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P1EXAM > Original Clinical Management > Flashcards

Original Clinical Management Flashcards

1
Q

How do you calculate RMI?

A

= ultrasound score x menopausal score = Ca125

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2
Q

What RMI score should warrant referral to the MDT?

A

> /= 250 (NICE), but a score >200 is recommended by RCOG to treat as highly suspicious of cancer

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3
Q

What is the current recommended HbA1c in pregnancy?

A

=< 48

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4
Q

At what HbA1c should a woman be advised not to get pregnant?

A

> 86
i.e. 10%

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5
Q

What proportion of women have the classic ‘frothy’ discharge of TV?

A

Only 20%
Only 2% get cervicitis - i.e. strawberry cervix

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6
Q

What is the 1st line treatment of TV?

A

Metronidazole 400-500mg BD for 5-7 days. Also 1st line in pregnancy. BASHH recommend 500mg BD for 7 days in concurrent HIV infection

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7
Q

Which 3 disease should be screened for antenatally?

A

1) HIV; 2) Hep B; 3) Syphillis

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8
Q

What is the tubal infertility rate following 1 episode of PID?

A

12.5%

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9
Q

What is the tubal infertility rate following 3 episodes of PID?

A

50%

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10
Q

What are the 3 different utertonics?

A

1) Oxytocin; 2) Prostaglandins - misoprostal being the most commonly used; 3) Ergometrine

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11
Q

What is the 1st-line uterotonic?

A

Oxytocin

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12
Q

What is the half-life of oxytocin?

A

5 minutes

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13
Q

What is the half-life of ergometrine?

A

30-120 minutes

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14
Q

What is the half life of misoprostal?

A

40 minutes

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15
Q

What type of receptor does oxytocin bind to?

A

G-protein coupled receptor requiring Mg2+ and cholesterol

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16
Q

What is syntometrine?

A

Combination oxytocin and ergometrine

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17
Q

What are uterotonics?

A

Drugs that aid uterine contraction

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18
Q

What is the most important process necessary for cervical ripening??

A

Degradation of type 1 collagen by interstitial collagenase

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19
Q

What is the cervical screening frequency?

A

Age 25-49 = every 3 years
Age 50-64 = every 5 years

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20
Q

What is the new style (2019) cervical screening?

A

If HPV -ve = routine recall
If HPV +ve –> cytology triage. If cytology normal, re-screen in 12 months, if abnormal, colposcopy

Pt’s whom are HPV +ve with normal cytology may be re-screened every 12 months for 2 cycles. If at the 3rd test, i.e. 2 years from the 1st HPV +ve result and the pt is still HPV +ve but with normal cytology, they then need to go for colposcopy like abnormal cytology would do

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21
Q

What is the most common cancer of the vagina?

A

Squamous cell

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22
Q

What is the most common cancer of the cervix?

A

Squamous cell

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23
Q

What is the most common cancer of the vulva?

A

Squamous cell

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24
Q

What is the most common cancer of the ovary?

A

Epithelial (85%), of which 75% are serous

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25
Q

What is the most common cancer of the endometrium?

A

Endometroid carcinoma

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26
Q

What is the LFT monitoring regime in obstetric cholestasis?

A

Every 1-2 weeks during pregnancy
10 days postnatally
Itching may occur before deranged LFTs - if LFTs normal, repeat in 1-2 weeks.

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27
Q

What does OC increase the risk of?

A

Pre-term delivery
Fetal distress / Passage of meconium
C-section
PPH

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28
Q

How long must a woman wait to become pregnant whom has received chemo for gestational trophoblastic disease?

A

1 year post-completion of treatment

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29
Q

What is the frequency of molar pregnancy?

A

1/1000 pregnancies

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30
Q

In what proportion of molar pregnancies is hCG high enough to trigger hyperthyroidism?

A

3%

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31
Q

What is choriocarcinoma?

A

= a malignant tumour of the trophoblast, 70% occur after a molar pregnancy (20% after TOP, 10% after a normal pregnancy)

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32
Q

How do ovarian cancers metastasise?

A

Transcoelomic route

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33
Q

How do choriocarcinomas metastasise?

