OB Questions PDF

**Why is it recommended to administer metoclopramide and sodium citrate before induction in pregnant patients?**\ A. To enhance uterine contractions\ B. To reduce the risk of aspiration pneumonitis\ C. To prevent hypotension during anesthesia\ D. To promote maternal analgesia\ **Answer**: B **Which...

**Why is it recommended to administer metoclopramide and sodium citrate before induction in pregnant patients?**\ A. To enhance uterine contractions\ B. To reduce the risk of aspiration pneumonitis\ C. To prevent hypotension during anesthesia\ D. To promote maternal analgesia\ **Answer**: B **Which vascular changes occur during pregnancy to accommodate increased cardiac output?**\ A. Increased systemic vascular resistance\ B. Decreased pulmonary vascular resistance\ C. Decreased venous capacitance\ D. Increased afterload\ **Answer**: B **Which coagulation factor decreases during pregnancy?**\ A. Factor VII\ B. Factor XII\ C. Protein S\ D. Factor X\ **Answer**: C **What increases the risk of thromboembolism in postpartum patients?**\ A. Elevated protein C activity\ B. Increased plasma albumin levels\ C. Hypercoagulable state and venous stasis\ D. Decreased cardiac output\ **Answer**: C **What cardiac auscultation finding is commonly observed in pregnant patients?**\ A. Loud S3 with an ejection murmur\ B. S4 gallop with splitting of S1\ C. Benign 2/6 systolic ejection murmur due to increased flow\ D. Continuous murmur from ductus arteriosus patency\ **Answer**: C **Why is functional residual capacity (FRC) decreased in pregnancy?**\ A. Increased inspiratory reserve volume\ B. Diaphragmatic elevation by the gravid uterus\ C. Reduced respiratory rate\ D. Enhanced oxygen consumption\ **Answer**: B **Which physiological mechanism allows for oxygen transfer from maternal to fetal circulation?**\ A. Maternal rightward oxyhemoglobin dissociation curve and fetal leftward shift\ B. Increased maternal hemoglobin concentration\ C. Direct mixing of maternal and fetal blood\ D. Maternal hypoventilation during labor\ **Answer**: A **What structural change in the heart is commonly seen in pregnant patients?**\ A. Right ventricular hypertrophy\ B. Leftward displacement of the heart with left ventricular hypertrophy\ C. Narrowing of mitral valve diameter\ D. Decreased tricuspid regurgitation\ **Answer**: B **What is the primary function of the intervillous space in the placenta?**\ A. To supply oxygen and nutrients to the fetus\ B. To store fetal waste products\ C. To regulate maternal glucose metabolism\ D. To prevent fetal exposure to maternal proteins\ **Answer**: A **Which fetal shunt allows oxygenated blood to bypass the lungs?**\ A. Umbilical artery\ B. Ductus arteriosus\ C. Umbilical vein\ D. Portal vein\ **Answer**: B **Why is placental drug transfer reduced for neuromuscular blocking agents?**\ A. Their high ionization and poor lipid solubility\ B. Their low molecular weight\ C. Their metabolism by fetal liver enzymes\ D. Their affinity for fetal hemoglobin\ **Answer**: A **Which medication is safest for anticoagulation in a pregnant patient with an artificial heart valve?**\ A. Warfarin throughout pregnancy\ B. Unfractionated heparin at term\ C. Low molecular weight heparin without monitoring\ D. Aspirin during the first trimester\ **Answer**: B **Why are pregnant patients considered at higher risk of difficult airway management?**\ A. Increased airway collapsibility\ B. Engorgement and edema of the upper airway\ C. Reduced tongue space\ D. Increased size of the cricoid ring\ **Answer**: B **Why does aortocaval compression lead to maternal hypotension?