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Board Review > Exam 3: Key Terms > Flashcards

Exam 3: Key Terms Flashcards

1
Q

What are some nonsurgical treatment options for pelvic relaxation?

A
  • Bladder training and biofeedback
  • Medical therapy (Anticholinergics, beta agonist, dopamine agonist, antidepressants)
  • Kegel exercises
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2
Q

What is the only definitive treatment option for pelvic relaxation and prolapse?

A

Surgical Treatment

  • Anterior vaginal wall repair
  • retropubic suspension procedure
  • sling procedure
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3
Q

Define endometriosis

A

Presence of endometrial tissue in extrauterine locations

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4
Q

What is the most common benign tumor in the female genital tract?

A

Leiomyoma (fibroids)

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5
Q

What are the symptoms of Leiomyomas (fibroids)?

A
  1. Bleeding (most common)
  2. Pain
  3. Pressure symptoms
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6
Q

What is the most common form of GYN cancer that also has the highest survival rate among American women?

A

Cervical cancer

-Routine Pap smears make identification of precursor lesions easier

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7
Q

What form of GYN cancer has the highest mortality rate?

A

Ovarian cancer

Much harder to detect, symptomatic only after extensive metastasis

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8
Q

What is pelvic relaxation/pelvic organ prolapse?

A

When there is descending or prolapsing into the vaginal wall.

(Urethrocele, cystocele, rectocele)

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9
Q

Where is endometriosis commonly found and what is the widely excepted cause?

A

Ovaries (60%)

Retrograde menstruation is widely excepted cause

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10
Q

How is diagnosis of endometriosis made and what is the definitive treatment?

A

Diagnosis under direct visualization (surgery)

Definitive treatment = TAH w/ BSO & removal of adhesions

{TAH w/ BSO = Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy}

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11
Q

Growth potential of fibroids is related to what? And what generally stops their growth?

A

Growth potential is related to estrogen production

Menopause generally stops it

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12
Q

What does it mean when a fibroid is pedunculated and what effect does it have on the patient?

A

Pedunculated = on stalk, twists, loses blood supply

Extremely painful

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13
Q

What are the surgical treatment options for fibroids?

A

Myomectomy = more complications, attempt to preserve fertility

Hysterectomy = Definitive treatment for women who have completed childbearing

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14
Q

What is the most common indication for hysterectomy?

A

Leiomyomas (fibroids)

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15
Q

What does the depth of penetration of malignant cells tell you about cervical cancer?

A

Depth of penetration of malignant cells predicts extent of the cancer and likelihood of metastases

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16
Q

How does laparoscopy differ from laparotomy?

A

Laparoscopy = inspection and manipulation of tissue within abdominal cavity using endoscopic instruments

Laparotomy = inspection and manipulation of tissue via an incision that permits good exposure

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17
Q

What is the difference between a total and radical hysterectomy?

A 
Total = removal of all of uterus
Radical = removal of uterus with very wide margins of surrounding tissue
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18
Q

How does pregnancy affect blood volume?

A

Blood volume increases from
Normal = 60-65 mL/kg
Pregnancy = 90 mL/kg (3rd Trimester)

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19
Q

What are the normal values for PaCO2 in 3rd trimester?

A

Normal PaCO2 = 40 mmHg

1st/2nd/3rd trimester = 30 mmHg

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20
Q

What effect does pregnancy have on cardiovascular measurements?

A 
CO = +40%
SV = +30%
HR = +15-30%
SVR = -20%
PVR = -30%
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21
Q

What affect does caval compression have on hemodynamics and how is this alleviated?

A

Decreases cardiac output 25 to 40%
(Hypotension)

Alleviated most often by left uterine displacement

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22
Q

What is Methergine used for?

A

Stimulates contractions, given after delivery to reduce size/blood loss by making the uterus “clamp down”

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23
Q

What effect does pregnancy have on lung volumes and respiration?

A 
TV = +40%
RR = +0-15%
MV = +40%
VO2 = + 60%

FRC = -20% (desat. faster)

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24
Q

What are the determinants of uterine bloodflow at term gestation?

