HD EOYS2

Question 1

Strategies that may help with during episodes of non-reassuring fetal statusinclude [5]

Answer 1

• Changing the mother’s position
• Increasing maternal hydration
• Maintaining oxygenation for the mother
• Amnioinfusion, where fluid is inserted into the amniotic cavity to relieve pressure on the umbilical cord
• Tocolysis, a temporary stoppage of contractions that can delay preterm labour
• Intravenous hypertonic dextrose – gives mother more energy

Question 2

Explain manoeuvre used to fix shoulder dystopia? [1]

Whats are two other options? [2]

Answer 2

• McRoberts manoeuvrers tries to dislodge shoulder from being stuck on the pubis by pelvic symphysis orientated more horizontally to facilitate shoulder delivery
• Changing the mother’s position
• An episiotomy: surgical widening of the vagina, may be needed to make room for the shoulders

Question 3

How do you manage failure to progress:

• Initially? [1]
• If continued? [4]
• If still continued? [2]

Answer 3

How do you manage failure to progress:

• Initially: relax and wait
• If continued: givelabour-inducing medications: Oxytocin; misoprostal; mifepristone; oestrogen pessary
• If still not delivered: membrane sweep or c section

Question 4

Underlying causes and conditionsthat cause fetal distress include? [5]

Answer 4

Insufficient oxygen levels
Maternal anemia
Pregnancy-inducedhypertensionin the mother
Intrauterine growth retardation (IUGR)
Meconium-stained (baby poo) amniotic fluid: baby drinks own amniotic fluid

Question 5

Explain the significance and causes of variable decelerations and late deceleration in Cardiotocography [2]

Answer 5

Late deceleration:
* placenta is compressed and o2 to baby is compromised: causes vagal stimulation or myocardial depression
* Late and bradycardia: emergency C-section

variable decelerations:
- Abrupt decrease with rapid recovery from cord compression
- Looking at length of recovery of HR (as long as recovery is rapid, its fine)
- When contraction lessens is when HR should return to normal

Question 6

Name the drugs used for Tocolysis (a temporary stoppage of contractions that can delay preterm labour) [5]

Answer 6

• nifedipine (calcium antagonist)
• atosiban: oxytocin receptor antagonists
• indomethacine NSAID: inhibitors of prostaglandin synthesis
• nitroglycerine: NO donors, Betamimetics (sympathetic beta agonsists)
• magnesium sulphate

Question 7

Score system used to investigate perinatal asphyxia? [1]

Describe the clinical significance of APGAR scores

Answer 7

APGAR score

A low Apgar score of 0 to 1 at 1 minute is not predictive of adverse clinical outcomes or long-term health issues since most infants, even those with very low 1-minute scores will have normal scores by 5 minutes.

Low Apgar scores at 5 minutes correlate with mortality and may confer an increased risk of cerebral palsy in population studies but not necessarily with an individual neurologic disability

Scores less than five at 5 and 10 minutes correlate with an increased relative risk of cerebral palsy.

Question 8

What are the three types breech pregnancies?

Answer 8

Frank: Has most favourable outcomes for vaginal deliveries
Complete
Footing

Question 9

What type of delivery occurs if placenta previa occurs? [1]

What can plecenta previa increase risk of? [1]

Treatment of placenta previa? [1]

Answer 9

Placenta previa:
- C section only
- Increases the liklihood of placenta accreta (when placenta becomes inseperable from uterus
- Treat with blood transfuison

Question 10

What is difference between primary and secondary PPH? [2]

What are primary [4] and secondary [2] PPH associated with?

Answer 10

Primary PPH: bleeding within 24 hours of birth:
- Polyhydamnios
- Macrocosmic fetus
- Uterus overstretched
- Multifetal preg.

Secondary PPH: from 24 hours to 12 weeks after birth:
- Infection
- Retained products of conception

Question 11

Explain MoA of Tranexamic acid for PPH

Answer 11

Analogue of lysine
Binds to plasminogen and stops conversion of plasmin: causes bigger clots to form

Question 12

Which drugs are used to treat PPH? [5]

Answer 12

Oxytocin (slow injection followed by continuous infusion)
Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding

Question 13

What tests would you do to exclude a medical cause for mood distubance? [2]

Answer 13

Thyroid dysfunction
Anaemia

Question 14

What is brexanolone aka? [1]

What is MoA? [1]

Answer 14

allopregnanlone (a progesterone metabolite)

