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Truelearn Advanced Exam > TL block 6 > Flashcards

TL block 6 Flashcards

1
Q

Wernicke encephalopathy

A

ataxic gait, AMS, oculomotor dysfunction
-if you give alcoholics glucose w/o thiamine

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2
Q

Electrolyte abnormalities in chronic alcoholics

A

hypoCa
hypoMg
hypoPhos
hypoglycemia
***when giving glucose, give thiamine 1st to avoid Wernicke’s encephalopathy

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3
Q

Contraindications to low fresh gas flows in a circle system

A

-intoxicated alcohols: exhaled CO and methane, acetone
-uncompensated diabetic states
-carbon monoxide poisoning

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4
Q

Assoc w/ high rates of postop pulm complications

A

-dependent functional status
-ASA 3 or 4
-prolonged operative time
-age > 60
-COPD
-smoking

**male gender and lower BI assoc w/ postop PNA

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5
Q

why is hypothermia so devastating in newborns?

A

hypothermia is assoc w/ metabolic acidosis -> acidosis is assoc w/ inc in PVR and dec in SVR -> inc flow across PFO and PDA -> maintaining fetal circulation
(same thing w/ hypoxia and inc in PVR)

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6
Q

Eisenmenger complex

A

L to R shunting becomes R to L shunting

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7
Q

Edward Syndrome

A

Trisomy 18
-microcephaly, prominent occiput, micrognathia, congenital heart dx, intellectual disability, sz, renal anomalies, capillary hemangiomas

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8
Q

pulse ox goals for newborns

A

60-65% one minute of life
85-95% by 10 minutes of life

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9
Q

APGAR Score

A

Appearance: Color
Pulse: 0, <100, >100
Grimace: none, grimace, coughing
Activity: flaccid, flexion only, active
RR: no effort, slow, normal crying
0-2

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10
Q

chest compressions: RR neonates

A

3:1 3 chest compressions to 1 breath
-only if HR < 60

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11
Q

What congenital heart dx is assoc w/ aortic root dilation?

A

Bicuspid aortic valves

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12
Q

Pyloric stenosis, initial resuscitation

A

10-20 cc/kg of normal saline w/ 20 mEq/L of potassium
-do not use glucose containing fluids w/ large volume resuscitation b/c hyperglycemia -> do glucose containing fluids after rescucitation

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13
Q

End point of resuscitation for pyloric stenosis

A

Cl > 100
K > 3
no more clinical signs of hypovolemia

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14
Q

postop concern for pyloric stenosis

A

**postop apnea
-alterations in CSF pH and central chemoreceptors reponse to CO2
-minimize opioids and hyperventilation

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15
Q

newborns: mild dehydration: weight loss, UOP, and urine specific gravity

A

5% weight loss
UOP < 2cc/kg/hr
urine specific gravity < 1.02

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16
Q

newborns: moderate dehydration: weight loss, UOP, urine specific gravity

A

10% weight loss
UOP < 1 cc/kg/hr
urine specific gravity: 1.02-1.03

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17
Q

newborns: severe dehydration: weight loss, UOP, urine specific gravity

A

15% weight loss
UOP <0.5 cc/kg/hr
urine specific gravity: >1.03

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18
Q

newborn dehydration rehydration stratechy

A

1st: 20-30 cc/kg isotonic fluid bolus
2nd: 25-50 cc/kg over 6-8 hrs
reaminder of deficit over 24 hours

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19
Q

prevention for infant postop apnea

A

caffeine
theophylline (metabolized to caffeine)

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20
Q

Strongest RF for newborn postop apnea

A

prematurity

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21
Q

NPO time for carbonated beverages like soda

A

2 hours

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22
Q

Age what age does peds sympathetic nervous system mature to an adults?

A

7-8 years old

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23
Q

MC presenting sign of high/total spinal in infants or kids?

A

Apnea! (resp m paralysis)
-b/c immature symp NS -> no bradycardia or hypoTN

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24
Q

5d infant intubated, gastric distention, unable to place NG tube, exp volume significantly lower than insp volume

A

Tracheoesophageal fistula!
push ETT In deeper

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25
Q

Side effects to PGE1 to maintain PDAs

A

APNEA
-hypoTN
-fevers
-CNS irritability

**dec SVR and PVR

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26
Q

which onen is more common: gastroschisis or omphalocele?

