Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MFM Written Boards > Practice Questions - Large Doc (1-124) > Flashcards

Practice Questions - Large Doc (1-124) Flashcards

1
Q

Which of the following will allow you to differentiate maternal blood from fetal blood?

A

MCV
- Higher in fetal blood (fetal RBCs larger), depends on GA (145 at 16wks, 113 at 36wks)

Hemoglobin more unstable
- KB test - maternal hgb is unstable at low pH (cell membrane denatured), while HgbF has acid resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Fetal breathing is increased most by:

A

Maternal hypercarbia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which causes fetal CNS, renal, liver, thymus, and bone effects?

A

Vitamin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What drug is best to increase BP after induction of anesthesia for CD?

A

Ephedrine

Phenylephrine - superior in treating hypotension, increases umbilical pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you blunt the hypertensive effect following intubation or extubation?

A

Propranolol

  • Reflex sympathetic press or response to laryngoscope - increased HR and BP
  • Precedex blunts tachycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What drug causes worst ovarian dysfunction?

A

Cyclophosphamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hepatitis: WHich is associated w/ most infectivity?

A

HbEAg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most predictive of fetal/neonatal Graves disease?

A

Thyroid stimulating immunoglobulin

*should check TSH receptor antibody levels in 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which is not elevated in the fetus?
- Cholesterol
- Aldosterone
- Alpha globulin
- Beta globulin
- Gamma globulin

A

Cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which is true about amniotic fluid prolactin?

A

All of the above:
- Made in decidua
- Modulates osmotic volume in amniotic fluid
- Levels are increased in amniotic fluid
- Unresponsive to bromocriptine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Timing of division for placentation in twinning

A

Di-di (1-3 days)
Mono-di (4-8 days)
Mono-mono (9-12 days)
Conjoined (>13 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Type of placentation in:

TTTS
Acardiac twin (TRAP)
Twins at risk for cord entanglement

A

TTTS/TRAP - mono-di
Cord entanglement - mono-mono

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens to each in pregnancy?

Tidal volume
Expiratory reserve capacity
FRC
Residual volume
Respiratory rate

A

TV - increased
ERC - decreased
FRC - decreased
RV - decreased
RR - unchanged

FRC = ERC + RV (all decreased)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Type of test for - dichotomous drug effects w/ disease

A

Chi square

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Type of test/study for - % pregnant ladies who smoke

A

Cross-sectional study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Type of test/study for - ETOH use and breast cancer

A

Case-control study
Correlation coefficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Type of test/study for - single dose vs multiple dose drugs for UTI

A

Prospective cohort
Clinical trial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define RR (relative risk)

A

Incidence of outcome in exposed group compared to incidence of outcome in the unexposed group
RR <1 = incidence less in exposed group
Precision often expressed as 95% CI
- Should not cross 1 if significant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which cannot be diagnosed on 4CH view?
- VSD
- Transposition
- HRHS
- TOF

A

Transposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In the presence of thick meconium, which test is valid?
- L/S
- Phosphatidylglycerol (PG)
- Foam stability index (FSI)
- Microvesicometer
- Delta OD650

A

PG
- For amnio for FLM
- Valid w/ blood or mec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is not associated with accelerated fetal lung maturity?

A

Insulin

Those that ARE:
- TRH
- Steroids
- Interleukin-1
- Epidermal growth factor
= stimulate synthesis of surfactant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most common substance in surfactant?

A

Phosphatidylcholine

Major fatty acid component = palmitic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How to deliver a fetus w/ alobar holoprosencephaly and macrocrania?

A

SVD w/ cephalocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Sequence

A

Single developmental defect that causes chain of secondary defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Syndrome

A

Groups of anomalies w/ multiple malformations or sequences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Malformation

A

Intrinsic error of morphogenesis, genetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Deformation

A

Extrinsic disturbance in morphogenesis (develops in abnormal environment), secondary destruction of organ/body part (e.g. club foot)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Disruption

A

Genetically normal fetus suffers insult (e.g. amniotic band)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Association

A

Anomalies occur frequently together but no etiological link

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is not associated w/ parvovirus B19?

A

Hemolytic anemia

IS associated:
- Increased AFP
- Aplastic anemia
- Myocarditis
- Hydrops
- IUFD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Risk of fetal death in pregnant women exposed to child w/ parvo

A

<1%

~50% of women susceptible
Risk of loss higher <20wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Best anesthesia for severe asthmatic?

A

Continuous epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which clinical scenario best matches these Swan-Ganz #s?

