Obstetric Analgesia and Anaesthesia Multiple Choice Questions for Vol. 24, No. 3

  • 1.

    Regarding regional anaesthesia the following is/are true?

    • a.

      It is safe to site an epidural block after a prophylactic dose of low molecular heparin (LMWH) after 6 h

    • b.

      24 h should have elapsed before an epidural is sited after a therapeutic dose of LMWH

    • c.

      A regional block is contraindicated in a pregnant patient with HIV infection due to the risk of infective morbidity

    • d.

      A regional block is not advised in an otherwise healthy pregnant patient with a platelet count of 80 × 10 9

    • e.

      The platelet function must be measured with bleeding time prior to regional block with a platelet count of 80 × 10 9

  • 2.

    In a pregnant patient with severe aortic stenosis about to undergo an elective caesarean section, the following is/are true regarding anaesthetic drug administration:

    • a.

      A general anaesthetic is usually considered the safest option

    • b.

      A single shot spinal anaesthetic with a standard dose of local anaesthetic is acceptable

    • c.

      An epidural anaesthetic using an incremental technique with slow administration of epidural local anaesthetic is acceptable

    • d.

      A combined spinal epidural technique using a standard dose of spinal anaesthetic is acceptable

    • e.

      Administration of oxytocin should be avoided if possible due to adverse effects on venous return

  • 3.

    The following is/are the ultimate goal(s) of pharmacogenetics research:

    • a.

      To provide guidelines to pharmaceutical companies to help develop new drugs

    • b.

      To provide guidelines to help doctors tailor medicine to each individual’s unique genetic make-up

    • c.

      To make medicines safer and more effective for everyone

    • d.

      To identify individuals at risk for chronic diseases so that medical insurance companies can adjust their healthcare coverage

    • e.

      To help predict risks of adverse drug outcomes

  • 4.

    The β 2 -adrenergic receptor

    • a.

      Displays no genetic variability

    • b.

      Displays some genetic variability but with no clinical effects

    • c.

      Displays genetic variability but with no change in phenotype

    • d.

      Displays genetic variability and a haplotype has been shown to affect cardiovascular outcomes after acute coronary syndromes

    • e.

      Displays genetic variability and a haplotype has been shown to be associated with better responses to chemotherapy agents

  • 5.

    Genetic variability of β 2 -adrenergic receptor has been shown to influence

    • a.

      The response to bronchodilating agents

    • b.

      The response to tocolytics

    • c.

      The response to β-blockers

    • d.

      The response to vasopressors

    • e.

      The response to ACE inhibitors

  • 6.

    Future implications of pharmacogenetics research include(s) the following step(s):

    • a.

      Establishing lists of candidate genes involved in pharmacokinetic and pharmacodynamics variability

    • b.

      The study of relevant SNPs and their putative function

    • c.

      Randomized clinical trials stratified per genotype

    • d.

      Identification of sub-populations of patients for which targeted strategies should be provided

    • e.

      To identify SNPs for all drugs

  • 7.

    The neonatal effects of pethidine given for labour analgesia:

    • a.

      are most severe if it is given 3 h or more before delivery

    • b.

      are slight if it is given only during the last hour of labour

    • c.

      include respiratory depression

    • d.

      include a reduction in umbilical artery pH and base excess

    • e.

      are due in part to an active metabolite

  • 8.

    Epidural analgesia in labour:

    • a.

      exacerbates neonatal metabolic acidosis

    • b.

      is associated with lower Apgar scores than systemic analgesia

    • c.

      is associated with improved neonatal acid-base balance

    • d.

      if sited after starting a Syntocinon infusion, the infusion should be discontinued during epidural insertion

    • e.

      precludes early mother-infant bonding

  • 9.

    Maternal hyperventilation in response to pain in unmodified labour has been shown to lead to:

    • a.

      Respiratory alkalosis

    • b.

      Compensatory metabolic acidosis

    • c.

      Hypoventilation episodes

    • d.

      Haemoglobin desaturation

    • e.

      Uterine vasoconstriction

  • 10.

    The following is/are true regarding Entonox

    • a.

      It is the most popular analgesic for labour in the UK

    • b.

      Nitrous oxide passes readily across the placenta

    • c.

      It is rapidly excreted by the newborn lungs

    • d.

      Has been shown to have little apparent effect on Apgar scores

    • e.

      Has been shown to have little apparent effect on acid-base balance

  • 11.

    The effect(s) produced by raised plasma magnesium on the cardiovascular system include(s) the following:

    • a.

