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Ane Class Practice > OB exam 2-S4 > Flashcards

OB exam 2-S4 Flashcards

1
Q

What disease is a multi-system inflammatory disease. Hyperactivity of antibody producing B cells and defects of the helper and suppressor T cells.
Triggered by viruses and bacteria.
- Flares occur mostly in 2nd and 3rd trimesters and in the puerperium.
-Women with this have 2-4 fold increase in overall pregnancy complications: HTN, renal disease, preeclampsia, anemia.
Treated with DMARDS, Hydroxychloroquine, Corticosteroids and NSAIDS.

A

Systemic Lupus Erythematosus (SLE)

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2
Q

What drug can patients with SLE not have?

A

Toradol

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3
Q

Pericarditis, pleural effusions, valve disorder and pulmonary HTN are associated heavily with which disorder?

A

SLE

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4
Q

Which antibodies are tested for due to the ability to cause misscarriage?

A

Antiphospholipid antibodies

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5
Q

This is also known as Hughes Syndrome, it is an autoimmune prothrombotic disorder with the presence of aPL, aCL, and aB2GPI?

A

Antiphospholipid syndrome (APS)

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6
Q

What 2 things are associated with both arterial and venous thrombotic events?

A

aPL and aCL
lupus anticoagulant and anticardiolipin antibodies

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7
Q

How is Antiphospholipid Syndrome (APS) diagnosed?

A

Unexplained recurrent venous or arterial thrombosis, pregnany loss, and evidence of aCL or aPL.

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8
Q

Pregnant women with APS are at risk for what?

A

DVT, PE, MI, cerebral infarction and fetal loss.

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9
Q

What drug will help treat thrombocytopenia in women with APS?

A

Prednisone therapy

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10
Q

What is characterized by small vessel occlusions of various organs (thrombotic microangiopathy) and can cause intrauterine fetal death?

A

Catastrophic Antiphospholipid Syndrome (cAPS) or Asherson’s syndrome

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11
Q

Antiphospholipid Syndrome (APS) treatment involves the use of what drugs?

A

Thromboprophylaxis with low dose aspirin and heparin
or
Full anticoagulation with unfractionated heparin or LMWH for patients with history of APS with thrombosis

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12
Q

T/F
In the absence of underlying coagulation deficit, A prolonged PTT does not suggest a bleeding tendency and neuraxial is safe?

A

True

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13
Q

T/F
Aspirin is a contraindication to neuraxial?

A

False

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14
Q

A spinal or epidural should wait __ hours after the last dose of Unfractionated heparin?

A

4 hours

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15
Q

A spinal or epidural should wait __ hours after last dose of LMWH for prophylaxis?
(Low dose)

A

12 hours

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16
Q

A spinal or epidural should wait __ hours after last dose of LMWH for therapeutic?
(High dose)

A

24 hours

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17
Q

What can be used to document the clearance of heparin?

A

TEG

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18
Q

T/F
General anesthesia can cause a higher risk of venous thrombosis in pregnant moms with APS?

A

True

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19
Q

NYHA Classification of Heart failure
-NO limitations of physical activity?

A

Class 1

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20
Q

NYHA Classification of Heart failure
-Mild limitations of physical activity, regular activity causes symptoms?

A

Class 2

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21
Q

NYHA Classification of Heart failure
-Marked limitations of physical activity, no symptoms at rest, minimal activity causes symptoms?

A

Class 3

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22
Q

NYHA Classification of Heart failure
- Symptoms at rest?

A

Class 4

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23
Q

Cardiac Risk Prediction
- Class I?

A

No increase or mild increase in morbidity

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24
Q

Cardiac Risk Prediction
- Class II?

A

Small increase in maternal mortality,
- Arrhythmias
- Marfan
- Repaired tetralogy of Fallot

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25
Q

Cardiac Risk Prediction
- Class III?

A

Significant increase in maternal mortality
-Mechanical valves
- Complex congenital heart disease
-Marfan

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26
Q

Cardiac Risk Prediction
- Class IV?

A

Pregnancy is not recommended
- Severe aortic or mitral stenosis
- Pulmonary artery HTN

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27
Q

Treatment of SVT during pregnancy?

A

Stable- Vagal, Adenosine
Unstable- Synchronized Cardioversion

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28
Q

This disease is poorly tolerated in pregnancy.
-36% mortality
-Associated with IUGR, fetal loss and preterm delivery.
-Increased CV demands of pregnancy which can not be met?

