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Board Prep > Module 19 Obstetric & Pediatric > Flashcards

Module 19 Obstetric & Pediatric Flashcards

1
Q

What lung volume decreases during pregnancy? By how much

A

FRC decreases 20%

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2
Q

Is MAC increased or decreased during pregnancy

A

Decreased by 1/3

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3
Q

Does pregnancy mimic an obstructive or restrictive defect

A

Restrictive FEV1/FVC is normal

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4
Q

When is cardiac output greatest with pregnancy

A

After delivery for next few weeks

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5
Q

What hematologic changes are seen in pregnant patient

A

Plasma volume increases 25-40% leading to dilutional anemia

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6
Q

Pregnancy effects on coagulation

A

Accelerated but compensated coagulation
Increased platelet turnover
Increased clotting
Increased fibrinolysis

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7
Q

At term uterine blood flow is how much of cardiac output

A

10%

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8
Q

Painless vaginal bleeding during second or third trimester associated with

A

Placenta prevails

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9
Q

Painful vaginal bleeding is associated with

A

Placental abruption

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10
Q

Placenta invades and is confined to the myometrium

A

Placenta increta

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11
Q

Placenta adheres to myometrium without invasion or passage through uterine muscle

A

Placenta accreta

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12
Q

Placenta invades and may penetrate the myometrium, uterine serous, or other pelvic structure

A

Placenta percreta

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13
Q

AFE treatment

A

Atropine
Ondansetron
Ketorolac

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14
Q

PIH combined with new onset proteinuria after 20 weeks gestation

A

Pre-eclampsia

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15
Q

Hallmark of preeclampsia

A

Abnormal placental implantation

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16
Q

Definitive treatment for preeclampsia

A

Delivery of fetus

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17
Q

Drug of choice for preeclampsia and eclampsia

A

Magnesium sulfate

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18
Q

Preeclampsia in presence of seizures

A

Eclampsia

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19
Q

HELLP stands for

A

Hemolysis
Elevated Liver Enzymes
Low Platelets

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20
Q

Drug shown to improve maternal outcome in HELLP

A

Dexamethasone 10mg every 2 hours increases number of platelets

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21
Q

Magnesium sulfate dosing for preeclampsia/eclampsia

A

4-6g over 30 minutes followed by infusion 1-2g/hr

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22
Q

Normal magnesium level

A

1.8-2.5mg/dL

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23
Q

Loss of DTR at what magnesium level

A

7-12 mg/dL

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24
Q

Deceleration indicated head compression

A

Early deceleration

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25
Q

Deceleration indicated cord compression

A

Variable deceleration

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26
Q

What is the rule of 60s

A

Variable deceleration associated with fetal asphyxia if fetal HR decreases by 60bpm, greater than 60 seconds, persists for more than 60 seconds

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27
Q

Deceleration indicating uteroplacental insufficiency and fetal compromise. Occurs at peak of contraction

A

Late deceleration

BAD

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28
Q

How does maternal blood circulate through the placenta

A 
Uterine arteries (2) in
Spurted into intervillous space
Passes fetal villi
Drains back into urethane vein
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29
Q

Uterine blood flow formula

A

UBF = (Uterine MAP - Uterine vein pressure) / uterine vascular resistance

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30
Q

Predominant adrenergic receptor in Uterine vasculature

A

Alpha adrenergic receptors

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31
Q

3 factors that decrease uterine blood flow

A

Maternal hypotension
Uterine vasculature vasoconstriction (Neo)
Uterine contraction

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32
Q

Fetal bradycardia is defined as

A

HR < 120

33
Q

2 signs of fetal hypoxia

A

Fetal bradycardia

Late deceleration

34
Q

The amniotic sac has ruptured and is accompanied by bleeding and fetal heart rate deceleration. What should you suspect?

A

Vasa previa

Fetal vessels implanted over cervical os and not protected by placenta or umbilical cord

CAN LEAD TO EXSANGUINATION OF FETUS

35
Q

Classic presentation of AFE

A

Dramatic and abrupt onset of dyspnea and hypotension

Coagulopathy near delivery

Cardiovascular collapse

36
Q

Oxytocin should be avoided in what 3 groups of patients

A

Preeclampsia

HTN

Cardiac disease

37
Q

Oxytocin MOA

Side effects

A

Acts on uterine smooth muscle to stimulate frequency and force of contraction

Increase in BP and HR
antidiuretic effect leads to water intoxication, cerebral edema, and convulsions

