Statistics Flashcards
1
Q
Formula that relates sample size, power and effect size
A
n = [(Type 1 error)+Power]/Effect size
2
Q
Regression model that takes into account the time to an event
A
Cox regression
3
Q
Regression that adjusts for confounders of a continuous variable
A
Linear regression
4
Q
Regression model for a categorical outcome
A
Logistic regression
5
Q
Regression model for outcomes that are naturally ordered and categorical
A
Ordinal regression
6
Q
What type of study generates Odds ratio and why?
A
Case-control because this type of study doesn’t measure incidence of disease
7
Q
Positive outcomes on MOMS trial
A
- decreased need for VP shunt at 12 months
- decreased hindbrain herniation at 12 months
- increased rates of walking independently at 30 months
8
Q
TTTS survival rates stage 1 and stage 3
A
stage 1 - 80%
stage 3 - 0-30%
9
Q
T/F: valproic acid associated with reduced cognitive ability and autism in children
A
True
10
Q
Conflicting studies regarding teratogenicity of lamotrigine – what did the unfavorable studies find
A
impairment in neurodevelopmental outcomes
11
Q
Immunosuppressant associated with microtia, cleft lip/palate and miscarriage
A
Mycophenolate
12
Q
1st trimester maternal steroid exposure associated with what anomaly
A
orofacial cleft
13
Q
OB complications associated with long term steroid use
A
FGR
PPROM
14
Q
Effects and secondary effects of 2nd/3rd trimester ACEi/ARB treatment
A
Renal failure and oligohydramnios
Leading to FGR, calvarium hypoplasia, joint contractures, pulmonary hypoplasia
15
Q
Anomalies associated with 1st trimester ACEi/ARB exposure
A
inconclusive data – but cardiac and CNS anomalies
16
Q
Anomaly associated with Lithium
A
Ebstein (<1% but still relatively high)
17
Q
SSRI risk of PPHN due to
A
premature PDA closure
18
Q
Paroxetine use associated with
A
cardiac defects
19
Q
1st trimester opioid/codeine exposure associated with
A
cardiac defects
NTD
20
Q
Isotretinoin associated anomalies
A
Miscarriage Intellectual disability CNS malformations Microtia or anotia Micrognathia Cleft palate Eye malformations Conotruncal defects
21
Q
Isotretinoin SAB rate, structural defect rate, and intellectual disability rate
A
SAB - 22%
defects - 28%
intellectual disability - 47%
22
Q
Excess vitamin A (retinol) associated anomalies, and at what vitamin A dosing
A
similar to isoretinoin (>10,000 IU daily in 1st tri)
23
Q
High-dose radiation effects
A
microcephaly
intellectual disability
growth deficiency
24
Q
GA with highest potential risk of radiation exposure
A
10-17 weeks
25
Radiation dose associated with abnormalities and recommended max radiation dose
50 rad (cGY) to the uterus
Recommendations max of 5-10 rad(cGY) to uterus
26
Effect of elevated mercury
Neurodevelopmental disability
27
Recommended fish intake
8-12 oz or 4oz of big fish
28
Tobacco use associated anomalies
```
Cleft lip/palate
Gastroschisis
Clubfoot
Cardiac
Limb reduction
Ocular
```
29
OB complications associated with tobacco
FGR
PTB
SAB
30
Effects of radiation at 0-4 weeks, 4-10 weeks
0-4: all or none
4-10: growth issues, microcephaly
**carcinogenic potential at any GA
31
Risk factors for cerebral palsy
```
Prematurity (highest <28)
LBW (highest <1500g)
SGA
Intrauterine infection
Neonatal infection
APGAR <7 at 5 minutes
Placental abruption
Obesity/Smoking/Alcohol
Multiples
Pre-eclampsia
RDS/mechanical vent
```
32
Neonatal hypothermia requirements
1. >/= 36 weeks and 16
| - 10min APGAR
33
Thalassemia with elevated A2
B-thal
| Sickle/B-thal
34
Hgb chains in A1 and A2
A1 - 2 alpha, 2 beta
| A2 - 2 alpha, 2 delta
35
Swan parameters essentially unchanged in pregnancy
CVP
| PCWP
36
Type of shock that increases CO
Sepsis
37
Indications for Swan (5)
1. refractory ARDS/shock
2. CM w/ EF <20%
3. NYH III or IV
4. Severe pree with unresponsive oliguria
5. Severe valve disease
38
Singleton and twin growth curves are the same until what GA
26 weeks
39
Singleton growth rate per week in grams at early third vs late third trimester
```
early third (33wk) - 250g/week
late third - 200g/week
```
40
What happens to pCO2 in pregnancy and why?
pCO2 is slightly decreased due to the hyperventilation of pregnancy
41
What happens to HCO3 in pregnancy and why?
