A22year ol dwomanpr esent st ot he Emer gencyDepar t mentr equest i ng ' emer gencycont r acept i on’ .Shehad unpr ot ect edse xuali nt er cour se( UPSI ) appr oxi mat el y4daysear l i er . Quest i on: Whi chor al met hodofemer gency c ont r ac ept i v ec oul dbepr es c r i bedi nt hi s c as e?( 1) YourAnswer : Cor r ectAnswer : El l aOne( Ul i pr i s t al Ac et at e)i sl i c ens edf or us ewi t hi n5day s( 120hour s )ofUPSI
Quest i on:
Whi c hi mpor t antdr ugi nt er ac t i ons houl d y oubeawar eofwhenpr es cr i bi ngt hi s dr ug?( 2) YourAnswer : Cor r ectAnswer : Ul i pr i s t al Ac et at es houl dnotbeus edwi t h l i v erenz y mei nduc i ngdr ugsandi ti s r ec ommendedt hati ti snotus edi nwomen us i ngl i v erenz ymei nduc i ngdr ugsandf or 28day saf t ert hes edr ugsar es t opped. Quest i on: Whi c hnonor al f or m ofemer genc y c ont r ac ept i onwoul dbes ui t abl et obe us edi nt hi scas e?( 1) YourAnswer : Cor r ectAnswer :
Whi c hi mpor t antdr ugi nt er ac t i ons houl d y oubeawar eofwhenpr es cr i bi ngt hi s dr ug?( 2) YourAnswer : Cor r ectAnswer : Ul i pr i s t al Ac et at es houl dnotbeus edwi t h l i v erenz y mei nduc i ngdr ugsandi ti s r ec ommendedt hati ti snotus edi nwomen us i ngl i v erenz ymei nduc i ngdr ugsandf or 28day saf t ert hes edr ugsar es t opped. Quest i on: Whi c hnonor al f or m ofemer genc y c ont r ac ept i onwoul dbes ui t abl et obe us edi nt hi scas e?( 1) YourAnswer : Cor r ectAnswer :
Thec opper bear i ngi nt r aut er i nedev i c e c anbei ns er t edupt o120hour saf t er UPSI Quest i on: Li s t4c ont r ai ndi c at i onst ot henonor al met hodofemer genc yc ont r ac ept i on c hos eni npar t( c )abov e:( 4) YourAnswer : Cor r ectAnswer : • • • •
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An y4of : Si gni fi c ant l ydi s t or t edut er i neanat omy Unex pl ai nedv agi nal bl eedi ng Pel v i cma mal i gnanc y Ges t at i onal t r ophobl as t i cdi s eas ewi t h per s i s t ent l yel ev at edbet ahumanc hor i oni c gonadot r opi nl ev el s Ongoi ngpel v i ci nf ec t i on
Quest i on: Whi c ht woi mpor t antt hi ngss houl dbe di s c us s edwi t ht hepat i entatt hi s pr es ent at i on?( 2) YourAnswer : Cor r ectAnswer : Wo menat t endi ngf oremer gency
c ont r ac ept i onsshoul dbeoffer edt he oppor t uni t yt ounder got es t i ngf orSTI s i nc l udi ngHI V.Forwomenatr i s kofSTI s ,i f t es tr es ul t sar eunav ai l abl ebef or eI UD i ns er t i on,heal t hpr of es s i onal ss houl d c ons i derpr ophy l ac t i cant i bi ot i c satl eas tt o c o v erChl amy di a. Womens houl dbeadv i s edt hatnei t herof t hes eopt i onswi l l pr ov i dec ont r ac ept i v e c ov erf ors ubs equentac t sofUPSI . Ongoi ngc ont r ac ept i ons houl dbe di s cus sedwi t hal l womenev eni ft heydo
notpl ant ohav es exi nt hef or es eeabl e f ut ur e.
A23y ear ol dAf r oCar i bbeanl ady pr esent st ot heEmer gency Depar t ment .Shei s17weekspr egnant andi sknownt osufferf r om si ckl ecel l anaemi a.Shehaspassedal ar ge amountofbl oodandcl ot svagi nal l y andi scompl ai ni ngoff eel i ngdi z z y . Shei sal socompl ai ni ngofupperback andar m pai n.Herobst et r i cbooki ng bl oodsshow t hatshei sr hesus negat i v e.Herobser v at i onsar e:HR46, BP82/ 43,RR22andSaO2 94% onai r . Ther esusnur sehascannul at edt he
pat i entandaf ul lsetofbl oods i ncl udi ngacr ossmat chhasbeensent t ot hel ab. Quest i on: Whi c hfl ui dandhowmuc hwoul dy ou i ni t i al l yadmi ni s t er ?( 1) YourAnswer : Cor r ectAnswer : 12l i t r esor1020ml / k gofc r y s t al l oi de. g. 0. 9% s al i ne Quest i on: Whi c hdi agnos i sex pl ai nsherpr es ent at i on andobs er v a t i ons ?Whats houl dbey o ur nextmanagementst ep?( 2) YourAnswer : Cor r ectAnswer :
Herpr es ent at i onandobs er v at i ons ( v agi nal bl eedi ngwi t hbr ady c ar di aand hy pot ens i on)c anbeex pl ai nedbya di agnos i sofc er v i c al s hoc ks yndr ome. Pr oduc t sofc onc ept i on( POC)ar el i k el yt o bewi t hi nt heos .I nc er v i c al s hoc k s y ndr omet hec er v i xbec omesdi l at edby t hePOCcausi ngi ncr easedhaemor r hage andav as ov agal r eac t i on.As pec ul um ex ami nat i ons houl dbeper f or medandt he POCr emo v edwi t has t er i l es ponge f or c eps . Quest i on: Whati st hemos tl i k el yc aus ef orherpai n? ( 1) YourAnswer : Cor r ectAnswer : Apai nf ul v as ooc c l us i v es i c k l ec el l c r i s i s .
