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Untitled Flashcards

1
Q

Associated finding in Meckel-Gruber Syndrome

A

Multicystic Dysplastic Kidneys

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2
Q

*Rx for fetal thyrotoxicosis + fetal heart failure at 28 wks GA; mom s/p thyroid ablation

A

PTU

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3
Q

*BMZ decreases the following:

A

Movements/Variability

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4
Q

*Most likely to be abnormal with fetal acidemia

A

Decreased fetal tone

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5
Q

*Treacher-Collins associated with impairment of:

A

Mandible

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6
Q

Immunoglobin associated with mucosal defense in breast milk

A

IgA

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7
Q

*Petechiae +hepatosplenomegaly at birth

A

CMV

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8
Q

*Which is least likely with Listeria?
- PTL
-Chorio
- Hydrops

A

Hydrops

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9
Q

*Which is most associated with aneuploidy in isolation?
- Cleft lip
- Gastroschisis
- EIF
- Hydronephrosis
- Ventriculomegaly

A

Ventriculomegaly

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10
Q

*Which is most associated with aneuploidy?
- EIF
- Short humerus
- Echogenic bowel
- Pyelectasis

A

Echogenic bowel

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11
Q

*Which is most likely neonatal complication of PKU?
- Mental retardation
- Cardiac
- Microcephaly

A

Mental retardation

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12
Q

Least advised in pregnancy if mom has known PKU
- Amnio for PKU gene
- Paternal PKU testing
- Dietary restrictions
- Fetal echo

A

Amnio for PKU gene

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13
Q

Most commonly associated with SS-A and SS-B antibodies?
- Sjogrens
- Scleroderma

A

Sjogrens

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14
Q

Most likely to improve during pregnancy?
- RA
- Lupus

A

RA

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15
Q

*Most evidence for association with FGR?
- Atenolol
- HCTZ

A

Atenolol

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16
Q

*Worse prognosis for neonatal CMV?
- Microcephaly
- Cerebral calcifications
- Positive PCR after amnio

A

Microcephaly

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17
Q

*Least likely with hyperparathyroidism?
- Pancreatitis
- HTN
- Kidney stones
- Cranial calcifications
- Neonatal hypocalcemia

A

Cranial calcifications

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18
Q

*What causes insulin resistance at 4-8AM?
-Cortisol
- GH
- PRL
- Progesterone
- Androstenedione

A

Cortisol

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19
Q

*Which crossed placenta most readily?
- T3
- T4
- TSH
- TRH

A

TRH

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20
Q

Most likely cause of hypoxia post CS in obese class II patient?
- Apnea
- PE
- Pulm edema

A

Apnea

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21
Q

*Most common risk with AZT?
- Marrow suppression
- Rash
- Myositis

A

Marrow suppression (if HA/n/v was an option, choose that)

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22
Q

*HIV patient with some sort of liver dz, which med to avoid?
- Nevirapine
- Zidovudine
- AZT

A

Nevirapine

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23
Q

*HIV patient not on meds, presents in labor, best single agent?

A

AZT if it’s an option, or Nevirapine

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24
Q

*Most likley cause of pain from a “wet tap”?

A

Traction on nerves

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25
Q

*High spinal involving cervical roots results in..?

A

Dyspnea

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26
Q

*Which is not associated with advanced paternal age?
- Marfan’s
- Neurofibromatosis
- Achondroplasia
- Klinefelters

A

Klinefelters

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27
Q

*Initial symptoms with intravascular lidocaine injection?

A

Tinnitus

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28
Q

Which anesthetic has greatest cardiac risk?
- Bupivicaine
- Lidocaine
- 2-Chloroprocaine

A

Bupivicaine

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29
Q

Which screening not recommended for Jewish population?
- CF
- Tay Sachs
- Familial Dysautonomia
- Gaucher

A

Gaucher

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30
Q

Which most likely to recur in a subsequent pregnancy?
- Hemophilia
- NAIT

A

NAIT

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31
Q

Mechanism of action of LMWH

A

Xa inhibitor

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32
Q

*Which would decrease drug transport across placenta?
- Increased lipid solubility
- Increased protein binding
- Decreased ionization
- Placental degradation

A

Increased protein binding

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33
Q

*Most compounds cross placenta by what mechanism?

A

Simple diffusion

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34
Q

*What is the PO2 of the umbilical artery?
- 20
- 50
- 80

A

20

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35
Q

*Which has the lowest PO2?
- Umbilical artery
- Umbilical vein

A

Artery

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36
Q

Minimal PO2 to maintain maternal O2 sat >90%

A

60

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37
Q

*Which is least predictive of cerebral palsy?
- Neonatal seizures
- Low pH/high base excess
- Multi-organ dysfunction
- 10 min APGAR = 3
- Early onset encephalopathy

A
  • Low pH/high base excess
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38
Q

*Which is helpful for tx of HIE?

A

Cooling/”hypothermia”

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39
Q

*Most LIKELY to be helpful for tx of mitral stenosis intrapartum?
- Lasix
- Propanolol

A

Lasix

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40
Q

*Best rx for mom with dyspnea, cyanosis, large VSD and R to L shunt at 28 wks?
- Viagra
- Lasix

A

Viagra

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41
Q

*Best tx for pheochromocytoma
- Alpha blocker
- Clonidine
- Fluids
- Beta blocker

A

Alpha blocker

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42
Q

*Which inheritance pattern associated with variable penetrance?
- AD
- X-linked

A

AD

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43
Q

*Least likey in family hx of affected by Fragile X?
- POF
- Ataxis
- Fam hx of MR
- Gonadal cancer

A

Gonadal cancer

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44
Q

*Most likely outcome with Fragile X

A

Mental retardation

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45
Q

*Which SSRI most associated with increased fetal cardiac risk?

A

Paxil

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46
Q

*Least likely symptom with H1N1
- Fever
- Cough
- Sore throat
- N/V

A

N/V

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47
Q

*Most likely dx with unilateral pleural effusion?
- Hydrothorax
- CDH
- CCAM
- BPS

A

Hydrothorax

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48
Q

Most common OB fistula in US?
- Rectovaginal
- Vesicovaginal

A

Recto-vaginal

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49
Q

Source of metabolic fuel for fetal myocardium?
- Glucose
- Lactate

A

Lactate

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50
Q

Most direct cause of myometrial contractions?
- Myosin light chain kinase
- Tyromyosin
- Calponin

A

Myosin light chain kinase

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51
Q

Which contributes most to maternal weight gain in pregnancy?
- Blood
- Uterus
- Adipose

A

Split between adipose and uterus

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52
Q

*Which steroid influences sodium reabsorption

A

Fludrocortisone

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53
Q

Levels of which of the following are LEAST affected by liver cirrhosis?
- Lovenox
- Warfarin
- Dilantin

A

Lovenox

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54
Q

Which is least associated with low PAPP-A?
- Pre-e
- FGR
- Abruption
- 3rd trimester demise

A

3rd trimester demise

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55
Q

*Most associated with placental insufficiency
- Low PAPP-A
- High PAPP-A
- Low hcg

A

Low PAPP-A

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56
Q

Findings most likely due to PKU?
- Nail hypoplasia
- Cardiac
- Stippling

A

Cardiac

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57
Q

*Neonate with limb and muscle hypoplasia, derm and eye findings

A

Varicella

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58
Q

Greatest contraindication to PP combined OCPs?
- Hemorrhagic stroke w/ eclampsia
- Sagittal vein thrombosis
- Ovarian vein thrombosis

A

Sagittal vein thrombosis

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59
Q

Injury with brachial plexus injury resulting in Erb’s palsy

A

C5-C6

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60
Q

*Which most requires “an additional 1mg” of folic acid?
- Sickle cell
- Twins
- Short interpregnancy interval

A

Torn b/w A &B

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61
Q

*Discrepancy in which is best for TTTS dx?
- Oli/poly
- Fetal weight

A

Oli/poly

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62
Q

*What defines stage III TTTS?
- ADEF in donor twin
- Absent bladder
- Demise
- Hydrops
- Discordant growth

A

AEDF in donor twin

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63
Q

*Most likely cause of polyhydramnios
- Idiopathic
- DM
- TEF

A

Idiopathic

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64
Q

*Why does T4 demand increase in pregnancy
- Increased basal metabolic rate
- Plasma expansion
- Increased TBG

A

Increased TBG

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65
Q

*Worst cardiac lesion in pregnancy
- VSD with R to L shunt
- Aortic stenosis, severe
- Mitral stenosis, Class III NYHA

A

VSD with R to L shunt

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66
Q

*Low MCV and Hgb A2 2.5 (nl iron studies - some exams specified normal iron and some didn’t)
- Alpha thal
- Iron Deficiency anemia

A

Depends on iron studies! Tricky!

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67
Q

*Low MCV and increased Hgb A2 (>4%)

A

Beta-thalassemia

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68
Q

*Best way to differentiate lupus flare from pre-e

A

Increased DS DNA

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69
Q

*least likely with fetal alcohol syndrome
- MR
- Facial abnormalities
- Microcephaly
- Kidney abnormalities
- NTD

A

NTD

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70
Q

*Risk of peripartum transmission for recurrent HSV
- 1%
- 10%
- 15%

A

1%

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71
Q

Most likely to cause bleeding

A

Factor V deficiency

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72
Q

*How does iodide rx work?
- Suppresses thyroxine production
- Inhibits release of thyroid hormone
- Blocks conversion T4 to T3

A

Inhibits release of thyroid hormone

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73
Q

Most likely to cause cushinoid syndrome in pregnancy

A

Steroids

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74
Q

Most common ovarian cancer in pregnancy

A

Dysgerminoma

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75
Q

*Pre-e associated with which of the following
- Decreased urinary Ca
- Decreased thrombooxane
- Decreased sensitivity to angiotensin

A

Decreased urinary Ca

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76
Q

Which most explains decreased 2nd trimester BP
- Increased CO
- Increased renal blood flow
- Decreased angiotensin sensitivity

A

Decreased angiotensin sensitivity

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77
Q

*Which rate of dopamine infusion improves renal blood flow
- 4ug/min
- 8
- 12
-16
- 20

A

4ug/min

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78
Q

Most important for PGE2 production
- Arachidonic acid
- Prostacylcin

A

Arachidonic acid

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79
Q

*Most likely dx with CDH, FGR VSD
- T13
- T18
- T21
- Di George’s

A

T18

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80
Q

*Most likely dx with cystic hygroma
- T13
- T18
- T21

A

T21 (Turners was not an option)

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81
Q

*Aspartoacylase deficiency associated with which dz?
- Canavans
- Tay Sachs
- Gauchers

A

Canavans

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82
Q

Expansion of vulvar hematoma limited by which of the following?

A

Colles fascia

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83
Q

*Large CS incision injures iliohypogastric nerve, what is the most likely results?
- Decreased labial sensation
- Decreased sensation at mons
- Rectus necrosis

A

Decreased sensation at mons (question worded opposite in 2014; gave mons, asked nerve)

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84
Q

Which is associated with exposure to folic acid antagonists

A

Caudal regression syndrome

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85
Q

Which nerve fibers contribute to pain in 2nd stage of labor?

A

S2-4

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86
Q

Most likely outcome for baby if mom had childhood radiation exposure
- Single gene mutations
- Childhood cancer

A

Single gene mutations

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87
Q

*Both parents have normal stature, but both kids have achondroplasia, most likely reason
- Gonadal mosaicism
- De novo mutation

A

Gonadal mosaicism

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88
Q

*Necessary for production of all fetal steroids
- LDL cholesterol
- Free cholesterol
- Acetate

A

LDL cholesterol

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89
Q

*What is pulmonary capillary wedge pressure (PCWP)

A

LV pre-load

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90
Q

Stillbirth in setting of cholestasis, most likely finding

A

Meconium stained fetus/placenta

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91
Q

Most common mode of transmission for Hep B worldwide
- Mom-baby
- IVDA
- Transfusion

A

Mom-baby

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92
Q

What will progesterone do in breastfeeding women
- Increased triglycerides
- Decrease depression

A

??Increased triglycerides (couldn’t find source anywhere)

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93
Q

*Which is most likely to potentiate neuromuscular blockade?

A

Gentamycin

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94
Q

Why are basic drugs like demerol concentrated in an acidemic fetus?

A

Decreased isoelectric point/ion trapping

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95
Q

*What hormone does the placenta lack/is “inactive” that the fetus has/is “active?
- 17 alpha hydroxylase
- 21 hydroxylase
- 3 beta dehydroxylase

A

17 alpha hydroxylase

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96
Q

Rate of vertical transmission with primary CMV

A

1T = 30-40%
3T = 40-70%

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97
Q

*Pattern consistent with recurrent CMV
- (+) IgM/IgG, high IgG avidity
- Low IgG avidity

A

(+) IgM/IgG, high IgG avidity

Notes:
- IgM: can indicate recent or reactivation but cannot tell between primary or recurrent
- IgG:
Primary = significant rise in titers during early and late pregnancy
Recurrent = stable or minimal increase = recurrent
- IgG Avidity:
Low avidity EARLY in pregnancy = primary
Low avidity LATE in pregnancy = primary OR recurrent
High avidity = more likely recurrent?

