Practice Questions - Large Doc (397- Flashcards
Most frequent fetal tracing in women performing moderate exercise:
Modest increase in HR
Maximal exercise can cause bradycardia
AFP synthesis
AFP = Glycoprotein, made by fetal yolk sac, later by GI tract and liver
Abnormalities w/ T13
Brain (hydrocephalus)
Facial
Polydactyly
Renal
Omphalocele
Clubfeet
Most common chromosome anomaly a/w holoprosencephaly
Why is general anesthesia more rapid in pregnant women?
Concentration increases due to decreased FRC and RV.
Local anesthetic w/ greatest cardiotoxicity
Bupivicaine
95% protein bound, hard to reverse
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
Ppx in HIV based on CD4
<200 - PCP ppx w/ bactrim
<100 - Toxo ppx w/ bactrim
<50 - MAC ppx w/ azithro
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
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
Uterine contraction - cell signaling
Increased intracellular calcium activates calcium-calmodulin dependent myosin light chain kinase (MLCK)
MLCK phosphorylates myosin, initiating contraction in smooth muscle
Effect on Apgar by anesthesia
1min affected, 5min not
Timing of PVL
2wks to develop, as long as 104 days after initial insult
FSH/LH levels in pregnancy
Decreased/undetectable - due to feedback inhibition from estrogen/inhibin
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
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
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
Mycoplasma hominis - what can it cause?
Endometritis, BV
Teratogenicity of dilantin is a/w what enzyme?
Epoxide hydrolase
- Fetal enzyme activity weak, so they accumulate
Most common cause of cancer following in utero exposure
Hepatitis B
Most rapid method for uterine relaxation following uterine inversion
Terb
Mag
Then general anesthesia
What infection in pregnancy can be diagnosed with serologic markers?
Toxo
CMV
Chlamydia
HSV
Mycoplasma
Toxo - IgM positive after 7d and lasts 1 yr
Omphalocele associations
Associated malformations in 2/3
25% have aneuploidy or syndrome
T18 - most common aneuploidy
Cardiac defects common
Beckwith Wiedemann
Amino acid concentrations in fetus
Higher than maternal (decrease)
Acidic AA (aspartate and glutamate) don’t cross placenta - fetus makes them
HPV treatment
TCA (trichloroacetic acid)
Laser/cryoablation
5FU, imiquimod, interferon contraindicated in pregnancy
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%
1%
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%)