2018 - Final XLS in CSV form - Sheet1 Flashcards by Jay Barrow

Which cardiac disease is associated with the highest mortality?

Pulmonary HTN with VSD and Eisenmengers (Right to Left Shunt)

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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

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In a patient with T2DM and an elevated HbA1c, what is the most common finding on US?

Normal Ultrasound

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What is the most common complication of Chorioangioma?

Polyhydramnios

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Most common complication after narcotic anesthesia?

Pruritus

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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.

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Fish highest in mercury content?

King Mackerel (Shark, Swordfish, Tilefish, Ahi Tuna also)

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What can explain a discrepancy between amniocentesis results and CVS results?

Confined placental mosaicism

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Pt. had a CVS w/ Mosaic result, what can explain the birth of a normal baby?

Confined placental mosaicism

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What is the best way to decrease complications of shoulder dystocia?

Send staff for training, simulation

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Best way to prevent a retained sponge after a vaginal delivery?

Debriefing (via sponge count)

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39 week patient with a DVT, management?

Therapeutic Heparin

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A man of normal height has 3 dwarf children with 3 different mothers, explanation?

Gonadal Moasaicism

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What is the most common feature of turners syndrome?

Short stature

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What is a premutation of fragile X (how many repeats)?

Between 55-200 (premutation)

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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)

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What genetic principle explains a mom with tuberous sclerosus who has a child with heart problems, neurological lesion?

Variable Expressivity

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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

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Chorioangioma – most likely complication?

Polyhydramnios in 60% vs FGR in 20%

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Uncorrected ASD, increases the risk of?

Stroke (increased risk of emboli from arrhythmias)

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Discrepancy between cfDNA and fetal Karyotype, what can cause this?

Confined placental mosaicism

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Most likely ultrasound finding in a patient baby with Myotonic Dystrophy?

Polyhydramnios

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In Mono-Di twins, at what day does cleavage occur?

4-8 days

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Most common mutation in Osteogenesis Imperfecta?

ColA1,2

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When in pregnancy is the Cardiac output at its highest?

Immediately after delivery (autotransfusion of blood = 50% increase in CO)

Benefit of a SNP Array over CGH Array?

SNP Array can detect Triploidy

What is Alpha Error?

Type 1 error (False Positive, failing to reject the null hypothesis when you should have)

Which ethical concept is informed consent most closely tied to?

Autonomy

Which rash is associated with the worst neonatal / fetal complications?

Pemphigus Gestationalis (prematurity, SGA)

Which genetic condition should you consider in a Fetus with Increased Nuchal Translucency, but normal karyotype?

Noonan syndrome (10% of euploid with increased NT)

Patient with Preeclampsia with ruptured liver capsule, management?

- Correct Coagulopathies (likely DIC), - For surgical management Pack and drain - Improve surival with Hepatic Artery Embolization

Most common cause of non-hereditary deafness?

CMV (but remember 85% of congenital CMV are asymptomatic)

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 heart ultrasound finding most commonly associated with DiGeorge?

Interrupted Aortic Arch

What bacteria is associated with Alkaline Urine UTI's?

Proteus Mirabilis

At what gestational age woud you deliver a patient with a subchorionic hemorrhage?

At term

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)

Patient with recurrent cholelithiasis, management?

Lap Cholecystectomy

Simulation training has helped improve outcomes most in?

Brachial Plexus Injury (reduction by 60-90%)

What is the ethical principal which states that action is done for the benefit of others?

Beneficence

What is the ethical principal which states a physician must refrain from providing ineffective treatments or acting with malice toward patients

Non-maleficence

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

At what CD4 Count are you at risk of pneumocystic pneumonia?

<200

Most likely fetal outcome of radiation exposure in the first trimester?

Microcephaly - (also growth restriction and intellectual disability)

Preeclampsia - most common finding on pathology of placenta?

Parenchymal infarction

What is the management for a patient with Preterm Contractions but is closed?

Prolonged observation

What added step should you do in a cesarean section of a Morbidly obese patient?

Closed Subcutaneous layer

Obese patient comes to you with complaint sof fatigue and forgetfulness, what test should you order?

Sleep Study

Patient presents with IUFD, severe iugr + omphalocele, + large kidneys, what lab should you send?

Karyotype and Microarray

What is fastest onset anesthetic medication?

Lidocaine : 1-2 mins

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%)

What is the most common complication in pregnancy of women with Acromegaly?