Quest i on: Out l i ne4ot heri mmedi at emanagement s t eps :( 4) YourAnswer : Cor r ectAnswer : • • •
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Any4of :( ½ mar keach) Keept hepat i entwar m Gi v ehi ghfl ow( 15L)o x y gen Gi v eanal ges i ae. g.I VMor phi ne t i t r at edt or es pons e Bl oodt r ans f us i on46uni t sorac t i v at e mas s i v ehaemor r hagepr o t oc o l Empi r i c al ant i bi ot i ct her apyi fi nf ec t i on t houghtt obet het r i gger Quest i on: Doess h eneedt r eat mentf orherRhes us s t at usandi fs owhatandwhen?( 2) YourAnswer :
Cor r ectAnswer : Shes houl dbet r eat edass hei sr hes us negat i v eandbl eedi ngi near l ypr egnanc y i sa‘ s ens i t i s i ngev ent ’ .Admi ni s t er250U Ant i DI gI Mi mmedi at el yaf t ert he s ens i t i s i ngev entandor gani s ef ora f ur t her500Ut obegi v enaf t er20week s .
A32year ol dwomanwhoi s30weeks pr egnanthasbeenexposedt o chi ckenpoxatachi l d' sbi r t hdaypar t y . Shet hi nkst hatshehasneverhad chi ck enpoxher sel f .
Quest i on: Whi c hi mpor t antbl oodt es ts houl dy ou or gani z e?( 1) YourAnswer : Cor r ectAnswer : Ser um v ar i c el l aant i bodyt es t Quest i on: Youobt ai nc onfi r mat i ont hats hehas nev e rhadc hi c k e npo x .Whats houl dy o u doandwhi c h2i mpor t antpi ec esofadv i c e s houl dy ougi v eher ?( 3) YourAnswer : Cor r ectAnswer : Shes houl dhav eVar i c el l aZos t er I mmunogl obul i n( VZI G)admi ni s t er ed. Yous houl dadv i s ehert hats hei s pot ent i al l yi nf ec t i ousf r om 828day saf t er
VZI G andt hats hes houl dnot i f yherGPor mi dwi f ei far as hdev el ops . Quest i on: As econdwoman,whoi sal s o30week s pr egnant ,pr es ent swi t hc hi c k enpox .The r as hhasb eenpr es e nt12hour s .Ho w woul dy out r eatt hi s ?( pl eas ei nc l udeany dr ugdos es )( 1) YourAnswer : Cor r ectAnswer : Or al ac y c l ov i r800mgfi v et i mesperday f or7day s Quest i on: Name3s er i ousc ompl i c at i onst hats hei s atr i s kofdev el opi ng:( 3) YourAnswer : Cor r ectAnswer :
Pneumoni a Hepat i t i s Enc ephal i t i s Quest i on: Li s t4c i r c ums t anc est hats houl dpr ompta GPt or ef erapr egnantwomanwi t h c hi c k enpoxt oHos pi t al f oras ses sment :( 2) YourAnswer : Cor r ectAnswer :
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Ref er r al t oHos pi t al s houl doc c urunder t hef ol l owi ngc i r c ums t anc es :( ½ mar k each) Pr esenceofchestsy mpt oms Pr es enc eofneur ol ogi c al s y mpt oms Haemor r hagi cr as horbl eedi ng Dens er as hwi t horwi t houtmuc os al l es i ons
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Pr es enc eofs i gni fi cant i mmunosuppr essi on Ci gar et t es mok er s Hi s t or yofc hr oni cl ungdi s eas e T ak i ngc or t i c os t er oi ds Cons i derr ef er r al i nl at t erhal fof pr egnancy
A28year ol dl adyi sr ef er r edt ot he emer gencyDepar t mentbyherGPwi t h el e vat edbl oodpr essur eandswel l i ng ofherhandsandf ace.Shei s32weeks pr egnantandt heGPi sconcer nedt hat shemayhavepr eecl ampsi a. Quest i on:
Whati st hedefi ni t i onofpr eec l amps i a? ( 2) YourAnswer : Cor r ectAnswer : Pr eec l amps i ai sdefi nedasnew hy per t ens i on( >140/ 90)i napr egnant womanaf t er20week sges t at i onwi t h as s oc i at edpr ot ei nur i a( >300mgpr ot ei ni n a24hoursampl e) Quest i on: Li s t3f eat ur esofs ev er epr eec l amps i a: ( 3) YourAnswer : Cor r ectAnswer : •
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An y3of : Sus t ai neds ev er ehy per t ens i on( > 160/ 90) Sev er epr ot ei nur i a
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Ol i gur i a( ur i neout put<500ml s/24 h o u r s ) Neur ol ogi c al s y mpt omsands i gnse. g. headac he,papi l l oedema,c l onus Pl at el etc ount<100x1 / 09 L Epi gas t r i cpai nand/ orr i ghtupper quadr antt ender nes s El e v at edl i v erenz y mes( ASTandAL T) Quest i on: Li s t4r i s kf ac t or sf orpr eec l amps i a:( 2) YourAnswer : Cor r ectAnswer :
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Any4of :( ½ mar keach) Fi r s tpr egnanc y Mul t i pl epr egnanc y Obes i t y Ageol dert han35 Hi s t or yofdi abet es
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Hi s t or yofhy per t ens i on Hi s t or yofk i dneydi s eas e Quest i on: Li s t4pot ent i al c ompl i c at i onsofpr eec l amps i a:( 2) YourAnswer : Cor r ectAnswer :
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Any4of :( ½ mar keach) Ec l amps i a HELLPs y ndr ome Adul tr es pi r at or ydi s t r es ss y ndr ome Cer ebr al haemor r hage St r ok e Cor t i c al bl i ndnes s Rupt ur eofl i v er Pul monar yoedema Renal f ai l ur e
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Di s s emi nat edi nt r av as c ul ar c oagul at i on Quest i on: Name1bl oodt es tt hatc anbeus edt o pr edi c tmat er nal c ompl i c at i onswi t hpr eec l amps i a.( 1) YourAnswer : Cor r ectAnswer : Ser um ur i cac i d
