Practice Questions - Large Doc (397- Flashcards by Emily Zantow

Most frequent fetal tracing in women performing moderate exercise:

Modest increase in HR
Maximal exercise can cause bradycardia

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AFP synthesis

AFP = Glycoprotein, made by fetal yolk sac, later by GI tract and liver

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Abnormalities w/ T13

Brain (hydrocephalus)
Facial
Polydactyly
Renal
Omphalocele
Clubfeet
Most common chromosome anomaly a/w holoprosencephaly

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Why is general anesthesia more rapid in pregnant women?

Concentration increases due to decreased FRC and RV.

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Local anesthetic w/ greatest cardiotoxicity

Bupivicaine
95% protein bound, hard to reverse

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Dx and treatment of CAH

21-hydroxylase deficiency, CYP21A2 gene (chrom 6)
Lack 11 deoxycortisol and cortisol
Excess ACTH stimulates adrenal precursors like 17OHP
Dx made by CVS, DNA probes, deletions detected w/ genomic blot hybridization
Female fetus at risk for virilization
- Decrease risk w/ dexamethasone 20mcg/kg, need to start prior to 9wks b/c it can happen very early (4-9wks)
- 2/3 treated females need postnatal reconstruction

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Ppx in HIV based on CD4

<200 - PCP ppx w/ bactrim
<100 - Toxo ppx w/ bactrim
<50 - MAC ppx w/ azithro

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How much does 1 unit of FFP increase fibrinogen?
What factors is it exclusively a source of?

Increases fib by 10mg/dl/unit
Only source of factors V, XI, and XII

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Terbutaline mech of action

Acts through adenylate cyclase to increase cAMP, which inhibits MLCK by phosphorylation
- Key process in contraction (actin-myosin interaction)
Increased cAMP decreases intracellular free calcium

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Uterine contraction - cell signaling

Increased intracellular calcium activates calcium-calmodulin dependent myosin light chain kinase (MLCK)
MLCK phosphorylates myosin, initiating contraction in smooth muscle

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Effect on Apgar by anesthesia

1min affected, 5min not

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Timing of PVL

2wks to develop, as long as 104 days after initial insult

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FSH/LH levels in pregnancy

Decreased/undetectable - due to feedback inhibition from estrogen/inhibin

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Proper US transducer

Standard - 3.5MHz
Higher frequency, better resolution, shallower depth of penetration
- TVUS 5MHz
Use higher frequency earlier in pregnancy
If obese or term, may need lower frequency transducer

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Vitamin K in neonates - why is it needed

Vit K doesn’t cross placenta well
IM better than oral (doesn’t prevent later hemorrhage 4-6wks)
Babies born to moms on anticonvulsants at highest risk of hemorhage

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Eisenmenger’s

Most common cause - large VSD
Labor, delivery, PP - most dangerous
Any significant fall in venous return impairs ability of R heart to pump blood through high, fixed pulm resistance

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Mycoplasma hominis - what can it cause?

Endometritis, BV

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Teratogenicity of dilantin is a/w what enzyme?

Epoxide hydrolase
- Fetal enzyme activity weak, so they accumulate

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Most common cause of cancer following in utero exposure

Hepatitis B

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Most rapid method for uterine relaxation following uterine inversion

Terb
Mag
Then general anesthesia

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What infection in pregnancy can be diagnosed with serologic markers?

Toxo
CMV
Chlamydia
HSV
Mycoplasma

Toxo - IgM positive after 7d and lasts 1 yr

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Omphalocele associations

Associated malformations in 2/3
25% have aneuploidy or syndrome
T18 - most common aneuploidy
Cardiac defects common
Beckwith Wiedemann

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Amino acid concentrations in fetus

Higher than maternal (decrease)
Acidic AA (aspartate and glutamate) don’t cross placenta - fetus makes them