  • RA elevated
  • PA elevated
  • PCWP normal
  • CO normal
A

PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Swan Ganz #s in normal pregnancy

A

CO increased
SVR decreased
PVR decreased
Colloid oncotic pressure decreased
PCWP slightly increased
LVSW slightly increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Swan Ganz #s in preeclampsia

A

SVR increased
LVSWI increased (measure of overall LV function)
PCWP decreased (intravascular volume depletion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Swan Ganz #s in pulmonary edema

A

Colloid oncotic pressure to PCWP gradient <4
Elevated PCWP
>18 early
20-25 more overt
>25 more severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Swan Ganz #s in shock

A

Decreased SVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Swan Ganz #s in PHTN

A

High PA pressures, high PVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Swan Ganz #s in PE

A

High PA pressure, CO can be low, inability to wedge w/ PHTN, elevated CVP >10 if large PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which enzyme is necessary for estrogen synthesis?

A

Sulfatase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the immediate precursor of progesterone?

A

Pregnenolone

Converted by placenta (fetus doesn’t have 3betaOHsteroid dehydrogenase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Husband’s sister died at age 16 of CF. Wife phenotypically normal. Calculate risk to baby

A

Carrier risk of mom = 1/25
Carrier risk of dad = 2/3
- Both parents carriers, he is not affected

1/25 x 1/2 x 2/3 x 1/2 = 1/150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Residual risk of CF if deltaF508 neg

A

30%

  • dF508 accounts for 70% of CF mutations
  • Risk of being a carrier w/ neg dF508 testing = 1/25 (baseline carrier risk) x 3/10 (residual risk)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Fetal effect of cocaine

A

Elevated BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Fetal effect of heroin

A

Acute fetal distress and withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Fetal effect of methadone

A

Withdrawal 2-4wks after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which drug for HA is contraindicated in pregnancy?
- Ergotamine
- Propranolol
- Midrin
- Amitriptylene

A

Ergotamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Patient gets SOB after 1 flight of stairs. What NYHA class?

A

II

I - no sx
II - mild
III - symptoms interfere greatly w/ activity, no sx at rest
IV - sx at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Which US finding is not found at 16wks in a fetus w/ spina bifida?
- Concave frontal bones
- Loss of cisterna magna
- Ventriculomegaly
- Increased BPD
- Anterior deviation of cerebellum

A

Increased BPD (often decreased)

Lemon and banana signs less reliable after 24wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the most common finding in Hgb SC in pregnancy?

A

Fat embolism

The etiology of
fat embolism in patients with sickling disorders is
thought to be necrosis of bone marrow secondary to
ischemia with subsequent showering of the necrotic
marrow materials, mainly fat, to the systemic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is seen most often in renal transplant in pregnancy?

A

Preterm delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Renal patients are at increased risk for which of the following?

A

CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Lyme disease

A

Target lesion >50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Toxic shock syndrome

A

Desquamation of hands/soles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

GBS

A

Treat w/ ampicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Management of patient who had GBS

A

Amp intrapartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Abx for chlamydia

A

Erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Abx for toxo

A

Pyrimethamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Abx for gonorrhea

A

Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Abx for listeria

A

Ampicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Abx for mycoplasma

A

Erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Recurrence risk for Down Syndrome

A

1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Which drug interferes w/ OCPs?
- Rifampin
- Doxycycline
- Bromocriptine

A

Rifampin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Which has the highest incidence of cardiac abnormalities?
- T21
- T18
- 45 XO
- 47 XXY
- 47 XYY

A

T18 (80%)

T21 and 45 XO - 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What affects prognosis for omphalocele?

A

Presence of associated anomalies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is associated w/ increased paternal age?
- Achondroplasia
- Meckel-Gruber
- Beckwith-Wiedemann

A

Achondroplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Mechanism of action of labetalol

A

Alpha and beta blockade
- Does not decrease afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Colloid osmotic pressure
- Decreases w/ ritodrine
- Decreases after delivery
- Decreases w/ preeclampsia

A

All of the above

Delivery - blood loss, lots of IV fluids during labor
PEC - leaky capillaries (endothelial damage), fluid goes out

Risk of pulmonary edema w/ decreased COP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Which amino acids are glucogenic?

A

Valine
Serine
Glutamate
Glutamine
Alanine
**Everything but lysine and leucine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Which amino acids are ketogenic only?

A

Lysine
Leucine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Which amino acids are glutogenic and ketogenic?

A

Phenylalanine
Isoleucine
Tryptophan
Tyrosine
Threonine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Management of Guillain-Barre at 34wks w/ progressively worsening disease x 1wk, inspiratory capacity decreased from 3.5L to 2L

A

Plasmapheresis
- NOT delivery
- Removes circulating antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Which is least associated w/ fetal growth?
- Glucose
- Insulin
- Growth hormone
- Phenylalanine

A

Growth hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What has lower concentration in acute fatty liver of pregnancy?

A

Glucose
Platelets
ATIII
Fibrinogen

Increases:
- LFTs
- Ammonia
- Uric acid
- Creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Benefit of treating severe maternal HTN in early pregnancy?

A

Decreased maternal mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Mechanism of platelet destruction in preeclampsia?

A

Arteriole intimal damage?
Platelet activation and consumption, endothelial damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Most frequent life-threatening infection associated w/ HIV in pregnancy

A

PCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Which blood product is associated w/ 10-20% chance of transmission of hepatitis B

A

Factor VIII
Factor IX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the best way to diagnose vWD?

