Quiz questions Flashcards
Which of the following needles if placed in the subarachnoid space is most likely to cause a PDPH?
A. 18ga Tuohy B. 20ga Quincke C. 25ga Whitacre D. 27ga Sprotte E. 22ga Whitacre
A. 18ga Tuohy
Which drug is most commonly associated with TNS (transient neurological symptoms)?
A. Tetracaine B. Lidocaine C. Bupivicaine D. Ropivicaine E. Mepivicaine
B. Lidocaine
Factors contributing to a difficult airway in the parturient include all EXCEPT:
A. Redundant soft tissue of the neck, chest, and/or breasts
B. Improving mallampati scores as labor progresses
C. Mucosal venous engorgement creating a friable, bleeding airway
C. The combination of decreased FRC and increased O2 consumption
B. Improving mallampati scores as labor progresses
Which of the following is the most likely consequence of an untreated PDPH?
A. Resolution of symptoms over a week or so
B. Permanent cranial nerve symptoms
C. Cortical vein thrombosis
D. A headache persisting for months to years
E. Opioid addiction
A. Resolution of symptoms over a week or so
Which of the following agents acts fastest to facilitate gastric acid neutralization?
A. Ranitidine
B. famotidine
C. Metoclopramide
D. Sodium citrate
D. Sodium citrate
A patient for emergent c-section has aspirated following induction of general anesthesia. Which of the following is the most appropriate initial maneuver in their management?
A. Intubation and positive pressure ventilation
B. Administration of IV steroids
C. Pulmonary lavage
D. Administration of broad spectrum antibiotics
E. Allow the patient to wake, and proceed with spinal anesthesia
A. Intubation and positive pressure ventilation
Which has the greatest potential to increase uterine blood flow int he parturient?
A. Ketamine
B. Propofol
C. Sevoflurane
D. Epidural analgesia
D. Epidural analgesia
T/F
Pregnancy is associated with hypocoagulation, with both PT and PTT typically increased by approximately 20%
False
Which of the following is correct regarding early decelerations in fetal HR?
A. Usually indicate the need for an urgent c-section
B. Are caused by compression of the umbilical cord vessels
C. Is an expected, benign finding caused by fetal head compression
D. None of the above
C. Is an expected, benign finding caused by fetal head compression
In a cardiac arrest after spinal anesthesia, early administration of which of the following is most likely to be of maximal benefit?
A. Ephedrine B. Phenylephrine C. Epinephrine D. Isoproterenol D. NSS bolus 500-1000 cc
C. Epinephrine
Injury to which of the following nerves will cause a foot drop?
A. Femoral B. Common peroneal C. Femoral D. Pudendal E. Orbturator
B. Common peroneal
Which of the following statements regarding the parturient is FALSE?
A. Nasal intubation is relatively contraindicated
B. These patients are not considered to be high risk for aspiration of gastric contents
C. Serum creatinine levels tend to be lower than in the non-pregnant state
D. They tend to desaturate faster than non-parturients
B. These patients are not considered to be high risk for aspiration of gastric contents
T/F
To compensate for higher airway pressures due to the enlarged abdomen, a larger size endotracheal tube should usually be used for parturients
False
Expected CV changes with pregnancy include:
A. Decreased O2 delivery to tissues
B. Improved hemodynamics in the supine position
C. Increased PVR
D. Decreased plasma colloid osmotic pressure
D. Decreased plasma colloid osmotic pressure
Which of the following statements regarding hypoxia in the neonate is true?
A. Most likely will increase Left-to-right shunting via the ductus arterioles
B. Most likely will increase right-to-left shunting thru the ductus arteriosus
C. Will probably prevent the foramen vale from ever closing
D. Is rarely a problem because fetal hemoglobin compensates entirely
B. Most likely will increase right-to-left shunting thru the ductus arteriosus
Which of the following findings (compared to the non-pregnant state) would be most unusual in a term parturient?
A. Mild reduction in Hct
B. A new systolic murmur
C. No change in serum creatinine
D. A decreases in PaCO2
C. No change in serum creatinine
After identifying what you believe to be the epidural space with a loss of resistance technique, the patient complains of sudden onset of headache. Which of the following is the most likely cause?
A. PDPH B. Intrathecal air C. Epidural hematoma D. Cortical vein thrombosis E. Meningitis
B. Intrathecal air
T/F
When estimating vertebral level by palpation, most practitioners are actually a level lower than they think
False
they usually higher than they think
In the adult human the spinal cord usually ends at:
A. T12
B. L1
C. L2
D. L3
B. L1
A patient in preterm labor receiving tocolytic therapy is taken emergently to the OR for a c-section under general anesthesia. Usual induction agents are administered including propofol, succinylcholine, fentanyl, and rocuronium. The case takes longer than expected and 45 minutes later the surgeon is finished, and the patient has no twitches. What is a possible reason for the lack of twitches?
