TrueLearn1

Question 1

Dx of parvovirus in pregnancy

Answer 1

IgM, IgG.The IgM response indicates recent infection. IgM can be seen for 1 month up to several months after the infection. IgG antibodies indicate prior infection and immunity

Question 2

Abx endocarditis ppx

Answer 2

augmentin

Question 3

Most frequent non-rhesus antibody

Answer 3

The most frequently encountered non-Rhesus antibodies in pregnancy are the Lewis antibody and the I antibody. These antibodies do not cause hemolytic anemia because the immunoglobulin is type M (IgM), which does not cross the placenta.

Question 4

ureter transection @ pelvic brim?

Answer 4

uretetroureterostomy

Question 5

percentage seropositive for HSV2

Answer 5

26%

Question 6

most common sfx external beam radiation

Answer 6

Atrophy of the epithelium is the most consistent side effect of radiation therapy causing diarrhea, acute cystitis, vaginal mucositis, and skin erythema.

Question 7

death/neuro injury twin fetal demise

Answer 7

Surviving monochorionic twin

    neurological injury (18%)
    death (15%)

Surviving dichorionic twin

    neurological injury (1%) 
    death (3%)

Question 8

embryo implantation steps

Answer 8

Implantation consists of three stages. Apposition is the first step and consists of the embryo making contact with the endometrium. Adhesion is the second step, during which the embryo has further contact with the endometrium and becomes more adherent. Invasion is the final step in which the embryo becomes embedded.

Question 9

protein S change during pregnancy

Answer 9

decrease

Question 10

congenital rubella syndrome

Answer 10

, congenital rubella syndrome (CRS) has multiple anomalies. If exposure is suspected during the prenatal course, one should expect to see evidence of cardiac abnormalities, defects involving the central nervous system and its development, evidence of growth restriction, and hepatosplenomegaly

Question 11

fetomaternal hemorrhage- most common timing

Answer 11

Fetomaternal hemorrhage is most likely to occur at the time of delivery.

Question 12

warfarin embropathy

Answer 12

This includes nasal and midline facial hypoplasia and stippling of the vertebral and femoral epiphyses, which are rings noted near the epiphyseal plates on ultrasonography.

Question 13

half life, steady state of oxytocin

Answer 13

The half-life of oxytocin is approximately 3–5 minutes, therefore, the uterus will start contracting within 3–5 minutes of beginning an oxytocin infusion. Steady-state plasma levels are reached at about 40 minute

Question 14

pregnancy ABG

Answer 14

Maternal partial pressure of carbon dioxide drops from a range of about 36–44 mm Hg to a range of 28–32 mm Hg in pregnancy. -> “NORMAL” co2 would be a late finding

Question 15

endometritis when to dc abx

Answer 15

Antibiotics are continued until the patient has been afebrile for 24 hours. No further antibiotics are needed,

Question 16

mitral valve stenosis labr mgmt

Answer 16

Avoiding an increase in preload is absolutely the most important factor, so fluid restriction is key to proper management.

Question 17

signs of severe malnutrition in the elderly

Answer 17

Risk Factor Parameter
BMI BMI <18.5
Serum albumin Serum albumin <3.0 g/dL in the absence of hepatic or renal failure
Unintentional weight loss >10–15% within the most recent 6 months

Question 18

pathogenesis of endometriosis

Answer 18

Retrograde menstruation leading to attachment and implantation of endometrial glands and stroma on the peritoneum
Increase in cyclooxygenase-2 (COX-2) leading to local overproduction of prostaglandins
Increase in aromatase activity leading to overproduction of local estrogen
Progesterone resistance decreases the antiestrogenic effect of progesterone, which amplifies the local estrogenic effect

