OB Anesthesia Questions PDF

**Which of the following correctly defines the stages of labor?**\ A. Stage 1: Onset of contractions to complete dilation; Stage 2: Fetal delivery; Stage 3: Placenta delivery\ B. Stage 1: Contractions to placental delivery; Stage 2: Cervical dilation; Stage 3: Postpartum recovery\ C. Stage 1: Cervic...

**Which of the following correctly defines the stages of labor?**\ A. Stage 1: Onset of contractions to complete dilation; Stage 2: Fetal delivery; Stage 3: Placenta delivery\ B. Stage 1: Contractions to placental delivery; Stage 2: Cervical dilation; Stage 3: Postpartum recovery\ C. Stage 1: Cervical dilation; Stage 2: Placental delivery; Stage 3: Fetal delivery\ D. Stage 1: Onset of contractions to complete effacement; Stage 2: Uterine recovery; Stage 3: Delivery of fetus\ **Answer**: A **Why is aortocaval compression concerning in pregnant patients during the supine position?**\ A. It causes an increase in maternal cardiac output.\ B. It compresses the inferior vena cava and aortoiliac vessels, decreasing preload.\ C. It leads to increased blood flow to the uterus.\ D. It enhances oxygenation by improving venous return.\ **Answer**: B **Which physiologic change contributes to dilutional anemia during pregnancy?**\ A. Increased cardiac output\ B. Plasma volume increases more than red blood cell volume\ C. Decreased vascular resistance\ D. Increased hematopoiesis\ **Answer**: B **What is the most effective way to prevent supine hypotension in a parturient?**\ A. Administer phenylephrine.\ B. Use left uterine displacement.\ C. Avoid neuraxial anesthesia.\ D. Provide aggressive fluid boluses.\ **Answer**: B **Which respiratory change makes pregnant patients more prone to rapid desaturation during apnea?**\ A. Increased minute ventilation\ B. Reduced functional residual capacity and closing capacity\ C. Increased inspiratory capacity\ D. Decreased tidal volume\ **Answer**: B **Which fetal heart rate (FHR) pattern is most concerning?**\ A. Accelerations\ B. Early decelerations\ C. Variable decelerations without variability\ D. Late decelerations with moderate variability\ **Answer**: C **What is the primary cause of postdural puncture headache (PDPH)?**\ A. Intracranial hypertension\ B. Leakage of cerebrospinal fluid from the puncture site\ C. Compression of epidural veins\ D. Fetal head engagement causing nerve irritation\ **Answer**: B **Which medication is most appropriate to treat uterine atony in a hypertensive patient?**\ A. Oxytocin\ B. Methylergonovine\ C. Prostaglandin F2α\ D. Nitroglycerin\ **Answer**: A 11. **Which symptom indicates aortocaval compression during pregnancy?**\ A. Tachycardia and hypertension\ B. Diaphoresis, nausea, and hypotension\ C. Polyuria and headache\ D. Fever and bradycardia\ **Answer**: B 12. **What is the most significant contributor to the increased risk of venous thromboembolism (VTE) in pregnancy?**\ A. Increased platelet count\ B. Increased clotting factors and hypercoagulable state\ C. Decreased plasma volume\ D. Increased protein S activity\ **Answer**: B 13. **How is maternal cardiac output affected immediately postpartum?**\ A. It decreases due to loss of preload.\ B. It increases significantly due to autotransfusion and decreased venous capacitance.\ C. It remains stable compared to intrapartum levels.\ D. It decreases due to increased vascular resistance.\ **Answer**: B 14. **What is the primary reason for decreased maternal PaCO2 during pregnancy?**\ A. Increased respiratory rate and tidal volume\ B. Decreased metabolic demand\ C. Increased closing capacity\ D. Decreased oxygen consumption\ **Answer**: A 15. **Which anesthetic consideration is most relevant for a patient with gestational thrombocytopenia and platelet count of 65,000/mm³?**\ A. Avoid regional anesthesia due to risk of bleeding.\ B. Neuraxial anesthesia is safe without additional monitoring.\ C. Platelet transfusion is required before surgery.\ D. Administer anticoagulation prophylaxis before delivery.\ **Answer**: A 16. **Why is labor analgesia not associated with delayed labor progression?**\ A. Neuraxial analgesia only affects somatic pain pathways.\ B. Dilute local anesthetic and opioids do not significantly affect uterine contractions.