Practical procedures

Question 1

examining pregnant abdomen steps

Answer 1

1. general inspection
2. inspect abdomen
3. palpate abdomen
   - fundal location
   - fetal lie
   - fetal presentation
   - fetal engagement
4. SFH
5. fetal heartbeat

Question 2

general inspection features

Answer 2

pain
scars
pallor
jaundice
oedema

Question 3

inspect abdomen for what

Answer 3

• shape
• movements (visible >24 weeks)
• surgical scars
• linea nigra
• striae gravidarum
• striae albicans (mature stretch marks)

Question 4

different fundal locations by gestation

Answer 4

12 weeks = pubic symphysis
20 weeks = umbilicus
36 weeks = xiphoid process of sternum

Question 5

how do you assess fetal lie?

Answer 5

palpate each side of uterus
hard side = back
other side = limb

Question 6

3 main types of fetal lie

Answer 6

• longitudinal lie
• oblique lie
• transverse lie

Question 7

when is a fetus considered engaged?

Answer 7

> 50% presenting part in pelvis
entire head in abdomen = 5/5th palpable = not engaged
can’t feel head = 0/5th palpable

Question 8

SFH

Answer 8

fundus to symphysis pubis with tape measure

Question 9

fetal heart beat

Answer 9

over anterior shoulder

palpate maternal pulse

Question 10

LMP wheel

Answer 10

put arrow on date that was first date of your last menstrual period

Question 11

Naegele’s Rule

Answer 11

first day of LMP + 9 months + 7 days

if cycle longer than 28 days, add the extra number of days on

Question 12

How to use Epipen?

Answer 12

blue to sky, orange to thigh

1. lie flat on ground in comfortable position
2. pull off blue release
3. hold orange tip 10cm away from outer thigh (hold thigh still)
4. Jab epipen firmly to outer thigh at right angle, hold firmly for 3 seconds before removing
5. call 999

Question 13

website to tell people about for Epipen use

Answer 13

epipen.co.uk

information for patients

Question 14

AMTS

Answer 14

1. current year
2. age in years
3. time to nearest hour
   42 West Street
4. where are you now?
5. name 2 people here
6. DoB
7. WW2 end
8. Monarch
9. 20-1
10. recall address

Question 15

growth charts used

Answer 15

UK WHO growth charts

Question 16

key points about growth charts

Answer 16

• expect head growth centile to be bigger than body
• birth/weight/head circumference at age 0
• if point is within 1/4 of a space of line = on centile
• if not describe as between centil

Question 17

when to investigate?

Answer 17

sustained drop through 2 or more weight centiles

Question 18

what does 91st centile mean?

Answer 18

91% children below

Question 19

how many children are close to mid parental height?

Answer 19

90% children within +/- 2 centiles of mid parental height

Question 20

how to calculate mid parental height?

Answer 20

1. plot mum and dad height

2. join two lines, where cross = MPH centile

Question 21

Tanner stage meaning

Answer 21

1 = pre-puberty
2/3 = in puberty 
4/5 = completing puberty

Question 22

partogram components and timing

Answer 22

30 mins: maternal HR
1 hour: contractions (frequency, strength, regularuity), liquor
4 hour: BP, temp, urinalysis of mum, cervical dilation and head descent from PV exam

Question 23

how to explain bimanual to patient

Answer 23

vaginal exam
involve me using one hand to feel your tummy and the other to place 2 fingers into the vagina
it allows me to assess the vagina and reproductive organs
shouldn’t be painful but will feel a little uncomfortable
you can ask me to stop at any point
you will need to keep your knees bent but legs apart

Question 24

things to do before starting

Answer 24

• check understanding, get consent
• request chaperone
• any pain?
• let patient pass urine
• remove underwear and cover with sheet

Question 25

external parts of exam

Answer 25

abdo exam: palpate for massess/tenderness, palpate groin for lymphadenopathy

external exam: inspect, ask pt to cough, palpate labia majora

Question 26

steps to bimanual

Answer 26

lubrication and 2 fingers

1. feel for smoothness, mobility, firmess
2. flick up and assess uterus size
3. anteverted/ retroverted
4. adnexal massess
5. move cervix side to side for tenderness
6. remove fingers and inspect for blood/discharge

Question 27

explaining speculum to patient

Answer 27

involve me inserting a small plastic device into vagina
allow me to visualise the neck of the womb
shouldn’t be painful but will feel a little uncomfortable
can ask me to stop at any point
you may experience some light vaginal bleeding after procedure

Question 28

steps to speculum

Answer 28

1. lubricate speculum, warn patient
2. part labia with left hand
3. gently insert with right hand and rotate 90 degrees
4. slowly open and inspect cervix
5. tighten screw

Question 29

what to look for through speculum?

Answer 29

abnormal discharge
erosions
ulcerations
growth
inflammation
bleeding 
polyps

Question 30

explaining smear to patient

Answer 30

speculum +
I will then place a small brush into vagina and sample cells from neck of the womb
shouldn’t be painful but a little uncomfortable

Question 31

steps to carrying out a smear

Answer 31

1. insert brush into endocervical canal
2. rotate brush 7 times, 360 degrees in clockwise direction
3. carefully remove brush
4. place tip into liquid-based cytology container

Question 32

Abortion act A

Answer 32

greater risk to pregnant woman

Question 33

Act B

Answer 33

to prevent grave permanent injury to health of pregnant women

Question 34

Act C

Answer 34

< 24 weeks, continuing involve risk to health of woman

Question 35

Act D

Answer 35

< 24 weeks and continuing have effect on existing children

Question 36

Act E

Answer 36

child born with physical/mental problems

Question 37

F/G

Answer 37

emergency

save and prevent grave permanent injury to pregnant woman