Pt. Gravada 2 Para 1 presents @ 35 weeks with increased liver enzymes, hypoglycemia,
metabolic acidosis, and hyperammonemia. What is the most likely diagnosis?
a.
b.
c.
d.
HELLP
Hep C
Pre-eclamptic
AFLP
What is the treatment for the above patient?
a.
b.
c.
d.
MgSo4
2 units FFP
Prompt delivery of fetus
Sodium bicarbonate
T/F A morbidly obese woman slightly increases her chances of HTN and delivery via CSection.
As weight increases in an obese pregnant patient:
a.
b.
c.
d.
The oxygen consumption increases and the CO2 production decreases
The oxygen consumption increase and the CO2 production increases
The oxygen consumption decrease and the CO2 production increases
The oxygen consumption decrease and the CO2 production decreases.
A BMI of greater than 30 does what to hypertension
a.
b.
c.
d.
doubles it
triples it
quadruples it
has no effect on it
In pregnancy, the mother’s response to diabetes is:
a.
b.
c.
d.
decreased production of insulin
resistance of receptors to insulin
antibody production to insulin
response is same as non-pregnant patients
What are the factors related to stiff joint syndrome?
a.
b.
c.
d.
progesterone production, relaxin, and osteoarthritis
osteoarthritis, adult onset diabetes, and joint contractures
juvenile onset diabetes, short stature and joint contracture
diabetes, pregnancy, tb
What is the most common birth anomaly related to diabetes?
a.
b.
c.
d.
club foot
cardiac
pulmonary
cns
Which of the following would be a prudent consideration for a general anesthesic
delivery with MS?
a. RSI with succinylcholine and a pre-fasciculating dose
b. Awake extubation at end of case
c. A large initial dose for epidural anesthesia
d. Warming blanket
Most of the cases of cardiac diseases in pregnancy are:
a.
b.
c.
d.
rheumatic in nature
genetic
idiopathic
none of the above
Rheumatic heart disease
a. Is an inflammatory disease affecting the heart and subcutaneous tissue
b. Has beta hemolytic streptococcal antibodies
c. Increases the risk of pulmonary edema
d. All of the above
Maternal use of cocaine
a.
b.
c.
d.
decreases uterine contractions
decreases uterine blood flow
increases uterine vascular resistance
decreases peripheral circulating catacholamines
The #1 cause of fetal demise is pre-term labor T/F
What is the acceptable level of L/S ratio in diabetic patients?
a.
b.
c.
d.
1.9
1.6
3.0
2.0
What is the triple marker and what does it test for?
a. AFP, estradiol, and hCG. Tests for neural tube defects, trisomy 18 & 21
b. Amniotic fluid, AFP, and chorion sampling. Tests for surfactant, lecithin and
meconium
c. Ultrasound, fetal monitor, Nagel’s dating; Tests for fetal age
d. US, leopold’s maneuvers, palpation; fetal lie
T/F Lung maturity is reached by the 32nd week.
Which is NOT a reactive sign in the non-stress test?
a.
b.
c.
d.
e.
f.
At least 2 fetal movements in 40 minutes
Normal acceleration of FHR with movement
Baseline FHR of 120-160 BPM
Long term variability of 5 bpm
Both a & d
All of the above are positive signs in a non-stress test
The purpose of fetal monitoring is to assess fetal oxygenation T/F
Fetal scalp monitoring:
a.
b.
c.
d.
calculates fetal hr by measuring intrauterine pressures
causes moderate blood loss
measures the r-r interval
is only used to check hr variability
T/F The usual range for peak of uterine contractions is 80 – 100 mmhg
Which of the following is not a reassuring fetal heart tone:
a.
b.
c.
d.
a baseline beat-to-beat variability
long term variability
saltatory variability
all are reassuring fetal heart tones
Saltatory pattern is usually found in the:
a.
b.
c.
d.
