OB

Question 1

Risk factors for placenta accreta

Answer 1

previous uterine surgery, AMA, multiparity, placenta previa

Question 2

Risk of placenta accreta with one previous c/s, then with five or more

Answer 2

0.3%, 6.74%

Question 3

Risk of placenta accreta w/ second c/s and placenta previa

Answer 3

11%, 3rd c/s (40%), 4th (61%), Fifth (67%)

Question 4

Second and third trimester US findings associated with placenta accreta

Answer 4

persistent placenta previa, vascular lacunae in the placenta, loss of the normal hypoechoic zone between the placenta and the myometrium, thinned retroplacental bulging or exophytic extension, and abnormalities of color doppler flow

Question 5

The US marker with the strongest association with placenta accreta disorder in a patient with previous c/s is

Answer 5

persistent placenta previa

Question 6

Factors that increase the risk of VTN characterize patient is very high risk include

Answer 6

Class three obesity, immobility, preeclampsia, fetal growth restriction, infection, and emergency cesarean birth

Question 7

Low molecular weight heparin is preferred to unfractionated heparin as first line pharmacological agent because

Answer 7

It has a longer half-life, more predictable anticoagulation effect, fewer bleeding risk, and a lower risk of heparin induced thrombocytopenia

Question 8

A false positive nontreponemal test result can be related to

Answer 8

Acute febrile illness or recent immunizations, and these abnormalities typically are transitory, lasting for less than six months

Question 9

Primary syphilis diagnosis includes findint

Answer 9

a painless macular lesion producing the classic chancre

Question 10

Secondary Syphilis

Answer 10

Is a disseminated process occurring around six weeks to six months after primary syphilis. Some patients will have generalized macular papular rash including the skin of the palms and soles of the feet as well as mucous membranes. Secondary syphilis may also be notable for generalized lymphadenopathy, fever, weight loss, and condyloma lata.

Question 11

Latent Syphilis

Answer 11

By definition is a sentiment is divide into the early Latent or late lane period. Women with Leyton syphilis can transmit the infection to the fetus to sexual partners

Question 12

Tertiary Syphilis clinical manifestations:

Answer 12

Formation of gummatous disease in cardiovascular disease, and generally manifest 5 to 20 years after the disease has become latent

Question 13

Maternal syphilis infection is associated with higher rates of adverse obstetric outcomes including:

Answer 13

Fetal growth restriction, preterm birth, stillbirth, and congenital syphilis

Question 14

Congenital syphilis symptoms include:

Answer 14

Rash, hemorrhagic rhinitis, hepatosplenomegaly, skeletal anomalies, and meningitis

Question 15

Galactogogues are medication or supplements that induced coma maintain, or augment the milk supply. These include:

Answer 15

Metoclopramide and domperidone (dopamine antagonist that increase prolactin secretion), although data are inconclusive on their effectiveness

Question 16

The best indicator of nutritional vitamin D status, hint lab test

Answer 16

25 – hydroxy vitamin D, levels listen 32 ng/mL should be treated, most common doses are 2000 to 4000 international units daily

Question 17

After exposure, conversion to HOV positivity can occur within

Answer 17

2 -4 weeks or up to six months later

Question 18

Preexposure prophylaxis in pregnancy for HIV includes a drug regimen of

Answer 18

tenofovir and emtricitabine

Question 19

Before starting preexposure prophylaxis for HIV baseline testing should include

Answer 19

Combine HIV antibody and antigen testing, serum creatinine, hepatitis B surface antigen, hepatitis
C immunoglobulin G (IgG) antibody, hepatitis A IgG (for men who have sex with men or IVDU), and genital and non-genital chlamydia and gonorrhea screening by nucleic acid amplification

Question 20

You can use crown rump length to confirm or establish EDD up to a gestational age of

Answer 20

13 6/7 (Crown rump length greater than 84 mm corresponds to 14 weeks and zero days)

Question 21

what are the positive lab criterion to diagnose APS?

Answer 21

anticardiolipin IgG/IgM (greater than 40 or greater than the 99%ile), B2-glycoprotein IgG or IgM (greater than the 99th%ile) OR positive lupus anticoagulant,,,,, with repeat testing 12 weeks later

Question 22

What are the clinical criteria to diagnose APS?

