Practice Questions - Large Doc (397- Flashcards

1
Q

Most frequent fetal tracing in women performing moderate exercise:

A

Modest increase in HR
Maximal exercise can cause bradycardia

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

AFP synthesis

A

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

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

Abnormalities w/ T13

A

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

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

Why is general anesthesia more rapid in pregnant women?

A

Concentration increases due to decreased FRC and RV.

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

Local anesthetic w/ greatest cardiotoxicity

A

Bupivicaine
95% protein bound, hard to reverse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dx and treatment of CAH

A

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

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

Ppx in HIV based on CD4

A

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

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

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

A

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

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

Terbutaline mech of action

A

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

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

Uterine contraction - cell signaling

A

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

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

Effect on Apgar by anesthesia

A

1min affected, 5min not

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

Timing of PVL

A

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

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

FSH/LH levels in pregnancy

A

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

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

Proper US transducer

A

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

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

Vitamin K in neonates - why is it needed

A

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

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

Eisenmenger’s

A

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

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

Mycoplasma hominis - what can it cause?

A

Endometritis, BV

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

Teratogenicity of dilantin is a/w what enzyme?

A

Epoxide hydrolase
- Fetal enzyme activity weak, so they accumulate

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

Most common cause of cancer following in utero exposure

A

Hepatitis B

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

Most rapid method for uterine relaxation following uterine inversion

A

Terb
Mag
Then general anesthesia

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

What infection in pregnancy can be diagnosed with serologic markers?

Toxo
CMV
Chlamydia
HSV
Mycoplasma

A

Toxo - IgM positive after 7d and lasts 1 yr

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

Omphalocele associations

A

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

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

Amino acid concentrations in fetus

A

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

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

HPV treatment

A

TCA (trichloroacetic acid)
Laser/cryoablation

5FU, imiquimod, interferon contraindicated in pregnancy

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

SVT most common mechanism

A

Reentry

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

Fetal bradycardia

A

Not ominous if response to movement, if structurally normal

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

Complete heart block

A

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

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

Adverse maternal effects of steroids

A

Multiple fluid and lyte abn
Osteoporosis
Peptic ulcer
Mental disturbances

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

Things a/w low AFP

A

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

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

Most common complication of polycystic kidney disease

A

BP increase
Then PTD

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

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

A

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

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

A1c rate of malformation

A

22% if >8.5

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

AEDF risk of perinatal mortality

A

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

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

Increased Doppler S/D

A

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

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

Mechanism of prostaglandin E2

A

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

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

What is associated with increased transmission to the fetus in HIV positive women?

CD4 count
Viral load
CD
HAART tx

A

Viral load

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

What is a complication of combivir?

A

Anemia

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

Which syndrome is associated with macrosomia?

BW
Meckel gruber
Trisomy 21
Polyploidy

A

Beckwith Wiedemann

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

Heart defect with increased transmission to the fetus

ASD
Tetralogy
IHSS (Idiopathic hypertrophic subaortic stenosis)
Coarctation

A

IHSS - autosomal dominant

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

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

Maternal heart defect with lowest incidence of mortality?

Corrected tetralogy
Artificial heart valve
Eisenmenger’s

A

Corrected tetralogy

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

Which B cell disease gets worse in pregnancy?

Graves
Myasthenia gravis
SLE

A

SLE

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

Which chromosomal abnormality is not increased in offspring of AMA women?

Down syndrome
Kleinfelter’s
Turner’s syndrome
Edward’s syndrome

A

Turners

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

Risk of disease in population is 1/6400. What is carrier state?

1/20
1/40
1/80
1/100

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

GnRH is made where?

A

Cytotrophoblast of chorion

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

Which test should be used if one compares outcome before and after treatment?

Paired t test
Chi square
Mann Whitney U
ROC curve

A

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

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

Insulin affects growth in all tissues except:

Brain
Fat
Liver
Muscle

A

Brain

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

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

A

Ultrasound observation

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

What is the precursor of fetal adrenal steroids?

LDL
Amino acids
Glutathione
Vitamin D

A

LDL

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

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

A

Decidualization

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

The rapid GBS test is not used in practice because of:

Poor sensitivity
Low prevalence of GBS
Null hypothesis
Racial differences

A

Poor sensitivity

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

What best describes the physician patient relationship?

