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Year 2 HD > problems > Flashcards

problems Flashcards

1
Q

gestational diabetes when

A

20wks on

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2
Q

foetus can make mother insulin resistant. which hormones does the baby make

A

hPL PCRH making cortisol and PGH

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3
Q

pregnancy is a naturally …resistant state. why?

A

insulin
excess glucose is what foetus needs for growth

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4
Q

is gestational dm more like type 1 or 2

A

a mixture of both. insulin production is restricted from beta cells AND insulin resistance

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5
Q

increased cortisol leads to …resistance

A

insulin

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6
Q

massive baby might need what when it’s born

A

glucose drip to wean off hyperinsulinemia
perinatal hypoglycemia

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7
Q

meds for gestational dm

A

metformin glyburide

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8
Q

what levels of hepcidin in different stages of prg

A

Up in 1st trimester
Down in 2nd and 3rd trimester

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9
Q

when is gestational anemia more common

A

2 and 3 trimester

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10
Q

when is amniotic fluid most. how much

A

28 wks 800ml

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11
Q

what condition oligohydramnios. why?

A

Potter sequence - flat face, squished face, club foot
normally kidney abnormalities

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12
Q

cytomegalovirus what is it

A

generic sub-clinical virus but can be dangerous if mum catches primary infection in 1st trimester, 10% of asymptomatic babies and 90% of symptomatic babies have hearing probs (sensory neural deafness), mental retardation, microcephaly

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13
Q

what is the biggest cause of hearing loss in young children

A

cytomegalovirus

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14
Q

symptomatic baby CMV how does it look

A

petechial purpuria with jaundice

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15
Q

classic triad of gestational rubella

A

cardiac. cataract/glaucoma, deafness

cardiac probs:
patent ductus arteriosus, pulmonary valve stenosis

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16
Q

gestational toxoplasmosis

A

Chorioretinitis , hydrocephalus, intracranial atherosclerosis

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17
Q

mortality in untreated neonate herpes

A

65%

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18
Q

what sort of bateria is listeria

A

gram+ rod

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19
Q

congenital syphilis sequelae

A

Early 0-2 years
Rash
Rhinorrhoea (mucus full of T.pallidum)
Osteochondritis
Perioral fissures
Lymphadenoapthy
Pemphigus syphiliticus
Late >2 years
Hutchinson’s teeth
Clutton’s joints
Saber shins
High arched palate
Deafness
Saddle nose deformity
Frontal bossing

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20
Q

foetus makes what molecule -> Hyperemesis gravidarum

A

GDF15

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21
Q

which vitamin for morning sickness, when

A

B6 from point of conception

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22
Q

which is the only viable aneuploidy

A

Turner’s (X0)

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23
Q

inevitable miscarriage ultrasound

A

gestational sac is completely detached

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24
Q

recurrent miscarriage

A

3 or more consecutive miscarriages

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25
Q

where should pregnancy implant

A

top back wall

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26
Q
A

Placenta abruption
Placental praevia
Incidental genital tract pathology
Uterine rupture
Vasa praevia
Fetal blood vessels run close to or over opening of the uterus

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27
Q

symptoms of placental abruption

A

bleeding
tense woody uterus
weak or absent fetal heartrate

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28
Q

what is placental abruption

A

retroplacental blood clot

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29
Q

placenta praevia tx

A

lower segment C section

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30
Q

describe the placenta accreta etc problems

A
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31
Q

what is pre-eclampsia

A

hypertension after 20 wks, proteinuria, low placental growth factor

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32
Q

in pre-eclampsia, what happens to the spiral arteries

A

stay narrow so blood is under high pressure, baby gets much less O2

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33
Q

active stage of labour starts when

A

6cm

34
Q

what is prolonged labour

A

> 20h if 1st time
14 if 2nd etc

35
Q

drugs to help labour along

A

Oxytocin, misoprostol, mifepristone, oestrogen pessary

36
Q

how long is max for forceps or ventouse delivery

A

15 mins or 3 contractions

37
Q

when can’t you use forceps/ventouse

A

preterm, breech presentation

38
Q

which nerve can be damaged by forceps

A

facial

39
Q

most common complication of ventouse/forceps

A

retinal haemorrhage

40
Q

foetal heartrate should be

A

120-130

41
Q

what is monitored in labouring mother

A

HR sats, contractiona

42
Q

what heartrate changes is worrying in baby in labour - why

A

Late decelerations
Vagal stimulation or myocardial depression from placental insufficiency
Late decelerations and bradycardia emergency C-section

43
Q

what is definition of early deceleration

A

nadir of HR coincides with peak of contractino

44
Q

are variable decelerations in foetal HR in labour worrying? whyw?

