Practice Questions - Large Doc 2 (819-end)

Question 1

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

Answer 1

Polypeptide

Question 2

Half-life of HPL after CD?

Answer 2

15-30min

Not found after 1st PPD

Question 3

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?

Answer 3

Will increase but back to baseline after pregnancy

Question 4

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

Answer 4

Polypeptide

Question 5

Which CVS result has highest risk of uniparental disomy?

Answer 5

46XX/47XX+15

Question 6

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

Answer 6

Ductus arteriosus

Question 7

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

Answer 7

Practicing according to evidence based guidelines

Question 8

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

Answer 8

Informed consent

Question 9

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

Answer 9

Infection

Question 10

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

Answer 10

Fetal nucleated RBCs (wrong?)

I think cfDNA comes from placental trophoblasts

Question 11

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

Answer 11

Hypotonia

Question 12

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

Answer 12

2.5%

68/95/99.7

Question 13

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

Answer 13

Desired chi square result

Question 14

When to use one tailed test?

Answer 14

Results can only go in one direction

Question 15

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

Answer 15

Randomize

Question 16

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

Answer 16

Magnesium

Don’t know if this is right

Question 17

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

Answer 17

Immunosuppressed

Question 18

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

Answer 18

HSV

Question 19

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

Answer 19

Normal

Question 20

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

Answer 20

Decreased tubular secretion

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

Question 21

What is associated with preE?

Answer 21

Cellular fibronectin

Question 22

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

Answer 22

Prior child w/ autism

Question 23

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

Answer 23

Daughter w/ hemophilia

Question 24

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

Answer 24

Footling breech

Question 25

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

Answer 25

Prolonged 2nd stage

Question 26

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

Answer 26

Preeclampsia

Oxidative stress leads to inadequate placental perfusion

Question 27

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

Answer 27

CF
Meconium plug is common

Question 28

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

Answer 28

Positive pressure O2

Question 29

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

Answer 29

Oligo

Question 30

Best way to monitor acute asthma attack?

Answer 30

Peak expiratory flow

Question 31

Worst prognosis for subsequent pregnancy after peripartum cardiomyopathy?

Answer 31

Low EF after 12 weeks

Question 32

Most important in counseling after teratogen exposure?

Answer 32

Timing of exposure

Question 33

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

Answer 33

Lidocaine

Question 34

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

Answer 34

Spiral artery

Question 35

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

Answer 35

Lower O2 than uterine vein

Umb artery w/ have higher CO2 bc it is returning it to mom for excretion

Question 36

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

Answer 36

DHEAS

Made in fetal adrenals

Question 37

Where is fetal leptin produced?

Answer 37

Fetal adipose

Also in syncytiotrophoblast

Question 38

Which enzyme is responsible for placental metabolism of glucocorticoids?

Answer 38

11-beta steroid dehydrogenase type 2

Question 39

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

Answer 39

Hypospadias

Question 40

Valium during Cesarean most likely to cause:

Answer 40

Hypoxia

Question 41

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

Answer 41

Methadone

Question 42

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

Answer 42

Prosthetic valve

Question 43

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

Answer 43

CVP

CVP and PWCP do not change significantly in preg

Question 44

D/B+D =

Answer 44

Specificity

Question 45

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

Answer 45

Desired chi-squared result

Question 46

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

Answer 46

Amnio for CMV PCR at 21wks

• Should be done at least 7wks after maternal infection and after 21wks GA

Question 47

Which is usual cause of hemodynamic decompensation with mitral stenosis?

Answer 47

Increased preload

Causes backup into pulmonary

Question 48

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

Answer 48

HSV - usually transmitted intrapartum

Question 49

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

Answer 49

African American

MCV usually <80
Hgb A2 low

Question 50

What should you see in the plane when measuring AC?

Answer 50

Stomach

Question 51

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

Answer 51

75%

Question 52

Most common sign of uterine rupture?

Answer 52

FHR abnormalities

Question 53

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

Answer 53

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

Question 54

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

Answer 54

Preprandial hyperglycemia

Question 55

CVS cannot diagnose which?
- Thalassemia
- NTD

Answer 55

NTD

Question 56

IUGR is most associated with which disease later in life?

Answer 56

HTN

Question 57

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

Answer 57

40%

Question 58

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

Answer 58

Lipid soluble

Question 59

Management of patient with MI who is 35 weeks pregnant

Answer 59

Await spontaneous labor

Question 60

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

Answer 60

Doppler changes

Question 61

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

Answer 61

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)

Question 62

What pO2 = sat of 90%?