Question 19

cardiac abnormalitiy most associated w/ epidural placement mortality

Answer 19

aortic stenosis (bicuspid valve)- decrease resistance leads to decreased preload

Question 20

diabetes medication mgmt preop

Answer 20

Patients taking long-acting insulin at night or in the morning should take one-half to two-thirds of the usual dose; with intermediate-acting insulin taken twice daily, the normal dose should be given the night before and long-acting insulin should be taken at one-half to two-thirds of the usual dose.
Short-acting insulin should be held on the morning of surgery because it increases the risk of hypoglycemia.
Sulfonylureas such as glyburide increase the risk of hypoglycemia and should be held on the morning of surgery.
Thiazolidinediones may worsen fluid retention and can lead to heart failure and should be held on the morning of surgery.
Metformin increases the risk of renal hypoperfusion, lactic acidosis, and tissue hypoxia and should be held on the morning of surgery.
Sodium-glucose cotransporter 2 inhibitors increase the risk of hypovolemia and should be held on the morning of surgery.

Question 21

origin of the fetal umbilical arteries

Answer 21

internal iliac

Question 22

5a reductase deficiency- what develops abnormally, internal or external

Answer 22

external (penis, scrotum), urethra, prostate

Question 23

most common bug for bronchitis in pregnancy

Answer 23

parainfluenza

Question 24

what is the most sensitive test for a concealed abruption?

Answer 24

ctx on monitor (not coagulopathy b/c later sign)

Question 25

most common congenital infection?

Answer 25

CMV, though often asymptomatic

Question 26

what is the incidence of postterm syndrome in postterm pregnancy

Answer 26

10-20%

Question 27

best peripartum cardiomyopathy med

Answer 27

metoprolol- reduces pre-post load

Question 28

PTB rate in US

Answer 28

12%

Question 29

how long exclusiveley breastfeed, how long breastfeed w/ supplementation

Answer 29

6 and 12 mo

Question 30

uncomplicated twin gestation delivery timing

Answer 30

Monochorionic-monoamniotic 32–34 weeks Monochorionic-diamniotic 34–37 w6d Dichorionic-diamniotic 38 weeks

Question 31

during menstrual cycle- what makes progesterone and what makes estrogen

Answer 31

progesterone: theca (incidental breast ductal prolif) estrogen: graafian folicle (signals hypo/pit, and theca)

Question 32

cause of hypotension following epidural

Answer 32

loss of sympathetic innervation (decreased vascular tone and increased vasodilation)

Question 33

FDA approved for hirsutism in PCOS

Answer 33

eflurnithine

Question 34

most helpful test for vW dz dx?

Answer 34

``` factor VIII (levels decreased b/c not boudn by vWf) PTT would be INCREASED d/t above (intrinsic) ```

Question 35

most common nerve injury w/ pfannensteil

Answer 35

iliohypogastric

Question 36

contraindication for terb

Answer 36

maternal cardiac arrhythmia

Question 37

sickle cell dz inheritance and mode of dz

Answer 37

autosomal recessive, beta chain malformation

Question 38

ileus vs SBO?

Answer 38

ileus absent bowel sounds, SBO "tinkling"

Question 39

when to treat ITP? Tx modalities and time to make a difference?

Answer 39

clinical bleeding, plt <30 even w/o sx, epidural/spinal (needs plts >70), c/s or surgery (needs plts >50) steroids- 4-14 days (peaks 2-3 wk) IVIG- 1-3 days (peaks about 7 days)

Question 40

AFP sensitivity for open NTD and anencephaly?

Answer 40

65-80% and 95%, respectively

Question 41

what is the gold standard for dx of renal artery stenosis?

Answer 41

renal arteriography

Question 42

normal cord gas values

Answer 42

``` Normal Umbilical Artery Values pH 7.28 ± 0.05 PCO2 49.2 ± 8.4 mm Hg PO2 18.0 ± 6.2 mm Hg HCO3 22.3 ± 2.5 mEq/L Base deficit 4 ± 3 mmol/L ```

Question 43

UTI incidence young women

Answer 43

0.5 per person year

Question 44

anticoagulation in renal insufficiency

Answer 44

unfractionated heparin,[ LMWH is excreted by the kidneys]

Question 45

neonatal HSV infection- most common sites

Answer 45

Disseminated disease ~25% Central nervous system disease ~35% Disease limited to the skin, eyes, or mouth ~45%

Question 46

hyst route w/ highest ureteral injury risk

Answer 46

laparoscopic (7/1000)

Question 47

untreated hyperthyroidism in pregnancy can result in

Answer 47

hydrops, IUFD, IUGR

Question 48

call-exner bodies path description

Answer 48

granulosa cell. microfollicular pattern with numerous small cavities that may contain eosinophilic fluid.

