a = new Array(219);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) Incorrect. Placental insufficiency as a problem is greatest in the third trimester. A good example of a cause is maternal diabetes."
a[2] = f + "(B) CORRECT. Abnormalities such as trisomy 16 and tetraploidy, not typically seen in livebirths, are found in many first trimester abortuses. Many first trimester pregnancy losses relate to fetal, not maternal, problems."
a[3] = f + "(C) Incorrect. Infections usually have a greater impact upon fetal loss later in pregnancy."
a[4] = f + "(D) Incorrect. Toxemia has the greatest impact in the third trimester and during delivery."
a[5] = f + "(E) Incorrect. Maternal drug use is a sporadic problem. Mothers who use cocaine have increased fetal loss. Smoking leads to low birth weight babies."
a[6] = f + "(A) Incorrect. The insertion point of the cord is not determined by the length of the cord. The vessels in the velamentous insertion are more prone to trauma."
a[7] = f + "(B) Incorrect. A low lying placenta increases the risk for marked hemorrhage at the time of delivery."
a[8] = f + "(C) Incorrect. Placental abruption typically leads to marked abdominal pain, fetal distress, and increased blood loss."
a[9] = f + "(D) Incorrect. Amnion nodosum is a rare occurrence that results from prolonged oligohydramnios, which typically leads to a short umbilical cord."
a[10] = f + "(E) CORRECT. A long umbilical cord from increased fetal movement can more easily wrap around the fetus."
a[11] = f + "(A) Incorrect. Rubella infection does affect the fetus in the first trimester, and can lead to congenital anomalies including heart disease with hydrops, cataracts, and microcephaly, but this infant has no anomalies."
a[12] = f + "(B) Incorrect. A balanced translocation in the mother can lead to a chromosomal abnormality, such as trisomy 21, in the baby, some of which have congenital heart disease with hydrops, but this does not explain the anemia."
a[13] = f + "(C) CORRECT. The hydrops and the icterus are findings of erythroblastosis fetalis, which is most often due to Rh blood factor differences between mother and fetus. The mother is exposed to differing fetal Rh antigen in a previous pregnancy and develops antibodies that cross the placenta in subsequent pregnancies to cause destruction of fetal red blood cells, leading to anemia and icterus."
a[14] = f + "(D) Incorrect. Gestational diabetes can lead to macrosomia, but hydrops is not the mechanism for this."
a[15] = f + "(E) Incorrect. Phenylketonuria is a rare metabolic disorder. High phenylalanine levels damage the fetal central nervous system."
a[16] = f + "(A) Incorrect. CMV can be a congenital infection that can lead to fetal hydrops and marked destruction of central nervous system with findings such as periventricular leukomalacia."
a[17] = f + "(B) Incorrect. Syphilis can be a congenital infection that involves the fetus in the third trimester and leads to marked hydrops. There can be gummatous necrosis with neutrophils in fetal organs, but not typically acute chorioamnionitis."
a[18] = f + "(C) Incorrect. HSV is a congenital infection most often acquired via passage through the birth canal. It is not marked by acute inflammation."
a[19] = f + "(D) Incorrect. Toxoplasmosis can be a congenital infection that leads to hydrops. The central nervous system is most likely involved. Neutrophilic infiltrates are not typically seen with toxoplasmosis."
a[20] = f + "(E) CORRECT. The acute inflammation suggests a bacterial infection, and group B streptococcus (GBS), which can colonize the vagina, is a common cause. GBS can elaborate a factor that dampens C5a mediated neutrophil chemotaxis, but neutrophils are still present."
a[21] = f + "(A) Incorrect. Congenital infections are not known for association with oligohydramnios."
a[22] = f + "(B) CORRECT. The oligohydramnios is part of a deformation sequence resulting in pulmonary hypoplasia. The urethral atresia precludes output of fetal urine. The atresia should increase the size of the fetal bladder, but in this case imaging was difficult."
a[23] = f + "(C) Incorrect. Tracheal stenosis is not associated with oligohydramnios, though there is a modest net outflow of fluid from the respiratory tract."
a[24] = f + "(D) Incorrect. Gastrointestinal tract obstruction could lead to polyhydramnios from failure of intake of amniotic fluid."
