Untitled Flashcards
(638 cards)
1
Q
Associated finding in Meckel-Gruber Syndrome
A
Multicystic Dysplastic Kidneys
2
Q
*Rx for fetal thyrotoxicosis + fetal heart failure at 28 wks GA; mom s/p thyroid ablation
A
PTU
3
Q
*BMZ decreases the following:
A
Movements/Variability
4
Q
*Most likely to be abnormal with fetal acidemia
A
Decreased fetal tone
5
Q
*Treacher-Collins associated with impairment of:
A
Mandible
6
Q
Immunoglobin associated with mucosal defense in breast milk
A
IgA
7
Q
*Petechiae +hepatosplenomegaly at birth
A
CMV
8
Q
*Which is least likely with Listeria?
- PTL
-Chorio
- Hydrops
A
Hydrops
9
Q
*Which is most associated with aneuploidy in isolation?
- Cleft lip
- Gastroschisis
- EIF
- Hydronephrosis
- Ventriculomegaly
A
Ventriculomegaly
10
Q
*Which is most associated with aneuploidy?
- EIF
- Short humerus
- Echogenic bowel
- Pyelectasis
A
Echogenic bowel
11
Q
*Which is most likely neonatal complication of PKU?
- Mental retardation
- Cardiac
- Microcephaly
A
Mental retardation
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
13
Q
Most commonly associated with SS-A and SS-B antibodies?
- Sjogrens
- Scleroderma
A
Sjogrens
14
Q
Most likely to improve during pregnancy?
- RA
- Lupus
A
RA
15
Q
*Most evidence for association with FGR?
- Atenolol
- HCTZ
A
Atenolol
16
Q
*Worse prognosis for neonatal CMV?
- Microcephaly
- Cerebral calcifications
- Positive PCR after amnio
A
Microcephaly
17
Q
*Least likely with hyperparathyroidism?
- Pancreatitis
- HTN
- Kidney stones
- Cranial calcifications
- Neonatal hypocalcemia
A
Cranial calcifications
18
Q
*What causes insulin resistance at 4-8AM?
-Cortisol
- GH
- PRL
- Progesterone
- Androstenedione
A
Cortisol
19
Q
*Which crossed placenta most readily?
- T3
- T4
- TSH
- TRH
A
TRH
20
Q
Most likely cause of hypoxia post CS in obese class II patient?
- Apnea
- PE
- Pulm edema
A
Apnea
21
Q
*Most common risk with AZT?
- Marrow suppression
- Rash
- Myositis
A
Marrow suppression (if HA/n/v was an option, choose that)
22
Q
*HIV patient with some sort of liver dz, which med to avoid?
- Nevirapine
- Zidovudine
- AZT
A
Nevirapine
23
Q
*HIV patient not on meds, presents in labor, best single agent?
A
AZT if it’s an option, or Nevirapine
24
Q
*Most likley cause of pain from a “wet tap”?
A
Traction on nerves
25
*High spinal involving cervical roots results in..?
Dyspnea
26
*Which is not associated with advanced paternal age?
- Marfan's
- Neurofibromatosis
- Achondroplasia
- Klinefelters
Klinefelters
27
*Initial symptoms with intravascular lidocaine injection?
Tinnitus
28
Which anesthetic has greatest cardiac risk?
- Bupivicaine
- Lidocaine
- 2-Chloroprocaine
Bupivicaine
29
Which screening not recommended for Jewish population?
- CF
- Tay Sachs
- Familial Dysautonomia
- Gaucher
Gaucher
30
Which most likely to recur in a subsequent pregnancy?
- Hemophilia
- NAIT
NAIT
31
Mechanism of action of LMWH
Xa inhibitor
32
*Which would decrease drug transport across placenta?
- Increased lipid solubility
- Increased protein binding
- Decreased ionization
- Placental degradation
Increased protein binding
33
*Most compounds cross placenta by what mechanism?
Simple diffusion
34
*What is the PO2 of the umbilical artery?
- 20
- 50
- 80
20
35
*Which has the lowest PO2?
- Umbilical artery
- Umbilical vein
Artery
36
Minimal PO2 to maintain maternal O2 sat >90%
60
37
*Which is least predictive of cerebral palsy?
- Neonatal seizures
- Low pH/high base excess
- Multi-organ dysfunction
- 10 min APGAR = 3
- Early onset encephalopathy
- Low pH/high base excess
38
*Which is helpful for tx of HIE?
Cooling/"hypothermia"
39
*Most LIKELY to be helpful for tx of mitral stenosis intrapartum?
- Lasix
- Propanolol
Lasix
40
*Best rx for mom with dyspnea, cyanosis, large VSD and R to L shunt at 28 wks?
- Viagra
- Lasix
Viagra
41
*Best tx for pheochromocytoma
- Alpha blocker
- Clonidine
- Fluids
- Beta blocker
Alpha blocker
42
*Which inheritance pattern associated with variable penetrance?
- AD
- X-linked
AD
43
*Least likey in family hx of affected by Fragile X?
- POF
- Ataxis
- Fam hx of MR
- Gonadal cancer
Gonadal cancer
44
*Most likely outcome with Fragile X
Mental retardation
45
*Which SSRI most associated with increased fetal cardiac risk?
Paxil
46
*Least likely symptom with H1N1
- Fever
- Cough
- Sore throat
- N/V
N/V
47
*Most likely dx with unilateral pleural effusion?
- Hydrothorax
- CDH
- CCAM
- BPS
Hydrothorax
48
Most common OB fistula in US?
- Rectovaginal
- Vesicovaginal
Recto-vaginal
49
Source of metabolic fuel for fetal myocardium?
- Glucose
- Lactate
Lactate
50
Most direct cause of myometrial contractions?
- Myosin light chain kinase
- Tyromyosin
- Calponin
Myosin light chain kinase
51
Which contributes most to maternal weight gain in pregnancy?
- Blood
- Uterus
- Adipose
Split between adipose and uterus
52
*Which steroid influences sodium reabsorption
Fludrocortisone
53
Levels of which of the following are LEAST affected by liver cirrhosis?
- Lovenox
- Warfarin
- Dilantin
Lovenox
54
Which is least associated with low PAPP-A?
- Pre-e
- FGR
- Abruption
- 3rd trimester demise
3rd trimester demise
55
*Most associated with placental insufficiency
- Low PAPP-A
- High PAPP-A
- Low hcg
Low PAPP-A
56
Findings most likely due to PKU?
- Nail hypoplasia
- Cardiac
- Stippling
Cardiac
57
*Neonate with limb and muscle hypoplasia, derm and eye findings
Varicella
58
Greatest contraindication to PP combined OCPs?
- Hemorrhagic stroke w/ eclampsia
- Sagittal vein thrombosis
- Ovarian vein thrombosis
Sagittal vein thrombosis
59
Injury with brachial plexus injury resulting in Erb's palsy
C5-C6
60
*Which most requires "an additional 1mg" of folic acid?
- Sickle cell
- Twins
- Short interpregnancy interval
Torn b/w A &B
61
*Discrepancy in which is best for TTTS dx?
- Oli/poly
- Fetal weight
Oli/poly
62
*What defines stage III TTTS?
- ADEF in donor twin
- Absent bladder
- Demise
- Hydrops
- Discordant growth
AEDF in donor twin
63
*Most likely cause of polyhydramnios
- Idiopathic
- DM
- TEF
Idiopathic
64
*Why does T4 demand increase in pregnancy
- Increased basal metabolic rate
- Plasma expansion
- Increased TBG
Increased TBG
65
*Worst cardiac lesion in pregnancy
- VSD with R to L shunt
- Aortic stenosis, severe
- Mitral stenosis, Class III NYHA
VSD with R to L shunt
66
*Low MCV and Hgb A2 2.5 (nl iron studies - some exams specified normal iron and some didn't)
- Alpha thal
- Iron Deficiency anemia
Depends on iron studies! Tricky!
67
*Low MCV and increased Hgb A2 (>4%)
Beta-thalassemia
68
*Best way to differentiate lupus flare from pre-e
Increased DS DNA
69
*least likely with fetal alcohol syndrome
- MR
- Facial abnormalities
- Microcephaly
- Kidney abnormalities
- NTD
NTD
70
*Risk of peripartum transmission for recurrent HSV
- 1%
- 10%
- 15%
1%
71
Most likely to cause bleeding
Factor V deficiency
72
*How does iodide rx work?
- Suppresses thyroxine production
- Inhibits release of thyroid hormone
- Blocks conversion T4 to T3
Inhibits release of thyroid hormone
73
Most likely to cause cushinoid syndrome in pregnancy
Steroids
74
Most common ovarian cancer in pregnancy
Dysgerminoma
75
*Pre-e associated with which of the following
- Decreased urinary Ca
- Decreased thrombooxane
- Decreased sensitivity to angiotensin
Decreased urinary Ca
76
Which most explains decreased 2nd trimester BP
- Increased CO
- Increased renal blood flow
- Decreased angiotensin sensitivity
Decreased angiotensin sensitivity
77
*Which rate of dopamine infusion improves renal blood flow
- 4ug/min
- 8
- 12
-16
- 20
4ug/min
78
Most important for PGE2 production
- Arachidonic acid
- Prostacylcin
Arachidonic acid
79
*Most likely dx with CDH, FGR VSD
- T13
- T18
- T21
- Di George's
T18
80
*Most likely dx with cystic hygroma
- T13
- T18
- T21
T21 (Turners was not an option)
81
*Aspartoacylase deficiency associated with which dz?
