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Peurperium and puerperal sepsis

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					                                  PUERPERIUM

As regard puerperal sepsis, the following are correct, except:
A. Prolonged labor is one of predisposing factor.
B. It is common in C.S. rather than vaginal delivery..
C. E-Coli is the most causative microorganism.
D. Broad-spectrum antibiotic is best advised.

The puerperium:
A. The fundus of the uterus lies at the level of the symphysis pubis 1 week
   after delivery.
B. The lochia gradually decreases and fades out.
C. Colostrum secretion always starts immediately after delivery.
D. There is a tendency to urinary retention during the first few days
   following delivery.
E. Diuresis occurs during the first few days following delivery.

The puerperium:
A. Is the period of 4-6 weeks following delivery.
B. Pelvic floor exercises are strongly advised starting few days after delivery.
C. A breast abscess always requires incision.
D. The daily requirements of iron and calcium increase after delivery.
E. Postnatal care is required to detect any abnormality and to provide contraception.

Physiological changes in the puerperium include:
A. The uterus involutes to pre-pregnancy size by 3 weeks postpartum.
B. The cervix closes by 1 week postpartum.
C. After pains are felt at the site of episiotomy.
D. Constipation improves.
E. Menstruation always recurs by the end of the puerperium.

Physiological changes in the puerperium include:
A. Diuresis occurs during the first 2 days postpartum.
B. The uterine fundus is felt at the symphysis pubis by 2 weeks postpartum.
C. Constipation is common.
D. Milk secretion starts on the second day postpartum.
E. The lochia disappears by 10 days postpartum

Causes of sub involution of the uterus include:
A. Infection.
B. Retained placental fragment.
C. Uterine over distension during pregnancy.
D. Non-suckling.
E. Prolapse.

Puerperal sepsis:
A. Is one of the main causes of maternal mortality in developing countries.
B. Is considered as wound infection of the genital tract.
C. The majority of cases are severe.
D. Is the most common cause of puerperal pyrexia.
E. Infection always starts at the site of a laceration.

Causes of puerperal pyrexia include:
A. Mastitis.
B. Puerperal sepsis.
C. Cystitis.
D. Gastritis.
E. Pyelonephritis.

Puerperal sepsis is more commonly associated with:
A. Prolonged rupture of membranes.
B. Frequent PV examinations.
C. Multiple pregnancy.
D. Vaginal moniliasis.
E. Cesarean section.

Causative organisms of puerperal sepsis:
A. Anaerobic streptococci; responsible for severe cases.
B. Beta hemolytic streptococci; become pathogenic in the presence of
   devitalized tissue.
C. Staphylococci; usually found in infected perineal wounds.
D. Clostridium tetani does not cause puerperal sepsis.
E. Mixed type of infection commonly occurs.

Secondary sites of infection in cases of puerperal sepsis:
A. The tubes.
B. The ovaries.
C. The parametrium.
D. The urinary bladder.
E. The pelvic veins.

Pathology of puerperal sepsis:
A. Infection reaches the endometrium and the myometrium.
B. The uterine cavity contains necrotic tissue and pus.
C. Infection may reach the parametrium directly through the tubes.
D. A parametric abscess is intra peritoneal.
E. Thrombophlebitis starts in the large pelvic veins.

Clinical picture of puerperal sepsis:
A. Systemic manifestations are minimal.
B. The lochia is excessive and offensive.
C. The site of perineal laceration is red, hot, swollen and tender.
D. Peritonitis is always associated with board like rigidity.
E. Parametritis is suspected in presence of fever resistant to antibiotics.

Clinical picture of puerperal sepsis:
A. Septicemia is associated with minimal local manifestations.
B. Bilateral lower abdominal pain, fever and rigors point to diagnosis of salpingitis.
C. Pelvic abscess is indicated by pelvic heaviness and tenesmus.
D. Peritonitis is rarely associated with vomiting.
E. Pelvic thrombophlebitis commonly presents with bilateral edema of the
   lower limbs.

Management of puerperal sepsis:
A. The majority of etiological factors are unpreventable.
B. Excessive fluids, antipyretics and analgesics are important supportive measures.
C. Trendelenburg position is required for drainage.
D. A parametric abscess is drained through posterior colpotomy.
E. A single broad spectrum antibiotic is successful in the majority of cases.

