Unit 3 Module 1 Maternal Phys (Exam 2) Flashcards
1
Q
At what gestational age is a pregnancy considered “term gestation”?
a) 32-34 weeks
b) 34-36 weeks
c) 37-40 weeks
d) 40-42 weeks
A
c) 37-40 weeks
Slide 3
2
Q
True or False
Anything before 40weeks is considered “pre-term”
A
False
Anything before 37 weeks is considered “pre-term”
3
Q
How many trimesters are there in a full-term pregnancy?
a) 2
b) 3
c) 4
d) 5
A
b) 3
Slide 3
4
Q
What is the definition of “parturient”?
a) A woman who has never been pregnant
b) A woman who has had multiple pregnancies
c) One who is pregnant or in labor
d) One who has given birth to more than two children
A
c) One who is pregnant or in labor
Slide 4
5
Q
What does “gravida” refer to?
a) Number of pregnancies
b) Number of live births
c) Number of miscarriages
d) Number of gestational weeks
A
a) Number of pregnancies
Slide 4
6
Q
The term “para” refers to the number of ___.
a) Pregnancies a woman has had
b) Births that occur at ≥20 weeks gestation
c) Miscarriages before 20 weeks
d) Fertility treatments
A
b) Births that occur at ≥20 weeks gestation
slide 4
7
Q
True or False
Still-Births are considered “para” if they happen >/20 weeks of gestation
A
True
Live or still-births >/20weeks are considered “para”
Slide 4
8
Q
A woman who has never been pregnant is referred to as ___.
a) Primiparous
b) Primigravida
c) Multiparous
d) Nulligravida
A
d) Nulligravida
G0P0 = nulligravida/nulliparous
Slide 4
9
Q
A woman who is G1P0 is considered:
a) Nulligravida and nulliparous
b) Primigravida and multiparous
c) Primigravida and nulliparous
d) Multigravida and multiparous
A
c) Primigravida and nulliparous
AKA - “Primip” - Pregnant but not yet had the baby
Slide 4
10
Q
True or False
A G1P0 can mean a patient is pregnant and has had a miscarriage prior to 20weeks.
A
True
Slide 4
11
Q
If a woman is currently pregnant for the fourth time and has had one miscarriage and two live births, her obstetric history would be recorded as G___P___.
a) G3P2
b) G4P2
c) G3P3
d) G4P3
A
b) G4P2 - Multigravida/Multiparous “Multip”
This also could mean she has been pregnant 4 times and had two miscarriages prior to 20weeks..
Slide 4
12
Q
A woman who has had three pregnancies and two live births would be classified as:
a) G2P2
b) G2P3
c) G3P2
d) G3P3
A
c) G3P2
Also can mean she has has one miscarriage prior to 20weeks..
Slide 4
13
Q
True or False
A “multip” could have more complications as in bleeding or a fast birth?
A
True
Slide 4
14
Q
What is considered a normal and healthy minimum weight gain during pregnancy?
a) 8 kg
b) 10 kg
c) 12 kg
d) 15 kg
A
c) 12 kg
Slide 5
15
Q
True or False
It is normal for a pregnant person to lose weight in the first trimester
A
True - d/t food aversion, nausea and vomiting.
Slide 5
16
Q
Which of the following contributes approximately 2 kg to total pregnancy weight gain?
a) Increased blood volume
b) Placental weight
c) Amniotic fluid
d) Uterine growth
A
a) Increased blood volume
Slide 5
17
Q
How much weight gain is attributed to uterus and amniotic fluid combined?
a) 1 kg
b) 2 kg
c) 3 kg
d) 4 kg
A
b) 2 kg
(1 kg each for uterus and amniotic fluid)
Slide 5
18
Q
During pregnancy, new fat and protein stores contribute to an approximate weight gain of ___ kg.
a) 1 kg
b) 2 kg
c) 3 kg
d) 4 kg
A
d) 4 kg
19
Q
Which of the following correctly matches a pregnancy weight component to its approximate weight gain?
a) Fetal weight + placenta = 4 kg
b) Blood volume increase = 3 kg
c) New fat and protein stores = 2 kg
d) Uterus and amniotic fluid combined = 3 kg
A
a) Fetal weight + placenta = 4kg
Slide 5
20
Q
Matching
Depending on the pre-pregnancy BMI what should be the total weight gain and rate at which they should gain it?
A
1 → D → IV (Underweight: 28-40 lb, 1 lb/wk)
2 → B → III (Normal weight: 25-35 lb, 1 lb/wk)
3 → A → II (Overweight: 15-25 lb, 0.6 lb/wk)
4 → C → I (Obese: 11-20 lb, 0.5 lb/wk)
Slide 6
21
Q
By how much does blood volume increase during pregnancy?
a) 10-15%
b) 20-25%
c) 30-35%
d) 40-45%
A
c) 30-35%
Slide 7
22
Q
Between which weeks of pregnancy does blood volume expansion occur?
a) 4-20 weeks
b) 8-32 weeks
c) 12-36 weeks
d) 20-40 weeks
A
b) 8-32 weeks
Slide 7
23
Q
By what gestational age does the majority of blood volume increase occur?
a) 16 weeks
b) 20 weeks
c) 24 weeks
d) 28 weeks
A
c) 24 weeks
“front loaded”
Slide 7
24
Q
During pregnancy, which component of blood increases more significantly?
a) White blood cells (WBCs)
b) Plasma
c) Platelets
d) Clotting factors
A
b) Plasma
Expansion of both plasma & red blood cell volume (Plasma > RBC)
aka - dilutional anemia
Slide 8
25
The primary reason for blood volume expansion during pregnancy is:
a) To improve maternal oxygen uptake
b) To increase metabolic rate
c) To compensate for anticipated blood loss during delivery
d) To prevent blood clot formation
c) To compensate for anticipated blood loss during delivery
## Footnote
Slide 8
26
Approximately how much blood loss occurs during a **vaginal** delivery?
a) 250 mL
b) 500 mL
c) 750 mL
d) 800 mL
b) 500 mL
## Footnote
Slide 8
27
How much blood loss is expected during a **cesarean section** (C/S)?
a) 500 mL
b) 600 mL
c) 800 mL
d) 1000 mL
c) 800 mL
## Footnote
Slide 8
28
After delivery, blood volume returns to pre-pregnancy levels within:
a) 6 weeks
b) 8 weeks
c) 10 weeks
d) 12 weeks
a) 6 weeks
## Footnote
Slide 8
29
What is the approximate blood volume (BV) in a **non-pregnant** individual?
a) 45 ml/kg
b) 55 ml/kg
c) 65 ml/kg
d) 75 ml/kg
c) 65 ml/kg
## Footnote
Slide 9
30
What is the approximate blood volume (BV) in a **pregnant** individual?
a) 80-85 ml/kg
b) 85-90 ml/kg
c) 85-100 ml/kg
d) 90-95 ml/kg
b) 85-90 ml/kg
*...remember 30-35% blood volume increase
65ml x (0.30 to 0.35) = 84.5 - 87.75mL*
## Footnote
Slide 9
31
By how much does cardiac output increase at term during pregnancy?
a) 10%
b) 25%
c) 35%
d) 40%
d) 40%
## Footnote
Slide 10
32
What physiological factor contributes to the increase in cardiac output **by 6 weeks** of pregnancy?
a) Increase in maternal stroke volume
b) Increase in maternal heart rate
c) Decrease in maternal oxygen demand
d) Decrease in systemic vascular resistance
b) Increase in maternal heart rate
## Footnote
Slide 10
33
What additional factor contributes to increased cardiac output by **8-10 weeks** of pregnancy?
a) Increased stroke volume
b) Decreased stroke volume
c) Decreased maternal heart rate
d) Increased systemic vascular resistance
a) Increased stroke volume
## Footnote
Slide 10
34
Increased plasma renin activity during pregnancy is primarily responsible for:
a) Decreased plasma volume
b) Decreased sodium and water retention
c) Increased aldosterone production
d) Increased systemic vascular resistance
c) Increased aldosterone production
**This is due to pregnancy hormones like progesterone and estrogen.**
## Footnote
slide 11
35
Rearrange the following physiological changes in the correct order leading from **increased plasma renin activity to increased cardiac output** during pregnancy:
A. Increased plasma volume
B. Increased stroke volume
C. Increased sodium (Na⁺) reabsorption in the kidneys
D. Increased preload (venous return to the heart)
E. Increased aldosterone secretion
F. Increased cardiac output
G. Increased water retention
Increased plasma renin activity →
E → Increased aldosterone secretion
C → Increased sodium (Na⁺) reabsorption in the kidneys
G → Increased water retention
A → Increased plasma volume
D → Increased preload (venous return to the heart)
B → Increased stroke volume
F → Increased cardiac output
## Footnote
slide 11
36
How much does uterine blood flow (UBF) increase by term gestation?
a) 2-5 times
b) 5-10 times
c) 10-20 times
d) 20-30 times
c) 10-20 times
## Footnote
Slide 12
37
What is the baseline uterine blood flow in a **non-pregnant** individual?
a) 30 ml/min
b) 50 ml/min
c) 100 ml/min
d) 150 ml/min
b) 50 ml/min
## Footnote
Slide 12
38
What is the approximate uterine blood flow at **term** gestation?
a) 100 ml/min
b) 250 ml/min
c) 500 ml/min
d) 700 ml/min
d) 700 ml/min
## Footnote
Slide 12
39
How much does skin blood flow increase during pregnancy?
a) 3-4x
b) 5-6x
c) 6-7x
d) 8-9x
a) 3-4x
## Footnote
Slide 12
40
Which of the following are effects of increased skin blood flow during pregnancy? (Select three)
A. Increased skin temperature
B. Flushing
C. Decreased cardiac output
D. Itching
E. Reduced blood volume
A. Increased skin temperature
B. Flushing
D. Itching
## Footnote
slide 12
41
During pregnancy, systemic vascular resistance (SVR) ____________
a) Increases by 20%
b) Decreases by 20%
c) Remains the same
d) Increases due to higher blood volume
b) Decreases by 20% lower than pre-pregnant values
## Footnote
Slide 13
42
Which of the following contribute to the decrease in systemic vascular resistance (SVR) during pregnancy? (Select four)
A. Increased progesterone levels
B. Decreased relaxin levels
C. Increased prostacyclin
D. Increased systemic vasoconstriction
E. Increased relaxin levels
F. Increased estrogen
A. Increased progesterone levels
C. Increased prostacyclin
E. Increased relaxin levels
F. Increased estrogen
## Footnote
slide 13
43
Which best describes the vascular state of normal pregnancy?
a) High flow, high resistance
b) Low flow, high resistance
c) High flow, low resistance
d) Low flow, low resistance
c) High flow, low resistance
## Footnote
Slide 14
44
Which two physiological changes contribute to decreased systemic vascular resistance (SVR) during pregnancy?
select 2
A. Decreased maternal vasodilation
B. Low-resistance placental circulation
C. Increased renal vasculature resistance
D. Increased maternal vasodilation
B. Low-resistance placental circulation
D. Increased maternal vasodilation
**Maximal arterial dilation in the uterus!**
## Footnote
Slide 14
45
Which of the following are an effect of decreased SVR in pregnancy?
A. Maternal vasoconstriction
B. Decreased renal vascular resistance
C. High-resistance placental circulation
D. Increased renal vascular resistance
B. Decreased renal vascular resistance
## Footnote
Slide 14
46
Systemic vascular resistance ___ during pregnancy, leading to a decrease in ___.
a) Increases; cardiac output
b) Increases; venous return
c) Decreases; preload
d) Decreases; afterload
d) Decreases; afterload
## Footnote
Slide 15
47
By how much does left ventricular (LV) mass increase by term during pregnancy?
a) 10%
b) 25%
c) 50%
d) 75%
c) 50%
## Footnote
slide 16
48
Which type of ventricular hypertrophy is referred to as the "Athlete’s Heart"?
A. Concentric hypertrophy
B. Eccentric hypertrophy
C. Hypertrophic cardiomyopathy
D. Dilated cardiomyopathy
B. Eccentric hypertrophy
## Footnote
slide 16
49
Eccentric hypertrophy primarily occurs due to:
A. Increased afterload and decreased blood volume
B. Increased systemic vascular resistance
C. Decreased myocardial oxygen demand
D. Increased preload and blood volume
D. Increased preload and blood volume
## Footnote
Slide 16
50
During pregnancy, the heart shifts _________ and _________ due to **diaphragmatic elevation** from the growing uterus.
A. Posterior, right
B. Inferior, right
C. Anterior, left
D. Superior, left
C. Anterior, left
## Footnote
slide 17
51
The PMI (point of maximal impulse) shifts upward and to the left, typically to the **_______ intercostal space, _______ line**
a) 5th intercostal space, midclavicular line
b) 4th intercostal space, midclavicular line
c) 6th intercostal space, anterior axillary line
d) 3rd intercostal space, midaxillary line
b) 4th intercostal space, midclavicular line
## Footnote
Slide 17
52
On a chest radiograph, the heart may appear _________ due to its shift anteriorly.
A. larger
B. smaller
C. compressed
D. inverted
A. larger
**Lungs also apprear shifted upward as well**
## Footnote
Slide 17
53
During pregnancy, the QRS axis shifts:
A. Rightward in the 3rd trimester
B. Inferiorly throughout pregnancy
C. Leftward in the 3rd trimester
D. Anteriorly in the 2nd trimester
C. Leftward in the 3rd trimester
## Footnote
Slide 19
54
Which of the following EKG changes are commonly observed in pregnancy?
(Select 3)
A. Leftward QRS axis shift
B. T wave inversions
C. ST-segment elevation
D. QT interval increased
E. Prolonged PR interval
A. Leftward QRS axis shift
B. T wave inversions **(Lead III)**
D. QT interval increased **(but often WNL)**
## Footnote
Slide 19
55
What factors contribute to a **shortened PR interval in the 3rd trimester** of pregnancy? (Select 2)
A. Decreased sympathetic activity
B. Decreased AV node conduction velocity
C. Accelerated AV node conduction velocity
D. Increased sympathetic activity
Shortened PR interval in 3rd trimester
C. Accelerated AV node conduction velocity
D. Increased sympathetic activity **(In 3rd trimester)**
## Footnote
Slide 19
56
Which of the following EKG findings are consistent with left axis deviation (LAD)? (Select 4)
A. Positive QRS in Lead I
B. Negative QRS in Lead I
C. Positive QRS in aVL
D. Positive QRS in aVR
E. Negative QRS in aVF
F. Negative QRS in aVL
G Negative QRS in Lead II
A. Positive QRS in Lead I
C. Positive QRS in aVL
E. Negative QRS in aVF
G Negative QRS in Lead II
## Footnote
Slide 20
57
Increased cardiac size contributes to tachydysrhythmias in pregnancy.
True
These are the most common EKG "abnormalities"
58
Which of the following arrhythmias are commonly seen in pregnancy?
Select 2
A. PACs
B. Atrial flutter
C. PVCs
D. Third-degree heart block
A. PACs
C. PVCs
## Footnote
Slide 21
59
Pregnancy-related tachydysrhythmias are caused by _________ in cardiac ion channel conduction and _________ in cardiac size.
A. Change, increase
B. Stasis, decrease
C. Stabilization, decrease
D. Enervation, increase
A. Change, increase
## Footnote
Slide 21
60
What are common causes of tachydysrhythmias in pregnancy? (Select 2)
A. Decreased sympathetic activity
B. Anorexia
C. Changes in autonomic tone
D. Hormonal influences
C. Changes in autonomic tone
D. Hormonal influences
## Footnote
Slide 21
61
Which valvular abnormalities occur in **more than 90%** of pregnant patients by the **end of the third trimester?**
A. Aortic and mitral regurgitation
B. Tricuspid and pulmonic regurgitation
C. Mitral stenosis and tricuspid stenosis
D. Aortic stenosis and pulmonic stenosis
:B. Tricuspid and pulmonic regurgitation
**Freeman - d/t all the extra fluid 'sloshing around'**
## Footnote
Slide 22
62
What percentage of pregnant patients experience **mitral regurgitation**?
A. 10-15%
B. 20-25%
C. 25-30%
D. 40-50%
C. 25-30%
## Footnote
Slide 22
63
The valvular changes in pregnancy are often severe and require long-term management postpartum.
False
These are reversible changes that will
return to normal in postpartum period
## Footnote
Slide 22
64
The third heart sound (S3), often heard in pregnancy, is also referred to as a _________ and is commonly heard in the _________ trimester.
A. Atrial gallop, first
B. Diastolic gallop, second
C. Systolic murmur, third
D. Ventricular gallop, third
D. Ventricular gallop, third
**Freeman - d/t mitral opening and large amounts of fluid filling the very compliant left ventricle**
## Footnote
Slide 23
65
The fourth heart sound (S4) in pregnancy:
A. Becomes more pronounced at term
B. Disappears at term
C. Indicates heart failure in all cases
D. Is best heard over the pulmonic area
B. Disappears at term
**Freeman - low pitch sound, d/t late diastolic filling d/t atrial contraction**
## Footnote
Slide 23
66
A Grade II systolic ejection murmur (SEM) due to Cardiac Enlargement in pregnancy is best heard:
A. At the right sternal border
B. Over the left axilla
C. At the apex of the heart
D. Over the carotid arteries
A. At the right sternal border
## Footnote
Slide 23
67
Which factors can contribute to lower than normal blood pressure changes? (Select 3)
A. Fetal sex
B. Pregnancy complications
C. Gestational age
D. Maternal diet
E. Pre-existing conditions
B. Pregnancy complications
C. Gestational age
E. Pre-existing conditions
## Footnote
Slide 24
68
Which factors influence lower than normal blood pressure during pregnancy? (Select two)
A. Parity
B. Amount of fetal movement
C. Maternal age
D. Hair growth during pregnancy
A. Parity
C. Maternal age
## Footnote
Slide 24
69
_________ compression occurs when the enlarged uterus compresses the inferior vena cava and aorta, which can lead to a drop in blood pressure.
A. Carotid
B. Aortocaval
C. Jugular
D. Venous
B. Aortocaval
**Supine position causes the gravid uterus to compress inferior vena cava and aorta**
## Footnote
Slide 24
70
Anesthetic drugs that cause _________ can exacerbate aortocaval compression, leading to decreased venous return and hypotension.
A. Vasoconstriction
B. Tachycardia
C. Bradycardia
D. Vasodilation
D. Vasodilation
**Freeman - For example - spinals/epidurals that can cause sympathectomy and cause vasodilation**
## Footnote
Slide 25
71
Aortocaval compression can begin as early as _________ weeks gestation due to the increasing size of the gravid uterus.
A. 8–10
B. 13–16
C. 20–24
D. 30–34
B. 13–16
## Footnote
Slide 25
72
Put the following events of aortocaval compression in the correct order:
1. Decreased cardiac output
2. Decreased perfusion to the fetus
3. Decreased venous return to the right atrium
4. Decreased uterine blood flow
5. Hypotension
3 → 1 → 5 → 4 → 2
## Footnote
Slide 26
73
The initial cardiovascular response to aortocaval compression is _________, which is later followed by _________.
A. Tachycardia, bradycardia
B. Bradycardia, tachycardia
C. Hypertension, hypotension
D. Increased venous return, decreased cardiac output
A. Tachycardia, bradycardia
## Footnote
Slide 27
74
Which of the following symptoms may indicate aortocaval compression? (Select 4)
A. Nausea/Vomiting
B. Flushing
C. Loss of consciousness
D. Fetal distress
E. Hypertension
F. Pallor
A. Nausea/Vomiting
C. Loss of consciousness
D. Fetal distress
F. Pallor
## Footnote
Slide 27
75
To relieve aortocaval compression, the patient should be tilted to which side?
A. Left
B. Trendelenburg
C. Supine
D. Right
A. Left - **LUD = Left Uterine Displacement**
Displace uterus off vena cava and aorta
## Footnote
Slide 28
76
Which cardiovascular changes occur during the **first stage** of labor **between and during contractions**? (Select 3)
A. Increased cardiac output
B. Decreased blood volume
C. Increased heart rate
D. Autotransfusion of blood from the uterus
E. Decreased systemic circulation
A. Increased cardiac output
C. Increased heart rate
D. Autotransfusion of blood from the uterus
## Footnote
Slide 29
77
How much blood is autotransfused into the general circulation with each contraction?
A. 100–200 mL
B. 300–500 mL
C. 600–800 mL
D. 50–100 mL
B. 300–500 mL
## Footnote
Slide 29
78
During the **second stage** of labor, cardiac output increases by approximately _________%, primarily due to _________ efforts.
A. 25, breathing
B. 45, relaxation
C. 50, pushing
D. 10, reduced stroke volume
C. 50, pushing
Therefore the heart rate also increases
## Footnote
Slide 30
79
What percentage increase in cardiac output occurs **immediately after delivery**?
A. 30–50%
B. 50–70%
C. 60–80%
D. 90–100%
C. 60–80%
## Footnote
Slide 31
80
Which factors contribute to the increased cardiac output immediately postpartum? (Select 2)
A. Increased pressure on the vena cava
B. Uterus continuing to contract
C. Relief of pressure on the vena cava
D. Increased systemic vascular resistance
E. Decreased circulating blood volume
B. Uterus continuing to contract -*releasing blood into systemic circulation*
C. Relief of pressure on the vena cava
## Footnote
Slide 31
81
Cardiac output begins to decline within _________ minutes of delivery and returns to normal by _________ hours postpartum.
A. 10, 24
B. 20, 12
C. 5, 48
D. 15, 36
A. 10, 24
## Footnote
Slide 31
82
Pregnancy leads to vascular engorgement of the airway, resulting in _________ tissue and a potential for a _________ airway.
A. Friable, difficult
B. Thickened, narrowed
C. Stiff, restricted
D. Inelastic, obstructed
A. Friable, difficult
*Edemetous as well*
## Footnote
Slide 32
83
One common symptom of increased airway vascularity in pregnancy is _________, which may present as nasal congestion or _________.
A. Bronchospasm, wheezing
B. Rhinitis, nosebleeds
C. Hypoxia, coughing
D. Tracheomalacia, respiratory failure
B. Rhinitis, nosebleeds
**Freeman - First thing pregnant patients should do if they feel like they can't breath through her nose is blow their nose!**
## Footnote
Slide 32
84
# True or False
If a pregnant patient is having trouble breathing through their nose you can place a nasal trumpet to open their airway.
False
This can cause nose bleeds
85
Hyperemia Anesthetic implications include (select 3)
A. ETT 6.0-6.5
B. use nasal trumpets
C.increased risk for airway obstruction
D.Mallampati class improvement
E.airway difficulties
A. ETT 6.0-6.5
C. increased risk for airway obstruction
E. airway difficulties
**mallampati class may worsen, keep a bougie on hand**
| avoid nasal tube. trumpet/NGT
## Footnote
Slide 34
86
Progesterone can cause what 3 things:
A. decrease sensitivity to CO2
B. bronchodilation
C. hyperemia
D. increase respiratory sensitivity to CO2
B.bronchodilation
C.hyperemia
D. increase respiratory sensitivity to CO2
## Footnote
slide 35
87
# true or false
Estrogen will cause a decrease number and sensitivity of progesterone receptors in respiratory center in brain
false
increase number and sensitivity
so then will increase sensitvity to CO2
bronchodilation and hypermia/edema of respiratory passages
| slide 35
88
Relaxin causes hormonal and mechanical changes including (select 3)
A. ligamentous attachments to lower ribs to relax
B. sunken chest
C. subcoastal angle increase
D. ligamentous attachements to upper ribs relax
E. widened AP and transverse diameter of chest wall
A. ligamentous attachments to lower ribs to relax
C. subcoastal angles increase
E. WIdened AP and transverse diameter of chest wall (barrel chest)
## Footnote
slide 36
89
# true or false
Pulmonary changes includes preservation of total lung capacity
true
## Footnote
slide 37
90
# terminology review Matching
1. FRC
2. ERV
3. RV
A. extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal expiration
B. volume of air that prevents complete emptying of lungs and keeps small airways open
C. the volume of air that remains in the lungs after the ERV is expired
1. FRC: B
2. ERV: A
3. RV: C
| FRC=ERV + RV
## Footnote
slide 38
91
What will the decrease in FRC be at term?
A. 20%
B. 30%
C. 15%
D. 25%
A. 20%
## Footnote
slide 39
92
Decreased FRC results from decreased ____ and ____ (select 2)
A. RV
B. ERV
C. IC
D. IRV
A. RV
B. ERV
## Footnote
slide 39
93
With an elevated diaphragm negative pleural pressure is increased causing
A. delayed closure of small airways
B. decreased surfactant in large airways
C. earlier closure of small airway
D. increased surfactant in large airways
C. earlier closure of small airways
## Footnote
slide 40
94
FRC decrease is more profound in _____ position
A. supine
B. lateral
C. Prone
D. sitting
A. supine 30%
diaphragm elevated even more
increased alveolar atelectasis
## Footnote
slide 41
95
The ________ may exceed FRC causing small airway closure, v/q mismatch, and decreased O2 saturation
A. expiratory reserve volume
B. tidal volume
C. closing capacity
D. Inspiratory reserve volume
C. closing capacity
## Footnote
slide 41
96
Which 2 respiratory volumes are increased in pregnancy
A. expiratory reserve volume
B. tidal volume
C. inspiratory capacity
D. functional reserve capacity
B. Tidal volume
C. inspiratory capacity
## Footnote
slide 43
97
Increased metabolic CO2 production and respiratory drive related to high progesterone level is related to
A. expiratory reserve volume
B. tidal volume
C. inspiratory capacity
D. functional reserve capacity
B. Tidal volume
## Footnote
slide 43
98
Which 2 respiratory volumes are unchanged in pregnancy
A. total lung capacity
B. functional reserve capacity
C. expiratory reserve volume
D. vital capacity
A. total lung capacity - ***same d/t rib expansion from relaxin***
D. vital capacity
## Footnote
slide 44
99
# True or false
Pregnancy makes patient vulnerable to hypoxia
true
d/t elevated diaphragm (decreased FRC) and decreased oxygen reserves
| will desat faster!!
## Footnote
slide 45
100
What is an extremely important factor for the pregnant population regarding anesthesia
A. pain control
B. supine position
C. maintain neutrality
D. preoxygenation
D. preoxygenation
| may need supplemental O2 during labor and in times or distress
## Footnote
slide 46
101
What is the goal for preoxygenation?
A. bringing O2 to 98%
B. denitrogenate and oxygenate
C. nitrogenate and deoxygenate
D.so they can smell the balloon and you have time to get your life together
D. denitrogenate and oxygenate the bloodstream to a maximal level
* bring O2 sat as near as possible to 100%
* denitrogenate the **residual lung capacity **
* maximize the storage of oxygen in the lungs
## Footnote
slide 47
102
What are the 2 ways to preoxygenate?
A. 3-5 vital capacity breaths with a tight face mask seal delivering 100% O2
B. 8 deep breaths of an oxygen flow rate of 10L /min within a time period of 60 seconds
C. 10 vital capacity breaths with a tight face mask seal delivering 100% O2
D. 3 deep breaths of an oxygen flow rate of 5L/min within 30 seconds
A. 3-5 vital capacity breaths with a tight face mask seal delivering 100% O2
B. 8 deep breaths of an oxygen flow rate of 10L /min within a time period of 60 seconds
## Footnote
slide 48
103
# Not a question just read the card for tips you deserve a break
Preoxygenation tips: tight mask seal (can use mask straps), watch for an increase in FeO2 (0.9 is ideal), 20 degree reverse trendelenburg shown to be helpful in Pre O2
you're welcome.. now back to work
## Footnote
slide 49
104
What is the ideal fraction expired O2 while preoxygenating
A.0.6
B.0.8
C.0.3
D.0.9
D. 0.9
| I literally just gave a free one hope you didn't disappoint
## Footnote
slide 49
105
How much does Oxygen consumption increase during pregnancy at term
A. 23%
B. 30%
C. 17%
D. 20%
D. 20%
can cause increase work of breathing and increased cardiac workload
| increased metabloic need of fetus, uterus, and placenta
## Footnote
slide 50
106
When does dyspnea begin in pregnancy?
A. first trimester
B. second trimester
C. third trimester
A. first trimester
## Footnote
slide 51
107
What is dyspnea caused by in pregnancy (select 3)
A. decreased respiratory drive
B. increased O2 consumption
C. decreased PaCO2
D. lower pulmonary blood volume
E. increase RBC
F. nasal congestion
B. increased O2 consumption
C. decreased PaCO2
F. nasal congestion
also increased respiratory drive, larger pulmonary blood volume, and anemia
## Footnote
slide 51
108
Alveolar ventilation _________ during pregnancy.
A. increase
B. decrease
C. is unchanged
A. increase
## Footnote
slide 52
109
Due to increased ventilation caused by pregnancy, you can expect PaCO2 to _____ by _______.
A. increase; 8-10mmHg
B.decrease; 8-10mmHg
C. decrease; 4-6mmHg
D.Increase; 4-6mmHg
B. decrease; 8-10mmHg
30-32 vs 40
| respiratory alkolosis (pH 7.41-7.44)
## Footnote
slide 53/54
110
Due to increased ventilation caused by pregnancy, you can expect PaO2 to _____ by _______.
A. decrease; 10 mmhg
B. decrease 5mmHg
C. increase; 5mmHg
D. increase; 10mmHg
C. increase; 5mmHg
| 100-105 vs 100
## Footnote
slide 53/54
111
During pregnancy you can expect your HCO3 to be around
A.25mEq
B. 20mEq
C.22mEq
D. 15mEq
B. 20mEq
| vs 24-26
## Footnote
slide 54
112
During pregnancy you can expect your base excess to be
A. 1-5mEq/L
B. 4-6mEq/L
C. 3-6mEq/L
D. 2-3mEq/L
D. 2-3mEq/L
## Footnote
slide 54
113
During the first stage of labor your minute ventilation will be up
A. 20%
B. 200%
C. 140%
D. 157%
C. 140%
## Footnote
slide 55
114
Maternal CO2 will decrease by_____ during the second stage of labor
A. 5-10mmHg
B. 1-3mmHg
C. 4-6mmHg
D. 10-15mmHg
D. 10-15mmHg
## Footnote
slide 55
115
During second stage of labor you can expect minute ventilation to be up
A. 40%
B.200%
C. 140%
D. 157%
B. 200%
## Footnote
slide 55
116
During second stage of labor you can expect the following changes to occur. (select 3)
A. CO2 increase
B.O2 consumption increase
C. anaerobic requirements increase
D.aerobic requirments increase
E. maternal lactate level increase
B. O2 consumption increase (may need supplemental O2)
D. aerobic requirements increase
E. maternal lactate level increase
## Footnote
slide 55
117
What is the primary cause of dilutional anemia during pregnancy?
a) Decreased red blood cell production
b) Increased red blood cell destruction
c) Plasma volume increase exceeding red cell mass increase
d) Iron deficiency
C. plasma volume increase exceeding red cell mass increase
## Footnote
slide 57
118
By approximately 36 weeks' gestation, how much does hemoglobin typically drop from pre-pregnancy levels?
a) 1.2 g/dL
b) 2.4 g/dL
c) 3.6 g/dL
d) 4.8 g/dL
B. 2.4g/dL
## Footnote
slide 57
119
A pregnant woman's hematocrit decreases by approximately what percentage during pregnancy?
a) 3.25%
b) 5.0%
c) 6.5%
d) 8.0%
C. 6.5%
## Footnote
slide 57
120
What maternal hemoglobin concentration is considered abnormal during pregnancy?
a) Less than 9 g/dL
b) Less than 15 g/dL
c) Less than 13 g/dL
d) Less than 11 g/dL
D. less than 11g/dL
## Footnote
slide 57
121
If a pregnant woman's hemoglobin is greater than 13 g/dL, what conditions should she be monitored for? Select 2
a) Hemoconcentration
b) Iron deficiency anemia
c) Dilutional anemia
d) Pre-eclampsia
e) Gestational diabetes
A. hemoconcentration
d) Pre-eclampsia
## Footnote
slide 57
122
Iron is needed to make RBC's. During pregnancy how do you treat iron deficiency anemia.
A. oral iron formulations
B. PRBCs
C. Albumin
D. fluid
A. oral iron formulations
## Footnote
slide 58
123
What is a normal platelet count for a non pregnant patient?
A. 130,000-300,000mm3
B. 200,000-350,000mm3
C. 150,000-500,000 mm3
D. 165,000-415,000mm3
D. 165,000-415,000mm3
## Footnote
slide 59
124
What can you expect to see regarding the platelet count in a pregnant patient
A. no change
B. profound decrease
C. increase
A. no change (to moderate decrease)
## Footnote
slide 59
125
What is considered thrombocytopenia
A. <150,000
B.<100,000
C. <200,000
D. <250,000
A. <150,000
| for gestational <150k, no abnormal platelet function or bleeding seen
## Footnote
slide 59
126
Thrombocytopenia is considered (select 2)
A. normal
B. psychopathic
C. idiopathic
D. hypertensive disorder of pregnancy
C. idiopathic
D. hypertensive disorder of pregnancy
## Footnote
slide 59
127
What is the incidence of epidural hematoma
A. 1: 100,000-150,000
B. 1:300,000-350,000
C.1:150-000-250,000
D. 1:200,000 - 1:250,000
D. 1:200,000-1:250,000
"low risk"
## Footnote
slide 60
128
What is the big concern with epidural hematoma formation?
A. cause temporary or permanent neurological damage
B. cause headache and n/v
C. cause increase in difficuly breathing
D. can cause mom to be really really mad at you
A. cause temporary or permanent neurological damage
## Footnote
slide 60
129
If an emergency delivery comes in and a c-section is needed, the patient has no labs... what if anesthetic plan?
A. combined spinal/epidural
B.GETA
C. epidrual
D. spinal
B. GETA
| can be dependent on hopsital/anesthesia group policies
## Footnote
slide 60
130
For a plt count of_____ you would cancel surgery/procedure
A. 17,000mm3
B. 15,000mm3
C. 50,000mm3
D. 10,000mm3
D. 10,000mm3
| Thrombocytopenia
## Footnote
slide 61
131
Before major surgery plt count needs to be
A. 25,000mm3
B. 10,000mm3
C. 50,000mm3
D. 80,000mm3
C. 50,000mm3
## Footnote
slide 61
132
Before an epidural plt count needs to be
A. 25,000mm3
B. 10,000mm3
C. 50,000mm3
D. 80,000mm3
D. 80,000mm3
## Footnote
slide 61
133
# True or false
Pregnancy produces a hypocoagulable state.
False
pregnancy produces a **hypercoagulable** state
## Footnote
slide 62
134
All factors except___ (choose 4) increase in concentration
A. II
B. III
C.IV
D.V
E.XI
F.XII
G.XIII
A. II
D. V
E. XI
G. XIII
## Footnote
slide 62
135
Which factor has a siginificant increase during pregnancy
A. I
B. II
C. III
D. IV
A. I (fibrinogen)
| >400mg/dL at term (slide 63)
## Footnote
slide 62
136
Hyperfibrinogenemia leads to (select 2)
A. hemorrhage
B. increased clotting efficiency
C. impaired fibrinolysis
D. bleeding
B. increased clotting efficiency
C. impaired fibrinolysis
| protects against hemorrhage... but risk for blood clots increase
## Footnote
slide 63
137
What factors are increased at term gestation (select 6) ... sorry i know it sucks
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
A. I (fibrinogen)
G. VII (proconvertin)
H. VIII (antihemophilic factor)
I. IX (Christmas factor)
J. X (Stuart-Prower factor)
L. XII (Hageman factor)
## Footnote
slide 64
138
Which factors are unchanged at term gestation (select 2)
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
B. II (prothromin)
E. V (proaccelerin)
## Footnote
slide 65
139
Which factors are decreased at term gestation (select 2)
A. I
B. II
C.III
D.IV
E.V
F.VI
G. VII
H.VIII
I. IX
J. X
K. XI
L. XII
M. XIII
K. XI (throboplastin antecedent)
M. XIII (fibrin-stabilizing factor)
fibrinolytic activity decrease in third trimester
## Footnote
slide 65
140
What decreased by 20% at term gestation (select 2)
A. PT
B.PTT
C.INR
D. Plt
A. PT
B. PTT
## Footnote
slide 65
141
What decreased in the third trimester
A. sanity
B. fibrinolytic activity
C. clotting
D. blood pressure
B. fibrinolytic activity
## Footnote
slide 65
142
White blood cell count during *pregnancy* typically increases steadily to ___.
A) 6,000 – 8,000/mm³
B) 9,000 – 11,000/mm³
C) 15,000 – 20,000/mm³
D) 30,000 – 34,000/mm³
B) 9,000 – 11,000/mm³
## Footnote
Slide 66
143
During labor, WBC count can increase up to ___.
A) 15,000/mm³
B) 25,000/mm³
C) 34,000/mm³
D) 50,000/mm³
C) 34,000/mm³
## Footnote
Slide 66
144
During pregnancy, polymorphonuclear leukocyte function is:
A) Enhanced, leading to increased immune response
B) Impaired, leading to increased infection risk
C) Unchanged from pre-pregnancy levels
D) Increased only in the third trimester
B) Impaired, leading to increased infection risk
## Footnote
Slide 67
145
Which of the following best describes the immune system changes in pregnancy?
A) Increased polymorphonuclear leukocyte function and decreased infection risk
B) Decreased humoral antibody response but improved autoimmune disease symptoms
C) Increased antibody titers to viral infections
D) No significant changes in immune function
B) Decreased humoral antibody response but improved autoimmune disease symptoms
## Footnote
Slide 67
146
Decreased humoral antibody titers during pregnancy are specifically associated with which viruses?
A) Hepatitis B, Influenza B, and HIV
B) Measles, Influenza A, and Herpes Simplex
C) COVID-19, Epstein-Barr, and Measles
D) Influenza B, Varicella, and Mumps
B) Measles, Influenza A, and Herpes Simplex
## Footnote
Slide 67
147
Which of the following changes contribute to an increased risk of aspiration in pregnancy? (Select 3)
A) Enlarged uterus displacing the stomach cephalad
B) Increased gastric pressure
C) Decreased competence of the lower esophageal sphincter (LES)
D) Enhanced gastric motility leading to faster emptying
A) Enlarged uterus displacing the stomach cephalad
B) Increased gastric pressure
C) Decreased competence of the lower esophageal sphincter (LES)
## Footnote
Slide 68
148
How does lower esophageal sphincter (LES) tone change during pregnancy?
A) Increases throughout pregnancy, leading to decreased aspiration risk
B) Decreases throughout pregnancy and reaches its lowest at term
C) Remains constant until postpartum, when it decreases
D) Fluctuates randomly throughout pregnancy due to hormonal shifts
E) Only decreases in the first trimester and then stabilizes
B) Decreases throughout pregnancy and reaches its lowest at term
## Footnote
Slide 69
149
All parturients are considered to have a ___ regardless of fasting status.
A) Delayed gastric emptying
B) Full stomach
C) Increased LES tone
D) Reduced gastric pressure
B) Full stomach
## Footnote
Slide 68
150
LES tone typically returns to normal around ___ postpartum.
A) Immediately
B) 4 weeks
C) 3 months
D) 6 months
B) 4 weeks
## Footnote
Slide 69
151
How does gastric emptying change during pregnancy and labor?
A) Gastric emptying is delayed throughout pregnancy and worsens in labor
B) Gastric emptying remains the same throughout pregnancy but becomes delayed during labor
C) Gastric emptying increases during labor to provide more energy for contractions
D) Gastric emptying is completely stopped during pregnancy and labor
B) Gastric emptying remains the same throughout pregnancy but becomes delayed during labor
## Footnote
Slide 70
152
What type of food or liquid is generally allowed during labor?
A) Clear liquids
B) Solid foods
C) Both clear liquids and solid foods
D) Nothing by mouth (NPO) for all laboring patients
A) Clear liquids
*Solid food generally not
(depends on where you give birth/provider)*
## Footnote
Slide 70
153
For how long should postpartum patients continue to be treated as having a full stomach?
A) 1-2 weeks
B) 2-3 weeks
C) 4-6 weeks
D) 8-10 weeks
C) 4-6 weeks
*LES tone returns to normal around 4 weeks*
## Footnote
Slide 71
154
How long does it take for the uterus to return to its normal size postpartum?
A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks
C) 6 weeks
## Footnote
Slide 71
155
Which of the following increases the risk of aspiration pneumonia?
A) Gastric pH < 4.5 and gastric volume > 50 mL
B) Gastric pH < 2.5 and gastric volume > 25 mL
C) Gastric pH > 5.0 and gastric volume < 10 mL
D) Gastric pH > 3.5 and gastric volume > 40 mL
B) Gastric pH < 2.5 and gastric volume > 25 mL
## Footnote
Slide 72
156
What is Mendelson’s Syndrome?
A) A syndrome caused by increased gastric acid production
B) Perioperative aspiration of gastric contents leading to lung inflammation
C) A gastrointestinal disorder leading to delayed gastric emptying
D) An infection caused by bacteria in the stomach
B) Perioperative aspiration of gastric contents leading to lung inflammation
| Slide 72
157
Which of the following are true regarding hepatic changes in pregnancy? (Select 2)
A) Liver size remains unchanged
B) Hepatic blood flow shows little to no change
C) Portal venous pressure decreases
D) Risk of esophageal varices decreases
A) Liver size remains unchanged
B) Hepatic blood flow shows little to no change
## Footnote
Slide 73
158
An increase in ____, ____, and ____ venous pressure during pregnancy contributes to the risk of esophageal varices.
A) Splanchnic
B) Portal
C) Esophageal
D) Renal
E) Pulmonary
A) Splanchnic
B) Portal
C) Esophageal
## Footnote
Slide 73
159
# Hepatic Changes
Which liver enzymes are known to increase during pregnancy? (Select 3)
A) Serum aspartate aminotransferase (AST)
B) Lactic dehydrogenase (LDH)
C) Alkaline phosphatase (ALP)
D) Gamma-glutamyl transferase (GGT)
A) Serum aspartate aminotransferase (AST)
B) Lactic dehydrogenase (LDH)
C) Alkaline phosphatase (ALP)
## Footnote
Slide 74
160
# Hepatic Changes
It is normal for a healthy parturient to have increased ________ and ________.
A) Liver enzymes and cholesterol
B) Bilirubin and creatinine
C) Albumin and hemoglobin
D) Blood pressure and glucose
A) Liver enzymes and cholesterol
## Footnote
Slide 74
161
# Hepatic Changes
Which of the following factors contribute to a decrease in colloid oncotic pressure during pregnancy? (Select 2)
A) Decreased total protein levels
B) Increased albumin synthesis
C) Decreased albumin-to-globulin ratio
D) Increased intravascular oncotic pull
A) Decreased total protein levels
C) Decreased albumin-to-globulin ratio
## Footnote
Slide 75
162
# Hepatic Changes
____ oncotic pressure decreases further after delivery and returns to normal at approximately ___ weeks postpartum.
Answer Choices:
A) Colloid; 6
B) Hydrostatic; 4
C) Capillary; 8
D) Interstitial; 2
A) **Colloid** oncotic pressure ; **6** weeks postpartum
## Footnote
Slide 75
163
# Hepatic Changes
Pseudocholinesterase activity decreases by ____ before delivery and by ___ on the third postpartum day.
A) 10%; 15%
B) 25%; 33%
C) 50%; 75%
D) 5%; 10%
B) decreases by **25%** before deliver; by **33%** on the third postpartum day
## Footnote
Slide 76
164
Cholestasis is most commonly associated with which stage of pregnancy?
A) First trimester
B) Second trimester
C) Third trimester
D) Postpartum period
C) Third trimester
*(1/100 people)*
## Footnote
Slide 77
165
What physiological change does cholestasis cause in pregnancy?
A) Increased bile secretion and biliary stasis
B) Decreased liver enzyme production
C) Increased renal clearance of bilirubin
D) Suppression of the immune system
A) Increased bile secretion and biliary stasis
## Footnote
Slide 77
166
What is a potential complication of cholestasis in pregnancy?
A) Decreased risk of gallstones
B) Increased risk of cholelithiasis (gallstones)
C) Increased renal excretion of bile salts
D) Permanent liver failure
B) Increased risk of cholelithiasis (gallstones)
## Footnote
Slide 77
167
Cholestasis has a high probability of ___ in future pregnancies.
A) Improving liver function
B) Not recurring
C) Returning
D) Preventing cholelithiasis
C) Returning
*May have to have gallbladder out*
## Footnote
Slide 77
168
Which symptoms are commonly associated with cholestasis in pregnancy? (Select 3)
A) Pruritus
B) High serum bilirubin
C) Abnormal liver function tests
D) Bradycardia
A) Pruritus
B) High serum bilirubin
C) Abnormal liver function tests
## Footnote
Slide 77
169
What happens to the kidneys during pregnancy?
A) They shrink due to increased renal clearance and decreased metabolic demand
B) They remain unchanged in size and function throughout pregnancy
C) They enlarge due to increased blood flow and return to baseline ~6 weeks postpartum
D) They atrophy due to decreased blood flow and reduced filtration rate
C) They enlarge due to increased blood flow and return to baseline ~6 weeks postpartum
## Footnote
Slide 78
170
During pregnancy, renal blood flow increases by ____.
A) 25%
B) 50%
C) 75%
D) 100%
C) 75%
## Footnote
Slide 78
171
Renal vasodilation during pregnancy contributes to a decrease in ____.
A) Systemic vascular resistance (SVR)
B) Renal perfusion
C) Glomerular filtration rate (GFR)
D) Cardiac output
A) Systemic vascular resistance (SVR)
## Footnote
Slide 78
172
Which renal changes occur during pregnancy? (Select 3)
A) Increased glomerular filtration rate (GFR)
B) Increased creatinine clearance
C) Decreased blood urea nitrogen (BUN)
D) Decreased renal blood flow
A) Increased glomerular filtration rate (GFR)
B) Increased creatinine clearance
C) Decreased blood urea nitrogen (BUN)
## Footnote
Slide 79
173
Pregnancy causes increased creatinine clearance and decreased serum creatinine, which is typically ___ at term.
A) 0.2 – 0.3 mg/dL
B) 0.5 – 0.6 mg/dL
C) 0.8 – 1.2 mg/dL
D) 1.0 – 1.5 mg/dL
B) 0.5 – 0.6 mg/dL
## Footnote
Slide 80
174
Blood urea nitrogen (BUN) decreases to approximately ____ mg/dL at term.
A) 2 – 4
B) 5 – 7
C) 8 – 9
D) 10 – 12
C) 8 – 9
## Footnote
Slide 80
175
Which of the following are normal findings in pregnancy but can also indicate underlying pathology if excessive? (Select 2)
A) Glucosuria
B) Proteinuria
C) Hematuria
D) Ketonuria
A) Glucosuria
B) Proteinuria
## Footnote
Slide 81
176
Why does glucosuria occur in healthy pregnant women?
A) Increased insulin resistance leading to glucose excretion
B) Tubular glucose reabsorption may not keep up with increased glomerular filtration rate (GFR)
C) Decreased renal clearance of glucose
D) Increased renal glucose reabsorption capacity
B) Tubular glucose reabsorption may not keep up with increased glomerular filtration rate (GFR)
| Slide 81
177
Proteinuria is common during pregnancy, but excessive protein in the urine can be a sign of ____.
A) Gestational diabetes
B) Hypoglycemia
C) Preeclampsia
D) Hyperthyroidism
C) Preeclampsia
## Footnote
Slide 81
178
Which of the following laboratory findings may indicate abnormal renal function in a pregnant woman near term and require further evaluation? (Select 3)
A) BUN greater than 15 mg/dL
B) Serum creatinine greater than 1.0 mg/dL
C) Creatinine clearance less than 100 mL/min
D) Serum creatinine between 0.5 - 0.6 mg/dL
A) BUN greater than 15 mg/dL
✅ B) Serum creatinine greater than 1.0 mg/dL
✅ C) Creatinine clearance less than 100 mL/min
## Footnote
Slide 82
179
Which of the following is a common thyroid change during pregnancy?
A) Thyroid size decreases due to metabolic adaptations
B) Thyroid enlarges by 50-70%, increasing the potential for a difficult airway
C) Hypothyroidism is rare and has no significant fetal impact
D) Thyroid hormone levels remain unchanged during pregnancy
B) Thyroid enlarges by 50-70%, increasing the potential for a difficult airway
## Footnote
Slide 83
180
Which of the following are possible complications of untreated hypothyroidism in pregnancy?
A) Fetal cognitive issues and growth restriction
B) Increased risk of spontaneous abortion
C) Placental abruption
D) All of the above
D) All of the above
## Footnote
Slide 83
181
What is the primary treatment for hypothyroidism in pregnancy?
A) Metformin
B) Synthroid (levothyroxine)
C) Insulin
D) Radioactive iodine therapy
B) Synthroid (levothyroxine)
## Footnote
Slide 83
182
What hormone is responsible for insulin resistance during pregnancy?
A) Human chorionic gonadotropin (hCG)
B) Human placental lactogen (hPL)
C) Progesterone
D) Estrogen
B) Human placental lactogen (hPL)
*Increased blood glucose*
## Footnote
Slide 84
183
How much does cortisol increase during pregnancy?
A) 50% in the first trimester, 100% by term
B) 100% in the first trimester, 200% by term
C) 200% in the first trimester, 400% by term
D) Cortisol levels remain unchanged during pregnancy
B) 100% in the first trimester, 200% by term
## Footnote
Slide 85
184
Which additional hormonal change occurs alongside increased cortisol during pregnancy?
A) Decrease in plasma endorphins
B) Increase in plasma endorphins
C) Decrease in aldosterone secretion
D) Complete suppression of the adrenal gland
B) Increase in plasma endorphins
## Footnote
Slide 85
185
During pregnancy, how much does the pituitary gland increase in size?
A) It remains the same size
B) Doubles in size
C) Triples in size
D) Shrinks due to hormonal changes
C) Triples in size
## Footnote
Slide 86
186
Which anterior pituitary hormone increases significantly during pregnancy?
A) Growth hormone
B) Prolactin
C) Oxytocin
D) Adrenocorticotropic hormone (ACTH)
B) Prolactin
## Footnote
Slide 86
187
# anterior pituitary
What is the primary function of increased prolactin during pregnancy, and what is a potential side effect of hyperprolactinemia?
A) Milk production preparation for breastfeeding; Acne
B) Inhibition of uterine contractions; Increased fertility
C) Enhancing glucose metabolism; Hyperthyroidism
D) Suppressing immune function; Decreased pituitary function
A) Milk production preparation for breastfeeding
Hyperprolactinemia → **acne**
## Footnote
Slide 86
188
What hormone in the Posterior Pituitary
increases by 30% by term and plays a key role in labor and lactation?
A) Prolactin
B) Oxytocin
C) Estrogen
D) Progesterone
B) Oxytocin
## Footnote
Slide 87
189
Which of the following is a function of oxytocin during pregnancy and postpartum?
A) Stimulation of uterine contractions
B) Breast milk letdown
C) Facilitation of maternal-infant bonding
D) All of the above
D) All of the above
## Footnote
Slide 87
190
Which of the following musculoskeletal symptoms is commonly associated with increased relaxin levels during pregnancy?
A) Sacroiliac pain
B) Knee pain
C) Increased risk of joint overstretching
D) All of the above
D) All of the above
## Footnote
Slide 89
191
Which type of pain is commonly experienced due to nerve compression during pregnancy?
A) Sciatic pain
B) Migraine headaches
C) Abdominal cramping
D) Trigeminal neuralgia
A) Sciatic pain
## Footnote
Slide 90
192
Which nerve is compressed in meralgia paresthetica during pregnancy?
A) Sciatic nerve
B) Lateral femoral cutaneous nerve
C) Obturator nerve
D) Tibial nerve
B) Lateral femoral cutaneous nerve
## Footnote
Slide 90
193
Meralgia paresthetica affects which area of the body?
A) Outer side of the thigh
B) Lower back
C) Inner calf
D) Sole of the foot
A) Outer side of the thigh
*compressed at the inguinal ligament as it exits the pelvis*
## Footnote
Slide 91
194
Which of the following are symptoms of meralgia paresthetica?
A) Tingling
B) Numbness
C) Burning pain
D) All of the above
D) All of the above
## Footnote
Slide 91
195
What musculoskeletal change during pregnancy contributes to back and hip pain?
A) Kyphosis
B) Scoliosis
C) Lumbar lordosis
D) Thoracic compression
C) Lumbar lordosis
## Footnote
Slide 92
196
Which of the following are key characteristics of lumbar lordosis during pregnancy? (Select 2)
A) Widening of intervertebral spaces
B) Anterior pelvic tilt
C) Reduced spinal curvature
D) Shift in center of gravity
B) Anterior pelvic tilt
D) Shift in center of gravity
## Footnote
Slide 92
197
What structural spinal change occurs due to lumbar lordosis during pregnancy?
A) Widening of the intervertebral spaces
B) Narrowing of the intervertebral spaces
C) Decreased spinal flexibility
D) Fusion of the lumbar vertebrae
B) Narrowing of the intervertebral spaces
## Footnote
Slide 92
198
An increased anterior pelvic tilt due to lumbar lordosis can result in ________.
A) Better balance and stability
B) Increased back and hip pain
C) Reduced risk of musculoskeletal issues
D) Shortening of the spine
B) Increased back and hip pain
## Footnote
Slide 92
199
Which nervous system changes occur during pregnancy? (Select 3)
A) Increased cerebral blood flow (CBF)
B) Increased permeability of the blood-brain barrier (BBB)
C) Decreased pain threshold
D) Increased plasma endorphins
A) Increased cerebral blood flow (CBF)
B) Increased permeability of the blood-brain barrier (BBB)
D) Increased plasma endorphins
## Footnote
Slide 93
200
# True or False
Plasma endorphins increase during pregnancy, leading to an increased pain threshold
True
## Footnote
Slide 93
201
Progesterone contributes to pain relief by activating ____ receptors in the spinal cord.
A) Mu-opioid
B) Kappa-opioid
C) Delta-opioid
D) Serotonin
B) Kappa-opioid
## Footnote
Slide 93
202
What happens to the volume of the venous plexus in the epidural space during pregnancy?
A) It decreases due to vascular constriction
B) It remains unchanged
C) It increases, leading to engorged epidural veins
D) It becomes compressed, reducing blood flow
C) It increases, leading to engorged epidural veins
## Footnote
Slide 94
203
Why does local anesthetic spread more widely in pregnant patients receiving an epidural?
A) Increased CSF volume
B) Decreased CSF volume leading to reduced epidural space
C) Decreased venous congestion
D) Higher metabolic breakdown of anesthetics
B) Decreased CSF volume leading to reduced epidural space
## Footnote
Slide 94
204
# True or False
Pregnant patients require higher doses of local anesthetic for epidural anesthesia due to increased CSF volume.
False
*Dr Freeman: You have a much greater spread than if you were injecting it into a high volume of fluids. So that's why that decreased CSF is going to cooperate lower total dose of local anesthetic.*
## Footnote
Slide 94
205
What is a major concern when performing epidural placement in a pregnant patient?
A) Increased risk of arterial puncture
B) Higher risk of venous puncture due to engorged epidural veins
C) Decreased effectiveness of local anesthetic
D) Greater cerebrospinal fluid (CSF) volume
B) Higher risk of venous puncture due to engorged epidural veins
## Footnote
Slide 94
206
Pregnant patients exhibit enhanced sensitivity to which class of neuromuscular blockers?
A) Depolarizing neuromuscular blockers
B) Non-depolarizing neuromuscular blockers
C) Both depolarizing and non-depolarizing
D) Neither depolarizing nor non-depolarizing
B) Non-depolarizing neuromuscular blockers
*Enhanced sensitivity to Vecuronium and Rocuronium*
## Footnote
Slide 96
207
How does pregnancy affect the metabolism of depolarizing neuromuscular blockers?
A) Increases pseudocholinesterase activity, shortening duration
B) Decreases pseudocholinesterase activity, potentially prolonging effects
C) Has no effect on neuromuscular blocker metabolism
D) Increases breakdown of Succinylcholine
B) Decreases pseudocholinesterase activity, potentially prolonging effects
*Not usually clinically significant with one dose of Succinylcholine, but can be.*
208
During pregnancy your minute ventilation increases due to and increase in tidal volume and respiration. By how much does your respiration increase per minute while pregnant?
A. 1-4 breaths
B. 3-4 breaths
C. 2-4 breaths
D.1-2 breaths
D. 1-2 breaths
| hormone mediated increase neural drive to breath
## Footnote
slide 52