- Canavans
- Tay Sachs
- Gauchers
Canavans
82
Expansion of vulvar hematoma limited by which of the following?
Colles fascia
83
*Large CS incision injures iliohypogastric nerve, what is the most likely results?
- Decreased labial sensation
- Decreased sensation at mons
- Rectus necrosis
Decreased sensation at mons (question worded opposite in 2014; gave mons, asked nerve)
84
Which is associated with exposure to folic acid antagonists
Caudal regression syndrome
85
Which nerve fibers contribute to pain in 2nd stage of labor?
S2-4
86
Most likely outcome for baby if mom had childhood radiation exposure
- Single gene mutations
- Childhood cancer
Single gene mutations
87
*Both parents have normal stature, but both kids have achondroplasia, most likely reason
- Gonadal mosaicism
- De novo mutation
Gonadal mosaicism
88
*Necessary for production of all fetal steroids
- LDL cholesterol
- Free cholesterol
- Acetate
LDL cholesterol
89
*What is pulmonary capillary wedge pressure (PCWP)
LV pre-load
90
Stillbirth in setting of cholestasis, most likely finding
Meconium stained fetus/placenta
91
Most common mode of transmission for Hep B worldwide
- Mom-baby
- IVDA
- Transfusion
Mom-baby
92
What will progesterone do in breastfeeding women
- Increased triglycerides
- Decrease depression
??Increased triglycerides (couldn't find source anywhere)
93
*Which is most likely to potentiate neuromuscular blockade?
Gentamycin
94
Why are basic drugs like demerol concentrated in an acidemic fetus?
Decreased isoelectric point/ion trapping
95
*What hormone does the placenta lack/is "inactive" that the fetus has/is "active?
- 17 alpha hydroxylase
- 21 hydroxylase
- 3 beta dehydroxylase
17 alpha hydroxylase
96
Rate of vertical transmission with primary CMV
1T = 30-40%
3T = 40-70%
97
*Pattern consistent with recurrent CMV
- (+) IgM/IgG, high IgG avidity
- Low IgG avidity
(+) 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?
98
*Which is anti-inflammatory?
- IL-10
- IL-6
- IL-11
IL-10 (the others are PRO-inflammatory)
TGF-beta is also anti-inflammatory
99
Which are not involved in basic immune response in pregnancy?
- T-lymphocytes
- NK cells
- Monocytes
T-lymphocytes
100
*Preload and afterload optimized, which med can improve cardiac contractility?
Hydralazine
101
*Worst prognosis for pt with CF
- R-sided heart failure
- Lung infections
R-sided heart failure
102
*Which is not helpful for identifying lupus anticoagulant?
- ANA
- DRVVT
- Kaolin clot test
- Prolonged PT
ANA
103
*Microtia is associated with which of the following?
Accutane
104
*The best test to compare the mean in 3 groups
ANOVA
105
*Which is associated with inappropriate failure to reject the null hypothesis?
Type II error
106
*Which is best study design for a rare outcome?
Case-control
107
*Which is the usual cause of hemodynamic decompensation with mitral stenosis peripartum
Increased pre-load
108
Which is least important for power analysis?
- Desired chi-square result
- Sample size
- STD deviation
- Analysis of covariance
2 similar Qs - 1x was for nominal variable (answer A), 2nd time for continuous variable (Answer D)
109
*Formula for odd ratio is:
AD/BC but in actual words
Ratio of exposed vs unexposed cases divided by exposed vs unexposed controls
110
*Swan values in 3T pregnancy (vs pre-pregnancy)
Decreased SVR/PAP, no change PCWP
111
*Which changes least in pregnancy?
- CVP
- CO
- SVR
- PVP
CVP
112
Decreased SVR least likely to be harmful for which of the following?
- Aortic stenosis
- Mitral stenosis
- IHSS (idiopathic hypertrophic subaortic stenosis)
- PHTN
Mitral Stenosis
113
*Which is least likely to need bacterial endocarditis ppx?
- MVP with regurg
- Mechanical valve
- Hx of endocarditis
MVP with regurg
114
*Umbilical artery
- Decreased O2 vs uterine vein
- Decreased Hgb vs uterine vein
- Lower pH than umbilical vein
Decreased O2 vs uterine vein
115
*which has the lowest O2 content?
- Umbilical artery
- Umbilical vein
- Uterine artery
- Uterine vein
Umbilical artery
116
*What is the most important factor in development of fetal hydantoin syndrome?
- Genetic polymorphisms
- Other medications
Genetic polymorphisms (epoxide hydrolase)
117
*What is the best way to monitor improvement in metabolic acidosis in DKA?
Anion gap
118
Which has clinically significant levels of Factor X?
- FFP
- Cryo
FFP
119
Mom has sickle cell (hgb SS), dad unknown but carrier rate is 1/12, what is the chance fetus will have hgb SS
1/24
120
*Least associated with embryopathy
- Azathioprine
- Warfarin
- Hydantoin
Azathioprine
121
*Which is most associated with fetal risk?
- Thyroid stimulating antibodies
- TSH
Thyroid stimulating antibodies
122
*Randomization is best for which of the following reasons
Decreased confounding
123
*Best way to perform randomization
- Random number block permutation
- Basket of cards
Random number block permutation
124
*When to use a one-tailed t-test
Results can only go in one direction
125
*Which is LEAST important in adaptive immunity ?
- Monocytes
- Trophoblast
- T
- B
Monocytes (this is innate immunity)
126
*Which is most common with malarial infection?
Anemia
127
*What is the most likely outcome with amnio 45, XX der (13,21)
- Normal
- Down syndrome
- Was inherited from dad
Normal
128
*Which CVS results most associated with uniparental disomy
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.
129
*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%
Inadequate power
130
*Carrier frequency of AR disease is prevalence is 1/6400
1/40
131
*Precursor to estriol
DHEAS? Androstenedione?
DHEAS-16 from fetal liver --> androstenedione --> estriol
132
*What affects PPV the MOST?
- Prevalence of disease
- ROC curve
- # of people sampled
Prevalence of disease
133
*Which maternal cardiac lesion most likely transmitted to fetus?
IHSS
134
*HLA is not expressed on which of the following?
- Syncitiotrophoblast
- Cytotrophoblast
Syncitiotrophoblast
135
*PPx for mycobacterium avium with CD4 count 45
- Azithromycin
- Ethambutol
Azithromycin
136
Which enzyme deficiency is a concern with chloroprocaine?
- Epoxide hydrolase
- Pseudocholinesterase
Pseudocholinesterase
137
*Pattern of glucose in pregnancy
Decreased fasting glucose/increased postprandial glucose
138
*Pt can't dorsiflex after forceps delivery which nerve injured?
- Femoral
- Peroneal
- Sciatic
Peroneal
139
*Which sticks around in the body for 2 years
Etretinate (used for psoriasis)
140
*Which is not associated with hydrops?
- Listeria
- Syphillis
- Parvo
Listeria
141
*Neonatal lupus most likely to present with which of the following?
- Transient thrombocytopenia
- Complete heart block
-1st or 2nd degree heart block
Split b/w A and C; rash was NOT an option. I think it's A (look in Creasy)
142
*Triple screen with normal HCG, AFP but very low estriol
X-linked iccthyosis
143
*Which is the stats term used for inter-observer agreement
Kappa
144
*Best test to compare continuous variable in pts before and after tx with experimental med
Paired t-test
145
*Which would make it necessary to increase sample size
A. Non-parametric testing
B. Looking at 3 outcomes instead of 1
A. Non-parametric testing
146
Which is best test if using multiple variables to assess survival?
Cox-regression
147
*What is the best test to compare nominal outcomes
Chi-square
148
MCA is not helpful for which of the following
- Sickle Cell
- Kell
- Anti-D
Sickle cell
149
Which is most likely to result in a fetus with T21?
Translocation (21q, 21q)
150
Mechanism of anemia in parvovirus?
- Hemolytic effect
- Viral effect on erythroid precursors
Viral effect on erythroid precursors
151
Most likely to decrease breast milk flow
- OCPs
- IUD
- Depo-provera
OCPs
152
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
7-8 weeks
153
Which is not associated with autonomic hyperreflexia?
- Hypotension
- Bradycardia
- Piloerection
Hypotension
NOTE: get a reflex bradycardia
154
What is the reason for maternal hypoxia at time of induction of general anesthesia
Decreased residual volume
155
*Which is NOT true with pre-e at the induction of anesthesia?
- Decreased vasoresponsiveness to pressors
- Decreased plasma volume
- Increased coagulopathy
Decreased vasoresponsiveness to pressors
156
Risk of NTD with valproic acid
1-2%
157
Which causes a rash and complement deposits in basement membrane?
- Herpes gestationalis
- PUPPS
Herpes gestationalis
158
*What is the mechanism of action of beta mimetics
- Enhance phosphodiesterase
- Enhance adenylate cylcase
- Increase cAMP
Increase cAMP
159
*What can be directly measured by PA catheter?
