pregnancy, childbirth, and puerperium

Question 1

What is an absolute contraindication to isotretinoin treatment for severe acne

Answer 1

pregnancy

2 forms of birth control and monthly pregnancy tests are recommended

Question 2

physiologic increase in maternal insulin resistance ocurs in 2nd and 3rd trimesters due to the action of _____, a peptide hormone released by syncytiotrophoblasts

Answer 2

human placental lactogen (hPL)

Question 3

what is a septic abortion

Answer 3

any type of abortion that results in infected retained products of conception in the uterine cavity

Question 4

what organisms are common causes of septic abortion

Answer 4

staph aureus, gram negatives (E coli), and group B strep

Question 5

what are causes of low maternal serum alpha feto protein

Answer 5

aneuploidies (trisomy 18 and 21)

Question 6

what are causes of elevated maternal serum alpha feto protein

Answer 6

open NT defects
ventral wall defects
multiple gestation

Question 7

Neonates born to mothers with poorly controlled blood sugar commonly experience transient _____

Answer 7

hypoglycemia

fetal hyperglycemia in utero –> increased insulin production and islet cell hyperplasia

Question 8

beta hCG is detectable in maternal serum approximately ___ days after fertilization and ___ days in urine

Answer 8

8

14

Question 9

neonatal abstinence syndrome due to withdrawal from opiates should be treated how?

Answer 9

opiod therapy (morphine, methadone)

Question 10

uterine findings during an ectopic pregnancy are consistent with what phase of the menstrual cycle

Answer 10

luteal phase:
dilated, coiled endometrial glands and vascularized edematous stroma
no uterine or trophoblastic tissue will be present such as villi

Question 11

what cause of post partum hemorrhage also requires manual placental extractions typically yielding small placental fragments which typically increases bleeding

Answer 11

placenta accreta

Question 12

how many amnions and how many chorions are present in dizygotic twins

Answer 12

2 chorions and 2 amnions

dichorionic/diamniotic

Question 13

how many chorions and amnions are present if zygote division of monozygous twins occurs at 0-4, 4-8, 8-12, >13 days

Answer 13

0-4= 2 and 2
4-8= 2 amnion 1 chorion
8-12= 1 amnion and 1 chorion
>13= 1 amnion and 1 chorion and conjoined twins

Question 14

A neonate born with pulmonary hypoplasia and skeletal defects likely had what complication in utero

Answer 14

oligohydramnios

Question 15

ACE inhibitors have what complications during pregnancy

Answer 15

fetal anuria (due to low angiotensin II which is required for normal renal development) –> oligohydraminos –> potters sequence

Question 16

what is the diagnosis of the following karyotype: 46,XX,t(14;21)?

Answer 16

translocation Down syndrome (Robertsonian trnaslocation)

Question 17

Treatment for early, unruptured ectopic pregnancy

Answer 17

methotrexate

Question 18

why is proteinuria a normal finding in pregnancy?

Answer 18

pregnancy increases GFR and permeability of glomerular basement membrane which both allow more protein leakage

Question 19

what causes decreased vascular resistance during pregnancy

Answer 19

increased release of vasodilators, decreased sensitivity to vasoconstrictors , and formation of a high flow , low resistance circuit within the uterus and placenta