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HPV treatment

TCA (trichloroacetic acid)
Laser/cryoablation

5FU, imiquimod, interferon contraindicated in pregnancy

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SVT most common mechanism

Reentry

Fetal bradycardia

Not ominous if response to movement, if structurally normal

Complete heart block

Bad prognosis if hydrops, malformation, or ventricular escape rates <55

Adverse maternal effects of steroids

Multiple fluid and lyte abn Osteoporosis Peptic ulcer Mental disturbances

Things a/w low AFP

Obesity, GDM, T21, T18 Smoking increases levels Black race - 10-15% higher

Most common complication of polycystic kidney disease

BP increase Then PTD

Hepatitis B serology - 1st element elevated - Can remain elevated after infection - Elevated during clinical sx

HBsAg HBeAg, also anti-core IgG Anti-core IgM

A1c rate of malformation

22% if >8.5

AEDF risk of perinatal mortality

Absent - 10% Reversed - 30% If a/w IUGR, can be due to aneuploidy Normal <15wks

Increased Doppler S/D

Closer to placenta is decreased - lower impedance - Dopplers are worse on the fetal end Increased FHR - can shorten or lengthen diastole resulting in less or more time for runoff affecting both S and D velocities

Mechanism of prostaglandin E2

Histologic changes involving dissolution of collagen bundles and increase in submucosal water content

What is associated with increased transmission to the fetus in HIV positive women? CD4 count Viral load CD HAART tx

Viral load

What is a complication of combivir?

Anemia

Which syndrome is associated with macrosomia? BW Meckel gruber Trisomy 21 Polyploidy

Beckwith Wiedemann

Heart defect with increased transmission to the fetus ASD Tetralogy IHSS (Idiopathic hypertrophic subaortic stenosis) Coarctation

IHSS - autosomal dominant Recurrence of: AS - 13-18% VSD - 6-10% TOF - 3-4% Coarc - 4% AVSD - 2-6%

Maternal heart defect with lowest incidence of mortality? Corrected tetralogy Artificial heart valve Eisenmenger’s

Corrected tetralogy

Which B cell disease gets worse in pregnancy? Graves Myasthenia gravis SLE

SLE

Which chromosomal abnormality is not increased in offspring of AMA women? Down syndrome Kleinfelter’s Turner’s syndrome Edward’s syndrome

Turners

Risk of disease in population is 1/6400. What is carrier state? 1/20 1/40 1/80 1/100

p2 = 1/6400 p = 1/80 q = 79/80 2pq = 79/6400x2 = 158/6400 = 79/3200 ~1/40

GnRH is made where?

Cytotrophoblast of chorion

Which test should be used if one compares outcome before and after treatment? Paired t test Chi square Mann Whitney U ROC curve

Paired t test Ex - pre-test and post-test score w/ intervention administered in between Compares means of 2 measurements taken from same individual, object, or related units

Insulin affects growth in all tissues except: Brain Fat Liver Muscle

Brain

In patient with known parvo exposure (+ IgM), what is the best management if a small pericardial effusion is noted in the fetus? Cordocentesis with transfusion Amniocentesis for delta OD Ultrasound observation Repeat maternal IgM levels

Ultrasound observation

What is the precursor of fetal adrenal steroids? LDL Amino acids Glutathione Vitamin D

LDL

What is the effect of the mini pill on the endometrial lining? Increased stroma and glands Decidualization Increased blood loss during menses Thin cervical mucous

Decidualization

The rapid GBS test is not used in practice because of: Poor sensitivity Low prevalence of GBS Null hypothesis Racial differences

Poor sensitivity

What best describes the physician patient relationship? Autonomy Fiduciary Beneficence Non malfeasance

Fiduciary Patients, implicitly or explicitly, allocate on clinicians discretion to act on patients' behalf with respect to their health

These drugs should not be used in patients with myasthenia except: Curare (alkaloid arrow poison from plants, causes weakness of muscles) Mestinon Magnesium Gentamicin

Mestinon (pyridostigmine) - Used to treat myasthenia - inhibits acetylcholinesterase and increases conc of ACh at the NMJ Curare (alkaloid arrow poison from plants, causes weakness of muscles)

How does magnesium affect myasthenia gravis?

