2016 - Final XLS in CSV form - Sheet1 Flashcards by Jay Barrow

The most accurate description of Standard error is?

The same as standard deviation

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What are the last 5 phases of lung development? At what weeks do they occur?

Embryonic -3 - 7
 Pseudoglandular - 5-17
 Canalicular - 16-26
 Saccular - 26- 36
 Alveolar - 36+

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At which phase do type 2 pneumocytes appear?

Canalicular

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What pregnancy complications are associated with Multiple Sclerosis?

Increased risk of Growth restriction (and of C/section, but less than IUGR)

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The most common symptom of appendicitis in pregnancy is?

Abdominal pain

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periventricular leukomalacia is most commonly associated with what pregnancy complication?
Why does it happen?

Intra-amniotic Infection/Chorioamnionitis

Proinflammatory cytokines damage the white matter of the brain

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Histologic Chorioamnionitis without clinical signs of infection is associated with what neonatal complications?

Interventricular hemorrhage, periventricular leukomalacia and Cerebral palsy

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Treatment for toxoplasma in pregnant women?

Spiramycin

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Common findings in congenital toxoplasmosis?

Chorioretinitis, hepatosplenomegaly, periventricular calfications, ventriculomegaly, disseminated purpuric rash

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If a parent has a robertsonian translocation 45XXder(14:21)(10q:10q) What is the chance that offspring will have phenotype of T21?

1/6 chance that baby is T21, but 3/6 of babies will be miscarriage so depends on if question asks about liveborn or just whether they’ll have trisomy 21. (Because 1/3 of the live births will be T21, but 1 in 6 possible outcomes of which 3 are miscarriage)

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Baby delivered at 35 weeks. 30 minutes after delivery, develops severe respiratory distress. Preductal O2sat = 70%. Postductal O2sat = 90%. CXR normal. Diagnosis?

Postductal > Preductal, think TGA

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Genetic diagnosis most associated with a mom that has preeclampsia?

Trisomy 13

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Nuchal translucency is 5.4mm. Next best step?

CVS (genetic testing)

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Which procedure has the greatest risk of alloimmunziation?

Amnio, CVS or Cordocentesis?

Cordocentesis (close to 40%)

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What clinical scenario should cause you to test for Antiphospholipid Antibodies?

Any of the following:

(a) 1+ episode of vascular thrombosis
(b) 1+ death of morphologically normal fetus at 10+ weeks
(c) 1+ birth before 34 weeks due to preeclampsia/eclampsia or features associated with placental insufficiency
(d) 3+ unexplained pregnancy losses before 10 weeks (after maternal/paternal genetic and anatomic/hormonal causes excluded)

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18 weeks pregnant with Non-Hodgkins Lymphoma, best treatment?

Combination Chemotherapy

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What enzyme is associated with Hydantoin syndrome?

Epoxide Hydrolase. Teratogenicity of several anticonvulsant medications is associated with elevated level of oxidative metabolites normally eliminated by epoxide hydrolase

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Management of Acute Fatty Liver of Pregnancy?

Delivery despite gestational age

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Most specific finding to distinguish TTP from HELLP

LDH to AST ratio (elevated in TTP)

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Patient meets clinical criteria for antiphospholipid syndrome. Recommended testing?

Lupus Anticoagulant (Kaolin, Dilute russelll venom viper test, B2 Glycoprotein, Anti Cardiolipin Antibody

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Omphalocele is associated with which genetic syndrome?

Beckwith wiedemann, kartagener, meckel gruber?

Beckwith Wiedemann

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Most likely cause of a nonreative tracing in a term fetus

Sleep cycle

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What is the positive predictive value of an NST for cerebral palsy?

<1%

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A woman with a prolactinoma wants to breast feed, you advise?

Okay for microadenoma prolactinoma to breast feed

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Amino acids cross the placenta via what type of movement?

Active Transport

Best outcome following in utero repair of myelomeningocele is seen with?

Lower limb muscle strength

Which is most associated with aneuploidy: a. Thickened nuchal fold b. Short humerus c. Echogenic bowel d. EIF

Thickened Nuchal Fold

Most likely finding of fetus in mom with hyperparathyroidism:

Neonatal Hypocalcemia

20 yo Asian woman with low MCV, HgbA2 2.4%. Most likely cause:

Alpha Thalassemia

Woman with MCV of 62, normal ferritin, HgbA2 4.2%. Most likely cause:

Beta Thalassemia

What mechanism does cAMP work in B-mimmetic?

