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
2
Q
Fetal breathing is increased most by:
A
Maternal hypercarbia
3
Q
Which causes fetal CNS, renal, liver, thymus, and bone effects?
A
Vitamin A
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
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
6
Q
What drug causes worst ovarian dysfunction?
A
Cyclophosphamide
7
Q
Hepatitis: WHich is associated w/ most infectivity?
A
HbEAg
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
9
Q
Which is not elevated in the fetus?
- Cholesterol
- Aldosterone
- Alpha globulin
- Beta globulin
- Gamma globulin
A
Cholesterol
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
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)
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
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)
14
Q
Type of test for - dichotomous drug effects w/ disease
A
Chi square
15
Q
Type of test/study for - % pregnant ladies who smoke
A
Cross-sectional study
16
Q
Type of test/study for - ETOH use and breast cancer
A
Case-control study
Correlation coefficient
17
Q
Type of test/study for - single dose vs multiple dose drugs for UTI
A
Prospective cohort
Clinical trial
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
19
Q
Which cannot be diagnosed on 4CH view?
- VSD
- Transposition
- HRHS
- TOF
A
Transposition
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
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
22
Q
Most common substance in surfactant?
A
Phosphatidylcholine
Major fatty acid component = palmitic acid
23
Q
How to deliver a fetus w/ alobar holoprosencephaly and macrocrania?
A
SVD w/ cephalocentesis
24
Q
Sequence
A
Single developmental defect that causes chain of secondary defects
25
Syndrome
Groups of anomalies w/ multiple malformations or sequences
26
Malformation
Intrinsic error of morphogenesis, genetic
27
Deformation
Extrinsic disturbance in morphogenesis (develops in abnormal environment), secondary destruction of organ/body part (e.g. club foot)
28
Disruption
Genetically normal fetus suffers insult (e.g. amniotic band)
29
Association
Anomalies occur frequently together but no etiological link
30
What is not associated w/ parvovirus B19?
Hemolytic anemia
IS associated:
- Increased AFP
- Aplastic anemia
- Myocarditis
- Hydrops
- IUFD
31
Risk of fetal death in pregnant women exposed to child w/ parvo
<1%
~50% of women susceptible
Risk of loss higher <20wks
32
Best anesthesia for severe asthmatic?
Continuous epidural
33
Which clinical scenario best matches these Swan-Ganz #s?
- RA elevated
- PA elevated
- PCWP normal
- CO normal
PE
34
Swan Ganz #s in normal pregnancy
CO increased
SVR decreased
PVR decreased
Colloid oncotic pressure decreased
PCWP slightly increased
LVSW slightly increased
35
Swan Ganz #s in preeclampsia
SVR increased
LVSWI increased (measure of overall LV function)
PCWP decreased (intravascular volume depletion)
36
Swan Ganz #s in pulmonary edema
Colloid oncotic pressure to PCWP gradient <4
Elevated PCWP
>18 early
20-25 more overt
>25 more severe
37
Swan Ganz #s in shock
Decreased SVR
38
Swan Ganz #s in PHTN
High PA pressures, high PVR
39
Swan Ganz #s in PE
High PA pressure, CO can be low, inability to wedge w/ PHTN, elevated CVP >10 if large PE
40
Which enzyme is necessary for estrogen synthesis?
Sulfatase
41
What is the immediate precursor of progesterone?
Pregnenolone
Converted by placenta (fetus doesn't have 3betaOHsteroid dehydrogenase)
42
Husband's sister died at age 16 of CF. Wife phenotypically normal. Calculate risk to baby
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
43
Residual risk of CF if deltaF508 neg
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)
44
Fetal effect of cocaine
Elevated BP
45
Fetal effect of heroin
Acute fetal distress and withdrawal
46
Fetal effect of methadone
Withdrawal 2-4wks after delivery
47
Which drug for HA is contraindicated in pregnancy?
- Ergotamine
- Propranolol
- Midrin
- Amitriptylene
Ergotamine
48
Patient gets SOB after 1 flight of stairs. What NYHA class?
