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dd72d18a-33f8-5758-adf1-317fd4a67179
Select the TRUE statement regarding complex regional pain syndrome (CRPS) in children
More common in males than females
Upper extremity is more frequently involved than the lower extremity
Best treated with sympathetic blocks
Often associated with depression and anxiety
4
D
1
null
null
null
null
null
70faf36d-5d2a-51ea-96be-3538b864731c
Which of the following statements regarding perioperative cardiac arrest in children is NOT correct?
Cardiac arrest is more common in neonates than in infants or older children
"Equipment related" causes occur in more than 25% of cardiac arrests
Resuscitation is more often successful if the cause is anesthesia related rather than nonanesthesia related
Emergency surgery is associated with greater than four times the chance of a cardiac arrest
4
B
1
null
null
null
null
null
6876028a-969f-56cc-8408-6ae0d9a24194
Which of the following represents the greatest risk for postoperative apnea in an infant?
PCA of 60 weeks
Hemoglobin 10 g/dL
Recovery in the postanesthesia care unit (PACU) after pyloric stenosis repair
20th weight percentile on growth chart
4
C
3
null
null
null
null
null
7f7c7b12-bf49-5594-8e20-5c21ee3ec697
Which of the following statements regarding the Mapleson D breathing circuit is FALSE?
It has a proximal fresh gas inflow and a distal overflow valve
With an inspiratory-to-expiratory (I:E) breathing ratio of 1:2, rebreathing is eliminated with spontaneous ventilation when the fresh gas flow is three times the minute ventilation
The Mapleson D circuit requires lower fresh gas flows with spontaneous ventilation compared with controlled ventilation
The Bain circuit is a modification of the Mapleson D circuit
4
C
1
null
null
null
null
null
737577b1-fb53-5ed6-9a78-70a71c94e319
Which of the following is LEAST likely to reduce the incidence of postoperative apnea in preterm infants undergoing surgery for inguinal hernia repair?
Delaying operation until 60 weeks' PCA
Preoperative correction of anemia
Caffeine administration
Spinal anesthetic with ketamine sedation
4
D
3
null
null
null
null
null
0b552a43-5451-58d5-a70b-3f31da9824b5
A 32-week-EGA, 2-kg newborn born a few hours ago is to undergo a repair of his gastroschisis under general anesthesia. Which of the following sizes of uncuffed ETTs should you use, and how far should it be positioned to most likely be properly placed in the trachea (gums to midtrachea distance)?
2.0-internal diameter (ID) ETT placed at 6 cm
2.5-internal diameter (ID) ETT placed at 8 cm
3.0-internal diameter (ID) ETT placed at 10 cm
3.5-internal diameter (ID) ETT placed at 12 cm
4
B
2
null
null
null
null
null
01abb434-3e33-57bc-abb4-0412b1d6941e
Induction of general anesthesia for an elective operation should be
2 hours
4 hours
6 hours
No fasting needed because breast milk is OK
4
B
1
null
null
null
null
null
3a457653-a56f-59be-846d-17c78ed71ee7
In the infant, hypothermia would LEAST likely manifest as
Metabolic acidosis
Prolonged duration of action of nondepolarizing muscle relaxants
Hyperglycemia
Impaired coagulation
4
C
1
null
null
null
null
null
5193a5f3-ead0-5e7c-8b88-ea63a5842622
Necrotizing enterocolitis (NEC) has all of the following characteristics EXCEPT
Most have thrombocytopenia (< 70,000/mm3 ) and a prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT)
Commonly associated with decreased cardiac output in the presence of fetal asphyxia or postnatal respiratory complications
Umbilical artery catheters are useful to assess acid-base status
Occurs in 10% to 20% of newborns weighing less than 1500 g
4
C
1
null
null
null
null
null
41205312-44f1-5d91-872d-d719b9bcbdd0
Which of the following statements concerning codeine is INCORRECT?
Codeine is a weak opioid and is used for the treatment of mild to moderate pain
Peak blood level after oral or IM administration is about 30 minutes
Codeine is metabolized to morphine
Codeine is the postoperative analgesic of choice, after acetaminophen, for the treatment of pain after tonsillectomy in children < 12 years of age
4
D
1
null
null
null
null
null
4043ba9f-773f-55c5-ad65-0fc19f57bd13
Which of the following drugs is LEAST likely to be used for a 4-yearold receiving proton beam radiation treatment for his medulloblastoma?