A

Pulmonary HTN

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29
Q

Which drug do we avoid giving to mothers with Pulmonary HTN?

A

Methergine

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30
Q

WHO Group __? Pulmonary HTN
- Idiopathic PAH
- Heritable PAH
- Drug and Toxin induced
- Associated with HIV, connective tissue disorder, portal HTN.

A

Group 1 PAH

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31
Q

WHO Group __? Pulmonary HTN
- Associated with left ventricular systolic or diastolic dysfunction, left sided valve disease.

A

Group 2 due to left heart disease

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32
Q

WHO Group __? Pulmonary HTN
- Associated with COPD, lung diseases

A

Group 3 due to lung disease/hypoxia

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33
Q

WHO Group __? Pulmonary HTN
-Chronic

A

Group 4

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34
Q

WHO Group __? Pulmonary HTN
- Includes systemic diseases, hematologic disorders, chronic renal, chronic anemia

A

Group 5 with unclear or multifactorial

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35
Q

CO increases how much with pregnancy?

A

30-50%

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36
Q

SVR decreases how much with pregnancy?

A

-10%

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37
Q

Pulmonary artery pressure greater than___ indicates pulmonary artery hypertension?

A

> 25mmHg

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38
Q

Which syndrome is a subclass to PAH and occurs in patient with congenital heart disease who suffer from anatomic systemic to pulmonary shunt?

A

Eisenmenger syndrome

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39
Q

The hypoxemia and cyanosis associated with Eisenmenger syndrome occurs from which shunt?

A

Right to left shunt

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40
Q

Management of which syndrome includes ?
-diuretics to manage volume control
- Dobutamine to improve RVF
- Inhaled Nitric Oxide to dilate pulmonary vasculature
- Chronic anticoagulation to prevent thromboembolism (LMWH)

A

Eisenmenger syndrome

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41
Q

Which delivery form is preferred in patients with Eisenmenger syndrome?

A

Cesarean delivery @ 34-36 weeks

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42
Q

Vaginal delivery is contraindicated in mothers with Eisenmenger syndrome due to what?

A

Valsava could lead to rapid CV collapse and pain/anxiety can greatly affect SNS

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43
Q

Maintain adequate SVR
Maintain intravascular volume
Avoidance of aortocaval compression
Prevent pain
Avoid myocardial depression
Slow titrate of locals
all are what?

A

Goals of treatment

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44
Q

This congenital heart disease is associated with ?
-Right ventricular overload leading to pulmonary HTN and Eisenmenger syndrome
- SVT/ Ventricular arrhythmias
- Pre-eclampsia, fetal demise, Small gestational age

A

Atrial Septal Defect

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45
Q

This congenital heart disease is associated with ?
- Pregnancy is tolerated with repaired defect or small defect in absence of Pulm HTN
- Unrepaired defect has high risk of maternal cardiac complications
- Preeclampsia is seen more frequently in those with unrepaired defect

A

Ventricular Septal Defect

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46
Q

This congenital heart disease is associated with ?
-Pregnancy well tolerated
- Left to right shunt may cause Pulm HTN
-Pregnancy not recommended if associated with Eisenmenger syndrome

A

Patient Ductus Arteriosus (PDA)

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47
Q

What heart condition is most commonly caused by congenital bicuspid aortic valve?
-symptoms include dyspnea on exertion, chest pain and syncope.
- General anesthesia is gold standard

A

Aortic Stenosis

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48
Q

Patients with aortic stenosis need what for induction?

A

Etomidate
A-line

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49
Q

Chronic Aortic Regurgitation is caused by what?

A

Degenerated bicuspid aortic valve

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50
Q

Acute Aortic Regurgitation is caused by what?

A

Endocarditis

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51
Q

What is okay to maintain in mothers with Aortic Regurgitation?

A

Slightly elevated Heart Rate

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52
Q

This heart condition is caused by Rhematic disease, can become symptomatic during pregnancy.
- May lead to pulmonary edema due to increased blood volume and decreased diastolic filling
- Systemic anticoagulation is recommended during pregnancy and postpartum

A

Mitral stenosis

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53
Q

A pregnant mother with Mitral stenosis cannot have this medication?

