pre-eclampsia, PIH, obesity

Question 1

what is the most common medical problem of pregnancy

Answer 1

diabetes

Question 2

what is the pathophys behind DM

Answer 2

hyperplasia of pancreatic B-cells

Question 3

how prevalent is GD? (first diagnosed in pregnancy)

Answer 3

4%

Question 4

____ is associated with advanced maternal age, obesity, fam hx of DM, hx of stillbirth, neonatal death, fetal malformation or macrosomia

Answer 4

GD

Question 5

GD is most prevalent in __ and ___ trimesters

Answer 5

2nd and 3rd

Question 6

T/F GD is associated with higher incidence of gestational HTN, polyhedramnios and cesarean delivery

Answer 6

TRUE

Question 7

normal range for A1C is ___, risk of vascular dz increases at ____

Answer 7

4-6%, 6.5%

Question 8

stiff joint syndrome incidence ___ in type 1 diabetics

Answer 8

30-40%

Question 9

T/F Stiff Joint syndrome occurs in patients with long-standing type 1 diabetes and is associated with non-familial short stature, joint contractures and tight skin.

Answer 9

TRUE

Question 10

T/F all Type 1 DM pt’s should have pre-anesthetic flexion-extension cerical spine x-rays

Answer 10

FALSE - no evidence indicates that this makes a difference

Question 11

maternal insulin requirements ___ progressively during the __ and ___ trimester and ___ at the onset of labor and continue to ___ following delivery

Answer 11

maternal insulin requirements increase progressively during the 2nd and 3rd trimester and decrease at the onset of labor and continue to decrease following delivery

Question 12

tighter glucose control is req for which anesthetic techinque

Answer 12

c/s

Question 13

mom has ___ response to atropine and propanolol

Answer 13

decreased

Question 14

protamine sulfate anaphylaxis is seen in patients taking ___ or ___

Answer 14

NPH or protamine zinc insulin

Question 15

diabetic patients have ____ clearance and ___ serum levels following epidural lidocaine

Answer 15

delayed, higher

Question 16

DKA: plasma glucose >___, pH < ___, acetone positive :

Answer 16

> 300, 7.30. acetone positive 1:3

Question 17

T/F Ketones cross placenta and decrease fetal oxygenation

Answer 17

TRUE

Question 18

T/F continuous fetal heart monitoring is not required for DKA

Answer 18

FALSE

Question 19

MLAC (minimum local anesthetic concentration) of bupivacaine in women at term gestation - obese women was ___% ___ than non-obsese

Answer 19

41% lower

Question 20

T/F Despite lower anesthetic concentrations administered to obese women, they achieved higher sensory blockade with no differences in pain scores

Answer 20

TRUE

Question 21

T/F Non-obese women have a greater distribution of epidural LA within epidural space compared to obese.

Answer 21

FALSE. greater distribution in obese

Question 22

maternal DPB > ___ is associated with increased risk of placental abruption and fetal growth restriction

Answer 22

110

Question 23

superimposed ____ with htn causes most of the morbidity

Answer 23

pre-eclampsia

Question 24

PIH = sustained BP increase to SBP > ___ or DBP > ___

Answer 24

140, 90

Question 25

T/F PIH is usually mild and early in pregnancy

Answer 25

FALSE - early

Question 26

T/F PIH usually does not have renal or other systemic involvement

Answer 26

TRUE

Question 27

T/f PIH resolves after delivery

Answer 27

FALSE - 12w postpartum

Question 28

PIH may evolve to ____

Answer 28

preeclampsia

Question 29

Preeclampsia resolves within ___h postpartum

Answer 29

48

Question 30

preeclampsia is new onset HTN after ___ weeks gestation or early ____, previously normotensive.