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98
Q

*Which is anti-inflammatory?
- IL-10
- IL-6
- IL-11

A

IL-10 (the others are PRO-inflammatory)
TGF-beta is also anti-inflammatory

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99
Q

Which are not involved in basic immune response in pregnancy?
- T-lymphocytes
- NK cells
- Monocytes

A

T-lymphocytes

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100
Q

*Preload and afterload optimized, which med can improve cardiac contractility?

A

Hydralazine

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101
Q

*Worst prognosis for pt with CF
- R-sided heart failure
- Lung infections

A

R-sided heart failure

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102
Q

*Which is not helpful for identifying lupus anticoagulant?
- ANA
- DRVVT
- Kaolin clot test
- Prolonged PT

A

ANA

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103
Q

*Microtia is associated with which of the following?

A

Accutane

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104
Q

*The best test to compare the mean in 3 groups

A

ANOVA

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105
Q

*Which is associated with inappropriate failure to reject the null hypothesis?

A

Type II error

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106
Q

*Which is best study design for a rare outcome?

A

Case-control

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107
Q

*Which is the usual cause of hemodynamic decompensation with mitral stenosis peripartum

A

Increased pre-load

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108
Q

Which is least important for power analysis?
- Desired chi-square result
- Sample size
- STD deviation
- Analysis of covariance

A

2 similar Qs - 1x was for nominal variable (answer A), 2nd time for continuous variable (Answer D)

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109
Q

*Formula for odd ratio is:

A

AD/BC but in actual words

Ratio of exposed vs unexposed cases divided by exposed vs unexposed controls

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110
Q

*Swan values in 3T pregnancy (vs pre-pregnancy)

A

Decreased SVR/PAP, no change PCWP

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111
Q

*Which changes least in pregnancy?
- CVP
- CO
- SVR
- PVP

A

CVP

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112
Q

Decreased SVR least likely to be harmful for which of the following?
- Aortic stenosis
- Mitral stenosis
- IHSS (idiopathic hypertrophic subaortic stenosis)
- PHTN

A

Mitral Stenosis

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113
Q

*Which is least likely to need bacterial endocarditis ppx?
- MVP with regurg
- Mechanical valve
- Hx of endocarditis

A

MVP with regurg

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114
Q

*Umbilical artery
- Decreased O2 vs uterine vein
- Decreased Hgb vs uterine vein
- Lower pH than umbilical vein

A

Decreased O2 vs uterine vein

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115
Q

*which has the lowest O2 content?
- Umbilical artery
- Umbilical vein
- Uterine artery
- Uterine vein

A

Umbilical artery

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116
Q

*What is the most important factor in development of fetal hydantoin syndrome?
- Genetic polymorphisms
- Other medications

A

Genetic polymorphisms (epoxide hydrolase)

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117
Q

*What is the best way to monitor improvement in metabolic acidosis in DKA?

A

Anion gap

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118
Q

Which has clinically significant levels of Factor X?
- FFP
- Cryo

A

FFP

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119
Q

Mom has sickle cell (hgb SS), dad unknown but carrier rate is 1/12, what is the chance fetus will have hgb SS

A

1/24

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120
Q

*Least associated with embryopathy
- Azathioprine
- Warfarin
- Hydantoin

A

Azathioprine

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121
Q

*Which is most associated with fetal risk?
- Thyroid stimulating antibodies
- TSH

A

Thyroid stimulating antibodies

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122
Q

*Randomization is best for which of the following reasons

A

Decreased confounding

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123
Q

*Best way to perform randomization
- Random number block permutation
- Basket of cards

A

Random number block permutation

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124
Q

*When to use a one-tailed t-test

A

Results can only go in one direction

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125
Q

*Which is LEAST important in adaptive immunity ?
- Monocytes
- Trophoblast
- T
- B

A

Monocytes (this is innate immunity)

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126
Q

*Which is most common with malarial infection?

A

Anemia

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127
Q

*What is the most likely outcome with amnio 45, XX der (13,21)
- Normal
- Down syndrome
- Was inherited from dad

A

Normal

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128
Q

*Which CVS results most associated with uniparental disomy

A

46XX[10]/47XX+15[5]

“46XX[10]”: This indicates that the individual has a normal female karyotype (chromosomal makeup) with 46 chromosomes, including two X chromosomes. The “[10]” indicates the total number of cells analyzed and found to have this karyotype.

“47XX+15[5]”: This indicates that in addition to the majority of cells with a normal 46XX karyotype, there are five cells that have an extra chromosome 15 (trisomy 15), resulting in 47 chromosomes. These five cells have both copies of chromosome 15 from one parent and none from the other parent, representing a case of uniparental disomy for chromosome 15.

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129
Q

*Which is least likely if study results with p<0.01
- Inadequate power
- A smaller sample size may have had nonsignificant effect
- Chances results were due to chance are <1%

A

Inadequate power

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130
Q

*Carrier frequency of AR disease is prevalence is 1/6400

A

1/40

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131
Q

*Precursor to estriol

A

DHEAS? Androstenedione?

DHEAS-16 from fetal liver –> androstenedione –> estriol

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132
Q

*What affects PPV the MOST?
- Prevalence of disease
- ROC curve
- # of people sampled

A

Prevalence of disease

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133
Q

*Which maternal cardiac lesion most likely transmitted to fetus?

A

IHSS

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134
Q

*HLA is not expressed on which of the following?
- Syncitiotrophoblast
- Cytotrophoblast

A

Syncitiotrophoblast

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135
Q

*PPx for mycobacterium avium with CD4 count 45
- Azithromycin
- Ethambutol

A

Azithromycin

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136
Q

Which enzyme deficiency is a concern with chloroprocaine?
- Epoxide hydrolase
- Pseudocholinesterase

A

Pseudocholinesterase

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137
Q

*Pattern of glucose in pregnancy

A

Decreased fasting glucose/increased postprandial glucose

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138
Q

*Pt can’t dorsiflex after forceps delivery which nerve injured?
- Femoral
- Peroneal
- Sciatic

A

Peroneal

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139
Q

*Which sticks around in the body for 2 years

A

Etretinate (used for psoriasis)

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140
Q

*Which is not associated with hydrops?
- Listeria
- Syphillis
- Parvo

A

Listeria

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141
Q

*Neonatal lupus most likely to present with which of the following?
- Transient thrombocytopenia
- Complete heart block
-1st or 2nd degree heart block

A

Split b/w A and C; rash was NOT an option. I think it’s A (look in Creasy)

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142
Q

*Triple screen with normal HCG, AFP but very low estriol

A

X-linked iccthyosis

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143
Q

*Which is the stats term used for inter-observer agreement

A

Kappa

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144
Q

*Best test to compare continuous variable in pts before and after tx with experimental med

A

Paired t-test

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145
Q

*Which would make it necessary to increase sample size
A. Non-parametric testing
B. Looking at 3 outcomes instead of 1

A

A. Non-parametric testing

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146
Q

Which is best test if using multiple variables to assess survival?

A

Cox-regression

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147
Q

*What is the best test to compare nominal outcomes

A

Chi-square

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148
Q

MCA is not helpful for which of the following
- Sickle Cell
- Kell
- Anti-D

A

Sickle cell

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149
Q

Which is most likely to result in a fetus with T21?

A

Translocation (21q, 21q)

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150
Q

Mechanism of anemia in parvovirus?
- Hemolytic effect
- Viral effect on erythroid precursors

A

Viral effect on erythroid precursors

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151
Q

Most likely to decrease breast milk flow
- OCPs
- IUD
- Depo-provera

A

OCPs

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152
Q

When should dexamethasone be given if potential fetal CAH?
- Preconception
- 7-8 weeks
- After CVS results confirm female
- After amnio results confirm abnormal CYP gene

A

7-8 weeks

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153
Q

Which is not associated with autonomic hyperreflexia?
- Hypotension
- Bradycardia
- Piloerection

A

Hypotension
NOTE: get a reflex bradycardia

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154
Q

What is the reason for maternal hypoxia at time of induction of general anesthesia

A

Decreased residual volume

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155
Q

*Which is NOT true with pre-e at the induction of anesthesia?
- Decreased vasoresponsiveness to pressors
- Decreased plasma volume
- Increased coagulopathy

A

Decreased vasoresponsiveness to pressors

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156
Q

Risk of NTD with valproic acid

A

1-2%

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157
Q

Which causes a rash and complement deposits in basement membrane?
- Herpes gestationalis
- PUPPS

A

Herpes gestationalis

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158
Q

*What is the mechanism of action of beta mimetics
- Enhance phosphodiesterase
- Enhance adenylate cylcase
- Increase cAMP

A

Increase cAMP

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159
Q

*What can be directly measured by PA catheter?

A

• Directly: HR, CVP, PAS, PAD, PCWP, CO, BP
• Indirectly (calculated): SV, SVR, PVR, LVSW, MAP, CI, stroke index, SVRI, PVRI, LVSWI, RVSWI, RVSW

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160
Q

*Which is associated with non-cardiogenic pulmonary edema?

A

Normal PCWP

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161
Q

*Which is associated with pre-renal oliguria
- Urine osm 550
- Urine Na <20
- Serum BUN: Cr 1:1

A

Urine Osm 550

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162
Q

Which blood product has the highest risk for hepatitis?

A

Factor VIII or IX concentrate 10-20%

Whole blood 0.2-0.7%
PRBC <0.1%
Serum albumin 0
Platelet, FFP, cryo 0.1-0.2%

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163
Q

*PA catheter readings: high PA and RA pressure, normal/low CO, normal PCWP

A

Pulmonary embolus

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164
Q

*How do you dx Von Willebrand’s Disease

A

Ristocetin cofactor activity

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165
Q

*Best rx for type 1 Von Willebrand’s
- Desmopressin
- Cryo
- FFP

A

Desmopressin

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166
Q

Which decrease with pregnancy?
- Protein S
- Factor V
- Factor VII

A

Protein S

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167
Q

*Patient’s husband’s sister died of CF; carrier rate is 1/25, what is the risk to the fetus?
- 1/50
- 1/100
- 1/150

A

1/150

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168
Q

*What is the term when it matters from which parent an allele was inherited?

A

Imprinting

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169
Q

Which situation allows you to override patient confidentiality?

A

Someone in serious danger

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170
Q

*Which initiates preterm labor?
- Prostagladin dehydrogenase (PGDH)
- Phospholipase A2
- Metalloproteinase S
- Prostaglandin synthase

A

Phospholipase A2

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171
Q

Most common cause of mortality with anesthesia

A

Failed intubation

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172
Q

*How is calcium transported across placenta

A

Active transport

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173
Q

Which maternal cardiac lesion most associated with fetal hypoxia

A

Pulmonary HTN

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174
Q

Which is most associated with enlarged pale, placenta, hydrops

A

Syphilis

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175
Q

The main factor that influences fetal growth

A

Insulin

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176
Q

*OCPs have the least beneficial effect in preventing:
- Breast cancer
- Ovarian cancer
- Uterine cancer

A

Breast cancer

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177
Q

*FGR is most associated with what later in life?

A

Metabolic syndrome

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178
Q

*Greatest risk with lupus nephritis

A

Pre-eclampsia

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179
Q

*Patient at 35 wks with C6 spinal cord lesion admitted with severe HTN, flushing with CTX. What is the next best step in management?
- Mag sulfate
- Spinal anesthesia
- Epidural anesthesia
- Narcotics

A

Epidural anesthesia

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180
Q

*For which of the following is plasmapharesis 1st line tx

A

TTP

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181
Q

Which is not associated with FGR?
- Hyperthyroidism
- Sickle cell
- Parvo

A

Parvo

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182
Q

Which is least associated with pregnancy loss after amnio?
- Tenting
- Multiple attempts
- Needle gauge
- Transplacental stick

A

Transplacental stick

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183
Q

*Why is ROC a good test

A

Balances sensitivity and specificity

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184
Q

*Which is true regarding oxygen dissociation curve?

