Order Fetal Sacrococcygeal Teratoma Discussion

Order Fetal Sacrococcygeal Teratoma Discussion
Order Fetal Sacrococcygeal Teratoma Discussion
1. A 23-year-old G1P0 woman who just had a successful vaginal delivery with
epidural analgesia now has persistent bleeding suspected to be related to
retained placenta. Which of the following actions is the least appropriate to
pursue for this patient’s anesthetic management?
A. Use of oxytocin for increased uterine tone after manual removal of the placenta
B. Neuraxial anesthesia to achieve a block height of T6
C. Intermittent boluses of ketamine to facilitate extraction
D. Administering nitroglycerin spray to the mother
E. Transport to OR and induction of general anesthesia with 1.5-2 MAC (minimum
alveolar concentration) of volatile anesthetic
2. You are called to the bedside to evaluate a 31-year-old G2P1 at term who is
attempting a trial of labor after cesarean (TOLAC) and is complaining of
abrupt onset of abdominal pain despite previously adequate epidural analgesia.
She has a history of a prior cesarean delivery for arrest of descent at 39 weeks.
Which of the following statements regarding TOLAC and vaginal birth after
cesarean (VBAC) is false?
A. Contraindications to VBAC include a previous classic incision uterine surgery.
B. Risk of uterine rupture is significantly increased in patients attempting a TOLAC.
C. The risk of maternal mortality is less in a TOLAC than that in an elective
cesarean section.
D. Gestation beyond 40 weeks carries a higher risk of uterine rupture in an
attempted TOLAC.
E. Increased BMI (>30) significantly decreases the likelihood of a successful
3. A 24-year-old G1P0 patient at 33 weeks’ gestation with twins presents to
triage with uterine contractions and a concern for preterm premature rupture
of membranes. Which of the following complications of pregnancy is not
consistently associated with multiple gestations?
A. Preterm labor
B. Acute fatty liver of pregnancy
C. Placental abruption
D. Postpartum hemorrhage
E. Gestational diabetes
Order Fetal Sacrococcygeal Teratoma Discussion
4. Which of the statements below regarding preterm labor is most correct?
A. Preterm labor complicates roughly 5% of all pregnancies in the United States.
B. Birth weight of preterm neonates does not correlate with morbidity and mortality.
C. Urinary tract infections may predispose patients to preterm labor.
D. Neonatal benefits of maternal administration of corticosteroids in preterm labor
are limited to pulmonary maturation.
E. Magnesium sulfate is preferred as a first-line agent for tocolysis in preterm
5. 45. Which of the following statements is false regarding breech presentation
and delivery?
A. External cephalic version is more likely to be successful if performed with
general anesthesia.
B. Perinatal morbidity and mortality are greater in planned cesarean delivery than
those in planned vaginal delivery.
C. Maternal morbidity is lower in planned cesarean delivery than that in planned
vaginal delivery.
D. Institutional protocols for vaginal breech delivery to select appropriate
candidates and labor management may be appropriate.
E. Fetal head entrapment during delivery may require administration of
nitroglycerin to the mother.
6. A neonate, born with a heart rate of 109 beats per minute, is taking gasping
irregular breaths, appears cyanotic, grimaces to stimulation, and flexes the
extremities. Which of the following is the infant’s Apgar score?
A. 2
B. 4
C. 5
D. 7
E. 8
7. A neonate is delivered at 38 weeks via cesarean section after a failed induction
for intrauterine growth restriction. Which of the following is most likely to be
associated with increased neonatal morbidity?
A. Two separate episodes of FHR late decelerations each lasting 90 seconds
B. An Apgar score of 6 at 1 minute after delivery
C. Umbilical artery pH of 7.18 and base deficit of 10 mmol/L
D. Umbilical artery pH less than 7.0 and base deficit of 14 mmol/L
E. Stage I hypoxic-ischemic encephalopathy
Order Fetal Sacrococcygeal Teratoma Discussion
8. A neonate is delivered at 35 weeks via an emergent cesarean section and is
noted to have rapid shallow gasping, appears cyanotic, and has a heart rate of
110 beats per minute. Which of the following is the most appropriate next step
in fetal resuscitation?
A. Continue to observe.
B. Provide positive pressure ventilation.
C. Provide blow-by supplementary oxygen.
D. Administer epinephrine.
E. Begin chest compressions.
9. You are caring for a 29-year-old G2P1 at 28 weeks’ gestation with the
pregnancy complicated by a fetal sacrococcygeal teratoma, who is presenting
for an intrauterine surgical intervention. Which of the following statements is
NOT true regarding intrauterine surgery?
A. Volatile anesthetic agents are used at 2-3 MAC for maintenance of anesthesia.
B. Magnesium and nitroglycerin may be used to provide tocolysis.
C. Maternal administration of paralytic agents is needed to ensure maternal and fetal
D. Vasopressor use to maintain placental perfusion is frequently required.
E. Subsequent pregnancies should be delivered via cesarean section rather than
allowing labor.
10. A healthy 24-year-old G2P1 at term with an epidural in place for analgesia who
is currently at 7 cm cervical dilatation develops a late deceleration in the FHR
tracing. Her current heart rate is 108 beats per minute, blood pressure is
80/47 mm Hg, and oxygen saturation is 97%on room air. Which of the following
interventions is least likely to be beneficial for correction of fetal distress?
A. IV fluid bolus
B. IV bolus of phenylephrine
C. Terbutaline
D. Maternal repositioning
E. Maternal oxygen supplementatio
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