Day 1 Learning

Question 1

When should an echo be done for a fetus in utero?

Answer 1

22-24 weeks

Question 2

What does AMA stand for in OBGYN?

Answer 2

Advanced medical age

Question 3

Where should the cord exit the placenta and what are common deviations?

Answer 3

Centrally; common to see it exit marginally with twins

Question 4

What are the 4 main conditions searched for on carrier screenings?

Answer 4

CF, Fragile-X, Sickle-cell, Spinal Muscular Atrophy

Question 5

What do positive anti/Ro and anti/La antibodies increase risk for in baby?

Answer 5

Neonatal lupus and fetal heart block (may need pacemaker if block is bad enough)

Question 6

When is an amniocentesis usually done?

Answer 6

16-22 weeks

Question 7

What antidepressant is good to give in pregnancy?

Answer 7

Sertraline

Question 8

What does hx of anxiety and depression in pregnancy lead to?

Answer 8

Increased risk of postpartum depression

Question 9

Can cleft palates be ruled out on US? What is an indicator?

Answer 9

No; look for lips - if normal appearing, decreased risk for cleft palate

Question 10

What are complications that can occur on baby with mom having GDM?

Answer 10

Macrosomia, neonatal hypoglycemia, hyperbilirubenemia, shoulder dystocia, birth trauma

Question 11

When is screening for GDM performed?

Answer 11

24-28 weeks

Question 12

What is the screening process for GDM?

Answer 12

2-step:
1) 50g oral glucose followed by 1 hour venous glucose determination
2) 100g, 3 hour diagnostic OGTT (oral glucose tolerance test)

Question 13

What medication(s) is given to women in preterm labor?

Answer 13

Magnesium sulfate and steroids

Question 14

Why is mag sulfate given to women in preterm labor?

Answer 14

Neonate neuroprophylaxis and tocolysis (slow/stop contractions)

Question 15

When and why are steroids given to pregnant women?

Answer 15

If women goes into preterm labor 2 doses 24 hours apart…2 more doses 2 weeks later 24 hours apart; given to help advance fetal lung maturity

Question 16

What drug can be given along with magnesium sulfate and corticosteroids in a patient in preterm labor and why?

Answer 16

Nifedipine - can be given for tocolysis (tocolytics are not always indicated nowadays)

Question 17

What is considered AMA and what testing is recommended in this patient?

Answer 17

35 or older by the estimated due date and amniocentesis is recommended

Question 18

What medication is given to patients with an increased risk for preeclampsia, preterm labor, or poor fetal growth, why, and how when should it be given?

Answer 18

Baby aspirin; to reduce risk of all of the mentioned complications; started between 12-28 weeks and continued throughout the rest of the pregnancy

Question 19

What does a BP of greater than 160/110 in a pregnant women increase risk for?

Answer 19

Greatly increase risk of MI and stroke in mom

Question 20

What can surgery in the abdomen during pregnancy increase the risk of?

Answer 20

Labor and bleeding at surgical site due to stretching

Question 21

What is the inheritance pattern for sickle cell disease?

Answer 21

Autosomal recessive

Question 22

What medication and what dosage should be given to patients with previous anencephaly?

Answer 22

4 mg of folate

Question 23

What is echogenic bowel and what is it associated with?

Answer 23

Bowel appears bright like bone on US; increased risk for chromosomal abnormalities (i.e. Down’s syndrome, CF, etc.)

Question 24

What is vasa previa?

Answer 24

Umbilical vessels lying over or near the birthing canal

Question 25

What is considered fetal growth restriction?

Answer 25

Fetal weight or abdominal circumference less than 10th percentile

Question 26

What are the qualifications for small gestational age (SGA)?

Answer 26

Newborns whose birth weight is less than the 10th percentile

Question 27

What infection accounts for most cases of infection-related fetal growth restriction worldwide?

Answer 27

Malaria

Question 28

What are the four biometric measures most commonly used to assess for fetal growth restriction?

Answer 28

Biparietal diameter, head circumference, abdominal circumference, and femur length

Question 29

What should be performed at each prenatal care visit after 24 weeks gestation?

Answer 29

Fundal height measurements

Question 30

What does a discrepancy between weeks of gestational age and fundal height measurement of greater than 3 mean?

Answer 30

May have fetal growth restriction

Question 31

What should be assessed once fetal growth restriction is diagnosed?

Answer 31

Serial umbilical artery Doppler velocimetry

Question 32

When is delivery suggested in a women with a baby measuring 3rd-10th percentile with a normal umbilical artery Doppler?

Answer 32

38 0/7 - 39 0/7 weeks

Question 33

When is delivery suggested in a women with a baby measuring less than the 3rd percentile with a normal umbilical artery Doppler?

Answer 33

37 0/7 weeks

Question 34

When is delivery suggested in a women with a baby measuring 3rd-10th percentile with an abnormal umbilical artery Doppler?

Answer 34

Earlier than 37 0/7 weeks

Question 35

What type of diet is recommended in a patient with GDM?

