Practice Questions - Large Doc 2 (819-end) Flashcards by Emily Zantow

What is insulin?
- Polypeptide
- Hormone carbohydrate
- Hormone nucleotide

Polypeptide

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Half-life of HPL after CD?

15-30min

Not found after 1st PPD

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Patient with class F and R diabetes with creatinine clearance of 90 and 24’ urine of 0.8 g baseline. If no preE later, what would her 24’ urine look like at 30 weeks?

Will increase but back to baseline after pregnancy

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What is TRH?
- Polypeptide
- Hormone carbohydrate
- Hormone nucleotide

Polypeptide

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Which CVS result has highest risk of uniparental disomy?

46XX/47XX+15

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Failure of closure of which has the worst outcome?
- DV
- Sinus venosus
- Ductus arteriosus
- Foramen ovale

Ductus arteriosus

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What is fiduciary responsibility?
- Practicing according to evidence based guidelines
- Patient responsibility to doctor
- Financial gain
- Time management

Practicing according to evidence based guidelines

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What is most important in clinical research?
- Informed consent
- Confidentiality
- Lack of conflict of interest

Informed consent

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Which is most associated with HIE?
- In utero demise of mono-di co-twin
- Infection

Infection

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Which is the source of fetal DNA in maternal serum?
- Fetal nucleated RBCs
- Fetal leukocytes
- Trophoblasts
- Fetal epithelial cells

Fetal nucleated RBCs (wrong?)

I think cfDNA comes from placental trophoblasts

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Which is least associated with long term sequelae in the neonate?
- Oliguria
- Elevated LFTs
- Hypotonia
- pH >7.05

Hypotonia

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What % of results are greater than 2 SDs above the mean in a 2 tailed test?

2.5%

68/95/99.7

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Which is least important in determining sample size?
- Desired alpha
- Desired beta
- Desired chi square result
- Prevalence in controls
- Desired prevalence in treatment group

Desired chi square result

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When to use one tailed test?

Results can only go in one direction

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Best way to minimize confounding factors?
- Randomize
- ANOVA
- Prospective study

Randomize

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Which is least likely to affect baseline FHR variability?
- Terbutaline
- Demerol
- Magnesium

Magnesium

Don’t know if this is right

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Who needs pneumovax?
- Epidemic conditions
- Immunosuppressed
- Post exposure

Immunosuppressed

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Recurrent infection of which has the highest fetal risk?
- CMV
- Varicella
- HSV
- Toxo

HSV

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Patient at 11 weeks with N/V, low TSH, normal T3 and T4. Most likely?

Normal

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Least likely with preE?
- Increased BUN
- Increased creatinine
- Decreased tubular secretion
- Decreased renal plasma flow
- Decreased GFR

Decreased tubular secretion

PEC - compromise of proximal tubular reabsorption, so secretion is INCREASED

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What is associated with preE?

Cellular fibronectin

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Highest chance of autism?
- Fragile X
- Prior child w/ autism
- Male gender

Prior child w/ autism

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Least likely with paternal age >50
- NF
- Daughter w/ hemophilia
- Marfan’s

Daughter w/ hemophilia

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Which is least likely to delivery vaginally if term, 6 cm and 0 station?
- Brow
- Mentum anterior
- Footling breech
- OP
- OT

Footling breech

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What is most likely with epidural for term labor? - Endometritis - Prolonged 1st stage - Prolonged 2nd stage - Cesarean - Malpresentation

Prolonged 2nd stage

Oxidative stress is important in the pathophys of which? - GDM - PPROM - PTL - Abruption - PEC

Preeclampsia Oxidative stress leads to inadequate placental perfusion

Most likely cause of delayed meconium passage in neonate? - T21 - Hirschsprung's - CF - TE fistula

CF Meconium plug is common

Neonate has apnea lasting >30s - Intubate - Positive pressure O2 - Chest compressions

Positive pressure O2

Least likely to see w/ ICP? - Oligo - Non-reactive NST

Oligo

Best way to monitor acute asthma attack?

Peak expiratory flow

Worst prognosis for subsequent pregnancy after peripartum cardiomyopathy?

Low EF after 12 weeks

Most important in counseling after teratogen exposure?

Timing of exposure

Which has the fastest onset when given intrathecally? - Lidocaine - Tetracaine - Bupivicaine - Ropivicaine

Lidocaine

Which has the highest O2 content? - Spiral artery - Intervillous space - Umbilical artery - Umbilical vein

Spiral artery

Umbilical vein: - Lower O2 than uterine vein - Higher pH than umbilical artery - Higher CO2 than umbilical artery

Lower O2 than uterine vein Umb artery w/ have higher CO2 bc it is returning it to mom for excretion

Which is not dependent on placental blood flow? - DHEAS - Estriol - Estrone - Estradiol

DHEAS Made in fetal adrenals

Where is fetal leptin produced?