A

Ristocetin
- Measures vWF functional activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What condition will most likely lead to isoimmunization?
- Mom DU +/fetus
- Mom Du +/fetus
- Mom RhO- / fetus RhA+
- Mom RhO- / fetus O+
- Mom RhO- / fetus Du+

A

Mom O- / fetus O+
- ABO incompatibility more rapidly cleared (lower risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Need central monitoring for all of the following except:
- DIC
- Septic shock
- Respiratory insufficiency
- Oliguria
- Pulmonary edema

A

DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Using central monitoring, one can measure all of the following except:
- Cardiac output
- RV stroke volume
- PA pressure

A

RV stroke volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Type of study:
- Study to determine the effectiveness of a single dose of abx vs standard regimen for UTI

A

RCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Type of study:
- Relationship of EtOH consumption and breast cancer

A

Case control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Type of study:
- Study to determine prevalence of smoking in pregnancy

A

Cross sectional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Most frequent location of IVH

A

Germinal matrix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What percentage of Rh negative women become Rh sensitized by their first delivery?

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Most common cause of macrosomia?

A

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Which fetal arrhythmia is most common?
- SVT
- PACs
- PVCs
- Complete heart block

A

PACs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is true of SVT?

A

If it persists >12h, it could lead to hydrops
- Usually NOT associated w/ structural abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Best treatment for patient who recently converted to positive syphilis serology during pregnancy and is allergic to PCN

A

PCN after desensitization (should do skin test w/ IgE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Hyperparathyroidism in mother can cause all of the following in the fetus except:

A

Hypercalcemia
- Maternal hypercalcemia/PTH suppress fetal parathyroid causing hypocalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Diabetic at 35wks, NST is reactive but has 1 variable decel down to 100 for 30s. Cause/management?

A

Due to nuchal cord
- Do not need to deliver immediately, not a/w fetal acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Most drugs cross the placenta by:

A

Simple diffusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Most likely reason for decreased Apgar in AGA premie delivered vaginally?

A

Prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What crosses the placenta by active transport?

A

Amino acids, iodide, vitamin C, calcium, FA, B12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What crosses the placenta by facilitated diffusion?

A

Glucose, vitamin K, lactate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What crosses the placenta by simple diffusion?

A

Gases, FFAs, urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What crosses the placenta by pinocytosis?

A

IgG, insulin, LDL, transferrin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Urine electrolytes in a woman who is oliguric from preeclampsia w/ prerenal causes

A

Osmolality 550 (high, >450)
Sodium low
FENA <1%
BUN/Cr >20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Leading cause of maternal mortality

A

Hemorrhage (worldwide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Higher concentration of anesthetics which are basic in an acidotic fetus is based on the principle of…

A

Ion trapping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Which drug has the shortest half-life in the fetus?
- Marcaine
- Chloroprocaine
- Pontocaine
- Mepivicaine

A

Chloroprocaine - 43 sec

Marcaine/mepivicaine 8-9hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Phenotype of: 45 XX -14, -21, t(14,21)

A

Phenotypically normal female
- Balanced translocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Phenotype of: 46 XX -14, t(14,21)

A

Female w/ features of Down Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Phenotype of: 45 XX -13, -14, t(13,14)

A

Phenotypically normal female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Phenotype of: 46 XX, inv9(p11,q11)

A

Phenotypically normal female
- Pericentric inversion of chromosome 9

108
Q

Which test is most predictive of fetal outcome?
- Anti-microsomal antibodies
- Anti-thyroglobulin antibodies
- Amniotic fluid thyroxine
- LATS antibodies
- TSH

A

LATS antibodies (same as thyroid stimulating immunoglobulin)
- Long acting thyroid stimulator

109
Q

Which of the following does not adversely affect fetal outcome?
- Multiple sclerosis
- Myasthenia gravis
- Graves
- Myotonic dystrophy

A

MS

110
Q

Ligating the anterior branch of the hypogastric artery includes all of the following vessels except:
- Superior gluteal
- Inferior gluteal
- Superior vesical
- Inferior hemorrhoidal

A

Superior gluteal

Branches of posterior division = I Love Sex
- Iliolumbar
- Lateral sacral
- Superior gluteal

Anterior division:
- Uterine
- Vaginal
- Superior, middle, and inferior vesical
- Inferior gluteal
- Obturator
- Internal pudendal
- Inferior hemorrhoidal/inferior rectal
- Middle hemorrhoidal

111
Q

Bilateral polycystic kidney disease is associated with:
- Autosomal dominant
- Chromosomal abnormalities
- Autosomal recessive

A

All of the above

112
Q

Rh+ woman has anti-Kell titer of 1:512 as a result of transfusion. Next step is:

A

Test husband for Kell antigen

113
Q

A woman has a positive indirect Coombs. Next step is:

A

Antigen identification

  • Indirect Coombs tests for antibodies in blood
114
Q

Which procoagulant is decreased in pregnancy?
- VII
- VIII
- IX
- X
- XI

A

XI

Increased: fibrinogen, prothrombin, factor V, VIII, IX, X

115
Q

Protein S activity in pregnancy

A

Decreased

116
Q

In a hemochorial placenta, the layers between maternal and fetal blood include all of the following except:
- Fetal capillary
- Trophoblast
- Maternal capillary
- Connective tissue

A

Maternal capillary

Maternal blood, syncytiotrophoblast, cytotrophoblast, fetal connective tissue, fetal capillary, fetal blood

117
Q

What drug should you avoid in myasthenia?
- Lidocaine
- Chloroprocaine
- Gentamicin

A

Chloroprocaine and gentamicin

118
Q

Which of the following is most useful in differentiating HELLP from TTP?
- Thrombocytopenia
- Microangiopathic hemolysis
- Elevated LDH
- Elevated vWF multimer
- CNS involvement

A

Elevated vWF multimer - ADAMTS13 that cleaves von Willebrand factor is deficient in TTP

119
Q

Initial treatment of a stable patient with sustained V tach includes
- DC cardioversion
- Lidocaine
- Procainamide
- Oxygen
- Epinephrine

A

Oxygen

120
Q

The drug of choice for the treatment of malignant hyperthermia is

A

Dantrolene

121
Q

Pulmonary artery wedge pressure provides a clinical measurement of:

A

LV preload

122
Q

Primary HSV in pregnancy risks:

A

40% of infants infected
- 50% die
- 35-40% suffer neurologic morbidity

123
Q

Recurrent HSV in pregnancy transmission rate

A

5%
If asymptomatic, risk is 1/1000

124
Q

Delivery mode for AVM

A

If successfully obliterated or ruptured before last trimester, can deliver by SVD

If ruptured w/in 2 months or incompletely obliterated, CD advisable around 38wks

125
Q

Delivery mode for pseudotumor cerebri

A

SVD

126
Q

Delivery mode for cerebral artery thrombosis

A

SVD

127
Q

Delivery mode for cerebral vein thrombosis

A

Operative VD if earlier, otherwise CD may be needed

128
Q

In GDM, what is the likelihood of developing DM postpartum

A

50% within 20yrs of delivery
If fasting hyperglycemia, more likely to persist - when fasting exceeds 130, likelihood is 86%

Answer = 70%

129
Q

Autonomic dysreflexia - location and symptoms

A

Transection above T6
Symptoms - throbbing HA, HTN, reflex bradycardia, sweating, congestion, cutaneous vasodilation, piloerection above level of lesion
Due to sudden release of catecholamines

130
Q

Autonomic dysreflexia - treatment

A

Reserpine - depletes catecholamines (can cause dangerous neonatal nasal congestion
Can also treat w/ atropine, clonidine, glyceryl trinitrate or hexamethonium

Prevent w/ spinal or epidural extending to T10

131
Q

Most common symptom in TTP

A

Neurologic - HA, AMS, seizure, stroke

132
Q

Mechanism of AZT

A

Nucleoside RT inhibitor
- Main side effect - bone marrow suppression

133
Q

Nevirapine mechanism of action

A

NNRTI (non-nucleoside reverse transcriptase inhibitor)

134
Q

Types of HIV meds

A

NNRTI (nevirapine)
NRTI (zidovudine [AZT], lamivudine)
Protease inhibitors

135
Q

Major antiseizure med that is renally excreted

A

Primidone (mysoline)
- Phenobarbitol is a metabolite

136
Q

Antiseizure meds to avoid in pregnancy

A

Phenytoin
Phenobarbitol
Topiramate
Carbamazepine
Valproate

137
Q

Changes in or preceding preeclampsia

A

Cellular fibronectin - increased
Urinary calcium excretion - decreased
Ratio of prostacyclin to thromboxane - decreased (decrease in prosta, no change to throm)
Angiotensin II sensitivity - increased

138
Q

Only blood product source of factors V, XI, and XII

A

FFP

139
Q

Cryoprecipitate components

A

Mostly - fibrinogen
Also - factor VIII, XIII, and vWF

140
Q

Risks of blood transfusion

A

HIV - 1/700k
Hep B - 1/140k
Hep C - 1/90k
Hemolytic rxn - 1/600k

PRBCs, FFP, cryo, plts same risk of transmission as unit of whole blood

141
Q

Teratogenic effects of vitamin A

A

Severe ear defects, CV, CNS, thymus
Doses >10k IU/day

142
Q

Which has lower fasting state during pregnancy?
- Glucose
- Cholesterol
- Cortisol

A

Glucose

143
Q

Maternal response to feeding

A

Hyperglycemia
Hyperinsulinemia
Hyperlipidemia
Reduced sensitivity to insulin

144
Q

Purpose of parenteral vitamin K to neonates?

A

Prevent hemorrhage
- Those born to moms on seizure meds at higher risk
- Oral vitamin K not as effective

145
Q

Rate limiting step of prostaglandin synthesis?