Question 49

what percentage of mature teratomas will develop into squamous cell cancers?

Answer 49

1%

Question 50

percentage of pregnancies affected by any kind of thrombocytopenia

Answer 50

7-12%

Question 51

severe refractory mastalgia after OCP tx?

Answer 51

NSAIDs, danazol (high risk of hirsutism though, cant take more than 6mo)

Question 52

msot common way to contract toxo?

Answer 52

udnercooked pork, lamb (not litter box)

Question 53

By how much does breastfeeding increase maternal caloric requirements?

Answer 53

500 cal/day

Question 54

which is the BEST time to perform hysteroscopy in a premenopausal woman?

Answer 54

The early proliferative phase of the menstrual cycle is when the endometrial lining is the thinnest. Performing hysteroscopy during this time of the cycle allows for better visualization of anatomical abnormalities such as polyps. The thin lining also allows for easier removal of masses noted

Question 55

the MOST common lesion identified in uterine papillary serous carcinomas on microscopy

Answer 55

psammoma body (looks like a onion cut in half)

Question 56

STI ppx post exposure (date rape etc)

Answer 56

gonorrhea, chlamydia, hep B, trich

Question 57

What is the relative risk of developing breast cancer with a diagnosis of atypical ductal hyperplasia?

Answer 57

ADH conveys a substantial increase in the risk of breast cancer, both ipsilateral and contralateral. That risk is estimated at 4.5 to 5.0.

Question 58

metabolic syndrome

Answer 58

``` 3+ must be present, for women: BP > 130/85 mm Hg BG >100 mg/dL HDL <50 mg/dL TG >150 mg/dL Waist circumference >35 inches (88 cm) ```

Question 59

After an eclamptic seizure, which region of the brain is MOST likely to be abnormal on MRI?

Answer 59

occiptial (least common is temporal)

Question 60

most common lymph node upper 2/3 vagina (ca spread)

Answer 60

pelvic (the deep inguinal drains the lower third of vagina

Question 61

protein abnormality most commonly associated w/ AFLP?

Answer 61

deficiency of LCHAD

Question 62

heparin MOA

Answer 62

binds and activates antithrombin, which inhibits thrombins change of fibrinogen to fibrin

Question 63

treatment of choice for varicella pneumonia during pregnancy

Answer 63

IV acyclovir

Question 64

hep c and cholestasis of pregnancy relationship

Answer 64

over 20x more likely to have ICP

Question 65

What is the CORRECT way to document the perinatal death rate?

Answer 65

live births and stillbirths/1000

Question 66

ITP and steroid admin- when do you notice a difference and when is peak effect?

Answer 66

should notice change w/in 4-14 days, peak is 2-3 wks

Question 67

most predictive of neonatal opioid CNS depression

Answer 67

relative infant dose in mg/kg

Question 68

complete vs partial mole histology, p57 stain?

Answer 68

``` complete = diffuse villous edema, negative p57 partial = focal/variable villous edema, pos p57 ```

Question 69

Diagnosis of post molar gestational trophoblastic neoplasia is made by either:

Answer 69

a) hCG plateau (four values within +/- 10%) over 4 weeks or | b) hCG rise of 10% across 3 values over two weeks

Question 70

Classic urethral diverticulum triad

Answer 70

1. postvoid dribbling 2. dysuria 3. dyspareunia

Question 71

how long after contraction of HIV does it take for a positive test? how often should you retest after assault?

Answer 71

it takes 3-4 wks before a pt will test positive. you should retest at 6 wks, 3 mo, and 6 mo.

Question 72

sequence of the layers of the bladder from inner to outer?