Slight increase to compensate for the respiratory alkalosis
42
Normal ABG pregnancy
pH - 7.4-7.44
PaCO2 - 27-32mmHg
PaO2 - 72-104mmHg
HCO3 - 18-22meq/L
43
Leading cause of hearing loss in children
CMV infection
44
CMV positive with no ultrasound findings, what is chance of symptoms at birth
10-15%
45
Viral infection associated with PDA, cataracts/glaucoma, microcephaly, thrombocytopenia
Rubella
46
T/F: risk of Rubella is worse<20 weeks
True
47
Virus associated with Hutchinson teeth, mulberry molars
Syphilis
48
Virus associated with cardiac defects, deafness, blindness
Rubella
49
2 viruses rarely transmitted <20 weeks
Varicella
| Toxo
50
Viruses rarely transmitted >20 weeks
Parvo
| Rubella
51
High IgG avidity for CMV means infection occurred at least ____ months ago
Four
52
How long after acute Parvo infection do you keep checking MCAs
8-12 weeks
53
Chlamydia -- first line and 2 alternatives
1. Azithromycin
Alt: erythromycin, amoxicillin
54
Gonorrhea first line and 2 alternative treatments
1. Ceftriaxone (and treat CT if not ruled out)
Alt: Genta and Azithro, Cefipime (and treat CT if not ruled out)
55
Local anesthetic agents that are amino amides
Lidocaine
Bupivicaine
Ropivicaine
56
Medication to blunt hypertension at time of GETA induction
Labetalol
57
Best and second best anesthesia agents for asthmatics
1. regional
| 2. ketamine and succinylcholine (can use enflurane/isoflurane if needed)
58
Most common respiratory complication of pregnancy
Asthma
59
Risk of asthma exacerbation with SVD vs CS
Csection 18-fold increased risk
60
Treatment/management of IHSS
Propanolol
| Avoid preload and ephedrine
61
T/F: PCWP is a measure of LV preload
True
62
Treatment for refractory maternal SVT
Digoxin
CCB's
B-blockers
63
Variables directly measured versus calculated with a Swan catheter
Measured:
1. HR
2. CO
3. CVP
4. PA pressures in systole and diastole
5. PCWP
Calculated:
1. SV
2. SVR
3. PVR
4. LVSI
64
SVR calculation
MAP-CVP/COx80
65
PVR calculation
PAP - PCWP / CO x 80
66
LVSWI Calculation
SV x MAP x 0.0144
67
T/F: SVR and PVR are measures of afterload
True
68
Swan reading highly predictive of pulmonary edema
CO/PCWP <4
69
What happens to SVR, LVSWI in preeclamspai
Increased
70
CVP that can be massively increased may be due to
massive PE
71
OB complications most-->least predictive of CP
1. Chorio
2. Prolonged ROM
3. Maternal infection
4. FGR
72
Hallmark lab values of AFLP
Elevated bilirubin, ammonia, ALP
| Decreased glucose, ATIII, fibrinogen
73
Dermatosis of pregnancy associated with deposit of complement in basement membrane
pemphigoid gestationis
74
Dermatosis with perivascular T-lymphocytic infiltrate with Eosinophils
PUPPS
75
Dermatosis with spongiosis and a perivascular mononuclear infiltrate
Atopic dermatitis
76
Dermatosis with spongiform pustules with neutrophils
pustular psoriasis
77
Medication classes that can lessen OCP effectiveness
ABX - PCN, tetracyclines
Antiepileptic
St Johns Wort
Rifampin
78
Sx of immediate (IgE) allergy
```
Anaphylaxis
Hypotension
Angioedema
Respiratory distress
Urticaria
Laryngeal edema
```
79
Biologic precurose of NO
L-Arginine
80
Medication that has a long half-life, delay pregnancy for 2 years
Etidronate - used for psoriasis
81
Most common malformations with anti-seizure drugs (most--> least (3))
1. cleft lip/palate
2. cardiac
3. ONTD
82
Drugs to avoid in Myasthenia Gravis
Magnesium
Vecuronium/Rocuronium
Aminoglycosides
Ester anesthetics - chlorprocaine, tetracaine
83
HPV treatments OK and not OK to use
Ok: laser, cryo, TCA, bicholroacetic acid
Not OK: 5FU cream, Podophyllin, Imiquimod, Interferon
84
MOA of glyburide
stimulate insulin release from pancreas
85
Homolog of HPL/HcSommato.
