EBCOG Part 1-Postnatal Care & Sexual Reproductive Health-Day 3(EMQ)

A. Amoxicillin
B. Benzylpenicillin
C. Cefuroxime
D. Clarithromycin
E. Clindamycin
F. Co-amoxiclav
G. Erythromycin
H. Gentamicin
I. Meropenem
J. Metronidazole
K. Piperacillin
L. Vancomycin

For each of the following clinical scenarios, select the single most appropriate choice of antibiotic based on the information provided. Each option may be chosen once, more than once or not at all.

1.A 26-year-old woman is diagnosed with severe pyelonephritis 2 days after a caesarean section. Culture of a midstream urine sample grows an extended- spectrum β-lactamase (ESBL)-producing organism. She has no known allergies, and is given a single dose of gentamicin. What antibiotic should also be commenced?

2. A 24-year-old woman is 6 days postpartum. She complains of having had a sore throat for the last 2 days, and culture of a throat swab has confirmed the presence of group A Streptococcus. It is suspected that she is developing toxic shock syndrome. Which antibiotic should be used inorder to switch off exotoxin production?

3.A 32-year-old woman develops sepsis 2 days after a caesarean section. She is a nurse and is known to carry methicillin-resistant Staphylococcus aureus (MRSA). Which antibiotic should be used to ensure that MRSA is treated effectively?

 5. A 32-year-old woman presents with mild vaginal bleeding 10 days post normal delivery. She is well in herself with no pyrexia. She has no allergies. What is the most appropriate next step?

6.A 32 year old woman has had an emergency  caesarean section for undiagnosed breech. She has had a previous delivery complicated by postpartum haemorrhage. She is very keen to have a prophylactic measure taken for the management of the third stage of labour.

A high concentration of oxygen (10-15 litres/minute)

B Urinary catheter

C Two 14-gauge IV cannula

D Commence crystalloid infusion

E Keep the woman warm

F Oxygen (10-15 litres/minute) and anaesthetic help

G Send investigations

H One 14-gauge IV cannula

I Recombinant factor Vila therapy

J Arrange blood

Instruction: For each question posed below, choose the single most appropriate initial management from the list above. The given option may be used once, more than once or not at all.

7.A26 year old woman has delivered normally but had prolonged first stage of labour. Her BMI is 34. She has collapsed soon after delivery after severe PPH and bled approximately 1.5 litres.

8.A 32 year old woman delivered normally with a prolonged second stage of labour, She had an epidural and had normal vaginal delivery. She bled approximately 700m1 soon after delivery and had no other risk factor for PPH.

A Haemostatic brace suturing

B Ergometrine 0.5mg

C Syntocinon infusion (40 units in 500 ml Hartmann's solution at 125 milhour)

D Ensure bladder is empty

E Intrauterine balloon tamponade

F Bimanual uterine compression

G Syntocinon 5 units

H Direct intramyometrial injection of carboprost 0.5mg

I Misoprostol 1000 micrograms rectally

J Bilateral ligation of uterine arteries

Instruction: For each option posed below, choose the single most appropriate initial management from the A—J list above. The given option may be used once, more than once or not at all.

9.A 30 year old multigravida woman delivered twins with a normal vaginal delivery. Soon after the third stage she started bleeding profusely. There is no perineal laceration and the uterus is very soft and not contracting properly.

10.A 32 year old woman in her first pregnancy has had normal vaginal delivery. Her second stage was prolonged. She had a small vaginal tear and required no suturing. Soon after delivery of the placenta, she started having profuse vaginal bleeding. Uterus was found to be relaxed and atonic. Pharmacological method and bimanual compression have failed to control bleeding. She wants to preserve her fertility.

A summon help

B methotrexate

C bimanual compression

D fresh frozen plasma

E B Lynch suturing

F laparotomy/hysterectomy

G 40 units of oxytocin in 500S of normal saline

H intramuscular carboprost

I repeat Syntinnetrine

J examination under anaesthesia

K examination of the placenta

L intravenous access

M internal iliac artery ligation

N broad-spectrum antibiotics

O uterine packing

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

11. A 27-year-old multiparous woman has a rapid delivery soon after arriving in the delivery suite. After delivery of the placenta she is noted to have heavy vaginal bleeding. Help has been summoned. What is the most appropriate next step?

12. A 22-year-old woman in her first pregnancy is noted to have prolonged first and second stages of labour. She was induced at 38 weeks' gestation for pre-eclampsia and was augmented with oxytocin. She bleeds heavily after the third stage and already has two intravenous lines inserted. Help has been summoned and an oxytocin infusion has been set up. Abdominal examination demonstrates a relaxed uterus. What is the most appropriate next step?

13.A 38-year-old lady has had a forceps delivery for prolonged second stage. The pla-centa is noted to be complete on examination. She has a massive postpartum haemorrhage (PPH). Help has been summoned and intravenous access obtained. Syntometrine has been given. On examination the uterus is well contracted. What is the most appropriate next step?

14. A 25-year-old woman in her first pregnancy is being induced for unexplained intrauterine death at 37 weeks' gestation. She has received three doses of vaginal prostaglandin and been augmented with oxytocin infusion. She has a PPH. Intravenous access has already been secured. On examination the uterus is well contracted and the placenta is noted to be complete. Blood investigations reveal a haemoglobin level of 11.2 g/dL, and the activated partial thromboplastin time is 70 seconds with a control of 32 seconds. What is the most appropriate manage-ment option?

A Misoprostol 1000 mcg rectally

B Oral ampicillin and metronidazole

C Oral clindamycin

D Surgical evacuation of uterus/retained products

E IV oxytocin 5 IU

F IM oxytocin 10 IU

G Carboprost 0.25 mg IM

H Pelvic ultrasound

I Surgical evacuation of uterus/retained products with consultant supervision and IV antibiotics

J Conservative management of the third stage (physiological third stage)

K IM oxytocin and ergometrine

L MRI scan

Match the most appropriate management to each scenario:-

15.A 27-year-old woman in her first pregnancy with no identifiable risk factors for PPH delivers vaginally What should be offered for management of the third stage of labour?

16. A 32-year-old woman presents with mild vaginal bleeding 10 days post normal delivery. She is well in herself with no pyrexia. She has no allergies. What is the most appropriate next step?

17.A 34-year-old woman presents with heavy vaginal bleeding five days post normal delivery.The woman is pyrexial and has been commenced on oral antibiotics by the GP, however is not responding to treatment. On admission, her blood pressure is 90/50 mmHg and her pulse rate is 120 .On examination, she has a tender uterus. What is the most appropriate next step?

A 40%

B 1.5%

C 20%

D 60%

E 50%

F 91%

G 100%

H 75%

I 97%

J 0.5%

K 1in 200

Each of the following Options describes various

Percentages on woman presenting with postpartum haemorrhage i.For each patient select the single most appropriate diagnosis from the list above. Each option may be used once, more than once or not at all

18.26 year old Tesisly has delivered 6weeks back . She underwent cesarean section for Prolonged rupture of membranes with suspected chorioamnionitis, Now she had presented with heavy vaginal bleeding . Her ultrasound shows retained membranes -she is for evacuation of uterus .What is her chances of having uterine perforation