A

omphalocele

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27
Q

which one as a higher risk of heat loss, repaid dehydration and infxn: omphalocele or gastroschisis?

A

gastroschisis

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28
Q

Electrolyte issues w/ refeeding syndrome

A

-hyperglycemia
-hyperinsulinemia
-hypercarbia
-hypoK (inc insulin)
-hypoMg
-***hypophos
-thiamine def

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29
Q

Sepsis initial fluid resuscitation

A

30 cc/kg

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30
Q

MOA of organophosphate poisoning

A

AChE inhibitors

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31
Q

What syndrome is a destruction of VG Ca channels?

A

Lambert-Eaton myasthenic syndrome

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32
Q

What dx is a desetruction of postjunctional ACh receptors?

A

myasthenia gravis

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33
Q

Hepatic steatosis and TPN

A

-common b/c glucose calories can exceed caloric requirements
-> store excess surgar as fat in the liver
-AST/ALT rise -> usually return to normal after TPN adjustments

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34
Q

Def of septic shock

A

after adequate fluid resuscitation req pressors to get MAP >65 and lactate > 2

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35
Q

qSOFA csore

A

RR > 22 (1 pt)
AMS (1 pt)
systolic BP < 100 (1pt)
total of 3
-scores 2 or higher are assoc w/ worse outcomes

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36
Q

Equation for amount of sodium bicarb needed to correct acidosis in pt

A

Sodium bicarb mEq = (0.2 * weight kg * base excess)

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37
Q

why hypoTN w/ severe acidosis

A

catecholamines don’t bind receptors as well w/ severe acidosis

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38
Q

ARDS Network mechnical vent goals

A

TV 6 cc/kg of ideal body weight w/ PLATEAU pressures < 30

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39
Q

Pulm issues w/ drowinging

A

-wash out of surfactant -> inc permeability of the alveolar-capillary membrane, dec lung compliance, V/Q mismatch

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40
Q

Which has a higher flow rate: tibial or humeral IO lines?

A

humeral!

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41
Q

IV:IO ratio of meds and fluids

A

1:1
-often need a pressure bag for IO though due to increased pressure

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42
Q

IO access w/ fastest uptake of drugs and fluids

A

manubrium of the sternum

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43
Q

IO infxn rates

A

0.6%, very rate
-femoral CVC have 15%

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44
Q

Hemodynamic prerequisites to name someone brain dead

A

Temp > 36 C
Systolici BP > 100

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45
Q

To minimize ventilator associated PNA

A

-daily sedation weaning trials w/ SBT to assess readiness to extubate
-use NIPPV instead of intubating when appropriate
-HOB at 35-40 degrees
-early mobilization
-avoid changing ventilator circuit
-subglottic secretion drainage ports on ETT

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46
Q

Stress ulcer ppx and ventilator assoc PNA

A

-can actually have an increase in VAP w/ PPIs and H2 blockers b/c dec in acidity allows bacteria in stomach to increase -> inc PNA

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47
Q

If concern for multi-drug resistant pathogens tx should include:

A

MRSA converage (Linezolid or Vanco)
plus
TWO anti-pseudomonal agents

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48
Q

RF for multi-drug resistant pathogens causing ventilator-assoc PNA

A

-5 or more days of hospitalization
-prior IV abx w/i 90 days
-septic shock at time of occurrence
-ARDS or acute renal replacement therapy prior to onset

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49
Q

Major cause of tetanus associated morbidity and mortality

A

Autonomic dysfunction
-initially sweating, vasoconstriction, severe tachycardia and HTN -> which rapidly alternate w/ bradycardia and hypoTN

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50
Q

Treatment of CN toxicity if concurrent carbon monoxide poisoining

A

Hydroxocobalamin (Vit B12)
or thiosulfate
-no nitrites b/c of CO poisoning

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51
Q

Tigecycline

A

covers MRSA and gram negative organisms

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52
Q

Linezolid

A

MRSA and Vanc resistant enterococcus

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53
Q

Meds that worsen myasthenia gravis

A

NMB
fluoroquinolones
aminoglycosides
Mg sulfate
penicillamine

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54
Q

What levels does a TAP block cover?

