WEEK 4 END OF WEEK FORMATIVE

Question 1

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?

Answer 1

Most likely diagnosis

Peuperal diagnosis

Question 2

When does peuperal diagnosis usually present?

What are symptoms?

Answer 2

Usually presents within 2 weeks of pregnancy

Symptoms include irrational ideas,sleep disturbances and confusion,which can present to mania and delusions/hallucinations

Question 3

What are the risk factors for peurperal psychosis?

Answer 3

Bipolar disoreer
1st degree family history or relative with the condition

Previous puerperal psychosis

Question 4

What are baby blues?

When do they usually occur and how long do they take to recover from?

Answer 4

‘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

Question 5

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

Answer 5

D - Anencephaly - this is associated with a neural tube defect (folate deficiency)

Question 6

What is micrognathia?

What is microcephaly?

Answer 6

Micrognathia is a condition in which the jaw is undersized

Microcephaly is an undersized head

Question 7

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

Answer 7

Pain from pelvic organs are visceral afferents

E - Visceral afferents to T11-L2 spinal cord levels - run alongside sympathetic fibres

Question 8

Which structure can be used as a landmark to administer a pudendal nerve block?

Answer 8

Ischial spine

Question 9

Which muscles contribute to the pelvic diaphragm?

Answer 9

Levator ani - puborectalis, pubococcygeus, ischiococcygueeus
and

Coccygeus

Question 10

The ischio-anal fossae are normally filled with?

OPTIONS:

A Air

B - Blood

C Faeces

D Fat

E Muscle

Answer 10

D - Fat

Question 11

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

Answer 11

D - Mirabegron does not affect the voiding phase

Question 12

Name two antimuscarinics given for OAB syndrome?

What effects do these drugs have?

Answer 12

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

Question 13

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

Answer 13

D On the form of the Topical Estrogens only in the case of the atrophy of the vaginal mucosa

Question 14

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

Answer 14

C - Uterus and soften to touch

Classically - cord lengthening, uterus contracts, hardens and rises and gush of blood appears

Question 15

Describe the second stage of labour

Answer 15

It starts with full cervical dilation and ends with complete delivery of the baby

Question 16

What is the length of time considered normal for return of tissues to normal state following childbirth?

Answer 16

6 weeks is normal for tissues to return to normal

Question 17

Normal Blood loss in labour is considered to be
OPTIONS:

A 600mls

B 1000mls

C 200mls

D 500mls

E 1500mls

Answer 17

D - 500mls is normal blood loss in vaginal delivery labour

Question 18

What is the approximate normal blood loss in a cesarean section?

Answer 18

Normal blood loss in a cesarean section is up to 1000ml

Question 19

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

Answer 19

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

Question 20

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

Answer 20

C - Painless usually recurrent bleeds in the third trimester

Non tender non tense uterus