Which lab result is most indicative of recurrent CMV infection?

A

IgM: +
IgG: +
High IgG avidity

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38
Q

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

A

Ilioinguinal

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39
Q

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

A

Preeclampsia

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40
Q

What nerves is second stage labor pain due to?

A

Pudendal nerve S2-S4

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41
Q

Which fetal organ system is subject to malformations the longest?

A

Nervous system

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42
Q

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

A

Syncytiotrophoblasts

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43
Q

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

A

They develop hypotension from HYPONATREMIC volume contraction

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44
Q

What effect does medroxyprogesterone have postpartum?

A

Decreased bone mineral density long term use

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45
Q

What is the most likely cause of low estriol levels?

A

Placental sulfatase deficiency (XLI) or SLOS

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46
Q

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

A

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

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47
Q

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

A

Pre-eclampsia

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48
Q

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

A

Twin peak sign

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49
Q

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

A

Gonorrhea

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50
Q

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

A

Complete AV canal

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51
Q

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

A

Closure of DV (occurs within 1 week)

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

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52
Q

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

A

IgA

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53
Q

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

A

Beta thalassemia

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54
Q

What happens to gluconeogenesis with persistent fasting in pregnancy?

A

Gluconeogenesis is not increased, as would be expected.

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

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55
Q

Where does a subgaleal hemorrhage occur?

A

Between skull periosteum and scalp galea aponeurosis

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56
Q

Which medication relieves symptoms of cholestasis?

A

Ursodiol

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57
Q

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

A

Azathoprine

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58
Q

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

A

Variable Course, usually improves

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59
Q

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

A

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

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60
Q

What is the initial treatment of pheochromocytoma in pregnancy?

A

Phenoxybenzamine (Alpha blocker)

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61
Q

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

A

Multicystic dysplastic Kidneys (100%)

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62
Q

Which mode of inheritance applies to penetrance and variable expressivity?

A

Autosomal Dominant

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63
Q

Which is LEAST likely a finding in pseudotumor cerebri?

A

Ventriculomegaly

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64
Q

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

A

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

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65
Q

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

A 
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)
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66
Q

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

A 
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
Q

What is the MOST specific marker for T21?

A 
Absent nasal bone
 #1 Absent Nasal Bone
 #2 Nuchal fold
 #3 AND 4, NOT SURE THE ORDER - Echogenic bowel and Ventriculomegaly
68
Q

Which medication decreases OCP efficacy?

A

Carbamezapine, Phenytoin, Rifampin

69
Q

How do you treat MAI if CD4 is 50?

A

Azithromycin

70
Q

Which anesthetic is the MOST cardiotoxic?

A

Bupivicaine

71
Q

What is the most likely risk from regional anesthesia?

A

Toxicity from local anesthetic

72
Q

What is the cause of a post regional headache?

A

traction of pain sensing cranial structures

73
Q

PVL is associated with which maternal infection?

A

Chorioamnionitis

74
Q

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

A

Viral load/HIV RNA

75
Q

What is the most common trisomy in first trimester abortuses?

A

Trisomy 16

76
Q

Which cancer do OCPs decrease the least?

A

Breast Cancer

77
Q

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

A

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

78
Q

What is the precursor for fetal steroid synthesis?

79
Q

Most drugs cross the placenta by which mechanism?

A

Simple Diffusion

80
Q

How does IgG cross the placenta?

A

Pinocytosis / endocytosis

81
Q

What enzyme is missing in the placenta but fetus has?

A

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

82
Q

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

A

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

83
Q

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

84
Q

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

85
Q

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

A

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

86
Q

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

A

Calcium Gluconate

87
Q

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

A

Fasting ↓ Postprandial ↑

88
Q

What enzyme deficiency is seen with hydantoin syndrome?

A

Epoxide hydralase

89
Q

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

A

Etretinate

90
Q

What drug is commonly associated with microotia?

A

Isoretinoin

91
Q

What condition with cystic fibrosis carries a poor prognosis?

A

Right heart failure (Cor Pulmonale)

92
Q

What maternal cardiac disease is associated with a poor prognosis?

A

VSD with R-> L shunt (Eisenmenger)

93
Q

The use of valproic acid carries what risk of NTD?

94
Q

Which vessel has the highest fetal oxygenation?

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

A

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

95
Q

What is the most common presentation of neonatal lupus?

A

Rash and second thrombocytopenia

96
Q

How do you make the diagnosis of Von Willibrands?

A

Ristocetin test

97
Q

Which coagulation factor decreases in pregnancy?

A

Protein S, Factor XI, XIII and platelets

98
Q

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

A

Zidovudine or Lamivudine (if azt not an option)

99
Q

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

A

Femoral nerve (Diffficulty with kicking motion)

100
Q

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

101
Q

Which antihypertensive INCREASES maternal cardiac output?