A

T7-L1

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55
Q

Normal serum osmolality

A

280-290 mOsm/kg

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56
Q

Serum osmolality for hyperglycemic hyperosmolar state

A

> 320

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57
Q

symptoms for hyperosmolar hyperglycemia state

A

altered mental status! stupor, coma, sz
***b/c of hyperosmolarity -> cerebral fluid loss to buffer -> coma/sz

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58
Q

SIADH lyte abnormalities

A

Urine osm > 100
FeNa > 1%
Urine Na > 20
low serum uric acid and BUN
dilution, euvolemic hyponatremia Na < 135

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59
Q

Sites for IO placement

A

manubrium of sternum
proximal humerus
proximal tibia
distal tibia

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60
Q

Pacemaker 5 position

A

PCR
1. Paced
2. sensed
3. action taken
4. rate modulation
5. location of multisense pacing

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61
Q

What is minimally invasive coronary artery bypass?

A

surgical method for LAD revascularizatin vita anastomosis to LIMA via L thoractomy

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62
Q

Contraindications to minimally invasive coronary artery bypass

A

-blood clot in L subclavian (b/c use LIMA)
-cardiogenic shock due to acute LAD occlusion (minimally invasive takes longer time for dissection)

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63
Q

Hypoplastic L heart syndrome

A

-LV hypoplastic
-ASD
-severely stenotic mitral and aortic valves
-PDA
-hypoplastic ascending aorta

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64
Q

what would cause a complete loss of ipsilateral brainstem auditory evoked potentials?

A

Transection of CN VIII

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65
Q

Which evoked potentials are most resistant to anesthesia techniques?

A

Brainstem auditory evoked potentials

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66
Q

Which evoked potentials are the MOST sensitive to anesthetic technique?

A

Visual evoked potentials

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67
Q

Coags TPN

A

increased PT
-require Vit K supplementation and commonly assoc w/ acute liver injury

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68
Q

Echogenicity of tissues on u/s determined by:

A

density of the tissue
-greater echogenicity = greater intensity (brightness)

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69
Q

Technique to rapidly reverse suspected high spinal

A

CSF lavage
-remove 20-30cc of CSF -> replace it with sterile saline

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70
Q

Monitoring during parathyroidectomy

A

-intraop PTH monitoring (1/2 life of 3-5 minutes, goal is reduction of at least 50%
-postop Ca monitoring

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71
Q

Predictors of hypoxemia during one lung ventilation

A

-high FEV1 prior to surgery
-hypoxemia w/ 2 lung ventilation
-R sided surgery
-supine position during surgery
-high perfusion in operative lung w/ V/Q scan

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72
Q

which lung is the dependent lung in one lung ventilation?

A

the one that is being ventilated, the non-operative lung

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73
Q

hyperthermia, tachycardia, diaphoresis, arrythmia, agitation, and confusion dx?

A

Thyroid Storm

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74
Q

How to tell thyroid storm apart from Anticholinergic toxicity

A

diaphoresis! Thyroid storm people sweat, Anticholinergic tox “dry as a cracker”

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75
Q

Duchenne muscular dystrophy anesthesia concerns

A

-GI tract hypomotility, gastroparesis
-impaired swallowing
-inc risk of aspiration

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76
Q

Treatment for lambert eaton syndrome

A

3,4 diaminopyridine
immunosuppresion
steroids

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77
Q

attempted epidural placement, variable motor blockade, dense sensory blockade, and sympathetic block out of proportion to an epidural block

A

subdural block

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78
Q

Physiologic factors that attenuate SSEP monitoring

A

-hypoTN
-hypothermia
-hypocarbia
-hypoxemia
-anemia

**hyperthermia red latency

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79
Q

Risk factors for transientn neurologic symptoms

A

-intrathecal lidocaine
-lithotomy position
-pt positioning for knee arthroscopy
-outpatient status

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80
Q

Treatment for transient neurologic syndrome

A

NSAIDs and will resolve w/i 3 days of surgery

81
Q

RF for GERD during pregnancy

A

-gestational age
-GERD symp prior to pregnancy
-multipartity

**BMI IS NOT ONE*

82
Q

Gastric emptying slowing in pregnacy

A

ONLY during labor itself!

83
Q

Sodium citrate

A

increases gastric pH
-no effect on gastric emptying

84
Q

AHI scores for OSA

A

5-15: mild
15-30: mod
>30: severe

85
Q

Medications for central sleep apnea

A

Acetazolamide
Theophylline
-stimulates breathing

86
Q

Differentiate b/w OSA and central sleep apnea

A

Snoring more common in OSA

87
Q

which prior uterine surgery is more likely to cause uterine rupture w/ labor?