EMLA cream
Propofol
Rocuronium
Dexmedetomidine
4
C
2
null
null
null
null
null
93cd66d5-4d5b-56cd-af41-aa6367354f8a
A 5-year-old girl with hemolytic-uremic syndrome (HUS) is brought to the OR for placement of a dialysis catheter. Medical issues typical for this disease include
Thrombocytopenia
Increased intracranial pressure
Pancreatitis
All of the above
4
D
1
null
null
null
null
null
bcea7431-9e20-503d-bc49-181c27b98d91
A 3-year-old child status post resection of Wilms tumor at age 2 years is receiving doxorubicin (Adriamycin) and cyclophosphamide for metastatic disease. The patient is scheduled for placement of a Hickman catheter for continued chemotherapy. Anesthetic concerns related to this patient's chemotherapeutic treatment incl...
Thrombocytopenia
Inhibition of plasma cholinesterase
Cardiac depression
Pulmonary toxicity
4
D
1
null
null
null
null
null
d295a5c9-be67-5964-b5bd-25ce4686c9e1
Hypotension in children is characterized by a systolic blood pressure
Less than 60 mm Hg for the term neonate (0-28 days old)
Less than 70 mm Hg for infants 1 to 12 months old
Less than 70 mm Hg + (2 × age in years) mm Hg for children 1 to 10 years old
All of the above
4
D
1
null
null
null
null
null
16111876-3470-5d9b-a669-76d2286918b0
What percent of the adult's glomerular filtration rate, or GFR, does a 1 year-old possess?
30%
50%
75%
100%
4
D
1
null
null
null
null
null
c029ee82-c4ac-5768-9e22-f7b659706ba8
Each of the following results in a reduction of the incidence of postoperative vomiting (POV) in children undergoing strabismus surgery EXCEPT
IV hydration of 30 mL/kg/hr
Dexamethasone 0.15-0.5 mg/kg IV
Ondansetron 50 to 200 μg/kg IV
Anticholinergics (atropine 10-20 μg/kg or glycopyrrolate 10 μg/kg)# Pediatric Physiology and Anesthesia
4
D
1
null
null
null
null
null
8e189cf5-b6f0-5218-af12-c84a6876b91c
Which of the following drugs does NOT pass the placenta easily?
Etomidate
Ephedrine
Atropine
Glycopyrrolate
4
D
1
null
null
null
null
null
e98ce3c4-c686-5d2d-88c8-27700e142622
A 38-year-old obese patient is receiving subcutaneous low-molecularweight heparin (LMWH) for thromboprophylaxis. Her epidural for an elective cesarean delivery was placed 14 hours after the heparin was stopped. She developed Horner syndrome on the left side 30 minutes after placement of the epidural. On physical examin...
Remove the epidural
Consult a neurosurgeon
Obtain a computed tomographic scan
None of the above
4
D
3
null
null
null
null
null
af2e7c62-ddf6-5774-9166-3991631883ba
What percentage of all pregnancies is affected by hypertension?
3%-5%
7%-10%
15%
20%
4
B
1
null
null
null
null
null
cc24970a-ebf4-54b5-8045-82060d55e998
Magnesium sulfate (MgSO4 ) is used as an anticonvulsant in patients with preeclampsia and for fetal neuroprotection and sometimes for short-term tocolysis. MgSO4 may produce any of the following effects
Sedation
Respiratory paralysis
Inhibition of acetylcholine (ACh) release at the myoneural junction
Hypertension when used with nifedipine
4
D
1
null
null
null
null
null
f23b8e4f-741d-592c-a512-a325acb15c61
Normal fetal heart rate (FHR) is
60 to 100 beats/min
90 to 130 beats/min
110 to 160 beats/min
150 to 200 beats/min
4
C
1
null
null
null
null
null
95078886-95de-5f24-952a-5201d3a4b4e2
Which of the following is the MOST likely cause of pregnancy-related deaths in the United States (2011-2013)?
Anesthesia complications
Hemorrhage
Cardiovascular disease
Hypertensive disorders of pregnancy
4
C
1
null
null
null
null
null
991b877d-cc82-5eff-b243-13d19aed57ae
Drugs useful in the treatment of uterine atony in an asthmatic patient with severe preeclampsia include
Oxytocin (Pitocin) only
Ergonovine (Ergotrate) or methylergonovine (Methergine) only
15-Methyl prostaglandin F2α (PGF2α ) (Carboprost, Hemabate) only
All of the above are safe and can be used alone or in combination with the others
4
A
2
null
null
null
null
null
9c2cd3e0-cbf4-5845-9002-3aac329472d7
What is the P50 of fetal hemoglobin at term?
12 mm Hg
18 mm Hg
24 mm Hg
30 mm Hg
4
B
1
null
null
null
null
null
a7aed22a-9943-5a63-912e-14c603adc69c
Side effects of terbutaline include all of the following EXCEPT
Hypertension
Hyperglycemia
Pulmonary edema
Hypokalemia
4
A
1
null
null
null
null
null
febb7327-1d72-56d9-8828-16b5eda08877
Cardiac output increases dramatically during pregnancy and delivery. The cardiac output returns to nonpregnant values by how long postpartum?
