Twinning
Medical Conditions
Physiology & Embryology
Genetics
Potpourri
100
The obstetric or neonatal complication most likely to occur in twin pregnancies
What is preterm birth?
100
Of the two types of bariatric surgery, the type more likely to be associated with nutritional deficiencies.
What are malabsorptive procedures?
(Roux-en-Y gastric bypass, biliopancreative diversion, biliopancreatic diversion with duodenal switch, jejunoileal bypass)
vs
Restrictive (vertical banded gastroplasty, vertical sleeve gastrectomy, adjustable gastric banding)
100
The normal physiologic change in maternal cardiovascular function that best explains the following: A 19-year-old G2P1 at 18 weeks reports frequent lightheadedness upon standing, BP 95/60, HR 85
What is decreased systemic vascular resistance?
Because of increases in estrogen and progesterone and the activation of the renin–angiotensin–aldosterone system, pregnancy causes a continuous increase in cardiac output and plasma volume and a decrease in maternal systemic vascular resistance. Blood pressure initially decreases but increases in the third trimester. Uterine mechanical compression of the inferior vena cava can occur during the second and third trimesters, potentially reducing venous return to the right ventricle, causing a postural hypotensive syndrome and exacerbating lower-extremity edema.
100
The mode of inheritance pictured here
What is autosomal recessive?
Skips generations
Male/female equally affected
100
Magnesium administration when IV access is not available
What is 5 mg IM Magnesium in each buttock?
200
The best next step in management of mono-di twins at 20 weeks with the following ultrasound findings
A: MVP 12 cm
B: MVP 1 cm, bladder not visualized, AEDV
What is fetoscopic laser photocoagulation of placental anastomoses?
200
Most likely cause of new-onset hand tremor, excessive sweating, anxiety, weight loss and rapid heart rate in a pregnant patient
What is Graves disease?
200
23 year old G1P0 at 20 weeks presents for anatomy scan and found to have evidence of a complex lesion containing neural elements, reflecting a failure of neural tube fusion at this gestational age
40 days from LMP
The caudal portion of the neural tube fuses by 40 days of gestation (calculated from LMP).
200
The first trimester ultrasound marker most commonly used for screening for Down syndrome
What is nuchal translucency?
Other possible soft markers?
What are some second trimester ultrasound markers for Down syndrome?
What are major structural abnormalities?
200
These vaccines are contraindicated in pregnancy
What are MMR, Varicella, HPV?
300
When cleavage of the fertilized ovum occurred based on the following ultrasound findings: 2 fetuses in 2 discrete gestational sacs, 2 placentas, and a twin peak sign.
What is 1 to 3 days post-fertilization?
300
First line therapy for hyperthyroidism in the second and third trimesters
What is methimazole?
Methimazole is the recommended treatment in the second and third trimesters, but it should not be used in the first trimester because of an association with embryopathy, including esophageal or choanal atresia and aplasia cutis. Propylthiouracil is recommended in the first trimester of pregnancy to avoid this embryopathy, but it can potentially be hepatotoxic and therefore is not continued throughout pregnancy.
300
Recommended dose of folic acid supplementation in low risk patients vs those with history of NTD
What is 400 mcg (low risk) and 4 mg (history of NTD)
Risk factors: obesity, poorly controlled diabetes, use of antiepileptic medications, family history of NTD
Mode of inheritance: multifactorial
300
The acrocentric chromosomes
13, 14, 15, 21, 22
Why is this important?
300
A single dose of Rhogam (300 mcg) covers what volume of Rh-positive fetal red blood cells?
What is 15 mL fetal RBC (or 30 mL whole blood)?
400
The recommended IOM gestational weight gain for someone with a twin prepregnancy and BMI of 20
What is 37-54 lbs?
400
The laboratory finding most significantly associated with stillbirth in cholestasis of pregnancy
What are bile acids > 100 micromol/L?
400
Next best step in evaluation of a 25 year old G0 presents for pelvic pain, ultrasound shows unicornuate uterus
What is a renal ultrasound?
400
Expansion of this trinucleotide repeat is implicated in altered transcription of the FMR1 gene resulting in fragile X syndrome
What is cytosine-guanine-guanine (CGG)?
400
The type of professional liability insurance policy that would cover a claim for incidents that happen while a provider had coverage in effect, even if they are no longer covered by the insurer or policy.
What is occurrence?
This covers any claim for an event that took place during the period the policy was in effect, even if the claim is filed after the policy lapses
vs
Claims-made policy -provides coverage only if the policy is in effect BOTH when the incident took place and when the lawsuit is filed
Umbrella insurance
Goes above the limits and coverages of your other insurance policies
If you have a claim against your car insurance or homeowner’s insurance, that policy will only cover you up to a certain amount
If you don’t have an umbrella policy, you will have to pay for any extra amount that you owe; helps protect your assets
Covers: bodily injury liability, property damage liability, landlord liability, libel, slander, defamation, etc
DOES NOT COVER: MALPRACTICE
500
The type of twins for which fetal echocardiogram is recommended
What are monochorionic twins?
500
These thrombophilias can be reliably tested for during active thromboses
What are factor V Leiden and prothrombin gene mutation?
500
The digestive tract forms from this component of a 21-day embryo
What is the yolk sac?
Yolk sac: develops into respiratory system and digestive system
Body stalk: connects developing embryo to chorion, ultimately becomes umbilical cord
Neural plate: ultimately develops into the brain and spinal cord.
500
A 22 year old G1 presents at 9 weeks to discuss NIPT. When counseling, you explain that the patient's age will have this effect on the statistical reliability of this screening test.
What is decrease the PPV?
Screening tests: sensitivity and specificity not affected by prevalence
PPV and NPV affected by prevalence
500
The type of extended reporting endorsement policy that covers a claim related to an incident that happened while a provider was insured under a claims-made policy when the claim is filed after the original policy is no longer in effect
What is tail coverage?
An extended reporting endorsement policy, or tail coverage, covers a claim related to an incident that happened while insured under a claims-made policy is filed after that policy is no longer in effect. Tail coverage must be purchased from the insurer that issued the claims-made policy when it expires or it will cover for future claims. Cost of tail coverage may be two to 10 times the amount of the last annual premium, depending on the number of years in practice and claims experience.