A

Upper segment scar&raquo_space; lower

88
Q

RF for uterine rupture

A

-prior uterine surgery
-uterine hypercontractility
-oxytocin use
-PG use
-prolonged labor
-dystocia
-multiparity
-multiple gestations
-congenital uterine anomalies
-polyhydramnios
-trauma

89
Q

def of post partum hemorrhage

A

blood loss > 1000cc either vaginal or c/s

90
Q

RF for uterine atony

A

-multiparity
-multiple gestations
-polyhydramnios
-chorioamnionitis
-prolonged labor
-oxytocin-induced labor

91
Q

Terbutaline side effects

A

-tachycardia
-hypokalemia
-hyperglycemia (despite inc in insulin) -> inc in glycogen breakdown

92
Q

Indomethacin side effects when used as a tocolytic

A

-plt dysfunction
-renal dysfunction
-premature PDA closure (when used after 32 weeks)

93
Q

what is fetal fibronectin testing used for?

A

as a screen for preterm labor -> if negative rate of preterm labor is < 1% for the next week

94
Q

Amniotic fluid embolism stsages

A
  1. severe pulm vasospasm -> R heart dysfxn/failure -> low cardiac output -> V/Q mismatch, hypoxemia, hypoTN
  2. severe pulm edema -> L heart dysfxn/failure
    -consumptive coagulopathy
    -if pt still pregnant -> emergency c/s due to severe hypertonus of uterus
95
Q

Labor analgesisa plan for pts taking buprenorphine

A

-continue during labor -> divide the daily dose into multiple times per day
-neuraxial anesthesia
-has inc postpartum pain scores compared to controls -> can inc buprenorphine up to 32mg per day

96
Q

side effects of terbutaline

A

-hypoTN
-tachycardia
-inc cardiac output
-hyperglycemia
-hypoK
-pulm edema

97
Q

preterm labor, weeks?

A

< 37 week

98
Q

Normal pregnancy ABG

A

PaO2: 105isih
PaCO2: 30
bicarb: 20
pH: 7.44

99
Q

acid-base changes in pregnancy

A

-Inc PaO2 (inc in MV, improves alveolar ventilation)
-Dec PaCO2 (inc in MV) -> resp alkalosis
-Dec in bicarb (compensatory metabolic acidosis)
-decrease in base excess
-pH: alkalotic
-p50 increases (Hg curve shifts to the right)

100
Q

Base excess

A

-amount of acid required to restore a liter of blood to a normal pH w/ a PaCO2 of 40
-if high: inc level of bicarb in blood
-if low: lower bicarb in blood (metabolic acidosis or compensated resp alk)

101
Q

RF for placental abruption

A

-maternal HTN
-maternal cocaine/tobacco use
-paternal tobacco use
-trauma
-adv maternal age
-parity
-hx of prior abruption
-chorioamnionitis

102
Q

Variable decelerations OB

A

umbilical cord occlusion
-healthy fetus can tolerate mild to moderate w/o decompensation
-w/ sustained, severe variable -> hard to maintain cardiac output

103
Q

sinusoidal fetal heart rate pattern

A

fetal anemia

104
Q

Fetal response to terbutaline for preterm labor

A

maternal hyperglycemia -> fetal hyperglycemia -> fetal hyperinsulinemia -> after born baby is hypoglycemic
-fetal tachycardia
-myocardial ischemia or hypertrophy

105
Q

Amniotic fliud embolism criteria:

A
  1. hypoTN or cardiac arrest
  2. hypoxia
  3. coagulopathy or hemorrhage
106
Q

When is amniotic fluid embolism likely to occur?

A

-onset of labor
-during c/s
-w/i 30 minutes postpartum

107
Q

treatment for amniotic fluid emoblism

A

resuscitative and supportive!
-airway support (ETT)
-vasopressors/inotropes
-coagulopathy (pRBCs, FFP, cryo, plts)

108
Q

Why do pregnant women desat so quickly?

A

-Decreased FRC and high O2 utilization

109
Q

Pregnancy and closing capacity

A

NO EFFECT!
-obesity and pregnancy no effect, only changes w/ age over 40

110
Q

normal umbilical artery blood gas sample

A

pH: 7.2-7.3
pCO2: 50-55
pO2: 20
bicarb: 20-25
base excess -2.7 to -4.7

111
Q

most sensitive and specific sign of uterine rupture?