Answer 35

Similar to keto but can have some complex carbs

Question 36

What is the composition of hemoglobin A?

Answer 36

2 alpha-chains and 2 beta-chains

Question 37

What is the composition of hemoglobin F?

Answer 37

2 alpha-chains and 2 gamma-chains

Question 38

What is the composition of hemoglobin A2?

Answer 38

2 alpha-chains and 2 delta-chains

Question 39

What chromosome are genes that code for alpha-globin located on?

Answer 39

16

Question 40

What chromosome are genes that code for beta-globin located on?

Answer 40

11

Question 41

What is the genetic mutation that causes sickle cell disease?

Answer 41

Single nucleotide substitution of valine for glutamic acid coding for beta-globin polypeptide

Question 42

What is Hb SS, what organ complication is associated with it and what does this result in?

Answer 42

Hb SS - hemoglobin structure in sickle cell disease; patients with Hb SS are functionally asplenic due to autosplenectomy by adolescence; increased incidence and severity of infection

Question 43

Look up video on velamentous placenta!!

Answer 43

Do it

Question 44

What is the most significant threat to patients with sickle cell disease and what does this entail?

Answer 44

Acute chest syndrome; pulmonary infiltrate with fever that leads to hypoxemia and acidosis - infiltrates are not infectious in origin but are due to vasoocclusion from sickling or embolization of marrow from long bones affected by sickling

Question 45

How are hemoglobinopathies diagnosed?

Answer 45

Hemoglobin electrophoresis and CBC

Question 46

What do thalassemias ultimately result in?

Answer 46

Microcytic anemia

Question 47

What are the different categories of alpha-thalassemia and their associated sxs?

Answer 47

1 alpha mutation - silent mutation - no effect 2 alpha mutations - alpha-thal trait/minor - mild asymptomatic microcytic anemia 3 alpha mutations - HbH - mild to moderate hemolytic anemia 4 alpha mutations - Hb Bart’s - hydrops fetalis

Question 48

What ethnicity is commonly associated with trans deletion in alpha thalassemia trait and what effect does this have on inheritance?

Answer 48

African; Hb Bart’s not typically developed in patients of African origin due to (alpha - / alpha -)

Question 49

What ethnicity is commonly associated with a cis deletion in alpha-thalassemia trait?

Answer 49

Asian

Question 50

What type of hemoglobin is absent in beta-thalassemia?

Answer 50

HbA

Question 51

What are the classifications of beta-thalassemia?

Answer 51

Beta-thal minor - heterozygous mutation Beta-thal intermedia - homozygous mutation with less severe clinical complications Beta-thal major - homozygous mutation with more severe clinical complications

Question 52

What are the complications associated with beta-thal major?

Answer 52

Sever anemia with resultant extramedullary hematopoesis, delayed sexual development, and poor growth. Elevated HbF levels and death usually occurs by age 10 unless early intervention by blood transfusions.

Question 53

What ethnicities are at higher risk for hemoglobinopathies and should therefore be offered carrier screenings?

Answer 53

African, southeast Asian, and Mediterranean

Question 54

What is recommended for expecting parents where both parents are carriers for potential disorders?

Answer 54

Genetic counseling

Question 55

When should chorionic villus sampling (CVS) be done?

Answer 55

10-12 weeks

Question 56

How much folate should a patient with sickle cell disease take and why?

Answer 56

4 mg; continual turnover of red blood cells

Question 57

What drug is commonly used in patients with lupus and can it be used in Pregnancy?

Answer 57

Hydroxyurea - reduces the frequency of painful crises; cannot be used in pregnancy because it is teratogenic

Question 58

What are pregnant women with sickle cell disease at an increased risk for?

Answer 58

Spontaneous abortion, preterm labor, IUGR, and stillbirth

Question 59

When is the best time to deliver a pregnant patient with oligohydramnios?

Answer 59

36-38 weeks

Question 60

What is an EIF and why is it significant?

Answer 60

A bright spot on the heart (similar to bone); indicates increased risk for Down Syndrome

Question 61

What does EIF stand for?

Answer 61

Echogenic intracardial focus

Question 62

What is a common risk factor associated with obesity?

Answer 62

Stillbirth

Question 63

What is the treatment plan for a neonate with an ASD?

Answer 63

Prostaglandins can be given initially; if unsuccessful, cardiac catheterization

Question 64

What are the best medications for HTN post-parturition?

Answer 64

Labetalol (1st line); can use nifedipine (procardia) if cannot use labetalol

Question 65

What does an absent nasal bone on US indicate?

Answer 65

Increased risk of Down Syndrome

Question 66

What is “normal” fetal positioning?

Answer 66

Head first

Question 67

What is breech fetal positioning?

Answer 67

Feet/butt first

Question 68

What is fetal fibronectin and what does it test used for?

Answer 68

The “glue” that holds the amniotic sac to the lining of the uterus; tested to see if the patient is at higher risk for preterm labor

Question 69

What is velamentous cord insertion?

Answer 69

An abnormal cord insertion in which the umbilical vessels diverge as they traverse between the amnion and chorion before reaching the placenta