Complicated OB part 2 (KM) Flashcards
(295 cards)
1
Q
Umbilical cord prolapse occurs when the umbilical cord slips through the ______ into or beyond the ______ before or with the presenting fetal part.
A. uterus; placenta
B. amniotic sac; cervix
C. cervix; vagina
D. placenta; uterus
A
C. cervix; vagina
Slide 3
2
Q
What is the most common fetal heart rate pattern noted on Fetal Heart Tracings (FHT) associated with umbilical cord prolapse?
A. Fetal tachycardia
B. Fetal bradycardia
C. Late decelerations
D. Variable decelerations
A
B. Fetal bradycardia
“Cord compression by presenting part of fetus”
Slide 3
3
Q
Which term describes a cord prolapse that cannot be seen or felt but causes fetal compromise?
A. Visual prolapse
B. Overt prolapse
C. Primary prolapse
D. Occult prolapse
A
D. Occult prolapse
Slide 3
4
Q
Which of the following best describes an overt umbilical cord prolapse?
A. The cord is compressed behind the fetal head and cannot be seen or felt
B. The cord prolapses between contractions but returns during relaxation
C. The umbilical cord is visible or palpable in the vaginal canal
D. The prolapse only occurs after delivery of the fetal head
A
C. The umbilical cord is visible or palpable in the vaginal canal
3
5
Q
Which of the following factors increase the risk of umbilical cord prolapse?
Select 2
A. Abnormal presentation
B. Occiput anterior presentation
C. Cephalic presentation
D. Multiple gestation
E. Prolonged third stage of labor
A
A. Abnormal presentation
D. Multiple gestation
4
6
Q
In multiple gestation, abnormal fetal presentations such as ______ or ______ increase the risk of umbilical cord prolapse.
A. Breech; shoulder
B. Vertex; cephalic
C. Occiput anterior; longitudinal lie
D. Chin tucked; footling breech
A
A. Breech; shoulder
4
7
Q
In a twin gestation, umbilical cord prolapse most commonly occurs (from slide):
Select 2
A. Before the delivery of Baby A
B. After delivery of Baby B
C. Before delivery of the placenta
D. After delivery of Baby A
A
A. Before the delivery of Baby A
D. After delivery of Baby A
On slide - “May occur before or after delivery of baby A”
Cornelius - “…happens between twins…first baby is delivered and then the cord for the second baby becomes prolapsed resulting in problems.”
4
8
Q
What is the primary goal of manual elevation of the presenting part in umbilical cord prolapse?
A. Stimulate uterine contractions
B. Relieve compression of the umbilical cord
C. Reduce maternal discomfort
D. Induce cervical ripening
A
B. Relieve compression of the umbilical cord
5
9
Q
One common maternal position used to relieve umbilical cord pressure during a prolapse is the ____ position, which uses gravity to shift the fetus away from the cervix.
A. Fowler’s
B. Supine
C. Knee-chest
D. Lithotomy
A
C. Knee-chest
5
10
Q
What is the purpose of retrograde bladder filling in the management of umbilical cord prolapse?
A. Slow uterine contractions
B. Displace the prolapsed cord
C. Slow cervical dilation
D. Displace the presenting fetal part
A
D. Displace the presenting fetal part away from the cord
“…if this doesn’t fix the problem and the fetus remains in distress, you’re going to proceed quickly to an emergency section.”
6
11
Q
Retrograde bladder filling involves instilling ______ to ______ mL of saline into the bladder to displace the presenting part and relieve cord compression.
A. 500–600
B. 400–500
C. 300–400
D. 200–300
A
A. 500–600
Corn - “You’re going to put a half liter to a liter of saline in there”
6
12
Q
Which of the following are acceptable anesthetic strategies for managing umbilical cord prolapse in the setting of fetal distress?
Select 3
A. Bolus of lidocaine through epidural catheter
B. General anesthesia for emergent cesarean
C. Slow spinal anesthetic with morphine
D. Bolus of chloroprocaine through epidural
E. Regional anesthesia always preferred over general
A
A. Bolus of lidocaine through epidural catheter
B. General anesthesia for emergent cesarean
D. Bolus of chloroprocaine through epidural
Corn - “a lot of times it depends (situational) on the exact circumstances of things, kind of where mom’s at in the process”
7
13
Q
Mulitple Gestation
Monozygotic twins are also called ______ twins, while dizygotic twins are also called ______ twins.
A. fraternal; identical
B. identical; fraternal
C. similar; non-identical
D. single-cell; dual-cell
A
B. identical; fraternal
8
14
Q
Which of the following correctly describes monozygotic twins?
A. Arise from two separate fertilized eggs
B. Are always different genders
C. Fertilization of a single egg by a single sperm
D. Are more common with advanced maternal age
A
C. Fertilization of a single egg by a single sperm
8
15
Q
Dizygotic twins, develop from ______ separate ova fertilized by ______ different sperm.
A. one; one
B. two; two
C. two; one
D. one; two
A
B. two; two
8
16
Q
Twin-to-twin transfusion syndrome (TTTS) is primarily associated with ______ twins due to shared ______ vasculature.
A. dizygotic; umbilical
B. monoamniotic; arterial
C. dichorionic; chorionic
D. monochorionic; placental
A
D. monochorionic; placental
9
17
Q
Monochorionic monoamniotic twins share both a ______ and a ______.
A. placenta; amniotic sac
B. cervix; cord
C. uterus; placenta
D. chorion; yolk sac
A
A. placenta; amniotic sac
9
18
Q
In monochorionic diamniotic twins, the fetuses share a ______ but have separate ______.
A. uterus; hearts
B. placenta; amniotic sacs
C. chorion; embryos
D. cord; yolk sacs
A
B. placenta; amniotic sacs
9
19
Q
Dichorionic diamniotic twins are typically:
A. Identical and share a placenta
B. Conjoined twins
C. Identical and share an amniotic sac
D. Seperate placentas and sacs
A
D. Separate placentas and sacs
Can be fused placentas..
10
20
Q
Which maternal organ systems show the most significant physiologic changes during multiple gestation?
A. Hepatic and renal
B. Cardiovascular and pulmonary
C. Gastrointestinal and CNS
D. Endocrine and integumentary
A
B. Cardiovascular and pulmonary
11
21
Q
Compared to singleton pregnancies, cardiac output in multiple gestation increases approximately:
A. 5%
B. 10%
C. 20%
D. 35%
A
C. 20%
Primarily related to SV
11
22
Q
As term approaches in a multiple gestation pregnancy, what pulmonary changes are expected due to uterine size?
Select 2
A. Increased total lung capacity
B. Increased functional residual capacity
C. Decreased total lung capacity
D. Decreased functional residual capacity
D. No significant changes from singleton pregnancies
A
C. Decreased total lung capacity
D. Decreased functional residual capacity
“Increased risk of hypoxemia”
11
23
Q
Which of the following maternal organ systems show no significant physiologic change in multiple gestation compared to a singleton pregnancy?
A. Cardiovascular and pulmonary
B. Renal, hepatic, and CNS
C. Endocrine and integumentary
D. Musculoskeletal and gastrointestinal
A
B. Renal, hepatic, and CNS
11
24
Q
After approximately ______ weeks gestation in multiple pregnancies, maternal weight gain tends to accelerate significantly.
A. 20
B. 24
C. 28
D. 30
A
D. 30
12
25
Which of the following physiologic changes increase the risk of aspiration in multiple gestation?
Select 3
A. Cephalad displacement of the stomach
B. Increased gastric pH
C. Decreased competence of the lower esophageal sphincter
D. Increased intra-abdominal pressure
E. Increased gastric emptying rate
A. Cephalad displacement of the stomach
C. Decreased competence of the lower esophageal sphincter
D. Increased intra-abdominal pressure
## Footnote
12
26
In a multiple gestation pregnancy, maternal blood volume is approximately:
A. 105 mL/kg
B. 115 ml/kg
C. 120 ml/kg
D. 135 mL/kg
A. 105 mL/kg
Corn - "From a physiologic standpoint, the maternal blood volume is generally about 100 to 110 mL/kg"
## Footnote
13
27
What physiologic factor contributes to a greater likelihood of anemia in multiple gestation pregnancies?
A. Decreased iron absorption
B. Increased fetal red cell production
C. Greater plasma volume expansion
D. Suppression of maternal erythropoiesis
C. Greater plasma volume expansion
## Footnote
13
28
In multiple gestation pregnancies, plasma volume increases by an additional ______ mL compared to singleton pregnancies.
A. 250 mL
B. 750 mL
C. 1200 mL
D. 1500 mL
B. 750
Corn - "..plasma volume increases when you compare it to like a singleton pregnancy. Usually it's like 500 to 1000 mLs greater than with just a single pregnancy"
## Footnote
13
29
Compared to singleton pregnancies, estimated blood loss (EBL) at delivery in multiple gestation is typically greater by:
A. 250 mL
B. 500 mL
C. 1000 mL
D. Unaffected unless cesarean delivery is used
B. 500 mL
## Footnote
13
30
Twin-to-twin transfusion syndrome (TTTS) is primarily caused by:
A. Maternal hypotension during early gestation
B. Unequal implantation of umbilical cords
C. Deep arteriovenous vascular anastomoses
D. Shared yolk sac abnormalities
C. Deep arteriovenous vascular anastomoses
## Footnote
14
31
Which of the following best describes the **donor** in Twin-Twin Transfusion Syndrome ?
A. Plethoric, polycythemic, and volume overloaded
B. At risk for hypervolemia and cardiac hypotrophy
C. Larger, anemic and volume overloaded
D. Smaller, anemic, and intrauterine growth restriction
D. Smaller, anemic, and intrauterine growth restriction
## Footnote
14
32
In TTTS, the **recipient** twin is at risk for all of the following **except:**
A. Polyhydramnios
B. Cardiac failure
C. Hypovolemia
D. Volume overload
C. Hypovolemia
"plethoric / risk of volume overload & cardiac failure **especially right ventricle**"
## Footnote
14
33
What percentage of multiple gestation pregnancies result in delivery before 37 weeks?
A. Nearly all
B. Less than 30%
C. Approximately 40%
D. Greater than 50%
D. Greater than 50%
## Footnote
15
34
To decrease perinatal complications, twins are typically delivered around ______ weeks gestation.
A. 37
B. 38
C. 39
D. 35
B. 38
## Footnote
15
35
What is the recommended planned delivery timing for triplets or higher-order multiples to reduce perinatal mortality?
A. 35 weeks
B. 33 weeks
C. 37 weeks
D. 38 weeks
A. 35 weeks
## Footnote
15
36
Why is fetal monitoring more challenging during labor in multiple gestation pregnancies?
A. Increased maternal anxiety makes monitoring unreliable
B. Fetuses may shift positions rapidly during contractions
C. Difficulty distinguishing multiple fetal heart rates
D. The fetuses are too large for Doppler signal penetration
C. Difficulty distinguishing multiple fetal heart rates
## Footnote
15
37
Which of the following are appropriate considerations or responses when providing anesthesia to a patient with multiple gestation with larger than normal uterine distention?