A

Haematogenous route

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34
Q

When should platelets be administered?

A

When = 75 give x1 pool

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35
Q

When should fibrinogen be administered?

A

When =2 give x2 pools of cryoprecipitate

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36
Q

When should FFP be administered?

A

If ongoing haemorrhage, after 4 units of blood and no haemostatic tests yet available - give 4 units FFP

If ongoing haemorrhage and prolonged APTT/PT, give 12-15ml/kg of FFP

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37
Q

What is a WHO group I ovulation disorder?

A

Hypothalamic pituitary failure (Stress, anorexia, exercise induced)

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38
Q

What is a WHO group II ovulation disorder?

A

Hypothalamic-pituitary-ovarian dysfunction (PCOS)

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39
Q

What is a WHO group III ovulation disorder?

A

Ovarian failure

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40
Q

How do you manage a WHO group I ovulation disorder with regards to fertility?

A

Increase BMI >19
reduce exercise
pulsatile GnRH to induce ovulation

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41
Q

How do you manage a WHO group II ovulation disorder with regards to fertility?

A

Weight reduction if BMI >30
1st line: clomiphene +/- metformin
2nd line: gonadotrophins or laparoscopic drilling

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42
Q

What is the risk of fetal laceration in CS?

A

2%

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43
Q

What is the average blood loss in a cycle?
What is the upper limit of normal?

A

average 35-40ml
upper limit normal blood loss = 80ml

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44
Q

What are the 2 types of endometrial hyperplasia?

A

1) Hyperplasia without atypia
2) Atypical hyperplasia

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45
Q

How should endometrial atypical hyperplasia be managed?

A

Hysterectomy
IUS or oral progesterone for those who decline surgery

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46
Q

How should endometrial hyperplasia w/out atypia be managed?

A

IUS first-line with 6 monthly endometrial surveillance

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47
Q

What is the progression rate to cancer of endometrial hyperplasia w/out atypia?

A

<5% over 20 years

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48
Q

What is used to inhibit Galactopoiesis and Lactogenesis?

A

Cabergoline and bromocriptine

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49
Q

After how long do you SUSPECT delay in multips/nullips?

A

SUSPECT:
Multips = inadequate progress in active 2nd stage after 30 mins
Nullips = inadequate progress in active 2nd stage after 1 hour

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50
Q

What can you do if you SUSPECT delay in labour?

A

If membranes intact, may offer amniotomy

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51
Q

Is lamotrigine an enzyme inducer?

A

No

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52
Q

What contraceptives may be used with lamotrigine?

A

Progesterone only

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53
Q

Why can’t combined contraception be used when a pt is taking lamotrigine?

A

The oestrogen component has been shown to reduce lamotrigine levels and therefore increases the risk of seizure.

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54
Q

What is St Anthony’s fire?

A

= ergotism, i.e. posioning by ergot compounds. Ergometrine is an ergot alkaloid

Erogtism causes convulsions and gangrene, the gangrene being due to prolonged vasospasm

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55
Q

What is the only UKMEC 4 condition for POP?

A

Breast cancer within the last 5 years

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56
Q

What produces superior images during hysteroscopy - distension with saline or CO2?

A

Saline

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57
Q

What type of hysteroscopes should be used in outpatient setting?

A

Miniature hysteroscopes - 2.7mm

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58
Q

Which nerve roots does the brachial plexus consist of?

A

C5-T1

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59
Q

What nerve roots are damaged in Erb’s palsy?

A

C5-C6

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60
Q

What is the most common cause of Erb’s palsy?

A

Shoulder dystocia

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61
Q

What is the prevalence of endometriosis?

A

2-3%

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62
Q

How is stage I endometriosis defined?

A

Superficial lesions & filmy adhesions

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63
Q

How is stage II endometriosis defined?

A

Deep lesions at cul-de-sac (space between the uterus and the rectum)

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64
Q

How is stage III endometriosis defined?

A

As above + ovarian endometriomas

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65
Q

How is stage IV endometriosis defined?

A

As above + extensive adhesions

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66
Q

What are the risks in laparoscopy?