A28year ol dwomant hati s35weeks pr egnantpr esent swi t hsever el ower abdomi nalpai n.Whi l sti nt he depar t mentshesuffer sanepi sodeof vagi nalbl eedi ng.Herobser vat i onsar e asf ol l ows:HR136bpm,BP88/ 42, SaO2 99% onai r ,t emper at ur ei s37. 1° C. Onexami nat i onshehasr ebound
t ender nessandguar di ngi nt hel ower abdomen.Youar econcer nedt hatshe mayhavesuffer edut er i ner upt ur e. Quest i on: Li s t3r i s kf ac t or sf ornont r aumat i cut er i ne r upt ur e.( 3) YourAnswer : Cor r ectAnswer : • • • • • • • •
An y3of : Pr ev i ousCaes ar eans ec t i on Pr ev i ousmy omec t omy Mul t i par i t y Mal pr es ent at i on Cephal opel v i cdi s pr opor t i on Sy nt oc i nonaugment at i onofl abour Obs t r uc t edl abour Pl ac ent aper c r et aori nc r et a
Quest i on: Des cr i be3f ac t or st hatmak et he ev al uat i onofabdomi nal pai nmor edi ffic ul t i npr egnanc y .( 3) YourAnswer : Cor r ectAnswer : •
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An y3of : Thei nt r aabdomi nal or gansc hange pos i t i onast hepr egnanc ypr ogr es sese. g. bowel i sdi s pl ac edi nt ot heupperabdomen andt heappendi xi ss hi f t edupwar ds t owar dst hegal l bl adder Per i t oneal s i gnsmaybeabs entast he ut er usc anl i f tt heabdomi nal wal l away f r om t hear eaofi nfl ammat i on Theut er usc a nobs t r uc tt hemo v ement oft heoment um t ot hear eaofi nfl ammat i on Thepr es enc eoft hef et usandpl ac ent a c anc l oudt hepi c t ur ef ur t her
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Labor at or ypar amet er sc anbenons pec i fi candar eof t enal t er edduet ot he phy s i ol ogi c al c hangesi npr egnanc y I magi ngi smor edi ffic ul tduet ot he r i s k sofr adi at i onex pos ur et ot hef et us Quest i on: Des c r i be2t hi ngsy ouwoul ddot oas s es s t hepr egnanc yandut er usaspar tofy our ex ami nat i on?( 2) YourAnswer : Cor r ectAnswer :
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An y2of : Pal pat eut er usf orf undal hei ght ,f et al pos i t i onandpr es ent at i on Pal pat ef orf et al mov ement s As s es st hef et al hear tbeat( ei t herwi t h Doppl ers c anorc ar di ot oc ogr aphy )
Quest i on: Name2pot ent i al c ompl i c at i onsofut er i ne r upt ur e.( 2) YourAnswer : Cor r ectAnswer : • • •
An y2of : Emer gencyhys t er ect omy Fet al deat h Mat er nal deat h
A27year ol dwomanpr esent st ot he EDasshei sconcer nedt hatshehas mor evagi naldi schar get hanusual .The di schar gei sagr ayi shcol ourandhasa fishysmel l .Ther ei snosi gni ficant pai n,i r r i t at i onorer yt hemaoft hear ea.
Quest i on: Youpl anonper f or mi ngav agi nal ex ami nat i onandt hepat i enthas r eques t edt hatac haper onei spr es ent . Ac c o r di ngt ot heGMCani deal c haper one s houl df ul fi l l s ev er al c r i t er i a.Li s t4oft hes e c r i t er i a.( 4) YourAnswer : Cor r ectAnswer :
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Acc or di ngt ot heGMCachaper one s houl dus ual l ybeaheal t hpr of es s i onal andy oumus tbes at i s fi edt hatt he c haper onewi l l : Bes ens i t i v eandr es pec tt hepat i ent ’ s di gni t yandc onfi dent i al i t y Reas sur et hepat i enti ft heys how s i gnsofdi s t r es sordi s c omf or t Bef ami l i arwi t ht hepr oc edur es i nv ol v edi nar out i nei nt i mat eex ami nat i on
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St ayf ort hewhol eex ami nat i onandbe abl et os eewhatt hedoc t ori sdoi ng,i f pr ac t i c al Bepr epar edt or ai s ec onc er nsi ft hey ar ec onc er nedaboutt hedoc t or ’ s behav i ourorac t i ons . Quest i on: Whati st hemos tl i k el ydi agnos i si nt hi s c as e?( 1) YourAnswer : Cor r ectAnswer : Bac t er i al v agi nos i s Quest i on: Whati st hec o mmones tc aus at i v e or gani s mf ort hi sc ondi t i on?( 1) YourAnswer : Cor r ectAnswer :
Gar dner el l av agi nal i s Quest i on: Li s t3t es t st hatc oul dbeus edt oc onfi r m t hi sdi agnos i s .( 3) YourAnswer : Cor r ectAnswer : Vagi nal pHt es t i ng( >4. 5) . Addi t i onofpot as si um hy dr ox i det ov agi nal fl ui dr es ul t i ngi nafi s hyodour . Mi c r os c opyofv agi nal fl ui dr ev eal i ng v agi nal epi t hel i al c el l sc oat edwi t hal ar ge numberofbac i l l i . Quest i on: Whati st het r eat mentf ort hi sdi agnos i s ? ( 1) YourAnswer : Cor r ectAnswer :
Or al met r oni daz ol e400mgBDf or57 d a y s .
A30year ol dwomant hati s36weeks pr egnanti sbr oughti nbyambul ance havi ngbeeni nvol vedi nar oadt r affic acci dent . Quest i on: Atwhatl ev el woul dy ouex pec tt heut er us t obepal pat edatherc ur r entges t at i on? ( 1) YourAnswer : Cor r ectAnswer : At3436week sges t at i ont heut er ushas r eac hedt hel ev el oft hec os t al mar gi n.
