Mixed/MCQ Questions

Question 1

T/F. Regional anaesthesia is associated with less blood loss?

Answer 1

True - due to reduced arterial and venous pressures

Question 2

T/F. Epidural anaesthesia is associated with increased risk of DVT/ VTE?

Answer 2

False because:
1. Blood flow thru legs is improved due to sympathectomy-induced vasodilation.
2. Reduced perioperative hypercoagulopathy due to the surgical stress response.

Question 3

Benefits of epidural analgesia?

Answer 3

• Better pain control
  —can reduce pain from several hours to several days, depending on the technique used.
• Earlier mobilization and discharge
  —- due to improved pain management
• Decreased blood loss
  -Allows patient involvement in childbirth
• Reduced rates of VTE
  —- due to improved circulation in the legs & decreased perioperative hypercoagulopathy due to surgical stress response

Question 4

T/F. Rate of csection is higher after epidural vs systemic analgesics (IM pethidine)

Answer 4

False. No difference between the two.

Question 5

T/F. Epidural/intrathecal analgesia is associated with a shorter first and second stage of labour compared to systemic analgesia?

Answer 5

True

Question 6

T/F. Incidence of agpars <7 are higher with epidural vs systemic analgesics.

Answer 6

False. Epidural is assoc with less aggars <7.

Question 7

What are the contraindications to epidural analgesics?

Answer 7

1. Patient refusal
2. Anticoagulation/maternal coagulopathy
3. Severe Thrombocytopenia <50
4. Active maternal haemorrhage
5. Maternal septicaemia
6. Untreated febrile illness
7. Infection at or near needle insertion site
8. Allergy to local anaesthetic or opiates

Question 8

Can an epidural be started in the second stage of labour?

Answer 8

Yes

Question 9

What is a common delayed complication of epidural analgesia?

Answer 9

Postural puncture headache
— from leakage of CSF
—–Leads to decreased intracranial pressure and compensatory cerebral vasodilation.
—–‐— Causes traction on pain sensitive intracranial structures

Question 10

T/F. Immune thrombocytopenia is often assoc with APH?

Answer 10

False. Spontaneous APH in these women is uncommon.

Question 11

For a pt with immune thrombocytopenia, what platelet count is required for epidural?

Answer 11

> 80 x 10^9/L

Question 12

For a pt with immune thrombocytopenia, what platelet count is required for csection?

Answer 12

At LEAST 50 x 10^9/L

Question 13

What platelet count requires treatment, in pts with immune thrombocytopenia?

Answer 13

<20 x10^9/L

Question 14

What are the treatment options for immune thrombocytopenia?

Answer 14

1. Corticosteroids - first line
2. IV gamma globulin for refractory disease
3. Splenectomy - AVOID in pregnancy

Question 15

Which drugs carry very high risk of harming the breastfed baby?

Answer 15

Antithyroid agents
- PTU may be at a higher conc in breastmilk than maternal plasma

Question 16

What are the complications of massive blood transfusion?

Answer 16

• Hyperkalcaemia (lysis of rbcs)
• Hypocalcaemia (anticoagulants in blood products chelate calcium)
• thrombocytopenia
• coagulopathy [due to depleted clotting factors. Also anticoagulants in blood products accumulate to cause coagulopathy in MASSIVE transfusions].

Question 17

Bowel adhesions to the anterior abdominal wall are seen in what percentage of patients without prior surgery?

Answer 17

0.5%

Question 18

What is the advantage of open laparotomy?

Answer 18

Reduced vascular injury

Question 19

Risks associated with urinary bladder catheterization?

Answer 19

• UTI
• uretral pain
• difficulty voiding post removal
• delayed ambulatory
• increased hospital stay

Question 20

What is the numerical ratio for:
1. Very common
2. Common
3. Uncommon
4. Rare
5. Very rare

Answer 20

1. 1/1 to 1/10
2. 1/10 to 1/100
3. 1/100 to 1/1,000
4. 1/1,000 to 1/10,000
5. Less than 1/10,00

Question 21

What are the components of the Centor criteri foe pharyngitis

Answer 21

1.No cough
2.Tender anterior cervical lymphadenopathy
3. Fever
4. Tonsillar exudate