A

Non-reassuring fetal heart rate patterns

112
Q

RF for uterine rupture

A

-grand multiparity > 5 births
-previous c/s
-prev myomectomy
-induction of labor w/ oxytocin
-fetal malpresetation

113
Q

Hemodynamic changes in pregnancy

A

-Inc cardiac output
-Inc HR
-Inc SV
-inc intravascular volume
-inc plasma volume
-inc RBC mass
-NO change in CVP
-DEC SVR
-dec afterload

114
Q

Asherman’s syndrome

A

intrauterine adhesions or intrauterine synechiae) occurs when scar tissue forms inside the uterus and/or the cervix. These adhesions occur after surgery of the uterus or after a dilatation and curettage

115
Q

P50 pregnancy and fetus

A

Normal p50: ~27
pregnancy p50: ~30
fetal p50: 21
-so R shift of Hg curve in pregnancy to increase O2 offload -> L shift of fetal Hg curve to inc O2 acceptance from mom

116
Q

Def of proteinuria for preeclampsia

A

Urine Pr:Cr ratio > 0.3
24 hr collection > 300mg
1+ dipstick

117
Q

Preeclampsia def

A

> 20 weeks gestation HTN >140/90 4 hrs apart with:
-proteinuria (urine Pr:Cr > 0.3, 300mg 24 hrs, +1 dipstick)
-plts < 100k
-visual changes
-pulm edema
-AST/AST x2
-Cr > 1.1

118
Q

SE of adding epi to bupi for epidural

A

-increasing muscular blockade
-possible tocolytic effects (beta 2 agonism)
-dec placental BF (alpha 1 agonism)
-dec minimum local anesthetic conc of epidural bupi

119
Q

Methylergonovine MOA

A

ergot alkaloid
-inc intracellular Ca -> uterine contractions

120
Q

Methylergonovine SE

A

-sudden HTN
-bradycardia
-coronary vasospasm
-cardiogenic pulm edema

121
Q

Carboprost MOA

A

stimulates smooth m and uterine contraction by prostaglandin-like effects

122
Q

Carboprost SE

A

nausea, diarrhea, bronchospasm

123
Q

Oxytocin side effects

A

-hypoTN w/ bolus
-arrhythmias (ST changes)
-hypertonic uterine contractions
-nausea
-HA

124
Q

Misoprostol MOA

A

-prostaglandin analogue -> binds myometrial cells to cause myometrial contractions

125
Q

When is misoprostol used?

A

ripen the cervix and induce labor

126
Q

for amniotic fluid embolism, what site are the factors/inflammatory mediators entering maternal circulation?

A

placenta
endocervical veins
uterine trauma site

127
Q

Amniotic fluid emoblism criteria

A
  1. hypoxemia
  2. hypoTN or cardiac arrest
  3. coagulpathy or severe hemorrage
128
Q

O2 delivery to fetus determined by:

A

-O2 carrying capacity: O2 saturation and maternal Hg
-uteroplacental BF

129
Q

neuraxial anesthesia and uterine Blood flow

A

-Increases! -> b/c pain relief, dec sympathetic activity and dec maternal hyperventilation

130
Q

which coag factors increase the most in pregnancy

A

factor VII
fibrinogen

131
Q

albumin and pregnancy

A

decrease!
-inc in intravasc volume with no change in albumin prod -> dec

132
Q

Normal fetal heart rate

A

120-160

133
Q

fetal heart rate healthy variability

A

5-25
if variability <5 or >25 -> non-reassuring

134
Q

def of a deceleration in fetal heart rate monitoring

A

> 15 decrease in HR

135
Q

Metabolism of chloroprocaine

A

Plasma esterases

136
Q

dx if fetal decreased variability

A

-fetal hypoxia
-fetal sleep state
-maternal opioid use
-fetal neuro abnormality

137
Q

After what gestational age is a pregnant pt at increased risk of aspiration

A

18 weeks

138
Q

RF for aspiration pneumonitis

A

pH of fluids < 2.5
volume of aspirate > 0.4 cc/kg
particulates in the aspirate

139
Q

Gastric emptying and pregnancy

A

-not delayed until the start of labor

140
Q

What medications are used to inc gastric pH?

A

sodium citrate
citric acid

141
Q

Why inc risk of aspiration with pregnancy

A

-dec LES tone
-inc intragastric pressure (gravid uterus)

142
Q

how long after delivery does risk of aspiration decrease?

