WEEK 4 END OF WEEK FORMATIVE Flashcards
A woman is day 6 postnatal. Having had an uncomplicated pregnancy and delivery, with no significant past medical history. Her partner reports that she isn’t sleeping and as a result seemed confused the previous day. Today she is full of ideas about the coming days activities. She is very confident about caring for her baby and reports being extremely happy. She appears to be very talkative and is talking very fast. What diagnosis is most likely?
Most likely diagnosis
Peuperal diagnosis
When does peuperal diagnosis usually present?
What are symptoms?
Usually presents within 2 weeks of pregnancy
Symptoms include irrational ideas,sleep disturbances and confusion,which can present to mania and delusions/hallucinations
What are the risk factors for peurperal psychosis?
Bipolar disoreer
1st degree family history or relative with the condition
Previous puerperal psychosis
What are baby blues?
When do they usually occur and how long do they take to recover from?
‘Baby blues’ are probably due to the sudden hormonal and chemical changes that take place in your body after childbirth.
Women are feeling down and depressed at a time where they should be happy and have a baby to look after
It occurs in 50% of women - women can feel emotional, irritable, depressed, anxious, confused
Usuallly occurs around 3-10 days post delivery and usually only last for a few days
Which fetal anomaly is NOT associated with Fetal Alcohol Spectrum Disorder?
OPTIONS:
A
Dysplastic kidneys
B Ventricular septal defect
C Micrognathia and smooth philtrum
D Anencephaly
E Microcephaly
D - Anencephaly - this is associated with a neural tube defect (folate deficiency)
What is micrognathia?
What is microcephaly?
Micrognathia is a condition in which the jaw is undersized
Microcephaly is an undersized head
Pain from the body of the uterus is carried in which of the following nerve fibres?
OPTIONS:
A Parasympathetic fibres to S2-S4 spinal cord levels
B Somatic motor fibres via the pudendal nerve
C Somatic sensory fibres via the pudendal nerve
D Visceral afferent fibres to S2-S4 spinal cord levels
E Visceral afferent fibres to T11-L2 spinal cord levels
Pain from pelvic organs are visceral afferents
E - Visceral afferents to T11-L2 spinal cord levels - run alongside sympathetic fibres
Which structure can be used as a landmark to administer a pudendal nerve block?
Ischial spine
Which muscles contribute to the pelvic diaphragm?
Levator ani - puborectalis, pubococcygeus, ischiococcygueeus
and
Coccygeus
The ischio-anal fossae are normally filled with?
OPTIONS:
A Air
B - Blood
C Faeces
D Fat
E Muscle
D - Fat
B- 3 receptor agonist- Mirabegron for OAB treatment- what feature you would not consider as an advantage over antimuscarinic drugs.
OPTIONS:
A Mirabegron does not affect cognitive function
B Mirabegron is related to lower risk of side effects
C Mirabegron is cheaper
D Mirabegron does not affect voiding phase
E Mirabegron has higher persistence
D - Mirabegron does not affect the voiding phase
Name two antimuscarinics given for OAB syndrome?
What effects do these drugs have?
Oxybutynin and tolterodine - they competitively antagonise M1,M2,M3 muscarinic acetylcholine receptors
They reduce intra-vesical pressure
Increase the threshold for micturition (affecting voiding phase)
Increase compliance
In the treatment of OAB ( Overactive Bladder Syndrome) you may consider Estrogens:
OPTIONS:
A On the form of HRT
B On the form of only Estrogens Replacement Therapy
C On the form of the Topical Estrogens irrespectively of the condition of the vaginal mucosa
D On the form of the Topical Estrogens only in the case of the atrophy of the vaginal mucosa
E Estrogens do not help in the treatment of OAB
D On the form of the Topical Estrogens only in the case of the atrophy of the vaginal mucosa
Following labour there are classic signs to indicate placental separation.
Which answer is NOT a classic sign?
OPTIONS:
A Uterus contracts, hardens and rises
B Increasing length of umbilical cord is visible at the introitus
C Uterus relaxes and softens to touch
D Gush of blood appears
E Mother has feeling of fullness in vagina
C - Uterus and soften to touch
Classically - cord lengthening, uterus contracts, hardens and rises and gush of blood appears
Describe the second stage of labour
It starts with full cervical dilation and ends with complete delivery of the baby
What is the length of time considered normal for return of tissues to normal state following childbirth?
6 weeks is normal for tissues to return to normal
Normal Blood loss in labour is considered to be
OPTIONS:
A 600mls
B 1000mls
C 200mls
D 500mls
E 1500mls
D - 500mls is normal blood loss in vaginal delivery labour
What is the approximate normal blood loss in a cesarean section?
Normal blood loss in a cesarean section is up to 1000ml
Which of the following is an appropriate management for minimal bleeding from suspected mild placental abruption , not in labour, and a normal fetal well being at 32 weeks
OPTIONS:
A Immediate Caesarean section
B Induce as soon as possible and aim for a vaginal delivery
C Admit, give steroids and observe closely
D Send home and reassure as its only mild bleeding
E Arrange for ultrasound to confirm diagnosis of placental abruption
C Admit, give steroids and observe closely
Steroid will help with foetal lung maturation - can be given up to and including 34 weeks
USS is not good for diagnosing placental abruption but good for ruling out placenta praevia
Which statement best describes bleeding in cases of placenta Previa
OPTIONS:
A Most bleeds are due to trauma to the abdomen
B Mostly presents with painful bleeds in second trimester
C Painless, usually recurrent bleeds in third trimester
D Painful bleeds in the third trimester
E Painful bleeds in the second trimester
C - Painless usually recurrent bleeds in the third trimester
Non tender non tense uterus