• Modulates synaptic GABA-receptors and extrasynaptic GABA-A receptors: (GABA is an inhibitory receptor)
• Allows GABA that binds to receptor to have a bigger effect on the GABA receptor Makes patients feel open and feeling of relaxtion

Question 15

Which of the following has a possible risk of growth retardation in chiild?

fluoxetine
sertraline
citalopram
nortriptyline
duloxetine

Answer 15

Which of the following has a possible risk of growth retardation in chiild?

fluoxetine
sertraline
citalopram
nortriptyline
duloxetine

Question 16

Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??

fluoxetine
sertraline
citalopram
nortriptyline
duloxetine

Answer 16

Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??

fluoxetine
sertraline
citalopram
nortriptyline
duloxetine

Question 17

Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?

fluoxetine
sertraline
citalopram
nortriptyline
duloxetine

Answer 17

Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?

fluoxetine
sertraline
citalopram
nortriptyline
duloxetine

Question 18

How do you treat postnatal psychosis? [3]

Answer 18

Mood stabilizer: (lithium, valproic acid and carbamazepine)

In combination with antipsychotic medications and benzodiazepines

electroconvulsive therapy is well tolerated and rapidly effective

Question 19

Which drugs prescribed should women avoid breastfeeding [2] (and why) [1]

Answer 19

valproic acid and carbamazepine should avoid breastfeeding

Linked to hepatotoxicity in the infant

Question 20

What food substance / nutrient can you give to prevent PPD in pregnancy? [1]

Answer 20

Omega-3 (fish oil etc)

Question 21

Label A-E

Answer 21

A: Testis
B: Epididymis
C: Left and right crus penis
D: bulb of penis
E: Bulbo-urethral or Cowper’s gland

Question 22

Label A-E

Answer 22

A: Rectovesical pouch
B: Rectum
C: Deep inguinal ring
D: Inferior epigastric arteries
E: Femoral Nerve

Question 23

Which nerves innervate the cremaster and dartos:

Anteriorly [2]
Posteriorly [1]

Answer 23

Anteriorly: Genitofemoral
Ilioinguinal

Posteriorly:
Pudendal

Question 24

Label A-D

Answer 24

A: Pampiniform venous plexus
(anterior veins)
B: Ductus deferens
C: Testicular artery
D: Artery of ductus deferens

Question 25

How can you distinguish a direct and indirect hernia clinically? [1]

Answer 25

A direct hernia can be distinguished from an indirect hernia **clinically by reducing it** then putting **manual pressure over the deep inguinal ring** and asking the patient to **cough**. A **direct** hernia should **reappear**; an **indirect hernia should no**

Question 26

A man is referred to neurosurgery urgently due to a concern about cauda equina syndrome. Which urinary symptom is typically associated with cauda equina syndrome acutelyy? [1]

Answer 26

Acceptable answers; **urinary retention** Remember that the sympathetic outflow is thoracolumbar, whereas the parasympathetic outflow is craniosacral, **so cauda equina syndrome will affect the parasympathetic nervous system but not the sympathetic** This means that the detrusor muscle will not be able to contract

Question 27

What are the different layers from superficial to deep of testis? [6]

Answer 27

The layers that will be encountered are (in order): 1. Skin 2. Dartos fascia and muscle 3. External spermatic fascia 4. Cremasteric muscle and fascia 5. Internal spermatic fascia 6. Parietal layer of the tunica vaginalis **Some Damn Englishman Called It The Testes** (Mnemonic to remember the layers) **S**kin, **D**artos fascia/muslce, **E**xternal spermatic fascia, **C**remasteric fascia/muscle, **I**nternal spermatic fascia, **T**unica vaginalis (parietal), **T**unic albuginea (visceral)

Question 28

which hormone controls the formation of external genitalia? ``` testosterone MIF DHT cHG ​LH ```

Answer 28

which hormone controls the formation of external genitalia? ``` testosterone MIF **DHT** cHG ​LH ```

Question 29

name this structure [1]

Answer 29

external urethral sphincter

Question 30

which hormone peaks at ovulation? ``` LH FSH Oestrogen Progesterone ​Testosterone ```

Answer 30

which hormone peaks at ovulation? ``` **LH** FSH Oestrogen Progesterone ​Testosterone ```

Question 31

which hormone causes endometrial thickening? ``` LH FSH Oestrogen Progesterone ​Testosterone ```

