El contexto familiar como base para el desarrollo socio-emocional del niño

25–1.

Approximately what percentage o maternal deaths are attributable to anesthetic complications?

a.

^1.2%

b.

^2.4%

c.

^3.6%

d.

^4.8%

25–2.

Which o the ollowing statements is true regarding the American College o Obstetricians and

Gynecologists opinion on which patients should receive anesthesia in labor?

a.

All patients with heart disease

b.

All patients with severe preeclampsia

c.

All patients with gestational diabetes

d.

Any woman who requests it and has no contraindication to its administration

25–3.

Which parenteral anesthetic agent has the shortest neonatal hal -li e?

a.

^Morphine

b.

^Nalbuphine

c.

^Meperidine

d.

Butorphanol

25–4.

What is the hal -li e o meperidine in the newborn?

a.

^{4 hr}

b.

^{9 hr}

c.

^{13 hr}

d.

^{21 hr}

25–5.

What percentage o newborns will need naloxone treatment in the delivery room i their mother has received meperidine in labor?

a.

^1%

b.

^3%

c.

^5%

d.

^10%

25–6.

Which patient should not receive naloxone while in labor?

a.

A patient with severe preeclampsia

b.

A patient with respiratory depression

c.

A newborn o a narcotic-addicted mother

d.

A patient who has just received intravenous morphine

25–7.

What is the direct cause o most maternal deaths involving regional anesthesia?

a.

Drug reaction

b.

Cardiac arrhythmia

c.

High spinal blockade

d.

Central nervous system in ection

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167 25–8.

In the igure below, blockade at which sensory level

would provide the best analgesia during early labor?

Modif ed with permission rom Eltzschig HK, Lieberman ES, Camann WR: Medical progress: regional anesthesia and analgesia or labor and delivery. N Engl J Med 348:

319-332, 2003, Figure 1.

a.

b.

c.

d.

25–9.

Which nerve is primarily involved with the pain associated with perineal stretching?

a.

Ischial nerve

b.

Pudendal nerve

c.

Hypogastric nerve

d.

Frankenhäuser ganglion

25–10.

In the image shown below, which ligament is the needle passing through to reach the pudendal nerve?

Modif ed with permission rom Cunningham FG, Leveno KJ, Bloom SL, et al (eds):

Obstetrical analgesia and anesthesia. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 25-2.

a.

Pudendal ligament

b.

Sacroiliac ligament

c.

Sacrospinous ligament

d.

Sacrotuberous ligament

25–11.

Which o the ollowing statements is true regarding butorphanol in labor?

a.

Neonatal depression is greater than with meperidine.

b.

It can be administered contiguously with meperidine.

c.

It can be associated with a transient sinusoidal etal heart rate.

d.

All o the above

25–12.

A patient in early labor is sitting up or her epidural.

An anesthetic test dose is given. The patient’s heart rate and blood pressure rise immediately a ter

administration o the test dose. What has most likely caused her change in vital signs?

a.

The patient just had a contraction.

b.

The test dose was given intravenously.

c.

The text dose created high spinal blockade.

d.

None o the above

La bor

SECTION7

168 25–13.

A diabetic, preeclamptic patient requires cesarean delivery or breech presentation and is sitting up or a spinal anesthetic block. A ter administration o her spinal block, she has a seizure. Which o the ollowing diagnoses should be considered in the di erential?

a.

Eclamptic seizure

b.

High spinal blockade

c.

Pro ound hypoglycemia

d.

All o the above

25–14.

Re erring to the patient in Question 25–13, the etal heart rate tracing is notable or bradycardia while the patient is seizing. Which drug would be most help ul in allowing intubation o the patient?

a.

Diazepam

b.

Succinylcholine

c.

Magnesium sul ate

d.

All o the above

25–15.

Which anesthetic is associated with neurotoxicity and cardiotoxicity at virtually identical serum drug levels? the quality o regional anesthesia that reaches the dermatome level marked by the X in this igure?

Obstetrical analgesia and anesthesia. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 25-4A.

a.

It is adequate or orceps delivery.

b.

It is adequate or a cesarean delivery.

c.

It is adequate or spontaneous vaginal delivery.

d.

All o the above

25–17.

Using the same image in Question 25–16, regional anesthesia that reaches which dermatome level is required or cesarean delivery?

a.