Select 3
A. Maintain left uterine displacement during neuraxial anesthesia
B. Anticipate uterine atony and have uterotonics available
C. Supine positioning is preferred to enhance epidural spread
D. Monitor for signs of hypotension due to aortocaval compression
E. Use higher doses of oxytocin as the only uterotonic
A. Maintain left uterine displacement during neuraxial anesthesia
B. Anticipate uterine atony and have uterotonics available
D. Monitor for signs of hypotension due to aortocaval compression
## Footnote
16
38
What is the purpose of a “double setup” in anesthesia management for multiple gestation deliveries?
A. To prepare for emergency hysterectomy and manual extraction
B. To allow conversion between vaginal and cesarean delivery in the OR
C. To provide separate anesthesia teams for each fetus
D. To initiate preterm labor and delivery simultaneously
B. To allow conversion between vaginal and cesarean delivery in the OR
## Footnote
17
39
What is the recommended dose of terbutaline IV and SQ for uterine relaxation in the obstetric setting?
A. 250 mcg
B. 400 mcg
C. 100-250 mcg
D. 105 mg
A. 250 mcg
## Footnote
17
40
Which of the following is the correct **IV dose** range of nitroglycerin used for uterine relaxation?
A. 100–250 mcg IV
B. 2–4 mg/kg IV
C. 5–10 mcg/min infusion
D. 0.4 mg/kg IV
A. 100–250 mcg IV
## Footnote
17
41
# True or False
To facilitates podalic version of twin B to delivery vaginally you can give nitroglycerin sublingual 250mcg
False
Nitroglycerin can be given sublingual at a **400mcg dose**
## Footnote
17
42
# Fun Fact
**Podalic version of twin B** - This procedure involves a doctor inserting a hand into the uterus and manually turning the fetus to a breech presentation. This is done after the first twin is born, while the uterus is still relaxed.
Better relax that uterus with some NTG or terbutaline
| 🫣
43
When both twins are expected to be delivered vaginally, the preferred neuraxial technique is ______.
Select 2
A. Spinal anesthesia
B. General anesthesia
C. Combined spinal epidural
D. TAP block
E. Epidural analgesia
C. Combined Spinal Epidural
E. Epidural analgesia
## Footnote
18
44
What are appropriate anesthetic techniques when both twins are delivered by cesarean section?
Select 3
A. Combined spinal epidural
B. Epidural anesthesia
C. GETA only
D. Local infiltration only
E. Subarachnoid block
A. Combined spinal epidural
B. Epidural anesthesia
E. Subarachnoid block
## Footnote
18
45
A patient delivers twin A vaginally with CSE or epidural, but twin B requires urgent cesarean delivery. What is the best anesthetic transition?
A. Replace with spinal anesthetic
B. Convert to just epidural anesthesia
C. Remove epidural and induce general anesthesia
D. Begin fentanyl PCA
B. Convert to just epidural anesthesia
## Footnote
18
46
# True or False
General anesthesia will decrease the neonatal acidosis and depression in twin A
False
General anesthesia will **increase** the neonatal acidosis and depression in twin **B**
## Footnote
19
47
Which of the following are known risks or complications of using GETA for cesarean delivery in multiple gestation?
Select 2
A. Difficult maternal intubation
B. Increased neonatal acidosis in twin A
C. Enhanced uterine tone
D. Greater estimated blood loss
E. Reduced uterine perfusion due to sympathetic block
A. Difficult maternal intubation
D. Greater estimated blood loss
## Footnote
19
48
Gestational hypertension is diagnosed when blood pressure is elevated > ______ mmHg.
A. 129/79
B. 139/89
C. 140/90
D. 150/95
C. 140/90
## Footnote
20
49
After gestational age of ________________, you can diagnose gestational hypertension with two measurements.
A. 12 weeks
B. 20 weeks
C. 28 weeks
D. 37 weeks
B. 20 weeks
## Footnote
20
50
**Most cases** of gestational hypertension develop after ______ weeks gestation.
A. 32
B. 34
C. 35
D. 37
D. 37
## Footnote
20
51
A key feature distinguishing gestational hypertension from preeclampsia is the absence of ______.
A. headache
B. edema
C. proteinuria
D. visual disturbances
C. proteinuria
## Footnote
20
52
What percentage of patients with gestational hypertension develop preeclampsia?
A. 10%
B. 25%
C. 50%
D. 75%
B. 25%
## Footnote
21
53
A definitive diagnosis of gestational hypertension is made postpartum when the patient returns to a __________ state within ____ weeks.
A. normotensive; 12
B. hypertensive; 6
C. hypotensive; 12
D. normotensive; 6
A. normotensive; 12
Corn - "...if you're taking care of mom for procedures after birth, maybe she's coming back for a tubal or, you know, an unrelated procedure, just be cautious because that blood pressure may still be elevated.."
## Footnote
21
54
Preeclampsia is diagnosed when a patient develops new-onset __________________ & ______________ after 20 weeks gestation.
A. Hypotension; proteinuria
B. Hypertension; glucose in urine
C. Hypertension; proteinuria
D. Hypotension; ketonuria
C. Hypertension; proteinuria
## Footnote
22
55
Which of the following are possible symptoms or findings associated with preeclampsia? (Select 4)
A. Left upper quadrant pain
B. Visual disturbances
C. Elevated liver enzymes
D. Hyperglycemia
E. Thrombocytopenia
F. Epigastric pain
B. Visual disturbances - **cerebral symptoms** *blurry vision, floaters*
C. Elevated liver enzymes
E. Thrombocytopenia
F. Epigastric pain - **right upper quadrant - gallbladder**
## Footnote
22
56
# True or false
Intrauterine growth restriction is commonly associated with preeclampsia
True
## Footnote
22
57
The diagnosis of preeclampsia **without severe** features includes a blood pressure ≥ 140/90 mmHg and proteinuria of ≥ __________ in a 24-hour urine collection.
A. 150 mg
B. 200 mg
C. 300 mg
D. 500 mg
C. 300 mg
## Footnote
23
58
On a urine dipstick, a result of __________ is sufficient for the diagnosis of proteinuria in preeclampsia.
A. 1+
B. trace
C. 2+
D. negative
A. 1+
## Footnote
23
59
Which lab finding supports a diagnosis of preeclampsia without severe features?
A. Platelets < 100,000/mm³
B. Serum creatinine > 2.5
C. AST/ALT > 1000
D. Protein:Creatinine ratio ≥ 0.3
D. Protein:Creatinine ratio ≥ 0.3
## Footnote
23
60
Which of the following blood pressure readings meets criteria for preeclampsia **with** severe features?
A. 130/85 mmHg
B. 140/92 mmHg
C. 154/95 mmHg
D. 165/112 mmHg
D. 165/112 mmHg
## Footnote
24
61
A patient with preeclampsia and a platelet count of < __________/mm³ meets criteria for severe features.
A. 120,000
B. 110,000
C. 100,000
D. 80,000
C. 100,000
## Footnote
24
62
A diagnosis of severe preeclampsia may be supported by a serum creatinine level greater than ____________, or **2x baseline:**
A. 0.8 mg/dL
B. 1.1 mg/dL
C. 1.8 mg/dL
D. 2.0 mg/dL
B. 1.1 mg/dL ✅
## Footnote
24
63
Which of the following clinical signs or lab findings are associated with preeclampsia with severe features?
Select 3
A. Pulmonary edema
B. Platelet count of 130,000/mm³
C. New onset visual disturbances
D. Serum creatinine < 1.1 mg/dL
E. Mild headache that resolves with Tylenol
F. AST and ALT 3x upper limit of normal
A. Pulmonary edema
C. New onset visual disturbances
F. AST and ALT 3x upper limit of normal (impaired liver enzymes)
## Footnote
24
64
Which of the following are diagnostic indicators of **chronic hypertension** in pregnancy?
select 3
A. Pre-pregnancy DBP < 90 mmHg
B. Pre-pregnancy DBP ≥ 90 mmHg
C. BP returning to baseline pospartum
D. BP not returning to baseline postpartum
E. Pre-pregnancy DBP ≥ 90 mmHg
B. Pre-pregnancy DBP ≥ 90 mmHg
D. BP not returning to baseline postpartum
E. Pre-pregnancy DBP ≥ 90 mmHg
## Footnote
25
65
Up to ______% of women with chronic hypertension may develop preeclampsia.
A. 10-20%
B. 10-20%
C. 15-25%
D. 20-25%
D. 20-25%
## Footnote
25
66
Superimposed preeclampsia is characterized by which of the following?
Select 3
A. Chronic hypertension prior to pregnancy
B. New-onset seizures before 20 weeks
C. New or sudden increase in proteinuria
D. Decreased risk for fetal complications
E. Increased morbidity for mother and fetus
A. Chronic hypertension prior to pregnancy
C. New or sudden increase in proteinuria
E. Increased morbidity for mother and fetus
## Footnote
26
67
Preeclampsia can occur in the **absence of a viable fetus**, as seen in which of the following conditions?
A. Blighted ovum
B. Molar pregnancy
C. Ectopic pregnancy
D. Missed abortion
B. Molar pregnancy
## Footnote
27
68
What is the pathophysiological mechanism contributing to preeclampsia in abnormal placentation?
A. Excessive placental angiogenesis
B. Hypoplastic uterine wall
C. Impaired spiral artery remodeling
D. Enhanced uterine relaxation
C. Impaired spiral artery remodeling
## Footnote
27
69
Which of the following are characteristics or consequences of preeclampsia?
Select 2
A. Impaired spinal artery remodeling
B. Large, dilated placental vessels
C. Small, constricted vasculature
D. Adequate fetal oxygenation
E. Multisystem involvement
C. Small, constricted vasculature -**Unable to deliver O2 and nutrients to the fetus**
E. Multisystem involvement
## Footnote
27
70
Which placental factor contributes to endothelial dysfunction in preeclampsia?
A. Antiangiogenic proteins
B. Beta-hCG
C. Angiotensinogen
D. Aldosterone
A. Antiangiogenic proteins
## Footnote
28
71
Which of the following contributes to the effect of vasoconstriction in preeclampsia?
A. Increased nitric oxide and decrease prostacyclin
B. Decreased angiotensin II sensitivity
C. Decreased prostacyclin and nitric oxide
D. Increased albumin levels and increased prostacyclin
C. Decreased prostacyclin and nitric oxide
## Footnote
28
72
Which of the following best explains how increased angiotensin II sensitivity contributes to preeclampsia pathophysiology?
A. Promotes vasodilation and placental perfusion
B. Leads to vasoconstriction and placental insufficiency
C. Enhances renal filtration and urine output
D. Inhibits aldosterone secretion
B. Leads to vasoconstriction and placental insufficiency
## Footnote
28
73
What condition results from **low oncotic pressure due to hypoalbuminemia** in preeclampsia?
A. Pulmonary hypertension
B. Decreased vascular resistance
C. Third spacing
D. Hypervolemia
C. Third spacing and **intravascular volume depletion**
## Footnote
28
74
In early-onset preeclampsia, symptoms typically begin **before** _____ weeks and are associated with _____ outcomes.
