ACOG quiz UPDATED ACTUAL
Questions and CORRECT Answers
Most lethal finding in achondroplasia in infant - CORRECT ANSWER - The most
ominous complication of achondroplasia in infancy is pulmonary hypoplasia, which is indicated
by a small chest- to- abdominal circumference ratio (<0.6). The ratio can be measured prenatally,
and it is a strong predictor of perinatal lethality.
Risk factors for anencephaly - CORRECT ANSWER - Possible teratogens associated with
NTDs include: folic acid deficiency, heat (e.g., due to fever or use of hot tubs or saunas),
irradiation, alcohol abuse, aminopterin, valproic acid (spina bifida rather than anencephaly), and
maternal obesity
What is the banana sign? - CORRECT ANSWER - banana sign (Figure 4) is due to
distortion in shape of the cerebellum. It is typically associated with obliteration of the cisterna
magna and is due to the Arnold-Chiari malformation (downward herniation of the brain stem in
infants with spina bifida).
What is lemon sign indicative of? - CORRECT ANSWER - Spina bifida; The lemon sign
(Figure 1) is present in approximately 90% of fetuses at less than 24 weeks' gestation. After that
point in gestation, the skull is more rigid, and the scalloping of the frontal area is not as obvious.
Choriod plexus cyst, ventriculoseptal defect, omphalocele, and "rocker bottom" feet -
CORRECT ANSWER - Trisomy 18
Parvo B19, erythema infectious, most common fetal congenital effect? - CORRECT
ANSWER - hydrops
Associated with echogenic bowel - diseases? - CORRECT ANSWER - Four major
conditions/abnormalities have been associated with echogenic bowel: cystic fibrosis, congenital
cytomegalovirus (CMV) infection, Down's syndrome, and aspiration of blood.
,BV pregnancy treatment - CORRECT ANSWER - oral metronidazole (250 mg three times
daily for 7 days).
Pentalogy of Cantrel? - CORRECT ANSWER - This fetus has the Pentalogy of Cantrell,
which is a rare congenital syndrome that has abnormalities in the following anatomic sites: lower
sternum, anterior diaphragm, diaphragmatic pericardium, anterior supraumbilical abdominal
wall, and heart. The most common cardiac anomaly is ectopia cordis, as illustrated in the
photograph, where the cardiac silhouette is outside of the thoracic cavity adjacent to the
hypoplastic lungs and liver.
WHEN DOES splitting of the twins occur? - CORRECT ANSWER - Division at day 1 to
3 results in diamniotic, dichorionic placentation. Division at day 4 to 8 results in diamniotic,
monochorionic placentation. Finally, division at day 9 to 12 results in monoamniotic,
monochorionic placentation. C
Causes of hydrops - CORRECT ANSWER - Other causes of hydrops fetalis include
tachyarrhythmias, chromosomal abnormalities, lysosomal storage disorders, and alpha-
thalassemia. Infectious diseases that can also cause hydrops fetalis include Parvovirus B19,
syphilis, cytomegalovirus, and toxoplasmosis. In patients with fetal hydrops, MCA doppler
studies are invaluable in confirming the diagnosis of fetal anemia. When the peak systolic
velocity in the MCA exceeds 1.5 multiples of median (MoM), the fetus almost certainly has
moderately severe anemia. Cordocentesis should then be performed to directly assess the fetal
hematocrit and perform an intrauterine transfusion.
Van see woude syndrome - CORRECT ANSWER - van der Woude syndrome, which is
characterized by cleft lip or cleft palate, or both, in association with pit-like depressions on the
lower lip. Van der Woude syndrome is caused by mutations in the IRF6 gene, which is a
transcription factor that affects development and maturation of facial tissue. This syndrome is
inherited in an autosomal dominant pattern. Individuals with van der Woude syndrome may have
an increased risk of delayed language development and learning disabilities in the future, as well
as mild cognitive problems.
Rocker bottom feet, micrognathia, IUGR, microcephaly, low set ears, omphalocele, VSD/ASD -
CORRECT ANSWER - Trisomy 18
, S/e of protease inhibitors - CORRECT ANSWER - lipodystrophy (redistribution of fat to
the back of the neck and away from the cheeks; elevated insulin elects, glucose, LDL, TG, and
cholesterol
What is the threshold to start vaginal progesterone? - CORRECT ANSWER - <20 mm cx
What type of virus is Zika virus? - CORRECT ANSWER - Flavivirus, like West Nile,
Dengue; spread by Aeges aegypti; sexual contact; 20% have clinical findings (conjunctivitis,
maculopapular rash, arthralgia, low grade fever); incubation period for virus is 3-14 days; test
mom with serum and urine RT PCR. Fetus -amniocentesis PCR.
What ovulation induction agent do u use in PCOS patients? - CORRECT ANSWER -
Letrozole
At what viral load is it appropriate for HIV patient to deliver vaginally? - CORRECT
ANSWER - VL < 1000 copies/ml; greater than that, needs CS at 38W
What is the preferred regimen in HIV pos patient in pregnancy - CORRECT ANSWER -
Tenofovir - emtricitabine + atazanavir + ritonavir
Lemon sign shows... - CORRECT ANSWER - spina bifida
Banana sign? - CORRECT ANSWER - Deformation of the cerebellum - means
obliteration of the cisterns magna with NTD and ventriculomegal
Side effects of term ( what is term) - CORRECT ANSWER - B2 agonist of smooth muscle
of the uterus - causing it to relax; Can affect the beta 1 receptors of the heart; tachycardia,
palpitations, arrhythmias, pull edema, hypotension
What is the limit for when amnio can be done? - CORRECT ANSWER - >15W; before
that, CVS
Questions and CORRECT Answers
Most lethal finding in achondroplasia in infant - CORRECT ANSWER - The most
ominous complication of achondroplasia in infancy is pulmonary hypoplasia, which is indicated
by a small chest- to- abdominal circumference ratio (<0.6). The ratio can be measured prenatally,
and it is a strong predictor of perinatal lethality.
