15/6/22

Question 1

Mx of anaphylactic reaction? Which children also need extra?

Answer 1

FLACOS

Fluids
Legs elevated
Adrenaline
IV Chlophenamine + Hydrocortisone
Oxygen

Neb salbutamol - in asthmatics / wheezy children

Question 2

Mx of GORD in formula fed children >24m

Answer 2

Review feednig

Smaller more frequent feeds

Thickened formula

Alginate therapy

PPI or H2RA

Consider admission for feeding / nissen fundoplication

Question 3

Mx of GORD in breastfed children >24m

Answer 3

Breastfeeding assessment

Alginate therapy

PPI or H2RA

Consider admission for feeding / nissen fundoplication

Question 4

Organism that causes scarlet fever? mx?

Answer 4

Group A strep - strep pyogenes

10 day course of phenoxymethypenicillin (Penicillin V)

Question 5

Mx of asymptomatic bacteruria in pregnancy?

Answer 5

7d nitrofurantoin PO

Important to treat due to increased risk of pyelonephritis + pre-term delivery

Question 6

Common complications of epidural?

Answer 6

Urinary retention - important to catheterise

Hypotension

Headache - due to accidentally entering subarachnoid space causing CSF to leak

If opioid leaks through and goes across placental -> NRDS

Question 7

Which women need referral to obstetric anaesthetist for assessment?

Answer 7

BMI >40 - probs will need instrumental delivery as they will find it harder to have epidural

Question 8

Which women should have aspirin from 12w gestation until birth?

Answer 8

1st pregnancy

40+

10+ y between pregnancies

BMI 35+

FHx of pre-eclampsia

Pre-exisiting DM (NOT GDM)

Question 9

Incontience - continuous leaking + upon stress after c-section, most likley dx?

Answer 9

Vesicovaginal fistula

Classic presentation is
continuous (day and night) incontinence with a history of obstructed labour or
gynaecological surgery.

The patient might also complain of a degree of stress
incontinence as sneezing or coughing causes an increase in intra-abdominal
pressure which pushes more urine through the fistula

Question 10

Describe the number of antenatal appts and schedule of serial growth and doppler US in DCDA pregnancy?

Answer 10

at least 8 appts

Every 4w from 20w gestation

Question 11

Describe the number of antenatal appts and schedule of serial growth and doppler US in MCDA pregnancy?

Answer 11

at least 11

Every 2w from 16w gestation appts

Question 12

Describe the number of antenatal appts and schedule of serial growth and doppler US in TCTA pregnancy?

Answer 12

at least 9 appts

Every 2w from 20w gestation

Question 13

Describe the number of antenatal appts and schedule of serial growth and doppler US in MCTA OR DCTA pregnancy?

Answer 13

at least 11 appts

Every 2w from 16w gestation appts

Question 14

What mode for DCDA or MCDA?

Answer 14

Can be vaginal if 1st twin is cephallic - if non-reassuring CTG and not delivered in 20mins consider C-section

Question 15

What mode for MCMA or triplets?

Answer 15

Elective c-section

Question 16

When to aim for delivery in:

• DCDA
• MCDA
• MCMA
• TCTA / DCTA
• MCTA or triplets sharing amnion

Answer 16

• DCDA = 37w
• MCDA = 36w + steroids
• MCMA = 32w + steroids
• TCTA / DCTA = 35w + steroids
• MCTA or triplets sharing amnion
• 60% of twin pregnancies result in spontaneous birth before 37 weeks
• 75% of triplet pregnancies result in spontaneous birth before 35 weeks