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

1.Septic shock is caused by severe bacterial infection .it is commonly caused by toxins of

2.Patients in septic shock would show all of the following except

3. Mrs KM is a 39 year old P2.Had elective caesarean section 12 days ago for previous caesarean section & fibroid uterus.During second operation she had massive PPH which needed B-Lynch suture,uterine artery embolization & 12 units blood.She is febrile since the operation & having profuse purulent discharge from the wound.She is on parenteral antibiotics & her most recent blood culture was positive for E.coli.What is the most likely complication she has had?

4. A 32 year old woman is brought into the A & E with a 1 day H/O fever,rigors,abdominal pain &heavy lochia.She had an uncomplicated spontaneous vaginal delivery 2 days ago.on arrival ,she has a temperature of 39֯ C,a heart rate of 143 bpm ,a BP of 82/59 mmHg & a RR of 40/min.Following initial resuscitation ,what is the most appropriate immediate management?

5.A primi presents 2 days after a normal vaginal delivery c/o feeling unwell.On exam ,she has a temperature of 38֯ C,pulse rate of 110bpm & BP of 90/50 mmHg.Thre are no localising signs of infection.Blood tests are performed.What test result would indicate a severe sepsis?

6. A woman is readmitted 48 hours after a normal vaginal delivery.signs & symptoms suggest profound septic shock.what is the most appropriate first line antibiotic regime to use?

7.You are asked to review a woman 8 hours after a vaginal delivery.She has an obstetric mofigied early warning score of 6,which 4 hours previously was 0.She is tachycardic,tachypnoeic,hypotensive & pyrexial.She has abdominal tenderness & a sore throat.What is the most likely causative organism?

8. According to Confidential Enquiry Into Maternal Deaths (2016), which organism is most commonly identified in pregnant women dying from sepsis?

9.A woman had an emergency caesarean section for a pathological CTG and pyrexia in labour. She was discharged on postoperative day 4 but re-admitted on day 6 with pyrexia, tachypnoea, tachycardia and hypotension. Haemoglobin is 105 g/l. Septic shock is the main differential diagnosis. Following the Sepsis 6 bundle, along with antibiotics and blood cultures, which other important blood test needs to be taken?

 10. A 33 year old woman presents to the A & E on D5 after a caesarean birth with a disturbed level of consciousness,pulse of 120bpm,RR of 26/min & BP 90/50 mmHg.There was no vaginal bleeding .On assessment the MDT decided to draw blood for culture & lactate & start Iv antibiotic,IV fluids & assisted ventilation.What is the suitable level of care for her?

 11.Clinical signs suggestive of sepsis include all of the following except:

12. You have just examined Mrs X in the postpartum clinic. She is complaining of breast pain and discomfort. You have established a diagnosis of postpartum mastitis. All of the following are treatment options for her except:

13. The commonest urinary problem occurring in the postpartum period is:

14. A 24-year-old woman presents to delivery suite with a 12 h history of right-sided chest pain and shortness of breath. She is at 7 days’ postnatal having delivered her baby by emergency caesarean section at 34 weeks. Her pregnancy was complicated by severe hypertension and postpartum haemorrhage of 1 L. She has a BMI of 32. Her BP is 130/80 mmHg, pulse is 108 bpm, temperature is 37.2 and oxygen satura- tions are 94 % in air. What is the SINGLE most likely diagnosis?

15. Ms. XY is brought to the A + E department, unwell. She is a para 1, post-SVD 3 days ago with ragged membranes noted at delivery. Her observations include pulse 128 bpm, BP 80 systolic, RR 24 breaths/min and temp 39° C and she feels cold and clammy. She reports heavy offensive lochia.She has been fluid resuscitated now and commenced on oxygen by mask. What is the next immediate step in her management?