12 hours
1 day
2 weeks
6 months
4
C
1
null
null
null
null
null
b3a021e8-1b1c-57e1-af15-c16317dd17a9
A 32-year-old parturient with a history of spinal fusion, severe asthma, and hypertension (blood pressure 180/110) is brought to the operating room wheezing. She needs an emergency cesarean section under general anesthesia for a prolapsed umbilical cord. Which of the following induction agents would be MOST appropriate...
Sevoflurane
Midazolam
Ketamine
Propofol
4
D
3
null
null
null
null
null
9b75c2d6-4104-54a9-8966-a6adeaf30eda
Uterine blood flow at term pregnancy typically increases to about
100 mL/min
250 mL/min
500 mL/min
750 mL/min
4
D
1
null
null
null
null
null
f937982b-d93f-514b-95c0-bb1e5fbcea57
Which one of the following statements is TRUE regarding human immunodeficiency virus (HIV) infected parturients?
Central neurologic blockade and epidural blood patches increase the chance of neurologic complications
Ninety percent of newborns of untreated HIV-seropositive mothers become infected in utero, during vaginal delivery,or with breastfeeding
The pharmacologic effects of benzodiazepines and narcotics are prolonged in patients taking protease inhibitors
The risk of seroconversion after percutaneous exposure to HIV-infected blood is about 5%
4
C
1
null
null
null
null
null
b8064eaa-4ad2-58c1-8a62-700057afb66d
Which of the following cardiovascular parameters is decreased at term?
Central venous pressure
Pulmonary capillary wedge pressure
Systemic vascular resistance
Left ventricular end-systolic volume
4
C
1
null
null
null
null
null
b3bc590c-81da-56a8-8c1b-000316f4119b
Which of the following signs and symptoms is NOT associated with amniotic fluid embolism (AFE)?
Chest pain
Bleeding (disseminated intravascular coagulation [DIC])
Pulmonary vasospasm with severe pulmonary hypertension and right heart failure
Left ventricular failure and pulmonary edema
4
A
1
null
null
null
null
null
cbc57c92-c89f-5565-93e4-0277e2dda81c
When is the fetus most susceptible to the effects of teratogenic agents?
1 to 2 weeks of gestation
3 to 8 weeks of gestation
9 to 14 weeks of gestation
15 to 20 weeks of gestation
4
B
1
null
null
null
null
null
e2e6553e-0fe8-52bb-b927-f6e548eb94da
A 28-week estimated gestational age (EGA), 1000-g male infant is born to a 24-year-old mother who is addicted to heroin. The mother admits taking an extra "hit" of heroin before coming to the hospital because she was nervous. The infant's respiratory depression would be best managed by
0.1 mg/kg naloxone intramuscularly (IM) in the newborn's thigh muscle
0.1 mg/kg naloxone down the endotracheal tube
0.4 mg naloxone IM to the mother during the second stage of labor
None of the above
4
D
2
null
null
null
null
null
80db68b8-9539-5cef-bc64-70a185992908
Cardiac output is GREATEST
During the first trimester of pregnancy
During the third trimester of pregnancy
During labor
Immediately after delivery of the newborn
4
D
1
null
null
null
null
null
2c99aaba-4eb4-5de9-bf51-abdb25628b10
A 1000-g, 27-week EGA boy is born with a heart rate of 80 beats/min. He has slow irregular respiratory efforts, grimaces when a suction catheter is inserted into the mouth and nose for suctioning, and flexes his limbs some but is totally cyanotic. The umbilical cord has only two vessels. The 1-minute Apgar score would ...
3
4
6
7
4
B
2
null
null
null
null
null
fff85a0a-3c53-5794-9676-86deeb257684
Which of the following respiratory parameters is NOT increased in the parturient?
Minute ventilation (MV)
Tidal volume (Vt)
Arterial Pao2
Serum bicarbonate
4
D
1
null
null
null
null
null
b7df4541-0c4a-56a3-8807-2b9914da6f0f
Which of the following drugs should NOT be used during transvaginal oocyte retrieval (TVOR) for assisted reproductive technology (ART)?
Propofol
Ketamine
Midazolam
All are safe and can be used
4
D
1
null
null
null
null
null
9cc1df7b-9c70-57ab-a22b-03a7e48bdcfb
Which of the following conditions is associated with increased bleeding during pregnancy?
Lupus anticoagulant
Factor V Leiden mutation
Protein C deficiency
None of the above
4
D
1
null
null
null
null
null
de3b483c-22e1-52da-b60d-cb301111ffee
What is the BEST way to prevent autonomic hyperreflexia in a quadriplegic woman who is to undergo induction of labor? The complete spinal cord lesion occurred 2 years ago.