A

48 hours

143
Q

H2 antagonists

A

famotidine
ranitidine

144
Q

APGAR

A

Appearance: 0 cyanotic 2 fully pink
Pulse 0: none, 1: <100, 2: >100
Grimace: 0 no resp to stimulation, 2 full grimace and cry
Activity: 0: none, 1: flexion 2: active
Respirations: 0: not breathing 1: weak, irregular, shallow, gasping 2: full strong regular cry

145
Q

Uterine blood flow

A

UBF = BP/ Uterine vascular resistance
-if decrease in uterine arterial pressure (hemorrhage, hypovolemia, sympathetic blockade [epidural]) or increase in uterine venous pressure (caval compression, uterine contraction) -> placental perfusion is decreased
**BP most important to maintain flow
-if no decrease in BP -> uterine BF better w/ analgesia and improvement in fetal acid base status (no hypervent -> hypervent from pain shifts O2-Hg curve to the left)

146
Q

Stages of labor

A

I: onset of labor w/ regular contractions until cervix completely dilated
II: fully dilated to baby delivered
III: baby delivered to placenta delivered

147
Q

What spinal levels need to be covered for stage 1 of labor?

A

T10-L1

148
Q

What spinal levels for second stage of labor?

A

T12-L1 PLUS S2-4

149
Q

most common cause of pregnancy-related maternal mortality in the USA?

A

cardiovascular conditions

150
Q

Unfractionated heparin and pregnancy

A

Bioavailability decreases
-inc protein binding
-inc heparinases -> inc breakdown
-inc plasma volume
-inc renal clearance

151
Q

Therapeutic unfractionated heparin in pregancy

A

10,000 U or more subq every 12 hours -> PTT goal 1.5-2.5x 6 hours after injxn

152
Q

unfractionated heparin ppx dose

A

5k-7k every 12 hours 1st and 2nd trimester
1k every 12 hours 3rd trimester
-PTT should be normal

153
Q

Recommendation on holding low dose subq heparin (5-7k) before neuraxial

A

4-6 hours prior or coags

154
Q

Recommendation on holding moderate dose subq heparin (7.5k-10k) before neuraxial

A

12 hours and coags should be assessed

155
Q

Recommendation on holding therapeutic heparin

A

24 hours and coags should be assessed

156
Q

IV pain med of choice for 2nd stage labor

A

remifentanil -> metabolized too rapidly and redistributed too quickly to accumulate in fetal blood stream

157
Q

Highest cardiac output w/ pregnancy, when and how much?

A

immediately after delivery -> autotransfusion
2.5x cardiac output

158
Q

How long for cardiac output to approach prepregnant values?

A

2 weeks postpartum: ~10% above prepregnancy
up to 24 weeks to full normal

159
Q

Which factors decrease during pregnancy?

A

XIII and XI

160
Q

flow-volume loop pregnancy

A

NORMAL

161
Q

Best time to do surgery during pregnancy

A

2nd trimester
-minimize risk of abnormal organogenesis
-minimize risk of preterm labor

162
Q

What is the earliest age fetal heart rate monitoring is possible?

A

18-20 weeks gestation

163
Q

At what age does fetal heart rate variability occur?

A

25-27 weeks

164
Q

Pregnant but not-OB surgery concerns after 18 weeks

A

-inc aspiration risk-> H2 blockers + antacid
-L uterine displacement during surgery
-have tocolytics available
-consider intraop fetal monitoring -> if unable minimum is pre and post op
-minimize insufflation pressures (10-15) to prevent dec in uterine perfusion
-mild hypocarbia (etCO2 32-36)

165
Q

Ketamine and pregnancy

A

during 1st 2 trimesters >2mg/kg can cause uterine hypertonus

166
Q

neonate’s HR <60

A

CPR rate of 3:1, rate of 120 events per minute (90 chest compressions, 30 breaths)

167
Q

Epi dosing neonate

A

10-30 mcg/kg

168
Q

stage I of labor

A

stage I: latent and active phase of labor
-active phase: acceleration v deceleration phases
-latent: regular painful contractions w/o cervical dilation
-once active phase: dilate 1-1.5 cm/hour

169
Q

most common cause of prolonged latent labor

A

“unripe” cervix when labor begins

170
Q

Issues causing prolongation of labor in active phase

A

2 types: not dilating at the appropriate rate, or arrest of dilation
-usually linked to cephalopelvic disproportion

171
Q

At what pH is a fetus considered acidotic and need an emergency c/s?