• Directly: HR, CVP, PAS, PAD, PCWP, CO, BP
• Indirectly (calculated): SV, SVR, PVR, LVSW, MAP, CI, stroke index, SVRI, PVRI, LVSWI, RVSWI, RVSW
160
*Which is associated with non-cardiogenic pulmonary edema?
Normal PCWP
161
*Which is associated with pre-renal oliguria
- Urine osm 550
- Urine Na <20
- Serum BUN: Cr 1:1
Urine Osm 550
162
Which blood product has the highest risk for hepatitis?
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%
163
*PA catheter readings: high PA and RA pressure, normal/low CO, normal PCWP
Pulmonary embolus
164
*How do you dx Von Willebrand's Disease
Ristocetin cofactor activity
165
*Best rx for type 1 Von Willebrand's
- Desmopressin
- Cryo
- FFP
Desmopressin
166
Which decrease with pregnancy?
- Protein S
- Factor V
- Factor VII
Protein S
167
*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
1/150
168
*What is the term when it matters from which parent an allele was inherited?
Imprinting
169
Which situation allows you to override patient confidentiality?
Someone in serious danger
170
*Which initiates preterm labor?
- Prostagladin dehydrogenase (PGDH)
- Phospholipase A2
- Metalloproteinase S
- Prostaglandin synthase
Phospholipase A2
171
Most common cause of mortality with anesthesia
Failed intubation
172
*How is calcium transported across placenta
Active transport
173
Which maternal cardiac lesion most associated with fetal hypoxia
Pulmonary HTN
174
Which is most associated with enlarged pale, placenta, hydrops
Syphilis
175
The main factor that influences fetal growth
Insulin
176
*OCPs have the least beneficial effect in preventing:
- Breast cancer
- Ovarian cancer
- Uterine cancer
Breast cancer
177
*FGR is most associated with what later in life?
Metabolic syndrome
178
*Greatest risk with lupus nephritis
Pre-eclampsia
179
*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
Epidural anesthesia
180
*For which of the following is plasmapharesis 1st line tx
TTP
181
Which is not associated with FGR?
- Hyperthyroidism
- Sickle cell
- Parvo
Parvo
182
Which is least associated with pregnancy loss after amnio?
- Tenting
- Multiple attempts
- Needle gauge
- Transplacental stick
Transplacental stick
183
*Why is ROC a good test
Balances sensitivity and specificity
184
*Which is true regarding oxygen dissociation curve?
Fetus has higher O2 sat at any PO2 than mom
185
PKU disease freq is 1/10,000, what is carrier freq?
- 1/100
- 1/50
- 1/400
1/50
186
Freq of an autorecessive disease is 1/6400, what is the carrier frequency?
- 1/80
- 1/40
- 1/20
1/40
187
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%
Split between 10% and 50%
188
fetal anomaly in obese patients?
- Gastroschisis
- NTD
- Cleft
NTD
189
Echogenic bowel seen at 20 weeks, what is most likely dx?
- CF
- FGR
- T21
- Normal
Normal
190
Worst neonatal prognosis in CMV
- Microcephaly
- Calcifications
Microcephaly
191
What placental product is least likely to change throughout pregnancy?
- Estrogen
- Progesterone
- Cortisol
- Somatostatin
Somatostatin
192
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
Remove IUD
193
What is most likely complication in pregnancy conceived with IUD in place?
- Chorio
- PTB
- SAB
- Fetal malformation
PTB
194
HIV med to avoid in 1st trimester
Efavirenze (also Delavirdine) both for NNRTI
195
Which "Ashkenazi disease" is treatable with enzyme replacement?
- Gaucher
- Tay Sachs
Gaucher
196
Which fetal cardiac lesion is LEAST likely to result in a critically ill newborn?
- TGA
- HLHS
- AVCD
- ToF w/ Pulm Atresia
AVCD
197
TTTS is best diagnosed with discrepancy in
- Fetal EFW
- Amniotic fluid
- Dopplers
- Chromosomes
Amniotic fluid
198
Which is associated with highest risk of malignancy?
- CDH
- BPS
- CCAM
CCAM
199
Sacrococcygeal teratoma is LEAST likely associated with
- Hydronephrosis
- Mirror syndrome
- Hydrops
- Polyhydramnios
- Placentomegaly
Hydronephrosis
200
Smoking is LEAST likely associated with an increase in:
- Perinatal mortality
- PTB
- FGR
- Pre-e
Pre-e
201
NOT associated with SSRI in pregnancy
- Persistent fetal circulation
- Cardiac defects
- Neonatal withdrawal
- Gastroschisis
Gastroschisis
202
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
Bowel dilation
203
What's most important in O2 delivery?
- CO + acid base balance
- CO + PaO2
- CO + Hgb
- CO + O2 saturation
Torn between A & B
204
Class I MHC get attacked by
- NK
- Cytotoxic T cells
- T helper cells
- Macrophages
Cytotoxic T cells
205
Who doesn't have HLA on them?
Syncitiotrophoblast
206
What is the PRIMARY fetal immune response?
- IgM
- IgG
- Increase in dendritic cells
IgM
207
What is MOST involved in innate immunity?
- B cells
- T cells
- Monocytes
- Trophoblasts
Monocytes
208
Low estriol is most commonly associated with:
- T21
- Placental sulfatase deficiency
- SAB
Placental sulfatase deficiency
209
Therapy for suspected NAIT
- Delayed until after confirmatory amnio results
- Includes IVIG
- Includes oral steroids
Includes IVIG
210
Mode of inheritance for IHSS?
- Autosomal dominant
- Multifactorial
Autosomal dominant
211
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
Thonatophoric dysplasia?
212
What changes with dialysis in pregnancy?
- Longer dialysis sessions
- More frequent sessions
- Add less Ca to diasylate
- Add more bicarb to diasylate
Longer dialysis sessions
213
What enables increased fetal Ca?
- Increased absorption of Ca
- Increased absorption of Vit D
- Increased total Ca
???increased absorption of ca and vit d
214
Why does creatinine decrease in pregnancy?
- Increased dilation of renal vessels
- Increased plasma volume
- Increased permeability of tubules
Increased dilation of renal vessels?
215
What is thyroid profile seen in 1T?
- low TSH; normal T4
- low TSH; high T4
Low TSH; normal T4
216
What is least commonly seen in fetal alcohol syndrome?
- SUA
- FGR
- Midface hypoplasia
- Renal dysplasia
- MR
SUA
217
Most associated with placental insufficiency?
- Low hcg
- Low PAPP-A
Low PAPP-A
218
FGR at 20 wks is most associated with:
- T13
- T21
- DiGeorge
- Fragile X
- BWS
T13?
219
#1 aneuploidy found in 1T abortuses
T16
220
GA at which fetal alveolarization occurs?
- 22
- 26
- 30
- 36
30? real answer 32-36 wks
221
Major component of surfactant
- Saturated phosphatidylcholine
- Phophatidylglycerol
- Cholesterol
- Palmitic acid
- Neutral lipis
Saturated phosphatidylcholine
222
What stage of lung development is surfactant produced?
- Embryonic
- Pseudoglandular
- Cannicular
- Saccular
- Alveolarization
Alveolar
Remember: "Every Pulmonologist Can See Alveoli"
223
Most transmitted during breastfeeding
- CMV
- Hep B
- HSV
CMV
224
DS most likley in setting of
- Brachycephaly
- Hypertrophic mid-phlangeal joint of 5th digit
- normal humerus
B?? is that clinodactyly?
225
Someone with APLS, where is their most likely venous clot
- Portal
- Splenic
- mesenteric
- Cerebral
- Subclavian
Cerebral
226
What is due to pituitary deficiency
- Acromegaly
- Diabetes insipidus
- Addisons
- Cushings
Diabetes insipidus
227
According to Barker hypothesis, which is most likely in FGR fetuses later in life?
- T2DM
- CAD
- HTN
- Obesity
Metabolic disorder was not a choice
All of these except obesity were in Creasy
228
Most important thing in PPV
- Prevalence of disease
- # of subjects
- ROC curve
Prevalence of disease
229
LEAST common in myxedema
- Hypothermia
- Hypoglycemia
- Bradycardia
- Hypocapnea
Hypocapnea
230
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
Direct gene analysis
231
Which PG does not cause labor
- PGE1
- PGE2
- PGE3
- Prostacyclin
- Thromboxane
Prostacyclin
232
Pt tests IgM+ for parvo at 20 weeks. How long should the fetus be monitored?
- 1 week
- 4 weeks
- 10 weeks
- 20 weeks
10
233
What is the # cause of low maternal estriol (they did no specify isolated)
- Placental sulfatase deficiency
- T21
- SAB
Placental sulfatase deficiency
234
#1 source of estradiol production by the placenta?
- Cholesterol
- C19 adrenal steroids
C19 adrenal steroids
235
#1 cause of vulvar hematoma
- Mid rectal artery
- Superior gluteal artery
- Internal pudendal artery
Internal pudendal artery
236
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
Over the common iliac artery
237
#1 dx with an increased NT (they gave a value 4mm?)
- T21
- T13
- 45X
45X
238
When opening the rectus muscles in a pfannensteil incision, which vessel is most likely injured?