**\ A. Decreased systemic vascular resistance\ B. Reduced venous return and cardiac preload\ C. Increased maternal oxygen demand\ D. Enhanced uterine contractility\ **Answer**: B **What is the primary advantage of adding epinephrine to local anesthetics for neuraxial analgesia?**\ A. Enhanced motor blockade\ B. Reduced systemic absorption and prolonged duration\ C. Increased sensory blockade without affecting motor strength\ D. Reduced fetal drug exposure\ **Answer**: B **Which type of drug is least likely to cross the placenta?**\ A. Highly lipid-soluble drugs\ B. Low molecular weight drugs drugs\ C. Large molecular weight drugs like NDNMBs\ D. Drugs with a high pKa\ **Answer**: C **How does pregnancy affect the epidural space and neuraxial anesthesia?**\ A. Increases cerebrospinal fluid (CSF) volume\ B. Engorgement of epidural veins reduces available space for local anesthetic\ C. Decreases sensitivity to local anesthetics\ D. Requires higher doses of local anesthetics\ **Answer**: B **What is the recommended treatment for Type 2 von Willebrand disease during labor?**\ A. Platelet transfusion\ B. DDAVP administration\ C. Heparin infusion\ D. Fresh frozen plasma\ **Answer**: B **Why is MAC reduced in pregnant patients?**\ A. Increased cardiac output\ B. Decreased sensitivity to volatile anesthetics\ C. Hormonal changes and reduced cerebrospinal fluid volume\ D. Decreased oxygen consumption\ **Answer**: C **What distinguishes uterine rupture from uterine atony?**\ A. Uterine rupture is associated with painless vaginal bleeding, while atony involves severe pain.\ B. Uterine rupture presents with fetal bradycardia and loss of station, while atony involves a soft, boggy uterus.\ C. Both conditions present with similar symptoms but require different treatments.\ D. Uterine atony is more likely after cesarean delivery.\ **Answer**: B **Which is a characteristic finding in amniotic fluid embolism?**\ A. Progressive hypoxemia and disseminated intravascular coagulation (DIC)\ B. Bradycardia and sudden uterine rupture\ C. Fever and maternal tachycardia\ D. Hypertension and fetal tachycardia\ **Answer**: A **What is unique about the WBC count during pregnancy?\ a. Leukocytosis is common\ b. Leukopenia is common\ c. WBC count remains unchanged\ d. WBC count decreases during labor\ Correct Answer: a. Leukocytosis is common** 1. **What is the most significant factor in causing increased CO in the pregnant patient?\ a. Increase in HR more than SV\ b. Decrease in SVR\ c. Increase in SV more than HR\ d. Increase in blood volume\ Correct Answer: c. Increase in SV more than HR** 2. **How much does CO increase during pregnancy?\ a. 20-30%\ b. 30-40%\ c. 40-50%\ d. 50-60%\ Correct Answer: c. 40-50%** 3. **When does the largest increase in CO occur?\ a. During the first trimester\ b. During labor\ c. 80-100% increase immediately postpartum\ d. 1-2 weeks postpartum\ Correct Answer: c. 80-100% increase immediately postpartum** 4. **What is the compensation for aortocaval syndrome?\ a. Increased blood volume\ b. Increased peripheral SNS activity to increase SVR and BP\ c. Decreased HR and BP\ d. Redistribution of blood flow to the uterus\ Correct Answer: b. Increased peripheral SNS activity to increase SVR and BP** 5. **What puts pregnant patients at risk for gallbladder disease?\ a. Increased bile production\ b. Incomplete gallbladder emptying\ c. Increased fat metabolism\ d. Decreased bile concentration\ Correct Answer: b. Incomplete gallbladder emptying** 6. **What is uterine blood flow directly proportional to?\ a. Uterine vascular resistance\ b. Fetal HR\ c. Maternal cardiac output\ d. Placental hormone levels\ Correct Answer: c. Maternal cardiac output** 7. **What is uterine blood flow indirectly proportional to?\ a. Fetal movement\ b. Maternal cardiac output\ c. Uterine vascular resistance\ d. Blood volume\ Correct Answer: c. Uterine vascular resistance** 8. **What is the purpose behind increased plasma volume in pregnancy?