A. The patient was receiving terbutaline and has residual skeletal muscle relaxation.
B. The patient was receiving nubbin prior to the OR and is “narcotized”
C. The patient was receiving magnesium and is sensitive to neuromuscular blockade
D. The patient is faking just to annoy you, because this c-section occurred at 2:30am
C. The patient was receiving magnesium and is sensitive to neuromuscular blockade
You are checking on a VBAC (vaginal birth after c-section) patient on the L and D floor who has a functional epidural that has been working well for the past few hours. While telling you that she has been very comfortable, the patient suddenly reports severe abdominal pain. Her BP is now lower and her fetal heart tone tracing is erratic.
Your next course of action is to:
A. Notify the obstetrician/L and D RN of a suspected uterine rupture: prepare for stat c-section
B. Re-dose the epidural to attempt to improve her pain relief
C. Place her in right lateral decubitus position and slow down her IV fluids
D. Make a note in the chart that everything looks good, and go about your business
A. Notify the obstetrician/L and D RN of a suspected uterine rupture: prepare for stat c-section
T/F
Epidural analgesia is absolutely contraindicated for intrauterine fetal demise deliveries
False
It is a relative contraindication. Just be sure no DIC present before proceeding with epidural
A parturient with a history of spina bifida request a labor analgesia at 7cm dilation. Which of the following is the best option?
A. Spinal sufentanil
B. Epidural bupivicaine
C. Fentanyl PCA
D. Transtracheal block
C. Fentanyl PCA
T/F
The structure encountered immediately before entering the epidural space is ligament flavor
True
Which of the following agents is a tocolytic?
A. Ritodrine
B. Magnesium
C. Oxytocin
D. Terbutaline
C. Oxytocin
Sodium bicarbonate added to a local anesthetic for epidural anesthesia speeds the onset of anesthesia by:
A. Raising the pH to a value closer to the local anesthetic pKa
B. Constricting vasculature surrounding the epidural space
C. Decreasing protein binding, creating more available local anesthetic
D. Increasing the total volume of solution injected
A. Raising the pH to a value closer to the local anesthetic pKa
The most effective route of delivery for narcotics for treating labor pain is:
A. Intramuscualr
B. Intraocular
C. Subcutaneous
D. Spinal
D. Spinal
Contraindications to neuraxial blockade include:
A. Obesity
B. Recent blood transfusion
C. Coagulopathy
D. History of low back pain
C. Coagulopathy
The most likely side effect expected with nalbuphine (Nubaine) is:
A. Pruritis
B. Dysphoria
C. Respiratory depression
D. Seizures
B. Dysphoria
T/F
Meperidine has been associated with seizures
True
You are covering the OB unit at the hospital and are in the OR caring for your c-section patient. The baby has been delivered and is on the warming cart. You patient is hypotensive and the surgeon is having a difficulty with the placenta resulting in a large amount of blood loss. The nurses caring for the baby yell that they baby is not breathing and we need to intubate now. They are calling for the neonatologist who is 5 minutes away. What do you do?
Continue caring for the mother and wait for the neonatologist to intubate the baby
After placing a SAB, your patient begins to tell you that she is really having a hard time breathing and begins to gasp for air, then just starts shaking her head vigorously. Which of the following would you do first?
A. Assist her ventilations with the mask and circuit on anesthesia machine
B. Reassure her that it is normal
C. Start 2nd IV of fluid administration and support BP
D. Immediately place ETT
A. Assist her ventilations with the mask and circuit on anesthesia machine
All of the following are considered when preparing for a c-section except?
A. Patient has a full stomach
B. Patient has a difficult airway
C. Patient has a decreased FRC
D. Patient is an ASA 3
D. Patient is an ASA 3
The purpose of left uterine displacment is?
to displace the uterus to the left, thus relieving pressure on the inferior vena cava and abdominal aorta, maintaining uterine blood flow
A cesarean section is a complex psychosocial procedure with one of the main differences from other procedures being?
The patient is awake
After dosing a spinal for C section, the patient complains of nausea. What is the most likely cause?
A. Vagal reaction from a needle in the back B. Hypoxia C. Hypotension D. Motion sickness E. Food poisoning
C. Hypotension
An epidural block is placed for c-section. After dosing the epidural a block height of T10 is demonstrated. Which of the following actions would be best at this time?
A. Allow the surgeon to start
B. Pull the catheter out and place a spinal
C. Do a general anesthetic
D. Give another 5-10cc of local anesthetic
D. Give another 5-10cc of local anesthetic
T/F
Phenylephrine is contraindicated for BP management during c-section because of potential uterine artery spasm
False
T/F
Elective procedures are usually postponed at least 6 weeks postpartum
True
T/F
Preterm labor is a distinct possibility with non obstetric surgeries near the future
True
Which of the following agents best reduces gastric acid secretion?
A. Sodium citrate
B. Rantitidine
C. Metoclopramide
D. Propofol
B. Rantitidine
Which of the following agents should probably be avoided the parturient undergoing non-obstetric surgery?