↑ intracellular cAMP-> activates PKA -> Phosphorylates myosin light chain Kinase (Which inactivates it) -> ↓ intracellular calcium and Muscle Relaxation

What is the origin of cell free dna?

apoptosis of placental cells (syncytiotrophoblast)

Best contraceptive option for patient with Hepatitis C and liver disease

Copper IUD

Which medication is the best anticoagulant to prevent clot in pregnancy:

Lovenox

Treatment for malignant hyperthermia?

Dantrolene

The benefit of doing a multivariate analysis in a cohort study is?

Decrease confounding

Patient Is 8 weeks pregnant with an IUD in place, strings are visible. You should?

Pull string

Fetus at 28 weeks with CCAM type I lesion and hydrops. Management?

Thoracoamniotic shunt

Fetus with posterior urethral valves, what findings signify renal impairment?

Increases in Ca, Cl, Na, Microglobulin or OsmolaRity

Which cardiac lesion is most specific with T21?

AV Canal defect

Maternal death is most associated with?

Cardiac Disease

Most likely complication for patients with aortic stenosis in the peripartum period?

Arrhythmias

Newborn with Thrombocytopenia and Interventricular Hemorrhage, likely Diagnosis?

Alloimmune thrombocytopenia

What does not get absorbed in patient with Roux-En-Y bypass vs. gastric banding?

B12 Deficiency

What is the most likely cause for an LGA Fetus?

Maternal Obesity

Mom with uncontrolled hyperthyroidism causes what risk to fetus?

``` #1: Preeclampsia #2: Growth Restriction #3: Preterm delivery ```

What would make a medication most likely to cross in to breast milk?

Lipid Solube, Not bound to protein, non ionized, small/low molecular weight

Which bacterial enzyme is most associated with preterm birth?

Phospholipase a2

Increased Fluid is most beneficial for what lesion?

Aortic Stenosis

Most common presentation of Turners syndrome?

Short Stature

A couple wants to know the likelihood of their baby being affected with PKU. The father has PKU (disorder frequency 1/10,000). What is the likelihood the mother is a carrier?

Jan-50

``` Pregnancy after endometrial ablation is associated with what outcome most frequently? S Ab PTD Malpresentation Placenta Accreta ```

Malpresentation (39%) Morbidly adherent placenta (26%) PTD (20%) Sab (12%)

How do you test for familial dysautonomia?

DNA analysis

What is the disease characterized by a deficiency in aspartoacylase?

Canavans

What antihypertensive medication increases cardiac output?