Quest i on: Whyc anpr egnantt r aumapat i ent sl os ea s i gni fi cantamountofbl oodbef or es i gnsof hy pov l oaemi adev el op?( 2) YourAnswer : Cor r ectAnswer : I nc r eas edangi ot ens i nI Ienc our ageswat er ands odi um r et ent i on,l eadi ngt oan i nc r eas edi nt r av as cul arv ol ume.Bec aus e oft hi si nc r eas edi nt r av as c ul arv ol ume pr egnantpat i ent sc anl os eas i gni fi c ant v ol umeofbl oodbef or et ac hy c ar di a, hy pot ens i onandot hers i gnsof h y pov o l aemi adev e l op. Quest i on: GI v et woot heri mpor t antc hangest ot he c ar di ov as cul ars y st em t hatmus tbe
c ons i der edi nt heas s es s mentofpr me egnant t r aumapat i ent s .( 2) YourAnswer : Cor r ectAnswer : • •
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An y2of : Car di acout puti nc r eas esby30t o50% Hear tr at ei nc r eas esby10t o15 beat s / mi n Sy s t ol i canddi as t ol i cbl oodpr es s ur e f al l sb y5t o15mmHgdur i ngmi d pr egnanc ybyr et ur nsbac kt onor mal by week36 I nt hes upi nepos i t i onv enac av a c omp mpr ess i onc anc omp mpr omi mi s ev enous r et ur n Quest i on: Gi v et woECG changest hatcanoccur s ec ondar yt opr egnanc y .( 2)
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An y2of : Theax i sma mayshi f tl ef t war dbyupt o15 d e g r e e s Fl at t enedori nv er t edTwav esc an oc curi nl eadsI I I ,aVF ,V1andV2 Q wav esc anoc c uri nl eadsI I Iand aVF Ec t opi cbeat soc curmor ef r equent l yi n pr egnancy Quest i on: Li s t3modi fi c at i onst hats houl doc c uri n t hi sc as ec ompar edt oas t andar dt r auma c al l .( 3) YourAnswer : Cor r ectAnswer : An y4of :
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Anobs t et r i c i ans houl dbepr es ent Theut er uss houl dbemanual l y di s pl ac edt ot hel ef tt or emov ec av al c ompr es s i on Thet abl es houl dbeputi nal ef tl at er al t i l t( i deal l y1530degr eesoft i l t ) Cont i nuousc ar di ot oc ogr aphy( CTG) moni t or i ngs houl dbeper f or med
A29year ol dwomant hati s8weeks pr egnantpr esent swi t hv agi nal bl eedi ng.Shest at est hatshehada posi t i v epr egnancyt estathomel ast week.Herobser v at i onsar easf ol l ows:
Temper at ur e36. 6° C,HR80,BP125/ 78, RR14. Quest i on: Whi c hbeds i det es ts houl dbeper f or med f ort hi spat i ent ?( 1) YourAnswer : Cor r ectAnswer : Aur i nar ypr egnanc yt es ts houl dbe per f or medt oc onfi r m pr egnanc y . Quest i on: Li s t3f eat ur est hatwoul ds uppor ta t hr eat enedmi s c ar r i ageov erani nev i t abl e mi s c ar r i age.( 3) YourAnswer : Cor r ectAnswer : At hr eat enedmi s c ar r i agewoul dbe s ugges t edby :
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Mi ni mal bl eedi ng Nopai n Cer v i c al osc l os edons pec ul um ex ami nat i on Quest i on: Li s t4r i s kf ac t or sf ormi s c ar r i age.( 4) YourAnswer : Cor r ectAnswer :
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An y4of : Ageov er35 Hi s t or yofpr ev i ousmi s c ar r i age Connec t i v et i s suedi s or der se. g.SLE Poor l yc ont r ol l eddi abet esmel l i t us Dr ugandal c ohol abus e I nv as i v epr enat al t es t se. g.c hor i oni c v i l l uss ampl i ng Ut er i neorc er v i c al abnor mal i t i es
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Ex c e s si v el yhi ghorl owbodymas s i ndex( BMI ) Quest i on: Li s t4oft heTORCHi nf ec t i ons .( 2) YourAnswer : Cor r ectAnswer :
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Any4of( ½ mar keach) : T=T ox opl as mos i s O=Ot her( anyofs y phi l i s ,HI V, par v o v i r usB19andgonor r hoea) R=Rubel l a C=Cy t omegal ov i r us H =Her pes
A33year ol dwomanpr esent swi t ha pai nl essswel l i ngont her i ghtsi deof
herl abi a.I thasdevel opedovert he pastf ew days.Onexami nat i onyousee t hef ol l owi ng:
Quest i on: Whati st hedi agnos i s ?( 1) YourAnswer : Cor r ectAnswer : Ri ghts i dedBar t hol i n’ sc y s t
I mag es o ur c e df r om Wi k i pedi a( l i nki s ex t er nal ) Cour t esyofMedi mageCCBYSA3. 0( l i nk i sex t er nal ) Quest i on: Whati st hepat hophy si ol ogyoft hi s c ondi t i on?( 1) YourAnswer : Cor r ectAnswer : ABar t hol i n’ sc y s tdev el opswhent heduc t t hatdr ai nst hegl andbec omesbl oc k ed. Obs t r uc t i onoft heduc tr es ul t si nt he ac cumul at i onofs ec r et i onsandc y s t f or mat i on. Quest i on: Bef or ec onduc t i ngani nt i mat e e x ami nat i on,whi c h4t hi ngsdot heGMC
r ec ommends houl dbedonei nt hei r gui danc eoni nt i mat eex ami nat i ons ?( 4) YourAnswer : Cor r ectAnswer : The2013GMCgui del i nesoni nt i mat e e x ami nat i onsandc haper ones r ec ommendt hatt hef ol l owi ngoc curpr i or t ot hei nt i mat eex ami nat i on: 1. Expl ai nt ot hepat i entwhyt he ex ami nat i oni snec es sar yandgi v et he pat i entanoppor t uni t yt oas kques t i ons 2. Expl ai nwhatt heex ami nat i onwi l l i nv ol v e,i nawayt hepat i entc an under s t and,s ot hatt hepat i enthasac l ear i deaofwhatt oex pec t ,i nc l udi nganypai n ordi s comf or t 3. Gett hepat i ent ’ sp er mi s s i onbef or et he ex ami nat i onandr ec or dt hatt hepat i enthas gi v eni t 4. Offert hepat i entac haper one
