A's Exam Review MCQ 2011 Flashcards
Where is: - umbilicus level - aortal bifurcation level - depth of aorta average How many cm below aorta bifurcation is Lt common illiac vein located
- L3-4
- usually L4 - 5, caudal if obese
- 6 cm
- 3-6cm caudal, umbilicus always cephalad to that point
- Where is Palmer’s Point?
- Lateral Trochar placement
- 2 vessels and 2 nerves to avoid?
- steps to avoid injury
- 3 cm below Lt costal margin, midclavicular
2.
- inf and superior epigastrics, illioinguinal, illiohypogastric
- place lat ports superior to asis, 6+ cm lateral to midline
At what level does an epidural work for 1st and 2nd stage labour.
1st stage contractions: T10-L1
2nd stage: must extend S2,3,4 late stage 1 and stage 2
DDx Vaginal Bleeding in Peds (Life threatening and common)
Life threatening:
- Malignancy (endodermal sinus tumor or rhabdomyosarcomas) usually present < 3yrs
- Trauma (abuse, water jets, recreational injury, stradle inj)
Common:
- Neo withdrawal PVB
- Foreign Body
- Infection (GAS and Shigella a/w PVB specifically but also have discharge)
- lichen sclerosus (purpura and hematomas)
- urethral prolapse
Uncommon:
- exogenous estrogen
- precocuscious puberty
- hypothyroidism
- CI to regional anesthesia
- ThromboProphylaxis
- time between last does and initiation
- time between last dose and removal of catheter
- time between neuraxial and restarting anticoag
1.
- coagulopathy
- increased ICP
- infection to lower back
- Thromboprophylaxis:
*insertion:
UH no delay (up to 10 000 then 4h)
LMWH: 10-12h
* removal:
UH 4h
LMWH 10-12h
*restart:
UH 1-8h
LMWH 6-8h
Where i estrogen produced?
Testosterone secretion?
- E2 from granulosa cells of developing follicles and conversion of E1 (estrone to peripherally)
- Testosterone secretion: 25 % ovary, 25% adrenals, 50% peripheral conversion of androstenedione
VARICELLA:
- Incubation period
- Does Shingles have fetal sequelae
- Infectious period?
- Pneumonitis: risk of getting, most risk for death in what trimester, what day of infection would it usually occur?
- Incubation period 10-21 days
- not associated with viremia or fetal sequela
- infectious period: 48 hours before the rash until the vesicles crust over
- 5-10% pregnant women with varicella, T3, Day 4 usually
Classification of Operative Vaginal delivery
OUTLET: - scalp visible at introitus without separating labia - fetal skull has reached pelvic florr - fetal head at or on perineum - Direct OA, OP or LOA/ROA - Rotation does not exceed 45 degrees LOW: - Spines + 2 or more then either - rotation < 45 or > 45 degrees MID: Station spines 0-2cm HIGH: NO
Requirements and CI to OVD
Prereqs:
- vertex, engaged
- Fully, ROM
- exact position known
- adequate pelvis
- analgesia
- bladder empty
- informed consent
- appropriate personel/backup
- skilled operator
CI: ABSOLUTE: - no vertex or brow - unengaged head - not fully - evidence of CPD - fetal coagulopathy
Complications of OVD
Both Vacuum and forceps:
- Mat trauma
- Fetal scalp bruising/lacs, bleeding
- RARE: ICH, retinal hemorrhage, facial nerve injury, skull fracture
FORCEPS: also rarely minor ext occular trauma
Risks of cocaine use in pregnancy?
Fetal:
- SA
- IUFD
- Abruption
- Prematurity
- IUGR
Maternal:
- CV cocaine toxicity: HTN (dont use beta blockers! cause end organ ischemia, use hydralazine)
- stroke
- MI
Complications of Midtrimester PPROM
PTB Chorio, endometritis abruption cord prolapse IUFD Retained placenta Neo: morbidity, pulm hypoplasia, msk deformities
Prevalence of Pulmonary Hypoplasia in midtrimester PPROM
Mortality and predictors
Prevalence 9 % in this pop mortality 70-90%
Predictors:
- GA a time of PPROM (rare after 26 wks)
- Degree of oligo
Most common cause of hypothyroidism in pregnancy (1st world)
Chronic Autoimmune Thyroiditis
Risk of untreated overt hypothyroidism
PTB
LBW
SA
?Neurodevelopmental