A

Arachidonic acid (AA) - obligate precursor to prostaglandins
- Membrane phospholipids (phosphatidyl ethanoloamine or inositol) release AA via phospholipase C or phospholipase A2

146
Q

What is required for estrogen synthesis in the placenta?

A

DHEAS (derived from fetal adrenals)
- Acetate, cholesterol, and progesterone can’t be used as precursor bc CYP17 not expressed by placenta

147
Q

Requirements for blood in fetal transfusion (if infant Rh+)

A

O neg leukocyte reduced PRBCs
- Desired hematocrit 75-85%
- Transfusion rate 5-10ml/min
If intraperitoneal, volume is (GA weeks minus 20) x 10
If intravenous, volume based on formula (uses starting fetal hct and donor hct)

148
Q

Benefits of transabdominal vs transcervical CVS

A

Decreased VB
Decreased infection
Easier to train
NOT larger sample size (this is larger w/ transcervical)

149
Q

S/sx of maternal hypercalcemia

A

N/V, weakness, AMS, dehydration, possibly HTN

Persistent Ca >9.5 - concerning for PTH

Can result in neonatal hypocalcemia - manifests 2-14 days of life

150
Q

Components of active management of labor

A

Strict criteria for admission (regular painful ctx w/ complete effacement, bloody show, or ROM)
Early amniotomy
q1h cervix checks
Early IUPC
High dose oxytocin

151
Q

Which valvular lesion has the worst prognosis with respect to volume overload?

A

Mitral stenosis
- Increased venous return leads to pulmonary edema
Labor increases venous return and pulm congestion
- CO limited by passive flow through valve during diastole
- Worsens w/ tachycardia (reduced LV filling)
- Beta blocker helpful

152
Q

Mitral stenosis - effects of volume overload

A

Volume overload = bad prognosis
- Increased venous return leads to pulmonary edema
Labor increases venous return and pulm congestion
- CO limited by passive flow through valve during diastole
- Worsens w/ tachycardia (reduced LV filling)
- Beta blocker helpful

153
Q

Aortic stenosis - effects of volume overload

A

Volume overload causes excess LV overload - increased cardiac O2 requirement due to LVH
- Increased diastolic ventricular pressure impairs diastolic coronary perfusion
- LV needs adequate filling to generate sufficient pressure for flow across valve - small loss of filling = large fall in CO
- Very sensitive to loss of preload from bleeding or epidural
Pulmonary edema due to excess preload is far better than hypotension from hypovolemia

154
Q

Hypertrophic cardiomyopathy - effects of volume overload

A

Obstruction of space between ventricular septum and anterior leaflet of MV (LVOT)
- Worsened w/ increased inotropes, decreased heart size, and diminished vascular resistance
- Normal fall in PVR w/ pregnancy increases outflow tract obstruction (compensated w/ increased blood volume)
- Caval obstruction and EBL can cause hypotension
- Catecholamines in labor can also worsen

155
Q

Aldosterone in pregnancy

A

Increased
Renin and angiotensin II also increased
Decreased sensitivity to RAAS
Prostacyclin and thromboxane increase in normal pregnancy

156
Q

Human placental lactogen - other name

A

Human chorionic somatomammotropin (HCS)

157
Q

Half-life of HPL

A

10-30 minutes

158
Q

Most common fetal response to chorioamnionitis?

A

Tachycardia/decreased variability

159
Q

When is the inciting event for PVL (periventricular leukomalacia)?

A

Antepartum

160
Q

Fetal thyroid function

A

Starts at 10 weeks
- By week 12, TRH, TSH, and T4 present
TSH rapidly increases 20-24wks, then decreases
T4 metabolism low before 30wks

Minimal transfer of maternal thyroid hormones after 1st trimester

161
Q

GBS testing - gold standard

A

Bacteriologic culture
- Todd-Hewitt broth or selective blood agar medium

162
Q

Hormones for lactation

A

Prolactin - major for production (induces synthesis of mRNA for production of enzymes and milk proteins)
Cortisol, insulin, PTH, GH - carb/lipid production in milk
Oxytocin - milk letdown

Ovarian hormones not needed, suppressed by prolactin

163
Q

What is the sensitivity of triple screen for T21?

What is the most likely result?

A

60%

High hCG, low AFP/estriol

164
Q

Type I error

A

Alpha error - concluding that treatment differs when they don’t

165
Q

Type II error

A

Beta error - concluding there is no effect when there is one

166
Q

Power

A

1 minus beta

167
Q

Which is not associated w/ advanced paternal age?
- Achondroplasia
- Osteogenesis imperfecta
- Beckwith Wiedemann

A

Beckwith Wiedemann

APA a/w achondroplasia, thanatophoric dysplasia, OI (de novo mutations)

168
Q

Closure of neural tube complete by:

A

5-7 weeks gestational age

28 days after conception

169
Q

Normal outcome most likely with:
- AV canal defect
- TGA

A

TGA

170
Q

Arachnoid cysts are most commonly located in:
- Posterior fossa
- Interhemispheric area
- Sylvian fissure
- Supratentorial

A

Supratentorial (middle cranial fissure)

171
Q

Which first trimester marker is worse for preeclampsia?
- PAPP-A >95%
- PAPP-A <5%

A

<5%

172
Q

Patient treated with anti-neoplastic Rx. What do you have at delivery?