Answer 22

vascular thromboses or pregnancy morbidity, with one or more unexplained fetal deaths occurring after 10 weeks of gestation, one or more preterm births occurring before 34 weeks of gestation due to pre E or placental insufficiency or both, or three or more unexplained consecutive spontaneous pregnancy losses before 10 weeks

Question 23

Recommended delivery window for patients with previous classical/T-Shaped hysterostomies and with previous uterine rupture

Answer 23

36-37 0/7

Question 24

Delivery window for patients with history of transmural myomectomy

Answer 24

37-38 0/7, BUT can be considered earlier if extensive myomectomy

Question 25

Indications for cervical cerclage in women with singleton pregnancies

Answer 25

History: history of one or more second-trimester pregnancy losses related to painless cervical dilation and in the absence of labor or abruptio placentae OR prior cerclage due to painless cervical dilation in the second trimester Physical Exam: painless cervical dilation in the second trimester US: CL of less than 25 mm before 24 weeks gestation AND history of prior spontaneous preterm birth less than 34 weeks

Question 26

Ultrasound findings in CMV

Answer 26

abdominal calcifications, hepatospenomegaly, echogenic intrabdominal organs, ascites, cerebral ventriculomegaly, intracranial calcifications, microcephaly, hydrops fetalis, growth restriction

Question 27

Viral load testing HIV during pregnancy

Answer 27

every 2-4 weeks after initiating or changing treatment, monthly until that level is undetectable, and after that, every 3 months until delivery

Question 28

Neonatal Levels of care

Answer 28

Level 1: 35 weeks and above Level 2: 32 weeks and infants weighing more than 1,500 g Level 3: all gestations Level 4: all gestations and pediatric subspecialties (cardiopulmonary bypass)

Question 29

Treatment for bells palsy

Answer 29

Prednisone (start ASAP to increase chance of recovery) Studies have shown that Steroid + acyclovir DID NOT improve resolution and is not recommended

Question 30

Risk factors of pre eclampsia needing ASA

Answer 30

High Risk: history of pre e, multifetal gestation, cHTN, pregestational T1/T2DM, kidney disease, autoimmune disease (SLE/APLS), multiple moderate RF Moderate RF: nulliparity, obesity (BMI >30), family hx of pre e (mother or sister), black, lower income, AMA, personal history factors (low birth weight or small for gestational age, previous adverse pregnancy outcome, greater than 10 year pregnancy interval), IVF

Question 31

What is an abnormal nuchal translucency measurement?

Answer 31

3.0 mm or more or above the 99th%ile for crown-rump length Measured between 10-14 weeks

Question 32

Moderate to high risk factors for having open neural tube defect

Answer 32

previous child with ONTD, family history of ONTD, anticonvulsants (carbamazepine and valproic acid with highest risk), pregestational diabetes, pre-pregnancy obesity of BMI greater than 30 rec 4,000 mcg begging 3 months prior to pregnancy and continuing until 12 weeks of gestation regular reg: 400 mcg 1 month prior to pregnancy until 12 weeks gestation

Question 33

Dx of peripartum cardiomyopathy

Answer 33

heart failure within 1 month of delivery and up to 5 months postpartum in the absence of other causes; left ventricular dysfunciton on echocardiography with a EF of less than 45% or motion-mode fractional shortening less than 30%, or both; and left ventricular end diastolic dimension of greater than 2.7 cm/m^2

Question 34

Risk factors for VTE

Answer 34

previous clot; presence of thrombophilia; pelvic surgery (c/s); complications during delivery, such as infection or hemorrhage; and comorbidities, such as morbid obesity, sickle cell disease, autoimmune diseases, and preeclampsia

Question 35

Transfuse platelets during HELLP when..

Answer 35

Plts 50,000 or less and c/s is indicated or if DIC is suspected transfuse platelets to avoid spontaneous bleeding when counts are 15,000-30,000 1unit of Plts will increase plt 30,000

Question 36

Indications to start antiviral therapy in pregnant patients with chronic Hep B

Answer 36

elevated ALT greater than twice the upper limit of normal and HBV DNA greater than 200,000 IU/mL in the presence of positive HBsAg Also a patient in the second or third trimester with a viral load of 2 x 10^5 IU/mL or over 10^6 copies/mL, even in the setting of normal ALT levels Start on Tenofovir Disoproxil fumarate

Question 37

Dx asthma:

Answer 37

Reversible airway obstruction, more than a 12% increase in FEV1 after therapy with broncodilator

Question 38

Poor controlled asthma can increase these pregnancy conditions:

Answer 38

preterm birth, FGR, preE, C/S, and maternal morbidity and mortality

Question 39

Describe candida infection of the nipple during breastfeeding:

Answer 39

erythema and scaly, shiny changes to the skin. Pain and burning with nipple manipulation Tx: topical miconazole and treat infant with nystatin suspension of miconazole gel, if symptoms do ont resolve in 7 days then give oral fluconazole

Question 40

Most common pathogens in mastitis

Answer 40

staphylococcus aureus (MC in breast abcesses), staph epidermidis, streptococcal species, and occasionally gram-neg rods.