\ C. Neuraxial analgesia promotes uterine contractions by reducing catecholamines.\ D. The effects are limited to motor blockade, sparing sensory fibers.\ **Answer**: B 17. **Which physiologic adaptation explains why pregnant patients have a higher risk of difficult airway management?**\ A. Increased minute ventilation\ B. Decreased inspiratory capacity\ C. Engorgement of airway capillaries and edema\ D. Decreased closing capacity\ **Answer**: C 18. **What is the most likely cause of decreased maternal PaCO2 during painful contractions?**\ A. Hypoventilation\ B. Hyperventilation due to pain-induced tachypnea\ C. Increased functional residual capacity\ D. Decreased tidal volume\ **Answer**: B 19. **Which medication combination is recommended to reduce the risk of aspiration during induction in a parturient?**\ A. Sodium citrate and metoclopramide\ B. Lidocaine and ondansetron\ C. Phenylephrine and ephedrine\ D. Heparin and naloxone\ **Answer**: A 20. **How does hypocapnia during pregnancy affect uteroplacental blood flow?**\ A. It increases uterine vascular resistance, decreasing blood flow.\ B. It enhances placental perfusion.\ C. It reduces fetal oxygenation by lowering maternal PaCO2.\ D. It causes maternal hypertension, improving fetal perfusion.\ **Answer**: A 21. **Which uteroplacental adaptation allows continuous oxygen and nutrient delivery to the fetus during contractions?**\ A. Increased uterine vascular resistance\ B. Large intervillous space\ C. Autoregulation of uterine blood flow\ D. Leftward shift of maternal oxyhemoglobin dissociation curve\ **Answer**: B 22. **What intervention is indicated for a patient experiencing fetal bradycardia due to umbilical cord compression?**\ A. Administer magnesium sulfate.\ B. Relieve cord compression by maternal repositioning.\ C. Perform an emergency cesarean section immediately.\ D. Discontinue oxygen supplementation.\ **Answer**: B 23. **What is the preferred treatment for tachysystole in labor?**\ A. Nitroglycerin or beta-2 agonists\ B. Oxytocin infusion\ C. Magnesium sulfate\ D. Sodium bicarbonate\ **Answer**: A 24. **Why do laboring women with neuraxial analgesia require close monitoring of blood pressure?**\ A. Increased risk of seizure activity\ B. Sympathetic blockade decreases systemic vascular resistance, leading to hypotension.\ C. Hypertension due to epidural opioid use is common.\ D. Intrathecal local anesthetics increase preload.\ **Answer**: B 25. **Which factor increases the likelihood of uterine atony?**\ A. Use of volatile anesthetics\ B. Retained placental tissue\ C. Use of terbutaline\ D. All of the above\ **Answer**: D 26. **What is the most appropriate initial treatment for postpartum uterine atony?**\ A. Oxytocin infusion and manual massage\ B. Magnesium sulfate administration\ C. Maternal repositioning to the left side\ D. Prostaglandin E2 bolus\ **Answer**: A 27. **Which medication is NOT safe for treating postpartum hemorrhage in a hypertensive patient?**\ A. Oxytocin\ B. Misoprostol\ C. Methylergonovine\ D. Carboprost tromethamine\ **Answer**: C 28. **Which physiologic change during pregnancy impacts the effectiveness of general anesthetics?**\ A. Decreased MAC requirement by 25-30%\ B. Increased functional residual capacity\ C. Enhanced protein binding of drugs\ D. Increased hepatic metabolism of anesthetics\ **Answer**: A 31. **Which fetal circulation shunt bypasses the liver?**\ A. Ductus arteriosus\ B. Foramen ovale\ C. Umbilical vein\ D. Ductus venosus\ **Answer**: D 32. **What is the mechanism of ion trapping of local anesthetics in the fetus?**\ A. High molecular weight of the drug\ B. Acidic fetal pH ionizing the drug, preventing it from crossing back to the maternal circulation\ C. Increased protein binding of the drug in the fetus\ D. Poor lipid solubility of the drug\ **Answer**: B 33. **Which change in maternal respiratory physiology increases the risk of rapid desaturation during apnea?**\ A. Decreased functional residual capacity (FRC)\ B. Increased oxygen consumption\ C. Reduced expiratory reserve volume\ D. All of the above\ **Answer**: D 34. **Which drug is most effective in treating maternal hypotension during spinal anesthesia?**\ A. Ephedrine\ B. Phenylephrine\ C. Atropine\ D. Dopamine\ **Answer**: B 35. **What is the primary determinant of placental drug transfer?