Qu’ils mangent de la brioche

During a trip to this amazing palace early last year, I was taken on a tour that included the room where Marie Antoinette gave birth. As princesses of the royal blood were not able to take the throne, the birth was public to ensure no substitution of the neonate at birth. Marie-Antoinette was married for 8 years prior to the birth of her first child, and her sister-in-law had already produced two male heirs to the throne. The pressure was on.

Her first born was, indeed, a girl and Marie Antoinette fainted on delivery. Historians have not come to a conclusion as to why this “faint” occurred, but many reason have been postulated and many of which have links to the primary learning objectives. It was thought the pressure to produce a male heir was too much and she fainted on the delivery of a female. She may have also fainted due to the heat from such a crowd in the room. Two enormous tapestry sheets surrounded her bed and fell on her immediately after delivery, due to the crush of people wanting to see the gender of the baby. And as the baby was born in 1778, there was no pain relief for delivery.

Whatever the reason, the management of this loss of consciousness was to open some windows and provide venesection therapy. Correlation and causation have been confused in history and these treatments were deemed successful.

Marie Antoinette went on to have four children, however her first child was the only one to reach adulthood. She was Queen of France for 20 minutes after her father-in-law abdicated and her husband (and cousin) took twenty minutes to sign the same document.

SS_OB 1.4 Describe the utero-placental circulation and the principles of placental physiology as related to placental gas exchange and regulation of placental blood flow.

Uteroplacental blood flow at term is approximately 1125mL/min TRUE/FALSE

The utero-placental arteries have alpha-adrenergic receptors. TRUE/FALSE

The greatest driving force for diffusion of oxygen from maternal to foetal blood is the Bohr effect. TRUE/FALSE

The Haldane effect facilitates oxygen transfer from the mother to the foetus. TRUE/FALSE

The foetus has foetal haemoglobin which has a greater affinity for oxygen than adult haemoglobin. TRUE/FALSE

Aortocaval compression

SS_OB 1.5 Describe the mechanism and consequences of aorta-caval compression in pregnancy

In supine hypotensive syndrome, blood still returns to the right heart through the epidural, azygos and vertebral veins. TRUE/FALSE

Supine hypotension is compensated by an increase in peripheral sympathetic activity. TRUE/FALSE

The blood pressure measured in the arms, is a reliable predictor of uterine and placental blood flow, when the patient is supine. TRUE/FALSE

Aortocaval compression can reduce uterine perfusion due to reduced uterine venous pressure. TRUE/FALSE

General anaesthesia has no effect on supine hypotensive syndrome. TRUE/FALSE


Obs, Obs, Baby.

SS_OB 1.6 Describe the changes in the anatomy of the maternal airway and their impact on airway management during anaesthesia.

SS_OB 1.1 Describe the physiological changes and their implications for anaesthesia that occur during pregnancy, labour and delivery.

The increased risk of airway bleeding during manipulation is primarily due to platelet dysfunction in pregnancy. TRUE/FALSE

Lung compliance decreases in pregnancy. TRUE/FALSE

Closing capacity increases during pregnancy. TRUE/FALSE

Oxygen consumption is increased at term, regardless of whether the patient is in labour or not. TRUE/FALSE

Airway oedema can occur due to venous engorgement from labour. TRUE/FALSE

Neonatal circulation

SB_OB 1.3 Describe the transition from foetal to neonatal circulation and the establishment of ventilation.

At birth, the circulation changes from parallel to in series. TRUE/FALSE

Delivery of the neonate causes a reduction in flow through the IVC to the right atrium. TRUE/FALSE

The newborn’s ventricle is less compliant than an adult’s due to a lower proportion of non contractile proteins in the myocardial cells. TRUE/FALSE

Pulmonary vascular resistance falls at birth due to decreasing pH TRUE/FALSE

The neonatal circulation can revert back to the pattern of foetal circulation if there is pulmonary vasoconstriction. TRUE/FALSE

BT_PO 1.9 Hypoxia

Hypoxia is a strong driver to increase respiratory rate. TRUE/FALSE.