A

Hemabate due to increase in PVR

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54
Q

This condition is associated with-
- Biventricular failure with orthopnea
- Dyspnea on exertion, palpitations, chest pain
- Unknown cause during the last month of pregnancy or within 5 months of delivery ?

A

Peripartum Cardiomyopathy

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55
Q

What is required for peripartum cardiomyopathy diagnosis?

A

-Heart failure wtithin last month of pregnancy or 5 months postpartum
- Absence of prior heart disease
- No determinable cause
- Strict echocardiographic indication of Left ventricular dysfunction EF<45% or Fractional shortening <30%

56
Q

This condition includes any degree of glucose intolerance with onset during pregnancy
-screening at 24-28 weeks
- Cannot produce enough insulin to compensate for enhanced resistance to insulin during 2&3 trimesters

A

Gestational Diabetes

57
Q

T/F
Mothers who have gestational DM have an increased risk for DM later in life and 30-70% chance of Gestational DM in another pregnancy?

A

True

58
Q

T/F
Pregnant Mothers with pregestational DM will have an increased insulin requirement due to peripheral insulin resistance in the 2&3 trimesters?

A

True

2-3x more insulin required

59
Q

Pregestational DM or Gestational DM?
- Is associated with 2-3 fold incidence of preterm labor and delivery?

A

Pregestational DM

60
Q

T/F
Incidence of hyperglycemia in first trimester (5-8 weeks) increases the risk of first trimester fetal loss and congenital malformations?

A

True

61
Q

Neonatal macrosomia weight?

A

> 4000-4500 grams

62
Q

What is the most clinically significant neonatal morbidly usually resulting from sustained hyperinsulinemia?

A

Neonatal hypoglycemia

63
Q

What are the 3 physiologic changes in glucose metabolism occur during pregnancy?

A
  1. Increased risk of fasting hypoglycemia
  2. Insulin Resistance
  3. Accelerated starvation resulting in increased lipolysis and ketone production
64
Q

Insulin sensitivity is decreased by ___% in the 3rd trimester?

A

50

65
Q

T/F
After the placenta is delivered a rapid decrease in insulin dose occurs?
Decreased by 2/3 of prepregnancy dose

A

True

66
Q

Which condition is associated with ?
-Prayer sign
-Difficult intubation
- Limited movement of the atlantooccipital joint

A

Diabetic Stiff-Joint Syndrome

67
Q

Target values during pregnancy for mothers with DM-
Fasting?
1 hour post meal?
Hemoglobin A1C?

A

Fasting= 65-99
1 hour post meal= 100-120
A1C= 6-6.5%

68
Q

Normal total T3 value?

A

1.4-3.2 nmol/L

69
Q

Normal total T4 value?

A

50-150 nmol/L

70
Q

T/F
Do concentrations of FREE T3 and T4 change during pregnancy?

A

False
No change in free

71
Q

T/F
Do concentrations of TOTAL T3 and T4 change during pregnancy?

A

50% change

72
Q

Hypothyroidism is diagnosed by measuring what?

A

A decreased level of FREE T4

73
Q

The fetus depends on maternal Thyroxine until the fetal thyroid system is fully functional at ___ weeks?

A

20 weeks
Then independent of maternal

74
Q

Maternal Hypothyroidism in 1st trimester can affect fetal___?

A

Brain development

75
Q

What disease is the leading cause of hyperthyroidism in pregnancy?

A

Graves disease

76
Q

Which drugs should be avoided in mothers with hyperthyroidism?

A

Ketamine and Atropine

77
Q

Thyroid storm symptoms include?

A

Fever, HTN, Tachycardia, Agitation

78
Q

Infants at risk for congenital cretinism
(Growth failure, Mental retardation or neuro deficits) are associated with which disorder?

A

Iodine-deficient hypothyroidism

79
Q

This disorder is the persistent severe form of N/V
- Specific to pregnancy
- Usually resolves 12-20 weeks gestation
- Can be a sign of molar pregnancy
- Not a true liver disease
- Treated with Ginger, Vitamins, Antiemetics, IV hydration

A

Hyperemesis Gravidarum

80
Q

This condition is associated with
- Increasing levels of estrogen
- Moderate to severe Itching and elevated bile acid levels
- Older mom, family history, Hep C at higher risk
- Labs will have 10-100x increase in bile acid, Bilirubin levels >6mg/dL
-Treated with antihistamines, antipruritic and Ursodeoxycholic acid (UDCA) in severe cases
-Rapid resolution after delivery

A

Intrahepatic Cholestasis of Pregnancy

81
Q

This condition is also called reversible peripartum liver failure
- More common with twins
- Microvesicular fatty infiltration of liver due to defective beta oxidation of fat in 3rd trimester
- Primiparous with multiple gestation and male fetus are high risk factors.
-Genetic defect in the fetus and placenta cause toxic free fatty acid metabolites.

