Obs and Gynae pretest Flashcards
What level is the epidural needle inserted into?
Inserted between L3/L4 (as below spinal cord, which ends at L1/L2)
What level does the spinal cord end at?
L1/L2
Which space is the spinal anaesthetic inserted into?
The subarachnoid space
What should you give a woman prior to an epidural and why?
Should give 500ml-1000ml crystalloid fluid as epidural will lower her blood pressure
(hypotension because of vasodilation)
To provide relief for pain caused by uterine contractions, which levels must you block?
Must block levels T10-S4
T10-T12 -sympathetic nerves
L1 - ilioinguinal nerve
S2,S3,S4 - pudendal nerve
Lymphatic drainage of fundus of uterus
Para-aortic nodes
Lymphatic drainage of cervix
Internal and external iliac nodes
Lymphatic drainage of bladder
Internal and external iliac nodes
Lymphatic drainage of ovary
Para-aortic nodes
Lymphatic drainage of labia minora?
Superficial inguinal nodes
Which drug is given to a woman with eclampsia to treat seizures and prevent further seizures?
Magnesium sulphate
How should you check liver function in pre-eclampsia?
Serum ALT
How should you check renal function in pre-eclampsia?
Serum urate
How should you check haematological system in pre-eclampsia?
Check platelet count
How should you check neurology in pre-eclampsia?
Patellar reflexes
How should you check placental sufficiency in pre-eclampsia?
Umbilical artery doppler
How long is the female urethra?
4cm
Lymphatic drainage of ovaries?
Para-aortic nodes
When does the uterus rise from the pelvis in pregnancy?
Rises out of pelvis at 12 weeks
Is the posterior fornix of the vagina related to the peritoneal cavity (pouch of douglas)?
Yes, vaginal injury damaging the posterior fornix will open the peritoneal cavity and facilitate spread of infection to the cavity
Most common HPV causing cervical cancer?
HPV 16 and 18
Where does cervical intraepithelial neoplasia usually occur?
CIN usually occurs in the transformation zone at the squamo-columnar junction
Which percentage of ovarian cancers are genetic and which genes are associated?
Around 5% of cases are genetic
Associated with BRCA1 and BRCA2
How may ovarian cancer present?
Usually presents with non-specific symptoms such as abdominal pain, dyspepsia and weight loss.
MAY ALSO present initially as leg pain and swelling as a result of DVT
Ovarian cancer survival
Most people die 3-5 years after diagnosis
Does the pudendal nerve pass in front or behind the ischial spine?
Behind
How big is the vagina?
About 8cm
Which vessel does the ovarian artery arise from?
Arises from the aorta
At ovulation, is the ovum extruded into the peritoneal cavity?
Yes - as the ovum is extruded into the peritoneal cavity, it is possible to develop an intra-peritoneal ectopic pregnancy
Does plasma volume increase during pregnancy?
Yes, plasma volume increases by about 50% during pregnancy (this means blood becomes diluted so physiological anaemia)
When does blood pressure decrease in pregnancy?
Blood pressure decreases in second trimester due to vasodilation
What happens to glomerular filtration during pregnancy?
Glomerular filtration increases to cope with the additional load of the fetus - this results in a decrease in creatinine and urea levels
Are systolic murmurs common in pregnancy?
yes - there is about a 35-40% increase in cardiac output during pregnancy, so systolic murmurs are common
By how much is your risk of thromboembolism increased in pregnancy?
Increased by about 10%