Only IV drugs should be used; spinal and epidural anesthesia are contraindicated
Spinal or epidural lumbar local anesthetics such as bupivacaine alone are effective
Spinal or epidural narcotics such as fentanyl alone are effective
Autonomic hyperreflexia appears only when the complete spinal cord lesion is below T6, so there is no need to worry
4
B
2
null
null
null
null
null
2098d859-c60d-54fc-b966-343cb72ff124
A 24-year-old gravida 2, para 1 parturient is anesthetized for emergency cesarean section. On emergence from general anesthesia, the endotracheal tube is removed and the patient becomes cyanotic. Oxygen is administered by positive-pressure bag and mask ventilation. High airway pressures are necessary to ventilate the p...
Amniotic fluid embolus (AFE)
Mucus plug in trachea
Tension pneumothorax
Aspiration
4
D
2
null
null
null
null
null
0aa6b0d7-258c-5188-b49b-56d8769da26f
A lumbar epidural is placed in a 24-year-old gravida 1, para 0 parturient with myasthenia gravis (MG) for labor. Select the TRUE statement regarding neonatal MG.
The newborn is almost always affected with myasthenia
The newborn is affected by maternal immunoglobulin M (IgM) antibodies
The newborn may require anticholinesterase therapy for up to 4 weeks
The newborn will need lifelong treatment
4
C
1
null
null
null
null
null
91462985-036e-5930-8458-02d77e9c3fa3
A patient having which of the following conditions is LEAST likely to develop DIC?
Severe preeclampsia
Placental abruption
Placenta previa (bleeding)
Dead fetus syndrome
4
C
1
null
null
null
null
null
835e3f61-5ea0-53c6-affd-afbd6b95f440
A 28-year-old gravida 1, para 0 parturient with Eisenmenger syndrome (pulmonary hypertension with an intracardiac right-to-left or bidirectional shunt) is to undergo placement of a lumbar epidural for analgesia during labor. It may be wise to avoid a local anesthetic with epinephrine in this patient because it
Lowers pulmonary vascular resistance
Lowers systemic vascular resistance
Increases heart rate
Causes excessive increases in systolic blood pressure (SBP)
4
B
2
null
null
null
null
null
ef166ff9-aa93-5221-b765-72eab8c777c6
Which of the following patients is MOST likely to need an emergency hysterectomy for uncontrolled bleeding at the time of delivery?
Patient undergoing cesarean section after an unsuccessful trial of labor after cesarean (TOLAC)
Patient with quadruplets
Patient with a placenta previa (not bleeding) for an elective repeat cesarean section
Patient with an abdominal pregnancy
4
C
3
null
null
null
null
null
08624a03-6afa-541c-aaea-5591a25f97fc
The MOST common injury recorded in the American Society of Anesthesiologists' (ASA's) Closed Claims Project regarding obstetric anesthetic claims is
Pain during anesthesia
Maternal nerve damage
Headache
Aspiration pneumonitis
4
B
1
null
null
null
null
null
47e2e7b7-f524-5a6f-b30e-97f7e413f265
Which of the following statements about chorioamnionitis is FALSE?
Chorioamnionitis occurs in about 1% of all pregnancies
Clinical signs include temperature higher than 38° C, maternal and fetal tachycardia, and uterine tenderness
Antibiotics are administered only after delivery, because intrapartum antibiotics may "obscure the results of neonatal blood cultures"
Epidural anesthesia can be safely administered
4
C
1
null
null
null
null
null
542a739b-7751-5571-b97a-8851efd3a930
Which of the following statements regarding newborns with thick meconium-stained amniotic fluid is TRUE?
Only oral or nasal suctioning with a bulb syringe is needed in newborns that are vigorous
Intubation is required for all such newborns
Antibiotics and steroids are often needed to treat the infection
Respiratory distress syndrome (RDS) is common
4
A
1
null
null
null
null
null
9c1a218a-d67f-5f11-802c-fc05653c3940
A 38-year-old primiparous patient with placenta previa and active vaginal bleeding arrives in the operating room with a systolic blood pressure (SBP) of 85 mm Hg. A cesarean section is planned. The patient is lightheaded and scared. Which of the following anesthetic induction plans would be most appropriate for this pa...
Spinal anesthetic with 12 to 15 mg bupivacaine
General anesthetic induction with 2 to 2.8 mg/kg propofol and paralysis with 1 to 1.5 mg/kg succinylcholine
General anesthesia induction with 0.75 to 1 mg/kg ketamine and paralysis with 1 to 1.5 mg/kg succinylcholine
Replace lost blood volume first, then use any anesthetic the patient wishes
4
C
3
null
null
null
null
null
7fbb0335-3188-529d-aee3-3943552b6f09
Which of the following lung volumes or capacities change the LEAST during pregnancy?