Fetal adipose Also in syncytiotrophoblast

Which enzyme is responsible for placental metabolism of glucocorticoids?

11-beta steroid dehydrogenase type 2

Ambiguous genitalia on US least likely to be: - Cloacal exstrophy - Hypospadias - CAH - Exogenous androgens

Hypospadias

Valium during Cesarean most likely to cause:

Hypoxia

Which is most likely to result in prolonged neonatal withdrawal? - Methadone - Heroin - SSRI - Valium

Methadone

Which is most likely to need bacterial endocarditis prophylaxis? - Afib - IHSS - Prosthetic valve - Pacemaker - Asymptomatic MVP

Prosthetic valve

Which changes the least in pregnancy? - CO - SVR - PVR - COP - CVP

CVP CVP and PWCP do not change significantly in preg

D/B+D =

Specificity

Which is least important for power analysis? - Sample size - Standard deviation - Variance - Coefficient of variance - Desired chi-squared result

Desired chi-squared result

Which is most sensitive to detect fetal CMV infection if mom was exposed at 10 wks?

Amnio for CMV PCR at 21wks - Should be done at least 7wks after maternal infection and after 21wks GA

Which is usual cause of hemodynamic decompensation with mitral stenosis?

Increased preload Causes backup into pulmonary

Which is least likely to be transmitted to fetus before 20 weeks? - CMV - Parvo - HSV - Toxo - Syphilis

HSV - usually transmitted intrapartum

Which decreases the likelihood of alpha thal? - SE Asian - African American - Hgb A2 <2% - 125 mc/dL

African American MCV usually <80 Hgb A2 low

What should you see in the plane when measuring AC?

Stomach

What is the sensitivity of a quad in detecting T21 in a patient <35?

75%

Most common sign of uterine rupture?

FHR abnormalities

Which of the following is least likely to be caused by transplacental antibodies? - ITP - Congenital myasthenia gravis - GVHD - Heart block

Congenital myasthenia gravis (different than neonatal) - Inherited, not from maternal antibodies

The most common complication from insulin pump is: - Hypoglycemia - Preprandial hyperglycemia - Anti-insulin antibodies

Preprandial hyperglycemia

CVS cannot diagnose which? - Thalassemia - NTD

NTD

IUGR is most associated with which disease later in life?

HTN

What is the risk of transmission in the first trimester with primary CMV?

40%

Drugs in the highest concentration in breast milk are more likely to be:

Lipid soluble

Management of patient with MI who is 35 weeks pregnant

Await spontaneous labor

What is the first to change in a growth restricted fetus? - AFI - NST - Breathing - Gross movements - Doppler changes

Doppler changes

Term fetus becomes cyanotic 2 hours after birth. Preductal O2 90%, postductal O2 70%. What is the malformation? - PDA - TGA - Mitral insufficiency

TGA - I don't think this is right - I think it's PDA - TGA causes reverse of this (higher sats in lower half of body)

What pO2 = sat of 90%?

60mmHg

Down syndrome most likely: - Absent nasal bone - Cardiac defect

Absent nasal bone (60%) Cardiac = 50%

Components and drug class of combivir

Lamivudine and zidovudine = NRTIs

What gives immunotolerance in the placenta?

Variable expression of paternal HLA in the syncytiotrophoblast

What is not normal in pregnancy for EKG? - Prolonged PR interval - Mild ST segment changes - Left axis deviation - Q waves in leads...

Prolonged PR interval

What is most likely a/w aneuploidy? - Pelviectasis - Short humerus - EIF - Echogenic bowel

Echogenic bowel (LR 5.5) Highest LR = increased nuchal fold >5mm (LR 18) Then echogenic bowel, short humerus (2.5), short femur (2.2), EIF (2), UTD (1.6)

What is least transmitted in banked breastmilk? - HIV 1&2 - HepB - HepC - CMV

CMV? Killed in pasteurization process

Most likely finding in neonatal lupus - Complete heart block - Another heart block - Thrombocytopenia - (Rash not a choice)

Thrombocytopenia

How do you differentiate b/w lupus flare and preE? - Thromboxane - Increased LFTs - Increased dsDNA - ANA elevated

Increased dsDNA

OCPs are most likely to be given to a patient with - Heterozygous FVL - Homozygous MTHFR

Homozygous MTHFR

How do you diagnose primary adrenal insufficiency? - CRH stimulation test - Basal cortisol test - ACTH stim

ACTH stim

Fragile X is not associated with: - Gonadal cancer - Ataxia - Premature ovarian failure - Autism

Gonadal cancer

What’s the biggest barrier to drugs crossing the placenta? - Placenta metabolizes the drug - Lipid solubility - Ion trapping

Lipid solubility

Single left pulmonary effusion in otherwise normal infant most likely the result of: - Hydrothorax - CPAM - BPS - CDH - High bronchial lesion: non-communicating

Hydrothorax

In TTTS, which has no improvement in neonatal outcome? Septostomy Amnioreduction Selective laser Cord ligation

Septostomy

Morbidly obese patient has CD. Postop has hypoxia. Most likely due to? PE Sleep apnea

Sleep apnea

What doesn’t improve after fetal surgery? - Sacrococcygeal teratoma - TRAP - TTTS - BOO

??BOO Improves the outcome (shunt from bladder to AFI, helps w/ lung development) but doesn't relieve the obstruction

Infant with dermatomal rash, chorioretinitis, microcephaly. Most likely infection? HSV Congenital varicella

Varicella

What is different in breast milk than colostrum?

