Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
3 Cards in this Set
- Front
- Back
|
1. A 34-year-old woman had a caesarean section after 24 h of labour due to secondary arrest of cervical dilatation and maternal exhaustion. Two hours post-LSCS, she complained of acute-onset left-sided chest pain radiating to the left shoulder and arm along with breathlessness. She had no previous known medical conditions or family history of cardiac disease. Which of the following statements is true regarding investigations planned to rule out acute myocardial infarction?
A. Acute MI is highly unlikely in this clinical scenario, and precious time andefforts should not be wasted on the same in this scenario. B. Coronary angiography is useful in diagnosing and treating acute MI in postpartum patients. C. Isoenzyme MB will be more specifi c and should be used in this case. D. Normal ECG would rule out acute myocardial infarction. E. Troponin T levels may increase in prolonged labour or caesarean section andhence cannot be used in this case. KEY B
2. A pregnant women's increased insulin requirement by third trimester is approx
A)10% B)30% C)60% KEY B.
3. The prevalence of Preecclampsia is reported to be 5-8% in women with diabetes. T 4. ULIPRISTAL 30 mg [ ELLaone] 5. 3rd perineal tear manual removal placenta= i/v Augmentin + i/v metro
5. Most common antihypertensive used during the antenatal period is
A)labetalol B)methydopa C)nifedipine D)hydralazine E)atenolol Key B |
TOG 17:9
Water immersion
The proposed mechanism of pain relief is a physiological increase in uterine perfusion, which may promote endorphin and oxytocin release, thus increasing maternal satisfaction.
Nitrous oxide (gas and air)
It suppresses activity within the reticulo-endothelial system and increases the release of endogenous endorphins, corticotrophins and dopamine, which activate descending pain pathways.
Nitrous oxide has a short half-life of 2–3 minutes and is cleared rapidly via the lungs.
Common adverse effects include lightheadedness, nausea, vomiting and, less commonly, hallucinations, hyperventilation and tetany.
Prolonged nitrous oxide exposure for more than 5 hours per week in some healthcare workers has been linked to decreased fertility, preterm birth and vitamin B12 deficiency,
Paracetamol is a cyclo-oxygenase 2 inhibitor that reduces the inflammatory response and subsequent pain by blocking the production of prostaglandins via the arachidonic acid pathway.
Commonly used opioids include dihydrocodeine, pethidine, diamorphine, fentanyl and remifentanil.
Intramuscular pethidine is the most commonly used opioid worldwide for labour analgesia and is one of the most frequently used in the UK because midwives are licensed to prescribe and administer it.
Tramadol, meptazinol and pentazocine are not used routinely in the UK although evidence suggests no advantage over pethidine.
Opioid receptors are mainly located in the periaqueductal grey area of the brain and spinal cord, with sparse locations elsewhere.
A neonate may take up to 6 days to eliminate pethidine from its system
Their activation leads to a reduction in neuronal cell excitability and transmission of nociceptive impulses.
Epidural anaesthesia involves the use of local anaesthetics with or without an opioid injected into the epidural space to produce a reversible loss of sensation and motor function.
Local anaesthetics inhibit nerve conduction by blocking sodium channels in nerve cell membranes, thereby preventing the propagation of nerve impulses
Remifentanil is a rapidly acting synthetic opioid, which is rapidly metabolised by tissue esterases and has a half-life of 3 minutes.
One-third of labour units in the UK now offer remifentanil PCA as a form of analgesia.
Epidural
A fine plastic tube is inserted into the epidural space L4–L5 or L5–S1Takes 20 minutes to set up and 20 minutes to work
Failure to work (1 in 10) Pruritus and shivering Significant hypotension (1 in 50) Severe headache (1 in 100) Temporary nerve damage (1 in 1000) Permanent nerve damage (1 in 13 000) Infection, meningitis, epidural blood clot (<1 in 50 000)
Remifentanil patient-controlled analgesia (PCA)
IV access attached to a PCA pump Provides pain relief on demand Takes 5 minutes to work
1 in 8 will require gas and air in addition
Contraindicated if morphine or pethidine given in previous 4 hours
Caution if heart problems or allergy to pethidine or morphine
Failure to work (1 in 10)
Stopping the use of the PCA because of hypoxia and reduced Glasgow Coma Scale (1 in 28 women)
Cardio-respiratory arrest (<1 in 2200)
Intramuscular 7.5 mg diamorphine gave significantly better analgesia than 150 mg pethidine but prolonged delivery by approximately 82 minutes.
