Apex quiz questions - OB Flashcards
1
Q
Maternal pH from baseline?
A
No change
2
Q
Maternal PaO2 from baseline?
A
Increased
3
Q
Maternal PaCO2 from baseline?
A
Decreased
4
Q
Maternal HCO3 from baseline?
A
Decreased
5
Q
Maternal oxyHgb curve shift baseline?
A
Increased or to the right
6
Q
Maternal MV baseline? How much?
A
Increased by 50%
7
Q
Maternal TV baseline? How much?
A
Increased 40%
8
Q
Maternal RR baseline? How much?
A
Increased 10%
9
Q
Maternal Total lung capacity? What does this include?
A
Decreased 5%
All values
10
Q
Maternal VC? What does this include?
A
No change
Everything except CC
11
Q
What happens to Mallampati score during pregnancy ?
A
It increases (becomes harder to view)
12
Q
What happens to FRC in pregnancy ? What does this include?
A
It decreases
ERV
CC
13
Q
What happens to CC during pregnancy ?
A
No change
14
Q
O2 consumption ?
A
Increases with each stage of labor
15
Q
Which hormones contribute to vascular engorgement?
A
Relaxin
Progesterone
Estrogen
16
Q
Should nasal intubation be considered ?
A
No avoid at all costs
17
Q
HR during pregnancy ?
A
Increased - Due to increased demand
18
Q
SV during pregnancy ?
A
Increased - Due to increased volume
19
Q
SVR during pregnancy ?
A
Decreased - Due to increased nitric oxide from progesterone
20
Q
Pulmonary artery occlusion pressure during pregnancy?
A
Unchanged
21
Q
O2 consumption?
A
Increased
22
Q
MAP?
SBP?
DBP?
A
MAP - no change
SBP - no change
DBP - Decreased
23
Q
PVR during pregnancy ?
A
Decreased
24
Q
CVP and PAOP?
A
No change
25
Cardiac axis during pregnancy ?
Up and to the lef
26
Which three clotting factors decrease?
11, 13, protein S
27
Fibrin breakdown during pregnancy ?
Increases
28
PTT and antithrombin during pregnancy ?
Decreases
29
Plt count during pregnancy ?
Unchanged
30
Does pregnancy cause a hyper or hypercoagulable state? Risk for?
Hyper
6 times greater risk for DVTs
31
GFR and Creatinine Clearance in pregnancy ?
Increased due Higher cardiac output and higher intravascular volume
32
Gastric pH????
Decreases - the PH DECREASES (more acidic)
33
LES tone?
Decreases
34
Glucose in urine ?
Increases
35
Gastric emptying during pregnancy ?
No change until labor begins, then, decreases
36
Sensitivity to local anesthetics?
Increased sensitivity
37
Creatinine and BUN?
Decreases
38
Serum albumin and pseudocholinesterase ?
Decreases
39
Does heparin cross the placenta?
No
40
Does ketamine cross the placenta?
Yes
41
Do non depolarizing NMB cross the placenta?
No
42
Does metoprolol cross the placenta?
Yes
43
Does sevo and iso cross the placenta?
Yes
44
Does lidocaine cross the placenta?
Yes
45
Does fentanyl cross the placenta?
Yes
46
Does succ cross the placenta?
No
47
Does atropine cross the placenta?
Yes
48
Does versed cross the placenta?
Yes
49
Does glyco cross the placenta?
No
50
Does propofol cross the placenta?
Yes
51
Does insulin cross the placenta?
No
52
Does mag cross the placenta?
Yes
53
What is uterine blood flow at term?
700ml/min or 10% CO
54
What molecular weight is able to cross the placenta?
Low, <500 Daltons
55
which stage of labor has perineal pain
Stage 2
56
When does the first stage of labor begin and end?
Begins with regular contractions and ends at 10cm fully dilated
57
When does the latent stage of labor end? What stage is this apart of?
Apart of stage 1
Ends at 3 cm dilated
58
When does active labor begin? What stage is this apart of?
Apart of stage 1
Begins at 3 cm dilated
59
Do epidurals affect labor or increase the chance of C sections?
No
60
What should NPO guidelines be for mom during labor?
ALWAYS considered a full stomach after 20 weeks
Encourage liquids throughout
Stop solid foods when neuraxial block is done
61
Which block is specific to the second stage of labor?
Pudendal
62
Which nerve innervates the perineum? What level?
Pudendal nerve from S2-S4
63
What is the total coverage for labor?
T10 - S4
64
Is nitrous safe in pregnancy? Does it affect uterine contractility ?
Yes
No it does not affect it
65
What happens when mom hyperventilates?
Causes a left shift in the oxyhgb curve, thus keeping O2 from baby
66
What is the epidural volume technique?
Saline is injected right after the local to help spread the local higher
67
Which local reduces the efficacy of epidural morphine?
Chloroprocaine because it antagonizes the mu and kappa receptors
68
What are three ways a patient can develop a total spinal?
Epidural dose injected into the subdural space
Epidural dose injected into the subarachnoid space
Single shot spinal after failed epidural
69
How does a total spinal present?
-Rapid progression of sensory and motor block
-Dyspnea, difficulty talking
-Hypotension
-LOC
70
What position should a patient be put in for a total spinal?
Left uterine displacement
71
mnemonic for FHR?
VEAL CHOP
Variable - cord compression
Early - Head compression
Accelerations - okay
Late - Placental insufficiency
72
What are late decelerations? Risk for fetal hypoxemia?
Placental insufficiency - BAD
FHR falls after peak of contraction instead of recovering
YES
73
What causes late decels?