Answer 62

60mmHg

Question 63

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

Answer 63

Absent nasal bone (60%)

Cardiac = 50%

Question 64

Components and drug class of combivir

Answer 64

Lamivudine and zidovudine = NRTIs

Question 65

What gives immunotolerance in the placenta?

Answer 65

Variable expression of paternal HLA in the syncytiotrophoblast

Question 66

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

Answer 66

Prolonged PR interval

Question 67

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

Answer 67

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)

Question 68

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

Answer 68

CMV? Killed in pasteurization process

Question 69

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

Answer 69

Thrombocytopenia

Question 70

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

Answer 70

Increased dsDNA

Question 71

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

Answer 71

Homozygous MTHFR

Question 72

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

Answer 72

ACTH stim

Question 73

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

Answer 73

Gonadal cancer

Question 74

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

Answer 74

Lipid solubility

Question 75

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

Answer 75

Hydrothorax

Question 76

In TTTS, which has no improvement in neonatal outcome?

Septostomy
Amnioreduction
Selective laser
Cord ligation

Answer 76

Septostomy

Question 77

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

PE
Sleep apnea

Answer 77

Sleep apnea

Question 78

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

Answer 78

??BOO

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

Question 79

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

HSV
Congenital varicella

Answer 79

Varicella

Question 80

What is different in breast milk than colostrum?

Answer 80

Fat - higher
Glucose - higher
Protein - lower
Immunoglobulins - lower
Lactose - higher

Colostrum has more protein, immunoglobulins; mature milk has more fat, glucose, lactose

Question 81

Terb side effects

Answer 81

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

Question 82

Triploidy - most common composition

Answer 82

Diploid egg, 1 sperm

Question 83

Beta blocker mechanism

Answer 83

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

Question 84

Acrocentric chromosomes

Answer 84

13
14
15
21
22

Can be involved in Roberstonian translocation

Question 85

Myotonic dystrophy - phenotype w/ parental origin

Answer 85

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

Question 86

B cell function in pregnancy

Answer 86

Decreased

Question 87

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

Answer 87

Suppresses function. Competitive inhibition of thyroid hormone synthesis/organification

Question 88

What is most strongly associated with aneuploidy?

Cystic hygroma
Short femur
EIF
Echogenic bowel
Omphalocele

Answer 88

Cystic hygroma (50%)

Question 89

Transmission rate of CMV in pregnancy

Answer 89

30-40% (2nd tri)

Question 90

What is contraindicated in pregnancy?

Influenza vaccine
Intranasal flu vaccine
Amantadine

Answer 90

Intranasal flu vaccine (live virus)

Question 91

The umbilical vein:

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

Answer 91

Has a lower O2 than the uterine vein

Question 92

What hormone is responsible for hyperpigmentation in pregnancy?

Estrogen
Progesterone
Cortisol

Answer 92

Estrogen

Or melanocyte stimulating hormone

Question 93

Severe IUGR at 21wks most likely:

T18
T13
T21
Triploidy

Answer 93

Triploidy

Question 94

Which increases with advanced paternal age

Neurofibromatosis
T21
T18
T13
CF

Answer 94

Neurofibromatosis

Question 95

When is CVS contraindicated?

Kell isoimmunization
Rh disease

Answer 95

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

Question 96

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

T4
T10
C4

Answer 96

T10

Question 97

What drug would you start in a patient with Marfans with aortic root of 4.1 cm?

Beta blocker
Alpha blocker
CCB
Hydralazine

Answer 97

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

Question 98

What is most likely contributing to increased perinatal M&M with diabetes?

Congenital anomalies
Growth discrepancies
Poor glycemic control
Stillbirth

Answer 98

Poor glycemic control

Question 99

In a hypoxic fetus, what physiologically is occurring?

Shunting of blood to adrenals
Shunting of blood to the brain

Answer 99

Shunting of blood to the brain

Question 100

What is true of the fetal hemoglobin oxygenation curve?

Answer 100

Higher sats per PaO2 always

L shift

Question 101

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

AZT
Nevirapine
Kaletra

Answer 101

Nevirapine

In resource-limited settings

Question 102

Most common side effect of Combivir?

Bone marrow suppression
Nausea
Anorexia

Answer 102

Nausea (most common)

Bone marrow suppression also major side effect

Question 103

What is most likely to be persistently absent or abnormal in an acidotic fetus?

Tone
Breathing
Movement
AFI

Answer 103

Breathing

Question 104

What decreases efficacy of OCPs?