A. 37, improved
B. 40, neutral
C. 28, better
D. 34, worse
D. 34, worse
## Footnote
29
75
Late-onset preeclampsia typically presents after _______ weeks gestation and is more often associated with __________ conditions.
A. 20; autoimmune
B. 32; thromboembolic
C. 34; metabolic
D. 30; renal
C. 34; metabolic
## Footnote
29
76
Which of the following are features of postpartum preeclampsia?
Select 3
A. Develops within 7 days of delivery
B. Seizures may be the presenting symptom
C. Requires presence of fetus for diagnosis
D. Often includes proteinuria
E. Only occurs in C-section patients
A. Develops within 7 days of delivery
B. Seizures may be the presenting symptom
D. Often includes proteinuria
## Footnote
30
77
Which imbalance contributes to the development of preeclampsia during pregnancy?
A. Increased thromboxane relative to prostacyclin
B. Increased nitric oxide relative to angiotensin II
C. Decreased thromboxane relative to prostacyclin
D. Equal levels of thromboxane and prostacyclin
A. Increased thromboxane relative to prostacyclin
## Footnote
31
78
What is the role of aspirin in preeclampsia prophylaxis?
Select 2
A. Promotes prostacyclin production
B. Inhibits renin-angiotensin conversion
C. Inhibits synthesis of prostaglandins
D. Enhances nitric oxide release
E. Inhibits biosynthesis of platelet thromboxane A₂
C. Inhibits synthesis of prostaglandins
E. Inhibits synthesis of platelet thromboxane A₂
## Footnote
31
79
When should aspirin be initiated for optimal prophylaxis of preeclampsia?
A. After 34 weeks
B. At 16 weeks
C. At 24 weeks
D. At delivery
B. At 16 weeks *or earlier for best benefit*
## Footnote
31
80
A patient with suspected severe preeclampsia presents with the following findings. Which would be concerning indicators for possible complications? (Select 4)
A. Late onset
B. Thrombocytopenia
C. Elevated creatinine
D. Hypernatremia
E. Chest pain or dyspnea
F. Increased AST concentration
B. Thrombocytopenia
C. Elevated creatinine
E. Chest pain or dyspnea **(low SpO2)**
F. Increased AST concentration
* Early Onset
## Footnote
32
81
Which of the following is a clinical feature of central nervous system involvement in preeclampsia?
A. Bradycardia
B. Urinary retention
C. Hypothermia
D. Hyperreflexia
D. Hyperreflexia
## Footnote
33
82
A preeclamptic patient becomes disoriented, talks excessively out of character, and then giggles uncontrollably. This is most consistent with:
A. Hyperexcitability
B. Postpartum psychosis
C. Hypoglycemia
D. Serotonin syndrome
A. Hyperexcitability
## Footnote
33
83
Which of the following is a central nervous system (CNS) symptom commonly associated with preeclampsia?
A. Myopia
B. Severe headache
C. Tachycardia
D. Mydriasis
B. Severe headache
## Footnote
33
84
In the progression of untreated CNS symptoms in preeclampsia, which of the following is most likely to occur **last**?
A. Hyperreflexia
B. Visual disturbances
C. Seizures
D. Severe headache
C. Seizures
Coma
Death
## Footnote
33
85
Which of the following visual symptoms is most commonly reported by patients with preeclampsia?
A. Photophobia
B. Scotoma
C. Amaurosis
D. Blurred vision
D. Blurred vision
Corn -" just make sure that it's all neurologic and it's not a volume status issue. If anybody's ever been dehydrated, you know when you stand up, sometimes your vision becomes blurry"
## Footnote
34
86
A 29-year-old preeclamptic patient reports a painless, transient loss of vision in one eye. This is most consistent with:
A. Retinal detachment
B. Amaurosis
C. Scotoma
D. Corneal abrasion
B. Amaurosis
## Footnote
34
87
Scotoma, when seen in preeclampsia, is best described as:
A. Flashes of light
B. A floating gray veil
C. Localized blind spots
D. Tunnel vision
C. Localized blind spots
## Footnote
34
88
In preeclampsia, loss of **cerebral autoregulation** may lead to _____ and subsequent ** vasogenic cerebral edema**.
A. Hyperperfusion
B. Hypovolemia
C. Vasoconstriction
D. Arterial dissection
A. Hyperperfusion
## Footnote
35
89
Loss of cerebral vascular autoregulation in preeclampsia leads to which of the following?
A. Hypoperfusion and ischemic stroke
B. Bradycardia and hypoxia
C. Retinal hemorrhage
D. Vascular barotrauma
D. Vascular barotrauma
## Footnote
35
90
What does the acronym "PRES" stand for in the context of preeclampsia?
A. Pre-Eclamptic Renal Syndrome
B. Posterior Reversible Edema Syndrome
C. Posterior Reversible Encephalopathy Syndrome
D. Pressure-Related Edematous Seizure
C. Posterior Reversible Encephalopathy Syndrome
Corn - "this is kind of a cumulative diagnosis for all the symptoms they're presenting with, visual disturbances, headaches, seizures, altered mental status.
The good news is it tends to be easily reversible and it's related to that volume status, but it's just kind of a summary or emulation of all those symptoms"
## Footnote
35
91
Which airway changes are commonly seen in preeclamptic patients? (Select 3)
A. Pharyngeal and laryngeal edema
B. Decreased tracheal diameter
C. Supraglottic swelling
D. Tracheomalacia
E. Subglottic swelling
A. Pharyngeal and laryngeal edema
B. Decreased tracheal diameter - *capillary engorgement*
E. Subglottic swelling
## Footnote
36
92
Which airway management strategies are appropriate for patients with preeclampsia-related airway edema? (Select 3)
A. Prepare a range of smaller ETT sizes
B. Avoid rapid-sequence induction
C. Anticipate difficult intubation
D. Perform awake fiberoptic intubation in all cases
E. Exchange for a larger ETT if patient transfers to ICU
A. Prepare a range of smaller ETT sizes
C. Anticipate difficult intubation
E. Exchange for a larger ETT if patient transfers to ICU
## Footnote
36
93
Which of the following is NOT a typical cardiovascular feature of *preeclampsia*?
A. Exaggerated response to catecholamines
B. Increased vascular tone
C. Profound vasodilation
D. Severe vasospasm
C. Profound vasodilation
Corn -"...increased sensitivity to vasoconstrictors and catecholamines...if you're giving them something like ephedrine or epinephrine, that you get an exaggerated response. A little bit goes a long way with patients with preeclampsia"
## Footnote
37
94
# True or False
Magnesium sulfate tends to decrease vascular tone so administration in preeclampsia can blunt the response to catecholamines
True
Corn - "if they're on magnesium, a lot of times it's decreased that vascular tone, so they may not be quite as responsive as they normally would."
## Footnote
37
95
In a patient with severe preeclampsia, plasma volume may be decreased by as much as:
A. 10%
B. 20%
C. 30%
D. 40%
D. 40%
## Footnote
38
96
_______ is commonly seen in the left ventricle of preeclamptic patients and reflects enhanced systolic performance.
A. Hyperdynamic function
B. Dilated cardiomyopathy
C. Ischemic remodeling
D. Mitral regurgitation
A. Hyperdynamic function
## Footnote
39
97
In the absence of pulmonary edema, cardiac output in preeclampsia is often _______.
A. Severely depressed
B. Normal or increased
C. Unaffected or decreased
D. Increased moderately
B. Normal or increased
## Footnote
39
98
Which feature is commonly associated with cardiac performance in severe preeclampsia?
A. Bradyarrhythmias
B. Decreased preload with high stroke volume
C. Diastolic dysfunction
D. Cardiogenic shock
C. Diastolic dysfunction
D/t Mild to moderate increased SVR
## Footnote
39
99
Approximately what percentage of parturients with preeclampsia develop pulmonary edema?
A. < 1%
B. 3%
C. 13%
D. 35%
B. 3%
## Footnote
40
100
Which of the following are the 3 risk factors for pulmonary edema in preeclampsia? (Select 3)
A. Advanced maternal age
B. Gestational diabetes
C. Renal disease
D. Hypothyroidism
E. Preeclampsia with chronic hypertension
F. Liver disease
A. Advanced maternal age (35)
C. Renal disease
E. Preeclampsia with chronic hypertension
## Footnote
40
101
Which of the following mechanisms contribute to pulmonary edema in preeclampsia? (Select 3)
A. Decreased plasma colloid osmotic pressure
B. Increased pulmonary capillary permeability
C. Elevated intravascular hydrostatic pressure
D. Decreased systemic vascular resistance
E. Excess aldosterone suppression
A. Decreased plasma colloid osmotic pressure
B. Increased pulmonary capillary permeability
C. Elevated intravascular hydrostatic pressure
| ....schmidt..
## Footnote
41
102
What is the most common hematologic abnormality in preeclampsia?
A. Hemolytic anemia
B. Leukocytosis
C. Thrombocytopenia
D. Polycythemia
C. Thrombocytopenia
## Footnote
42
103
Platelet counts below _______/mm³ are associated with severe disease or HELLP syndrome.
A. 100,000
B. 120,000
C. 150,000
D. 200,000
A. 100,000
HELLP - Hemolysis, Elevated Liver enzymes, and Low Platelet count
Corn - "it's fairly common to have platelets as low as 25 or 30,000. So they're very quickly approaching that point where they may spontaneously hemorrhage"
## Footnote
42
104
Normal pregnancy is a ______ state
A. Hypercoagulable
B. Hypercoagulable
C. Normal coagulation
D. Decreased platelet function
B. Hypercoagulable
## Footnote
slide 44
105
In severe disease preeclampsia you will have a _______ state and plt _______
A. Hypocoagulable; degranulation
B. Hypercoagulable; degranulation
C. Hypocoagulable; increase
D. Hypercoagulable; plt aggregation
A. Hypocoagulable; degranulation
Plt activation-->plt degranulation-->decreased plt function
Plt aggregation--> decreased plt count
Slide 44
106
Preeclampsia without severe features is in a _______
A. Hypercoagulable
B. Normal coagulation
C. Hypercoagulable
D. Decreased platelet function
C. hypercoagulable
Slide 44
107
DIC from preeclampsia is typically present in all the following except
A. Severe liver involvement
B. IUFD
C. Placenta abruption
D. Post partum hemorrhage
E. Placenta accreta
E. Placenta accreta
## Footnote
slide 45
108
Which of the following best describes the hematologic manifestations of Disseminated Intravascular Coagulation (DIC) in preeclampsia ?