A

Risk of ‘serious’ complication = 2/1000
Risk of bowel injury = 0.4/1000
Risk of vascular injury = 0.2/1000
Risk of death = 5/100,000

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67
Q

What are your first-line treatments for hyperthyroidism in pregnancy?

A

Propylthiouracil - as crosses the placenta less
Then carbimazole

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68
Q

What are the risk factors for acute fatty liver of pregnancy?

A

1) Male fetus
2) Obesity
3) Nulliparous
4) Multiple pregnancy

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69
Q

What is the cause of acute fatty liver of pregnancy?

A

Fetal deficiency of long-chain 3-hydroxyl-CoA dehydrogenase (LCHAD) - causes accumulation of toxic products of impaired fatty acid metabolism which then accumulate in the maternal circulation

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70
Q

What is the risk of VIN progressing to SCC?

A

15%

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71
Q

What are the histological features of lichen sclerosis?

A

1) Epidermal atrophy
2) Hydropic degeneration of the basal layer (sub-epidermal hyalinisation)
3) Dermal inflammation

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72
Q

What are the histological features of lichen simplex?

A

1) Epithelial thickening
2) Increased mitosis in basal and prikle layers

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73
Q

What are the histological features of VIN?

A

1) Epithelial nuclear atypia
2) Loss of surface differentiation
3) Increased mitosis

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74
Q

What would be the cause of a tender nodule during PV exam?

A

Endometriosis of the uterosacral ligament (sign specific to this)

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75
Q

How far back do individuals need to contact trace when diagnosed with an STI?

A

Men - 4 weeks if was symptomatic, 6 months if were asymptomatic at diagnosis
Women - 6 months

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76
Q

Which women would you give 5mg folate to daily?

A

1) On AEDs
2) Coeliac’s
3) DM
4) Prev. neural tube defect
5) FHx neural tube defects
6) On methotrexate
7) Sickle Cell

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77
Q

What is the risk cut off at which CVS would be offered?

A

> 1/150

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78
Q

In whom should cell salvage be used?

A

In those whom >1500ml blood loss is anticipated

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79
Q

What intra-abdominal pressure is required to insert the primary trocar?

A

20-25mmHg

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80
Q

What intra-abdominal pressure should be maintained once the trochar is inserted?

A

12-15mmHg

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81
Q

What is significant proteinuria?

A

Significant proteinuria = urinary protein:creatinine ratio >30 mg/mmol
or 24-hour urine collection result shows greater than 300 mg protein

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82
Q

What is the Abx regime in medical abortion?

A

Dual (unless tested -ve for chlyamydia in which case metronidazole PR only) - either azithromycin + metronidazole PR, or doxycycline + metronidazole PR

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83
Q

When does the luteoplacental shift occur?

A

6-8 weeks

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84
Q

When should simple ovarian cysts have follow-up?

A

When they are 50-70mm in daimeter there should be annual USS F/U

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85
Q

What is the maternal and fetal mortality rate of acute fatty liver of pregnancy?

A

20%

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86
Q

What is the definition of placenta accreta?

A

Chorionic villi attached to myometrium rather than decidua basalis

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87
Q

What is the definition of placenta increta?

A

Chorionic villi invade into the myometrium

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88
Q

What is the definition of placenta percreta?

A

Chorionic villi invade through the myometrium and into serosa

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89
Q

What proportion of birthing brachial plexus injuries are permanent?

A

<10%

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90
Q

What is the most common form of fibroid degeneration?

A

Hyaline

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91
Q

What is the most common form of fibroid degeneration in pregnancy?

A

Red

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92
Q

What are the Rotterdam criteria for PCOS?

A

1) Polycystic ovaries: >=12 peripheral follicles / increased ovarian volume >10cm3
2) Oligo-ovulation/ anovulation
3) Clinical and/or biochemical hyperandrogenism

Need 2/3 to meet criteria

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93
Q

What is the histological feature indicative of serous ovarian cancer?

A

Psammoma bodies

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94
Q

What is the histological feature indicative of mucinous ovarian cancer?

A

Mucin vacuoles

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95
Q

What proportion of pregnancies are choriocarcinoma?

A

1/45,000

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96
Q

How long do afterpains go on for post-delivery?

