Common Osce Review Questions Flashcards
Active mgt of 3rd stage of labor
1) Oxytocin 10 IU IM(5IU each buttock)
2) Uterine massage
3) Early cord clamping
4) Controlled cord traction
X-ray features of osteomyelitis
S3 C3 I P
Sinus tract Sclerosis Sequestration Cloaca Cortical irregularity Cortical thickness Involucrum Periosteal elevation
Maternal mortality
Death of a woman while pregnant or within 42 days after termination of pregnancy, irrespective of the site and duration of pregnancy from any cause related to or aggravated by the pregnancy or its mgt and not from incidental or accidental causes.
Causes of maternal mortality
HITLA
Hemorrhage (APH,PPH) Infection (malaria,SCD) Toxemia (Pre eclampsia, eclampsia) Obstructed labor Unsafe abortion Anemia
Delays in maternal mortality
Phase 1: from the woman and family at home
Phase 2: delay in Distance and bad road to health facilities
Phase 3: delay in the hospital, poor health care, insufficient staff and equipment, incorrect treatment and delayed tx
Methods of induction of labor
1) Medical: Oxytocin titration, misoprostol and prostaglandin
2) Surgical: Artificial rupture of membrane(Arom), Arom + oxytocin titration, extra-amniotic saline infusion.
Methods of Cervical ripening
1) trans-cervical extra amniotic foleys catheter
2) misoprostol
3) other prostaglandin analogue
4) oxytocin
5) estradiol/ estrogen
6) insertion of luminaria tents/ dilapan tru the cervix
7) membrane stripping/sweeping
8) castor oil
9) relaxin gel
Cardinal movements of labor
ED FIERES
Engagement Descent Flexion Internal rotation Extension Restitution External rotation Shoulder rotation and delivery of baby.
Specific symptoms and tx of BV
- Thin grayish white vaginal discharge
- fishy vaginal smell especially after coitus and menstruation
- burning while urinating
- vag itchy
Treatment
1)Oral metronidazole 500mg BID for 7days for non pregnant women
2) clindamycin gel 2% intravaginally for 7days. At bed time
Characterise specific symptoms and tx for gonorrhoea
Mild in women some asymptomatic
-mucopurulent vag discharge
Treatment
Procaine penicillin, strep and genta IM for penicillin allergy
Risk factors of cervical cancer
- HPV infection
- herpes
- Early coitarche
- race (blacks and Caucasian )
- in utero diethly stilbesterol
- Advanced age
- Immunodeficiency
- Lack of regular screening
- pervious hx of cervical displasia
- family hx of cervical cancer
Treatment of cervical cancer
1) surgery alone (for stage 1-2a)
2) radialology alone (advanced lesions of stage 1a)
3) combined
4) chemotherapy
Pap smear
Papanicoliau test, developed 1940’s by georgios papanicoliau.
Involves: exfoliating from transformation zone if the cervix, to enable examination of the cells to detect pre cancerous or cancerous lesions.
Instrument: cervical brush
Recommended every 3yrs in women age 21-65, or earlier if the woman has been sexually active in earlier yrs.
Age 30-65 hpv every 5yrs
Symptoms of cervical cancer
Early stage: asymptomatic, or postcoital, post menopausal intermentraul vaginal bleeding
Advanced stage: pain(infiltration to sacral plexus) Diarrhea, constipation, urine and fecal incontinence, lymphedema
Terminal: oliguria, anuria, weight loss,
Characterise candidiasis
Whitish odourless vag discharge
Itchiness and painful sex
Tx : fluconazole
Characterise trichomoniasis
Yellowish greenish fishy smell vag discharge
Itchiness
Painful sex
Postcoital bleeding
Tx metronidazole
X-ray features of Intestinal obstruction
Supine view: Gaseous dilated bowel loop, small intestine- dilated bowel is central
McAfee regime (mgt of APH)
1) Admit pt
2) Strict bed rest and advice pt to avoid strenuous activity
3) Check PCV
4) blood grouping and cross matching then transfuse if necessary
5) perineal pad to monitor blood loss, check twice daily.
6) monitor vitals of mother and fetus
-give steroids if fetus <34wks
Mgt of ruptured ectopic pregnancy
- Admit pt
- Call for help
- 2 Wide bore cannula (one for fluid one for blood grouping and cross matching)
- IV fluid resuscitation
- urgent blood transfusion in case of severe blood loss
- emergency exploratory larparotomy with any of the these:
salpingotomy
Milking of the tube
Salpingostmy
Saplingectomy
- broad spectrum antibiotic and analgesics
- monitor vital signs
- irrigate abdominal cavity with warm normal saline.
- pass catheter to drain and suture
Cyanotic hrt diseases
A congenial hrt diseases causing oxygenated and non oxygenated blood to mix.
5 T’s
1) Truncus arteriosus (vessels join to form 1)
2) Transposition of great vessels ( 2 major vessels switch )
3) Tricuspid valve atresia (3 valves abnormally formed it not formed at all)
4) Teteralogy if fallot (4 abnormalities)
5) Total anomalous pulmonary Venus return (TAPVR) (5 letters)
Radiological features tetralogy
1) Up turned apex if the hrt
2) Boot shaped hrt
3) Concave pulmonary artery segment
A cyanotic hrt diseases
VSD
ASD
PDA
Coarctation of aorta
Complications of blood transfusion (early and late)
Early
Reactions
Early Haemolytic rxn
Non hemolytic febrile rxn
Allergic reaction
Rxn secondary to bacteria contamination
Transfusion related injury Circulatory overload Air embolism Hyperkalemia Hypothermia Clotting abnormalities (after massive blood transfusion) Citrate toxicity
Late
Thrombophlebitis Post transfusion thrombocytopenia Iron overload CMV HIV MP HBV Immune sensitivity (rhesus d antigen)
Side effects of Ace inhibitors
You can Use this mnemonic CAPTOPRIL
COUGH ANGIOEDEMA POTASSIUM ELEVATION TERATOGENIC IN PREGNANCY OTHER( FATIGUE & HEADCHE) PROTEINURIA RENAL IMPAIRMENT ITCHING LOW BP