Answer 104

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

Question 105

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

Answer 105

Increase in pulmonary arterial pressure

Question 106

What product is used to replace factors V, IX and fibrinogen?

Cryo
FFP
Whole blood

Answer 106

FFP

Question 107

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

Answer 107

Add 15% for nonparametric test (not normally distributed)

Question 108

When studying association between PNV and ovarian cancer, what is the best initial form of study?

Case control
Cohort
RCT
Retrospective chart review

Answer 108

Case control

Question 109

Depo provera has which effects?

Increased triglycerides
Decreased depression
Decreased urinary calcium excretion

Answer 109

Increased triglycerides

Question 110

Beta agonist mechanism of action

Answer 110

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

Question 111

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

CNS
GI
Spine
Limbs

Answer 111

CNS

Question 112

Level for regional anesthesia block for C/S?

Answer 112

T5

Question 113

Most common skeletal dysplasia?

Answer 113

Thanatophoric

No fractures

Question 114

A woman had a baby die of CAH. Most likely cause of death?

Hypoglycemia
Salt wasting dehydration
Hyperkalemia

Answer 114

Salt wasting dehydration

Question 115

Drug most commonly associated w/ microtia?

Answer 115

Accutane

Question 116

Majority of increased prolactin comes from:

Answer 116

Placenta

Question 117

CGH best used to detect:

Aneuploidy
Balanced translocations
Microdeletions

Answer 117

Microdeletions

Comparative genomic hybridization - looks at copy number variants

Question 118

Which most highly correlates with impending fetal death in IUGR?

BPP of 2
UA Dopplers with AEDF

Answer 118

BPP of 2

Question 119

Least likely finding for T21 at 18 weeks on US

Short humerus
Short femur
Double bubble
Increased nuchal fold
Pyelectasis

Answer 119

Double bubble

Usually found >24wks

Question 120

Ductal dependent fetal lesions

Answer 120

TGA, TOF, Coarc, HLHS, Ebstein’s, AS, PS/PA, tricuspid atresia

NOT ductal dependent - VSD, balanced AV canal, ASD

Question 121

What bacterial enzyme is responsible for preterm labor?

Prostaglandin synthase
Prostaglandin dehydrogenase
MMP
Phospholipase (or lipoxygenase) A2

Answer 121

Phospholipase (or lipoxygenase) A2

Question 122

Child w/ DiGeorge most likely has decreased:

T cells
B cells

Answer 122

T cells

(hypoplastic thymus)

Question 123

What are the borders of the pelvic inlet?

Answer 123

Sacral promontory, arcuate line, superior aspect of pubis

Question 124

Main pelvic floor support

Answer 124

Levator ani

Question 125

Statistical test to measure difference in variation between survival curves?

Cox regression
Kaplan Meier

Answer 125

Cox regression

Question 126

Treacher Collins affects which facial feature

Mandible
Maxilla

Answer 126

Mandible

Question 127

Lab findings in primary adrenal insufficiency?

Answer 127

Elevated ACTH

Question 128

Normal EKG changes in pregnancy:

Answer 128

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

Question 129

In which lesion is spinal most contraindicated?

Aortic stenosis
Pulmonary hypertension
Mitral stenosis
Pulmonic stenosis

Answer 129

PHTN

Question 130

Which mode of inheritance affected by penetrance, expressivity?

AR
AD
X

Answer 130

AD

Question 131

Which antibiotic has big salt load?

Answer 131

Zosyn

Question 132

When is cardiac output the greatest?

Immediately postpartum
Third trimester
Early labor
Second stage labor
Second trimester

Answer 132

Immediately postpartum

Question 133

Which class of anti-depressants has the least maternal/fetal adverse profile?

MAOI
Dopamine reuptake inhibitors
TCAs
SSRIs

Answer 133

SSRIs

Question 134

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

Syphilis
Gonorrhea

Answer 134

Gonorrhea

Question 135

Metformin mechanism

Answer 135

AMP activated protein kinase

Question 136

Which changes the least in pregnancy?

Heart rate
CO
SVR
Mean arterial pressure

Answer 136

MAP

Question 137

30 weeks with proteinuria, hematuria and edema. Most likely:

Minimal change dz
PreE
Glomerulonephritis

Answer 137

Glomerulonephritis?

Question 138

Which allows you to see the contribution of each variable to the outcome?

T-test
Logistic regression
Chi sqaure
ANOVA

Answer 138

Logistic regression

Question 139

Best immediate tx for thyroid storm?

Iodine
Methimazole
Propranolol
Radioablation

Answer 139

Methimazole

Question 140

Worst thrombophilia?