There were no significant differences in neonatal adverse outcomes between the two medication
Evidence available AnalgesiaShown to be effective
Epidural Combined spinal–epidural Continuous one-to-one support
May be effective
Music/music-assisted relaxation techniques Birthing ball/upright posture Water immersion Nitrous oxide Relaxation techniques/massage Acupuncture/acupressure Non-opioids Sterile water injections Remifentanil patient-controlled analgesia
Insufficient evidence
Transcutaneous electrical nerve stimulation Biofeedback Hypnosis Aromatherapy Oral/parenteral opioids |
|
|
1. Regards Cushing syndrome
Rate of pregnancy loss is 40% . Maternal morbidity is 60-70%. Severe Preeclampsia is10-15% Maternal mortality is 2-4% Metyrapone is the most commonly used anriandrogenic drug during pregnancy.
2. First stage 90% ,2nd stage 18%,3rdstage 8% risk of uterine rupture
3. Fetus can accumulate 25-30 g of calcium over the course of pregnancy particularly in third trimester? ?TRue
4. Positive Sen 1 ေအာက္ out Sensitivit/1-Specificity Neg ratio 1-Sensitivity/ Specigicity
5. HRT does not increase cardiovascular disease risk when started in women aged under 60years. T
HRT does not affect the risk of dying from cardiovascular disease. T
Trichomonas vaginalis=Preterm birth low birth wt & little neonatal moridity. Strawberry Cx 2% of trichomonas.
Fascia dehisence 0.4 %
stimp carcinoma 0.3 %
Fluid overload in operative hysteroscoly 0.1 - 0.2 % |
1. Post pill amenorrhoea up to 6 month 2. HMBLEEDING 1. LNG-IUS 2. XAMIC or NSAID or COC 3. Norethisterone 15 mg daiy 5-26 Days orDePo 3. Endo abalation no bigger than 10 wks 4. Vaginal > Abdominal hysterectomy 2. Severe hirsutism wt gain irregular period = Danzl > coc pill
|
|
|
1. Replen = moisturisers & lubricant
2. Cord prolapse 2nd stage forceps dt risk of cord impinge wirh vaccum
3. LMWH is unsuitable for mechanical valves.
4 Readmission LMWH for 10 days 5. Detection rate for adnexal mass by VE 70%
7. Brainstroming = group discussin to produce ideas & ways of solving problems.
Delphi technique= each person prpvides anonymous answers & a facilitator amagamates results for feedback.
Fish bowl method = small group teaching in which students engag n a discussion while observers form a circle around them.
The 1-minute preceptor
This is a five-step process that can be carried out in minutes with the purpose of structuring teaching opportunities that arise in the clinical environment.
The five steps are:
• commitment• justification • application • positive reinforcement • correction of mistakes Eg APH
Schema activation
A schema is a representation of a plan in the form of a model. From a philosophical perspective a schema is a conception of what is common to all members of a class. For instance, it is quite reasonable for a clinical teacher to expect specialist trainees in year 1 to understand the anatomy of the vagina and cervix. These learners would have been taught the basic anatomy in medical school. The teacher would activate recall of basic facts and concepts prior to enhancing learning. An example would be the task of providing a tutorial to specialist trainees in years 1 and 2 on the
Schema refinement
This is a useful method for teaching more advanced learners. In this technique the learners are encouraged to apply basic concepts, clarify their understanding and solve clinical problems.
One example would be the use of a tutorial on the anatomy, physiology and endocrinology appropriate to amenorrhoea followed by a series of clinical cases which could include post-chemotherapy amenorrhoea, Turner syndrome, hyperprolactinaemia and complete androgen insensitivity syndrome.
Snowballing
This is a useful technique to employ if the teacher isunsure of the current level of knowledge or skills ofthe learners. This is not an ideal situation but itcould arise.The discus
TO1 = feedback form sent to a colleague as a part of multisource feedback. TO2 = feedback to trainee by trainee's supervisor
ARCP = annual review of competency progression
Appraisal= annually as part of a five-year revalidation cycle.