Inhibits release of acetylcholine

Myasthenia gravis mechanism

Autoimmune Antibodies form against nicotinic acetylcholine (ACh) postsynaptic receptors at the neuromuscular junction (NMJ) of the skeletal muscles, causing muscle weakness and rapid muscle fatigue

Which derm condition is associated with bullae on external surfaces of arms, pruritis with deposition of compliment on the basement membrane? Herpes gestationis Hereditary angioedema Erythema multiforme PUPPS

Herpes gestationis - AKA pemphigoid gestationis

What drug causes hypothermia in the newborn?

Valium

Which organism is most associated with preterm birth? Ureaplasma BV GBS Chlamydia

Ureaplasma

What drug should be used to treat resistant/refractory V tach in the mother? Adenosine Quinidine Capsaicin Lidocaine

Lidocaine Can also use amiodarone

Which is not a sign of BV? positive whiff test pH <4.5 Thin, homogenous discharge >20% clue cells

pH <4.5 - pH GREATER than 4.5 in BV

GBS is most resistant to: PCN Clinda Erythromycin Bactrim

Bactrim? not used for GBS Next would be erythromycin

Which enzyme is theoretically deficient in fetuses who manifest birth defects d/t antiepileptic drugs?

Epoxide hydrolase

What complication is associated with exteriorization of the uterus? Air embolism Uterine atony Patent foramen ovale

Air embolism

What are the risks in the mother who gave birth to a 22 week stillbirth and has positive ACA and LA? Hyperemesis B-12 deficiency Thrombosis Berry aneurysm

Thrombosis

Which vaccine is contraindicated in pregnancy? Influenza Rabies Varicella Cholera

Varicella

What is associated with fetal abdominal calcifications? EBV CMV Parvo Turner

CMV

Which syndrome is a/w fetal thrombocytopenia? Absent radii syndrome Gestational thrombocytopenia Erythroblastosis fetalis Bernard-Soulier syndrome

Absent radii syndrome - Called thrombocytopenia-absent radius syndrome (TAR) Bernard- Soulier - AR, giant platelets and bleeding, can cause mild TCP but in children

What is the precursor of deoxycorticosterone? Aldosterone DHEAS Progesterone

Progesterone

What is the #1 cause of malformations? Radiation Infection Genetics Medication

Genetics

What is the treatment of 21 OH deficiency in the female fetus? Cortisone acetate Diestryl acetate Dexamethasone Aldosterone

Dexamethasone Maternal CAH does not lead to virilization of fetus (due to powerful aromatization capabilities of placenta) Fetal inheritance of CAH can cause virilization of a female fetus

What causes virilization of a female fetus? Luteoma of pregnancy Cystadenoma Prolactinoma Oral contraceptives

Luteoma of pregnancy - Benign neoplasm of ovary - Can present w/ virilization of mother or infant - 1/3 of women affected, 3/4 of these w/ female fetuses will be affected - Spontaneously regress PP - Causes increased progesterone, testosterone

PO2 in the umbilical vein approaches that of the: Middle cerebral artery Uterine vein Uterine artery Radial artery

Uterine vein

In which disorder is IgG contraindicated? Recurrent pregnancy loss Myasthenia gravis ITP Rheumatoid arthritis

Unknown - can be used in all RPL - recent studies

Risk of neonatal infection with SVD in a woman with recurrent vulvar herpes lesion 50% 1% 100% 0%

Gaucher’s disease is a disorder of: Aspartoacylase Hexose aminidase A Glucocerebrosidase

Glucocerebrosidase

What lab value is seen with preeclampsia? Decreased urine calcium Decreased cellular fibronectin Decreased thromboxane

Decreased urine calcium

What type of inheritance is associated with Leber’s optic atrophy? AR AD X-linked Mitochondrial

Mitochondrial Leber Hereditary Optic Neuropathy (LHON) is the most common inherited mitochondrial disorder and typically affects young males - Progressive visual loss due to optic neuropathy

Which disorder is associated with uniparental disomy? William’s syndrome Cri du chat Hydantoin syndrome Prader-Willi

Prader-Willi

Diseases associated with DNA repeats include all except: Fragile X Huntington’s Myotonic dystrophy CF

CF Fragile X - CGG - 55-200 premutation, >200 symptomatic Huntingtons - CAG - Autosomal dominant - >40 will be affected, risk to offspring 50% MD - CTG - AD - 38-49 premutation, >50 symptomatic

HIV is… DNA virus Prion RNA retrovirus Mad cow disease

RNA retrovirus

An Apgar of < 3 is associated with this risk of CP: 5% 15% 50% 100%

15% I think

NTDs are usually: Due to single gene defects Caused by teratogens Multifactorial in nature Associated with aneuploidy

Multifactorial in nature

A normal appearing woman has a homozygous 21/21 translocation. What % of her offspring will have Down syndrome?

