‫ميحرلا نمحرلا هللا‬ ‫بسم‬

Sep. 2015 mrcog part 2 recalls

( Recalls group telegram)
1 - Full Term, PROM, Fully Dilated, head 2/5 per abd., station at spines,
mec.stained, with decelerations + reduced variability (pathological CTG)

* pathological cat 1 Answer : cat. 1 cs

* non reassuring ctg cat II
* Continous brady or maternal life thre cat 1

head 2/5 per abd.

No forceps
2 - Ft PROM thick meconium abn CTG FullyD vertex at +2 OP position.
Options
Answer : forceps delivery, O. theater as st. +2 OP is
axis traction forceps 2 pulls indicated for theatre
axis traction forceps 3 pulls
suspesion of failed forceps ,,,,,,,,,theater
6 pulls
Big big mid+ op
outlet forceps
Big baby
Kielland forceps Big mother theater
Midcavity
class 1 cs
Op
expectant manag Thats a famous ACRONYM
ressess in 30 min
+2 exactly and after then for the room
reassess in 1 hr
Mid cavity above station +2 not above ischial spine
reassess in 2 hrs

3 - Fullterm Fully-dilated station +2 OA CTG prolonged deceleration and she is

on epidural Answer : forceps in d. room

Be carefull the leading point not mean the biparietal diamerter

4 - FT, PROM, meconium, FD, vertex at spine, significant caput oedema, position of
vertex not identified due to caput, ctg tacchycardia 170 b/min, reduced variability for 50
min Answer : emergency cs
5 - Another one FD station +2 OA can't remember can't push or weak
contractions Answer : 3 pulls foreceps del.

Any patient cant push apply forcep

maternal exhausion indication for op vd

6 - You have been called due slow progress in multipara was 9cm dil when you
come to assess she is fully dilated contractions 1 in 4 head at 0 station
Answer : reassess after 1 h
 If patient progress well dont rupture the membr all rules follow it

7 - CTG picture of IUGR showing repeated variable decelerations +reduced

variability done after epidural given 30 min ago
Picture due to hypoxia due to IUGR
Options
vagal response due to hypoxia
A Expectant management fetal vagal response due to epidural

B Expectant management + coticosteroids+ antibiotics

C expectant + antibiotics Answer :iv fluid if persist cs ?

D expectant + coticosteroids

E Em Cs
SVD AFTER PROM : 60% for term and 40% for preterm
F IOL
7 - PROM 34ws ctg normal got corticosteroid 1 week ago, now 2 cm dilated
Answer: c

8 - PROM > 30hrs all normal no fever clear liquor ,no cervical changes

Management Answer : iol

9 - primi breech in labour

ANSWER :councling the patiet about

lscs vs breach del.
10 - Preterm labour 36ws with hx of GBS HSV +ve ANSWER : IAP

11 - GBS with bacteriuria in current preg Answer : ttt now and iap
so remember if GBS and confirmed PTL give IPA even if she is not PORM
According to allergy if not severe allegy cephalosporin if severe allergy
vancomycin
For pprom recomendation for erythromythin for 10 days
 12 - At 22 weeks, with pain, breech with cord presentation, 2 cm dil, memb.
prolapsed in vagina, FHR is regular

Explanation: Rescue cerclage may delay delivery by a further

Answer : expectant
5 weeks. It is also associated with
a two‐fold reduction in the chance of delivery prior to 34
.weeks Rescue cerclage
It should be noted dilatation of the cervix >4cm is associated 16 - 27- 6 ws
with high risk of cerclage failure

Options Any non reasure ctg in breech cs

Class 1CS • Any suspect delay in breech differe from cephalic you will do cs
not pv after 2h
Class 2 CS •

Class 3 CS •

Forceps labour room •

Forceps in theatre •

reassess in 2 hrs •
Answer : cat 2 cs
reassess in 4 hrs •

13 - Ft primi breech, opted for vaginal delivery, examined 4.5cm after 4hrs
5.5cm, extended breech, ctg tacchycardia 170 b/min and early decelerate
14 - Ft PROM in labour induction was done by PG gel 3 doses for slow
progress oxytocin started 2hrs later 4.5 cm ctg reassuring

* Suspect delay examine after 2 h Answer : reassess after 4 hs

* normal progress examine after 4 h

* if you start syntc examine after 4h

* After Arm 2hrs exam

if we have suspected delay in breach shall we do ARM or go for CS ….>>> go to cs

15 - 19 year old, primi, in latent phase, 2 cm dil., fully effaced, contractions

1in 10 Answer : allow or send her home and encourage ambulation

16 - Which of the following reduces perineal tears

 perineal massage 2nd stage Answer : c

Episiotomy worm comprression first if present if not hand on

perineal massage not mean worm compression
hands on technique
Answer : continues support
17 - which reduces need for OVD

18 -.PG 29 wks, abdominal pain, increased uterine tone between contractions,

minimal vaginal bleeding, (=abruption was diagnosed), mother vitally stable.
...Fetal tacchycardia with easily provoked decelerations
If progress rapidly for vd Answer : cat 1 cs
If not give in the quest. immient vd do not give choice for Vd

19 - PG placenta previa mild bleeding at 36 ws settled maternal and fetal

wellbeing assessed normal plan of management Answer : admit
: 20 - Placenta accreta strong association with = corticoseriod
cs at 38 - 39 ws
maternal age >40, smoking , previous CS
Answer :prev. cs

high-risk cases suspected of having

placenta accreta, planned delivery at
around 36–37
weeks of gestation (with corticosteroid
cover92) is a reasonable compromise,
while in those with
uncomplicated placenta praevia delivery
can be delayed until 38–39 completed
weeks of gestation
21 - PG at term no abd pain reduced FM CTG absent variability,shallow
decelerations, after CS baby was severely anemic ANSWER : FM HGE

)neonatal infection as parovirus B19 or Fetomaternal hge ,Vasaprevia (

** vasa previa with bradycadia +ROM …..No rupture mem so not vas prev…… in vasa
previa thereis sinosiodal ctg
** in fetal anaemia CTG shows sinisudal pattern
** in infection tachy cardia with decrease variability Nothing mentioned about infection
also
** With parvo MCAPSV>1.5 mom should have been deliverd earlier if discoverd
** couses of chronic infection Maternal alloimmunization / Fetal infection parvovirus19
** this case it is not acute anemia more likly it is chronic from the patern of the ctg
** so …. Heamolytic anemia…….fetomaternal hge …… Alloimmunization

Although the differentiation between acute and chronic FMH may be

clinically problematic, its distinction can significantly influence
perinatal management
22 - Teacher on anomaly scan at 20 wks mild hydrops f. of parvovirus infection
in school children
ANSWER : Refer to FM centre

Why not f/u after 4 wks and if

confirmed then FMU?
23 - Multi breech 8 cm dilated cord presentation,CTG normal ,O.R busy
) delivered a baby 10 min ago ANSWER : TERBUTALINE
0.25 mcg sc
Cord prolapse ctg normal cs cat 2…. abnormal ctg cate1 ………fully dilated
operative Vd………… if OR busy terbutaline

OR BUSY OROOM

24 - EMQ.Cause of anemia in each of the following: 1-Pre-eclampsia ,2-On

peritoneal dialysis with heavy period.3- Mediterranean patient heavy periods?
1 - heamolysis if HELLP