      Stable blood pressure and no significant change in haemodynamic variables.

    • b.

      Increased cardiac output and stroke volume.

    • c.

      Increased risk of hypotension during epidural analgesia.

    • d.

      The need for larger doses of phenylephrine to maintain arterial pressure during epidural or spinal analgesia.

    • e.

      Cardiac toxicity, with cardiac arrest at concentrations around 7 mmol/L.

  • 12.

    Elevated plasma magnesium concentrations produce the following physiological change(s):

    • a.

      Decreased acetylcholine release at the motor endplate that may contribute to neuromuscular weakness.

    • b.

      Direct depression of central respiratory drive, decreasing the CO 2 response curve.

    • c.

      Reduction in intracranial pressure through cerebral vasoconstriction.

    • d.

      Clinically relevant inhibition of platelet function that contributes to increased bleeding during operative delivery.

    • e.

      Reductions in catecholamine release and activity that are of value in hypertensive emergencies.

  • 13.

    In pre-eclampsia, magnesium:

    • a.

      has been proven to be superior to phenytoin or diazepam for the prevention of convulsions in pre-eclampsia and for the control of recurrent convulsions in eclamptic patients,

    • b.

      has no direct anticonvulsant activity in the brain and prevents convulsions primarily by inhibiting neuromuscular activity through inhibition of acetylcholine release,

    • c.

      may contribute to inadequate uterine contraction, resulting in prolonged labour and an increased risk of postpartum haemorrhage,

    • d.

      decreases foetal heart rate variability and may be associated with hypotonia in the neonate,

    • e.

      has a very narrow therapeutic index

  • 14.

    In premature labour, magnesium:

    • a.

      Is more effective than placebo in delaying labour for 48 h,

    • b.

      Has proven risks of cardiac failure if combined with calcium antagonists,

    • c.

      Should be given in higher doses than those traditionally used for management of pre-eclampsia

    • d.

      Has been associated in recent meta-analyses with a reduction in the risk of cerebral palsy in the premature neonate

    • e.

      Has been largely discarded as a tocolytic in the USA.

  • 15.

    The following conditions significantly increase maternal mortality rates:

    • a.

      asthma.

    • b.

      pulmonary hypertension.

    • c.

      mitral valve prolapse.

    • d.

      sickle cell disease.

    • e.

      psychiatric illness.

  • 16.

    Epidural analgesia during labour is contraindicated in women with:

    • a.

      cardiac conditions that lead to a fixed cardiac output.

    • b.

      untreated streptococcal pneumonia.

    • c.

      paraplegia with spinal transection at T7.

    • d.

      multiple sclerosis.

    • e.

      schizophrenia who do not consent to the procedure.

  • 17.

    General anaesthesia for caesarean section:

    • a.

      should be avoided in myotonic disorders.

    • b.

      is the method of choice for a mother with a history of crack-cocaine and heroin abuse.

    • c.

      must be avoided in epileptic patients as it provokes seizures.

    • d.

      always requires the use of suxamethonium.

    • e.

      is unsafe if an uncorrected coagulopathy exists.

  • 18.

    An obese parturient is more likely than a normal patient to demonstrate

    • a.

      Difficulty of tracheal intubation

    • b.

      Hypoxaemia during induction of general anaesthesia

    • c.

      Hypertension

    • d.

      Increased incidence of venous thromboembolism

    • e.

      A decreased in rate of lower segment caesarean section with increasing BMI

  • 19.

    The following statement(s) is/are true about pregnancy:

    • a.

      Gastrointestinal motility and stomach acidity is unchanged during labour

    • b.

      Resuscitation of pregnant patients should follow appropriate guidelines which include left lateral tilt to avoid supine hypotension.

    • c.

      Pregnancy-induced changes in lung volumes cause desaturation to occur more rapidly than in non-pregnant patients during induction of general anaesthesia

    • d.

      The stomach is pushed up against the left hemi-diaphragm by the gravid uterus in late pregnancy, which contributes to the risk of aspiration during induction of general anaesthesia.

    • e.

      There is a reduced risk of difficult airway in pregnant patients who undergo general anaesthesia for emergency surgery.

  • 20.

    The following statements are true regarding regional anaesthesia:

    • a.

      Ephedrine is a better pressor to use in the mother for treatment of hypotension post spinal anaesthesia compared to phenylephrine because the former is better at maintaining utero-placental blood flow

    • b.

      Overall, mortality after general anaesthesia is greater than for regional anaesthesia for caesarean section delivery

    • c.

