2013-14 - Final XLS in CSV form - Sheet1 Flashcards
1
Q
What US findings are associated with Meckel Gruber?
A
Multicystic dysplastic Kidney, Encephalocele, Postaxial Polydactyly
2
Q
Fetal thyrotoxicosis with heart failure in a mom with s/p thyroid ablation, whats the likely diagnosis and treatment?
A
Maternal Graves (TSI antibodies still present despite ablation), PTU
3
Q
Betamethasone decreasese what in fetuses?
A
Fetal Breathing and movement
4
Q
Which is most likely to be abnormal with fetal acidemia
Absent accelerations
decreased fetal tone
decreased fetal breathing
A
First lose accelerations, then breathing then movement then tone.
5
Q
Treacher collins is associated with impairment in what structure?
A
The mandible
6
Q
Which Immunoglobin associated with mucosal defense in
breast milk?
A
IgA
7
Q
Petechiae + hepatosplenomegaly at birth, which infectious etiology?
A
CMV
8
Q
Which infection is associated with Placental Microabscesses?
A
Listeria
9
Q
Which is least likely with listeria?
preterm labor, chorioamnionitis, hydrops?
A
Hydrops (one of the less common etiologies of hydrops)
10
Q
Which is the most likely neonatal complication with PKU?
A
Mental Retardation
11
Q
What is least advised in pregnancy if mom has known PKU? amnio for enzyme paternal PKU testing dietary restrictions fetal echo
A
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.
12
Q
Which disease is most commonly associated with Ro and La Antibodies?
A
Sjogrens syndrome (SSA and SSB) - 80-90% only in 30% of Lupus patients
13
Q
Which autoimmune disorder is more likely to improve during pregnancy?
A
Rheumatoid Arthritis improves in 50-70% of cases in pregnancy
14
Q
Antihypertensive with most evidence for association with IUGR?
A
Atenolol
15
Q
Worst prognosis for neonatal CMV with?
A
Microcephaly
16
Q
Least likely with hyperparathyroidism? Pancreatitis HTN kidney stones cranial califications neonatal hypocalcemia
A
Cranial Calcifications
17
Q
Which crossed placenta most readily?
T3, T4, TSH, TRH, TSI?
A
TSI is the most, followed by TRH and Iodine.
There is some T3 and T4 crossing and TSH Tcannot cross the placenta
18
Q
Most likely cause of hypoxia post c-section in obese class II patient?
A
Apnea
19
Q
Most common risk with AZT?
A
Anemia (Marrow Suppression) - most common adverse reaction
But Nausea.vomitting, more common / less specific.
20
Q
Which medication is contraindicated in women with liver failure for HIV treatment?
A
Nevirapine, less so Lopinavir/Ritonavir (Kaletra)
21
Q
HIV patient not on meds, presents in labor, best single agent?
A
Zidovudine / Lamivudine
22
Q
Which HIV Medication shouldnt be used In the first trimester?
A
Efavirenz (Increased Myelomeningocele risk)
23
Q
What is the most likely cause of pain from a Wet tap?
A
Traction of nerves from CSF leak
24
Q
Which of the following have associations with advanced paternal age?
A
Marfan, Achondroplasia, Neurofibromatosis (MAN)
25
Initial symptom of Intravascular Lidocaine injection?
Tinnitus
26
Which anesthetic has greatest cardiac risk?
Bupivacaine (Marcaine)
27
Which screening is recommended for Ashkenazi Jewish population?
Familial Dysautonomia
Cystic Fibrosis
Canavan: Aspartocyclase
Tay Sachs: Hexosaminidase A
28
What is the mechanism of action of LMWH?
1. Inhibits Prothrombin
| 2. Binds ATIII and inhibits thrombin formation
29
Most drugs cross the placenta by what method?
Simple diffusion
30
What is the PO2 in the Umbilical artery?
20
31
Which fetal vessel has the lowest PO2?
Umbilical Artery
32
What is the minimal PO2 needed to maintain maternal SaO2 >90%?
60
33
Which is helpful for treatment of HIE?
Cooling
34
Most likely to be helpful for treatment of mitral stenosis intrapartum?
Propranolol (Beta blocker)
35
Best Rx for mom with dyspnea, cyanosis, large VSD and R to L shunt at 28 weeks?
Viagra
36
Best Treatment for a Pheochromocytoma
Phenoxybenzamine (Alpha Blocker)
37
Which inheritance pattern is most associated with variable penetrance?
Autosomal Dominant
38
```
Least likely in family hx affected by Fragile X?