Fat - higher Glucose - higher Protein - lower Immunoglobulins - lower Lactose - higher Colostrum has more protein, immunoglobulins; mature milk has more fat, glucose, lactose

Terb side effects

Maternal - hyperglycemia, hypokalemia Neonatal - hypoglycemia, hypocalcemia, ileus

Triploidy - most common composition

Diploid egg, 1 sperm

Beta blocker mechanism

B1 - side effects, acts on heart B2 - smooth muscle relaxation

Acrocentric chromosomes

13 14 15 21 22 Can be involved in Roberstonian translocation

Myotonic dystrophy - phenotype w/ parental origin

If inherited from mom - risk of congenital disease w/ contractures, respiratory distress If inherited from dad - onset at 3-5yrs

B cell function in pregnancy

Decreased

What effect does iodine have on maternal thyroid function and why?

Suppresses function. Competitive inhibition of thyroid hormone synthesis/organification

What is most strongly associated with aneuploidy? Cystic hygroma Short femur EIF Echogenic bowel Omphalocele

Cystic hygroma (50%)

Transmission rate of CMV in pregnancy

30-40% (2nd tri)

What is contraindicated in pregnancy? Influenza vaccine Intranasal flu vaccine Amantadine

Intranasal flu vaccine (live virus)

The umbilical vein: Has a lower O2 than the uterine vein Lower pH than UA Higher CO2 than UA

Has a lower O2 than the uterine vein

What hormone is responsible for hyperpigmentation in pregnancy? Estrogen Progesterone Cortisol

Estrogen Or melanocyte stimulating hormone

Severe IUGR at 21wks most likely: T18 T13 T21 Triploidy

Triploidy

Which increases with advanced paternal age Neurofibromatosis T21 T18 T13 CF

Neurofibromatosis

When is CVS contraindicated? Kell isoimmunization Rh disease

Rh disease - relative contraindication, may cause more severe hemolytic disease

In a patient with autonomic dysreflexia, how high do you want to titrate your epidural? T4 T10 C4

T10

What drug would you start in a patient with Marfans with aortic root of 4.1 cm? Beta blocker Alpha blocker CCB Hydralazine

Beta blocker During pregnancy goals of treatment are to decrease the pulsatile forces on the aorta with the use of a β-blocker Highest risk >40mm, >50mm should undergo repair prior to pregnancy

What is most likely contributing to increased perinatal M&M with diabetes? Congenital anomalies Growth discrepancies Poor glycemic control Stillbirth

Poor glycemic control

In a hypoxic fetus, what physiologically is occurring? Shunting of blood to adrenals Shunting of blood to the brain

Shunting of blood to the brain

What is true of the fetal hemoglobin oxygenation curve?

Higher sats per PaO2 always L shift

What is appropriate for HIV prophylaxis as a single dose at delivery? AZT Nevirapine Kaletra

Nevirapine In resource-limited settings

Most common side effect of Combivir? Bone marrow suppression Nausea Anorexia

Nausea (most common) Bone marrow suppression also major side effect

What is most likely to be persistently absent or abnormal in an acidotic fetus? Tone Breathing Movement AFI

Breathing

What decreases efficacy of OCPs?

Anything that increases liver microsomal activity (phenobarb, Dilantin, rifampin, Griseofulvin)

What is least likely to occur in 24 hours? Closure of the DA Closure of the DV Closure of the foramen ovale Increase in pulmonary arterial pressure Constriction of umbilical vessels

Increase in pulmonary arterial pressure

What product is used to replace factors V, IX and fibrinogen? Cryo FFP Whole blood

FFP

How would use of a nonparametric test or use of an odds ratio with CI affect your calculated sample size?

Add 15% for nonparametric test (not normally distributed)

When studying association between PNV and ovarian cancer, what is the best initial form of study? Case control Cohort RCT Retrospective chart review

Case control

Depo provera has which effects? Increased triglycerides Decreased depression Decreased urinary calcium excretion

Increased triglycerides

Beta agonist mechanism of action

Bind to beta-2 adrenergic receptors (a G protein coupled R) on smooth muscle of bronchial tissue, activates adenylyl cyclase, causes release of cAMP, causes smooth muscle relaxation

Which organ system is affected by teratogens the earliest in gestation and for the longest period of time? CNS GI Spine Limbs

CNS

Level for regional anesthesia block for C/S?