A

< 7.20

172
Q

anesthetic plan for ex utero intrapartum treatment procedure?

A

uterine relaxation w/ avoidance of uterotonics
-usually GA w/ anesthetic goal of MAC 2-3, or lower dose volatiles w/ nitroglycerin supplementation
-fent, NMB, atropine can also be given to the fetus IM after partial delivery

173
Q

Goals for DIC treatment

A

Hg >7
PT/PTT < 1.5
plts >50k
fibrinogen > 300
-deliver fetus -> GA can’t do neuraxial

174
Q

Fibrinogen levels in pregnancy

A

DOUBLE
non-pregnant ~200
pregnant ~400

175
Q

protein C and S pregnancy

A

-protein C increased resistance
-protein S levels decrease
-resistant has 2s already -> protein C

176
Q

electrolyte abnormality w/ high dose oxytocin

A

hypoNa (similar structure to ADH) -> volume overload is sensed by atria -> ANP -> natriuresis -> hypoNa (in addition to dilutional from inc water reabsorb)

177
Q

SE from high dose oxytocin

A

-hypoNa (similar to ADH)
-N/V

178
Q

RF for meconium passage -> inc risk of meconium aspiration

A

later gestational age

179
Q

When should maternal steroids be given to further lung development?

A

24-34 weeks

180
Q

Pruritis: epidural v CSE?

A

higher in CSE!

181
Q

epidural v CSE: can provide complete analgesia in 1st stage of labor w/ opioids alone, no sympathectomy or motor blockade

A

CSE! intrathecal opioids provide adequate analgesia

182
Q

What decreases uterine blood flow?

A

-hypoTN maternal
-uterine contractions
-uterine vasoconstriction (severe hypocapnia, alpha agonists, preeclampsia)
-uterotonics!

183
Q

which inhaled anesthetic doesn’t cause uterine relaxation?

A

nitrous oxide

184
Q

postpartum, HA w/ sz, no eclampsia

A

Cerebral venous/sinus thrombosis
-due to thrombosis in cerebral venous complex (dural venous sinuses or verebral vwins)
dx w/ MRI

185
Q

frontal HA soon after dural puncture

A

pneumocephalus
-may be positional (worse when upright)

186
Q

time frarme for PDPH

A

24-48 hours typically, within 5 days definitively

187
Q

RF for GERD w/ pregnancy

A

-gestational age
-hx of heartburn before pregnancy
-multiparity

188
Q

Drugs that don’t cross placenta

A

tHINGS don’t cross
Heparin
Insulin
NDNMB
Glycopyrrolate
Succ

189
Q

Possible causes of preeclampsia

A

-narrow of spiral arteries -> endothelial activation
-paternal genetic factors (paternal family hx inc risk)
-immunologic factors (pts w/ HIV have dec risk)

190
Q

How long after taking heparin does a pt need a plt count for a spinanl?

A

5 days!

191
Q

GA v spinal for cerclage placement?

A

-spinal generally preferred unless membranes bulging -> GA decrease intrauterine pressure as long as intubation and extubation conducted to avoid coughing and straining
-hyperflexed spine for spinal placement also inc intraabd pressures
-can use LMA if <18 weeks
-if >22 weeks -> need FHR monitoring
-PONV ppx, N/V inc pressures

192
Q

Utertonics post delivery

A

all deliveries get uterontics! ppx oxytocinn for all

193
Q

OB pt: chronic HTN v gestational HTN

A

chronic: < 20 weeks gestation
gestational: > 20 weeks gestation w/o signs of proteinuria or end organ dysfxn (would make it PEC)

194
Q

when does gestaional HTN typically resolve?

A

postpartum week 12

195
Q

what abx toxic to kidneys when taken w/ ACE inh?

A

aminoglycosides and amphotericin B

196
Q

What to measure to dx carcinoid syndrome?

A

24 hr urinary 5-hydroxy-indole-acetic-acid (5-HIAA)
-release of serotonin from metastatic carcinoid tumors
- >30mg for dx (norm 3-15)

197
Q

Cardiac involvement w/ carcinoid syndrome?

A

TR!

198
Q

What are you testing for w/ 24-hour vanillymandelic acid?

A

Pheo (same w/ urinary normetanephrines)

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