Normal Pregnancy, Prenatal care, and Lab changes (Moulton)

Question 1

Starting __1__ supplementation at least 1 month before conception reduces the incidence of __2__ such as spina bifida and anencephaly.

Answer 1

1) Folic acid

2) Neural tube defects

Question 2

__1__ refers to the number of times a woman has been pregnant.

__2__ refers to the number of pregnancies led to a birth at or beyond 20 weeks or an infant weighing more then 500 grams.

Answer 2

1) Gravidity

2) Parity

Question 3

What does G1P1002 mean?

What does G4P1123 mean?

Answer 3

1) A woman who has given birth to 1 set of twins at term and both are living
2) A woman who has given birth to one term infant, one set of preterm twins, and has had 1 miscarriages and 1 ectopic pregnancy. She has 3 living children.

Question 4

____ patients receive Rhogam at 28 weeks and anytime sensitization may occur.

Answer 4

Rh negative

Question 5

What should you vaccinate against postpartum if not already immune?

Answer 5

Rubella

Question 6

With a prenatal visit, what should you screen for if the patient presents as obese?

Answer 6

Diabetes

Question 7

Gestational age is the number of weeks that have elapsed between the __1__ and __2__.

Answer 7

1) First day of the LMP

2) The date of delivery

Question 8

hCG can be first detected in serum ____ to ____ days after ovulation.

Answer 8

6 to 8

Question 9

hCG less than ____ IU/L is negative.

Level above ____ IU/L considered positive.

A level of about ____ IU/L is reached by time of expected menses.

Answer 9

1) 5
2) 25
3) 100

Question 10

In the first 30 days of a normal pregnancy hCG __1__ every 2.2 days.

This is used to evaluate for early intrauterine pregnancy vs __2__.

Answer 10

1) Doubles

2) Ectopic pregnancy

Question 11

With a transvaginal ultrasound, the __1__ is seen around 5 weeks.

__2__ is seen at 6 weeks.

__3__ is seen at 7 weeks.

Answer 11

1) Gestational sac
2) Fetal pole
3) Cardiac activity

Question 12

When estimating gestation age/due date, what is Naegele’s rule based on?

How is it calculated

Answer 12

1) Regular 28 day menstrual cycle

2) Add 7 days from LMP and subtract 3 months

Question 13

____ between 6-11 weeks can determine due date within 7 days.

Answer 13

Crown rump Length

Question 14

____ can be diagnosed if CRL > 5mm w/ absence of fetal cardiac activity.

Answer 14

Fetal demise

Question 15

Children born to women that are 35 yrs and older are at increased risk of?

Answer 15

The autosomal trisomies (13, 18 or 21)

Question 16

95% of Downs Syndrome cases are due to meiotic nondisjunction events leading to __1__ chromosomes with an extra copy of chromosome __2__.

Answer 16

1) 47

2) 21

Question 17

Most common class of spontaneous abortions are the __1__.

__2__ is the most common one.

Answer 17

1) Autosomal trisomies

2) Trisomy 16

Question 18

Most common single chromosomal abnormality found in spontaneous abortions is?

Answer 18

45XO

Question 19

With autosomal dominant disorders, the affected individual has a ____ chance of passing the gene and disorder to the offspring.

Answer 19

50%

Question 20

____ couples are at increased risk for having a child who is homozygous for recessive gene

Answer 20

Consanguineous

Question 21

Carrier screening programs focus on high-risk populations because the frequency of __1__ is greater than that of the general population.

For example, Tay-Sachs should be screened for in __2__.

Answer 21

1) Heterozygotes

2) Eastern European Jewish

Question 22

__1__ is the most common gene carried in North America whites, frequency is 1 in 25.

__2__ is important for CF screening because 15% of carriers are undetected.

Answer 22

1) Cystic Fibrosis

2) Genetic counseling

Question 23

Sex linked disorders primarily affect which sex?

Which sex are usually the unaffected carriers?

This is due to?

Answer 23

1) Males
2) Females
3) Recessive genes located on the X chromosomes

Question 24

What is the most common form of inherited mental retardation and the second most common form of mental retardation after Trisomy 21?

Answer 24

Fragile X syndrome

Question 25

Many sex linked disorders can be diagnosed prenatally by __1__ sampling or __2__.

Answer 25

1) Chorionic villus

2) Amniocentesis

Question 26

Cleft lip or palate, congenital heart defects, pyloric stenosis and neural tube defects are all examples of birth defects inherited in what fashion.

Answer 26

Multifactorially (both genetic and environmental factors)

Question 27

Why should women with an affected child for neural tube defect take 4 mg of folic acid in subsequent pregnancies before conception?

Answer 27

Since neural tube closure is complete at 28 days post conception

Question 28

First trimester screening can assess increased ____ thickness which is associated with both chromosomal and congenital anomalies.

Answer 28

Fetal nuchal translucency (echo free area at the back of the fetal neck between 10 and 14 weeks)

Question 29

With first trimester screening, elevated Beta hCG and low Pregnancy associated plasma protein-A (PAPP-A) associated with?

Answer 29

Down’s syndrome

Question 30

What is the triple screen associated with second trimester screening which occurs between 16 and 20 weeks and can detect Trisomy 21?

What is added to make it a quadruple screen and increase the detection rate of Trisomy 21?