16.Ms. XY is brought to the A + E department, unwell. She is a para 1, post-SVD 3 days ago with ragged membranes noted at delivery. Her observations include pulse 128 bpm, BP 80 systolic, RR 24 breaths/min and temp 39° C and she feels cold and clammy. She reports heavy offensive lochia. She has been fluid resuscitated now and commenced on oxygen by mask. Which of the following blood results reflect severe sepsis?

17.Ms. XY is brought to the A + E department, unwell. She is a para 1, post-SVD 3 days ago with ragged membranes noted at delivery. Her observations include pulse 128 bpm, BP 80 systolic, RR 24 breaths/min and temp 39° C and she feels cold and clammy. She reports heavy offensive lochia. Which of the following antibiotics are best suited to her?

18.Ms. XY is on day 1 postpartum following a vaginal delivery at home. She presents to the A + E department in septic shock. She gives history of a fever and sore throat leading up to the delivery.What is the most likely organism responsible for her condition?

19. Which one of the following best defines secondary postpartum haemorrhage?

20. Mrs.Teresa , 28 year old woman had a primary PPH 2 hours previously after delivery of a 4.1 kg boy. You are asked to review as she is confused and agitated. There is no sign of ongoing bleeding. Her pulse is 143 beats / min. Her Bp is 89/45 mmgh and her booking weight was 71 kg. Approximately how much blood this woman lost?

21. After a significant period of hypovolemic shock, the bleeding was controlled and the vascular volume replaced. Estimates of blood loss were over 2,500 cc. The patient apparently recovered well. However, she was unable to breast-feed and gradually noted breast atrophy and no resumption of menses. Later, she developed constipation, slurred speech, and moderate nonpitting edema. Which of the following is the most likely diagnosis?

22. A patient calls your clinic complaining of continued heavy vaginal bleeding. She had an “uncomplicated” vaginal birth 2 weeks ago of her second child. What is the most likely diagnosis from the following differentials?

23.A woman has a massive PPH and receives a transfusion of 18 units of red blood cells, 12 units of fresh frozen plasma, 5 units of platelets and 3 units of cryoprecipitate. At the time of hysterectomy it was decided to give her recombinant factor VIIa. Which of the following are blood marker targets prior to giving this agent?

24. You see a 30-year-old para 1+0 woman in the antenatal clinic. The woman wishes to discuss her delivery for her current pregnancy. In her first pregnancy she had a PPH of 1 litre secondary to uterine atony, which was treated medically. She is very keen to deliver her baby in a low-risk community midwife-led birthing unit with access to a birthing pool. She is also keen to have a physiological third stage.What would you inform her?

25.In managing an atonic PPH a correct drug prescription is…

26. A woman undergoes a massive transfusion of both O negative and cross matched blood products for the management of a major PPH. What is the woman most at risk of?

27.A 24-year-old woman has a retained placenta after a normal delivery. She is prepared for theatre for manual removal of placenta. What is the best option regarding antibiotic prophylaxis use?

28.The emergency buzzer went off in the postnatal ward & you called to see a patient who delivered 4 hours earlier via ventouse. You note a bulging haematoma has developed and patient is hypotensive. With regard to vulval haematoma’s what structure limits its spread?

29.26-year-old woman has just given birth and her newborn baby undergoes assessment. His body is pink with blue extremities and has a heart rate of 150 beats per minute. He demonstrates grasping, feeble cry and Little flexion on stimulation. What is the most likely Apgar score?

30.A 33-year-old primigravida with asthma delivers a live infant at term. There was no meconium.The infant makes no spontaneous attempt at breathing and is floppy. It is dried, covered and assessed. Five inflation breaths are performed. There is good chest movement on inflation. The neonate is then reassessed: there is a heart rate of around 50 bpm although still no breathing. Senior assistance is summoned and en route. What is the next immediate step?

31.A newborn with birth weight of 4.2 kg , had a difficult delivery . But baby cried immediately and was doing well . Suddenly midwife noticed that baby is not moving right arm and started crying when she tried to move . She also noticed that baby is not making fist on that side . What is the diagnosis ?