A

2-3 days

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97
Q

How long does it take for the uterus to involute?

A

4-6/52

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98
Q

How long does it take for vaginal tone to return?

A

4-6/52

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99
Q

How long does lochia flow for?

A

3-6/52

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100
Q

What proportion of women are asymptotic of gonorrhoea?

A

50%

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101
Q

At what gestation does a fetus start to urinate?

A

Weeks 8-11

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102
Q

At what gestation does a fetus start to swallow?

A

Week 12

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103
Q

Which COCP is used in hirsutism?

A

Dianette (co-cypindriol). It should be discontinued 3-4/12 after resolution of hirsutism. If the hirsutism relapses after discontinuation of Dianette consider use of Yasmin

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104
Q

What is the risk of serious neonatal infection in PROM?

A

1/100

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105
Q

What gestation/circumstances is it reasonable to induce labour in PROM?

A

> 34/40 and >24 hours post-rupture
If <34/30, induction shouldn’t be performed unless obstetric indication e.g. infection

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106
Q

What proportion of women with PROM will go into labour within 24 hours?

A

60%

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107
Q

What are the changes in blood composition in pregnancy?

A

Reduced platelet count
Increased ESR, coagulation factors, fibrinogen

108
Q

Should routine episiotomy be performed after previous 3rd/4th degree tears?

A

No

109
Q

What are the contraindications to ARM (artificial rupture of membranes)?

A

High presenting part (re cord prolapse)
Polyhydramnios/malposition/malpresentation
Placenta praevia
Vasa praevia
Preterm labour
Known HIV carrier

110
Q

What are the USS features of partial molar pregnancy?

A

1) Enlarged placenta
2) Fetus with severe structural abnormality
3) Oligohydramnios or deformed gestational sac

111
Q

What are the USS features of complete molar pregnancy?

A

1) Snowstorm
2) Bunch of grapes - represents swelling of trophoblastic villi
3) No identifiable fetal tissue or gestational sac

112
Q

How long may a tocolytic prolong a pregnancy by?

A

7 days

113
Q

What proportion of individuals whom are allergic to penicillin will also be allergic to cephalosporins?

A

0.5-6.5%

114
Q

What are the 1st line choices for OAB after bladder training/treatment of vaginal atrophy?

A
  1. Oxybutynin
  2. Tolterodine
  3. Darifenacin
115
Q

What are the 2nd line choices for OAB/adjuvant treatments?

A

2nd line = mirabegron
Adjuvants = desmopressin if struggling with nocturia; duloxetine if unsuitable for/declines surgery

116
Q

What ABx should given to women with suspected UTI (don’t wait for the culture results, start empirical treatment)?

A
  1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days
  2. Trimethoprim 200 mg twice daily, for 7 days - give folic acid 5 mg OD if it is the 1st trimester
  3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days
117
Q

At what gestation should CTG be performed for RFM?

A

28/40+

118
Q

What should not be used to diagnose BV?

A

Positive vaginal culture for Gardnerella vaginalis - since can be positive in 50 % of women w/out BV

119
Q

What Hb levels define anaemia in pregnancy?

A

1st trimester <110
2nd-3rd trimester <105
Postnatal <100

120
Q

At what gestation does amniotic fluid peak?

A

35/40

121
Q

What is the relative risk of VTE in pregnancy?

A

4-6x fold increase

122
Q

What is the absolute risk of VTE in pregnancy?

A

1-2/1000 pregnancies

123
Q

At what gestation may bleeding be defined as APH?

A

24/40

124
Q

Which clotting factors reduce during pregnancy?

A

Factors XI and XIII

125
Q

What are the risks of hysteroscopy?

A

Serious complications = 0.2%
Uterine perforations = 0.13%
Risk of death (under GA) = 8/100,000

126
Q

By what percentage can prophylactic oxytotics reduce the risk of PPH in the 3rd stage?

A

60%

127
Q

What proportion of women with gonorrhoea will develop PID?

A

15%

128
Q

What proportion of women are asymptomatic of TV?

A

50%

129
Q

In whom are polymorphic eruptions of pregnancy more common?