-Maternal hypotension
-Acidosis
-Hypovolemia
-Preeclampsia
74
What are early decelerations? Risk for fetal hypoxemia?
Head compression -
No risk for fetal hypoxemia
75
What are variable decelerations? Risk for fetal hypoxemia?
Cord compression
RISK FOR fetal hypoxemia
76
When giving a beta 2 agent, how does the uterus respond? Where does potassium shift?
-Uterus relaxes through increased cAMP
-K shifts into the cell thus resulting in hypokalemia
77
How does blood sugar respond from a beta 2 agent?
Hyperglycemia occurs from glycogenolysis from the liver
78
When a beta-2 agent is given to mom, what is the baby at risk for after delivery ?
Hypoglycemia because the mother's glucose supply is gone but baby's insulin is still in circulation
79
How does magnesium effect calcium ?
It is an antagonist - blocks it
80
How does magnesium effect the RMP?
It hyperpolarizes the cell
81
What is a normal magnesium level ?
1.8-2.5
82
What are responses to hypomagnesaemia
Tetany
Seizures
Dysrhythmias
(body is in an excited response)
83
Symptoms of a magnesium level of 2.5-5?
No symptoms
84
Symptoms of a magnesium level of 5-7?
Lethargy
Diminished reflexes
Flushing
N/V
85
Symptoms of a magnesium level of 7-12?
Loss of deep tendon reflexes
Hypotension
EKG changes
86
Symptoms of a magnesium level of >12?
Apnea
Heart block
Cardiac arrest
87
Treatment for hypermagnesemia?
Calcium gluconate (1g over 10 minutes
Diuretics
Fluids
88
What are 4 tocolysis drugs? What are they used for?
Stop contractions and relax the uterus
Beta-2
Mag
CCB
NO donors
89
How do CCB effect the uterus? Which CCB is used?
Block calcium from entering the uterus
PO nifedipine
90
How does NO effect the uterus? How?
Relaxes by increasing cGMP
91
What increases the chances of prematurity?
Multiple gestations and premature rupture of membranes
92
What are 6 complications of premature delivery
RINHHH
Respiratory distress
Intraventricular hemorrhage
NEC
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
93
Co-administering what drug with nifedipine increases the likelihood of skeletal muscle weakness in the pregnant patient?
Magnesium
94
How does magnesium effect NMBs?
Potentiates them by creating muscle weakness
95
If magnesium is low, what are likely the levels of potassium and calcium
All low
Hypokalemia
Hypocalcemia
Hypomagnesemia
96
Where is oxytocin stored and released?
Posterior pituitary with vasopressin
97
What can rapid infusion of oxytocin cause?
Cardiovascular collapse
98
Side effects of oxytocin?
Water retention, hypotension, hyponatremia
99
What routes can oxytocin be given?
IV or injected into uterus
100
What is the second line uterotonic drug? Dosage?
Methergine
0.2mg only IM
101
Side effects of methergine ?
Significant vasoconstriction and hemorrhage
102
Third line uterotonic drug? Dose?
Hemabate - same drug as Carboprost
(prostaglandin F2)
250mcg IV or intrauterus
103
What is the major side effect and contraindication of Hemabate?
Bronchoconstriction (ASTHMA)
104
When should oxytocin be given ?
After delivery of the placenta
105
What is the most common cause of maternal death during delivery? What is the mortality rate of general anesthesia?
Failure to manage the airway
17x higher
106
Position and tub size for intubation?
HEELP
6.0-7.0
RSI
107
When is mom considered a full stomach?
20 weeks
108
Timeframe for the baby to get out after uterine incision? What is increased after the missed time?
3 minutes, otherwise baby becomes acidotic
109
What is the triple prophylaxis for aspiration?
Sodium citrate (neutralizes acid)
H2 - Ranitidine (blocks secretion)
Gastrokinetic - Reglan (hastens emptying and increases LES tone)
110
Three benefits of GA?
Speed of onset
Secure airway
Greater hemodynamic stability
111
When is GA warranted?
Maternal hemorrhage
Fetal distress
Coagulopathy
Refusal to regional
Contraindications to regional
112
When should nitrous be avoided?
First and second trimester
113
What drugs have long track records of safety?
Opioids
Inhalation
All muscle relaxants
Thiopental
114
How long should elective surgery be delayed?
2-6 weeks
115
What is the best trimester for surgery ?
Second
116
When is the highest risk of teratogenicity ?
Organogenesis (day 13-60)
117
What signs are consistent with preeclampsia?
Proteinuria
HTN
Increased thromboxane
Decreased prostacyclin
Platelet aggregation
118
What is the definitive treatment for preeclampsia and eclampsia? What happens even after delivery ?
Delivery
Mom still at risk for HTN, stroke for 4 weeks after
119
Treatment for eclampsia?
Magnesium 4g over 10 minutes
1g an hour after
120
Which beta blocker is okay to use in cocaine overdose with mom?
Labetalol
121
Best drug of choice for hypotension with a mom using cocaine?
Phenyl because cocaine depletes natural catecholamines
122
How can cocaine effect platelets ?
Decreases them
123
Antidote for mag toxicity?
10mL of calcium gluconate
124
What is the most significant concern regarding abnormal placental implantation?
Impaired uterine contractility and massive blood loss
125
What are 3 causes of DIC during labor?
Amniotic fluid embolism
Placenta abruption
Intrauterine fetal demise
126
Fluid dosage for a neonate? Epi dose?
10ml/kg
.01mg or 10mcg /kg
127
What type of heat protects newborns from hypothermia?
Radiant
128
Normal HR and RR of a neonate?
120-160 bpm
30-60 breaths per minute
129
What is a normal SpO2 of the neonate immediately after delivery ?
60%
