PRINCIPLES 3: EXAM 2 ALL QUESTIONS AND
ANSWERS 2022 SOLUTION
● Basic Physiologic Changes with pregnancy
○ Greater hormonal production by the _______ and the placenta further alters maternal physiology.
○ The hallmark of successful anesthetic management of the pregnant woman is recognition of these
changes and appropriate adaptation of ___________ techniques to account for them. Correct
Answer: ○ Greater hormonal production by the ovaries and the placenta further alters maternal
physiology.
○ The hallmark of successful anesthetic management of the pregnant woman is recognition of these
changes and appropriate adaptation of anesthetic techniques to account for them.
● Specifics on changes with pregnancy
○ Cardiac changes
■ CO increases ?-?% first trimester and 50% through second trimester
■ HR increases ?-?% first trimester
■ SV increases 20% first trimester and 25-30% second trimester Correct Answer: ● Specifics on
changes with pregnancy
○ Cardiac changes
■ CO increases 35-40% first trimester and 50% through second trimester
■ HR increases 15-25% first trimester
■ SV increases 20% first trimester and 25-30% second trimester
Diaphragm excursion is ?
Total Lung Capacity is ?
TV is Increased (45%)
IRV is ?
ERV is ?
RV is ?
FRC is Decreased (80%)
Chest wall excursion is ?
Pulmonary resistance is Decreased 50%
FEV1 is
FEV1/FVC is
Flow-volume loop is
Closing capacity is Correct Answer: Diaphragm excursion is Increased
Total Lung Capacity is Decreased
TV is Increased (45%)
IRV is Increased
ERV is Decreased
RV is Decreased
FRC is Decreased (80%)
Chest wall excursion is Decreased
Pulmonary resistance is Decreased 50%
Unchanged x 4
, ■ _________ is a common complaint during pregnancy, affecting up to 75% of women. Correct
Answer: ■ Dyspnea is a common complaint during pregnancy, affecting up to 75% of women.
○ GI Changes
■ The stomach is displaced upward toward the _____ side of the diaphragm during pregnancy, and
its axis is rotated approximately ___ degrees to the right from its normal vertical position.
● This altered position displaces the intra-abdominal segment of the _________ into the thorax in
most women, causing a reduction in tone of the lower esophageal high-pressure zone (LEHPZ),
which normally prevents the reflux of gastric contents.
● ________ also contribute to relaxation of LEHPZ
■ Risk factors for GERD in pregnancy include _________ age, heartburn antecedent to pregnancy,
and multiparity Correct Answer: ○ GI Changes
■ The stomach is displaced upward toward the left side of the diaphragm during pregnancy, and its
axis is rotated approximately 45 degrees to the right from its normal vertical position.
● This altered position displaces the intra-abdominal segment of the esophagus into the thorax in
most women, causing a reduction in tone of the lower esophageal high-pressure zone (LEHPZ),
which normally prevents the reflux of gastric contents.
● Progestins also contribute to relaxation of LEHPZ
■ Risk factors for GERD in pregnancy include gestational age, heartburn antecedent to pregnancy,
and multiparity
○ Kidney changes
■ Total intravascular volume, both renal vascular and interstitial volume _______ during pregnancy.
■ Creatinine clearance is increased to ____ to _____ mL/min from the normal baseline values of 120
mL/min. Correct Answer: ○ Kidney changes
■ Total intravascular volume, both renal vascular and interstitial volume increase during pregnancy.
■ Creatinine clearance is increased to 150 to 200 mL/min from the normal baseline values of 120
mL/min.
○ Hematology changes
■ Maternal plasma volume expansion begins as early as __ weeks' gestation and continues until it
reaches a net increase of approximately ___% by 34 weeks' gestation.
■ The increase in plasma volume ________ the increase in red blood cell volume, resulting in the
physiologic ________ of pregnancy.
● After 34 weeks' gestation, the plasma volume ________ or decreases slightly.
■ Red blood cell volume ________ during the first 8 weeks of pregnancy, increases to the pre-
pregnancy level by 16 weeks, and undergoes a further rise to 30% above the pre-pregnancy level at
term.
■ Plasma albumin concentration _________
■ The plasma cholinesterase concentration falls by approximately 25% during the first trimester and
remains at that level until the end of pregnancy.
■ Pregnancy is associated with enhanced platelet turnover, clotting, and fibrinolysis Correct Answer:
○ Hematology changes
■ Maternal plasma volume expansion begins as early as 6 weeks' gestation and continues until it
reaches a net increase of approximately 50% by 34 weeks' gestation.
