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Boards - Pediatrics
OBGYN Qualifying Exam
162
Other
Post-Graduate
06/24/2020

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Cards

Term
levels of NICU care
Definition
1 - NRP, healthy, stabilize
2 - moderatly ill, expect quick recovery
3 - extreme prematurity, critically ill, surgery
4 - complex surgery, ECMO
Term
infants transferred to higher care have - 4
Definition
lower ICH, RDS, PDA, infection
Term
APGAR scoring
Definition
0 - blue, no pulse, no grimace, limp, no resp
1 - pink/blue, <100bpm, grimace, some activity, slow resp
2 - pink, >100bpm, cries, active, strong cry
Term
APGAR associated with CP
Definition
5, 10min <5 - slight increased risk
Term
APGAR score ruling out hypoxia as encephalopathy etiology
Definition
5min >6
Term
when do you need to do 10, 15, 20 min apgar
Definition
5min <7
Term
teratogen valproic acid - 3
Definition
ONTD, cardiac/TOF, clefts
Term
highest risk seizure med for anomalies
Definition
valproic acid 8.7%
Term
ACEI teratogen - 9
Definition
renal dysplasia, oligo, anuria, arterial hypotension, IUGR, RDS, pulmonary hypoplasia, limb defects, death
Term
lithium teratogen and % - 1
Definition
ebstrains 0.01-0.5%
Term
isotretinoin teratogen % risk and 6 defects
Definition
30-60% - carinofacial, cardiac, neurologic, thymic
20-25% - hydrocephaly, microtia
Term
thalidomide teratogen - 1
Definition
phocomelia
Term
tetracyclines teratogen - 2
Definition
enamal hypoplasia, tooth discoloration
Term
amantadine teratogen - 1
Definition
TOF
Term
coumadin teratogen - 8
Definition
nail hypoplasia, stippled bone epiphyses, hydrocephaly, microcephaly, opth abnormalities, IUGR, developmental delay, TOF
Term
topomax teratogen - 1
Definition
clefts
Term
gluburide teratogen - 2
Definition
hypoglycemia, macrosomia
Term
indocin teratogin - 5
Definition
closure of ductus, NEC, oligo, pulm HTN, IVH
Term
magnesium teratogen - 4
Definition
lethargy, hypotonia, RDS, bone demineralizaton (prolonged)
Term
clavulonic acid teratogen - 1
Definition
NEC
Term
live flu vaccine teratogen - 1
Definition
PTD
Term
BB teratogen - 1
Definition
IUGR
Term
HCTZ teratogen - 1
Definition
thrombocytopenia
Term
nutroprusside teratogen - 1
Definition
thiocynate toxicity
Term
smoking teratogen 10
Definition
SGA, PPROM, SAB, PTD, stillbirth,a bruption, previa, SIDS, childhood asthma, infant colic, childhood obesity
Term
opioids teratogen - 3
Definition
abrupt discontinuation - disress, PTL, demise
Term
MTU teratogen - 2
Definition
1T - aplasia cutis, coloanal atresia
Term
paxil teratogen - 1
Definition
1T - cardiac defects
Term
SSRI teratogen - 1
Definition
persistent pulmomnary HTN
Term
SSRI withdrawal neonatal - 6
Definition
>20wk - jittery, RDS, TTN, weak cry, poor tone, NICU admissions
Term
benzo teratogen - 4
Definition
floppy infant, sedation, withdrawal, clefts
Term
afavirenz teratogen - 1
Definition
<8wk ONTD
Term
dolutegravir teratogen - 1
Definition
ONTD
Term
danazol teratogen - 1
Definition
masculinization of female
Term
progestin teratogen - 1
Definition
masculinization of female
Term
finasteride teratogen - 1
Definition
feminization of male
Term
spironolactone teratogen - 1
Definition
feminization of male
Term
tamoxifen teratogen - 3
Definition
SAB, stillbirth, congenital anomalies
Term
hydroxyuria teratogen - 2
Definition
stillbirth, congenital anomalies
Term
trastumab teratogen - 2
Definition
oligohydraminos, anhydraminos
Term
chemotherapy general teratogen - 2
Definition
IUGR, PTD, neutropenia
Term
IUD teratogen - 4
Definition
SAB, septic Ab, PTD, PROM #1
Term
#1 risk of IUD in pregnancy
Definition
PROM
Term
DES teratogen - 9
Definition
vaginal clear cell, cervical clear cell, GU abnormalities, infertility, RPL, PTL, CIN, vaginal adenosis, breast cancer
Term
radiation teratogen - 4
Definition
genital malformations, MR, miscarrage, IUGR
Term
TMP teratogen - 3
Definition
1T - SAB, ONTD, CV defect
Term
SMX teratogen - 1
Definition
kinecterus
Term