A

not usually because different parts of baby being compressed

45
Q

late decels and bradycardia in labour in foetus ->

A

emergency caesarian section

46
Q

early deceleration in foetal HR known as, what shape

A

type 1 dip, V shape

47
Q

late deceleration in foetal HR known as, what shape

A

type 2 dip, U shape

48
Q

drugs to delay labour

A

It’s Not My Time
Indomethecin (NSAID Cox inhibitors)
Nifedipine (Ca channel blocker)
Magnesium sulphate (fetal neuroprotection)
Terbutaline (adrenergic agonist (beta)

49
Q

what to do to support foetal distress

A

Changing the mother’s position
Increasing maternal hydration
Maintaining oxygenation for the mother
Amnioinfusion, where fluid is inserted into the amniotic cavity to relieve pressure on the umbilical cord

50
Q

how to check for cyanotic baby

A

check mucus membranes

51
Q

danger of meconium in utero

A

aspiration

52
Q

discuss APGAR score

A
53
Q

shoulder dystocia what is it

A

shoulder gets stuck under pubic bone

54
Q

how do you deal with shoulder dystocia

A

McRoberts manoeuvre
episiotomy

55
Q

which nerve is normally stretched in shoudler dystocia

A

radial

56
Q

which bones can be broken in shoulder dystocia

A

clavicle and humerus

57
Q

why does haemorrhage in labour occur

A

Bleeding happens after the placenta is expelled, because uterine contractions are too weak and cannot provide enough compression to the blood vessels at the site of where the placenta was attached to the uterus

58
Q

link between multi preg and haemorrhage

A

over-distension of uterus

59
Q

best breech presentation

A

Frank breech

60
Q

worst breech presentation

A

footling breech

61
Q

main symptom of placenta previa

A

bleeding in 3rd trimester

62
Q

signs of uterine rupture

A

Abnormal heart rate in the baby
Abdominal pain and uterine tenderness
Vaginal bleeding
Slow progress in labour
Altered uterine contractions
Rapid heart rate and low blood pressure in the mother

63
Q

precipitous labour=

A

birth in <3 hours

64
Q

complcation of precipitous labour

A

hypotonic uterus - haemorrhage

65
Q

changes in uterus from delivery to 6 wks

A

900g -> 60g

66
Q

what is leading cause of maternal death in postnatal period (6wks)

A

thrombosis and thromboembolism

67
Q

2 examples of uterine infection

A

endometritis, parametritis

68
Q

what do you see on MRI if post-partum uterine infections

A

purulent uterus and gas pockets

69
Q

causes of post or peri partm haemorrhage (4 T’s)

A

Tone = 75-80% of cases, overdistension, intrinsic or extrinsic dysfunction
Tissue = retained products of conception
Trauma = tears to vagina, cervix, uterine rupture, instrument delivery
Thrombosis = thrombin, anticoagulant use and bleeding tendency

70
Q

what suturing is this to stop PPH

A

B lynch

71
Q

cause of endometritis

A

retained products of conceptio

72
Q

what is Homan’s sign - what condiiton - what tx

A

forced dosiflexion of foot elicits pain - DVT - heparin

73
Q

does heparin go to breast milk

A

no

74
Q

are SSRI’s teratogenic?

A

no

75
Q

which preg related hormone has an effect on serotonin

A

oestrogen

76
Q

presentation of HELLP syndrome

A

right upper quadrant abdominal pain or epigastric pain resulting from liver distension. Individuals may experience general symptoms like nausea, vomiting, generalized edema, malaise, headache, visual changes, or jaundice

77
Q

What does HELLP syndrome stand for

A

Haemolysis
Elevated liver enzymes
Low Platelets

78
Q

which 2 hormones are tested for in Down Syndrome maternal blood test and what are the levels

A

B-HCG high and PaPPA low
Beta human chorionic gonadotrophin
Pregnancy associated Plasma Protein A

79
Q
  1. What cells invade the maternal spiral arteries normally that allow these vessels to become low resistance vessels?
A

endovascular trophoblasts

80
Q

what should you do with pregnant mother who is on ACE or ARB

A

discontinue immediately and commence labetalol

81
Q
A

Year 2 HD (15 decks)

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