Answer 31

which hormone causes corpus luteum formation? ``` **LH** FSH Oestrogen Progesterone ​Testosterone ```

Question 32

which hormone causes oestrogen levels to rise? ``` LH FSH Oestrogen Progesterone ​Testosterone ```

Answer 32

which hormone causes oestrogen levels to rise? ``` LH **FSH** Oestrogen Progesterone ​Testosterone ```

Question 33

which of following is C? ``` LH FSH Oestrogen Progesterone ​Testosterone ```

Answer 33

which of following is C? ``` **LH** FSH Oestrogen Progesterone ​Testosterone ```

Question 34

which hormone initiates milk production? ``` prolactin FSH oestrogen oxytocin progesterone ```

Answer 34

which hormone initiates milk production? ``` **prolactin** FSH oestrogen oxytocin progesterone ```

Question 35

which hormones inhibit secretrory acitivity of mammary tissue? [2] ``` prolactin FSH oestrogen oxytocin progesterone ```

Answer 35

which hormones inhibit secretrory acitivity of mammary tissue? ``` prolactin FSH **oestrogen** oxytocin **progesterone** ``` **lactogensis occurs by fall in ^^ levels**

Question 36

what happens during the menstrual cycle when FSH and LH fall? [1]

Answer 36

FSH and LH fall, **the corpus luteum degenerates** Degeneration of the corpus luteum results in **loss of progesterone production.** The subsequent falling level of **progesterone triggers menstruation and the entire cycle begins again**

Question 37

which of the following is the cytotrophoblast? A B C

Answer 37

which of the following is the cytotrophoblast? A **B** ​C

Question 38

combination of which two molecules induces spermatogenesis? [2]

Answer 38

**testosterone and androgen binding protein** ## Footnote * - Gonadotropin releasing hormone (GnRH) stimulates FSH & LH from AP - LH stimulates testosterone production by Leydig cells* * •Main target of testosterone and pituitary FSH are Sertoli cells* * •Sertoli cells then secrete androgen binding protein (ABP) and tubular fluid* * •ABP binds to testosterone & carries it to area of seminiferous tubule where it stimulates spermatogenesis*

Question 39

which cells form the blood-testis barrier?

Answer 39

sertoli cells

Question 40

which cell types causes the increase in size of spiral arteries during placental development? [1] explain how this occurs [2]

Answer 40

**cytotrophoblasts** (after invading through syncytiotrophoblasts) **replaces the endothelium and smooth muscl**e of the arteries with themselves (i.e. trophoblasts).

Question 41

label A-C

Answer 41

A: **oestrogen** B: **progesterone** C: **hCG**

Question 42

which hormone controls the formation of external genitalia? ``` testosterone MIF DHT cHG LH ```

Answer 42

which hormone controls the formation of external genitalia? ``` testosterone MIF **DHT** cHG LH ```

Question 43

what is the cell indicated? 1. mesothelial cell 2. syncytiotrophoblast 3. mesenchymal cell 4. cytotrophoblast 5. endothelial cell 6. decidual cell

Answer 43

what is the cell indicated? 1. mesothelial cell **2. syncytiotrophoblast** 3. mesenchymal cell 4. cytotrophoblast 5. endothelial cell ​6. decidual cell

Question 44

In this sagittal section of the female pelvis, which of the labelled structures is mainly supplied by the gonadal artery? C D E F H

Answer 44

In this sagittal section of the female pelvis, which of the labelled structures is mainly supplied by the gonadal artery? C D E **F** H **In this sagittal section of the female pelvis, the structure labelled F is an ovary and is mainly supplied by the gonadal artery. The ovarian artery is the main arterial supply to the gonads in females.**

Question 45

In this prosection of a female in the lithotomy position, identify A ``` A. perineal body B. bulbospongiosus C. greater vestibular (Bartholin's) gland D. Cowper's gland E. crus of clitoris ```