FVL
ATIII
Prothrombin
MTHFR

Answer 140

ATIII

Question 141

Mom had prior kid with severe thrombocytopenia. Next best step?

Paternal platelet antigen
Maternal IVIG
Prednisone
CVS for fetal platelet type

Answer 141

Paternal platelet antigen

Question 142

Protective anastamosis in monochorionic twins

AV
VV
AA

Answer 142

AA

Question 143

Treatment for steroid resistant lupus

Azathioprine
Cyclosporine
Hydroxychloroquine
Cyclophosphamide

Answer 143

Hydroxychloroquine

Question 144

Most common finding in non-cardiogenic pulmonary edema?

Answer 144

Normal PCWP

Question 145

Most common reason for Prader Willi?

Maternal uniparental disomy
Paternal deletion

Answer 145

Paternal deletion (70%)

But can be caused by maternal UPD

Question 146

Low estriol most a/w:

Placental sulfatase deficiency
Fetal death

Answer 146

Placental sulfatase deficiency (ichthyosis)

Question 147

Mechanism of LMWH

Answer 147

Binds to antithrombin to form complex to inhibit factor Xa

Question 148

Fetal myotonic dystrophy a/w all except

Talipes
Polyhydramnios
Hypotonia
IUGR

Answer 148

IUGR

Question 149

Most likely side effect of local anesthetic toxicity?

Seizures
Tinnitus
Hypotension

Answer 149

Tinnitus

Question 150

Injection of local anesthesia 🡪 seizure. First step:

Magnesium
Succinylcholine
Diazepam
Nifedipine

Answer 150

Diazepam

Question 151

How is IHSS inherited?

Answer 151

AD

Question 152

Most likely maternal complication of malaria?

Answer 152

Anemia

Question 153

Roux en Y least likely to have what deficiency?

Folate
B12
Vitamin K
Vitamin D

Answer 153

Vitamin K

Question 154

What is not a presentation of AFE?

Hypotension
Dyspnea
Seizures

Answer 154

Seizures

Question 155

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

Kaletra
Nevirapine

Answer 155

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

Question 156

Best predictor for preE recurrence in patient with prior early onset preE?

APLAS
FVL
GA at recurrence

Answer 156

GA at recurrence

Question 157

Don’t give OCPs to:

Answer 157

ATIII

Hepatic adenoma

Question 158

MAI (mycobacterium avium) prophylaxis

Answer 158

Azithromycin

Question 159

PCP pneumonia treatment

Answer 159

Bactrim
- Also use for ppx

Question 160

Anti-inflammatory cytokine

IL-10
IL-1
TNF alpha

Answer 160

IL-10

Question 161

Mom with pulmonic stenosis. Most common problem?

RV hypertrophy
Arrhythmias

Answer 161

RV hypertrophy

Question 162

What is the most common problem with MVP?

Arrhythmia
LV hypertrophy

Answer 162

Arrhythmia

Question 163

What makes mitral stenosis worse?

Increased preload
Increased SVR
Increased afterload

Answer 163

Increased preload

Question 164

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

Answer 164

Sildenafil

Question 165

Aortic stenosis – what is worst for this condition?

Caval compression
Increased afterload
Bradycardia

Answer 165

Caval compression (decreased preload/hypovolemia)

Question 166

Which lesion is worst for fetal oxygenation?

ASD
VSD
Pulmonary hypertension

Answer 166

PHTN

Question 167

What is not associated with IUFD?

Toxo
Listeria
Syphilis
CMV

Answer 167

CMV?

Listeria - 50%
Syphilis - 21%

Question 168

Plasmapheresis for which maternal disease?

TTP
Guillain Barre

Answer 168

TTP

Question 169

Neonatal circumcision bleeding

XIII
XI
V
Prothrombin
MTHFR

Answer 169

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.

Question 170

Neonatal circumcision bleeding

Factor VII
Factor IX
Factor XI
Factor XII

Answer 170

Factor IX

Question 171

Which is least likely to cause hyperbilirubinemia in infant?

AB-
B-
A-
O-

Answer 171

If fetal = O-
If maternal = AB-

Question 172

Most important function of IRB?

Answer 172

Protect best interest of patient

Question 173

Ethical principles in clinical research

Answer 173

Autonomy, beneficence, nonmaleficence, justice

Question 174

Odds ratio calculation

Answer 174

(#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

Question 175

Inhaled anesthetics like halothane for:

Amnesia
Analgesia
Uterine relaxation
Maintain normotension

Answer 175

Amnesia

Question 176

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

Answer 176

Justice

Question 177

Which principle is behind a patient requesting an elective CD?