II
I - no sx
II - mild
III - symptoms interfere greatly w/ activity, no sx at rest
IV - sx at rest
49
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
Increased BPD (often decreased)
Lemon and banana signs less reliable after 24wks
50
What is the most common finding in Hgb SC in pregnancy?
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
51
What is seen most often in renal transplant in pregnancy?
Preterm delivery
52
Renal patients are at increased risk for which of the following?
CMV
53
Lyme disease
Target lesion >50%
54
Toxic shock syndrome
Desquamation of hands/soles
55
GBS
Treat w/ ampicillin
56
Management of patient who had GBS
Amp intrapartum
57
Abx for chlamydia
Erythromycin
58
Abx for toxo
Pyrimethamine
59
Abx for gonorrhea
Ceftriaxone
60
Abx for listeria
Ampicillin
61
Abx for mycoplasma
Erythromycin
62
Recurrence risk for Down Syndrome
1%
63
Which drug interferes w/ OCPs?
- Rifampin
- Doxycycline
- Bromocriptine
Rifampin
64
Which has the highest incidence of cardiac abnormalities?
- T21
- T18
- 45 XO
- 47 XXY
- 47 XYY
T18 (80%)
T21 and 45 XO - 50%
65
What affects prognosis for omphalocele?
Presence of associated anomalies
66
What is associated w/ increased paternal age?
- Achondroplasia
- Meckel-Gruber
- Beckwith-Wiedemann
Achondroplasia
67
Mechanism of action of labetalol
Alpha and beta blockade
- Does not decrease afterload
68
Colloid osmotic pressure
- Decreases w/ ritodrine
- Decreases after delivery
- Decreases w/ preeclampsia
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
69
Which amino acids are glucogenic?
Valine
Serine
Glutamate
Glutamine
Alanine
**Everything but lysine and leucine
70
Which amino acids are ketogenic only?
Lysine
Leucine
71
Which amino acids are glutogenic and ketogenic?
Phenylalanine
Isoleucine
Tryptophan
Tyrosine
Threonine
72
Management of Guillain-Barre at 34wks w/ progressively worsening disease x 1wk, inspiratory capacity decreased from 3.5L to 2L
Plasmapheresis
- NOT delivery
- Removes circulating antibodies
73
Which is least associated w/ fetal growth?
- Glucose
- Insulin
- Growth hormone
- Phenylalanine
Growth hormone
74
What has lower concentration in acute fatty liver of pregnancy?
Glucose
Platelets
ATIII
Fibrinogen
Increases:
- LFTs
- Ammonia
- Uric acid
- Creatinine
75
Benefit of treating severe maternal HTN in early pregnancy?
Decreased maternal mortality
76
Mechanism of platelet destruction in preeclampsia?
Arteriole intimal damage?
Platelet activation and consumption, endothelial damage
77
Most frequent life-threatening infection associated w/ HIV in pregnancy
PCP
78
Which blood product is associated w/ 10-20% chance of transmission of hepatitis B
Factor VIII
Factor IX
79
What is the best way to diagnose vWD?
Ristocetin
- Measures vWF functional activity
80
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+
Mom O- / fetus O+
- ABO incompatibility more rapidly cleared (lower risk)
81
Need central monitoring for all of the following except:
- DIC
- Septic shock
- Respiratory insufficiency
- Oliguria
- Pulmonary edema
DIC
82
Using central monitoring, one can measure all of the following except:
- Cardiac output
- RV stroke volume
- PA pressure
RV stroke volume
83
Type of study:
- Study to determine the effectiveness of a single dose of abx vs standard regimen for UTI
RCT
84
Type of study:
- Relationship of EtOH consumption and breast cancer
Case control
85
Type of study:
- Study to determine prevalence of smoking in pregnancy
Cross sectional
86
Most frequent location of IVH
Germinal matrix
87
What percentage of Rh negative women become Rh sensitized by their first delivery?
15%
88
Most common cause of macrosomia?
Obesity
89
Which fetal arrhythmia is most common?
- SVT
- PACs
- PVCs
- Complete heart block
PACs
90
What is true of SVT?
