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Lifespan > Apex quiz questions - OB > Flashcards

Apex quiz questions - OB Flashcards

1
Q

Maternal pH from baseline?

A

No change

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2
Q

Maternal PaO2 from baseline?

A

Increased

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3
Q

Maternal PaCO2 from baseline?

A

Decreased

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4
Q

Maternal HCO3 from baseline?

A

Decreased

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5
Q

Maternal oxyHgb curve shift baseline?

A

Increased or to the right

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6
Q

Maternal MV baseline? How much?

A

Increased by 50%

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7
Q

Maternal TV baseline? How much?

A

Increased 40%

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8
Q

Maternal RR baseline? How much?

A

Increased 10%

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9
Q

Maternal Total lung capacity? What does this include?

A

Decreased 5%

All values

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10
Q

Maternal VC? What does this include?

A

No change

Everything except CC

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11
Q

What happens to Mallampati score during pregnancy ?

A

It increases (becomes harder to view)

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12
Q

What happens to FRC in pregnancy ? What does this include?

A

It decreases

ERV
CC

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13
Q

What happens to CC during pregnancy ?

A

No change

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14
Q

O2 consumption ?

A

Increases with each stage of labor

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15
Q

Which hormones contribute to vascular engorgement?

A

Relaxin
Progesterone
Estrogen

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16
Q

Should nasal intubation be considered ?

A

No avoid at all costs

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17
Q

HR during pregnancy ?

A

Increased - Due to increased demand

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18
Q

SV during pregnancy ?

A

Increased - Due to increased volume

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19
Q

SVR during pregnancy ?

A

Decreased - Due to increased nitric oxide from progesterone

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20
Q

Pulmonary artery occlusion pressure during pregnancy?

A

Unchanged

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21
Q

O2 consumption?

A

Increased

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22
Q

MAP?
SBP?
DBP?

A

MAP - no change
SBP - no change
DBP - Decreased

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23
Q

PVR during pregnancy ?

A

Decreased

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24
Q

CVP and PAOP?

A

No change

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25
Q

Cardiac axis during pregnancy ?

A

Up and to the lef

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26
Q

Which three clotting factors decrease?

A

11, 13, protein S

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27
Q

Fibrin breakdown during pregnancy ?

A

Increases

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28
Q

PTT and antithrombin during pregnancy ?

A

Decreases

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29
Q

Plt count during pregnancy ?

A

Unchanged

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30
Q

Does pregnancy cause a hyper or hypercoagulable state? Risk for?

A

Hyper

6 times greater risk for DVTs

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31
Q

GFR and Creatinine Clearance in pregnancy ?

A

Increased due Higher cardiac output and higher intravascular volume

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32
Q

Gastric pH????

A

Decreases - the PH DECREASES (more acidic)

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33
Q

LES tone?

A

Decreases

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34
Q

Glucose in urine ?

A

Increases

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35
Q

Gastric emptying during pregnancy ?

A

No change until labor begins, then, decreases

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36
Q

Sensitivity to local anesthetics?

A

Increased sensitivity

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37
Q

Creatinine and BUN?

A

Decreases

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38
Q

Serum albumin and pseudocholinesterase ?

A

Decreases

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39
Q

Does heparin cross the placenta?

A

No

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40
Q

Does ketamine cross the placenta?

A

Yes

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41
Q

Do non depolarizing NMB cross the placenta?

A

No

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42
Q

Does metoprolol cross the placenta?

A

Yes

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43
Q

Does sevo and iso cross the placenta?

A

Yes

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44
Q

Does lidocaine cross the placenta?

A

Yes

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45
Q

Does fentanyl cross the placenta?

A

Yes

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46
Q

Does succ cross the placenta?

A

No

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47
Q

Does atropine cross the placenta?

A

Yes

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48
Q

Does versed cross the placenta?

A

Yes

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49
Q

Does glyco cross the placenta?

A

No

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50
Q

Does propofol cross the placenta?

A

Yes

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51
Q

Does insulin cross the placenta?

A

No

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52
Q

Does mag cross the placenta?

53
Q

What is uterine blood flow at term?

A

700ml/min or 10% CO

54
Q

What molecular weight is able to cross the placenta?