1st stage of labor
Second stage of labor
Third stage of labor
Between the 24th and 25th week of pregnancy
Late decelerations are associated with
a. fetal head compressions
b. uteroplacental insufficiency
c. umbilical cord compression
d. b & c
What is the most ominous fetal sign?
a.
b.
c.
d.
no beat-to beat variable
prolonged severe bradycardia
fetal tachycardia
persistant late decelerations
What is a pseudosinusoidal pattern?
a.
b.
c.
d.
benign pattern associated with the use of stadol
a non-reassuring fetal heart tone
on ominous fetal heart tone
none of the above
T/F A fetal pH of 7.27 is considered within normal range
A newborn has pink coloring, hr >100, grimaces, some flexion and a good cry. What is
the Apgar?
a.
b.
c.
d.
e.
6
7
8
9
10
In the ductus venosus, the fetal blood supply
a.
b.
c.
d.
is shunted from the right ventricle to the aorta
is shunted from the right atrium to the left atrium
found in the liver and closes in 2-3 weeks
shunts blood away from the lungs
Which is not a function of catecholamine release in a newborn?
a.
b.
c.
d.
Production and release of surfactant
Thermoregulation of newborn
Mediation of preferential blood flow to vital organs during birth
Closing of the foramen ovale
T/F Newborns achieve thermogenesis by oxidizing brown fat
A 1500g baby is intubated. What tube size and placement is required for a neonate of
this size?:
a.
b.
c.
d.
2.5 ETT, 9 cm
3.0 ETT, 7 cm
3.5 ETT, 8 cm
3.0 ETT, 9 cm
An indication of chest compressions of a newborn is a sustained HR of less than 100 bpm
T/F?
The dose of epinephrine [1:10,000] for sustained low hr in spite of compressions is:
a.
b.
c.
d.
.1 to .3 mg/kg
.1 to .3 mcg/kg
.1 to .3 ml/kg
.1 to .3 nano/kg
T/F Sodium bicarb should be administered quickly in cases of acidosis without regard to
ventilation and circulation
Lupus anticoagulant antibody causes additional bleeding in the mom T/F
Slide presentation 7
T/F Preterm births range from 23 weeks to 37 weeks and have a survival rate of 84%
(slide 3)
Which of the following is correct in describing premature infants?: (slide 4)
a.
b.
c.
d.
low birth weight infants are less than 3.3 pounds
very preterm is less than 30 weeks
low birth weight is less than 1500 grams
none of the above are correct
T/F At 24 weeks a premature neonate has a 50/50 chance of surviving (slide 6)
A factor for morbidity and mortality in a premature infant delivered (slide 8)
a.
b.
c.
d.
decreased surfactant production before the 28th week
PDA’s
Intraventricular hemorrhage
All of the above are factors for M&M
T/F The most definitive factor for preterm labor is obesity (slide 9)
Confirmation of pre-term labor is made by: (slide 10)
a.
b.
c.
d.
e.
persistent uterine contractions (at least 4 in 20 minutes)
vaginal bleeding
cervical dilation of greater than 2 cm
at least 80% effacement of the cervix
either c or d confirm preterm labor
Why do we give the mom corticosteroids during pre-term labor: (slide 21)
a.
b.
c.
d.
to decrease the possibility of an asthma attack
to increase the production of surfactant
decrease the risk of infection
try to slow or stop the labor
The definitive diagnosis of abrupto placenta is made by (slide 38)
a.
b.
c.
d.
US
Painful vaginal bleeding
Port-wine non-clotting blood
Fetal distress
T/F A long umbilical cord is a risk factor for abrupto placenta (slide 40)
Which of the following is the correct grading for abrupto placenta? (slide 41)
a.
b.
c.
d.
Asymptomatic grade A
Maternal shock, fetal demise grade 2
External vaginal bleeding, fetal distress grade C
Vaginal bleeding, no shock or fetal distress grade 1
T/F the major fetal risk of abrupto placenta is fetal death (slide 43)
T/F Placenta Previa is the most common cause of DIC (slide 48)
The lab value of choice for someone going into DIC from a placental abruption is: (slide
49)
a.
b.
c.
d.
platelets
LFT
FDP
PT, PTT
T/F Smoking is NOT a risk factor for placenta previa (slide # 53)
T/F Placenta previa has painful vaginal bleeding which abrupto placenta is painless (slide
# 53)
Which of the following is commonly associated with placenta previa: (slide # 58)
a.
b.
c.
d.
