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JFNG > 2013-14 - Final XLS in CSV form - Sheet1 > Flashcards

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

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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

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3
Q

Betamethasone decreasese what in fetuses?

A

Fetal Breathing and movement

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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.

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5
Q

Treacher collins is associated with impairment in what structure?

A

The mandible

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6
Q

Which Immunoglobin associated with mucosal defense in

breast milk?

A

IgA

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7
Q

Petechiae + hepatosplenomegaly at birth, which infectious etiology?

A

CMV

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8
Q

Which infection is associated with Placental Microabscesses?

A

Listeria

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9
Q

Which is least likely with listeria?

preterm labor, chorioamnionitis, hydrops?

A

Hydrops (one of the less common etiologies of hydrops)

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10
Q

Which is the most likely neonatal complication with PKU?

A

Mental Retardation

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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.

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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
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13
Q

Which autoimmune disorder is more likely to improve during pregnancy?

A

Rheumatoid Arthritis improves in 50-70% of cases in pregnancy

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14
Q

Antihypertensive with most evidence for association with IUGR?

A

Atenolol

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15
Q

Worst prognosis for neonatal CMV with?

A

Microcephaly

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16
Q 
Least likely with hyperparathyroidism? 
 Pancreatitis 
 HTN 
 kidney stones
 cranial califications 
 neonatal hypocalcemia
A

Cranial Calcifications

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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

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18
Q

Most likely cause of hypoxia post c-section in obese class II patient?

A

Apnea

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19
Q

Most common risk with AZT?

A

Anemia (Marrow Suppression) - most common adverse reaction

But Nausea.vomitting, more common / less specific.

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20
Q

Which medication is contraindicated in women with liver failure for HIV treatment?

A

Nevirapine, less so Lopinavir/Ritonavir (Kaletra)

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21
Q

HIV patient not on meds, presents in labor, best single agent?

A

Zidovudine / Lamivudine

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22
Q

Which HIV Medication shouldnt be used In the first trimester?

A

Efavirenz (Increased Myelomeningocele risk)

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23
Q

What is the most likely cause of pain from a Wet tap?

A

Traction of nerves from CSF leak

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24
Q

Which of the following have associations with advanced paternal age?

A

Marfan, Achondroplasia, Neurofibromatosis (MAN)

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25
Q

Initial symptom of Intravascular Lidocaine injection?

A

Tinnitus

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26
Q

Which anesthetic has greatest cardiac risk?

A

Bupivacaine (Marcaine)

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27
Q

Which screening is recommended for Ashkenazi Jewish population?

A

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

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28
Q

What is the mechanism of action of LMWH?

A
  1. Inhibits Prothrombin

2. Binds ATIII and inhibits thrombin formation

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29
Q

Most drugs cross the placenta by what method?

A

Simple diffusion

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30
Q

What is the PO2 in the Umbilical artery?

A

20

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31
Q

Which fetal vessel has the lowest PO2?

A

Umbilical Artery

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32
Q

What is the minimal PO2 needed to maintain maternal SaO2 >90%?

A

60

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33
Q

Which is helpful for treatment of HIE?

A

Cooling

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34
Q

Most likely to be helpful for treatment of mitral stenosis intrapartum?

A

Propranolol (Beta blocker)

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35
Q

Best Rx for mom with dyspnea, cyanosis, large VSD and R to L shunt at 28 weeks?

A

Viagra

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36
Q

Best Treatment for a Pheochromocytoma

A

Phenoxybenzamine (Alpha Blocker)

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37
Q

Which inheritance pattern is most associated with variable penetrance?

A

Autosomal Dominant

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38
Q 
Least likely in family hx affected by Fragile X?
 Premature ovarian failure
 Ataxia 
 Family history MR 
 Gonadal Cancer
A

Gonadal Cancer

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39
Q

Most likely outcome with Fragile X?

A

Mental Retardation

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40
Q

Which SSRI most associated with increased fetal cardiac risk

A

Paxil (ASD, or outflow tract obstruction)

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41
Q

Least likely symptom with H1N1?

Nausea/Vomitting, Cough, Fever, Sore Throat?

A

Nausea/Vomitting

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42
Q

Most likley diagnosis with fetal unilateral pleural effusion?

A

Hydrothorax

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43
Q

Most common obstetric fistula?

A

rectovaginal fistula

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44
Q

What is the form of the source of metabolic fuel for the fetal myocardium?

A

Glucose

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45
Q

Which steroid influences sodium reabsorption?

a. Fludrocortisone
b. Hydrocortisone
c. Betamethasone
d. Cortisol

A

Fludrocortisone (Mineralocorticoid)

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46
Q

Levels of which drug are least effected by liver metabolism?