Answer 177

Autonomy

Question 178

Which ethical principle is behind health care reform?

Answer 178

Justice

Question 179

Best product to replace factors V, VII, XII?

Factor V concentrate
FFP
PRBCs
vWF

Answer 179

FFP

Question 180

What can be calculated in a case-control study?

Answer 180

OR

Question 181

Major problem w/ RCTs

Answer 181

Generalizability

Question 182

Major problem with cohort study?

Confounders
Selection bias
Recall bias

Answer 182

Confounders

Question 183

Metabolic deficiency in Fanconi Anemia

Answer 183

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.

Question 184

ROC best shows:

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

Answer 184

Relationship between sensitivity and specificity

Question 185

How to treat pheochromocytoma:

B blocker
A blocker
Hydralazine

Answer 185

A blocker

Question 186

Highest O2 sat in the following vessels

Ductus – which one?
LA
Umbilical artery

Answer 186

DV

Then LA, then DA, then umb art

Question 187

Increasing at the end of gestation:

Ventricular compliance
SVR

Answer 187

SVR

Question 188

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

Answer 188

Normal

Mosaic - most likely confined placental mosaicism

Question 189

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

Answer 189

Balanced translocation of 14/21

Question 190

Depo provera a/w the most

Elevated lipids/triglycerides
Depression
VTE
Decreased breast milk

Answer 190

Elevated lipids/triglycerides

Question 191

Best med for flu

Answer 191

Oseltamivir

Question 192

Least associated with adaptive immunity

T cell
B cell
Cytokine
Monocyte

Answer 192

Cytokine

Question 193

Innate immunity least associated with

Neutrophils
Monocytes
Macrophages
T cells

Answer 193

T cells

Question 194

Hodgkin’s lymphoma in pregnancy at 18 weeks

Radiation
Chemo
Chemo/rads
No treatment

Answer 194

Chemo

Question 195

Most teratogenic

Cyclosporine
Carbemazepine
Azathioprine

Answer 195

Carbemazepine

Question 196

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

Answer 196

Cox regression

Question 197

What increases sample size to maintain power?

Log transformation
Nonparametric test
Alpha level
Beta level

Answer 197

Nonparametric test

Question 198

Normal size parents with recurrent achondroplastic kid

Reduced penetrance
Reduced expressivity
Gonadal mosaicism
New mutation

Answer 198

Gonadal mosaicism

Question 199

Most common associated with cystic hygroma:

Cardiac
T21
T18
T13
Triploidy
XXY

Answer 199

T21 (more common than 45 XO)

Question 200

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

Normal
Cardiac defect

Answer 200

Normal

Question 201

Which is least likely to be transmitted?

Answer 201

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

Question 202

Which is least likely to be associated with IUGR?

Parvo
CMV
Rubella
Varicella
Toxo

Answer 202

Parvo

Question 203

Most common cause of hep B in the world?

Blood transfusion
Sexual contact
Vertical transmission
Needles

Answer 203

Vertical transmission

Question 204

LCHAD homozygous associated with:

Fatty liver
PreE

Answer 204

Fatty liver

LCHAD deficiency - inability to metabolize long-chain fatty acids

Fetal LCHAD homozygotes highly a/w maternal AFLP

Question 205

What is maternal blood directly exposed to?

Maternal endothelial cell
Placental endothelial cell
Syncytiotrophoblast
Cytotrophoblast

Answer 205

Syncytiotrophoblast

Question 206

ACEi teratology

Answer 206

Cardiac

Question 207

What least likely decreases placental transport?

Ionization
Lipid solubility
Protein binding
Placental degradation

Answer 207

Lipid solubility

Question 208

What is associated with DiGeorge syndrome?

Answer 208

Thymus aplasia

Question 209

Maternal mortality highest with:

Varicella
H1N1
Seasonal flu
Leptospirosis

Answer 209

Varicella

Question 210

When is asthma likely exacerbated?

1st trimester
2nd trimester
36-40 weeks
Intrapartum
Postpartum

Answer 210

2nd trimester

Question 211

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

Answer 211

Early sepsis
- Low SVR, high CO

Question 212

Ashkenazi Jewish

Gaucher
Familial dysautonomia
CF
Huntingtons

Answer 212

Familial dysautonomia

Question 213

Maternal PKU a/w fetal:

Epiphyseal abnormalities/limb reduction
V shape brow
Cardiac
Renal agenesis

Answer 213

Cardiac

Question 214

S/D ratio decreases with fetal:

Age
Bradycardia
IUGR
Hypoplastic L heart

Answer 214

Age

Question 215

Stages of TTTS

Answer 215

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

Question 216

Medication contraindicated in breast feeding:

Cyclosporine
PTU
Warfarin
Dilantin

Answer 216

Cyclosporine

Question 217

Leading cause of PVL

Answer 217

Chorioamnionitis

Question 218

Leading cause of neonatal chorioretinitis?