A

1) Multiple gestation pregnancies
2) Excessive maternal weight
3) Rh +ve blood type

130
Q

When should women who have previously had GDM be tested in subsequent pregnancies?

A

As soon as possible after booking

Otherwise if risk factors alone = week 24-28 pregnancy

131
Q

What tumour markers should you measure in women <40 with a complex ovarian mass and why?

A

AFP, hCG, lactate
The reason being to exclude germ cell tumours

132
Q

What is the Zavanelli manoeuvre?

A

Replacement of the baby’s head prior to emergency CS

133
Q

What percentage of parasited red blood cells in a pregnant woman can indicate severe malaria?

A

2%

134
Q

Which Abx is used to treat P vivax, P malariae and P ovale?

A

Chloroquine

135
Q

Which Abx is used to treat P falciparum?

A

Clindamycin and quinine (used in combination)

136
Q

How should severe infection with P falciparum be treated?

A

IV artesunate

137
Q

What is type 1 FGM?

A

Partial or total removal of the clitoris

138
Q

What is type 2 FGM?

A

Partial or total removal of clitoris and labia minora (with or w/out excision of the labia majora)

139
Q

What is type 3 FGM?

A

Narrowing of the vaginal orifice, with or w/out the excision of the clitoris

140
Q

What is type 4 FGM?

A

All other harmful procedures to the female genitalia including pricking, incising, scraping, piercing and cauterisation

141
Q

What is the correct position for the ventouse cup?

A

On the sagittal suture line, approximately 3 cm anterior (in front) of the posterior fontanelle

142
Q

What is the risk of uterine perforation in hysteroscopy?

A

1%

143
Q

Administration of oxytocin reduces the risk of PPH by what percentage?

A

60%

144
Q

What is the minimum number of sperm in a normal ejaculate?

A

39x10(6)

145
Q

What is the volume of the female bladder?

A

400-600ml

146
Q

What is the max. flow rate of urine?

A

18ml/sec

147
Q

What is the max. normal residual bladder volume?

A

10ml

148
Q

What are
a) the early filling pressure of the bladder
b) micturition prompting pressures
c) max. urethral closing pressure

A

a) 10
b) 25-40
c) 60

149
Q

In pregnancy are hydroureter and hydronephrosis more common on the R or the L, and it is seen in what proportion of pregnancies?

A

More common on the R
Seen in 80% of pregnancies

150
Q

Which oestrogen is secreted predominantly post-menopausally?

A

Oestrone

151
Q

What happens to testosterone levels post-menopause?

A

Fall

152
Q

How can OHSS (Ovarian Hyperstimulation Syndrome) present to an ED/AMU?

A

Thromboembolic events - preference for upper limb sites and the arterial system

153
Q

In which trimester does obstetric cholestasis usually occur?

A

3rd trimester

154
Q

What proportion of pregnancies are affected by OC?

A

0.7%

155
Q

What are tocolytic agents?

A

Agents used to suppress contractions

156
Q

What are the different tocolytic agents available?

A

1st line: Nifedipine (Ca2+ channel blocker)
2nd line: Atosiban (oxytocin antagonist)
<30/40: Magnesium sulphate (neuroprotection)

Avoid: NSAIDs, GTN, B2 agonists e.g. ritodrine; terbutaline; fenoterol

157
Q

What are the 1st and 2nd choice tocolytics?

A

1st - nifedipine
2nd - atosiban

158
Q

Which women are most likely to benefit from tocolytics?

A

1) Pre-term labour
2) Those that need transfer to hospitals with neonatal units
3) Those that have not yet completed steroids

159
Q

What is the most significant factor in slowing down drug metabolism in pregnancy?

A

Progesterone effect on gastric motility

160
Q

What is the lifetime prevalence of fibroids?

A

30%

161
Q

What type of drug is Levonelle?

A

Synthetic progesterone

162
Q

What type of drug is EllaOne?

A

Selective progesterone receptor modulator

163
Q

Can women using enzyme inducers - e.g. phenytoin - use hormonal emergency contraception?

A

Yes - double dose of ullipristal. Copper IUS preferred

164
Q

What is the incidence of obstetric anal sphincter injuries (OASIS)?

