passmed q's w/c25/12/23

Question 1

pregnancy physiological changes
respiratory system?

Answer 1

pulmonary ventilation : UP 40%
TV 500ml-700ml

oxygen requirements increase by 20%

Question 1

pregnancy physiological changes
Cardiovascular
what effect does the enlarged uterus have

Answer 1

SV up 30%
HR up 15
CO 40%

enlarged uterus =
venous return> ankle oedema>supine hypotension and varicose veins

Question 2

maternal blood volume up 20%
what constitutes this?

Answer 2

RBC by 20%
plasma up 50% so HB fall

Question 3

blood - effects of pregnancy

Answer 3

rise in fibrinogen and factors 7,8,10
placental suppresion of fibrinolytic activity
platelets fall

WCC and ESR rise

Question 4

urinary system - pregnancy related changes
blood flow?

Answer 4

increases - 30%
GFR- 30/60%

reduced urea, reduced creatinine, increase urinary protein loss

Question 5

Proteinuria in normal pregnancy

Answer 5

GFR increases by 50%
renal plasma flow increases by 80%
increased perfusion to the kidneys in pregnancy

Question 6

instrumental delivery requirements?

Answer 6

Fully dilated cervix generally the second stage of labour must have been reached
OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure
Ruptured Membranes
Cephalic presentation
Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally
Pain relief
Sphincter (bladder) empty this will usually require catheterization

Question 7

lochia?
how long does it last?

Answer 7

is the passage of blood, mucus and uterine tissue that occurs during the puerperium
4-6 weeks

Question 8

what are the 3 stages of lochia?

Answer 8

rubra - red (4days))
serosa - yellow (brown/red; 2/3 weeks
alba - white

Question 9

abruption

Answer 9

A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen- C-section);
P for Polyhydramnios;
T for Twins or multiple gestation/multiparity;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

Question 10

vasa praevia

Answer 10

foetal distress
bradycardia, late decelerations
ROM - blood from fetus

Question 11

PLACENTA PRAEVIA

Answer 11

PLACENTA PRAEVIA = baby fine usually, just painless PV bleed

Question 12

PRE -ECLAMPSIA MAGNesium treatment when should it be stopped

Answer 12

24hours after seizure / delivery whichever is last

Question 13

umblical cord prolapse

Answer 13

insert urinary catheter and filld bladder with saline in an effort to lift presenting part of the cord

Question 14

placental abruption management
fetus not indistress <36 weeks?

Answer 14

admit mother
adminster steroids (fetal lung development)
threshold to deliver

Question 15

hydaridiform mole

Answer 15

pre-cancerous form of gestational trophoblastic disease
abnormal trophoblastic tissue can produce excessive amounts of hcg

Question 16

hydatidiform mole
what is needed for the definitive diagnosis?

Answer 16

histopathological examination

Question 17

32 weeks pregnant presents to ED with painless leakage

PPROM

severe pen allergy
mx for infection control?

Answer 17

10 days erythromycin

Question 18

downs’ syndrome and turner are both associated with ___ _____ defects

Answer 18

congenital heart defects
> increase lymphatic accumulation

(weak pumping)
= increased nuchal translucency

Question 19

Nuchal translucency is a sign of ?

Answer 19

foetal oedema

Question 20

causes of hyperechogenic bowel?

Answer 20

CF
down’s
cytomegalovirus

Question 21

what is used to detect antibodies in maternal blood?

Answer 21

indirect coombs

Question 22

what drug must be avoided in pregnancy?

associated with a condition that causes
Encephlopathy
fatty liver damage
elevated transaminases

Answer 22

aspirin
> metabolic acidosis of infant

increases risk of reye’s syndrome

Question 23

what type of insulin in diabetes

Answer 23

short acting

Question 24

what drug to adminster whilst awaiting surgery for umbilical cord prolapse?

Answer 24

terbutaline
tocolytic
reduces uterus contraction

Question 25

erb’s plasy

Answer 25

damage to brachial plexus
adducted and internat rotation

waiter’s tip

Question 26

Klumpke’s palsy

Answer 26

lower brachial plexus
innervating hand