So meditenean anaemia is thalassemia major 2 – Erythropoitin dif ( renal failure )

3 – inherited ( haemolysis )

** 1.Hellp,preeclampsia---The angiopathy results in consumption of circulating

platelets, causes hemolysis in affected microvessels and reduces portal blood flow in
the liver
** SCD is the most common inherited condition world wide
It's true.. approx 3,00,000 children are born each year
As compared to only 70,000 /yr for beta thalesemia..as per the data in the guidelines

25 - TSH common alpha subunit with?

 suppress HPO axis

Supression of
ovulation

26 - Mech of action of OCPs

27 - Recurrence of symptoms after UAE: 5-10%, 10-15%, 15-20%, 20-30%, 30-

40%
Reintervention after 5 yrs = 32% Vs 4% in hystrectomy Answer : 20 – 30%
Reintervention = 10% from 40 to 50yrs old
Ovarian failure
25% for < 40yrs. Old.
Need for further ttt. Hystrectomy = 1% 1–2%
28 - Untrreated CIN for FU at 12 months pap smear borderline changes HPV -
ve Answer : rotein recall

29 - Instruments pictures + names EMQ?

Hysterectomy: Uterine a moynihan's clamp

30 - For bowel holding ? what instrument

31 - Ureteric tunnel dissection ? Long

curved
artery without toothed in the end Hysterectomy: Zeppelin hysterectomy
clamp
32 -G2p1with prev baby micro deletion 16p wants to know risk in current
pregnancy (PCR, Fish, Chr.microarray ) Answer :arry CGH
(acgh ) Array comparative genomic hyperdization (Specifically for
chromosomal deletion)

Q188 manda book

33 -Combined test result report given HIV +ve done aneuploidy scan
age 37 yrs triosmy 21 1:355, triosmy13 and 18 1:22 further
management 13 and 18 1:22 further management
discuss with her amniocentesis at 16 ws
]NB: Amniocentesis >15wks, CVS 11-13+6wks, additional R.of misc. around 1%[

Answer : REFER TO
FMU

34 - Same patient states that she is worried coz her date of birth was
incorrectly entered in her report that it was 1972 instead of 1969 what action
?to take Repeat all tests
Options: Reassure , repeat all tests, repeat biochemical tests only

* Age becomes 40 not 37 so higher risk Because all data will be wrong
* changed you have to repeat all

35 -PG HIV -ve ,partener HIV +ve worried about baby

counsel her and explain sero conversion

So the answer will be repeat hiv test to check sericonvversion

serodiscordant couples• The risk of transmission for each act of sexual intercourse is
0.001% – 0.03%. This risk is significantly reduced, if the male partner has a viral load of <
50 copies/ml and is taking HAART. The risk can be further reduced by limiting exposure to

36 - PG with HIV +ve viral load 30,000, not on HAART management

Answer : ECS at 39 ws with prior zidovudine and no breast feeding
 <50VD…….,50-399CS considered,…… >400 CS between 38-39

37 - Post exposure prophylaxis in neonate Zidovudine for how long

withen 4 h and for 4weeks

3drug therapy for pt with viral load

>50
38 - complicated falciparum malaria treatment

Correct Answer:
IV Artesunate
Explanation: There are greater than 2% parasitised red cells which means this is classified
as
complicated/severe malaria
Initial treatment is with Artesunate IV 2.4 mg/kg at 0, 12 and 24 hours, then daily. This
can be
stepped down to oral therapy once the patient is stable
An alternative regime if artesunate is unavailable is
Quinine IV 20 mg/kg loading dose (no loading dose if patient already taking quinine or
mefloquine) in 5% dextrose over 4 hours and then 10 mg/kg IV over 4 hours every 8
hours PLUS clindamycin IV 450 mg every 8 hours (max. dose quinine 1.4 g )

39 - Herpes EMQ: PG at 37ws with 1ry herpes management

 acyclovir and cs at 39

RISK OF NEONATAL INF.

1ry 41%
RECURRENT 0 – 3 %

400 mg tds for 5 days

1ry or 2ry
By history an specific ab
800 in varesilla (7d ) and 400 in herpes ( 5d )

15%of patients with primary are already have previous Not identified

Ig G type specific only is the result will affect mood of delivery

40 - Chicken pox : Patient called G.P after confirmation of chicken

pox to her son, she has got rash for 48hrs she nonimmune
Answer : reassure her, no further action required + avoid other 8 - 28 if she took ivig
pregnant or children till the lesion crust over [= 5d after rash onset]
8 - 21 if she didn’t

Sever inf and women smoker. Chest dis. Immunosuppressive 10 – 14% pneumonia
drugs .second half of preg for iv acyclovir and addmition
Mortality 0-14%
EMQ Rash in pregnancy.

41 -PG with Flue like symptoms with mac.pap rash started at face spread to
trunk, incubation period 14-21days spread by droplet it is infective before and
...after the rash Answer : rubella by ip
 Incubation period
Rubella ............... 14-21 days •
Parvovirus B19... 14-21 days •
Measles ............. 8-14 days •
chickenpox ........ 10-21 days •
Infectivity period (days pre and post rash onset)
Rubella .............. 7 days pre to.. 10 days post.. onset of rash [7/10 ] •
Parvovirus B19 .. 10 days pre to day of onset of rash [10/0 ] •
Measles ...... 4 days before onset of rash to 4 days after [4/4 ] •
chickenpox . 2 days pre onset of rash until all lesions crusted [2/5 ] •

** Koplik Spots. Mouth of a patient with Koplik spots, an early sign of measles infection.
Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red
spots that appear on the face at the hairline and spread downward to the neck, trunk,
arms, legs, and feet.Feb 17, 2015

**Rubella is also called German measles, while rubeola is regular measles. The biggest
difference between the two is that rubella is considered to be a milder disease that only
lasts around three days. Rubeola can become a serious illness that lasts several days and
can cause other serious permanent complications.

42 -PG with nonspecific symptoms arthralgia lace like lesions over extremities
Answer : Parvo19... The Fifth disease…erythema infectiosum…
Parvo 19…….arthralgia
60 %of adult are sero positive
Infectivity period is till start rash
Key wordArthralgia +Lace rash slapped chicks
Infectivity For 3-10 days post exposure or until rash
appear ……Percentage of hydrops is low 3%
Polyarthropathy and A plastic crisis high fatality rate with hydroponic babies up to 50 %

43 -Diagnostic test for Syphilis

)agglutination test, FTA (fluorescernce treponemal antibody test)

Treponemal antibody tests - TPHA (treponema Pallidum haemagglutination)

and FTA-ABS (fluorescent treponemal antibody - absorption test)
Answer : TPHA (treponema Pallidum haemagglutination )
44 -PG, HIV +ve, VDRL +ve screening test, TPHa confirmatory test +ve,
management ( ATBTcs EMQ) wants treatment for syphilis

** First ,second one dose/ third trimister 2 doses 1 week apart

2.4 Iu benzyl penicillin IM stat, At T3 2 inj. 1 week apart
* * incidence of jarishhexheimer reaction? 40%
** The Jarisch–Herxheimer reaction is traditionally associated with
antimicrobial treatment of syphilis. The reaction is also seen in the
other diseases caused by spirochetes: Lyme disease, relapsing fever,
and leptospirosisis
?
45 - POST partum fever 38, feeling unwell , painful red quadrant in her breast