ANSWERS 2022 SOLUTION
● Basic Physiologic Changes with pregnancy
○ Greater hormonal production by the _______ and the placenta further alters maternal physiology.
○ The hallmark of successful anesthetic management of the pregnant woman is recognition of these
changes and appropriate adaptation of ___________ techniques to account for them. Correct
Answer: ○ Greater hormonal production by the ovaries and the placenta further alters maternal
physiology.
○ The hallmark of successful anesthetic management of the pregnant woman is recognition of these
changes and appropriate adaptation of anesthetic techniques to account for them.
● Specifics on changes with pregnancy
○ Cardiac changes
■ CO increases ?-?% first trimester and 50% through second trimester
■ HR increases ?-?% first trimester
■ SV increases 20% first trimester and 25-30% second trimester Correct Answer: ● Specifics on
changes with pregnancy
○ Cardiac changes
■ CO increases 35-40% first trimester and 50% through second trimester
■ HR increases 15-25% first trimester
■ SV increases 20% first trimester and 25-30% second trimester
Diaphragm excursion is ?
Total Lung Capacity is ?
TV is Increased (45%)
IRV is ?
ERV is ?
RV is ?
FRC is Decreased (80%)
Chest wall excursion is ?
Pulmonary resistance is Decreased 50%
FEV1 is
FEV1/FVC is
Flow-volume loop is
Closing capacity is Correct Answer: Diaphragm excursion is Increased
Total Lung Capacity is Decreased
TV is Increased (45%)
IRV is Increased
ERV is Decreased
RV is Decreased
FRC is Decreased (80%)
Chest wall excursion is Decreased
Pulmonary resistance is Decreased 50%
Unchanged x 4
, ■ _________ is a common complaint during pregnancy, affecting up to 75% of women. Correct
Answer: ■ Dyspnea is a common complaint during pregnancy, affecting up to 75% of women.
○ GI Changes
■ The stomach is displaced upward toward the _____ side of the diaphragm during pregnancy, and
its axis is rotated approximately ___ degrees to the right from its normal vertical position.
● This altered position displaces the intra-abdominal segment of the _________ into the thorax in
most women, causing a reduction in tone of the lower esophageal high-pressure zone (LEHPZ),
which normally prevents the reflux of gastric contents.
● ________ also contribute to relaxation of LEHPZ
■ Risk factors for GERD in pregnancy include _________ age, heartburn antecedent to pregnancy,
and multiparity Correct Answer: ○ GI Changes
■ The stomach is displaced upward toward the left side of the diaphragm during pregnancy, and its
axis is rotated approximately 45 degrees to the right from its normal vertical position.
● This altered position displaces the intra-abdominal segment of the esophagus into the thorax in
most women, causing a reduction in tone of the lower esophageal high-pressure zone (LEHPZ),
which normally prevents the reflux of gastric contents.
● Progestins also contribute to relaxation of LEHPZ
■ Risk factors for GERD in pregnancy include gestational age, heartburn antecedent to pregnancy,
and multiparity
○ Kidney changes
■ Total intravascular volume, both renal vascular and interstitial volume _______ during pregnancy.
■ Creatinine clearance is increased to ____ to _____ mL/min from the normal baseline values of 120
mL/min. Correct Answer: ○ Kidney changes
■ Total intravascular volume, both renal vascular and interstitial volume increase during pregnancy.
■ Creatinine clearance is increased to 150 to 200 mL/min from the normal baseline values of 120
mL/min.
○ Hematology changes
■ Maternal plasma volume expansion begins as early as __ weeks' gestation and continues until it
reaches a net increase of approximately ___% by 34 weeks' gestation.
■ The increase in plasma volume ________ the increase in red blood cell volume, resulting in the
physiologic ________ of pregnancy.
● After 34 weeks' gestation, the plasma volume ________ or decreases slightly.
■ Red blood cell volume ________ during the first 8 weeks of pregnancy, increases to the pre-
pregnancy level by 16 weeks, and undergoes a further rise to 30% above the pre-pregnancy level at
term.
■ Plasma albumin concentration _________
■ The plasma cholinesterase concentration falls by approximately 25% during the first trimester and
remains at that level until the end of pregnancy.
■ Pregnancy is associated with enhanced platelet turnover, clotting, and fibrinolysis Correct Answer:
○ Hematology changes
■ Maternal plasma volume expansion begins as early as 6 weeks' gestation and continues until it
reaches a net increase of approximately 50% by 34 weeks' gestation.