a[25] = f + "(E) Incorrect. The lack of just one kidney would not be sufficient to significantly reduce fetal urine output. Bilateral renal agenesis would lead to oligohydramnios."
a[26] = f + "(A) Incorrect. An elevated AFP suggests a neural tube defect. A decreased AFP is seen with some genetic abormalities."
a[27] = f + "(B) Incorrect. The fetal lung immaturity of this case is not a feature more common to genetic abnormalities."
a[28] = f + "(C) CORRECT. There is fetal lung immaturity leading to hyaline membrane disease. Tests for fetal lung maturity (usually reached by 35 to 36 weeks when there is sufficient production of surfactant by type II pneumocytes in fetal lung; intracellular surfactant is contained within lamellar bodies), including the older L:S ratio, as well as lamellar body count, phosphatidylglycerol, and fluorescence polarization (fpol). These can be done on amniotic fluid."
a[29] = f + "(D) Incorrect. TORCH titers are done to determine if a congenital infection is present, not test for fetal lung maturity."
a[30] = f + "(E) Incorrect. Maternal drug abuse with cocaine may increase placental problems and stillbirth but does not directly affect fetal lung function."
a[31] = f + "(A) Incorrect. Multiple external anomalies are readily apparent with trisomy 18, and it is rare for such a fetus to reach term."
a[32] = f + "(B) Incorrect. This inborn error of metabolism manifests itself months to years following birth."
a[33] = f + "(C) Incorrect. Babies of diabetic mothers tend to be large, not small."
a[34] = f + "(D) Incorrect. Hydrops and anomalies such as congenital heart diseasse are seen with this congenital infection."
a[35] = f + "(E) CORRECT. Smoking is the most common cause for low birth weight babies in developed nations. From maternal causes, the head size tends to be preserved in the fetus. Such babies have more complications following birth."
a[35.1] = f + "(F) Incorrect. Cord accidents such as tearing of a velamentous insertion, true knot, or nuchal cord are typically sudden peripartum events not affecting fetal size."
a[36] = f + "(A) Incorrect. About 1 in 850 males has Klinefelter's syndrome (47, XXY), but they are of normal intelligence."
a[37] = f + "(B) Incorrect. Gaucher's disease is a storage disease due to lack of glucocerebrosidase. It is autosomal recessive. The most common type does not involve brain."
a[38] = f + "(C) CORRECT. This is the most common cause of familial mental retardation, with karyotype 46 fra(X)Y. It is due to a 'triple repeat' mutation of a sequence of three nucleotides involving the FMR-1 gene that codes for FMRP that is found in cell cytoplasm, most prominently in brain and gonads."
a[39] = f + "(D) Incorrect. This autosomal recessive disorder occurs with an incidence of between 1:10000 and 1:25000. If not treated, mental retardation may result in either males or females."
a[40] = f + "(E) Incorrect. Mental retardation is a feature of all children with trisomy 21 (Down syndrome), whether male or female. Trisomy 21 is most often related to maternal age, not a family history."
a[40.1] = f + "(F) Incorrect. The extra Y chromosome results in males that are slightly taller than average, but mental function is normal. The prevalence is about 1 in 1000 males."
a[41] = f + "(A) Incorrect. Urinary tract anomalies are typically a cause for decreased amounts of amniotic fluid, known as oligohydramnios."
a[42] = f + "(B) Incorrect. VSD and other types of congenital cardiac disease often lead to congestive heart failure and fetal hydrops, but not increased amniotic fluid."
a[43] = f + "(C) Incorrect. CMV and other congenital infections often lead to fetal hydrops, but not often to increased amniotic fluid."
a[44] = f + "(D) CORRECT. Anomalies that interfere with fetal swallowing are most likely to produce an excess of amniotic fluid. Esophageal and intestinal atresias do this."
a[45] = f + "(E) Incorrect. The absence of a fetal cranial vault precludes cerebral development, leading to anencephaly, but this has no bearing on the amount of amniotic fluid."
a[45.1] = f + "(F) Incorrect. Gastroschisis is a lateral abdominal wall defect that can lead to an elevated alpha-fetoprotein in amnionic fluid and in maternal serum, but the amount of amnionic fluid would not likely be greatly affected. The defect could lead to intestinal malrotation but not obstruction."
a[46] = f + "(A) Incorrect. A di-di placenta is the most common variety of twin placenta and does not have vascular anastomoses."
