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OB S.Horvath > coexisting disease > Flashcards

coexisting disease Flashcards

1
Q

what are the s/s for thyroid storm?

A

high fever, tachycardia, agitation, severe dehydration

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2
Q

in a patient with hyperthyroidism, propranolol may exacerbate ___ following SAB

A

hypotension

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3
Q

patient with hyperthyroidism has an ____ response to prossors.

A

exaggerated

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4
Q

pheochromocytoma secretes excessive catecholamines including ____ and ____

A

norepinephrine and epi

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5
Q

pheochromocytoma: neuroendocrine tumor of the adrenal glands or ____ tissue that failed to involute

A

extra-adrenal chromaffin

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6
Q

a patient with a pheochromocytoma - anesthetic plan?

A
  • elective C-section

- preop therapy with a-blockers followed by b-blockers

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7
Q

B-blockade without prior A-blockade results in

A

unopposed a-stimulation, severe HTN

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8
Q

T/F: Pregnancy has no consistent effect on the course of bronchial asthma

A

TRUE

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9
Q

T/F: Bronchial asthma may be exacerbated during pregnancy d/t bronchoconstriction

A

FALSE: Bronchial asthma may improve during pregnancy d/t bronchodilation

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10
Q

anesthetic plan for pt with bronchial asthma?

A

continuous labor epidural

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11
Q

Why is an epidural preferable to spinal in bronchial asthmatic patient?

A

gradual onset- tolerate intercostal muscle weakness. reports of bronchoconstriction following SAB

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12
Q

avoid H2 blockers (cimetidine, ranitidine) because it increases sensitivity to ___ that causes ____

A

histamine, spasm

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13
Q

avoid GETA in asthmatic pt because ETT can trigger ____

A

bronchospasm

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14
Q

which drug on induction will cause bronchial relaxation

A

ketamine

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15
Q

which IH should you avoid in asthmatic?

A

desflurane

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16
Q

T/F paraplegia causes an increased incidence of preterm labor

A

TRUE

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17
Q

Paraplegia - consider autonomic hyperreflexia if lesion is above what spinal level?

A

T7

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18
Q

Autonomic hyperreflexia - triggers

A

stimulation of skin, distention of hollow viscus (bladder, uterus)

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19
Q

Autonomic hyperreflexia s/s

A

pilomotor erection, sweating, flushing, headache, severe HTN, bradycardia

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20
Q

paraplegic patient - avoid ___ d/t risk of hyperkalemia

A

succinylcholine

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21
Q

anesthetic plan for paraplegia: early ____ to prevent ____

A

early epidural analgesia to prevent hyperreflexia

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22
Q

which pattern of MS is characterized by attacks that appear abruptly and resolve over several months?

A

exacerbating remitting

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23
Q

what are the 2 general patterns of MS

A

exacerbating remitting and chronic progressive

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24
Q

how does MS manifest?

A

neurological defects that present as pyramidal, cerebellar, or brainstem symptoms

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25
Q

T/F the etiology for MS is unclear

A

TRUE. but possible link to previous exposure to vial agent that may trigger autoimmune response. [loss of myelin in CNS]

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26
Q

motor weakness, impaired vision, ataxia, bladder/bowel dysfunction, and labile emotions are characteristic of what disease?

A

MS

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27
Q

How is MS treated?

A

symptomatically and by immunosuppression. often tx is marked by relapses and regression

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28
Q

T/F Pregnancy has no effect on progression Multiple Sclerosis

A

TRUE.

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29
Q

T/F Pregnancy decreases the risk of relapse of MS

A

FALSE - slight increase

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30
Q

T/F MS relapses are most often seen in the postpartum period

A

TRUE. approx 3x higher rate than non-pregnant

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31
Q

T/F Pregnancy does not have an overall negative effect on long-term outcome of MS

A

TRUE

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32
Q

MS - anesthetic plan should have a careful assessment of which two areas

A

neurological and respiratory

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33
Q

What is the concern with MS and neuraxial anesthesia?

A
  • potential neurotoxic exposure of demyelinated spinal cord.

- concerns over relapse of symptoms

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34
Q

For an MS patient, do not exceed concentrations of >____% bupivacaine infusions.

A

0.25

35
Q

T/F SAB is recommended over epidural for MS pt

A

FALSE - Epidural better tolerated than SAB for MS patient, however SAB has been successfully employed. CSE technique well tolerated with IT opioids

36
Q

T/F GA Is contraindicated with MS

A

FALSE - but avoid succs with severe musculoskeletal involvement

37
Q

What can happen with a dural puncture with a patient with a brain tumor?

A

brain herniation and death

38
Q

Brain tumor patient: ____ blocks for first stage labor, ___ block for 2nd stage labor

A

b/l lumbar sympathetic blocks for first stage, pudendal block for second stage

39
Q

Brain Tumor C section: GETA with generous narcs to blunt reflexes during laryngoscopy and avoid sudden inc in ___ and ____

A

BP and ICP

40
Q

T/F Pseudotumor Cerebri - benign intracranial HTN is not mass related, and epidural or spinal block is okay

A

TRUE

41
Q

T/F Epilepsy is shown to have an increased risk of convulsions with use of local anesthetics

A

FALSE. proceed as normal

42
Q

Myasthenia Gravis is usually treated with anticholinergic agents such as ____ or ____

A

neostigmine or edrophonium

43
Q

T/F women are 3 times more likely to develop MG than men

A

TRUE

44
Q

Pregnancy can exacerbate MG symptoms, causing cholinergic crisis, which requires dose adjustment of ____

A

neostigmine

45
Q

MG contraindicated drugs

A

-ABX: gentamycin, kanamycin, streptomycin, plymyxin, colistin, tetracycline, lincomyicn

Tocolytics: Mag sulf

Cardiac meds: quinidine, propranolol

Beta Adrenergics: Ritodrine, Terbutaline

Others: Quinine, Penicillamine, Lithium

46
Q

IV dose of neostigmine is given in ratio of __:__ to oral dose

A

30:1. monitor fetal HR!