50% of conceptuses 100% of live births Monosomy 21 incompatible with life

A normal appearing woman has a homozygous 21/21 translocation. What % of her conceptuses will be monosomy 21?

50% Lethal diagnosis

The most important predisposing risk factor for macrosomia is: GA >40w Previous macrosomia Maternal smoking Male fetus

Previous macrosomia

The byproduct of carbohydrate metabolism is: CO2 H20 NH3 Lactic acid

Lactic acid

What decreases in pregnancy? Factor VI Factor V Factor XIII

Factor XIII

Which local anesthetic causes neurologic toxicity?

Chloroprocaine

Which local anesthetic causes psychiatric side effects?

Lidocaine

Which alk phos is produced by the placenta? Heat labile Heat stable

Heat stable

What hepatitis is associated with the greatest amount of chronic disease? Hep B Hep A Hep E Hep C

Hep B - More people worldwide living with HepB - 5-10% of adults develop chronic infection - 90% of infants infected at birth develop chronic infection Hep C more likely to develop into chronic (75-80%)

Which fetal urine electrolyte predicts a good response after bladder shunt placement in a fetus with PUV? Na >100 Chloride >90 Osmolality <210 Urine output <2cc/hr

Osmolality <210 Poor renal function is indicated if urine sodium >100, osmolality >200

Which drugs should not be used in women who could get pregnant?

Acitrefin or etretinate (psoriasis drugs): last forever; don’t get pregnant for 3 years

Scalp pH represents pH of fetal: Arterial blood Venous blood Amniotic fluid

Arterial blood

Normal amount of amniotic fluid at 12 weeks 10 cc 50 cc 400 cc 1000 cc

50cc

Compared to fetal plasma, the amniotic fluid in the latter part of pregnancy is: Hypertonic Hypotonic Isotonic

Hypotonic

What is not present on the trophoblast?

Class I major histocompatibility antigens

What is the first sign of folate deficiency? NTDs Hypersegmented polymorphonuclear leukocytes Low MCHC

Hypersegmented polymorphonuclear leukocytes

What is associated with a normal ristocetin test? Von Willebrands Bernard Soulier Glanzmann’s thromobasthena

Glanzmann’s thromobasthena - bleeding disorder - bleeding time abnormal, but ristocetin normal BS - no platelet aggregation in response to ristocetin

Which does not cause hemolytic disease of the newborn? Kell Duffy Lewis D

Lewis

Neonatal resuscitation - indications for interventions

When to give O2? - Labored breathing or persistent cyanosis (but normal HR and no apnea/gasping) Bag and mask - PPV indicated if apnea, gasping, or HR <100 Intubation - HR <60 Epi - Intubated, chest compressions, O2 at 100% and HR remains <60

The mother has type O+ blood and baby is A+. The baby has been breast feeding and 2 days post partum is jaundiced. The mom has no antibodies but there is a + direct Coombs. What is the most likely cause? Breast feeding ABO incompatibility Rh disease Immature fetal liver enzymes

ABO incompatibility + Direct Coombs means there is maternal antibody on neonate's RBC, consistent w/ HDN

What is not covered by cephalosporins? Enterococcus Group A strep Group B strep

Enterococcus

What causes toxic shock syndrome? Group A strep Group B strep Clostridium Anaerobic strep

Group A strep

What decreases OCP efficacy? Rifampin Flagyl Nitrofurantoin

Rifampin

What measure on vesicocentesis was predictive of poor renal function/outcome? Na <20 Ca <8 Osmolality >200 Beta 2 microglobulin <4 Total protein <20

Osmolality >200

After a meal, what is most likely to be seen to increase in the BPP? Breathing Movement Tone Reactive NST AFI