a[47] = f + "(B) Incorrect. A congenital infection is likely to affect both fetuses in utero."
a[48] = f + "(C) Incorrect. Rh immunization with antibody directed against fetal cells will affect both fetuses."
a[49] = f + "(D) CORRECT. This is a twin-twin transfusion syndrome in which there is a vascular anastomosis across a monochorionic placenta leading to the marked size differential between the babies. The 'donor' twin becomes anemic, while the 'recipient' twin becomes plethoric from the vascular overload. The risk for death is greater in the plethoric recipient infant because of the potential for congestive heart failure. If they survive, the smaller eventually catches up in size"
a[50] = f + "(E) Incorrect. Such hemangiomas are rare, but the effects of this mass lesion will probably affect both fetuses."
a[51] = f + "(A) Incorrect. A decreased thyroxine suggests abnormal thyroid function. Inherited disorders of thyroid metabolism leading to cretinism are quite rare."
a[52] = f + "(B) Incorrect. HIV infection can predispose to infections that could cause diarrhea, but not meconium ileus."
a[53] = f + "(C) CORRECT. The findings are typical for cystic fibrosis, which is an inherited defect in chloride ion transport from a faulty CFTR gene. Meconium ileus manifesting soon after birth may be the first indication of cystic fibrosis. Later, pulmonary problems develop."
a[54] = f + "(D) Incorrect. Increased HVA suggests a congenital neuroblastoma, a mass lesion that arises most often in the adrenal gland."
a[55] = f + "(E) Incorrect. Jaundice is not a feature of cystic fibrosis. The pancreas is affected to produce the steatorrhea from fat malabsorption."
a[56] = f + "(A) Incorrect. Deformation of a body part occurs from a problem extrinsic to that part. A good example is oligohydramnios producing chest constriction and pulmonary hypoplasia."
a[57] = f + "(B) Incorrect. A disruption is typically a sporadic event, such as occurs with the limb body wall complex, where embryogenesis is disrupted with adhesions forming amnionic bands. The event causing early amnion disruption is not known."
a[58] = f + "(C) Incorrect. A sequence follows from a single anomaly, as can happen with urethral obstruction sequence leading to hydronephrosis and renal failure."
a[59] = f + "(D) Incorrect. Single gene mutations can account for the appearance of anomalies, but the variety of findings in this case does not fit with a known genetic defect."
a[60] = f + "(E) CORRECT. The fetus has the VATER association. An association is less specific for determination of subsequent recurrence risk than a defined syndrome."
a[61] = f + "(A) Incorrect. A cord should not be longer than about 72 cm."
a[62] = f + "(B) Incorrect. There should be two arteries and a vein. About 1% of livebirths have a single umbilical artery, which by itself is not life-threatening, but such a finding should prompt search for additional anomalies."
a[63] = f + "(C) CORRECT. This paracental location is the insertion point for most cords and has no significance."
a[64] = f + "(D) Incorrect. True knots are rare, but are abnormal and may lead to fetal death from hypoxia."
a[65] = f + "(E) Incorrect. Such acute inflammation (funisitis) points to intrauterine infection."
a[66] = f + "(A) Incorrect. Prolapse is a threat to the baby because the fetal blood supply can be cut off. The cord does not hemorrhage."
a[67] = f + "(B) CORRECT. In placenta previa, the placenta overlies the outlet to the birth canal, with resultant hemorrhage as it is pulled apart during dilation and subsequent descent of the baby into the birth canal."
a[68] = f + "(C) Incorrect. Infection may be associated with preterm premature rupture of membranes, but hemorrhage is not a feature."
a[69] = f + "(D) Incorrect. Most infarcts are small and inconsequential. Regardless of size, placental infarcts do not hemorrhage."
a[70] = f + "(E) Incorrect. Diabetes mellitus increases the risk for fetal loss, but hemorrhage is not a complication."
a[71] = f + "(A) Incorrect. Organogenesis has not started at the blastocyst stage."
a[72] = f + "(B) CORRECT. The point at which the developing organs are most susceptible to malformation from the teratogenic effect of rubella virus is in the first trimester (particularly from 5 to 8 weeks when significant organogenesis is occurring)."
a[73] = f + "(C) Incorrect. By the second trimester of pregnancy, virtually all of organogenesis is complete."
