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Obestetrics > Progidy- OB > Flashcards

Progidy- OB Flashcards

1
Q

RSI should be done for pregnant patients at how many weeks?

A

2nd trimester - 14 weeks per rob

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2
Q

Oxygen-poor blood from the fetus returns to the placenta how?

A

by the 2 umbilical arteries

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3
Q

Local anesthetics in an epidural work where? What about epidural opioids?

A

Local anesthetics work on the axon of the nerves
Opioids work on receptors in the substantia gelatinosa in the dorsal horn of the spinal cord

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4
Q

Where is a labor epidural typically placed?

A

at L2-L3 or L3-L4 interspace

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5
Q

Typical epidural infusion

A

Ropi 0.1 - 0.2% @ 8-12mL/hr

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6
Q

What could you do for a laboring mother with aortic stenosis?

A

a CSE with opioids only into the spinal space - no motor block (sympathectomy), then the epidural

OR you could do local in the spinal space just less and use the saline technique to raise the smaller dose higher

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7
Q

What kind of block would be used to provide anesthesia for a forceps delivery or an episotomy?

A

pundenal

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8
Q

What is the leading cause of anesthesia-related maternal death?

A

failure to intubate/ventilate

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9
Q

What is the most common dose of local anesthetic used in a spinal for a C-Section?

How long does it provide sufficient anesthesia for?

A

1.6-1.8mLs of 0.75% bupivicaine

1.5-2 hours

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10
Q

Morphine in a spinal can provide analgesia for up to how long after delivery?

A

18 hours

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11
Q

T/F: the incidence of shivering and breakthrough pain is less with a CSE than for an epidural only

A

True

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12
Q

T/F: To prevent the spinal from raising further, you should put mom in reverse trendelenberg

A

false- thsi will worsen hypotension - instead, flex moms her neck and raise her legs

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13
Q

Initial signs of LAST (4)

A
  1. circumoral numbness
  2. blurred vision
  3. tinnitus
  4. agitation
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14
Q

What is most commonly the first arrhythmia seen with LAST?

A

bradycardia

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15
Q

Why is airway management the primary intervention for LAST?

A

bc hypoxia and acidosis can enhance toxicity through ion trapping in the brain.

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16
Q

Bolus dosing and infusion of 20% lipids for LAST

A

1.5mL/kg over 1 minute
0.25mL/kg/min

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17
Q

Treatment of cardiomyopathy of pregnancy involves therpies aimed at doing what 3 things?

A
  1. increase myocardio contractility
  2. optimize preload
  3. reduce afterload
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18
Q

Blood sugar goals for mom with gestational diabetes

A

60-120

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19
Q

There’s a belief that C-sections are a safer, more controlled event than a vaginal delivery….however, what’s the risks of c-sections compared to vaginal delivery?

A

Risk of emergency hysterectomies following C/S is 10x higher
& risk of matenral death is 16x higher

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20
Q

First line drug for treating hypertension during anesthesia for preeclamptic patients

A

labetalol

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21
Q

PPH is considered to occur when more than how much blood is lost from a vaginal delivery vs C/S

A

> 500mls for vaginal delivery
1L for c-section

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22
Q

T/F- amniotic embolism can occur during labor

A

True

23
Q

Rather than a pure embolic event, amniotic embolism is believed to be associated more as what?

A

an anaphylactoid reaction

24
Q

s/s of amniotic fluid embolism?

treatment?

A

sudden hypotension, anxiety, dyspnea, hypoxia
eventaully CV collapse and coagulopathies

supportive treatment- airway management, CV resusitation, tx of coagulopathies

25
Q

Very low birth weight applies to any infant who weighs less than what

A

1500g at delivery

26
Q

Bc pregnant patients are more sensitive to local anesthetics; how much should the dose of any local anesthetic be reduced by?

A

25%

27
Q

The greatest increase in maternal cardiac output occurs:

A. during the first trimester
B. immediately after delivery
C. during the first stage of labor
D. during the second trimester

A

B. immediately after delivery

28
Q

Compared to nonpregnant patients, during the third trimester of pregnancy, a neuraxial anesthetic will most likely
A. exhibit a significantly shorter duration
B. require a larger volume of local anesthetic
C. exhibit less motor block
D. exhibit an increased block height

A

D

29
Q

You are preparing to perform a general anesthetic for appendectomy on a parturient in her second trimester. You know that this patient will exhibit a _____ induction and a _____ emergence from inhalation anesthesia.
A. slower, slower
B. faster, slower
C. slower, faster
D. faster, faster

A

D

30
Q

When the placenta abnormally implants into the lower segment of the uterus and entirely or partially covers the cervical opening, it creates a condition known as
A. placental abruption
B. dystocia
C. placenta previa
D. placenta increta

A

C

31
Q

Which of the following is associated with a higher risk of placenta accreta in parturients already presenting with placenta previa?
A. Pre-eclampsia
B. History of multiple cesarean sections
C. Substance abuse
D. Pulmonary hypertension

A

B

32
Q

Pregnancy typically produces
A. an increase in the serum creatinine level
B. a decrease in renal blood flow
C. an increase in the blood urea nitrogen level
D. an increase in the glomerular filtration rate

