OB (7/10)

Question 1

an epidural test dose consists of __________ lidocaine and ___________ epi

Answer 1

1.5%; 1:200000

Question 2

if your epidural catheter is in the epidural vein, after test dose your HR would raise by _____________

Answer 2

20-40 bpm

Question 3

if your epidural catheter is in the subarachnoid space, when you administer your test dose, what would happen

Answer 3

rapid spinal block in 3-5 min

Question 4

T/F: loading doses into epidural should be given as bolus

Answer 4

false; should be incremental

Question 5

what are your options for loading dose epidural after you get a negative test dose

Answer 5

1. 0.25% bupivicaine
2. infusion solution (0.125% bupiv/2 mcg/mL fentanyl)
3. 100 mcg of fentanyl (gives fast onset while waiting on LA)
4. lidocaine 1-2%

Question 6

which is more accurate in assessing the level of a regional block - etoh swab or pin prick?

Answer 6

pin prick

Question 7

if your epidural block seems adequate except in the sacral area, how should you intervene?

Answer 7

consider large volume of local (1% lido in 15 cc)

Question 8

if your pt is having breakthrough pain with epidural, but the sensory block seems adequate ________________ of the block may be inadequate; therefore you should use a ________________ of local

Answer 8

density; more concentrated

Question 9

pt with epidural is having decreased efficacy of pain control with repeated doses of LA. how should you intervene?

Answer 9

pt is experiencing tachyphylaxis - switch to different LA

Question 10

which organ system is more susceptible to LAST ?

Answer 10

CNS

Question 11

tx for LAST

Answer 11

1. stop LA
2. maintain ABGs
3. iv infusion of 20% lipid emulsion
4. tx arrhythmias
5. Bz for seizures
6. IV fluids/vasopressors (epi preferred)
7. avoid: CCB, LA, BB, vasopressin

Question 12

progression of sx you may see with LAST

Answer 12

1. numbness of tongue (1st sxs)
2. lightheadedness
3. muscular twitch
4. loss of consciousness
5. convulsions
6. coma
7. respiratory arrest
8. CVS depression (last sx)

Question 13

________________ is the most common anesthetic used for C-section

Answer 13

spinal anesthesia

Question 14

indications for spinal anesthesia in OB

Answer 14

1. cerclage (incompetent cervix - has to be sutured to prevent early opening)
2. non-OB surgery during pregnancy
3. instrumental vaginal delivery
4. C-section
5. removal of retained placenta
6. postpartum tubal ligation or salpingectomy
7. labor analgesia

Question 15

how long does a laboring spinal typically last

Answer 15

70-120 minutes

Question 16

laboring spinal

Answer 16

1. single shot LA into SA space during labor
2. smaller doses to avoid motor block

Question 17

laboring spinal is ideal for which patient

Answer 17

spontaneous labor in multiparous pt with advanced dilation

Question 18

what are the different htn d/o that can be experienced during pregnancy

Answer 18

1. preeclampsia
2. eclampsia
3. gestational Htn
4. chronic htn

Question 19

________________ is a pt who did not have htn prior to pregnancy, but because htn during pregnancy but do not have any features of preeclampsia

Answer 19

gestational HTN

Question 20

_________________ is new onset of hypertension after 20 weeks gestation

Answer 20

preeclampsia

Question 21

preeclampsia affects _______% of pregnancies

Answer 21

4

Question 22

what is the only effective and definitive tx of preeclampsia

Answer 22

delivery of infant and placenta

Question 23

what is the leading cause of pre-term deliveries

Answer 23

preeclampsia

Question 24

______________ can present as maternal syndrome with or without fetal syndrome

Answer 24

preeclampsia

Question 25

what is the maternal syndrome experienced with preeclampsia

Answer 25

htn and proteinuria

Question 26

what are the fetal syndromes that can exist due to preeclampsia

Answer 26

1. fetal growth restriction 2. oligohydraminos 3. abnormal oxygenation

Question 27

pregnant woman > 20 wks gestation with htn + proteinuria = definitive diagnosis of __________________