GH and prolactin
86
HPL half life
10-30 mins
87
Treatment of HTN from pheo
phenoxybenzamine
88
meds that provoke a pheo
b- blockers
reglan
high dose steroids
89
Recommended serum PKU levels in pregnancy
2-6mg/dL
90
Rate limiting step in PG synthesis
Cyclooxygenase and Phospholipase A2
91
4 ethical principles
Autonomy
Beneficence
Non-maleficence
Justice
92
Most common GA for heart block from SSA/SSB
18-25 weeks
93
Vesicocentesis results you want/aim for (Na, Cl, Osm, Ca, B2-microglobulin)
```
Na - <100mEq/L
Cl - <90 mEq/L
Osm - <210 mEq/L
Ca - <2 mmol/L
B2-microglobulin - <2 ug/L
```
94
Most common causes of macrosomia
1. enhanced intrinsic growth potential
2. abnormal glucose tolerance
3. obesity (might be higher risk than glucose intolerance)
4. parental sizes
5. multiparity
6. prolonged gestation
95
Fetal effects of uncontrolled maternal PKU
Phenylalanine crosses the placenta
1. pregnancy loss
2. microcephaly
3. cardiac defects
long term - mental retardation, hypopigemntation of hair/eyes/skin
96
PI and RI formulas
PI = S-D / mean
RI = S-D/ S
97
GA when diastolic flow in Doppler starts to be seen
~15 weeks
98
UA resistance higher/lower close to placenta
Lower
99
Major fatty acid in surfactant phospholipids
Palmitic acid
100
Substances that delay fetal lung maturation
Androgens
Insulin
TGF-Beta
101
Substances that promote fetal lung maturation
```
Steroids
TRH/T3
Prolactin
TGF-alpha
Estrogen
Bombeisin
B-agonists
```
102
Enzyme lacked by the (1) fetus and (2) placenta
(1) 3-betaOHSD (can't make pregnenlone --> progesterone)
| (2) 17-alpha hydroxylase
103
Incidence of CP when 5 min APGAR
5% at 5 mins
| IF >20 mins then 20%
104
ACOG hypoxia/asphyxia definition
1. acidemia
2. persistent Apgar 5 minutes
3. evidence of neuro sequelae
4. organ system dysfunction
105
AF volume at its maximum at what GA
32-36weeks
106
Hgb concentration higher in umbilical or uterine artery
uterine artery
107
SCA associated with AMA
47, XXX
| 47, XXY
108
Karyotype in UPD
46 XX or 46 XY with a deletion
109
AD conditions associated with advanced paternal age
Achondroplasia
Marfans
Apert syndrome
Neurofibromatosis
110
Risk of having an affected child with a paternal inversion
no previously affected children - 1-3%
| previously affected children - 5-10%
111
Difference between reciprocal and robertsonian translocation
roberstonian - involves accrocentric chromosomes
reciprocal - involves the same chromosome
112
Highest --> lowest risk of T21 offspring: roberstonian, reciprocal, T21
1. reciprocal (all)
2. trisomy 21 (30%)
3. roberstoniant (5-10%)
113
% infants with T21 born to women <35
80%
114
Effect of smoking on AFP levels
increases
115
Blood product with high level of fibrinogen
Cryo
116
FFP contains ____
| Cryo contains _____
FFP - all clotting factors but no platelets
| Cryo - fibrinogen, factors VIII and XIII
117
Blood product with highest Hep B transmission
Factor VIII or IX concentrate
118
Hemoglobinopathy most likely to present for first time in pregnancy
HgbSC
119
MAC prophylaxis (first line and alternative)