- Deep circumflex
- Inferior epigastric artery
Inferior epigastric
239
Which medication increases contractility?
- Beta adrenergic
- Hydralazine
(Dig was not an option)
Torn between A &B
240
Which medication increases CO when preload and afterload have been optimized?
- Hydralazine
- Beta adrenergic
- Alpha adrenergic
Hydralazine
241
How to distinguish pre-e from lupus flaure
- Urine complement
- Urine sediment
- Thrombocytopenia
- BP
urine sediment
242
how to initially investigate whether there is an association between smoking and bladder cancer?
- Case- control
- Meta- analysis
- Retrospective analysis
- RCT
Case-control
243
Maternal blood is most directly in contact with
- Synctiotrophoblast
- Cytotrophoblast
- Maternal epithelium
- Fetal epithelium
Synctiotrophoblast
244
Which rash is associated with worse neonatal/fetal complications
- PUPPS
- Pruritis? gestationis or something
- Pemphigoid gestationalis
- Erythema nodosum
Pemphigoid gestationalis
245
The discussion about mode of delivery in the setting of a lethal fetal anomaly most directly involves
- Beneficence
- Non-maleficence
- Autonomy
Torn b/w B&C
246
When can you override refusal of tx?
- Harm to fetus
- maternal heath is in danger
- Religion
- Lack of capacity
Lack of capacity
247
In the setting of uterine inversion, what is the 1st line medication?
- Magnesium
- Terbutaline
- Nitric oxide
- General anesthesia
Terb
248
When CVS result is a mosaic, the most likely outcome is
- Confirmed/actual mosaic
- Maternal cell contamination
- Confined placental mosaicism
- Lab error
Confined placental mosaicism
249
Anesthetic with fastest onset of action
- Lidocaine
- 2-chloroprocaine
- Bupivicaine
Lidocaine
250
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
Pulsatile UA/ continuous UV flow
251
After fasting overnight, which is most likely to be decreased in the morning?
- Insulin
- Glucose
- Fatty acids
- Ketones
Glucose
252
What is #1 precipitating factor in DKA in T1DM?
- N/V of pregnancy
- Increased catecholamines
- Respiratory acidemia
Increased catecholamines? Infection is #1 per Creasy
253
What is NOT a feature of DKA
- pH <7.3
- Uosm of xxx (can't remember #)
- Bicarb >20
Bicarb >20
254
If O2 is decreased, blood flow to which fetal organ will decrease
- Brain
- Adrenals
- Myocardia
- Lungs
Lungs
255
What does NOT cause pulmonary HTN of the newborn
- Indomethacin
- Fluoxetine
- Paroxetine
- Keppra
Keppra
256
What contraception do you NOT give someone who has PP depression
Depo
257
What contraception do you NOT give someone with known insulin sensitivity?
Depo
258
What contraception do you NOT give a GDM because of increased risk of DM outside pregnancy in future?
Depo
259
What is the #1 enzyme deficiency in CAH?
- 11-hydroxylase
- 21- hydroxylase
- 18- hydroxylase
- 3- beta hydroxylase
21-hydroxylase
260
Mechanism of action for iodine in maternal thyroid function
- Block T4 --> T3
- Block TRH release
- Block release of thyroid hormone from the gland
Block release of thyroid hormone from the gland
261
What is absent corpus callosum most commonly associated with?
- Upward displacement of 3rd ventricle
- Absent CSP
- Big/little 3rd ventricle (can't remember which)
Absent CSP
262
#1 location of an arachnoid cyst
- Midline interhemispheric
- Posterior fossa
midline interhemispheric
263
Sensitivity of 4chamber heart view is WORST for
- Ebsteins anomaly
- HLHS
- TGA
- VSD
(coarct was not a choice)
VSD
264
What fish should be avoided in pregnancy
- Halibut
- King Mackerel
- Salmon
(Tuna and swordfish were not listed)
King Mackerel
NOTE: if tuna or swordfish are options, choose those
265
Which is NOT associated with relapsing/remitting fever
- Brucellosis
- Listeria
- Lyme
Lyme
266
Why is NPH around longer than aspart
- Decreased degradation
- Decreased renal clearance
- Decreased hepatic clearance
Decreased degradation
267
Wedge pressure represents
- LV preload
- RV preload
- LV wall tension
LV preload
268
Which coagulation factor is decreased in pregnancy?
XI
269
Which cytokine is ANTI-inflammatory?
IL-10
270
Treatment for what condition is plasmapheresis?
TTP
271
Foot drop postop - what nerve is most likely injured?
Peroneal
272
Decreased sensation at labia after section - what nerve?
Ilioinguinal
273
17P is best in which setting
A. Short cervix
B. PTL
C. H/o spontaneous PTB
D. Vaginal bleeding
C. H/o spontaneous PTB
274
Which medication is most associated with FGR?
A. Metoprolol
B. Atenolol
C. Propanolol
D. Labetolol
E. Nifedipine
B. Atenolol
275
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. BPP
276
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
Hysterectomy
277
The greatest percentage of fetal cardiac output is distributed to:
A. Placenta
B. Brain
C. Extremities
D. Adrenal glands
A. Placenta
Placenta 40%
Brain 13%
Lung 7%
Heart 3.5%
278
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
Anti-Kell
279
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
H/o HSC septum resection
280
Medroxyprogesterone acetate increases levels of what?
Triglycerides
281
OCPs have the LEAST beneficial effect in preventing:
A. Ovarian CA
B. Breast CA
C. Toxic Shock Syndrome
D. Uterine CA
Breast CA
282
FGR is most associated with what disease later in life:
A. SLE
B. HTN
B. HTN
283
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. PDA
Note: R arm higher than body. Ductus closes and there's not mixing. PPHN with duct shunting
284
Pts with MS are most likely to have which:
A. children at increased risk of developing MS
B. Flare during pregnancy
C. PTL
A. Children at increased risk of developing MS
285
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
C. Epidural
286
Rate of valproate causing NTD
1-5%
287
What is the substrate for oxidative metabolism of the placenta:
A. Ketone bodies
B. Lactate
C. Fatty acids
D. Glucose
Glucose
288
What is the most effective first line tx for TTP
A. Steroids
B. Plasmapharesis
B. Plasmapharesis
Note: Steroids would be for ITP
289
A pt with PPH and is HYPOtensive - which is LEAST appropriate:
A. PRBC
B. Crystalloid
C. FFP
D. Low Salt Albumin
FFP
290
US image with CPC - which aneuploidy is this associated with:
A. T21
B. T13
C. T18
C. T18
291
Multiple intraabdominal echogeneicities - LEAST associated with:
A. Cystic Fibrosis
B. Aneuploidy
C. Toxo
D. Parvo
E. Meconium peritonitis
C. Toxo
292
Which of the following syndromes is caused by uniparental disomy
Prader Willi and Angelmann's
PW - maternal uniparental
Angelmann- paternal uniparental
293
Which is the most predictive of fetal goiter in hyperthyroidism?
Titer of anti-thyroid stimulating abs (TSI)
294
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
E. Antithrombin III Deficiency
295
Antithrombin III deficiency is most associated with
VTE
296
What does the pulmonary artery catheter directly measure?
A. CI
B. Stroke Volume
C. LV Work index
D. Pulmonary Vascular Resistance
HR, CVP, PAP, PCWP
CO, O2 Sat
297
What are Swan readings associated with noncardiogenic pulmonary edema?
12 PCWP
298
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
C. Urine Osm = 550
299
Which is most predictive of development of CP?
A. Maternal Thrombophilia
B. Chorioamnionitis
C. Pre-e
B. Chorio
300
What is the reason for a low APGAR score in a non-hypoxic pretermer?
A. It's preterm
301
Picture of confidence intervals - which one is the lowest relative risk (ie. which one is lowest and doesn't cross 1 is the issue).
Read stats
302
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
C. PE
303
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
B. Corrected ToF
304
How do you treat refractory maternal SVT?
A. Digoxin
B. Procainimide
C. Adenosine
D. Lidocaine
C. Adenosine
Note: Vagal first
305
Why is it a bad plan to give Iodine-131 in pregnancy?
It ablates fetal thyroid
306
Which is most likely to cause fetal thyroid effects?
A. Graves Disease
B. Hashimotos Thyroiditis
A. Graves Disease
307
What is NOT associated with PP thyroiditis
Depression? But Creasy says it is directly associated
Note: PP thyroiditis 10%
Note: Anti-TPO associated with PP thyroiditis
308
How does IgG get across the placenta?
A. Pinocytosis
B. Simple diffusion
C. Active Transport
A. Pinocytosis
309
How do most maternal drugs get across the placenta?
Diffusion
310
As a class, what is the most common etiology for fetal malformations?
A. Genetic
B. Drugs
C. Environmental exposures
A. Genetic
Note: Drugs and environmental exposures make up 3%
Note: unknown 43%, multifactorial 23%, fam 15%?
311
Folate most helpful in what setting:
No answer. See if there is one involved in folate metabolism
312
A fetus had hydronephrosis, absent radii severe FGR - what is the syndrome?
VACTERL
313
What is associated with Meckel-Gruber Syndrome?