phenytoin teratogen - 6
Definition
MR, IUGR, microcephaly, nail hypoplasia, clefts, heart defects
Term
mercury teratogen - 5
Definition
developmental delays, memory deficits, hydrocephaly, cleft palate, PTD
Term
recommended fish servings by risk of murcery and age
Definition
adult 2-3 servings (4oz) of fish/wk from best choices or 1-2 servings from good choices
start 1-2 servings at 2yo (2oz)
Term
fish high in mercury - 7
Definition
king mackerel, marlin, orangy roughy, shark, swordfish, tile fish from gulf of mexico, bigeye tuna
Term
incidence of T21 in absence of fhx
Definition
97%
Term
incidence of T21 <35yo
Definition
80%
Term
incidence of T21 if balanced robertsonian
Definition
10-15% each pregnancy
Term
#1 defect in down syndrome
Definition
cardiac (AVSD > VSD)
Term
most common anomalies in down syndrome 5
Definition
cardiac defects, NT >6mm in 2T, cystic hygroma, hyperechoic bowel, absent nasal bone
Term
% T21 with normal US
Definition
50
Term
soft markers in down syndrome - 7
Definition
pyelectasis, echogenic bowel, UTD, EIF, duodenal atresia, nuchal fold thickening, limb shortening
Term
major anomalies in T21 - 9
Definition
cystic hygroma 22%, hydrops, cardiac 40%, AVSD, diaphragmatic hernia, duodenal atresia 15%, jujenal atresia, ventriculomeagly, IUGR 29%
Term
T18 incidence and survival
Definition
1:3000 live births, 10% survival beyond neonatal
Term
most common signs of T18 - 2
Definition
IUGR and poly is T18 until proven otherwise
Term
signs of T18 from most to least prevalent - 13
Definition
IUGR 87%, overlapping digits 50-70%, polyhydraminos 30-60%, SUA 29%, CBC, rocker feet, echogenic bowel, ventriculomeagly, cardiac enomalies, omphalocele, strawberry head, CNS anomalies, isolated CPC <1%
Term
T13 incidence
Definition
1:5000
Term
signs T13 - 6
Definition
midline defects - clefts, holopros (75% of all holopros)
polydactyly 77%
CV anomaly 77%
omphalocele
hydrocephalus
Term
what is the most common imprinting disorder
Definition
prader-willi
Term
signs of prader-willi / angelman in utero
Definition
decreased FM in 3T, otherwise normal
Term
cause of prader willi / angelman
Definition
imprinting, which disease determined by dad, del15q11-13
Term
smith lemli optiz incidence
Definition
1:20,000, 1:70 carrier
Term
most common single gene disorder leading to intellectual disability
Definition
smith lemli optiz
Term
smith lemli optiz inheritence
Definition
AR
Term
most common congenital anomaly
Definition
cardiac
Term
% cardiac anomalies associated with aneuploidy
Definition
30
Term
risk of recurrence of cardiac anomalies in next pregnancy
Definition
2-3%
Term
highest recurring cardiac anomaly
Definition
hypoplastic left heart syndrome
Term
parts of TOF
Definition
VSD
pulmonary stenosis
overriding aorta
RV hypertrophy
absence of subpulmonary conus - infundibulum muscle
Term
incidence of TOF
Definition
6-8% cardaic defects
Term
recurrence of TOF in nexr pregnancy and in offspring
Definition
2.5% sibling, 2.5% offspring
Term
are most cardiac anomalies aneuploity or euploidy
Definition
euploidy
Term
causes of TOF - 10
Definition
T21, DiGeorge, prune belly, CHARGE, valproate, amantadine, coumadin, DM, T18, T13
Term
systemic signs associated with TOF - 5
Definition
reversed ductal flow, pulmonary atresia, levorotation, poly, hydrops
Term
DiGeorge signs - 5
Definition
cefts, cardiac anomalies / TOF, hypocalcemia, skeletal anomalies, thymic aplasia
Term
when is TOF corrected
Definition
2-6mo, earlier if tet spells
Term
what is correlated with TOF prognosis
Definition
degree of pulmonary atresia
Term
incidence of CP
Definition
0.5% of all births
Term
% CP associated with a perinatal hypoxic event
Definition
<25%
Term
% CP associated with normal apgars
Definition
75%
Term
things associated with CP - 5
Definition
IUGR, maternal infection, congenital malformations, multiples, metabolic disorders
Term
definition of hypoxic ischemic encephalopathy
Definition
disturbed neurologic function within the 5d after birth of a 35wk+ bay
