7th deck Flashcards by Philippa S

Nerve supple genitofemoral nerve

L1/2

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direct blood supply to the ascending colon

Blood supply - right colic and iliocolic branches of the SUPERIOR mesenteric artery

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aorta enters abdomen

T12

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The level of the bifurcation of the common iliac artery

SI joint

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Lymphatic drainage of the proximal part of the rectum

Inferior mesenteric nodes

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An unpaired branch that arises from the aortic bifurcation

Median sacral artery

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With respect to the regions of the abdomen, the stomach is located within

The left hypochondrium, umbilical and epigastric regions

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Which of the following nerves pierces the internal oblique muscle and passes through the inguinal canal?

Ilio-inguinal nerve

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During renal transplantation, the renal artery is typically anastomosed to which vessel

Common or external iliac artery

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The blood supply to the appendix

posterior caecal

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The inferior vena cava originates from the common iliac veins at the level of

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Lymphatic drainage of the vulva

Deep inguinal nodes

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Lymphatic drainage of the distal part of the rectum

Internal iliac nodes

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The arterial supply to the appendix typically arises from the

Ileocolic artery

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The relations of the epiploic foramen include

anterior
posterior
superior
inferior

Anterior - right free border of LESSER omentum (containing bile duct to the right and in front, hepatic artery to the left and in front and portal vein posteriorly)
Posterior - inferior vena cava
Superior - caudate lobe of liver
Inferior - first part of duodenum

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The caecum has what which converge at the appendix

TENIA COLI

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The superior vesical artery is a branch of the

Internal illiac artery

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Branches of internal iliac artery

(anterior division)

3 urinary
3 visceral
3 parietal

3 urinary: umbilical artery, superior vesical artery, inferior vesical artery
3 visceral: uterine artery, vaginal artery, middle rectal artery
3 parietal: obturator artery, internal pudendal artery, inferior gluteal artery

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Gynecoid pelvis

Oval,
TR diameter wider than AP diameter
Cavity: shallow
Sidewalls: straight
Ischial spines: blunt
Sacrum: broad and well curved
Sub-pubic arch: wide, 90-100 degrees

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The round ligament of the uterus exits the pelvis through the

deep inguinal ring

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he diagonal conjugate of the pelvis extends from

he inferior border of the symphysis pubis to the sacral promontory

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With respect to the innervation of the cervix, the cervix contains what types of nerve

Sensory, sympathetic and parasympathetic nerves

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A 36 year old woman with irregular periods for 2 years is referred to the gynaecology clinic because she has not had any periods for 6 months. Urine pregnancy test is negative. FSH = 3.7 iu/L, LH = 1.2 iu/L, prolactin = 17 ng/ml and TSH = 7.2 mIU/L. What is the most likely diagnosis?

seconday amenorrhea

In diagnosing the underlying cause of amenorrhea, the first step should always be to rule out pregnancy with a negative urine or serum hCG result
Next, TSH, prolactin, LH and FSH should be ordered
If prolactin, LH, and FSH are normal, but TSH is elevated, then the amenorrhea is due to hypothyroidism

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A 30 years old women who regularly takes insulin for diabetes presents with palpitations and loss of weight. TSH is low & Total T3 high. What is the most likely diagnosis?

Graves

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Immediately after birth, a baby is noted to have a heart rate of 150/min, pink body and blue extremities with minimal response to stimulation with some flexion of limbs with slow irregular respiration. What is the Apgar score

AGPAR 6 Activity = some flexion = 1 Pulse over 100 = 2 Grimace = minimal response = 1 Appearance pink / blue = 1 Respiration = slow irregular = 1

MCV less that 80

microcytic IDA chronic disease

MCV 80-100

haemorrhagic aneamia

MCV >100

folate B12 drug indused ETOH

23 year old woman has a glucose tolerance test at 25 weeks gestation. Fasting glucose = 4.6 mM and the 2 hour value = 7.4 mM. What is the diagnosis

NORMAL Fasting plasma glucose level of 5.6 mM or above or 2-hour plasma glucose level of 7.8 mM or above.

A healthy 27 year old woman who is 32 weeks pregnant has been walking at high altitude. She feels short of breadth with pins and needles in her hands. What is the most likely acid-base imbalance?