A

2.9%

165
Q

What is the incidence of OASIS in primips?

A

6.1%

166
Q

What is the incidence of OASIS in multips?

A

1.7%

167
Q

What percentage of women with OASIS will be asymptomatic at 12 months post-delivery?

A

60-80%

168
Q

What type of stitch is used in the anorectal mucosa?

A

Continuous interrupted suture
3-0 vicryl (braided)

169
Q

What type of stitch is used in the external anal sphincter?

A

End-to-End sutures

3-0 PDS (monofilament) /
2-0 vicryl (braided)

vicryl aka polyglactin

170
Q

What type of stitch is used in the internal anal sphincter?

A

Interrupted mattress
Either 3-0 PDS (monofilament) or 2-0 vicryl (braided)

171
Q

What are the risks of abdominal hysterectomy?

A

Overall serious complications = 4%
Haemorrhage requiring transfusion = 2.3%
Bladder/ureter injury = 0.7%
Return to theatre = 0.7%
VTE = 0.4%
Pelvic abscess/infection = 0.2%
Bowel injury = 0.04%
Risk of death w/in 6/52 = 0.03%

172
Q

What is the risk of serious complication in abdominal hysterectomy?

A

4%

173
Q

What is the risk of haemorrhage requiring transfusion in abdominal hysterectomy?

A

2.3%

174
Q

What is the risk of bladder/ureter injury in abdominal hysterectomy?

A

0.7%

175
Q

What is the risk of returning to theatre in abdominal hysterectomy?

A

0.7%

176
Q

What is the risk of VTE in abdominal hysterectomy?

A

0.4%

177
Q

What is the risk of pelvic abscess/infection in abdominal hysterectomy?

A

0.2%

178
Q

What is the risk of bowel injury in abdominal hysterectomy?

A

0.04%

179
Q

What is the risk of death w/in 6/52 in abdominal hysterectomy?

A

0.03%

180
Q

What are the constituents of breast milk?

A

Sugar 7%
Fat 4%
Protein 1%

181
Q

What is the risk of placenta accreta/increta/percreta?

A

1.7/10,000 deliveries

182
Q

What is the mode of action of tranexamic acid?

A

Inhibits plasminogen activation
Can reduce flow by 50%

183
Q

What is the mode of action of mefenamic acid?

A

Inhibits prostaglandin synthesis
Reduces menstrual loss by 25%

184
Q

What is the most common type 2 congenital thrombophillia?

A

Factor V Leiden

185
Q

What are examples of type I thrombophillia?

A

Protein C + S deficiencies

186
Q

What type of thrombophillia is antiphospholipid?

A

Acquired

187
Q

What is current?

A

Rate of flow (amps)

188
Q

What is voltage?

A

Force of flow (volts)

189
Q

At what frequency do electrosurgery generators operate at?

A

200kHz - 3.3 MHz

190
Q

At what temp does tissue death occur in electrosurgery?

A

45 degrees

191
Q

At what temp does coagulation occur in electrosurgery?

A

70 degrees

192
Q

At what temp does desiccation occur in electrosurgery?

A

90 degrees

193
Q

At what temp does vaporisation occur in electrosurgery?

A

100 degrees

194
Q

At what temp does carbonisation occur in electrosurgery?

A

200 degrees

195
Q

What is cut mode in electrosurgery?

A

Continuous wave form at low voltage

196
Q

What is coagulation mode in electrosurgery?

A

Current produced in spikes at higher voltage

197
Q

What should the surgical site infection rate be below?

A

<2%

198
Q

SSI (surgical site infection) causes an average increase in hospital stay of how many days?

A

6.5 days

199
Q

What are Littlewoods forceps usually used for?

A

Grasping rectus sheath

200
Q

What are Rampley forceps usually used for?

A

Swab on a stick

201
Q

What are Babcocks used for?

A

Delicate structures e.g. ovaries/fallopian tubes

202
Q

What are vullselum forceps used for?

A

Grasping the cervical lip

203
Q

What are the commonly used types of retractors?

A

Doyens and Langenbecks

204
Q

What are Green-Armytage’s used for?