Azithromycin
| Rifabutin
120
Methyldopa MOA
central alpha-2 agonist, leads to reduced SVR
121
Clonidine MOA
alpha-2 agonist
122
Lyme disease treatmen
Amoxicillin
| Cefuroxime, Ceftriaxone
123
Top causes of pneumonia
1. strep
| 2. h influenza
124
early onset versus late onset GBS timing
early - birth to 7 days
| late - >7days
125
risk of neonatal GBS with GBS+ mother
1%
126
T/F: Delta OD450 may not be reliabel in Kell
True
127
Potential neonatal effects of FGR
polycythemia
hypoglycemia
acidosis
hypercapnea
128
Where can prostaglandin dehydrogenase be found
Chorion
129
Sources of PGF2 alpha and E2 in uterus
E2 - fetal membranes
| F2alpha - decidua
130
Why is Mg >Dilantin for use
better efficacy
131
Top 3 causes of thrombocytopenia
1 gestational
2 pree
3 ITP
132
How does NO lead to smooth muscle relaxation
stimulates production of cGMP which leads to activation of MLC phosphatase
133
Function of MLC phophatase
dephsophorylation of the MLC ultimately leading to smooth muscle relaxation
134
Atosiban MOA
Oxytocin receptor antagonist
135
ALPS benefit
decrease in composite outcome of need for respiratory support and decrease in severe respiratory morbidity composite
136
Who gets ALPS
high risk of delivery within next 7 days and before 37 weeks
137
ALPS inclusion/exclusion
Inclusion:
Singleton (twin reduction <14)
34-36+5 weeks
Delivery: PTL w/ intact membranes >/= 3cm or 75%, SROM, indicated delivery
```
Exclusion:
Prior BMZ
Stress dose steroids
Demise or know major anomaly
Maternal BMZ contraindciation
Pregestational DM
Delivery expected within 12hr (pit held for 12hrs)
Chorio or NRFHT
>/=8cm
```
138
Antiseizure med associated w/ vit K deficiency in neonate
Phenytoin
Primidone
Phenobarbital
139
Anomalies associated w/ phenobarb and primidone
phenobarb - CHD
| primidone - cleft lip
140
Is TRH polypeptide, carbohydrate or hormone
polypeptide
141
Principal risk of prolactinoma
will pregnancy lead to an increase in size sufficient to cause neurologic symptoms, most importantly visual impairment (low risk with microadenoma, higher with macroadenoma)
142
Ok to breastfeed with prolactinoma?
Yes - not associated with adenoma growth
143
How to estimate fluid deficit in DKA
100mL/kg
144
Fluid replacement in DKA
Isotonic Saline:
1st hr - 1L
2nd and 3rd hr - 500mL
250cc/hr thereafter of LR or .45NS
145
Goal of K in DKA
4.5-5
146
Typical agents for chemo in breast cancer
doxorubicin + cyclophosphamide OR
| Doxorubicin + cyclophosphamide + 5-FU
147
Trastuzumab associated with
oligohydramnios
148
Drugs to avoid with pseudocholinesterase deficiency
succyincholine
| ester local anesthetics
149
Ester local anesthetics
Chlorprocaine
Benzacaine
Procaine
Tetracaine
150
Fetal effect of paracervical block
fetal bradycardia
151
Lidocaine dosing with and without epi
4mg/kg no epi
| 7mg/kg epi
152
Local anesthetic that rapidly crosses placenta
chloroprocaine - but such short half life
153
If a preeclamptic needs GETA for delivery what can be a complication
Worsened hypertension
154
One bag of FFP/cryo will increase fibrinogen....
