RNC-OB Exam: Study Points UPDATED ACTUAL Questions and CORRECT
Answers
Twin to Twin Transfusion Blood flows evenly between babies. The donor twin has decreased BV, is smaller,
and has poor UO = low AFI. The recipient twin has a high AFI and increased BV
which leads to strain to the heart and potential heart failure.
, Chronic Twin to Twin Transfusion Happens between 12-26 wks. It is the most serious type of TTS because they
cannot be delivered premature. Most do not survive, but if they do, they have
birth deficits.
Acute Twin to Twin Transfusion Occurs suddenly when there is a huge difference in blood flow between twins
that could be related to death or illness in one twin (donor) which flood the
recipient twin with volume. ATTS has a better prognosis.
Folate Deficiency High risk of NTD. Pts should take 0.4-0.8 mg (400-800mcg) of Folic Acid.
Maternal Lupus High risk of heart block in newborns. If pt is taking steroids, they will need a stress
dose w/ labor (can lead to NEC in infant).
Hydrops Fetalis Rh - mom attacks Rh + fetus (immune response)
Hyperthyroid Increased risk of PTD
Hypothyroid/Hashimotos Leads to infertility, increased risk of fetal brain/spinal cord problems, and PTD.
McBurney's Point RLQ pain associated with appendicitis.
What medication can you not give to a pt on Nubain or Stadol. These will cause immediate withdrawal.
Methadone/drug addict?
Amniocentesis Performed around 14-20 wks. Before 14 wks, risk is club foot and 15-26 wks, risk is
resp distress.
L/S Ratio 3:1 in DM. Contaminated amniotic fluid (blood or mec) can give a false ratio.
Chorionic Villus Sampling (CVS) Can not diagnose NTD/Spina bifida.
Early Decels Occur due to vagal response (increase ICP due to head compression).
Reactive NST A reactive NST is good for 24 hrs. Criteria is 15x15 accels at 32 wks (or 10x10 <32
wks), moderate variability, 20 mins (can extend to 40 if needed). Can be reactive
w/ variables if accel criteria is met (need BPP and AFI). Most common cause of
non-reactivity is fetal sleep.
BPP A reassuring BPP is good for 7 days. Measures breathing, movement, tone, AF,
NST. Last measures to be lost is tone and then fluid.
Moderate Variability Indicates an absence of acidemia and mature CNS.
Accels Indicates an absence of acidemia but cannot reliably predict acidosis.
Marked Variability No baseline is present.
Variable Decels Delta hypotension due to cord compression.
Answers
Twin to Twin Transfusion Blood flows evenly between babies. The donor twin has decreased BV, is smaller,
and has poor UO = low AFI. The recipient twin has a high AFI and increased BV
which leads to strain to the heart and potential heart failure.
, Chronic Twin to Twin Transfusion Happens between 12-26 wks. It is the most serious type of TTS because they
cannot be delivered premature. Most do not survive, but if they do, they have
birth deficits.
Acute Twin to Twin Transfusion Occurs suddenly when there is a huge difference in blood flow between twins
that could be related to death or illness in one twin (donor) which flood the
recipient twin with volume. ATTS has a better prognosis.
Folate Deficiency High risk of NTD. Pts should take 0.4-0.8 mg (400-800mcg) of Folic Acid.
Maternal Lupus High risk of heart block in newborns. If pt is taking steroids, they will need a stress
dose w/ labor (can lead to NEC in infant).
Hydrops Fetalis Rh - mom attacks Rh + fetus (immune response)
Hyperthyroid Increased risk of PTD
Hypothyroid/Hashimotos Leads to infertility, increased risk of fetal brain/spinal cord problems, and PTD.
McBurney's Point RLQ pain associated with appendicitis.
What medication can you not give to a pt on Nubain or Stadol. These will cause immediate withdrawal.
Methadone/drug addict?
Amniocentesis Performed around 14-20 wks. Before 14 wks, risk is club foot and 15-26 wks, risk is
resp distress.
L/S Ratio 3:1 in DM. Contaminated amniotic fluid (blood or mec) can give a false ratio.
Chorionic Villus Sampling (CVS) Can not diagnose NTD/Spina bifida.
Early Decels Occur due to vagal response (increase ICP due to head compression).
Reactive NST A reactive NST is good for 24 hrs. Criteria is 15x15 accels at 32 wks (or 10x10 <32
wks), moderate variability, 20 mins (can extend to 40 if needed). Can be reactive
w/ variables if accel criteria is met (need BPP and AFI). Most common cause of
non-reactivity is fetal sleep.
BPP A reassuring BPP is good for 7 days. Measures breathing, movement, tone, AF,
NST. Last measures to be lost is tone and then fluid.
Moderate Variability Indicates an absence of acidemia and mature CNS.
Accels Indicates an absence of acidemia but cannot reliably predict acidosis.
Marked Variability No baseline is present.
Variable Decels Delta hypotension due to cord compression.