Breathing

What is the most common cause of maternal mortality in the US? Thromboembolism Hemorrhage Hypertension Infection

Hemorrhage (14%) Then cardiac conditions, then infection, then VTE, then HTN New data - mental health conditions are highest (23%)

What is the most likely risk from regional anesthesia Allergic reaction to local Toxicity from local Epidural bleeding Brain herniation

Toxicity from local

What is the most common side effect with combivir and lamivudine? Anemia Hepatotoxicity Rash

Anemia

PVL is associated with which maternal infection? Pyelo Pneumonia Chorio

Chorio

What is the most predictive of HIV transmission? Ruptured membranes CD4 count Viral load/HIV RNA

Viral load/HIV RNA

What is associated with reversible hearing loss in the fetus? ASA Streptomycin Cisplatin

ASA

What is the most common trisomy of abortuses? 16 18 13 21

Which is seen with holoprosencephaly and midline facial defects? Trisomy 13 Trisomy 21 Trisomy 18

Trisomy 13

What is used in the treatment of IHSS? Nifedipine Hydralazine Magnesium Propranolol

Propranolol - Reduces myocardial O2 requirements

How do you treat refractory SVT in the mother? Adenosine Lidocaine Digoxin

Adenosine

The best test to compare means between three groups is? Student t-test Chi square Wilcoxan rank sum test ANOVA

ANOVA

What is not good in monitoring Kell sensitization? Delta OD450 MCA

Delta OD450 - Not a hemolytic anemia - affects bone marrow

What does oral contraception decrease the least? Breast cancer Uterine Cancer Anemia PIH Toxic shock syndrome

Increases risk for breast cancer and preeclampsia

What situation can override a patient’s decision?

Competency

How does IgG cross the placenta? Pinocytosis Simple diffusion Active transport Facilitated diffusion

Pinocytosis

Ion trapping

Ion trapping of basic drugs occurs in an acidotic fetus Fetal pH is usually less than maternal pH, which can lead to ion trapping and greater drug concentration in fetus Non-ionized drugs cross more easily Local anesthetic - increased protein binding in mother means less medication that will diffuse across placenta - Bupivicaine, ropivicaine will have lower fetal blood levels than lidocaine (less protein bound) Chloroprocaine has least amt of placental transfer bc it is rapidly eliminated/short half-life)

A patient has CHTN with superimposed preE with a BP of 160/120 on nifedipine at 35 weeks. She was given magnesium and her BP drops to 60/40. How do you treat? Calcium gluconate Ephedrine IV fluids Methergine

Calcium gluconate - Mag reversal?

What is the most common cause of neonatal hyperthyroidism? Hashimoto’s Graves Toxic adenoma Exogenous T3 or T4

Graves

What causes chronic active hepatitis and cirrhosis? Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E

Hepatitis C

Most drugs can cross the placenta by which mechanism? Simple diffusion Facilitated diffusion Active transport Pinocytosis

Simple diffusion

A normal pregnant patient in the third trimester has what fasting and postprandial glucose? Low fasting, high PP Low fasting, low PP High fasting, high PP High fasting, low PP

Low fasting, high PP

What dictates mode of delivery in patients with ITP? Obstetrical indications Maternal platelet count Fetal scalp platelet count

Obstetrical indications

What is the least likely risk to the fetus from a vacuum assisted delivery? Tentorial tearing Scalp lac Facial nerve palsy Brachial plexus injury Subgaleal

Facial nerve palsy

Patient has a vulvar hematoma s/p exploration and packing and transfusion. Now the patient is experiencing bright red vaginal bleeding through the packing. Next step? Explore Repack Embolize Exploratory laparotomy

Embolize

What is not associated with calcifications in the fetal abdomen? Toxo CMV Parvo Meconium CF

Parvo

What is the most common finding with an increased NT at 10 weeks? Normal Turner Downs

Normal

What is the most common finding on a term infant with Down syndrome? Simian crease Hypotonia LBW <2500g

Hypotonia

What condition with cystic fibrosis carries a poor prognosis Cor pulmonale Recurrent pneumonia Pancreatitis