Quest i on: Thes amepat i entr et ur nsac oupl eof week sl at erbec aus et hel umphas bec omepai nf ul andr ed.One x ami nat i on t hel umpf eel sfl uc t uant .Whi c h c ompl i c at i onhasoc cur r ed?( 1) YourAnswer : Cor r ectAnswer : ABar t hol i n’ sabs c es shasdev el oped. Quest i on: Howwoul dy oumanaget hi spat i enti nt he Emer gencyDepar t ment ?( 2) YourAnswer : Cor r ectAnswer : • •
An y2of : Pr ov i deappr opr i at eanal ges i a Commenc eant i bi ot i c s( e. g. fl uc l ox ac i l l i n500mgQDS)
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Ref ert ogy naec ol ogyf orc ons i der at i on ofi nc i s i onanddr ai nageorbal l oonc at het er i ns er t i on Quest i on: Whati st hedefi ni t i v emanagementoft hi s c ondi t i on?( 1) YourAnswer : Cor r ectAnswer : Mar s upi al i s at i on
A27year ol dwomant hati s31weeks pr egnantpr esent swi t hv agi nal bl eedi ng.Shehasbeenbl eedi ngf or
appr oxi mat el y5hour sandt he bl eedi nghasbecomeheavi erovert he past30mi nut es.Herobser vat i onsar e asf ol l ows:Temper at ur e36. 4° C,HR 112,BP114/ 58,RR22. Quest i on: Li s t4c l i ni c al f eat ur est hatwoul ds uppor t adi agnos i sofpl ac ent apr aev i aov er abr upt i opl ac ent ae.( 4) YourAnswer : Cor r ectAnswer : • •
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An y4of : Pai nl es sv agi nal bl eedi ng Obs t et r i cs hoc ki npr opor t i ont ot he amountofv agi nal bl oodl os s Nont enderut er usonex ami nat i on Foet ushasnor mal pr es ent at i onandl i e Nos i gnsoff oet al di s t r es spr es ent
Quest i on: Whi c he x ami nat i ons houl dnotbe per f or medandwhy?( 2) YourAnswer : Cor r ectAnswer : Av agi nal ex ami nat i ons houl dnotbe per f or medasi tma ypr ov ok es ev er e haemor r hagei nt hepr es enc eofpl ac ent a pr aev i abydi s t ur bi ngbl oodv es s el sl y i ng ac r os st hec er v i c al os . Quest i on: Li s t4f ac t or st hatpr edi s pos et opl ac ent a pr aev i a.( 2) YourAnswer : Cor r ectAnswer : • •
Any4of( ½ mar keach) : Pas thi s t or yofpl ac ent apr aev i a Lar gepl ac ent ae. g.mul t i pl epr egnanc y
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Hi ghpar i t y Abnor mal ut er use. g.fi br oi dspr es ent Hi s t or yofpr ev i ousCaes ar i ans ec t i on Quest i on: Li s t4managementpoi nt si nt heED.( 2) YourAnswer : Cor r ectAnswer :
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Any4of( ½ mar keach) : I ns er t2l ar gebor eI Vc annul ae T ak ebl oods–U&Es ,LFTs ,c l ot t i ng Cr os smat c h6uni t sofbl ood Ref erur gent l yt oonc al l obs t et r i c i an Commencec ar di ot ocogr aphy( CTG) moni t or i ng
A30year ol dwomani sbr oughti nby ambul ancef ol l owi ngar oadt r affic acci dentwher eshewasapassengeri n acarhi tbyal or r yathi ghspeed.She i s34weekspr egnant .Herobser vat i ons ar easf ol l ows:HR122,BP100/ 64, SaO2 98% onhi ghflow oxygen,RR25, t emper at ur e36. 6° C.HerCspi nei s t r i pl ei mmobi l i sed.Theai r wayi spat ent andherchestexami nat i oni snor mal . Shehashadasmal lamountofvagi nal bl eedi ngandi scompl ai ni ngof abdomi nalpai nandabdomi nal t ender ness.Twowi debor ecannul ae havebeeni nser t edi nherant ecubi t al f ossaeandaf ul lsetofbl oodsha ve beensentt ot hel ab,i ncl udi nga r equestf oracr ossmat ch.Shehashad asmal lamountofvagi nalbl eedi ngand i scompl ai ni ngofabdomi nalpai n.
Quest i on: Wher edoest heut er usl i eat34week s ges t at i on?( 1) YourAnswer : Cor r ectAnswer : At3436week sges t at i ont heut er usl i esat t hec os t al mar gi n. Quest i on: Gi v eonemai ndi ff er enc est ohowt he pr i mar ys ur v eys houl dbeper f or medi n t r aumai nv ol v i ngapr egnantpat i ent .( 1) YourAnswer : Cor r ectAnswer : Theut er usshoul dbedi s pl ac edmanual l y t ot hel ef ts i det or el i ev epr es s ur eont he i nf er i orv enac av a.
Quest i on: Whatar et het womai nc aus esoff oet al deat hi nt r auma?( 2) YourAnswer : Cor r ectAnswer : 1. 2.
Mat er nal s hoc k Abr upt i opl ac ent ae
Quest i on: Li s t4c l i ni c al f eat ur est hatar es ugges t i v e ofabr upt i opl ac ent ae.( 4) YourAnswer : Cor r ectAnswer : • • • •
An y4of : Vagi nal bl eedi ng Ut er i net ender nes s Fr equentut er i nec ont r ac t i ons Ut er i net et any
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Ut er i nei r r i t abi l i t y( ut er usc ont r ac t s whent ouc hed) Quest i on: Youc ans eef r om t hepat i ent ’ sant enat al book i ngbl oodst hats hei sr hes usD negat i v e.Whats houl dt hepat i entbe gi v enandwi t hi nwhatt i mef r ame?( 2) YourAnswer : Cor r ectAnswer : Ant i Di mmunogl obul i ns houl dbegi v en wi t hi n72hour s .
