Obstetrics
- 1.Which of the following obstetric patients has the lowest risk for post-dural puncture headache?
- A.
A 18 yo with repaired spina bifida cystica
- B.
A 22 yo with previous thoracic spinal fusion for scoliosis
- C.
A 35 yo with severe Kyphoscoliosis affecting pulmonary function
- D.
A 28 yo with a BMI > 40
- E.
A 20 yo with a history of ataxic cerebral palsy
- 2.A 32-year old Nigerian immigrant who is 37 weeks pregnant by ultrasound presents to the Labor and Delivery triage complaining of blurred vision. Her chart reveals she is pregnant with twins and has a history of focal segmental glomerulonephritis from HIV. Her initial BP is 190/115 mmHg, and a urine dipstick is 3+ for protein. You place an 18 gauge IV and a radial arterial line, and after giving her a 4g Magnesium Sulfate (MgSO4) bolus, you start a labetalol drip for blood pressure control along with a steady MgSO4 infusion. You also place an epidural without acute complications. Six hours later you are called because the patient has become drowsy. Her vital signs are: 135/80, 80, 6, 99.8 F, and 95% on 2L nasal cannula. Fetal monitoring of her twins is reassuring, and she is arousable to sternal rub. The best management is which of the following:
- A.
Atropine 0.5g IVP
- B.
Calcium Gluconate 1g IVP
- C.
Delivery by emergent Caesarian section
- D.
Bolus 1L of Lactate Ringers
- E.
Narcan 0.4mg IVP initial dose and maximum of 2mg cumulative dose
- F.
Flumazenil 0.5mg IVP initial dose and maximum 3mg cumulative dose
- G.
None of the above
- 3.Which of the following is the leading cause of maternal death in the US?
- A.
General anesthesia (failed intubation or aspiration)
- B.
Hemorrhage
- C.
Pulmonary embolism
- D.
Infection
- E.
Pregnancy-induced hypertension
- 4.Which of the following lab values increases in a normal pregnancy?
- A.
Hemoglobin
- B.
Creatinine
- C.
PaCO2
- D.
Fibrinogen
- E.
Platelets
- F.
Bicarbonate
- G.
None of the above
- 5.The distance from the skin to the epidural space correlates with which of the following factors: 1. Age 2. Height 3. BMI
- A.
1, 3
- B.
2, 3
- C.
1, 2, 3
- D.
3
- 6.Which of the spinal levels below is the lowest location for a blockade that would impede the cardioaccelerator fibers?
- A.
T1
- B.
T3
- C.
T4
- D.
T6
- E.
T7
- 7.
The fetal heart monitor result above is thought to be caused by which of the following:- A.
Fetal head compression
- B.
Umbilical cord compression
- C.
Fetal hypoxia
- D.
Uteroplacental insufficiency
- 8.
The fetal heart monitor result above is thought to be caused by which of the following:
- A.
Fetal head compression
- B.
Umbilical cord compression
- C.
Uteroplacental insufficiency
- D.
None of the above
- 9.
The fetal heart monitor result above is thought to be caused by which of the following:
- A.
Fetal head compression
- B.
Umbilical cord compression
- C.
Uteroplacental insufficiency
- D.
Fetal hypoxia and acidosis
- E.
None of the above
- 10.A healthy girl is born with APGAR scores of 9 and 9. Which of following blood gases would you expect to see drawn from her umbilical artery at the time of birth?
- A.
7.4 / 40 / 171 / 24
- B.
7.26 / 52 / 17 / 22
- C.
7.1 / 81 / 28 / 28
- D.
7.21 / 55 / 103 / 22
- 11.Which of the following does not interfere with an epidural test dose?
- A.
Age > 60
- B.
Administration of beta blockers
- C.
General anesthesia
- D.
Administration of Midazolam
- 12.A 23 yo F who is G1P0 presents at 39 weeks with 3cm dilation. She has no medical problems and has never had surgery before. Which tests should she have prior to the delivery?
- A.
CBC
- B.
CMP
- C.
Type and Screen
- D.
PT/ PTT
- E.
None of the above
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