A

Acute Fatty Liver of Pregnancy (AFLP)

82
Q

This condition is an Emergency that needs rapid treatment.
- Can progress to DIC, hepatic and renal failure, ARDS
- Fetal compromise and death secondary
- Immediate delivery of the fetus of termination of pregnancy must happen
- Anticipate Hemorrhage

A

Acute Fatty Liver of Pregnancy (AFLP)

83
Q

AFLP is distinguished by a marked increase in what lab value?

A

Serum Bilirubin

84
Q

Management of what condition is associated with controlling HTN, seizure prophylaxis, immediate delivery of fetus or termination of pregnancy, Liver transplant in severe cases. Postpartum hemorrhage?

A

Acute Fatty Liver Pregnancy
AFLP

85
Q

The main difference between HELLP and AFLP is signs of what?

A

AFLP has signs of coagulopathy, hypoglycemia, encephalopathy and renal impairment.

86
Q

Postural scoliosis or Idiopathic scoliosis is associated with Nonstructural curves?

A

Postural Scoliosis
also sciatica

87
Q

Postural scoliosis or Idiopathic scoliosis is associated with Structural curves?

A

Idiopathic Scoliosis
leads to rib hump and reduced mobility

88
Q

MAC is decreased by ___% for pregnant women?

A

30% decrease

89
Q

Neuraxial anesthetic doses decreased by ___% at term for pregnant mothers?

A

40% decrease

90
Q

Which neurological condition is caused by immune mediated inflammatory demyelination of white matter throughout the CNS?
-often between 20-40 years old
-Unpredictable course of frequent attacks and remissions, can progress to incapacitation.
- Ataxia, paresthesias, diplopia, bladder/bowel dysfunction, motor weakness
- DO NOT Give Succinycholine/Rocuronium

A

Multiple Sclerosis
MS

91
Q

Multiple Sclerosis (MS) relapses are caused by what?

A

Stress
Emotional distress
Infection
Trauma
Increased Body Temperature

92
Q

Treatment of Multiple Sclerosis (MS) in pregnant patients includes ?

A

Corticosteroids
Glatiramer
IVIG

93
Q

Which condition is associated with ?
-Infants with high incidence of meconium aspiration
- Small for gestational age
- Rate of relapse increases in first 3 month postpartum
- Pregnancy does not affect long term course

A

Multiple Sclerosis (MS)

94
Q

Which condition is an autoimmune disorder with episodes of muscle weakness and fatigue that are made worse by activity?
- autoimmune destruction of inactivation of post-synapatic acetycholine receptors at the NMJ.

A

Myasthenia Gravis

95
Q

T/F
In Myasthenia Gravis smooth muscle and cardiac muscle are not affected?

A

True
only skeletal

96
Q

Which condition is caused by Immunoglobin G (IgG) antibodies targeting the nicotinic acetycholine receptors leading to repetitive contractile ability exhaustion?

A

Myasthenia Gravis

97
Q

What is the order of muscle involvement in Myasthenia Gravis, which affected first?
-Proximal limb
-Bulbar
-Ocular
-Respiratory muscles

A

Ocular-First
Bulbar
Proximal limb
Respiratory muscles- Last

98
Q

What drug is the preferred therapy for Myasthenia Gravis?

A

Pyridostigmine

99
Q

Myasthenia Gravis exacerbation in a pregnant mother commonly occurs during ___?

A

Delivery and postpartum
Uterine smooth muscle is unaffected

100
Q

Which class of local anesthetic should be used for a patient with Myasthenia Gravis?

A

Amide locals due to prolongation half life of esters

101
Q

Which drugs can exacerbate Myasthenia Gravis?