CMV
Rubella
Syphilis

Answer 218

CMV

Question 219

Highest pO2 in fetus?

IVC
Ductus arteriosus
Right ventricle
Descending aorta

Answer 219

IVC

Question 220

Highest failure rate of glyburide

Obesity
Fasting Glucose >115

Answer 220

Fasting Glucose >115

Question 221

A1C of 12.5%

NTD
Caudal regression
Transposition
Gastroschisis

Answer 221

Transposition

Question 222

Moderate pulm stenosis in pregnancy most a/w:

RVH
Normal pregnancy and delivery
Syncope

Answer 222

Normal pregnancy and delivery

Question 223

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

Lactic acid
Beta hydroxybuterate

Answer 223

Beta hydroxybuterate

Question 224

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

Answer 224

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

Question 225

Medication used for primary pulmonary hypertension

Answer 225

Sildenafil (Viagra)

Question 226

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

Answer 226

Decreased release of thyroxine

Question 227

Most likely outcome with AFP 1.01; hCG 1.23; uE3 0.11

T21
NTD
X-linked ichthiosis
T18

Answer 227

X-linked ichthyosis

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

Question 228

Duration of action of lantus in non-preggo

0-4h
4-8
8-12
18-24

Answer 228

18-24h

Question 229

Fetal regulation of LH

Answer 229

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

Question 230

In asthmatic with respiratory rate of 30, what is worst predictor of her condition?

pH 7.4
HCO3 22
pO2 100
pCO2 40

Answer 230

pCO2 40 worst prognosis

Question 231

Worst prognosis for CPAM lesion

Size
Solid
Dextrocardia
Hydrops

Answer 231

Hydrops

Question 232

Worst prognosis for CDH:

Liver up
Size of defect
Contralateral lung tissue
Ipsilateral lung tissue

Answer 232

Liver up

Question 233

Most common cause of death from regional anesthesia in CD

Answer 233

Local anesthetic toxicity

Question 234

Most likely reason for false positive KB?

Answer 234

Answer unclear but likely sickle cell anemia due to HgbF

Question 235

Which bug is least affected by cephalosporins?

E. coli
Enterococcus
GAS
GBS

Answer 235

Enterococcus

Question 236

MS exacerbation most common:

1st trimester
2nd trimester
3rd trimester
Intrapartum
Postpartum

Answer 236

Postpartum

Question 237

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

Answer 237

Using nonparametric data (need 15% more)

Question 238

What do you not need to calculate power?

Coefficient of variance
SD
Alpha
Beta

Answer 238

Coefficient of variance

Question 239

Which one is always less than the standard deviation?

Coefficient of variance
Standard error of the mean
Variance (SD squared)

Answer 239

Standard error of the mean

Question 240

Patient can’t stand after delivery:

Obturator
Sciatic
Peroneal
Femoral

Answer 240

Femoral

Question 241

Patient unable to adduct leg after labor:

Obturator
Sciatic
Peroneal
Femoral

Answer 241

Obturator

Question 242

Which is in the innate immune system?

T cells
B cells
Monocyte
Macrophage

Answer 242

Macrophage

Question 243

Best contraception for PE:

Micronor
Mirena
OCPs
Male condom
Female condom

Answer 243

Mirena

Question 244

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

Spinal
Epidural
Parenteral

Answer 244

Epidural

Question 245

Which is the preferred method of diagnosing PE

VQ
Spiral CT
MR of chest
Echo

Answer 245

Spiral CT

Question 246

Reason for increased DVT on left

Crossing of left iliac vein by left iliac artery
Crossing of left iliac vein by right iliac artery

Answer 246

Crossing of left iliac vein by right iliac artery

Question 247

Worst prognostic factor with acute asthma exacerbation?

Decreased pO2
Increased pCO2
Decreased peak flow
Wheezing

Answer 247

Increased pCO2

Question 248

What is the most actively produced hormone during pregnancy?

Progesterone
Estriol
DHEAS

Answer 248

Progesterone

Question 249

What is the most important in determining fetal hydantoin syndrome?