Tidal volume (Vt)
Functional residual capacity (FRC)
Expiratory reserve volume (ERV)
Vital capacity (VC)
4
D
1
null
null
null
null
null
3536d425-e527-5f94-9d4d-9581b433338a
General anesthesia is induced in a 35-year-old patient for elective cesarean section. No part of the glottic apparatus is visible after two unsuccessful attempts to intubate, but mask ventilation is adequate. The most appropriate step at this point would be to
Wake up the patient
Attempt a blind nasal intubation
Continue mask ventilation and cricoid pressure
Use a laryngeal mask airway
4
A
2
null
null
null
null
null
486942ac-8bc4-5ec8-9862-0fcd13e4a163
Which patients describe their labor pain as being the MOST intense?
Primipara patients attending prepared childbirth classes
Primipara patients not attending prepared childbirth classes
Multipara patients attending prepared childbirth classes
Multipara patients not attending prepared childbirth classes
4
B
2
null
null
null
null
null
4bab1db3-1088-5478-b5fa-6aa1be508cf3
Cigarette smoking is associated with an increase of each of the following EXCEPT
Spontaneous fetal loss
Placental abruption
Preeclampsia
Sudden infant death syndrome (SIDS)
4
C
1
null
null
null
null
null
96eaf1b4-3fbf-5ace-839d-8eb2be0d03e9
All of the following are TRUE regarding the use of nitrous oxide for labor analgesia EXCEPT
Significant anxiolysis occurs
Do not need to have an IV line in place
Needs to be administered by anesthesia personnel
Only the patient can hold the mask or mouthpiece
4
C
1
null
null
null
null
null
d81188b5-f6c8-5924-87b9-5ba028ffebcd
When performing a rapid-sequence induction (RSI) for an emergency cesarean delivery, which of the following muscle relaxants is LEAST desirable to use after the IV general anesthetic is administered?
Atracurium
Rocuronium
Succinylcholine
Vecuronium
4
A
2
null
null
null
null
null
394c3194-8a0c-5d80-a651-72c847df50b8
True statements regarding inclusion of intrathecal morphine, fentanyl, or sufentanil in obstetric anesthesia practice include each of the following EXCEPT
The chief site of action is the substantia gelatinosa of the dorsal horn of the spinal column
There is no motor and no sympathetic blockade
Pain relief is adequate for the second stage of labor
Lipophilic narcotics are associated with less respiratory depression than nonlipophilic narcotics
4
C
1
null
null
null
null
null
301cbb2c-662f-522e-a614-19ae5d035d68
The MOST common side effect of intraspinal narcotics in the obstetric population is
Pruritus
Nausea and vomiting
Respiratory depression
Urinary retention
4
A
1
null
null
null
null
null
16f71641-fba2-592f-bc8f-781f50ba7b99
A 110-kg (242-lb), gravida 1, para 0 woman has a blood pressure of 180/95 during an office visit at the 16th week of gestation and 175/90 1 week later. She has some ankle but no facial edema, and no protein detected in her urine. Her serum creatinine is 1.2. These findings would be classified as
Preeclampsia
Chronic hypertension
Chronic hypertension with superimposed preeclampsia
Gestational hypertension
4
C
3
null
null
null
null
null
0d332e14-47c9-5ed6-ac51-e1ed7c3d29ec
An epidural is placed into a 32-year-old parturient in active labor receiving magnesium therapy for preeclampsia. Five minutes after administration of the test dose, the loading dose of bupivacaine and fentanyl is administered. The patient becomes panic-stricken, wrestles briefly with the reassuring nurses, gasps for a...
Amniotic fluid embolism
High spinal
Intravascular bupivacaine injection
Eclampsia
4
A
3
null
null
null
null
null
71b8150b-bc50-53b5-83fb-e870f7183dcd
Which of the following narcotics has the LONGEST duration of action when added during a cesarean section under epidural anesthesia?
50 to 100 μg fentanyl
10 to 20 μg sufentanil
3 to 4 mg morphine
50 to 75 mg meperidine
4
C
1
null
null
null
null
null
4010ca38-d129-5c2f-b9c1-afd7596a35d2
Which of the following is NOT increased during pregnancy?
Renal plasma flow
Creatinine clearance
Blood urea nitrogen (BUN)
Glucose excretion
4
C
1
null
null
null
null
null
fb719c0e-8cd5-5bfe-ae26-b423caf4971a
Which inhalation anesthetic does NOT produce uterine relaxation?
