HD EOYS3 Flashcards
Explain the significance and causes of acceleration and early deceleration in Cardiotocography [2]
Acceleration:
- Sympathetic activation in response to fetal movement or scalp stimulation. Baby is moving around in the uterus / cervix. Normal
Early deceleration:
- Parasympathetic response to head compression
- Fetal HR decreases BEFORE contractions: normal
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
Possible complications of shoulder dystopia? [4]
- Fetal brachial plexus injury: Erb-Duchenne palsy - Single nerve stretching eg radial nerve
- Fetalfracture: Humerus or collar-bone break, which usually heal without problems
- Hypoxic-ischemic brain injury, or a low oxygen supply to the brain: Cerebral palsy
- Maternal complications include uterine, vaginal, cervical or rectal tearing and heavy bleeding after delivery
Explain 3rd stage of labour [1]
What does active managment of 3rd stage of labour decrease the risk of ? [1]
Which drug do you use for ^? [1]
Expulsion of placenta and membranes
Active management decreases risk of PPH - use oxytocin to stimulate placental delivery
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
CTG deceleration:
Abrupt decrease in baseline heart rate of >[] bpm for >[] seconds
Abrupt decrease in baseline heart rate of >15 bpm for >15 seconds
Explain potential complications of secondary perinatal apnea [3]
Not getting o2 in lungs and distributing surfactant.
Can lead to hypoxaemia: brain damage, heart damage and cause resp. acidosis.
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 are the 4 types of placenta previa? [4]
Minor praevia, or grade I – the placenta is in the lower uterus but not reaching the internal cervical os
Marginal praevia, or grade II – the placenta is reaching, but not covering, the internal cervical os
Partial praevia, or grade III – the placenta is partially covering the internal cervical os
Complete praevia, or grade IV – the placenta is completely covering the internal cervical os
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
Define precipitous labour [1]
Describe the two types of precipitous labour
Precipitous labor is defined as expulsion of the fetus within less than 3 hours of commencement of regular contractions.
1st is when it starts in the 1st stage of labour: lot of super intense contractions
2nd starts in the 2nd stage of labour: 2nd stage is “pushing stage”
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
What is a positive Homon’s sign for investigating thromboembolic disease? [1]
Positive Homon’s sign: Pain with forced dorsiflexion of the foot
Which screening scale is used for post natal depression? [1]
What score requires further evaluation? [1]
Edinburgh Postnatal Depression Scale (EPDS):
* 0 item, self-rated questionnaire used extensively for detection of postpartum depression
* Score of 10 or more on EPDS or an affirmative answer on question 10 requires further evaluation
* Presentation is clinically indistinguishable from major depression
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
Which drugs are used as pharmalogical therapy for post natal depression? [4]
SSRIs: Selective serotonin reuptake inhibitors:
* Citalopram (SSRI)
* Sertraline (SSRI)
(SNRI) serotonin-noradrenaline reuptake inhibitor:
* Duloxetine (SNRI)
TCA: Tricyclic antidepressants
* Nortriptyline
What is the name of the progesterone metabolite important in PPD and which receptor does it work on? [2]
Progesterone metabolite allopregnanolone (ALLO) is a involved with GABA receptor and is a neurosteroidal transmitter
How do oestrogen levels change after birth? [1]
Why reduced levels of oestrogen affect which NT in PPD? / Why is giving it good? [1]
The change of what family of enzymes alter oestroen levels after delivery? [1]
What do have to be careful with oestrogen therapy? [1]
Oestrogen levels acutely fall
Oestrogen gives rise to increased serotonin
Monoamine oxidases (family of enzymes) rise after birth till day 4-6: causes oestrogen levels to be depressed (and therefore depressive symptoms)
Oestrogen therapy has a bell curve effect (bad at extreme high / lows)
What tests would you do to exclude a medical cause for mood distubance? [2]
Thyroid dysfunction
Anaemia
Which anxiolytics may be recommended as an adjunctive treatment for PPD? [2]
Explain MoA [1]
Lorazepam and clonazepam
GABA benzodiazepines (enhances GABA activity)
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 does not cause nausea in mother?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following does not cause nausea in mother?
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 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)
Describe pathophysilogy of pre-menstrual dysphoric disorder (PMDD)
What is used to treat? [1]
Symptoms start at late luteal phase: corpus luteum is shutting down and you lose progesterone
Ends soon after menstruation starts
Use ALLO to treat
Question 1 of 3
How is a post-partum haemorrhage defined?
