A's Exam Review MCQ 2011

Question 1

Where is:
- umbilicus level
- aortal bifurcation level
- depth of aorta average
How many cm below aorta bifurcation is Lt common illiac vein located

Answer 1

• L3-4
• usually L4 - 5, caudal if obese
• 6 cm
• 3-6cm caudal, umbilicus always cephalad to that point

Question 2

1. Where is Palmer’s Point?
2. Lateral Trochar placement
   - 2 vessels and 2 nerves to avoid?
   - steps to avoid injury

Answer 2

1. 3 cm below Lt costal margin, midclavicular
   2.
   - inf and superior epigastrics, illioinguinal, illiohypogastric
   - place lat ports superior to asis, 6+ cm lateral to midline

Question 3

At what level does an epidural work for 1st and 2nd stage labour.

Answer 3

1st stage contractions: T10-L1

2nd stage: must extend S2,3,4 late stage 1 and stage 2

Question 4

DDx Vaginal Bleeding in Peds (Life threatening and common)

Answer 4

Life threatening:
- Malignancy (endodermal sinus tumor or rhabdomyosarcomas) usually present < 3yrs
- Trauma (abuse, water jets, recreational injury, stradle inj)
Common:
- Neo withdrawal PVB
- Foreign Body
- Infection (GAS and Shigella a/w PVB specifically but also have discharge)
- lichen sclerosus (purpura and hematomas)
- urethral prolapse
Uncommon:
- exogenous estrogen
- precocuscious puberty
- hypothyroidism

Question 5

1. CI to regional anesthesia
2. ThromboProphylaxis
   - time between last does and initiation
   - time between last dose and removal of catheter
   - time between neuraxial and restarting anticoag

Answer 5

1.

• coagulopathy
• increased ICP
• infection to lower back

2. Thromboprophylaxis:
   *insertion:
   UH no delay (up to 10 000 then 4h)
   LMWH: 10-12h
   * removal:
   UH 4h
   LMWH 10-12h
   *restart:
   UH 1-8h
   LMWH 6-8h

Question 6

Where i estrogen produced?

Testosterone secretion?

Answer 6

• E2 from granulosa cells of developing follicles and conversion of E1 (estrone to peripherally)
• Testosterone secretion: 25 % ovary, 25% adrenals, 50% peripheral conversion of androstenedione

Question 7

VARICELLA:

• Incubation period
• Does Shingles have fetal sequelae
• Infectious period?
• Pneumonitis: risk of getting, most risk for death in what trimester, what day of infection would it usually occur?

Answer 7

• Incubation period 10-21 days
• not associated with viremia or fetal sequela
• infectious period: 48 hours before the rash until the vesicles crust over
• 5-10% pregnant women with varicella, T3, Day 4 usually

Question 8

Classification of Operative Vaginal delivery

Answer 8

OUTLET: 
- scalp visible at introitus without separating labia
- fetal skull has reached pelvic florr
- fetal head at or on perineum
- Direct OA, OP or  LOA/ROA 
- Rotation does not exceed 45 degrees
LOW:
- Spines + 2 or more then either - rotation < 45 or > 45 degrees
MID: Station spines 0-2cm
HIGH: NO

Question 9

Requirements and CI to OVD

Answer 9

Prereqs:

• vertex, engaged
• Fully, ROM
• exact position known
• adequate pelvis
• analgesia
• bladder empty
• informed consent
• appropriate personel/backup
• skilled operator

CI:
ABSOLUTE:
- no vertex or brow
- unengaged head
- not fully
- evidence of CPD
- fetal coagulopathy

Question 10

Complications of OVD

Answer 10

Both Vacuum and forceps:
- Mat trauma
- Fetal scalp bruising/lacs, bleeding
- RARE: ICH, retinal hemorrhage, facial nerve injury, skull fracture
FORCEPS: also rarely minor ext occular trauma

Question 11

Risks of cocaine use in pregnancy?