Most common skeletal dysplasia?

Thanatophoric No fractures

A woman had a baby die of CAH. Most likely cause of death? Hypoglycemia Salt wasting dehydration Hyperkalemia

Salt wasting dehydration

Drug most commonly associated w/ microtia?

Accutane

Majority of increased prolactin comes from:

Placenta

CGH best used to detect: Aneuploidy Balanced translocations Microdeletions

Microdeletions Comparative genomic hybridization - looks at copy number variants

Which most highly correlates with impending fetal death in IUGR? BPP of 2 UA Dopplers with AEDF

BPP of 2

Least likely finding for T21 at 18 weeks on US Short humerus Short femur Double bubble Increased nuchal fold Pyelectasis

Double bubble Usually found >24wks

Ductal dependent fetal lesions

TGA, TOF, Coarc, HLHS, Ebstein’s, AS, PS/PA, tricuspid atresia NOT ductal dependent - VSD, balanced AV canal, ASD

What bacterial enzyme is responsible for preterm labor? Prostaglandin synthase Prostaglandin dehydrogenase MMP Phospholipase (or lipoxygenase) A2

Phospholipase (or lipoxygenase) A2

Child w/ DiGeorge most likely has decreased: T cells B cells

T cells (hypoplastic thymus)

What are the borders of the pelvic inlet?

Sacral promontory, arcuate line, superior aspect of pubis

Main pelvic floor support

Levator ani

Statistical test to measure difference in variation between survival curves? Cox regression Kaplan Meier

Cox regression

Treacher Collins affects which facial feature Mandible Maxilla

Mandible

Lab findings in primary adrenal insufficiency?

Elevated ACTH

Normal EKG changes in pregnancy:

Increased HR, left axis deviation, inverted T in lead III, Q in III and AVF, non-specific ST changes

In which lesion is spinal most contraindicated? Aortic stenosis Pulmonary hypertension Mitral stenosis Pulmonic stenosis

PHTN

Which mode of inheritance affected by penetrance, expressivity? AR AD X

Which antibiotic has big salt load?

Zosyn

When is cardiac output the greatest? Immediately postpartum Third trimester Early labor Second stage labor Second trimester

Immediately postpartum

Which class of anti-depressants has the least maternal/fetal adverse profile? MAOI Dopamine reuptake inhibitors TCAs SSRIs

SSRIs

Patient presents with fever, joint pain, tenosynovitis and pustular rash on hands Syphilis Gonorrhea

Gonorrhea

Metformin mechanism

AMP activated protein kinase

Which changes the least in pregnancy? Heart rate CO SVR Mean arterial pressure

MAP

30 weeks with proteinuria, hematuria and edema. Most likely: Minimal change dz PreE Glomerulonephritis

Glomerulonephritis?

Which allows you to see the contribution of each variable to the outcome? T-test Logistic regression Chi sqaure ANOVA

Logistic regression

Best immediate tx for thyroid storm? Iodine Methimazole Propranolol Radioablation

Methimazole

Worst thrombophilia? FVL ATIII Prothrombin MTHFR

ATIII

Mom had prior kid with severe thrombocytopenia. Next best step? Paternal platelet antigen Maternal IVIG Prednisone CVS for fetal platelet type

Paternal platelet antigen

Protective anastamosis in monochorionic twins AV VV AA

Treatment for steroid resistant lupus Azathioprine Cyclosporine Hydroxychloroquine Cyclophosphamide

Hydroxychloroquine

Most common finding in non-cardiogenic pulmonary edema?

Normal PCWP

Most common reason for Prader Willi? Maternal uniparental disomy Paternal deletion

Paternal deletion (70%) But can be caused by maternal UPD

Low estriol most a/w: Placental sulfatase deficiency Fetal death

Placental sulfatase deficiency (ichthyosis)

Mechanism of LMWH

Binds to antithrombin to form complex to inhibit factor Xa

Fetal myotonic dystrophy a/w all except Talipes Polyhydramnios Hypotonia IUGR

IUGR

Most likely side effect of local anesthetic toxicity? Seizures Tinnitus Hypotension

Tinnitus

Injection of local anesthesia 🡪 seizure. First step: Magnesium Succinylcholine Diazepam Nifedipine

Diazepam

How is IHSS inherited?

Most likely maternal complication of malaria?