Polycystic Kidneys
Encephalocoel
Polydactyly
Pulm Hypoplasia --death
314
To compare means between 3 groups:
ANOVA
315
What type of variables do you need to test for to compare APGAR scores between 2 groups?
A. Ordinal
B. Continuous
C. Categorical
A. Ordinal
316
Whole mess of antibodies - which one does not cause hemolytic disease?
A. Anti-Jka
B. Anti-Fya
C. Anti-c
D. Anti-MNs
D. Anti-MNs
317
What is not reliable in Kell-sensitized pt?
A. Husband genotype
B. Delta OD 450
C. MCA dopplers
B. Delta OD 450
318
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
B. Amnio for fetal PCR
319
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. Mom is 45XXrob (14, 21)
Note: 15% mom, 2% dad if robertsonian translocation
320
What are consequences of uteroplacental insufficiency in neonate?
A. Hypocalcemia
B. Polycythemia
C. CP
D. All
D. All
321
Which of the following is NOT associated with AMA?
A. T21
B. T18
C. 45XO
D. T13
C. 45XO
322
Which genetic condition is associated with coarctation of the aorta?
45XO
323
Why is Mag Sulfate preferred to dilantin in pre-e?
A. Ease of use
B. Fewer side effects
C. Greater efficacy
C. Greater efficacy
324
Cordocentesis is best for which of the following clinical situations?
A. NIH
B. ITP
C. Neonatal Alloimmune Thrombocytopenia
C. NAIT
325
Which atypical ab not only causes hemolytic disease but also suppresses erythroporesis?
Kell
326
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
C. Virus interferes directly with erythropoesis
327
In which situation are OCPs contraindicated?
A. SC disease
B. Had a DVT in pregnancy
C. Seizure Disorder
B. Had a DVT in pregnancy
328
Depo provera is best for what siutation
A. Nursing moms
329
At what gestation should dexamethasone be given to mothers of potential CAH fetuses?
A. Preconception
B. 7-8 wks
C. 12-13 wks
B. 7-8 wks
330
What can be given to prevent virilization in a female fetus with CAH?
Cortisone acetate/dexamethasone
331
What is the most common cause of CAH?
A. 11 hydroxylase deficiency
B. 21 hyrdoxylase deficiency
B. 21 hydroxylase deficiency
332
Where can prostaglandin dehydrogenase be found?
A. Amnion
B. Chorion
C. Amniotic fluid
D. Myometrium
B. Chorion
333
Which is the GREATEST component of surfactant at term?
A. Phosphatidyl choline
B. Phosphatidylglycerol
C. Phosphatidylinositol
A. Phosphatidyl Choline (50%)
Note: Phosphatidylinositol down, PG goes up
334
Which drug may lessen effectiveness of OCPs
Rifampin
335
Which factor decreases in pregnancy?
A. VIII
B. IX
C. X
D. XI
D. XI
NOTE: 11 and 13 decrease during pregnancy
336
Which is associated with the highest incidence (not prevalence) of chronic active hepatitis and cirrhosis:
A. Hep A
B. Hep B
C. Hep C
C. Hep C
337
Most common cause of mortality in setting of epidural placed for CS:
A. Local toxicity
B. Hematoma
C. Anaphylaxis
A. Local toxicity
Note: Not high spinal choice
338
Most common cause of maternal mortality
A. Infection
B. Hemorrhage
C. Thromboembolism
D. HTN
C. Thromboembolism
339
Antihypertensives during pregnancy prevent or reduce:
A. Pre-e
B. FGR
C. PTD
D. Maternal CVA
D. Maternal CVA
340
Which enzyme does the fetus have that the placenta doesn't?
A. 17 hydroxylase
B. 3B-something
C. Sulfatase
A. 17 hydroxylase
Note: Placenta has 3B-something, sulfatase, and aromatase
341
Precursor for fetal steroid synthesis
LDL Cholesterol
342
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
C. LDH =900
Note: HELLP?
343
What distinguishes AFLP from HELLP
Glucose = 40
344
Management of pt with MI and 35 wks pregnant
A. Induce labor
B. Await spontaneous labor
C. CS
B. Await spontaneous labor
345
Which infection is a transplant pt MOST susceptible to compared with non-transplant pt?
A. E.coli
B. Chlamydia
C. CMV
C. CMV
346
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. Amnio for toxo PCR
347
What is the chorionicity/amnionicity if embryo divides between day 8 and 13?
A. Di/Di
B. Mono/Di
C. Mono/Mono
D. Conjoined
C. Mono/Mono
348
WHat disease is AD and associated with telangiectasia, ataxia, thrombocytopenia
A. Osler Weber Rendu
B. Ehlers Danlos
C. Wiskott Aldrich
A. Osler Weber Rendu (aka HHT)
Note: Wiskott Aldrich --> thrombocytopenia, eczema, malignancy, infection, X-linked
(WATER)
- Wiskott
- Aldrich
- Thrombocytopenia
- Eczema
- Recurrent infections
349
All injuries from vacuum except:
A. Brachial plexus injury
B. Sub-Galeal injury
C. Scalp Injury
A. Brachial Plexus Injury
350
Nerve injured during prolonged pushing with hyperflexed legs?
A. Obturator
B. Femoral
C. Pudendal
B. Femoral
351
Pt can't dorsiflex after forceps delivery. What is the nerve injury?
Common peroneal
Note: forceps injury - obturator
352
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
C. Cephalosporin (cefuroxinme)
Note: but if neuro, then ceftriaxone of PCN G
353
What drug potentiates neuromuscular blockade?
Gentamycin
354
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
B. Ca gluconate
355
How is prostaglandin F2 alpha different than E2
Bronchocontristriction
E1 = miso
E2 = dinoprostone
F2a = hemabate
356
Most common thrombophilia?
A. Antithrombin III def
B. Protein S def
C. Factor V Leiden
C. Factor V Leiden
357
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
D. Embolization
358
If you embolize the hypogastric artery, which vessel WON'T be involved
A. Superior gluteal
B. Obturator
C. Inferior vesicle
D. Inferior epigastric
D. Inferior epigastric
359
Which paramter is not useful in determine FGR vs incorrect dates?
A. AC
B. Foot length
C. BPD
D. Cerebellum
A. AC
360
Which organ gets the greatest proportion of fetal blood flow at term?
A. Brain
B. Adrenal
C. Lungs
D. Spleen
Greatest amount: brain, lungs
Greatest amount relative to wt of organ: adrenal
361
Which fetal vessel has the highest O2 saturation?
A. Femoral Vein
B. Umbilical artery
C. Pulmonary artery
D. R Carotid artery
D. R carotid artery
362
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 and B
Note: Shift to LEFT
increase pH
Decrease temp
Decrease DPG
Fetus
363
Microtia associated with what?
A. Alcohol
B. Warfarin
C. Some anti-sz med
D. Accutane
D. Accutane
364
Stick around in system for 2 yrs?
Etridonate
365
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
C. Varicella
366
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. Viral load
NOTE: increased VL is associated with increased vertical transmission as long as it is above 1000
367
What is the action of AZT
A. Anti-DNA
B. Reverse transcriptase inhibitor
C. Anti-RNA
D. Antibiotic
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
What is a complication of Combivir?
Anemia
Note:
AZT --> Anemia, HA, neutropenia, increased LFTs
Nevirapine --> RASH, even Stevens Johnson Syndrome
369
Which syndrome is associated with macrosomia?
A. Beckwith Weidemann
B. Meckel Gruber
C. Trisomy 21
D. Polyploidy
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
Heart defect with increased transmission to fetus
A. ASD
B. ToF
C. IHSS (Idiopathic Hypertrophic Subaortic Stenosis)
D. Coarctation of aorta
C. IHSS (Idiopathic Hypertrophic Subaortic Stenosis) -- it's AD
371
Maternal heart defect with LOWEST incidence of mortality
A. Corrected ToF
B. Artificial heart valve
C. Eisenmenger's Syndrome
A. Corrected ToF - mortality rates is similar to normal
372
Which B cell disease gets worse with pregnancy
A. Graves
B. Myastenia Gravis
C. SLE
D. HIV
SLE
373
Myastenia Gravis Notes
- 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
CPC associated with which chromosomal abnormality
A. T18
B. T13
C. T21
D. Pericentric inversions
A. T18
375
Which chromosomal abnormality is not increased in offspring of AMA females?
A. Downs
B. Turners
C. Kleinfelter
D. Edwards
B. Turners
Note: all the rest are age dependent non-disjunctional events
376
Risk disease is 1/6400, what is carrier rate?
A. 1/20
B. 1/40
C. 1/80
D. 1/100
B. 1/40
Note: p2 + 2pq +q2 = 1
Q = 1/40 or 1/20
377
GnRH is made in which tissue?
Decidiua (cytotrophoblast)
378
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. Paired T-Test
379
STATS Info
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
Insulin affects growth in all tissues except:
A. Brain
B. Liver
C. Fat
D. Muscle
A. Brain
Note: brain has no IGF receptors
381
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. 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
Notes on Parvo
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
What is the precursors of fetal adrenal steroids?
