OB chp 23, 24, 25
Help!
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| which c-section incision is the modern type | low vertical with curve
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| which c-section incision has a high incidence of rupture | classic
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| uterine rupture will cause disruption of labor, fetal distress, vag. bleeding, hypoTN, shock, pain (10%):which one is a tool to help dx rupture | fetal distress
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| T or F previous c-section for dystocia or cephalopelvic disporp. contradicts a trail of labor | false, doesn't contradict
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| does a previous classic or Tshaped uterine incision contradict a trail of labor | yes
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| implement of VBAC could avoid __,000 c-sections annually | 200,000
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| after thorough counseling that wts the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat c-section should be made by the ___ and ___ | pt and physician
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| risk of VBAC incidence of uterine rupture __% | 0.8
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| the essential first sign of trouble is _____ and is the most reliable sign of uterine rupture | decreased FHR
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| T or F intrauterine pressure monitoring is ideal to dx uterine rupture | false, difficult to
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| this type of augmentation is controversial and studies show it may increase rupture incidence | oxytocin augmentation
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| what is the most common indication for c-section | previous c-section
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| T or F c-section is the most freq. performed operation in the Us | T
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| a trial of labor is successful in _% to _% of women who had a low-transverse incision: 40%-50%, 20%-40%, 60% to 80% | 60% to 80%
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| continuous electronic FHR monitoring represents the best means of detecting | uterine rupture
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| what age must the pt be at least to perform a tubal ligation | 21
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| consent for tubal ligation is only valid for __ days | 180
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| a total of __ days must pass b/n the date the consent is signed and the date the procedure is performed | 30
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| if pt is not hemodynamically stable for a tubal you should delay for _ to _ wks | 6 to 8
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| T or F you should evaluate neonate prior to tubal | T
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| what is a major risk assoc. with anesthesia for postpartum tubal | aspiration
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| T or F opioids given prior to can decrease delay of gastric emptying | F; can increase, so avoid prior to tubal procedure
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| metoclopramide may accelerate gastric emptying in pts who have recieved an opioid | F; may not
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| when does gastroesphageal reflux return to normal postpartum | 2nd postpartum day
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| an hour after 4th stage of labor pt is at risk for | bleeding; therfore there is a 8 hr wait period prior to tubal
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| __% tubal sterilizations worldwide | 75
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| MAC greater than _ may inhibit oxytocin | 1; and cause uterine atony
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| metoclopriamide increase NMB duration with sCh | false, prolongs
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| most NDMB actions are prolonged except | atracurium and cisatracurium
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| T or F sCh action is prolonged during preg. | T
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| this type of anesthesia provides excellent operation conditions for postpartum tubals | regional
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| what level should the regional be at for tubal | T4
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| it is advised to wait _ hrs postpartum for a tubal | 8
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| regional may require more anesthesia secondary to decreased levels of | progesterone
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| lg volumes required of regionals can possible cause | cardiotoxicity
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| this medicine is contradicted with nursing mothers b/c of possible adverse effects of prostaglandin sysnthetase inhibitors on neonates | ketorolac
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| c-section rate exceeds __% | 24
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| _ to _% of all maternal deaths due to anesthesia (general), failed airway common etilogy | 3 to 12%
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| versed is recommended as part of anesthesia | false
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| anxiolysis are rarely given b/c mother wants to remeber birth | T
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| before regional _to_cc/kg given _mins prior reduces hypoTN and improves uteroplacental circulation | 15 to 20; 30
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| what type of IVF should be avoided | glucose containing solutions
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| avoid hyperventilation it can cause | uterine artery vasoconstriction
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| should you be concerned if mother has ST segment changes | No!(can be common) but rule out possible causes(hypervolemia, tachy, VAE, coronay vasospasm, anmiotic emboli)
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| use of doppler u/s should be routinely used for VAE | false
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| what triad should be rely on for VAE and txment | CP, desat., arrthy, right-sided strain; IVF and 5 to 10 degree reverse trendelenburg
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| all pregnant pt should receive what med before GA | aspiration prophylaxis (H2 blockers)
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| prevention of aspiration includes | avoid GA; awake intubation with diff. airway; cricoid, RSI, untubation with cuffed tube
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| goal pharmacotherapy of gastric secretions is to __ gastric vol, and __ pH | decrease, increase
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| these drugs don't alter pH of existing gastric contents | H2 receptor antagonist
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| this drug increases gastric emptying and increases LES tone and antiemetic | metoclopramide
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| what is the most common complication of regional anesthesia | hypotension
