Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APEX > Unit 11 - OB Part 2 > Flashcards

Unit 11 - OB Part 2 Flashcards

1
Q

1 major difference in prepping for surgery for a c section under general vs other surgeries

A

prep and drape prior to induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

induction drugs to use for C section under GA

A
  • 2-2.5 mg/kg propofol
  • 0.3 mg/kg etomidate
  • 1 mg/kg ketamine

choose 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

induction drugs to use for C section under GA

A
  • 2-2.5 mg/kg propofol
  • 0.3 mg/kg etomidate
  • 1 mg/kg ketamine

choose 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

should defasiculating dose be given with succs for OB patients

A

not needed – pregnancy reduces risk of myalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

should defasiculating dose be given with succs for OB patients

A

not needed – pregnancy reduces risk of myalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ideal volatile concentration for c section under GA

A

low concentration of volatile (0.8 MAC) + 50% nitrous oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

risk of neonatal acidosis increases when time between uterine incision and delivery is greater than:

A

3 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

normal amniotic fluid volume

A

~700 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

fetal risks of nonobstetric surgery during pregnancy

A
  • growth restriction
  • low birth weight
  • demise
  • increased incidence of preterm labor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ideally, surgery is delayed for how long in pregnant patient?

A

delayed 2-6 weeks after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

nonobstetric surgeries during pregnancy assoc with highest fetal risks

A

intraabdominal and pelvic surgeries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

if unable to delay until after delivery, when is the best time for pregnant pt to undergo surgery?

A

2nd trimester

avoids higher risk of teratogenicity in 1st trimester and increased risk of preterm labor in 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when is risk of teratogenicity highest

A

during organogenesis (day 13-60)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

can pregnant patients undergoing nonobstetric surgery have preop anxiolytic

A

yes

Some evidence that links high-dose diazepam in first trimester to cleft palate but Barash says preop benzo is acceptable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

can pregnant patients undergoing nonobstetric surgery have preop anxiolytic

A

yes

Some evidence that links high-dose diazepam in first trimester to cleft palate but Barash says preop benzo is acceptable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

at what plasma level does magnesium diminish DTRs

A

5-7 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

is hypokalemia assoc with hyper or hypo-magnesemia

A

hypo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how should methergine be admin

A

always IM
IV assoc with severe HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

3 benefits of GA over neuraxial for c section

A
  1. speed of onset
  2. secure airway
  3. greater hemodynamic stability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

situations that warrant GA for c section

A
  • Maternal hemorrhage
  • Fetal distress
  • Coagulopathy
  • Patient refusal of regional anesthesia
  • Contraindications to regional anesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when are pregnant patients full stomachs

A

18-20 wga

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

aspiration ppx for nonobstetric surgery during pregnancy

A
  • sodium citrate 15-30 mL within 15-30 min of induction
  • ranitidine 1 hour before induction
  • metoclopramide 1 hour before induction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

at what point in pregnancy should you start LUD

A

2nd & 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

meds that should be avoided in nonobstetric surgery during pregnancy

A

NSAIDs

potentially close ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

meds that should be avoided in nonobstetric surgery during pregnancy

A

NSAIDs

potentially close ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

why should hyperventilation be avoided in nonobstetric surgery during pregnancy

A

normal maternal PaCO2 is ~30 mmHg
hyperventilation reduces placental blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

pregnancy-induced HTN that occurs before 20 weeks gestation

A

chronic HTN

does not return to normal after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

when does gestational HTN develop

A

after 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Only away to truly diagnose gestational HTN

A

after delivery (return to normotensive state rules out chronic HTN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

when does preeclampsia develop

A

after 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

BP in mild preeclampsia

A

> 140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

BP in severe preeclampsia

A

> 160/110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

common UA finding in pt with preeclampsia

A

proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

s/s preeclampsia that may exist in the absence of proteinuria

A
  • persistent RUQ or epigastric pain
  • persistent CNS or visual symptoms (HA, hyperreflexia, hyperexcitability, coma)
  • fetal growth restriction
  • thrombocytopenia
  • elevated serum liver enzymes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what is eclampsia

A

mother with preeclampsia develops seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

most common critical pathology associated with the healthy parturient

A

Preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

preeclampsia is most common in:

