EBCOG Part 1-Postnatal Care & Sexual Reproductive Health-Day 2(SBA)

1.Mrs. Pink, 22 years P1L1 is seen in the postnatal ward following a caesarean section four days ago. She underwent CS for failure to progress and is very tearful. The midwives are worried that she may be depressed. All are true regarding postnatal blues except:

a) Typically occurs between fourth and tenth days of puerperium
b) It occurs in 50-70% of the women and affects primiparous more commonly than multiparous
c) It is common in breast feeding or bottle feeding mothers
d) Self-limiting and usually lasts 24-48 hrs
e) Precipitated following a poor night sleep and trivial problems may provoke anxiety or sadness

2. In humans, the hind milk contains

a) High salt content
b) Low energy content
c) High protein
d) High fats
e) Low iron

3.Which hormone is responsible for Milk ejection

a) Oxytocin
b) Prolactin
c) Estrogen
d) Progesterone
e) Cortisol

4.Breastfeeding is associated with the following implications for the neonate:

a) Increased risk cardiovascular disease, reduced risk eczema, necrotising enterocolitis, obesity and GI infections, no impact on cognitive ability
b) Increased risk eczema, reduced risk cardiovascular disease, necrotising enterocolitis, obesity and GI infections, improved cognitive ability
c) Increased risk obesity and cardiovascular disease in later life, reduced risk eczema, necrotising enterocolitis and GI infections
d) Improved cognitive ability, reduced risk obesity, cardiovascular disease, eczema, necrotising enterocolitis and GI infections
e) No impact on cognitive ability, reduced risk obesity, cardiovascular disease, eczema, necrotising enterocolitis and GI infections

5. Which of the following statements concerning the impact of prolactin on breastfeeding is correct:

a) Stimulation of the nipple by suckling causes release of prolactin from the posterior pituitary gland
b) Stimulation of the nipple and emptying of the milk glands causes release of prolactin from the anterior pituitary gland
c) One of the actions of prolactin is to cause the milk collecting ducts to dilate
d) Prolactin levels remain high throughout the time that a woman breastfeeds for
e) Cabergoline stimulates prolactin release from the anterior pituitary to increase milk production

6.In which of the following situations would breastfeeding not be advised:

a) Maternal mastitis associated with breast abscess
b) Maternal mastitis on antibiotics
c) Maternal HIV infection on anti-retroviral therapy with undetectable viral load
d) Neonatal weight loss at day 5 of >10% of birth weight
e) Unilateral cleft lip and palate in the neonate

7.30 year old women in the post natal ward is suspected to have pulmonary embolism. She underwent VQ scan. What should be the advice given to her regarding breast feeding

a) It is safe to breast feed the baby without any break
b) Avoid breast feeding for 12 -24 hrs and express milk in this time
c) Avoid feeding the baby for 5-7 days and express milk in this time
d) Completely avoid breast feeding
e) It is recommended to suppress breast milk production to prevent engorgement

8.Breastfeeding is absolutely contraindicated in women taking…

a) Azothioprine
b) Chloroquine
c) Cyclophosphamide
d) Phenytoin
e) Sulfasalazine

9. You are asked to see a woman on the fifth day following an uncomplicated spontaneous vertex delivery at 39 weeks of gestation. The woman complains of unilateral breast pain. She is breastfeeding. Which of the following statements is correct?

a) A single dose of Carbergoline is required to suppress lactation
b) Localised tenderness on examination would suggest abscess formation
c) This is most likely an infective process
d) This woman may have flu-like symptoms
e) Treatment will be analgesia, expression/feeding, firm bra and oral antibiotics

10.A woman with postnatal blues…

a) Is most like to be a primigravid women than a parous women
b) Can present with confusion
c) Can present with hypochondriasis
d) Is most likely to be breastfeeding
e) Is most likely between day 2 and 3 postpartum

11. You see a multiparous woman in the antenatal clinic at 37 weeks of gestation who has been diagnosed with pelvic girdle pain. The woman is requesting induction of labour. She is unable to weight bear and hip abduction is <20°. The woman is very concerned about vaginal delivery and the postpartum period. What do you advise her?

a) Imaging is required to make the diagnosis
b) Intrapartum epidural anaesthesia will prevent further symphyseal injury
c) Requires a neurological examination
d) She requires delivery by caesarean section
e) The symptoms will resolve immediately following delivery

12.A 38-year-old woman in her fifth pregnancy is keen to discuss contraception for after her delivery. She is booked to have an elective caesarean section at 39 weeks of gestation. What should you advise her?

a) If she is planning to exclusively breastfeed, she does not necessarily need additional contraception for 6 months unless she has vaginal bleeding
b) She can use her own diaphragm anytime postnatally
c) That an intrauterine device has a 20% expulsion rate if fitted within 4 months following pregnancy
d) That sterilisation at the time of the ceasarean section has an increased failure rate of 1/1000
e) That vasectomy has a few complications and a failure rate of 1/1000

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EBCOG Part 1-Postnatal Care & Sexual Reproductive Health-Day 2(SBA)

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