A

Fetus has higher O2 sat at any PO2 than mom

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185
Q

PKU disease freq is 1/10,000, what is carrier freq?
- 1/100
- 1/50
- 1/400

A

1/50

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186
Q

Freq of an autorecessive disease is 1/6400, what is the carrier frequency?
- 1/80
- 1/40
- 1/20

A

1/40

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187
Q

Woman has had 3 recurrent SAB, workup reveals karyotype with balanced translocation. Phenotypic trisomy 21 will be present in what % of subsequent surviving pregnancies?
- 1%
- 10%
- 50%

A

Split between 10% and 50%

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188
Q

fetal anomaly in obese patients?
- Gastroschisis
- NTD
- Cleft

A

NTD

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189
Q

Echogenic bowel seen at 20 weeks, what is most likely dx?
- CF
- FGR
- T21
- Normal

A

Normal

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190
Q

Worst neonatal prognosis in CMV
- Microcephaly
- Calcifications

A

Microcephaly

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191
Q

What placental product is least likely to change throughout pregnancy?
- Estrogen
- Progesterone
- Cortisol
- Somatostatin

A

Somatostatin

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192
Q

Patient has IUD in place. Develops fevers, chills, abdominal pain. Found to have 8 wk IUP, strings visible at os on exam
- Hydration and expectant management
- IV abx and evacuate uterus
- Remove IUD

A

Remove IUD

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193
Q

What is most likely complication in pregnancy conceived with IUD in place?
- Chorio
- PTB
- SAB
- Fetal malformation

A

PTB

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194
Q

HIV med to avoid in 1st trimester

A

Efavirenze (also Delavirdine) both for NNRTI

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195
Q

Which “Ashkenazi disease” is treatable with enzyme replacement?
- Gaucher
- Tay Sachs

A

Gaucher

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196
Q

Which fetal cardiac lesion is LEAST likely to result in a critically ill newborn?
- TGA
- HLHS
- AVCD
- ToF w/ Pulm Atresia

A

AVCD

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197
Q

TTTS is best diagnosed with discrepancy in
- Fetal EFW
- Amniotic fluid
- Dopplers
- Chromosomes

A

Amniotic fluid

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198
Q

Which is associated with highest risk of malignancy?
- CDH
- BPS
- CCAM

A

CCAM

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199
Q

Sacrococcygeal teratoma is LEAST likely associated with
- Hydronephrosis
- Mirror syndrome
- Hydrops
- Polyhydramnios
- Placentomegaly

A

Hydronephrosis

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200
Q

Smoking is LEAST likely associated with an increase in:
- Perinatal mortality
- PTB
- FGR
- Pre-e

A

Pre-e

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201
Q

NOT associated with SSRI in pregnancy
- Persistent fetal circulation
- Cardiac defects
- Neonatal withdrawal
- Gastroschisis

A

Gastroschisis

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202
Q

Which sono finding in setting of gastroschisis is MOST associated with intestinal atresia
- Thickened intestinal wall outside the body
- Stomach outside the body
- Bowel dilation

A

Bowel dilation

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203
Q

What’s most important in O2 delivery?
- CO + acid base balance
- CO + PaO2
- CO + Hgb
- CO + O2 saturation

A

Torn between A & B

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204
Q

Class I MHC get attacked by
- NK
- Cytotoxic T cells
- T helper cells
- Macrophages

A

Cytotoxic T cells

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205
Q

Who doesn’t have HLA on them?

A

Syncitiotrophoblast

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206
Q

What is the PRIMARY fetal immune response?
- IgM
- IgG
- Increase in dendritic cells

A

IgM

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207
Q

What is MOST involved in innate immunity?
- B cells
- T cells
- Monocytes
- Trophoblasts

A

Monocytes

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208
Q

Low estriol is most commonly associated with:
- T21
- Placental sulfatase deficiency
- SAB

A

Placental sulfatase deficiency

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209
Q

Therapy for suspected NAIT
- Delayed until after confirmatory amnio results
- Includes IVIG
- Includes oral steroids

A

Includes IVIG

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210
Q

Mode of inheritance for IHSS?
- Autosomal dominant
- Multifactorial

A

Autosomal dominant

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211
Q

Short, bent femurs seen at 20 wks, along with humerus, radii and thoracic circumference <5%. Normal ossification at cranium and spine. Most likely dx?
- Achondroplasia
- Thonatophoric dysplasia
- O.I.
- Hypophasphatasia

A

Thonatophoric dysplasia?

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212
Q

What changes with dialysis in pregnancy?
- Longer dialysis sessions
- More frequent sessions
- Add less Ca to diasylate
- Add more bicarb to diasylate

A

Longer dialysis sessions

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213
Q

What enables increased fetal Ca?
- Increased absorption of Ca
- Increased absorption of Vit D
- Increased total Ca

A

???increased absorption of ca and vit d

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214
Q

Why does creatinine decrease in pregnancy?
- Increased dilation of renal vessels
- Increased plasma volume
- Increased permeability of tubules

A

Increased dilation of renal vessels?

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215
Q

What is thyroid profile seen in 1T?
- low TSH; normal T4
- low TSH; high T4

A

Low TSH; normal T4

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216
Q

What is least commonly seen in fetal alcohol syndrome?
- SUA
- FGR
- Midface hypoplasia
- Renal dysplasia
- MR

A

SUA

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217
Q

Most associated with placental insufficiency?
- Low hcg
- Low PAPP-A

A

Low PAPP-A

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218
Q

FGR at 20 wks is most associated with:
- T13
- T21
- DiGeorge
- Fragile X
- BWS

A

T13?

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219
Q

1 aneuploidy found in 1T abortuses

A

T16

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220
Q

GA at which fetal alveolarization occurs?
- 22
- 26
- 30
- 36

A

30? real answer 32-36 wks

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221
Q

Major component of surfactant
- Saturated phosphatidylcholine
- Phophatidylglycerol
- Cholesterol
- Palmitic acid
- Neutral lipis

A

Saturated phosphatidylcholine

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222
Q

What stage of lung development is surfactant produced?
- Embryonic
- Pseudoglandular
- Cannicular
- Saccular
- Alveolarization

A

Alveolar

Remember: “Every Pulmonologist Can See Alveoli”

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223
Q

Most transmitted during breastfeeding
- CMV
- Hep B
- HSV

A

CMV

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224
Q

DS most likley in setting of
- Brachycephaly
- Hypertrophic mid-phlangeal joint of 5th digit
- normal humerus

A

B?? is that clinodactyly?

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225
Q

Someone with APLS, where is their most likely venous clot
- Portal
- Splenic
- mesenteric
- Cerebral
- Subclavian

A

Cerebral

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226
Q

What is due to pituitary deficiency
- Acromegaly
- Diabetes insipidus
- Addisons
- Cushings

A

Diabetes insipidus

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227
Q

According to Barker hypothesis, which is most likely in FGR fetuses later in life?
- T2DM
- CAD
- HTN
- Obesity

A

Metabolic disorder was not a choice
All of these except obesity were in Creasy

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228
Q

Most important thing in PPV
- Prevalence of disease
- # of subjects
- ROC curve

A

Prevalence of disease

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229
Q

LEAST common in myxedema
- Hypothermia
- Hypoglycemia
- Bradycardia
- Hypocapnea

A

Hypocapnea

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230
Q

woman being treated with dex for possible fetal CAH,
best way to test for fetal disease
- Amniotic fluid 17-OHP
- Linkage analysis
- Direct gene analysis

A

Direct gene analysis

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231
Q

Which PG does not cause labor
- PGE1
- PGE2
- PGE3
- Prostacyclin
- Thromboxane

A

Prostacyclin

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232
Q

Pt tests IgM+ for parvo at 20 weeks. How long should the fetus be monitored?
- 1 week
- 4 weeks
- 10 weeks
- 20 weeks

A

10

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233
Q

What is the # cause of low maternal estriol (they did no specify isolated)
- Placental sulfatase deficiency
- T21
- SAB

A

Placental sulfatase deficiency

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234
Q

1 source of estradiol production by the placenta?

  • Cholesterol
  • C19 adrenal steroids
A

C19 adrenal steroids

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235
Q

1 cause of vulvar hematoma

  • Mid rectal artery
  • Superior gluteal artery
  • Internal pudendal artery
A

Internal pudendal artery

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236
Q

When you open the broad ligament, where do you find the ureter?
- Lateral to the ovarian vessels
- Over the uterine artery
- Over the common iliac artery
- Over the common iliac vein

A

Over the common iliac artery

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237
Q

1 dx with an increased NT (they gave a value 4mm?)

  • T21
  • T13
  • 45X
A

45X

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238
Q

When opening the rectus muscles in a pfannensteil incision, which vessel is most likely injured?
- Deep circumflex
- Inferior epigastric artery

A

Inferior epigastric

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239
Q

Which medication increases contractility?
- Beta adrenergic
- Hydralazine
(Dig was not an option)

A

Torn between A &B

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240
Q

Which medication increases CO when preload and afterload have been optimized?
- Hydralazine
- Beta adrenergic
- Alpha adrenergic

A

Hydralazine

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241
Q

How to distinguish pre-e from lupus flaure
- Urine complement
- Urine sediment
- Thrombocytopenia
- BP

A

urine sediment

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242
Q

how to initially investigate whether there is an association between smoking and bladder cancer?
- Case- control
- Meta- analysis
- Retrospective analysis
- RCT

A

Case-control

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243
Q

Maternal blood is most directly in contact with
- Synctiotrophoblast
- Cytotrophoblast
- Maternal epithelium
- Fetal epithelium

A

Synctiotrophoblast

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244
Q

Which rash is associated with worse neonatal/fetal complications
- PUPPS
- Pruritis? gestationis or something
- Pemphigoid gestationalis
- Erythema nodosum

A

Pemphigoid gestationalis

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245
Q

The discussion about mode of delivery in the setting of a lethal fetal anomaly most directly involves
- Beneficence
- Non-maleficence
- Autonomy

A

Torn b/w B&C

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246
Q

When can you override refusal of tx?
- Harm to fetus
- maternal heath is in danger
- Religion
- Lack of capacity

A

Lack of capacity

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247
Q

In the setting of uterine inversion, what is the 1st line medication?
- Magnesium
- Terbutaline
- Nitric oxide
- General anesthesia

A

Terb

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248
Q

When CVS result is a mosaic, the most likely outcome is
- Confirmed/actual mosaic
- Maternal cell contamination
- Confined placental mosaicism
- Lab error

A

Confined placental mosaicism

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249
Q

Anesthetic with fastest onset of action
- Lidocaine
- 2-chloroprocaine
- Bupivicaine

A

Lidocaine

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250
Q

in TRAP, what is found in the acardiac twin’s dopplers
- Pulsatile UA/continuous UV flow
- Pulsatile UV/continuous UA
- Pulsatile in UA and UV
- Continuous in UA and UV

A

Pulsatile UA/ continuous UV flow

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251
Q

After fasting overnight, which is most likely to be decreased in the morning?
- Insulin
- Glucose
- Fatty acids
- Ketones

A

Glucose

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252
Q

What is #1 precipitating factor in DKA in T1DM?
- N/V of pregnancy
- Increased catecholamines
- Respiratory acidemia

A

Increased catecholamines? Infection is #1 per Creasy

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253
Q

What is NOT a feature of DKA
- pH <7.3
- Uosm of xxx (can’t remember #)
- Bicarb >20

A

Bicarb >20

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254
Q

If O2 is decreased, blood flow to which fetal organ will decrease
- Brain
- Adrenals
- Myocardia
- Lungs

A

Lungs

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255
Q

What does NOT cause pulmonary HTN of the newborn
- Indomethacin
- Fluoxetine
- Paroxetine
- Keppra

A

Keppra

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256
Q

What contraception do you NOT give someone who has PP depression

A

Depo

257
Q

What contraception do you NOT give someone with known insulin sensitivity?

A

Depo

258
Q

What contraception do you NOT give a GDM because of increased risk of DM outside pregnancy in future?

A

Depo

259
Q

What is the #1 enzyme deficiency in CAH?
- 11-hydroxylase
- 21- hydroxylase
- 18- hydroxylase
- 3- beta hydroxylase

A

21-hydroxylase

260
Q

Mechanism of action for iodine in maternal thyroid function
- Block T4 –> T3
- Block TRH release
- Block release of thyroid hormone from the gland

A

Block release of thyroid hormone from the gland

261
Q

What is absent corpus callosum most commonly associated with?
- Upward displacement of 3rd ventricle
- Absent CSP
- Big/little 3rd ventricle (can’t remember which)

A

Absent CSP

262
Q

1 location of an arachnoid cyst

  • Midline interhemispheric
  • Posterior fossa
A

midline interhemispheric

263
Q

Sensitivity of 4chamber heart view is WORST for
- Ebsteins anomaly
- HLHS
- TGA
- VSD
(coarct was not a choice)

A

VSD

264
Q

What fish should be avoided in pregnancy
- Halibut
- King Mackerel
- Salmon
(Tuna and swordfish were not listed)

A

King Mackerel

NOTE: if tuna or swordfish are options, choose those

265
Q

Which is NOT associated with relapsing/remitting fever
- Brucellosis
- Listeria
- Lyme

A

Lyme

266
Q

Why is NPH around longer than aspart
- Decreased degradation
- Decreased renal clearance
- Decreased hepatic clearance

A

Decreased degradation

267
Q

Wedge pressure represents
- LV preload
- RV preload
- LV wall tension

A

LV preload

268
Q

Which coagulation factor is decreased in pregnancy?

A

XI

269
Q

Which cytokine is ANTI-inflammatory?

A

IL-10

270
Q

Treatment for what condition is plasmapheresis?