A

mothers < 20 yrs and > 35 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

moms with highest risk of developing preeclampsia

A

Patients with chronic renal disease and those that are homozygous for the angiotensinogen T235 allele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

roles of thromboxane in the pt with preeclampsia

A
  • increased plt aggregation
  • increased vasoconstriction
  • increased uterine activity
  • decreased uteroplacental blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

roles of prostacyclin in normal pregnancy

A
  • ↓ platelet aggregation
  • ↓ vasoconstriction
  • ↓uterine activity
  • ↑ uteroplacental blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

roles of thromboxane in normal pregnancy

A
  • ↑ platelet aggregation,
  • vasoconstriction
  • ↑ uterine activity
  • ↓ uteroplacental blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

prostacyclin and thromboxane production in pt with preeclampsia

A

produces up to 7x more thromboxane than prostacyclin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

key maternal complications of preeclampsia

A
  • heart failure
  • pulmonary edema
  • intracranial hemorrhage
  • cerebral edema
  • DIC
  • proteinuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

BP threshold before treating HTN in preeclamptic patient

A

160/110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

consequences of endothelial damage resulting from vasoactive substances

A
  • glomerular leak
  • activation of clotting cascade
  • platelet aggregation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

proteinuria in mild vs severe preeclampsia

A

mild: < 5 g/24 hr
< 3+ dipstick
severe 5+ g/24 hr
> 3+ dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what causes proteinuria in preeclamptic patient

A

Glomerular capillary endothelial destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

24-hr urine total in mild vs severe preeclampsia

A

mild: > 500 mL
severe: < 500 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what causes edema in preeclampsia

A

↓ oncotic pressure
↑ vascular permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what causes pulmonary edema in severe preeclampsia

A

Heart failure
↓ oncotic pressure
↑ vascular permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what causes headache in severe preeclampsia

A

Cerebral edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what causes visual impairment in severe preeclampsia

A

Vasoconstriction of ocular arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what causes epigastric pain in severe preeclampsia

A

Liver subscapular hemorrhage
Hypoxic liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

plt count in mild vs severe preeclampsia

A

mild = > 100,000
severe = < 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

does preeclampsia affect fetal growth?

A

mild - no
severe - yes d/t uteroplacental hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

primary reasons for medicating a pt with preeclampsia and HTN

A

to prevent a cerebrovascular accident, myocardial ischemia, and placenta abruption

medicate when > 160/110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

primary reasons for medicating a pt with preeclampsia and HTN

A

to prevent a cerebrovascular accident, myocardial ischemia, and placenta abruption

medicate when > 160/110

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

treatment for acute HTN in preeclampsia

A
  • Labetalol 20 mg IV followed by 40 - 80 mg q 10 min up to a max dose of 220 mg
  • Hydralazine 5 mg IV q 20 min up to a max dose of 20 mg
  • Nifedipine 10 mg PO q 20 min up to a max dose of 50 mg
  • Nicardipine infusion started at 5 mg/hr and titrated by 2.5 mg/hr q 5 min up to a max dose of 15 mg/hr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

dose of labetolol for HTN assoc with preeclampsia

A

20 mg IV followed by 40 - 80 mg q 10 min up to a max dose of 220 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

dose of hydralazine for HTN assoc with preeclampsia

A

5 mg IV q 20 min up to a max dose of 20 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

dosing nifedipine for preeclamptic pt with HTN

A

10 mg PO q 20 min up to a max dose of 50 mg

62
Q

nicardipine infusion dosing for preeclamptic pt with BP > 160/110

A

infusion started at 5 mg/hr and titrated by 2.5 mg/hr q 5 min up to a max dose of 15 mg/hr

63
Q

how long do risks of complications with preeclampsia continue

A

up to 4 weeks postpartum

64
Q

when are the of pulmonary HTN and stroke highest in preeclamptic pt

A

in postpartum period

65
Q

preeclamptic patients have an exaggerated response to what meds

A

sympathomimetics
methergine

66
Q

Seizure prophylaxis with magnesium in pt with preeclampsia

A

4g loading dose over 10 min + infusion 1-2 g/hr

67
Q

antidote for magnesium toxicity

A

10 mL 10% calcium gluconate IV

68
Q

what is HELLP syndrome

A

Hemolysis, Elevated liver enzymes, Low Platelet count

69
Q

incidence of HELLP syndrome

A

Develops in 5-10% of those with preeclampsia

70
Q

definitive treatment of preeclampsia, eclampsia, & HELLP syndrome

A

delivery of the fetus and placenta

71
Q

HELLP syndrome increases what 2 risks

A

DIC
intraabdominal bleeding (from liver)