A. Elevated platelet count, decreased fibrin degradation products, and improved organ perfusion
B. Consumption of procoagulants, increased fibrin degradation products, and microthrombi causing end-organ damage
C. Isolated thrombocytopenia without clotting factor involvement
D. Reduced fibrinolytic activity and decreased D-dimer levels
B. Consumption of procoagulants, increased fibrin degradation products, and microthrombi causing end-organ damage
slide 46
109
Which of the following best describes advanced DIC in preeclampsia? (select 2)
A. Procoagulants decrease
B. Procoagulants increase
C. Spontaneous hemorrhage risk
D. Reduced fibrinolytic activity
A. Procoagulants decrease
C. Spontaneous hemorrhage risk
## Footnote
slide 47
110
Hepatic clinical presentation of preeclampsia will include all the following except
A. Periportal hemorrhage
B. Fibrin deposition in hepatic sinusoids
C. RLQ pain
D. Epigastric pain
E. spontaneous hepatic rupture
C. RLQ pain
It is RUQ pain ;
slide 48
111
Renal preeclampsia presentation has a defining characteristic of
A. oliguria
B. decrease in creatinine levels
C. dysuria
D. persistent proteinuria
D. persistent proteinuria
slide 49
112
Persistent proteinuria is due to impaired ________ reabsorption of protein and glomerular filter change in pore size or charge selectivity
A. proximal tubular
B. distal convoluted tubule
C. loop of Henle
D. descending loop
A. proximal tubular
slide 49
113
How does the GFR in preeclampsia differ from the GFR in normal pregnancy?
A. Large increase
B. Decrease
C. Small increase
D. Significant decrease
C. small increase
slide 50
114
How does BUN and creatinine appear in preeclampsia
A. Increased
B. Normal
C. Decreased
D. Significantly increased
B. normal range
slide 50
115
Renal clinical presentation of preeclampsia includes (select 2)
A. Oliguria
B. Polyuria
C. Hypouricemia
D. Hyperuricemia
A. oliguria
D. hyperuricemia
slide 50
116
Hyperuricemia is due to decreased renal clearance or ______ which is the primary mechanism
A. Protein
B. Creatinine
C. Uric acid
D. Sodium
C. uric acid
slide 50
117
With severe features of preeclampsia, labs should be drawn
A. Every week or every other week
B. Twice a week
C. Every day or every other day
D. Every 12 hours
C. every day or every other day
slide 51
118
True or false: hemodilution is indicative of preeclampsia and the H/H is increased with hemolysis
False- hemoconcentration is indicative or preeclampsia and the H/H is decreased with hemolysis
slide 51
119
If the platelet count in preeclampsia is _______ then no further coagulation testing is needed
A. >100,000/mm3
B. <100,000/mm3
C. >80,000/mm3
D. >80/mm3
A. >100,000mm3
## Footnote
slide 52
120
If the platelet count is less than 100,000/mm3 then what could also be possible (select 2)
A. Decreased factor III
B. Decreased fibrinogen concentration
C. Increased factor Xa
D. Prolonged PT/aPTT
B. decreased fibrinogen concentration
D. prolonged PT/aPTT
consider further coag studies
## Footnote
slide 52
121
A preeclamptic patient has now been induced for labor. She has a history of thrombocytopenia. What 3 interventions should take place (select 3)
A. Repeat plt count every 6 hours
B. Maintain active type and screen
C. Type and cross match for at least 2U PRBCs
D. Repeat labs every 4 hours
E. Have 2 units of plts upfront
A. Repeat plt count every 6 hours
B. Maintain active type and screen
C. Type and cross match for at least 2U PRBCs
slide 53
122
Why should you repeat plt count every 6 hours on a preeclamptic patient with thrombocytopenia ( select 2)
A. Detects change in fetal oxygenation
B. Detects start of DIC
C. Readily detects decreasing plt count
D. Guides timing of delivery and neuroaxial anesthetic
C. Readily detects decreasing plt count
D. Guides timing of delivery and neuroaxial anesthetic
slide 53
123
What labs should be performed on ALL preeclamptic patient
A. LFTs
B. B. thyroid function
C. 24 hour urine
D. BNP
A. LFTs
Abnormal levels indicate more severe disease
## Footnote
slide 54
124
An increase ALT indicates …
A. Mild disease with cardiac involvement
B. Severe disease with hepatic involvement
C. Mild disease with hepatic compensation
D. Severe disease with renal involvement
B. Severe disease with hepatic involvement
## Footnote
slide 54
125
A urine protein creatinine ratio and a 24 hour urine is performed on a pregnant patient with a BP of 180/100. They came back positive for proteinuria. What does this indicate
A. Pregnancy induced hypertension
B. Chronic hypertension
C. Preeclampsia
D. Normal pregnancy
C. Preeclampsia
## Footnote
slide 54
126
If you have an abnormal or rising creatinine in a pregnant patient this is indicative of___.
A. Eclampsia
B. Mild preeclampsia
C. Moderate preeclampsia
D. Severe preeclampsia
D. Severe preeclampsia
## Footnote
slide 55
127
For acute HTN management in preeclampsia, what blood pressure would indicate the need for antihypertensives
A. 159/109
B. 183/112
C. 158/109
D. 143/99
B. 183/112
| SBP>160 DBP>110
## Footnote
slide 56
128
Acute HTN management is aimed to prevent maternal sequelae including all the following except
A. Hypertensive encephalopathy
B. Cerebrovascular hemorrhage
C. Myocardial ischemia
D. Congestive heart failure
E. Restrictive lung disease
E. Restrictive lung disease
## Footnote
slide 56
129
What is the ideal decrease in BP after starting management of acute HTN for preeclampsia
A. 15-25%
B. 30-40%
C. 25-30%
D. 10-15%
A. 15-25%
rapid and drastic changes may negatively impact uteroplacental perfusion and O2 delivery
## Footnote
slide 57
130
The SBP goal during the management of acute HTN in preeclampsia is
A. 130-170
B. 110-130
C. 100-120
D. 120-160
D. 120-160
## Footnote
slide 57
131
The DBP goal during management of acute HTN in preeclampsia is
A. 70-90
B. 80-105
C. 90-110
D. 75-100
B. 80-105
## Footnote
slide 57
132
Matching
* A → 2
* B → 4
* C → 3
* D → 1
## Footnote
slide 58
133
What is the best agent for prevention of seizures
A. Ativan
B. Labetolol
C. Mag sulfate
D. Precedex
C. Mag sulfate
## Footnote
slide 59
134
Mag sulfate will decrease the risk of (select 2)
A. Developing eclampsia
B. Placental abruption
C. Maternal respiratory depression
D. C-section
A. Developing eclampsia
B. Placental abruption
## Footnote
slide 59
135
Mag sulfate will increase the risk of (select 2)
A. Developing eclampsia
B. Placental abruption
C. Maternal respiratory depression
D. C-section
C. Maternal respiratory depression
D. C-section
## Footnote
slide 59
136
Mag sulfate has many side effects including all the following except
A. Warm /flushed feeling
B. N/V
C. Headache
D. Hypertension/ dizziness
E. Muscle weakness/drowsiness
D. HTN/dizziness
will cause hypotension and dizziness along with confusion
## Footnote
slide 60
137
What are fetal effects of mag sulfate (select 2)
A. Increased fetal HR
B. Increased variability
C. Decreased HR
D. Decreased variability
C. Decreased HR
D. Decreased variability
HR remains <110
## Footnote
slide 61
138
Which of the following is not a known effect of magnesium sulfate in seizure prophylaxis?
A. Decreases cerebral edema
B. Enhances NMDA receptor activity
C. Protects the blood-brain barrier
D. Decreases peripheral vascular resistance
B. Enhances NMDA receptor activity
## Footnote
slide 62
139
Magnesium sulfate raises the seizure threshold primarily through:
A. Inhibiting sodium-potassium ATPase
B. Inhibiting serotonin reuptake
C. Increasing GABA release
D. Competitive blockade at central NMDA receptors
D. Competitive blockade at central NMDA receptors to raise the seizure threshold
## Footnote
slide 62
140
One of the protective effects of magnesium sulfate in the CNS includes:
A. Reducing oxygen consumption in neurons
B. Enhancing cerebral perfusion via increased ICP
C. Protecting the integrity of the blood-brain barrier
D. Blocking dopamine receptors in the hypothalamus
C. Protecting the integrity of the blood-brain barrier
## Footnote
slide 62
141
Magnesium sulfate helps prevent seizure activity in preeclampsia by all of the following mechanisms except:
A. Increasing free intracellular calcium levels
B. Decreasing cerebral edema
C. Decreasing peripheral vascular resistance
D. Blocking NMDA receptors centrally
A. Increasing free intracellular calcium levels
## Footnote
slide 62
142
What is the load dosing of mag sulfate for preeclampsia/eclampsia
A. 5-7g
B. 4-6g
C. 500mg
D. 2000mg
B. 4-6g
## Footnote
slide 63
143
What is the infusion rate for mg sulfate for preeclampsia/eclampsia
A. 3-4gm/hr
B. 4-6gm/hr
C. 1-2gm/hr
D. 2-3gm/hr
C. 1-2gm/hr
## Footnote
slide 63
144
What is the load dose for recurrent eclampsia
A. 1 G over 10 min
B. 500mg over 5 min
C. 5 G over 1 hour
D. 2 G over 5 min
D. 2 G over 5 min
## Footnote
slide 63
145
What is the infusion dose for mag sulfate for recurrent eclampsia
A. 1-2g/hr
B. 3-4g/hr
C. 2-3g/hr
D. 5-6g/hr
A. 1-2g/hr
## Footnote
slide 63
146
What are some of the ansethetic considerations for mag sulfate? (select 3)
A. Continue infusion in the OR during c/s
B. Increases release of acetylcholine at NMJ
C. Decreases sensitivity of NMJ acetylcholine
D. Depresses excitability of muscle fiber membrane
E. Patient will require more sucs
A. Continue infusion in the OR during c/s
C. Decreases sensitivity of NMJ acetylcholine
D. Depresses excitability of muscle fiber membrane
limits release of acetylcholine at NMJ
## Footnote
slide 64
147
Magnesium sulfate has what effect on neuromuscular blocking agents?
A. Antagonizes both depolarizing and non-depolarizing agents
B. Potentiates both depolarizing and non-depolarizing agents
C. Prevents breakdown of neuromuscular blockers
D. Has no effect on neuromuscular blocking agents
B. Potentiates both depolarizing and non-depolarizing agents
## Footnote
;slide 65
148
When administering non-depolarizing muscle relaxants to a patient on magnesium sulfate, the anesthesia provider should:
A. Use full doses and skip nerve monitoring
B. Administer a defasciculating dose to reduce muscle rigidity
C. Use decreased doses and monitor with peripheral nerve stimulation
D. Increase the dose due to competition at the receptor site
C. Use decreased doses and monitor with peripheral nerve stimulation ;
Avoid defasciculating doses of NDMR
## Footnote
slide 65
149
Magnesium sulfate affects neuraxial anesthesia by:
A. Decreasing local anesthetic potency
B. Reducing risk of hypotension
C. Eliminating the need for opioids
D. Increasing the potency of local anesthetics
D. Increasing the potency of local anesthetics
## Footnote
slide 65
150
Which of the following is a risk when neuraxial anesthesia is administered to a patient receiving magnesium sulfate?
A. Hypertension
B. Bradycardia
C. Hypotension
D. Tachyphylaxis
C. Hypotension
## Footnote
slide 65
151
What is the therapeutic range of mag sulfate for seizure prophylaxis
A. 5-9mg/dL
B. 6-7mg/dL
C. 9-10mg/dL
D. 4-6mg/dL
A. 5-9mg/dL
## Footnote
slide 66
152
How is mag sulfate eliminated
A. Hepatic
B. Renal
C. Lungs
D. Uptake into the GI tract
B. renal
## Footnote
slide 66
153
Which laboratory value suggests a risk for magnesium accumulation and toxicity?