a[74] = f + "(D) Incorrect. By the third trimester of pregnancy, virtually all of organogenesis is complete."
a[75] = f + "(E) Incorrect. At term, virtually all organs have developed to their final stage of differentiation, with only an increase in cell size to follow."
a[76] = f + "(A) Incorrect. The baby was born at term. Prematurity is defined as less than 38 weeks gestation."
a[77] = f + "(B) CORRECT. Although the baby was born at term, the size is very small."
a[78] = f + "(C) Incorrect. Infants of diabetic mothers are typically larger than normal (they have macrosomia from the growth-promoting effects of increased insulin production by the fetal islets of Langerhans in the maternal hyperglycemic environment."
a[79] = f + "(D) Incorrect. Cystic fibrosis does not produce problems until after birth."
a[80] = f + "(E) Incorrect. Abruptio is a sudden event--a retroplacental blood clot--and does not affect fetal weight."
a[81] = f + "(A) Incorrect. von Gierke disease is a form of glycogen storage disease due to lack of glucose-6-phosphatase and leads to glycogen deposition in liver, with hepatomegaly but without cataract formation."
a[82] = f + "(B) Incorrect. Marfan syndrome is a connective tissue disorder with no primary effects on the liver."
a[83] = f + "(C) CORRECT. Galactosemia is due to a lack of an enzyme necessary to convert galactose to glucose."
a[84] = f + "(D) Incorrect. This is the 'R' in TORCH and leads to congenital malformations."
a[85] = f + "(E) Incorrect. PKU is due to a lack of phenlyalanine hydroxylase. The major problem is development of mental retardation if mother and/or child do not keep to a phenylalanine-free diet."
a[86] = f + "(A) Incorrect. Recurrent pneumonia with bronchiectasis is a complication of cystic fibrosis that begins in childhood."
a[87] = f + "(B) Incorrect. The pancreatic fibrosis with cystic fibrosis leads to diminished pancreatic lipase and other enzymes promoting fat absorption, but may eventually lead to loss of islets of Langerhans as well, but usually not until adulthood."
a[88] = f + "(C) CORRECT. Thick, viscid meconium in small intestine may lead to ileus in the immediate neonatal period in infants with cystic fibrosis."
a[89] = f + "(D) Incorrect. Right heart failure from chronic lung disease (bronchiectasis) is a complication that takes years to develop."
a[90] = f + "(E) Incorrect. Hepatic failure is not a feature of cystic fibrosis."
a[91] = f + "(A) Incorrect. Although Marfan syndrome is a connective tissue disorder, skin and joints are not affected."
a[92] = f + "(B) Incorrect. Osteogenesis imperfecta leads to fractures."
a[93] = f + "(C) CORRECT. Ehlers-Danlos syndrome comprises several variants which have as an underlying cause an inherited genetic defect in collagen synthesis and structure."
a[94] = f + "(D) Incorrect. This disease is also known as neurofibromatosis. The key feature is neoplasia."
a[95] = f + "(E) Incorrect. Children with xeroderma pigmentosa are subject to development of skin cancers because of an inability to repair DNA damaged from ultraviolet light."
a[96] = f + "(A) Incorrect. Tuberculosis does not produce perinatal infections, and the time course is too short for a granulomatous disease."
a[97] = f + "(B) Incorrect. Herpes simplex infection is typically acquired via passage of the baby through the birth canal."
a[98] = f + "(C) CORRECT. This is an acute chorioamnionitis, and bacterial infections that precede or follow premature rupture of membranes (PROM) are most often to blame."
a[99] = f + "(D) Incorrect. Syphilis is a congenital infection acquired in the third trimester, and it doesn't typically produce an acute chorioamnionitis."
a[100] = f + "(E) Incorrect. <I>Candida</I> is not known as a congenital infection."
a[101] = f + "(A) Incorrect. This is a so-called 'superfemale' or 'triple-X' karyotype."
a[102] = f + "(B) CORRECT. This is the karyotype for Turner syndrome (monosomy X). This karyotype is often seen with abortuses from the first trimester, but some persist, perhaps as a result of confined placental mosaicism."
a[103] = f + "(C) Incorrect. This is a normal female karyotype."
a[104] = f + "(D) Incorrect. This is the karyotype for Klinefelter's syndrome."
