OB anesthesia Practice Questions And Answers 2023

OB anesthesia Practice Questions And Answers 2023 CV changes that accompany a normal pregnancy include an increased: (Select 3) a. SVR b. HR c. plasma volume d. SV e. SBP f. DBP - ANS-Answer: b, c, d Rationale: -SVR decreases -CO increases -DBP decreases -SBP unchanged -SV increases -HR increases -Plasma volume increases -Erythrocyte volume increases A pregnant mother has a history of mitral stenosis. When is she at GREATEST risk of hemodynamic compromise? a. second trimester b. third trimester c. second stage of labor d. third stage of labor - ANS-Answer: third stage of labor Rationale: CO is 80-100% over prelabor value during third stage of labor (after delivery). Patients w/ a history of valvular stenosis or pulmonary HTN are at greatest risk of compromise when CO is highest. P50: a. increases in the mother and decreases in the fetus b. decreases in the mother and increases in the fetus c. remains constant in the mother and decreases in the fetus d. remains constant in the mother and increases in the fetus - ANS-Answer: increases in the mother and decreases in the fetus Rationale: The OxyHgb curve tells us the tendency of hgb to bind to oxygen and P50 is the PaO2 where hgb is 50% saturated by O2. A high P50 reflects a right shift (right = release). A lower P50 reflects a left shift (left = love) To ensure fetal oxygenation, there has to be an O2 concentration gradient from mother to fetus. Mother P50 is higher = 30 mmHg, Fetal P50 is lower = 19 mmHg. The higher P50 in mother & lower P50 in fetus ensures O2 offloading across placenta. Which arterial blood gas is MOST likely to occur in a pregnant patient's first trimester? a. 7.42/30/101/20 b. 7.36/36/97/22 c. 7.33/44/96/19 d. 7.45/31/85/19 - ANS-Answer: a. Rationale: Progesterone is a respiratory stimulant, increasing MV up to 50%. PaCO2 decreases ~30 (respiratory alkalosis), renal compensation - HCO3 decreases ~20 (metabolic acidosis), pH unchanged. All of the following increase the risk of pulmonary aspiration before the onset of labor EXCEPT: a. increased gastrin secretion b. decreased gastric emptying c. decreased gastroesophageal barrier pressure d. increased progesterone production - ANS-Answer: decreased gastric emptying Rationale: gastric acid production is increased by increased gastrin production, LES tone is decreased by inc progesterone & cephalad movement of uterus; Gastric emptying does NOT change during pregnancy. During labor gastric emptying slows as a function of pain, anxiety, SNS stimulation, and opioids. Physiologic effects of progesterone during pregnancy include: (Select 3) a. dec MAC b. dec PaCO2 c. dec renin d. inc sensitivity to anesthetics e. inc SVR f. inc LES tone - ANS-Answer: a, b, d Rationale: Progesterone increases: -MV (dec PaCO2 & inc HCO3) -RAAS activity -Vascular muscle relaxation (dec SVR, dec PVR) Progesterone decreases: -airway resistance (inc bronchodilation) -MAC -LES tone Which drugs undergo GREATEST amount of uteroplacental transfer? (select 3): Continues..