A26year ol df emal epr esent swi t hl ef t i l i acf ossapai n.Herl astmenst r ual per i odwas7weeksago.Youar e
concer nedt hatshei shavi ngan ect opi cpr egnancy. Quest i on: Li s t6pr edi s pos i ngr i s kf ac t or sf orec t opi c pr egnanc y :( 3) YourAnswer : Cor r ectAnswer : • • • • •
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Any6of :( ½ mar keach) Pel v i ci nfl ammat or ydi s eas e Pr ev i ouspel v i corabdomi nal s ur ger y Pr ev i oushi s t or yofec t opi cpr egnanc y Pr ev i oust ubal s ur ger y Us eofi nt r aut er i nec ont r ac ept i v e dev i c e Endomet r i os i s Hi s t or yofI VForas s i s t edf er t i l i s at i on t ec hni ques Hi s t or yofs ubf er t i l i t y
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Di et hy l s t i l boes t r ol ex pos ur e Advancedmat er nal age Ci gar et t es mok i ng Quest i on: Li s t2addi t i onal hi s t or ypoi nt st hatwoul d s uppor tadi agnos i sofec t opi cpr egnanc y : ( 2) YourAnswer : Cor r ectAnswer :
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An y2of : Suddenons ets ev er euni l at er al pai n Vagi nal bl eedi ng Rec entus eofmor ni ngaf t erpi l l Shoul dert i ppai n( i ndi c at i ng per i t oni s m) Vomi t i ngdur i ngpai n Epi s odeofs y nc opeorc ol l aps e
Quest i on: Li s t2addi t i onal ex ami nat i onfi ndi ngst hat woul ds uppor tadi agnos i sofec t opi c pr egnanc y :( 2) YourAnswer : Cor r ectAnswer : • • • • •
An y2of : Cer v i c al ex c i t at i on Adne x al t ender nes s Per i t oni s m onabdomi nal pal pat i on Pal pabl eadne x al mas s Feat ur esofhaemodynami c c ompr omi s e( t ac hy c ar di aandhy pot ens i on) Quest i on: Li s t3al t er nat i v edi agnos esofLI Fpai n. ( 3) YourAnswer : Cor r ectAnswer :
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An y3of : Pel v i ci nfl ammat or ydi s eas e Rupt ur edc or pusl ut eum c y s t Thr eat enedmi s car r i age Sal pi ngi t i s Ov ar i ant or s i on Ur i nar yt r ac ti nf ec t i on Renal c ol i c
A29y ear ol dl adypr esent swi t h bl eedi ngi near l ypr egnancy .Youpl an onper f or mi ngaspecul um exami nat i on. Quest i on:
Whi c h4t hi ngsshoul doc curpr i ort o per f or mi ngani nt i mat eex ami nat i on ac cor di ngt ot hec ur r entGMCgui del i nes : ( 4) YourAnswer : Cor r ectAnswer :
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Bef or ec onduc t i ngani nt i mat e ex ami nat i ony ous houl d: Ex pl ai nt ot hepat i entwhyan ex ami nat i oni snec es sar yandgi v et he pat i entanoppor t uni t yt oas kques t i ons Ex pl ai nwhatt heex ami nat i onwi l l i nv ol v e,i nawayt hepat i entc an under s t and,s ot hatt hepat i enthasac l ear i deaofwhatt oex pec t ,i nc l udi ngany pot ent i al pai nordi s c omf or t Obt ai nt hepat i ent ' sper mi s s i onbef or e t heex ami nat i onandr ec or dt hatper mi s si on hasbeenobt ai ned
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Gi v et hepat i entpr i v ac yt oundr es sand dr es sandk eept hepat i entc ov er edas muc haspos s i bl et omai nt ai nt hei rdi gni t y . Donotas s i s tt hepat i enti nr emov i ng c l ot hi ngunl es sy ouhav ec l ar i fi edwi t ht hem t haty ouras s i s t anc ei sr equi r ed Quest i on: Whi c h3t hi ngss houl doc curdur i ngt he i nt i mat eex ami nat i onac c or di ngt ot he c ur r entGMCgui del i nes : YourAnswer : Cor r ectAnswer :
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Dur i ngt heex ami nat i ony ous houl d: Ex pl ai nwhaty ouar egoi ngt odo bef or ey oudoi tand,i ft hi sdi ffer sf r om whaty ouhav eal r eadyout l i nedt ot he pat i ent ,ex pl ai nwhyands eekt hepat i ent ' s per mi s si on
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Bepr epar edt odi s cont i nuet he ex ami nat i oni ft hepat i entas k sy out o Keepdi s c us s i onr el ev antanddonot mak eunnecess ar yper s onalc omment s . Quest i on: Howc any o udi ffer ent i at ebet weena t hr eat enedandi nev i t abl emi s c ar r i agewi t h y ourex ami nat i on?( 2) YourAnswer : Cor r ectAnswer : At hr eat enedmi s c ar r i agei sdefi nedas bl eedi ngi near l ypr egnanc ywi t houtt he pas s ageofpr oduc t sofc onc ept i on( POC) ordi l at at i onoft hec er v i x .Ani nev i t abl e mi s c ar r i agei sdefi nedasbl eedi ngi near l y pr egnanc ywi t houtt hepas s ageofPOC butwi t hac c ompany i ngdi l at at i onoft he c er v i x .Ther ef or ei fnoPOChav ebeen
pas s edandt heosi sopent hedi agnos i s ofani nev i t abl emi s car r i agec anbemade. Quest i on: Whati sani nc ompl et emi s c ar r i age?( 1) YourAnswer : Cor r ectAnswer : Ani nc ompl et emi s c ar r i agei sdefi nedas bl eedi ngi near l ypr egnanc ywi t h ac c ompany i ngc er v i c al di l at at i onandt he par t i al pas sageoft hePOC.Onc eal l of t hePOChav ebeenpas s edt hi sbec omes ac ompl et emi s c ar r i age.