A

Uterine bloodflow is PRESSURE DEPENDENT, NOT auto-regulated

From 50mL/min -> 600-700mL/min @ term

(Increase pressure, increase flow)

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25
Q

What is the P50 of maternal hemoglobin? How is this different from fetal or normal hemoglobin?

A 
Maternal = 30
Normal = 27
Fetal = 19
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26
Q

Normal physiological changes during pregnancy effect what systems?

A 
Cardiovascular
Respiratory
Neurological
Renal
Hepatic
Endocrine
Gastrointestinal
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27
Q

When during the course of pregnancy and delivery is cardiac output greatest?

A

Cardiac output greatest immediately following delivery

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28
Q

What effect does pregnancy have on MAC requirements? Local anesthetics?

A

Decreases MAC progressively (up to 40%)

Decreases local requirements (up to 33%)

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29
Q

What happens to PT and PTT in pregnant women?

A

Both shortened by 20%

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30
Q

Describe the stages of labor

A

Stage 1: water breaks, contractions start, ends with full cervical dilation

Stage 2: fetal descent and delivery

Stage 3: delivery of placenta

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31
Q

What effect does labor have on minute ventilation and oxygen consumption?

A

MV = 300% increase during intense contractions

VO2 = 60% increase from 3rd trimester values

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32
Q

What are some of the effects of preeclampsia?

A 
HTN
Proteinuria 
Edema
Headache 
Blurred vision
RUQ pain
Low platelet count
HELLP syndrome
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33
Q

When considering 3rd trimester bleeding, what is the difference between placenta previa and placental abruption?

A

Placenta previa = painless vaginal bleeding
–can localize on ultrasound

Placental Abruption = separation of placenta (most common cause of intrapartum fetal death)

  • port wine colored amniotic fluid
  • internal bleeding can make it difficult to gauge blood loss
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34
Q

What is a classic test dose for an epidural catheter?

A

45 mg of 1.5% lidocaine with 1:200,000 epi in 3mL

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35
Q

What is a normal fetal heart rate?

A

110-160 bpm

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36
Q

With neuraxial anesthesia, what level block is necessary for a C-section?

A

T4 (nipple level)

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37
Q

What is true of pregnant women and local anesthetics?

A

More sensitive by up to 33%

  • Decreased CSF volume causes enhanced cephalad spread of local
  • Higher risk for LAST
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38
Q

Early decelerations in fetal heart rate tracings are often associated with what?

A

Head compression as fetus moves toward delivery

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39
Q

Variable decelerations in fetal heart rate tracing are often associated with what?

A

Umbilical cord prolapse

-Umbilical cord comes between baby and opening, cutting off O2

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40
Q

Late decelerations in fetal heart rate tracings are suggestive of what?

A

Fetal asphyxia following contractions, such that contractions are cutting off fetal blood supply

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41
Q

What is the site of action for magnesium sulfate?

A

Direct vasodilation action on smooth muscle of arterioles and uterus

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42
Q

Why is it important to measure heart rate decelerations on the fetal heart rate tracing?

A

Heart rate decelerations are one of the only measurable fetal responses to stress

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43
Q

What type of anesthetic is preferred for a C-section and why?

A

Neuraxial

-Mortality rate 17x greater with general than with neuraxial anesthesia.

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44
Q

Why is pre-hydration for the parturient receiving a spinal block important?

A

Helps prevent hypotension

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45
Q

What is the most common indication for C-section?

A

Arrest of dilation

46
Q

What is the first sign of hypotension in the parturient?

A

Nausea and vomiting

47
Q

What NMB is typically used for induction during a stat C-section?

A

Succinylcholine

48
Q

What drug is often used as an adjunct for analgesia in the presence of an inadequate block?

A

Ketamine

49
Q

What is the number one cause of maternal mortality worldwide?

A

Hemorrhage

US = cardiovascular disease

50
Q

What is the safest and most effective medical intervention for labor pain?

A

Lumbar epidural

51
Q

Pain during stage 1 comes from the uterus and cervix. Where are they innervated?

A

T10-L1

52
Q

What is the difference in pain during stage 1 and stage 2?