Hydralazine

What is the most likely outcome with AS? a. Arrhythmia b. Stroke c. MI d. Heart failure e. Maternal death

``` Heart Failure (7-17%) Arrhythmia (3-33%) ```

Which of the following valve lesions as the highest risk of mortality for the mother? AS, AR, MS, MR?

Mitral Stenosis

Difference in allele inheritance based on maternal and paternal genes best describes:

Imprinting

Recurrent achondroplasia in a couple who are not affected are most likely associated with:

Germline Mutation AKA Gonadal Mosaicism

How is Fragile X inherited?

X linked dominant

SSA and SSB antibodies are most associated with?

Neonatal Lupus (25%), Heart block ( 1-3%), Normal pregnancy most likely

What should the work up of a woman with a Spontaneous Abortion at 12 weeks include?

Antiphospholipid Antibodies

What is the most likely to have a low estriol? a. IUFD b. Trisomy 21 c. Placental sulfatase deficiency

Placental Sulfatase Deficiency

Which statistical test will account for survival accounting for multiple variables?

Cox Regression

What do you use to compare two means that are normally distributed that are continuous:

T test

When does cardiac output increase the most?

Immediately postpartum

Mitral stenosis worsens with?

Increased Preload

The fetal organ that receives the highest proportion of cardiac output:

Placenta

The PO2 is lowest in which vessel? | UmbA, Umb V, Uter A , Uter V

Umbilical Artery

Who is the best candidate for an IUD? a. Uterine anomaly b. Benign ovarian tumors c. AIDS d. Active chlamydia

AIDS

Hypospadias and congenital anomalies are increased with what REI?

IVF with ICSI

Which antiseizure drug has the highest risk of NTD?

Valproic acid 1-2%

What is the primary source of precursor estrogen synthesis in the placenta?

C19 Precursor DHEAS from the Fetal Adrenal (Fetal Zone)

Which HIV medication is worst for liver toxicity?

Nevirapine (most), Ritonavir/lopinavir (if its not there)

A patient is newly diagnosed with HIV not previously on any medication. What is the best way to prevent HIV transmission?

AZT (zidovudine)

Which Interleukin is Anti-inflammatory

IL-10

What increases the risk of preterm birth a. IL-6 maternal serum b. IL-6 amniotic fluid c. IL-10 maternal serum d. IL-10 amniotic fluid

Amniotic Fluid IL6

Foot drop is associated with what nerve injury:

Peroneal

What is a contraindication to breast feeding? a. CMV b. HCV c. HBV d. Genital HSV e. Active TB

Active untreated TB, or HSV on breast (not genitals), HIV

Which characteristic will increase passage into milk during lactogenesis

Lipid Soluble, Non Protein Bound, Non Ionized, Low Weight will increase passage into milk during lactogenesis.

Baby delivered at 35 weeks. 30 minutes after delivery, develops severe respiratory distress. Preductal O2sat = 90%. Postductal O2sat = 70%. CXR normal. Diagnosis?

PPHN, Persisent fetal circulation

Treatment of NAIT should be? At what gestational age?

IVIG, starting at 12 weeks

What is the most appropriate US surveillance for MCDA twins?

US every other week at 16 weeks

What is the most likely outcome with demise of one twin in a MCDA pair?

Neurologic Sequelae in the surviving twin (15-25%)

Which elevated value is the most predictive for poor kidney function? a. Osmolality b. Na c. Chloride d. B2-microglobulin

All are predictive if elevated

What is the likelihood of poor neurological outcome after the death of one twin in a MCDA twin?

15-25%

A women has preeclampsia and oliguria. What is indicative of pre-renal process?

Osm >550

What happens to beta cells in pregnancy?

Beta cell islet hypertrophy

What are the findings of Neonatal Myasthenia Gravis?

Poor cry, decreased muscle tone, respiratory muscle weakness

What is the follow-up for 6 mm bilateral pyelectasis and normal karyotype?

Repeat at 32 weeks

Most likely genetic cause of early IUGR?

<26 weeks think Triploidy | > 26 weeks think T18

What is the most likely outcome for patient on dialysis?

Preterm Delivery (50-80%) Polyhydramnios (40%) Anemia (100%) Hypertension (100%)

The difference between quality and safety is:

Quality measures efficient effective care that gets the right job done at the right cost (doing things well), safety is preventing harm

Mother refuses a CS for fetal decelerations remote from delivery, what do you do?

Continue to manage her do not do cesarean against her will

Your primary ethical responsibilities to the patient are:

Beneficence and autonomy (more so than nonmaleficence)

A physician practices evidence-based medicine. This represents

Integrity

When should you get the flu vaccine in pregnancy?

As early as possible

Highest risk of Preterm birth is in what uterine anomaly? What about miscarriages?

PTD: Bicornuate uterus 60-70% | Sab: Septate

Who is microarray most appropriate for? a. Abnormal integrated screen b. VSD c. Partner with Robertsonian translocation d. CPC

VSD microarray analysis helpful to reveal more than karyotype in 6.0% with a structural anomaly and 1.7% of AMA or positive serum screen

Hyperparathyroidism is most associated with: a. Neonatal hypocalcemia b. IUGR c. PTL d. SAB

50% risk of neonatal hypocalcemia (over production of calcium suppresses babies PTH and then when delivered he cant raise Ca2+ levels once he loses the moms calcium) ~10 % SAB rate

Patient with uncontrolled hyperthyroidism most likely to present with:

``` #1: Preeclampsia #2: Growth Restriction #3: Preterm delivery ```

Betamethasone is metabolized in the placenta by:

11β-hydroxysteroid dehydrogenase type 2

Placenta degrades _____ the most: a. Betamethasone b. Prednisone c. Insulin d. Heparin

Prednisone

What hormone decreases after delivery to allow for lactation?

Estrogen

What increases alveolirization in the lungs?

Thyroxine or Vitamin A

Club foot after oligo is the best example of a: | Malformation, Deformation, Disruption?

Deformation

What is the highest complication associated for 10 rads exposure at 15 weeks?

prior to 2 weeks: sab (all or none) 2-8 weeks: growth restriction/anomalies 8-15weeks: Intellectual Disability

Diabetic nephropathy most common pregnancy complications?

Preeclampsia (53%) Preterm delivery (51%) IUGR (11%)