a[105] = f + "(E) Incorrect. This is a mosaic that is not typical for the findings given."
a[105.1] = f + "(F) Incorrect. The pattern of anomalies does not fit with trisomy 18. Moreover, long survivial with trisomy 18 is unlikely."
a[106] = f + "(A) Incorrect. The fetal circulation is usually adequate prior to birth with this condition. Following birth there would not be sufficient left heart function for prolonged survival."
a[107] = f + "(B) Incorrect. The diaphragmatic hernia allows abdominal contents access to the chest cavity, reducing the amount of space for lung development. After birth, however, without oxygen supplied via the placenta, the infant's respiratory status would be severely compromised."
a[108] = f + "(C) Incorrect. In utero, a fetal enzyme defect may not a problem, because of mother's intact metabolic pathways."
a[109] = f + "(D) Incorrect. Spina bifida, with incomplete posterior vertebral arch fusion is the least severe form of a neural tube defect and would have no major effect in utero."
a[110] = f + "(E) CORRECT. <I>Toxoplasma gondii</I> is an organism that can cause congenital infection and can lead to severe organ damage in utero."
a[111] = f + "(A) Incorrect. Congenital infections may lead to hydrops, but not macrosomia, and there is typically no tendency to hypoglycemia."
a[112] = f + "(B ) Incorrect. Liveborns with DiGeorge syndrome are at risk for hypocalcemia. A variety of congenital anomalies, including congenital heart disease, may be present. The lack of cell-mediated immunity takes time to manifest itself."
a[113] = f + "(C) CORRECT. At birth, the infant's islets of Langerhans are numerous and enlarged from being in the maternal hyperglycemic environment in utero, predisposing to hypoglycemia followin birth. Infants of diabetic mothers tend to be large, but with lung immaturity."
a[114] = f + "(D) Incorrect. Pancreatitis is generally not seen in newborns."
a[115] = f + "(E) Incorrect. Congenital neoplasms are not known for producing either large infants or hypoglycemia."
a[116] = f + "(A) CORRECT. The onset for an autosomal dominant condition, in this case Marfan syndrome, is most typical in infancy or childhood."
a[117] = f + "(B) Incorrect. For autosomal recessive conditions, the disease is only clinically apparent in the homozygotes. For autosomal dominant conditions, presence of a single gene mutation is sufficient for the disease to occur."
a[118] = f + "(C) Incorrect. Spontaneous new mutations do not commonly arise for autosomal recessive conditions, but are common for autosomal dominant conditions."
a[119] = f + "(D) Incorrect. The expression of an autosomal recessive disease within families is often quite similar, but there is often variable expressivity for autosomal dominant conditions."
a[120] = f + "(E) Incorrect. Recessive conditions often involve enzyme deficiencies, but autosomal dominant conditions typically involve structural genes."
a[121] = f + "(A) Incorrect. Abruptio placenta is a problem of later gestation."
a[122] = f + "(B) Incorrect. Torsion is not common and is not a major cause of fetal loss in the first trimester."
a[123] = f + "(C) Incorrect. <I>T. pallidum</I> crosses the placenta in the third trimester."
a[124] = f + "(D) CORRECT. A major cause for first trimester spontaneous abortion is fetal chromosomal anomalies, of which trisomy 16 is one of the most common."
a[125] = f + "(E) Incorrect. A maternal bicornuate uterus is rare, and would affect the fetus more in later gestation."
a[126] = f + "(A) Incorrect. Trauma does not lead to pulmonary hypoplasia."
a[127] = f + "(B) Incorrect. Polyhydramnios does not lead to pulmonary hypoplasia."
a[128] = f + "(C) CORRECT. The oligohydramnios that accompanies renal agenesis involving both kidneys leads to pulmonary hypoplasia and the Potter phenotype from constriction in utero."
a[129] = f + "(D) Incorrect. Lack of surfactant only becomes a problem after birth in a premature infant."
a[130] = f + "(E) Incorrect. Cystic fibrosis does not manifest pulmonary disease (recurrent infections) until childhood."
a[130.1] = f + "(F) Incorrect. <I>Listeria monocytogenes</I> can cross the placenta to infect the fetus. Pathologic findings include inflammatory foci resembling microabscesses or poorly formed granulomas. There is often hydrops fetalis."