A

Low, <500 Daltons

55
Q

which stage of labor has perineal pain

56
Q

When does the first stage of labor begin and end?

A

Begins with regular contractions and ends at 10cm fully dilated

57
Q

When does the latent stage of labor end? What stage is this apart of?

A

Apart of stage 1

Ends at 3 cm dilated

58
Q

When does active labor begin? What stage is this apart of?

A

Apart of stage 1

Begins at 3 cm dilated

59
Q

Do epidurals affect labor or increase the chance of C sections?

60
Q

What should NPO guidelines be for mom during labor?

A

ALWAYS considered a full stomach after 20 weeks

Encourage liquids throughout

Stop solid foods when neuraxial block is done

61
Q

Which block is specific to the second stage of labor?

62
Q

Which nerve innervates the perineum? What level?

A

Pudendal nerve from S2-S4

63
Q

What is the total coverage for labor?

64
Q

Is nitrous safe in pregnancy? Does it affect uterine contractility ?

A

Yes

No it does not affect it

65
Q

What happens when mom hyperventilates?

A

Causes a left shift in the oxyhgb curve, thus keeping O2 from baby

66
Q

What is the epidural volume technique?

A

Saline is injected right after the local to help spread the local higher

67
Q

Which local reduces the efficacy of epidural morphine?

A

Chloroprocaine because it antagonizes the mu and kappa receptors

68
Q

What are three ways a patient can develop a total spinal?

A

Epidural dose injected into the subdural space

Epidural dose injected into the subarachnoid space

Single shot spinal after failed epidural

69
Q

How does a total spinal present?

A

-Rapid progression of sensory and motor block
-Dyspnea, difficulty talking
-Hypotension
-LOC

70
Q

What position should a patient be put in for a total spinal?

A

Left uterine displacement

71
Q

mnemonic for FHR?

A

VEAL CHOP

Variable - cord compression
Early - Head compression
Accelerations - okay
Late - Placental insufficiency

72
Q

What are late decelerations? Risk for fetal hypoxemia?

A

Placental insufficiency - BAD

FHR falls after peak of contraction instead of recovering

YES

73
Q

What causes late decels?

A

-Maternal hypotension
-Acidosis
-Hypovolemia
-Preeclampsia

74
Q

What are early decelerations? Risk for fetal hypoxemia?

A

Head compression -

No risk for fetal hypoxemia

75
Q

What are variable decelerations? Risk for fetal hypoxemia?

A

Cord compression

RISK FOR fetal hypoxemia

76
Q

When giving a beta 2 agent, how does the uterus respond? Where does potassium shift?

A

-Uterus relaxes through increased cAMP
-K shifts into the cell thus resulting in hypokalemia

77
Q

How does blood sugar respond from a beta 2 agent?

A

Hyperglycemia occurs from glycogenolysis from the liver

78
Q

When a beta-2 agent is given to mom, what is the baby at risk for after delivery ?

A

Hypoglycemia because the mother’s glucose supply is gone but baby’s insulin is still in circulation

79
Q

How does magnesium effect calcium ?

A

It is an antagonist - blocks it

80
Q

How does magnesium effect the RMP?

A

It hyperpolarizes the cell

81
Q

What is a normal magnesium level ?

82
Q

What are responses to hypomagnesaemia

A

Tetany
Seizures
Dysrhythmias

(body is in an excited response)

83
Q

Symptoms of a magnesium level of 2.5-5?

A

No symptoms

84
Q

Symptoms of a magnesium level of 5-7?

A

Lethargy
Diminished reflexes
Flushing
N/V

85
Q

Symptoms of a magnesium level of 7-12?

A

Loss of deep tendon reflexes
Hypotension
EKG changes

86
Q

Symptoms of a magnesium level of >12?

A

Apnea
Heart block
Cardiac arrest

87
Q

Treatment for hypermagnesemia?

A

Calcium gluconate (1g over 10 minutes

Diuretics

Fluids

88
Q

What are 4 tocolysis drugs? What are they used for?

A

Stop contractions and relax the uterus

Beta-2
Mag
CCB
NO donors

89
Q

How do CCB effect the uterus? Which CCB is used?

A

Block calcium from entering the uterus

PO nifedipine

90
Q

How does NO effect the uterus? How?

A

Relaxes by increasing cGMP

91
Q

What increases the chances of prematurity?