Lovenox, Warfarin, Dylantin?

A

Lovenox

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47
Q

Most common complication of PKU?

What is the most common structural complication in PKU?

A

Mental retardation = most common

Cardiac (hence we do echo’s on these fetuses) = most common structural

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48
Q

Neonate with limb and muscle hypoplasia, derm and

eye finding, Diagnosis?

A

Congenital Varicella

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49
Q

Injury with brachial plexus injury resulting in Erb’s palsy is at what level?

A

C5-6

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50
Q

Discrepancy in which is best for TTTS diagnosis?

A

Amniotic Fluic (Poly/Oli)

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51
Q

When do you prophylax and with what for CD4 counts in HIV?

A

<200 : PCP : Bactrim
<100 : Toxo : Bactrim
<50 : MAI : Azithro

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52
Q

What defines Stage 3 TTTS?

A 
Doppler abormalities (AEDF, REDF) 
 Stage 1: Poly/oli
 Stage 2: Absent bladder
 Stage 3: Doppler AEDF or REDF
 Stage 4: Hydrops
 Stage 5: Death
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53
Q

Most common cause of Polyhydramnios?

A

Idiopathic

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54
Q

Why does T4 demand increase in pregnancy?

A

Increased TBG, to maintain adequate free T3 T4 there is increased production

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55
Q

Which Cardiac Lesion is the worst in pregnancy?

A

VSD with R to L shunt

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56
Q

Low MCV, HbA2 2.2% Normal Iron Studies, Dx?

A

Alpha Thalassemia

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57
Q

Low MCV, HbA2 3.9% Normal Iron Studies, Dx?

A

Beta Thalassemia

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58
Q

Low MCV, HbA2 2.2% Low Iron Studies, Dx?

A

Iron deficiency anemia

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59
Q

Best way to differentiate a lupus flare from Preeclampsia?

A

Measurement of ANA, anti-dsDNA, decreased CH50, and active urinary sediment(cellular casts, aseptic leukocyturia, and hematuria) may help distinguish SLE nephritis flare

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60
Q

What are the main features of Fetal Alcohol Syndrome?

A 
Mental retardation
 Cardiac Septal Defects
 Growth Restriction
 Smooth Filtrum
 Small upper lip
 Small Palpebral fissures
 Kidney Abnormalities
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61
Q

Risk of peripartum transmission for recurrent HSV

A

Low, 1%

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62
Q

How does iodide treatment work?

A

Decreases the circulating supply of T4 and T3 by inhibiting release of stored thyroid hormone.

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63
Q

How long should you use Iodide for?

A

No more than 2 weeks as it increases the risk of fetal goiter (due to lack of release of the stored thyroid hormone)

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64
Q

Most common ovarian cancer found in pregnancy?

A

Dysgerminoma (30% of ovarian cancers found in pregnancy)

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65
Q

Decreased Urinary Calcium is associated with what pregnancy disorder?

A

Preeclampsia

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66
Q

Which most explains decreased 2nd tri BP?
increased cardiac output
increased renal blood flow
decreased angiotensin sensitivity

A

Decreased Angiotensin Sensitivity

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67
Q

Which rate of dopamine infusion improves renal blood flow?

A

Low dose, <5ug/kg/min for renal blood flow

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68
Q

Which of the following is important for PGE2 creation?

Arachidonic acid or Prostacyclin

A

Arachidonic acid

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69
Q

CDH, IUGR, VSD , most likely diagnosis?

A

T18

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70
Q

Most likely diagnosis with a cystic hygroma?

A

40% T21, 30% Turners

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71
Q

Aspartoacylase deficiency is associated with?

A

Canavan disease

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72
Q

Expansion of a vulvar hematoma is limited by?

a. Inguinal ligament
b. Levator ani muscles
c. Colles fascia

A

Colles Fascia, Urogenital Diaphragm, and Anal fascia

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73
Q

Large c-section incision injures iliohypogastric/ilioinguinal nerve, what is the most likely result?

A

Paresthesia/Pain at mons (hypogastric)

ilioinguinal more labia

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74
Q

Folic Acid antagonist use is associated with?

A

Neural Tube Defects, Cardiac Defects and Oral Clefts

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75
Q

Which nerve fibers contribute to pain in 2nd stage of labor?

A

Pudendal nerve (S2-4)

76
Q

Both parents have normal stature, but both kids have achondroplasia, most likely reason?

A

Gonadal mosaicism

77
Q

What is the precursor of fetal steroid synthesis?