A. Serum creatinine < 0.8 mg/dL
B. Serum sodium > 145 mEq/L
C. Serum creatinine > 1.2 mg/dL
D. Serum potassium < 3.0 mEq/L
C. Serum creatinine > 1.2 mg/dL
## Footnote
slide 66
154
3. In a patient with renal insufficiency, administration of magnesium sulfate may lead to:
A. Decreased serum levels of magnesium
B. Enhanced magnesium clearance
C. No changes in serum magnesium levels
D. High serum magnesium levels and risk of toxicity
D. High serum magnesium levels and risk of toxicity
## Footnote
slide 66
155
Hypermagnesmia side effects include all the following except
A. Chest pain and tightness
B. Palpaitations
C. Nausea
D. Blurred vision
E. Excitement
F. Transient hypotension
E. excitement
sedation
## Footnote
slide 67
156
During reflex testing on your patient on mag sulfate what level would you expect to see if their DTRs were abolished?
A. 12mg/dL
B. 15-20gm/dL
C. >25mg/dL
D. 10mg/dL
A. 12mg/dL
## Footnote
slide 68
157
During reflex testing on your patient on mag sulfate what level would you expect to see if they had respiratory depression?
A. 12mg/dL
B. 15-20gm/dL
C. >25mg/dL
D. 10mg/dL
B. 15-20gm/dL
## Footnote
slide 68
158
During reflex testing on your patient on mag sulfate what level would you expect to see if they went into cardiac arrest?
A. 12mg/dL
B. 15-20gm/dL
C. >25mg/dL
D. 10mg/dL
C. >25mg/dL
## Footnote
slkide 68
159
Treatment of mag sulfate toxicity includes (select 2)
A. Calcium gluconate 500mg over 5-10min
B. Calcium chloride 1g over 3-10 min
C. Calcium gluconate 1 g over 3-10 min
D. Calcium chloride 10% 500mg over 5-10 minutes
C. Calcium gluconate 1 g over 3-10 min
D. Calcium chloride 10% 500mg over 5-10 minutes
## Footnote
slide 69
160
What is the most common CNS feature for preeclampsia?
A. Respiratory depression
B. Reversible cerebral edema
C. CVA
D. Seizures
B. Reversible cerebral edema
## Footnote
slide 70
161
What is the leading cause of death in preeclampsia
A. Respiratory depression
B. Reversible cerebral edema
C. CVA
D. Seizures
C. CVA
; risk of intracerebral and subarachnoid hemorrhage
## Footnote
slide 70
162
Most CVA are ______ and occur______
A. Ischemia; antepartum
B. Ischemia; postpartum
C. Hemorrhagic; antepartum
D. Hemorrhagic; postpartum
D. Hemorrhagic; postpartum
## Footnote
slide 70
163
True or false: risk of ischemic stroke is due to failure to adequately control HTN
true
## Footnote
slide 70
164
Acute renal failure complication from preeclampsia is rare but the prerenal cause is caused by
A. Renal hypoperfusion
B. Obstructive uropathy
C. Intrinsic renal parenchymal damage
D. Renal hyperperfusion
A. Renal hypoperfusion
## Footnote
slide 71
165
Acute renal failure from preeclampsia intrarenal cause is
A. Renal hypoperfusion
B. Obstructive uropathy
C. Intrinsic renal parenchymal damage
D. Renal hyperperfusion
C intrinsic renal parenchyma damage
## Footnote
slide 71
166
Acute renal failure from preeclampsia post renal cause is
A. Renal hypoperfusion
B. Obstructive uropathy
C. Intrinsic renal parenchymal damage
D. Renal hyperperfusion
B. Obstructive uropathy
## Footnote
slide 71
167
Abruption from preeclampsia affects 2% of parturients with preeclampsia and the incidence is greater with______ mentioned in lecture
A. Anterior placenta
B. Multiple gestations
C. Previous c-section
D. Chronic HTN
D. chronic HTN
## Footnote
slide 72
168
With abruption caused by preeclampsia you have a risk of
A. DIC
B. Placenta previa
C. prematurity
D. HTN
A. DIC
## Footnote
slide 72
169
HELLP syndrome caused by preeclampsia include all the following (select 2)
A. Hemolysis
B. Elevated levels of liver enzymes
C. High plt count
D. HTN always
A. Hemolysis
B. Elevated levels of liver enzymes
LOW plt count, possible with or w/o HTN or proteinuria
## Footnote
slide 73
170
HELLP usually occurs_____
A. Postpartum
B. Antepartum
C. Intrapartum
D. Prematurely
B. Antepartum
normally requiring preterm delivery; some cases occur postpartum
## Footnote
slide 73
171
With HELLP syndrome you have increased risk for all the following except
A. DIC
B. Placenta abruption
C. Pulmonary edema
D. Acute renal failure
E. Liver hemorrhage/failure
F. ARDS
G. Sepsis
H. Stroke
I. Hypoglycemia
J. Death
I. hypoglycemia
## Footnote
;slide 74
172
In the presence of microangiopathic hemolytic anemia from HELLP syndrome you would except which symptoms (select 5)
A. RUQ or epigastric pain
B. N/V
C. Diarrhea
D. Headache
E. Hypertension
F. Proteinuria
G. Weakness
A. RUQ or epigastric pain
B. N/V
D. Headache
E. Hypertension
F. Proteinuria
## Footnote
slide 75
173
During HELLP syndrome you will see a bilirubin level of
A. >3.5 mg/dl
B. >1.2mg/dL
C. <0.8mg/dL
D. <4mg/dL
B. >1.2mg/dL
## Footnote
slide 76
174
Liver enzymes for help syndrome will be (select 2)
A. AST>/= 90
B. LDH > 900 IU/L
C. AST >/=70 IU/L
D. LDH>600IUL
C. AST >/=70 IU/L
D. LDH>600IUL
## Footnote
slide 76
175
HELLP syndrome thrombocytopenia plt count will be
A. <100,000/mm3
B. <80,000/mm3
C. <150,000/mm3
D. <120,000mm3
A. <100,000/mm3
## Footnote
slide 77
176
In the setting of HELLP syndrome, when should a platelet count be reassessed before neuraxial anesthesia?
A. Only during labor onset
B. At the time of hospital admission
C. Immediately before neuraxial anesthetic placement
D. 24 hours after corticosteroid administration
C. Immediately before neuraxial anesthetic placement
## Footnote
slide 77
177
Platelet levels typically reach their lowest point (nadir) in HELLP syndrome:
A. At time of diagnosis
B. 2–3 days postpartum
C. During the second trimester
D. 1 week after delivery
B. 2–3 days postpartum
## Footnote
slide 77
178
What is the preferred anesthetic approach for cesarean delivery if the platelet count is < 50,000/mm³?
A. Spinal anesthesia
B. Epidural anesthesia
C. Combined spinal-epidural
D. General endotracheal anesthesia (GETA)
D. General endotracheal anesthesia (GETA)
## Footnote
slide 77
179
Which of the following may help improve platelet count in patients with HELLP syndrome?
A. Magnesium sulfate
B. Dexamethasone
C. Oxytocin
D. Hydralazine
B. Dexamethasone
## Footnote
slide 77
180
In HELLP syndrome, platelet transfusion is indicated if the platelet count is:
A. < 70,000/mm³ for vaginal delivery
B. < 40,000/mm³ with cesarean section planned
C. < 60,000/mm³ for epidural placement
D. < 50,000/mm³ in all cases
B. < 40,000/mm³ with cesarean section planned
## Footnote
slide 78
181
2. What is the critical threshold platelet count below which transfusion is generally recommended regardless of delivery method?
A. 50,000/mm³
B. 40,000/mm³
C. 30,000/mm³
D. 20,000/mm³
D. 20,000/mm³
## Footnote
slide 78
182
Which of the following interventions is essential in preparing a HELLP patient with severe thrombocytopenia for potential hemorrhage? (select 2)
A. Foley catheter placement
B. Nasal cannula oxygen
C. Type & crossmatch for 2 units PRBCs
D. Large bore IV access
C. Type & crossmatch for 2 units PRBCs / D. Large bore IV access
## Footnote
slide 78
183
A HELLP patient with a low platelet count and planned cesarean section is at increased risk for:
A. Postpartum hemorrhage
B. Spinal cord injury
C. Eclampsia
D. Preeclampsia
A. Postpartum hemorrhage
## Footnote
slide 78
184
Management in HELLP syndrome includes (select 3)
A. Bed rest until term
B. Delivery
C. Mag sulfate
D. Antihypertensives
B. Delivery
C. Mag sulfate
D. Antihypertensives
## Footnote
slide 79
185
If possible in HELLP syndrome you should try and delay delivery for ______ for _______ administration
A. 24-48 hours; corticosteroid administration
B. 48 hours; surfactant
C. 24 hours; PRBC
D. 12 hours; plt
A. 24-48 hours; corticosteroid administration
improve lung maturity
## Footnote
slide 79
186
True or false Anesthetic management for a parturient without severe features of preeclampsia management is similar to healthy parturient
true
## Footnote
slide 80
187
Airway considerations for preeclampsia includes (select 3)
A. Risk of obstruction
B. Difficulty to DL
C. Normal airway
D. Video laryngoscope
A. Risk of obstruction
B. Difficulty to DL
D. Video laryngoscope
## Footnote
slide 80
188
Which of the following is a common indication for arterial line placement in a preeclamptic patient undergoing general anesthesia?
A. Continuous glucose monitoring
B. Monitoring maternal oxygen consumption
C. Continuous blood pressure monitoring during induction and emergence
D. Invasive temperature monitoring
C. Continuous blood pressure monitoring during induction and emergence
## Footnote
slide 81
189
In the presence of pulmonary edema in a preeclamptic patient, arterial line placement helps assess:
A. Pulmonary vascular resistance
B. Arterial oxygenation via ABG
C. Left ventricular ejection fraction
D. Central venous pressure
B. Arterial oxygenation via ABG
## Footnote
slide 81
190
What is one of the anesthetic planning reasons for placing an arterial line in severe preeclampsia?
A. To allow safe administration of rapid-acting vasodilators
B. To facilitate slow induction of labor
C. To titrate long-acting beta-blockers
D. To monitor central venous pressure continuously
A. To allow safe administration of rapid-acting vasodilators
## Footnote
slide 81
191
Arterial line placement in the context of preeclampsia is useful for:
A. Administering hypertonic solutions
B. Measuring maternal CO₂ production
C. Monitoring fetal scalp pH
D. Estimating intravascular volume status
D. Estimating intravascular volume status
## Footnote
slide 81
192
Which of the following is an appropriate indication for placement of a central venous or pulmonary artery catheter in a preeclamptic patient?
A. Anticipated need for epidural anesthesia
B. Isolated mild hypertension
C. Multiple organ failure
D. Gestational diabetes
C. Multiple organ failure
## Footnote
slide 82
193
Central venous or pulmonary artery catheterization is most appropriate in preeclampsia when the patient has:
A. Chronic anemia
B. Valvular heart disease
C. Mild thrombocytopenia
D. Controlled asthma
B. Valvular heart disease;
## Footnote
slide 82
194
In the presence of critical cardiovascular instability in preeclampsia, which of the following should be considered?