A

Thrombocytopenia

173
Q

Prognosis for lupus during pregnancy depends on:

A

Lupus activity during 6 months preconception

174
Q

SLE nephritis most likely to cause:
- IUFD
- Preeclampsia

A

Preeclampsia

175
Q

What is not associated with fragile X?
- Ataxia
- Gonadal cancer

A

Gonadal cancer

176
Q

Pain during 2nd stage of labor carried through:

A

Sensory fibers of S2-S4
(Pudendal nerve)

1st stage - visceral afferent (sympathetic) nerves T10-12

177
Q

What inhibits cyclooxygenase?

A

ASA
- Inhibits COX-1 (more so) and COX-2

178
Q

UPD most likely with chromosome:

A

15
- Angelmann - mother’s lost (only paternal)
- Prader-Willi - father’s lost (only maternal)

179
Q

Which is not metabolized in the liver?
- Antiepileptic drugs
- LMWH
- Warfarin

A

LMWH

180
Q

Weight gain in pregnancy throughout gestation most likely due to contribution of:
- Fetus
- Placenta
- AFI
- Decreased sensitivity to angiotensin system
- Fat

A

Fat

181
Q

RAAS system in pregnancy

A

Aldosterone, renin, and angiotensin increase (increased activity of RAAS system) - causes increase in plasma volume
Vasoconstrictor sensitivity to circulating angiotensin II is decreased in normal pregnancy = normal reduction in systemic vascular resistance

182
Q

Anemia in pregnancy most likely due to:

A

Maternal red blood cell mass
- Doesn’t increase as much as volume expansion

183
Q

Different expression based on allele transmission from either mother or father?

A

Imprinting

184
Q

All are appropriate in management of mother with PKU except:
- Paternal testing for PKU
- Fetal echo
- Amniotic fluid analysis for PAH
- Dietary restriction for mother

A

Amniotic fluid analysis for PAH

PKU - autosomal recessive, mutation in PAH gene

185
Q

Which is least important for sample size calculation?
- Incidence of outcome after intervention
- Alpha error
- Beta error
- Desired p value

A

Desired p value

186
Q

Falsely concluding that treatment works:
- Type 1 error
- Type 2 error

A

Type 1 error

187
Q

Autonomic dysreflexia is associated w/ all of the following except:
- Bradycardia
- Flushing
- Hypotension
- Sweating

A

Hypotension

188
Q

Which is seen in pregnancy?

A

Beta cell hyperplasia in pancreas

189
Q

All of the following prostaglandins cause uterine contractions except
- PGE1
- PGE2
- PGE3
- PGF2

A

PGE 3

E and F series prostaglandins important in labor

190
Q

In the first trimester, what happens to TSH and free T4?

A

TSH decreases
fT4 normal

191
Q

SSRI associated w/ CHD

A

Paroxetine

192
Q

Erb’s palsy is due to lesion in:

A

C5-C6

193
Q

Most appropriate treatment of NAIT

A

IVIG

194
Q

Which has the greatest effect on sodium metabolism?
- Hydrocortisone
- Prednisone
- Methylprednisolone
- Fludrocortisone

A

Fludrocortisone

195
Q

Which least likely to have effect on fetal kidney?
- Aminoglycosides
- Sulfa
- NSAIDs
- ACEi

A

Sulfa

196
Q

Risk of NTD due to antiepileptic drugs?

A

1%

197
Q

Advanced paternal age is associated with all of the following except:
- 47, XYY
- Achondroplasia
- Marfan’s
- Female carrier of hemophilia A
- Neurofibromatosis

A

47, XYY

198
Q

Subgaleal hematoma is a collection between:

A

Periosteum and epicranial aponeurosis

199
Q

Most likely course of MS

A

Variable

200
Q

Lupus anticoagulant affects all except:
- DRVTT
- aPTT
- Platelet neutralization
- Kaolin
- ANA

A

ANA

201
Q

Treatment for type 1 vWD?

A

Desmopressin

202
Q

Most common complication of fetal blood sampling:
- Fetomaternal hemorrhage
- Fetal bradycardia
- Fetal death
- Blood streaming

A

Blood streaming

203
Q

Which most rapidly crosses placenta?
- TSH
- TRH
- T4
- T3

A

TRH

204
Q

Woman here for preconception counseling. Advise against pregnancy if:
- Right to left shunt
- Significant aortic stenosis
- Mitral stenosis

A

R to L shunt

205
Q

Seizures are reduced by:
- Hypothermia
- Hyperglycemia

A

Hypothermia

206
Q

Definition of neonatal encephalopathy includes all except:
- pH <7.0
- BE <-12
- Spastic CP
- Seizures

A

Spastic CP

207
Q

Most common neonatal finding in CMV?