Answer 72

transitional epithelium, lamina propia, submucosa, detrusor, adventitia

Question 73

at what advanced maternal age is there an increased rate of stillbirth @ 39 wks?

Answer 73

40 y

Question 74

how long postpartum does it take for the uterus to completely involute

Answer 74

4 wks

Question 75

indications for cerclage

Answer 75

History 1 or more 2nd trimester losses due to painless cervical dilation AND absence of abruption OR prior 2nd trimester cerclage due to painless cervical dilation Exam Finding of dilated cervix in the 2nd trimester Ultrasound Current singleton pregnancy with a short cervical length (less than 25 mm) before 24 weeks of gestation in addition to a prior spontaneous preterm birth at less than 34 weeks of gestation

Question 76

of women who are seropositive for HSV, what percentage are aware of their positivity?

Answer 76

15%

Question 77

what is the most common cause of fistula dz in USA? what is the best dx study for identify urogenital fistula?

Answer 77

hysterectomy = most common cause (about 10% are d/t obstetric causes in US). best test is cystouretheroscopy

Question 78

how does preeclampsia predispose pts to PPH?

Answer 78

exacerbates atony and coagulation, pts have RR of >3 for PPH

Question 79

The borders of the femoral triangle consist of which anatomical structures?

Answer 79

sartorius, adductor longus, inguinal ligament

Question 80

vesicovaginal space borders

Answer 80

anterior vagina, posterior bladder, vesicouterine ligaments

Question 81

pararectal space borders

Answer 81

base of cardinal ligament, ureter, internal iliac a

Question 82

paravesical space borders

Answer 82

obturator internus, internal iliac a, arcus tendineus

Question 83

retropubic space borders

Answer 83

transversalis fascia, urethra, pubic symphisis

Question 84

what percentage of moms experience postpartum blues?

Answer 84

40-80%

Question 85

IUFD fetal workup

Answer 85

fetal autopsy, fetal cytogenetics, placenta pathology

Question 86

lynch syndrome colonoscopy initiation and frequency

Answer 86

q1-2 years starting @ age 20-25 or 2-5 yr before youngest relative dx

Question 87

u/s frequency after parvo exposure

Answer 87

q 1-2 wks for 8-12 wks after exposure

Question 88

when do you vaccinate for shingles in immunocompetent pts?

Answer 88

age 50. two doses, give 2nd dose 2-6 mo after first

Question 89

isoretinoin birth defects

Answer 89

Defects as a result of isotretinoin use include external ear malformations, cleft palate, micrognathia, conotruncal heart defects, ventricular septal defects, aortic-arch malformations, and certain brain malformations.

Question 90

first degree relatives and NTD risk

Answer 90

``` Family History of NTD Risk of Fetal NTD 1 parent only with NTD 4.5% 1 parent with NTD 1 sibling with NTD 12% 2 parents with NTD No affected siblings 30% 2 parents with NTD 1 affected sibling 33% ```

Question 91

pelvis shapes are their associated arrest d/o

Answer 91

gynecoid- normal, most favorable anthropod- triangle shaped, least favorable android- oval shaped, OP arrest platypelloid- least common, transverse arrest

Question 92

what are the daily recommended iodine intake values for nonpregnant, pregnant, and breastfeeding women?

Answer 92

150, 220, 290 respectively

Question 93

What is the carrier frequency of factor V Leiden in White pts?

Answer 93

5%

Question 94

what is the difference between surrogate and proxy consent?

Answer 94

``` surrogate= non-legal decision maker in emergency proxy= pre-arranged individual for decision making ```

Question 95

what are the approximate changes of a preterm birth and PPROM for CKC, respectively? What about of PTD/ PPROM in the normal population?

Answer 95

10, 15% | 12%, 3%

Question 96

what is the most dangerous fetal arrythmia? why?

Answer 96

atrial flutter. high rates of hydrops. even if no hyrdops most will have arrhythmia later in life.

Question 97

most conclusive dx and best tx

Answer 97

venogram, selevtive venous embolism

Question 98

within what time window should HIV PEP be started?

Answer 98

72 hrs