10mg/unit
155
Factors in cryo
vwF
Fibrinogen
Factor 1, 5, 8, 13
156
Clotting factors requiring Vit K
Factors 7, 9, 10, prothrombin (2)
157
Labetalol MOA
alpha1 , beta 1 and beta 2 blockers
158
Anti-HTN that (1) increase and (2) decrease cardiac output
Increase: hydralazine
Decrease: Thiazide, propanolol
159
propanolol MOA
pure b-block
160
Anti-HTN that (1) increases and (2) decreases renal blood flow
1. Hydralazine
| 2 Thiazide, Propranolol
161
Top OB adverse outcomes with cHTN
1. Preeclampsia
2. PTB
3. FGR
4. Perinatal death
5. Abruption
162
Prazosin MOA
vasodilation via alpha agonist
163
Preeclamptic women are more sensitive to what substance
Angiotensin II -- this sensitivity is seen before clinical evidence of disease
164
What happens to preeclamptics when they are exposed to endogenous pressors (norepinephine, angiotensin ii)
MBP significantly increases
165
T/F: in normal pregnancy there is unchanged sensitivity to norepinephrine, epinephrine, and vasopressin
True
166
Factors causing right shift in hemoglobin curve
decreased O2 affinity, give tissues O2
Acidosis
Fever
Increased 2-3,DPG
167
Factors causing left shift in oxygen-saturation curve
DecreaseO2 offloading
Alkalosis
Reduce 2,3-DPG
Hypothermia
168
PaO2 that is 50% Hgb saturation
27
169
K repletion in DKA
Start repletion once K is <5
If >4 give 10-20mEq
If <4 give 30-40mEq
170
What is the cytokine shift that happens at implantation to prevent host rejection
Shift from Th1 to Th2 cytokine profile
171
Cells that are thought to act locally to prevent fetal-parental rejective
Tregs
172
Most predominant immune cell in the uterine decidua
NK cells
173
Suspected role of NK cells
spiral artery remodeling
174
predominant antigen presenting cell in pregnancy
macrophages
175
Villous vascular development is driven by what cells
cytotrophoblasts
176
Cells that produce the following hormones in the placenta:
1. Prolactin
2. GnRH
3. hPL
1. Decidua
2. Cytotrophoblast
3. Synctiotrophoblast
177
Immune cells that are increased
Th2 (increase IL 4, 6, 13)
Granulocytes and CD8 lymphocytes
C3 and C4
178
Dose alterations of amide local anesthetics in what patients
patients with renal or liver disease
179
Lido toxicity - which symptom first
Neuro then cardiac toxicity symptoms
180
Bupivicaine toxicity - which symptoms first
Neuro and cardiac at same time
181
Anti-HTN medication for mysathenia patients
Hydralazine or methyldopa
182
Potential fetal effects of maternal myasthenia
Poly
DFM
Arthrogryposis
183
Reason Graves disease improves in pregnancy
decrease in TSH receptor antibody concentrations
184
what type of virus is HIV
RNA retrovirus
185
Verapamil + Digoxin for fetal SVT =
risk of feta cardiac arrest/depression
186
Possible effects of thiazide use near time of delivery
lyte abnormalities
thrombocytopenia
bleeding issues
187
loop diuretic with possible fetal ototoxicity
ethacyrnic acid
188
fetal concern w/ lasix
PDA closure
189
treatment of anthrax exposure
anthrax vaccine
| Cipro
190
Drug associated with neonatal hypothermia
Valium (diazepam)
191
Precursor for deoxycortisol
progesterone (via 21-hydroxylase)
192
Can cause fetal virilzation
Aromatase deficiency
| Luteoma of pregnancy
193
Byproduct of carbohydrates and proteins
Carbs - CO2
| Protein - NH3
194
Amniotic fluid volume at different GA
```
8wk - 10cc
12wk - 50cc
20wk - 400cc
22wk - 630cc
28wk - 770cc
30-34 - max
36-38 wk - plateau around 500cc
```
195
Compared to fetal plasma the amniotic fluid is....
isotonic in first trimester
| hypotonic after that
196
What is volume of intermembranous space? intervillous space?
