pass med Q's - Obs

Question 1

what is hyperemesis gravidarum

Answer 1

extreme nausea + vomiting in pregnancy 
triad needed for diagnosis 
- 5% of pre pregnancy weight loss
- dehydration 
- electrolyte imbalance

Question 2

risk factors for hyperemesis gravidarum

Answer 2

multiple pregnancy
trophoblastic disease
hyperthyroidism
obesity

Question 3

management of hyperemesis gravidarum

Answer 3

antihistamines – promethazine first line or cyclizine

may need admitted for IV fluids

Question 4

what is a neuro complication of hyperemesis gravidarum

Answer 4

wernicke’s encephalopathy

• thiamine deficiency
• triad: ophthalmoplegia/ nystagmus, ataxia, confusion

tx: pabrinex

Question 5

what is protective against hyperemesis

Answer 5

smoking

Question 6

what should be taken if women are at a high risk of pre-eclampsia

Answer 6

aspirin 75mg from 12 weeks to term

Question 7

risk factors for pre-eclampsia

Answer 7

HTN in previous pregnancies
CKD
SLE, antiphospholipid
diabetes

Question 8

treatment of eclampsia

Answer 8

IV magnesium sulphate + delivery of baby

Question 9

what is given to reverse magnesium sulphate induced respiratory depression

Answer 9

calcium gluconate

Question 10

what is the station of a baby

Answer 10

position of the head in relation to ischial spine
0 = at level of ischial spine
-2 = 2cm above ischial spine
+ 2 = 2cm below ischial spine

Question 11

layers cut through in C section from superficial to deep

Answer 11

Superficial fascia 
Deep fascia 
anterior rectus sheath 
rectus abdominis muscle 
transversals fascia 
exztraperitoneal connective tissue 
peritoneum 
uterus

Question 12

when should a mother feel fetal movements by?

Answer 12

24 weeks

• if no movements felt refer to maternity unit
• hand held doppler used to find heart beat
• if no heart beat – USS
• if heart beat present – CTG

Question 13

When is nuchal scan offered ?

what conditions can cause increased nuchal thickness ?

Answer 13

11 - 13 weeks

• Downs syndrome
• congenital heart defects
• abdominal wall defects

Question 14

what are the contraindications to a vaginal delivery if the woman has previously had a C section

Answer 14

previous uterine rupture

vertical incision

Question 15

what things cause a raised AFP

Answer 15

multiple pregnancy
abdominal wall defects e.g. omphalocele
neural tube defects

Question 16

what supplement should everyone take in early pregnancy

Answer 16

folic acid 400 micrograms until 12 weeks

Question 17

what groups of people should take a higher dose of folic acid? what is the dose?

Answer 17

5mg from before conception to 12 weeks if

• previous pregnancy with neural tube defects
• diabetic
• on anti-epileptics
• obese BMI > 30
• coeliac

Question 18

features of placental abruption

Answer 18

constant pain - tense tender uterus
shock out of keeping with visible blood loss
normal fetal lie + presentation but may be distressed – C Section

Question 19

features of placenta praevia

Answer 19

low lying placenta - often picked up at 16 - 20 week scan

can present with painless pv bleeding

Question 20

what is placenta accreta

Answer 20

attachment of placenta to the myometrium
increased his with previous c sections or placenta praevia
- can cause post partum haemorrhage

Question 21

management of placenta accreta

Answer 21

delivery planned 35- 36 weeks

definitive – hysterectomy or uterus persevering surgery if they wish to have more children

Question 22

what is a big risk factor for cord prolapse

Answer 22

artificial rupture of membranes

Question 23

management of cord prolapse

Answer 23

presenting part of fetus can be pushed back inside

position woman on all 4 fours until emergency C section

Question 24

management of premature rupture of membranes

Answer 24

admit
oral erythromycin for 10 days
steroids
delivery at 34-35 weeks

Question 25

what score is used to assess post natal depression

Answer 25

Edinburgh score

Question 26

presentation of vasa praevia

Answer 26

rupture of membranes followed by vaginal bleed + fetal bradycardia

Question 27

management of a breech baby

Answer 27

if < 36 weeks the majority will turn themselves

if >36 weeks offer external cephalic version

Question 28

signs of congenital rubella

Answer 28

sensorineural deafness
growth retardation
salt + pepper chorioretinitis

Question 29

presentation of cholestasis in pregnancy

Answer 29

itch, jaundice, RUQ pain

increased ALP over ALT

Question 30

treatment of cholestasis

Answer 30

ursodeoxycholic acid

increased risk of still birth so indice delivery 37 - 38 weeks

Question 31

presentation of acute fatty liver of pregnancy

Answer 31

abdo pain 
N + V
jaundice
headache 
massively raised ALT

Question 32

what is HELLP syndrome

Answer 32

severe form of pre - eclampsia

• Haemolysis
• Elevated liver enzymes
• low platelets

symptoms: N+V, headache, malaise

Question 33

what cells secrete HCG

Answer 33

synctiotrophoblasts - acts to maintain production of progesterone by corpus luteum

Question 34

what manoeuvre is used to treat shoulder dystocia

Answer 34

McRoberts manœuvre

Question 35

safest antidepressants in breastfeeding women

Answer 35

sertraline or paroxetine

Question 36

what is chorioamnionitis

Answer 36

bacterial infection of amniotic fluid

• pyrexia, tachycardia, smelly discharge
  tx: delivery of baby + antibiotics

Question 37

what is the most common cause of puerperal pyrexia (temp > 38 in first 14 days)

Answer 37

endometritis

- ADMIT patient

Question 38

most common cause of post partum haemorrhage

Answer 38

uterine atony

Question 39

step wise management of post partum haemorrhage

Answer 39

bimanual uterine compression 
IV oxytocin 
IM carboprost 
rectal misoprostol 
surgical -- balloon

Question 40

first line investigation for premature ROM

Answer 40

speculum examination

- if unsure can do fetal fibronectin