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
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
B. Decidualization
Note: all the rest are effects of estrogen
385
The rapid GBS test is not used because of:
A. Poor sensitivity
B. Low prevalence of GBS
C. Null hypothesis
A. Poor sensitivity
Note: GBS carrier prevalence (20%)
Routine screen PPV 79%, NPV 93%
PCR sensitivity 97%, specificity 100%, PPV 100%
386
Which malformation has the greastest risk of underlying aneuploidy?
A. CHD
B. Gastroschisis
C. Omphalocele
D. Clubbed foot
C. omphalocele (30%)
Cardiac is about 5-10%
387
Which best describes the physician-pt relationship
A. Autonomy
B. Fiduciary
C. Beneficence
D. Non-malfeasance
D. Non-malfeasance (do no harm)
Note: Beneficency = doing an action to benefitus, removes harm
388
Which drugs should NOT be used in pts with MG except for?
A. Curare
B. Magnesum
C. Gentamicin
D. Mestinon (pyridostigmine bromide)
D. Mestinon (pyridostigmine bromide)
Note: MPB is used for tx of MG (ACH inhibitor)
Curare is used for dx of MG
389
Meds you DON'T use in myasthenia gravis
- 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
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. 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
Which is associated with preterm birth?
A. Ureaplasma
B. BV
C. GBS
D. Chlamydia
B. BV
?GBS?
392
What drugs should be used for maternal V tach?
A. Lidocaine
B. Adenosine
C. Quinidine
D. Capsacin
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
What is NOT a sign of BV
A. pH <4.5
B. +Wiff test
C. Thin homogenous discharge
D. >20% clue cells
A. pH <4.5
394
GBS is most resistant to:
A. PCN
B. Clinda
C. Ery-C
D. TMX-sulfa
D. TMX-Sulfa
395
Which enzyme is theoretically deficient in fetuses who manifest birth defects from antiepileptic drugs?
Epoxide dehydrogenase or epoxide hydrolase
This alters folate metabolism
Epoxide hydrolase deficiency with phenytoin, carbamezepine, phenobarbital, possible fetal alcohol syndrome and valproic acid
396
What complication is associated with exteriorization of the uterus
A. Air embolism
B. Uterine atony
C. Patent foramen ovale
A. Air embolism
Note: other complications: N/V, hypotension, pain
397
What are the risks associated with 22 wks stillbirth, +aca and +LA
A. Thrombosis
B. B12 def
C. Hyperemesis
D. Berry aneurysm
A. thrombosis from APLS
398
Which vaccine is contraindicated in pregnancy
A. Varicella
B. Influenza
C. Rabies
D. Cholera
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
Notes about varicella
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
Which is associated with fetal abdominal calcifications?
A. EBV
B. CMV
C. Parvovirus
D. Turners
B CMV
Note: CMV causes hepatic calcifications, others include herpes, rubella, varicella, syphilis
401
Notes about CMV
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
Which syndrome is associated with fetal thrombocytopenia?
A. Absent radius
B. Gestational thrombocytopenia
C. Erythoblastosis fetalis
D. Bernard Soulier Syndrome
A. Absent Radius
TAR syndrome is AR
Also Fanconi Anemia --> absent radii, PANcytopenia
403
What is the precursor of DOC (deoxycorticosterone)?
Progesterone
404
What is the #1 cause of malformations?
A. Radiation
B. Infection
C. Genetics
D. Medication
C. Genetics
405
What is the tx of 21-OH deficiency in the female fetus?
A. Cortisone acetate
B. Diestryl acetate
C. Dexamethasone
D. Aldosterone
C. Dexamethasone
406
Tx of 21 Hydroxylase Deficiency
- 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
What causes virilization of a female fetus
A. Luteoma of pregnancy
B. Cystadenoma
C. Prolactinoma
D. OCPs
A. Luteoma
408
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. Uterine vein
Note: Umbilical vein has highest PO2 of fetal circulation
409
The insulin pump is associated with
A. Asymptomatic hypoglycemia
B. Poor compliance
C. Tachyphlaxis
A. Asymptomatic hypoglycemia
410
Which is elevated in fasting pregnant females?
A. Glucose
B. Cholesterol
C. Creatinine
D. Sodium
B. Cholesterol
411
In which disorder is IgG contraindicated?
A. Recurrent pregnancy loss
B. Myasthenia gravis
C. ITP
D. RA
A. Recurrent pregnancy loss
412
Risk of neonatal infection with SVD in a woman with a recurrent vulvar herpes lesion is:
A. 50%
B. 1%
C. 100%
D. 0%
B. 1%
Note: with primary outbreak, there is a 40-50% transmission
413
Gaucher's disease is a disorder:
A. Aspartoacylase
B. Hexoseaminidase A
C. Glucocerebrosidase
D. Glucosylceramine storage disease
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
Which abnormality is increased when CHD is diagnosed on an US?
A. Previa
B. Sickle Cell
C. T21
C. T21
415
What lab value is seen with pre-e?
- Decreased GFR
- Decreased urinary Na and increased plasma UA
- Decreased Ca excretion 2/2 increased tubular reabsorption
416
Which type of inheritance is associated with Leber's optic atrophy?
A. AR
B. AD
C. X-linked
D. Mitochondrial
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
Which disorder is associated with uniparental disomy?
A. Cri di chat
B. Williams
C. Preder Willi
D. Hydantoin
C. Preder Willi
Note: Preder Willi/Angelmans chrom 15
Beckwith Wediman Chrom 11
Deletions:
- Cri Di Chat --> del 5
- Williams --> del chrom 7q
418
Disease associated with DNA repeats except:
A. Fragile X
B. Huntington's
C. CF
D. Myotonic Dystrophy
C. CF
419
HIV is a:
A. DNA virus
B. Prion
C. RNA retrovirus
C. RNA retrovirus
420
An APGAR score of <3 at 20 wks gestation is associated with this risk of CP:
A. 5%
B. 100%
C. 50%
D. 15%
B. 100%
NOTE:
APGAR 0-3
5 min: 0.3-1%
10 min: 10%
15 min: 35%
20 min: 50%
421
NTDs are usually:
A. Due to single gene defects
B. Caused by teratogens
C. Multifactorial
D. Aneuploidy
C. Multifactorial
422
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%
B. 100%
G. 50%
423
The most important predisposing risk factor for macrosomia is:
A. Post dates
B. Previous macrosomia
C. Smoking
B. Previous macrosomia
424
The byproduct of CHO metabolism is
A. CO2
B. H2O
C. NH3
D. Lactic acid
A. CO2
Note:
O2 + C6H12O6 --> CO2 + H2o + energy (heat)
425
Pinocytosis
IgG
Fe
Folate
B12
426
Active Transport
Amino acids
Ca
Phosphate
Mag
Vit A
Vit K
427
Facilitated Diffusion
Fe
Vit C
Glucose
Lactic acid
428
Simple Diffusion
H2O
O2
CO2
Anesthetic gases
Electrolytes
Insulin
Steroid hormones
Fatty acids
Thyroid hormones
429
Which of the following will allow you to differentiate maternal blood from fetal blood?
430
What is the substrate for oxidative metabolism of the placenta?
- Ketone bodies
- Lactate
- Fatty aids
- Glucose
Glucose
431
Which is the most thrombogenic thrombophilia?
- Factor V Leiden
- Prothrombin Gene mutation
- Protein S Deficiency
- Protein C Deficiency
- AT III Deficiency
AT III Deficiency
432
AT III is most associated with
VTE
433
Where can prostaglandin dehydrogenase be found?
- Amnion
- Chorion
- Amniotic fluid
- Myometrium
Chorion
434
Factors that decrease during pregnancy
Protein S, Factor 11 and 13 (per a study guide)
435
436
Most common side effect of AZT and other NRTIs
Bone marrow suppression
437
Ppx for MAC and what CD4 count
Azithromycin 1200mg Qweek
CD4 count <75
438
Ppx for PCP in HIV
Bactrim DS QD
Also covers toxo
CD4 count <200
439
Ppx for cryptococcus in HIV
Diflucan 150mg QD
CD4 count <50
440
Local anesthetic half-lives
-Chloroprocaine
- Lidocaine
- Bupivicaine
- Mepivicaine
-Chloroprocaine 25 secs
- Lidocaine 2 hr
- Bupivicaine 2.5 hrs
- Mepivicaine 3 hrs
441
Side effects of halothane
Malignant hyperthermia**
Hypotension
Hepatotoxicity**
Cardiac dysrrhythmia
Excessive bleeding
Confusion
442
Homolog to HPL (aka hCS)
Human chorionic somatomammotropin (hCS), which was formerly referred to as human placental lactogen (hPL
Human pituitary growth hormone (87%)
Prolactin (67%)
443
MOA of glyburide
Increases insulin secretion by pancreatic beta cells
444
Risk factor for macrosomia in GDM
Postprandial glucose level
445
Risk factors for increased fetal fat mass in GDM
Fasting glucose level
446
Vacuum delivery complications
Caput succedaneum
Retinal hemorrhage (38%)
Cephalohematoma (11%)
Subgaleal hematoma (5%)
ICH (~0.1%)
447
Management of Lyme disease in pregnancy
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
Pt has hypotensive episode after Mg bolus for pre-e how do you treat?