Autonomy
Fiduciary
Beneficence
Non malfeasance

A

Fiduciary

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

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

These drugs should not be used in patients with myasthenia except:

Curare (alkaloid arrow poison from plants, causes weakness of muscles)
Mestinon
Magnesium
Gentamicin

A

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

How does magnesium affect myasthenia gravis?

A

Inhibits release of acetylcholine

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

Myasthenia gravis mechanism

A

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

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

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

A

Herpes gestationis
- AKA pemphigoid gestationis

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

What drug causes hypothermia in the newborn?

A

Valium

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

Which organism is most associated with preterm birth?

Ureaplasma
BV
GBS
Chlamydia

A

Ureaplasma

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

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

Adenosine
Quinidine
Capsaicin
Lidocaine

A

Lidocaine

Can also use amiodarone

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

Which is not a sign of BV?

positive whiff test
pH <4.5
Thin, homogenous discharge
>20% clue cells

A

pH <4.5
- pH GREATER than 4.5 in BV

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

GBS is most resistant to:

PCN
Clinda
Erythromycin
Bactrim

A

Bactrim? not used for GBS
Next would be erythromycin

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

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

A

Epoxide hydrolase

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

What complication is associated with exteriorization of the uterus?

Air embolism
Uterine atony
Patent foramen ovale

A

Air embolism

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

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

A

Thrombosis

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

Which vaccine is contraindicated in pregnancy?

Influenza
Rabies
Varicella
Cholera

A

Varicella

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

What is associated with fetal abdominal calcifications?

EBV
CMV
Parvo
Turner

A

CMV

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

Which syndrome is a/w fetal thrombocytopenia?

Absent radii syndrome
Gestational thrombocytopenia
Erythroblastosis fetalis
Bernard-Soulier syndrome

A

Absent radii syndrome
- Called thrombocytopenia-absent radius syndrome (TAR)

Bernard- Soulier - AR, giant platelets and bleeding, can cause mild TCP but in children

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

What is the precursor of deoxycorticosterone?

Aldosterone
DHEAS
Progesterone

A

Progesterone

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

What is the #1 cause of malformations?

Radiation
Infection
Genetics
Medication

A

Genetics

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

What is the treatment of 21 OH deficiency in the female fetus?

Cortisone acetate
Diestryl acetate
Dexamethasone
Aldosterone

A

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

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

What causes virilization of a female fetus?

Luteoma of pregnancy
Cystadenoma
Prolactinoma
Oral contraceptives

A

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

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

PO2 in the umbilical vein approaches that of the:

Middle cerebral artery
Uterine vein
Uterine artery
Radial artery

A

Uterine vein

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

In which disorder is IgG contraindicated?

Recurrent pregnancy loss
Myasthenia gravis
ITP
Rheumatoid arthritis

A

Unknown - can be used in all
RPL - recent studies

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

Risk of neonatal infection with SVD in a woman with recurrent vulvar herpes lesion

50%
1%
100%
0%

A

1%

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

Gaucher’s disease is a disorder of:

Aspartoacylase
Hexose aminidase A
Glucocerebrosidase

A

Glucocerebrosidase

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

What lab value is seen with preeclampsia?

Decreased urine calcium
Decreased cellular fibronectin
Decreased thromboxane

A

Decreased urine calcium

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

What type of inheritance is associated with Leber’s optic atrophy?

AR
AD
X-linked
Mitochondrial

A

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

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

Which disorder is associated with uniparental disomy?

William’s syndrome
Cri du chat
Hydantoin syndrome
Prader-Willi

A

Prader-Willi

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

Diseases associated with DNA repeats include all except:

Fragile X
Huntington’s
Myotonic dystrophy
CF

A

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

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

HIV is…

DNA virus
Prion
RNA retrovirus
Mad cow disease

A

RNA retrovirus

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

An Apgar of < 3 is associated with this risk of CP:

5%
15%
50%
100%

A

15% I think

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

NTDs are usually:

Due to single gene defects
Caused by teratogens
Multifactorial in nature
Associated with aneuploidy

A

Multifactorial in nature

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

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

A

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

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

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

A

50%
Lethal diagnosis

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

The most important predisposing risk factor for macrosomia is:

GA >40w
Previous macrosomia
Maternal smoking
Male fetus

A

Previous macrosomia

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

The byproduct of carbohydrate metabolism is:

CO2
H20
NH3
Lactic acid

A

Lactic acid

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

What decreases in pregnancy?