Flucloxacillin 1gm iv /6hs

46 - PROM in PTL with hx. of carrier GBS present pregnancy

Without PTL bezelpeniciiline lP

With PTL erythromycin & fu till 34

IAP 3 gm benzylpenicillin then 1.5 gm / 4 hrs till delivery.(in the past Clindamycin IV
900mg / 8hours if allergic to benzylpenicillin). Now an alternative agent vancomycin if
current clindamycin resistance rates(10%)
47 post partum septicemia least likely organism ANSWER : PERFRIGES

GAs, bacterroides, peptostreptococus, clostridium perfringe s

52 - 52.chlamydia diagnosis by

( NAAT, TMA, SDA, an alternative

real time PCR) ANSWER : NAAT

NAAT is a molecular test that detects the

genetic material (DNA) of Chlamydia
trachomatis. It is generally more sensitive and
specific than other chlamydia tests and can be
performed on a vaginal swab on women, or
urine from both men and women, which
eliminates the need for a pelvic exam in wome

53 -Young patient with recurrent postcoital + intermenstrual bleeding, recent

pap smear + colposcopy ?borderline changes for f/up after 6 ms

further investigation ANSWER : Endocervical/Vaginal swab for NAAT

:EMQ options.

Heterotopic preg

Ectopic preg

Ectopic preg too early to confirm

IU preg too early to confirm viability

Ectopic preg with resolving trophoblast

IU viable preg

IU preg too early to confirm location

54 - Early pregnancy with bleeding BHCG doubled from 600 to 1300 in 48 hrs
TVS GS with no yalk sac Answer : PUV

55 - Early preg 7 ws amenorrhea + bleeding ,TVS intrauterine

central(pseudocyst) sac like structure, Rt adenexal mass(ec topic) or cyst
30x35mm separated from ovary Answer : ectopic to be confirmed

56 - Early pregnancy 7 ws ,bleeding ,abdominal pain TVS 2 small sac like

structures IU 25x26x28, 20x22x23mm with adenexal cyst +/- 3x2cm (more
corpus luteum) BHCG 967 IU Answer : PUV?

Heterotopic pregnancy should be considered in all women presenting after assisted

reproductive technologies, in women with an intrauterine pregnancy complaining of
persistent pelvic pain and in those women with a persistently raised β-hCG level
following miscarriage or termination of pregnancy.50,71

57 - Early preg with bleeding IU sac like structure 17x18x20 mm and

intrauterine collection with adenexal mass no free fluid in D.P
58 %of multiple preg in IVF patients answer : heteroectopic

58 -% of multiple preg in IVF patients

Multiple pregnancy in General population is 1:80 ANSWER : 25%

59 - In IVF cycle which is an acceptable reason for double embryo transfer

ANSWER : B
a) pt age 37-39 first cycle

b) pt age 40-42 first cycle

c) Any cycle where top quality embryos not available

d) pt age 37-39 second cycle

60 - pt IVF cycle 5 ws after embryo transfer came bleeding + abd pain

a) miscarriage
Answer : b ectopic
b) ectopic

c) biochem preg

61 - EMQ .options

a) intra abdominal bleeding vessel

b) OHSS

c) Bowel perforation ANSWER : a

d) Ectopic pregnancy INTERNAL ILIAC ARTERY INJ.

61 - IVF cycle 4hrs after egg retrieval hypotension tacchycardia shocked

62 - 2 days post egg retrieval patient came with acute abdomen , fever 38.5
nausea and vomiting
In urter he will give key like urine decrease or loin ANSWER : BOWEL PERFORATION
pain Or Flank pain but here Voming no loin pain
No loin pain ureteric injury well less fever

63 -.EMQ most likely diagnosis

1ry inf both young 22 and 24.She has regular menses P4 2 reports >5.Tall male
with Azospermia Answer : klinefilter ( talllll 47xyyy- hypergonadotrophic
Ovulating / klinefilter Low tesresterone)

64 - Patient with hx. of post partum hge 8 ms, lactating amenorrhea using
barrier CC

NB: Lact.ameno. as CC for only 6mo. Lactating &↑Prolactin

 Answer : pregnancy
a - Lh 1.1
never with shehan all are low
b- FSH 1.2

c - S.Prolactin 1890 If fsh / lh very low, prolactin and est. high think pregancy

d- S.estradiol 2300 If no prolactin here…………………granulosa cell tuomur

65 - EMQ most likely finding on physical examination

.. In pt with PCOs Answer : Acanthosis nigricans

66 - Most common cause of hyperandrogenism

According to the Androgen Excess and Polycystic Ovary Syndrome Answer : pco
Society (AE&PCOS), the main feature of PCOS is clinical
hyperandrogenism or laboratory hyperandrogenaemia. Therefore, in
diagnosing PCOS one must always exclude other causes of androgen
excess

67 - Infertile couple >4yrs Female PCOs normal BMI. Male normal. 1st line
management Clomifene for just 6 months Answer : clomid

68 - PG type I D.M on insulin stopped insulin for 1 day now severe vomiting
,lab Ketoacidosis (dehydration + acetone) treatment
Answer : admission for rehydaration and
insulin
I.V fluids (treat dehydration & get rid of acetone through kidney) and insulin

69 - PG type I D.M hyperemesis lab ketoacidosis , ABG = metabolic acidosis

with respiratory compensation , Q is asking about the pic of ABG
(metabolic acidosis with respiratory copunsation pic of ABG )
 Look at pH - < 7.40 - Acidosis; > 7.40 - Alkalosis
-If pH indicates acidosis, then look at paCO2and HCO3
If paCO2is ↑, then it is primary respiratory acidosis
If paCO2↓ and HCO3- is also ↓→ primary metabolic acidosis
If pH indicates alkalosis, then look at HCO3- and paCO2
If paCO2is ↓ → then it is primary respiratory alkalosis
Whether it is acute or chronic
If paCO2 ↑ and HCO3- also ↑ → then it is primary metabolic alkalosis
If pH is normal ABG may be normal or mixed disorder
a) ↑paCO2 and ↓HCO3-→ respiratory and metabolic acidosis
b) ↓paCO2 and↑ HCO3-→ respiratory and metabolic alkalosis

Calculate compensation by the respective methods:

Acute: [HCO3-]↓ by 2 mEq/L for every 10 mmHg
↓in paCO2below 40
Chronic: [HCO3-] ↓ by 5 mEq/L for every
10 mmHg ↓ in paCO2 below 4
70 - PG 30 with IUGR CTG unprovoked decelerations Answer : CAT 1 CS

(Unprovoked means deceleration without contraction )

71 - PG 32 weeks, D.M on insulin prev CS U/S IUGR <3rd centile next

management
Answer : UA DOPPLAR

Fundal level less than normal growth scan not umblical artery follow rules , here he
state that the baby iugr 3rd percentile so do dupplar umblical ( pt)

But Mca at 32 wks has limited accuracy and should not be used to time delivery

So for determine lab. dv for preterm Mca for term

72 - 42 yr old for TAH with BSO for fobroid uterus, normal BMI ,
thromboprohylaxis with elastic stockings, what will be the most likely serious
complication (4%)
a) Blood transfusion d.t hge b) Bladder and ureteric injury c) Wound dehescence/ return
to theatre because of bleeding d) VTEe) Pelvic abscess/infection f) Bowel injury g) Death
within 6 weeks ANSWER : BT

