Obs and Gynae pretest

Question 1

What level is the epidural needle inserted into?

Answer 1

Inserted between L3/L4 (as below spinal cord, which ends at L1/L2)

Question 2

What level does the spinal cord end at?

Answer 2

L1/L2

Question 3

Which space is the spinal anaesthetic inserted into?

Answer 3

The subarachnoid space

Question 4

What should you give a woman prior to an epidural and why?

Answer 4

Should give 500ml-1000ml crystalloid fluid as epidural will lower her blood pressure

(hypotension because of vasodilation)

Question 5

To provide relief for pain caused by uterine contractions, which levels must you block?

Answer 5

Must block levels T10-S4
T10-T12 -sympathetic nerves
L1 - ilioinguinal nerve
S2,S3,S4 - pudendal nerve

Question 6

Lymphatic drainage of fundus of uterus

Answer 6

Para-aortic nodes

Question 7

Lymphatic drainage of cervix

Answer 7

Internal and external iliac nodes

Question 8

Lymphatic drainage of bladder

Answer 8

Internal and external iliac nodes

Question 9

Lymphatic drainage of ovary

Answer 9

Para-aortic nodes

Question 10

Lymphatic drainage of labia minora?

Answer 10

Superficial inguinal nodes

Question 11

Which drug is given to a woman with eclampsia to treat seizures and prevent further seizures?

Answer 11

Magnesium sulphate

Question 12

How should you check liver function in pre-eclampsia?

Answer 12

Serum ALT

Question 13

How should you check renal function in pre-eclampsia?

Answer 13

Serum urate

Question 14

How should you check haematological system in pre-eclampsia?

Answer 14

Check platelet count

Question 15

How should you check neurology in pre-eclampsia?

Answer 15

Patellar reflexes

Question 16

How should you check placental sufficiency in pre-eclampsia?

Answer 16

Umbilical artery doppler

Question 17

How long is the female urethra?

Answer 17

4cm

Question 18

Lymphatic drainage of ovaries?

Answer 18

Para-aortic nodes

Question 19

When does the uterus rise from the pelvis in pregnancy?

Answer 19

Rises out of pelvis at 12 weeks

Question 20

Is the posterior fornix of the vagina related to the peritoneal cavity (pouch of douglas)?

Answer 20

Yes, vaginal injury damaging the posterior fornix will open the peritoneal cavity and facilitate spread of infection to the cavity

Question 21

Most common HPV causing cervical cancer?

Answer 21

HPV 16 and 18

Question 22

Where does cervical intraepithelial neoplasia usually occur?

Answer 22

CIN usually occurs in the transformation zone at the squamo-columnar junction

Question 23

Which percentage of ovarian cancers are genetic and which genes are associated?

Answer 23

Around 5% of cases are genetic

Associated with BRCA1 and BRCA2

Question 24

How may ovarian cancer present?

Answer 24

Usually presents with non-specific symptoms such as abdominal pain, dyspepsia and weight loss.
MAY ALSO present initially as leg pain and swelling as a result of DVT

Question 25

Ovarian cancer survival

Answer 25

Most people die 3-5 years after diagnosis

Question 26

Does the pudendal nerve pass in front or behind the ischial spine?

Answer 26

Behind

Question 27

How big is the vagina?

Answer 27

About 8cm

Question 28

Which vessel does the ovarian artery arise from?

Answer 28

Arises from the aorta

Question 29

At ovulation, is the ovum extruded into the peritoneal cavity?

Answer 29

Yes - as the ovum is extruded into the peritoneal cavity, it is possible to develop an intra-peritoneal ectopic pregnancy

Question 30

Does plasma volume increase during pregnancy?

Answer 30

Yes, plasma volume increases by about 50% during pregnancy (this means blood becomes diluted so physiological anaemia)

Question 31

When does blood pressure decrease in pregnancy?

Answer 31

Blood pressure decreases in second trimester due to vasodilation

Question 32

What happens to glomerular filtration during pregnancy?

Answer 32

Glomerular filtration increases to cope with the additional load of the fetus - this results in a decrease in creatinine and urea levels

Question 33

Are systolic murmurs common in pregnancy?

Answer 33

yes - there is about a 35-40% increase in cardiac output during pregnancy, so systolic murmurs are common

Question 34

By how much is your risk of thromboembolism increased in pregnancy?

Answer 34

Increased by about 10%