Obstetrics 5

Question 1

Which signs are consistent with a diagnosis of preeclampsia?
a. seizures
b. increased thromboxane
c. increased prostacyclin
d. proteinuria
e. vasoconstriction
f. impaired platelet aggregation

Answer 1

b. increased thromboxane
d. proteinuria
e. vasoconstriction

Question 2

We can classify obstetric hypertensive disorders as

Answer 2

Chronic hypertension
gestational hypertension
preeclampsia
eclampsia

Question 3

Describe chronic hypertension in the setting of obstetric hypertensive disorders.

Answer 3

occurs before 20 weeks of gestation
does not return to normal after delivery

Question 4

______ is a risk factor for developing preeclampsia

Answer 4

Chronic HTN

Question 5

Eclampsia occurs when the mother

Answer 5

with preeclampsia develops seizures

Question 6

Severe preeclampsia occurs when

Answer 6

the BP exceeds 160/110

Question 7

Gestational hypertension develops after

Answer 7

20 weeks of gestation
- proteinuria does not occur

Question 8

The only way to truly diagnose gestation HTN is

Answer 8

after delivery when a return to a normotensive state rules out chronic hypertension

Question 9

Preeclampsia includes

Answer 9

HTN that develops after 20 weeks gestation
proteinuria is typically present

Question 10

Describe mild vs. severe preeclampsia

Answer 10

mild= BP >140/90
severe= BP >160-110

Question 11

The definitive treatment for preeclampsia and eclampsia is

Answer 11

delivery of the fetus and placenta

Question 12

The presence of _____ differentiates eclampsia from prreclampsia

Answer 12

seizures

Question 13

_______ is the drug of choice for seizure prophylaxis.

Answer 13

Magnesium sulfate

Question 14

________ is the treatment for magnesium toxicity

Answer 14

Calcium chloride

Question 15

Chronic cocaine abuse is associated with

Answer 15

thrombocytopenia (check platelet count before neuraxial anesthesia

Question 16

Cocaine abuse increases the risk of

Answer 16

spontaneous abortion, premature labor, placental abruption, and low Apgar scores

Question 17

HELLP syndrome stands for

Answer 17

hemolysis, elevated liver enzymes, and low platelet count

Question 18

Don’t place a neuraxial block in a patient with a platelet count below

Answer 18

100,000 per microliter of blood

Question 19

_____________ is a reasonable option for cocaine overdose because of its

Answer 19

labetalol; mixed beta 1 and beta 2 effects

Question 20

Selectively blocking the beta-1 receptor can cause

Answer 20

heart failure if the SVR is significantly elevated
(causes myocardial depression)

Question 21

Selectively blocking the beta-2 receptor (impaired vasodilation in muscular beds) can cause

Answer 21

heart failure if the SVR is significantly elevated (it causes SVR to increase further)

Question 22

In some cases, preeclampsia can exist in the absence of proteinuria if the patient has any of these conditions:

Answer 22

persistent RUQ or epigastric pain
fetal growth restriction
thrombocytopenia
elevated serum liver enzymes
persistent CNS or visual symptoms (headache, hyperreflexia, hyperexcitability and coma)

Question 23

Preeclampsia is more common in these age groups

Answer 23

<20 years old
>35 years old

Question 24

Patients with these conditions have the highest rate of developing preeclampsia

Answer 24

chronic renal disease
homozygous for the the angiotensinogen T235 allele

Question 25

The patient with preeclampsia produces up to 7x more thromboxane than prostacyclin, increased thromboxane favors

Answer 25

vasoconstriction platelet aggregation reduced placental blood flow

Question 26

Key complications of preeclampsia include

Answer 26

heart failure pulmonary edema intracranial hemorrhage cerebral edema DIC proteinuria

Question 27

If symptoms of preeclampsia and eclampsia are mild and the fetus is young, the mother may be managed with

Answer 27

observation and bed rest

Question 28

The primary reason why we medicate beyond 160/110 for severe preeclampsia is

Answer 28

to prevent a CVA, MI, and placenta abruption

Question 29

Treatment for acute hypertension includes:

Answer 29

labetalol 20 mg IV hydralazine 5 mg IV Nifedipine 10 mg PO Nicardipine infusion

Question 30

Describe the seizure prophylaxis with magnesium sulfate.

Answer 30

load: 4 g loading dose over 10 minutes infusion: 1-2 g/hr

Question 31

For patients with preeclampsia, neuraxial anesthesia assists with

Answer 31

blood pressure control & provides better uteroplacental perfusion

Question 32

Patients with preeclampsia have an exaggerated response to

Answer 32

sympathomimetics and methergine

Question 33

The hemodynamic response to laryngoscopy for patients with preeclampsia can b blunted with

Answer 33

labetalol, esmolol, remifentanil, or magnesium

Question 34

_________ relaxes the uterus and increases the risk of postpartum hemorrhage

Answer 34

Magnesium

Question 35

Patients with HELLP are at higher risk for

Answer 35

DIC & Intra-abdominal bleeding from the liver

Question 36

The definitive treatment for HELLP syndrome is

Answer 36

delivery of the fetus; HELLP syndrome can present though for the first time in the postpartum period

Question 37

CV risks of cocaine abuse include

Answer 37

tachycardia, dysrhtymias, coronary vasoconstriction, and myocardial ischemia

Question 38

CNS risks of cocaine abuse include

Answer 38

cerebral vasoconstriction, ischemia, seizures, and stroke

Question 39

Acute cocaine intoxication and chronic cocaine intoxication affect MAC in the following ways:

Answer 39

chronic- decreases MAC acute- increases MAC

Question 40

Labetalol is a reasonable choice for cocaine overdose because it blocks _________

Answer 40

alpha-mediated peripheral vasoconstriction

Question 41

Hypotension may not respond to ______ in chronic cocaine abusers.

Answer 41

ephedrine (d/t catecholamine depletion) Neo is the best option for hypotension

Question 42

What is the antidote for magnesium toxicity?

Answer 42

10 mL of 10% calcium gluconate IV

Question 43

This is when the placenta attaches to the lower uterine segment

Answer 43

placenta previa -associated with painless vaginal bleeding

Question 44

______ occurs when there's partial or complete separation of the placenta from the uterine wall before delivery.

Answer 44

placental abruption (abruptio placentae)

Question 45

Placental abruption is associated with

Answer 45

pain and vaginal hemorrhage along with fetal hypoxia

Question 46

_______ is when the placenta attaches to the surface of the myometrium

Answer 46

placenta Accreta

Question 47

_____ is when the placenta invades the myometrium

Answer 47

placenta Increta

Question 48

______ is when the placenta extends beyond (penetrates) the uterus

Answer 48

placenta Percreta

Question 49

The placenta normally implants into the

Answer 49

decidua of the endometrium

Question 50

With abnormal placental implantation, uterine contractility is

Answer 50

impaired, and there is a potential for tremendous blood loss

Question 51

Describe the preferred anesthetic for patients with abnormal placental implantation

Answer 51

although neuraxial anesthesia is safe GA is preferred

Question 52

Abnormal placental implantation is associated with

Answer 52

placenta previa & previous C-sections

Question 53

Risk factors for placenta previa include

Answer 53

previous C-sections history of multiple births

Question 54

Placenta previa often requires

Answer 54

C-section

Question 55

Risk factors for placental abruption include

Answer 55

PIC preeclampsia chronic HTn cocaine use smoking excessive alcohol use