78
Q

What is pulmonary capillary wedge pressure (PCWP) reflects?

A

Left Ventricular Preload

79
Q

Stillbirth in setting of cholestasis, most likely finding?

A

Meconium stained amniotic fluid

80
Q

Most common mode of transmission for Hep B worldwide?

A

Vertical Transmission from mother to baby

81
Q

Which antibiotic has the ability to potentiate the neurmuscular blocking ability of magnesium sulfate?
Unasyn
Gentamicin
Erythromycin

A

Gentamicin

82
Q

Why are basic drugs like demerol concentrated in an acidemic fetus?

A

Ion trapping from a decreased isoelectric point

83
Q

What hormone does the placenta lack / is “inactive” that the fetus has / is “active”?

A

17-alpha-hydroxylase, it breaks down progesterone, which we don’t want the placenta to be able to do

84
Q

What antibody pattern is consistent with Recurrent CMV?

85
Q

Which IL is antiinflammatory?

86
Q

If preload and afterload are already optimized, what is the best way to increase cardiac output?

A

Beta adrenergic

87
Q

Which is not helpful for identifying lupus anticoagulant?

Dilute russell venom, Kaolin, Prolonged PTT, ANA?

88
Q

Microtia is associated with what medication?

A

Microtia - Undeveloped external ear, happens from isotretinoin (accutane)

89
Q

Best test to compare the mean in 3 groups?

A

ANOVA (used for comparing means in more than 2 groups)

90
Q

Which error is failing to reject the null hypothesis when its false?

A

Type 2 Error (failed “2” reject the null)

91
Q

What is type 1 error?

A

Rejecting the null when you shouldn’t have

92
Q

Which study type is ideal for studying rare outcomes/diseases?

A

Case-Control Study

93
Q

Which is the usual cause of hemodynamic decompensation with mitral stenosis peripartum?

A

Increased Preload

94
Q

Formula for odds ratio is?

A

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
Q

Which changes least in pregnancy?

CVP, CO, SVR, PVR

A

CVP does not change in preg.
Increase: CO, HR
Decrease: SVR, PVR, COP go down
Stays Same: PCWP, CVP

96
Q

Spinal anesthesia resulting in sympathetic blockade is worst for?
Aortic stenosis, mitral stenosis, IHSS, Pulm HTN

A

Pulmonary Hypertension, Decreased SVR results in drop in preload which would result in inability to perfuse the pulmonary vascular bed

97
Q

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

A

Lower O2 than uterine vein

98
Q

Which has the lowest O2 content?

umbilical artery, umbilical vein, uterine artery, uterine vein

A

Umbilical Artery

99
Q

What are the features of Fetal Hydantoin Syndrome?

A 
IUGR, 
 MR, 
 Nail/Digit hypoplasia,
  Hypertelorism, 
 low set ears, 
 short nose / flat nasal bridge
100
Q

What is the best way to monitor improvement in metabolic acidosis in DKA?

101
Q

Which has clinically significant levels of Factor X?

FFP or cryo?

A

FFP - has fibrinogen, factors 2, 5, 7, 9, 10, 11

102
Q

Mom has sickle cell (hgb SS), dad unknown but carrier rate is 1/12, what is chance fetus will have hgb SS?

A

1/24,

1/12 chance hes a carrier x 1/2 risk of passing on the bad one

103
Q

Least associated with embryopathy?

Azathioprine, warfarin, hydantoin

A

Azathioprine (not associated with major anomalies)

104
Q

Which is most associated with fetal risk?

Thyroid stimulating antibodies, TSH?

105
Q

Why is Randomization good practice?

A

Helps decrease confounding

106
Q

What is the best way to perform randomization?

A

Random number block permutation

107
Q

When should you only use a one tailed test?

A

When results can only go in one direction

108
Q

What is the most common complication of malarial infection?

109
Q

What is most likely outcome with amnio 45, XX der (13,21)?

A

Normal (no extra 13 or 21, just 1x13, 1x21 and 1x13-21 together))

110
Q

Carrier frequency of AR gene if prevalence is 1/6400?

A

~1/40 q^2 = 1 6400, q = 1/80 p = 79/80, (carrier rate = 2PQ = 2* 79/80 * 1/80)

111
Q

What is the precursor to estriol?

A

C9 Precursor DHEAS (from the fetal adrenal, fetal zone)

112
Q

What affects positive predictive value (PPV) the MOST?

A

Prevalence

113
Q

Which maternal cardiac lesion most likely transmitted to fetus?

