EBCOG P1 High Yield ques – Post OP Care -(E.M.Q)

A All four position

B Anticipate postpartum haemorrhage (PPH)

C Check for perineal tears after delivery

D Delivery of the posterior shoulder should be attempted

E Episiotomy

F Fundal pressure

G Help should be summoned immediately

H Internal rotation manoeuvre

I Maternal pushing should be encouraged

J McRobert's manoeuvre

K Suction of baby's nostrils to avoid meconium aspiration

L Suprapubic pressure

M Watchful expectancy

For each case described below, choose the single most appropriate course of action from the list of options. Each option may be used once, more than once or not at all.

1. A primigravid woman has been in the 2nd stage of labour for 2.5 hours. The head has been delivered by Haig Ferguson forceps. The liquor is meconium-stained, and there is difficulty in delivering the shoulders.

2. A midwife is attending a home delivery of a 28-year-old woman in her second pregnancy at 39 weeks with body mass index of 22. The head remains tightly applied to the vulva and does not restitute.

3.A registrar is attending a delivery of a 29-year-old woman in her second uneventful pregnancy at 39 weeks. Her previous pregnancy ended with a vaginal delivery complicated by a shoulder dystocia. The baby had a transient Erb's palsy. She is now fully dilated and the head is at the direct occipitoanterior position with no caput or moulding. She has been pushing for 20 minutes. The cardiotocography is normal.

A Baby blues

B Postnatal depression

C Panic disorders

D Schizophrenia

E puerperal psychosis

F Bipolar affective disorder

G Depression

H Withdrawal psychosis

I Personality disorder

J Space-occupying lesions

K Acute confusional state

L Metabolic disorder

M Post-traumatic stress disorder

N None of the above

 For each case below, choose the single most appropriate diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

4.A 27-year-old woman who has had a normal delivery 10 hours earlier is noted by the ward staff to be having difficulties sleeping, is overactive and expresses feelings of excitement.

 5. An 18-year-old woman presents at the booking clinic. She is 9 weeks into in her first pregnancy and has been referred by the community midwife for consultant care. She feels well in herself and says that a specific voice has been speaking to her every morning instructing her to do things. She is not on any medication,

 6.A 36-year-old woman presents on the 4th day after a normal delivery. Her husband brought her in to the emergency department after he noticed an abrupt change in her behaviour. He describes her as confused, restless and expressing thoughts of self-harm.

A Common peroneal nerve

B Femoral nerve

C Genitofemoral nerve

D Iliohypogastric nerve

E Ilioinguinal nerve

F Lateral cutaneous nerve of the thigh

G Obturator nerve

H Pudendal nerve

I Radial nerve

J Tibial nerve

K Ulnar nerve

From the list of options above, which nerve is the most likely to be damaged in each of the following clinical scenarios? Each option may be used once, more than once or not at all.

7. Following a prolonged difficult hysterectomy for rectovaginal endometriosis, a 48-year-old woman makes a good postoperative recovery in hospital, although she did notice some altered sensation on the medial aspect of the thigh and calf. When she returns home a few days later, she is unable to climb the stairs.

8. Following a sacrospinous fixation procedure, a woman returns to hospital with worsening gluteal and vulval pain. The pain is worse when she sits down.

9. A woman with a body mass index (BMI) of 38 kg/m2 is placed in the lithotomy position for a planned vaginal hysterectomy. It is necessary to hyperflex and abduct her thighs in order to gain adequate access. Postoperatively, she has foot drop and has altered sensation on the lateral aspect of her calf and the dorsum of her foot.

A Bladder injury

B Death

C Femoral nerve damage

D Haemorrhage requiring blood transfusion

E Pelvic abscess

F Prolapsed fallopian tube

G Rectovaginal fistula

H Surgical-site infection

I Ureteric leakage

J Ureteric ligation

K Urinary tract infection

L Vault haematoma

M Vault prolapse

N Venous thromboembolism

O Vesicovaginal fistula

P Wound dehiscence

The risk of an operation can be categorised into serious risk and frequently occurring risk. From the list of risks described above, choose the single most appropriate option for the scenario in question. Each option may be used once, more than once or not at all.

10. The most common serious risk of an abdominal hysterectomy.

11. The most common serious risk of vaginal surgery for prolapse.

12.The most common visceral injury (serious risk) associated with caesarean section.

A Mixed respiratory and metabolic acidosis

B Mixed respiratory and metabolic alkalosis

C No derangement of acid–base balance

D Primary metabolic acidosis

E Primary metabolic acidosis with respiratory compensation

F Primary metabolic alkalosis

G Primary metabolic alkalosis with respiratory compensation

H Primary respiratory acidosis

I Primary respiratory acidosis with renal compensation

J Primary respiratory alkalosis

K Primary respiratory alkalosis with renal compensation

The list above describes some derangements of acid–base balance. For each of the following clinical scenarios, choose the single most appropriate derangement (if any) of acid–base balance. Each option may be used once, more than once or not at all.

13.  Following a difficult hysterectomy for large fibroids, a woman remains in recoveryfor some time and needs several doses of morphine to maintain pain control. She returns to the ward with a patient- controlled analgesia device. When reviewed by a nurse 1 hour later, she has a low respiratory rate and low oxygen saturation on pulse oximetry.Her arterial blood gas results are:

14. Following a difficult outpatient hysteroscopy, a woman becomes increasingly  anxious. She is sweating and describes palpitations. Her ECG is normal.Her arterial blood gas results are:

15. A woman with polycystic ovarian syndrome (PCOS) has been booked for laparoscopic ovarian drilling. Her periods are infrequent and she has been prescribed metformin to induce ovulation. Unbeknown to her gynaecologist, she has doubled the dose following internet advice that metformin induces weight loss. Following the laparoscopy, she is clammy and sweaty in the recovery area. She is tachypnoeic but her ECG is normal.Her results are:

16. A woman is admitted for surgical evacuation of the uterus following a presumed diagnosis of molar pregnancy. She has had severe vomiting for several days before the procedure. In the recovery area, she has ongoing vomiting, which is not controlled well by antiemetics. Eventually, a nasogastric tube is passed and attached to suction to keep her stomach empty. She continues to feel unwell with  a low respiratory rate.Her arterial blood gas results are:

A Sensitivity

B Positive predictive value

C Odds ratio

D Screen positive rate

E False negative rate

F Accuracy

G Likelihood ratio

H True positive rate

I Negative predictive value

J False positive rate

K Specificity

For each clinical scenario described below, choose the single most appropriate test from the list of options above. Each option may be used once, more than once or not at all.

17. The ability of a screening test to identify unaffected individuals

18. The likelihood that an individual screened positive for the condition actually has the disease

19. The proportion of individuals screened positive who do not actually have the condition

20. The ability of a test to identify affected individuals