72
Q

s/s HELLP syndrome

A

epigastric pain
upper abd tenderness

73
Q

how does cocaine use affect MAC

A
  • Acute intoxication increases MAC
  • Chronic use decreases MAC
74
Q

reasonable choice of antihypertensive for cocaine user

A

labetolol

75
Q

reasonable choice of antihypertensive for cocaine user

A

labetolol

76
Q

hematologic consequence of chronic cocaine use

A

thrombocytopenia

77
Q

best option to treat hypotension in chronic cocaine user

A

neo

Hypotension may not respond to ephedrine (d/t catecholamine depletion)

78
Q

best option to treat hypotension in chronic cocaine user

A

neo

Hypotension may not respond to ephedrine (d/t catecholamine depletion)

79
Q

placenta accreta

A

placenta attaches to surface of myometrium

80
Q

placenta increta

A

placenta invades myometrium

81
Q

placenta percreta

A

placenta extends beyond uterus

82
Q

placenta previa

A

placenta partially or completely covers cervical os

83
Q

where does the placenta normally implant

A

into decidua of endometrium

84
Q

preferred anesthesia method in pts with abnormal placental implantation

A

Although neuraxial is safe, GA is preferred

85
Q

abnormal placental implantation is closely assoc with what 2 conditions

A

placenta previa & previous c sections

86
Q

sign of placenta previa

A

painless vaginal bleeding

87
Q

risk factors for placenta previa

A
  • previous c-sections
  • history of multiple births
88
Q

placental abruption

A

Partial or complete separation of the placenta from the uterine wall before delivery

89
Q

6 risk factors for placental abruption

A
  • PIH
  • preeclampsia
  • chronic HTN
  • cocaine use
  • smoking
  • excessive alcohol use
90
Q

placental disorder assoc with inc risk amniotic fluid embolism

A

placental abruption

91
Q

s/s placental abruption

A
  • maternal pain
  • vaginal hemorrhage
  • fetal hypoxia
92
Q

most significant concerns regarding abnormal placental implantation

A
  • impaired uterine contractility
  • potential for tremendous blood loss during labor & delivery
93
Q

most common cause of postpartum hemorrhage

A

uterine atony

94
Q

4 risk factors for uterine atony

A
  • Multiparity
  • Multiple gestations
  • Polyhydramnios
  • Prolonged oxytocin infusion before surgery
95
Q

other causes of OB bleeding

besides uterine atony

A
  • Retained placenta/placenta fragments
  • Laceration to the cervix or vaginal wall
  • Uterine inversion
  • Coagulopathy
  • Placenta previa
  • Placental abruption
  • Abnormal placental implanation (acreta, increta, percreta)
96
Q

med used to provide uterine relaxation for extraction of retained placenta

A

IV nitro

97
Q

method to tamponade postpartum hemorrhage when other methods are ineffective

A

intrauterine balloon

98
Q

methods to stop postpartum hemorrhage

A
  • uterine massage
  • oxytocin
  • ergot alkaloids
  • manual massage
  • intrauterine balloon
99
Q

OB conditions assoc with DIC

A
  • AFE
  • placental abruption
  • intrauterine fetal demise
100
Q

when is APGAR score assessed

A

1 and 5 min after delivery

101
Q

Apgar score at 1 min correlates with:

A

fetal acid-base balance

102
Q

Apgar score at 5 min may be predictive of:

A

neurologic outcome

103
Q

normal apgar score

A

8-10

104
Q

apgar score assoc with moderate distress

A

4-7

105
Q

apgar score assoc with impending demise

A

0-3

106
Q

5 aspects of apgar score

A
  1. heart rate
  2. resp effort
  3. muscle tone
  4. reflex irritability
  5. color
107
Q

Apgar scoring - heart rate

A
  • absent = 0
  • 1 = < 100
  • 2 = > 100
108
Q

Apgar scoring - resp effort

A

absent = 0
slow, irregular = 1
normal, crying = 2

109
Q

Apgar scoring - muscle tone

A

limp = 0
some flexion of extremities = 1
active motion = 2

110
Q

Apgar scoring - reflex irritability

A

absent = 0
grimace = 1
cough, sneeze, or cry = 2

111
Q

Apgar scoring - color

A

pale, blue = 0
body pink, extremities blue = 1
completely pink = 2

112
Q

normal neonatal HR

A

120-160

113
Q

normal neonatal RR

A

30-60

114
Q

when does neonatal breathing begin

A

30 seconds after delivery

normal pattern is established at 90 seconds

115
Q

when does neonatal breathing begin

A

30 seconds after delivery

normal pattern is established at 90 seconds

116
Q

neonatal SpO2 after delivery

A

Immediately after delivery, normal SpO2 is 60%.