A

IHSS (autosomal dominant)

114
Q

HLA is not expressed on which?

Syncytiotrophoblast or cytotrophoblast

A

The Syncytiotrophoblast -has NO Antigens

115
Q

Prophlyaxis for mycobacterium avium with CD4 count 45 is?

A

Azithromycin when CD4 < 50

116
Q

Which enzyme deficiency is a concern with chloroprocaine?

A

Pseudocholinesterase

117
Q

Prophylaxis for PCP in CD4 < 200?

118
Q

Pattern of glucose levels by time of day in pregnancy?

A

Decreased fasting levels, Increased postprandials

119
Q

Patient can’t dorsiflex after forceps delivery, which nerve injured

A

Common Peroneal

120
Q

Which drug sticks around in the body for 2 years?

A

Etretinate

121
Q

Which is not associated with hydrops

listeria, syphillis, parvo, cmv, toxo

A

All of them are, Listeria is probably the least

122
Q

Neonatal lupus most likely to present with which?

A

Rash (25%), Complete heart block (3%)

Thrombocytopenia (10%, but that was in one random BMJ article)

123
Q

Triple screen with nl HCG, AFP but very low estriol, think?

A

X-linked iccthyosis(Placental sulfatase deficiency) and SLOS

124
Q

Which is the stats term used for inter-observer agreement?

A

kappa (intra observer variability / agreement)

125
Q

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

A

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

126
Q

Which is best test if using multiple variables to assess surival?

A

cox regression

127
Q

MCA is not helpful for which of the following?

Sickle cell, kell, Anti-D

A

Sickle Cell (they have Fetal Hb, so no bad anemia in utero)

128
Q

Which translocation most likley to result in fetus with T21?

A

21:21 Homologous 21 translocation

129
Q

Mechanism of anemia in parvovirus?

hemolytic effect, viral effect on erythroid precursors?

A

Effect on erythroid precursors

130
Q

Most likely to decrease breast milk flow?

OCP’s IUD Depo-provera

131
Q

When should you treat potential fetal CAH and with what medication?

A

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

132
Q

Which is not associatied with autonomic hyperreflexia? At what level injury is it seen in? How is it prevented?
Hypotension, bradycardia, piloerection

A

Hypotension (Hypertension happens), T6 and above, early epidural

133
Q

What is the reason for maternal hypoxia at time of induction of general anesthesia?

A

Decreased Functional Residual Capacity

134
Q

Which is not true with preeclampsia at induction of anesthesia?
decreased vasoresponsiveness to pressors
decreased plasma volume
increased coagulopathy

A

decreased vasoresponsiveness to pressors

135
Q

Risk of NTD with valproic acid?

136
Q

Bullous lesions with biopsy showing C3 deposition in the basement membrane: Diagnosis?

A

Herpes gestationis (Aka Pemphigoid gestationis))

137
Q

Complications associated with Herpes Gestationis?

A

PTD, IUGR, increased neonatal mortality

138
Q

What is the mechanism of action of b-mimetics?

A

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
Q

Which is associated with pre-renal oliguria?

Urine osm 550, Urine Na > 20, Serum BUN:Cr 1:1

A

Urine Osm >450

140
Q

How do you diagnosis Von Willebrand’s disease?

A

Ristocetin cofactor activity

141
Q

Best Rx for type 1 Von Willebrand’s Disease?

Desmopressin, cryo, FFP

A

Desmopressin

142
Q

Which Coagulation factors decrease with pregnancy?

A

Factor XIII, XI, Protein S and Platelets

143
Q

Which Coagulation factors increase in pregnancy?

A

Fibrinogen, Factor VII, Factor X, vwF:Roc

144
Q

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

145
Q

What is the term that means it matters from which parent an allele was inherited?

A

imprinting

146
Q

Which situation allows you to override patient confidentiality?

A

someone in serious danger

147
Q 
Which initiates preterm labor? 
 Prostaglandin dehydrogenase (PGDH) 
 phospholipase A2
 metalloproteinases
 prostaglandin synthase
A

Phospholipase a2 (Phospholipase A2 is associated with the arachidonic acid pathway to production of prostaglandins. Prostaglandins are associated with labor induction/progression)

148
Q

What crosses placenta via Facilitated diffusion?

149
Q

What crosses the placenta via active transport?

A

PICA - Phosphorous, Iron, Calcium, Amino Acids

150
Q

What crosses the placenta via Simple Diffusion?

A

COKED - CO2, O2, Ketones, Electrolytes, Drugs (most)

151
Q

What crosses the placenta via Endocytosis?