If it persists >12h, it could lead to hydrops
- Usually NOT associated w/ structural abnormalities
91
Best treatment for patient who recently converted to positive syphilis serology during pregnancy and is allergic to PCN
PCN after desensitization (should do skin test w/ IgE)
92
Hyperparathyroidism in mother can cause all of the following in the fetus except:
Hypercalcemia
- Maternal hypercalcemia/PTH suppress fetal parathyroid causing hypocalcemia
93
Diabetic at 35wks, NST is reactive but has 1 variable decel down to 100 for 30s. Cause/management?
Due to nuchal cord
- Do not need to deliver immediately, not a/w fetal acidosis
94
Most drugs cross the placenta by:
Simple diffusion
95
Most likely reason for decreased Apgar in AGA premie delivered vaginally?
Prematurity
96
What crosses the placenta by active transport?
Amino acids, iodide, vitamin C, calcium, FA, B12
97
What crosses the placenta by facilitated diffusion?
Glucose, vitamin K, lactate
98
What crosses the placenta by simple diffusion?
Gases, FFAs, urea
99
What crosses the placenta by pinocytosis?
IgG, insulin, LDL, transferrin
100
Urine electrolytes in a woman who is oliguric from preeclampsia w/ prerenal causes
Osmolality 550 (high, >450)
Sodium low
FENA <1%
BUN/Cr >20
101
Leading cause of maternal mortality
Hemorrhage (worldwide)
102
Higher concentration of anesthetics which are basic in an acidotic fetus is based on the principle of...
Ion trapping
103
Which drug has the shortest half-life in the fetus?
- Marcaine
- Chloroprocaine
- Pontocaine
- Mepivicaine
Chloroprocaine - 43 sec
Marcaine/mepivicaine 8-9hrs
104
Phenotype of: 45 XX -14, -21, t(14,21)
Phenotypically normal female
- Balanced translocation
105
Phenotype of: 46 XX -14, t(14,21)
Female w/ features of Down Syndrome
106
Phenotype of: 45 XX -13, -14, t(13,14)
Phenotypically normal female
107
Phenotype of: 46 XX, inv9(p11,q11)
Phenotypically normal female
- Pericentric inversion of chromosome 9
108
Which test is most predictive of fetal outcome?
- Anti-microsomal antibodies
- Anti-thyroglobulin antibodies
- Amniotic fluid thyroxine
- LATS antibodies
- TSH
LATS antibodies (same as thyroid stimulating immunoglobulin)
- Long acting thyroid stimulator
109
Which of the following does not adversely affect fetal outcome?
- Multiple sclerosis
- Myasthenia gravis
- Graves
- Myotonic dystrophy
MS
110
Ligating the anterior branch of the hypogastric artery includes all of the following vessels except:
- Superior gluteal
- Inferior gluteal
- Superior vesical
- Inferior hemorrhoidal
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
Bilateral polycystic kidney disease is associated with:
- Autosomal dominant
- Chromosomal abnormalities
- Autosomal recessive
All of the above
112
Rh+ woman has anti-Kell titer of 1:512 as a result of transfusion. Next step is:
Test husband for Kell antigen
113
A woman has a positive indirect Coombs. Next step is:
Antigen identification
- Indirect Coombs tests for antibodies in blood
114
Which procoagulant is decreased in pregnancy?
- VII
- VIII
- IX
- X
- XI
XI
Increased: fibrinogen, prothrombin, factor V, VIII, IX, X
115
Protein S activity in pregnancy
Decreased
116
In a hemochorial placenta, the layers between maternal and fetal blood include all of the following except:
- Fetal capillary
- Trophoblast
- Maternal capillary
- Connective tissue
Maternal capillary
Maternal blood, syncytiotrophoblast, cytotrophoblast, fetal connective tissue, fetal capillary, fetal blood
117
What drug should you avoid in myasthenia?
- Lidocaine
- Chloroprocaine
- Gentamicin
Chloroprocaine and gentamicin
118
Which of the following is most useful in differentiating HELLP from TTP?