Answer 30

1) b-hCG, estriol, and maternal serum alpha fetoprotein

2) Inhibin A

Question 31

The non invasive prenatal testing that occurs around 9-10 weeks tests cell free fetal DNA, thought to be derived apoptosis of __1__ cells that have entered the maternal circulation.

It has extremely high detection rates for __2__, __2__, and __2__.

It does not test for ____ defects.

Answer 31

1) Trophoblastic
2) Trisomy 21, 18, and 13
3) Neural tube

Question 32

Cell free fetal DNA tests should only be ordered in high risk patients, including one or more of the following:

__1__ maternal age.

History of prior pregnancy with a __2__.

Family history of __3__ abnormalities.

Fetal ultrasound abnormalities suggestive of __4__.

Answer 32

1) Advanced
2) Trisomy
3) Chromosomal
4) Aneuploidy

Question 33

When can an amniocentesis be performed?

When can chorionic villi sampling be performed?

What risk do both carry?

Answer 33

1) 16-20 weeks
2) 11 weeks
3) Miscarriage

Question 34

__1__ is defined as any agent or factor that can cause abnormalities of form or function in an exposed fetus.

For example, ____ which was used in the 50s caused phocomelia (short limbs).

Answer 34

1) Teratogen

2) Thalidomide

Question 35

The most vulnerable stage of teratogen exposure is from day __1__ to day __1__ post conception period known as __2__.

Answer 35

1) 17 to 56

2) Organogenesis

Question 36

What is the most common teratogen to which a fetus is exposed?

Answer 36

Alcohol

Question 37

____ is drug of choice for anxiety and depression during pregnancy.

Answer 37

Fluoxetine

Question 38

The antineoplastic drugs aminopterin and methotrexate have been established as teratogens because they are both ____ antagonists.

Answer 38

Folic acid

Question 39

What teratogen causes a syndrome of growth restriction, low set ear, smooth philtrum, thin upper lip, microcephaly and mental retardation?

Answer 39

Alcohol (Fetal alcohol syndrome)

Question 40

Which of the following alkylating agents, busulfan, chlorambucil, and cyclophosphamide are not teratogenic agents?

Answer 40

They all are

Question 41

What anticoagulant crosses the placenta and cause spontaneous abortion, intrauterine growth restriction, and central nervous system defects like mental retardation?

Which anticoagulant is the drug of choice because it does not cross the placenta?

Answer 41

1) Warfarin (Coumadin)

2) Heparin

Question 42

Which anticonvulsant causes a syndrome of craniofacial abnormalities, limb reduction defects, prenatal onset growth restriction, mental deficiency, and cardiovascular anomalies?

Answer 42

Diphenylhydantoin (Phenytoin)

Question 43

Which anticonvulsants have an increased risk for spina bifida?

Answer 43

1) Valproic acid

2) Carbamazepine

Question 44

Exposure to what hormone causes an increased risk for vaginal cell cancer and can cause a T shaped uterus?

Answer 44

Diethylstilbestrol (DES)

Question 45

The risk of spontaneous abortion or congenital malformations is as high as 50% in women who take what vitamin A derivative drug used for severe acne in the first trimester?

Answer 45

Isotretinoin

Question 46

What interferes with fetal growth- weight, length, and head circumference?

Answer 46

Tobacco smoking

Question 47

Exposure to what infectious agent in early pregnancy can result in proptosis, depressed nasal bridge and triangular mouth?

Answer 47

CMV

Question 48

There is a critical period between ___ and ___ weeks post conception for a lethal effect due to radiation exposure.

Answer 48

2 and 6

Question 49

Heartburn affects about 2/3 of pregnancies due to relaxation of esophageal sphincter by what hormone?

Answer 49

Progesterone

Question 50

What other GI complaints are common unpleasant symptoms of pregnancy?

Answer 50

1) Constipation

2) Hemorrhoids

Question 51

What MSK complaint is a common unpleasant symptom of pregnancy especially at night?

What MSK complaint is common especially in late pregnancy?

Answer 51

1) Leg cramps

2) Back pain

Question 52

BMI < 19 recommended weight gain is ____ lbs.

BMI 19-25 recommended weight gain is ____ lbs.

BMI > 25 recommended weight gain is ____ lbs.

Answer 52

1) 28-40
2) 25-35
3) 15-25

Question 53

The first sensation of movement is known as quickening and occurs on average at ___ weeks.

Answer 53

20

Question 54

What routine screening should be performed at 20 weeks?

Answer 54

Fetal survey ultrasound

Question 55

What routine screening/procedures should be performed at 28 weeks?

Answer 55

1) Gestational diabetes
2) Rhogam injection to Rh negative patients
3) Tdap (Tetanus, diphtheria, & acellular pertussis)

Question 56

What routine screening should be performed at 36 weeks?

Answer 56

Screening for group B strep carrier with vaginal culture

Question 57

Reactive nonstress test should reveal __1__ accelerations of at least __2__ beats above baseline lasting at least __3__ seconds during 20 minutes of monitoring.

Answer 57

1) 2
2) 15 beats
3) 15

Question 58

With the Contraction stress test, you want to give __1__ to establish at least __2__ contractions in a 10 min period. If late decelerations are noted with the majority of contractions the test is positive and __3__ is warranted

Answer 58

1) Oxytocin
2) 3
3) Delivery