47
Q

In an MG patient, ____ anesthesia is preferable to ____.

A

regional, general

48
Q

MG patient is highly sensitive to which agents

A

depolarizing and NDNMB. intubation doses 1/2 to 1/3 normal

49
Q

T/F MG patient is more resistant to effects of opioids and LA agents.

A

FALSE. more receptive to effects of opioids and LA.

50
Q

Cholinergic crisis should be treated with which drug?

A

atropine - IV & IM

51
Q

profound muscle weakness, resp failure, loss of bladder/bowel function, disorientation, diplopia are symptoms of?

A

Cholinergic Crisis (MG)

52
Q

Normal Hgb= HgbA, Sickle Cell =

A

HgbS

53
Q

Heteroxygous “sickle trait” =

A

HgbAS

54
Q

Homozygous =

A

HgbSS

55
Q

which Two forms of sickle cell dz have a higher incidence off preeclampsia?

A

HgbSS or HgbSC

56
Q

6 things to avoid in sickle cell patient

A

hypoxia, HoTN, dehydration, hypothermia, acidosis, tourniquets

57
Q

Sickle Cell: prefer epidural with adequate bolus with ___ prior to block

A

warmed IVF

58
Q

Sickle Cell: spinal or epidural?

A

epidural. decreased risk of HoTN.

59
Q

what is the most common hereditary coagulation abnormality

A

VonWillebrand Disease

60
Q

VonWillebrand Disease: what is the most common type? how do you tx?

A

type 1, Rx with DDAVP 0.3mg/kg

61
Q

Tachphylaxis can occur with DDAVP therapy at >___hr

A

48

62
Q

T/F Neuraxial blockade is a relative contraindication to sickle cell, although can be considered if coagulation times are monitored and appropriately treated

A

TRUE

63
Q

Factor V Leiden: variant of human coagulation factor __ that cannot be activated by ___ and therefore causes a ___coagulability disorder

A

V C hyper

64
Q

Factor V Leiden: Patient on lovenox very early in pregnancy is converted to heparin at week __ to facilitate neuraxial blockade

A

38

65
Q

Factor V Leiden: if prophylactic LMWH dose- hold >__hours before block

A

12

66
Q

Factor V Leiden: if therapeutic LMWH dose- hold >__hours before block

A

24

67
Q

Rheumatoid Arthritis - what are the resp concerns

A

restrictive lung dz, possible pleural effusions

68
Q

RA - what is the preferred anesthetic

A

continuous labor epidural, but may fail d/t arthritis.

for c-section, can use epidural or spinal. avoid potential difficult airway, may need awake fiberoptic intubation

69
Q

SLE: Early implementation of ___ anesthesia is recommended

A

regional

70
Q

T/F Due to the incidence of valve disorders and vegetation on SLE patient, prophylactic antibiotics are always recommended.

A

FALSE. only required if pt is high risk for endocarditis. (previous IE, unprepared cyanotic heart disease, implanted prosthetic devices, cardiac transplantation with cardiac valvulopathy)

71
Q

vocal cord palsy is seen with which disorder

A

SLE

72
Q

Maternal Addiction to amphetamines has what effect on catecholamines?

A

depletion. limited response to indirectly acting sympathomimietics such as ephedrine.

73
Q

Maternal Addiction to amphetamines increases or decreases MAC for GA? what is the consequence?

A

increases. increased IH = inc risk for uterine atony.

74
Q

Maternal Addiction - which drug can decrease plasma cholinesterase?

A

cocaine - prolongs duration of 2-chloroprocaine and succinylcholine

75
Q

the vasoconstrictive effects of cocaine have what effect on the fetus?

A

decreased uteroplacental blood flow

76
Q

Chronic cocaine - preferred anesthetic for C section

A

neuraxial - less HoTN - exaggerated HTN, tachycardia with ETT, severe tachyarryhtmias with GA

77
Q

T/F There is little evidence that HIV or antiretroviral drugs increase the incidence of pregnancy complications, or that pregnancy alters the course of infection

A

TRUE

78
Q

Pharyngeal lymphatic hypertrophy can create a potentially difficult airway in the patient with ___

A

HIV

79
Q

Hypotension d/t decreased afterload will reverse a ____ shunt, with resulting ___ shunting and cyanosis.

A

L–>R, R–>L

beware SAB!

80
Q

cardiac output is highest in pregnancy when?

A

~80% above baseline immediately following delivery, this will be stressful for patient with cardiomyopathy

81
Q

How does alcohol affect pregnancy/

A

increased risk of hemorrhage d/t esophageal varies, clotting abnormalities d/t hepatic dz, cardiomyopathy, neuropathy, increased gastric volume, acidity

82
Q

Which drug causes an increased risk of PTL, abrupt placentae, congenital abnormalities, growth retardation, LBW?

A

cocaine

83
Q

T/F Chronic cocaine use can cause increased clotting

A

FALSE - causes thrombocytopenia

OB S.Horvath (5 decks)

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