\ a. To support fetal development\ b. To compensate for EBL during childbirth\ c. To decrease maternal blood viscosity\ d. To regulate blood pressure\ Correct Answer: b. To compensate for EBL during childbirth** 9. **What condition is associated with fetal acidosis?\ a. Prolonged labor\ b. Prolonged maternal hypotension\ c. Maternal hypertension\ d. Maternal hypoglycemia\ Correct Answer: b. Prolonged maternal hypotension** 11. **What lung volumes increase during pregnancy?\ a. Residual volume and expiratory reserve volume\ b. Tidal volume, inspiratory capacity, inspiratory reserve volume\ c. Functional residual capacity and residual volume\ d. Total lung capacity and expiratory reserve volume\ Correct Answer: b. Tidal volume, inspiratory capacity, inspiratory reserve volume** 12. **What is the effect of pregnancy on the renal system?\ a. Decreased renal blood flow (RBF), increased GFR\ b. Increased RBF, decreased GFR\ c. Increased RBF, GFR, and decreased tubular reabsorption of protein and glucose\ d. Decreased tubular filtration\ Correct Answer: c. Increased RBF, GFR, and decreased tubular reabsorption of protein and glucose** 13. **What does the majority of uterine blood flow perfuse?\ a. The myometrium\ b. The intervillous space in the placenta\ c. The uterine wall\ d. The ovarian arteries\ Correct Answer: b. The intervillous space in the placenta** 14. **Why is the first pass effect significant in the fetus?\ a. Most umbilical venous blood passes through the lungs\ b. Most umbilical venous blood passes through the kidneys\ c. Most umbilical venous blood passes through the liver\ d. Most umbilical venous blood bypasses the heart\ Correct Answer: c. Most umbilical venous blood passes through the liver** 15. **What medications easily cross the placenta?\ a. Volatile anesthetics, benzodiazepines, local anesthetics, opioids\ b. Neuromuscular blocking agents\ c. Insulin and heparin\ d. Proteins and amino acids\ Correct Answer: a. Volatile anesthetics, benzodiazepines, local anesthetics, opioids** 16. **What is a normal fetal HR?\ a. 80-120 bpm\ b. 110-160 bpm\ c. 100-140 bpm\ d. 90-170 bpm\ Correct Answer: b. 110-160 bpm** 17. **What is the Ferguson reflex?\ a. A reflex causing relaxation of uterine muscles\ b. Maternal nausea and vomiting during labor\ c. Dense blockade removing the maternal urge to push\ d. Reflexive fetal HR acceleration\ Correct Answer: c. Dense blockade removing the maternal urge to push** 18. **What is the cause of ineffective pushing?\ a. Decreased fetal movement\ b. Motor weakness secondary to a dense block\ c. Maternal hypotension\ d. Overhydration during labor\ Correct Answer: b. Motor weakness secondary to a dense block** 19. **What are the desired dermatomes for coverage in epidural anesthesia?\ a. T6-T10\ b. T10-L1 and caudally to S2-S4\ c. L1-L4\ d. T4-T12\ Correct Answer: b. T10-L1 and caudally to S2-S4** 20. **How should local anesthetics (LA) be administered?\ a. As a single bolus\ b. In 10mL increments\ c. In 5mL increments\ d. Through continuous infusion only\ Correct Answer: c. In 5mL increments** 21. **What is a complication associated with a combined spinal-epidural (CSE)?\ a. Fetal tachycardia and maternal hypotension\ b. Fetal bradycardia and maternal pruritus\ c. Maternal hypertension and fetal hypoxia\ d. Maternal and fetal respiratory depression\ Correct Answer: b. Fetal bradycardia and maternal pruritus** 22. **What local anesthetics (LA) are typically used for labor epidurals?\ a. Lidocaine and bupivacaine\ b. Ropivacaine and chloroprocaine\ c. Bupivacaine and ropivacaine\ d. Lidocaine and ropivacaine\ Correct Answer: c. Bupivacaine and ropivacaine** 23. **What local anesthetics (LA) are typically used for c-sections?