HD EOYS2 Flashcards
Strategies that may help with during episodes of non-reassuring fetal statusinclude [5]
- Changing the mother’s position
- Increasing maternal hydration
- Maintaining oxygenation for the mother
- Amnioinfusion, where fluid is inserted into the amniotic cavity to relieve pressure on the umbilical cord
- Tocolysis, a temporary stoppage of contractions that can delay preterm labour
- Intravenous hypertonic dextrose – gives mother more energy
Explain manoeuvre used to fix shoulder dystopia? [1]
Whats are two other options? [2]
- McRoberts manoeuvrers tries to dislodge shoulder from being stuck on the pubis by pelvic symphysis orientated more horizontally to facilitate shoulder delivery
- Changing the mother’s position
- An episiotomy: surgical widening of the vagina, may be needed to make room for the shoulders
How do you manage failure to progress:
- Initially? [1]
- If continued? [4]
- If still continued? [2]
How do you manage failure to progress:
- Initially: relax and wait
- If continued: givelabour-inducing medications: Oxytocin; misoprostal; mifepristone; oestrogen pessary
- If still not delivered: membrane sweep or c section
Underlying causes and conditionsthat cause fetal distress include? [5]
Insufficient oxygen levels
Maternal anemia
Pregnancy-inducedhypertensionin the mother
Intrauterine growth retardation (IUGR)
Meconium-stained (baby poo) amniotic fluid: baby drinks own amniotic fluid
Explain the significance and causes of variable decelerations and late deceleration in Cardiotocography [2]
Late deceleration:
* placenta is compressed and o2 to baby is compromised: causes vagal stimulation or myocardial depression
* Late and bradycardia: emergency C-section
variable decelerations:
- Abrupt decrease with rapid recovery from cord compression
- Looking at length of recovery of HR (as long as recovery is rapid, its fine)
- When contraction lessens is when HR should return to normal
Name the drugs used for Tocolysis (a temporary stoppage of contractions that can delay preterm labour) [5]
- nifedipine (calcium antagonist)
- atosiban: oxytocin receptor antagonists
- indomethacine NSAID: inhibitors of prostaglandin synthesis
- nitroglycerine: NO donors, Betamimetics (sympathetic beta agonsists)
- magnesium sulphate
Score system used to investigate perinatal asphyxia? [1]
Describe the clinical significance of APGAR scores
APGAR score
A low Apgar score of 0 to 1 at 1 minute is not predictive of adverse clinical outcomes or long-term health issues since most infants, even those with very low 1-minute scores will have normal scores by 5 minutes.
Low Apgar scores at 5 minutes correlate with mortality and may confer an increased risk of cerebral palsy in population studies but not necessarily with an individual neurologic disability
Scores less than five at 5 and 10 minutes correlate with an increased relative risk of cerebral palsy.
What are the three types breech pregnancies?
Frank: Has most favourable outcomes for vaginal deliveries
Complete
Footing
What type of delivery occurs if placenta previa occurs? [1]
What can plecenta previa increase risk of? [1]
Treatment of placenta previa? [1]
Placenta previa:
- C section only
- Increases the liklihood of placenta accreta (when placenta becomes inseperable from uterus
- Treat with blood transfuison
What is difference between primary and secondary PPH? [2]
What are primary [4] and secondary [2] PPH associated with?
Primary PPH: bleeding within 24 hours of birth:
- Polyhydamnios
- Macrocosmic fetus
- Uterus overstretched
- Multifetal preg.
Secondary PPH: from 24 hours to 12 weeks after birth:
- Infection
- Retained products of conception
Explain MoA of Tranexamic acid for PPH
Analogue of lysine
Binds to plasminogen and stops conversion of plasmin: causes bigger clots to form
Which drugs are used to treat PPH? [5]
Oxytocin (slow injection followed by continuous infusion)
Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding
What tests would you do to exclude a medical cause for mood distubance? [2]
Thyroid dysfunction
Anaemia
What is brexanolone aka? [1]
What is MoA? [1]
allopregnanlone (a progesterone metabolite)
- Modulates synaptic GABA-receptors and extrasynaptic GABA-A receptors: (GABA is an inhibitory receptor)
- Allows GABA that binds to receptor to have a bigger effect on the GABA receptor Makes patients feel open and feeling of relaxtion
Which of the following has a possible risk of growth retardation in chiild?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of growth retardation in chiild?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
How do you treat postnatal psychosis? [3]
Mood stabilizer: (lithium, valproic acid and carbamazepine)
In combination with antipsychotic medications and benzodiazepines
electroconvulsive therapy is well tolerated and rapidly effective
Which drugs prescribed should women avoid breastfeeding [2] (and why) [1]
valproic acid and carbamazepine should avoid breastfeeding
Linked to hepatotoxicity in the infant
What food substance / nutrient can you give to prevent PPD in pregnancy? [1]
Omega-3 (fish oil etc)
Label A-E
A: Testis
B: Epididymis
C: Left and right crus penis
D: bulb of penis
E: Bulbo-urethral or Cowper’s gland
Label A-E
A: Rectovesical pouch
B: Rectum
C: Deep inguinal ring
D: Inferior epigastric arteries
E: Femoral Nerve
Which nerves innervate the cremaster and dartos:
Anteriorly [2]
Posteriorly [1]
Anteriorly: Genitofemoral
Ilioinguinal
Posteriorly:
Pudendal
Label A-D
A: Pampiniform venous plexus
(anterior veins)
B: Ductus deferens
C: Testicular artery
D: Artery of ductus deferens
How can you distinguish a direct and indirect hernia clinically? [1]
A direct hernia can be distinguished from an indirect hernia clinically by reducing it then putting manual pressure over the deep inguinal ring and asking the patient to cough.