A

TTP

271
Q

Foot drop postop - what nerve is most likely injured?

A

Peroneal

272
Q

Decreased sensation at labia after section - what nerve?

A

Ilioinguinal

273
Q

17P is best in which setting
A. Short cervix
B. PTL
C. H/o spontaneous PTB
D. Vaginal bleeding

A

C. H/o spontaneous PTB

274
Q

Which medication is most associated with FGR?
A. Metoprolol
B. Atenolol
C. Propanolol
D. Labetolol
E. Nifedipine

A

B. Atenolol

275
Q

Pt is 41wks with 2cm dilated cer vix and normal AFI. What is the next most appropriate step in management?
A. BPP
B. Pitocin
C. Prostin
D. Amnioinfusion

A

A. BPP

276
Q

Pt with a prior CS now with an IUFD at 34 wks - what is the LEAST appropriate management
A. Pitocin
B. Laminaria
C. Hysterectomy
D. Prostaglandin agent
E. Amniotomy

A

Hysterectomy

277
Q

The greatest percentage of fetal cardiac output is distributed to:
A. Placenta
B. Brain
C. Extremities
D. Adrenal glands

A

A. Placenta

Placenta 40%
Brain 13%
Lung 7%
Heart 3.5%

278
Q

Which antibody is MOST likely to be acquired from a blood transfusion:
A. Anti-D
B. Anti-E
C. Anti-C
D. Anti-Kell
E. Anti-M

A

Anti-Kell

279
Q

Which is the strongest candidate for VBAC?
A. Prior low vertical incision
B. H/o myomectomy
C. H/o HSC septum resection
D. Multiple gestation
E. Prior CS x 3

A

H/o HSC septum resection

280
Q

Medroxyprogesterone acetate increases levels of what?

A

Triglycerides

281
Q

OCPs have the LEAST beneficial effect in preventing:
A. Ovarian CA
B. Breast CA
C. Toxic Shock Syndrome
D. Uterine CA

A

Breast CA

282
Q

FGR is most associated with what disease later in life:
A. SLE
B. HTN

A

B. HTN

283
Q

Term fetus becomes cyanotic 2 hrs after birth - preductal O2 sat is 90%, postductal O2 sat is 70%. What is the malformation?
A. PDA
B. TGA
C. Mitral Insufficiency

A

A. PDA
Note: R arm higher than body. Ductus closes and there’s not mixing. PPHN with duct shunting

284
Q

Pts with MS are most likely to have which:
A. children at increased risk of developing MS
B. Flare during pregnancy
C. PTL

A

A. Children at increased risk of developing MS

285
Q

Pregnant pt at 35 wks with C6 lesion is admitted with severe HTN and is noted to have flushing with contractions. What is the best next management:
A. Mag sulfate
B. Spinal
C. Epidural

A

C. Epidural

286
Q

Rate of valproate causing NTD

A

1-5%

287
Q

What is the substrate for oxidative metabolism of the placenta:
A. Ketone bodies
B. Lactate
C. Fatty acids
D. Glucose

A

Glucose

288
Q

What is the most effective first line tx for TTP
A. Steroids
B. Plasmapharesis

A

B. Plasmapharesis
Note: Steroids would be for ITP

289
Q

A pt with PPH and is HYPOtensive - which is LEAST appropriate:
A. PRBC
B. Crystalloid
C. FFP
D. Low Salt Albumin

A

FFP

290
Q

US image with CPC - which aneuploidy is this associated with:
A. T21
B. T13
C. T18

A

C. T18

291
Q

Multiple intraabdominal echogeneicities - LEAST associated with:
A. Cystic Fibrosis
B. Aneuploidy
C. Toxo
D. Parvo
E. Meconium peritonitis

A

C. Toxo

292
Q

Which of the following syndromes is caused by uniparental disomy

A

Prader Willi and Angelmann’s
PW - maternal uniparental
Angelmann- paternal uniparental

293
Q

Which is the most predictive of fetal goiter in hyperthyroidism?

A

Titer of anti-thyroid stimulating abs (TSI)

294
Q

Which is the most thrombogenic thrombophilia?
A. Factor V Leiden
B. Prothrombin Gene mutation
C. Protein S Deficiency
D. Protein C Deficiency
E. Antithrombin III deficiency

A

E. Antithrombin III Deficiency

295
Q

Antithrombin III deficiency is most associated with

A

VTE

296
Q

What does the pulmonary artery catheter directly measure?
A. CI
B. Stroke Volume
C. LV Work index
D. Pulmonary Vascular Resistance

A

HR, CVP, PAP, PCWP
CO, O2 Sat

297
Q

What are Swan readings associated with noncardiogenic pulmonary edema?

A

12 PCWP

298
Q

Which of the following are associated with prerenal oliguria
A. Urine Na = 20
B. SG = 1.015
C. Urine Osm = 550
D. BUN: Cr = 5:1

A

C. Urine Osm = 550

299
Q

Which is most predictive of development of CP?
A. Maternal Thrombophilia
B. Chorioamnionitis
C. Pre-e

A

B. Chorio

300
Q

What is the reason for a low APGAR score in a non-hypoxic pretermer?

A

A. It’s preterm

301
Q

Picture of confidence intervals - which one is the lowest relative risk (ie. which one is lowest and doesn’t cross 1 is the issue).

A

Read stats

302
Q

Some PAP pressure are given, they are high (44/22). Normal to low CO for pregnancy. PCWP = 7. What is this associated with?
A. Pre-e
B. Sepsis
C. PE
D. Pulmonary Edema

A

C. PE

303
Q

Which of the following has the lowest mortality in pregnancy?
A. Marfan with normal aortic root
B. Corrected ToF
C. PHTN
D. Mitral stenosis, NYHA class III

A

B. Corrected ToF

304
Q

How do you treat refractory maternal SVT?
A. Digoxin
B. Procainimide
C. Adenosine
D. Lidocaine

A

C. Adenosine
Note: Vagal first

305
Q

Why is it a bad plan to give Iodine-131 in pregnancy?

A

It ablates fetal thyroid

306
Q

Which is most likely to cause fetal thyroid effects?
A. Graves Disease
B. Hashimotos Thyroiditis

A

A. Graves Disease

307
Q

What is NOT associated with PP thyroiditis

A

Depression? But Creasy says it is directly associated
Note: PP thyroiditis 10%
Note: Anti-TPO associated with PP thyroiditis

308
Q

How does IgG get across the placenta?
A. Pinocytosis
B. Simple diffusion
C. Active Transport

A

A. Pinocytosis

309
Q

How do most maternal drugs get across the placenta?

A

Diffusion

310
Q

As a class, what is the most common etiology for fetal malformations?
A. Genetic
B. Drugs
C. Environmental exposures

A

A. Genetic
Note: Drugs and environmental exposures make up 3%
Note: unknown 43%, multifactorial 23%, fam 15%?

311
Q

Folate most helpful in what setting:

A

No answer. See if there is one involved in folate metabolism

312
Q

A fetus had hydronephrosis, absent radii severe FGR - what is the syndrome?

A

VACTERL

313
Q

What is associated with Meckel-Gruber Syndrome?

A

Polycystic Kidneys
Encephalocoel
Polydactyly
Pulm Hypoplasia –death

314
Q

To compare means between 3 groups:

A

ANOVA

315
Q

What type of variables do you need to test for to compare APGAR scores between 2 groups?
A. Ordinal
B. Continuous
C. Categorical

A

A. Ordinal

316
Q

Whole mess of antibodies - which one does not cause hemolytic disease?
A. Anti-Jka
B. Anti-Fya
C. Anti-c
D. Anti-MNs

A

D. Anti-MNs

317
Q

What is not reliable in Kell-sensitized pt?
A. Husband genotype
B. Delta OD 450
C. MCA dopplers

A

B. Delta OD 450

318
Q

Pt presents at 20 wks, she had a really bad RH disease last pregnancy with same husband. Next step:
A. Antibody titer
B. Amnio for fetal PCR

A

B. Amnio for fetal PCR

319
Q

Which situation is most likely to result in fetus having T21:
A. Mom is 45XXrob (14,21)
B. Dad is 45XY rob (14,21)

A

A. Mom is 45XXrob (14, 21)
Note: 15% mom, 2% dad if robertsonian translocation

320
Q

What are consequences of uteroplacental insufficiency in neonate?
A. Hypocalcemia
B. Polycythemia
C. CP
D. All

A

D. All

321
Q

Which of the following is NOT associated with AMA?
A. T21
B. T18
C. 45XO
D. T13

A

C. 45XO

322
Q

Which genetic condition is associated with coarctation of the aorta?

A

45XO

323
Q

Why is Mag Sulfate preferred to dilantin in pre-e?
A. Ease of use
B. Fewer side effects
C. Greater efficacy

A

C. Greater efficacy

324
Q

Cordocentesis is best for which of the following clinical situations?
A. NIH
B. ITP
C. Neonatal Alloimmune Thrombocytopenia

A

C. NAIT

325
Q

Which atypical ab not only causes hemolytic disease but also suppresses erythroporesis?

A

Kell

326
Q

What is the mechanism of anemia in parvovirus?
A. Hemolysis
B. Suppression of erythropoeisis by toxins
C. Virus interferes directly with erythropoesis
D. Splenic sequestration

A

C. Virus interferes directly with erythropoesis

327
Q

In which situation are OCPs contraindicated?
A. SC disease
B. Had a DVT in pregnancy
C. Seizure Disorder

A

B. Had a DVT in pregnancy

328
Q

Depo provera is best for what siutation

A

A. Nursing moms

329
Q

At what gestation should dexamethasone be given to mothers of potential CAH fetuses?
A. Preconception
B. 7-8 wks
C. 12-13 wks

A

B. 7-8 wks

330
Q

What can be given to prevent virilization in a female fetus with CAH?

A

Cortisone acetate/dexamethasone

331
Q

What is the most common cause of CAH?
A. 11 hydroxylase deficiency
B. 21 hyrdoxylase deficiency

A

B. 21 hydroxylase deficiency

332
Q

Where can prostaglandin dehydrogenase be found?
A. Amnion
B. Chorion
C. Amniotic fluid
D. Myometrium

A

B. Chorion

333
Q

Which is the GREATEST component of surfactant at term?
A. Phosphatidyl choline
B. Phosphatidylglycerol
C. Phosphatidylinositol

A

A. Phosphatidyl Choline (50%)
Note: Phosphatidylinositol down, PG goes up

334
Q

Which drug may lessen effectiveness of OCPs

A

Rifampin

335
Q

Which factor decreases in pregnancy?
A. VIII
B. IX
C. X
D. XI

A

D. XI
NOTE: 11 and 13 decrease during pregnancy

336
Q

Which is associated with the highest incidence (not prevalence) of chronic active hepatitis and cirrhosis:
A. Hep A
B. Hep B
C. Hep C

A

C. Hep C

337
Q

Most common cause of mortality in setting of epidural placed for CS:
A. Local toxicity
B. Hematoma
C. Anaphylaxis

A

A. Local toxicity
Note: Not high spinal choice

338
Q

Most common cause of maternal mortality
A. Infection
B. Hemorrhage
C. Thromboembolism
D. HTN

A

C. Thromboembolism

339
Q

Antihypertensives during pregnancy prevent or reduce:
A. Pre-e
B. FGR
C. PTD
D. Maternal CVA

A

D. Maternal CVA

340
Q

Which enzyme does the fetus have that the placenta doesn’t?
A. 17 hydroxylase
B. 3B-something
C. Sulfatase

A

A. 17 hydroxylase
Note: Placenta has 3B-something, sulfatase, and aromatase

341
Q

Precursor for fetal steroid synthesis

A

LDL Cholesterol

342
Q

What. is the most compelling reason for delivery in a 32 weeker with pre-e
A. 4+ protein
B. BP 160/110
C. LDH = 900
D. UA = 6

A

C. LDH =900
Note: HELLP?

343
Q

What distinguishes AFLP from HELLP

A

Glucose = 40

344
Q

Management of pt with MI and 35 wks pregnant
A. Induce labor
B. Await spontaneous labor
C. CS

A

B. Await spontaneous labor

345
Q

Which infection is a transplant pt MOST susceptible to compared with non-transplant pt?
A. E.coli
B. Chlamydia
C. CMV

A

C. CMV

346
Q

Which is the most sensitive test to determine whether the fetus is infected with toxo?
A. Amnio for toxo PCR
B. PUBS for fetal IgM
C. PUBS for fetal IgG

A

A. Amnio for toxo PCR

347
Q

What is the chorionicity/amnionicity if embryo divides between day 8 and 13?
A. Di/Di
B. Mono/Di
C. Mono/Mono
D. Conjoined

A

C. Mono/Mono

348
Q

WHat disease is AD and associated with telangiectasia, ataxia, thrombocytopenia
A. Osler Weber Rendu
B. Ehlers Danlos
C. Wiskott Aldrich

A

A. Osler Weber Rendu (aka HHT)

Note: Wiskott Aldrich –> thrombocytopenia, eczema, malignancy, infection, X-linked
(WATER)
- Wiskott
- Aldrich
- Thrombocytopenia
- Eczema
- Recurrent infections

349
Q

All injuries from vacuum except:
A. Brachial plexus injury
B. Sub-Galeal injury
C. Scalp Injury

A

A. Brachial Plexus Injury

350
Q

Nerve injured during prolonged pushing with hyperflexed legs?
A. Obturator
B. Femoral
C. Pudendal

A

B. Femoral

351
Q

Pt can’t dorsiflex after forceps delivery. What is the nerve injury?

