Systemic Lupus Erythematosus In Pregnancy?

Systemic Lupus Erythematosus In Pregnancy?
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Systemic Lupus Erythematosus In Pregnancy?
1. You are asked to provide an anesthesia consultation for a 33-year-old G1P0
with a medical history significant for relapsing and remitting multiple sclerosis
that was diagnosed 4 years before this pregnancy. She is currently not taking
any medications, and her last relapse was 15 months ago. Her physical
examination is significant only for right foot drop. Which of the following is the
most appropriate management for her obstetric anesthesia?
A. Spinal and epidural analgesia are contraindicated for labor.
B. Spinal techniques are significantly safer than epidural techniques and are
preferred for analgesia or anesthesia.
C. Epidural techniques are significantly safer than spinal techniques and are
preferred for analgesia or anesthesia.
D. Spinal and epidural techniques are both considered to be safe and can be pursued
for analgesia or anesthesia.
E. General anesthesia has been implicated in relapses of multiple sclerosis and
should be avoided.
2. A 24-year-old G2P0 woman, 7 weeks pregnant based on the last menstrual
period, presents to the ED with right lower quadrant pain, tachycardia, and
vaginal bleeding concerning for threatened abortion. Which of the following
statements is correct?
A. If on physical examination she has cervical dilation without fetal or placental
expulsion, this would be considered a threatened abortion.
B. Spontaneous abortions are most commonly related to maternal immunologic
phenomena.
C. Methotrexate may be used to treat this patient with suspected ectopic pregnancy.
D. The rate of serum β-hCG concentration rise is not reliable for the diagnosis of
ectopic pregnancies.
E. Transvaginal ultrasound is the best modality to image if an ectopic pregnancy is
suspected.
3. Which of the following statements is not true regarding systemic lupus
erythematosus (SLE) in pregnancy?
A. Patients with SLE have an increased risk of preterm delivery.
B. The presence of atypical blood antibodies may make it challenging to obtain a
blood type and crossmatch.
C. The presence of lupus anticoagulant increases the patient’s risk of bleeding
complications from neuraxial anesthesia.
D. Patients with SLE are at risk of pericarditis and cardiac tamponade.
E. Infants born to mothers with SLE may be born with congenital heart block.
Systemic Lupus Erythematosus In Pregnancy?
4. 34. Which of the following hematologic disorders is not associated with an
increased risk of thrombotic events in pregnancy?
A. Protein C deficiency
B. Antithrombin III deficiency
C. Disseminated intravascular coagulation
D. Von Willebrand disease
E. Antiphospholipid syndrome
3. Which of the following statements regarding management of a parturient with
mitral stenosis is most correct?
A. Percutaneous mitral balloon valvuloplasty may be considered during pregnancy
in patients with severe disease who are refractory to medical management.
B. The physiologic changes of pregnancy are well tolerated with the peak period of
symptoms in the first trimester that typically improves throughout gestation.
C. Peripartum β-blockers may be used but have been associated with worse
maternal outcomes.
D. Percutaneous valvuloplasty should be performed postconception in patients with
moderate or severe mitral stenosis, as the clinical course during pregnancy is
widely variable.
E. Epidural labor analgesia is not recommended given the risk of cardiovascular
collapse.
36. Which of the following associations between findings from fetal heart rate
(FHR) monitoring and their causes is most accurately paired?
A. Early decelerations—umbilical cord compression
B. Variable decelerations—fetal head compression
C. Late decelerations—umbilical cord compression
D. Sinusoidal pattern—fetal anemia
E. Accelerations—fetal distress
7. A 36-year-old G1P0 at 37 weeks’ gestation presents to triage complaining of a
severe headache and blurry vision. Her vital signs include T 37.8, HR 84, RR
8, and BP 190/114. Her laboratory evaluation is significant for proteinuria and
shows a platelet count of 86 000/mm3 with normal coagulation studies. Which of
the following steps of management is inappropriate?
A. Treatment of hypertension to a goal of 15%-25% reduction in mean arterial
pressure with intravenous (IV) hydralazine
B. Initiating seizure prophylaxis with magnesium sulfate
C. Performing an epidural for labor analgesia
D. Placement of a radial arterial blood pressure catheter
E. Platelet transfusion to achieve a platelet count of >100 000 mm3 before
performing neuraxial anesthesia
8. A 42-year-old G1P0 woman complains of shortness of breath 3 hours after
undergoing cesarean delivery of a term infant. She was initially admitted for
preeclampsia and had a prolonged induction during which time she received 5 L
of crystalloid infusions. Which of the following is the most likely etiology of her
hypoxemia?
A. Pulmonary embolism
B. Pulmonary edema
C. Spontaneous pneumothorax
D. Atelectasis
E. Pneumonia
Systemic Lupus Erythematosus In Pregnancy?
19. 39. Which of the following statements is most correct regarding umbilical cord
prolapse during labor?
A. Vaginal delivery may be attempted if the diagnosis is made during the first stage
of labor; however, if diagnosed in the second stage, then cesarean delivery
should be performed.
B. Manual elevation of the presenting limb is contraindicated.
C. Neuraxial anesthesia should be attempted before the use of general anesthesia.
D. Macrosomia is associated with an increased risk of umbilical cord prolapse.
E. The risk of complications is decreased with a shorter interval from diagnosis to
delivery.
40. Which of the following interventions is not recommended for aspiration
prophylaxis in pregnant patients?
A. Ondansetron
B. Metoclopramide
C. H2
-receptor antagonists
D. Nonparticulate antacids
E. Avoidance of solid foods during labor
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