A

Multiple gestations and premature rupture of membranes

92
Q

What are 6 complications of premature delivery

A

RINHHH

Respiratory distress
Intraventricular hemorrhage
NEC
Hypoglycemia
Hypocalcemia
Hyperbilirubinemia

93
Q

Co-administering what drug with nifedipine increases the likelihood of skeletal muscle weakness in the pregnant patient?

94
Q

How does magnesium effect NMBs?

A

Potentiates them by creating muscle weakness

95
Q

If magnesium is low, what are likely the levels of potassium and calcium

A

All low

Hypokalemia
Hypocalcemia
Hypomagnesemia

96
Q

Where is oxytocin stored and released?

A

Posterior pituitary with vasopressin

97
Q

What can rapid infusion of oxytocin cause?

A

Cardiovascular collapse

98
Q

Side effects of oxytocin?

A

Water retention, hypotension, hyponatremia

99
Q

What routes can oxytocin be given?

A

IV or injected into uterus

100
Q

What is the second line uterotonic drug? Dosage?

A

Methergine

0.2mg only IM

101
Q

Side effects of methergine ?

A

Significant vasoconstriction and hemorrhage

102
Q

Third line uterotonic drug? Dose?

A

Hemabate - same drug as Carboprost
(prostaglandin F2)

250mcg IV or intrauterus

103
Q

What is the major side effect and contraindication of Hemabate?

A

Bronchoconstriction (ASTHMA)

104
Q

When should oxytocin be given ?

A

After delivery of the placenta

105
Q

What is the most common cause of maternal death during delivery? What is the mortality rate of general anesthesia?

A

Failure to manage the airway

17x higher

106
Q

Position and tub size for intubation?

A

HEELP

6.0-7.0

RSI

107
Q

When is mom considered a full stomach?

108
Q

Timeframe for the baby to get out after uterine incision? What is increased after the missed time?

A

3 minutes, otherwise baby becomes acidotic

109
Q

What is the triple prophylaxis for aspiration?

A

Sodium citrate (neutralizes acid)
H2 - Ranitidine (blocks secretion)
Gastrokinetic - Reglan (hastens emptying and increases LES tone)

110
Q

Three benefits of GA?

A

Speed of onset
Secure airway
Greater hemodynamic stability

111
Q

When is GA warranted?

A

Maternal hemorrhage
Fetal distress
Coagulopathy
Refusal to regional
Contraindications to regional

112
Q

When should nitrous be avoided?

A

First and second trimester

113
Q

What drugs have long track records of safety?

A

Opioids
Inhalation
All muscle relaxants
Thiopental

114
Q

How long should elective surgery be delayed?

115
Q

What is the best trimester for surgery ?

116
Q

When is the highest risk of teratogenicity ?

A

Organogenesis (day 13-60)

117
Q

What signs are consistent with preeclampsia?

A

Proteinuria
HTN
Increased thromboxane
Decreased prostacyclin
Platelet aggregation

118
Q

What is the definitive treatment for preeclampsia and eclampsia? What happens even after delivery ?

A

Delivery

Mom still at risk for HTN, stroke for 4 weeks after

119
Q

Treatment for eclampsia?

A

Magnesium 4g over 10 minutes
1g an hour after

120
Q

Which beta blocker is okay to use in cocaine overdose with mom?

121
Q

Best drug of choice for hypotension with a mom using cocaine?

A

Phenyl because cocaine depletes natural catecholamines

122
Q

How can cocaine effect platelets ?

A

Decreases them

123
Q

Antidote for mag toxicity?

A

10mL of calcium gluconate

124
Q

What is the most significant concern regarding abnormal placental implantation?

A

Impaired uterine contractility and massive blood loss

125
Q

What are 3 causes of DIC during labor?

A

Amniotic fluid embolism
Placenta abruption
Intrauterine fetal demise

126
Q

Fluid dosage for a neonate? Epi dose?

A

10ml/kg

.01mg or 10mcg /kg

127
Q

What type of heat protects newborns from hypothermia?

128
Q

Normal HR and RR of a neonate?

A

120-160 bpm

30-60 breaths per minute

129
Q

What is a normal SpO2 of the neonate immediately after delivery ?

Lifespan (11 decks)

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