a[131] = f + "(A) CORRECT. There are several syndromes associated with increased risk for Wilms tumor, including WAGR, Beckwith-Wiedemann, and Denys-Drash syndromes. The most common age of presentation for Wilms tumor is 3; most of these renal neoplasms are sporadic, not familial."
a[132] = f + "(B) Incorrect. Edwards syndrome is a synonym for trisomy 18, which is associated with a variety of congenital anomalies, but not neoplasms."
a[133] = f + "(C) Incorrect. Tay-Sachs disease is an inherited autosomal recessive storage disease that leads to severe psychomotor abnormalities but not to neoplasia."
a[134] = f + "(D) Incorrect. The amniotic band syndrome is a manifestation of the limb-body wall complex which results from early amnion disruption. It is not associated with neoplasia."
a[135] = f + "(E) Incorrect. Galactosemia is an autosomal recessive inborn error of metabolism that mainly affects the liver. It is not associated with neoplasia."
a[136] = f + "(A) Incorrect. RPKD is a bilateral process leading to very large kidneys and often renal failure from birth."
a[137] = f + "(B) Incorrect. Cystic fibrosis is relatively silent at this age, because severe pulmonary disease is still developing."
a[138] = f + "(C) Incorrect. Galactosemia typically produces prominent liver disease."
a[139] = f + "(D) CORRECT. Childhood tumors are not common, but at this age and at that location (presumably adrenal) neuroblastoma is high on the list."
a[140] = f + "(E) Incorrect. A cystic hygroma involves the posterior neck region and is best known as a feature of monosomy X (Turner syndrome)."
a[141] = f + "(A) Incorrect. A heart rate is present, though low, so a single point is given."
a[142] = f + "(B) CORRECT. A single point can be awarded in this case for the low heart rate. The prognosis with such a low Apgar score is very poor. This scale of measurement is named for Dr. Virginia Apgar, who was one of the founders of the field of neonatology."
a[143] = f + "(C) Incorrect. The heart rate is too low for the full 2 points to be given."
a[144] = f + "(D) Incorrect. Only a heart rate is detected in this case."
a[145] = f + "(E) Incorrect. Only a heart rate is detected in this case."
a[146] = f + "(A) Incorrect. This is too early to have an effect on organogenesis, though the infection might lead to abortion."
a[147] = f + "(B) CORRECT. This is the gestational age at which the heart and other major organs are most often affected by teratogenic agents, such as congenital rubella infection."
a[148] = f + "(C) Incorrect. PROM most often leads to bacterial infection with chorioamnionitis with abortion, not malformation."
a[149] = f + "(D) Incorrect. This exposure is less likely to cause cardiac malformation than an exposure earlier when organogenesis is most prominent (5 to 8 weeks gestation)."
a[150] = f + "(E) Incorrect. By delivery, the organs have already formed."
a[151] = f + "(A) Incorrect. Such malformations could be present either in a stillborn or an abortus."
a[152] = f + "(B) Incorrect. The manner of delivery may be a consequence, but not a cause, for abortion."
a[153] = f + "(C) Incorrect. Either abortuses or stillbirths may be macerated. Maceration results from prolonged death in utero."
a[154] = f + "(D) Incorrect. Infection could result in either abortion or stillbirth, depending upon when it occurred during gestation."
a[155] = f + "(E) CORRECT. An abortus is less than 20 weeks gestation and weighs less than 500 grams."
a[156] = f + "(A) Incorrect. Alpha feto-protein is about as abundant as albumin in fetal blood, though its function is obscure. It is best known as a marker of body wall defects such as neural tube defects and gastroschisis of the abdomen."
a[157] = f + "(B) Incorrect. Polyhydramnios suggests a gastrointestinal tract abnormality."
a[158] = f + "(C) Incorrect. This is the karyotype for Klinefelter syndrome, which affects about 1 in 500 males and has no major complications in utero."
a[159] = f + "(D) CORRECT. A large for gestational age baby with immature lungs suggests diabetes. The risk for premature delivery and pulmonary immaturity leading to hyaline membrane disease is increased when maternal diabetes is present."
a[160] = f + "(E) Incorrect. An elevated b-HCG can be seen with molar pregnancies."
a[161] = f + "(A) Incorrect. Tetralogy of Fallot is a form of cyanotic congenital heart disease."