Term
incidence of HIE
Definition
1.5:1000
Term
cause of HIE
Definition
fetal acidosis, worse with intrapartum fever
Term
long term sequalae of HIE - 2
Definition
CP, spastic quadriplegia
Term
short time sequalae of HIE - 6
Definition
neuro issues, organ dysfunction, lower LOC, seiures, depressed reflexes, respiratory depression
Term
signs of a neonatal acute intrapartum event - 6
Definition
APGAR <5 at 5 and 10 min
pH <7
BE <-12
sustained NRFHT
multi organ failure within 72h
MRI brain with HIE changes (non-focal)
Term
signs HIE was caused by acute intrapartum event - 4
Definition
NRFHT, event right before delivery, timing of brain injuryr consitent with acute intrapartum event, no other contributing factors
Term
when to get cord gasses - 7
Definition
CD for NRFHT, 5m apgar <7, NEFHT, severe IUGR, maternal thyroid disease, intrapartum fever, multiple gestation
Term
normal cord pH
Definition
7.25-7.28
Term
normal cord CO2
Definition
49.9-50.3
Term
normal cord bicarb
Definition
20-23.1
Term
normal cord base deficit
Definition
-4.3 to -2.7
Term
cause of fetal respiratory alkalosis
Definition
transient cord compression
Term
cord gasses associated with fetal respiratory acidosis
Definition
low pH, high CO2
Term
cord gas pattern most associated with neurologic damage
Definition
metabolic acidosis
Term
best cord gas to evaluate risk of neurologic injury
Definition
base deficit
Term
theraputic hypothermia has to be done within ___h of birth and lasts __h
Definition
6h, 72h
Term
theraputic hypothermia improves - 6
Definition
mortality, neurodevelopmental disability, major disability, neuromotor delay, CP, IQ
Term
rate of inifant death and disability in HIE
Definition
death 15-20%, disability 25%
Term
prognosis of fetal arrhythmia - 5
Definition
95% resolve
if dont...
20% mortality in 1st year of life
20% chance fetal mortality
67% liklihood of requiring pacing
15% risk of cardiomyopathy
Term
most common cause of fetal arrhythmia - 2
Definition
PAC/SVT (220-240) and Afib
Term
causes of fetal heart block andincidence - 3
Definition
55% structual heart disease, 40% lupus antibodies, 5% genetic conduction defect/myocarditis, methothelioma of the AV node
Term
rate of a complete heart block
Definition
50-70bpm
Term
recurrence of complete heart block
Definition
16-20%
Term
% lupus and sjogerns that have babies with complete heart block
Definition
10-60% lupus, 70-95% sjogerns
Term
physiology hayline membrane disease
Definition
high alveolar surface tension, low surfactant, immature lungs
Term
prognosis hayline membrane disease
Definition
increased fetal death <32wk
Term
signs hayline membrane disease - 10
Definition
tachypnea, nasal flaring, expiratory grunting, cyanosis, retractions, <28wk, atelectsis, pulmonary edema, diffuse ground glass CXR
Term
signs TTN - 6
Definition
increased WOB, tachypnea, cyanosis, 34-37wk, CXR diffuse infiltrates and perihilar streaking
Term
benefits of circumcisionj - 5
Definition
decreased UTI, penile cancer, HIV, genital ulcers, cervical cancer
Term
contraindications circumcision - 3
Definition
prematurity, fhx bleeding, penile abnormalities
Term
physiology dandy walker malformation
Definition
hypoplasia of cerebellar vermis
Term
signs dandy walker malformation 2
Definition
ventriculomeagly
Term
when does the neural tube close
Definition
4wk (6wk LMP)
Term
types of ONTD and incidence
Definition
spina bifidia 50%
anancephaly 45%
encephalocele 5%
Term
physiology anancephaly
Definition
absence of all or part of brain, scalp, skin
Term
incidence anancephaly
Definition
1:1000
Term
causes of anancephaly - 8
Definition
multifactorial - obesity, DM, valproic acid, alcohol, carbamazapine, radiation, heat, low folic acid
Term
recurrence rates anancephaly
Definition
2%, lowered 60% by 4mg folic acid daily
Term
physiology encephalocele
Definition
failure of skull to form with extrusion of brain into membranous sac
Term
physiology spina bifida
Definition