A

IgG, LDL, Insulin (If IgG), Transferrin

152
Q

Most common cause of mortality with anesthesia?

A

Failed intubation

153
Q

How is calcium transported across placenta?

A

Active transport

154
Q

Which maternal cardiac lesion most associated with fetal hypoxia?

A

Pulmonary Hypertension

155
Q

Which is most associated with enlarged placenta, pale placenta, hydrops?

156
Q

The main factor that influences fetal growth?

A

Insulin, HPL

157
Q

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

A

Breast Cancer

158
Q

IUGR is most associated with what later in life?

A

metabolic syndrome / dm2

159
Q

Greatest risk with lupus nephritis?

A

Preeclampsia

160
Q

Patient at 35 weks with C6 spinal cord lesion admitted with severe hypertension, flushing with contractions. What is next best step in management ?

A

Epidural anesthesia (autonomic dys/hyperreflexia)

161
Q

For which of the following is plasmapharesis 1st line Rx?

162
Q

Which is not associated with IUGR?

Hyperthyroidism, sickle cell, parvo

A

Parvovirus (anemia and heart failure, not usually FGR)

163
Q

Which is least associated with pregnancy loss after amniocentesis?
Tenting, multiple attempts, needle gauge, transplacental stick?

164
Q

Why is ROC a good test?

A

sensitivity = y , 1- specificity = x allows to balance between them

165
Q

Which is true regarding oxygen dissociation curve?

A

A fetus has higher O2 saturation at any PO2 than mom

166
Q

Which Anastomoses protect against TTTS?

167
Q

What infection is most likely to be transmitted with breast feeding?

a. Hep B
b. Hep C
c. CMV
d. Herpes

168
Q

What happens to thyroid hormones in the first trimester?

A

TBG increases, Total T4 Increases, Free T4 Increases, TSH Decreases

169
Q

What influences the volume of AF the least in pregnancy?

a. Swallowing
b. Urine production
c. Maternal weight
d. Dehydration
e. Transudation

A

Maternal weight

170
Q

What is most associated with ARDS in pregnancy?

PE, Infection?

171
Q

Most likely complication of pyelo in pregnancy?

a) Urosepsis
b) ARDS
c) Preterm delivery
d) Anemia
e) Decreased creatinine clearance

A

Anemia (33%)

172
Q

CVS is most contraindicated in?

A

Existing Rh isoimmunization is a contraindication to CVS

173
Q

Which is not associated with SSRI?

a. Congenital heart defect
b. NTD
c. Neonatal withdrawal
d. PPHN

174
Q

Where does a sub-galeal hemorrhage happen?

A

Between skull periosteum and the scalp galea aponeurosis

175
Q

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 –

A

colpocephaly (tear drop ventricles)

176
Q

Which of the following is most associated with aneuploidy in isolation?
cleft lip, gastroschisis, EIF, hydronephrosis, or ventriculomegaly?

A

Ventriculomegaly (3.81X LR)

177
Q

Which is most associated with aneuploidy?

EIF, short humerus, echogenic bowel , pyelectasis?

A

Echogenic bowel (1.65X LR)

178
Q 
What hormone causes insulin resistance at 4-7AM? 
 cortisol 
 GH 
 PRL 
 progesterone
  androstenedione
A

GH, (Human placental Growth Hormone causes insulin resistance via decreasing insulin receptor sites)

179
Q 
Which would decrease drug transport across placenta? 
 increased lipid solubility
 increased protein binding
 decreased ionization
 placental degradation
A

Increased protein binding

180
Q

What are the features that make a drug more likely to cross the placenta?

A

Low molecular weight
Lipophilic (soluble)
Nonpolar (not ionized)
Unbound to protein

181
Q 
Which is predictive of cerebral palsy? 
 neonatal seizures
 low pH / high base excess
 multi-organ dysfunction 
 10 min Apgar =3
 early onset encephalopathy
A

Neonatal Seizures, Low pH (high BE), 10 min apgar<=3, Early encephalopathy

182
Q

Most direct biochemical cause of a myometrial contraction?

A

Myosin Light Chain Kinase

183
Q

Most associated with placental insufficiency?

Low Papp-A, High Papp-A, HcG?

A

Low Papp-a

184
Q

Greatest contraindication to postpartum combined OCP’s
hemorrhagic stroke w/ eclampsia
sagittal vein thrombosis
ovarian vein thrombosis

A

Sagittal Vein Thrombosis

185
Q

Most likely to cause neonatal cushingoid syndrome in pregnancy?

A

Repeated steroid doses (though this looks like it has fallen out of favor)

JFNG (9 decks)

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