      When compared to single-shot spinal anaesthesia, a combined spinal-epidural technique for caesarean section for an obese parturient permits more control over the duration of surgery

    • d.

      High risk pregnant patients e.g. morbidly obese parturient, should have a functioning epidural catheter placed early in labour.

    • e.

      Spinal anaesthesia should not be used for emergency caesarean section because it is slower than general anaesthesia.

  • 21.

    Factors that are shown to help in improving fetal outcome are:

    • a.

      Displacement of the uterus by turning the patient to the left lateral position during fetal bradycardia

    • b.

      Increased decision-to-delivery interval

    • c.

      Continuous foetal monitoring after insertion of epidural/combined spinal epidural for labour analgesia

    • d.

      Giving 100% oxygen to the mother during fetal distress

    • e.

      Good communication between obstetricians, midwives and anaesthetists for high-risk pregnancies.

  • 22.

    The following statement(s) is/are true about changes to the haematological system during pregnancy:

    • a.

      the increase in clotting activity is highest during the second trimester

    • b.

      all coagulation factors increase during pregnancy

    • c.

      platelet count is often less then 100 × 10 9 L −1

    • d.

      fibrinolysis is reduced

    • e.

      neuraxial haematomas are common in obstetric anaesthesia

  • 23.

    The following statement(s) is/are true about von Willebrand disease:

    • a.

      There are three types of von Willebrand disease

    • b.

      Transmission is recessive

    • c.

      laboratory diagnosis only needs von Willebrand factor measurement

    • d.

      Women with vWd in pregnancy generally have good pregnancy outcomes

    • e.

      Neuraxial blocks are safe in all types of vWd

  • 24.

    Thromboembolic disease:

    • a.

      Affects 100 per 1,000,000 pregnancies

    • b.

      is more common following vaginal rather then cesarean delivery

    • c.

      the risk of thromboembolism is greatest in the first trimester

    • d.

      LMWH is commonly used for thromboprophylaxis in pregnancy

    • e.

      Inherited thrombophilias increase the risk of thromboembolism in pregnancy

  • 25.

    Which of the following statement(s) is/are true about ergometrine?

    • a.

      Ergometrine causes nausea and vomiting

    • b.

      Ergometrine is associated with pyrexia

    • c.

      Pre-eclampsia is a contra-indication to ergometrine

    • d.

      Ergometrine can be given rectally

    • e.

      Ergometrine should not be given to an asthmatic

  • 26.

    Donor blood

    • a.

      Has immediate good oxygen carrying capacity

    • b.

      Can cause hypokalaemia

    • c.

      Can cause hypocalcaemia

    • d.

      Should be warmed during transfusion

    • e.

      Is more expensive than the disposable kit for the cell salvage machine

  • 27.

    Jehovah’s witnesses

    • a.

      Will refuse all blood products

    • b.

      Have no increased risk of dying in pregnancy compared to a non-Jehovah’s witness

    • c.

      Should be delivered at home

    • d.

      Should have an active third stage

    • e.

      Will all refuse cell salvage

  • 28.

    Which of the following statement(s) is/are true about surgical techniques for major haemorrhage

    • a.

      Insertion of tamponade balloons does not require general anaesthesia

    • b.

      Rusch/Bakri balloons are deflated immediately after bleeding ceases

    • c.

      Compression sutures must be removed before subsequent pregnancies

    • d.

      Bilateral ligation of the uterine arteries will not cause complete cessation of bleeding

    • e.

      Subtotal hysterectomy should be performed in persistently bleeding women

  • 29.

    There are accurate estimates of the following type of nerve injury after neuraxial analgesia during childbirth?

    • a.

      Direct trauma to the spinal cord from the epidural or spinal needle.

    • b.

      Palsy of a lower extremity peripheral nerve.

    • c.

      Spinal cord compression from a spinal-epidural hematoma.

    • d.

      Spinal cord compression from an epidural abscess.

    • e.

      Abducens nerve palsy.

  • 30.

    Meningitis associated with neuraxial procedures is caused by which of the following organisms?

    • a.

      Streptococcus salivarius

    • b.

      Streptococcus pneumoniae

    • c.

      Neisseria meningitis

    • d.

      Haemophilus influenza

    • e.

      Staphylococcus aureus

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Nov 9, 2017 | Posted by in OBSTETRICS | Comments Off on Obstetric Analgesia and Anaesthesia Multiple Choice Questions for Vol. 24, No. 3

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