Answer 30

20 , postpartum

Question 31

PIH proteinuria > ___

Answer 31

300mg/24h

Question 32

maternal risk factors for pre-eclamspia

Answer 32

first pregnancy, age younger then 18 or older than 35, prior hx preeclampsia black chronic htn, renal dz, DM, antiphospholipid Syndrome twins fam hx

Question 33

maternal risk factors for pre-eclamspia

Answer 33

first pregnancy, age younger then 18 or older than 35, prior hx preeclampsia black chronic htn, renal dz, DM, antiphospholipid Syndrome twins fam hx

Question 34

T/f Headache, visual disturbances, epigastric pain are seen in mild preeclampsia

Answer 34

FALSE - severe

Question 35

in pre-eclampsia plasma volume is ___

Answer 35

reduced

Question 36

in pre-eclampsia, CO and SVR are

Answer 36

increased

Question 37

in pre-eclampsia, CVP is ___ or ___

Answer 37

normal or slight increase

Question 38

T/F pulmonary edema occurs in 3% of pre-e pt's

Answer 38

TRUE

Question 39

severe PIH or preeclampsia is complicated by ___ which is characterized by periportal hemm, ischemic lesion, generalized swelling, hepatic swelling, epigastric pain

Answer 39

HELLP

Question 40

in pre-e, GFR and CrCl ___

Answer 40

decrease

Question 41

in pre-e, BUN ____

Answer 41

increases

Question 42

T/F In a patient with pre-eclampsia, oliguria and renal failure may occur in the absence of hypovolemia. Be careful with hydration, as it can cause pulmonary edema

Answer 42

TRUE

Question 43

In pre-e, uterine activity is ____, and is ____ to oxytocin

Answer 43

increased, hyperactive

Question 44

in pre-e, uterine/placental blood flow is ___ by 50-70%

Answer 44

decreased

Question 45

T/F the incidence of uterine abruption is decreased in pre-e

Answer 45

FALSE - increased

Question 46

leading cause of maternal death in PIH is

Answer 46

ICH

Question 47

T/F DIC is usually associated with placental abruption and is uncommon as a primary manifestation of pre-e.

Answer 47

TRUE

Question 48

what does HELLP stand for

Answer 48

Hemolysis, elevated liver enzymes, low platelets

Question 49

HELLP is diagnosed at

Answer 49

36

Question 50

HELLP : hemostasis is problematic when platelets fall below

Answer 50

40k

Question 51

whats the definitive cure of HELLP

Answer 51

delivery. plt count is normal within 72h

Question 52

regional anesthesia is ___ in HELLP

Answer 52

contraindicated - fall is sudden

Question 53

whats the drug of choice for pre-e

Answer 53

MgSO4 (mag sulf)

Question 54

T/F MgSO4 does not significantly reduce systemic BP at the serum concentration that are efficacious in treating preeclampsia.

Answer 54

True

Question 55

Goals of care for pre-e

Answer 55

control BP, prevent sz, deliver fetus

Question 56

what drug do you not wanna give for htn and why?

Answer 56

nitroprusside - risk of cyanide toxicity in the fetus

Question 57

what should you give for magnesium toxicity

Answer 57

10 ml of 10% Ca Gluconate IV slowly

Question 58

plasma level of ca should be between

Answer 58

4-6

Question 59

5-10 mEq/L you'd see

Answer 59

prolonged PR, widened QRS

Question 60

11-14 mEq/L you'd see

Answer 60

depressed tendon reflexes

Question 61

15-24 mEq/L you'd see

Answer 61

SA, AV node block, resp paralysis

Question 62

>25 mEq/L you'd see

Answer 62

cardiac arrest

Question 63

T/F In a mom, routine coats not recommended unless there is clinical suspicion

Answer 63

TRUE

Question 64

T/F Epidurals may reduce vasospasm and htn - may improve uteroplacental blood flow.

Answer 64

TRUE

Question 65

T/F Neuraxial anesthesia in pre-e pt is controversial... but can be safely administered.. dilute epidural infusions of LA plus opioids produce adequate sensory block without motor block or clinically significant sympathectomy

Answer 65

TRUE

Question 66

GA laryngeal response can be blunted by pre tx with ___ ___ or ___

Answer 66

hydralazine, nitroglycerin , labetalol

Question 67

In pt receiving mgso4, succs activity is ___ and ___ sensitivity to non-depolarizing relaxants

Answer 67

potentiated (need less), enhanced.

Question 68

T/F MgSO4 blunts response to vasoconstrictors and inhibits catecholamine release after sympathetic stim

Answer 68

TRUE