Question 41

Tx for mastitis (with alternatives)

Answer 41

Dicloxacillin Alternatives: cephalexin or clindamycin continue for 10-14 days

Question 42

A standard 300-microgram vial of Rh immune globulin will provide adequate prophylaxis for a feto-maternal hemorrhage of

Answer 42

30 mL or less of fetal whole blood

Question 43

A critical titer that increases the risk of severe erythroblastosis fetalis and hydrops is

Answer 43

1:8 to 1:32, depending on individual institutional experience start MCA dopplers at 24 weeks with women with critical titer levels Women who have had a previous pregnancy complicated by alloimmunization start dopplers at 18 weeks Conduct them at 1 or 2 week intervals

Question 44

A peak systolic velocity greater than ** multiples of the mean for gestational age predicts moderate to severe fetal anemia with 100% sensitivity

Answer 44

1.5 After 1.5 you should start percutaneous umbilical blood sampling for direct hematocrit assessment and intravascular, intrauterine fetal transfusion as indicated

Question 45

In alloimmunized patients with mild disease or no evidence of hemolytic disease, delivery should be

Answer 45

delayed until term (37-38+6)

Question 46

A common cause of early pregnancy loss is chromosomal abnormality (60% of the time). MC chromosome abnormality...

Answer 46

autosomal trisomies, MC being trisomy 16

Question 47

Define recurrent pregnancy loss

Answer 47

the loss of two or more clinical pregnancies after US evidence of a gestational sac or histopathology

Question 48

Universally screen gDM (gestational age)

Answer 48

24-28 weeks

Question 49

Early pregnancy screening for gDM is indicated in:

Answer 49

BMI > 25 (23 in asian americans) AND with: - first degree relative with diabetes - prior newborn weighing more than 4,000 g - prior diagnosis of gDM - HTN - High cholesterol (HDL < 35, triglyceride level greater than 250) - A1c of 5.7-6.4% - PCOS - Physical inactivity - History of cardiovascular disease

Question 50

Percentage of expulsion of IUD placed immediate PP vs. interval placement

Answer 50

10-27% vs 2-10% in the first year

Question 51

How long does a person need to be on PEP after HIV exposure?

Answer 51

4 weeks w/ at least 3 antiviral agents if the person is pregnant avoid efavirenz in the first trimester for possible increased risk of NTD

Question 52

CVS and amniocentesis performed when? and complication rates...

Answer 52

CVS: 10-14 weeks gestation, complication rate 1% Amnio: no earlier than 15 weeks, less than 0.1%

Question 53

Tell me about the Quad screen

Answer 53

Done between 16-21 weeks Tests bhCG, alpha fetoprotein, dimeric inhibin A, and unconjugated estriol, in combo with maternal factors such as maternal age, weight, presence of pregestational diabetes to calculate risk estimate

Question 54

The five A's

Answer 54

Asking about tobacco or nicotine use Advising the patient ot stop using tobacco or nicotine Assessing the patients willingness to stop Assisting the patient with quitting with specific techniques Arranging follow up

Question 55

Smoking cessation in pregnancy therapies

Answer 55

cognitive behavioral techniques Bupropion: norepi-dopamine reuptake inhibitor and nicotinic agonist Varenicline: partial agonist for nicotine receptors Nicotine replacement therapy: "USPSTF concluded that there is insufficient evidence ot assess the benefits and harms of nicotine replacement in pregnancy." AKA shared decision making

Question 56

Echogenic Bowel is associated with:

Answer 56

]9% intra-amniotic bleeding 5% trisomy 21 2% cystic fibrosis 2% fetal CMV infection approx 13% develop FGR

Question 57

Side effects of Antihypertensive agents used for spot treatment

Answer 57

Labetalol: tachycarida - avoid with asthma, preexisting myocardial disease, decompensated cardiac function, and heart block and bradycardia Hydralazine: maternal hypotension, headaches, abnormal fetal heart rate tracings (w/ higher or more frequent dosage) Nifedipine: reflex tachycardia and headaches

Question 58

Posterior reversible encephalopathy syndrome image findings:

Answer 58

vasogenic edema, often in the parietal-occipital regions of the brain likely secondary to failure of the normal autoregulation in cerebral blood flow

Question 59

Complications during pregnancy after previous bariatric surgeries

Answer 59

anastomic leaks, bowel obstructions, internal hernias, ventral hernias, band erosion, and band migration Internal hernia causing SBO is the most common postbariatric surgery complication occurring during pregnancy and is more common after laparoscopic than open procedures

Question 60

Complications of fetal anomalies, growth restriction, or miscarriage have not been reported with radiation exposure less than

Answer 60

50 millligray (mGy)