Anemia

Roux en Y least likely to have what deficiency? Folate B12 Vitamin K Vitamin D

Vitamin K

What is not a presentation of AFE? Hypotension Dyspnea Seizures

Seizures

Which HIV med would you not give to somebody with hepatitis toxicity? Kaletra Nevirapine

Nevirapine - Don't give to patients at higher risk for developing liver problems

Best predictor for preE recurrence in patient with prior early onset preE? APLAS FVL GA at recurrence

GA at recurrence

Don't give OCPs to:

ATIII Hepatic adenoma

MAI (mycobacterium avium) prophylaxis

Azithromycin

PCP pneumonia treatment

Bactrim - Also use for ppx

Anti-inflammatory cytokine IL-10 IL-1 TNF alpha

IL-10

Mom with pulmonic stenosis. Most common problem? RV hypertrophy Arrhythmias

RV hypertrophy

What is the most common problem with MVP? Arrhythmia LV hypertrophy

Arrhythmia

What makes mitral stenosis worse? Increased preload Increased SVR Increased afterload

Increased preload

How to treat VSD w/ R->L shunt?

Sildenafil

Aortic stenosis – what is worst for this condition? Caval compression Increased afterload Bradycardia

Caval compression (decreased preload/hypovolemia)

Which lesion is worst for fetal oxygenation? ASD VSD Pulmonary hypertension

PHTN

What is not associated with IUFD? Toxo Listeria Syphilis CMV

CMV? Listeria - 50% Syphilis - 21%

Plasmapheresis for which maternal disease? TTP Guillain Barre

TTP

Neonatal circumcision bleeding XIII XI V Prothrombin MTHFR

XIII Factor XIII deficiency is a rare autosomal recessive congenital deficiency. Factor XIII plays an important role in the cross-linking of polymerized fibrin. Patients present with bleeding and delayed wound healing usually first noted at the umbilical stump or after circumcision.

Neonatal circumcision bleeding Factor VII Factor IX Factor XI Factor XII

Factor IX

Which is least likely to cause hyperbilirubinemia in infant? AB- B- A- O-

If fetal = O- If maternal = AB-

Most important function of IRB?

Protect best interest of patient

Ethical principles in clinical research

Autonomy, beneficence, nonmaleficence, justice

Odds ratio calculation

(#exposed cases x #unexposed non-cases) / (#exposed non-cases x # unexposed cases) Assume exposure leads to cases - situation you expect goes in numerator OR >1 suggests exposure a/w higher odds of outcome

Inhaled anesthetics like halothane for: Amnesia Analgesia Uterine relaxation Maintain normotension

Amnesia

Which ethical principle is behind insurance companies not covering first trimester screening?

Justice

Which principle is behind a patient requesting an elective CD?

Autonomy

Which ethical principle is behind health care reform?

Justice

Best product to replace factors V, VII, XII? Factor V concentrate FFP PRBCs vWF

FFP

What can be calculated in a case-control study?

Major problem w/ RCTs

Generalizability

Major problem with cohort study? Confounders Selection bias Recall bias

Confounders

Metabolic deficiency in Fanconi Anemia

Chromosome defect in cluster of proteins needed for DNA repair. Most AR. Some X. Hematologic components don’t develop. Cancer risk. Also can be deficient in GH, thyroid hormone, can have abn glucose metabolism, dyslipidemia and metabolic synd.

ROC best shows: Further to upper left, poorer the test Compares false negative rate and specificity Relationship between sensitivity and specificity

Relationship between sensitivity and specificity

How to treat pheochromocytoma: B blocker A blocker Hydralazine

A blocker

Highest O2 sat in the following vessels Ductus – which one? LA Umbilical artery

DV Then LA, then DA, then umb art

Increasing at the end of gestation: Ventricular compliance SVR

SVR

46 (15)/47 XX + 15 on CVS. Most likely outcome

Normal Mosaic - most likely confined placental mosaicism

45 XX der (14:21)(q10;q10)

Balanced translocation of 14/21

Depo provera a/w the most Elevated lipids/triglycerides Depression VTE Decreased breast milk

Elevated lipids/triglycerides

Best med for flu

Oseltamivir

Least associated with adaptive immunity T cell B cell Cytokine Monocyte

Cytokine

Innate immunity least associated with Neutrophils Monocytes Macrophages T cells

T cells

Hodgkin’s lymphoma in pregnancy at 18 weeks Radiation Chemo Chemo/rads No treatment

Chemo

Most teratogenic Cyclosporine Carbemazepine Azathioprine

Carbemazepine

Kaplan Meier only can do single binary predictor - what test do you use for more?

Cox regression

What increases sample size to maintain power? Log transformation Nonparametric test Alpha level Beta level

Nonparametric test

Normal size parents with recurrent achondroplastic kid Reduced penetrance Reduced expressivity Gonadal mosaicism New mutation

Gonadal mosaicism

Most common associated with cystic hygroma: Cardiac T21 T18 T13 Triploidy XXY

T21 (more common than 45 XO)

Which is most likely with 4 mm NT and normal karyotype? Normal Cardiac defect

Normal

Which is least likely to be transmitted?