A

Deafness

208
Q

Most likely finding in recurrent CMV (serology)

A

IgM pos, IgG pos, high avidity

Low avidity = recent infection

209
Q

Folic acid antagonists cause:
- Limb reduction defects
- CHD
- Caudal regression

A

CHD

Folic acid antagonists, which include such common drugs as trimethoprim, triamterene, carbamazepine, phenytoin, phenobarbital, and primidone, may increase the risk not only of neural-tube defects, but also of cardiovascular defects, oral clefts, and urinary tract defects.

210
Q

Infection associated w/ limb defects?
- CMV
- Parvo
- Varicella
- HSV

A

Varicella

211
Q

Mode of delivery with myasthenia?

A

Assisted vaginal delivery

212
Q

Most likely normal developmental finding around 11 weeks?

A

Herniation of midgut

Should be intraabdominal by 12 weeks (CRL 55-60mm)

213
Q

Most likely associated w/ aneuploidy?
- CHD
- Omphalocele
- Gastroschisis

A

Omphalocele

214
Q

Most likely outcome w/ echogenic bowel?
- T21
- T18
- T13
- Normal outcome

A

Normal outcome

215
Q

Decrease in SVR is best tolerated in:
- MS
- AS
- IHSS
- Eisenmenger’s

A

MS

AS - SVR needed for coronary perfusion

IHSS = idiopathic hypertrophic subaortic stenosis
- Decreased SVR results in systemic hypoperfusion (inability to augment cardiac output because of outflow obstruction)

Eisenmenger’s - R to L shunt worse

216
Q

In fetal hypoxia, fetus compensates most likely by decreasing blood flow to which organ
- Brain
- Heart
- Adrenal
- Kidney
- Lungs

A

Kidney

Fetus adapts to hypoxia by increasing the blood supply to the brain, myocardium, and upper body and decreasing the perfusion of the kidneys, gastrointestinal tract, and lower extremities.

217
Q

Estrogens in maternal circulation are mostly:

A

Estradiol

218
Q

What test can give you a survival analysis?

A

Cox proportional hazard test

219
Q

Multivariate regression will reduce which of the following:
- Variance
- Confounding

A

Confounding

220
Q

Test used to compare means for two groups of nominal data

A

Chi square

221
Q

Ordinal data

A

Used to measure variables in a natural order, such as rating or ranking.

Ex: having a position in class as “First” or “Second”.
Data come with a level of order.

222
Q

Nominal data

A

Used to categorize data into mutually exclusive categories or groups.

Ex: Country, gender, race, hair color, etc. of a group of people
- Usually nouns

223
Q

Test used to compare means for non-normally distributed samples, two groups

A

Wilcoxon rank sum test

224
Q

Best initial study design to show association between smoking and bladder cancer

A

Case control

(Rare outcome)

225
Q

Prior history of Graves s/p ablation. Fetus with craniosynostosis and heart failure. What is the next step?

A

Maternal PTU

Fetal thyrotoxicosis:
- Due to thyroid stimulating immunoglobulins transferred through placenta
- Mortality rate 12-20%, due to heart failure
- Fetal tachycardia, craniosynostosis, heart failure, hydrops
- Mother can be treated and euthyroid but antibodies still present
- Treat w/ medication - crosses placenta and reduces fetal thyroid hormones
- Can add thyroxine to mom if she becomes hypothyroid - doesn’t cross placenta as readily
- Titrate med to fetal heart rate

226
Q

Least likely to be a/w fetal hyperthyroidism
- IUGR
- Oligo
- Abruption
- Craniosynostosis

A

Abruption

227
Q

Most important precursor for placental estriol is:

A

Adrenal C19 steroids

228
Q

Most important precursor for fetal DHEAS

A

LDL

229
Q

MHC class 1 on placenta most likely to interact with:

A

Cytotoxic T cells

230
Q

Breast milk has which humoral immunity factor?

A

IgA

231
Q

Which anomaly is most likely to need ECMO?
- TE fistula
- CPAM
- HLHS
- Neck mass

A

CPAM

232
Q

Least likely to find cardiac defect during echo for which?
- Pregestational DM
- Prior child w/ CHD
- Increased NT
- Non-immune hydrops
- Obesity

A

Obesity

Risk of CHD in gen pop - 1%
Fam hx - 2-15%
DM - 4x more likely

233
Q

Late decels following hypoxia most likely due to:
- Baroreceptor
- Chemoreceptor

A

Chemoreceptor
- Arterial chemoreceptors sensitive to low pH and low O2
- When activated, cause vasoconstriction and hypertension
- Elevated BP is perceived by the baroreceptors which stimulate the parasympathetic system to decrease the fetal heart rate, causing late deceleration

234
Q

LMWH mechanism of action?