Cor pulmonale = R heart failure due to lung pathology

Hemoglobin and O2 differences between mom and fetus

Fetal hgb - higher O2 affinity (basis of transfer of O2 to fetal RBCs across placenta) Fetal pO2 always lower Fetal % hgb saturation (O2 sat) always higher HgbF (gamma) has decreased affinity for 2,3 DPG - shifts curve to L

Effect of acidosis on fetal O2

Shifts to R - acidosis decreases O2 affinity - Tissues acidotic to improve O2 release, lungs alkalotic to increase O2 uptake Maternal hypoventilation leads to fetal respiratory acidosis - fetal pH influenced by maternal pH

Which vessel has the highest fetal oxygenation? Carotid Aorta Pulmonary artery Umbilical artery Femoral vein

Carotid L atrium highest chamber

During stress, what organ gets preferential shunting in the fetus? Adrenal Liver Lung

Adrenal Brain, heart, adrenals most important

What time of day does the fetus move the most? 6-8 AM 10-12 PM 14-1600 18-2000 22-2400

22-2400

Medroxyprogesterone has which effect postpartum? Decrease lactation Decrease triglycerides Increased thromboembolism Decreases depression Increases calcium

Decrease lactation

What levels are increased in the fasting state of pregnancy?

Cholesterol

Postpartum thyroiditis has all of the following symptoms except Depression Tachycardia HTN Diarrhea

HTN Thyrotoxicosis followed by hypothyroidism

Which autosomal dominant disorder has telangiectasia, epistaxis and AV malformations?

Osler-Weber-Rendu Also called hereditary hemorrhagic telangiectasia - blood vessel malformations

What increases fibrinogen the most?

Cryo

Which fetal syndrome has absent radius, polyhydramnios and hydronephrosis?

VACTERL

costo-Vertebral abnormalities Anal atresia Cardiac Trachea/esophageal abnormalities Renal Limbs

All are associated with increased AFP except? Chorioangioma Velamentous cord insertion Subchorionic cyst Umbilical cord cyst

Velamentous cord insertion

What is not related to poor fetal outcome? Circumvallate placenta 2 vessel cord Velamentous insertion Battledore placenta

Battledore placenta

What has the highest risk of PTD in an asymptomatic patient with no risk factors? Increased WBC in amniotic fluid Increased vaginal MMP Increased FFN

Increased WBC in amniotic fluid

What is most commonly seen with APLAS? IUGR Fetal death PTD

PTD

A patient has a PE. What is the most likely thrombophilia? Factor V leiden AT III APLAS

Factor V leiden (most common inherited thrombophilia)

What is the most appropriate to give a patient for long-term anticoagulation and breast feeding? LMWH Full dose heparin Coumadin Mini-heparin ASA

Coumadin

What is not associated with placental thickening? Syphilis Rh isoimmunization Non-immune hydrops Listeria

Listeria

Lyme disease treatment

Not pregnant - doxy Pregnant - PCN

What is least useful with SC disease? Iron Folic acid Pneumovac Antibiotics for suppression

Iron

Folic acid lowers the plasma level of what medication?

Dilantin

What fetal anomalies are seen with maternal ingestion of a folic acid antagonist? Cardiac Amniotic band GI NTD

NTD Also cardiac, cleft, urinary tract

What other anomaly is most commonly seen with CDH? Cardiac Renal Neuro

Cardiac

What nerve is affected if the mother’s legs are hyperflexed during delivery? Femoral Obturator Peroneal

Femoral

A mother is s/p forceps and can’t dorsiflex her foot. What nerve has been affected?

Common peroneal

What is a measure of prevalence? Morbidity Mortality Attack rate Autopsy rate

Morbidity - presence of disease in a population - How many are ill at a given time

A patient was diagnosed with IUFD. After delivery, there appeared to be no gross anomalies, placenta appeared normal and the fetus was macerated and weighed 2500g. What would most likely give you the diagnosis? Autopsy Karyotype KB TORCH

Autopsy

A mom has DM. Which is the least likely complication to fetus? Hypoglycemia Hypocalcemia Hypothermia Polycythemia

Hypothermia

What drug would you see opiate withdrawal if given in labor? Stadol Toradol Valium Morphine