Answer 27

preeclampsia

Question 28

htn without proteinuria must present with what to be diagnosed as pre-eclampsia

Answer 28

1. persistant epigastric pain or RUQ pain 2. peristent cerebral sx - HA, visual disturbances, confusion 3. fetal growth restriction 4. thrombocytopenia 5. elevated liver enzymes

Question 29

what is the leading risk factor for preeclampsia

Answer 29

nulliparity (first pregnancy)

Question 30

risk factors for preeclampsia

Answer 30

1. 1st pregnancy (nulliparity) 2. women with preeclampsia with previous pregnancy 3. women of advanced maternal age 4. maternal or paternal family hx 5. women with hx of previous placental abruption, IUGR, or fetal death 6. non-hispanic blacks

Question 31

what are some maternal comorbidities that increase the risk of preeclampsia

Answer 31

1. obesity 2. chronic HTN 3. DM 4. metabolic syndrome (obesity, hyperglycemia/insulin resistance, htn)

Question 32

for every _________ pt increase in BMI, risk of preeclampsia increases ___________ fold

Answer 32

5-7; 2

Question 33

T/F: smokers are at increased risk for preeclampsia

Answer 33

false; non smokers at higher risk

Question 34

preeclampsia is known to be a 2 stage disorder that is _________________ at the first stage and ______________ at the 2nd stage

Answer 34

asymptomatic; symptomatic

Question 35

T/F: the exact pathogenic mechanism of preeclampsia is not known

Answer 35

true - do know there is some failure of trophoblastic invasion though

Question 36

urine protein: urine Creatinine > ___________ = preeclampsia

Answer 36

0.3

Question 37

urine protein > __________ in 24 hour sample = preeclampsia

Answer 37

0.3 gm

Question 38

what defines mild preeclampsia

Answer 38

1. BP >/= 140/90 after 20 wks gestation 2. proteinuria > 0.3 gm on 24 hour urine

Question 39

what defines severe preeclampsia

Answer 39

1. BP >/= 160/110 2. proteinuria > 5 g/24 hour and at least one of the following: 3. increased serum Cr 4. pulmonary edema 5. oliguria 6. IUGR 7. HA 8. visual disturbances 9. epigastric pain or RUQ pain 10. signs of HELLP

Question 40

trophoblastic invasion of the spiral arteries causes the loss of _____________ ability of vessels to ___________ which explains the __________ resistance nature of the uteroplacental circulation

Answer 40

smooth muscle; constrict; low

Question 41

pre-eclampsia prophylaxis

Answer 41

1. ASA 2. Calcium 3. antioxidant supplements

Question 42

how does pre-eclampsia affect the airway

Answer 42

1. increased edema which could lead to obstruction 2. pulmonary edema (3%) 3. decreased tracheal size

Question 43

how does preeclampsia affect the CV system

Answer 43

1. hyperdynamic 2. BP and SVR increased 3. increased vascular tone 4. vasospasm of vessels 5. exaggerated response to catecholamines 6. edema everywhere 7. plasma volume decreased by 40% (so do not even get benefits of increased plasma volume with preg)

Question 44

how does preeclampsia affect the hepatic system

Answer 44

increased risk of liver rupture --> hemorrhage and death

Question 45

how does preeclampsia affect the kidneys

Answer 45

1. decreases GFR 2. proteinuria

Question 46

T/F: decreased UOP is an early sign of pre-eclampsia

Answer 46

false; it is a late sign

Question 47

how is the hematologic system affected by pre-eclampsia

Answer 47

1. hypocoagulable (increased bleeding risk) 2. risk of DIC

Question 48

how do you manage pre-eclampsia

Answer 48

1. fetal monitoring 2. tx of htn (typically hydralazine and/or labatelol + mg + epidural) 3. seizure prophylaxis (magnesium gtt) 4. delivery decisions 5. betamethasone

Question 49

what sx should you be assessing for when pt comes in with pre-eclampsia

Answer 49

1. HA 2. visual disturbances 3. AMS 4. SOB 5. abdominal pain 6. N/V 7. decreased UOP 8. seizures

Question 50

what is the plasma magnesium level goal for the pt with pre-eclampsia

Answer 50

5-9 (remember normal is 1.7-2.7)