Mat and Peds Exam

Question 1

Pulled and dislocated elbow- which ligament gets affected?

Answer 1

common under age of five, also called nursemaid’s elbow.

annular ligament of radius

Question 2

Ectopic pregnancy

most commonly Fallopian tubes. Rarely (but can exist with intrauterine pregnancy)

11/1000 pregnancies; people at risk are those who don’t seek medical help.

Risk factors; IVF, history of PID, adhesions, previous ectopic, IUCD use (1 in 1,000 over five years).

A pregnancy test should be performed on all women of childbearing age presenting with lower abdominal pain where pregnancy is even the remotest possibility.

How does it present?

Answer 2

Consider in ALL women of reproductive age. Symptoms can mimic UTI and GI conditions.

Common symptoms; abdominal pain, pelvic pain, missed period, vaginal bleeding.

Other symptoms very variable.

** if RUPTURES then bleeding is PROFUSE and mainly into the PELVIS. May be hypovolaemic shock.

Common signs; Pelvic/ abdo tendernes, adnexal tenderness.

Dx: Ultrasound (not bimanual >> risk of rupture)

Question 3

What is the adnexa of the uterus?

Answer 3

63% of ectopic pregnancies present with an adnexal mass.

Some sources define the adnexa as the fallopian tubes and ovaries.

Others include the supporting tissues.

One dictionary includes the fallopian tubes, ovaries, and ligaments(without specifying precisely which ligaments are included).

Question 4

Define Gestational diabetes mellitus (GDM)

Answer 4

Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with its onset (or first diagnosis) during pregnancy and usually resolving shortly after delivery.

Over the course of pregnancy, postprandial glucose concentrations increase as insulin resistance increases. in GDM there is insufficient compensatory rise in insulin production.

Question 5

What have large studies indicated, regarding maternal glucose levels (below those diagnostic of diabetes)?

Answer 5

continuous association of maternal glucose levels with increased birth weight, and significant associations with secondary outcomes such as preterm labour, shoulder dystocia, birth injury, intensive neonatal care requirement, hyperbilirubinaemia and pre-eclampsia. GDM increases the risk of developing diabetes later in life,

Question 6

What is Gestational trophoblastic disease (GTD) and what are the risks?

Answer 6

Group of pregnancy-related tumours (mostly benign eg. hydatiform mole or molar pregnancy). Hydatiform moles are the most common they made up of villi that have become swollen with fluid.

These tumours start in the layer of cells called the trophoblast that normally surrounds an embryo and form the placenta. The trophoblasts form villi that interlace into the uterus.

[tropho - nutrition. blast - bud]

Risk: choriocarcinoma - malignant tumour. Half of all gestational choriocarcinomas start off as molar pregnancies

Question 7

Why is the risk of CVD the same with women and men after the menopause?

Lipids!!

Answer 7

Cardioprotective effect on premenopausal women is believed to be imposed by adequacy of endogenous estrogen level produced during menstrual cycle.

Hormone levels (incl. LH, FSH) have significant effect on plasma lipid and lipoprotein metabolism resulting in ultimate cardiac related disorders.

Question 8

Ovarian cancer - what are the RISK factors?

LEADING cause of death from gynae cancer in the UK. Lifetime risk of 2%.

Most commen in women over 50 years age.

PROTECTIVE

PARITY, breast-feeding, early menopause, OCO Pill

Any factor which prevents or inhibits ovulation appears to protect against ovarian cancer

Answer 8

Early symptoms may be subtle and presentation is often LATE.

90% are epithelial ovarian tumours.

Risk factors; important

• Increasing age
• Lifestyle (21%); Obesity, smoking, lack of exercise.
• Nulliparity, early menarche and late menopause.
• Iatrogenic; Increased risk with HRT usage for more than five years. 1% of cases of ovarian cancer in UK thought to linked be HRT use. Also use of fertility drugs (e.g. clomifene)
• FH, BRAC genes. BRAC1 gene confers familial susceptibility for the breast-ovarian cancer syndrome.
• MH: prior history of related cancers, history of endometriosis.

Question 9

Definition of :

Stress incontinence (most common) - incompetent sphincter

and

Urge incontinence

Answer 9

Stress incontinence: involuntary leakage of urine on effort or exertion, or on sneezing or coughing. This is due to an incompetent sphincter. Stress incontinence may be associated with genitourinary prolapse.

Urge incontinence: involuntary urine leakage accompanied by, or immediately preceded by, urgency of micturition.

urgency and failure to reach a toilet in time

In urge incontinence there is detrusor instability or hyperreflexia leading to involuntary detrusor contraction.

This may be idiopathic or secondary to neurological problems such as stroke, Parkinson’s disease, multiple sclerosis, dementia or spinal cord injury. It can sometimes be caused by local irritation due to infection or bladder stones.

Question 10

Overactive bladder syndrome

versus

urge incontinence

Answer 10

Overactive bladder syndrome; urgency that occurs with or without urge incontinence and usually with frequency and nocturia.