Answer 45

``` A. perineal body B. bulbospongiosus **C. greater vestibular (Bartholin's) gland** D. Cowper's gland E. crus of clitoris ```

Question 46

In this diagram of a growing placenta (~21 days), the large black arrow indicates the 1. Extraembryonic mesoderm 2. Stratum basalis of the endometrium 3. Decidua basalis 4. Syncytiotrophoblast 5. Trophoblastic lacuna 6. Cytotrophoblast shell

Answer 46

In this diagram of a growing placenta (~21 days), the large black arrow indicates the 1. Extraembryonic mesoderm 2. Stratum basalis of the endometrium 3. Decidua basalis 4. Syncytiotrophoblast 5. Trophoblastic lacuna * *6. Cytotrophoblast shell**

Question 47

Testis: What cell is indicated by the arrows? 1. Spermatocyte 2. Spermatid (late) 3. Spermatid (early) 4. Spermatogonia

Answer 47

Testis: What cell is indicated by the arrows? **1. Spermatocyte** 2. Spermatid (late) 3. Spermatid (early) 4. Spermatogonia **Primary spermatocytes are cells with large nuclei fairly close to the bottom of the seminiferous tubule but above the spermatogonia (which have more condensed nuclei).**

Question 48

What is A? 1. sphincter urethrae 2. prostate gland 3. internal urethral sphincter 4. bulbosponiosus 5. detruser muscle

Answer 48

``` What is A? ​ **1. sphincter urethrae** 2. prostate gland 3. internal urethral sphincter 4. bulbosponiosus 5. detruser muscle ```

Question 49

Erbs palsy effects which trunk of the brachial plexus? [1]

Answer 49

**upper trunk C5-C6** of the brachial plexus.

Question 50

Which movements cannot occur in a person with Erbs palsy? [2] Which movements are able to occur in a person with Erbs palsy? [1] Which reflex is lost [1] and which is still present? [1]

Answer 50

**Arm** **cannot** be **raised** from the side All **power** of **flexion** of the **elbow** is lost due to the **paralysis** of the **biceps** muscle. **Moro reflex** is **absent** on the affected side. **Grasp** reflex is **present** (which differentiates it from another brachial nerve palsy, Klumpke palsy (C7, C8, and T1))

Question 51

How is Erbs palsy differnt to Klumpkes palsy? [1]

Answer 51

**Klumpke injury**: C8-T1 there is paralysis of the forearm and hand muscle due to injury in C7, C8, and T1. The neonate presents with a "claw hand" due to injury to the flexor muscles of the wrist, fingers, and forearm pronator. **Erb Palsy:** C5, C6 - superior trunk - damage to: Axillary nerve Musculocutaneous nerve Suprascapular nerve

Question 52

How is Erbs palsy differnt to Klumpkes palsy? [1]

Answer 52

In the case of Klumpke injury, there is **paralysis of the forearm** and **hand** muscle due to injury in **C7, C8, and T1** The neonate presents with a "**claw hand**" due to injury to the flexor muscles of the wrist, fingers, and forearm pronator.

Question 53

A 6-month-old boy presents with an inability to move his right arm. His history is significant for gestational diabetes with poor glycemic control. The delivery was complicated by shoulder dystocia resulting in a birth injury. His right arm hangs limply by his side. Damage to which structure(s) will result in the "waiter's tip" position? A. The entire brachial plexus B. Ulnar nerve C. C5 and C6 D. Median nerve

Answer 53

A 6-month-old boy presents with an inability to move his right arm. His history is significant for gestational diabetes with poor glycemic control. The delivery was complicated by shoulder dystocia resulting in a birth injury. His right arm hangs limply by his side. Damage to which structure(s) will result in the "waiter's tip" position? A. The entire brachial plexus B. Ulnar nerve **C. C5 and C6** D. Median nerve

Question 54

After a difficult delivery a neonate is noted to have asymmetric Moro reflex. One of the arms is held in adduction, shows internal rotation at the shoulder, is pronated and extended at the elbow, and wrist flexion. Which nerve roots are most likely affected? A. C4-C5 B. C5-C6 C. C6-C7 D. C7-C8

Answer 54

After a difficult delivery a neonate is noted to have asymmetric Moro reflex. One of the arms is held in adduction, shows internal rotation at the shoulder, is pronated and extended at the elbow, and wrist flexion. Which nerve roots are most likely affected? A. C4-C5 **B. C5-C6** C. C6-C7 D. C7-C8

Question 55

What is drug A? [1]

Answer 55

Tranexamic acid

Question 56

Which drug is used to treat premenstrual dysphoric disorder (PMDD) Allopregnanolone Dehydroepiandrosterone (DHEA) Oestradiol Prostergerone Testosterone

Answer 56

Which drug is used to treat premenstrual dysphoric disorder (PMDD) **Allopregnanolone** Dehydroepiandrosterone (DHEA) Oestradiol Prostergerone Testosterone