Isoflurane
Sevoflurane
Nitrous oxide
All produce uterine relaxation
4
C
1
null
null
null
null
null
ad17dd7a-6d44-50f3-a98f-b519a5b41b5d
Passive diffusion of substances across the placenta is enhanced by all of the following EXCEPT
Low molecular weight of the substance
High water solubility of the substance
Low degree of ionization of the substance
Large concentration gradient of the drug
4
B
1
null
null
null
null
null
401a9ab4-474b-5e7e-8066-b0e82c83de90
Cesarean delivery is associated with a blood loss of about
250 mL
500 mL
750 mL
1000 mL
4
D
1
null
null
null
null
null
4a0aa139-3d17-52ad-a234-b860d9dd3ab0
Which of the following statements is CORRECT in describing differences between fetal and maternal blood during labor?
Fetal blood has a lower hemoglobin concentration than does maternal blood
Fetal placental blood flow is twice maternal placental blood flow
Fetal hemoglobin has a greater affinity for O2 than does maternal hemoglobin
The fetal oxyhemoglobin dissociation curve is shifted to the right of the maternal oxyhemoglobin dissociation curve
4
C
1
null
null
null
null
null
199c6c09-240d-5c3a-b4ad-2cde815af7e0
In general, morbidly obese patients have a higher incidence of all of the following EXCEPT
Cesarean deliveries
Postdural puncture headaches (PDPHs)
Preeclampsia
Thromboembolic diseases
4
B
1
null
null
null
null
null
0e07613a-a2d4-57a6-be2a-fcf87d5040bd
A term infant with good muscle tone and a strong cry has an oxygen saturation of 83%, breathing room air 5 minutes after delivery. The MOST appropriate action at this point would be
Supplemental increased oxygen concentration with a blender up to 50% by a face mask
Spontaneous breathing with 100% oxygen by face mask
Positive-pressure ventilation with 100% oxygen
Observation
4
D
2
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af8fecdb-52c2-5d58-baa6-e589ffd0a2db
Which condition BEST describes the third-trimester maternal condition with the following signs and symptoms: new-onset vaginal bleeding that stops, no pain, no fetal distress?
Placental abruption
Placenta previa
Uterine rupture
Vasa previa
4
B
1
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57d182bd-2442-5bc9-bdc9-e74d5e2de60e
During the second stage of labor, complete pain relief can be obtained with
Paracervical block
Neuraxial block with fentanyl and morphine
Pudendal nerve block
Lumbar epidural block with bupivacaine and no narcotic
4
D
1
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d9f0637e-d36e-5c4f-bb8a-ddcc53abc6ca
Anesthetic considerations for open fetal surgery include all of the following EXCEPT
Uterine relaxation is essential
Maternal hypotension (mean blood pressure < 65 mm Hg) can be treated with phenylephrine or ephedrine
Vecuronium at the ED95 dose of 0.04 mg/kg should be administered IM or IV by the obstetrician or surgeon if fetal muscle relaxation is needed
Normal fetal oxygen saturation is 50% to 70%
4
C
1
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edd1cf86-28b0-50f4-b9e0-31db402081be
15-Methyl PGF2α is administered directly into the myometrium to treat uterine atony in a 28-year-old mother. Possible effects from treatment with this drug include
Nausea and vomiting
Bronchospasm
Hypoxia
All of the above
4
D
1
null
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2ddfe911-d131-5673-8490-5a177423034d
Which of the following statements regarding MgSO4 therapy for preeclampsia is TRUE?
The therapeutic range for serum magnesium is 10 to 15 mEq/L
High serum magnesium levels can be estimated by changes in deep tendon patellar reflexes in a patient with an epidural anesthetic loaded for a cesarean section
Excessive serum magnesium levels cause widening of the QRS complex
As soon as delivery occurs, the chance for eclampsia no longer exists and the magnesium should be reversed so that postpartum bleeding is less likely to occur
4
C
1
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e273efe3-c4e7-5878-98c6-b48416eaf497
While moving a parturient from the birthing room to the operating room for an emergency cesarean section for a prolapsed umbilical cord, the patient develops cough, wheezing, and stridor and becomes cyanotic.
Intravenous lidocaine to suppress the cough
Glucocorticoids
100% oxygen and positive end-expiratory pressure (PEEP)
Saline lavage
4
C
2
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ad13c2d1-3ad6-5932-8ed3-53e2418017d4
Aortocaval compression starts to become significant in a normal pregnancy at how many weeks EGA?
10 weeks
15 weeks
20 weeks
25 weeks
4
C
1
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9c80f21c-1aeb-51dd-a916-a120d20f53c7
Which agent is the MOST useful for raising the gastric pH just before induction of general anesthesia for emergency cesarean section?