Stadol

A fetus is born with IUGR. What is the most likely complication in the first 24 hours? Hypoglycemia Hyperbilirubinemia RDS

Hypoglycemia

What is the least useful sonographic measurement to differentiate b/t IUGR and wrong dates? AC BPD Cerebellum Foot

What is the most useful measurement in diagnosing IUGR? Transcerebellar AC BPD Foot

What is given for decreased maternal cardiac output? Hydralazine Labetalol Lasix

Hydralazine

What is the mechanism for a beta agonist? Increased cAMP Decreased cAMP

Increased cAMP

Which drug inhibits conversion of T4 to T3? Propranolol Iodine Lithium Cimetidine

Propranolol

A patient presents at 20 weeks with h/o RH isoimmunization in which the baby needed only phototherapy. This pregnancy is with the same partner. What is the next step in management? MCA Amnio Fetal blood sampling Maternal antibody titer

Subsequent pregnancy after child already affected - don't need to measure titers - Test fetus first - can use cfDNA or amnio - If Rh+, do MCAs

What is least useful for PCR diagnosis in amniotic fluid? ITP NAIT Rh disease Kell

PCR of fetal cells can detect fetal antigen status

Acute pyelo is least associated with: Anemia HTN Renal dysfunction Respiratory distress

HTN

What is avascular? Chorion laeve Chorion frondosum Decidua capsularis Decidua basalis Decidual

Chorion laeve (smooth chorion)

What amino acid is associated with NTD? Phenylalanine Homocysteine Glutamic acid

Homocysteine

What is an obligate precursor for NO?

L-arginine

What is the mechanism of glyburide?

Increases insulin secretion

What drug is concentrated in breastfeeding? Cyclophosphamide Cyclosporine PTU

Cyclophosphamide

What is the best way to analyze studies on apgar scores? Chi square T test Mann-Whitney

Mann-Whitney Non-parametric, ordinal

What is used to measure intraobserver variability?

Kappa score

Which is the best test to determine which variable is related to survival? Chi square Kaplan meier Student t test Wilcoxin rank sum

Kaplan meier

A mom presents with ptyalism. Most likely dx? Parotitis Caloric deficiency Electrolyte imbalance

Caloric deficiency

Which maternal cardiac lesion is a/w the greatest fetal risk? Uncorrected TOF Aortic stenosis VSD Mitral stenosis

Uncorrected TOF

What test has the least radiation? Lumbar myelogram CT with contrast CT pelvimetry Abdominal flat and lateral IVP

Abdominal flat and lateral

Prostaglandin dehydrogenase is found where?

Chorion - 15 hydroxy prostaglandin dehydrogenase These enzymes upregulate placental oxytocin expression and interfere with progesterone signaling.

Which is not part of innate immunity? Toll like receptors NK cells Monocytes Macrophages

Monocytes macrophages, neutrophils, NK cells, mast cells, eosinophils, basophils, dendritic cells, toll like receptors. monocytes can differentiate into macrophages Adaptive immune response is carried out by lymphocytes: B cells and T cells Apparently monocytes can influence adaptive immune responses.

Which decreases in pregnancy? IgM B cells NK cells

NK cells

Which maternal cardiac lesion affects fetal O2 the most? VSD PHTN AS MI

PHTN

Which does not express MHC class I? Syncytiotrophoblasts Cytotrophoblasts Epithelial cells Stroma

Syncytiotrophoblasts By not displaying the MHC-1, it avoids a chance of attack by maternal immune system’s T cells.

What is associated with graft vs host dz Psoriasis Eczema Erythema multiforme PUPPS

PUPPS

Preload and afterload fixed. What increases CO? Alpha adrenergic Beta adrenergic Hydralazine Lasix

Beta adrenergic

Least helpful for pseudotumor? Aminophylline Lasix Steroids Lumbar puncture

Aminophylline

Most common cause of death from epidural toxicity?

Marcaine cardiotoxicity

What affects fetal growth the most? IGF Insulin Glucagon

Insulin

TTP first line of therapy? Steroids IVIG Plasmapheresis

Plasmapheresis

How does recurrent antenatal steroids affect fetal growth?