**\ A. Drug solubility in water\ B. Maternal blood concentration of the drug\ C. Fetal protein binding of the drug\ D. Placental enzymatic activity\ **Answer**: B 36. **Why is the closing capacity reduced during pregnancy?**\ A. Increased airway resistance\ B. Decreased lung compliance\ C. Compression of the diaphragm by the gravid uterus\ D. Hyperventilation\ **Answer**: C 37. **Which stage of labor is most affected by dense neuraxial anesthesia?**\ A. Stage 1\ B. Stage 2\ C. Stage 3\ D. No stage is significantly affected\ **Answer**: B 38. **Which change occurs in uteroplacental circulation during contractions?**\ A. Increased uterine blood flow\ B. Reduced perfusion due to increased vascular resistance\ C. Continuous perfusion due to autoregulation\ D. Enhanced diffusion capacity of the placenta\ **Answer**: B 39. **Which symptom is most concerning for amniotic fluid embolism?**\ A. Maternal hypertension and tachycardia\ B. Respiratory distress and disseminated intravascular coagulation (DIC)\ C. Increased fetal heart rate variability\ D. Abdominal pain and uterine rupture\ **Answer**: B 40. **What is the primary function of the ductus arteriosus in fetal circulation?**\ A. To bypass the liver\ B. To connect the pulmonary artery to the aorta\ C. To shunt blood from the right atrium to the left atrium\ D. To supply oxygenated blood to the liver\ **Answer**: B 41. **Which drug combination is most appropriate for the treatment of amniotic fluid embolism?**\ A. AOK = Atropine, ondansetron, and ketorolac\ B. Oxytocin, phenylephrine, and magnesium sulfate\ C. Fentanyl, naloxone, and ephedrine\ D. Methergine, misoprostol, and nitroglycerin\ **Answer**: A 42. **Why is phenylephrine preferred over ephedrine for treating hypotension in parturients?**\ A. It increases fetal oxygenation by maintaining maternal blood pressure without reducing uteroplacental perfusion.\ B. It reduces maternal cardiac output more effectively than ephedrine.\ C. It has no effect on the fetal heart rate.\ D. It selectively vasodilates uteroplacental vessels.\ **Answer**: A 43. **Which condition requires emergent cesarean section to prevent fetal compromise?**\ A. Prolonged decelerations with loss of variability\ B. Early decelerations during contractions\ C. Maternal fever with tachycardia\ D. Maternal nausea and vomiting\ **Answer**: A 51. **What is the primary benefit of co-loading fluids during spinal anesthesia for cesarean delivery?**\ A. To prevent maternal aspiration\ B. To minimize maternal hypotension\ C. To enhance the effectiveness of neuraxial blockade\ D. To reduce the need for vasopressors\ **Answer**: B 52. **What is the recommended treatment for a postdural puncture headache?**\ A. Intravenous fluids and oxygen supplementation\ B. Epidural blood patch with 15-20 mL of autologous blood\ C. Administration of nitroglycerin\ D. High-dose corticosteroids\ **Answer**: B 53. **Which medication is most likely to cause neonatal respiratory depression if administered in labor due to accumulation of active metabolites?**\ A. Fentanyl\ B. Meperidine\ C. Lidocaine\ D. Nitrous oxide\ **Answer**: B 54. **What is the physiologic explanation for the rightward shift of the maternal oxyhemoglobin dissociation curve during pregnancy?**\ A. Increased binding affinity of hemoglobin for oxygen\ B. Increased oxygen unloading to meet fetal demands\ C. Decreased maternal metabolic rate\ D. Decreased plasma volume\ **Answer**: B 55. **What is the recommended ETT size to use in pregnant patients? 6-6.5 due to vocal cord and arytenoid edema** 56. **Which placental condition requires an elective cesarean section before labor begins?**\ A. Placenta previa\ B. Placental abruption\ C. Abruptio placenta\ D. Uterine atony\ **Answer**: A 57. **Which fetal circulation feature bypasses pulmonary circulation?**\ A. Foramen ovale\ B. Ductus venosus\ C. Umbilical vein\ D. Umbilical artery\ **Answer**: A 58. **Which is a sign of uterine rupture during labor?**\ A. Increased uterine tone between contractions\ B. Fetal bradycardia, loss of station, cessation of uterine contractions\ C. Prolonged variable decelerations\ D. Increased maternal blood pressure\ **Answer**: B 59. **What is the most appropriate management for a Category III fetal heart rate tracing?