\ a. Lidocaine and bupivacaine\ b. Lidocaine and 2-chloroprocaine\ c. Ropivacaine and bupivacaine\ d. Ropivacaine and 2-chloroprocaine\ Correct Answer: b. Lidocaine and 2-chloroprocaine** 24. **What cranial nerve is most affected by post-dural puncture headache (PDPH)?\ a. Optic nerve (CN II)\ b. Abducens nerve (CN VI)\ c. Facial nerve (CN VII)\ d. Vagus nerve (CN X)\ Correct Answer: b. Abducens nerve (CN VI)** 25. **What local anesthetics are associated with transient neurologic symptoms (TNS) and cauda equina syndrome?\ a. Lidocaine and 2-chloroprocaine\ b. Bupivacaine and ropivacaine\ c. Lidocaine and ropivacaine\ d. Chloroprocaine and ropivacaine\ Correct Answer: a. Lidocaine and 2-chloroprocaine** 26. **What complications are associated with volatile anesthetics in obstetric patients?\ a. Hypotension and fetal bradycardia\ b. High doses cause uterine atony and blood loss\ c. Uterine hypertonicity and fetal distress\ d. Increased fetal oxygenation and maternal hypertension\ Correct Answer: b. High doses cause uterine atony and blood loss** 27. **At what minimum alveolar concentration (MAC) is there no impaired oxytocin response?\ a. MAC \< 0.5\ b. MAC \< 0.75\ c. MAC \< 1.0\ d. MAC \< 1.5\ Correct Answer: b. MAC \< 0.75** 28. **By what mechanism are uterine contractions spared from the effects of neuromuscular blocking drugs (NMBD)?\ a. NMBDs do not cross the placenta\ b. Uterus is smooth muscle and is not affected by NMBDs\ c. NMBDs are metabolized before reaching the uterus\ d. Uterus has low receptor sensitivity to NMBDs\ Correct Answer: b. Uterus is smooth muscle and is not affected by NMBDs** 29. **When are induction medications administered during general anesthesia (GA) for an obstetric patient?\ a. Before the patient is positioned\ b. After fetal delivery\ c. When the patient is draped and the surgeon is ready to make the incision\ d. Immediately after intubation\ Correct Answer: c. When the patient is draped and the surgeon is ready to make the incision** 30. **What is gestational hypertension?\ a. SBP \> 140 or DBP \> 90 after 12 weeks of pregnancy\ b. SBP \> 140 or DBP \> 90 after 20 weeks of pregnancy\ c. SBP \> 150 or DBP \> 100 after 20 weeks of pregnancy\ d. SBP \> 160 or DBP \> 110 after 12 weeks of pregnancy\ Correct Answer: b. SBP \> 140 or DBP \> 90 after 20 weeks of pregnancy** 31. **What is pre-eclampsia?\ a. Gestational hypertension with proteinuria or protein/creatinine ratio of 0.3\ b. Gestational hypertension without proteinuria\ c. Gestational hypertension with pulmonary edema and thrombocytopenia\ d. Gestational hypertension with visual disturbances and liver impairment\ Correct Answer: a. Gestational hypertension with proteinuria or protein/creatinine ratio of 0.3** 32. **What is severe pre-eclampsia?\ a. Gestational hypertension with proteinuria only\ b. Gestational hypertension with thrombocytopenia, impaired liver function, progressive renal insufficiency, pulmonary edema, and visual abnormalities\ c. Gestational hypertension without proteinuria\ d. Gestational hypertension and seizures\ Correct Answer: b. Gestational hypertension with thrombocytopenia, impaired liver function, progressive renal insufficiency, pulmonary edema, and visual abnormalities** 33. **What is true about the pregnant patient with multiple sclerosis (MS)?\ a. Pregnancy is associated with worsening symptoms\ b. Pregnancy is associated with improvement in symptoms but worsening symptoms postpartum\ c. Symptoms remain stable throughout pregnancy and postpartum\ d. MS is unaffected by pregnancy\ Correct Answer: b. Pregnancy is associated with improvement in symptoms but worsening symptoms postpartum**