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| hypotension results from increased venous capacitance and decreased SVR from | sympathectomy from the blockade (avoid by IVF)
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| what things can be done to prevent hypotension | IVF, left uterine placement, prophylactic vasopressors
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| routinely administer prohylactic vasopressors is advised | false
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| which prophylactic vasopressors is preferred | ephedrine; give phenylephrine instead for tachy pt with low BP
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| what are some s/s of a high spinal | complete motor and sensory block, hypotn, brady, unconsciousness, loss of protective reflexes and respiratory arrest
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| if pt goes into cardiac collapse what should you do and should avoid | should intubate and paralysis, shouldn't sedate
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| how often does a high spinal occur out of 50,000 | 1 in 50,000
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| prevention of a high spinal | administer test dose, aspirate before injecting, and give 5cc increments and wait/watch
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| convulsions, unconsciousness, arrhythmias, cardiovascular collapse are s/s of | local toxicity
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| bupivicaine has a 4 hr 1/2 life and can cause ___ heart ___ | complete heart block
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| what is the recommendation for txment of bupivacaine toxicity | 20% intralipids; 1cc/kg bolus than 0.25cc/kg/min infusion with CPR
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| persistent neurologic deficit is common and occurs after administration of spinal or epidural | rare
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| transient neurologic syndrome (TNS) occured after intrathecal injection of | hyperbaric 5% lidocaine
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| s/s of TNS | burning pain and dysethesthia in the L5- S1 dermatones usually start after spinal and can last for an hr to 4 days
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| TNS is more common in what position, type of pt, and outpt surgeries | lithotomy and obese
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| TNS occurs most in all locals | false, greater with 5% lidocaine
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| what dermatones are effected in TNs | L5-S1
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| what is the recommended therapy for TNS with severe pain | NSAID or oral opioids
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| how long can TNS last | hour to 4 days
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| what can help reduce maternal nausea | supplemental o2
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| support person can have a significant contribution to the delivery process | true
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| there is a increase risk of VAE with | exteriorizing the uterus
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| only general when truly ___ conditions exists | stat
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| considerations of choice of anesthetic technique are | urgency of procedure, choice of mother, health of mother and fetus
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| this type of needle decrease PDPH (postdural puncture H/A) | non-cutting needles
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| what type of drug is commonly used for spinals | 0.75% bupivacaine
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| what is 0.75% bupivacaine duration and dosage range | 60-125mins and 7.5mg-15mg
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| does 5% lido or 0.75% bupicacaine have a longer duration | bupivacaine
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| epidural absolute dose is _ to _ times greater than spinal | 5 to 10
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| an epidural high spinal may be caused from | SA injection subarachnoid
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| should aspiration propylaxtis still be give for regional | yes; still at risk for aspiration
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| signficant coagulation is an indication for GA | true
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| inadequate regional anesthesia is an indication for GA | true
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| what is the most popular induction agent | thiopental
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| does thiopental cross the placenta | yes
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| thiopenthal has what kind of hemodynamic effects | negative inotrope and vasodilator
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| propofol is often used as an induction agent | false; never used in practice
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| the use of ketamine can increase BP by __% | 14
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| lg does of ketamine can __ uterine tone | increse
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| what are ketamines hemodynamic effects | indirect sympathomimetic
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| ketamine should be used in severe hypotn | false, can cause myocardial depression, decreased CO, hypotn
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| induction of asthmatic, modest hypovolemic pts should give | ketamine
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| this induction agent can cause dysphoria and hallucinations; | ketamine (give versed suggested)
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| this induction agent is excellent choice in hemodynamically compromised pt | etomidate
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| pain and myoclonus may occur with this induction agent | etomidate
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| midazolam only indication may be contraindication to | other agents
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| versed is commonly used | false
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| Sch crossed placenta and paralyzes fetus | false; ionized
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| homozygous atypical pseudocholinesterase may result in __ infant | apneic
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| high does volatile may induce | uterine relaxation and post partum bleeding
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| when should volatile be discontinued | uterine atony occurs
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| maternal hypotension may cause fetal | hypoxia and acidosis
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| longer I-D time with GA doesn't effect fetus | false
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| infants have a lower 1 min apgar score with what type of anesthesia | GA
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| 5 min apgar scores differ greater with GA or regional | false; when proper resuscitation is given
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| U-D time of greater than _ mins:bad apgar, low pH score, regardles of anesthetic tech. | 3 min.
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