**\ A. Administer magnesium sulfate and observe.\ B. Continue oxytocin augmentation.\ C. Initiate intrauterine resuscitation measures immediately.\ D. Perform scalp pH sampling.\ **Answer**: C 60. **When is the highest risk of VTE?** Postpartum 61. **Why should NSAIDs be avoided in late pregnancy?**\ A. They increase maternal blood pressure.\ B. They cause premature closure of the ductus arteriosus and fetal renal injury.\ C. They prolong uterine contractions.\ D. They inhibit maternal hemoglobin production.\ **Answer**: B 62. **What is the significance of a sinusoidal fetal heart rate pattern?**\ A. Normal finding in preterm fetuses\ B. Associated with fetal well-being\ C. Indicates fetal anemia or acidemia\ D. Reflects maternal metabolic derangement\ **Answer**: C 63. **Which medication is most appropriate for preeclampsia with severe features?**\ A. Oxytocin\ B. Magnesium sulfate\ C. Methergine\ D. Phenylephrine\ **Answer**: B 64. **Which maternal cardiac condition requires careful titration of neuraxial anesthesia to maintain preload?**\ A. Aortic stenosis\ B. Pulmonary hypertension\ C. Mitral regurgitation\ D. Patent foramen ovale\ **Answer**: A 71. **What physiologic change makes maternal cardiac output dependent on heart rate during labor?**\ A. Decreased preload\ B. Reduced preload and stroke volume during uterine contractions\ C. Increased systemic vascular resistance\ D. Increased uterine vascular tone\ **Answer**: B 72. **What effect does magnesium sulfate have on neuromuscular blocking agents?**\ A. Reduces the onset time of succinylcholine\ B. Potentiates non-depolarizing neuromuscular blockers\ C. Decreases the duration of blockade\ D. Enhances metabolism of blocking agents\ **Answer**: B 73. **Which fetal circulation shunt primarily directs oxygenated blood from the umbilical vein to the systemic circulation?**\ A. Foramen ovale\ B. Ductus arteriosus\ C. Ductus venosus\ D. Umbilical artery\ **Answer**: C 74. **Which physiologic adaptation to pregnancy facilitates venous stasis in the lower extremities?**\ A. Increased blood viscosity\ B. Compression of the inferior vena cava by the gravid uterus\ C. Decreased plasma volume\ D. Enhanced peripheral vasodilation\ **Answer**: B 75. **What causes the greatest increase in cardiac output immediately postpartum?**\ A. Increased sympathetic tone\ B. Increased preload from uterine autotransfusion\ C. Increased uteroplacental blood flow\ D. Enhanced myocardial contractility\ **Answer**: B 76. **What condition is characterized by painless vaginal bleeding during the third trimester?**\ A. Placenta previa\ B. Placental abruption\ C. Uterine rupture\ D. Uterine tonicity\ **Answer**: A 77. **What is the most common side effect of adding intrathecal opioids to neuraxial anesthesia?**\ A. Pruritus\ B. Hypotension\ C. Respiratory depression\ D. Tachycardia\ **Answer**: A 78. **Which uterotonic drug is contraindicated in hypertensive patients due to its vasoconstrictive effects?**\ A. Methylergonovine\ B. Misoprostol\ C. Carboprost tromethamine\ D. Oxytocin\ **Answer**: A 79. **Why is a combined spinal-epidural (CSE) technique often used for labor analgesia?**\ A. Eliminates the need for a test dose\ B. Provides rapid onset of analgesia with the option for continuous infusion\ C. Reduces the risk of hypotension compared to spinal anesthesia\ D. Requires lower doses of local anesthetics compared to epidural alone\ **Answer**: B 80. **Which maternal condition most commonly necessitates the use of general anesthesia during a cesarean section?**\ A. Elective cesarean delivery\ B. Severe coagulopathy\ C. Multiple gestations\ D. History of epidural placement\ **Answer**: B 81. **What is the most appropriate anesthetic technique for fetal distress during labor?**\ A. General anesthesia for immediate cesarean delivery\ B. Epidural anesthesia to facilitate vaginal delivery\ C. Neuraxial blockade for fetal monitoring\ D. Intravenous sedation to relax uterine tone\ **Answer**: A 82. **What is the safest time during pregnancy for non-obstetric surgery?**\ A. First trimester\ B. Second trimester\ C. Third trimester\ D. Postpartum period\ **Answer**: B 83. **Which placental condition involves fetal blood vessels crossing over the cervical os?