Varicella Parvo: 50% seroconv, 33% vert transmission of mat infxn CMV: 30-40% 3rd T Rubella: 80% FT Varicella: 2% Toxo: 10% FT, 60% 3T

Which is least likely to be associated with IUGR? Parvo CMV Rubella Varicella Toxo

Parvo

Most common cause of hep B in the world? Blood transfusion Sexual contact Vertical transmission Needles

Vertical transmission

LCHAD homozygous associated with: Fatty liver PreE

Fatty liver LCHAD deficiency - inability to metabolize long-chain fatty acids Fetal LCHAD homozygotes highly a/w maternal AFLP

What is maternal blood directly exposed to? Maternal endothelial cell Placental endothelial cell Syncytiotrophoblast Cytotrophoblast

Syncytiotrophoblast

ACEi teratology

Cardiac

What least likely decreases placental transport? Ionization Lipid solubility Protein binding Placental degradation

Lipid solubility

What is associated with DiGeorge syndrome?

Thymus aplasia

Maternal mortality highest with: Varicella H1N1 Seasonal flu Leptospirosis

Varicella

When is asthma likely exacerbated? 1st trimester 2nd trimester 36-40 weeks Intrapartum Postpartum

2nd trimester

CVP 5; PCWP3; SVR 600; CO 12; Etiology

Early sepsis - Low SVR, high CO

Ashkenazi Jewish Gaucher Familial dysautonomia CF Huntingtons

Familial dysautonomia

Maternal PKU a/w fetal: Epiphyseal abnormalities/limb reduction V shape brow Cardiac Renal agenesis

Cardiac

S/D ratio decreases with fetal: Age Bradycardia IUGR Hypoplastic L heart

Age

Stages of TTTS

I - poly/oli II - absent bladder III - abnormal Dopplers IV - hydrops V - fetal death

Medication contraindicated in breast feeding: Cyclosporine PTU Warfarin Dilantin

Cyclosporine

Leading cause of PVL

Chorioamnionitis

Leading cause of neonatal chorioretinitis? CMV Rubella Syphilis

CMV

Highest pO2 in fetus? IVC Ductus arteriosus Right ventricle Descending aorta

IVC

Highest failure rate of glyburide Obesity Fasting Glucose >115

Fasting Glucose >115

A1C of 12.5% NTD Caudal regression Transposition Gastroschisis

Transposition

Moderate pulm stenosis in pregnancy most a/w: RVH Normal pregnancy and delivery Syncope

Normal pregnancy and delivery

In DKA, the anion gap shows acid from acetoacetate and: Lactic acid Beta hydroxybuterate

Beta hydroxybuterate

Calculate A-a gradient with ABG given. Alveolar-arteriole gradient.

A-a gradient = PAO2(alveolar) – PaO2 (arteriole) 5-10 is normal and increases 1 with each decade Approximated as A-a = (150 – 5/4 PCO2) – PaO2 Increased means problem with diffusion, VQ mismatch or R🡪L shunt

Medication used for primary pulmonary hypertension

Sildenafil (Viagra)

Mechanism of action of iodine in hyperthyroidism/storm: Decrease uptake of iodine into thyroid Decreased release of thyroxine Decreased peripheral conversion Decreased action of thyroid hormone in periphery

Decreased release of thyroxine

Most likely outcome with AFP 1.01; hCG 1.23; uE3 0.11 T21 NTD X-linked ichthiosis T18

X-linked ichthyosis Very low estriol - defect in steroid sulfatase, unable to make estrogens

Duration of action of lantus in non-preggo 0-4h 4-8 8-12 18-24

18-24h

Fetal regulation of LH

In male fetuses, LH detected at 8-10wks. At 15-20wks, T regulation shifts to fetal pituitary as LH takes over from placental hCG to drive testosterone. Neg feedback w/ testosterone and inhibin B. Peak LH higher in females. At term, LH undetectable. Rises after delivery due to estrogen withdrawal from mother; then decreases again until puberty

In asthmatic with respiratory rate of 30, what is worst predictor of her condition? pH 7.4 HCO3 22 pO2 100 pCO2 40

pCO2 40 worst prognosis

Worst prognosis for CPAM lesion Size Solid Dextrocardia Hydrops

Hydrops

Worst prognosis for CDH: Liver up Size of defect Contralateral lung tissue Ipsilateral lung tissue

Liver up

Most common cause of death from regional anesthesia in CD

Local anesthetic toxicity

Most likely reason for false positive KB?