A36year ol dl adyi sbr oughtt ot he r esusci t at i onar eaofyourEmer gency Depar t mentbyambul ancehavi nga t oni ccl oni csei z ur e.Shei s34weeks pr egnantandhasbeent r eat edf orpr eecl ampsi aant enat al l ywi t hl abet ol ol 100mgbd.Herai r wayi spat entand herobser v at i onsar easf ol l ows:HR 100,BP162/ 94,SaO2100% onhi ghflow oxygen. Quest i on: Whati st hedi agnos i sandt heunder l y i ng pat hophy s i ol ogyofhers ei z ur e?( 2) YourAnswer : Cor r ectAnswer : Ec l amps i a. Thes ei z ur ei sar es ul tofbr ai nhy pox i a
duet oi s chaemi as ec ondar yt oc er ebr al oedemaandv as os pas m. Quest i on: Whati st hedr ugofc hoi c ef or managementofhers ei z ur e( pl eas e i nc l udet hedos eandr out eof admi ni s t r at i on) ?( 2) YourAnswer : Cor r ectAnswer : I VMagnesi um sul phat e4g Quest i on: Whati st hedefi ni t i v et r eat mentf ort hi s c ondi t i on?( 1) YourAnswer : Cor r ectAnswer : Del i v er yoft hebaby
Quest i on: Li s t2neur ol ogi c al f eat ur esofs ev er epr eec l amps i a:( 2) YourAnswer : Cor r ectAnswer : • • • • •
An y2of : Headac he Vi s ual di s t ur banc e Conf us i on Papi l l oedema Cl onus Quest i on: Li s t3abnor mal i t i esf oundonbl oodt es t s t hatar ei ndi c at i v eofs ev er epr eec l amps i a:( 3) YourAnswer : Cor r ectAnswer :
Rai s edc r eat i ni ne Lowpl at el etc ount( <100x1 / 09 L) El e v at edl i v erenz y mes( ASTandAL T)
A31y ear ol dl adypr esent st ot he Emer gencyDepar t mentwi t h abdomi nalpai nandvomi t i ng.Shei s34 weekspr egnantandhasbeenunder f ol l ow upf orpr egnancyi nduced hyper t ensi on.Shehashad2pr evi ous unevent f ulspont aneousvagi nal del i v er i esandhasnoot hermedi cal hi st or yofnot e.One xami nat i onshe hasmar kedr i ghtupperquadr ant t ender ness.Herobser vat i onsar eas f ol l ows:HR100,BP159/ 96,SaO299% onai r ,t emper at ur e36. 8° C.Herur i ne
di pst i ckr eveal s2+pr ot ei nandher venousbl oodsar eshownbel ow: Venousbl oods: Hb:8. 4g/ dL WCC:13. 8 Pl at el et s:36x1 / 09 L Ur ea:12. 2mmol / L Cr eat i ni ne:134mmol / L Na:137mmol / L K:3. 8mmol / L LDH:789I U/ L AST :276I U/ L ALP:368I U/ L Bi l i r ubi n:23mi cr omol / L
Quest i on: Whati st hedefi ni t i onofpr egnanc y i nduc edhy per t ens i on?( PI H) .( 2)
YourAnswer : Cor r ectAnswer : Thede v el opmentofnewh y per t ens i on wi t hbl oodpr es sur ehi ghert han140/ 90 wi t houtt hepr es enc eofpr ot ei ni nt he ur i neaf t er20week sofges t at i on. Quest i on: Whati st hemos tl i k el ydi agnos i si nt hi s c as e?( 1) YourAnswer : Cor r ectAnswer : HELLPsy ndr ome.( Haemol yt i canaemi a, El ev at edLi v erenz ymes ,LowPl at el et s ) Quest i on: Whati st hedefi ni t i v emanagementf ort hi s c ondi t i on?( 1) YourAnswer :
Cor r ectAnswer : Del i v er yoft hebaby Quest i on: Out l i ne2t r eat ment st hats houl dbe i ni t i at edpr i ort ot hi sdefi ni t i v e management .( 2) YourAnswer : Cor r ectAnswer : Ant i hy per t ens i v emedi c at i onse. g. l abet ol ol 100mgbd Cor t i c os t er oi dsf orf et al l ungdev el opment e. g.be t amet has one12mgI M Quest i on: Themot herdev el opsv agi nal bl eedi ngand herHbdr opst o7. 3.Out l i ney our i mmedi at emanagement .( 2) YourAnswer :
Cor r ectAnswer : •
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Any4of :( ½ mar keach) Gai nI Vac c es s( l ar gebor ec annul ae x 2i nant ec ubi t al f os s ae) Commenc eI Vfl ui ds St ar tbl oodt r ans f us i on St ar tpl at el ett r ans f us i on Ur gentr ef er r al t oobs t et r i c i ansf or ex pedi t eddel i v er yofbaby Quest i on: Li s t4pot ent i al c ompl i c at i onsoft hi s c ondi t i on:( 2) YourAnswer : Cor r ectAnswer :
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Any4of :( ½ mar keach) Di s s emi nat edi nt r av as c ul ar c oagul at i on Pul monar yoedema
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Ac ut er enal f ai l ur e Li v erf ai l ur e Li v erhaemor r hage Pl ac ent al abr upt i on
A27year ol dwomanpr esent st ot he EDasshei sconcer nedt hatshehas mor evagi naldi schar get hanusual .The di schar gei sagr ayi shcol ourandhasa fishysmel l .Ther ei snosi gni ficant pai n,i r r i t at i onorer yt hemaoft hear ea. Yoususpectadi agnosi sofbact er i al vagi nosi s( BV) . Quest i on:
Li s tAms el ’ sc r i t er i aus edf ort hedi agnos i s ofbac t er i al v agi nos i s .( 4) YourAnswer : Cor r ectAnswer :
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Ams el ’ sc r i t er i ac anbeus edf ort he di agnos i sofBV,wher et hr eeoft he f ol l owi ngf ourc r i t er i ons houl dbepr es ent : Vagi nal pHgr eat ert han4. 5 Theaddi t i onofpot as si um hy dr ox i de r es ul t si nafi s hys mel l ( pos i t i v es mel l t es t ) Cl uec el l sonmi c r os copy At hi n,whi t ehomogenousdi s c har ge Quest i on: Whati st hec o mmones tc aus at i v e or gani s mf ort hi sc ondi t i on?( 1) YourAnswer : Cor r ectAnswer : Gar dner el l av agi nal i s
Quest i on: Youpl anonc ar r y i ngoutav agi nal ex ami nat i onont hepat i ent .Ac c or di ngt o t heGMCgui del i nesoni nt i mat e ex ami nat i onswhi c h4t hi ngss houl dy ou dobef or ec onduc t i ngt heex ami nat i on?( 4) YourAnswer : Cor r ectAnswer :
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Bef or ec onduc t i ngani nt i mat e ex ami nat i on,y ous houl d: Ex pl ai nt ot hepat i entwhyan ex ami nat i oni snec es sar yandgi v et he pat i entanoppor t uni t yt oas kques t i ons Ex pl ai nwhatt heex ami nat i onwi l l i nv ol v e,i nawayt hepat i entc an under s t and,s ot hatt hepat i enthasac l ear i deaofwhatt oex pec t ,i nc l udi nganypai n ordi s comf or t
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Gett hepat i ent ’ sper mi s s i onbef or et he ex ami nat i onandr ec or dt hatt hepat i enthas gi v eni t Offert hepat i entac haper one Quest i on: Whati st het r eat mentf orbac t er i al v agi nos i s ?( 1) YourAnswer : Cor r ectAnswer : Or al met r oni daz ol e400mgBDf or57 d a y s .
