Regarding placental physiology, which one of the following drugs crosses the placenta in appreciable amounts?

• Atropine

• Glycopyrrolate

• Succinylcholine

• Vecuronium

• Heparin

An infant with a heart rate of 70, a weak cry, minimal muscle flexion, a grimace to oropharyngeal suctioning and acrocyanosis at five minutes would receive an Apgar score of

• 2

• 4

• 5

• 6

• 7

Well known gastrointestinal changes that occur during pregnancy include all of the following EXCEPT

• the combination of esophageal displacement into the thorax and progestin

  result in a lowering of the lower esophageal sphincter tone

• gastric emptying of liquid and solid

  materials is not altered during pregnancy

• a higher risk of gallbladder disease secondary to biliary stasis and an increased

  secretion of bile

• gastric emptying is slowed during labor

• epidural anesthesia using local anesthetics only delays gastric emptying

Regarding placental transfer of d rugs, which one of the following favors increased maternal to fetal drug transfer?

• Molecular weight less than 1,000

  Daltons

• Hydrophilic substance

• Charged substance

• High bound drug fraction

• Lower portion of unionized drug in

  maternal plasma

Well known endocrine changes that occur during pregnancy include all of the following EXCEP

• The thyroid gland enlarges during

  pregnancy

• estrogen induces an increase in thyroid-binding globulin which results in

  a relative hyperthyroid state during

  pregnancy

• free T3 and free T4 concentrations

  remain unchanged

• pregnant patients are insulin resistant

  primarily due to placental production of

  lactogen

• cortisol levels are increased during

  pregnancy

Which one of the following changes in lab values is expected during pregnancy?

• Decreased hematocrit

• Increased PCO2

• Increased pH

• Increased creatinine

• Decreased factors VII, VIII, X, and

  fibrinogen

Well-known changes that occur in the central nervous system of the parturient include all of the following conditions EXCEPT

• nerve fibers have increased sensitivity to

  local anesthetics

• MAC for inhalational agents is

  decreased by approximately 40%

• activation of the endorphin system

• no change in dose requirement for local

  anesthetic in the first trimester

• spinal CSF volume is reduced

The local anesthetic that attains the lowest fetal concentration relative to maternal concentration is

• lidocaine

• ropivacaine

• 2-chloroprocaine

• mepivacaine

• bupivacaine

In a pregnant woman at term, you would expect an increase in all of the following values EXCEPT

• functional residual capacity

• dead space

• tidal volume

• lung compliance

• inspiratory reserve volume

Plasma cholinesterase concentrations during pregnancy are

• highest at term

• unchanged from normal levels

• increased

• decreased resulting in a clinically significant prolongation of amide type local

  anesthetics

• decreased to a degree not resulting in a

  clinically significant prolongation of

  succinylcholine