Factor VI
Factor V
Factor XIII

A

Factor XIII

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

Which local anesthetic causes neurologic toxicity?

A

Chloroprocaine

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

Which local anesthetic causes psychiatric side effects?

A

Lidocaine

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

Which alk phos is produced by the placenta?

Heat labile
Heat stable

A

Heat stable

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

What hepatitis is associated with the greatest amount of chronic disease?

Hep B
Hep A
Hep E
Hep C

A

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%)

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

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

A

Osmolality <210

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

92
Q

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

A

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

93
Q

Scalp pH represents pH of fetal:

Arterial blood
Venous blood
Amniotic fluid

A

Arterial blood

94
Q

Normal amount of amniotic fluid at 12 weeks

10 cc
50 cc
400 cc
1000 cc

A

50cc

95
Q

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

Hypertonic
Hypotonic
Isotonic

A

Hypotonic

96
Q

What is not present on the trophoblast?

A

Class I major histocompatibility antigens

97
Q

What is the first sign of folate deficiency?

NTDs
Hypersegmented polymorphonuclear leukocytes
Low MCHC

A

Hypersegmented polymorphonuclear leukocytes

98
Q

What is associated with a normal ristocetin test?

Von Willebrands
Bernard Soulier
Glanzmann’s thromobasthena

A

Glanzmann’s thromobasthena - bleeding disorder
- bleeding time abnormal, but ristocetin normal

BS - no platelet aggregation in response to ristocetin

99
Q

Which does not cause hemolytic disease of the newborn?

Kell
Duffy
Lewis
D

A

Lewis

100
Q

Neonatal resuscitation - indications for interventions

A

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

101
Q

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

A

ABO incompatibility

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

102
Q

What is not covered by cephalosporins?

Enterococcus
Group A strep
Group B strep

A

Enterococcus

103
Q

What causes toxic shock syndrome?

Group A strep
Group B strep
Clostridium
Anaerobic strep

A

Group A strep

104
Q

What decreases OCP efficacy?

Rifampin
Flagyl
Nitrofurantoin

A

Rifampin

105
Q

What measure on vesicocentesis was predictive of poor renal function/outcome?

Na <20
Ca <8
Osmolality >200
Beta 2 microglobulin <4
Total protein <20

A

Osmolality >200

106
Q

After a meal, what is most likely to be seen to increase in the BPP?

Breathing
Movement
Tone
Reactive NST
AFI

A

Breathing

107
Q

What is the most common cause of maternal mortality in the US?

Thromboembolism
Hemorrhage
Hypertension
Infection

A

Hemorrhage (14%)

Then cardiac conditions, then infection, then VTE, then HTN

New data - mental health conditions are highest (23%)

108
Q

What is the most likely risk from regional anesthesia

Allergic reaction to local
Toxicity from local
Epidural bleeding
Brain herniation

A

Toxicity from local

109
Q

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

Anemia
Hepatotoxicity
Rash

A

Anemia

110
Q

PVL is associated with which maternal infection?

Pyelo
Pneumonia
Chorio

A

Chorio

111
Q

What is the most predictive of HIV transmission?

Ruptured membranes
CD4 count
Viral load/HIV RNA

A

Viral load/HIV RNA

112
Q

What is associated with reversible hearing loss in the fetus?

ASA
Streptomycin
Cisplatin

A

ASA

113
Q

What is the most common trisomy of abortuses?

16
18
13
21

A

16

114
Q

Which is seen with holoprosencephaly and midline facial defects?

Trisomy 13
Trisomy 21
Trisomy 18

A

Trisomy 13

115
Q

What is used in the treatment of IHSS?

Nifedipine
Hydralazine
Magnesium
Propranolol

A

Propranolol
- Reduces myocardial O2 requirements

116
Q

How do you treat refractory SVT in the mother?

Adenosine
Lidocaine
Digoxin

A

Adenosine

117
Q

The best test to compare means between three groups is?

Student t-test
Chi square
Wilcoxan rank sum test
ANOVA

A

ANOVA

118
Q

What is not good in monitoring Kell sensitization?

Delta OD450
MCA

A

Delta OD450
- Not a hemolytic anemia - affects bone marrow

119
Q

What does oral contraception decrease the least?

Breast cancer
Uterine Cancer
Anemia
PIH
Toxic shock syndrome

A

Increases risk for breast cancer and preeclampsia

120
Q

What situation can override a patient’s decision?

A

Competency

121
Q

How does IgG cross the placenta?

Pinocytosis
Simple diffusion
Active transport
Facilitated diffusion

A

Pinocytosis

122
Q

Ion trapping

A

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)

123
Q

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

A

Calcium gluconate
- Mag reversal?

124
Q

What is the most common cause of neonatal hyperthyroidism?

Hashimoto’s
Graves
Toxic adenoma
Exogenous T3 or T4

A

Graves

125
Q

What causes chronic active hepatitis and cirrhosis?

Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E

A

Hepatitis C

126
Q

Most drugs can cross the placenta by which mechanism?

Simple diffusion
Facilitated diffusion
Active transport
Pinocytosis

A

Simple diffusion

127
Q

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

A

Low fasting, high PP

128
Q

What dictates mode of delivery in patients with ITP?

Obstetrical indications
Maternal platelet count
Fetal scalp platelet count

A

Obstetrical indications

129
Q

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

A

Facial nerve palsy

130
Q

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

A

Embolize

131
Q

What is not associated with calcifications in the fetal abdomen?

Toxo
CMV
Parvo
Meconium
CF

A

Parvo

132
Q

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

Normal
Turner
Downs

A

Normal

133
Q

What is the most common finding on a term infant with Down syndrome?

Simian crease
Hypotonia
LBW <2500g

A

Hypotonia

134
Q

What condition with cystic fibrosis carries a poor prognosis

Cor pulmonale
Recurrent pneumonia
Pancreatitis

A

Cor pulmonale = R heart failure due to lung pathology

135
Q

Hemoglobin and O2 differences between mom and fetus

A

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

136
Q

Effect of acidosis on fetal O2

A

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

137
Q

Which vessel has the highest fetal oxygenation?

Carotid
Aorta
Pulmonary artery
Umbilical artery
Femoral vein

A

Carotid

L atrium highest chamber

138
Q

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

Adrenal
Liver
Lung

A

Adrenal

Brain, heart, adrenals most important

139
Q

What time of day does the fetus move the most?

6-8 AM
10-12 PM
14-1600
18-2000
22-2400

A

22-2400

140
Q

Medroxyprogesterone has which effect postpartum?

Decrease lactation
Decrease triglycerides
Increased thromboembolism
Decreases depression
Increases calcium

A

Decrease lactation

141
Q

What levels are increased in the fasting state of pregnancy?

A

Cholesterol

142
Q

Postpartum thyroiditis has all of the following symptoms except

Depression
Tachycardia
HTN
Diarrhea

A

HTN

Thyrotoxicosis followed by hypothyroidism

143
Q

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

A

Osler-Weber-Rendu

Also called hereditary hemorrhagic telangiectasia
- blood vessel malformations

144
Q

What increases fibrinogen the most?

A

Cryo

145
Q

Which fetal syndrome has absent radius, polyhydramnios and hydronephrosis?

A

VACTERL

146
Q

VACTERL

A

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

147
Q

All are associated with increased AFP except?

Chorioangioma
Velamentous cord insertion
Subchorionic cyst
Umbilical cord cyst

A

Velamentous cord insertion

148
Q

What is not related to poor fetal outcome?

Circumvallate placenta
2 vessel cord
Velamentous insertion
Battledore placenta

A

Battledore placenta

149
Q

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

A

Increased WBC in amniotic fluid

150
Q

What is most commonly seen with APLAS?

IUGR
Fetal death
PTD

A

PTD

151
Q

A patient has a PE. What is the most likely thrombophilia?

