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All Subjects In One > SUM - sheets- FINAL - Sheet1 > Flashcards

SUM - sheets- FINAL - Sheet1 Flashcards

1
Q

Can you reverse CCHB in an affected fetus?

A

No

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2
Q

Fetus grows how many grams per week?

A

5g/wk at 15
10g/wk at 20
30g/wk at 32

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3
Q

Apocrine and Eccrine gland activity in pregnancy?

A 
Apocrine glands (hair follicles axilla and groin) Decreases
 Eccrine glands (throughout the body) Increases
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4
Q

Most common infectious cause of Non-immune Hydrops

A

Parvovirus

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5
Q

Which is the most abundant secretory hormone produced by the placenta?

A

HPL aka Human Chorionic Somatomammotropin

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6
Q

Normal Acid base values in pregnancy?

A

pH: 7.4-7.48 (unchanged)
O2: 101-104 (increased)
CO2: 27-32.5 (decreased)
HCO3: 18-26 (decreased)

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7
Q

Asthma Inhaler response, what is Good what is incomplete, what is poor? What do you do for each of those?

A

Good = PEFR >80% (repeat q 3-4 hrs PRN)
Incomplete = PEFT 50-80% (q 20 mins x 2 times, and call MD if not improved)
Poor = PEFR <50% (repeat treatment and seek medical attention)

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8
Q

NAIT mode of delivery?

A

Check Fetal platelet count at 32 weeks via PUBS, if >100,000 Vaginal okay, if <100,000 C/S

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9
Q

In a term newborn with neonatal encephalopathy, which MOST STRONGLY suggests that acute hypoxia-ischemia in the peripartum or intrapartum period was a contributor?

A

Presence of multi-system organ failure increases the chances of hypoxic-ischemic injury as an explanation for neonatal encephalopathy.
This finding has the strongest association with hypoxic-ischemic encephalopathy of the options presented.
However, it alone is insufficient for the diagnosis.

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10
Q

Name some sentinel obstetric events?

A

sentinel obstetric events occurring immediately before or during labor and delivery increase the chance of hypoxic-ischemia contributing to neonatal encephalopathy. Examples include uterine rupture, placental abruption, umbilical cord prolapse, amniotic fluid embolus, and hemorrhage associated with vasa previa.

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11
Q

Recommendation for delivery mode in twins with cephalic presentation of Twin A?

A

Perinatal outcomes for twin gestations in which first twin is in cephalic presentation are not improved by cesarean delivery. Thus, women with either cephalic/cephalic-presenting twins or cephalic/noncephalic-presenting twins should be counseled to attempt vaginal delivery

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12
Q

Most common site for fetal blood sampling?

A

Umbilical Vein close to the placental insertion site.

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13
Q

Indications in CDH for Fetal Endotracheal Obstruction (FETO)?

A

defined as LHR<1.0, 1/3 liver herniation

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14
Q

Which of the following is the most common indication for fetal intracardiac intervention?

A

Most common is balloon aortoplasty in fetus.
Possible fetal procedures include aortic valvuloplasty for critical aortic stenosis; atrial septostomy for hypoplastic left heart syndrome with intact interatrial septum, and pulmonary valvuloplasty for pulmonary atresia with intact interventricular septum.

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15
Q

When is Aortic Valvuloplasty used in a fetus?

A

It is offered for selected cases of critical aortic stenosis in which the left ventricle is either normal sized or dilated to prevent HLHS

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16
Q

Delivery plan for a CPAM?

A

if CVR (lxwxhx 0.52) (CPAM Volume ratio) > 1.6 consider EXIT procedure.

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17
Q

When in CPAM is more monitoring needed?

A

CVR > 1.6 (increaed risk of hydrops)

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18
Q

Maximum recommended dose of Lidocaine for local anesthetic?

A

4mg/kg max, or 7mg/kg if given with epinephrine

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19
Q

Most important determinant of drug transfer into maternal milk is?

A

Maternal plasma levels (more than the lipophilic, non protein bound, low molecular weight, non ionized)

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20
Q

When do you deliver IUGR?

A

With normal UA Doppler deliver at 38-39 weeks
If absent end diastolic flow deliver at 34 weeks, if the antepartum testing is reassuring
With reverse end diastolic flow, the recommendation is to deliver at 32 weeks.

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21
Q

Management of CPAM with Hydrops?

A

Drain / Shunt if possible if not consider Steroids and postnatal resection due to increased risk of malignancy.

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22
Q

Date discrepancy / change criteria?

A

o More than 5 days at less than 8 6/7 weeks
o More than 7 days between 9 and 13 6/7 weeks based on CRL
o More than 7 days between 14 and 15 6/7 weeks based on biometry
o More than 10 days between 16 and 21 6/7 weeks based on biometry
o More than 14 days between 22 and 27 6/7 weeks based on biometry
o More than 21 days at 28 weeks and beyond based on biometry

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23
Q

A G1P0 is admitted for preterm labor at 26 weeks gestation. Which of the following is the MOST appropriate reason to administer intravenous magnesium sulfate?

A

Reduction in cerebral palsy AND death (not just CP alone)

24
Q

What best describes the research regarding the efficacy of activity restriction in reducing the risk of preterm birth in this patient?

A

Only studied retrospectively and found to be harmful towards preterm birth.

25
Q

What is the incidence of a stillbirth per thousand (corrected for anomalies and unpredictable causes) within 1 week of a normal modified biophysica profile?