A direct hernia should reappear; an indirect hernia should no
A man is referred to neurosurgery urgently due to a concern about cauda equina syndrome. Which urinary symptom is typically associated with cauda equina syndrome acutelyy? [1]
Acceptable answers; urinary retention
Remember that the sympathetic outflow is thoracolumbar, whereas the parasympathetic outflow is craniosacral, so cauda equina syndrome will affect the parasympathetic nervous system but not the sympathetic
This means that the detrusor muscle will not be able to contract
What are the different layers from superficial to deep of testis? [6]
The layers that will be encountered are (in order):
1. Skin
2. Dartos fascia and muscle
3. External spermatic fascia
4. Cremasteric muscle and fascia
5. Internal spermatic fascia
6. Parietal layer of the tunica vaginalis
Some Damn Englishman Called It The Testes (Mnemonic to remember the layers)
Skin, Dartos fascia/muslce, External spermatic fascia, Cremasteric fascia/muscle, Internal spermatic fascia, Tunica vaginalis (parietal), Tunic albuginea (visceral)
which hormone controls the formation of external genitalia?
testosterone MIF DHT cHG LH
which hormone controls the formation of external genitalia?
testosterone MIF **DHT** cHG LH
name this structure [1]
external urethral sphincter
which hormone peaks at ovulation?
LH FSH Oestrogen Progesterone Testosterone
which hormone peaks at ovulation?
**LH** FSH Oestrogen Progesterone Testosterone
which hormone causes endometrial thickening?
LH FSH Oestrogen Progesterone Testosterone
which hormone causes corpus luteum formation?
**LH** FSH Oestrogen Progesterone Testosterone
which hormone causes oestrogen levels to rise?
LH FSH Oestrogen Progesterone Testosterone
which hormone causes oestrogen levels to rise?
LH **FSH** Oestrogen Progesterone Testosterone
which of following is C?
LH FSH Oestrogen Progesterone Testosterone
which of following is C?
**LH** FSH Oestrogen Progesterone Testosterone
which hormone initiates milk production?
prolactin FSH oestrogen oxytocin progesterone
which hormone initiates milk production?
**prolactin** FSH oestrogen oxytocin progesterone
which hormones inhibit secretrory acitivity of mammary tissue? [2]
prolactin FSH oestrogen oxytocin progesterone
which hormones inhibit secretrory acitivity of mammary tissue?
prolactin FSH **oestrogen** oxytocin **progesterone**
lactogensis occurs by fall in ^^ levels
what happens during the menstrual cycle when FSH and LH fall? [1]
FSH and LH fall, the corpus luteum degenerates
Degeneration of the corpus luteum results in loss of progesterone production.
The subsequent falling level of progesterone triggers menstruation and the entire cycle begins again
which of the following is the cytotrophoblast?
A
B
C
which of the following is the cytotrophoblast?
A
B
C
combination of which two molecules induces spermatogenesis? [2]
testosterone and androgen binding protein
- Gonadotropin releasing hormone (GnRH) stimulates FSH & LH from AP
- LH stimulates testosterone production by Leydig cells*
- •Main target of testosterone and pituitary FSH are Sertoli cells*
- •Sertoli cells then secrete androgen binding protein (ABP) and tubular fluid*
- •ABP binds to testosterone & carries it to area of seminiferous tubule where it stimulates spermatogenesis*
which cells form the blood-testis barrier?
sertoli cells
which cell types causes the increase in size of spiral arteries during placental development? [1]
explain how this occurs [2]
cytotrophoblasts (after invading through syncytiotrophoblasts)
replaces the endothelium and smooth muscle of the arteries with themselves (i.e. trophoblasts).
label A-C
A: oestrogen
B: progesterone
C: hCG
which hormone controls the formation of external genitalia?
testosterone MIF DHT cHG LH
which hormone controls the formation of external genitalia?
testosterone MIF **DHT** cHG LH
what is the cell indicated?
- mesothelial cell
- syncytiotrophoblast
- mesenchymal cell
- cytotrophoblast
- endothelial cell
- decidual cell
what is the cell indicated?
- mesothelial cell
2. syncytiotrophoblast - mesenchymal cell
- cytotrophoblast
- endothelial cell
6. decidual cell
In this sagittal section of the female pelvis, which of the labelled structures is mainly supplied by the gonadal artery?
