OB Emergencies
DOSING of local anesthetic (mg/kg) (ie for CS under local anesthesia)
Lidocaine with epinephrine 7 mg/kg
also accepted 4mg/kg with OUT epi
In which scenario would you NOT recommend or offer a CD to prevent perinatal HSV?
A) Active genital lesions
B) HSV lesion on buttock, back or thigh
C) Prodromal symptoms of pain/burning
D) Primary or non-primary first episode of genital HSV during the third trimester
HSV lesion on buttock, back or thigh
Your patient screens positive with a sequential stepwise screen (CA State Screen) for Trisomy 21? What is the detection rate of this test for Trisomy 21?
95% / 88% / 99% / 81%
95%
Recommended age for general population (average risk) colon cancer screening to begin
Age 45- changed due to the increasing incidence in colon cancers in Americans < 50
Fibrinogen
Increased
After a 5 min shoulder dystocia, on Day of Life 1, the neonate exhibits isolated hand paralysis with loss of grasp reflex and horner syndrome. Name this palsy.
Klumpke Palsy: C5-T1 - Specifically C8-T1
35 year old at 16 wks gestation and works at a daycare. She presents with a reticular rash on her trunk and joint pain. 4 weeks later her anatomy scan shows size equal to dates with hydrops (ascites and pleural effusion). What additional screening test would you want?
A) Umbilical artery Dopplers
B) Ductus venosus Dopplers
C) Middle cerebral artery Dopplers
D) Uterine Artery Doppler
C) Middle cerebral artery Dopplers
Which 2 maternal analytes are INCREASED in T21?
hCG, Inhibin (HI goes up)
At what gestation does a fetal thyroid begin producing thyroid hormone?
~12 weeks
Creatinine
Decreased (increased GFR)
A 36 year old G1P0 at 31 wks gestation with di-di twins, admitted with new onset mild range blood and proteinuria. Her O2 sat is 92% and she has significant bilateral edema. You get a CXR showing pulmonary edema and an echocardiogram showing normal biventricular function. What is your next step?
A) Start Magnesium for seizure prophylaxis and deliver
B) Start Keppra and expectantly manage until delivery at 34 wks gestation for pre-eclampsia with SF
C) Deliver now
D) Give Lasix, start Magnesium and expectantly manage
C) Deliver now
21 yo G1P0 at 13 weeks gestation and presents with a generalized maculopapular rash and lymphadenopathy. She notes she had a painless genital ulcer with a raised border and indurated base that resolved spontaneously 5 weeks ago. She has an allergy to penicillin (IgE mediated). What is your treatment?
C) Desensitization with IM Penicillin G 2.4 million units x1 dose (some say 2)
Which of the following is NOT a reason for a no call result with cfDNA?
A) Early Gestational Age (<9-10 wks)
B) Genetic Conditions (T13 or 18)
C) Low maternal BMI (<18 kg/m2)
D) LMWH
C) Low BMI
This singer, who is known for singing about her work hours is the Godmother of Miley Cyrus?
Dolly Parton
WBC Count
Increased
A patient has two prior cesarean deliveries and is planning a third repeat. What do you counsel her about her a priori risk of accreta?
40%
24 yo G3P1011 at 36 weeks GA, who is living with the diagnosis of HIV positivity. Her labs are: viral load: 2000, CD4 400. In order to decrrease risk of vertical transmission, what would be your:
1. delivery mode
2. timing recommendation to decrease the risk of vertical transmission?
A) Prelabor CD at 38 weeks gestation and IV Zidovudine 3 hours preoperatively
What is a 40yo age related risk of Down’s Syndrome AND any chromosomal abnormality?
A) 1/365, 1/180
B) 1/50, 1/100
C) 1/36, 1/18
D) 1/100, 1/50
D) 1/100 (Down syndrome); 1/50 any chromosomal abnormality
Threshold of Anemia (< Hb or <Hct) in Third trimester
-First trimester: 11 g/dL; 33%
-Second trimester: 10.5 g/dL; 32%
-Third trimester: 11g/dL; 33%
Uretereal motility
Decreased
Name 3 conditions in which pregnancy is contraindicated (mWHO Risk Class IV)
9 total
Pulmonary arterial hypertension
Systemic ventricular dysfunction (EF<30%, NYHA III-IV)
Severe mitral stenosis
Severe symptomatic aortic stenosis
Systemic RV with moderate to severely decreased ventricular function
Aortic dilation (>45 mm Marfan; >50 mm in BAV; >25 mm/m2 in Turner; >50 mm in Tetralogy of Fallot)
Vascular Ehlers-Danlos
Severe coarctation
Fontan circulation with ANY complication
What is the mortality rate of neonatal herpes, (with disseminated neonatal disease)?
Disseminated disease (25% of infections, 30% mortality)
**PHOTO DAILY DOUBLE*
Name this Ultrasound finding and which chromosomal abnormality is most commonly associated ?
Trisomy 21
Trisomy 18
Monosomy X
Trisomy 13
Trisomy 18, Choroid Plexus Cyst
What is the ACOG Hyperthyroidism treatment of choice
Part 1: first trimester?
Part 2: 2/3rd trimester?
First tri: PTU (Risks: liver toxicity, agranulocytosis)
2nd and 3rd tri: Methimazole (Risk: Aplasia Cutis, embryopathy with esophageal or choanal atresia)
Antithrombin III activity
Decreased