OB 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**