A. Delay delivery to establish central monitoring
B. Proceed immediately with induction
C. Delay neuraxial anesthesia
D. Administer magnesium sulfate bolus
A. Delay delivery to establish central monitoring
## Footnote
slide 82
195
The primary anesthetic benefit of central hemodynamic monitoring in preeclampsia is:
A. Pain management
B. Blood glucose control
C. Guidance for fluid and vasopressor therapy
D. Faster delivery planning
C. Guidance for fluid and vasopressor therapy
## Footnote
slide 82
196
For anesthetic management of preeclampsia a POC transthoracic echocardiogram with passive leg raise and clinical exam wis valuable assessment of
A. Coronary congestion
B. EF
C. Left ventricular function
D. Fluid status and responsiveness
D. Fluid status and responsiveness
## Footnote
slide 83
197
Neuraxial anesthesia provides which of the following benefits in preeclampsia management? (Select 2)
A. Reduction in hypertensive episodes
B. Avoidance of airway management
C. Increased risk of difficult intubation
D. Increased systemic vascular resistance
A. Reduction in hypertensive episodes
B. Avoidance of airway management
## Footnote
Slide 84
198
In a preeclamptic patient with severe features, which laboratory value is essential to assess before initiating neuraxial anesthesia?
A. Hemoglobin
B. Platelet count
C. Sodium
D. Creatinine
B. Platelet count
*Consider trending platelet count*
## Footnote
Slide 86
199
Which anesthetic technique is preferred for managing labor analgesia in patients with preeclampsia?
A. General anesthesia
B. Peripheral nerve block
C. CLE & CSE
D. Local infiltration
C. CLE & CSE
## Footnote
Slide 84
200
Which of the following is NOT a benefit of CLE or CSE for labor analgesia in preeclamptic patients?
A. Lessens hypertensive response to pain
B. Decreases circulating catecholamines and stress-related hormones
C. Converts labor analgesia to surgical anesthesia when needed
D. Increases systemic vascular resistance
E. Potential improvement in intervillous blood flow
D. Increases systemic vascular resistance
## Footnote
Slide 84
201
When is labor analgesia/neuraxial anesthesia ideally initiated in a patient with preeclampsia?
A. After full cervical dilation
B. Only if cesarean is planned
C. As early as possible
D. When blood pressure stabilizes
C. As early as possible
## Footnote
Slide 85
202
Which of the following must be considered when planning neuraxial anesthesia in a patient with preeclampsia? (Select 4)
A. Coagulation status
B. Pre-procedure IV hydration
C. Risk of hypertension following injection
D. Management of resultant hypotension
E. Use of epinephrine-containing local anesthetics
A. **Coagulation** status
B. Pre-procedure **IV hydration**
D. Management of resultant **hypotension**
E. Use of **epinephrine-containing local anesthetics**
## Footnote
Slide 85
203
# Matching Question
A → 2 **> 80,000/mm3 – no concerns**
B → 3 **50,000-80,000/mm3 – weigh benefits/risks/alternatives**
C → 1 **< 50,000/mm3 – no neuraxial**
## Footnote
Slide 86
204
In preeclamptic patients, what is the minimum platelet count range generally considered acceptable for epidural catheter removal?
A. 50,000–59,999/mm³
B. 60,000–74,999/mm³
C. 75,000–80,000/mm³
D. >100,000/mm³
C. 75,000–80,000/mm³
## Footnote
Slide 87
205
__ before neuraxial placement is recommended to reduce the risk of hypotension associated with sympathetic blockade.
A. Antiemetic administration
B. Oxygen supplementation
C. IV hydration
D. Vasopressor infusion
C. IV hydration
## Footnote
Slide 87
206
Which of the following are appropriate considerations regarding IV hydration before neuraxial placement in preeclamptic patients? (Select 3)
A. Always prevents hypotension regardless of patient condition
B. Should be avoided in all cases to prevent fluid overload
C. Requires caution due to the risk of pulmonary edema
D. Consider preload in patients with narrow pulse pressure
E. Use of vasopressors is preferred to manage hypotension
C. Requires caution due to the risk of pulmonary edema
D. Consider preload in patients with narrow pulse pressure
E. Use of vasopressors is preferred to manage hypotension
## Footnote
Slide 87
207
In the management of hypotension in preeclamptic patients, one important consideration is their __ to vasopressors.
A. Resistance
B. Increased sensitivity
C. Tachyphylaxis
D. Delayed response
B. Increased sensitivity
## Footnote
Slide 88
208
To manage hypotension in preeclamptic patients, appropriate vasopressor dosing includes phenylephrine ___ and ephedrine ___.
A. 100–200 mcg ; 1–2 mg
B. 25–50 mcg ; 5–10 mg
C. 2–4 mg ; 25–50 mcg
D. 0.5–1 mg ; 15–30 mg
B. 25–50 mcg ; 5–10 mg
**Phenylephrine 25-50 mcg**
**Ephedrine 5-10 mg**
## Footnote
Slide 88
209
In a preeclamptic parturient who has received labetalol, why might a standard epinephrine test dose be unreliable?
A. It causes exaggerated hypertension
B. It may induce uterine contractions
C. The tachycardic response may be blunted
D. It increases the risk of fetal bradycardia
C. The tachycardic response may be blunted
## Footnote
Slide 89
210
In preeclamptic patients with a history of labetalol use, an ___ test dose may be necessary due to potential blunting of the tachycardic response.
A. Standard
B. Alternative
C. Ephedrine-based
D. Lidocaine-only
B. Alternative
## Footnote
Slide 89
211
Due to increased sensitivity to vasopressors, use of epinephrine intravascular injection test doses should be __ in patients with *severe features* of preeclampsia.
A. Avoided
B. Doubled
C. Encouraged
D. Delayed
A. Avoided
## Footnote
Slide 89
212
What is the current preferred anesthetic technique for cesarean delivery in patients with preeclampsia?
A. General anesthesia
B. Local infiltration
C. Neuraxial anesthesia
D. Total intravenous anesthesia
C. Neuraxial anesthesia (spinal or epidural)
*Formerly – spinal was discouraged*
## Footnote
Slide 90
213
Preload and coload with IV fluids are often ___ in preventing hypotension following neuraxial anesthesia in preeclamptic patients.
A. Effective
B. Contraindicated
C. Potentially ineffective
D. Curative
C. Potentially ineffective
## Footnote
Slide 90
214
In the management of Neuraxial anesthesia hypotension during cesarean delivery in a preeclamptic patient, which of the following is preferred?
A. Coloading with 1 L of crystalloids
B. Elevating the legs
C. Use of vasopressors
D. Administering magnesium sulfate
C. Use of vasopressors
## Footnote
Slide 90
215
What is a primary airway-related concern when using general anesthesia in a preeclamptic parturient?
A. Hyperventilation
B. Airway obstruction due to fetal compression
C. Potential difficulty with airway management
D. Risk of hypokalemia during intubation
C. Potential difficulty with airway management
## Footnote
Slide 91
216
Which of the following is a hemodynamic risk during tracheal intubation and extubation in patients with preeclampsia?
A. Severe hypotension
B. Severe hypertension
C. Bradycardia
D. Vasodilation
B. Severe hypertension
*Risk of cerebral hemorrhage & pulmonary edema*
## Footnote
Slide 91
217
In preeclamptic patients, magnesium sulfate can affect ___, which is important to consider when administering neuromuscular blocking agents.
A. Cerebral perfusion
B. Neuromuscular transmission
C. Myocardial contractility
D. Renal clearance
B. Neuromuscular transmission
## Footnote
Slide 91
218
What is the target blood pressure before induction of general anesthesia in a patient with preeclampsia?
A. 120/80 mmHg
B. 160/110 mmHg
C. 140/90 mmHg
D. 100/60 mmHg
C. 140/90 mmHg
*GETA – blood pressure management goals*
## Footnote
Slide 92
219
During laryngoscopy and intubation in a preeclamptic patient, the recommended blood pressure targets are SBP ____ mmHg and DBP ___ mmHg.
A. SBP 160–180; DBP 100–110
B. SBP 120–140; DBP 80–90
C. SBP 140–160; DBP 90–100
D. SBP 110–130; DBP 70–85
C. SBP 140–160; DBP 90–100
## Footnote
Slide 92
220
What is the recommended dose of Labetalol or Esmolol for managing hypertension during GETA in a preeclamptic patient?
A. 0.5 mg/kg
B. 2 mg/kg
C. 10 mg/kg
D. 5 mcg/kg
B. 2 mg/kg
## Footnote
Slide 93
221
For attenuating hypertensive response during GETA in a preeclamptic patient, Remifentanil is administered at a dose of ___.
A. 0.5 mg/kg
B. 1 mcg/kg
C. 0.5 mcg/kg
D. 2 mcg/kg
C. 0.5 mcg/kg
## Footnote
Slide 93
222
Magnesium sulfate is typically administered at a dose of ___ after induction in cesarean deliveries for preeclamptic patients.
A. 10–15 mg/kg
B. 20–25 mg/kg
C. 30–40 mg/kg
D. 50–60 mg/kg
C. 30–40 mg/kg
## Footnote
Slide 93
223
Which of the following are appropriate anesthetic management strategies in the postpartum period for a patient with preeclampsia?
A. Use high-dose IV opioids as the sole analgesic approach
B. Avoid regional techniques due to risk of hypertension
C. Utilize multimodal analgesia, including neuraxial opioids
D. Delay pain management until blood pressure stabilizes
C. Utilize multimodal analgesia, including neuraxial opioids
## Footnote
Slide 94
224
If hypertension persists for more than 24 hours postpartum in a preeclamptic patient, what pharmacologic consideration should be made?
A. Increase opioid dosing
B. Switch to general anesthesia
C. Discontinue NSAIDs
D. Begin diuretic therapy immediately
C. Discontinue NSAIDs
*Potential contribution to HTN*
## Footnote
Slide 94
225
When does preeclampsia typically resolve after delivery?
A. Within 24 hours
B. Within 2 days
C. Within 5 days
D. After 2 weeks
C. Within 5 days
## Footnote
Slide 95
226
What physiological change commonly occurs after delivery in a patient recovering from preeclampsia?
A. Severe hypovolemia
B. Marked diuresis
C. Increased pulmonary resistance
D. Decreased renal perfusion
**B. Marked diuresis**
* Mobilization of extracellular fluid
* Increased intravascular volume
## Footnote
Slide 95
227
What is a significant postpartum concern in patients with severe features of preeclampsia due to fluid shifts and increased intravascular volume?
A. Risk of pulmonary embolism
B. Risk of pulmonary edema greatest
C. Risk of urinary retention
D. Risk of uterine atony
B. Risk of pulmonary edema greatest
*Noted with severe features*
## Footnote
Slide 95
228
When is the risk of cerebrovascular accident (CVA) highest in preeclamptic patients?