Premature ovarian failure
Ataxia
Family history MR
Gonadal Cancer
```
Gonadal Cancer
39
Most likely outcome with Fragile X?
Mental Retardation
40
Which SSRI most associated with increased fetal cardiac risk
Paxil (ASD, or outflow tract obstruction)
41
Least likely symptom with H1N1?
| Nausea/Vomitting, Cough, Fever, Sore Throat?
Nausea/Vomitting
42
Most likley diagnosis with fetal unilateral pleural effusion?
Hydrothorax
43
Most common obstetric fistula?
rectovaginal fistula
44
What is the form of the source of metabolic fuel for the fetal myocardium?
Glucose
45
Which steroid influences sodium reabsorption?
a. Fludrocortisone
b. Hydrocortisone
c. Betamethasone
d. Cortisol
Fludrocortisone (Mineralocorticoid)
46
Levels of which drug are least effected by liver metabolism?
| Lovenox, Warfarin, Dylantin?
Lovenox
47
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
48
Neonate with limb and muscle hypoplasia, derm and
| eye finding, Diagnosis?
Congenital Varicella
49
Injury with brachial plexus injury resulting in Erb's palsy is at what level?
C5-6
50
Discrepancy in which is best for TTTS diagnosis?
Amniotic Fluic (Poly/Oli)
51
When do you prophylax and with what for CD4 counts in HIV?
<200 : PCP : Bactrim
<100 : Toxo : Bactrim
<50 : MAI : Azithro
52
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
```
53
Most common cause of Polyhydramnios?
Idiopathic
54
Why does T4 demand increase in pregnancy?
Increased TBG, to maintain adequate free T3 T4 there is increased production
55
Which Cardiac Lesion is the worst in pregnancy?
VSD with R to L shunt
56
Low MCV, HbA2 2.2% Normal Iron Studies, Dx?
Alpha Thalassemia
57
Low MCV, HbA2 3.9% Normal Iron Studies, Dx?
Beta Thalassemia
58
Low MCV, HbA2 2.2% Low Iron Studies, Dx?
Iron deficiency anemia
59
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
60
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
```
61
Risk of peripartum transmission for recurrent HSV
Low, 1%
62
How does iodide treatment work?
Decreases the circulating supply of T4 and T3 by inhibiting release of stored thyroid hormone.
63
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)
64
Most common ovarian cancer found in pregnancy?
Dysgerminoma (30% of ovarian cancers found in pregnancy)
65
Decreased Urinary Calcium is associated with what pregnancy disorder?
Preeclampsia
66
Which most explains decreased 2nd tri BP?
increased cardiac output
increased renal blood flow
decreased angiotensin sensitivity
Decreased Angiotensin Sensitivity
67
Which rate of dopamine infusion improves renal blood flow?
Low dose, <5ug/kg/min for renal blood flow
68
Which of the following is important for PGE2 creation?
| Arachidonic acid or Prostacyclin
Arachidonic acid
69
CDH, IUGR, VSD , most likely diagnosis?
T18
70
Most likely diagnosis with a cystic hygroma?
40% T21, 30% Turners
71
Aspartoacylase deficiency is associated with?
Canavan disease
72
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
73
Large c-section incision injures iliohypogastric/ilioinguinal nerve, what is the most likely result?
Paresthesia/Pain at mons (hypogastric)
| ilioinguinal more labia
74
Folic Acid antagonist use is associated with?
Neural Tube Defects, Cardiac Defects and Oral Clefts
75
Which nerve fibers contribute to pain in 2nd stage of labor?
Pudendal nerve (S2-4)
76
Both parents have normal stature, but both kids have achondroplasia, most likely reason?
Gonadal mosaicism
77
What is the precursor of fetal steroid synthesis?
LDL
78
What is pulmonary capillary wedge pressure (PCWP) reflects?
Left Ventricular Preload
79
Stillbirth in setting of cholestasis, most likely finding?
Meconium stained amniotic fluid
80
Most common mode of transmission for Hep B worldwide?
Vertical Transmission from mother to baby
81
Which antibiotic has the ability to potentiate the neurmuscular blocking ability of magnesium sulfate?
Unasyn
Gentamicin
Erythromycin
Gentamicin
82
Why are basic drugs like demerol concentrated in an acidemic fetus?
Ion trapping from a decreased isoelectric point
83
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
84
What antibody pattern is consistent with Recurrent CMV?
#ERROR!
85
Which IL is antiinflammatory?
IL10
86
If preload and afterload are already optimized, what is the best way to increase cardiac output?
