2022 Qs

Question 1

Etiology of Hydranencephaly

Answer 1

ischemic stroke of both carotid arteries, progressive necrosis of areas affected by infarct

Question 2

Reason to use VV ECMO?

Answer 2

ARDS

Question 3

Reason to use VA ECMO?

Answer 3

Cardiogenic Shock, PE with RV failure

Question 4

Isotrentinoin fetal effects

Answer 4

CNS malformations, microtia or anotia, micrognathia, cleft palate, conotruncal cardiac and great vessel defects, thymic abnormalities, eye malformations, and intellectual disability

Question 5

Time to wait before conceiving if on isoretinoin?

Answer 5

1 month

Question 6

PEC patient with dyspnea, how do you explain symptoms?

Answer 6

low colloid oncotic pressure causing leading to pulmonary edema

Question 7

which respiratory parameter changes the most?

Answer 7

50% increase in TV

Question 8

What leads to increase plasma volume in pregnancy

Answer 8

nitric oxide–mediated vasodilation, which induces the renin-angiotensin-aldosterone system and stimulates sodium and water retention

Question 9

What pregnancy adaptation leads to shorter half life for medications?

Answer 9

increased renal clearance (GFR)

Question 10

US findings toxo

Answer 10

Ventriculomegaly, intracranial calcifications, microcephaly, hepatomegaly, liver calcifications, placentomegaly, growth restriction, or ascites

Question 11

US findings zika

Answer 11

microcephaly, cerebral calcifications, ventriculomegaly, fetal growth restriction, arthrogryposis

Question 12

Most common cause of ARDS in pregnancy

Answer 12

Viral infection/pneumonia

Question 13

Diagnose NAIT to predict risk in subsequent pregnancy?

Answer 13

1Maternal anti platelet antibodies, #2 parental and infant platelet antigen genotype

Question 14

Hydropic fetus with Parvo IgM+, next step?

Answer 14

PUBS with IUT. By the time hydrops is present, HCT likely < 20%

Question 15

What is the incidence of short cervix in pregnancy in patients with prior preterm birth?

Answer 15

About 30%

Question 16

Nullip with CL 1.5 cm, next step?

Answer 16

Vaginal progesterone

Question 17

US features of arcuate uterus?

Answer 17

serosal indentation/ Arcuate distance <1cm angle >90 degrees

Question 18

US features of bicornuate uterus

Answer 18

serosal indentation of >1cm

Question 19

Decrease the risk of loss of pregnancy with triplet with monochorionic pair?

Answer 19

KCL of both MONO chorionic pair. NEXT best? KCL the singleton

Question 20

Monochorionic twins, demise of one twin at 26 weeks, next step?

Answer 20

expectant management until 34 weeks

Question 21

Unstable patient after CPR with ROSC, vaginal bleeding, next step to direct management?

Answer 21

echo (more accurate at measuring pulmonary pressures than PAC! both are estimates)

Question 22

how does perimortem cesarean improve maternal suvivability

Answer 22

Decrease compression of the IVC which improves venous return *

Question 23

Most effective opioid for patient controlled analgesia in labor

Answer 23

Remifentanil

Question 24

What monitoring necessary for a patient with remifentanil administration

Answer 24

Continuous oxygen saturation monitoring (may cause respiratory depression)

Question 25

Above what level are patients at risk of autonomic dysreflexia?

Answer 25

T6

Question 26

Treatment autonomic dysreflexia during labor (what position)

Answer 26

Epidural extending to the level of the 10th thoracic segment, Sit upright (will reduce arterial BP)

Question 27

Risk of chromosomal abnormality with isolated msucular VSD?

Answer 27

Not significant, sporadic!

Question 28

Most likely chromosome abnormality with membranous VSD?

Answer 28

Likely T21

Question 29

What is the best way to test for maternal CMV infection?

Answer 29

PCR (or IgM which could demonstrate recent infection)

Question 30

what is the mechanism of action of methimazole?

Answer 30

Blocks production of new thyroid hormone by inhibiting thyroid peroxidase and organification of iodine

Question 31

Molar triploidy most likely associated with???

