pregnancy

Question 1

what two vitamins should you be taking in pregnancy

Answer 1

Folic Acid 400 micrograms per day - shown to reduce the occurrence of neural tube defects (NTD). Recommended to all woman pre-pregnancy and up to 12 weeks gestation. A higher dose of 5mg per day is recommended to women at increased risk of NTD

Vitamin D 10 micrograms (400 units) per day - shown to be beneficial in foetal bone formation. Recommended for all pregnant women throughout pregnancy and breastfeeding

Question 2

what are the absolute contraindications with breastfeeding

Answer 2

Infants of mothers with TB infection
Infants of mothers with uncontrolled/unmonitored HIV
Infants of mothers who are taking medications which may be harmful e.g. amiodarone

Question 3

A 32 year old G1P1 presents for a follow-up appointment 6 weeks post-delivery. She is wondering if she can stop breastfeeding due to breast pain and engorgement and move her baby to specialised formula feeds. She is informed and counselled about a medication which would help her stop breastfeeding.

Which of the following medications can be used to suppress lactation

Answer 3

cabergoline

Question 4

moa of cabergoline

Answer 4

Cabergoline exerts an inhibitory effect on prolactin secretion by acting on dopamine receptors present in pituitary lactotrophs. This drug also binds to dopamine D2 receptors in the corpus striatum, thereby mimicking the actions of dopamine on motor control. therfore stoping lactation

Question 5

what are braxton hicks contractions

Answer 5

Braxton-Hicks contractions, also known as prodromal or false labor pains, are contractions of the uterus that typically are not felt until the second or third trimester of the pregnancy. Braxton-Hicks contractions are the body’s way of preparing for true labor, but they do not indicate that labor has begun.

Question 6

selective screenign for gestational diabetes is offered at 26-28 weeks based off what facotrs

Answer 6

previous macrosomic baby over 4.5kg
BMI over 30
previosu gestational diabetes
first degree relative with diabetes
ethnic orgin

Question 7

A 29 year old woman delivered her third baby via a spontaneous vaginal delivery. The following day, she is being assessed for discharge. Her haemoglobin taken this morning is newly found to be low at 9.8mg/dL with a low mean corpuscular volume (MCV). She is well, has no syncopal symptoms, shortness of breath or fatigue and is keen to go home. Her observations are normal.

What is the most appropriate management of this woman’s post partum anaemia?

Answer 7

oral ferrous frumate

IV if cant tolerate oral

Question 8

A 34 year old G2P0 at 36 weeks gestation presents to the antenatal clinic complaining of a week long history of general malaise, vomiting, and anorexia. She has had a poor appetite. She also complains of abdominal pain on the right side and indigestion. She denies any visual changes, headaches, and swellings. She denies any abnormal discharge and reports presence of foetal movements. On examination, her blood pressure is 135/85 mmHg and she appears mildly jaundiced.

Her blood test results are shown below:

Hb: 129 g/l (115-160 g/l)

Platelets: 175 x 109/l (150-400 x 109/l)

WBC: 10 x 109/l (4.0 - 11.0 x 10 9/l)

PT: 16 secs (10-14 secs)

Bilirubin: 36 umol/l (3-7 umol/l)

ALP: 344 u/l (30-100u/l)

ALT: 200 u/l (3-40 u/l)

AST: 350 u/l (3-30 u/l)

What is the most likely diagnosis?

Answer 8

acute fatty liver of preg

cholestasis lvier enxymes above 250

Question 9

postmenopausal bleeding what you thinking

Answer 9

endometrial cancer

Question 10

contraindication to digital vaginal exam

Answer 10

vaginal bleeding

as placenta pravia - this could cause serious hemorrhage

Question 11

membranes rupture what infection you worreid baotu post 24 weeks

Answer 11

chorioaminonitis

Question 12

what lasts longer spinal or epidural

Answer 12

If you’re heading into your first birth, your medical team may opt for an epidural. Here’s why: First births can last for 12 to 18 hours. Whereas a spinal gives you pain relief for an hour or two, an epidural offers you the option of pain relief for a longer period of time.

epidurals in knwon labour
spinal block in c section

Question 13

What hormone can be measured via a blood test to investigate
whether a patient is ovulating successfully?

Answer 13

progesterone

Question 14

when does amniotic fluid embolism most commonly occur

Answer 14

during labour and delivery or immediately post partum
fever chills coughing and SOB
cyanosis tachy , hypotension and arrhymia

Question 15

causes of lactational amenorrhea

Answer 15

risperidone
reduced sex drive
galactorrhea

Question 16

A 44 year old female presents to the Emergency Department complaining of abnormally heavy menstrual bleeding. She has associated abdominal pain and pain on urination. She also has a fever and blood tests show a raised ESR, CRP and leukocytosis. Given the most likely diagnosis, what investigation will be confirmatory?

what condtion and what test

Answer 16

PID - heavy bleed

high vaginal swab

Question 17

major risk factor for ectopic

Answer 17

PID

Question 18

what is an indication fro c section

Answer 18

HIV

Question 19

in pregnnacy shoudl you increase the levothyroxine dose

Answer 19

yes increase levythyroxine dose and measure again in 4 weeks

up to 12th week foetus secretes stufff

Question 20

in pregnnacy shoudl you increase the levothyroxine dose

Answer 20

yes increase levythyroxine dose and measure again in 4 weeks

up to 12th week foetus secretes stufff

Question 21

Mx of perineal tears grade 3 above

Answer 21

Third and fourth degree tears require surgical repair by an experienced clinician and should take place in an operating theatre under regional or general anaesthetic.

Broad-spectrum antibiotics and laxatives should be given post-operatively.

Question 22

patiens with severe pre-eclampsia should have their blood tested how many times a week

Answer 22

three times per week to anticipate if a patient is to develop HELLP syndrome

Question 23

complications of pre-rupture of membranes

Answer 23

The rupture of the amniotic membranes can allow bacteria into the uterus. This can lead to chorioamnionitis due to ascending infection.

Increased risk of preterm birth and the associated complications (e.g. respiratory distress syndrome, necrotising enterocolitis, foetal death).

Low levels of amniotic fluid due to PPROM can lead to developmental problems such as pulmonary hypoplasia, facial and limb deformities (due to compression in the uterus) and cord prolapse.