A. During the second trimester
B. Intrapartum
C. Postpartum
D. During induction of labor
**C. Postpartum**
*Potentially longer duration of HTN in women with severe features*
## Footnote
Slide 96
229
Antihypertensive therapy is indicated postpartum in preeclamptic patients when:
A. SBP is < 140 mmHg and DBP < 90 mmHg
B. SBP > 150 mmHg or DBP > 100 mmHg
C. HR > 100 bpm
D. Magnesium sulfate has been discontinued
B. SBP > 150 mmHg or DBP > 100 mmHg
## Footnote
Slide 96
230
Magnesium sulfate is typically continued for ___ postpartum in patients with severe preeclampsia.
A. 6 hours
B. 12 hours
C. 24 hours
D. 48 hours
C. 24 hours
## Footnote
Slide 96
231
Eclampsia is defined as:
A. Seizures in any pregnant patient
B. Seizures or unexplained coma in the presence of signs/symptoms of preeclampsia
C. Seizures with known epilepsy in pregnancy
D. Seizures occurring prior to 20 weeks gestation
***NEW ONSET***
B. Seizures or unexplained coma in the presence of signs/symptoms of preeclampsia
## Footnote
Slide 97
232
When is the most common onset of eclampsia?
A. First trimester
B. During intrapartum or within 48 hours postpartum
C. After 4 weeks postpartum
D. Before 20 weeks gestation
B. During intrapartum or within 48 hours postpartum
## Footnote
Slide 97
233
Late eclampsia is defined as seizure onset occurring ___ postpartum.
A. Within 24 hours
B. Between 48 hours and 4 weeks
C. After 6 weeks
D. Any time before delivery
B. Between 48 hours and 4 weeks
## Footnote
Slide 97
234
Which of the following is NOT a recognized maternal complication of eclampsia?
A. Aspiration
B. Pulmonary edema
C. Postpartum hemorrhage
D. Acute renal failure
E. Venous thromboembolism (VTE)
F. Cerebrovascular accident (CVA)
G. Death
C. Postpartum hemorrhage
## Footnote
Slide 98
235
Which of the following are fetal complications associated with eclampsia? (Select 3)
A. Placental abruption
B. Severe IUGR
C. VTE
D. Extreme prematurity
E. Maternal aspiration
A. Placental abruption
B. Severe IUGR
D. Extreme prematurity
## Footnote
Slide 98
236
Which of the following symptoms are the most common premonitory neurologic signs of eclampsia?
A. Photophobia and nausea
B. RUQ pain and bradycardia
C. Headache and visual disturbances
D. Flank pain and tremor
C. Headache and visual disturbances
## Footnote
Slide 99
237
Which of the following best describes the proposed pathophysiologic mechanism of eclampsia?
A. Cerebral hemorrhage from hypoperfusion
B. Increased cerebrospinal fluid production
C. Loss of normal cerebral autoregulatory mechanism
D. Dehydration leading to syncope
C. Loss of normal cerebral autoregulatory mechanism
## Footnote
Slide 101
238
Which of the following is NOT a typical clinical feature associated with the premonitory phase of eclampsia?
A. Photophobia
B. RUQ or epigastric pain
C. Hyperreflexia
D. Bradycardia
E. Altered mental status
D. Bradycardia
## Footnote
Slide 99
239
Place the following events in the correct sequence for a typical eclamptic seizure presentation:
A. Clonic phase with apnea (~1 minute)
B. Facial twitching → tonic phase (15–20 seconds)
C. Postictal state
D. Abrupt onset of seizure
Correct order:
D → B → A → C
1. D. Abrupt onset of seizure
2. B. Facial twitching and tonic phase x 15 – 20 seconds
3. A. Clonic phase with apnea ~ 1 minute
4. C. Postictal state concludes the seizure episode.
## Footnote
Slide 100
240
# True or False
All eclamptic seizures are witnessed and follow a typical presentation.
FALSE
**Atypical presentation possible
with no witnessed seizures but *parturient lapses into coma***
## Footnote
Slide 100
241
Fetal bradycardia during or after a maternal eclamptic seizure:
A. Always requires immediate cesarean delivery
B. Is typically due to uterine rupture
C. Often resolves without intervention unless prolonged
D. Indicates fetal demise
C. Often resolves without intervention unless prolonged
## Footnote
Slide 102
242
In eclampsia, ___ leads to interstitial or vasogenic cerebral edema, contributing to decreased cerebral blood flow.
A. Cerebral hemorrhage
B. Hyperperfusion
C. Hyponatremia
D. Vasoconstriction
B. Hyperperfusion
## Footnote
Slide 101
243
# True or False
Eclampsia is believed to be a possible manifestation of Posterior Reversible Encephalopathy Syndrome (PRES).
True
## Footnote
Slide 101
244
In the management of an eclamptic seizure, the first priority is to ____.
A. Deliver the fetus
B. Start oxytocin
C. Stop the seizure
D. Administer antibiotics
## Footnote
Slide 102
245
During eclamptic seizure management, efforts to prevent complications include *maintaining a patent airway* and preventing ___ and ___.
A. Bradycardia; fever
B. Hypoxemia; aspiration
C. Hypertension; hypotension
D. Hyperglycemia; seizures
B. Hypoxemia; aspiration
## Footnote
Slide 102
246
What is the first-line medication for preventing further seizures in eclampsia?
A. Diazepam
B. Midazolam
C. Magnesium sulfate
D. Lorazepam
**C. Magnesium sulfate**
*bolus & infusion to prevent more seizures*
## Footnote
Slide 103
247
If seizures recur despite magnesium therapy, ___ or ___ may be used to raise the seizure threshold.
A. Ketamine; propofol
B. Diazepam; midazolam
C. Dexmedetomidine; fentanyl
D. Labetalol; esmolol
B. Diazepam; midazolam
## Footnote
Slide 103
248
Which of the following is a critical concern during the management of recurrent seizures in eclampsia?
A. Hypernatremia
B. Increased intracranial pressure
C. Pulmonary embolism
D. Metabolic alkalosis
B. Increased intracranial pressure
## Footnote
Slide 103
249
When is increased intracranial pressure (ICP) a major concern in a patient with eclampsia?
A. If patient is alert and communicating
B. Only after delivery
C. If patient is comatose and exhibiting posturing
D. ICP is never a concern in eclampsia
C. If patient is comatose and exhibiting posturing
*No concern if patient alert / communicating*
## Footnote
Slide 104
250
In patients with eclampsia, fluid administration should be ___ to decrease the risk of exacerbating cerebral edema.
A. Aggressive
B. Restricted
C. Unchanged
D. Doubled
B. Restricted
## Footnote
Slide 104
251
Which of the following blood pressure targets is appropriate for anesthetic management in a patient with eclampsia?
A. SBP < 180 mmHg, DBP < 120 mmHg
B. SBP < 160 mmHg, DBP < 110 mmHg
C. SBP < 140 mmHg, DBP < 90 mmHg
D. SBP < 150 mmHg, DBP < 100 mmHg
B. SBP < 160 mmHg, DBP < 110 mmHg
## Footnote
Slide 105
252
In a patient with eclampsia, which of the following lab tests should be ordered even if the platelet count is normal?
A. Type and screen
B. Liver function tests
C. Coagulation studies
D. Arterial blood gas
C. Coagulation studies
## Footnote
Slide 105
253
# True or False
Neuraxial anesthesia is always contraindicated in patients with a history of eclamptic seizures.
FALSE
Neuraxial techniques may be acceptable if the patient is conscious and has not had recent seizures.
## Footnote
Slide 106
254
Ongoing seizures in patients with eclampsia can lead to increased:
A. Cardiac output
B. Cerebral oxygen consumption
C. Intracranial pressure
D. Pulmonary compliance
C. Intracranial pressure
## Footnote
Slide 106
255
Propofol is the preferred anesthetic agent during general anesthesia for eclampsia due to which of the following reasons?
A. It increases uterine tone and systemic vascular resistance
B. It decreases cerebral metabolic rate and cerebral blood flow
C. It prolongs neuromuscular blockade independently
D. It enhances sympathetic tone and increases intracranial pressure
B. It decreases cerebral metabolic rate and cerebral blood flow
*decrease CBV & intracranial pressure*
## Footnote
Slide 106
256
Which of the following statements best explains why *hyperventilation* is not recommended in the anesthetic management of eclampsia?
A. It increases cerebral blood flow and CMRO₂
B. It causes respiratory alkalosis, worsening seizure risk
C. It decreases cerebral blood flow without reducing CMRO₂
D. It increases seizure threshold and blood pressure
C. It decreases cerebral blood flow without reducing CMRO₂
## Footnote
Slide 107
257
Place the following steps of the coagulation system activation in the correct sequence as seen in amniotic fluid embolism:
A. Release of thromboxane & serotonin
B. Fetal squamous cells have high tissue factor
C. Irreversible aggregation of platelets and platelet degranulation
D. Activation of the coagulation system related to platelet activation
D → B → C → A
D. Activation of the coagulation system related to platelet activation
B. Fetal squamous cells have high tissue factor
C. Irreversible aggregation of platelets and platelet degranulation
A. Release of thromboxane & serotonin
## Footnote
Slide 109
258
What is a potential risk of *hypoventilation* in patients with eclampsia?
A. Decreased cardiac output
B. Hyperthermia
C. Lowered seizure threshold
D. Increased CMRO₂
C. Lowered seizure threshold
## Footnote
Slide 107
259
Which of the following is NOT recommended for minimizing neurologic injury in a patient with eclampsia?
A. Maintain cerebral perfusion pressure
B. Avoid hypoxemia
C. Induce mild hyperthermia
D. Avoid hyperthermia
E. Avoid hyperglycemia
C. Induce mild hyperthermia
## Footnote
Slide 107
260
Which of the following terms is now considered a more accurate description of amniotic fluid embolism?
A. Pulmonary thrombosis of pregnancy
B. Mechanical obstruction syndrome
C. Anaphylactoid syndrome of pregnancy
D. Amniotic particulate syndrome
**C. Anaphylactoid syndrome of pregnancy**
*Past mindset: Amniotic fluid created mechanical blockade in pulmonary circulation – determined to be unlikely*
## Footnote
Slide 108
261
The systemic inflammatory response in amniotic fluid embolism (AFE) is believed to be triggered by the release of which of the following?
A. Fetal hemoglobin
B. Surfactant proteins
C. Endogenous proinflammatory mediators
D. Maternal catecholamines
**C. Endogenous proinflammatory mediators**
*Arachidonic acid metabolites*
## Footnote
Slide 108
262
Complement activation in amniotic fluid embolism is believed to contribute to which of the following physiological responses?
A. Coagulation suppression
B. Bronchodilation
C. Inflammatory cascade
D. Parasympathetic activation
C. Inflammatory cascade
## Footnote
Slide 109
263
Which of the following best describes the initial hemodynamic effect of proinflammatory mediators during an amniotic fluid embolism (AFE)?
A. Prolonged bradycardia and hypotension
B. Transient period of pulmonary and systemic hypertension
C. Immediate left ventricular failure
D. Persistent decrease in pulmonary vascular resistance
B. Transient period of pulmonary and systemic hypertension
## Footnote
Slide 110
264
What cardiovascular changes are associated with Phase 1 of amniotic fluid embolism?