Factor V leiden
AT III
APLAS

A

Factor V leiden (most common inherited thrombophilia)

152
Q

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

A

Coumadin

153
Q

What is not associated with placental thickening?

Syphilis
Rh isoimmunization
Non-immune hydrops
Listeria

A

Listeria

154
Q

Lyme disease treatment

A

Not pregnant - doxy
Pregnant - PCN

155
Q

What is least useful with SC disease?

Iron
Folic acid
Pneumovac
Antibiotics for suppression

A

Iron

156
Q

Folic acid lowers the plasma level of what medication?

A

Dilantin

157
Q

What fetal anomalies are seen with maternal ingestion of a folic acid antagonist?

Cardiac
Amniotic band
GI
NTD

A

NTD

Also cardiac, cleft, urinary tract

158
Q

What other anomaly is most commonly seen with CDH?

Cardiac
Renal
Neuro

A

Cardiac

159
Q

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

Femoral
Obturator
Peroneal

A

Femoral

160
Q

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

A

Common peroneal

161
Q

What is a measure of prevalence?

Morbidity
Mortality
Attack rate
Autopsy rate

A

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

162
Q

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

A

Autopsy

163
Q

A mom has DM. Which is the least likely complication to fetus?

Hypoglycemia
Hypocalcemia
Hypothermia
Polycythemia

A

Hypothermia

164
Q

What drug would you see opiate withdrawal if given in labor?

Stadol
Toradol
Valium
Morphine

A

Stadol

165
Q

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

Hypoglycemia
Hyperbilirubinemia
RDS

A

Hypoglycemia

166
Q

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

AC
BPD
Cerebellum
Foot

A

AC

167
Q

What is the most useful measurement in diagnosing IUGR?

Transcerebellar
AC
BPD
Foot

A

AC

168
Q

What is given for decreased maternal cardiac output?

Hydralazine
Labetalol
Lasix

A

Hydralazine

169
Q

What is the mechanism for a beta agonist?

Increased cAMP
Decreased cAMP

A

Increased cAMP

170
Q

Which drug inhibits conversion of T4 to T3?

Propranolol
Iodine
Lithium
Cimetidine

A

Propranolol

171
Q

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

A

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

172
Q

What is least useful for PCR diagnosis in amniotic fluid?

ITP
NAIT
Rh disease
Kell

A

PCR of fetal cells can detect fetal antigen status

173
Q

Acute pyelo is least associated with:

Anemia
HTN
Renal dysfunction
Respiratory distress

A

HTN

174
Q

What is avascular?

Chorion laeve
Chorion frondosum
Decidua capsularis
Decidua basalis
Decidual

A

Chorion laeve (smooth chorion)

175
Q

What amino acid is associated with NTD?

Phenylalanine
Homocysteine
Glutamic acid

A

Homocysteine

176
Q

What is an obligate precursor for NO?

A

L-arginine

177
Q

What is the mechanism of glyburide?

A

Increases insulin secretion

178
Q

What drug is concentrated in breastfeeding?

Cyclophosphamide
Cyclosporine
PTU

A

Cyclophosphamide

179
Q

What is the best way to analyze studies on apgar scores?

Chi square
T test
Mann-Whitney

A

Mann-Whitney
Non-parametric, ordinal

180
Q

What is used to measure intraobserver variability?

A

Kappa score

181
Q

Which is the best test to determine which variable is related to survival?

Chi square
Kaplan meier
Student t test
Wilcoxin rank sum

A

Kaplan meier

182
Q

A mom presents with ptyalism. Most likely dx?

Parotitis
Caloric deficiency
Electrolyte imbalance

A

Caloric deficiency

183
Q

Which maternal cardiac lesion is a/w the greatest fetal risk?

Uncorrected TOF
Aortic stenosis
VSD
Mitral stenosis

A

Uncorrected TOF

184
Q

What test has the least radiation?

Lumbar myelogram
CT with contrast
CT pelvimetry
Abdominal flat and lateral
IVP

A

Abdominal flat and lateral

185
Q

Prostaglandin dehydrogenase is found where?

A

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

186
Q

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

A

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.