Dose
Genetic heterogeneity
Other medications

Answer 249

Genetic heterogeneity

Question 250

Microtia is most associated with:

Fetal alcohol syndrome
Warfarin
Isotretinoin
Hydantoin

Answer 250

Isotretinoin

Question 251

Most associated with IUGR:

Propranolol
Nifedipine
Metoprolol
Lasix

Answer 251

Propranolol

Question 252

Best medicine for intermittent angina in patient with hypertrophic cardiomyopathy:

Nifedipine
Lasix
Propranolol
Nitroglycerin

Answer 252

Propranolol

Question 253

Spinal anesthesia is worst with:

Mitral regurg
Mitral stenosis
Pulmonary hypertension
Coarctation
Hypertrophic cardiomyopathy

Answer 253

PHTN

Question 254

Least helpful in treating vWF:

DDAVP
Humate-P
Platelets
Recombinant vWF
Cryo

Answer 254

Platelets

Question 255

Most appropriate candidate for combined OCPs:

ATIII
Protein C
Protein S
Factor V Leiden
Anticardiolipin

Answer 255

FVL

Question 256

Least likely to pick up IUGR on ultrasound in a patient with:

Hyperthyroidism
Hemoglobin SC
HIV
Elevated AFP

Answer 256

Hemoglobin SC

Question 257

Who is most likely to need 1 mg folic acid during pregnancy

Sickle cell anemia
2nd pregnancy in 1 year

Answer 257

Sickle cell

Question 258

Effects of betamethasone

Decreased movement
Decreased breathing
Decreased variability

Answer 258

Decreased breathing

Question 259

Most correlated with fetal acidosis

Decreased heart rate reactivity
Fetal breathing
Fetal movement
Fetal tone
Decreased AFI

Answer 259

Fetal tone

• True lack of tone a/w highest perinatal death rate

Question 260

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

Eclampsia
Cerebral venous thrombosis

Answer 260

Eclampsia

Question 261

Mechanism of spinal headache?

Maternal hypovolemia
Cerebral Vasoconstriction
Tension of pain sensing neural fibers
Early ambulation

Answer 261

Tension of pain sensing neural fibers

Question 262

Medroxyprogesterone acetate postpartum most associated with?

Elevated triglycerides/LDL
Thromboembolism
Decreased milk production
Depression

Answer 262

Elevated triglycerides/LDL

Question 263

Maternal hyperparathyroidism. Least associated?

Hypercalcemia
HTN
Fetal intracranial calcification
Neonatal hypocalcemia

Answer 263

Fetal intracranial calcification

Question 264

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?

Answer 264

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

Question 265

Source of maternal GnRH

Decidua
Chorion
Amnion
Endometrium
Maternal pituitary

Answer 265

Chorion (placenta produces GnRH as well as pituitary)

Question 266

Best test to follow patient on PTU

Total T4
TSH
TRH
Total T3
Free T4

Answer 266

Free T4

Question 267

Which diabetic med has least transfer across placenta?

Glyburide
Glypizide
Metformin
Tobua—

Answer 267

Glyburide

Question 268

Which antibiotic has minimal transfer across placenta secondary to albumin binding?

Erythromycin
Sulfa
Gentamicin
Ancef
Ampicillin

Answer 268

Erythromycin

Question 269

Hormone most affected by uterine blood flow?

Estriol
Estrone
Estradiol
Progesterone
DHEAS

Answer 269

Estradiol - increases uterine blood flow

Question 270

Fetal enzyme most responsible for the breakdown of maternal glucocorticoids

Answer 270

Placental 11 beta hydroxysteroid dehydrogenase
- Breaks down cortisol

Question 271

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

Answer 271

Amnio with PCR at 23 weeks

Question 272

Appropriate f/u for bilateral renal pelvis of 9 mm at 30 weeks

Weekly AFI
Amniocentesis
Repeat US in 4 weeks
Neonatal renal ultrasound

Answer 272

Repeat US in 4 weeks

Question 273

Highest sensitivity at 20 week ultrasound for Down Syndrome?

Short 5th digit
Short humerus
Echogenic bowel
Short femur
Pyelectasis

Answer 273

Echogenic bowel

Question 274

HIE is most associated with:

Chorio
Demise of one monochorionic twin
Prematurity <28 weeks
pH=7.0

Answer 274

Chorio

Question 275

Which is most associated with preterm birth?

Cervical index >50 (funnel length/cervical length)
CL <15 mm
Sludge
Funneling

Answer 275

CL <15 mm

Question 276

If you have a high spinal, the effect on the cervical branches is:

Paresthesia of the chest
Dyspnea

Answer 276

Dyspnea

Question 277

In which disease is amniotic PCR least helpful?