A

Stage 1 = visceral (intense, but dull. Not localized)

Stage 2 = somatic (sharper, well localized)

53
Q

What are some of the signs of amniotic fluid embolism?

A

Triad: 1. Acute hypoxemia 2. Hemodynamic collapse 3. Coagulopathy without obvious cause (DIC)

Others: Tachypnea, cyanosis, CV shock, pulmonary edema, fetal distress, seizures

54
Q

What are two causes of antepartum hemorrhage?

A

Placenta previa

Placental abruption

55
Q

Define premature labor

A

Labor that occurs between 20 and 37 weeks gestation

56
Q

What is chorioamnionitis?

A

Infection of the chorionic and amniotic membrane, may involve the placenta, uterus and umbilical cord

57
Q

What are the clinical signs of chorioamnionitis?

A

Fever
Maternal and fetal tachycardia
Uterine tenderness
Foul-smelling amniotic fluid

58
Q

What is the mortality rate associated with amniotic fluid embolism?

A

86%

Most diagnosed postmortem

59
Q

What is the most common cause of intrapartum fetal death?

A

Placental abruption

60
Q

What is the most common form of placenta accreta?

A

Placenta accreta vera

-Adherence to myometrium without invasion of or passage through uterine muscle

61
Q

What is the major cause of postpartum hemorrhage?

A

Uterine atony

62
Q

How is uterine atony treated?

A

Oxytocin
Methergine
Hemabate

63
Q

What is HELLP syndrome?

A

PIH associated with
Hemolysis
Elevated Liver enzymes
Low Platelet count

64
Q

What type of anesthetic is generally not recommended for patients with HELLP syndrome?

A

Regional

-Platelet count actively falling

65
Q

Which drug used to treat hyperreflexia and prevent seizures in eclampsia can potentiate NMBs and sedative effects of opioids?

A

Magnesium sulfate

66
Q

What is the therapeutic level of magnesium sulfate and what can happen in excess of this range?

A

Therapeutic = 4-6 mEq/L

Above Therapeutic Level: ECG changes, muscle weakness, respiratory depression, SA/AV block, cardiac arrest

67
Q

Which two drugs can you not use for the treatment of PIH?

A

Esmolol (Bad for baby)

Calcium channel blockers (tocolytic)

68
Q

What should be avoided in patients with mitral or aortic insufficiency?

A

AVOID:

  • Increase in SVR
  • Decrease in contractility
  • Bradycardia
69
Q

What should be avoided in patients with mitral stenosis?

A

AVOID:

  • Sinus tachycardia
  • Atrial fibrillation
  • Increases in blood volume
70
Q

What should be avoided in patients with aortic stenosis?

A

AVOID:

  • Decreases in SVR
  • Bradycardia
  • Hypovolemia
71
Q

In general, which type of valvular disease is better tolerated in the pregnant patient stenotic or regurgitant?

A

Regurgitant

72
Q

List three left to right shunts

A
  • VSD
  • ASD
  • PDA
73
Q

Name one right to left shunt

A

TOF (Tetralogy of Fallot)

74
Q

What are the risk factors for gestational diabetes?

A

Advanced maternal age
Obesity
Family history
History of prior stillbirth, fetal malformation

75
Q

What is the primary chronic effect on the fetus of a mother with gestational diabetes?

A

Macrosomia (Big baby)

76
Q

What are the two most common structural malformations in fetuses born to mothers with gestational diabetes?

A
  1. Cardiac

2. CNS

77
Q

How do infants generate heat without the ability to shiver?

A

Brown fat metabolism

78
Q

80% pediatric cardiopulmonary arrests are due to what?

A

Respiratory distress

79
Q

How does the pediatric larynx differ from an adult?

A

Funnel shaped larynx

Narrowest point = cricoid ring

80
Q

At what age does obligate nasal breathing subside?

A

3 to 5 months

81
Q

How does an infant’s epiglottis differ from an adult’s?

A

Infant = omega shaped and angled away from the axis of the trachea

Adult = broader

82
Q

Where is the glottic opening relative to cervical vertebrae in the full-term infant? In the adult?

A

Full-term infant = C3, C4

Adult = C5, C6

83
Q

How is an endotracheal tube sized in the pediatric population?