Resp alklalosis

Gestational diabetes insipidus is characterised by

Urine specific gravity less than 1.005

A 24 year old woman with gestational thrombocytopaenia is awaiting anaesthetic review. She will like to know the lowest platelet count that would permit her to have an epidural in labour

>80

Question 22 A 37 year old woman presents at 32 weeks gestation with pleuritic chest pain and shortness of breadth. Pulmonary embolism is suspected and arterial blood gas analysis is undertaken. Which one is typical of pulmonary embolism?

Low PO2, low PCO2, low pH

A 23 year old woman with a 10 year history of type 1 diabetes presents to the assessment unit at 8 weeks gestation. She gives a 12 hour history of feeling increasingly unwell with vomiting and abdominal pain. You suspect that she has developed diabetic ketoacidosis (DKA) and arterial blood gas analysis is undertaken. Which findings are consistent with a diagnosis of DKA?

Low pH, normal K+, Low bicarbonate, Increased anion gap

B Low pH + normal PO2 + low PCO2 + low bicarbonate

35 year old woman who is 26 wks gestation goes for walking up a hill and when she gets to the top of the hill she becomes little breathless and has paraesthesia in her hands. What is the cause of paraesthesia?

HYPOCAPNIA

You are asked to explain to a patient the results of her Rubella screen. They are as follows: Rubella IgG +ve Rubella IgM -ve

Immunity to rubella Rubella is an acute infection and does not cause chronic infection. If IgG and IgM are negative the patient is susceptible to Rubella infection. If IgG +ve and IgM -ve the patient should be considered immune. If IgM +ve this suggests acute infection or false positive IgM (not uncommon)

what clotting factors increase in pregnancy

The hyper-coaguable state is thought to result primarily from the increased levels of factor VII and fibrinogen. Other clotting factors also rise (VIII,IX,X,XII)

which cotting factors reduce

Clotting factors XI and XIII reduce during pregnancy

Haemolytic Disease of the Newborn falls into what type of hypersensitivity reaction?

type 2 igg

Thromboplastin is what type of agent

pro-thrombotic.

What is the leading cause of primary aldosteronism

conns -adrenal hyperplasia Aldosterone increases the reabsorption of sodium ions (and subsequently water) in exchange for potassium in the kidney.

mechanisms leading to closure of the DA

increased po2, increased bradykinin, decreased prostahlandin E2

The sacroiliac joint is what type of joint

synovial joint.

lymph drainage of the cervix where does the majority of lymph drain to

external illiac

Human placental lactogen (hPL) is structurally similar to which of the following hormones

prolactin and growth hormone

vessels greater sciatic foramen

Superior Gluteal Artery & Vein Inferior Gluteal Artery & vein Internal Pudendal Artery & vein

nerves greater sciatic formaen

sciatic nerve Sup Gluteral nerv inf gluteal nerve Pudendal Nerve Posterior Femoral Cutaneous Nerve Nerve to Quadratus Femoris Nerve to Obturator Internus

What is the NICE advice regarding timing of Rhesus Anti-D Immunoglobulin following abortion

at time of

Bladder neck closure and relaxation of the bladder is mediated by

Sympathetic T10- L2 Detrusor relaxation during storage & bladder neck closure

A 34 year old patient is being investigated in the infertility clinic and is offered Hysterosalpingography (HSG). She has 28 day cycles. When should the HSG test be performed

6-12

Macrophages are derived from what type of white blood cell

monocytes

She has a history of atrial fibrillation and is treated with dabigatran. Her renal function is normal. Which test(s) should be used to monitor the coagulation system pre-operatively?

Dabigatran inhibits thrombin. There is no routine coag test validated for monitoring.

A 65 year old woman is due to be admitted for vaginal hysterectomy because of prolapse symptoms. She has a history of anti-phospholipid antibody syndrome and is on long-term warfarin therapy. Warfarin has been discontinued pre-operatively and therapy with heparin started according to instructions from the haematologist. When should warfarin be re-started?

12-24 hours post op warfarin stop 5 days pre op. proceed if surgery INR <1.4 start asap post op will take 5-10 days for INR to rise above 2.0 post op

How many days will it take after re-introduction of warfarin for INR to rise above 2.0?

5-10

Warfarin has been discontinued pre-operatively and therapy with heparin started according to instructions from the haematologist. On the morning of surgery, her INR is 1.6 what level INR can surgery proceed

less than 1.5

What artery is injured during sacro-spinous ligament fixation

INFERIOR GLUTEAL ARTERY

Where is a JOEL COHEN incision made

2-4cm below the level of the ASIS

where is maylard incision made

3-8cm above pubic symphysisi

what incision Provides more rapid access to the abdominal cavity than the Pfannestiel incision

Joel-cohen

how long should suture length be compared to wound

4:1

A 57 year old woman develops foot drop following surgery. Which nerve roots contribute to the injured nerve?