Beta adrenergic
87
Which is not helpful for identifying lupus anticoagulant?
| Dilute russell venom, Kaolin, Prolonged PTT, ANA?
ANA
88
Microtia is associated with what medication?
Microtia - Undeveloped external ear, happens from isotretinoin (accutane)
89
Best test to compare the mean in 3 groups?
ANOVA (used for comparing means in more than 2 groups)
90
Which error is failing to reject the null hypothesis when its false?
Type 2 Error (failed "2" reject the null)
91
What is type 1 error?
Rejecting the null when you shouldn’t have
92
Which study type is ideal for studying rare outcomes/diseases?
Case-Control Study
93
Which is the usual cause of hemodynamic decompensation with mitral stenosis peripartum?
Increased Preload
94
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)
95
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
96
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
97
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
98
Which has the lowest O2 content?
| umbilical artery, umbilical vein, uterine artery, uterine vein
Umbilical Artery
99
What are the features of Fetal Hydantoin Syndrome?
```
IUGR,
MR,
Nail/Digit hypoplasia,
Hypertelorism,
low set ears,
short nose / flat nasal bridge
```
100
What is the best way to monitor improvement in metabolic acidosis in DKA?
Anion gap
101
Which has clinically significant levels of Factor X?
| FFP or cryo?
FFP - has fibrinogen, factors 2, 5, 7, 9, 10, 11
102
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
103
Least associated with embryopathy?
| Azathioprine, warfarin, hydantoin
Azathioprine (not associated with major anomalies)
104
Which is most associated with fetal risk?
| Thyroid stimulating antibodies, TSH?
TSI's
105
Why is Randomization good practice?
Helps decrease confounding
106
What is the best way to perform randomization?
Random number block permutation
107
When should you only use a one tailed test?
When results can only go in one direction
108
What is the most common complication of malarial infection?
Anemia
109
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))
110
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)
111
What is the precursor to estriol?
C9 Precursor DHEAS (from the fetal adrenal, fetal zone)
112
What affects positive predictive value (PPV) the MOST?
Prevalence
113
Which maternal cardiac lesion most likely transmitted to fetus?
IHSS (autosomal dominant)
114
HLA is not expressed on which?
| Syncytiotrophoblast or cytotrophoblast
The Syncytiotrophoblast -has NO Antigens
115
Prophlyaxis for mycobacterium avium with CD4 count 45 is?
Azithromycin when CD4 < 50
116
Which enzyme deficiency is a concern with chloroprocaine?
Pseudocholinesterase
117
Prophylaxis for PCP in CD4 < 200?
Bactrim
118
Pattern of glucose levels by time of day in pregnancy?
Decreased fasting levels, Increased postprandials
119
Patient can't dorsiflex after forceps delivery, which nerve injured
Common Peroneal
120
Which drug sticks around in the body for 2 years?
Etretinate
121
Which is not associated with hydrops
| listeria, syphillis, parvo, cmv, toxo
All of them are, Listeria is probably the least
122
Neonatal lupus most likely to present with which?
Rash (25%), Complete heart block (3%)
| Thrombocytopenia (10%, but that was in one random BMJ article)
123
Triple screen with nl HCG, AFP but very low estriol, think?
X-linked iccthyosis(Placental sulfatase deficiency) and SLOS
124
Which is the stats term used for inter-observer agreement?
kappa (intra observer variability / agreement)
125
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).
126
Which is best test if using multiple variables to assess surival?
cox regression
127
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)
128
Which translocation most likley to result in fetus with T21?
21:21 Homologous 21 translocation
129
Mechanism of anemia in parvovirus?
| hemolytic effect, viral effect on erythroid precursors?
Effect on erythroid precursors
130
Most likely to decrease breast milk flow?
| OCP's IUD Depo-provera
OCP's
131
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)
132
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
133
What is the reason for maternal hypoxia at time of induction of general anesthesia?
Decreased Functional Residual Capacity
134
Which is not true with preeclampsia at induction of anesthesia?
decreased vasoresponsiveness to pressors
decreased plasma volume
increased coagulopathy
decreased vasoresponsiveness to pressors
135
Risk of NTD with valproic acid?
1-2%
136
Bullous lesions with biopsy showing C3 deposition in the basement membrane: Diagnosis?
Herpes gestationis (Aka Pemphigoid gestationis))
137
Complications associated with Herpes Gestationis?
