Maternal Physiology

Question 1

Creasy’s 2 things you need invasive monitoring for

Answer 1

1. Sepsis w/ pulmonary edema and

2. Persistent hypoTN

Question 2

Indices that are directly measured from a well-placed PA catheter:

Answer 2

• CVP
• Right-sided intracardiac pressure
• PA pressure
• PA occlusion pressure (aka wedge)
• CO
• SvO2

Question 3

Calculated central monitoring indices

Answer 3

• Cardiac indices that are calculated rather than measured
  
  • SVR
  • PVR
  • CI
  • SVI (stroke volume index)
  • LVSWI
  • RVSWI
  • DO2 (oxygen delivery = CI x 13.4 x Hgb concentration x SaO2)
  • VO2 (oxygen uptake = CI x 13.4 x Hgb concentration x [SaO2-SvO2])

Question 4

CVP
PVR
PCWP
SVR

Answer 4

CVP 4
PVR 80
PCWP 8
SVR 1200

Question 5

Rx entirely alpha 1 agonist

Answer 5

Phenylephrine

Question 6

Rx entirely alpha 2 agonist

Answer 6

NE
Clonidine
Aldomet

Question 7

Rx entirely beta 1 agonist

Answer 7

Dobutamine

Question 8

Rx entirely beta 2 agonist

Answer 8

Albuterol

Terbutaline

Question 9

Rx entirely beta 1 antagonist

Answer 9

Atenolol

Metoprolol

Question 10

Rx mixed beta antagonist (w/o alpha activity)

Answer 10

Propranolol

Question 11

What kind of adrenergic activity labetalol?

Answer 11

Beta 1, beta 2&raquo_space; alpha 1

Question 12

PFTs: what increases in pregnancy

Answer 12

“I see TV”

IC, TV (and as a result minute ventilation)

Question 13

PFTs: what doesn’t change during pregnancy

Answer 13

“Things you record on VCR video”

VC (I)RV

Question 14

PFTs: what decreases

Answer 14

Everything else apart from IC, TV, VC, IRV…

RV, ERV, TLC, FRC

Question 15

Which PFT change makes GA tough?

Answer 15

Reduced FRC

Question 16

Define & formulas & units for...
SO2
PO2
CaO2
DO2

Answer 16

Proportion of RBCs whose Hgb is bound to O2, %
Amount of oxygen dissolved in the plasma, mmHg
Amount of O2 both bound to Hgb + dissolved in plasma, mm O2/dL (#Hgb%sat + #*PaO2)
Oxygen delivery, mL/min (cardiac output * CaO2)

Question 17

Immunologic changes: increase or decrease?
C3, C4 (2nd-3rd tri)
CD4 T-lymphocytes
CD8 lymphocytes
CRP
Cytotoxic T
ESR
Granulocytes
Leukocyte alkaline phosphatase
Monocytes
NK cells
TH1 cells (IL-2, IFN-gamma, TNF-alpha, INF-alpha)
TH2 cells (IL-4, IL-6, IL-13)

Answer 17

DECREASE
* Th1 (aka: T-helper cells)
* Tc (T-cytotoxic cells)
* The decrease in the above 2 suppresses secretion of IL2, INF-gamma, TNF-alpha INF-alpha
* CD4 T lymphocytes
* Monocytes
* NK cells
INCREASE in the following:
* Granulocytes
* CD8 lymphocytes (especially in 3rd trimester)
* Th2 cells (that then increase secretion of IL4, IL6, IL13) (maybe IL-10?)
* C3 and C4 (2nd and 3rd trimester)
* CRP, ESR, Leukocyte alkaline phosphatase

Question 18

Immunosuppressive agents made by placenta

Answer 18

IL-10
Progesterone
PGE2
IL-4

Question 19

Bupivicaine half life? (for neonate and for adult)?

Answer 19

8 h / 3 hr

Question 20

Tx HypoTN post-epidural w/ low HR and w/ high HR?

Answer 20

Low HR: ephedrine

High HR: phenylephrine

Question 21

Dopamine low vs high doses

Answer 21

Docile beta to start (0.5-3 mcg/kg/min)… beta-1 = renal vessel dilation.
But once get to > 5 mcg/kg/min see renal vessel constriction and 10-20 see SVR go up.

Question 22

Among steroids, which with highest anti-inflammatory potency (top 4)?

Answer 22

Beta/Dex (25)

Triamcinolone/Methylprednisolone (5)

Question 23

Among steroids, which with highest mineralocorticoid potency (top 2)?

Answer 23

Fludrocortisone (125)

Hydrocortisone (1)

Question 24

Glucogenic vs Ketogenic vs Both Amino Acids

Answer 24

Ketogenic “L” ones (Leucine Lysine)
Both PhITTT (phenylalanin, Isoleucine, Threonine, Tryptophan, Tyrosine)
REST are glucogenic

Question 25

Anterior branch internal iliac

Answer 25

OUUMI or i love going Places In My Very Own Underwear
Pudendal
Inferior vesical
Middle rectal
Vaginal
Obturator
Uterine

Question 26

Highest mGy exposure to fetus?

Answer 26

IVP, barium enema, Tech-99 bone