Ranitidine
Sodium citrate
Metoclopramide
Magnesium hydroxide and aluminum hydroxide
4
B
1
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468702f4-1b58-5900-8f81-5e3cda2b0b8c
Causes of fetal bradycardia include all of the following EXCEPT
Maternal smoking of cigarettes
Neostigmine and glycopyrrolate reversal of neuromuscular blockers
Acidosis
Umbilical cord compression
4
A
1
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3d5fb97c-7dc0-5094-bec5-1998816e2b57
Most cases of cerebral palsy (CP) are due to conditions during
Antepartum
Labor
Delivery
The first 30 days of life
4
A
1
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3d62821d-ad1f-59d2-9df3-aaca93738ff4
All of the following statements regarding pregnant diabetic patients are true EXCEPT
Gestational diabetes mellitus (DM) occurs in about 7% of all pregnancies in the United States
Insulin readily crosses the placenta and causes larger babies
Cesarean section is more common in diabetic pregnancies
Diabetic ketoacidosis (DKA) occurs in 1% to 2% of Type- 1 DM pregnancies
4
B
1
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0f4ef80c-ae0d-5618-8982-b7ddfe883231
In addition to the postural component of a postdural puncture headache (PDPH), signs and symptoms may include any of the following EXCEPT
Double vision
Hearing changes
Neck stiffness
Fever
4
D
1
null
null
null
null
null
36232e30-4d32-515b-b0d0-2abc0a37b2bb
Early decelerations may occur in response to
Fetal head compression
Uteroplacental insufficiency
Maternal hypotension
Umbilical cord compression
4
A
1
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null
b849c55b-4f4b-55d9-8f02-b13605b676e2
Agents that are useful for decreasing the incidence of shivering during cesarean section under regional anesthesia or for treating shivering include all of the following EXCEPT
Administration of intrathecal local anesthetic with fentanyl and/or morphine
Intravenous magnesium sulfate
Administration of epidural local anesthetic solutions with epinephrine
Intravenous meperidine
4
C
1
null
null
null
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null
f032bed0-9ccb-5ed8-864c-16f5584436a4
An umbilical arterial blood gas sample at the time of an emergency cesarean delivery shows a Po2 of 20 mm Hg, a Pco2 of 50 mm Hg, a
Severe hypoxemia
Respiratory acidosis
Metabolic acidosis
Normal values
4
D
1
null
null
null
null
null
e797e0e7-67f9-5862-8ea4-6ae7ab2e909b
Which is the MOST frequent condition requiring blood transfusions during or after a cesarean delivery?
Multiple gestations
Placental abruption
Placenta previa
Postpartum hemorrhage
4
D
1
null
null
null
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null
15658b8a-30ca-5d25-9e03-638fbe3ebdec
All of the following are appropriate techniques or drug doses to be used in resuscitating a depressed term newborn EXCEPT
Begin ventilation with air rather than 100% oxygen
If the heart rate is less than 60 beats/min, start chest compressions (ratio of chest compressions to ventilations is 3:1)
After adequate ventilation and chest compressions, administer 0.1 mg/kg of epinephrine IV
After 10 minutes of no detectable heart rate, it may be reasonable to discontinue resuscitation efforts
4
C
1
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e574a396-8aaa-590a-b09b-fa8f7684dd31
Compared with a healthy 25-year-old primigravida, which of the following conditions is NOT associated with a significantly higher incidence of hypertensive disorders of pregnancy?
Multiple gestations
Cigarette smoking (> 1 pack/day)
Obesity
Placental abruption
4
B
1
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7e9ef673-1038-56dc-918d-b832aee88353
Adverse effects (on the mother) associated with aortocaval compression by the gravid uterus include
Nausea and vomiting
Changes in cerebration
Fetal distress
All of the above
4
D
1
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null
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1d0ad9e0-aba3-503d-8043-e7dbe06e149c
Which of the following statements regarding a pregnant patient abusing cocaine is FALSE?
Hypertension, arrhythmias, myocardial ischemia, and tachycardia may occur with the rapid-sequence induction of general anesthesia in the acutely intoxicated patient
The minimum alveolar concentration (MAC) for general anesthetics is increased in chronic cocaine addicts
Some states consider in utero drug exposure to be a form of child abuse and require physicians to report these patients
If a vasopressor is needed to treat hypotension, phenylephrine is preferred over ephedrine
4
B
1
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702deaec-4a0e-5462-ad7f-4dbe62a016a2
Each of the following is correct when advising the surgeon to perform infiltration anesthesia for an emergency cesarean delivery when general and neuraxial anesthesia are contraindicated EXCEPT
A midline incision is most desirable
The rectus muscle should be injected to provide good skin analgesia
Bupivacaine with bicarbonate is the local anesthetic of choice
Mild sedation with ketamine and midazolam is permissible
4
C
2
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bf5b6382-3869-5111-b652-798182c3c1d8
A 24-year-old primiparous woman is undergoing an elective cesarean section (breech position). After prehydration with 1500 mL of saline, a spinal anesthetic is performed; 5 minutes later, the blood pressure is noted to be 80/40 mm Hg and the heart rate is 110 beats/min. The BEST treatment (best fetal pH) after ensuring...
