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Question

Breech vaginal delivery risks and Mx

Answer 1

If breech presentation were diagnosed prior to labor , ultrasound would have been of value to: 1.check your baby's size, 2.type of breech presentation 3.check whether the fetal neck is extended. However, as you are already in labor, ultrasound examination will probably be difficult to arrange urgently. Risks of Breech Delivery: (5) 1.Fetal distress/ Asphyxia/CTG abnormality 2.Cord prolapse 3.Hip or shoulder dislocation 4.Fracture (femur, humerus and clavicle) 5.Prolonged /Obstructed labour esp if Big baby Mx:- As soon as your Membranes rupture, we would do a Vaginal examination to: (2) 1.Exclude Cord prolapse 2.Confirm the Type of breech presentation.  Continuous CTG monitoring: to pick up any abnormalities during Labor and Delivery. Immediate Caesarean section if: (2) 1.slow progress/ inadequate progress of labor 2.fetal distress /CTG abnormality Reassurance: (But do not be stressed, a successful outcome of labor can be anticipated with your condition.)

Answer 2

=7 1.Polyp 2.Fibroid 3.Adhesions 4.Defects of uterus 5.IUD- DUB 6.Fertility problems-Subfertility- SHG 7.PPH

Answer 3

can ask q regarding: HOPC: what symptoms u had b4 hospitalisation? 1)Overdose: any change in dosage by you or GP? 2)Skipped meal, change in diet: Did u have a lighter meal or skip your meal altogether? 3)R/O Dehydration: a.excessive exercise b.any infec c.diarrhea (bcoz infec coz glycemic control prob and hypoNa), 4)Self-care: how often u measure bsl, last checkup 1st time? Mild symptoms like feeling (4) hungry, sweaty, hand shakes or funny racing of the heart. Severe symptoms like (4) Loss of concentration, confusion, fits or even Loss of consciousness.

Answer 4

ECTROPION: 1)Cryotherapy 2)Laser Ablation 3)Electrocautery WARTS: 1)non-invasive...med & injection 2)Cryosurgery 3)Laser 4)Electrocautery 5)Excision 5)Minor Surgery HPV: (same as Warts except Cone Bopsy) 1)Cryosurgery 2)Laser 3)Electrotherapy 4)Loop excision 5)Excision/Surgery 6)Cone Biopsy: Cone shaped segment Endometriosis: 1)Medical: Contraceptive methods 2)Laser 3)Electrocautery 4)Laparoscopic Excision DUB: 1)Medical: Mefenamic/ Contraceptive methods 2)Endometrial laser ablation 3)ElectroDiathermy (Ds: DUB & Diathermy) 4)Excision 5)Hysterectomy Endometritis: 1)PCM 2)IV Antibx AUGMENTIN + Gentamicin + Metronidazole) and when you start responding then Oral Augmentin 3)IV Oxytocin +/- IV/IM Ergometrine 4)If RPOC: EUA, Gental Blunt Curettage 5)If Episiotomy: Swab & Restitch (look out: Electrocautery in Endometriosis, Ectropion, Warts, Electrotherapy in HPV, Electrodiathermy in DUB, Curretage in Endometritis)

Answer 5

role-play 76 2. Warfarin counselling- missed INR check, Took pills on travel, type of food(leafy, Vit K, cranberry, binge drinking, (aspirin/NSAID) weakness, HA, B&B? PEx: Fundoscopy, Turner/Cullen sign, Neuro, UA, ECG Mx: Skip 1 dose, Start with 2 mg Daily INR for 1 week,and adjust dose Folow up 2 Wkly then 4 Wkly. role-play 68 4.Apixaban counselling: DVT?/elective? stop 2D b4 and start 2D after surgery. Keep blood products ready. role-play 61 3.Bowel surgery with h/o warfarin: Must INR <1.5 role-play 47 5. Pre-operative counselling of anticoagulant to a pt with DES: Clopidogrel/not + Asprin add after 78

Answer 6

▪ Symptoms of hyponatraemia – irritability confusion weakness seizures ▪ Causes of hyponatraemia – V/D Trauma Temperature(heat exposure) H/O Heart failure Liver failure Renal failure increased water intake (psy: Polydipsia) SIADH(Syndrome of Inappropriate Diuretic Hormone): Carbamezapine? Drugs llike Indapamide?