Ca gluconate 1 amp
449
Infectious causes of non-immune hydrops
Toxo
CMV
Parvo
Syphilis
HSV
Rubella
450
Values of Na, Cl, osmolarity, beta2-microglobulin, Ca in fetus with renal failure
Na >100 mEq/L
CL >90
Osm >219
Beta 2-microglobulin >4 mg/L
Ca >8 mg/dl
451
Values of Na, Cl, osmolarity, beta2-microglobulin in normal fetal kidneys
Na <90 mEq/L
Cl <90
Osm <200
Beta2-microglobulin <6mg/L
Ca <8mg/dl
452
Normal fetal urine..hypotonic or isotonic?
Hypotonic
453
Neonatal lupus associated with what symptoms and antibodies?
Anti-SSA/SSB abs
15-20% have NLE
Primarily presents with dermatologic symptoms
Thrombocytopenia and other hematologic abnormalities are rare
454
Neonatal lupus and CHD rates
1-2% presence of SSA/SSB abs
15% recurrence if prior affected child
455
Ballard examination less accurate prior to what GA
28 weeks
456
Ballard eye findings
Complete coverage of the lens by vessels at 27-28 wks
457
Ballard foot findings
4.5cm at 25 wks then increases by 0.25cm/wk thereafter
458
Does palmar crease have anything to with Ballard score
No, only foot crease. Greater the crease, more term baby is
459
Ballard breast findings
5-10 mm breast bud in term infant
460
Ballard posture
Flexed upper and lower extremities in term
461
Ballard arm recoil
Full recoil to flexed position at term
462
Ballard wrist findings
Flexed wrist at term
463
Most common finding in Downs neonate
Hypotonia
464
Ddx of REALLY low estriol in quad screen (<0.5MoM, <5%-ile)
Placental sulfatase deficiency (X-linked)
X-linked ichthyosis
Smith Lemli Opitz
CAH
465
Smith Lemli Opitz :
Inheritance, enzyme deficiency, prenatal dx
AR
3beta-hydroxysteroid 7 reductase
Elevated amniotic fluid 7 dehydrocholesterol and low amniotic fluid cholesterol
466
Placental sulfatase deficiency - genetics
X-linked recessive
Xp22.3
467
X-linked iccthyosis - genetics
Xp22.3
468
If contiguous deletion of Xp22.3, what happens
Can extend to cause Kallman syndrome or chondrodysplasia punctata
469
What chromosome is the alpha gene located
chromosome 16
470
What chromosome is the beta, delta, and gamma genes located
chromosome 11
471
Fetal renin levels
Increased without concomitnant increase in aldosterone and Angiotensin II levels (increased degradation in placenta)
472
Fetal vasopressin levels respond most to
Fetal hypoxemia
473
Effect of Angiotensin II on placental blood flow
Decreases placental blood flow; likely etiology for increased placental clearance
474
Cordocentesis is the best therapy for which fetal disorder?
NAIT
475
Therapy for pseudotumor cerebri
Diamox
Optic nerve fenestration if visual symptoms
Lumbar puncture for relief (temporary)
476
Therapy for pseudotumor cerebri
Diamox
Optic nerve fenestration if visual symptoms
Lumbar puncture for relief (temporary)
477
478
478
Risk for early onset dz in GBS positive patients
1 in 100
479
Amino acid precursor for nitric oxide
Arginine
480
Increased cAMP activates what enzyme?
Protein kinase A which dephosphorylates (inactivates MLCK)
481
High prevalence of chronic hepatitis is what?
Hep C
482
Fetal cardiac output at term
500cc/kg/min
483
Negative CF screen - potential carrier rate in :
- Caucasian
- Blacks
- Jewish
- Caucasian 1 in 240
- Blacks 1 in 200
- Jewish 1 in 800
484
What enzyme is missing in placental but is in fetal adrenal gland
17 OH dehydrogenase
17, 20 desmolase
485
What enzyme is missing in fetal adrenal but present in the placenta?
3 beta hydroxysteroid dehydrogenase
486
Major product of fetal adrenal gland
DHEA-S
487
Likely neonatal issue associated with PPROM with chorio
CP
PVL
488
Radiation exposure from VQ scan
0.022 rads - very low
489
Mechanism associated with sickling process of RBCs
Gain in extracellar Na
Loss of intracellular K
490
When time is DM most resistant to insulin
0500-0900
491
Preterm breast milk in comparison to term
- Protein
- Na
- Cl
- Lactose
- Protein high
- Na high
- C high
- Lactose low
492
Skin lesion most associated with graft vs host dz
PUPPS
493
Duration of action of Lantus
18-24 hrs
494
Precursor to estriol
Fetal adrenal DHEAS
495
What should you see where AC is measured
Stomach and portal vein
496
Local anesthetic epidural is LEAST associated with
Puritus - caused by morphine epidural
497
Pt with SC anemia would benefit from what
Folate supplementation
UTI suppression
Pneumovax vaccine
498
Pt with SC anemia would NOT benefit from
Iron supplementation
499
% of failed amnios when done <14 wks
2-3%
500
Complications associated with early amnio
high fetal loss rate
increased risk of club feet (talipes equinovarus)
501
Fetal cardiac cyanotic lesions
TGA
TAPVR
Single ventricle (ductal dependent)
ToF
502
Immediate precursor to progesterone
Pregnenolone
503
Progesterone is made in what feto-maternal unit?
Placenta
504
Enzyme that converts pregnenolone to progesterone
3 beta hydroxysteroid dehydrogenase, type 1
505
Precursor placenta uses to make progesterone
LDL cholesterol --> pregnenolone
506
Next step in estrogen synthesis after DHEAS from fetal adrenal gland is taken up by syncitiotrophoblast
placental sulfatase converts it to DHEA
507
How is DHEA converted to androstenedione
via 3 beta hydroxysteroid dehydrogenase, type 1
508
What converts androstenedione and estradiol to estrone?
Placental aromatase
509
Estriol is made from which precursor
Fetal 16 OH DHEAS --> placental sulfatase to 16-OH DHEA --> 3 beta hydroxy steroid dehydrogenase and aromatase to estriol
510
What substance falsely reduces urinary estriol levels
Mendelamine (abx used to treat UTI)
511
1/3 of placental glucose uptake is converted to what?
lactate
512
Placental lactate is thought to be what?
Fetal energetic substrate
513
What source is the glucose used by fetus from? Endogenous from fetus or other
Other- placenta
514
What other sources are used for fetal oxidative metabolism?
Amino acids - used primarily for oxidative metabolism as opposed to protein synthesis
Other sources: glucose, O2, fatty acids
515
Fetal growth primarily regulated by what substance?
IGF I and II
516
Fetal renin levels is increased or decreased?
Increased
517
Are fetal angiotensin II and aldosterone levels increased?
No
518
Fetal hgb and acid (i.e. KBT)
More resistant to acid in KBT testing
519
Effect on fetal breathing:
Hypoxemia
Acidosis
Alkalosis
Hypoxemia - inhibits
Acidosis - enhances
Alkalosis - suppresses
520
Maternal B19 (parvo) infection - fetal loss rate
5%
521
Vertical transmission associated with parvo
33%
522
Best anesthesia for a severe asthmatic in labor? and why?
lumbar epidural
Decrease O2 consumption and minute ventilation during labor
523
If general anesthesia needed for asthmatic, what medication is best and why?
Ketamine
Reduces risk for bronchospasm
524
Why is fentanyl better than meperidine for the asthmatic?
Less histamine production (2% risk of bronchospasm with use of meperidine)
525
Concerns regarding indomethacin and asthmatic pt
May lead to bronchospasm, especially in ASA sensitive pt
526
Placental enzymes required for estrogen synthesis
Sulfatase (DHEAS --> DHEA)
3 beta hydroxysteroid dehydrogenase (-->androstenedione)
Aromatase (--> estrone)
527
Trisomy associated with greatest risk fo cardiac anomalies
T18 - 90% in autopsy specimens, 50% prenatal
T13 - 80%
T21- 25%
528
MCC of macrosomia
maternal obesity
529
Mechanism of transplacental transfer
Iron
AA
Glucose
IgG
Medications
Iron - pinocytosis (apotransferrin)
AA - active (coupled with Na)
Glucose - facilitated diffusion (GLUT-1)
IgG - pinocytosis
Medications - simple diffusion
530
Associations
AFLP
TTP
Pre-e
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
Define ordinal data
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
Definition of continuous data
Data that can take any numerical value
533
Definition of categorical data
Data that can be separated into groups
534
Define nominal data
Categorical data where the order of the categories doesn't matter
E.g. race/ethnicitiy
535
Define correlation coefficient
Measure of the strength of the linear relationship between 2 variable
536
Anti-M isoimmunization: What type of antibody and does is cause RDFN
Typically IgM
Presents as cold agglutinin
Rarely IgG has been found at all
537
FYa vs FYb; which causes mild HDFN
FYb
538
What percent of people are kell negative?
92%; therefore check antigen status of father of baby
539
Majority of kel positive individuals
are heterozygous therefore amnio for antigen typing is indicated
540
Fetal red cell MCV
22% larger than adult red cells
541
Type of placentation in TRAP sequence
mono/di
542
Fetal SVT and association with structural abnormalities
Very rare
543
Syndrome often associated with fetal SVT
WPW
544
Treat SVT if tachycardia occurs what percent of the time?