Principal ivnvestigatir= authorized healthcsre professional responsibility for the trial.
Chief investigator (CI)
The healthcare professional who is authorised to take primary responsibility for the conduct of a clinical trial
Principal investigator (PI)
The authorised healthcare professional who is responsible for the conduct of the trial in a particular site. In cases of more than one individual involved in the study, the PI is the nominated lead for the site
Sponsor
An institution, company or a person that takes responsibility for the initiation, conduct and finance or arrangement of finance for the clinical study
Good Clinical Practice (GCP) Standard and guidelines for the conduct of clinical research
Clinical Trial of Investigational Medicinal Products (CTIMP)
Clinical trial involving an Investigational Medicinal Product that is defined as a pharmacological product in its active or placebo form that is tested or used as a reference in the study
Portfolio study
Studies that are eligible for support from the Clinical Research Network including both commercial and non-commercial studies. In England, where research funding is provided by the National Institute for Health Research, the studies are automatically eligible. The details of inclusion criteria for studies in the UK can be accessed here: http://www.crn.nihr.ac.uk/can-help/funders-academics/nihrcrn-portfolio/ which-studies-are-eligible-for-clinical-research-network-support/
Research costs
Costs incurred due to the conduct of the study, which end at the completion of the study
Treatment costs
Costs to provide treatment regimen, which are sustained when the intervention continues after the completion of the study
NHS service support costs
Patient care costs associated with the study that end once the study is complete
Levels of Evidence1++ High quality meta analyses, systematic reviews of RCTs or RCTs with a very low risk of bias 1+ Well conducted meta analyses, systematic reviews of RCTs or RCTs with a low risk of bias
1–
Meta analyses, systematic reviews of RCTs or RCTs with a high risk of bias
2++
High quality systematic reviews of case-control or cohort studies or high quality case-control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal
2+
Well conducted case control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal
2–
Case control or cohort studies with a high risk of confounding, bias, or chance and a significant risk that the relationship is not causal 3 Non-analytical studies e.g. case reports, case series 4 Expert opinion
2. Hyperkalaemia = 10% 10 ml Ca gluconate
3. Singley forceps = grasp lymph nodes = Babkob=Sklar blue Singley BLACK for Laser surgery
DeBakey = non- tooth forceps for vascular
Meigs-Navratil foeceps= Rightangle or curve or straight artery forceps
Tensile strength = ability of thread to oppose traction.
Elasticity = to elongate uder traction
Flexibity = to support acute anguation
Plasticity i lack f recovery of the initial dimension of the suture after firced lwngthing |
1. Kustner Cherney uro surgery Retzius Maylard Mouchel 2. Fasvia dehisence 0.4 %
3. SIRS Dx two of . T> 38.3°C or < 36 . RR >20/min or PaC2 < 32 mmHg ( 4.3 kPa) . HR > 90 bpm . TWBC < 4 ot > 12 × 10*9/L
Sepsis = SIRS + the presence of infwctiob
Septic shock= BP < 90 mmHg or reduction > 40mmHg from baaeline or lactate > 4 mmil/L
4. 3-0 PDS tensile strength 80 % at 2 wk 70 % at 4 wk 60 % at 6 wk
5. GnRH 40 % reduction in fibroids .
6. Cutting = continuous high frequency low voltage
Coagulation = pulsed waveform low frequency high voltage
7. K =+) cffDNA [+] --> weekly MCA psv & 2 wkly Ab titre
8. a schedule of 10 appointmentsshould be adequate. For a woman who is parous with anuncomplicated pregnancy, a schedule of 7 appointments .
9. Pregnant women should be informed of the potential dangers of certain activities during pregnancy, for example, contact sports,high-impact sports and vigorous racquet sports that may involvethe risk of abdominal trauma, falls or excessive joint stress, andscuba diving, which may result in fetal birth defects and fetal decompression disease.
10 . If the crown–rump length is above 184 mm, the gestational age should be estimated using headcircumference.
11. Pregnant women should be informed about the correct use of seatbelts (that is, three-point seatbelts ‘above and below the bump, not over it’). 10 UN 13-24% |