T₄

b.

T₆

c.

T₈

d.

T₁₀

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169 25–18.

Which complication occurs with approximately 15%

o paracervical blocks?

a.

In ection

b.

Fetal bradycardia

c.

Hematoma ormation

d.

Intravascular injection

25–19.

What is the main reason or the addition o glucose to the anesthetic agents chosen or a spinal blockade?

a.

To make the solution hyperbaric

b.

To make the solution hypertonic

c.

To provide glucose to the patient, who should be NPO

d.

To minimize hypotension associated with spinal blockade

25–20.

When used prophylactically in the obstetrical anesthesia setting, which vasopressor has been associated with etal acidemia?

a.

Ephedrine

b.

Ergonovine

c.

Phenylephrine

d.

Methylergonovine

25–21.

Which o the ollowing interventions has been

shown to reduce the incidence o postdural puncture headache?

a.

Vigorous prehydration

b.

Prophylactic blood patch

c.

Use o a smaller-gauge needle

d.

Keeping the patient supine during labor

25–22.

Absolute contraindications to regional anesthesia include all EXCEPT which o the ollowing?

a.

Scoliosis

b.

Maternal coagulopathy

c.

Skin in ection over the site o needle placement

d.

Use o low-molecular-weight heparin in the prior 6 hours

25–23.

Which structure in the image here is identi ied by the letter X?

a.

Dura mater

b.

Epidural space

c.

Ligamentum lavum

d.

Internal venous plexus

Epidural ne e dle

Modif ed with permission rom Cunningham FG, Leveno KJ, Bloom SL, et al (eds): Obstetrical anesthesia. In Williams Obstetrics, 23rd ed. New York, McGraw-Hill, 2010, Figure 19-4.

La bor

SECTION7

170 25–24.

The spread o anesthesia a ter epidural placement can be in luenced by all EXCEPT which o the ollowing?

a.

Maternal position

b.

Dose o anesthetic

c.

Type o catheter used

d.

Location o catheter tip

25–25.

Which is the most common complication encountered during epidural anesthesia?

a.

Fever

b.

Hypotension

c.

Total spinal blockade

d.

Ine ective analgesia

25–26.

All EXCEPT which o the ollowing are associated with breakthrough pain a ter epidural anesthesia is initially established?

a.

Nulliparity

b.

Heavier etal weight

c.

Lower maternal body mass index (BMI)

d.

Catheter placed at earlier cervical dilation

25–27.

Compared with intravenous meperidine, epidural anesthesia is associated with higher rates o all EXCEPT which o the ollowing?

a.

Cesarean delivery

b.

Oxytocin stimulation

c.

Operative vaginal delivery

d.

Prolonged irst-stage labor

25–28.

According to the American College o Obstetricians and Gynecologists, what is the threshold below

which thrombocytopenia may prevent a patient rom receiving epidural anesthesia?

a.

50,000

b.

75,000

c.

100,000

d.

150,000

25–29.

A patient with a known thrombophilia has just had a vaginal delivery under epidural anesthesia.

She had discontinued her low-dose low-molecular-weight anticoagulant prior to induction o labor.

When would it be sa e to restart her anticoagulant postpartum?

a.

Prior to removal o her epidural catheter

b.

As soon as her epidural catheter is removed

c.

At least two hours a ter epidural catheter removal

d.

When her partial thromboplastin time (PTT) is normal

25–30.

An opiate was used or epidural analgesia in a patient’s cesarean delivery, and now she is complaining o itching and being unable to

empty her bladder. Which drug will eliminate her symptoms without a ecting the analgesic action o the opiate?

a.

Naloxone

b.

Cetirizine

c.

Bupivacaine

d.

Diphenhydramine

25–31.

A patient requiring emergent cesarean delivery has a patchy epidural block and needs local in iltration o anesthesia to augment the blockade. In the image here, which nerve is identi ied by the letter X?

Modif ed with permission rom Cunningham FG, Leveno KJ, Bloom SL, et al (eds):

Obstetrical analgesia and anesthesia. In Williams Obstetrics, 24th ed. New York, McGraw-Hill, 2014, Figure 25-6.

a.

Ischial nerve

b.

Intercostal nerve

c.

Hypogastric nerve

d.

Ilioinguinal nerve

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171

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