A

Common peroneal

Note: forceps injury - obturator

352
Q

Pt went to Connecticut and has a target lesion, fevers, etc. She is 32 wks pregnant. Rx?
A. Tetracylcine
B. Ampicillin or PCN of some sort
C. Cephalosporin

A

C. Cephalosporin (cefuroxinme)
Note: but if neuro, then ceftriaxone of PCN G

353
Q

What drug potentiates neuromuscular blockade?

A

Gentamycin

354
Q

Pt given Mg Sulfate bolus for pre-e and has big hypotensive episode. What to do?
A. Ephedrine
B. Ca gluconate
C. Lots of NS bolus

A

B. Ca gluconate

355
Q

How is prostaglandin F2 alpha different than E2

A

Bronchocontristriction

E1 = miso
E2 = dinoprostone
F2a = hemabate

356
Q

Most common thrombophilia?
A. Antithrombin III def
B. Protein S def
C. Factor V Leiden

A

C. Factor V Leiden

357
Q

Pt has bleeding vulvar hematoma that has already been packed and explored and the vessel can’t be isolated but she is still bleeding. Next step?
A. Ex-lap
B. Repack
C. Look again
D. Embolization

A

D. Embolization

358
Q

If you embolize the hypogastric artery, which vessel WON’T be involved
A. Superior gluteal
B. Obturator
C. Inferior vesicle
D. Inferior epigastric

A

D. Inferior epigastric

359
Q

Which paramter is not useful in determine FGR vs incorrect dates?
A. AC
B. Foot length
C. BPD
D. Cerebellum

A

A. AC

360
Q

Which organ gets the greatest proportion of fetal blood flow at term?
A. Brain
B. Adrenal
C. Lungs
D. Spleen

A

Greatest amount: brain, lungs
Greatest amount relative to wt of organ: adrenal

361
Q

Which fetal vessel has the highest O2 saturation?
A. Femoral Vein
B. Umbilical artery
C. Pulmonary artery
D. R Carotid artery

A

D. R carotid artery

362
Q

Complicated question about O2 dissociation curve - which are true statements?
A. Fetus has higher O2 sat at any PO2 than mom
B. Mom’s blood pH influences O2 sat of fetus
C. Other complicated physiologic situations involving fetal hgb 2,3 diphosphate or whatever it is

A

A and B

Note: Shift to LEFT
increase pH
Decrease temp
Decrease DPG
Fetus

363
Q

Microtia associated with what?
A. Alcohol
B. Warfarin
C. Some anti-sz med
D. Accutane

A

D. Accutane

364
Q

Stick around in system for 2 yrs?

A

Etridonate

365
Q

Which has LOWEST chance of MR in child?
A. Accutane first trimester
B. Rubella exposure first trimester
C. Varicella exposure first trimester
D. Warfarin exposure first trimester

A

C. Varicella

366
Q

What is associated with increased transmission of the fetus in HIV positive women?
A. Viral load
B. CD4 count
C. CS
D. HAART therapy

A

A. Viral load
NOTE: increased VL is associated with increased vertical transmission as long as it is above 1000

367
Q

What is the action of AZT
A. Anti-DNA
B. Reverse transcriptase inhibitor
C. Anti-RNA
D. Antibiotic

A

B. Reverse transcriptase inhibitor

Note:
AZT = nucleoside reverse transcriptase inhibitor (NRTI)
Velfinavir = protease inhibitor
Side effects: new onset DM, DKA so screen each trimster
Combivir (lamivudene) = NRTI dual agent
It’s AZT + 3TC

368
Q

What is a complication of Combivir?

A

Anemia

Note:
AZT –> Anemia, HA, neutropenia, increased LFTs
Nevirapine –> RASH, even Stevens Johnson Syndrome

369
Q

Which syndrome is associated with macrosomia?
A. Beckwith Weidemann
B. Meckel Gruber
C. Trisomy 21
D. Polyploidy

A

A. Beckwith Weidemann or polyploidy

Note:
Beckwith Weidemann–> overexpression of insulin0like growth factor 2 (ILGF-2), causes macrosomia, macroglossial, omphalocele, all paternal origin, oaternia disomy, neonatal hypolgycemia, increased rates of Wilm’s tumor and adrenal carcinoma

Meckel Gruber Syndrome –> polycystic kidneys, plydactaly, mental retardation, encephalocele, AR, Chrom 17, 11, 8, 100% mortality 2/2 pulm hypoplasia

370
Q

Heart defect with increased transmission to fetus
A. ASD
B. ToF
C. IHSS (Idiopathic Hypertrophic Subaortic Stenosis)
D. Coarctation of aorta

A

C. IHSS (Idiopathic Hypertrophic Subaortic Stenosis) – it’s AD

371
Q

Maternal heart defect with LOWEST incidence of mortality
A. Corrected ToF
B. Artificial heart valve
C. Eisenmenger’s Syndrome

A

A. Corrected ToF - mortality rates is similar to normal

372
Q

Which B cell disease gets worse with pregnancy
A. Graves
B. Myastenia Gravis
C. SLE
D. HIV

A

SLE

373
Q

Myastenia Gravis Notes

A
  • Drugs contraindicated: lots of them
  • Effect of MG on pregnancy –> little effect. May have exacerbations (mostly in first part and PP). May have problems pushing with labor although uterine contractions not affected, CS for OB indications
  • MG pathophysiology, thymectomy
    Circulating abs to the ACH receptor of skeletal (muscarinic) neuromuscular junction, sensation and thinking not affected, weakness can be profound. Abs also bind to myoid cells of thymus, thymectomy recommended for all but the mildest disease and often leads to prolonged remission.

Edrophonium (short-active ACH inhibitor) used for dx

Tx with ACH inhibitor, steroids, plasmapheresis, IVIG

374
Q

CPC associated with which chromosomal abnormality
A. T18
B. T13
C. T21
D. Pericentric inversions

A

A. T18

375
Q

Which chromosomal abnormality is not increased in offspring of AMA females?
A. Downs
B. Turners
C. Kleinfelter
D. Edwards

A

B. Turners

Note: all the rest are age dependent non-disjunctional events

376
Q

Risk disease is 1/6400, what is carrier rate?
A. 1/20
B. 1/40
C. 1/80
D. 1/100

A

B. 1/40

Note: p2 + 2pq +q2 = 1
Q = 1/40 or 1/20

377
Q

GnRH is made in which tissue?

A

Decidiua (cytotrophoblast)

378
Q

Which test should be used to compare outcomes before and after treatment?
A. Paired T-test
B. Chi-squared test
C. Mann-Whitney Test
D. ROC Curve Test

A

A. Paired T-Test

379
Q

STATS Info

A

2 groups: interval, nominal, ordinal

3 or more groups:
- Diff individuals:
t-test unpaired
chi-square
Mann-Whitney
Rank sum test

ANOVA
Chi-Square
Kruskal Wallis

Before and after one tx, same individual:
- Paired t-test
- McNemar’s test
- Wilcoxon signed-rank

Mult txs, same individual:
- Repeated ANOVA

380
Q

Insulin affects growth in all tissues except:
A. Brain
B. Liver
C. Fat
D. Muscle

A

A. Brain
Note: brain has no IGF receptors

381
Q

In a pt with known parvovirus infection (IgM+), what is the best management of choice if a small pericardial effusion is noted in the fetus?
A. Cordo with transfusion
B. Amnio for delta OD
C. Ultrasound observation
D. Repeat Maternal IgM levels

A

A. Cordo with transfusion

Note:
MCA for detection of anemia prior to development of hydrops
Screen 10-12 weeks post exposure
Peak incidence hydrops 4-6 wks after maternal infection
If elevated MCA or hydrops bw 24-34 wks, PUBS + steroids
30% of anemic fetus hydrops resolve spontaneously over 4-6 weeks

382
Q

Notes on Parvo

A

Parvovirus (CMV, Parvo, Toxo, Syphilis, HSV, Rubella)

Parvovirus: erythema infectiosum (5th dz), slapped cheek rash
Adult polyarthropathy in 50-80% of infected women, rash usually not seen
Fetal aplastic anemia (rapidly expanding blood volume, shorter RBC half life, immature immune system)
Risk of transmission to fetus: 1/4-1/3 transmitted with no adverse outcome
Up to 5% of maternal infections –> aplastic crisis, high output failure, hydrops, death
IgG denotes immunity with no risk to fetus
IgG and IgM is susceptible, use caution
IgG neg and IgM pos - closely monitor for hydrops
Hydrops usually 4-6 wks after infection

383
Q

What is the precursors of fetal adrenal steroids?

A

LDL

Note: LDL –> DHEAS –> placenta (sulfatase) –> DHEA –> aromatase –> estrone + estradiol

Estrone –> mom-fetus
Estradiol –> 90% to mom

Placental estrogen production unique due to no 17a hydroxylase in placenta

384
Q

What is the effect of the “mini pill” on endometrial lining?
A. increased glands and stroma
B. Decidualization
C. Increased blood loss with menses
D. Thin cervical mucus

A

B. Decidualization

Note: all the rest are effects of estrogen

385
Q

The rapid GBS test is not used because of:
A. Poor sensitivity
B. Low prevalence of GBS
C. Null hypothesis

A

A. Poor sensitivity

Note: GBS carrier prevalence (20%)
Routine screen PPV 79%, NPV 93%
PCR sensitivity 97%, specificity 100%, PPV 100%

386
Q

Which malformation has the greastest risk of underlying aneuploidy?
A. CHD
B. Gastroschisis
C. Omphalocele
D. Clubbed foot

A

C. omphalocele (30%)
Cardiac is about 5-10%

387
Q

Which best describes the physician-pt relationship
A. Autonomy
B. Fiduciary
C. Beneficence
D. Non-malfeasance

A

D. Non-malfeasance (do no harm)

Note: Beneficency = doing an action to benefitus, removes harm

388
Q

Which drugs should NOT be used in pts with MG except for?
A. Curare
B. Magnesum
C. Gentamicin
D. Mestinon (pyridostigmine bromide)

A

D. Mestinon (pyridostigmine bromide)

Note: MPB is used for tx of MG (ACH inhibitor)
Curare is used for dx of MG

389
Q

Meds you DON’T use in myasthenia gravis

A
  • Mag
  • Aminoglycosides (GNATS)
  • non-depolarizing muscle relaxants (-curoniums)
  • Neuromuscular blocking agents
  • Quinine** (treats malaria)
  • Many abx
  • Possibly terb and ritrodine
  • Must use narcotics with caution
  • Ether
390
Q

Which dermatologic condition is associated with bullae on the external surfaces or arms, purities with deposition of compliment on the basement membrane?
A. Herpes gestationalis
B. Hereditary angioedema
C. Erythema multiforms
D. PUPPS

A

A. Herpes gestationalis

Note: also bullous pemphigoid are simliar disorders.
Urticarial lesions progress to blisters + deposits of C3 in linear pattern on basement membrane

HG only in pregnancy

Erythema multiforme has target lesions

391
Q

Which is associated with preterm birth?
A. Ureaplasma
B. BV
C. GBS
D. Chlamydia

A

B. BV
?GBS?

392
Q

What drugs should be used for maternal V tach?
A. Lidocaine
B. Adenosine
C. Quinidine
D. Capsacin

A

A. Lidocaine

NOTE:

Epi: 1mg of 1:10,000 IV q3-5 mins for all pulseless arrests (for anaphylaxis 1:1000 in 3 cc)

Atropine: 1mg IV q3-5 mins for slow pulseless Mobitz II + asystole

Adenosine: 6mg IV over 1-2mins, SVT pulse 150-250

Lidocaine: Vfib/Vtch 1mg/kg IV

MagSO4: torsades 1-2g load

Vasopressin

Labetalol: 2nd line Vfib

Amiodarone: Vfib, pulseless Vtach unresponsive to shock, CPR+vasopressin

393
Q

What is NOT a sign of BV
A. pH <4.5
B. +Wiff test
C. Thin homogenous discharge
D. >20% clue cells

A

A. pH <4.5

394
Q

GBS is most resistant to:
A. PCN
B. Clinda
C. Ery-C
D. TMX-sulfa

A

D. TMX-Sulfa

395
Q

Which enzyme is theoretically deficient in fetuses who manifest birth defects from antiepileptic drugs?

