20/4/22

Question 1

What is the difference between ‘station’ and ‘engagement’?

Answer 1

Station = position of baby's head in relation to ischial spines
Engagement = position of baby's head when felt abdominally

Question 2

How do you manage polycythaemia vera?

Answer 2

Phlebotomy

Question 3

Explain obstertic cholestatsis and it’s management

Answer 3

Increase in bile salts

• leads to itching in mothers
• can in extreme cases lead to death and apoxia (severe hypoxia) in babies due to immature liver being unable to break down increase in bile salts and bile salts causing placental vasoconstriction

Presents

• Itching
• ~Jaundice
• Increase in bilirubin

Management

• Induction of labour at 37-38wks
• Ursodeoxycholic acid
• Vit K supplements

Question 4

What is the investigation and management of premature preterm rupture of membranes?

Answer 4

Invx - sterile speculum to check for posterior pooling of amniotic fluid -> abdo USS to check for olgiohydramnios

Manage

• ADMIT
• Regular obs to check for chorioamnionitis
• 10 days of oral erythromycin

Delivery considered if occurs at 34wks

Question 5

Where do all the arteries of the perineum and pelvis come from?

Answer 5

Internal iliac artery

Question 6

Describe the blood supply to the vagina and uterus

Answer 6

Ovarian artery

Internal iliac artery -> 3rd branch = Uterine artery

Uterine artery and ovarian artery anastomise to on the uterus

Question 7

Go to pelvic side wall/mass and complete blood supply section

Question 8

What are the symptoms of cerebral venous thrombosis?

Who is at an increased risk?

How is it investigated? What should be done to rule out other condition?

How is it managed?

What is ‘empty delta sign’?

Answer 8

Headache - often sudden - with signs etc. of raised ICP
~Seizures
~ Eye pain/palsy
~ Reduced conciousness
~ Change in mental state

Increase risk of clots

• Thromobophilias
• Antiphospholipid syndrome
• Pregnancy
• Dehydration

MRI venography = gold standard
Lumbar puncture - rule out meningitis
CT scan - rule out stroke if presenting in that way

1. LWMH
2. Warfarin (3-6mnth = provoked, 6-12mnth = unprovoked, lifelong = 2+ episodes)

Empty delta sign = CT w/ contrast reveals empty delta sign at posterior of skull - normally contrast would run through the sagittal sinus but clot means no contrast getting through hence “empty”

Question 9

Complete venous sinus anatomy in anatomy spot

Where do all dural venous sinus drain to?

Answer 9

Internal jugular vein

Question 10

Define postural hypotension and how you would measure it

Answer 10

Definiton

• drop in systolic of 20+
• drop to below 90mmHg systolic
• drop in diastolic of 10+ with symptoms

1. Patient lie down for at least 5 minutes
2. At 5 mins measure BP

STAND UP

1. Measure BP in 1st min
2. Measure BP after 3 mins
3. Repeat recording until BP stops dropping and then repeat regularly until resolved

Question 11

What medication exacerbates psoriasis?

Answer 11

Beta blockers

Question 12

What is the most common cause of epiglottitis?

Answer 12

Haemophilus influenza B