Board Questions Flashcards
Still birth eval
Still birth term cause
Still birth risk factors
- hp
- fetal autopsy (30%)
- placenta eval (30%)
- fetal karyotype (8%) through amnio prior del > umbilical cord seg
- Least helpful: KB, syphilis, cups anticoagulant, anticardiolipin antibodies, B2glycoporetin antibodya
- Don’t order: routine testing for inherited thrombophilias
- mostly unknown cause
- old, fat, poor, first pregnancy or many pregnancies before,
Risk of death and neurological injury for
1) dichorioinc
2) monochorionic twins
AFTER 14w
1) di: death 3% death other, 1% neurological do other
2) mono: 15% death other, 18% neurological do other
(First trimester vanishing twin di/di, almost no effects)
WArfarin effects in pregnancy
- readily crosses the placenta
- “warfarin embryopathy” = nasal and midline facial hypoplasia, stippling of the vertebral and femoral epiphyses (rings near epiphyseal plates on US)
Lithium effects pregnancy
Epstein anomaly, downward displacement of tricuspid valve
methamphetmaine effects pregnancy
FGR
Retinoic Acid exposure pregnancy
1st tri: spontaneous abortion and microtia and anotia (small/no ears)
alpha thal racial least asosciated with
- northern european
- Very much correlated with: African West Indian, mediterranean, southeast asian
- cannot be dx on eletrophoresis
- South Asian more likely to have hem BART (two gene deletions in CIS chromosome (hydrops fetalis)
Antibodies:
1) duffy
2) kell
3) kidd
4) Lewis
5) Lutheran
6) I
1) duffy = severe hemolytic anemia
2) kell = severe hemolyic anemia, TITER DOES NOT REP RISK
3) kidd = severe hemolytic anemia
4) Lewis = most recently encountered other then Rh, IgM, does not cross placenta, does not cause hemolytic anemia
5) Lutheran = mild hemolytic anemia
6) I = also most common non-Rh, IgM, doesn’t cross, doesn’t cause problems.
Most effective way to dx CPD
interspinous diameter
LMWH vs UFH
1) both:
- don’t cross the placenta
1) LMWH better than UFH
- lower risk of HITT
- more predictable response
- fewer bleeding episodes
- longer half life (less administrations)
- less bone mineral density loss
- can’t reverse well
2) UFH better than LMWH
- shorter half life (good for delivery)
- can assess with PTT
typical dose of 3rd trimester Rhogam __, protects against __ transfer of blood
300 mcg
30 mg
risk NTD
1) baseline
2) sibling with it
3) two siblings with it
1) 0.04%
2) 3%
3) 10%
2nd degree tear break down with infection
- treat with abs
- 1st and 2nd degree allow to heal by secondary intention (on own)
neonatal lupus
- transfer of maternal antibodies across placenta
- specifically anti SSA/Ro, anti SSB/La.
- or to moms with SLE, Sjorens
= cuteanous rash+ cardiac findings: heart block - need regular fetal echocardiograms (weekly, or every other week)
fetal-maternal hemorrhage most likely to occur during:
- vaginal delivery (reasons everyone gets Rhogam)
- give up to 72h pp, but also up to 28d pp
- 300 mcg covers 30mL whole blood, 15mL PRBC
sickle cell disease basics
- AR (right cause you can have trait, duh)
- b-globin gene
- substitution of thymine for adenine (sub valine for gluatmic substitution)
- makes hemoglobin S
- types SS, SC, S beta thalassemia, S beta-zero thalassemia
GERD treatment line
- lifestyle changes
- antacids (calcium)
- H2 receptor blockers (ranitidine/famotidine
- PPI (ompeprazole, esmoperazole)
- EGD
neonatal HSV rates of type of infection
- skin (45%)
- CNS (35%)
- Disseminated (25%)
- HSV pneumonia happens in adults not infants
syphilis chart of phases
see chart attached
sphyilis rash
Target lesions hands/feet
dosing of vit D in supplements during pregnancy in prenatal vitamin
the recommended amount of daily Vit D
400 international units in prenatal
600 international units daily recommended
Epidural effect on FHT
- decreased variability AND decreased accelerations
Hep C is associated with
Cholestasis in pregnancy (20x increase)
Graves Disease in Pregnancy is associated with
- associated with medically indicated deliveries and low birth weights
- fetal HYPO or HYPER thyroid
thrombophilia
- inhereted
- acquired
Inherited do NOT cause FGR
- factor V lieden
- prothrombin mutuation
- MTHFR
Acquired cause FGR
- antiphospholipid syndrome
Clotting factor changes in pregnancy
Increased:
7, 8, 10, 12, fibrinogen, plasma activating inhibitors, vWD
No change:
5, 9, antithrombin, protein C
Decreased Protein S (makes you more coagulable to have less)
Coagulation cascade and anticlotting drugs to memorize
Memorize
Definition ACOG massive transfusion adn indication
- blood loss 1500 with ongoing bleeding
- 10 units in 24h pp
- 4 units in 1h pp
- replacement entire blood volume of pt
Screening fetal chromosom definitions
First trimester
- NT, msAFP, bhcg,
When to do each type of genetic fetal screen
The rates of detecting downs syndrome with it
urogyn drugs: MOA and use
1) mirabegron
2) coaptite injectin
3) oxybutynin
4) onabotulinumtoxinA
5) tolterodine
1) mirabegron: B3 adrenergic recept agonist treating overactive bladder, relaxes detrusor muscle
2) coaptite injection: reuthral bulking agent, SUI
3) oxybutynin: antimuscarinic, acts at M2/3 receptors, (note bladder mostly M3) SUI
4) onabotulinumtoxinA (botox): neurotoxin from clostridium botulinum, inhibits vesicle-mediated release of acetylcholine from presynaptic nerves at NM junction, therefor decreasing detrusor contractility (injected directly into bladder)
5) tolterodine: antimuscarinic, non selective at M2/3 SUI
w/u for hirsutism
- total testosterone
- DHEA-S (adrenal glands, >700 mean tumor)
- 17-hydroxyprogesterone
steps of embryo implantation
- 2 capacitation: what sperm has to do to fertilize an oocyte prior to embryo made
- Bastulation: forming of blastocyst
- Hatching
- Bastulation: forming of blastocyst
- apposition: blastocyst hatches from zona pellucida
- adhesion: embryo and endometrium leak out proteins
- invasions: trophoblasts at the implantatin site have formed masses of cytotrophoblasts and syncytiotrophoblasts
vaccines cannot give in pregnancy
- varicella
- rubella
- nasal flu
division of internal iliac artery
Anterior
Posteroir
Anterior
- uterine
- umbilical
- superior vesical
- obturator
- internal pudendal
- interfior gluteal
- middle rectal
- vaginal
Posterior
- superior gluteal
- lateral sacral
- iliolumbar
best explanation for decreased urine output during LSC surgery with trendelenburg?
- increased release of renin
= especially in obese patients - releases more renin, aldosterone, and antidiuretic hormone = decreased renal blood flow, reducing glomerular filtration rate = oliguria
==
- cuases decreased cardiac output
- acidemia
- oliguria
- difficulty wiht ventilation
layers of the bladder inside to outside
- transitional epithelium
- lamina propria
- submucosa
- detrusor muscle (muscularis propria)
- adventisia (serosa)
fetal circulation