a[162] = f + "(B) Incorrect. There are no anomalies in this case characteristic for a chromosomal abnormality."
a[163] = f + "(C) Incorrect. Fetal alcohol syndromem is accompanied by very subtle morphologic findings, but not anemia or hydrops."
a[164] = f + "(D) CORRECT. Fetal hydrops can be immune or non-immune. Non-immune causes include fetal anemia, cardiac defects, and chromosomal abnormalities. In this case, the lack of anomalies along with the anemia suggest congenital infection with parvovirus, which infects erythroid precursors. About 20% of women are seronegative for parvovirus, putting them at risk for passing the virus to the fetus during pregnancy if they become infected, but only a subset of these congenital infections have severe anemia."
a[165] = f + "(E) Incorrect. The lack of hyperbilirubinemia, and lack of prior pregnancy, is against immune hydrops in this case."
a[166] = f + "(A) CORRECT. An umbilical cord with a single artery suggests that other anomalies may be present, but does not guarantee it. The lack of the other artery is due either to aplasia or atrophy in development."
a[167] = f + "(B) Incorrect. Two vessel cords are seen more often with maternal diabetes, but most two vessel cords are not found in diabetic mothers."
a[168] = f + "(C) Incorrect. Risk for infection occurs at term with premature rupture of membranes, but this does not lead to a two vessel cord."
a[169] = f + "(D) Incorrect. The lack of one artery does not significantly compromise oxygenation of the fetus. At 38 weeks, fetal lung development should be sufficient to prevent respiratory distress."
a[170] = f + "(E) Incorrect. A normal umbilical cord has two arteries and a vein for a total of three vessels ('three vessel cord')."
a[171] = f + "(A) Incorrect. Herpes simplex virus is typically acquired by the fetus as it passes through the birth canal."
a[172] = f + "(A) Incorrect. Multiple gestation presents additional problems for mother and fetus, but acute chorioamnionitis is not increased significantly."
a[173] = f + "(C) Incorrect. Meconium presents a risk to the fetus from aspiration of the amniotic fluid containing the meconium."
a[174] = f + "(D) Incorrect. A retroplacental hematoma leads to fetal distress."
a[175] = f + "(E) CORRECT. The intact amniotic cavity protects the baby from ascending infection. The rupture of membranes breaches the sterile environment so infectious agents, particularly bacteria, can more easily reach the fetus."
a[176] = f + "(A) CORRECT. Fetal cells obtained from amniocentesis can by karyotyped to give a definitive answer regarding presence or absence of Down syndrome as well as other chromosomal abnormalities."
a[177] = f + "(B) Incorrect. Never, never, never tell the mother that a normal ultrasound rules out Down syndrome!!!"
a[178] = f + "(C) Incorrect. MSAFP is helpful to detect neural tube defects, not chromosomal abnormalities."
a[179] = f + "(D) Incorrect. Blood typing is routinely performed to determine whether there is a risk for hemolytic disease of the newborn from Rh incompatibility."
a[180] = f + "(E) Incorrect. A Pap smear can detect cervical infection or neoplasia, not fetal abnormalities."
a[181] = f + "(A) Incorrect. Many first trimester spontaneous abortions are due to trisomy 16. This is not seen in livebirths."
a[182] = f + "(B) Incorrect. The donor twin may be less developed and more prone to develop HMD, but this is not the best answer here."
a[183] = f + "(C) Incorrect. There is a greater likelihood that anomalies are present along with prematurity that predispose to HMD, but this is not the best answer here."
a[184] = f + "(D) Incorrect. Infants of diabetic mothers are at increased risk to be born prematurely with risk for HMD, but this is not the best answer here."
a[185] = f + "(E) CORRECT. The diminished surfactant from type II pneumonocytes is the underlying problem with HMD of the newborn. This occurs with prematurity, because fetal lung maturity has not been reached."
a[186] = f + "(A) Incorrect. Urinary tract abnormalities are not high on the list of findings with trisomy 13."
a[187] = f + "(B) Incorrect. Cystic hygroma most often suggests Turner syndrome with 45 X karyotype."
a[188] = f + "(C) CORRECT. Postaxial polydactyly is a key feature that suggests trisomy 13 (Patau syndrome). The prognosis is poor."