Management of puerperal sepsis:
A. Isolation may be required in some cases.
B. Ergometrine helps drainage.
C. A pelvic abscess is drained through posterior colpotomy.
D. Cases of generalized peritonitis require large amounts of parentral antibiotics.
E. Heparin therapy is essential for cases of pelvic thrombophlebitis.

Management of puerperal sepsis:
A. Removal of sutures is required with infected lacerations.
B. Fowler's position is required for drainage.
C. Antibiotic therapy should include gentamycin for anaerobic infection.
D. Cases of generalized peritonitis require large amounts of IV fluids.
E. Immobilization of the lower limbs is required during the initial phase of
   pelvic thrombophlebitis.

1- Normal puerperium, all are false EXCEPT:
    A) Red lochia for 6 weeks
       B) In non lactating mothers menstrual periods start usually
       C) Uterus involuted after 7 days
       D) Tetanus may occur
       E) Ultrasound scan done within a week of delivery to assess the uterus
2- Puerperal Pyrexia , all are true EXCEPT:
       is still a significant cause of maternal mortality
       is usually due to chlamydia
       Maternal infection is usually apparent within the first two days of the
           puperperium
       It can be due to DVT
3- Which of the following terms refers to a physical change that occurs to
   women after childbirth?
       A) decompression
       B) decompensation
       C) involution
       D) menarche
4- Lactation, all are true EXCEPT:
       A) human milk contains more protein than cows’ milk.
       B) human milk has a higher energy content and more fat than cows’ milk.
       C) prolactin stimulates milk secretion.
       D) oxytocin produces milk ‘let down’.
       E) prolactin production is stimulated by suckling.
5- Lactation, all are true EXCEPT:
       A) breast feeding does not protect against infection in the baby.
       B) lactation is effectively suppressed by bromocryptine.
       C) breast feeding fails in Sheehan’s syndrome.
       D) breast milk contains immunoglobulin A.
6- Benefits of breast feeding include, all are true EXCEPT:
       A) decreased infant infection
       B) reduced incidence of juvenile diabetes
       C) reduced incidence of neonatal jaundice
       D) reduced incidence of maternal breast and ovarian cancer
7- The production of milk is promoted by:
       A) estrogen .
       B) progesterone .
       C) gonadotropin releasing hormone .
    D) oxytocin .
       E) prolactin.
8- The alveolar sacs in the mammary glands are where ……. is produced
   and stored.
       A) Prolactin
       B) milk
       C) semen
       D) fat
9- Milk is rich in all the following, EXCEPT:
       A) Iron
       B) Calcium
       C) Phosphorus
       D) Sodium.
10- Milk is rich in the following vitamins, EXCEPT:
       A) Vtamin A
       B) Vitamin B
       C) Vitamin K
       D) Vitamin D
11- …………Stimulates milk production, but ………. stimulates milk letdown.
       A) Progesterone, estrogen
       B) HCG, oxytocin
       C) Prolactin, oxytocin
       D) Prolactin, estrogen
       E) Prolactin, progesterone
12- After parturition, the decrease in ……….. allows milk production to
   occur.
       A) HCG
       B) oxytocin
       C) FSH and LH
       D) estrogen and progesterone
       E) GnRH
13- The use of estrogen to suppress lactation is associated with which of
 the following?
       A) Venous thrombosis and thromboembolism
       B) Decreased prolactin levels
       C) Breast cancer
       D) Suppurative mastitis
14- Following a vaginal delivery, a woman develops a fever, lower abdominal
    pain. and uterine tenderness. She is alert, and her blood pressure and
    urine output are good. Large gram positive rods suggestive of Clostridia
    are seen in a smear of the cervix. Management should include all
    EXCEPT:
       A) close observation for renal failure or hemolysis
       B) immediate radiographic examination for gas in the uterus
       C) high-dose antibiotic therapy
       D) hysterectomy
15- A puerperal infection is characterized by which of the following
    statements?
       A) A temperature of 38°C or higher on any 2 of the first 10 postpartum days
          (excluding the first day) is considered the standard definition of puerperal
          morbidity
       B) Iatrogenic causes are significant sources of infection
       C) The most common pathogens involved are those that normally inhabit the bowel
          and lower genital tract
       D) Anaerobic infections are common and frequently are caused by Bacteroides,
          Petostreptococcus or Clostridium.
       E) All of the above
16- A 23-year-old woman (gravida 2, para 2) calls her physician 7 days
    postpartum because she is concerned that she is still bleeding from the