L4,5, S1,2 - common peroneal nerve injury

A 34 year old woman with three previous caesarean sections is due to have a caesarean hysterectomy at 34 weeks gestation because of placenta acreta. The interventional radiologist has attended to insert balloons and minimise blood loss. In which blood vessels should the balloons be located

internal illiac arteries because uterines have ++ anaestomosis and therefore occulision needs to be higher up

A 27 year old woman requires blood transfusion at 26 weeks gestation because of heavy bleeding from a low lying placenta. Which type of blood should be used in principle?

Kell neg blood

Which nerve is most commonly injured during gynaecological laparotomy?

femoral nerve L2,3,4 anterior.med thigh and med calf injury due to compression against pelvic side wall

A 33 year old woman has undergone laparoscopic surgery for stage 3 endometriosis. She telephones 4 days later because of numbness in the medial aspect of her upper thigh. Which nerve is most likely to have been injured during surgery?

obtuator nerve L2,3,4 sensation upper thigh thigh adduction injured commonly in excision of endometriosis

A healthy 23 year old woman had an emergency caesarean section because of fetal bradycardia. 2 weeks later, she is referred by her general practitioner because of persistent burning pain extending from the right end of her scar to the mons pubis and right labia. Which nerve is likely to have been injured?

iliohypogastric

Branches of which nerve are likely to be injured during a Pfannenstiel incision which extends beyond the lateral margins of the rectus abdominis muscl

ilio inguiinal

A 63 year old woman with a history of atrial fibrillation requires a vaginal hysterectomy because of prolapse symptoms. She is taking apixaban. How would you advise her regarding apixaban

3 days preop

A 34 year old woman has a total abdominal hysterectomy because of a large fibroid uterus. Intra-operative blood loss was measured at 500 ml and the woman has no significant medical history. Do post-operative day 2, the woman appears confused and agitated. P = 98/min, BP = 120/77 mmHg, SPO2 = 98% on air, Temp = 36.8C. Hb = 107 g/L, Na = 129 mM, K = 3.6mM and all other blood tests are normal. What is the most likely cause of hyponatraemia?

SIADH can be causes post op Caused by surgical stress resulting in a syndrome of inappropriate antidiuretic hormone secretion and promoting water retention for several days

An obstetrician performs a mediolateral episiotomy to expand the birth canal during a child birth. Which of the following muscles is typically incised during this procedure?

bulbospongiosus

The level of the umbilicus varies in obese women. What reference point can be used instead during abdominal surgery?

ASIS

Which vessels can possibly be injured in the subcutaneous tissue when a transverse Pfannestiel incision is made?

sup epigastric vessels

Which drug can mask the symptoms of hypoglycaemia in diabetics?

labetalol

Diazepam can cross the placenta due to

lipid solubility

This antimetabolite is the pro-drug for 6-mercaptopurine

AZATHIOPRINE

Half life of amiodarone is what

100 days due to extensive fat storage

Warfarin acts by inhibiting the synthesis of

PROTHROMBIN

labetolol has what effect on cardiac OP and HR

nil

Following birth, the proximal part of the umbilical artery becomes

superior vesical artery distal part becomes Medial umbilical lig

Which organism is not sensitive to metronidazole

psuedomonas

MOA trimethoprim

inhibits DNA synthesis

incubation cmv

3-12 weeks

incubation cmv

3-12 weeks

incubation cmv

3-12 weeks

moa TXA

inhibit plasminogen activation

progesterone blood level normal range for ovulation

16-28nmol

study to assess prognosis of disease

cohort study

calculate standard error of mean

SD/ square root of sample size.

homeostatic response to hypocalcaemia

increased PTH, increased 1,25 dihydoxycholecalciferol, and low phosphateg

what stage of syphylis is a gumma found

unit of absorbed dose of radiation

GRAY

level 1a evidence

Ia - Evidence from Meta-analysis of Randomized Controlled Trials

level 1b evidence

Ib - Evidence from at least one Randomized Controlled Trial

level 2a evidence

IIa - Evidence from at least one well designed controlled trial which is not randomized

level 2b evidence

IIb - Evidence from at least one well designed experimental trial

level 3 evidence

III - Evidence from case, correlation, and comparative studies.

level 4 evidence

IV - Evidence from a panel of experts