A. Fentanyl
B. Thiopnetal
C. N2O
D. Isoflurane
C. N2O
When planning for a potentially difficult airway, all of the following should be utilized EXCEPT:
A. Additional experienced personal
B. Specialized airway equipment
C. Preoxygenation
D. A long acting muscle relaxant for induction
D. A long acting muscle relaxant for induction
A T6 block height would most likely result in all of the following except:
A. Adequate block for c-section
B. Hypotension
C. Bradycardia
D. Numb legs
C. Bradycardia
A parturient with a known difficult airway presents for c-section for failed induction of labor. Select the most appropriate anesthetic:
A. General anesthetic with RSI B. Acupuncture C. Spinal anesthesia D. LA infiltration by surgeon supplemented with light sedation E. Hypnosis
C. Spinal anesthesia
T/F
Painless vaginal bleeding is usually associated with placental abruption
False
A laboring term parturient with BP’s in the 150/90’s and proteinuria. Epidural analgesia is requested. Select the most appropriate way to proceed.
A. Place the epidural if coagulation profiles an PLT’s are favorable
B. Refuse based on the fact that her BP might become unstable
C. Place the epidural only after an arterial line is in place
D. Put the patient on a fentanyl PCA
A. Place the epidural if coagulation profiles an PLT’s are favorable
A parturient presents being currently treated DKA with an insulin infusion at 5 units/hr and D5W drip, last serum glucose 238. The OB wishes to proceed with an urgent c-sectionfor persistent late decelerations. Which of the following statements is most likely FALSE regarding the patient?
A. The patient has uteroplacental insufficiency causing frtal distress
B. Ketones are crossing the placenta and causing decreased oxygenation fetal distress
C. The D5W infusion should be stopped prior to surgery, and resumed once the patient is stable in PACU
D. If an epidural is employed, this patient is likely to have increased serum lidocaine levels compared to a non diabetic patient
C. The D5W infusion should be stopped prior to surgery, and resumed once the patient is stable in PACU
T/F
Amniotic fluid embolism is rarely fatal
False
A patient in active labor whom you are evaluating for placement of an epidural complains of sudden anxiety, dyspnea, and within a few seconds becomes pulseless. Which is the most likely diagnosis?
A. Amniotic fluid embolism
B. Uterine rupture
C. Cord prolapse
D. Placental abruption
A. Amniotic fluid embolism
A patient with pregnancy-induced HTN is about to undergo a c-section because her liver enzymes are starting to rise. Her PLT count and coagulation profiles drawn 24 hrs ago on admission were within normal limits. Which of the following actions is most appropriate?
A. Place a spinal
B. Do a general anesthetic with RSI
C. Do a general anesthetic with an awake intubation
D. Repeat the PLT count and coagulation studies
D. Repeat the PLT count and coagulation studies
Which of the following id definitive evidence of amniotic fluid embolism?
A. Sudden hemodynamic collapse
B. Demonstration of fetal cells in maternal circulation
C. A sudden decrease in EtCO2
D. Seizures
B. Demonstration of fetal cells in maternal circulation
Which of the following is the most effective treatment for pregnancy-induced HTN?
A. Magnesium
B. Delivery of the fetus and placenta
C. Corticosteroids
D. None of the above
B. Delivery of the fetus and placenta
Which of the following is most likely in a patient with preeclampsia?
A. Thrombocytopenia
B. Hepatic failure
C. Auditory hallucinations
D. Oliguria
A. Thrombocytopenia
A parturient presents for repeat c-section with a placenta prevue. Which of the following statements is most accurate?
A. Regional anesthesia is absolutely contraindicated
B. Massive blood loss should be anticipated
C. If a spinal is selected, a short acting agent should be used to reduce the chance of prolonged sympathectomy
D. This patient is at risk for uterine rupture
B. Massive blood loss should be anticipated
Regarding an otherwise health parturient with a suspected placenta accretion ultrasound exam presenting for elective repeat c-section with possible myomectomy, possible hysterectomy, select the TRUE statement:
A. Neuraxial anesthesia is contraindicated due to a high incidence of DIC
B. Spinal anesthesia is preferred over epidural due to reliable profound block
C. The patient’s previous c-section increased her risk of accrete
D. An MRI would confirm diagnosis of accrete with certainty and should be performed prior to surgery
C. The patient’s previous c-section increased her risk of accrete
Which of the following agents is contraindicated in asthmatics?
A. Ritodrine
B. Oxytocin
C. Carboprost (prostaglandin F-2a)
D. Methylergonovine (Hemabate)
C. Carboprost (prostaglandin F-2a)
Chest compression in the parturient are:
A. A recorded method to induce labor
B. Very effective when the patient is in the lateral position
C. Effective as long as the patient is in trendelenberg position
D. Largely ineffective until the baby is delivered
D. Largely ineffective until the baby is delivered
T/F
General anesthesia is the best choice for cases of uterine inversion
True
The most common cause of intrauterine fetal demise at term is :
A. Placenta previa
B. Pulmonary embolism
C. Placental abruption
D. Placenta accreta
C. Placental abruption