73 - EMQ G.p letters

Options

a) Admit to mother and baby unit

b) Admit to mother and baby unit under mental health act

c) Psychological counseling
ANSWER : C
d) CBT behavioral therapy

e) Psychosexual counseling

73 -G.P letter 1: a G2P1 previous1 CS developed claustrophobia [fear of

confined places], refuses hospital delivery and requests home delivery

74 - 74. G.P letter 2

ANSWER : B
Post partum pt history of schizophrenia day 10 abn behaviour hallucinations
not taking medication

75 - Ovarian cyst premenopausal 46 yrs 65mm simple ov cyst incidental

finding during CT for renal cause

NB: < 5 cm simple cysts no f/up. 5–7 cm Annual U/S. >7cmmSurg./MRI

a) Reassure
ANSWER : E
b) Ca 125
c) MRI

d) Refer to oncologist

e) Annual U/S

:.76 - Options

a) CA 125 b) Ref to cancer centre c) Reassurance d) MRI e) CT

76 - Postmenopausal women with abdominal bloating and simple ovarian cyst

35mmx35mm
ANSWER : A

RMI = U x M x s-CA 125

The RMI score (malignancy risk index) is calculated based on the s-CA 125 value, menopausal
.)status (M), and evaluation of ultrasound (U
Ultrasound criteria (score)
Multilocular cyst 1
Solide areas 1
Bilateral lesions 1
Ascites 1
Intraabdominal metastases 1
Score 0–1: U=1
Score 2–5: U=3
Menopausal status (M score)
Premenopausal 1
Postmenopausal 3
s-CA 125 (u/ml) (the actual value is us
77 - 54 yr old with Bilateral complex ovarian cyst 65mmx55mm and
35mmx45mm with CA 125 = 78
:.Options ANSWER : E

a) CA 125 Than refer

b) Ref to cancer centre

c) Reassurance

d) MRI

e) CT
 78 - G3 32wks PG with Asthma on inhaled short acting B2 agonist and
corticosteroid 800 micgm came with shortness of breath and decreased peak
flow rate .next step of management
ANSWER : LONG ACTING B2 AGONIST

NB: 30-35% oration of

asthma in pregnancy, and 23 %
improvement
Well controlled asthma little or
no ↑ in maternal or fetaI
complication
Poorly controlled A/W
hyperemesis. hypertension, pre-
eclampsia, vaginal bleeding,
complicated labour, FRG. preterm
delivery, ↑ perinatal M.&M., and
↑ CS rate
79 - Post-delivery neonate with fluctuating swelling on scalp with ill-defined
?margins, down to the eye of the baby, and severe anemia HB 6 Diagnosis

:Options ANSWER : Sub galeal hge

Cephalhematoma, intracranial hge, subgaleal hemorrhage, subdural hematoma

80 - Pt. delivered by LSCS at 28wks for PIH with Abruption .Risk of the
.following will be increased. Options: HTN / Preeclampsia % 55/ DM / VTE

ANSWER : PE55%
81 - Drug of choice for OAB for eldery women
ANSWER : DARIFANCIN old frail women for darifenacin

Options-Darifenancin, mirabegon, desmopressin ,HRT

NOT OXYBUTANIN AS IT CROSS BBB

82 - 58 yrs. old pt with vault prolapse with short and narrow vagina surgical
procedure Answer : asc
83 - old woman with vault prolapse does not want to retain sexual function.
sx procedure Answer : Colpoleices

84 - During vaginal hysterectomy vaginal vault was reaching up to introitus

.surgical procedure to prevent vault prolapse Answer : ssf
85 Post-menopausal woman with Mixed UI and OAB tried bladder training
and all medical treatment with no improvement in symptoms .Next
investigation Options: Videourodynamic/cystometry/post void volm
Answer : cystometry

86 - Post-menopausal Pt with Ant wall prolapse with OAB .Pt tried all types of
medical treatment with no benefit. Next step in management
Answer : NB: UI + symptomatic prolapse that is visible at or below the vaginal
introitus Refer to a specialist
There is one question came in march exam 2017 about patient had uterine prolapse and
cystocele and young age i dont know the answer but i found the answer in the tog article
about prolapse hysteropexy without cystocele as cystocele it will corrected sponeatous
with hysteropexy
Open 1 - Abdominal sacrocolpopexy (SCP)
** decreased rates of recurrent vault prolapse, dyspareunia and postoperative stress
urinary incontinence (sui) when compared with vaginal sacrospinous fixation (ssf)
** increased number of posterior vaginal wall prolapse following abdominal SCP,
reoperation rate13%
satisfaction
2 - Vaginal Sacrospinous fixation (SSF): requires adequate vaginal length and vault width
to reach the sacrospinous ligament
** Co-existent anterior and/or posterior vaginal wall prolapse: Easily managed by
anterior and/or posterior repair while performing vaginal SSF
** Shorter operating time and hospital stay, Lower postoperative morbidity
suitable for frail women because of morbidity associated with abd. SCP
A/W exaggerated retroversion of the vagina
following SCP and SSF may cause vaginal narrowing and shortening, especially if
combined with anterior / posterior repair
.Reoperation rate 26%
** R. of injury to pudendal and sacral nerves and vessels a/w SSF
3 - Laparoscopic SCP : as effective as open SCP but requires skills and longer times
4 - Ileo-coccygeus fixation, NRR
5 - Vaginal utero-sacral ligament suspension effective, but a/w R. of ureteric injury10.9%,
bladder injury, UTI, blood transfusion, small bowel injury, reoperation rate of 4.5%,
patient dissatisfaction rate of 11%, direct prolapse recurrence rate was 5% and the
.indirect prolapse recurrence rate 23%
83 - old woman with vault prolapse does not want to retain sexual function. sx
procedure
6 - colpocleisis: For unfit for major surgery & who do not wish to retain sexual function. A
short operating time and low incidence of complications, success rates of 97%, under local
anaesthesia and low risk of morbidity
7 - Total mesh reconstruction: sheet of synthetic mesh material is fixed at a number of
.points to act as a new pelvic floor. Complications: mesh erosion and infection

8 - Anterior and posterior vaginal repair + obliteration of the enterocele sac, inadequate,
.R. vaginal narrowing and shortening