The usual cause of this problem is detrusor overactivity

Question 11

What is overflow incontinence?

Answer 11

Usually due to chronic bladder outflow obstruction. It is often due to prostatic disease in men. It can lead to obstructive nephropathy due to back pressure.

Overflow incontinence may also be due to a neurogenic bladder.

Question 12

What are the risk factors associated with urinary incontinence in women?

Answer 12

pregnancy, vaginal deliveries, diabetes, oral oestrogen therapy, high BMI, hysterectomy, childbirth, forceps delivery, UTI

Question 13

PID - facts

general term for infection of the upper female genital tract, including the uterus, Fallopian tubes, and ovaries.

Risk age group for women; 20-29 years

Answer 13

• PID usually results from ascending infection from the cervix
• It is a common and serious complication of some sexually transmitted diseases, especially chlamydia and gonorrhoea.
• Untreated PID can lead to serious complications, including infertility, ectopic pregnancy, abscess formation and chronic pelvic pain.

Question 14

What symptoms and signs would suggest PID?

Answer 14

Symptoms

• Bilateral lower abdominal pain.
• Deep dyspareunia.
• Abnormal vaginal bleeding (postcoital, intermenstrual or menorrhagia).
• Vaginal or cervical discharge that is purulent.

SIgns

• Lower abdominal tenderness (usually bilateral).
• Mucopurulent cervical discharge and cervicitis seen on speculum examination.
• Cervical motion tenderness and adnexal tenderness on bimanual vaginal examination.
• Fever above 38°C (but may be apyrexial).

Question 15

PID - what other DDs are there?

Answer 15

appendicitis

ectopic pregnancy

other causes of abnormal vaginal bleeding, other causes of vaginal discharge (e.g. foreign body)

other causes of dyspareunia eg. endometriosis

Question 16

Acute exacerbation of asthma - child

management and diagnosis.

Answer 16

Life-threatening; PEFR less than 33% of best or predicted.

Oxygen sats less than 92%

+ clinical symptoms.

Acute severe; 33-50% of best or predicted. Inability to complete sentence in one breath. accessory muscle use, inability to feed (infants).

Tx: Oxygen immediately.

Salbutamol nebs - oxygen driven 6 L/min

Poor response to Salbutamol - tiotropium added.

Ipratropium Bromide - for children <12 months because Beta receptors are not developed.

IV or Oral steroids for all attacks of all severities.

Question 17

Syphilis

organism: Treponema pallidum

Question 18

What is the CA125 tes used for?

Answer 18

CA 125 is a protein often found on the surface of ovarian cancer cells and in some normal tissues.

It is used as a marker for ovarian cancer.

However, CA 125 levels may also be high in other types of non-cancerous conditions, including menstruation, pregnancy, and pelvic inflammatory disease.

If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis.

It is present in up to 80% of cases of advanced ovarian cancer

It is often negative earlier in the disease.

Question 19

What is placental accreta?

Answer 19

Placenta accreta: chorionic villi penetrate the decidua basalis to attach to the myometrium.

All are associated with retained placenta requiring surgical management and have high risk of massive postpartum haemorrhage.

Is associated with preterm delivery: 40% of women deliver before 38 weeks of gestation; caesarean should be planned for 36-37 weeks.

Question 20

What is the commonest cause of antepartum haemorrhaging?

Answer 20

Placenta Abruption (30%)

• premature separation of the placenta from the uterine side wall.

then

Placenta previa (20%)

Question 21

What is placenta adherens?

Answer 21

Placenta Adherens

Placenta Adherens occurs when the contractions of the womb are not robust enough to completely expel the placenta.

This results in the placenta remaining loosely attached to the wall of the uterus.

This is the most common type of retained placenta.

Question 22

What’s the management of placenta atony?

Answer 22

• The first step in management of uterine atony is uterine massage.
• The next step is pharmacological therapies, the first of which is oxytocin, used because it initiates rhythmic contractions of the uterus, compressing the spiral arteries which should reduce bleeding
• The next step in the pharmacological management is the use of methylergometrine, which is an ergot derivative, much like that use in the abortive treatment of migraines
• Its side effect of hypertension means its use should not be used in those with hypertension or pre-eclampsia

Question 23

What’s the first thing you should think of if there is a sudden decrease in foetal heart rate?

Answer 23

umbilical cord prolapse

Question 24

What is a pessary and what is it used for?

Answer 24

The pessary is a plastic or silicone device that fits into the vagina to help support the pelvic organs and hold up the uterus

A pessary is a good way of supporting a prolapse

This is a choice if the patient:

–does not wish to have surgery

•Pessaries are more likely to help:

a uterine prolapse

anterior wall prolapse

•Are less likely to help:

a posterior wall prolapse

The pessary is a plastic or silicone device that fits into the vagina to help support the pelvic organs and hold up the uterus

Question 25

Broad ligament

Answer 25

Externally the broad ligament supports and suspends the uterus

The nature of this ligament alters after pregnancy

Question 26

Where’s the usual site for implantation of the blastocyst?

Answer 26

Body