- Thrombocytopenia
- Microangiopathic hemolysis
- Elevated LDH
- Elevated vWF multimer
- CNS involvement
Elevated vWF multimer - ADAMTS13 that cleaves von Willebrand factor is deficient in TTP
119
Initial treatment of a stable patient with sustained V tach includes
- DC cardioversion
- Lidocaine
- Procainamide
- Oxygen
- Epinephrine
Oxygen
120
The drug of choice for the treatment of malignant hyperthermia is
Dantrolene
121
Pulmonary artery wedge pressure provides a clinical measurement of:
LV preload
122
Primary HSV in pregnancy risks:
40% of infants infected
- 50% die
- 35-40% suffer neurologic morbidity
123
Recurrent HSV in pregnancy transmission rate
5%
If asymptomatic, risk is 1/1000
124
Delivery mode for AVM
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
Delivery mode for pseudotumor cerebri
SVD
126
Delivery mode for cerebral artery thrombosis
SVD
127
Delivery mode for cerebral vein thrombosis
Operative VD if earlier, otherwise CD may be needed
128
In GDM, what is the likelihood of developing DM postpartum
50% within 20yrs of delivery
If fasting hyperglycemia, more likely to persist - when fasting exceeds 130, likelihood is 86%
Answer = 70%
129
Autonomic dysreflexia - location and symptoms
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
Autonomic dysreflexia - treatment
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
Most common symptom in TTP
Neurologic - HA, AMS, seizure, stroke
132
Mechanism of AZT
Nucleoside RT inhibitor
- Main side effect - bone marrow suppression
133
Nevirapine mechanism of action
NNRTI (non-nucleoside reverse transcriptase inhibitor)
134
Types of HIV meds
NNRTI (nevirapine)
NRTI (zidovudine [AZT], lamivudine)
Protease inhibitors
135
Major antiseizure med that is renally excreted
Primidone (mysoline)
- Phenobarbitol is a metabolite
136
Antiseizure meds to avoid in pregnancy
Phenytoin
Phenobarbitol
Topiramate
Carbamazepine
Valproate
137
Changes in or preceding preeclampsia
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
Only blood product source of factors V, XI, and XII
FFP
139
Cryoprecipitate components
Mostly - fibrinogen
Also - factor VIII, XIII, and vWF
140
Risks of blood transfusion
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
Teratogenic effects of vitamin A
Severe ear defects, CV, CNS, thymus
Doses >10k IU/day
142
Which has lower fasting state during pregnancy?
- Glucose
- Cholesterol
- Cortisol
Glucose
143
Maternal response to feeding
Hyperglycemia
Hyperinsulinemia
Hyperlipidemia
Reduced sensitivity to insulin
144
Purpose of parenteral vitamin K to neonates?
Prevent hemorrhage
- Those born to moms on seizure meds at higher risk
- Oral vitamin K not as effective
145
Rate limiting step of prostaglandin synthesis?
Arachidonic acid (AA) - obligate precursor to prostaglandins
- Membrane phospholipids (phosphatidyl ethanoloamine or inositol) release AA via phospholipase C or phospholipase A2
146
What is required for estrogen synthesis in the placenta?
DHEAS (derived from fetal adrenals)
- Acetate, cholesterol, and progesterone can't be used as precursor bc CYP17 not expressed by placenta
147
Requirements for blood in fetal transfusion (if infant Rh+)
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
Benefits of transabdominal vs transcervical CVS
Decreased VB
Decreased infection
Easier to train
NOT larger sample size (this is larger w/ transcervical)
149
S/sx of maternal hypercalcemia
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
Components of active management of labor
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
Which valvular lesion has the worst prognosis with respect to volume overload?
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
Mitral stenosis - effects of volume overload
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
Aortic stenosis - effects of volume overload
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
Hypertrophic cardiomyopathy - effects of volume overload
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
Aldosterone in pregnancy
Increased
Renin and angiotensin II also increased
Decreased sensitivity to RAAS
Prostacyclin and thromboxane increase in normal pregnancy
156
Human placental lactogen - other name
Human chorionic somatomammotropin (HCS)
157
Half-life of HPL
10-30 minutes
158
Most common fetal response to chorioamnionitis?
Tachycardia/decreased variability
159
When is the inciting event for PVL (periventricular leukomalacia)?
Antepartum
160
Fetal thyroid function
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
GBS testing - gold standard
Bacteriologic culture
- Todd-Hewitt broth or selective blood agar medium
162
Hormones for lactation
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
What is the sensitivity of triple screen for T21?
What is the most likely result?
60%
High hCG, low AFP/estriol
164
Type I error
Alpha error - concluding that treatment differs when they don't
165
Type II error
Beta error - concluding there is no effect when there is one
166
Power
1 minus beta
167
Which is not associated w/ advanced paternal age?
- Achondroplasia
- Osteogenesis imperfecta
- Beckwith Wiedemann
Beckwith Wiedemann
APA a/w achondroplasia, thanatophoric dysplasia, OI (de novo mutations)
168
Closure of neural tube complete by:
5-7 weeks gestational age
28 days after conception
169
Normal outcome most likely with:
- AV canal defect
- TGA
TGA
170
Arachnoid cysts are most commonly located in:
- Posterior fossa
- Interhemispheric area
- Sylvian fissure
- Supratentorial
Supratentorial (middle cranial fissure)
171
Which first trimester marker is worse for preeclampsia?
- PAPP-A >95%
- PAPP-A <5%
<5%
172
Patient treated with anti-neoplastic Rx. What do you have at delivery?
Thrombocytopenia
173
Prognosis for lupus during pregnancy depends on:
Lupus activity during 6 months preconception
174
SLE nephritis most likely to cause:
- IUFD
- Preeclampsia
Preeclampsia
175
What is not associated with fragile X?
- Ataxia
- Gonadal cancer
Gonadal cancer
176
Pain during 2nd stage of labor carried through:
Sensory fibers of S2-S4
(Pudendal nerve)
1st stage - visceral afferent (sympathetic) nerves T10-12
177
What inhibits cyclooxygenase?
ASA
- Inhibits COX-1 (more so) and COX-2
178
UPD most likely with chromosome:
15
- Angelmann - mother's lost (only paternal)
- Prader-Willi - father's lost (only maternal)
179
Which is not metabolized in the liver?
- Antiepileptic drugs
- LMWH
- Warfarin
LMWH
180
Weight gain in pregnancy throughout gestation most likely due to contribution of:
- Fetus
- Placenta
- AFI
- Decreased sensitivity to angiotensin system
- Fat
Fat
181
RAAS system in pregnancy
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
Anemia in pregnancy most likely due to:
Maternal red blood cell mass
- Doesn't increase as much as volume expansion
183
Different expression based on allele transmission from either mother or father?
Imprinting
184
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
Amniotic fluid analysis for PAH
PKU - autosomal recessive, mutation in PAH gene
185
Which is least important for sample size calculation?
- Incidence of outcome after intervention
- Alpha error
- Beta error
- Desired p value
Desired p value
186
Falsely concluding that treatment works:
- Type 1 error
- Type 2 error
Type 1 error
187
Autonomic dysreflexia is associated w/ all of the following except:
- Bradycardia
- Flushing
- Hypotension
- Sweating
Hypotension
188
Which is seen in pregnancy?
Beta cell hyperplasia in pancreas
189
All of the following prostaglandins cause uterine contractions except
- PGE1
- PGE2
- PGE3
- PGF2
PGE 3
E and F series prostaglandins important in labor
190
In the first trimester, what happens to TSH and free T4?
TSH decreases
fT4 normal
191
SSRI associated w/ CHD
Paroxetine
192
Erb's palsy is due to lesion in:
C5-C6
193
Most appropriate treatment of NAIT
IVIG
194
Which has the greatest effect on sodium metabolism?
- Hydrocortisone
- Prednisone
- Methylprednisolone
- Fludrocortisone
Fludrocortisone
195
Which least likely to have effect on fetal kidney?
- Aminoglycosides
- Sulfa
- NSAIDs
- ACEi
Sulfa
196
Risk of NTD due to antiepileptic drugs?
1%
197
Advanced paternal age is associated with all of the following except:
- 47, XYY
- Achondroplasia
- Marfan's
- Female carrier of hemophilia A
- Neurofibromatosis
47, XYY
198
Subgaleal hematoma is a collection between:
Periosteum and epicranial aponeurosis
199
Most likely course of MS
Variable
200
Lupus anticoagulant affects all except:
- DRVTT
- aPTT
- Platelet neutralization
- Kaolin
- ANA
ANA
201
Treatment for type 1 vWD?
Desmopressin
202
Most common complication of fetal blood sampling:
- Fetomaternal hemorrhage
- Fetal bradycardia
- Fetal death
- Blood streaming
Blood streaming
203
Which most rapidly crosses placenta?
- TSH
- TRH
- T4
- T3
TRH
204
Woman here for preconception counseling. Advise against pregnancy if:
- Right to left shunt
- Significant aortic stenosis
- Mitral stenosis
R to L shunt
205
Seizures are reduced by:
- Hypothermia
- Hyperglycemia
Hypothermia
206
Definition of neonatal encephalopathy includes all except:
- pH <7.0
- BE <-12
- Spastic CP
- Seizures
Spastic CP
207
Most common neonatal finding in CMV?
Deafness
208
Most likely finding in recurrent CMV (serology)
IgM pos, IgG pos, high avidity
Low avidity = recent infection
209
Folic acid antagonists cause:
- Limb reduction defects
- CHD
- Caudal regression
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
Infection associated w/ limb defects?
- CMV
- Parvo
- Varicella
- HSV
Varicella
211
Mode of delivery with myasthenia?
Assisted vaginal delivery
212
Most likely normal developmental finding around 11 weeks?
Herniation of midgut
Should be intraabdominal by 12 weeks (CRL 55-60mm)
213
Most likely associated w/ aneuploidy?
- CHD
- Omphalocele
- Gastroschisis
Omphalocele
214
Most likely outcome w/ echogenic bowel?
- T21
- T18
- T13
- Normal outcome
Normal outcome
215
Decrease in SVR is best tolerated in:
- MS
- AS
- IHSS
- Eisenmenger's
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
In fetal hypoxia, fetus compensates most likely by decreasing blood flow to which organ
- Brain
- Heart
- Adrenal
- Kidney
- Lungs
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
Estrogens in maternal circulation are mostly:
Estradiol
218
What test can give you a survival analysis?
Cox proportional hazard test
219
Multivariate regression will reduce which of the following:
- Variance
- Confounding
Confounding
220
Test used to compare means for two groups of nominal data
Chi square
221
Ordinal data
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
Nominal data
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
Test used to compare means for non-normally distributed samples, two groups
Wilcoxon rank sum test
224
Best initial study design to show association between smoking and bladder cancer
Case control
(Rare outcome)
225
Prior history of Graves s/p ablation. Fetus with craniosynostosis and heart failure. What is the next step?
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
Least likely to be a/w fetal hyperthyroidism
- IUGR
- Oligo
- Abruption
- Craniosynostosis
Abruption
227
Most important precursor for placental estriol is:
Adrenal C19 steroids
228
Most important precursor for fetal DHEAS
LDL
229
MHC class 1 on placenta most likely to interact with:
Cytotoxic T cells
230
Breast milk has which humoral immunity factor?
IgA
231
Which anomaly is most likely to need ECMO?
- TE fistula
- CPAM
- HLHS
- Neck mass
CPAM
232
Least likely to find cardiac defect during echo for which?
- Pregestational DM
- Prior child w/ CHD
- Increased NT
- Non-immune hydrops
- Obesity
Obesity
Risk of CHD in gen pop - 1%
Fam hx - 2-15%
DM - 4x more likely
233
Late decels following hypoxia most likely due to:
- Baroreceptor
- Chemoreceptor
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
LMWH mechanism of action?