38
Q

Tocolytic MOA

Name 2

A

Suppress uterine contractile activity

Ritodrine
Terbutaline

39
Q

Formula for ETT size in children over 2

A

(16 + age)/4

40
Q

Formula for ETT depth

A

ETT internal diameter x 3

41
Q

Normal SBP formula children >1yo

A

(Age x2) + 70

42
Q

EBV premie

A

90-100ml/kg

43
Q

EBV term newborn

A

80-90ml/kg

44
Q

EBV 3mo to 3yo

A

75-80ml/kg

45
Q

EBV 3-6yo

A

70-75ml/kg

46
Q

EBV >6

A

65-70ml/kg

47
Q

EBV obese

A

50-55ml/kg

48
Q

Congenital diaphragmatic hernia most common at what site

A

Left foramen of Bochdalek

49
Q

Goal in treatment of congenital diaphragmatic hernia

A

Preductal sat >85% with PIP <25cmH20

Avoid N20

50
Q

Most common variation of TEF

A

Ends in a blind pouch and lower esophagus that connects to trachea

51
Q

Intubation technique for TEF

A

Intentionally mainstem then withdraw until bilateral breath sounds. Tip distal to TEF (between TEF and carina)

52
Q

Nonbilious projectile vomiting at 2-5 weeks of age associated with

A

Pyloric stenosis

53
Q

Classic metabolic disturbance with pyloric stenosis

A

Hypokalemic, hypochloremic metabolic alkalosis with compensatory respiratory acidosis

54
Q

Bilious vomiting is classic sign of

A

Intestinal malrotation and volvulus

55
Q

How to mix racemic epi new

A

2.25% solution. 0.5-1ml in 2-3 ml NS

Repeat in 20 minutes and every 2-4 hours PRN

56
Q

APGAR score 0-2 action

A

Intubate and CPR

57
Q

APGAR 3-4 action

A

Temporary ventilation assistance

58
Q

APGAR 5-7 action

A

Stimulation and oxygen across face

59
Q

Normal HR and RR for newborn

A

RR 30-60

HR 120-160

60
Q

Hallmark of intravascular fluid depletion in neonates is

A

Hypotension without tachycardia

61
Q

Two limitations of kidney function in newborn

A

Obligate sodium excreters

Diminished ability to concentrate urine

62
Q

When is cytochrome P450 enzyme system fully functional

A

1 month old

63
Q

Hemoglobin concentration drops after birth when/to what

A

9-12 weeks reaching 10-11g/dL

64
Q

When does hemoglobin stabilize

A

12 weeks until 2 years 11.5-12g/dL

65
Q

What is the caloric need in relation to BSA for full term infant

A

30kcal/m2 per hour

By 2 yo 50kcal/m2 per hour

66
Q

Resting 02 consumption for infant

A

6-8ml/kg/min

67
Q

Where are pulse oximetry placed to monitor preductal and postductal saturation

A

Preductal right hand

Post ductal left foot

68
Q

Preductal pulse ox used to monitor

A

Cerebral oxygenation

69
Q

Postductal sat monitor monitors what

A

Quantitative severity of left to right shunt

70
Q

What causes foramen ovale to close

A

Decrease in PVR and increased pulmonary flow

Increased pressure in LA shuts the flap

71
Q

What closes the ductus arteriosus

A

Increased arterial oxygen tension and decreased circulating prostaglandins

72
Q

4 factors that may cause infant to return to fetal circulation

A

Hypothermia
Hypercarbia
Acidosis
Hypoxemia

Increased PVR and R-L shunting

73
Q

Congenital defects in which there is a simple right to left shunt

A

TOF
Pulmonary atresia
Epstein’s anomaly
Eisenmenger’s syndrome

74
Q

Congenital defects in which there is a simple left to right shunt

A 
ASD
VSD
AV canal defect
PDA
Aortopulmonary window
75
Q

Conditions that increase PVR

A 
Hypoxia
Hypercarbia
Acidosis
Hypothermia
High mean airway pressures
Catecholamine release
Medications (neo, ketamine, N20)
Decreased SVR
B2 agonists
Neuraxial
Deep general anethesia
76
Q

Congenital defects seen with tetralogy of fallot

A

VST
RVOT
RV hypertrophy
Overriding aorta

77
Q

Mandibular hypoplasia is associated with what congenital diseases

A

Pierre Robin
Treacher Collins
Goldenhar

78
Q

What are the causes of retinopathy of prematurity

A

Oxygen toxicity

Prematurity (PCA <32 weeks)

Board Prep (19 decks)

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