II: Pregnancy- Fetus

Question 1

____ twins are at highest risk for Twin-Twin Transfusion Syndrome

Answer 1

Monochorionic; diamniotic

Question 2

____ twins are at highest risk of entanglement of umbilical cords.

Answer 2

Monoamniotic

Question 3

____ villi: cytotrophoblast core surrounded by syncytiotrophoblasts

Answer 3

Primary

Question 4

____ villi: cytotrophoblasts contact decidua and invade through to the inner third of the myometrium

Answer 4

Anchoring

Question 5

____ villi: extraembryonic mesoderm growing into the cytotrophoblast layer

Answer 5

Secondary

Question 6

____ villi: majority of placental mass, responsible for nutrient exchange

Answer 6

Floating

Question 7

____ villi: mesenchymal cell differentiation into blood vessels to form arteriocapillary network in the villous

Answer 7

Tertiary

Question 8

_____ are specialized basic histones with disulfide bonds that compact sperm DNA

Answer 8

Protamines

Question 9

______ do not express MHC molecules

Answer 9

Syncytiotrophoblasts

Question 10

______ may downregulate immune function regionally

Answer 10

Cytotrophoblasts

Question 11

______: morphological and biochemical differentiation of uterine stromal cells

Answer 11

Decidualization

Question 12

______: process by which blastocyst escapes the zona pellucida

Answer 12

Hatching

Question 13

______: trophectoderm cells of the blastocyst interdigitate with the luminal epithelium of the uterus

Answer 13

Apposition

Question 14

___-zygote: majority of spontaneous twin pregnancies (70%)

Answer 14

di

Question 15

An activated oocyte releases ___, to prevent polyspermy.

Answer 15

ZP3-F

Question 16

Capacitated sperm can bind to the _______ and undergo the acrosomal reaction.

Answer 16

zona pellucida

Question 17

Dizygotic twins are __-chorionic and __-amniotic.

Answer 17

di; di

Question 18

Fertilization occurs _____ hours following ovulation.

Answer 18

12 to 24

Question 19

HbF has a lower affinity for ______.

Answer 19

2,3-BPG

Question 20

How can TTTS be diganosed?

Answer 20

Placental Injection Studies

Question 21

Hyperemesis in the context of twin pregnancies can be attributed to higher levels of ___

Answer 21

hCG

Question 22

Implantation occurs approximately ___ days following fertilization.

Answer 22

6

Question 23

In the placental-fetal unit, which produces 17-hydroxyprogesterone?

Answer 23

Fetus

Question 24

In the placental-fetal unit, which produces estrogens?

Answer 24

Placenta

Question 25

In the placental-fetal unit, which produces progesterone?

Answer 25

Placenta

Question 26

In TTTS, the ____ twin is at risk for developmental and growth defects

Answer 26

Donor

Question 27

In TTTS, the ____ twin is at risk for fetal hydrops.

Answer 27

Recipient

Question 28

Monozygotic twins dividing during days 0-3 are __-chorionic and __-amniotic

Answer 28

di; di

Question 29

Monozygotic twins dividing during days 13+ are __-chorionic and __-amniotic

Answer 29

mono; mono; (Conjoined)

Question 30

Monozygotic twins dividing during days 4-8 are __-chorionic and __-amniotic

Answer 30

mono; di

Question 31

Monozygotic twins dividing during days 9-12 are __-chorionic and __-amniotic

Answer 31

mono; mono

Question 32

Name the 4 stages of implantation.

Answer 32

Pre-Implantation; Apposition, Adhesion, Invasion

Question 33

Name the three most common causes of polyhydramnios.

Answer 33

Congenital abnormalities; Gestational diabetes; Hydrops

Question 34

Name the three stages of placental development.

Answer 34

Pre-lacunar; Lacunar/Trabecular; Villous Stage

Question 35

Name three treatments for TTTS.

Answer 35

Reduction Amniocentesis, Microseptostomy, Laser Ablation

Question 36

On day 5, the blastocyst escapes the ______.

Answer 36

Zona pellucida

Question 37

Oocyte-derived _____ reduces sperm protamines to decondense the sperm DNA and form the pronucleus.

Answer 37

Glutathione

Question 38

Sperm binding to the zona pellucida is mediated by ____.

Answer 38

ZP3

Question 39

Sperm traverse the _____ to reach the zona pellucida

Answer 39

Cumulus oophorus/corona radiata

Question 40

Umbilical ____ carry deoxygenated blood.