Decreased HC

Least likely associated with intellectual disability? 1st trimester varicella 1st trimester rubella CMV

1st trimester varicella

At term, fetal CO in mL/min/kg 100 350 250 500

500

Where is the largest % of fetal cardiac output?

Placenta

Dose for renal dopamine? 4 8 12 20

PPV increases with _____ prevalence

Increasing

AF acetylcholinesterase least helpful with? Omphalocele Gastroschisis Congenital nephrosis Anencephaly

Congenital nephrosis

A woman has a h/o recurrent SAB. She has 45, XX (t21,22) karyotype. Her husband is 46, XY. Chance next offspring will have down syndrome? <1% 10% 33% 50% 100%

10% if mother is carrier 2.5% if father

Which is the most necessary in a vegan? Vit B6 Vit B12 Iron Folate

Vit B12

Location where HIE occurs Parietal lobe Occipital lobe Frontal lobe Periventricular area Cerebellum

Periventricular area

PGF2a vs PGE2 causes which side effect?

Bronchoconstriction

When is malaria more common?

Pregnancy increases infection High parity decreases More often seen in pregnant women, younger women, first/second pregnancy, HIV+, first and second trimesters

Which is the least likely side effect of aldomet?

Neuro

Medicine associated with fetal hearing loss Cisplatinum Carboplatin Streptomycin

Streptomycin

Differences between early amnio (11-12wks) and normal time

Early amnio (10-13w) has rates of pregnancy loss of 2.5% (vs 0.7% with usual time) This would be a 3.57-fold difference Membrane rupture is more likely Clubfoot is 1.3% (early) vs 0.1% (usual time) - this is a 13 fold difference More amniotic fluid culture failure

Which is most likely a teratogen? Cyclosporine Carbamazepime Azathioprine

Carbamazepime

Which of the following is not a possible side effect of halothane given for CD? Hemorrhage Malignant hyperthermia Hepatotoxicity Rash

Hemorrhage

Which one of the following is not a mechanism of action of glyburide? Increased insulin release from alpha cell of pancreas Increase insulin mediated glucose transport Increasing number of insulin receptors

Increased insulin release from alpha cell of pancreas

A 36 year old G3P2 patient presents to you at 23 weeks of EGA with a fever and rash. Exam reveals a target shaped lesion. Upon questioning, you find out that the patient just returned from visiting relatives in Connecticut. What is the appropriate therapy? Oral doxy x 5-7 days Oral amox x 5-7 days Oral doxy x 14-28 days Oral amox x 14-28 days

Oral amox x 14-28 days

Which medication potentiates the neuromuscular blockade of magnesium sulfate? Nifedipine Terbutaline Indomethacin Gentamicin

Gentamicin

Hemabate

PGE F2a analogue

Misoprostol

PGE E1 analogue

Dinoprostone

PGE E2 analogue

ITP - Risk of fetal plt <50? - Should you do CD?

10-15% of fetuses in ITP will have plt <50 CD doesn't decrease risk of bleeding in thrombocytopenic infants

Lanugo

More common in premature babies

Which of the following is the least likely diagnosis in a pregnancy in which the triple screen shows a high msAFP, normal hcG and normal estriol? Fetal death Subchorionic hemorrhage Gestational trophoblastic disease Cystic hygroma

Gestational trophoblastic disease - would have high hcg - AFP low

All of the following can cause elevated amniotic fluid AFP except? Chorioangioma Umbilical cord cyst Fetal hydrops Cleft lip

Cleft lip

Prevalence of a disease is the biggest influence on sample size in power calculations: True False

True

Depo provera is best for which situation? Patients with undiagnosed irregular bleeding Moms with high cholesterol Nursing mothers Patients with pseudotumor cerebri

Nursing mothers Pseudotumor - depo can make HA worse

What are swan ganz findings in the initial phase of amniotic fluid embolism? Decreased PA pressure Increased PA pressure Increased CO Systemic HTN

Increased PA pressure Two phases - First with intense pulm vasospasm and RHF. Then LV failure and elevated PCWP and more modest increase in PA pressures. Coagulopathy develops if they survive the cardiovascular collapse

Risk of early-onset GBS sepsis in untreated GBS+ moms

1/100