Analgesia SMFM questions

Question 1

level of spinal for c-section

Answer 1

T4

Question 2

level of epidural for vaginal delivery

Answer 2

T10

Question 3

Spinal nerves for uterine pain

Answer 3

10-12

Question 4

Spinal nerves for perineal pain

Answer 4

S2-4

Question 5

Spinal nerves affected with numbess of hands

Answer 5

C6-8

Question 6

Spinal nerves for the diaphram

Answer 6

C3-5

Question 7

Vassopressors for hypotension after spinal

Answer 7

ephedrine 5-10 mg (alpha and beta agonist)- fetal tachycardia
Phenylephrine 50-100 mcg ( higher umbical pH and less nausea/vomiting)

Question 8

What are the two opioid agonist/antagonists

Answer 8

nubain ( nalbuphine), and Stadol (butorphanol)

Question 9

are any of the anesthetic agents teratogenic?

Answer 9

No

Question 10

level of spinal cord lesion where autonomic dysreflexia is suspected

Answer 10

T6 - 80% wil have autonomic dysreflexia

Question 11

Cuases of autonomic dysreflexia

Answer 11

bowel/bladder distension, pelvic exams, painful stimuli

Question 12

Symptoms of autonomic dysreflexia

Answer 12

hypertension, hyperthermia, respiratory distress, bradycardia, tachycardia, seizures, death

Question 13

invasive hemodynamic monitoring in pregnancy

Answer 13

MAP 90
Cardiac output 6 
SVR 1200 
PCWP 7.5
CVP 3.5
LVSWI 48
COP 18

Question 14

pseudocholinesterase deficieny

Answer 14

accentuated by pregnancy (decreased 25%)

- prolongation of succinylcholine

Question 15

magnesium effect on anesthesia

Answer 15

binds to prejunctional motor nerve endings
block entry of calcium
decreasing the release of acetylcholine
decreasing sensitization of the motor end plate
prolongation of nondepolarizing muscle relaxants (no suc)

Question 16

neuraxial anesthesia with brain mass

Answer 16

mass without any mass effect, or evidence of hydrocephalus, or increased intracranial pressure, or CSF flow obstruction can have neuraxial anesthesia. Everyone else needs a neurosurgery consult

Question 17

anesthesia with Arnold chiari malformation type 1

Answer 17

No new onset symptoms lower risk

some will not place an epidural

Question 18

Anesthesia for pulmonary hypertension

Answer 18

minimize pulmonary vascular resistance
- avoid over-sedation/prostaglandin
- given oxygen 
Maintain blood volume 
Avoid myocardial depression 
- avoid beta blockers 
- Tele 
Maintain Afterload 
- intra arterial blood pressure 
- careful neuraxial 
- phenylepherine for vasopressors 
- titrate oxytoxin carefully

Question 19

anesthesia for aortic root dilation

Answer 19

continue beta blocker
careful neuraxial
avoid methergine/prostaglandins

Question 20

anesthesia for aortic stenosis

Answer 20

maintain afterload! 
- art line monitoring
- careful neuraxial 
- phenylephrine if needed 
Avoid tachycardia 
Tele
Maintain normovolemia

Question 21

anesthesia for mitral stenosis

Answer 21

avoid atrial fib (consider cardioversion)

Question 22

Fetal Hyperthroidisum

Answer 22

Growth restriction
fetal tachycardia
fetal goiter
craniocynostosis

Question 23

Thyroid storm

Answer 23

fever
tachycardia
cardiac dysregulation
CNS dysfunction

• PTU/dex (block conversion)
• iodine (block release)

Question 24

Anesthesia for cardiomyopathy

Answer 24

ephedrine (consider milrinone, dobutamine)

avoid bradycardia

Question 25

effect of NO on pulmonary pressure

Answer 25

can increase pulmonary pressure