PTD, IUGR, increased neonatal mortality
138
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
139
Which is associated with pre-renal oliguria?
| Urine osm 550, Urine Na > 20, Serum BUN:Cr 1:1
Urine Osm >450
140
How do you diagnosis Von Willebrand's disease?
Ristocetin cofactor activity
141
Best Rx for type 1 Von Willebrand's Disease?
| Desmopressin, cryo, FFP
Desmopressin
142
Which Coagulation factors decrease with pregnancy?
Factor XIII, XI, Protein S and Platelets
143
Which Coagulation factors increase in pregnancy?
Fibrinogen, Factor VII, Factor X, vwF:Roc
144
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
145
What is the term that means it matters from which parent an allele was inherited?
imprinting
146
Which situation allows you to override patient confidentiality?
someone in serious danger
147
```
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)
148
What crosses placenta via Facilitated diffusion?
Glucose
149
What crosses the placenta via active transport?
PICA - Phosphorous, Iron, Calcium, Amino Acids
150
What crosses the placenta via Simple Diffusion?
COKED - CO2, O2, Ketones, Electrolytes, Drugs (most)
151
What crosses the placenta via Endocytosis?
IgG, LDL, Insulin (If IgG), Transferrin
152
Most common cause of mortality with anesthesia?
Failed intubation
153
How is calcium transported across placenta?
Active transport
154
Which maternal cardiac lesion most associated with fetal hypoxia?
Pulmonary Hypertension
155
Which is most associated with enlarged placenta, pale placenta, hydrops?
Syphillis
156
The main factor that influences fetal growth?
Insulin, HPL
157
OCP's have the least beneficial effect in preventing which cancer?
Breast Cancer
158
IUGR is most associated with what later in life?
metabolic syndrome / dm2
159
Greatest risk with lupus nephritis?
Preeclampsia
160
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)
161
For which of the following is plasmapharesis 1st line Rx?
TTP
162
Which is not associated with IUGR?
| Hyperthyroidism, sickle cell, parvo
Parvovirus (anemia and heart failure, not usually FGR)
163
Which is least associated with pregnancy loss after amniocentesis?
Tenting, multiple attempts, needle gauge, transplacental stick?
Tenting
164
Why is ROC a good test?
sensitivity = y , 1- specificity = x allows to balance between them
165
Which is true regarding oxygen dissociation curve?
A fetus has higher O2 saturation at any PO2 than mom
166
Which Anastomoses protect against TTTS?
A-A
167
What infection is most likely to be transmitted with breast feeding?
a. Hep B
b. Hep C
c. CMV
d. Herpes
CMV
168
What happens to thyroid hormones in the first trimester?
TBG increases, Total T4 Increases, Free T4 Increases, TSH Decreases
169
What influences the volume of AF the least in pregnancy?
a. Swallowing
b. Urine production
c. Maternal weight
d. Dehydration
e. Transudation
Maternal weight
170
What is most associated with ARDS in pregnancy?
| PE, Infection?
Infection
171
Most likely complication of pyelo in pregnancy?
a) Urosepsis
b) ARDS
c) Preterm delivery
d) Anemia
e) Decreased creatinine clearance
Anemia (33%)
172
CVS is most contraindicated in?
Existing Rh isoimmunization is a contraindication to CVS
173
Which is not associated with SSRI?
a. Congenital heart defect
b. NTD
c. Neonatal withdrawal
d. PPHN
NTD
174
Where does a sub-galeal hemorrhage happen?
Between skull periosteum and the scalp galea aponeurosis
175
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)
176
Which of the following is most associated with aneuploidy in isolation?
cleft lip, gastroschisis, EIF, hydronephrosis, or ventriculomegaly?
Ventriculomegaly (3.81X LR)
177
Which is most associated with aneuploidy?
| EIF, short humerus, echogenic bowel , pyelectasis?
Echogenic bowel (1.65X LR)
178
```
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)
179
```
Which would decrease drug transport across placenta?
increased lipid solubility
increased protein binding
decreased ionization
placental degradation
```
Increased protein binding
180
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
181
```
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
182
Most direct biochemical cause of a myometrial contraction?
Myosin Light Chain Kinase
183
Most associated with placental insufficiency?
| Low Papp-A, High Papp-A, HcG?
Low Papp-a
184
Greatest contraindication to postpartum combined OCP's
hemorrhagic stroke w/ eclampsia
sagittal vein thrombosis
ovarian vein thrombosis
Sagittal Vein Thrombosis
185
Most likely to cause neonatal cushingoid syndrome in pregnancy?
Repeated steroid doses (though this looks like it has fallen out of favor)