A

Diameter = 4 + (age/4)

84
Q

How is the depth of an endotracheal tube determined in the pediatric population?

A

Where you hear bilateral breath sounds

Depth = 12 + (age/2)

85
Q

At what pressure is it appropriate to have a leak in an uncuffed endotracheal tube?

A

15-25 cmH2O

86
Q

Why has an uncuffed ETT been traditionally recommended in children less than eight years of age?

A

To avoid post extubation stridor and subglottic stenosis

However, requires more fresh gas flow and increases risk for aspiration

87
Q

Why is airway edema of greater concern in the pediatric population?

A

Poiseuille’s law (R=8nl/π^4)

A decrease in the radius will have an even greater effect on resistance

88
Q

Laryngotracheal stenosis occurs in what percent of prolonged pediatric intubations?

A

90%

89
Q

What is the oxygen consumption of an infant?

A

6 mL/kg/min (2x adults)

90
Q

True or False: Hypercarbia will stimulate ventilation in the term newborn

A

TRUE

91
Q

What effect does hypoxia have on newborns?

A

< 2-3 weeks: Transient increase in ventilation followed by a sustained depression

> 3 weeks: Hypoxemia induces sustained hyperventilation

92
Q

How is cardiac output controlled in the neonate?

A

HEART RATE Dependent

93
Q

What is the normal blood volume for a premature infant, full-term neonate, 12 month infant?

A

Premie = 90-100 mL/kg
Full-Term Neonate = 80-90 mL/kg
12 mo Infant = 75-80 mL/kg

94
Q

What are the normal blood pressure values for a neonate, 12 month old, 3 year old, 12 year old?

A

Neonate = 65/40
12 mo = 95/65
3 y/o = 100/70
12 y/o = 110/60

95
Q

What are the normal heart rate values for a neonate, 12 mo, 3 y/o, 12 y/o?

A

Neonate = 140
12 mo = 120
3 y/o = 100
12 y/o = 80

96
Q

What are the normal values for respiratory rate in a neonate, 12 mo, 3 y/o, 12 y/o?

A

Neonate = 40
12 mo = 30
3 y/o = 25
12 y/o = 20

97
Q

What is the pediatric dose of atropine?

A

0.01-0.02 mg/kg IV

Min PALS dose 0.1 mg

98
Q

What is the pediatric dose of succinylcholine?

A

2 mg/kg IV, 4 mg/kg IM

99
Q

What is the pediatric dose of versed?

A
  1. 5 mg/kg PO

0. 1 mg/kg IV

100
Q

What is the pediatric dose of rocuronium?

A

Same as adults

0.6-1.2 mg/kg IV

101
Q

What is the pediatric dose of fentanyl?

A

1-2 mcg/kg IV

102
Q

What is the pediatric dose of Zofran?

A

0.1 mg/kg IV

103
Q

What is the pediatric dose of Ancef?

A

25-50 mg/kg IV

104
Q

What are the pediatric fasting guidelines (in hours) for clear liquids and solids/milk?

A

Clear Liquids:
At least 2 hours

Solids, Milk, Formula:
< 6 mo = 4 hrs
6-36 mo = 6 hrs
> 36 mo = 8 hrs

105
Q

At what age are MAC requirements highest?

A

Peak @ 1-6 mo
~1.8 MAC

Levels out @ 1-5 years
~ 1.6 MAC

106
Q

What is the “rule of thumb” for caudal blocks?

A

Younger than 7 or less than 30 kg

107
Q

When do most cardiac arrests occur in children in the operative setting?

A

During induction

108
Q

What are two predictors of mortality in infants in the operative setting?

A 
ASA class 3-5
Emergency status
109
Q

At what point in gestation is pulmonary surfactant production sufficient?

A

> 35 weeks

110
Q

What is an anesthetic concern common to premature infants?

A

Respiratory distress due to insufficient surfactant

111
Q

What are two important considerations for airway management in a down syndrome child?

A
  • Downsize the tube by 0.5

- Cervical instability

112
Q

What are three important criteria for intraoperative management of a child with sickle cell disease?

A
  • Warm
  • Hydrated
  • Pain-free

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