A

Haemostatic forceps - usually 4, one on each side of uterine incision angle

205
Q

What are the different surgical positions?

A

1) Lithotomy
2) Trendelenberg - 45 degrees head down tilt
3) Lloyd Davis - 30 degrees head down tilt, hips flexed at 15 degrees

206
Q

What is the risk of Trendelenberg position?

A

Can increase V/Q perfusion mismatch and increase ICP

207
Q

What size suture is used in uterine culture?

A

Size 1

208
Q

What is the symbol representing a cutting needle?

A

Downwards triangle

209
Q

What is the symbol representing a tapered point needle?

A

Circle with a dot in the middle

210
Q

What is the healing time of skin?

A

1-2 weeks

211
Q

What is the healing time of peritoneum?

A

4-10 days

212
Q

What is the healing time of uterus?

A

8 days

213
Q

What is the healing time of vagina and perinum?

A

8-10 days

214
Q

What is the healing time of bladder?

A

5 days

215
Q

What are the rates of instrumental delivery in the UK?

A

10-13%

216
Q

What is an OUTLET instrumental delivery?

A

Fetal scalp visible w/out parting the labia

217
Q

What is a LOW cavity instrumental delivery?

A

Leading point of skull is at station +2

218
Q

What is a MID cavity instrumental delivery?

A

Fetal head no more 1/5th palpable per abdomen, leading point of skull above station +2

219
Q

What are the indications for instrumental delivery?

A

1) Inadequate progress, inc. maternal fatigue
2) Maternal factors - e.g. to reduce effects of 2nd stage labour on medical conditions

220
Q

When is inadequate progress DIAGNOSED in nullips?

A

Lack of progress for 2 hours w/out regional anaesthesia (suspect after 1 hours)

221
Q

When is inadequate progress DIAGNOSED in multips?

A

Lack of progress for 1 hour w/out regional anaesthesia (suspect after 30 mins)

222
Q

What are the foetal and maternal pre-requisites for instrumental delivery?
What are the ~procedural steps?

A

Head
- <1/5th palpable in the abdomen
- vertex presentation (not breech)
- assess caput, moulding
Maternal
- Cervix fully dilated
- Membranes ruptured
- Pelvis deemed ‘inadequate’
Procedural steps:
- Analgesia
- bladder emptied

223
Q

What conditions favour ventouse rather than forceps?

A

1) Urgent low lift out with no analgesia on-board
2) Rotational delivery

3) Operator/maternal preference when either instrument can be used

224
Q

What conditions favour forceps (rather than ventouse)?

A

Poor maternal effort

Marked active bleeding from FBS site
Large amount of caput
Face presentation
Gestation <34/40

Operator/maternal preference when either instrument can be used

225
Q

What are the neonatal risks of ventouse?

A

Cephalohaematoma
Retinal haemorrhage

226
Q

What are the indications for FBS?

A

1) Pathological CTG in labour (cervix >3cm)
2) Suspected acidosis in labour (cervix >3cm)

227
Q

What are the contraindications for FBS?

A

1) Maternal infection
2) Foetal blood disorders
3) Prematurity
4) Acute fetal compromise (e.g. prolonged bradycardia)

228
Q

What does a fetal pH of >/= 7.25 mean?

A

Normal, repeat after an hour if CTG remains same

229
Q

What does fetal pH of 7.21-7.24 mean?

A

Borderline, repeat after 30 mins

230
Q

What does fetal pH of = 7.2 mean?

A

Abnormal, consider delivery

231
Q

What are the limitations of continuous electronic fetal monitoring?

A

1) Decreased mobility
2) Increased intervention
3) Variation in CTG interpretation
4) Chorioamnionitis can make interpretation unreliable

232
Q

What is the recording rate of CTG?

A

1cm/min

233
Q

What is the rule of 3 for fetal bradycardia?

A

3 mins - call for help
6 mins - move to theatre
9 mins - prepare for assisted delivery
12 mins - aim to deliver the baby

234
Q

From what gestation can CTG replace handheld doppler to assess fetal movements?

A

24/40

235
Q

What is the earliest gestation that fetal heart can be detected on a transvaginal USS?

A

5-6 weeks

236
Q

What enzyme level may be raised in sarcoidosis?