Phenylephrine
Ephedrine
Epinephrine
1000 mL 5% dextrose in lactated Ringer solution
4
A
2
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7ef9368f-55e9-5661-ba53-8883228d79f6
A woman has been admitted for a dilation and evacuation (D&E) at 10 weeks' EGA. She has some persistent bleeding and cramping after the expulsion of some tissue. Her obstetric condition is called
A threatened abortion
An inevitable abortion
A complete abortion
An incomplete abortion
4
D
1
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60619cae-b9c8-50b3-ae53-13c387ab024c
Which of the following treatments has proven effective in decreasing the incidence of PDPHs after an accidental dural puncture with an epidural needle?
Bed rest
Prophylactic hydration
Prophylactic epidural blood patch after delivery
None of the above
4
D
1
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null
null
null
null
651ce2fb-bcca-5d0f-b24a-caa6317a05a9
Factors associated with advanced molar pregnancy (i.e., > 14 to 16 week size uterus) include all of the following EXCEPT
Hypertensive disorders of pregnancy
Hypothyroidism
Acute cardiopulmonary distress
Hyperemesis gravidarum
4
B
1
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null
null
null
e2958dfc-6a1a-5efe-8836-36bbce87957c
Refractory cardiac arrest is MOST likely after the rapid unintentional IV injection of which of the following local anesthetics?
Lidocaine
Bupivacaine
Ropivacaine
Chloroprocaine
4
B
1
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null
null
null
83650d57-d4d2-59eb-8bda-4f9fd432f1c0
American Society of Regional Anesthesia (ASRA) guidelines for the treatment of local anesthetic systemic toxicity (LAST) for cardiac arrhythmias include the use of Intralipid and the AVOIDANCE of all of the following drugs EXCEPT
Vasopressin
β-Blockers
Calcium channel blockers
Low-dose epinephrine (< 1 μg/kg)
4
D
1
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null
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null
c0eb56bf-27fb-55d5-86f3-147c0a639de4
Transient neurologic syndrome (TNS) is MOST commonly seen after the spinal anesthetic injection of which local anesthetic?
Lidocaine
Bupivacaine
Prilocaine
Tetracaine
4
A
1
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cdd026b0-0855-5df4-8642-507ce54b0407
You have a well-working T10 labor epidural in a woman with a questionable difficult airway and have just been informed that an urgent cesarean section is needed for a nonreassuring FHR tracing. Which of the following local anesthetics would give you the SLOWEST onset of surgical anesthesia?
3% chloroprocaine with freshly added epinephrine (1:200,000)
2% lidocaine with freshly added epinephrine (1:200,000)
2% lidocaine and epinephrine with added bicarbonate
0.5% levobupivacaine with fentanyl
4
D
1
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8d49b35c-2e8f-5ba1-918c-66cbdbafeab2
Which local anesthetic has the SHORTEST plasma half-life after being injected into the epidural space?
Bupivacaine
Chloroprocaine
Lidocaine
Ropivacaine# Obstetric Physiology and Anesthesia
4
B
1
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a8888356-d99e-51a5-91f6-16353a402b45
A 59-year-old man with a subarachnoid hemorrhage (SAH) is admitted to the intensive care unit (ICU). His serum sodium is 115 mEq/L, 24 hour urine sodium collection is 350 mmol, and central venous pressure (CVP) is 1 mm Hg. The MOST likely cause of these findings is
Acute tubular necrosis (ATN)
Diabetes insipidus (DI)
Cerebral salt-wasting syndrome (CSWS)
Syndrome of inappropriate antidiuretic hormone (SIADH)
4
C
2
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3a53419f-827d-5dc8-b284-6808d8e56985
Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above
5 to 10 mm Hg
15 to 20 mm Hg
25 to 30 mm Hg
30 + mm Hg
4
B
1
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null
49425ec5-fef5-5d77-b6e8-8b76ca50c8b8
Calculate cerebral perfusion pressure (CPP) from the following data: blood pressure (BP) 100/70, heart rate (HR) 65 beats/min, cardiac output 5 L/min, CVP of 5 cm/H2O, and ICP 15 mm Hg
60 mm Hg
65 mm Hg
70 mm Hg
75 mm Hg
4
B
2
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null
7e1159be-4dba-53b4-bb81-6d9412291a78
Which of the following statements about cerebrospinal fluid (CSF) in a healthy adult is FALSE?
CSF volume is about 150 mL
CSF pressure is about 10 mm Hg
CSF volume turns over 4 times a day
Specific gravity of CSF is higher than the specific gravity of plasma
4
D
1
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