Loss of >500ml blood within 12 hours of delivery
Loss of >500ml blood within 24 hours of delivery
Loss of >1L blood within 12 hours of delivery
Loss of >1L blood within 24 hours of delivery
Question 1 of 3
How is a post-partum haemorrhage defined?
Loss of >500ml blood within 12 hours of delivery
Loss of >500ml blood within 24 hours of delivery
Loss of >1L blood within 12 hours of delivery
Loss of >1L blood within 24 hours of delivery
All of the following drugs are used in the management of primary PPH. Which one is a oxytocin analogue?
Ergometrine
Carboprost
Syntocinon
Misoprostol
All of the following drugs are used in the management of primary PPH. Which one is a oxytocin analogue?
Ergometrine
Carboprost
Syntocinon
Misoprostol
What is the name for this sign / test? [1]
What would a positive sign indicate? [1]
Homon sign
Positive sign indicates DVT / thromboemolic disease
Label A-E & Green Arrow [6]
A: Sigmoid colon
B: (Ampulla of) rectum
Green Arrow: (Ampulla of) vas deferens
C: External anal sphincter muscle
D: Internal anal sphincter muscle
E: Bulb of penis
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
Label A-G
A: Prostatic utricle (embryological remnant)
B: Ejac. ducts
C: Prostatic urethra
D: Membranous urethra
E: Spongy urethra
F: Sphincter urethrae muscle
G: Prostate
The wall of the vas deferens consists largely of smooth muscle, arranged in three muscle layers:
What are they?
Inner Layer: Longitudinal smooth muscle
Intermediate Layer: Circular smooth muscle
Outer Layer: Longitudinal smooth muscle
Where does lymph from the testes drain? [1]
Where does lymph from the scrotum drain? [1]
Testes: para-aortic
Scrotum: Superficial inguinal
Which nerves innervate the cremaster and dartos:
Anteriorly [2]
Posteriorly [1]
Anteriorly: Genitofemoral
Ilioinguinal
Posteriorly:
Pudendal
What effect does sympathetic innervation have on internal urethral sphincter? [1]
What effect does parasympathetic innervation have on internal urethral sphincter? [1]
Sympathetic action: mains contraction
Parasympathetic action: inhibits IAS - causing it relax and urine to pass
The [] zone is the exclusive site of benign prostatic hyperplasia (BPH).
transition zone
Prostate cancer arise from which zone?
Peripheral zone
Which structure does the vas deferen join?
Seminal vesicle
Name the structures within the pudendal canal [3]
Which muscle is the piudendal canal formed from the fascia of? [1]
(AKA alcocks canal)
internal pudendal artery, vein and nerv
sheath derived from the fascia of the obturator internus muscle
Label A-D
A: Pampiniform venous plexus
(anterior veins)
B: Ductus deferens
C: Testicular artery
D: Artery of ductus deferens
Label A-C [3]
A: Start of Vas deferens
B: Levator ani
C: Obturator internus muscle
Varicocoele is classically most associated with cancer of which solid abdominal organ? [1]
Why? [1]
Acceptable responses: kidney, renal, renal cell carcinoma
close association of the testicular vein and renal vein.
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
Detrusor muscle:
Sympathetic stimulation results in [],
Parasympathetic stimulation causes [], and [] of the bladder.
Sympathetic stimulation results in relaxation
parasympathetic stimulation causes contraction, and voiding of the bladder.
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
A 66-year-old woman is diagnosed with anal cancer. The tumour is located above the pectinate line.
This cancer is most likely to metastasise to which of these organs first? [1]
Liver
The venous drainage of the superior anal canal is via the superior rectal vein, which drains into the inferior mesenteric vein, which drains into the hepatic portal vein.
A woman in labour is due to undergo an episiotomy. Which of these is the most appropriate choice of anaesthetic for this procedure?
Spinal block
Caudal epidural
Pudendal nerve block
General anaesthetic
A woman in labour is due to undergo an episiotomy. Which of these is the most appropriate choice of anaesthetic for this procedure?
Spinal block
Caudal epidural
Pudendal nerve block
General anaesthetic
Which is the main muscle involved in helping to maintain erection? [1]
EXAM Q
Acceptable responses: bulbosongiosus, bulbospongiosus
Atherosclerosis of which artery is most likely to cause erectile dysfunction?
Superior gluteal artery
Inferior gluteal artery
Inferior rectal artery
Internal iliac artery
Perineal artery
Atherosclerosis of which artery is most likely to cause erectile dysfunction?
Superior gluteal artery
Inferior gluteal artery
Inferior rectal artery
Internal iliac artery
Perineal artery
The penile artery arises from the internal pudendal artery, which. arises from the internal iliac artery.
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)