A29year ol dwomant hati s8weeks pr egnantpr esent swi t hv agi nal bl eedi ng.Whi l sti nt heEmer gency Depar t mentshesuddenl ycompl ai nsof
f eel i ngdi z z yandyounot i cet hatshei s di aphor et i c.Youor gani seasetof obser vat i ons,whi char easf ol l ows: Temper at ur e36. 6° C,HR40,BP80/ 48, RR14. Quest i on: Whathashappenedt ocauset hese sy mpt oms?Descr i bet hemechani sm of howt hi soc c ur s .( 3) YourAnswer : Cor r ectAnswer : Thi spat i enthasdev el opedc er v i c al s hoc k. I ni nc ompl et emi s c ar r i age,pr oduc t sof c onc ept i onpas si ngt hr ought hec er v i xc an becomecaughtandcausev agal s t i mul at i on.Thepat i entwi l l ex per i enc e
v asov agal s y mpt omsandbecome hy pot ens i v eandbr ady c ar di c . Quest i on: Des c r i bey o uri mmedi at emanagementof t hi spat i ent .( 2) YourAnswer : Cor r ectAnswer :
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Thei mmedi at emanagementoft hi s pat i ents houl di nv ol v e: I mmedi at ei nt r av enousc annul at i on andfl ui dr es us c i t at i on Spec ul um e x ami nat i onandr emo v al of pr oduc t sofc onc ept i onus i ngas ponge hol di ngf or c eps Quest i on: Af t ert heabov emanagementt hepat i ent ’ s s y mpt omss et t l eandherbl oodpr es s ur e
andpul s er et ur nt onor mal .Af t eraf ur t her 45mi nut esherbl eedi ngbecomesmuch heav i er .Namet wodr ugst hatc oul dbe admi ni s t er edi nt heEDt or educ eher bl eedi ng.( Pl eas ei nc l udedos eandr out e ofadmi ni s t r at i on)( 2) YourAnswer : Cor r ectAnswer : T r ane x ami cac i d1gPO Er gomet r i ne0. 5mgI M orI V Quest i on: Whati sa‘ s ept i cabor t i on’ andhowdoesi t t endt opr es entc l i ni c al l y ?( 3) YourAnswer : Cor r ectAnswer : A‘ s ept i cabor t i on’ i sas pont aneous mi s c ar r i aget hati sas s oc i at edwi t han
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i nf ec t edut er i nec av i t y .I tt endst opr es ent c l i ni c al l ywi t ht hef ol l owi ngf eat ur es : Fev erand/ ors i gnsofs eps i s Offens i v ev agi nal di s char ge Abdomi nal pai nandc r ampi ng Pr ol ongedorheav yv agi nal bl eedi ng
A32year ol dwomant hati s39weeks pr egnantbecomessuddenl yver y br eat hl essshor t l yaf t ergoi ngi nt o l abour .Anambul ancei scal l edandshe i s‘ bl uel i ght ed’i nt ot her esusar eaof yourEmer gencyDepar t ment .She appear scyanosedandst at est hather hear tf eel sl i kei ti s‘ beat i ngver y qui ckl y’ .Herobser vat i onsar eas
f ol l ows:HR130bpm,BP88/ 42, SaO2 90% onai r ,t emper at ur ei s36. 4° C. Shor t l yaf t ert heobser vat i onsar e t akenshebecomesunr esponsi ve.You not i ceachangei nr hyt hm ont he car di acmoni t orandar eunabl et o det ectapul seoranysi gnsofl i f e.Her r hyt hm st r i pi sshownbel ow:
Quest i on: Whatdoest her hy t hm s t r i ps how?( 1) YourAnswer : Cor r ectAnswer : Vent r i c ul arfi br i l l at i on Quest i on:
Whatar et he2mos tl i k el ycaus esoft he c ar di acar r es ti nt hi sc as e?( 2) YourAnswer : Cor r ectAnswer : Amni ot i cfl ui dembol us Pul monar yembol us Quest i on: Li s t4modi fi c at i onst hats houl doc c uri n t hi scas ec ompar edt oas t andar dc ar di ac ar r es t .( 4) YourAnswer : Cor r ectAnswer : • •
An y4of : Anobs t et r i c i ans houl dbepr es ent Apaedi at r i c i anorneonat ol ogi s ts houl d bepr esent
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Theut er uss houl dbemanual l y di s pl ac edt ot hel ef tt or emov ec av al c ompr es s i on Thet abl es houl dbeputi nal ef tl at er al t i l t( i deal l y1530degr eesoft i l t ) Ear l yt r ac heal i nt ubat i ons houl dbe per f or medt or educ eas pi r at i onr i s k( ex per t anaes t het i cas si s t anc es houl dbes ought ) St ar tpr epar i ngf oranemer genc y Caes ar eans ec t i on Quest i on: Youri ni t i al at t empt satr es us c i t at i onar e uns uc ces s f ul .Whats houl doc curwi t hi n5 mi nut esoft heons etoft hi sc ar di acar r es t ? Wh ys houl dt hi sbedone?( 3) YourAnswer : Cor r ectAnswer :
Per i mor t em Caes ar eans ec t i ons houl dbe per f or medwi t hi n5mi nut esoft heons etof t hec ar di acar r es t .Del i v er ywi l l r el i ev e c av al c ompr es s i onandi mpr ov et he l i k el i hoodofs uc c es s f ul r es us c i t at i onby per mi t t i ngani nc r eas ei nv enousr et ur n dur i ngt heCPRat t empt .I twi l l al s o max i mi s et hec hanc esoft hei nf ant s s ur v i v al ast hebes ts ur v i v al r at eoc c ur s whendel i v er yi sac hi ev edwi t hi n5mi nut es oft heons etoft hemot her ’ sc ar di ac ar r es t .