It should rise to 90% after 10 minutes

117
Q

after delivery, the baby’s HR < ____ is assoc with significantly decreased CO

A

100

118
Q

considerations for assisted ventilation of neonate

A
  • Supplemental O2 increases risk of inflammatory response
  • if assisted ventilation is required, use room air instead of 100% FiO2
  • If bradycardia or inadequate oxygenation persists, use of supplemental O2 must be balanced against this risk
119
Q

best indicator of adequate ventilation in neonate

A

resolution of bradycardia

120
Q

3 possible routes emergency drugs can be given in newborn without IV access

A
  • umbilical vein
  • ETT
  • IO
121
Q

during which stage of labor are patients with valve stenosis and pHTN at greatest risk

A

stage 3 (immediate postpartum)

CO increases 80%

122
Q

during which stage of labor are patients with valve stenosis and pHTN at greatest risk

A

stage 3 (immediate postpartum)

CO increases 80%

123
Q

LA least likely to undergo fetal ion trapping

A

chloroprocaine

124
Q

LA least likely to undergo fetal ion trapping

A

chloroprocaine

125
Q

hallmark of placenta previa

A

painless vaginal bleeding ~32 weeks gestation

126
Q

when should uterine rupture be considered in laboring pt with epidural

A

new onset abdominal pain

127
Q

how does uterine rupture present

A
  • severe abdominal pain
  • may have referred shoulder pain from diaphragm irritation 2/2 intraabdominal blood
128
Q

primary contributor to placental drug transfer

A

maternal concentration of free drug

129
Q

most likely indicator of intravascular volume depletion in preclamptic patient

A

high Hct

130
Q

priorities in patients with eclampsia

A
  • airway management/aspiration prevention (#1)
  • control HTN
  • anti-seizure meds
131
Q

why do pregnant pts require increased neo dose to treat hypotension

A

down-regulation of alpha receptors

132
Q

what explains pregnant pt’s reduced sensitivity to sympathomimetics

A

beta receptor down regulation

133
Q

minimum FHR monitoring for nonobstetric surgery during pregnancy

A

< 23 wga: minimum pre and postop
> 23 wga: pre and postop FHR + pre and postop assessment of contractions

134
Q

initial treatment for retained products of conseption

A
  • uterine exam - nitro provides relaxation
  • curettage to extract retained products
135
Q

advantages of epidural volume extension technique for CSE

A

uses smaller dose of LA
more stable hemodynamic profile
faster recovery

136
Q

following IV drug delivery to parturient, drug enters fetus via:

A

umbilical vein

most of this travels to fetal liver and is subjected to 1st pass metabolism

137
Q

first priority in treating a term parturient with eclampsia

A

prevent aspiration/airway management

138
Q

is eclampsia an indication for emergency c section

A

no
seizure typically < 10 min long and not recurrent

139
Q

minimum fetal assessment required during anesthesia for non-obstetric abdominal surgery with a fetus < 23 weeks

A

document FHR pre and post op

140
Q

minimum fetal assessment required during anesthesia for non-obstetric abdominal surgery with a fetus > 23 weeks

A

document FHR pre and post op along with pre and postop assessment of uterine contractions

141
Q

primary contributor to placental drug transfer

A

maternal concentration of free drug

142
Q

how does molecular charge affect placental drug transfer

A

non-ionized = greater transfer

143
Q

how does plasma protein binding affect placental drug transfer

A

less binding = greater transfer

a high concentration gradient (driving force) between the mother and the fetus is the most important contributor of placental drug transfer.

144
Q

most common first sign of uterine rupture

A

fetal bradycardia

145
Q

“classic” triad of s/s with uterine rupture

A

abdominal pain
vaginal bleeding
abnormal FHR pattern

only in ~9%

146
Q

s/s uterine rupture

A

severe abdominal pain
fetal bradycardia
vaginal bleeding
undetectable uterine contractions
breakthrough pain with epidural that was previously working

147
Q

surgical treatment options for uterine rupture

A

uterine repair
arterial ligation
hysterectomy

The mother may require a c-section

148
Q

surgical treatment options for uterine rupture

A

uterine repair
arterial ligation
hysterectomy

The mother may require a c-section

149
Q

what should be ruled out if parturient is passing dark blood clots

A

placental abruption

150
Q

best pain management option for term parturient with severe aortic stenosis

A

opioid only neuraxial
could do opioid only CSE

if pt requires c-section, GA is the gold standard

APEX (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions