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WorksheetsReview of obstetric anesthesia block
Total questions: 30
Worksheet time: 30mins
Regarding placental physiology, which one of the following drugs crosses the placenta in appreciable amounts?
Atropine
Glycopyrrolate
Succinylcholine
Vecuronium
Heparin
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
A higher risk of gallbladder disease secondary to biliary stasis and an increased
secretion of bile
Epidural anesthesia using local anesthetics only delays gastric emptying
Gastric emptying of liquid and solid
materials is not altered during pregnancy
Gastric emptying is slowed during labor
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
Charged substance
Lower portion of unionized drug in
maternal plasma
Hydrophilic substance
High bound drug fraction
Well known endocrine changes that occur during pregnancy include all of the following EXCEP
The thyroid gland enlarges during
pregnancy
Free T3 and free T4 concentrations
remain unchanged
Cortisol levels are increased during
pregnancy
Estrogen induces an increase in thyroid-binding globulin which results in
a relative hyperthyroid state during
pregnancy
pregnant patients are insulin resistant
primarily due to placental production of
lactogen
The local anesthetic that attains the lowest fetal concentration relative to maternal concentration is
lidocaine
2-chloroprocaine
bupivacaine
ropivacaine
mepivacaine
Plasma cholinesterase concentrations during pregnancy are
highest at term
Increased
Decreased to a degree not resulting in a
clinically significant prolongation of
succinylcholine
unchanged from normal levels
Decreased resulting in a clinically significant prolongation of amide type local
anesthetics
During pregnancy, the disproportionate increase in plasma volume versus
erythrocyte volume accounts for
Increase in the mean arterial pressure
Increase in cardiac output
Relative anemia of pregnancy
Increase in stroke volume
By the third trimester of pregnancy, cardiac output increases to nearly 50% due to which of these alterations?
Increase in stroke volume and increase in heart rate
Increase in stroke volume and decrease in heart rate
Decrease in stroke volume and increase in heart rate
Decrease in stroke volume and decrease in heart rate
The largest increase in cardiac output is seen during this peripartum period:
During induction of anesthesia
Immediately after delivery
At conception
During the start of labor
The correct respiratory physiologic change associated with pregnancy is
Increase in arterial pH
Increase in PaCO2
Increase in HCO3
Increase in tidal volume
What is the P50 of fetal hemoglobin at term?
12 mm Hg
24 mm Hg
18 mm Hg
30 mm Hg
Cardiac output increases dramatically during pregnancy and delivery . The
cardiac output returns to nonpregnant values by how long postpartum?
12 hours
2 weeks
1 day
6 months
A 20-year-old G1 P0 female at 42 weeks of gestation presents to labor and delivery floor with rupture of membranes and onset of early labor. She appears uncomfortable and becomes extremely anxious with peripheral IV placement, and begins to hyperventilate. If allowed to continue hyperventilation, it will cause
Increased placental perfusion
Increased fetal arterial pH
Decreased maternal arterial pH
Decreased maternal uterine artery flow
A 38- year-old obese patient is receiving subcutaneous low-molecular -weight
heparin (LMWH) for thromboprophylaxis. Her epidural for an elective cesarean delivery was placed 14 hours after the heparin was stopped. She developed Horner syndrome on the left side 30 minutes after placement of the epidural. On physical examination, a T4 anesthetic level is noted, but aside from the Horner syndrome no other findings are revealed. The most appropriate course of action at this time would be to
Remove the epidural
Obtain a computed tomographic scan
Consult a neurosurgeon
None of the above
A 29- year -old gravida 1, para 0 woman at 8 weeks of gestation is to undergo
an emergency appendectomy under general anesthesia with isoflurane, N2O,
and oxygen. Which of the following is a proven untoward consequence of
general anesthesia in the unborn fetus ?
Congenital heart disease
Behavioral defects
Cleft palate
None of the above
A lumbar epidural is placed in a 24- year -old gravida 1, para 0 parturient with
myasthenia gravis (MG) for labor. Select the TRUE statement regarding neonatal MG.
The newborn is almost always affected with myasthenia
The newborn may require anticholinesterase therapy for up to 4
weeks
The newborn is affected by maternal immunoglobulin M (IgM)
antibodies
The newborn will need lifelong treatment
General anesthesia is induced in a 35- y ear -old patient for elective cesarean
section. No part of the glottic apparatus is visible after two unsuccessful
attempts to intubate, but mask ventilation is adequate. The most appropriate
step at this point would be to
Wake up the patient
Continue mask ventilation and cricoid pressure
Use a laryngeal mask airway
Attempt a blind nasal intubation
The MOST common side effect of intraspinal narcotics in the obstetric
population is
Pruritus
Respiratory depression
Nausea and vomiting
Urinary retention
A 110-kg , gravida 1, para 0 woman has a blood pressure of 180/95
during an office visit at the 16th week of gestation and 175/90 1 week later .
She has some ankle but no facial edema, and no protein detected in her urine.
Her serum creatinine is 1.2. These findings would be classified as
Preeclampsia
Chronic hypertension with superimposed preeclampsia
Chronic hypertension
Gestational hypertension
Cesarean delivery is associated with a blood loss of about
250 ml
500 ml
750 ml
1000 ml
Anesthetic considerations for open fetal surgery include all of the following
EXCEPT
Uterine relaxation is essential
Vecuronium at the ED95
dose of 0.04 mg/kg should be administered IM or IV by the obstetrician or surgeon if fetal
muscle relaxation is needed
Normal fetal oxygen saturation is 50% to 70%
Maternal hypotension (mean blood pressure < 65 mmHg) can be
treated with phenylephrine or ephedrine
Aortocaval compression starts to become significant in a normal pregnancy at
how many weeks EGA?
10 weeks
15 weeks
20 weeks
25 weeks
Which agent is the MOST useful for raising the gastric pH just before
induction of general anesthesia for emergency cesarean section?
Ranitidine
Metoclopramide
Sodium citrate
Magnesium hydroxide and aluminum hydroxide
Agents that are useful for decreasing the incidence of shivering during
cesarean section under regional anesthesia or for treating shivering include all
of the following EXCEPT
Administration of intrathecal local anesthetic with fentanyl
and/or morphine
Administration of epidural local anesthetic solutions with
epinephrine
Intravenous magnesium sulfate
Intravenous meperidine
True statements regarding inclusion of intrathecal morphine, fentanyl, or
sufentanil in obstetric anesthesia practice include each of the following
EXCEPT
The chief site of action is the substantia gelatinosa of the dorsal horn of the spinal column
Pain relief is adequate for the second stage of labor
Lipophilic narcotics are associated with less respiratory
depression than nonlipophilic narcotics
There is no motor and no sympathetic blockade
A 20-year-old G1 P0 female at 42 weeks of gestation presents to labor and delivery floor with rupture of membranes and onset of early labor. She appears uncomfortable and becomes extremely anxious with peripheral IV placement, and begins to hyperventilate. If allowed to continue hyperventilation, it will cause
Increased placental perfusion
Increased fetal arterial pH
Decreased maternal arterial pH
Decreased maternal uterine artery flow
Which of the following is TRUE regarding obstetric hemorrhage?
Antepartum hemorrhage is associated only with abruptio placentae.
The risk of placenta accreta in women with previa increases by 8% with each additional cesarean section.
Delivery of a placenta previa pregnancy carries a <1% risk of maternal mortality.
Postpartum hemorrhage is typically defined as blood loss greater than 2,000 mL following vaginal or cesarean section.
Four hours postdelivery, and after the epidural is removed, the patient now requires emergent anesthesia for surgical removal of retained placental products. The appropriate anesthetic management includes all of the following, except
General endotracheal inhaled anesthetic
Antibiotic administration
Sodium citrate
Total intravenous anesthesia
Postdural puncture headache (PDPH) occurs more frequently
In elderly (>50 year old)
vs.
young patients
With a cutting-point
vs.
pencil-point spinal needles
In underweight
vs.
overweight patients
With larger
vs.
smaller-gauge spinal needles
Which condition BEST describes the third-trimester maternal condition with
the following signs and symptoms: new-onset vaginal bleeding that stops, no
pain, no fetal distress ?
Placental abruption
Uterine rupture
Placenta previa
Vasa previa