Answer unclear but likely sickle cell anemia due to HgbF

Which bug is least affected by cephalosporins? E. coli Enterococcus GAS GBS

Enterococcus

MS exacerbation most common: 1st trimester 2nd trimester 3rd trimester Intrapartum Postpartum

Postpartum

Which of the following would require a larger sample size for a given power? Using log of data Looking at one group versus three Using nonparametric data

Using nonparametric data (need 15% more)

What do you not need to calculate power? Coefficient of variance SD Alpha Beta

Coefficient of variance

Which one is always less than the standard deviation? Coefficient of variance Standard error of the mean Variance (SD squared)

Standard error of the mean

Patient can’t stand after delivery: Obturator Sciatic Peroneal Femoral

Femoral

Patient unable to adduct leg after labor: Obturator Sciatic Peroneal Femoral

Obturator

Which is in the innate immune system? T cells B cells Monocyte Macrophage

Macrophage

Best contraception for PE: Micronor Mirena OCPs Male condom Female condom

Mirena

Patient presents at 36 weeks with history of T6 spinal lesion. Contractions, hypertension and flushing. What is best treatment? Spinal Epidural Parenteral

Epidural

Which is the preferred method of diagnosing PE VQ Spiral CT MR of chest Echo

Spiral CT

Reason for increased DVT on left Crossing of left iliac vein by left iliac artery Crossing of left iliac vein by right iliac artery

Crossing of left iliac vein by right iliac artery

Worst prognostic factor with acute asthma exacerbation? Decreased pO2 Increased pCO2 Decreased peak flow Wheezing

Increased pCO2

What is the most actively produced hormone during pregnancy? Progesterone Estriol DHEAS

Progesterone

What is the most important in determining fetal hydantoin syndrome? Dose Genetic heterogeneity Other medications

Genetic heterogeneity

Microtia is most associated with: Fetal alcohol syndrome Warfarin Isotretinoin Hydantoin

Isotretinoin

Most associated with IUGR: Propranolol Nifedipine Metoprolol Lasix

Propranolol

Best medicine for intermittent angina in patient with hypertrophic cardiomyopathy: Nifedipine Lasix Propranolol Nitroglycerin

Propranolol

Spinal anesthesia is worst with: Mitral regurg Mitral stenosis Pulmonary hypertension Coarctation Hypertrophic cardiomyopathy

PHTN

Least helpful in treating vWF: DDAVP Humate-P Platelets Recombinant vWF Cryo

Platelets

Most appropriate candidate for combined OCPs: ATIII Protein C Protein S Factor V Leiden Anticardiolipin

FVL

Least likely to pick up IUGR on ultrasound in a patient with: Hyperthyroidism Hemoglobin SC HIV Elevated AFP

Hemoglobin SC

Who is most likely to need 1 mg folic acid during pregnancy Sickle cell anemia 2nd pregnancy in 1 year

Sickle cell

Effects of betamethasone Decreased movement Decreased breathing Decreased variability

Decreased breathing

Most correlated with fetal acidosis Decreased heart rate reactivity Fetal breathing Fetal movement Fetal tone Decreased AFI

Fetal tone - True lack of tone a/w highest perinatal death rate

Patient presents with seizure 10 days out from delivery complicated by hypertension and regional anesthesia. Most likely reason? Eclampsia Cerebral venous thrombosis

Eclampsia

Mechanism of spinal headache? Maternal hypovolemia Cerebral Vasoconstriction Tension of pain sensing neural fibers Early ambulation

Tension of pain sensing neural fibers

Medroxyprogesterone acetate postpartum most associated with? Elevated triglycerides/LDL Thromboembolism Decreased milk production Depression

Elevated triglycerides/LDL

Maternal hyperparathyroidism. Least associated? Hypercalcemia HTN Fetal intracranial calcification Neonatal hypocalcemia

Fetal intracranial calcification

Mom is carrier of delta F508. Dad tested for 25 mutations and none were detected. What is risk of affected infant with carrier rate of 1/25?

Greater than the general population (residual risk 10% in dad)

Source of maternal GnRH Decidua Chorion Amnion Endometrium Maternal pituitary

Chorion (placenta produces GnRH as well as pituitary)

Best test to follow patient on PTU Total T4 TSH TRH Total T3 Free T4

Free T4

Which diabetic med has least transfer across placenta? Glyburide Glypizide Metformin Tobua---

Glyburide

Which antibiotic has minimal transfer across placenta secondary to albumin binding? Erythromycin Sulfa Gentamicin Ancef Ampicillin

Erythromycin

Hormone most affected by uterine blood flow? Estriol Estrone Estradiol Progesterone DHEAS

Estradiol - increases uterine blood flow

Fetal enzyme most responsible for the breakdown of maternal glucocorticoids

Placental 11 beta hydroxysteroid dehydrogenase - Breaks down cortisol

Most sensitive for CMV infection documented by serology at 10 weeks CVS for CMV Amnio with PCR at 16 weeks Amnio with culture at 20 weeks Amnio with PCR at 23 weeks

Amnio with PCR at 23 weeks

Appropriate f/u for bilateral renal pelvis of 9 mm at 30 weeks Weekly AFI Amniocentesis Repeat US in 4 weeks Neonatal renal ultrasound

Repeat US in 4 weeks

Highest sensitivity at 20 week ultrasound for Down Syndrome? Short 5th digit Short humerus Echogenic bowel Short femur Pyelectasis

Echogenic bowel

HIE is most associated with: Chorio Demise of one monochorionic twin Prematurity <28 weeks pH=7.0