A

Binds to ATIII
- Irreversibly inactivates factor Xa
- Eventually prevents conversion of fibrinogen to fibrin (forming clot)

235
Q

Exposed odds ratio is the ratio of odds among exposed and unexposed cases to:

A

Exposed controls and unexposed cases

236
Q

Most common reason for mosaicism seen on CVS is:

A

Confined placental mosaicism

237
Q

Aspartoacyclase is deficient in which disease?

A

Canavan disease

238
Q

Milking of blood in preterm infant is most likely to be helpful with:

A

Decrease IVH

239
Q

Least likely to be associated with myxedema
- Hyponatremia
- Hypothermia
- Hypocapnia

A

Hypocapnia

Myxedema - profound, long-standing hypothyroidism
- Causes hypoxia and HYPERcapnia

240
Q

Most likely finding following IUFD due to cholestasis?

A

Meconium staining of placenta and baby

241
Q

Which of the following is most helpful for determining etiology after a stillbirth?

A

Placental pathology

242
Q

Worst prognostic factor in CMV?
- Intracranial calcifications
- Microcephaly
- IUGR

A

Microcephaly

243
Q

Absent corpus callosum is most consistently associated with:
- Colpocephaly
- Downward displacement of 3rd ventricle
- Obliterated 3rd ventricle
- Microcephaly

A

Colpocephaly

Disproportionate prominence of the occipital horns of the lateral ventricles

244
Q

Spread of vulvar hematomas to the thigh is prevented by

A

Colles fascia

245
Q

Spiral arterioles are the direct branching of which of the following:

A

Basal

Uterine -> arcuate -> radial -> basal -> spiral

246
Q

Most likely result of reduced pituitary hormones?
- Cushing’s disease
- Addison’s
- Acromegaly
- Thyrotoxicosis

A

Addison’s

247
Q

IUGR, VSD, CDH seen with:
- T21
- T18
- T13
- DiGeorge

A

T18

248
Q

Most likely cause of mortality due to anesthesia:
- Hypotension
- Allergic reaction
- Arrythmia
- Failed intubation

A

Failed intubation

249
Q

Noncardiogenic pulmonary edema most likely has:
- Normal PCWP
- Elevated CO
- Elevated RA pressures
- Decreased SVR

A

Normal PCWP

250
Q

Unilateral pleural effusion most likely with:
- Hydrothorax
- CPAM
- BPS
- CDH

A

Hydrothorax

251
Q

Least reduction in SVR seen with:
- Intrathecal narcotics
- Intrathecal local anesthetics
- Continuous epidural narcotics
- Continuous epidural local anesthetics

A

Continuous epidural narcotics

252
Q

Which antibody is least likely to cause severe disease?
- Kell
- M
- C
- Jka

A

Jka

253
Q

Patient with toxo titer 1:4k and + IgM at 16 weeks. Which is most appropriate next step?
- Amnio for toxo PCR
- Antibiotic Rx
- Ultrasound

A

US

  • Amnio should be done >18wks, 2wks after documented seroconversion/4wks after maternal symptoms
254
Q

What would be least helpful in a postpartum hemorrhage significant enough to cause mild hypotension?
- PRBCs
- Colloids
- Salt-poor albumin
- FFP

A

Salt-poor albumin

255
Q

What is the expected outcome of a baby with mec, normal FHTs and delivery, who has normal CXR and mild tachypnea 30 minutes after delivery?

A

Normal long-term outcome

256
Q

Term multip at 41 weeks in clinic. 2 cm/50%. Least acceptable option:
- AROM
- Pit IOL
- BPP
- Expectant management
- Cervidil

A

Cervidil

257
Q

Which is the least acceptable excuse to withhold an epidural in labor?
- Unfractionated heparin 12h ago
- Skin infection adjacent to insertion site
- CNS mass lesion w/ increased ICP
- Maternal coagulopathy

A

Unfractionated heparin 12 hours ago

258
Q

What decreases after 40 weeks gestation?
- Amniotic fluid
- Placenta weight
- Birthweight

A

AFI

259
Q

What is different in preterm milk (as opposed to term milk)?

A

Increased protein, lower lactose, increased long chain fatty acids

260
Q

What is not needed for milk production?

A

Growth hormone

261
Q

What is not needed for milk production?

A

Growth hormone
(indirectly stimulates lactation?)

262
Q

Prostacyclin

A

Potent vasodilator made by endothelium
- Increases in pregnancy
- Decreases in preeclampsia

263
Q

What is the main source of PGE2 and PGF2 in pregnancy?

A

PGE2: amnion
PGF2: decidua

264
Q

Prostacyclin

A

Potent vasodilator made by endothelium
- Increases in pregnancy
- Decreases in preeclampsia

265
Q

Why are lidocaine levels higher in the newborn?

A

Acidosis in the fetus may result in trapping of ionized lidocaine in the fetal circulation and increase the transfer of lidocaine across the placenta.

MFM Written Boards (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions