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MFM Oral Boards 2020 > additional > Flashcards

additional Flashcards

1
Q

what is PUB’s blood

A

O - washed, CMV neg, leukoreduced, irradiated, concentrated <7 day old

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2
Q

how quickly does hydrops resolve

A

24-48 hr

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3
Q

threshold for transfusion

A

hct <30

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4
Q

goal hct for transfusion

A

35-50
prior to 24 weeks consider 25 adequte
- in this situation repeat in 48 hours and than repeat again in 7-10 days

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5
Q

hct decline per day after transfusion

A

1%

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6
Q

repeat transfusions

A

emperic 10 days after 1st
2 weeks after 2nd
3 weeks after 3rd

expected decline in fetal hemoglobin of 0.4 g/dL/day, 0.3 g/dL/day, and 0.2 g/dL/day after the first, second, and third transfusion,

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7
Q

MCA threshold after 1 IUT

A

1.69

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8
Q

Nait - what is affected but not severe

A

prior affected child with no ICH

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9
Q

Treatment for NAIT non-severe

A

20 wks: IVIG 2 gm /kg/wk
30 wks- add prednisone .5 mg /kg/day

CD at 37-38 weeks

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10
Q

Treatment of NAIT with a history of ICH

A

12 wks 1 gm/ kg/wk
20 wk 2 gm/kg/wk
28 wk add prednisone 0.5 mg/kg/day
CD 37-38 wks

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11
Q

early onset FGR at what week

A

32 weeks gestation

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12
Q

Do we use BPP in FGR

A

No

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13
Q

Where do you take your umbilical artery?

A

at the umbilicus

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14
Q

what is the cut off for umbilical artery dopplers?

A

> 95% RI, PI or S/d

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15
Q

What do you do with a fetus that has abnormal dopplers and FGR

A

weekly uad
nst 1-2 x week
EFW up to q2 weeks
deliver at 37

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16
Q

what do you do with a fetus that is <3rd with normal dopplers

A

weekly uad
weekly nst
consider efw q2
deliver at 37

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17
Q

what to do with >3rd and normal dopplers

A

uad q 1-2 weeks than q 2-4 if stable
weekly nst
ew q3-4
deliver 38-39

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18
Q

absent end diasolic flow

A 
admission (?)
UAD 2-3 x per week 
corticosteroids 
NST 2x weekly (if outpt) 
EFW q2 weeks 
deliv 33-34
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19
Q

reversed end diastolic flow

A 
admission 
steroids 
NST 1-2x day 
EFW q2 week 
Deliver 30-32 weeks
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20
Q

Recurrace risk for heart block in a fetus

A

16-18%

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21
Q

who should be screened with ssa levels?

A 
lupus
sjogrens
RA
mixed CTD
prior child with neonatal lupus or congential heart block
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22
Q

highest risk for heart block

A

18-24 weeks
rare after 30
- antibodies distroy av conduction

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23
Q

mode of delivery for fetal heart block

A

CD - can’t interpret the EFM

24
Q

definition of prolonged PR

A

> 150 msec

25
Q

Where to put the doppler for PR interval

A

accoss MV and LVOT
A wave- atrial contracting
PR- beginning of atrial contraction to beginning of ventricular contraction (how well is the AV node working )

26
Q

Why I don’t screen PR intervals

A

arrythmia noted with doppler
acultate weekly
1st degree does not always progress
2nd degree often progresses but may revert
complete heart block is permanent and not reversible
steroids have some risks and benefit is unclear

27
Q

what is 2nd degree heart block

A

prolonged PR and occasional dropped beats

28
Q

how do you monitor complete heart block

A

weekly hydrops checks and twice weekly bpp

29
Q

talk through a cervical length

A 
empty bladder
clean probe
insert towards anterior fornix
saggital view
remove until blurred and than reinsert
cervix should be 2/3 of the screen 
internal and external os should be visualized
take 3 measurements and use the best shortest
30
Q

when to send a FFN

A

PTL with a CL 20-30 mm 22-35 weeks

- consider ffn for PPROM

31
Q

preterm labor lab eval

A 
wet mount
GC swab
GBS
UDS
UA
32
Q

window for GBS testing

A

36-38

33
Q

high risk for penicillin allergy what gbs ppx

A

clinda if it’s sensitive

- consider penicillin allergy testing

34
Q

If rapid GBS testing is negative do you need gbs ppx

A

yes if there are risk factors for GBS sepsis (preterm , prolonged rom, fever)

35
Q

what is a mild penicilin allergy

A

non-uticarial rash
symptoms that are not consistent with an allergy
puritis without rash
reports history of allergy but unsure what happened

36
Q 
gbs regimen 
standard
low risk allergy 
high risk allergy 
high risk allergy clinda resistant
A

penicillin 5 m and 3 mil every 4 hours
ancef 2 gm than 1 gm every 8 hr
clinda 900 mg every 8 hours
vanco 30 mg/kg q 8 hours with max 2 gm

37
Q

IF you discontinued mag and need to restart. How long does it need to be to repeat the bolus

A

6 hr

38
Q

nitrozine test

A

vaginal 3.8-4.2

amniotic fluid 7

39
Q

amnisure looks for what

A

alpha microglobulin-1

(false positive up to 30%

40
Q

whats the dose of indigo

A

1 ml in 9 ml

- remove tampon 30 minutes later.

41
Q

vit K in last month of pregnancy with which medications

A 
phenobarbital 
carbamazepine
phenytoin 
topiramate
oxycarbazepine
42
Q

fetal hydantoin syndrome

A

Phenytoin

iugr, microcephaly, cardiac defect, hypoplastic nails, craniofacial abnormalities

  • 30 affected, full syndrome in 15%
43
Q

screening for drug use

A 
4 p's
parents use drugs
partner use drug
prior difficultly with drugs
present drug use
44
Q

iv drug use lab

A

STD evaluation

echocardiogram

45
Q

lovenox
ppx
theraputic

A

ppx- one prior unprovoked VTE, high risk thrombophilia

theraputic- high risk thrombophilia with one prior VTE or 2 prior VTE

46
Q

neonatal concerns with protein C or S

A

if homozygote neonatal purpur fulminans- requires life long anticoagulation

47
Q

spinal cord lesion above t10

A

SVE regularly at 26 wks
Inpatient at 32 weeks
use non-absorbable sutures and remove

48
Q

spinal cord lesion above T6

A

ptb
autonomic dysreflexia
- hypertension/bradycardia/headache/ congestion/rubor/sweating

treat with atropine/clonidine
prevent with epidural

49
Q

myasthenia gravis

A

abnormal t cell regulation - antibodies to acetylcholine receptor

  • no mag
  • neonatal myasthenia - resolves in 6 weeks
50
Q

benefits of delayed cord clamping

A

preterm- decreased need for blood transfusion/anemia, decreased NEC and IVH

51
Q

Why did you check MCA dopplers

A

Honestly, since the most recent FGR recommendations which stratifies FGR further into severe and non-severe and clearly reviewed the current MCA literature, we have stopped doing MCA Doppler’s. However, prior to the most recent FGR document we were using CPR to risk stratify FGR due to a number of poor outcomes we had seen in term FGR fetuses at altitude. We had decided to use CPR to help with risk stratification as there had been a growing body of literature on CPR’s in the 2000’s, some of which indicated that it might correlate with adverse outcomes better than just the uterine artery Doppler alone. We were simply trying to risk stratify, which we now do as per the subsequent recommendations.

52
Q

phe508 del

pro750 leu

A

CFTR mutations

53
Q

8q22.2 microdeletion

A
  • this deletion was smaller so unclear if this phenotype would occur.
    8q22. 1 Deletion. The phenotype of this deletion issimilar to that of the Nablus mask syndrome, symptoms in-clude ID, speech disorder and typical dysmorphic features.The deletion is approximately 1.6 Mb
54
Q

6q25 deletion

A

microcephaly, developmental delay, dysmorphic features and hearing loss, whereas two of them had agenesis of the corpus callosum. Dysmorphic features include midface hypoplasia, hypertelorism, broad nasal root and posteriorly rotated ears.

55
Q

20 q 13.2-13.33 duplication

A

moderate developmental delay, abnormal craniofacial features and ventricular septal defect

56
Q

Urinary tract dilation

A

A1 <28 week 4-7 mm
>28 weeks 7-10 mm

A2-3 <28 weeks >7mm
>28 weeks >10 mm
- upgraded due to peripheral calyceal dilation or abnormal echogenic renal parenchyma

> 15 does not have it’s own name but has worse prognosis

Mild hydronephrosis – Surgical intervention performed 10 percent
•Moderate hydronephrosis – Surgical intervention performed in 24 percent
•Severe hydronephrosis – Surgical intervention performed 63 percent

At 20 months hydronephrosis persisted in 10, 25, and 72 percent of patients with mild, moderate, and severe fetal hydronephrosis, respectively

Society of Fetal Urology- 4 levels ( same as above with 2/3 based on the number of calyces and 4 being cortical thinning

MFM Oral Boards 2020 (25 decks)

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