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Neonatal Board Questions > MFM > Flashcards

MFM Flashcards

1
Q

Infant with weak cry, hypotonia, poor oral feeding

A

Transient neonatal myasthenia gravis (10-20% infants effected) -
The presence of disease does not depend on severity of maternal disease or level of titers
Due to transplacental transfer of maternal Ach receptor antibodies
Symptoms by 72 hours with mean duration 18 days
Recovery by 2 months (90%) or 4 months (10% babies)

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2
Q

Neural tube, facial, cardiac defects, hypospadias, poor cognition

A

Valproic acid exposure in utero

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3
Q

Depressed nasal bridge, nasal hypoplasia, stippled bone epiphyses, low BW, seizures, cognitive disability

A

Warfarin exposure in utero

- If exposure happens after 12 weeks, less of an impact

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4
Q

Next step after elevated AFP

A

Fetal ultrasound

AFP least sensitive marker in quadruple screen

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5
Q

Elevated AFP, normal ultrasound

A

If gestational age confirmed and no fetal abnormality associated with elev AFP, genetic counseling is recommended and amniocentesis may be considered for karyotype

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6
Q

Side effects of intrapartum cocaine exposure

A

Stillbirth, placental abruption, skull abnormalities, cutis aplasia, porencephaly, ileal atresia, cardiac and urogenital anomalies

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7
Q

Late decelerations caused by

A

Uteroplacental insufficiency

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8
Q

Variable decelerations caused by

A

umbilical cord compression

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9
Q

Early decelerations caused by

A

Fetal head compression

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10
Q

What percent of population is single umbilical artery found in?
More common in which population?
Associated with:

A

1) <1%
2) Twins
3) Urogenital tract or cardiac anomalies

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11
Q

Nadir of deceleration at same time as peak of contraction

A

Early deceleration

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12
Q

Abrupt decrease in FHR with abrupt resolution

A

Variable deceleration

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13
Q

Onset, nadir and recovery after beginning, peak and end of contraction

A

Late deceleration

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14
Q

Pulmonary hypertension, renal insufficiency, ileal perforation, NEC

A

Indomethacin usage (prostaglandin synthase inhibitor) - used as tocolytic

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15
Q

Congenital heart defects, fetal goiter, premature birth, neonatal hypotonia, arrhythmias, seizures, diabetes insipidus

A

Lithium administration

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16
Q

Ebstein’s anomaly

A

Lithium exposure

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17
Q

Decreased respiratory rate, decreased peristalsis, hypotension, hypotonia

A

Magnesium sulfate administration (decreases Ach release from NMJ and calcium antagonist)- tocolytic

18
Q

Fetal effects of pregestational vs gestational DM

A

Pre: miscarriage, stillbirth, birth defects (especially heart and ONTD) * Highest risk when poor glycemic control BEFORE conception
Any DM: growth disorders (usually macrosomia but can be IUGR d/t small vessel dx), cardiomyopathy, birth injury, neonatal metabolic abnormalities, RDS

19
Q

Is caesarean recommended for DM?

A

Only if >4500g EFW (twice risk of having shoulder dystocia as same weight without DM)

20
Q

Is DM at risk of premature labor?

A

Yes, d/t poly (–> inc uterine distention, contractions, ROM)
(Unsure mechanism but thought d/t polyuria from inc glucose)

21
Q

Short palpebral fissures, thin vermillion border, smooth philthrum

A

Fetal alcohol syndrome

22
Q

Fetus is _calcemic to mother

A

HYPER
Most Ca transfer in 3rd trimester: Facilitative diffusion from mom to placenta and then active ATP pump from placenta to fetus.

23
Q

Calcitonin in pregnancy

A

Inhibits fetal bone resorption

Resorption process by which osteoclasts break down bone to release calcium

24
Q

Estrogen and calcium

A

Increases fetal mineral accretion

25
Q

ANS reduces:

A

IVH, NEC, mortality and RDS

NOT shown to reduce PDA or CLD

26
Q

Choroid plexus cysts are found in _% of fetuses

A

0.5%
Can be found as early as 11 weeks and usually disappear by 26 weeks
Some ass. with T18 but usually clinically insignificant

27
Q

pH of PROM

A

> /= 6.5
(pH vaginal fluid 4-4.5 and pH amniotic fluid 7-7.5)
False + with semen, blood, BV

28
Q

Diabetes medication allowed in pregnancy

A

Insulin

Metformin and Glyburide cross placenta

29
Q

When GDM test performed ?

A

24-28 weeks

1) 50g load –> >130–> take 3 hour; >200–> GDM dx
2) 3 hour test (100g load) –> tests at 1,2,3 hours (if 2 or more abnormal–> GDM)

30
Q

ITP vs gestational thrombocytopenia

A

ITP: maternal plts <70k; severe neonatal thrombocytopenia <10% babies
GT: maternal plts >70k; benign and no neonatal thrombocytopenia

31
Q

Which risk of 1st trimester abortion? Measles vs Mumps?

A

Mumps

32
Q

What is the dominant thyroid hormone during fetal life?

A

rT3 (reverse T3)

Fetus converts free T4 to rT3 by deiodinase (D3)- enzyme present in placental and fetal tissues

33
Q

Symptoms in donor twin (TTTS):

A

anemia, hypovolemia, oligo, decreased UOP, decreased growth

34
Q

Symptoms in recipient twin (TTTS):

A

polycythemia, hypervolemia, polyhydramnios, cardiac hypertrophy, hydrops

35
Q

Maternal adaptations to pregnancy:
RBF _creases, GFR _creases, tidal volume _creases, residual lung volume_creases, minute ventilation _creases, blood pressure _creases, pulse pressure _creases, pituitary gland size _creases, plasma volume _creases, RBC mass _creases

A

RBF increases, GFR increases, tidal volume increases, residual lung volume decreases, minute ventilation increases, blood pressure decreases, pulse pressure increases (diastolic decreases more than systolic), pituitary gland size increases, plasma volume increases, RBC mass increases (but PV increases more so dilution anemia)

36
Q

MCC fetal mortality associated with MVA

A

maternal shock - must ensure maternal hemodynamic stability!!

37
Q

Most common reason for non obstetric surgical intervention in pregnancy

A

Appendicitis

38
Q

Which has better safety profile? regional or general anesthesia?

A

Regional; General has 17 fold higher complication rate

39
Q

What do inhalation agents for general anesthesia do to uterine tone?

A

Decrease it thus inhibiting labor during the operative procedure

40
Q

Do anesthetics and muscle relaxants cross the placenta?

A

Anesthetics do and muscle relaxants do NOT

41
Q

IUGR, fingernail hypoplasia, craniofacial defects, NTD

A

Carbamazepine

sim to phenytoin but no CHD

42
Q

Cleft lip/palate, nail hypoplasia, IUGR, CHD

A

Phenytoin

sim to carbamazepine but no NTD

Neonatal Board Questions (12 decks)

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