A 
The following is a list of antenatal surveillance test modalities and their associated incidence of stillbirth per thousand, within one week of testing:
 Non stress test- 1.9 
 Biophysical profile- 0.8 
 Modified biophysical profile- 0.8 
 Contraction stress test- 0.3
26
Q 
Which of the following has the best positive predictive value for subsequent development of preeclampsia?
 First trimester Uterine Doppler
 Low PAPP-A
 Second Trimester MSAFP
 Clinical Risk Assessment
A

Clinical Risk Assessment

27
Q

Why do infants born to diabetic mothers have increased bilirubin?

A

Increased polycythemia from glucose stimulation resulting in increased bilirubin productiondue to RBC breakdown.

28
Q

A cesarean delivery is performed at 33 weeks gestation due to preterm labor and breech presentation. After the initial resuscitation, the neonate has persistent tachypnea, grunting, and cyanosis and continuous positive airway pressure (CPAP) is initiated. The chest x-ray shows low lung volumes, a diffuse reticulogranular pattern, and air bronchograms. Which is the most likely diagnosis?

A

Respiratory Distress Syndrome

29
Q

The single most important clinical benefit for delayed cord clamping in preterm infants is the possibility for a nearly 50% reduction in?

A

intraventricular hemorrhage

30
Q

ECMO Inclusion criteria?

A

Birth weight >2 kg
Gestational age >34 weeks
Absence of significant intracranial or other hemorrhage
Absence of lethal congenital or chromosomal abnormalities

31
Q

Mom is CF Carrier, dad tested and is negative for 80% of mutations, population risk is 1/25 of being a carrier, what is the risk of an affected child?

A

1/2 (mom) * 1/25 (carrier risk) *0.20(% left that he wasn’t tested for) * 1/2 (risk to pass it on) = 1/500?

32
Q

cfDNA RHD testing requires what to be valid?

A

SNP > 6 of 92 differing from the Mom (if fetus is female to make sure its not moms)

33
Q

If cdDNA RHD testing is not valid due to low SNP what can you do?

A

Consider repeating if time to get results back would be in time to initiate surveillance.

34
Q

Most common causes of Non-immune hydrops?

A 
Alphabetical ascending order
 #1 Cardiovascular
 #2 Chromosomal
 #3 Hematologic
 #4 Infectious
35
Q

Management of TTTS once diagnosed stage 1?

Prognosis?

A

Most experts agree that expectant management with weekly ultrasound surveillance is the appropriate choice to manage twins with Stage 1 TTTS.
The overall survival rate for Stage 1 TTTS with expectant management is 86%,after amnioreduction is 77% and after laser photocoagulation is 86%.
So expectant management is whats most recommended.

36
Q

What patients with liver disease should not use combined OCPs?

A

not be used in women with severe (decompensated) cirrhosis

its okay in mild cirrhosis or chronic hepatitis b

37
Q

You are providing obstetric care for a woman with a history of Roux-en-Y gastric bypass surgery. What do you tell her regarding OCPs?

A

Combined oral estrogen/progestin contraceptives can be safely used in women with a history of restrictive procedure, but should be avoided in women with a history of malabsorptive procedure.

38
Q

When is an IUD okay in an HIV patient?

A

If not AIDs or Severe HIV due to theoretical risk of infection

39
Q

Midgut herniation is normal until what CRL?

A

61mm

40
Q

The time period for an agent to inhibit neural tube closure in the human embryo is approximately

A

21 to 28 days after conception. (NEURAL TUBE = 6 + 4 = 4-6 weeks)

41
Q

Infliximiab use in pregnancy, recommendations?

A

If her disease remains in remission on infliximab through the 1st and 2nd trimesters, she could adjust her dosing schedule to give the last dose of the agent during pregnancy at 30-32 weeks in order to minimize the level of infliximab in the newborn.
No vaccines for first 6 months after birth with use.

42
Q

To what level does a spinal need to be to in order to do a cesarean section.

A

T4

43
Q

Management of Listeriosis exposure?

A

IF symptomatic / febrile = blood culture and IV Ampicillin

If asymptomatic = can expactantly manage

44
Q

Which is anesthetic agent is a known teratogen?

A

None of them

45
Q

Septic Shock treatment goals in first 1 hour? In first 4 hours?

A

1 hour: Blood cultures and ABx

4 hours: central line despite responsiveness to pressors

46
Q

What is the treatment for pheochromocytoma?

A

Surgery is the treament but give phenoxybenzamine while awaiting surgery

47
Q

What is an increased in leptin not associated with?

A

IUGR

48
Q

Adiponectins relationship to birth weight?

A

The largest drops in adiponectin levels are related to the largest birthweight

49
Q

Relationship between Ghrelin and BMI?

A

Inverse relationship also true for size of baby

50
Q

Adiponectin levels low = associated with?

A

Obesity, Diabetes, Metabolic syndrome

51
Q

Does adiponectin change with exercise?

A

No

52
Q

Robertsonian translocation 14:21 in mom, risk of a down syndrome child?

A

10-15%

53
Q

Robertsonian translocation 14:21 in dad, risk of a down syndrome child?

A

its 5%

54
Q

ROC Curve represents what as far as names for sensitivity and spec?

A

x axis true positive, y axis false positive

55
Q

Drug that levels are higher in the fetus than in the mom?

A

Ketamine

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