>33%
545
Risk of fetal hydrops associated with Parvo is associated with what factor?
GA at which maternal infection occurs
546
Parvo risk of fetal hydrops when maternal infection dx at 12 wks, 13-20 wks, >20wks
12 wks --> 10%
13-20 weeks --> 5%
>20 weeks -->1%
547
What antigen on fetal red stem cell does parvovirus attach to, thereby suppressing erythropoeisis? Where else is that antigen found in?
fetal "P" antigen
fetal myocardium --> myocarditis, heart failure and cardiomyopathy
548
What % of omphaloceles have aneuploidy?
50% (T18 and T13)
549
What % of omphalocele have other structural anomalies?
80%
550
What % of Beckwith-Wiedeman is due to paternal uniparental disomy (genetic imprinting?)
10-20%
551
What other form of inheritance of Beckwith-Wiedeman
AD or imprinting
552
Inheritance pattern of Meckel Gruber
AR
Defective cilia
553
Chromosome affected in Beckwith Wiedemann
What is it associated with?
What mutation does it have?
Chrom 11
Associated with omphalocele
IGF receptor mutation - overactivity
554
Chromosome affected in Meckel Gruber
Chrom 17q21-24; MKS1 gene
555
Why can't imuran (azathioprine) be activated in the fetus?
Fetus lacks enzyme inositol pyrophosphorylase
Azathioprine immunosuppressant used for autoimmune diseases
556
Complications of pregnancies in women with renal transplants?
Preterm birth in 45%
FGR in 22%
Major malformations in 3% (= background)
Pre-e in 30%
Allograft rejection 9% (= background)
557
How to differentiate renal transplant rejection from pre-e
bx of the kidney
24 hr urine protein and CrCl,
Serum Cr
558
How to follow renal function in pt with renal transplant
Monthly urine cx (may not feel pain - kidney denervated)
Monthly UTP and CrCl
559
Definition of malformation
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
Definition of deformation
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
Infection Vertical Transmission Rate
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
Definition of sequence
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
Definition of syndrome
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
Definition of association
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
Sequence vs Syndrome
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
Precursor to deoxycorticosterone
Progesterone
567
Precursor to 11-deoxycortisol
17 alpha hydroxyprogesterone
568
Does fetal brain have insulin receptors?
No
569
Enzyme that mediates progesterone --> deoxycorticosterone
21 alpha hydroxylase
570
Enzyme that mediates 17-OHP --> 11- deoxycortisol
21 alpha hydroxylase
571
Tx of Vtack or pulseless Vfib
ABCs, SHOCK
Lidocaine if stable
572
Tx for refractory SVT
Adenosine or ICD
Generally BB or CCB
573
Urinary Ca in Pre-e (increased or decreased)
Decreased
574
Gaucher's enzymatic defect
Glucocerebrosidase
575
Tay-Sacks enzymatic defect
Hexoseaminidase-A
576
Canavan's enzymatic defect
Aspartoacyclase
577
What substance is of lower concentration in acute fatty liver of pregnancy
Amino acids
578
Associations with placental sulfatase deficiency include:
X-linked recessive
Ichythyosis
Chondrodysplasia punctata
Low estriol in quad (<0.5 MoM)
579
Which cardiac arrhythmia is more commonly associated with CHD?
Congenital heart block
50% of CHB have a cardiac anomaly
580
Causes of newborn laryngeal papillomatosis
HPV 6 and 11
581
Where is hep B core antigen found
Only in hepatocytes, not in serum
582
Most important counter-regulatory hormone in glucose metabolism is...
Cortisol
583
Effect of Trimethadione on fetus
Head - MR, microcephaly
V-shaped eyebrows
Cardiac anomalies
Absent kidney
Omphalocele
584
Incidence of pre-e in daughters of women who had pre-e
20-40%
585
Incidence of pre-e in sisters of women who had pre-e
11-37%
586
Incidence of pre-e in monozygotic twin pairs
Up to 60%
587
Factor XI deficiency affects predominantly what population? What's the tx?
Ashkenazi Jews
Factor XI concentrate
588
Factor XIII deficiency:
- Inheritance pattern
- Associated with what clinical presentation
- Tx
- Inheritance pattern --> AR
- Associated with what clinical presentation --> intracranial hemorrhage
- Tx: FFP or cryo
589
Recurrent CMV transmission rate
0.1-1%
590
Of estimated 40,000 neonates infected with CMV< what % demonstrate congenital infection at birth?
5-6% (around 10%)
591
Most neonates infected with CMV are asymptomatic at birth but what happens later in life?
Develop chorioretinitis, hearing loss, neurological deficits, psychomotor retardation, learning disability
592
When is the highest risk of developing congenital varicella syndrome
13-20 weeks gestation
593
At 13-20 weeks gestation, what % will develop congenital varicella syndrome?
2%
594
Pathognomonic cardiac anomaly in congenital rubella syndrome
PDA
Pulmonary artery stenosis
595
Most common single defect in Rubella infected fetuses
Hearing loss - sensorineural deafness
596
Chorioretinitis + intracranial calcifications + hydrocephalus
Congenital toxoplasmosis
597
Fetus with pH of 7.15, PCO2 of 60, base excess of -4
Respiratory acidosis
598
Carbohydrate metabolism and what is the major byproduct of carbohydrate metabolism in the fetus?
Lactic acid
599
IVH and MC site
Germinal matrix
600
Increase in heat stable alkaline phophatase increases in pregnancy. This is found in the:
- Placenta
- Leukocytes
- Platelets
Placenta
601
An absence of end-diastolic flow has been associated with
increased risk of perinatal mortality and morbidity
602
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
if measurements are taken close to the placenta
603
Elevated maternal serum AFP at 16 wks which was elevated >4 MoM...what could be the causes?
IUFD
Omphalocele
Twins
Incorrect GA
604
Phospholipase II activity
Has been associated with certain species of bacteroides and gardnerella
Sometimes associated with preterm labor and amniorrhexis?
605
Fetal SVT associated with
- Lupus
-Hydrops
-High risk of chromosomal abnormalities
Hydrops
606
Action of prostacycline
Causes decreased platelet adhesiveness
Vasodilation of the arterials (decrease tone)
Decreases uterine activity
607
Why is thrombocytopenia is seen with PIH or pre-e?
Intimal damage in the small arterioles which causes an increase in platelet activation/consumption
608
What is the fatty acid involved with lung maturation, i.e. surfactant?
palmitic acid
609
Pt who is quadriplegic. What can be seen?
Fetal malpresentation
Uterine hypotonia
Autonomic hyperreflexia
610
Pt in 2T who develops hepatitis B. What would be appropriate management?
Give pt's contact hepatitis B immjunoglobulin, as well as hep B vaccine
611
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
612
Effect of prostin Ee2 on cervical ripening
Increased glycoaminoglycans
Glycoaminoglycans in the cervix have an affinity for water and help with cervical ripening.
613
Which thyroid substances readily cross the placenta?
TRH and Anti-thyroid stimulating abs
614
HgbA1C being elevated and its association with
Increased risk of SAB
Increased risk of fetal anomalies
615
Changes in respiratory physiology during pregnancy
Increased: IC, TV
Decreased: FRC, RV, ERV
616
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?
Normal
617
Amniotic fluid prolactin levels
- Affects the osmotic regulation of the AFI
- Source is the decidua
- It is not affected by bromocriptine
- Affects the osmotic regulation of the AFI
618
What affects the concentration of surfactants in the amniotic fluid?
Amniotic fluid volume
619
Which of the following disease is most appropriately diagnosed by immunological means?
- Chlamydia
- HSV
- CMV
- Hepatitis
- Toxoplasmosis
Toxoplasmosis
620
Young woman and pregnant with polycystic kidney disease? What would occur?
50% chance of PIH
621
What chromosome for Prader-Willi and Angelman?
Chromosome 15
622
What chromosome for myotonic dystrophy
Chromosome 19
623
What chromosome for Huntington Disease
Chromosome 4
624
Paternal age and new AD mutations
Achondroplasia
Marfan
Neurofibromatosis
Apert syndrome
Hemophilia A
Muscular dystrophy
Remember: All Male Nuts Affect His Muscles
625
X-linked recessive disorders
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
Trinucleotide Repeat Expansion Diseases
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
Repeats in Fragile X
CGG >200, males are MR
<45 = normal
45-55 = intermediate
55-200 = premutation
628
Repeats in myotonic dystrophy
CTG 1000-2000
629
Repeats in Huntington disease
CAG
630
Definition of disruption
Morphologic defect resulting from extrinsic breakdown or interference with originally normal developmental process (trauma, infection, teratogen) thalidomide
631
Definition of dysplasia
Abnormal organization of cells into tissue and its morphologic consequences (achondroplasia)
632
Capacity vs Competence
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
What is substituted judgement
What the patient has expressed in the past in past decisions or living will or power of attorney
634
Do child neglect laws apply to fetus?
No
635
Can a mother be legally required to submit to an invasive procedure?
No. The fetus life not favored over mother
636
Normal pregnancy rate after ectopic
H/o ectopic --> only 50% will deliver a liveborn child
25% of those who get pregnant will have a repeat ectopic
637
Branches of internal iliac
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