C
D
E
F
H
In this sagittal section of the female pelvis, which of the labelled structures is mainly supplied by the gonadal artery?
C
D
E
F
H
**In this sagittal section of the female pelvis, the structure labelled F is an ovary and is mainly supplied by the gonadal artery.
The ovarian artery is the main arterial supply to the gonads in females.**
In this prosection of a female in the lithotomy position, identify A
A. perineal body B. bulbospongiosus C. greater vestibular (Bartholin's) gland D. Cowper's gland E. crus of clitoris
A. perineal body B. bulbospongiosus **C. greater vestibular (Bartholin's) gland** D. Cowper's gland E. crus of clitoris
In this diagram of a growing placenta (~21 days), the large black arrow indicates the
- Extraembryonic mesoderm
- Stratum basalis of the endometrium
- Decidua basalis
- Syncytiotrophoblast
- Trophoblastic lacuna
- Cytotrophoblast shell
In this diagram of a growing placenta (~21 days), the large black arrow indicates the
- Extraembryonic mesoderm
- Stratum basalis of the endometrium
- Decidua basalis
- Syncytiotrophoblast
- Trophoblastic lacuna
* *6. Cytotrophoblast shell**
Testis: What cell is indicated by the arrows?
- Spermatocyte
- Spermatid
(late) - Spermatid
(early) - Spermatogonia
Testis: What cell is indicated by the arrows?
1. Spermatocyte
2. Spermatid
(late)
3. Spermatid
(early)
4. Spermatogonia
Primary spermatocytes are cells with large nuclei fairly close to the
bottom of the seminiferous tubule but above the spermatogonia (which
have more condensed nuclei).
What is A?
- sphincter urethrae
- prostate gland
- internal urethral sphincter
- bulbosponiosus
- detruser muscle
What is A? **1. sphincter urethrae** 2. prostate gland 3. internal urethral sphincter 4. bulbosponiosus 5. detruser muscle
Erbs palsy effects which trunk of the brachial plexus? [1]
upper trunk C5-C6 of the brachial plexus.
Which movements cannot occur in a person with Erbs palsy? [2]
Which movements are able to occur in a person with Erbs palsy? [1]
Which reflex is lost [1] and which is still present? [1]
Arm cannot be raised from the side
All power of flexion of the elbow is lost due to the paralysis of the biceps muscle.
Moro reflex is absent on the affected side.
Grasp reflex is present (which differentiates it from another brachial nerve palsy, Klumpke palsy (C7, C8, and T1))
How is Erbs palsy differnt to Klumpkes palsy? [1]
Klumpke injury: C8-T1
there is paralysis of the forearm and hand muscle due to injury in C7, C8, and T1. The neonate presents with a “claw hand” due to injury to the flexor muscles of the wrist, fingers, and forearm pronator.
Erb Palsy: C5, C6 - superior trunk - damage to:
Axillary nerve
Musculocutaneous nerve
Suprascapular nerve
How is Erbs palsy differnt to Klumpkes palsy? [1]
In the case of Klumpke injury, there is paralysis of the forearm and hand muscle due to injury in C7, C8, and T1
The neonate presents with a “claw hand” due to injury to the flexor muscles of the wrist, fingers, and forearm pronator.
A 6-month-old boy presents with an inability to move his right arm. His history is significant for gestational diabetes with poor glycemic control. The delivery was complicated by shoulder dystocia resulting in a birth injury. His right arm hangs limply by his side. Damage to which structure(s) will result in the “waiter’s tip” position?
A. The entire brachial plexus
B. Ulnar nerve
C. C5 and C6
D. Median nerve
A 6-month-old boy presents with an inability to move his right arm. His history is significant for gestational diabetes with poor glycemic control. The delivery was complicated by shoulder dystocia resulting in a birth injury. His right arm hangs limply by his side. Damage to which structure(s) will result in the “waiter’s tip” position?
A. The entire brachial plexus
B. Ulnar nerve
C. C5 and C6
D. Median nerve
After a difficult delivery a neonate is noted to have asymmetric Moro reflex. One of the arms is held in adduction, shows internal rotation at the shoulder, is pronated and extended at the elbow, and wrist flexion. Which nerve roots are most likely affected?
A. C4-C5
B. C5-C6
C. C6-C7
D. C7-C8
After a difficult delivery a neonate is noted to have asymmetric Moro reflex. One of the arms is held in adduction, shows internal rotation at the shoulder, is pronated and extended at the elbow, and wrist flexion. Which nerve roots are most likely affected?
A. C4-C5
B. C5-C6
C. C6-C7
D. C7-C8
What is drug A? [1]
Tranexamic acid
Which drug is used to treat premenstrual dysphoric disorder (PMDD)
Allopregnanolone
Dehydroepiandrosterone (DHEA)
Oestradiol
Prostergerone
Testosterone
Which drug is used to treat premenstrual dysphoric disorder (PMDD)
Allopregnanolone
Dehydroepiandrosterone (DHEA)
Oestradiol
Prostergerone
Testosterone