The aortic body peripheral chemoreceptors are the most important peripheral chemoreceptors in humans. TRUE/FALSE.

The central chemoreceptors respond directly to changes in the H+ concentration in the CSF. TRUE/FALSE.

Inflation of the lungs that is detected by pulmonary stretch receptors increases respiratory rate. TRUE/FALSE.

Rapid breathing in left heart failure is potentially due to stimulation of the junta-capillary receptors. TRUE/FALSE.

Pulmonary Circulation

An overall increase in vascular tone reduces blood volume within the pulmonary circulation. TRUE/FALSE

Pulmonary arterial pressure is much less then the systemic arterial pressure, although the capillary and venous pressure are not greatly different in the two circulations. TRUE/FALSE

Pulmonary vascular resistance tends to fall as flow increases. TRUE/FALSE

The arterioles are the main point providing resistance in the pulmonary vasculature. TRUE/FALSE

The greatest drive for hypoxic pulmonary vasoconstriction is the pulmonary arterial Po2. TRUE/FALSE.

Ventilation and Perfusion

Since the pulmonary circulation operates at low pressure, the distribution of blood is similar to the distribution of ventilation. TRUE/FALSE

Alveoli with no ventilation will have PO2 and PCO2 values that are the same as mixed venous blood. TRUE/FALSE.

A pulmonary embolism is a shunt. TRUE/FALSE

Pulmonary capillary blood flow + Venous admixture = Cardiac Output. TRUE/FALSE

Venous admixture increases arterial blood carbon dioxide content above that of pulmonary end-capillary blood. TRUE/FALSE


BT_PO 1.90

Describe the pharmacology of * insulin preparations *oral hypoglycaemic *corticosteroid drugs.

Intravenous dexamethasone has a slow onset of action. TRUE/FALSE

Prednisone and dexamethasone are synthetic corticosteroids with predominantly mineralocorticoid effects. TRUE/FALSE

The anti-inflammatory response of corticosteroids is a mineralocorticoid effect. TRUE/FALSE

Mineralocorticoid effects of synthetic corticosteroids are less than the natural hormones. TRUE/FALSE

Dexamethasone lacks mineralocorticoid effects. TRUE/FALSE






Stress: A state of mental or emotional strain or tension resulting from adverse or demanding circumstances.

Is it a bad thing?

I recently attended a management course that concentrated on resilience in the workplace. Learning how to identify stress in your life and identify it in others is at the crux of this course. The above slide was put up and my mind immediately travelled to performance in the primary examinations. Examinations are stressful, but is this a bad thing?

The above graph looks different for everyone but displays some important points. The yellow section is where people perform best. It is called the “optimum stress” area and is where you want to be when you sit the vivas. You are tense yet motivated, your senses are heightened and you are prepared for the challenge ahead.

At the Olympics, what separates good athletes from extraordinary athletes is often their ability to perform in high stress situations. Most of the athletes are very similar in their fitness and physique, and it comes down to performance on the day. Two people with very similar skills and training can perform drastically different when faced with high-pressure situations.

Everyone has warning signs about when they are moving into the overload category, and when fatigue is becoming exhaustion. In this overload area, we tend to do less of our normal, healthy coping mechanisms (e.g. exercise) and our performance starts to decline. This overload of stress has been linked to impaired performance in military and in civilian populations.

Resilience: The capacity to recover quickly from difficulties; toughness.

The good news is that you can get better at identifying and managing the stress you inevitably feel when facing difficult and uncertain situations. Identification and management of stress, and building of resilience, is possible. The trick is to manage your stress and keep it within optimal levels in order to perform on the day. If you don’t have the tools in place to keep your stress in check, you’ll under perform on the day of the exam.

The key thing to understanding this is that you are indeed facing uncertainty—the outcome of your future has not been decided. It’s up to you to develop the beliefs and mental toughness that will get you through the next few weeks, and perform well on the day of the viva.