failure of fusion of neural tube over 3-4 caudal vertebrae
Term
incidence of spina bifidia
Definition
1-2% of pregnancies
Term
signs of spinabifida and % incidence - 5
Definition
lemon sign 90%
banana sign (cerebellum)
cisterna magn 95%
arnold chiari herniation
ventriculomeagly 75%
Term
high folic acid goods - 8
Definition
beef liver, spinach, black eyed peas, fortified cereals, white rice, asparagus, spaghetti, brussel sprouts
Term
incidence of holoprosencephaly
Definition
1:16000 live births, 1:250 abortases
Term
physiology of holoprosencephaly
Definition
single primitive holoventricle and fused thalamus, failure of diverticulation of proencephalon
Term
types of holoprosencephaly 2
Definition
alobar - intrahemespheric fissue and falx absent
lobal - most favorable
Term
signs of holoprosencephaly - 2
Definition
sickle shaped ventricles, bulb like undivided thalamus
Term
associations with holoprosencephaly - 7
Definition
hypotelerosim, cyclopia, narrow nasal bridge, probiscus, clefts, T13, T18
Term
signs of myelodysplastic kidney - 5
Definition
UL, female, poor defined outlike, enlarged, non-communicating cysts of different sizes
Term
signs of ARPCKD - 9
Definition
enlarged, BL, poorly distended bladder, oligo, defined kidney outline, normal shape kidney, pulmonary hypoplasia, renal failure, hepeatic fibrosis
Term
signs of bladder obstruction - 1
Definition
bilateral kidney dilation
Term
signs of UTJ obstruction - 1
Definition
area of central dilation where ureter joins kidney
Term
management of sacrococcygeal teratoma
Definition
vertical CD
Term
complications sacrococcygeal teratoma - 2
Definition
<15% malignant, hemorrhage at birth
Term
cleafts are __% of all congenital anomalies
Definition
15
Term
prevalece of the types of cleft lip/palate combinations
Definition
50% combined - higher in males
50% one or other - palate alone higher in females
Term
% of clefts that are midline
Definition
1% - usually on left
Term
associations with clefts
Definition
cerebral anomalies, holoprosencephaly, AD (rare), phenytoin, valproic acid, topomax, smoking, alcohol, low folic acid, DiGeorge, treacher collins, amniotic bands, T13, mercury
Term
when can clefts be seen
Definition
12wk
Term
congenital cystic adenoid malformation of the lung - physiology
Definition
harmatoma of the terminal bronchioles
Term
congenital cystic adenoid malformation of the lung - signs - 6
Definition
usually UL and in 1 lobe, can cause vena cava compression and hydrops, polyhydraminos, and pulmonary hypoplasia
Term
congenital cystic adenoid malformation of the lung - types - 3
Definition
1- cysts 1.2cm
2- microcystic
3 - solid lesion
Term
congenital cystic adenoid malformation of the lung - prognosis
Definition
hydrops is a bad sign, need surgical resection after birth
Term
signs of thenatophoric dysplasia - 6
Definition
telephone reciever thigh bones (type 1), bell chest (narrow, short ribs), cloverleaf skull (type 2), flat spine (type 1), redundant folds, under developed lungs
Term
thenatrophoric dysplasia prognosis
Definition
usually die of respiratory failure in uteruo
Term
thenatrophic dysplasia inheritence
Definition
AD or de novo
Term
50% major cause of infant death
Definition
IVH
Term
causes of IVH - 3
Definition
indomethacin near delivery, BMTZ, prematurity
Term
Erb-duchenne cause, signs
Definition
injury C5-7, waiters tip
Term
Klumpkes palsy - cause, signs
Definition
C7-T1 injury, claw hand
Term
prognosis of brachial plexus injuries
Definition
90% resolve in 24mo
Term
% brachial plexus injuries occuring without TOL, in CD
Definition
5%
Term
weeks of gestation you would consider neonatal interventions
Definition
20-21+6 - none
22-22+6 - consider NRP and PROM Abx
23-23+6 - consider all meds
24-24+6 - consider CD for fetal inducations
25+ do CD for fetal indications
Term
rate of NICU admission, RDS, and CP in premature vs mature babies
Definition
CP - 0.1 to 0.4%
NICU - 7 to 36%
RDS 1 to 10%
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