9 - Sling procedures
Adequate patient counseling, compared posterior intravaginal slingoplasty with vaginal
.SSF, longer operating times and more blood loss with SSF
Direct recurrence rate 6% following infracoccygeal sacropexy. Anterior vaginal wall
.)prolapse was more common (12%) than posterior vaginal wall prolapse (8%
Short operating time, done in unfit for major surgery. The vaginal axis after posterior
intravaginal slingoplasty was found to be close to that following abdominal
.sacrocolpopexy on MRI
.Mesh erosion, infection and rectal perforation
.NICE: advised special consent, audit and research when using the technique
10 - Vault suspension to the anterior abdominal wall
.Simple measure, not enough studies to judge its value
.Operative complications were minimal
A higher direct recurrence rate, direct failure rate of 10%
11 - Vault suspension to the anterior abdominal wall
Bladder diaries
1.1.17 Use bladder diaries in the initial assessment of women with UI or OAB
Encourage women to complete a minimum of 3 days of the diary covering
variations in their usual activities, such as both working and leisure days. [2006]
Pad testing
1.1.18 Do not use pad tests in the routine assessment of women with UI. [2006 ]
Urodynamic testing
1.1.19 Do not perform multi-channel cystometry, ambulatory urodynamics or
videourodynamics before starting conservative management. [2006, amended2013 ]
Urinary incontinence in women: management (CG171)
NICE 2017. All rights reserved. Subject to Notice of rights ©
.)(https://www.nice.org.uk/terms-andconditions#notice-of-rights
Page 13 of49
1.1.20 After undertaking a detailed clinical history and examination, perform
:multi-channel filling and voiding cystometry before surgery in women who have
symptoms of OAB leading to a clinical suspicion of detrusor overactivity, or
symptoms suggestive of voiding dysfunction or anterior compartment prolapse, or
]had previous surgery for stress incontinence. [2006, amended 2013
1.1.21 Do not perform multi-channel filling and voiding cystometry in the small group
of women where pure SUI is diagnosed based on a detailed clinical history and
examination. [2006, amended 2013]
1.1.22 Consider ambulatory urodynamics or videourodynamics if the diagnosis is
unclear after conventional urodynamics. [2006, amended 2013]
Other tests of urethral competence
1.1.23 Do not use the Q-tip, Bonney, Marshall and Fluid-Bridge tests in the assessment
of women with UI. [2006]
Cystoscopy
1.1.24 Do not use cystoscopy in the initial assessment of women with UI alone. [2006]
Imaging
1.1.25Do not use imaging (MRI, CT, X-ray) for the routine assessment of women with
UI. Do not use ultrasound other than for the assessment of residual urine
volume. [2006]

87 - Cystoscopy picture
Interstitial cystitis

PBS

Hunner lesions?
 !!!!!!!!! according to new guidelines its painful bladder syndrome &

Characteristic cystoscopic findings that have ,During urodynamic studies

been ascribed to BPS include * pain on bladder filling
post distension glomerulations * reduced first sensation to void
reduced bladder capacity * reduced bladder capacity
are consistent with BPS
however, there are no urodynamic
criteria that are diagnostic for BPS
88 - Pt had reduced flow rate and reduced bladder capacity with cystoscopy
glomerulus app and hemorrhage Answer : interstitial cyst.
Options schistosomiasis/chronic cystitis/CA/interstitial cystitis
Answer : Cystoscopy + biopsy
89 - one more on cystoscopy?? Bladder tumour

90 -Pt had abruption during this pregnancy .Risk of recurrence in next

pregnancy
Ans 4-6%
If prev.one abruption Risk of recurrence 4.4%.
-25%

59 A 34-year-old in her 2nd pregnancy is seen in

the antenatal clinic at 12 weeks. 3 years ago she
had a placental abruption
26 weeks. She has no other relevant history.
What is her risk of another abruption in this
?pregnancy

a) 2–3% b) 4 – 5%(4.4%) c) 6–7%

d) 9–10% e) 11–12%
91 - Causes of death

Options: All Options were there

91 - Multigravida progressed rapidly and vaginal delivery.Post delivery
collapsed during resuscitation had PPH and caogulation profile was derranged
.Pt died during resuscitation.cause of death
Amniotic fluid embolism is very uncommon and the Answer : AFE AFE ——> DIC
rate at which it occurs is 1 instance per 20,000 births.
Though rare, it comprises 10% of all maternal And could it happen antenatally
deaths.[2] 2/100000
92 - Multigravida with BMI 40 full term pregnancy with Abruption was taken
for LSCS .past h/o difficult intubation (grade 3 intubation) during induction of
anaesthesia pt had tachycardia, bronchospasm and saturation was low. pt
died in spite of resuscitation .cause of death ANSWER :ASPIRATION
mendelson syndrome

93 - Antenatal pt with shortness of breath severe chest pain radiating to jaw.

Diagnosis Radition to shoud or jaw is sign of mi Answer : MI

There are many ways to describe this pain, including tightness or

unusual pressure in the center of the chest. While pain can radiate to
the shoulders, arms, neck, jaw or back, people often mistake this pain
for indigestion, which can be dangerous

94 - Antenatal pt with shortness of breath and reduced air entry in lower zone
)during auscultation ( no h/o respiratory infection Answer : PE …..?

95 - Diagnosis of MI (TOG article)

St Depression nomal in pregnancy Answer : st elevation in v1 v2 v3

96 - Post hysterectomy 12hrs later pts early warning score was poor

Tachycardia 123/min, BP 100/60mmhg, saturation 90%. propable cause

INTRNAL HGE
– Options :

a) IV fluids and nasogastric suction

b) CT abdomen

.c) Abdominal ultrasound

d) resuscitate and prepare for OT

e) primary hemorrhage

f) secondary hemorrhage

g) refer to surgery Ans: IV fluids and nasogastric tube d.t paralytic

ilieus esp. with no fever
 97 - Post op day 4 following debulking surgery for ca ovary pt had continuous
vomitting, abdominal distention, bowel sounds absent (usually day1 0r 2).
Initial management Answer : a

Wts the commonest cause of death in cancer ovary ? answer : renal failure

Q14: E. Tropinin I
Cardiac disease remains the largest single cause of indirect maternal deaths
Diagnosis of acute myocardial infarction (AMI) in pregnancy may be difficult because of
its low prevalence and consequent low index of suspicion. Two consecutive Maternal and
Child Enquiries (CMACE) reports have shown a consistent failure to consider AMI as a
.cause of chest pain in women with risk factors
ECGs are classically the first-line test in making a diagnosis of AMI in any patient
presenting with chest pain. The most sensitive and specific ECG marker is ST elevation,
.which normally appears within a few minutes of onset of symptoms
Cardiac-specific troponin I and troponin T are the specific biomarkers of choice
.for diagnosing myocardial infarction
In contrast, other cardiac markers – myoglobin, creatinine kinase, creatinine kinase
.isoenzyme – can be increased significantly in labour or Caesarean section

The troponin I level in serum appears to be the marker of choice of myocardial injury in
the pregnant patient because levels are not altered by normal pregnancy and delivery or
.]influenced by obstetric anaesthesia [43

Cardiac enzymes are useful in the diagnosis of MI. An elevated keratinise kinas CK-MB
fraction is a characteristic feature of MI. It is important to note that CK-MB may be
elevated in labour [7,43]. A rising level of CK-MB (>5% of total CK) in the presence of signs
and symptoms of MI is diagnostic. Elevated LDH is less reliable in the diagnosis of MI and
needs to be interpreted within the overall enzyme profile. The EKG changes of MI or
ischaemia and infarction are well described. Sustained T-wave inversion, ST-segment
.depression, and q-wave formation are diagnostic features of MI

98 - After vaginal hysterectomy pt was in recovery .Pt had tachycardia, BP

85/60mmhg, urine bag 50ml dark color of urine. Answer : d

99 - Pregnancy with huge fibroid delivered by LSCS .Post cs pt had abdominal

pain , fever, rigors, stony dullness in left hypochondrium and shoulder tip
pain. Diagnosis Options subphrenic abcess/pulmonary embolism/pneumonia
Subphrenic abcess
101 - Hereditory thrombophilia with hightest risk of VTE

Antithrombin III def.