Binds to ATIII
- Irreversibly inactivates factor Xa
- Eventually prevents conversion of fibrinogen to fibrin (forming clot)
235
Exposed odds ratio is the ratio of odds among exposed and unexposed cases to:
Exposed controls and unexposed cases
236
Most common reason for mosaicism seen on CVS is:
Confined placental mosaicism
237
Aspartoacyclase is deficient in which disease?
Canavan disease
238
Milking of blood in preterm infant is most likely to be helpful with:
Decrease IVH
239
Least likely to be associated with myxedema
- Hyponatremia
- Hypothermia
- Hypocapnia
Hypocapnia
Myxedema - profound, long-standing hypothyroidism
- Causes hypoxia and HYPERcapnia
240
Most likely finding following IUFD due to cholestasis?
Meconium staining of placenta and baby
241
Which of the following is most helpful for determining etiology after a stillbirth?
Placental pathology
242
Worst prognostic factor in CMV?
- Intracranial calcifications
- Microcephaly
- IUGR
Microcephaly
243
Absent corpus callosum is most consistently associated with:
- Colpocephaly
- Downward displacement of 3rd ventricle
- Obliterated 3rd ventricle
- Microcephaly
Colpocephaly
Disproportionate prominence of the occipital horns of the lateral ventricles
244
Spread of vulvar hematomas to the thigh is prevented by
Colles fascia
245
Spiral arterioles are the direct branching of which of the following:
Basal
Uterine -> arcuate -> radial -> basal -> spiral
246
Most likely result of reduced pituitary hormones?
- Cushing's disease
- Addison's
- Acromegaly
- Thyrotoxicosis
Addison's
247
IUGR, VSD, CDH seen with:
- T21
- T18
- T13
- DiGeorge
T18
248
Most likely cause of mortality due to anesthesia:
- Hypotension
- Allergic reaction
- Arrythmia
- Failed intubation
Failed intubation
249
Noncardiogenic pulmonary edema most likely has:
- Normal PCWP
- Elevated CO
- Elevated RA pressures
- Decreased SVR
Normal PCWP
250
Unilateral pleural effusion most likely with:
- Hydrothorax
- CPAM
- BPS
- CDH
Hydrothorax
251
Least reduction in SVR seen with:
- Intrathecal narcotics
- Intrathecal local anesthetics
- Continuous epidural narcotics
- Continuous epidural local anesthetics
Continuous epidural narcotics
252
Which antibody is least likely to cause severe disease?
- Kell
- M
- C
- Jka
Jka
253
Patient with toxo titer 1:4k and + IgM at 16 weeks. Which is most appropriate next step?
- Amnio for toxo PCR
- Antibiotic Rx
- Ultrasound
US
- Amnio should be done >18wks, 2wks after documented seroconversion/4wks after maternal symptoms
254
What would be least helpful in a postpartum hemorrhage significant enough to cause mild hypotension?
- PRBCs
- Colloids
- Salt-poor albumin
- FFP
Salt-poor albumin
255
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?
Normal long-term outcome
256
Term multip at 41 weeks in clinic. 2 cm/50%. Least acceptable option:
- AROM
- Pit IOL
- BPP
- Expectant management
- Cervidil
Cervidil
257
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
Unfractionated heparin 12 hours ago
258
What decreases after 40 weeks gestation?
- Amniotic fluid
- Placenta weight
- Birthweight
AFI
259
What is different in preterm milk (as opposed to term milk)?
Increased protein, lower lactose, increased long chain fatty acids
260
What is not needed for milk production?
Growth hormone
261
What is not needed for milk production?
Growth hormone
(indirectly stimulates lactation?)
262
Prostacyclin
Potent vasodilator made by endothelium
- Increases in pregnancy
- Decreases in preeclampsia
263
What is the main source of PGE2 and PGF2 in pregnancy?
PGE2: amnion
PGF2: decidua
264
Prostacyclin
Potent vasodilator made by endothelium
- Increases in pregnancy
- Decreases in preeclampsia
265
Why are lidocaine levels higher in the newborn?
Acidosis in the fetus may result in trapping of ionized lidocaine in the fetal circulation and increase the transfer of lidocaine across the placenta.