Answer 40

arteries

Question 41

Umbilical ____ carry oxygenated blood.

Answer 41

veins

Question 42

What is a potential medical treatment for ectopic pregnancy?

Answer 42

Methotrexate

Question 43

What is the composition of amniotic fluid early in pregnancy?

Answer 43

ultrafiltrate of maternal plasma

Question 44

What is the composition of amniotic fluid late in pregnancy?

Answer 44

Fetal urine (some lung secretions)

Question 45

What is the implication of untreated TTTS?

Answer 45

Mortality of at least one twin

Question 46

What is the most common cause of oligohydramnios?

Answer 46

rupture of membranes

Question 47

What is the normal value for normal concentration of sperm?

Answer 47

20 million per ml

Question 48

What is the normal value for normal morphology?

Answer 48

>14%

Question 49

What is the normal value for semen volume?

Answer 49

2ml

Question 50

What is the normal value for sperm motility?

Answer 50

>50%

Question 51

What is the predominant component of the zona pellucida?

Answer 51

Protein (70%)

Question 52

What protein mediates sperm-oocyte fusion?

Answer 52

Fertilin

Question 53

Which day of gestation? 4-8 cell embryo with the zona still present

Answer 53

3

Question 54

Which day of gestation? Appearance of inncer cell mass and outer cells that will comprise the future placenta

Answer 54

5

Question 55

Which day of gestation? Blastulation begins

Answer 55

4

Question 56

Which day of gestation? Two-cell embryo with symmetry and scant vacuoles

Answer 56

2

Question 57

Which enzymes does the fetus lack?

Answer 57

3-Beta-HSD, Aromatase

Question 58

Which enzymes does the placenta lack?

Answer 58

p450c17, 17-alpha-hydroxylase

Question 59

Which hormone promotes decidualization?

Answer 59

Progesterone

Question 60

Which pathology? Abdominal pain, vaginal bleeding, abnormally rising beta-hCG

Answer 60

Ectopic Pregnancy

Question 61

Which pathology? Impedes ability of baby to pass through cervix during delivery, can cause dangerous hemorrhage for mother and newborn

Answer 61

Placenta Previa

Question 62

Which pathology? Implantation near/on the cervix

Answer 62

Placenta Previa

Question 63

Which pathology? Implantation on a scarred region of uterine wall resulting in deep implantation; associated with previous C-section

Answer 63

Placenta Accreta

Question 64

Which pathology? Invasion through the uterine wall and into the abdominal cavity

Answer 64

Placenta Percreta

Question 65

Which pathology? Most common cause of maternal mortality during the first trimester of pregnancy

Answer 65

Ectopic Pregnancy

Question 66

Which pathology? Unblanced flow through connected vessels in the placenta

Answer 66

Twin Twin Transfusion Syndrome

Question 67

Which placental hormone? Controls maternal IGF-1 levels

Answer 67

hPGH

Question 68

Which placental hormone? Increases maternal plasma glucose content to make nutrients available to the fetus

Answer 68

hPL

Question 69

Which placental hormone? Maintains corpus luteum

Answer 69

hCG

Question 70

Which placental hormone? Stimulates trophoblast differentiation into cytotrophoblasts and syncytiotrophoblasts

Answer 70

hCG

Question 71

Which stage of placental development? Appearance of chorionic villi

Answer 71

Villous

Question 72

Which stage of placental development? Cytotrophoblasts proliferate and invade adjacent maternal tissue

Answer 72

Pre-lacunar

Question 73

Which stage of placental development? Vacuoles appear in syncytiotrophoblasts that coalesce to form lacunae that contact endometrial capillaries

Answer 73

Lacunar/Trabecular

Question 74

Which steroids are produced by trophoblasts in high levels?

Answer 74

Estrogen, Progesterone

Question 75

Which TTTS treatment has a higher complication rate and involves direct visualization of communicating vessels

Answer 75

Laser Ablation

Question 76

Which TTTS treatment may increase risk of cord entanglement

Answer 76

Microseptostomy

Question 77

Which TTTS treatment may need to be repeated?

Answer 77

Reduction Amniocentesis

Question 78

Which type of twins? Thick dividing membrane with lambda sign on imaging

Answer 78

Di-Di

Question 79

Which type of twins? Thin dividing membrane with T-sign on imaging

Answer 79

Mono-Di