History and Physical Examination

Patients with ileus typically have vague, mild abdominal pain and bloating. They may
report nausea, vomiting, and poor appetite. Abdominal cramping is usually not present.
.Patients may or may not continue to pass flatus and stool
A relapse of paralytic ileus is not uncommon in psychiatric patients with a history of
ileus; risk factors include being older, having a history of abdominal surgery, or having a
]longer duration of psychiatric disorders. [18
In renal transplant candidates with a history of peritoneal dialysis treatment, prior to
transplantation, carefully evaluate for symptoms of intermittent bowel obstruction.[19]
Encapsulating peritoneal sclerosis is a rare cause of ileus in patients during or following
]peritoneal dialysis or renal transplantation. [19
Physical examination
The abdomen may be distended and tympanic, depending on the degree of abdominal
and bowel distention, and may be tender. A distinguishing feature is absent or
hypoactive bowel sounds, in contrast to the high-pitched sound of obstruction. The silent
.abdomen of ileus reveals no discernible peristalsis or succussion splash
Signs and symptoms of bowel obstruction
A history of bowel movements, flatus, constipation, and associated symptoms should be
obtained. Complaints in patients with LBO may include the following
* Abdominal distention
* Nausea and vomiting
* Crampy abdominal pain
Other symptoms that may be diagnostically significant include the following:
Abrupt onset of symptoms (suggestive of an acute obstructive event)
Chronic constipation, long-term cathartic use, and straining at stools (suggestive of
diverticulitis or carcinoma)
Changes in stool caliber (strongly suggestive of carcinoma)
Recurrent left lower quadrant abdominal pain over several years suggestive of
)diverticulitis, a diverticular stricture, or similar problems)
Assessment of symptoms should attempt to distinguish the following:
Complete obstruction vs partial obstruction vs ileus
Colonic lesion development history LARGE BOWEL OBSTRUCTION
Obstruction secondary to intussusception
Obstruction secondary to acute colonic pseudo-obstruction (ACPO), or Ogilvie syndrome
Although a complete physical examination is necessary, the examination should place
special emphasis on the following key areas:
Abdomen (inspection, auscultation, percussion, and palpation) – Evaluate bowel sounds,
 Signs ands ym pt om s

tenderness, rigidity, guarding, and any mass or fullness

Inguinal and femoral regions – In particular, look for a possible incarcerated hernia
Rectum – Assess anal patency (in a neonate), contents of anal vault, and stool consistency;
perform fecal occult blood testing as appropriate
See Presentation for more detail
Diagnosis
The following laboratory studies may be helpful:
Complete blood count (CBC
Hematocrit
)Prothrombin time (PT
Type and crossmatch
Serum chemistries
)Serum lactate (if bowel ischemia is a consideration
Urinalysis
Stool guaiac test
Imaging modalities that may be considered are as follows:
Plain radiography (flat and upright)

Contrast radiography with enema

Computed tomography (CT) – This is the imaging modality of choice if a colonic
obstruction is clinically suspected; contrast-enhanced CT can help distinguish between
partial and complete obstruction, ileus, and small-bowel obstruction
.See Workup for more detail
Management
Initial therapy in patients with suspected LBO includes the following:
Volume resuscitation
Appropriate preoperative broad-spectrum antibiotics
Timely surgical consultation
Consideration of a nasogastric tube for severe colonic distention and vomiting
:The following are emergencies that callisfor
Ileus surgical
treated intervention
as follows:
Closed loop obstructions * Correction of fluid and electrolyte imbalances
Bowel ischemia * Treatment of the underlying disorder
Volvulus * If the patient is vomiting, nasogastric decompression
* Cessation of medications that slow colonic motility, if
possible
102 - 42 yrs old G4P3 13 wks pg smoker previous all normal deliveries ,no
family hx. of VTE.I in current pregnancy what advise u will give regarding VTE
prophylaxis
Answer : 3 ANTENATAL PROPH.
Options 42YS …..1
1 - antenatal thromboprophylaxis G4…..1
SMOKER …..1
2 - No need of TP
3 RISK FACTOR FOR 28
3 - post partum 6wks TP if delivered by CS WS TP
& 6WEEKS POST TP

104 - young pt with dysuria and burning discomfort,

frothy discharge in vulva & vagina. what findings

can b seen in patient exam Answer : strawberry cx

105 - young pt with multiple shallow ulcers with urinary retention

Herpes —--> retention Urine Answer : Herpes

simplex
DIAMONDS TEST ????? For candida KOH TEST FOR BV

TV is wet mount

106 - primipara delivered by forceps, post delivery hx. of urinary incontinence

temp 37.8, myalgia and feeling unwell. urine routine -protein+,nitrites
,+,microscopic hematuria
Answer : uti
Options
UTI —---> Fever + Nitrites in Urine
UTI /ureter injury / bowel injury
Pyelonephritis common presentation fever with rigors

107 - 54yrs old with mixed UI and repeated episodes of UTI & microscopic
.hematuria Adv Answer: cystoscopy

any heamaturia in pm pt r/o cancer 1 st Cystoscopy

Or refer
More than 50 and microsopi or frank haematur susp cancer According to options

108 - which of the following antihypertensives can cause Neonatal

- hypoglycemia
Answer : labetolol
 /labetelol/ nifedipin/ methyldopa

Forty eight neonates, born to mothers suffering from pregnancy induced hypertension
and receiving labetalol for control of blood pressure, were studied for the possible
adverse effects of the drug. ... It is concluded that maternal labetalol therapy is
associated with increased risk of neonatal hypoglycemia

109 - Pt operated fr TAH on sliding scale collapsed in ward

p 70/min, bp 80/40mmhg, RR 16/min, pinpoint pupils. which medication
u will give options
Atropine / adrenalin / glucagon / insulin / naloxone
= Naloxone is a competitive antagonist to opioid drugs and Answer : naloxone
is used in the treatment of opioid overdose. Its duration of
action is shorter than most opioid drugs, so close patient Opioid toxicity
monitoring and repeat doses or an infusion may be
required to maintain clinical effect. Pinpoint …pupil
= Naloxone will immediately reverse opioid induced
respiratory depression.
centeral deprission
= However, it will also antagonise the analgesic effect
110 - Pt had complex atypical hyperplasia undergone TAH chances of
malignancy in the histopath sample Answer : 43% gtg pag 17 2++

** Now it's endometrial hyperplasia without atypia and A typical hyperplasia

** Now it's endometrial hyperplasia without atypia and A typical hyperplasia

** and for the typical to progress to malegnancy is Less than 5 over 20yrs

1 - Patient with endometrial hyperplasia without atypia risk of progression to endometrial

:cancer
A.<1% B.2% C.4% D.10%
R. of endometrial hyperplasia without atypia progressing to endometrial cancer is < 5%
.over 20 years and majority will regress spontaneously during f/up
Source : RCOG/BSGE Green-top Guideline No. 67
But risk of co-existing cancer is <1%
. and in atypia, risk is 25-33% up to 59%
TOG: Malignant potential
1- Hyperplasia without atypia …..2% .
2 - When atypical hyperplasia simple or complex at diagnosis…23%
3 - When complex atypical hyperplasia at initial diagnosis …29%

The risk of developing endometrial cancer is highest in atypical hyperplasia. A case–control

study nested in a cohort of 7947 women diagnosed with atypical hyperplasia found that
the

cumulative risk of cancer in 4 years was 8% (95% CI 1.31–14.6), which increased to 12.4%

.95% CI 3.0–20.8) after 9 years and to 27.5% (95% CI 8.6–42.5) after 19 years(

33 Atypical

hyperplasia has also been associated with a rate of concomitant carcinoma of up to 43% in

.women undergoing hysterectomy

111 - Pt was refusing all kind of ttt options but she wants to know serious
.complication of her medical condition
Answer : anaemic
Fibroid ut with heavy irregular menses heart failure
112 - 112. Pt with ca cervix stage 2

.Options
Answer : 4 R.failure
1 - Severe anemia .

