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Obstetrics
OB
| Question | Answer |
|---|---|
| Which of the following blocks is useful for pain control in the parturient in the first stage of labor 1. Paravertebral lumbar sympathetic block 2. SAB 3. Epidural block 4. Femoral Nerve block | Paravertebral lumbar sympathetic block It blocks the transmission of painful stimuli from the cervical and uterine nerves. |
| What is the most common complication of neuraxial anesthesia in the parturient 1. Tinnitus 2. Bradycardia 3. Hypotension 4. Nausea and vomiting | Hypotension Bradycardia, n/v are often seen following neuraxial anesthesia, hypotension is the most common complication. Tinnitus is typically due to the toxic effects of the LA used and may indicate that an intravascular injection has occurred. |
| Which of the following interventions would be an alternative to administration of IA to facilitate uterine relaxation in a parturient 1. Pudendal block 2. Nitro 50 mcg IV 3. Ketamine 25 mg IV 4. All of the above | Nitro 50 mcg IV Although general anesthesia with 1.5-2.0 MAC of an IA will produce uterine relaxation for 2nd twin delivery, breech or removal of a retained placenta, the admin of nitro 50-500 mcg has replaced the need for GA to relax the uterus. |
| What is the minimum fasting period for an elective c-section 1. 4 hours 2. 6 hours 3. 8 hours 4. 12 hours | 6 hours Because parturients have decreased gastric emptying times and an increased risk for gastric reflux, the minimum fasting period for an elective cesarean section is 6 hours. |
| You are preparing to perform a lumbar epidural on a laboring patient. Compared to non-pregnant patient the parturient will require 1. Greater dose of LA 2. Lesser dose of LA 3. Addition of vasopressor for adequate analgesia 4. No change in dose | Lesser dose D/t a decrease in the epidural space due to venous congestion and/or progesterone-induced sensitivity to local anesthetics, pregnant patients require a lower total dose of local anesthetic to achieve an equivalent level of blockade. |
| Which of the following drugs will cross the placenta 1. Nitroprusside 2. Beta-blockers 3. Nitroglycerin 4. All of the above | All of the above |
| You are administering Nubain to a laboring patient, which 2 statements are true 1. greater degree of dysphoria than fentanyl 2. no active metabolites 3. lower incidence of nausea than morphine 4. produces resp depression like fentanyl | No active metabolites and less nausea than morphine Both nubain and stadol have lower incidences of nausea, vomiting, and dysphoria. They also have a ceiling effect on the degree of respiratory depression they produce. Their metabolites are inactive |
| You are performing a GA for c-section on a full term parturient using isoflurane. You know that this patient 1. the MAC of iso is elevated 2. the MAC of iso is decreased 3. the MAC of iso is unchanged 4. iso is contraindicated in parturients | the MAC of iso is decreased By 8-12 weeks of pregnancy, the MAC for volatile anesthetics is decreased and appears to parallel the rising progesterone levels. |
| Which of the following statements regarding obstetric patients is true 1. by 3rd tri CO is 50-60% higher than pre-pregnancy 2. by 3rd tri the renin activity is 12x higher than pre-pregnancy 3. CO is elevated for 21 days PP 4. All of the above are co | Renin activity is 12x higher than pre-pregnancy 1st trimester: CO is 15-25% higher. CO elevated x 24 hrs PP, returns to normal by 10 days. Despite the inc BV, renin/ATII levels are increased. Sensitivity to ATII is increased but Nepi is unchanged. |
| Which of the following LA do not place the fetus at risk for ion trapping 1. Chloroprocaine 2. Bupivicaine 3. Lidocaine 4. None of the above undergo ion trapping | Chloroprocaine Chloroprocaine is metabolized so quickly in the fetus that it has no opportunity to accumulate in any significant amount and is considered 'safe' from ion-trapping |
| How is the RAAS system altered by pregnancy 1. Renin activity is decreased 2. Sensitivity to ATII is decreased 3. Sensitivity to Nepi is increased 4. RAAS is not affected by pregnancy | Sensitivity to ATII is decreased Despite the increased BV, plasma renin and ATII levels are increased. By the 3rd trimester, renin activity is 12x greater. The sensitivity to ATII is decreased in the third trimester but sensitivity to Nepi is not chang |
| Which of the following respiratory changes occur during pregnancy 1. lung compliance doesn't change 2. airway resistance increases 3. MV decreases 4. dead space increases | lung compliance doesn't change Airway resistance decreases because progesterone induces bronchiolar smooth muscle relaxation. MV increases during pregnancy. Because dead space doesn't change, alveolar ventilation is increased by 70% at term. |
| Which of the following 6 parameters decrease during pregnancy 1. Plt count 2. O2 consumption 3. GFR 4. pulmonary vascular resistance 5. PVR 6. Hgb 7. SBP 8. FRC | plt, PulmVR, PVR, Hgb, SBP, FRC During pregnancy, O2 consumption and MV increase, but the FRC decreases. Both the plt count and hgb decrease. The CO, SV, and HR all increase but, the SBP, DBP, PVR, and pulmVR decrease. The GFR increases by 50%. |
| In the US the leading cause of maternal death a/w live birth is 1. PIH 2. PE 3. cardiomyopathy 4. hemorrhage | PE pulmonary embolism (21%) PIH (19%) other medical causes (17%). |
| On a per kg basis, ventilatory parameters that remain unchanged from birth through adulthood include 1. dead space 2. minute ventilation 3. FRC 4. closing capacity | dead space Tidal volume and dead space per kilogram remain constant during development. (M&M 923) |
| Well oxygenated fetal blood from the placenta has a PaO2 of about 1. 40 mmHg 2. 60 mmHg 3. 80 mmHg 4. 100 mmHg | 40 mmHg During a normal pregnancy, umbilical vein blood has a PaO2 of approximately 40 mmHg. (M&M 879) |
| 33 wk neonate is delivered by c-section. The baby shows signs of tachypnea, grunting, intercostal retractions and cyanosis. The cause of the cyanosis is 1. insufficient surfactant 2. transposition of the great vessels 3. insufficient Hgb F 4. ToF | insufficient surfactant Resp distress in preterms is caused by RDS (aka: hyaline membrane disease) (50-75% of deaths in preterms). Deficiency in production/secretion of surfactant, (type II pneumocytes). Adequate surfactant levels occur at 35 weeks. |
| EKG changes a/w the 3rd trimester of pregnancy 1. right axis deviation 2. 1st degree AVB 3. left axis deviation 4. sinus bradycardia | left axis deviation Elevation of the diaphragm shifts the heart position in the chest resulting in the appearance of an enlarged heart on a plain chest film and in left axis deviation and T wave changes on the electrocardiogram. (M&M 877) |
| 4 kg neonate has recurrent bradycardia. During an umbilical artery catheter placement the neonate becomes asystolic. Appropriate Epi dose 1. 0.01 mg 2. 0.25 mg 3. 0.04 mg 4. 0.5 mg | 0.04 mg Epinephrine 0.01 - 0.03 mg/kg is indicated for neonatal bradycardia (< 60 bpm) and asystole. This is usually delivered as a 1:10,000 solution. |
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Karebare25
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