Jeopardy

Causes54Diagnosis 300 PointsWhat is post-dural puncture headache?

08What is:Unstable angina pectorisCardiac dysrhythmiaHypertensionPeripheral nerve blocks to fingers, toes and penis (areas without collateral blood flow) ? Bad things 1000 Points0Management 1000 Points0Aortocaval compression starts to become significant in a normal pregnancy at how many weeks EGA?89Bad things 200 PointsHemolytic Anemia, Elevated Liver Enzymes, Low platelets0Four Contraindications to using vasoconstrictor additives (e.g. epinephrine) with local anesthetic

Bad things 1000 Points0Causes? 1000 PointsAn epidural is placed in a 32 yo parturient receiving magnesium therapy for preeclampsia. Five minutes after admin of the test dose, the bolus infusion is interrupted because of a contraction. After the contraction subsides, a slow epidural injection of the loading dose of bupivacaine and fentanyl is resumed. At the same time, the patient complains of shortness of breath. She is panic stricken and wrestles violently with the nurses who try to reassure her. She repeats that she cannot breathe, becomes cyanotic and loses consciousness. During resuscitation, blood is oozing from the IV sites and pink froth is noted in the ETT. The most likely diagnosis is: Amniotic fluid embolismHigh SpinalIntravascular bupivacaine injectionMagnesium overdoseEeclampsia 69Drug and dose to treat uterine hypertonusDrugs 400 Points49Miscellaneous 800 Points0Order the following list according to which regional anesthetic is associated with greater systemic vascular absorption of local anesthetic (from most to least) :EpiduralIntercostal nerve blockSciatic femoralSubcutaneous CaudalBrachial plexus 97A 32 yo parturient with history of spinal fusion, severe asthma and pregnancy-induced hypertension is brough to the OR wheezing and needs emergency C-section under GA for prolapsed umbilical cord. Which of the following induction agents is most appropriate for this induction?SevofluraneMidazolamKetamineThiopentalPropofolManagement 800 Points0870Bad things 800 PointsWhile moving a parturient from the birthing room to the OR for emergency C/section for prolapsed umbilical cord, the parturient develops cough, wheezing stridor and becomes cyanotic. The trachea is intubated and food is noted in the pharynx. Approriate treatment in this patient should consist of:IV lidocaine to suppress the coughGlucocorticoids100% oxygen and PEEPSaline lavageSodium bicarbonate lavage

770Causes? 800 PointsA 24 year old G2 P1 parturient is anesthetized for emergency C/S. On emergence from GA, endotracheal tube is removed and the patient becomes cyanotic. O2 is administered by PP bag mask ventilation. High airway pressures are necessary to ventilate the paitent, and wheezing is noted over both lung fields. The patients blood pressure falls from 120/80 to 60/30 mHg and the heart rate increases from 105 to 180 beats per minute. The most likely cause is:Venous air embolismAmniotic fluid embolismMucous plug in tracheaPneumothoraxAspiration67What is Intercostal nerve block (surrounded by rich vascular supply so this type of block has the highest risk of systemic LA toxic levels) > caudal > epidural > brachial plexus > sciatic femoral > subcutaneous ?Miscellaneous 800 Points098Miscellaneous 600 Points0The components of the APGAR Score95Management 600 Points0Dose of magnesium sulfate in treatment of preeclampsia85Diagnosis 300 Points028-year-old woman after spinal for C-section experiences a headache that worsens with sitting or standing, improves with lying down. 70Causes? 600 PointsDuring stage 2 of labour, pain is transmitted from the pelvic floor, lower vagina and perineum, entering the spinal cord at these levels65Miscellaneous 600 Points0

96Miscellaneous 400 Points0The weeks when the fetus is most susceptible to the effects of teratogenic agents93Management 400 Points0This local anesthetic ____ is associated with the risk of methemoglobinemia and can be treated with IV _____ 83Bad things 400 Points0Four adverse effects of neuraxial opioids

Causes? 400 PointsPain during first stage of labour is due to uterine contractions and cervical dilation, is visceral and is transmitted via sympathetic fibres entering the spinal cord at these levels.63Latest gestational age at which pregnant women taking vitamin K antagonists should be transitioned to heparin (UFH or LMWH)Anticoagulation 100 Points33Miscellaneous 200 Points0Neuraxial blocks should not be performed until at least:___ hours after the last dose of prophylactic LMWH (e.g. enoxaparin 40 mg) ___ hours after the last dose of therapeutic LMWH (e.g. enoxaparin1 mg/kg every 12 hours) 91Management 200 Points0Management of Total Spinal81Bad things 200 Points0HELLP syndrome stands for0Causes?200 PointsGravid uterus compressing on the inferior vena cava and aorta causing maternal hypotension and tachycardia, decrease in uterine and placental blood flow and resulting in fetal distress. What is this syndrome called?6110001000100010001000800800800800800600600600600600400400400400400200200200200200ManagementDrugsMiscellaneousBad thingsCauses059Round One should contain one Daily Double question. To insert the Daily Double Screen, follow these steps:

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FINAL111

Bad things55Management56Miscellaneous

57Drugs58Causes? 800 PointsWhat is E?A 24 year old G2 P1 parturient is anesthetized for emergency C/S. On emergence from GA, endotracheal tube is removed and the patient becomes cyanotic. O2 is administered by PP bag mask ventilation. High airway pressures are necessary to ventilate the patient, and wheezing is noted over both lung fields. The patients blood pressure falls from 120/80 to 60/30 mHg and the heart rate increases from 105 to 180 beats per minute. The most likely cause is:Venous air embolismAmniotic fluid embolismMucous plug in tracheaPneumothoraxAspiration (Wheezing over both lung fields and temporally fits best)068What is A? An epidural is placed in a 32 yo parturient receiving magnesium therapy for preeclampsia. Five minutes after admin of the test dose, the bolus infusion is interrupted because of a contraction. After the contraction subsides, a slow epidural injection of the loading dose of bupivacaine and fentanyl is resumed. At the same time, the patient complains of shortness of breath. She is panic stricken and wrestles violently with the nurses who try to reassure her. She repeats that she cannot breathe, becomes cyanotic and loses consciousness. During resuscitation, blood is oozing from the IV sites and pink froth is noted in the ETT. The most likely diagnosis is: Amniotic fluid embolismHigh Spinal (would be too weak to wrestle)Intravascular bupivacaine injection (would have CNS symptoms and CV collapse)Magnesium overdose (would usually be weak) Eeclampsia (usually would not complain of SOB unless aspiration or pulmonary edema) Causes? 1000 Points70Bad things 400 Points0Four adverse effects of neuraxial opioids

What is:PruritisNausea and vomitingRespiratory depressionUrinary retentionAs plasma concentrations increase, patients develop ECG changes with widening of the QRS complex and prolonged QT interval10 mEQ/L Deep tendon reflexes are absent15 mEq/L Sinoatrial block and respiratory paralysis25 mEq/L Cardiac arrest

(Remember therapeutic range = 4-8 mEq/L)Bad things 600 Points0Bad things 800 Points0.

What is C?While moving a parturient from the birthing room to the OR for emergency C/section for prolapsed umbilical cord, the parturient develops cough, wheezing stridor and becomes cyanotic. The trachea is intubated and food is noted in the pharynx. Approriate treatment in this patient should consist of:IV lidocaine to suppress the coughGlucocorticoids100% oxygen and PEEPSaline lavageSodium bicarbonate lavage78Management 200 Points0What is:Securing the airwayMechanical ventilationSedationVolume InfusionVasopressor SupportWhile waiting until spinal anesthetic subsides82Management 400 Points0What is prilocaine and methylene blue? Prilocaine is metabolized in the liver by O toluidine, which is capable of oxidizing hemoglobin to methemoglobin. This condition may be treated by IV methylene blue (1-2 mg/kg) 84Management 600 Points0What is MgSO4 IV 4-6 g bolus over 15 minutes followed by 1-3 g/hour

86What is E?A 32 yo parturient with history of spinal fusion, severe asthma and pregnancy-induced hypertension is brough to the OR wheezing and needs emergency C-section under GA for prolapsed umbilical cord. Which of the following induction agents is most appropriate for this induction?Sevoflurane (Not good for RSI in emergency case)Midazolam (Slow onset not good for RSI)Ketamine (good for asthma but bad for PIH)Thiopental (can trigger histamine release, avoid in asthma)Propofol (good for asthma and because of the PIH) Management 800 Points088Management 1000 Points0What is GA = 20 weeks?

Aortocaval compression is typically not a problem until about 20 weeks gestation when the uterus is large enough to compress the aorta and vena cava when the patient assumes the supine position90Miscellaneous 200 PointsWhat is 12 hours after last dose of prophylactic LMWH24 hours after last dose of therapeutic LMWH?092Miscellaneous 400 Points0What is Week 3-8 of gestation?

(This is when organogenesis mainly occurs) 94Drugs 400 PointsWhat are muscle relaxants?0Drugs 600 PointsWhat is E? Magnesium sulfate may produce any of the following effects EXCEPT:SedationRespiratory paralysisInhibition of acetylcholine release at the nyoneural junctionAntagonism of alpha-adrenergic agonistsStimulation of NMDA receptors

MgSO4 acts as antagonist at the NMDA receptros; however, clinically labor analgesia is minimal0Take a deep breath112Final JeopardyBad Things0113Final JeopardyList fifteen potential adverse effects or complications of neuraxial analgesia 0114Final JeopardyWhat is:Systemic local anesthetic toxicitySpinal epidural hematomaPneumocephalus Allergic reactions e.g. to local anestheticsHigh spinalHypotensionInadequate or failed blockRespiratory DepressionNausea and vomitting PruritisIntrapartum feverFetal bradycardiaPost dural puncture headache Associated with longer second stage (about 14 min longer)Urinary retention Shivering InfectionPostpartum neuropathy115Congratulations!

116The Daily Double0119