a[189] = f + "(D) Incorrect. Organomegaly is more typical for congenital infections than for chromosomal abnormalities."
a[190] = f + "(E) Incorrect. Most neural tube defects do not occur in the setting of a chromosomal abnormality."
a[191] = f + "(A) Incorrect. Placenta previa results with disruption of a low-lying placenta during delivery."
a[192] = f + "(B) Incorrect. Abruptio placenta results from a retroplacental hematoma with premature separation before delivery."
a[193] = f + "(C) Incorrect. Oligohydramnios can lead to the appearance of amnion nodosum, with focal small yellow-tan nodular excresences on the fetal surface."
a[194] = f + "(D) Incorrect. Infection leads to increased opacification of membranes and a yellow-tan appearance."
a[195] = f + "(E) CORRECT. Meconium imparts a greenish appearance when released from the baby, usually during fetal distress. It can be aspirated by the fetus in utero prior to delivery and produce a pneumonitis. When meconium spillage is suspected, lung lavage can be performed soon after delivery to aid in removal of the meconium from the lungs."
a[196] = f + "(A) CORRECT. This baby has a low birth weight (<2500 gm) and thus a 40X increased risk for death, regardless of the cause."
a[197] = f + "(B) Incorrect. Diabetes mellitus affects the fetus later in pregnancy via placental insufficiency. Also, infants of diabetic mothers tend to be larger than normal."
a[198] = f + "(C) Incorrect. Intraventricular hemorrhage is a complication of prematurity when the baby is between 22 and 30 weeks gestation."
a[199] = f + "(D) Incorrect. Fetal lung maturity is typically reached by 36 weeks gestation."
a[200] = f + "(E) Incorrect. Infections tend to produce growth retardation earlier in pregnancy. Infections late in pregnancy lead to premature birth and/or fetal death."
a[201] = f + "(A) CORRECT. Most dichorionic-diamnionic twin placentas occur in fraternal twins."
a[202] = f + "(B) Incorrect. Twin-twin transfusion is a complication of a monochorionic twin placenta."
a[203] = f + "(C) Incorrect. Malformations are more likely with a monochorionic-monoamnionic twin placenta."
a[204] = f + "(D) Incorrect. Infection is more likely to be related to maternal problems and not placental configuration."
a[205] = f + "(E) Incorrect. Fetal loss is more likely with a monochorionic-monoamnionic twin placenta."
a[206] = f + "(A) Incorrect. McArdle syndrome results from a deficiency of myophosphorylase and leads to muscle cramping with exercise."
a[207] = f + "(B) Incorrect. Hurler syndrome results from alpha-L-iduronidase deficiency and leads to one form of mucopolysaccharidosis characterized by progressive mental retardation, hepatosplenomegaly, and dwarfism, among others."
a[208] = f + "(C) Incorrect. Tay-Sachs disease results from a deficiency of hexosaminidase A and leads to severe neurologic abnormalities."
a[209] = f + "(D) CORRECT. There is a deficiency of glucose-6-phosphatase, so that glycogen is not metabolized readily to glucose. Because of this abnormality, patients have severe hypoglycemia, leading to convulsions. Intracytoplasmic accumulations of glycogen occur mainly in liver and kidney."
a[210] = f + "(E) Incorrect. Pompe disease occurs with a deficiency of alpha-1,4-glucosidase and leads to excess glycogen storage in the cardiac muscle."
a[211] = f + "(A) Incorrect. This is not a feature of trisomy 21, but can be seen with renal cystic diseases, though they are rarely manifested first at this age."
a[212] = f + "(B) Incorrect. Hepatic cirrhosis can be a feature of galactosemia, but survival to this age would be rare."
a[213] = f + "(C) CORRECT. He has Down syndrome, or trisomy 21. This is one of the trisomies that can result in a liveborn baby. However, there are often many associated congenital anomalies, particularly congenital heart disease, including ventricular septal defect."
a[214] = f + "(D) Incorrect. Trisomy 21 is not associated with accelerated atherosclerosis leading to coronary artery disease, and coronary atherosclerosis is highly unlikely at this age under any circumstance, even familial hypercholesterolemia."
a[215] = f + "(E) Incorrect. Aortic dissection is seen with Marfan syndrome, but typically in the 3rd or 4th decade."