Part 9

Question 1

management of HIV in pregnancy

Answer 1

HAART during pregnancy
4 weeks Post Exposure Prophylaxis for neonate (Truvada and raltegravir)
Exclusive formula feeding
Vaginal delivery if viral load undetected (<50)
C-section if viral load detected

Question 2

Target site of HIV

Answer 2

CD4 –> MHC2 –> adaptive immune response

<200 = opportunistic infection

Question 3

What is the maternal part of the foetus called?

Answer 3

Decidua basalis (chorion is the foetal part)

Question 4

Why does BP decrease in pregnancy

Answer 4

Progesterone = vasodilator

Addition of placenta = low resistance circuit

Question 5

Why are pregnant ladies prone to UTIs?

Answer 5

Urinary stasis resulting from enlarged uterus pressure on ureters.

Question 6

What is Pre-eclampsia?

Answer 6

pregnancy induced hypertension (>20 weeks) and proteinuria.
Kidney function declines –> (salt + water retention) oedema

Highest risk = previous pre-eclampsia

Deliver baby at term (37 weeks!!)

Question 7

What increases and decreases uterine contraction?

Answer 7

Oestrogen + oxytocin (posterior pituitary)

Progesterone decreases it

Question 8

the cutoff for mammography over US is…

Answer 8

> 35 = mammography

Question 9

50 yo patient with spontaneous, unilateral, blood stained nipple discharge think…

Answer 9

malignancy or papilloma (if benign)

Question 10

What is Korsakoff syndrome?

Answer 10

Anterograde amnesia
retrograde amnesia
-due to thiamine (B1) deficiency

can happen secondary to wernicke’s (ataxia, ophthalmoplegia + confusion)

Question 11

Management of placental abruption

Answer 11

Stabilise Mother - prevent Shock + anaemia [fluid + Blood transfusion] prevent DIC [FFP]
Assess CTG: Stable Foetus - vaginal delivery or conservative (<34 weeks);
Unstable foetus - Urgent C-Section (irrespective of gestational age)

Question 12

Management of placental praevia

Answer 12

Acute Bleed then use US to determine foetal lie (DONT do digital examination!!! may increase bleed) > stabilise patient > C section if no stabilisation or foetal compromise
ALSO
C/section : If placenta covers os or <2cm from cervical os
Vaginal delivery if placenta>2cm from os and no malpresentation

Question 13

Management of PPH (70% = atonic; trauma, tissue, thrombin = other causes)

Answer 13

Severe = >1500ml Mild = <500ml

uterine (fundal) massage, IV synctocinon (oxytocin)
Tranexamic acid
Packs + balloons OR Suturing, Hysterectomy

Question 14

What should be suspected in secondary PPH (>24hrs)?

Answer 14

Infection, Products of conception (do US)

Question 15

Parameters of HT in pregnancy

Answer 15

> 140/90 on 2 occasions; diastolic >110 on 1 occasion

Question 16

Pathogenesis of Pre-eclampsia + complications

Answer 16

Abnormal placentation and failure of trophoblast invasion cause spiral arteries to stay as high resistance/low flow vessels, leading to placental ischaemia -> endothelial damage and thrombosis.

eclampsia, pulmonary oedema, stroke, foetal damage (IUGR, placental abruption, still birth).

Question 17

Pre-eclampsia can increase risk of what…

Answer 17

HELLP Syndrome

Haemolysis; Elevated Liver enzymes; Low Platelets. Liver and blood clotting disorder.

Question 18

Parkinsonism with orthostatic hypotension + poor response to levodopa

Answer 18

Multiple System Atrophy

Question 19

imaging for vascular dementia

Answer 19

SPECT Scan (shows vascular insults not seen with MRI or CT)

Question 20

imaging for fronto-temporal dementia

Answer 20

MRI

Question 21

What should you tell pregnant women not to eat?

Answer 21

soft cheese

Listeria

Question 22

A stroke where can cause full paralysis except blinking + eye movement?

Answer 22

Basilar artery

Question 23

pain is carried from where at the pelvic organs in contact with the perineum (e.g uterus, ovaries and uterine tubes)

Answer 23

visceral afferents alongside sympathetic fibres to T11-L2

Question 24

How is pain carried from structures below the levator ani (inferior vagina, perineal muscles and skin)?

Answer 24

Pain is carried in somatic sensory fibres in the pudendal nerve to S2-4

Question 25

Where is pain carried in the the pelvic organs deep in the pelvis (cervix and superior vagina)?

Answer 25

Pain is carried in visceral afferents which run alongside parasympathetics to S2-4