Answer 11

Fetal:

• SA
• IUFD
• Abruption
• Prematurity
• IUGR

Maternal:

• CV cocaine toxicity: HTN (dont use beta blockers! cause end organ ischemia, use hydralazine)
• stroke
• MI

Question 12

Complications of Midtrimester PPROM

Answer 12

PTB
Chorio, endometritis
abruption
cord prolapse
IUFD
Retained placenta
Neo: morbidity, pulm hypoplasia, msk deformities

Question 13

Prevalence of Pulmonary Hypoplasia in midtrimester PPROM

Mortality and predictors

Answer 13

Prevalence 9 % in this pop mortality 70-90%
Predictors:
- GA a time of PPROM (rare after 26 wks)
- Degree of oligo

Question 14

Most common cause of hypothyroidism in pregnancy (1st world)

Answer 14

Chronic Autoimmune Thyroiditis

Question 15

Risk of untreated overt hypothyroidism

Answer 15

PTB
LBW
SA
?Neurodevelopmental

Question 16

Risk of untreated overt hyperthyroidism

Answer 16

PTD
LBW
IUFD
preeclampsia
cardiomyopathy --> pulm hypertension --> heart failure (8-90%)

Question 17

Treatment Hyperthyroidism

Answer 17

T1 PTU (propylthiouracil) as lower risks of birth defects, then methimazole T2/3 (risk of hepatotoxicity with PTU)

Question 18

Complications of long term beta blocker use

Answer 18

IUGR, fetal bradycardia, neo hypoglycemia

Question 19

List US findings suspicious for fetal hyperthyroidism (Trab positive complicaitons)

Answer 19

Fetal tachycardia
IUGR
goiter
accelerated bone maturation
heart failure
hydrops

Question 20

Thyroid Storm and or hyperthyroid related cardiomyopathy Treatment

Answer 20

ICU

• Thionamides (PTU) (blocks periph conversion T4->T3)
• HR control: BBlockers
• Iodine
• K Iodide
• Lugols (blocks release of thyroid hormone)
• Corticosteroids (dec peripheral conversion T4->T3

Question 21

DDX precocious puberty

Answer 21

Most common: Idiopathic Central Precocious Puberty (GnRH dependent)
- Intracranial lesions
Peripheral: 
- hormone secreting tumors (granulosa, sertoli/Leydig, gonadoblastoma)
- hypothyroid
- exogenous hormones
- adrenal tumor
- McCune Albrigth Syndrome

Question 22

What is McCune Albright Syndrome

Answer 22

Triad of precocious puberty, irregular cafe au lait spots and fibrous bone dysplasia.

Question 23

List 3 factors that affect MSAFP values

Answer 23

GA
Maternal Weight
DM
Fetal anomalies
Multiples
Race
Fetal viability

Question 24

Components of Apgar

Answer 24

Heart rate
Respiratory Effort
Muscle Tone
Reflex irritability
Color

Question 25

Do we use apgars as predictors of neo death/outcomes

Answer 25

NO. Not precise enough to use to Dx asphyxia (cord gases are used for this)

Question 26

1. What is the only type of CP a/w acute interruption of blood supply
2. Incidence of term CP
3. Factors a/w CP

Answer 26

1. spastic quadriplegia
2. 2-3/1000
3. • Maternal Co-morbidities
   • Multiples
   • PTB
   • IUGR
   • autoimmune, infection
   • Asphyxia
   • CNS, developmental, metabolic abnormalities
   • Substance abuse

Question 27

1. What percentage of children with CP had a demonstrated IP asphyxia?
2. Four essential criteria to associate CP with IP asphyxia
3. Criteria which suggest an IP insult

Answer 27

1. 10-20%
2. • Evidence of metabolic acidosis (ph < 7, BE > 12)
   • Early onset Neo Encephalopathy (> 34wks)
   • CP type spastic quadriplegia or dyskinetic type
   • Exclusion of other etiologies (trauma, coagulopathy, genetic anomaly etc)
     3.
   • sentinal hypoxic event
   • sudden/sustained fetal bradycardia or no variability in presence of lates/variables, when pattern previously normal
   • apgars 0-3 beyond 5 minutes
   • onset of multi system involvement within 72 h of birth
   • early imaging of acute, non focal, cerebral anomalies

Question 28

Risk factors for fetal NTD

Answer 28

• Personal/Family Hx both 1st and 2nd degree
• GI malabsorption d/o
• Advanced liver/renal disease
• Pre-gestational DM, Obesity
• Anti-epilepsy or anti-folate meds
• Smoking, ETOH
  low SES, food restrictions

Question 29

Classification or Risk for fetal NTD and related supplementation

Answer 29

Low: 0.4mg - 1mg
Mod: (Personal or family history of NTD or folate sensitive anomalies, Mat DM, meds, GI malabsorption) 1mg
High: (Parent with personal Hx NTD, previous child with NTD) 4mg

Question 30

What anomalies are thought to be folate sensitive

Answer 30

NTD
Cardiac
 limb
cleft palate
Urinary tract
 congenital hydrocephaly