    vagina. It would be appropriate to tell this woman that it is normal for
    bloody lochia to last up to:
          A) 2 days
          B) 5 days
          C) 8 days
          D) 11 days
          E) 14 days
17- During the first postpartum week, the uterus will lose what percent of its
    immediate postpartum weight?
          A) 10 percent
          B) 30 percent
          C) 50 percent
          D) 70 percent
18- Following delivery:
       A) Menstruation may resume by 6 to 8 weeks in most non lactating women
       B) approximately one-third of lactating women will resume menses by 3 months
       C) ovulation may occur within 6 weeks in lactating women
       D) women treated with bromocryptine for lactation suppression may ovulate by the
          second postpartum week
       E) All of the above
19- In the mother, suckling leads to the following responses EXCEPT:
       A) Release of oxytocin
       B) Decrease of prolactin inhibitory factor
       C) Decrease of hypothalamic dopamine
       D) Increase of luteinizing-hormone releasing factor
20- Concerning lactation, all are true EXCEPT:
      A) There is loss of normal pulsatile LH release
      B) The most important factor in the success of lactational infertility is the strength
         of the suckling stimulus
      C) While the patient experiences lactational "amenorrhea", then conception will not
         occur
      D) The progesterone only pill may have a beneficial effect on lactation
21- Which of the following cells in the breast are stimulated by oxytocin?
  A) Alveolar cells
  B) Myoepithelial cells
  C) Fat cells
  D) Connective tissue cells
22- The most abundant immunoglobulin found in human milk is:
  A) Secretory IgA
  B) IgC
  C) IgE
  D) IgM
23- During pregnancy, cellular proliferation of both ductal and alveolar
  elements of the breast begins in:
  A) The first trimester
  B) The second trimester
  C) The third trimester
  D) Postpartum
24- Estrogen stimulates all of the following EXCEPT:
  A) Ductal growth
  B) Lobuloalveolar growth
  C) Milk let down
  D) Prolactin release
25- In a woman having difficulty with milk production, increased milk will be
  produced by:
  A) More frequent suckling
  B) Longer duration of suckling
  C) Cessation of suckling for 24 hours
  D) Cold compresses
26- Receptors for which of the following hormones disappear from the
  breast during lactation?
  A) Oxytocin
  B) Prolactin
  C) Progesterone
  D) Cortisone
27- Precolostrum has a high concentration of all of the following EXCEPT:
  A) Immunoglobulins
  B) Lactoferrin
  C) Albumin
  D) Lactose
28- When compared with that of mothers delivering at term, the milk of
  mothers delivering preterm has a higher concentration of:
  A) Protein
  B) Lactose
  C) Calcium
  D) Phosphorus
29- Lactation has all of the following effects on diabetic mothers EXCEPT:
  A) Increased risk of mastitis
  B) Higher fasting blood sugars
  C) Increased frequency of yeast infections
  D) Reduced insulin requirement
10- Say true or false:
    a. Complicated ovarian tumors is common cause of puerperal pyrexia.
    b. Breast abscess should be drained when fluctuating.
    c. Parametric abscess may be drained at the vagina or the rectum.
    d. Anaerobic streptococci are the commonest cause of puerperal sepsis.
    e. Early isolation of suspected cases of puerperal sepsis is essential.
    f. Foul odor lochia may occur with infected submucous fibroids.
    g. Abdominal rigidity is a basic finding of puerperal peritonitis.
    h. Reflex pain from the perineum may result into urine retention.
    i. Providing postnatal contraception should be after 6-8 weeks.
    j. Sub involution of the uterus may be due to retroversion of the uterus.
    k. Resting in Flower's position is essential for drainage of the genital tract.
    l. Septic shock not responding to treatment is indication of hysterectomy in cases of
       puerperal sepsis.
    m. Fibrinogen level increases in the post-partum period.
    n. Breathing exercise should start shortly after labor.
    o. Pelvic floor exercise is started few days after labor to decrease the risk of genital prolapse.
p.   Open pulmonary T.B is an indication to stop lactation.
q.   Retroversion may develop 6 months after vaginal delivery.
r.   Any rise of temperature in the post-partum period is considered pathological.
s.   In putrid type there is deep invasion of the myometrium due to defective leucocytic barrier.
t.   Clostridial uterine infection is an indication for hysterectomy.

				
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Description: It can develop into puerperal sepsis, which is a serious form of septicaemia. .... of 100.4 �F (38 �C) or more on any two of the first ten days postpartum. (USJCMW) ...