Blood clots
shock
DIC
Fetal distress
The number one sign of uterine rupture is: (slide 71)
a.
b.
c.
d.
hemodynamic instability of the mother
recession of presenting part of the fetus
abdominal pain
fetal distress
A postpartum hemorrhage is defined as:
a.
b.
c.
d.
blood loss greater than 750 cc in a c-section
loss of more than 10% of blood volume
a drop in hematocrit of more than 10%
when the surgeon says so.
Which of the following scenarios would be be a correct classification of a postpartum
hemorrhage?( slide we do not have)
a.
b.
c.
d.
Loss of 1200-1500cc = asymptomatic
1800-2400cc loss = mild loss
2400cc = moderate loss
None of the above are correct
The most common type of abnormal implantation is (slide # 78)
a. Percreta
b. Increta
c. Accreta
T/F the second most common cause of periobstetrical hysterectomy is placenta accreta,
and the incidence increases with prior c-sections. (slide # 81 & 82)
One of the fastest ways to relax an inverted uterus is: (slide # 84)
a.
b.
c.
d.
iv nitroglycerine 50-100mcg
terbutaline
ritodrine
labetalol
The most common cause of post partum hemorrhage is (slide # 86)
a.
b.
c.
d.
placenta accrete
RPC
uterine rupture
none of the above
T/F Hemoglobin S is produced from a single nucleotide substitution of the amino acid
glutamic acid for valine at the sixth position in the B-globin chain (slide # 100)
Which of the following statements is true regarding sickle cell disease: (slide # 101)
a.
b.
c.
d.
It is an autosomal dominant disorder
The concentration of Hgb S does not affect the severity of the disease
The disease does not manifest itself until at least 6 months of age
None of the above are true
Which of the following are correct complications of sickle cell anemia: (slide # 102)
a.
b.
c.
d.
e.
Maternal mortality @ 1%
Fetal mortality @ 20%
Pulmonary embolism, e.g. GA is the anesthetic of choice
A & B only
All of the above are correct
Slide ppt 8
Match the following nerve with the mechanism of injury: (slides 67-69)
a.
b.
c.
d.
e.
Stirrups
Forceps
Fetal head
Retractor
Lithotomy position
1. Lateral and lateral femoral cutaneous nerves-E
2. Lumbo-sacral trunk, femoral nerve and obturator nerve-C
3. Lumbo-sacral trunk-B
4. common peroneal-A
5.The most common nerve injury (slide # 71)
a. women with platypoid pelvis are predisposed to it
b. occurs because of baby or forceps
c. are the result of trauma to L4-L5.
d. B & C
e. All of the above
6.Injury to the back of the leg is most likely affecting which nerves: (slide 73/74)
a.
b.
c.
d.
L4 and L5
T12 to L2
S1 and S2
None of the above affect the back of the legs
7.T/F. A primary headache is without an aura and a secondary headache is with an aura.
(slide # 82)
Match the following(:slides 84-98)
a.
b.
c.
d.
e.
LORT – air
Virchow’s triad
Treatment with 5-HT1d or beta blockers
Persistant leak of CSF
Av malformations
8. Pneumocephalis-A
9. CVT-B
10. Migraines-C
11. SDH-D
12. SAH-E
13. T/F Regardless of the etiology, it is always safe to do a blood patch (slide # 99)
13. A patient presents with the following…fever, headache, vomiting, seizures,
photophobia and positive kernig’s sign post epidural. What is the most likely
diagnosis? (slide 100)
a. PDPH
b. Meningitis
c. CVT
d. None of the above
14. How much spinal fluid does a normal adult have (slide 107)
a.
b.
c.
d.
450cc
150cc
250cc
500cc
15. T/F A history of PDPH is a contraindication for another epidural (slide 113)
16. which of the following is TRUE regarding PDPH: (slides 114-116)
a.
b.
c.
d.
PDPH is inversely proportional to age and increases with a larger gauge needle
PDPH is most common in women from 20 to 40 years of age
Needle insertion should always be vertical
PDPH does not affect men
17. T/F Transient neurologic syndrome and Arachnoiditis are CHEMICAL injuries in
nature (slide 126)