Answer 31

fetal growth restriction

Question 32

likely cause of fetal demise in preeclampsia

Answer 32

placenta infarction

Question 33

can microarray detect balanced translocations?

Answer 33

no

Question 34

persistent sepsis despite IVF and antibiotics?

Answer 34

transfer to ICU!

Question 35

most common complication in Sickle Cell in preg

Answer 35

Vasoocclusive event (50%)

Question 36

what hormone is elevated in baby with smith lemli opitz?

Answer 36

7-dehydrocholesterol

Question 37

what is the direct precursor to placental estriol synthesis?

Answer 37

16 alpha OH- DHEAS

Question 38

most commonly affected part in a etus with treacher collins syndrome?

Answer 38

Mandible hypoplastic versus eyes downward slant palpebral fissures

Question 39

characteristic finding of affected infants of congenital varicella

Answer 39

IUGR, scarring skin lesions, ocular defects, limb abnomralities (hypoplasia of bone and muscles), CNS ab

Question 40

most common effect of fetal CMV infection

Answer 40

SENSORINEURAL HEARING LOSS

Question 41

which anesthetic is cardiotoxic if injected intravascularly during epidural placement

Answer 41

BUPIVICAINE! one of the most cardiotoxic local anesthetic agents

Question 42

which anesthetic has the shortest half life?

Answer 42

2-chloroprocaine

Question 43

what is the most likely risk from regional anesthesia

Answer 43

toxicity from local anesthetic

Question 44

post regional headache

Answer 44

traction on pain sensitive structures- intracranial hypotension related to CSF leak may cause sagging of intracranial structures and stretch of sensory intracranial nerves, causing paina nd cn palsies

Question 45

Major side effect of volatile anesthetics (halothane)

Answer 45

fulminant hepatic necrosis

Question 46

AIDS: when PCP prophylaxis and what agent

Answer 46

CD4< 200, Bactrim DS

Question 47

AIDS: When Histoplasmosis prophylaxis, what agent?

Answer 47

CD4 < 150, itraconazole

Question 48

AIDS: when MAC prophylaxis and what agent

Answer 48

CD4 < 50, Azithromycin weekly (or clarithro)

Question 49

AIDS- when toxo prophylaxis and what agent

Answer 49

IgG positive, CD4 < 100, Bactrim

Question 50

acute HIV treatment

Answer 50

Dolutegravir plus tenofovir or tenofovir with emtricitabine

Question 51

Treatment of lyme disease in pregnancy

Answer 51

Oral amoxicillin TID x 2-3 weeks. If encephalitis: ceftriaxone 2g IV qD 14-28 days

Question 52

Treatment of Toxoplasmosis

Answer 52

< 18 weeks: Spiramycin, >18 weeks pyrimethamine, sulfadiazine, leucovorin. Check PCR of AF

Question 53

Critical Titer?

Answer 53

16

Question 54

high insulin in umbilical cord is associated with?/

Answer 54

MACROSOMIA

Question 55

acute cord occlusion what are the gasses?

Answer 55

wide difference between venous and arterial values usually associated with normal or near normal gasses

Question 56

most likely explanation for inconclusive cffdna

Answer 56

low fetal fraction

Question 57

limitation of cfDNA in low risk population

Answer 57

low PPV

Question 58

why use cfDNA instead of integrated screen

Answer 58

increased sensitivity for T21

Question 59

how to diagnosis TAPS?

Answer 59

MCA Dopplers

Question 60

Best prediction of prognosis in TRAP?

Answer 60

Ratio of weight of perfused twin to weight of pump twin: 30% chance of cardiac failure when ratio is greater than 0.7, compared with 10% when less than 0.7

Question 61

first trimester radiation exposure associated with?

Answer 61

Increased risk of microcephaly/ID/growth deficiency (between 10-17 wks)

Question 62

200 mGy exposure at or after 8 weeks gestation, associated with....

Answer 62

microcephaly, severe ID

Question 63

200 mGy exposure 2-8 weeks after fert (during organogenesis)

Answer 63

congenital anomalies (skeleton, eyes, genitals),FGR