Answer 7

General appearance : alert and conscious? GCS? No racoon eyes, no battle sign, No hemotympanum , no otorrhea or rhinorrhea Cervical spine exam : no rigidity , full active and passive movements , Spurling’s sign Cranial nerve exam: No cerebellar signs CVS , respiratory and abdominal exam

Answer 8

Scarlet FeverDrug: -Penicillin ( Phenoxymethyl ) for 10 days (2nd line oral agent:Cephalexin X 10 days , Anaphylaxis to beta beta-lactam antibiotics (penicillin and cephalosporins):Roxithromycin X10 days Exclusion 24 Hr after Tx started Pertussis Drug: Azithromycin 5 D, if allergic Trimethoprim Sulfamethaxazole Clarithromycin syrup (if cannot swallow) Exclusion 5 D after Tx started

Answer 9

High: beta endorphin and catecholamines

Answer 10

??? AAA: Arthritis Association Australia LFA: Lung Foundation Australia DSAA: Down's Syndrome Australia Synapse Crohns and colitis Australia Alcohol Anonymous Crisis Control center (Grief reaction) Fall prevention clinic Podiatrist Speech therapy? CAT team IBD helpline Quit line (for smokers) Rehab Speech and language therapists Physiotherapist Emotional and Behavioural Therapists Psychologists Bulimia support group Beyond blue Psycho education? Social worker Centrelink Diabetes Australia Audiologist: ADHD, Autism Community Asthma program Asthma foundation RCH child health info center: Enuresis/ Asthma PFLAG: Parents and Friends of Lesbians and Gays: Gender dysphoria Family Planning Victoria: for Gays Viral URTI due to Chemo

Answer 11

autism: Applied behavior analysis depression empty nest syn anniversary grief reaction normal grief reaction adjustment d. PTSD: CBT,Trauma Based Therapy, SSRI rape domestic violence addictions mania ECT counselling * GAD 2. Superficial cut risk assessment 3. OCD: CBT,Exposure and response prevention, SSRI Panic disorder with Agoraphobia: CBT,Exposure and systematic desensitization, SSRI Body dysmorphic disorder Bulimia Nervosa: Inv : FBE, ESR/CRP, UEC,ECG Tx:SSRI, bulimia support groups. Psychiatry 4 1. Substance abuse * Alcohol 🍷 counselling * Smoking 🚬 counselling * Marijuana counselling * Heroin addiction * BDZ dependancy Gender dysphoria Gay

Answer 12

DM HTN INR Allergies incl Hives Celiac

Answer 13

HTN Headache Breast CA/lump Cervical CA? DVT/PE Ectropion Vaginal Candidiasis

Answer 14

Orbital Cellulitis 14 D Tx Mastitis 5 D Endometritis: 1.Antibiotics- IV (amoxiclav+ gentamicin+metronidazole) Once IV response then 10 days of Augmentin 2. IV oxytocin (+/- ergometrine)........

Answer 15

The most common side effects of benzodiazepines include: drowsiness. light-headedness. confusion. unsteadiness (especially in older people, who may fall and experience injuries) dizziness. slurred speech. muscle weakness. memory problems.

Answer 16

Recurrent candidiasis: 4 episodes or more in 1 year Causes:  Pregnancy  Immune deficiency states  Medications like steroids  Antibiotics  Oral contraceptive pills  Diabetes  Usage of vaginal douches or creams BV Ix: high vaginal swab for microscopic c/s, wet film & PH Atrophic Vaginitis: Local E cream, TVS for Endometrial wall thickness

Answer 17

1.Teeth staining 2.Constipation 3.Black colored stools

Answer 18

Pulmonary edema due to CHF due to fluild overload Diabetic Ketoacidosis with Dehydration HF due to Infective Endocarditis HF due to COA COPD exacerbation due to Pneumonia/Pneumonia with COPD exacerbation Cereballar metastases secondary to lung carcinoma Vasovagal + HypoGlycemia Peripheral neuropathy+DM retinopathy+Arthritis

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