A

D

33
Q

Which of the following parameters increases with pregnancy?
A. PaO2
B. Total lung capacity
C. HCO3
D. PaCO2

A

A

34
Q

The administration of lidocaine to a parturient can result in an increased concentration of the drug in the fetus. This concept that describes why this occurs is
A. aqueous dissolution
B. ion trapping
C. phase two reaction
D. first-pass metabolism

A

B

35
Q

What is the most common anesthetic used for cesarean delivery?
A. Pudendal block
B. Spinal anesthetic
C. Epidural anesthetic
D. General anesthetic

A

B

36
Q

How long after delivery does the cardiac output of the mother remain elevated?
A. 2 days
B. 14 days
C. 7 days
D. 12 hours

A

B

37
Q

During the third trimester of pregnancy, the cardiac output
A. increases primarily due to an increase in stroke volume
B. decreases primarily due to a decrease in heart rate
C. decreases primarily due to a decrease in stroke volume
D. increases primarily due to an increase in heart rate

A

A

38
Q

What is the leading anesthesia-related cause of maternal death?
A. Hypovolemic shock
B. Amniotic fluid embolus
C. Stroke
D. Inability to intubate or ventilate

A

D

39
Q

Which of the following agents would most readily cross the placenta?
A. Succinylcholine
B. Ketamine
C. Cisatracurium
D. Glycopyrrolate

A

B

40
Q

Which patient would be most at risk to develop postdural puncture headache following a spinal anesthetic?
A. A 68 year-old female undergoing total hip arthroplasty
B. A 32 year-old female undergoing vaginal delivery
C. A 39 year-old male undergoing a bladder procedure
D. A 72 year-old male undergoing a knee replacement

A

B

41
Q

In pregnancy, insulin resistance
A. increases due to the effects of lactogen
B. increases due to the effects of epinephrine
C. decreases due to follicle stimulating hormone
D. decreases due to the effects of estrogen

A

A

42
Q

The phenomenon of ion trapping explains
A. the compensation of metabolic alkalosis
B. the accumulation of maternally-administered drugs in the fetus
C. the development of sickle cell crisis
D. the lipid-solubility of volatile anesthetics

A

B

43
Q

During the active stage of labor, pain is referred to the ____ spinal cord segments.
A. T9 to T12
B. T11 to L3
C. T10 to L1
D. T10 to T12

A

C

44
Q

Which of the following drugs will cross the placenta?
A. Nitroprusside
B. Succinylcholine
C. Heparin
D. Protamine

A

A

45
Q

A laboring patient suddenly becomes short of breath, hypoxic, cyanotic, and hypotensive. What is the most likely diagnosis?
A. Uterine rupture
B. Amniotic fluid embolism
C. Abruptio placentae
D. HELLP syndrome

A

B

46
Q

Which of the following would be considered an average blood loss from an uncomplicated cesarean section?
A. 100 mL
B. 300 mL
C. 1000 mL
D. 2000 mL

A

C

47
Q

A patient is undergoing labor with an extremely preterm infant. Vaginal delivery is planned. What anesthetic/analgesic technique would be most advantageous in this instance?
A. General anesthesia with sevoflurane
B. Analgesia with intravenous meperidine
C. Analgesia with intravenous ketamine
D. Neuraxial anesthetic

A

D

48
Q

Which class of patient is often said to be in a chronic compensated state of disseminated intravascular coagulation?
A. A full-term parturient
B. A patient with sickle cell anemia
C. A patient with hyperparathyroidism
D. A patient with myasthenia gravis

A

A

49
Q

Which is true of pain associated with the second stage of labor?
A. It is somatic
B. It begins with the onset of regular contractions
C. It is limited to spinal cord segments T10-L1
D. It results from traction on the round ligament

A

A

50
Q

You are performing a combined spinal-epidural for an obstetric patient in the first stage of labor and administer fentanyl 25 mcg intrathecally. You know that the incidence of delayed-onset respiratory depression from rostral spread of the drug is most common
A. three to four hours after administration
B. in patients with myasthenia gravis
C. when local anesthetic is combined with the opioid
D. within the first 30 minutes of administration

A

D

51
Q

Which of the following statements concerning respiratory changes during pregnancy is true?
A. Minute ventilation decreases
B. Functional residual capacity increases
C. Dead space increases
D. Airway resistance is essentially unchanged

A

D

52
Q

All of the following statements regarding administration of analgesics to a laboring parturient are true except:
A. Ketamine 0.2-0.4 mg/kg IV does not produce neonatal depression
B. Fentanyl may be administered safely to a laboring parturient
C. Meperidine produces greater respiration depression in neonates than morphine
D. Naloxone can be administered IM to newborns

A

C - i dont think this is right…

53
Q

Rapid sequence induction, cricoid pressure, and a cuffed endotracheal tube are recommended for pregnant women receiving general anesthesia from ____ weeks on even if no symptoms of reflux are present.
A. 18
B. 15
C. 20
D. 12

A

C

54
Q

Why is it recommended that an epidural anesthetic not be administered to a laboring parturient exhibiting cervical dilation less than 4 cm?
A. It can result in severe hypotension
B. It can result in dystocia
C. It can result in fetal depression
D. It can produce maternal tachycardia

A

B

Obestetrics (4 decks)

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