2018 - Final XLS in CSV form - Sheet1 Flashcards
Which cardiac disease is associated with the highest mortality?
Pulmonary HTN with VSD and Eisenmengers (Right to Left Shunt)
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
In a patient with T2DM and an elevated HbA1c, what is the most common finding on US?
Normal Ultrasound
What is the most common complication of Chorioangioma?
Polyhydramnios
Most common complication after narcotic anesthesia?
Pruritus
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.
Fish highest in mercury content?
King Mackerel (Shark, Swordfish, Tilefish, Ahi Tuna also)
What can explain a discrepancy between amniocentesis results and CVS results?
Confined placental mosaicism
Pt. had a CVS w/ Mosaic result, what can explain the birth of a normal baby?
Confined placental mosaicism
What is the best way to decrease complications of shoulder dystocia?
Send staff for training, simulation
Best way to prevent a retained sponge after a vaginal delivery?
Debriefing (via sponge count)
39 week patient with a DVT, management?
Therapeutic Heparin
A man of normal height has 3 dwarf children with 3 different mothers, explanation?
Gonadal Moasaicism
What is the most common feature of turners syndrome?
Short stature
What is a premutation of fragile X (how many repeats)?
Between 55-200 (premutation)
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)
What genetic principle explains a mom with tuberous sclerosus who has a child with heart problems, neurological lesion?
Variable Expressivity
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
Chorioangioma – most likely complication?
Polyhydramnios in 60% vs FGR in 20%
Uncorrected ASD, increases the risk of?
Stroke (increased risk of emboli from arrhythmias)
Discrepancy between cfDNA and fetal Karyotype, what can cause this?
Confined placental mosaicism
Most likely ultrasound finding in a patient baby with Myotonic Dystrophy?
Polyhydramnios
In Mono-Di twins, at what day does cleavage occur?
4-8 days
Most common mutation in Osteogenesis Imperfecta?
ColA1,2
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)
