Preg Phzzz
Ante
Fetal
ICU
Delivery
100
All of the following pulmonary changes increase in pregnancy except: RR, TV, MV, O2 consumption
What is RR. MV = TV x RR Progesterone increase TV which increases MV --> blow off CO2 creating comp resp alkalosis --> facilitates CO2 from fetus to mother Normal gas in pregnancy: 7.4-7.45/101-108/27-32/18-21
100
30yo G1 presents for first prenatal visit and is excited she "gets to eat for 2". Her BMI is 35. You tell her the recommended weight gain in her pregnancy is what?
Underweight: Less than 18.5: 28-40 Normal weight: 18.5-24.9: 25-35 Overweight: 25-29.9: 15-25 Obese: 30 and greater: 11-20
100
Fetuses have a DV and a DA, they are located where and what do they shunt?
DV shunts from UV to IVC. DA shunts from PA to Aorta.
100
Patient asks you for the criteria for preeclampsia you tell her it's BP plus what other 6 criteria?
What is 1. Proteinuria 2. Thrombocytopenia < 100k 3. Renal insuff Cr > 1.1 or doubling of baseline 4. Impaired liver fxn LFTs twice normal 5. Pulmonary edema 6. Persistent neurologic symptoms
100
Elective repeat Cesarean increases the risk of 3 fetal conditions over TOLAC. What are they?
What are respiratory morbidity (1-5% vs 0.1-1.8%) transient tachypnea of newborn (6.2% vs 3.5%) hyperbilirubinemia (5.8% vs 2.2%)
200
Increase in total body water is how many liters in pregnancy?
What is 6.5-8.5L?
200
Name the 5 components of a BPP
What are: Fetal movement (3 gross body/limb) Fetal tone (1 F/E) Fetal breathing x30sec AFI 2x2 pocket NST Reactive?
200
The frequency of the 3 types of placentation with twining is what?
What are DCDA 80% MCDA 19% MCMA 1%
200
What are the 4 most commonly used antihypertensive agents in pregnancy and the mechanism of action for each?
What are: 1. Hydralazine: direct dilation of arterioles 2. Labetalol: alpha and beta blocker 3. Nifedipine: Calcium channel blocker 4. Methyldopa: central CNS effect, comp inhibitor of DOPA decarboxylase
200
Criteria for chorioamnionitis include what 5 criteria? What is treatment regimen?
What are fever, maternal tachycardia, fetal tachycardia, fundal tenderness, vaginal discharge Amp/Gent +/- Clinda
300
Physiologic anemia of pregnancy is explained by what physiologic changes (including %) in the blood.
What is increase is plasma volume (approx. 30-50%) >> increase in RBC volume (approx. 20%)? Total blood volume increase 30-40%.
300
Patient presents for late prenatal care approx 28 weeks and on bedside US in triage you see some fluid in the fetal abdomen and her antibody screen is positive for anti-Kell antibodies titer (1:64). What US test do you do next?
What is perform MCA Dopper.
300
Patient presents with classic TTTS. She want to know when her embryo cleavage occurred. You tell her what?
What is 4-8days? DCDA 0-3 days MCDA 4-8 days MCMA 8-13 days Conjoined > 13 days
300
25yo presents at 32 weeks with N/V and seems confused. BP 160/82, HR 98, RR 18, Temp 101.5 Labs: Hg 8.2, Plts 20k, wbc 14, AST 52/ALT 64, LDH 1200, Cr 1.2, FSBG 95 Your leading diagnosis is...
What is TTP? Pentad: Hemolysis, uremia, thrombocytopenia, fever, AMS
300
Patient presents at 36 weeks with dec FM. US shows IUFD. In addition to delivery you initiate stillbirth workup. Name at least 5.
What are: autopsy, placental path, genetics (FISH, karyotype, microarray), Antibody screen, KB, tox screen, TORCH, parvo, APLAS, FSBG/A1c, TSH
400
Overall risk of VTE in pregnancy in increased, but by how much and what is the overall risk of a VTE in pregnancy?
What is 5-6 fold and 1/1500?
400
Patient has f/up visit at 20 weeks. Her anatomy scan showed ventricles of 12mm bilaterally and Quad screen shows low AFP, high hCG, low E3, and high inhibin? What do you recommend and why?
What is an amniocentesis for concern for T21? T21 US findings: Absent NB Thickened NT Cystic hygroma Ventriculomegaly Cardiac defects Echogenic bowel Pyelectasis Short long bones FGR
400
Patient presents for US for size < dates. US shows EFW < 10% and BPP 8/8. You perform what test next? What is the expected progression of this test?
What is UA Doppler exam. Normal, elevated UA PI, AEDF, REDF
400
25yo presents at 32 weeks with N/V and seems confused. BP 160/82, HR 98, RR 18, Temp 99.0 Labs: Hg 11.0, Plts 52k, wbc 14, AST 500/ALT 650, LDH 400, Cr 1.2, FSBG 41, INR 1.8 Your leading diagnosis is...
What is AFLP HYPOGYCEMIC is absent in other DDX HELLP, AFLP, TTP, HUS, SLE
400
Patient has shoulder dystocia? You tell her to stop pushing, call for help, mark the clock, then what??? name at least 5
McRoberts Suprapubic pressure Rotation maneuvers (Woods) Delivery of posterior arm Clavicular fx Zavanelli
500
Cardiac output = ? x ? BP = ? x ? What happens to each of these in pregnancy and how/why?
What is CO = HR x SV and BP = CO x SVR? CO increases via inc HR and SV BP decreases via dec SVR
500
There are three indications for cerclage what are they, be specific!?
What are 1. Hx indicated (1 or more 2nd trimester losses from CI or prior rescue cerclage) 2. Exam indicated 3. US indicated (singleton, prior PTB, CL < 25mm prior to 24wks)
500
Patient presents to US for f/up scan at 28 weeks for growth. An intracranial hemorrhage is noted. You suspect NAIT. What is your workup?
What is 1. maternal plt count 2. Mat plt Ag (IIB/IIIA complex), Pat plt Ag, mat plt Ab
500
What are the 4 cardiac conditions that carrier maternal mortality risk of 25-50%?
What are: 1. Eissenmenger's 2. Pulmonary hypertension 3. Marfan's with dilated aortic root 4. Peripartum cardiomyopathy with persistently reduced EF.
500
You just performed a D&C for a partial molar pregnancy. What is the expected karyotype.
What is 69XXX or 69XXY
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