ITP
Alloimmune thrombocytopenia
Rh disease
Toxo
CMV

Answer 277

ITP

Question 278

Most likely complication with C hyst

Cystotomy
Fistula
Ureteral injury
Pelvic abscess

Answer 278

Cystotomy

Question 279

Which is most predictive of TTTS?

Fluid
Weight
Dopplers
MCA

Answer 279

Fluid

Question 280

Least likely seen with A1C >12?

Skeletal
Cardiac
Renal
Gastroschisis
Sacral agenesis

Answer 280

Gastroschisis

Question 281

Single umbilical artery is most commonly associated with?

VSD
Omphalocele
Hydrocephalus

Answer 281

VSD

Question 282

How to differentiate HELLP from acute fatty liver?

Thrombocytopenia
LDH
Glucose

Answer 282

Glucose

Question 283

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

Answer 283

PDA

Question 284

What fetal vessel has the highest pO2?

Umbilical artery
Fetal femoral vein
Fetal pulmonary artery
Fetal pulmonary vein
Right carotid artery

Answer 284

Right carotid artery

Question 285

At 4 weeks, most likely adverse outcome of >5 rads exposure

Childhood leukemia
Microcephaly
IUGR
SAB

Answer 285

SAB

Question 286

In genetic counseling for teratogen risk, which is most important?

Drug dose
Other drugs
Timing of drug

Answer 286

Timing of drug

Question 287

Which is the worst malaria to get?

Plasmodia malariae
Plasmodia ovale
Plasmodium falciparum
Plasmodium vivax

Answer 287

Plasmodium falciparum

Question 288

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

CMV
Hep B

Answer 288

CMV

Question 289

On ultrasound, micromelia and hypocalcification of skull is noted. Which is least likely?

OI
Achondroplasia
Hypophosphatasia
Thanatophoric dysplasia

Answer 289

Achondroplasia

Question 290

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

Answer 290

Auscultation each visit

Question 291

Most common complication from pyelo

Anemia
Gram neg sepsis
ARDS
PTL
Increased creatinine

Answer 291

Anemia

Question 292

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

Answer 292

Increased total peripheral resistance
(vasoconstriction)

Question 293

In a term preeclamptic, what is the least likely?

Elevated BUN
Elevated Creatinine
Decreased GFR
Decreased tubular secretion
Decreased renal plasma flow

Answer 293

Decreased tubular secretion

Question 294

Where is prostaglandin dehydrogenase found?

Amnion
Chorion
Fetal pituitary
Cervix

Answer 294

Chorion

Question 295

Which is likely to become clinically apparent for the first time in pregnancy?

Sickle cell anemia
Alpha thal
Beta thal
Hemoglobin SC

Answer 295

Hgb SC

Question 296

What is the most reliable ultrasound criteria for dating?

HC
BPD
AC
FL

Answer 296

HC

Question 297

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

Answer 297

Stimulating fetal genital development

Question 298

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

Answer 298

Maternal incompetence

Question 299

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

Answer 299

47 XY, +15

(6, 7, 11, 14, 15, 20)

Question 300

Calculate the gene frequency if the homozygous state of the gene is 1/6400

1/20
1/40
1/80
1/160

Answer 300

p2 + q2 + 2pq = 1
p+q=1

p = allele frequency
2pq = heterozygotes

p2 = 1/6400
p = 1/80

Question 301

Which of these lab values changes in pregnancy?

Protein C
Protein S
APC resistance
PTT

Answer 301

Protein S

Question 302

Which test is not suggestive of APLAS?

Prolonged PT
Positive dRVVT
Kaolin clotting time
Abnormal aPTT

Answer 302

Prolonged PT

Question 303

Which blood product is best for replacement of factors IX and X?

Whole blood
Cryo
Platelets
FFP

Answer 303

FFP

Question 304

Which organism is the most common cause of RLL pneumonia in pregnancy?

H. flu
M. pneumoniae
S. pneumoniae
Varicella

Answer 304

S. pneumoniae

Question 305

Which is not associated with Meckel-Gruber?

Polyhydramnios
Encephalocele
Cystic dysplasia of kidneys
Polydactyly

Answer 305

Polyhydramnios

Question 306

A patient is sent at 22 weeks with absent radii bilaterally, hydronephrosis and severe IUGR. Most likely dx?

TAR
Carbamazepine exposure
VACTERL
Holt-Oram

Answer 306

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