OB
What major vessels are you offloading when doing left uterine displacement
Aorta & IVC
How is Bupivacaine metabolized?
It is metabolized in the liver by the cytochrome P450 enzyme
What is the maximum size ETT that can fit through a Size 2 LMA?
A. 4 mm
B. 6 mm
C. 5 mm
D. 4.5 mm
C. 5 mm
Which stage of labor is cardiac output the highest?
Fourth stage of Labor
What is the correct size cuffed tube for a 4 year old who weights 19 kg.
A. 3.5 mm
B. 4.0 mm
C. 4.5 mm
D. 3.5 mm
C. 4.5 mm
(Age/4)+3.5 for a cuffed tube
(Age/4) +4 for a uncuffed tube
Which of the following hormones decrease during pregnancy?
A. Estrogen
B. Progesterone
C. Relaxin
D. Parathyroid Hormone
D. Parathyroid Hormone
What are characteristics of a placenta previa?
Painless Vaginal Bleeding
Why is the Jackson-Rees preferred for neonates over a circle system?
A. Reduced resistance and dead space
B. Improved humidification
C. Ability to scavenge anesthetic gases
D. Ability to provide PEEP
A. Reduced resistance and dead space
Low resistance and minimal dead space make it ideal for small patients.
Preeclampsia is said to be an imbalance between which two hormones?
Prostacyclin & Thromboxane
A 3-year-old (15 kg) requires succinylcholine for RSI. What’s the correct IV dose?
A. 0.5 mg/kg
B. 1 mg/kg
C. 2 mg/kg
D. 3 mg/kg
C. 2 mg/kg
Children need ~2 mg/kg IV due to larger volume of distribution and receptor differences.
What are the cause and effects of Dilutional Anemia in Pregnancy?
Cause: Increased intravascular Volume
Effects: Decreased RBC, Hematocrit 33-35%, Increased plasma volume
At term, What percentage of cardiac output is going to the uterus?
10% or around 900 ml/min
Why are neonates more sensitive to nondepolarizing muscle relaxants?
A. Decreased extracellular fluid volume
B. Immature hepatic metabolism
C. Decreased acetylcholine receptor affinity
D. Increased protein binding
B. Immature hepatic metabolism
Immature hepatic and renal clearance prolongs effects of nondepolarizers.
What does HELLP stand for?
Hemolysis
Elevated Liver Enzymes
Low Platelets
In neonates, which factor primarily determines cardiac output?
A. Heart rate
B. Stroke volume
C. Systemic vascular resistance
D. Preload
A. Heart Rate
Neonatal myocardium is noncompliant—cardiac output depends on heart rate.
How does gestation diabetes effect a fetus/newborn
Hypoglycemia
Large for gestational age
What are the four "T" of Hemorrhage
Tone (uterine atony)
Trauma (lacerations)
Tissue (retained placental fragments)
Thrombin (coagulation defects).
What’s the main reason neonates lose heat so rapidly during anesthesia?
A. Reduced surface area–to–mass ratio
B. Limited ability to vasoconstrict
C. Low total body water content
D. High levels of brown fat metabolism
B. Limited ability to vasoconstrict
Neonates cannot vasoconstrict effectively, promoting heat loss.
List 4 reasons why general anesthesia would be used in a labor and delivery
Hemodynamic instability
Patient refusal of neuraxial for C-section
Failed Regional block without ability to fix
Urgency of fetal status requiring delivery
When an infant becomes apneic under anesthesia, they desaturate faster because…
A. Increased FRC relative to body weight
B. Decreased oxygen consumption per kilogram
C. Lower alveolar ventilation relative to minute ventilation
D. High oxygen consumption and small FRC
D. High oxygen consumption and small FRC
Infants have high O₂ demand (6–8 mL/kg/min) and small FRC, leaving little oxygen reserve during apnea.
What symptoms can be seen for a serum magnesium level of 6 mg/dL.
Diminished deep tendon reflexes
Lethargy
Flushing
What type of ABG finding would you find in a pregnant patient and what is the cause?
Compensated Respiratory Alkalosis
Minute ventilation increases by 50% by term
Decrease in PCO2 and a Decrease in HCO3
What’s the maintenance IV rate for a 10-kg infant?
A. 20 mL/hr
B. 30 mL/hr
C. 40 mL/hr
D. 50 mL/hr
C. 40 mL/hr
Describe key characteristics of a Placental Abruption
Vaginal bleeding
Abdominal pain
Uterine Tenderness
A neonate has retractions after extubating. Why is the neonate at high risk for fatigue?
A. Abundance of Type I muscle fibers
B. Reliance on diaphragm with few fatigue-resistant fibers
C. Increased FRC
D. Increased airway smooth muscle tone
B. Reliance on diaphragm with few fatigue resistant fibers
The diaphragm has fewer Type I (fatigue-resistant) fibers, causing early fatigue.
Complete VEAL CHOP
Variable Deceleration --> Cord Compression
Early Decelerations --> Head Compression
Acceleration --> Ok
Late Decelerations --> Placental insufficiency
What are 4 uterotonics used during L & D? What class of drugs are each of them
Oxytocin - Natural hormone
Methergine - Ergot alkaloids
Hemabate - Prostaglandins
Cytotec - Prostaglandins
Compared with adults, a 2-year-old receiving inhalational anesthesia will require…
A. A lower MAC
B. A higher MAC
C. The same MAC
D. Lower MAC due to lower body temperature
B. A Higher MAC
Children have higher MAC requirements from increased CNS excitability and metabolic rate.
Describe the differences between a placenta Accreta, Increta, Percreta
Accreta- Implantation of the basal plate of the placenta directly to the uterine myometrium without invading the decidual layer
Increta -Placenta chorionic villi invades into the myometrium
Percreta- The placenta invades through the myometrium into the serosa and sometimes surrounding organs → most commonly the bladder
Why are infants more prone to airway obstruction compared with adults?
A. The epiglottis is shorter and less floppy
B. The larynx is located at C6 rather than C3–C4
C. The tongue is proportionally larger relative to the oral cavity
D. The narrowest portion of the airway is at the vocal cords
C. The tongue is proportionally larger relative to the oral cavity
Infants have a relatively larger tongue and smaller mandible, increasing risk of obstruction under anesthesia.