intermembranous - 200-500cc
| intervillous - 140cc
197
Type of alkaline phosphatase made by placenta
Heat stable
198
most reliable initial sign of malignant hyperthermia
hypercarbia
followed by: tachycardia, masseter muscle rigidity, general muscle rigidity
199
meconium present, which FLM test is still valid
phosphitdylglycerol
200
what makes up most of surfactant
saturated lipids
201
FLM test that can be incorrect if high/low amniotic fluid
lamellar body counts
202
What you can and can't use for FLM in diabetics
don't use PG testing as it can be present if bad glycemic control
can use surfactant:albumin or lamellar body counts
203
MMA levels are elevated in what deficiency
Vit B12
204
Elevated homocysteine levels can be seen in what type of anemia
Vit b12 or folate
205
T/F: glanzman = normal ristocetin test
true
206
Which subtype of IgG play a role in hemolytic disease of newborn
1 and 3 --- 1 in first trimester, 3 is the most hemolytic
2 and 4 not associated w/ HLDN
206
Which subtype of IgG play a role in alloimmunization
1 and 3 --- 1 in first trimester, 3 is the most hemolytic
207
Neonate compressions:ventilation per minute
90 compressions:30 ventilations/minute
208
Phenylephrine is choice for epidural hyoptension, except in what cases
bradycardia - use ephedrine
209
Top complications associated with renal transplant
1. preterm birth
2. low birthweight
3. preeclampsia
4. SAB`
210
Most glucogenic amino acid
glutamate
211
CD4 count for AIDS
<200
212
What happens to platelets in preeclampsia
decrease in number
| decrease in aggregation
213
How can ion trapping happen w/ local anesthetic administration and the fetus
if fetus is more acidotic than mom then increased local will cross placenta (the ionized local gets trapped in fetal circulation)
214
another name for hypogastric artery
internal iliac
215
ARPKD fetal findings
enlarged echogenic kidneys
| oligohydramnios frequently
216
ADPKD fetal findings
enlarged echogenic kidneys (not as much as ARPKD)
typically normal AFI
can sometimes see cysts
217
layers of hemochorial placenta
```
maternal capillary
intervillous space
syncytiotrophoblast
cytotrophoblast
fetal mesenchyme
fetal capillary endothelium
fetal capillary
```
218
deformation
genetically normal structure becomes abnormal due to mechanical force (contractures from oligohydramnios)
219
association
anomalies occur together but not linked to a reason (CHARGE)
220
% of blood leaving RV that travels through PDA
90%
221
Most important surfactant protein
SP-A
222
Surfactant is most beneficial because it decreases risk of
death
223
Most common causes of acute pyelo
E coli
Klebsiella
Proteus
Enterobacter
224
Tocolytic that can cause hypokalemia
Terbutaline (ritodrine)
225
GBS is most resistant to what drug
Erythromycin
226
Prevalence of asx bacteriuria
5%
227
% of HSV2 positive individual with subclinical shedding
1-3%
228
Why are dex and beta able to cross placenta and have fetal effects
They're fluorinated, don't get broken down by placental hydroxylase
229
Decrease risk of PVL -- which steroid?
Beta (not dex)
230
Highest glucocorticoid potency
Beta
Dex
Methylprednisolone
231
Steroids with highest minerocorticoid properties
Hydrocortisone and cortisone
232
Most common problem for term FGR infant
hyperbilirubinemia
233
immunotropism
immunologic stimulation of trophoblasts
234
PVL damages what part of fetal brain
white matter
235
autonomic dysreflexia -- will items above or below lesion vasoconstrict?
below lesion = vasoconstriction
236
Medication to avoid in patient with spinal cord lesion to avoid hyperkalemia
Succinylcholine (will release stored K from denervated muscles)
237
heart lesion most essential to prevent hypotension and drop in SVR
Eisenmengers
238
Most common aneuploidy when severe FGR <22 weeks
T18
239
embryo sex differentiation at what GA
6-7 weeks
240
Leydig cells make ____, Sertoli cells make____
Testosterone, AMH
241
46XX with ambiguous genitalia differential
virilized from maternal androgen exposure
CAH (21-hydroxylase, 11-beta hydroxylase deficiency)
Maternal androgen secreting tumor
242
SLO clinical manifestations
Holopros
polydactyly or syndactyly
FGR
Ambiguous genitalia
243
Which subtype of 11-betaOHSD converts cortisol to cortisone
type II
244
17-hydroxylase function
c21 to c19 steroids
245
Fetal leptin site of production
mostly fetal adipose followed by placenta
246
hPL is most similar to which hormones
hGH and prolactin
247
Hormone needed by the adrenal gland to support its growth in late gestation
ACTH
248
T/F: spiral arteries lose their smooth muscle layer during cytotrophoblast invasion
True
