A's Exam Review MCQ 2011 Flashcards
(30 cards)
Where is: - umbilicus level - aortal bifurcation level - depth of aorta average How many cm below aorta bifurcation is Lt common illiac vein located
- L3-4
- usually L4 - 5, caudal if obese
- 6 cm
- 3-6cm caudal, umbilicus always cephalad to that point
- Where is Palmer’s Point?
- Lateral Trochar placement
- 2 vessels and 2 nerves to avoid?
- steps to avoid injury
- 3 cm below Lt costal margin, midclavicular
2.
- inf and superior epigastrics, illioinguinal, illiohypogastric
- place lat ports superior to asis, 6+ cm lateral to midline
At what level does an epidural work for 1st and 2nd stage labour.
1st stage contractions: T10-L1
2nd stage: must extend S2,3,4 late stage 1 and stage 2
DDx Vaginal Bleeding in Peds (Life threatening and common)
Life threatening:
- Malignancy (endodermal sinus tumor or rhabdomyosarcomas) usually present < 3yrs
- Trauma (abuse, water jets, recreational injury, stradle inj)
Common:
- Neo withdrawal PVB
- Foreign Body
- Infection (GAS and Shigella a/w PVB specifically but also have discharge)
- lichen sclerosus (purpura and hematomas)
- urethral prolapse
Uncommon:
- exogenous estrogen
- precocuscious puberty
- hypothyroidism
- CI to regional anesthesia
- ThromboProphylaxis
- time between last does and initiation
- time between last dose and removal of catheter
- time between neuraxial and restarting anticoag
1.
- coagulopathy
- increased ICP
- infection to lower back
- Thromboprophylaxis:
*insertion:
UH no delay (up to 10 000 then 4h)
LMWH: 10-12h
* removal:
UH 4h
LMWH 10-12h
*restart:
UH 1-8h
LMWH 6-8h
Where i estrogen produced?
Testosterone secretion?
- E2 from granulosa cells of developing follicles and conversion of E1 (estrone to peripherally)
- Testosterone secretion: 25 % ovary, 25% adrenals, 50% peripheral conversion of androstenedione
VARICELLA:
- Incubation period
- Does Shingles have fetal sequelae
- Infectious period?
- Pneumonitis: risk of getting, most risk for death in what trimester, what day of infection would it usually occur?
- Incubation period 10-21 days
- not associated with viremia or fetal sequela
- infectious period: 48 hours before the rash until the vesicles crust over
- 5-10% pregnant women with varicella, T3, Day 4 usually
Classification of Operative Vaginal delivery
OUTLET: - scalp visible at introitus without separating labia - fetal skull has reached pelvic florr - fetal head at or on perineum - Direct OA, OP or LOA/ROA - Rotation does not exceed 45 degrees LOW: - Spines + 2 or more then either - rotation < 45 or > 45 degrees MID: Station spines 0-2cm HIGH: NO
Requirements and CI to OVD
Prereqs:
- vertex, engaged
- Fully, ROM
- exact position known
- adequate pelvis
- analgesia
- bladder empty
- informed consent
- appropriate personel/backup
- skilled operator
CI: ABSOLUTE: - no vertex or brow - unengaged head - not fully - evidence of CPD - fetal coagulopathy
Complications of OVD
Both Vacuum and forceps:
- Mat trauma
- Fetal scalp bruising/lacs, bleeding
- RARE: ICH, retinal hemorrhage, facial nerve injury, skull fracture
FORCEPS: also rarely minor ext occular trauma
Risks of cocaine use in pregnancy?
Fetal:
- SA
- IUFD
- Abruption
- Prematurity
- IUGR
Maternal:
- CV cocaine toxicity: HTN (dont use beta blockers! cause end organ ischemia, use hydralazine)
- stroke
- MI
Complications of Midtrimester PPROM
PTB Chorio, endometritis abruption cord prolapse IUFD Retained placenta Neo: morbidity, pulm hypoplasia, msk deformities
Prevalence of Pulmonary Hypoplasia in midtrimester PPROM
Mortality and predictors
Prevalence 9 % in this pop mortality 70-90%
Predictors:
- GA a time of PPROM (rare after 26 wks)
- Degree of oligo
Most common cause of hypothyroidism in pregnancy (1st world)
Chronic Autoimmune Thyroiditis
Risk of untreated overt hypothyroidism
PTB
LBW
SA
?Neurodevelopmental
Risk of untreated overt hyperthyroidism
PTD LBW IUFD preeclampsia cardiomyopathy --> pulm hypertension --> heart failure (8-90%)
Treatment Hyperthyroidism
T1 PTU (propylthiouracil) as lower risks of birth defects, then methimazole T2/3 (risk of hepatotoxicity with PTU)
Complications of long term beta blocker use
IUGR, fetal bradycardia, neo hypoglycemia
List US findings suspicious for fetal hyperthyroidism (Trab positive complicaitons)
Fetal tachycardia IUGR goiter accelerated bone maturation heart failure hydrops
Thyroid Storm and or hyperthyroid related cardiomyopathy Treatment
ICU
- Thionamides (PTU) (blocks periph conversion T4->T3)
- HR control: BBlockers
- Iodine
- K Iodide
- Lugols (blocks release of thyroid hormone)
- Corticosteroids (dec peripheral conversion T4->T3
DDX precocious puberty
Most common: Idiopathic Central Precocious Puberty (GnRH dependent) - Intracranial lesions Peripheral: - hormone secreting tumors (granulosa, sertoli/Leydig, gonadoblastoma) - hypothyroid - exogenous hormones - adrenal tumor - McCune Albrigth Syndrome
What is McCune Albright Syndrome
Triad of precocious puberty, irregular cafe au lait spots and fibrous bone dysplasia.
List 3 factors that affect MSAFP values
GA Maternal Weight DM Fetal anomalies Multiples Race Fetal viability
Components of Apgar
Heart rate Respiratory Effort Muscle Tone Reflex irritability Color