A

Epoxide dehydrogenase or epoxide hydrolase

This alters folate metabolism

Epoxide hydrolase deficiency with phenytoin, carbamezepine, phenobarbital, possible fetal alcohol syndrome and valproic acid

396
Q

What complication is associated with exteriorization of the uterus
A. Air embolism
B. Uterine atony
C. Patent foramen ovale

A

A. Air embolism

Note: other complications: N/V, hypotension, pain

397
Q

What are the risks associated with 22 wks stillbirth, +aca and +LA
A. Thrombosis
B. B12 def
C. Hyperemesis
D. Berry aneurysm

A

A. thrombosis from APLS

398
Q

Which vaccine is contraindicated in pregnancy
A. Varicella
B. Influenza
C. Rabies
D. Cholera

A

A. Varicella

Vaccines CI in pregnancy:
- Nasal influenza
- MMR
- Varicella
- BCG

Note: Cholera vaccine is cat C, unknown but recommend if travel to endemic area

399
Q

Notes about varicella

A

Varicella: 90% have chicken pox by reproductive age. If not hx, then 70-90% have detectable abs
Mortality varicella PNA 0-25%, symptoms begin 2-6 days after rash
Chicken pox 1st 4mo rarely produces congenital varicella syndrome (2%)
Syndrome with cutaneous scars, limb hypoplasia, eye/CNS abnormalities, cerebral cortex atrophy, MR)
Herpes zoster-no maternal morbidity or fetal infection
VZIG if susceptible to varicella and exposed to chickenpox
17% of term infants infected with case fatality of 31%
Fetal dx: US detection of abnormalities, cordocentesis for fetal IgG, can do CVS and PCR
Hydrops, hyperechoic foci in liver, hydramnios
Vaccine not for pregnancy (live attenuated vaccine)

400
Q

Which is associated with fetal abdominal calcifications?
A. EBV
B. CMV
C. Parvovirus
D. Turners

A

B CMV

Note: CMV causes hepatic calcifications, others include herpes, rubella, varicella, syphilis

401
Q

Notes about CMV

A

CMV is the MCC of intrauterine infection (0.5-2.5% of all births), 5-10% infected have neurological sequelae, sequelae due to inflammation (not teratogen)

Reinfection can occur due to antigenic and genetic disparity among CMV strains. May become latent and be reactivated (DNA virus of herpesvirus group)

Mainly transplacental transmission although 30-50% acquiition rate if positive genital CMV infection at time of birth

Congenital infection in utero (not at birth) are most concerning, may be primary or recurrent

Primary infection more dangerous to fetus

2.5% of fetus infected –> 90% asymptomatic –> 5-10% late sequelae –> 10% symptomatic –> 90% neurologic sequelae

Symptoms at birth: premature, low birthweight, microcephaly, chorioretinitis, HSM, jaundice, thromboctyopenic purpura

Survivros of above have: microcephaly, intracranial calcifications, severe MR, chorioretinitis

Late sequelae if asymptomatic: sensorineural hearing loss, submormal intelligence, behavioral problems

Perinatal transmission (birth or breastfeed) no serious implications unless <1200g

Poorer prognosis: primary maternal infection (not recurrent, 1st of 2nd trimester

Dx: serologic infection not predictive of fetal infection
Paired specimen IgM
Seroconversion (neg IgM to pos IgM or neg IgG to pos IgG)
IgM lasts 4-8 months
Isolation of virus does not differentiate primary from recurrent infection
No change in ab levels with recurrent infection
Look for periventricular calcifications
Virus isolation more sensitive and direct than serology
No tx available, preventative measure is handwashing
Amniotic fluid PCR and cx if maternal primary CMV, FGR, hydrops, CNS abnormality
Initial and repeat in 4-8 wks with maternal primary CMV infection
Documented primary maternal infection in 1st 20 wks (mononucleosis like syndrome) –> offer termination
Prior Chid: incidence of recurrence is unknown, subsequent congenital infection have better prognosis than initial

402
Q

Which syndrome is associated with fetal thrombocytopenia?
A. Absent radius
B. Gestational thrombocytopenia
C. Erythoblastosis fetalis
D. Bernard Soulier Syndrome

A

A. Absent Radius

TAR syndrome is AR

Also Fanconi Anemia –> absent radii, PANcytopenia

403
Q

What is the precursor of DOC (deoxycorticosterone)?

A

Progesterone

404
Q

What is the #1 cause of malformations?
A. Radiation
B. Infection
C. Genetics
D. Medication

A

C. Genetics

405
Q

What is the tx of 21-OH deficiency in the female fetus?
A. Cortisone acetate
B. Diestryl acetate
C. Dexamethasone
D. Aldosterone

A

C. Dexamethasone

406
Q

Tx of 21 Hydroxylase Deficiency

A
  • MC congenital adrenal hyperplasia (90-95% of cases)
  • 2nd MC is 11-hydroxylase def
  • All CAH are AR
  • Inadequate synthesis of 11-deoxycortisol and coritsol, with resulting excess of ACTH stimulates adrenal precursors, especially 17-hydroxyprrogesterone (shunting results in excess androgens), may also have mineralocroticoid deficiency, diagnosed by excess basal 17-OH progesterone

Replace glucocorticoid (cortisole), monitor with 4-androstenedione, testosterone, 17OHP (free testosterone during pregnancy)

Most children of maternal CAH normal if therapy appropriate. If suboptimal then virilize female

Prenatal dx with elevated amniotic fluid 17-OHP
Treat all mothers with dexamethasone in 1st trimester (must start before end of 7th week), perform CVS, if male then stop tx, if female continue tx until DNA/HLA test results return

11-hydroxylase similar except dx with elevated 11DOC and deoxycorticosterone conentrations, measure 11-DOC in amniotic fluid for prenatal dx

407
Q

What causes virilization of a female fetus
A. Luteoma of pregnancy
B. Cystadenoma
C. Prolactinoma
D. OCPs

A

A. Luteoma

408
Q

PO2 in the umbilical vein (28-32) approaches that of the:
A. Uterine vein (42)
B. MCA
C. Uterine artery (72)
D. Radial artery

A

A. Uterine vein

Note: Umbilical vein has highest PO2 of fetal circulation

409
Q

The insulin pump is associated with
A. Asymptomatic hypoglycemia
B. Poor compliance
C. Tachyphlaxis

A

A. Asymptomatic hypoglycemia

410
Q

Which is elevated in fasting pregnant females?
A. Glucose
B. Cholesterol
C. Creatinine
D. Sodium

A

B. Cholesterol

411
Q

In which disorder is IgG contraindicated?
A. Recurrent pregnancy loss
B. Myasthenia gravis
C. ITP
D. RA

A

A. Recurrent pregnancy loss

412
Q

Risk of neonatal infection with SVD in a woman with a recurrent vulvar herpes lesion is:
A. 50%
B. 1%
C. 100%
D. 0%

A

B. 1%

Note: with primary outbreak, there is a 40-50% transmission

413
Q

Gaucher’s disease is a disorder:
A. Aspartoacylase
B. Hexoseaminidase A
C. Glucocerebrosidase
D. Glucosylceramine storage disease

A

D. Glucosylceramine storage disease

Note:

Aspartoacylase –> Canavan (AR, degenerative brain d/o (myelin deg) –> increase N-acyt aspart

Gauchers
- Glycosylceramine storage disease –> fatty deposits of glucocerbroside in spleen, liver, brain, brown tint to skin, yellow deposits on sclera, enlarged spleen or liver
- Lysosomal storage disease
-Lacking beta glucosidase

Tay Sachs - hexoseaminidase A
- AR
- Accumulation of gangliosides in brain (cherry red spot on optho exam)

414
Q

Which abnormality is increased when CHD is diagnosed on an US?
A. Previa
B. Sickle Cell
C. T21

A

C. T21

415
Q

What lab value is seen with pre-e?

A
  • Decreased GFR
  • Decreased urinary Na and increased plasma UA
  • Decreased Ca excretion 2/2 increased tubular reabsorption
416
Q

Which type of inheritance is associated with Leber’s optic atrophy?
A. AR
B. AD
C. X-linked
D. Mitochondrial

A

D. Mitochondrial

Note:
Mitochondrial diseases:
- MERRF (myoclonic epilepsy with ragged red fibers)
- Lebur hereditary optic neuropathy (LHON)
- Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome
- Neuropathy, ataxia and retinitis pigmentosa (NARP) syndrome

417
Q

Which disorder is associated with uniparental disomy?
A. Cri di chat
B. Williams
C. Preder Willi
D. Hydantoin

A

C. Preder Willi

Note: Preder Willi/Angelmans chrom 15
Beckwith Wediman Chrom 11

Deletions:
- Cri Di Chat –> del 5
- Williams –> del chrom 7q

418
Q

Disease associated with DNA repeats except:
A. Fragile X
B. Huntington’s
C. CF
D. Myotonic Dystrophy

A

C. CF

419
Q

HIV is a:
A. DNA virus
B. Prion
C. RNA retrovirus

A

C. RNA retrovirus

420
Q

An APGAR score of <3 at 20 wks gestation is associated with this risk of CP:
A. 5%
B. 100%
C. 50%
D. 15%

A

B. 100%

NOTE:

APGAR 0-3
5 min: 0.3-1%
10 min: 10%
15 min: 35%
20 min: 50%

421
Q

NTDs are usually:
A. Due to single gene defects
B. Caused by teratogens
C. Multifactorial
D. Aneuploidy

A

C. Multifactorial

422
Q

A normal woman has a homozygous 21/21 translocation. What % of HER OFFSPRING WILL have downs?
A. 0%
B. 100%
C. 50%
D. 20%

What % of her conceptuses will have monozygous 21?
E. 0%
F. 100%
G. 50%
H. 20%

A

B. 100%
G. 50%

423
Q

The most important predisposing risk factor for macrosomia is:
A. Post dates
B. Previous macrosomia
C. Smoking

A

B. Previous macrosomia

424
Q

The byproduct of CHO metabolism is
A. CO2
B. H2O
C. NH3
D. Lactic acid

A

A. CO2

Note:
O2 + C6H12O6 –> CO2 + H2o + energy (heat)

425
Q

Pinocytosis

A

IgG
Fe
Folate
B12

426
Q

Active Transport

A

Amino acids
Ca
Phosphate
Mag
Vit A
Vit K

427
Q

Facilitated Diffusion

A

Fe
Vit C
Glucose
Lactic acid

428
Q

Simple Diffusion

A

H2O
O2
CO2
Anesthetic gases
Electrolytes
Insulin
Steroid hormones
Fatty acids
Thyroid hormones

429
Q

Which of the following will allow you to differentiate maternal blood from fetal blood?

A
430
Q

What is the substrate for oxidative metabolism of the placenta?
- Ketone bodies
- Lactate
- Fatty aids
- Glucose

A

Glucose

431
Q

Which is the most thrombogenic thrombophilia?
- Factor V Leiden
- Prothrombin Gene mutation
- Protein S Deficiency
- Protein C Deficiency
- AT III Deficiency

A

AT III Deficiency

432
Q

AT III is most associated with

A

VTE

433
Q

Where can prostaglandin dehydrogenase be found?
- Amnion
- Chorion
- Amniotic fluid
- Myometrium

A

Chorion

434
Q

Factors that decrease during pregnancy

A

Protein S, Factor 11 and 13 (per a study guide)

435
Q
A
436
Q

Most common side effect of AZT and other NRTIs

A

Bone marrow suppression

437
Q

Ppx for MAC and what CD4 count

A

Azithromycin 1200mg Qweek
CD4 count <75

438
Q

Ppx for PCP in HIV

A

Bactrim DS QD
Also covers toxo
CD4 count <200

439
Q

Ppx for cryptococcus in HIV

A

Diflucan 150mg QD
CD4 count <50

440
Q

Local anesthetic half-lives
-Chloroprocaine
- Lidocaine
- Bupivicaine
- Mepivicaine

A

-Chloroprocaine 25 secs
- Lidocaine 2 hr
- Bupivicaine 2.5 hrs
- Mepivicaine 3 hrs

441
Q

Side effects of halothane

A

Malignant hyperthermia**
Hypotension
Hepatotoxicity**
Cardiac dysrrhythmia
Excessive bleeding
Confusion

442
Q

Homolog to HPL (aka hCS)

Human chorionic somatomammotropin (hCS), which was formerly referred to as human placental lactogen (hPL

A

Human pituitary growth hormone (87%)
Prolactin (67%)

443
Q

MOA of glyburide

A

Increases insulin secretion by pancreatic beta cells

444
Q

Risk factor for macrosomia in GDM

A

Postprandial glucose level

445
Q

Risk factors for increased fetal fat mass in GDM

A

Fasting glucose level

446
Q

Vacuum delivery complications

A

Caput succedaneum
Retinal hemorrhage (38%)
Cephalohematoma (11%)
Subgaleal hematoma (5%)
ICH (~0.1%)

447
Q

Management of Lyme disease in pregnancy

A

Amoxicillin is tx of choice
If neuro symptoms, IV rocephin or PCN G

FAKE a Key Lyme pie
Facial nerve palsy (typically b/l)
Arthritis
Kardiac block
Erythema migrans

448
Q

Pt has hypotensive episode after Mg bolus for pre-e how do you treat?

A

Ca gluconate 1 amp

449
Q

Infectious causes of non-immune hydrops

A

Toxo
CMV
Parvo
Syphilis
HSV
Rubella

450
Q

Values of Na, Cl, osmolarity, beta2-microglobulin, Ca in fetus with renal failure

A

Na >100 mEq/L
CL >90
Osm >219
Beta 2-microglobulin >4 mg/L
Ca >8 mg/dl

451
Q

Values of Na, Cl, osmolarity, beta2-microglobulin in normal fetal kidneys

A

Na <90 mEq/L
Cl <90
Osm <200
Beta2-microglobulin <6mg/L
Ca <8mg/dl

452
Q

Normal fetal urine..hypotonic or isotonic?

A

Hypotonic

453
Q

Neonatal lupus associated with what symptoms and antibodies?

A

Anti-SSA/SSB abs
15-20% have NLE
Primarily presents with dermatologic symptoms
Thrombocytopenia and other hematologic abnormalities are rare

454
Q

Neonatal lupus and CHD rates

A

1-2% presence of SSA/SSB abs
15% recurrence if prior affected child

455
Q

Ballard examination less accurate prior to what GA

A

28 weeks

456
Q

Ballard eye findings

A

Complete coverage of the lens by vessels at 27-28 wks

457
Q

Ballard foot findings

A

4.5cm at 25 wks then increases by 0.25cm/wk thereafter

458
Q

Does palmar crease have anything to with Ballard score

A

No, only foot crease. Greater the crease, more term baby is

459
Q

Ballard breast findings

A

5-10 mm breast bud in term infant

460
Q

Ballard posture

A

Flexed upper and lower extremities in term

461
Q

Ballard arm recoil

A

Full recoil to flexed position at term

462
Q

Ballard wrist findings

A

Flexed wrist at term

463
Q

Most common finding in Downs neonate

A

Hypotonia

464
Q

Ddx of REALLY low estriol in quad screen (<0.5MoM, <5%-ile)

A

Placental sulfatase deficiency (X-linked)
X-linked ichthyosis
Smith Lemli Opitz
CAH

465
Q

Smith Lemli Opitz :
Inheritance, enzyme deficiency, prenatal dx

A

AR
3beta-hydroxysteroid 7 reductase
Elevated amniotic fluid 7 dehydrocholesterol and low amniotic fluid cholesterol

466
Q

Placental sulfatase deficiency - genetics

A

X-linked recessive
Xp22.3

467
Q

X-linked iccthyosis - genetics

A

Xp22.3

468
Q

If contiguous deletion of Xp22.3, what happens

A

Can extend to cause Kallman syndrome or chondrodysplasia punctata

469
Q

What chromosome is the alpha gene located

A

chromosome 16

470
Q

What chromosome is the beta, delta, and gamma genes located

A

chromosome 11

471
Q

Fetal renin levels

A

Increased without concomitnant increase in aldosterone and Angiotensin II levels (increased degradation in placenta)

472
Q

Fetal vasopressin levels respond most to

A

Fetal hypoxemia

473
Q

Effect of Angiotensin II on placental blood flow

A

Decreases placental blood flow; likely etiology for increased placental clearance

474
Q

Cordocentesis is the best therapy for which fetal disorder?

A

NAIT

475
Q

Therapy for pseudotumor cerebri

A

Diamox
Optic nerve fenestration if visual symptoms
Lumbar puncture for relief (temporary)

476
Q

Therapy for pseudotumor cerebri

A

Diamox
Optic nerve fenestration if visual symptoms
Lumbar puncture for relief (temporary)

477
Q
A
478
Q
A
478
Q

Risk for early onset dz in GBS positive patients

A

1 in 100

479
Q

Amino acid precursor for nitric oxide

A

Arginine

480
Q

Increased cAMP activates what enzyme?

A

Protein kinase A which dephosphorylates (inactivates MLCK)

481
Q

High prevalence of chronic hepatitis is what?

A

Hep C

482
Q

Fetal cardiac output at term

A

500cc/kg/min

483
Q

Negative CF screen - potential carrier rate in :
- Caucasian
- Blacks
- Jewish

A
  • Caucasian 1 in 240
  • Blacks 1 in 200
  • Jewish 1 in 800
484
Q

What enzyme is missing in placental but is in fetal adrenal gland

A

17 OH dehydrogenase
17, 20 desmolase

485
Q

What enzyme is missing in fetal adrenal but present in the placenta?

A

3 beta hydroxysteroid dehydrogenase

486
Q

Major product of fetal adrenal gland

A

DHEA-S

487
Q

Likely neonatal issue associated with PPROM with chorio

A

CP
PVL

488
Q

Radiation exposure from VQ scan

A

0.022 rads - very low

489
Q

Mechanism associated with sickling process of RBCs

A

Gain in extracellar Na
Loss of intracellular K

490
Q

When time is DM most resistant to insulin

A

0500-0900

491
Q

Preterm breast milk in comparison to term
- Protein
- Na
- Cl
- Lactose

A
  • Protein high
  • Na high
  • C high
  • Lactose low
492
Q

Skin lesion most associated with graft vs host dz

A

PUPPS

493
Q

Duration of action of Lantus

A

18-24 hrs

494
Q

Precursor to estriol

A

Fetal adrenal DHEAS

495
Q

What should you see where AC is measured

A

Stomach and portal vein

496
Q

Local anesthetic epidural is LEAST associated with

A

Puritus - caused by morphine epidural

497
Q

Pt with SC anemia would benefit from what

A

Folate supplementation
UTI suppression
Pneumovax vaccine

498
Q

Pt with SC anemia would NOT benefit from

A

Iron supplementation

499
Q

% of failed amnios when done <14 wks

A

2-3%

500
Q

Complications associated with early amnio

A

high fetal loss rate
increased risk of club feet (talipes equinovarus)

501
Q

Fetal cardiac cyanotic lesions

A

TGA
TAPVR
Single ventricle (ductal dependent)
ToF

502
Q

Immediate precursor to progesterone

A

Pregnenolone

503
Q

Progesterone is made in what feto-maternal unit?

A

Placenta

504
Q

Enzyme that converts pregnenolone to progesterone

A

3 beta hydroxysteroid dehydrogenase, type 1

505
Q

Precursor placenta uses to make progesterone

A

LDL cholesterol –> pregnenolone

506
Q

Next step in estrogen synthesis after DHEAS from fetal adrenal gland is taken up by syncitiotrophoblast

A

placental sulfatase converts it to DHEA

507
Q

How is DHEA converted to androstenedione

A

via 3 beta hydroxysteroid dehydrogenase, type 1

508
Q

What converts androstenedione and estradiol to estrone?

A

Placental aromatase

509
Q

Estriol is made from which precursor

A

Fetal 16 OH DHEAS –> placental sulfatase to 16-OH DHEA –> 3 beta hydroxy steroid dehydrogenase and aromatase to estriol

510
Q

What substance falsely reduces urinary estriol levels

A

Mendelamine (abx used to treat UTI)

511
Q

1/3 of placental glucose uptake is converted to what?

A

lactate

512
Q

Placental lactate is thought to be what?

A

Fetal energetic substrate

513
Q

What source is the glucose used by fetus from? Endogenous from fetus or other

A

Other- placenta

514
Q

What other sources are used for fetal oxidative metabolism?

A

Amino acids - used primarily for oxidative metabolism as opposed to protein synthesis

Other sources: glucose, O2, fatty acids

515
Q

Fetal growth primarily regulated by what substance?

A

IGF I and II

516
Q

Fetal renin levels is increased or decreased?

A

Increased

517
Q

Are fetal angiotensin II and aldosterone levels increased?

A

No

518
Q

Fetal hgb and acid (i.e. KBT)

A

More resistant to acid in KBT testing

519
Q

Effect on fetal breathing:
Hypoxemia
Acidosis
Alkalosis

A

Hypoxemia - inhibits
Acidosis - enhances
Alkalosis - suppresses

520
Q

Maternal B19 (parvo) infection - fetal loss rate

A

5%

521
Q

Vertical transmission associated with parvo

A

33%

522
Q

Best anesthesia for a severe asthmatic in labor? and why?

A

lumbar epidural

Decrease O2 consumption and minute ventilation during labor

523
Q

If general anesthesia needed for asthmatic, what medication is best and why?

A

Ketamine
Reduces risk for bronchospasm

524
Q

Why is fentanyl better than meperidine for the asthmatic?

A

Less histamine production (2% risk of bronchospasm with use of meperidine)

525
Q

Concerns regarding indomethacin and asthmatic pt

A

May lead to bronchospasm, especially in ASA sensitive pt

526
Q

Placental enzymes required for estrogen synthesis

A

Sulfatase (DHEAS –> DHEA)
3 beta hydroxysteroid dehydrogenase (–>androstenedione)
Aromatase (–> estrone)

527
Q

Trisomy associated with greatest risk fo cardiac anomalies

A

T18 - 90% in autopsy specimens, 50% prenatal
T13 - 80%
T21- 25%

528
Q

MCC of macrosomia

A

maternal obesity

529
Q

Mechanism of transplacental transfer
Iron
AA
Glucose
IgG
Medications

A

Iron - pinocytosis (apotransferrin)
AA - active (coupled with Na)
Glucose - facilitated diffusion (GLUT-1)
IgG - pinocytosis
Medications - simple diffusion

530
Q

Associations
AFLP
TTP
Pre-e

A

AFLP:
- LCHAD def
- INCREASE in NH3 (AMMONIA!!!), uric acid, SCr, LFTs, LDH
- LOW glucose and AA’s

TTP:
- def ADAMTS-13
- HIGH ultra-large vWF

Pre-e:
- LOW levels of AT III

531
Q

Define ordinal data

A

Categorical data where there is a logical ordering to the categories.
E.g. scale that you see on surveys
1- strongly agree
2 - agree
3 - neutral etc…

532
Q

Definition of continuous data

A

Data that can take any numerical value

533
Q

Definition of categorical data

A

Data that can be separated into groups

534
Q

Define nominal data

A

Categorical data where the order of the categories doesn’t matter

E.g. race/ethnicitiy

535
Q

Define correlation coefficient

A

Measure of the strength of the linear relationship between 2 variable

536
Q

Anti-M isoimmunization: What type of antibody and does is cause RDFN

A

Typically IgM
Presents as cold agglutinin
Rarely IgG has been found at all

537
Q

FYa vs FYb; which causes mild HDFN

A

FYb

538
Q

What percent of people are kell negative?

A

92%; therefore check antigen status of father of baby

539
Q

Majority of kel positive individuals

A

are heterozygous therefore amnio for antigen typing is indicated

540
Q

Fetal red cell MCV

A

22% larger than adult red cells

541
Q

Type of placentation in TRAP sequence

A

mono/di

542
Q

Fetal SVT and association with structural abnormalities

A

Very rare

543
Q

Syndrome often associated with fetal SVT

A

WPW

544
Q

Treat SVT if tachycardia occurs what percent of the time?

A

> 33%

545
Q

Risk of fetal hydrops associated with Parvo is associated with what factor?

A

GA at which maternal infection occurs

546
Q

Parvo risk of fetal hydrops when maternal infection dx at 12 wks, 13-20 wks, >20wks

A

12 wks –> 10%
13-20 weeks –> 5%
>20 weeks –>1%

547
Q

What antigen on fetal red stem cell does parvovirus attach to, thereby suppressing erythropoeisis? Where else is that antigen found in?

A

fetal “P” antigen

fetal myocardium –> myocarditis, heart failure and cardiomyopathy

548
Q

What % of omphaloceles have aneuploidy?

A

50% (T18 and T13)

549
Q

What % of omphalocele have other structural anomalies?

A

80%

550
Q

What % of Beckwith-Wiedeman is due to paternal uniparental disomy (genetic imprinting?)

A

10-20%

551
Q

What other form of inheritance of Beckwith-Wiedeman

A

AD or imprinting

552
Q

Inheritance pattern of Meckel Gruber

A

AR

Defective cilia

553
Q

Chromosome affected in Beckwith Wiedemann
What is it associated with?
What mutation does it have?

A

Chrom 11
Associated with omphalocele
IGF receptor mutation - overactivity

554
Q

Chromosome affected in Meckel Gruber

A

Chrom 17q21-24; MKS1 gene

555
Q

Why can’t imuran (azathioprine) be activated in the fetus?

A

Fetus lacks enzyme inositol pyrophosphorylase

Azathioprine immunosuppressant used for autoimmune diseases

556
Q

Complications of pregnancies in women with renal transplants?