187
Q

Which decreases in pregnancy?

IgM
B cells
NK cells

A

NK cells

188
Q

Which maternal cardiac lesion affects fetal O2 the most?

VSD
PHTN
AS
MI

A

PHTN

189
Q

Which does not express MHC class I?

Syncytiotrophoblasts
Cytotrophoblasts
Epithelial cells
Stroma

A

Syncytiotrophoblasts

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

190
Q

What is associated with graft vs host dz

Psoriasis
Eczema
Erythema multiforme
PUPPS

A

PUPPS

191
Q

Preload and afterload fixed. What increases CO?

Alpha adrenergic
Beta adrenergic
Hydralazine
Lasix

A

Beta adrenergic

192
Q

Least helpful for pseudotumor?

Aminophylline
Lasix
Steroids
Lumbar puncture

A

Aminophylline

193
Q

Most common cause of death from epidural toxicity?

A

Marcaine cardiotoxicity

194
Q

What affects fetal growth the most?

IGF
Insulin
Glucagon

A

Insulin

195
Q

TTP first line of therapy?

Steroids
IVIG
Plasmapheresis

A

Plasmapheresis

196
Q

How does recurrent antenatal steroids affect fetal growth?

A

Decreased HC

197
Q

Least likely associated with intellectual disability?

1st trimester varicella
1st trimester rubella
CMV

A

1st trimester varicella

198
Q

At term, fetal CO in mL/min/kg

100
350
250
500

A

500

199
Q

Where is the largest % of fetal cardiac output?

A

Placenta

200
Q

Dose for renal dopamine?
4
8
12
20

A

4

201
Q

PPV increases with _____ prevalence

A

Increasing

202
Q

AF acetylcholinesterase least helpful with?

Omphalocele
Gastroschisis
Congenital nephrosis
Anencephaly

A

Congenital nephrosis

203
Q

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%

A

10% if mother is carrier
2.5% if father

204
Q

Which is the most necessary in a vegan?

Vit B6
Vit B12
Iron
Folate

A

Vit B12

205
Q

Location where HIE occurs

Parietal lobe
Occipital lobe
Frontal lobe
Periventricular area
Cerebellum

A

Periventricular area

206
Q

PGF2a vs PGE2 causes which side effect?

A

Bronchoconstriction

207
Q

When is malaria more common?

A

Pregnancy increases infection
High parity decreases

More often seen in pregnant women, younger women, first/second pregnancy, HIV+, first and second trimesters

208
Q

Which is the least likely side effect of aldomet?

A

Neuro

209
Q

Medicine associated with fetal hearing loss

Cisplatinum
Carboplatin
Streptomycin

A

Streptomycin

210
Q

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

A

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

211
Q

Which is most likely a teratogen?

Cyclosporine
Carbamazepime
Azathioprine

A

Carbamazepime

212
Q

Which of the following is not a possible side effect of halothane given for CD?

Hemorrhage
Malignant hyperthermia
Hepatotoxicity
Rash

A

Hemorrhage

213
Q

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

A

Increased insulin release from alpha cell of pancreas

214
Q

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

A

Oral amox x 14-28 days

215
Q

Which medication potentiates the neuromuscular blockade of magnesium sulfate?

Nifedipine
Terbutaline
Indomethacin
Gentamicin

A

Gentamicin

216
Q

Hemabate

A

PGE F2a analogue

217
Q

Misoprostol

A

PGE E1 analogue

218
Q

Dinoprostone

A

PGE E2 analogue

219
Q

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

A

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

220
Q

Lanugo

A

More common in premature babies

221
Q

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

A

Gestational trophoblastic disease
- would have high hcg
- AFP low

222
Q

All of the following can cause elevated amniotic fluid AFP except?

Chorioangioma
Umbilical cord cyst
Fetal hydrops
Cleft lip

A

Cleft lip

223
Q

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

True
False

A

True

224
Q

Depo provera is best for which situation?

Patients with undiagnosed irregular bleeding
Moms with high cholesterol
Nursing mothers
Patients with pseudotumor cerebri

A

Nursing mothers

Pseudotumor - depo can make HA worse

225
Q

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

A

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

226
Q

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

A

1/100