**\ A. Placenta previa\ B. Placental abruption\ C. Vasa previa\ D. Placental accreta\ **Answer**: C 91. **What is the most likely explanation for fetal bradycardia after administration of spinal anesthesia during a cesarean section?**\ A. Decreased maternal cardiac output and uteroplacental perfusion\ B. Direct fetal exposure to local anesthetic\ C. Increased uterine tone from neuraxial blockade\ D. Maternal hyperventilation causing fetal hypoxia\ **Answer**: A 92. **Which uterine abnormality is associated with abnormal adherence or invasion of the placenta into the uterine wall?**\ A. Placenta previa\ B. Placenta accreta\ C. Placental abruption\ D. Vasa previa\ **Answer**: B 93. **Which intervention is most appropriate for a prolapsed umbilical cord?**\ A. Emergency cesarean delivery with maternal repositioning to relieve compression\ B. Administration of oxytocin to enhance contractions\ C. Use of uterotonic agents to stimulate uterine activity\ D. Epidural analgesia to facilitate vaginal delivery\ **Answer**: A 94. **Why is it important to avoid hypocapnia during laparoscopic surgery in pregnant patients?**\ A. It increases the risk of preterm labor.\ B. It reduces uteroplacental perfusion due to vasoconstriction.\ C. It enhances maternal oxygen consumption.\ D. It decreases fetal respiratory effort after delivery.\ **Answer**: B 95. **Which factor most increases the risk of developing aspiration pneumonitis during pregnancy?**\ A. Reduced gastric emptying and increased gastric acidity\ B. Increased functional residual capacity\ C. Hyperdynamic circulation during pregnancy\ D. Increased uterine blood flow\ **Answer**: A 96. **What is the significance of reduced albumin levels during pregnancy?**\ A. Decreased uterine perfusion\ B. Reduced drug binding, increasing free drug concentrations\ C. Enhanced renal clearance of protein-bound drugs\ D. Decreased oncotic pressure leading to increased fetal edema\ **Answer**: B 97. **Which is the primary concern with excessive uterine contractions during labor?**\ A. Increased risk of postpartum hemorrhage\ B. Reduced fetal oxygenation due to uteroplacental insufficiency\ C. Enhanced maternal blood pressure\ D. Increased maternal cardiac output\ **Answer**: B 98. **Which anesthetic drug can be used for rapid induction during an emergency cesarean section?**\ A. Propofol\ B. Ketamine\ C. Etomidate\ D. All of the above\ **Answer**: D 101. **What hematologic change during pregnancy helps compensate for estimated blood loss (EBL) during delivery?**\ A. Increased erythropoietin production\ B. Increased plasma volume\ C. Decreased clotting factor synthesis\ D. Increased antithrombin III levels\ **Answer**: B 102. **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 103. **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 104. **Which coagulation factor decreases during pregnancy?**\ A. Factor VII\ B. Factor XII\ C. Protein S\ D. Factor X\ **Answer**: C 105. **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 106. **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 107. **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 108. **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 109. **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 110. **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 111. **Which fetal shunt allows oxygenated blood to bypass the lungs?**\ A. Umbilical artery\ B. Ductus arteriosus\ C. Umbilical vein\ D. Portal vein\ **Answer**: B 112. **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 113. **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 114. **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 115. **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 116. **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 117. **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 118. **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 119. **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 120. **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 121. **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 122. **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 123. **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**