2 - Secondary spread . bilateral ureteric obstruction uremia Renal Failure

3 - Septicemia .

4 - Renal failure .
fibroid

113 - Pt of PPH with p 123/min,BP 80/50mmhg Answer : Average B Wt = 70

Kg X 40 % = 2800
estimated blood loss 2800ml

114 - Rh -ve post delivery FMH 4ml, AntiD need

Answer : 4x125

115 - G2p1l1 Rh -ve mother with AntiD titre 1:64 [is higher conc.than 1:4]
,partner is heterozygous

And it disappeared 2 hrs after delivery Answer : Cffdna

If heter free fetal dna if homo refree to fetal medi And with high titre and homo high risk of
needing intrauterine transf so refer fmu
Hetero -ve or +ve baby if homo baby will be sure -ve
116 - SUTURE MATERIAL

Episiotomy skin suture

Answer : Rapid 2/0 vicrylround?

117 - Tubal recanalisation

Answer : 4-0 Prolene

118 - mid line abdominal verticle scar closure

Answer : Pds 1

So finally 180-210 days ( 6 – 7 month) IVC —-> proline 5-0 �

119 - PG with 24wks, Past h/o PIH with abruption .In current pregnancy her
bp 120/80mmhg ,urine albumin nil. which medication need to start
Aspirin(from 12 wks till delivery) / calcium / Vit E / no medication
required ANSWER : ASPIRIN
120 - G3p1l1 12wks ga with past h/o severe preeclampsia
121 -Biochemical marker in T1 predicting early onset preeclampsia.
who were given aspirin before 16 weeks’
gestation, were found to have a greater
than 50% relative risk reduction, while
those who began taking aspirin at 17–19
and ≥20 weeks’ gestation had 45% and
,18% reductions
ANSWER :ASPIRIN
By combining maternal history, MAP,
biochemical marker levels (notably PAPP-A
and PLGF) and uterine artery doppler
between 11 and 13+6 wks
of pre-eclampsia requiring delivery before
34 wks
Unfortunately, while calcium supplementation may
be associated with decreased occurrence of pre-
eclampsia in patients with low dietary intake, its
benefit to women with baseline intake at or above
the recommended level has not been proven. Thus,
while calcium supplementation is unlikely to be
harmful, it is also unlikely to be helpful in
preventing pre-eclampsia in women with a normal
diet in developed countries
Women who experience migraines have a more
than two-fold increased risk of pre-eclampsia
compared with women who do not .15 Women
need to be aware to consult a health
professional if their headache is different from
their usual migraine, and have their urine and
blood pressure checked. A population-based
analysis16 also found migraine was associated
with a 17-fold increased risk of stroke and a
four-fold increased risk of acute myocardial
.infarction
 2fold preeclampsia- 4 fold mi-
122 - Migrain @ with increasesd risk of 17 fold strok tog headache

Women who experience migraines have a more than

two-fold increased risk of pre-eclampsia compared with
women who do not .15 Women need to be aware to consult a
health professional if their headache is different from their
usual migraine, and have their urine and blood pressure
checked. A population-based analysis16 also found migraine
was associated with a 17-fold increased risk of stroke and a
.four-fold increased risk of acute myocardial infarction

123 - 123.Migrain @ with increased risk of following

Middle cerebral art infarction / SDH / ICH / CVT

Stroke= middle cerbral a infarction ANSWER: MCA INFARCTION

hemorrhagic stroke (including intracerebral and subarachnoid hemorrhage)

124 - Post op day 2 TVT pt developed voiding difficulty following reoval of
catheter ANSWER : CISC (Clear Intermittent Self Catheteriation )

125 - ABORTION clause ANSWER : C SOCIAL

options Clause A/B/C/D/E/F/G

Young 18yr old with 9wks PG unplanned came for termination

A,B,C ……MOM

D,E…… BABY

FATAL GRAVE INJ.

126 - young 19 yr old PG anomaly scan s/o multiple anomalies in fetus
ANSWER : E

127 - Chances of recurrence in shoulder dystocia

Answer : 10 folds

Answer : occipitofrontal (11.5 cm)

128 - Engaging diameter deflexed head

The, which follows a line extending from a point just above the root of the nose to the
.most prominent portion of the occipital bone
The biparietal (9.5 cm), the greatest transverse diameter of the head, which extends
.from one parietal boss to the other
.The bitemporal (8.0 cm), the greatest distance between the two temporal sutures
The occipitomental (12.5 cm), from the chin to the most prominent portion of the
.occiput
The suboccipitobregmatic (9.5 cm), which follows a line drawn from the middle of the
large fontanel to the undersurface of the occipital bone just where it joins the nec
* Got face submentobreatic ( 9.5 cm )
129 - A Drug causes Abruption

130 - Most common presenting symptom

of vault prolaps Answer : bulge in vagina

131 - After sitting epidural ctg showing bradycardia for 2mins

Answer : i v Fluid +
lt lateral

In epidural any abnormal ctg 1st give fluid then

reasses as epidu cause hypotension

132- 28 yrs old female with 3 T1.

Risk of abortion in next pregnancy

Answer : 40%

If more : 60%
133 - PG 32wks with first episode of reduced fetal movements

1ST STEP DO
NOT JUMP
134 - Non hormonal HRT in postmenopausal women with h/o CA BREAST
Answer : ssri

Relieving menopausal symptoms without hormone therapy

If you are having trouble with menopause symptoms, talk to your doctor about other ways besides
PHT to help with specific symptoms.
Soy products: Some doctors have suggested that phytoestrogens (estrogen-like substances from
certain plant sources, such as soy products) may be safer than the estrogens used in PHT. Eating soy
foods seems to be safe for breast cancer survivors and might be helpful for some women, although
it’s not clear if it can help relieve menopause symptoms. Women can get higher doses of
phytoestrogens in some dietary supplements (such as soy or isoflavone supplements). However, not
enough information is available on these supplements to know for sure if they are safe and if they
work. If you are considering taking one of these supplements, be sure to talk with your doctor
Non-hormone medicines: Drugs without hormone properties that may be helpful in treating hot
flashes include :
The antidepressant venlafaxine (Effexor )
The blood pressure drug clonidine
The nerve drug gabapentin (Neurontin )
If you are taking tamoxifen, it's important to note that some antidepressants can interact with
tamoxifen and could make it less effective. Ask your doctor about any possible interactions between
tamoxifen and any drugs you are taking
Acupuncture: Some research has suggested that acupuncture might be helpful in treating hot flashes.
This might be another option to discuss with your doctor .