Gestational Diabetes

In a mother that is Rh sensitized but has a low titer, what is the next step in management?

Continue to follow titers

Anemia, Thrombocytopenia and Renal Failure, Diagnosis?

HUS

Anemia, Thrombocytopenia, Renal Failure, Neurologic Abnormalities, and Fever

TTP

How much of the screen should a cervix take up for a cervical length?

3/4 of screen

Newborn with nose hypoplasia, stippled epiphyses, and limb hypoplasia, dx?

Warfarin embryopathy

Standard Error is interchangeable with Standard Deviation?

YES. Standard error is the estimation of the standard deviation

Cord Blood Gases – You have table, what is it?

Respiratory, metabolic, mixed?

pCO269, HCO3 20, BE -2

Respiratory

Which headache gets worse with sitting standing and better with laying flat?

Spinal Headache

Patient presents postpartum with fever, renal failure, anemia. Dx? Tx?

TTP, Plasmapheresis

What do you use to Differentiate TTP and HELLP

Fever

Mechanism of Progesterone IUD?

Cervical Mucous(most correct). Anovulation. Affecting Sperm Motility, preventing implantation

Most common complication of SSRI used in pregnancy used in a neonate?

Neonatal Abstinence

What statistical test do you use for evaluation of proportions?

Chi Square

What test do you use for evaluation of Means?

t-test

Pregnant patient with ab pain and bloody stool?

Stool culture

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

At what gestational age is Warfarin exposure at greatest risk for causing warfarin embryopathy?

6-9 weeks

What are the features of Warfarin Embryopathy?

``` SLIMNECk Stippled Epiphysis Limb Defects IUGR MR Nasal Hypoplasia Eye Defects CNS k - Vit K Antagonist Warfarin ```

Twins, when do you not do a CVS?

With Alloimmunication

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.

A pt. has Epistaxis, Telangiectasia. Diagnosis? Mode of inheritance?

Ossler Webber Rondu (AD)

Which medication needs adjustment for Increased GFR?

Digoxin

What is an early sign of TTTS?

NT and CRL discordance

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.

Duodenal Atresia in baby with Polyhydramnios. How does the amniotic fluid get absorbed if the baby has an obstruction?

Intramembranous absorption

Which Prostaglandin causes muscle relaxation?

Prostacyclin (PGI2)

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.

What is the main source of PGI2 in pregnancy?

The Myometrium

Which statistic test is used to differentiate between dependent and independent variables?

Logistic Regression

3+ groups which statistical test?

ANOVA

Evaluate the effect of Smoking on Lung Cancer, what type of study?

Case Control

Type I CPAM with Hydrops, what is the treatment?

Shunt for Drainage of Cyst

How do you treat a patient with Pulmonary hypertension, and you want to give general anesthesia.

Viagra

Most common complication with general anesthesia?

Failed Intubation

What enzyme is deficient in Canavans?

Aspartoacylase

What enzyme is deficient in Tay Sachs?

Hexosaminidase A

What enzym is deficient in Gaucher?

Glucocerebrosidase

What enzyme is deficient in Niemann Pick?

Sphingomyelinase

What are the last 3 phases of lung development? At wat weeks do they occur?

Cannalicular - 16-26 Saccular - 26- 36 Alveolar - 36+

At which phase do type 2 pneumocytes appear?

Cannalicular

Least likely to be transmitted in banked breast milk?

Syphilis

Which Aneuploidy is most common with CDH?

T18

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)

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)

Early Varicella Infection, whats the most common finding of baby?

Skin Scars

Fetus with intraabdominal Calcifications, Hepatosplenomegaly, Differential Diagnosis?

CMV/Toxo

Prerenal Azotemia with Preeclampsia,what lab is suggestive of this?

Urine osmolality >450

Most common complication of IUD in pregnancy?

Abortion

Most common Uterine Anomaly with Pregnancy loss?

Septate Uterus

At 30 seconds of resuscitation of a neonate, the HR is still low, Next step?

PPV

Kid got narcotic, what is the first sign of acidosis in tracing?

Loss of variability

Which part of the BPP is most closely correlated with Acidosis?

Loss of tone

Baby delivered and tried to resuscitate, Post ductal O2: 70%, Preductal 90%, likely diagnosis?

Persistent fetal circulation

What enzyme is deficient in Smith Lemli Optiz?

Dehydrocholesterol Reductase (DHCR7)

What medications can decrease the effectiveness of OCP's

Phenytoin, Carbamezapine, Rifampin

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)