A

NMBA- Succyncholine/Rocuronium
-Aminoglycosides
- Tocolytics/ Magnesium sulfate
- Lithium, quinidine, propanolol
- Ester locals

102
Q

Which condition occurs during the first few days of life in 20% of infants born to Myasthenia Gravis mothers?
-Caused by maternal IgG crosses placenta causing generalized weakness, hypotonia, weak cry and resp distress.
-Rapid decrease in alpha-fetoprotein
Treated with Pyridostigmine and ventilator can take weeks to months to resolve

A

Transitory Neonatal Myasthenia Gravis

103
Q

This condition is associated with acute onset of paralysis of the facial nerve (CN7) and excessive tear production?

A

Bells Palsy

104
Q

Which labor drug is a contraindication for mothers with asthma?

A

Hemabate

105
Q

IUGR
Preterm labor
SIDS
Tachycardia/HTN
Abruption placenta
Placenta previa
Ectopic pregnancy
all associated with mother use of what during pregnancy?

A

Nicotine use

106
Q

What is the leading cause of preventable birth defects in the US?

A

Intrauterine alcohol exposure

107
Q

Maternal use of what drug is associated with High placental abruption rate?

A

Cocaine

108
Q

What is the leading cause of maternal death worldwide?

A

Peripartum Hemorrhage

109
Q

Which drug is the first line treatment for uterine atony?

A

Oxytocin-pitocin

110
Q

What is this drug?
-1st line treatment for atony
-20U/40U in 1L bag
-must be given slow IV gtt
- Rapid infusion can cause CV collapse/hypotension

A

Oxytocin/pitocin

111
Q

What is this drug?
- 0.2mg IM
-10 min onset
- repeat q2-4hours
- Can cause vasoconstriction/Hypertension
-IM only
- Do not give to HTN or Preeclampsia

A

Methergine

112
Q

What is this drug?
- Synthetic prostaglandin F2
- stimulates uterine contractions
- 250mcg IM
- Repeat 15-90 mins up to 8 doses
- Can cause diarrhea, bronchospasm, pulmonary vasoconstriction
- Caution with asthmatics

A

Hemabate-Carboprost

113
Q

What is this drug?
- Synthetic Prostaglandin E1
- Rapid onset
- 200-1000mcg oral/rectal
- can cause increase in temperature

A

Misoprostol-Cytotec

114
Q

Which Umbilical cord prolapse is past the presenting part and easily palpable or visible?

A

Overt or Complete Prolapse

115
Q

Which Umbilical cord prolapse is alongside the presenting part and not externally visible?

A

Occult

116
Q

What is the most common sign of uterine rupture?

A

FHR abnormalities
Can sometimes have breakthrough pain

117
Q

What is the treatment for uterine rupture?

A

Emergency C-section

118
Q

Manipulation of the uterus and abdominal organs can cause what type of pain?

A

Visceral

119
Q

What is the gold standard for providing effective postcesarean analgesia?

A

Neuraxial opioids

120
Q

Morphine epidural dose?

A

2-5mg

121
Q

Morphine spinal dose?

A

.025-0.5mg

122
Q

_____ refers to the portion of the fetus that overlies the pelvic inlet?
-lie
-presentation
-position

A

Presentation

123
Q

____ refers to the alignment of the fetal spine to the maternal spine?
-lie
-presentation
-position

A

Lie

124
Q

_____ refers to the relationship of specific fetal bony point to the maternal pelvis?
-lie
-presentation
-position

A

Position

125
Q

Injury to common perineal nerve is associated with what symptom?

A

Foot drop

126
Q

Injury to the Femoral nerve is associated with what?

A

Medial sensory changes

127
Q

What 2 nerve injuries are potential complications in Lithotomy position?

A

Common Perineal Nerve
Femoral Nerve

128
Q

What dermatome level is needed for a Cervical Cerclage?

A

T10
Low dose spinal

129
Q

Persistent elevation in beta-hcg after the pregnancy is concluded is a a key sign/diagnosis of what disease?

A

Gestational Trophoblastic Disease (GTD)

130
Q

What is the main anesthetic consideration for a patient with GTD (molar pregnancy) suction D/C?

A

Risk for rapid, significant blood loss

131
Q

What dermatome level is needed for a Tubal Sterilization?

A

T4

132
Q

Elective surgery should be postponed until when?

A

6 weeks postpartum

133
Q

Before 24 weeks is considered what?

A

Pre-Viable

134
Q

After 24 weeks is considered what?

A

Viable

135
Q

In maternal Cardiac arrest how long after downtime of the arrest must the baby be delivered?

A

Fetus must be delivered Within 5 minutes after 4 mins downtime.

Ane Class Practice (24 decks)

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