A. Bradycardia and hypothermia
B. Acute pulmonary hypertension and right ventricular failure
C. Left ventricular hypertrophy and tachycardia
D. Decreased systemic vascular resistance and hyperoxia
B. Acute pulmonary hypertension and right ventricular failure
## Footnote
Slide 110
265
What is the effect of intraventricular septal deviation during AFE?
A. Improved left ventricular filling
B. Pulmonary edema
C. Decreased cardiac output and V/Q mismatch
D. Increased systemic perfusion
C. Decreased cardiac output and V/Q mismatch
*leads to O2 desaturation*
## Footnote
Slide 110
266
What physiologic effects are most likely to result from the release of endogenous catecholamines during an amniotic fluid embolism?
A. Bradycardia and uterine atony
B. Hypotension and respiratory alkalosis
C. Brief systemic hypertension and uterine tachysystole
D. Decreased systemic vascular resistance and uterine relaxation
C. Brief systemic hypertension and uterine tachysystole
## Footnote
Slide 110
267
Phase II of an amniotic fluid embolism typically occurs:
A. Immediately after delivery
B. 5–10 minutes after the event
C. 15–30 minutes after the initial event
D. Several hours postpartum
C. 15–30 minutes after the initial event
## Footnote
Slide 111
268
# True or False
In Phase II of AFE, right ventricular function continues to worsen, leading to biventricular failure.
FALSE
***RV function improves**, but LV failure predominates.*
## Footnote
Slide 111
269
Related to ischemic injury or direct myocardial depression, which of the following is NOT a condition associated with Phase II of amniotic fluid embolism?
A. Decreased systemic vascular resistance (SVR)
B. Decreased left ventricular stroke index
C. Pulmonary edema
D. Cardiac arrest
E. Increased cardiac output
E. Increased cardiac output
## Footnote
Slide 111
270
What coagulation pathway is activated when tissue factor binds to Factor VII during amniotic fluid embolism?
A. Intrinsic pathway
B. Common pathway
C. Extrinsic pathway
D. Fibrinolytic pathway
C. Extrinsic pathway
## Footnote
Slide 112
271
Which clotting factor is directly activated by tissue factor to trigger clotting in AFE Phase III?
A. Factor II
B. Factor X
C. Factor VIII
D. Factor XII
B. Factor X
*Triggers clotting by activating factor X → consumptive coagulopathy develops*
## Footnote
Slide 112
272
Place the following steps of Phase III AFE in the correct chronological order
A. Platelet factor III is released.
B. Tissue factor binds factor VII.
C. Activation of factor X and the consumptive coagulopathy develops
D. Clotting cascade activated
.
B → C → A → D
1. Tissue factor binds **factor VII** → activates extrinsic pathway
2. Activation of **factor X** and the consumptive coagulopathy develops
3. A. Platelet **factor III** is released.
*Thromboplastin like-effect platelet aggregation
4.Clotting cascade activated
## Footnote
Slide 112
273
Which of the following laboratory findings are commonly associated with DIC in the setting of amniotic fluid embolism? (Select all that apply)
A. Anemia
B. Thrombocytopenia
C. Prolonged PT
D. Prolonged PTT
E. Decreased fibrinogen levels
F. Elevated fibrin split products
All of the above
## Footnote
Slide 113
274
What factors contribute to further right ventricular (RV) failure during Phase I of amniotic fluid embolism?
A. Hyperglycemia and hypotension
B. Hypoxia, hypercapnia, and acidosis
C. Hyperkalemia and bradycardia
D. Hypothermia and respiratory alkalosis
B. Hypoxia, hypercapnia, and acidosis
*causes increased pulmonary vascular resistance*
## Footnote
Slide 114
275
Which of the following medications may be considered to improve right ventricular (RV) output in patients with amniotic fluid embolism?
A. Esmolol and labetalol
B. Dobutamine and milrinone
C. Furosemide and mannitol
D. Epinephrine and nitroprusside
B. Dobutamine and milrinone
## Footnote
Slide 114
276
Which of the following therapies may be used to improve pulmonary vascular resistance in the management of AFE? (Select 3)
A. Inhaled nitric oxide
B. IV or inhalted prostacyclin
C. Oral sildenafil
D. Inhaled corticosteroids
E. Dobutamine
A. Inhaled nitric oxide
B. IV or inhalted prostacyclin
C. Oral sildenafil
## Footnote
Slide 114
277
Which of the following should be part of the anesthesia management plan for a patient experiencing an amniotic fluid embolism (AFE)?
(Select 3)
A. Administer oxytocin bolus immediately
B. Prepare for massive hemorrhage
C. Get additional help immediately
D. Activate the massive transfusion protocol
E. Delay resuscitation until fetal delivery is complete
B. Prepare for massive hemorrhage
C. Get additional help immediately
D. Activate the massive transfusion protocol
## Footnote
Slide 124
278
During Phase I management, a patient with amniotic fluid embolism experiencing hypotension, which vasopressors are recommended?
A. Ephedrine and dopamine
B. Phenylephrine and labetalol
C. Norepinephrine and vasopressin
D. Milrinone and esmolol
C. Norepinephrine and vasopressin
## Footnote
Slide 114
279
What is a key component of Phase II management in amniotic fluid embolism?
A. Administer aggressive fluid resuscitation to restore preload
B. Increase pulmonary vascular resistance with phenylephrine
C. Avoid excess fluid administration
D. Use high tidal volumes to optimize oxygenation
C. Avoid excess fluid administration
→further dilates RV
* Increase risk of MI & pulmonary edema
## Footnote
Slide 115
280
In Phase II management of amniotic fluid embolism, which of the following strategies is recommended to improve cardiac function and avoid complications?
A. Administer large fluid boluses to restore intravascular volume
B. Use beta-blockers to reduce myocardial workload
C. Administer dobutamine and milrinone to improve left ventricular contractility
D. Prioritize diuretics to manage hypotension
C. Administer dobutamine and milrinone to improve left ventricular contractility
## Footnote
Slide 115
281
Which of the following interventions is used in Phase II management of amniotic fluid embolism to maintain coronary perfusion pressure?
A. Administer corticosteroids
B. Use vasopressors
C. Perform immediate intubation
D. Initiate diuretics
B. Use vasopressors
## Footnote
Slide 115
282
Which of the following is an essential initial step in Phase III management of amniotic fluid embolism (AFE)?
A. Administration of corticosteroids
B. Immediate delivery of the fetus
C. Early assessment of clotting status
D. Use of anticoagulation therapy
C. Early assessment of clotting status
## Footnote
Slide 116
283
Which of the following are components of Phase III management in amniotic fluid embolism (AFE)? (Select 4)
A. Administer oxytocin bolus
B. Activate massive transfusion protocol
C. Maintain platelet count > 50,000/mm³ & normal aPTT/INR
D. Administer Tranexamic Acid (TXA)
E. Consider recombinant activated factor VII
F. Use beta-blockers to reduce cardiac workload
B. Activate massive transfusion protocol
C. Maintain platelet count > 50,000/mm³ & normal aPTT/INR
D. Administer Tranexamic Acid (TXA)
E. Consider recombinant activated factor VII
*Concern of excessive diffuse thrombosis & multiorgan failure*
## Footnote
Slide 116
284
Which of the following best describes the classic triad of symptoms in amniotic fluid embolism (AFE)?
A. Bradycardia, fever, and tachypnea
B. Hypoxia, hypotension, and coagulopathy
C. Chest pain, hypertension, and hematuria
D. Leukocytosis, headache, and visual disturbances
B. Hypoxia, hypotension, and coagulopathy
## Footnote
Slide 117
285
Which of the following is NOT typically associated with the early presentation of amniotic fluid embolism (AFE)?
A. Anxiety
B. Restlessness
C. Confusion
D. Euphoria
E. Sense of impending doom
D. Euphoria
## Footnote
Slide 117
286
Which of the following respiratory signs is most consistent with the onset of amniotic fluid embolism (AFE)?
A. Gradual onset of wheezing and cough
B. Mild shortness of breath after exertion
C. Sudden onset of shortness and decreased SpO₂
D. Increased nasal congestion during labor
C. Sudden onset of shortness and decreased SpO₂
*rapidly lead to respiratory arrest*
## Footnote
Slide 117
287
Which of the following cardiovascular findings is associated with amniotic fluid embolism (AFE)?
A. Stable heart rate and mild hypotension
B. Severe hypotension and cardiac dysrhythmias
C. Bradycardia with no perfusion deficits
D. Gradual development of heart failure over weeks
B. Severe hypotension and cardiac dysrhythmias
*leads to cardiac collapse & cardiac arrest*
## Footnote
Slide 117
288
Which of the following fetal heart rate patterns may be seen during an amniotic fluid embolism (AFE)? (Select 2)
A. Accelerations with normal variability
B. Decelerations or sustained bradycardia
C. Loss of variability
D. Fetal tachycardia with marked variability
B. Decelerations or sustained bradycardia
C. Loss of variability
## Footnote
Slide 118
289
Which of the following responses may result from increased maternal catecholamines during an amniotic fluid embolism (AFE)?
A. Fetal tachypnea
B. Catecholamine induced uterine hypertonus
C. Accelerations in fetal heart rate
D. Increased uterine blood flow
B. Catecholamine induced uterine hypertonus
*Continued decline in uterine perfusion*
## Footnote
Slide 118
290
Improve maternal venous return is the goal of which AFE treatment maneuver?
A. Emergent delivery of fetus
B. Cardiopulmonary bypass
C. Left uterine displacement during OB ACLS
D. Administration of oxytocin
C. Left uterine displacement during OB ACLS
## Footnote
Slide 119
291
When should emergent delivery of the fetus occur following maternal cardiovascular collapse in AFE?
A. Within 1 minute
B. Within 10 minutes
C. Within 5 minutes
D. Only after maternal stabilization
C. Within 5 minutes
*Improve maternal outcome & neonatal viability*
## Footnote
Slide 119
292
What advanced therapy may be required in severe cases of AFE with cardiovascular collapse?
A. Beta-blockers
B. Cardiopulmonary bypass / ECMO
C. Magnesium sulfate
D. Regional anesthesia
B. Cardiopulmonary bypass / ECMO
## Footnote
Slide 119
293
Which medication works by causing vagolysis, thereby decreasing pulmonary vasoconstriction and reducing the risk of bradycardia and heart block?
A. Ondansetron
B. Ketorolac
C. Atropine
D. Epinephrine
C. Atropine
*A-OK*
## Footnote
Slide 120
294
Which medication contributes to vagotomy via 5-HT3 antagonism and helps prevent cardiovascular collapse?
A. Atropine
B. Ondansetron
C. Ketorolac
D. Ephedrine
B. Ondansetron
*A-OK*
## Footnote
Slide 121
295
Which medication blocks thromboxane production, thereby decreasing inappropriate clotting cascade activation and clot formation?
A. Heparin
B. Ketorolac
C. Atropine
D. Vasopressin
B. Ketorolac
*A-OK*
## Footnote
Slide 122