A

Preterm birth in 45%
FGR in 22%
Major malformations in 3% (= background)
Pre-e in 30%
Allograft rejection 9% (= background)

557
Q

How to differentiate renal transplant rejection from pre-e

A

bx of the kidney
24 hr urine protein and CrCl,
Serum Cr

558
Q

How to follow renal function in pt with renal transplant

A

Monthly urine cx (may not feel pain - kidney denervated)
Monthly UTP and CrCl

559
Q

Definition of malformation

A

associated with a disorder of tissue development
An intrinsically abnormal development process
MC types of malformations are due to incomplete morphogenesis, such as hypoplasia (e.g. microcephaly), incomplete closure (e.g. cleft palate) or incomplete separation (e.g. syndactyly)

560
Q

Definition of deformation

A

Condition arising from mechanical stress to normal tissue (e.g. club foot, congenital hip dislocation.

They occur late in fetal development and are caused by intrauterine mechanical forces that restrict the movement of the developing fetus.

Deformations may spontaneously improved postnatally, when the restriction on movement is no longer present.

561
Q

Infection Vertical Transmission Rate

A

CMV
- 1T = 30-40%
- 3T = 40-70%
- Reucrrent = 1%

Toxo
- 1T = 15-20%
- 3T = 65%

Parvo
- 30%
- Hydrops:
o <20 wks 10%
o >20 wks 5%

HSV
- Primary = 30-50%
- Recurrent = 1-3% if active lesion

HIV
- Without AZT = 25%
- With AZT = 8%
- AZT and CS = 2%
- ART + AZT and VL <1000 = 1-2%

Syphilis
- Primary =60%
- Secondary = 100%
- Tertiary = 10%

562
Q

Definition of sequence

A

A sequence occurs when a single develoopmental defect results in a chain of secondary defects, which may, in turn, lead to tertiary defects. The result is a variably expressed group of defects, all of which can be traced back to the original event.

E.g. The primary defect in Pierre Robin Syndrome is mandibular hypoplasia, which results in posterior displacement of the tongue, which precludes closure of the palatal arches.

563
Q

Definition of syndrome

A

Syndromes are groups of anomalies which contain multiple malformations and/or sequences. The malformations and sequences are variably expressed in a syndrome, such that a given anomaly may be incompletely expressed or absent in certain individuals with the syndrome. Single malformations that are unique to a syndrome, and that are always expressed in that syndrome, are very rare. Therefore, making the dx of a syndrome depends on recognizing the overall pattern of the anomalies.

564
Q

Definition of association

A

Occurrence in multiple pts of a group of anomalies not known to be a sequence of syndrome (e.g. CHARGE< VACTERL). It is not a specific disorder or dx. Its main utility as a designation is to alert clinicians to search for other possible components of the constellation in a pt with one or more anomalies.

565
Q

Sequence vs Syndrome

A

In syndromes, the pathogenic relationship of the group of anomalies is frequently not understood. By contrast, the entire cascade of events is often known in a sequence.

A sequence may have multiple known causes (e.g. Pierre Robin), whereas a syndrome can often be traced to a single genetic malformation (e.g. Downs).

In sequences, there is one primary defect causing a cascade of secondary anomalies.

In syndromes, there are often multiple primary defects resulting in several cascades of embryonically noncontiguous anomalies.

One or more sequences may be associated with various syndromes (e.g. Pierre Robin sequence is often seen in Stickler Syndrome)

566
Q

Precursor to deoxycorticosterone

A

Progesterone

567
Q

Precursor to 11-deoxycortisol

A

17 alpha hydroxyprogesterone

568
Q

Does fetal brain have insulin receptors?

A

No

569
Q

Enzyme that mediates progesterone –> deoxycorticosterone

A

21 alpha hydroxylase

570
Q

Enzyme that mediates 17-OHP –> 11- deoxycortisol

A

21 alpha hydroxylase

571
Q

Tx of Vtack or pulseless Vfib

A

ABCs, SHOCK
Lidocaine if stable

572
Q

Tx for refractory SVT

A

Adenosine or ICD
Generally BB or CCB

573
Q

Urinary Ca in Pre-e (increased or decreased)

A

Decreased

574
Q

Gaucher’s enzymatic defect

A

Glucocerebrosidase

575
Q

Tay-Sacks enzymatic defect

A

Hexoseaminidase-A

576
Q

Canavan’s enzymatic defect

A

Aspartoacyclase

577
Q

What substance is of lower concentration in acute fatty liver of pregnancy

A

Amino acids

578
Q

Associations with placental sulfatase deficiency include:

A

X-linked recessive
Ichythyosis
Chondrodysplasia punctata
Low estriol in quad (<0.5 MoM)

579
Q

Which cardiac arrhythmia is more commonly associated with CHD?

A

Congenital heart block
50% of CHB have a cardiac anomaly

580
Q

Causes of newborn laryngeal papillomatosis

A

HPV 6 and 11

581
Q

Where is hep B core antigen found

A

Only in hepatocytes, not in serum

582
Q

Most important counter-regulatory hormone in glucose metabolism is…

A

Cortisol

583
Q

Effect of Trimethadione on fetus

A

Head - MR, microcephaly
V-shaped eyebrows
Cardiac anomalies
Absent kidney
Omphalocele

584
Q

Incidence of pre-e in daughters of women who had pre-e

A

20-40%

585
Q

Incidence of pre-e in sisters of women who had pre-e

A

11-37%

586
Q

Incidence of pre-e in monozygotic twin pairs

A

Up to 60%

587
Q

Factor XI deficiency affects predominantly what population? What’s the tx?

A

Ashkenazi Jews

Factor XI concentrate

588
Q

Factor XIII deficiency:
- Inheritance pattern
- Associated with what clinical presentation
- Tx

A
  • Inheritance pattern –> AR
  • Associated with what clinical presentation –> intracranial hemorrhage
  • Tx: FFP or cryo
589
Q

Recurrent CMV transmission rate

A

0.1-1%

590
Q

Of estimated 40,000 neonates infected with CMV< what % demonstrate congenital infection at birth?

A

5-6% (around 10%)

591
Q

Most neonates infected with CMV are asymptomatic at birth but what happens later in life?

A

Develop chorioretinitis, hearing loss, neurological deficits, psychomotor retardation, learning disability

592
Q

When is the highest risk of developing congenital varicella syndrome

A

13-20 weeks gestation

593
Q

At 13-20 weeks gestation, what % will develop congenital varicella syndrome?

A

2%

594
Q

Pathognomonic cardiac anomaly in congenital rubella syndrome

A

PDA
Pulmonary artery stenosis

595
Q

Most common single defect in Rubella infected fetuses

A

Hearing loss - sensorineural deafness

596
Q

Chorioretinitis + intracranial calcifications + hydrocephalus

A

Congenital toxoplasmosis

597
Q

Fetus with pH of 7.15, PCO2 of 60, base excess of -4

A

Respiratory acidosis

598
Q

Carbohydrate metabolism and what is the major byproduct of carbohydrate metabolism in the fetus?

A

Lactic acid

599
Q

IVH and MC site

A

Germinal matrix

600
Q

Increase in heat stable alkaline phophatase increases in pregnancy. This is found in the:
- Placenta
- Leukocytes
- Platelets

A

Placenta

601
Q

An absence of end-diastolic flow has been associated with

A

increased risk of perinatal mortality and morbidity

602
Q

Doppler flow ratios will be increased:
- if measurements are taken close to the placenta
- in cases where there is an increase in fetal HR
- in cases where there is low serum glucose in mother

A

if measurements are taken close to the placenta

603
Q

Elevated maternal serum AFP at 16 wks which was elevated >4 MoM…what could be the causes?

A

IUFD
Omphalocele
Twins
Incorrect GA

604
Q

Phospholipase II activity

A

Has been associated with certain species of bacteroides and gardnerella

Sometimes associated with preterm labor and amniorrhexis?

605
Q

Fetal SVT associated with
- Lupus
-Hydrops
-High risk of chromosomal abnormalities

A

Hydrops

606
Q

Action of prostacycline

A

Causes decreased platelet adhesiveness
Vasodilation of the arterials (decrease tone)
Decreases uterine activity

607
Q

Why is thrombocytopenia is seen with PIH or pre-e?

A

Intimal damage in the small arterioles which causes an increase in platelet activation/consumption

608
Q

What is the fatty acid involved with lung maturation, i.e. surfactant?

A

palmitic acid

609
Q

Pt who is quadriplegic. What can be seen?

A

Fetal malpresentation
Uterine hypotonia
Autonomic hyperreflexia

610
Q

Pt in 2T who develops hepatitis B. What would be appropriate management?

A

Give pt’s contact hepatitis B immjunoglobulin, as well as hep B vaccine

611
Q

Match these:

HepBsAg
HepBAb
HepBcag
HepBcab
HepBE

First element seen elevated in patient’s serum
Can sometimes remain elevated after infection
Generally seen elevated during period of clinical jaundice and other clinical symptoms

A
612
Q

Effect of prostin Ee2 on cervical ripening

A

Increased glycoaminoglycans

Glycoaminoglycans in the cervix have an affinity for water and help with cervical ripening.

613
Q

Which thyroid substances readily cross the placenta?

A

TRH and Anti-thyroid stimulating abs

614
Q

HgbA1C being elevated and its association with

A

Increased risk of SAB
Increased risk of fetal anomalies

615
Q

Changes in respiratory physiology during pregnancy

A

Increased: IC, TV
Decreased: FRC, RV, ERV

616
Q

Women with DM at 35 wks has NST that shows a spontaneous variable from 135 –> 100 and otherwise is reactive. AFI wnl. What is the significance?

A

Normal

617
Q

Amniotic fluid prolactin levels
- Affects the osmotic regulation of the AFI
- Source is the decidua
- It is not affected by bromocriptine

A
  • Affects the osmotic regulation of the AFI
618
Q

What affects the concentration of surfactants in the amniotic fluid?

A

Amniotic fluid volume

619
Q

Which of the following disease is most appropriately diagnosed by immunological means?
- Chlamydia
- HSV
- CMV
- Hepatitis
- Toxoplasmosis

A

Toxoplasmosis

620
Q

Young woman and pregnant with polycystic kidney disease? What would occur?

A

50% chance of PIH

621
Q

What chromosome for Prader-Willi and Angelman?

A

Chromosome 15

622
Q

What chromosome for myotonic dystrophy

A

Chromosome 19

623
Q

What chromosome for Huntington Disease

A

Chromosome 4

624
Q

Paternal age and new AD mutations

A

Achondroplasia
Marfan
Neurofibromatosis
Apert syndrome
Hemophilia A
Muscular dystrophy

Remember: All Male Nuts Affect His Muscles

625
Q

X-linked recessive disorders

A

Bruton agammaglobulinemia
Wiskott-Aldrich
Fabry disease
G6PD deficiency
Ocular albinism
Lesch-Nyhan syndrome
Duchenne (and Becker) muscular dystrophy
Hunter Syndrome
Hemophilia A and B
Ornithine transcarbamylase deficiency

Remember: “Be Wise, For GOLD Houses Offer Hate”

626
Q

Trinucleotide Repeat Expansion Diseases

A

Huntington disease
Myotonic dystrophy
Friedreich ataxia
Fragile X syndrome

Fragile X syndrome = CGG
Friedreich ataxia = GAA
Huntington disease = CAG
Myotonic dystrophy CTG

They follow AD inheritance

Remember “Try (trinucleotide) hunting for my fried eggs (X)

X-Girlfriend’s First Aid Helped Ace My Test

627
Q

Repeats in Fragile X

A

CGG >200, males are MR

<45 = normal
45-55 = intermediate
55-200 = premutation

628
Q

Repeats in myotonic dystrophy

A

CTG 1000-2000

629
Q

Repeats in Huntington disease

A

CAG

630
Q

Definition of disruption

A

Morphologic defect resulting from extrinsic breakdown or interference with originally normal developmental process (trauma, infection, teratogen) thalidomide

631
Q

Definition of dysplasia

A

Abnormal organization of cells into tissue and its morphologic consequences (achondroplasia)

632
Q

Capacity vs Competence

A

Capacity determined by a medical professional
Competence determined by the courts

If incapable to make decision –> surrogate decision maker (family or court appointed guardian)

633
Q

What is substituted judgement

A

What the patient has expressed in the past in past decisions or living will or power of attorney

634
Q

Do child neglect laws apply to fetus?

A

No

635
Q

Can a mother be legally required to submit to an invasive procedure?

A

No. The fetus life not favored over mother

636
Q

Normal pregnancy rate after ectopic

A

H/o ectopic –> only 50% will deliver a liveborn child
25% of those who get pregnant will have a repeat ectopic

637
Q

Branches of internal iliac

A

Anterior branch:
o 3 urinary:
- Umbilical
- Superior vesicle
- Inferior vesicle
o 3 visceral
- Uterine
- Vaginal
- Middle rectal
o 3 parietal
- Obturator
- Internal pudendal
- Inferior gluteal

Posterior branch: “I Love Sex”
- Iliolumbar
- Lateral sacral
- Superior gluteal

MFM Boards (1 decks)

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