A

ACE

237
Q

What is normal CTG variability?

A

5-25

238
Q

At what hCG level would a single intrauterine pregnancy be visible on scan?

A

1000-2400

239
Q

Which bacterial cell component is detected by gram staining?

A

Peptidoglycan

240
Q

What is a risk factor for ectopic pregnancy?

A

Smoking

241
Q

What is the medical treatment for ectopic pregnancy?

A

Methotrexate 75mg IM STAT

242
Q

What proportion of teratomas are bilateral?

A

10%

243
Q

What is the radiation dose of a
CXR?
Chest CT?
Abdo/pelvis CT
Background radiation

A

CXR - 0.1 mSv
CT chest - 7 mSv
CT abdo/pelvis - 10 mSv
Background - 3mSv

244
Q

What is the causative agent of Kapsoi sarcoma?

A

Human herpes virus 8

245
Q

When in cutaneous wound healing do macrophages replace neutrophils?

A

48-92 hours

246
Q

What is stage 1 of labour?
How are the latent and active phases defined?

A

Effacement and dilatation of the cervix up to 10cm
—> Latent phase = <4cm
—> Active phase =>4cm

247
Q

What is stage 2 of labour?

A

From full dilatation to delivery of the fetus
—> Propulsive phase
—> Expulsive phase

248
Q

What is the process (steps) of delivery?

A

Engagement —>
Descent and flexion —>
Fetal head rotation to OA —>
Extension and delivery of head —>
Restitution (head transverse again)—>
Delivery of shoulders/body

249
Q

What are the different types of breech?

A

Extended (or frank)
Flexed (or complete)
Footling

250
Q

What are the fetal risks of vaginal breech delivery?

A

Intracranial haemorrhage
Brachial plexus injury
Spinal cord injury
Limb fractures

251
Q

Why is the presentation USUALLY cephalic?

A
  1. Piriform shaped uterus
  2. Calcification of the fetal skull, and therefore increased density
252
Q

What is the incidence of shoulder dystocia?

A

0.6%

253
Q

Which shoulder is most commonly involved in shoulder dystocia?

A

Anterior shoulder

254
Q

What is hypoxaemia? And how does the fetus respond to chronic hypoxaemia?

A

Decreased O2 content in arterial blood with normal cell and organ function

Reduced activity of fetus —> decreased fetal growth rate

255
Q

What is hypoxia? And how does the fetus respond to it?

A

O2 deficiency which affects peripheral tissues

Surge of stress hormones —> reduced peripheral blood flow —> redistribution of blood flow to central organs —> peripheral tissues enter anaerobic metabolism

256
Q

What is spalding sign?

A

Spalding sign on XR represents overlapping fetal skull bones in advanced maceration of fetal tissues

257
Q

What is the speed of CTG recording?

A

1cm/min

258
Q

What is the false +ve rate of CTG?

A

50%

259
Q

What are the causes of reduced variability?

A

Sleep cycle
Pre-terminal pattern

260
Q

When is a sinusoidal pattern seen on CTG?

A

Seen in fetal anaemia or feto-maternal haemorrhage
Frequency of 3-5 cycles/min
Seen as a smooth undulating sine wave pattern

261
Q

What are the 4 patterns of hypoxic change?

A

Acute - sudden drop in baseline rate

Subacute - HR below the baseline the majority of the time

Evolving - decelerations –> loss of accelerations –> tachycardia —> loss of variability

Chronic

262
Q

What are the causes of acute hypoxia?

A
  1. Unknown - approx. 50%
  2. Placental abruption
  3. Uterine rupture
  4. Cord prolapse
  5. Epidural top-up
263
Q

What are the stages of evolving hypoxia?

A
  1. Stress stage - decelerations
  2. Distress stage - max. tachycardia, marked reduction in variability
  3. Collapse stage
264
Q

What is evolving hypoxia also known as?

A

Hon’s stepladder pattern to death

265
Q

Which of the androgens in females is the most potent?

A

Dihydrotestosterone

266
Q

What is the distance between two z lines in a muscle fibre?

A

Sarcomeres

P1EXAM (27 decks)

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