Risk factors for anencephaly - CORRECT ANSWER - Possible teratogens associated with
NTDs include: folic acid deficiency, heat (e.g., due to fever or use of hot tubs or saunas),
irradiation, alcohol abuse, aminopterin, valproic acid (spina bifida rather than anencephaly), and
maternal obesity
What is the banana sign? - CORRECT ANSWER - banana sign (Figure 4) is due to
distortion in shape of the cerebellum. It is typically associated with obliteration of the cisterna
magna and is due to the Arnold-Chiari malformation (downward herniation of the brain stem in
infants with spina bifida).
What is lemon sign indicative of? - CORRECT ANSWER - Spina bifida; The lemon sign
(Figure 1) is present in approximately 90% of fetuses at less than 24 weeks' gestation. After that
point in gestation, the skull is more rigid, and the scalloping of the frontal area is not as obvious.
Choriod plexus cyst, ventriculoseptal defect, omphalocele, and "rocker bottom" feet -
CORRECT ANSWER - Trisomy 18
Parvo B19, erythema infectious, most common fetal congenital effect? - CORRECT
ANSWER - hydrops
Associated with echogenic bowel - diseases? - CORRECT ANSWER - Four major
conditions/abnormalities have been associated with echogenic bowel: cystic fibrosis, congenital
cytomegalovirus (CMV) infection, Down's syndrome, and aspiration of blood.
,BV pregnancy treatment - CORRECT ANSWER - oral metronidazole (250 mg three times
daily for 7 days).
Pentalogy of Cantrel? - CORRECT ANSWER - This fetus has the Pentalogy of Cantrell,
which is a rare congenital syndrome that has abnormalities in the following anatomic sites: lower
sternum, anterior diaphragm, diaphragmatic pericardium, anterior supraumbilical abdominal
wall, and heart. The most common cardiac anomaly is ectopia cordis, as illustrated in the
photograph, where the cardiac silhouette is outside of the thoracic cavity adjacent to the
hypoplastic lungs and liver.
WHEN DOES splitting of the twins occur? - CORRECT ANSWER - Division at day 1 to
3 results in diamniotic, dichorionic placentation. Division at day 4 to 8 results in diamniotic,
monochorionic placentation. Finally, division at day 9 to 12 results in monoamniotic,
monochorionic placentation. C
Causes of hydrops - CORRECT ANSWER - Other causes of hydrops fetalis include
tachyarrhythmias, chromosomal abnormalities, lysosomal storage disorders, and alpha-
thalassemia. Infectious diseases that can also cause hydrops fetalis include Parvovirus B19,
syphilis, cytomegalovirus, and toxoplasmosis. In patients with fetal hydrops, MCA doppler
studies are invaluable in confirming the diagnosis of fetal anemia. When the peak systolic
velocity in the MCA exceeds 1.5 multiples of median (MoM), the fetus almost certainly has
moderately severe anemia. Cordocentesis should then be performed to directly assess the fetal
hematocrit and perform an intrauterine transfusion.
Van see woude syndrome - CORRECT ANSWER - van der Woude syndrome, which is
characterized by cleft lip or cleft palate, or both, in association with pit-like depressions on the
lower lip. Van der Woude syndrome is caused by mutations in the IRF6 gene, which is a
transcription factor that affects development and maturation of facial tissue. This syndrome is
inherited in an autosomal dominant pattern. Individuals with van der Woude syndrome may have
an increased risk of delayed language development and learning disabilities in the future, as well
as mild cognitive problems.
Rocker bottom feet, micrognathia, IUGR, microcephaly, low set ears, omphalocele, VSD/ASD -
CORRECT ANSWER - Trisomy 18
, S/e of protease inhibitors - CORRECT ANSWER - lipodystrophy (redistribution of fat to
the back of the neck and away from the cheeks; elevated insulin elects, glucose, LDL, TG, and
cholesterol
What is the threshold to start vaginal progesterone? - CORRECT ANSWER - <20 mm cx
What type of virus is Zika virus? - CORRECT ANSWER - Flavivirus, like West Nile,
Dengue; spread by Aeges aegypti; sexual contact; 20% have clinical findings (conjunctivitis,
maculopapular rash, arthralgia, low grade fever); incubation period for virus is 3-14 days; test
mom with serum and urine RT PCR. Fetus -amniocentesis PCR.
What ovulation induction agent do u use in PCOS patients? - CORRECT ANSWER -
Letrozole
At what viral load is it appropriate for HIV patient to deliver vaginally? - CORRECT
ANSWER - VL < 1000 copies/ml; greater than that, needs CS at 38W
What is the preferred regimen in HIV pos patient in pregnancy - CORRECT ANSWER -
Tenofovir - emtricitabine + atazanavir + ritonavir
Lemon sign shows... - CORRECT ANSWER - spina bifida
Banana sign? - CORRECT ANSWER - Deformation of the cerebellum - means
obliteration of the cisterns magna with NTD and ventriculomegal
Side effects of term ( what is term) - CORRECT ANSWER - B2 agonist of smooth muscle
of the uterus - causing it to relax; Can affect the beta 1 receptors of the heart; tachycardia,
palpitations, arrhythmias, pull edema, hypotension
What is the limit for when amnio can be done? - CORRECT ANSWER - >15W; before
that, CVS