The SSRIs and SNRIs can reduce hot flashes by 65% and begin working within the first
week. Patient response is variable and if one drug does not improve hot flashes,
.another can be tried after a 1- to 2-week drug trial
135 - 135 Young Pt with 2ry amenorrhea with FSH 38
Answer : 1
1 - repeat FSH after 3-4 wks then start HRT

2 - karyotyping (with 20 yrs old) don’t give HRT

3 - start HRT then repeat FSH. X as HRT is not urgent to start 1st before
diagnosis

136 - PG during anomaly scan diagnosed with CDH..further management

options

1 - adv MRI to confirm and to decide further plan of management

Answer : 1
2 - ref to peadiatric surgen
 137 -..risk of ca ovary in BRCA1 in BRCA 2
Canser br. Double ( 60 – 90 ) &35 - 45

Answer : 35-45 BRCA 1 and 11- 27 BRCA 2

138 -In all types of vaginal delivery risk of sphincter injury

138 - n all types of vaginal delivery risk of sphincter injury

Answer : 2.9%

Nulli 6.3 ,multi 1.7 ……..…forceps 8 - 12 , ventose 1 – 4 ……..knot migration 7%

139 - Prevalance of OAB in Young
Answer :13 – 16%

)What is commonest type of incontinence in EUROPEAN WOMEN ( recall q)

SUI
140 - In polyhydromnios cause can be detected in
ANSWER : 50%

141 - Mod to Severe OHSS seen in

ANSWER : 3.1 – 8%
MILD 33%

15 20 % with IVF will have mild to moderate

3% required hospital admission

Incidence of thrombosis in ohhs is .7- 10%

Hyponateraemia in 56% of severe

142 - 2nd most common etiology in

POF

Family history, turner mosaics,

......... chemotherapy, surgical

FIRST – IDIOPATHIC ( AUTOIMMUNE )

ANSWER :XCHROMOSMAL AB.

( TURNER )

143 - Post dural puncture headache seen in

ANSWER : 0.5 - 2.5%
144 -.Post dural puncture headache
Answer: 7 – 10 days
typically last for
145 - mbrrace most common cause of

neurological death
Answer : ICH

146 - Mc cause of neurological death

in preecclapsia Answer : ICH

* Indirect causes = cardiac(23%)

147 - MBRRACE mc cause of direct
Answer : cardiac
and indirect
MBRRACE2016:
Indirect causes of death 59%
Indirect causes = cardiac(23%)... then
neurological decrease by 25% but not
statistically significant.... sepsis not changed
..apart of influenza has significantly changed
Direct causes of death = VTE (11%),,,, AFE,,,,
sucide,,, hge,,, hypertensive disorders is
lowest(<1 women / million dies from
preclamsia in UK where 100 /day died
globally
*? Whats the commonest cause in cardiac ARRHYTHMIAS

Most sudden cardiac deaths are caused by abnormal heart rhythms called arrhythmias.
The most common life-threatening arrhythmia is ventricular fibrillation, which is an
erratic, disorganized firing of impulses from the ventricles (the heart's lower
chambers).Feb 16, 2016
148 - Laparoscopic ureteric injury in severe endometriosis
Answer : 1 / 5 (20%)

Rates as low as 0.06% (of laparoscopic subtotal hysterectomies), and as high as 21% (of
.)deep infiltrating endometriosis associated with hydronephrosis

149 - young pt on DMPA came 3 wks late after her appointment .UPT -ve
.Answer: DMPA and additional CC for 7dys

150 - Pt on enzyme inducing drugs choice of CC ..COC/DMPA/POP [3i =

inj.,IUD,IUS] Answer : IUD , IUS , DMPA
3iii ( inj. Iud iusd )
151 - Pt on COC in 3rd week of pills had diarrhea for 1dy
Answer : Nothing if more than 24 h deal as misses pill

Reassure , if vomiting then repeat of PPV

153 –.calculation

Start by ( T)

154 -. Test to apply to reduce labour room admissions of preterm labour

Answer :Fetal fibronectin test
 The Abortion Act 1967
forms the basis on which legally TOP in UK. There are 7 Clauses or Grounds on
which legally TOP.

A: The continuation of pregnancy would involve risk to life of pregnant greater than TOP

B: TOP prevent grave permanent injury to the physical or mental health of the pregnant.

Note that no gestation age limit in Clauses A & B.

C: The pregnancy has NOT > 24th week and that the continuation of the pregnancy would
involve risk, greater than TOP, of injury to the physical or mental health of the pregnant
(includes GA up to 24 weeks + 0 days) This clause called ‘social’ abortions

D: The pregnancy has NOT > its 24th week and that the continuation of the pregnancy
would involve risk, greater than TOP, of injury to the physical or mental health of any
existing child(ren) of the family or of the pregnant (includes GA up to 24 weeks + 0 d)

E: There is a substantial risk that if the child were born, it would suffer from such physical
or mental abnormalities as to be seriously handicapped This clause forms the basis for
terminations for fetal abnormalities. NO GA LIMIT IN THIS CLAUSE.
F and G are for emergency terminations only.
F: To save the life of the pregnant ;
G: to prevent grave permanent injury to the physical or mental health of the pregnant

Vulvodynia
Localised provoked vulvodynia [vestibulodynia]
Aetiology
Likely to be multifactorial; a history of vulvovaginal candidiasis, usually recurrent, is
the most commonly reported feature
Symptoms
Vulval pain
frequently felt at the introitus at penetration during sexual intercourse or on
insertion of tampons
There is usually a long history
Signs
Focal tenderness elicited by gentle application of a cotton wool tip bud at the
introitus or around the clitoris
no signs of an acute inflammatory process
Complications
Sexual dysfunction
Psychological morbidity
Diagnosis
Clinical diagnosis made on history and examination
Management
no further ,
investigation is required
Recommended regimens
Avoidance of irritating factors
Use of emollient soap substitute
Topical local anaesthetics e.g. 5% lidocaine ointment or 2% lidocaine gel should be
used with caution as irritation may be caused. The applic ation should be made 15-
20 minutes prior to penetrative sex
Physical therapies
Pelvic floor muscle biofeedbac k
Vaginal transcutaneous electrical nerve stimulation [TENS]
Vaginal trainers
Cognitive behaviour therapy
Alternative Regimens
Pain modifiers – the benefit of drugs such as tricyclic antidepressants, gabapentin
and pregabalin is not clear. Amitriptyline gradually titrated from 10mg up to 100
mg according to response and side effects may be beneficial in some women
Surgery – Modified vestibulectomy may be considered in cases where other
measures have been unsuccessful
follow up
as clinically indicated
Un provoked Vulvodynia
Aetiology
is unknown and the condition is best managed as a chronic pain syndrome
Symptoms
Pain that is longstanding and unexplained
May be associated with urinary symptoms such as interstitial cystitis
Signs
The vulva appears normal
Complications
Sexual dysfunction Psychological morbidity
Diagnosis
Clinical diagnosis made on history and examination having excluded other causes
treatment
The British Society for the Study of Vulval Disease [BSSVD] recommends a
multidisciplinary approach to patient care and that combining treatments can be
helpful in dealing with different aspects of vulval pain
Treatment resistant unprovoked vulvodynia may require referral to a pain clinic.
Recommended regimens

Pain modifiers – tricyclic antidepressants are well established in chronic pain

management. amitriptyline is frequently first line treatment
If unresponsive or unable to tolerate the side effects, gabapentin or pregabalin58
may be used

Topical local anaesthetic e.g. 5% lidocaine ointment or 2% lidocaine gel . A trial of

local anaesthetic may be considered although irritation is a common side effect
Cognitive behavioural therapy and psychotherapy
Acupuncture
Follow up As clinically required
 with best wiches for all
dr / hamada said aborouh