Chorio

Which is most associated with preterm birth? Cervical index >50 (funnel length/cervical length) CL <15 mm Sludge Funneling

CL <15 mm

If you have a high spinal, the effect on the cervical branches is: Paresthesia of the chest Dyspnea

Dyspnea

In which disease is amniotic PCR least helpful? ITP Alloimmune thrombocytopenia Rh disease Toxo CMV

ITP

Most likely complication with C hyst Cystotomy Fistula Ureteral injury Pelvic abscess

Cystotomy

Which is most predictive of TTTS? Fluid Weight Dopplers MCA

Fluid

Least likely seen with A1C >12? Skeletal Cardiac Renal Gastroschisis Sacral agenesis

Gastroschisis

Single umbilical artery is most commonly associated with? VSD Omphalocele Hydrocephalus

VSD

How to differentiate HELLP from acute fatty liver? Thrombocytopenia LDH Glucose

Glucose

Non-closure of what fetal shunt causes the most neonatal complications? - Ductus arteriosus - Foramen ovale - Ductus venosus

PDA

What fetal vessel has the highest pO2? Umbilical artery Fetal femoral vein Fetal pulmonary artery Fetal pulmonary vein Right carotid artery

Right carotid artery

At 4 weeks, most likely adverse outcome of >5 rads exposure Childhood leukemia Microcephaly IUGR SAB

SAB

In genetic counseling for teratogen risk, which is most important? Drug dose Other drugs Timing of drug

Timing of drug

Which is the worst malaria to get? Plasmodia malariae Plasmodia ovale Plasmodium falciparum Plasmodium vivax

Plasmodium falciparum

If person gets allograft, what does she most likely acquire? CMV Hep B

CMV

On ultrasound, micromelia and hypocalcification of skull is noted. Which is least likely? OI Achondroplasia Hypophosphatasia Thanatophoric dysplasia

Achondroplasia

How do you follow woman with SSA and prior affected infant? Auscultation each visit Repeat echo for type 2 block Serial US for pericardial effusion Follow maternal titers

Auscultation each visit

Most common complication from pyelo Anemia Gram neg sepsis ARDS PTL Increased creatinine

Anemia

In term preE, what is the reason for decreased plasma volume? Increased total peripheral resistance Increased mean arterial pressure Decreased colloid oncotic pressure Capillary leak Hypertension

Increased total peripheral resistance (vasoconstriction)

In a term preeclamptic, what is the least likely? Elevated BUN Elevated Creatinine Decreased GFR Decreased tubular secretion Decreased renal plasma flow

Decreased tubular secretion

Where is prostaglandin dehydrogenase found? Amnion Chorion Fetal pituitary Cervix

Chorion

Which is likely to become clinically apparent for the first time in pregnancy? Sickle cell anemia Alpha thal Beta thal Hemoglobin SC

Hgb SC

What is the most reliable ultrasound criteria for dating? HC BPD AC FL

What is the main function of fetal luteinizing hormone? Stimulating fetal pituitary growth Stimulating fetal spinal development Stimulating fetal genital development Stimulating placental estrogen synthesis

Stimulating fetal genital development

What is the most common reason to seek to override a maternal refusal of treatment? Maternal incompetence Maternal poor judgement Risk of harm to fetus Maternal drug abuse

Maternal incompetence

Which of the following karyotypes obtained on CVS is most likely d/t uniparental disomy? 45 Xo 47 XXX 47 XY, +15 47 XX +21

47 XY, +15 (6, 7, 11, 14, 15, 20)

Calculate the gene frequency if the homozygous state of the gene is 1/6400 1/20 1/40 1/80 1/160

p2 + q2 + 2pq = 1 p+q=1 p = allele frequency 2pq = heterozygotes p2 = 1/6400 p = 1/80

Which of these lab values changes in pregnancy? Protein C Protein S APC resistance PTT

Protein S

Which test is not suggestive of APLAS? Prolonged PT Positive dRVVT Kaolin clotting time Abnormal aPTT

Prolonged PT

Which blood product is best for replacement of factors IX and X? Whole blood Cryo Platelets FFP

FFP

Which organism is the most common cause of RLL pneumonia in pregnancy? H. flu M. pneumoniae S. pneumoniae Varicella

S. pneumoniae

Which is not associated with Meckel-Gruber? Polyhydramnios Encephalocele Cystic dysplasia of kidneys Polydactyly

Polyhydramnios

A patient is sent at 22 weeks with absent radii bilaterally, hydronephrosis and severe IUGR. Most likely dx? TAR Carbamazepine exposure VACTERL Holt-Oram

VACTERL (V) = (costo-) vertebral abnormalities. (A) = anal atresia. (C) = cardiac (heart) defects. (TE) = tracheal-esophageal abnormalities, including atresia, stenosis and fistula. (R) = renal anomalies. (L) = limb defects