A

Hydralazine

102
Q

What is the mechanism for a β-agonist?

A

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

103
Q

Why are pregnant patients more susceptible of hypoxia during intubation?

A

Decreased functional reserve

104
Q

What is the mechanism of fetal anemia caused by parvovirus?

A

Cytotoxic to erythrocyte precursors

105
Q

Which disease is associated with increased paternal age?

A

Achondroplasia

Neurfibromatosis Marfans

106
Q

What is an obligate precursor for NO?

A

L-arginine

107
Q

Which phospholipid is the largest percentage in the fetal lungs?

A

Phosphatidylcholine

108
Q

Which is the best way to randomize?

A

table of generated numbers with block randomization

109
Q

What is used to measure inter-observer variability?

A

Kappa Score

110
Q

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

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

A

Fetal intracranial calcification

111
Q

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?

A

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

112
Q

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

A

Pulmonary Hypertension

113
Q

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

A

Herpes/Pemphigoid Gestationalis

114
Q

Which is consistent with prerenal oliguria?

A

Osmolality>450

115
Q

Prostaglandin dehydrogenase is found where?

116
Q

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

A

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

117
Q

Which does not express MHC?

A

Syncytiotrophoblasts

118
Q

Preload and afterload fixed, what increases CO?

A

beta adrenergic (dobutamine)

119
Q

How to control for a variable in survival analysis?

A

Cox-regression

120
Q

Which affects fetal growth the most?

A

Fetal Insulin, HPL (aka human somatomammotropin)

121
Q

Renal dose of Dopamine?

A

<4mcg/kg/min

122
Q

What statistic would you use to compare three means?

123
Q

Hypoxic-ischemic–encephalopathy is most associated with?

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

A

pH 7.0 (acidemia)

124
Q

What is the most common complication of AZT?

A

Bone marrow suppression

125
Q

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

A

1/24 (1 x ½ x 1/12)

126
Q

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

127
Q

Which is NOT associated with autonomic hyperreflexia?

A

Hypotension

128
Q

What is the odds ratio formula?

A

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

129
Q

What is the medication used for primary pulmonary hypertension?

130
Q

Umbilical vein has what O2 compared to uterine vein?

A

lower O2 than uterine vein

131
Q

How do you monitor improvement of metabolic acidosis in DKA?

A

Follow anion gap

132
Q

When should you use a one tailed t-test?

A

results can only go in one direction

133
Q

What is the mechanism of insulin resistance in pregnancy?

A

HPL and Human Placental Growth Hormone reduce insulin receptor sites

134
Q

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

A

Combination chemotherapy

135
Q

Which medication is LEAST likely a teratogen?

Azathioprine, Cyclophosphamide, Cyclosporine

A

Azathioprine

136
Q

What is the most common maternal complication of malaria?

137
Q

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

A

Sjogren’s

138
Q

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

A

Balanced translocation

139
Q

What is most likely diagnosis of ambiguous genitalia?

140
Q

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

A

CAH - salt wasting

141
Q

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

A

Klienfelter’s

142
Q

What is the definition of imprinting?

A

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
Q

Which part of the fetal adrenal gland makes DHEAS?

A

Fetal zone

144
Q

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

A

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

145
Q

Erb’s palsy is damage to which nerve roots?

146
Q

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
A

Multicsystem organ failure

147
Q

Which blood product increases fibrinogen the MOST?

148
Q

What does wedge pressure measure?

A

LV filling pressure

149
Q

What does giving betamethasone due to biophysical profile?

A

Decreases breathing and Movement

150
Q

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?

151
Q
  1. Which anomaly is LEAST associated with very ill neonate after birth
    a. Interrupted aortic arch
    b. AV canal
    c. Other CHD
152
Q

Which fetal lung lesion is MOST associated with malignant transformation

153
Q

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

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

154
Q

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

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

A

Chi squared?

155
Q

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

156
Q

Physiology of late decelerations?

A

Chemoreceptor reflex

157
Q

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

A

Decreased variability

158
Q
  1. Which causes a recurring fever?
    a. Listeriosis
    b. Syphilis
    c. Lyme dz
    d. Others
A

Lyme Disease, Brucellosis also

159
Q

Fetus with thyrotoxicosis/hyperthyroidism will have the following issues:

A

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

160
Q

Treatment for fetal thyrotoxisocis / hyperthyroidism?

A

Maternal PTU

161
Q

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

A

Odds Ratio

162
Q

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

163
Q

Steroids are least likely to help

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

A

BPD - no effect

164
Q

Bleeding circ most likely associated with what deficiency

A

Factor XIII

JFNG (9 decks)

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