Unit 11 - Across the Lifespan

Question 2

What is the impact of increased progesterone, estrogen, and relaxin on the upper airway during pregnancy?

Answer 2

Causes vascular engorgement and hyperemia

This leads to a higher risk for difficult mask ventilation, difficult laryngoscopy, and difficult intubation.

Question 3

What factors complicate airway management during pregnancy?

Answer 3

• Increased Mallampati score
• Upper airway vascular engorgement
• Narrowing of the glottic opening

Question 4

What effect does relaxin have on the ribcage during pregnancy?

Answer 4

Relaxin relaxes the ligaments, allowing the ribs to assume a more horizontal position

Question 5

How does pregnancy affect Functional Residual Capacity (FRC)?

Answer 5

FRC is reduced due to a decrease in expiratory reserve volume and RV

Question 6

What is the consequence of increased oxygen consumption paired with decreased FRC during apnea in pregnant women?

Answer 6

Hastens the onset of hypoxemia, which can lead to brain death of the mother and fetus

Question 7

What is the physiological effect of progesterone on minute ventilation during pregnancy?

Answer 7

Increases minute ventilation up to 50%

Question 8

What happens to pH during pregnancy due to renal compensation?

Answer 8

Eliminates bicarbonate to normalize pH

Question 9

What is the normal cardiac output increase during the stages of labor?

Answer 9

• 1st stage: 20%
• 2nd stage: 50%
• 3rd stage: 80%

Question 10

What changes occur in blood pressure during pregnancy?

Answer 10

MAP and SBP remain stable while DBP, SVR, and PVR decrease

Question 11

What is the most common cause of thrombocytopenia during pregnancy?

Answer 11

Gestational thrombocytopenia

Question 12

What is the effect of aortocaval compression in the supine position during pregnancy?

Answer 12

Decreases cardiac output and compromises fetal perfusion

Question 13

What is the primary dependency of uterine blood flow during pregnancy?

Answer 13

Dependent on MAP, cardiac output, and uterine vascular resistance

Question 14

What is the preferred drug for maintaining placental perfusion during pregnancy?

Answer 14

Phenylephrine

Question 15

Fill in the blank: Fetal acidosis can lead to _______ between maternal and fetal circulation.

Answer 15

ion trapping

Question 16

What are the three stages of labor?

Answer 16

• Stage 1: Beginning of regular contractions to full cervical dilation
• Stage 2: Full cervical dilation to delivery of the fetus
• Stage 3: Delivery of the placenta

Question 17

True or False: A laboring mother is always considered a full stomach.

Answer 17

True

Question 18

What is the primary pain pathway during the first stage of labor?

Answer 18

Pain signals travel to the T10-L1 posterior nerve roots

Question 19

What is the common analgesic option for second stage labor pain?

Answer 19

Neuraxial blockade and a pudendal nerve block

Question 20

What is the common side effect of neuraxial opioids?

Answer 20

Pruritus

Question 21

What is a total spinal?

Answer 21

Rapid progression of sensory and motor block due to local anesthetic in the subarachnoid space

Question 22

What is the normal fetal heart rate range?

Answer 22

110-160 bpm

Question 23

What are the types of fetal deceleration phenomena?

Answer 23

• Early: Head compression
• Late: Placental insufficiency
• Variable: Cord compression

Question 24

What is the preferred first-line tocolytic agent?

Answer 24

PO Nifedipine

Question 25

What is the role of magnesium sulfate in pregnancy?

Answer 25

Relaxes smooth muscle and is used for seizure prophylaxis in preeclampsia

Question 26

What is the primary function of oxytocin during labor?

Answer 26

Induction or augmentation of labor by stimulating uterine contraction

Question 27

What is the primary use of Oxytocin in obstetrics?

Answer 27

Induction or augmentation of labor, stimulating uterine contraction, combating uterine hypotonia and hemorrhage ## Footnote Oxytocin is synthesized in the paraventricular nuclei of the hypothalamus and released from the posterior pituitary gland.

Question 28

What are the side effects of Oxytocin?

Answer 28

Water retention, hyponatremia, hypotension, reflex tachycardia, coronary vasoconstriction ## Footnote Rapid IV administration can cause cardiovascular collapse.

Question 29

What is Methergine and its primary use?

Answer 29

Second-line uterotonic that can only be given IM ## Footnote IV administration can cause significant vasoconstriction, hypertension, and cerebral hemorrhage.

Question 30

What is the dosage for Methergine?

Answer 30

0.2 mg IM ## Footnote Methergine has a half-life of 2 hours.

Question 31

What are the indications for using general anesthesia in cesarean sections?

Answer 31

Maternal hemorrhage, fetal distress, coagulopathy, patient refusal of regional anesthesia, contraindications to regional anesthesia

Question 32

What is the risk of mortality associated with general anesthesia in cesarean sections?

Answer 32

17-times higher ## Footnote This is particularly relevant in emergency situations.

Question 33

What is the significance of left uterine displacement during cesarean sections?

Answer 33

Minimizes aortocaval compression

Question 34

What is the recommended induction agent for general anesthesia in cesarean sections?

Answer 34

Propofol, Etomidate, or Ketamine ## Footnote Dosages: Propofol (2-2.5 mg/kg), Etomidate (0.3 mg/kg), Ketamine (1 mg/kg).

Question 35

True or False: The risk of neonatal acidosis increases when the time between uterine incision and delivery exceeds 3 minutes.

Answer 35

True

Question 36

What is the risk of teratogenicity during pregnancy?

Answer 36

Highest during organogenesis (day 13-60) ## Footnote Nitrous oxide is linked to congenital defects in animal studies.

Question 37

What is HELLP syndrome?

Answer 37

Hemolysis, Elevated Liver Enzymes, and Low Platelet count

Question 38

What defines chronic hypertension in pregnancy?

Answer 38

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

Question 39

What are the key symptoms of preeclampsia?

Answer 39

Hypertension (BP >140/90), proteinuria, and various systemic symptoms ## Footnote Can exist in absence of proteinuria if certain conditions are present.

Question 40

What is the definitive treatment for preeclampsia?

Answer 40

Delivery of the fetus and placenta

Question 41

What is the loading dose for magnesium sulfate for seizure prophylaxis in preeclampsia?

Answer 41

4 g over 10 minutes

Question 42

What is the risk associated with cocaine abuse in pregnancy?

Answer 42

Increased risk of spontaneous abortion, premature labor, placental abruption, and low Apgar scores

Question 43

What is the most common cause of uterine hemorrhage?

Answer 43

Uterine atony ## Footnote Risk factors include multiparity, multiple gestations, polyhydramnios, and prolonged oxytocin infusion.

Question 44

What does the Apgar score assess?

Answer 44

The newborn and guides resuscitative efforts based on five parameters

Question 45

What are the normal ranges for heart rate and respiratory rate in newborns?

Answer 45

HR: 120-160 bpm, RR: 30-60 bpm

Question 46

What is the normal Apgar score range?

Answer 46

8 - 10

Question 47

What are the potential routes for drug administration during neonatal resuscitation?

Answer 47

Umbilical vein, endotracheal tube, intraosseous