This document discusses various contraceptive methods and their effectiveness. It provides data on typical and perfect use failure rates for different methods including condoms, oral contraceptives, IUDs, implants, injections, sterilization procedures and emergency contraception. The most effective long-acting reversible methods are IUDs and implants, with failure rates below 1%. The document also contains sample questions to assess knowledge of contraceptive options, their use, and management of any issues.
OSCE REVISION IN OBSTETRICS AND GYNECOLOGY 2015,NEARLY COVERING COURSE CURRICULUM .Prepared by Dr Manal Behery.Professor of OB&Gyne .Faculty of medicine,Zagazig University
OSCE REVISION IN OBSTETRICS AND GYNECOLOGY 2015,NEARLY COVERING COURSE CURRICULUM .Prepared by Dr Manal Behery.Professor of OB&Gyne .Faculty of medicine,Zagazig University
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Contraception is the only topic from which question appears in all pg entrance exam...so u need to be thorogh with it....I have created this ppt to simplify this topic to u...hope its useful...A.A.B
contraception is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
Anatomy of the breast for medical/dental students. This presentation also contains MCQs to test your knowledge as well as clinical scenario to apply your knowledge.
Also known as GP note, "Pol" note, PP note
Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.
Also known as GP note, "Pol" note, PP note
Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.
Also known as GP note, "Pol" note, PP note
Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.
Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.
The original teachings of Jesus Christ were an outcome of
Buddhism, says Holger Kersten, a German theology teacher.
Hence one of the titles of the chapters in his book, "The
Original Jesus" (sub-titled 'Buddhist sources of Christianity') is 'Jesus the Buddhist'!
Examination of lower limb in neurology-Short case approach for Final MBBSYapa
Examination of lower limb in neurology-medicine short case approach.
This document was prepared based on the teachings of Dr.Kahathuduwa.
Fonts in blue indicate sample way of presenting the case.
By: Ajaan Mahā Boowa Ñānasampanno
Translated by: Ajaan Paññāvaddho
A senior disciple of Ajaan Mun, Ajaan Khao Anālayo was one of the foremost meditation masters of our time. He always preferred to practice in remote, secluded locations and with such single-minded resolve that his diligence in that respect was unrivaled among his peers in the circle of Thai forest monks. In his frequent encounters with wild animals, Ajaan Khao exhibited a special affinity for elephants.
“The Gift of Dhamma Excels All Other Gifts”
—The Lord Buddha
Dhamma should not be sold like goods in the market place.
Permission to reproduce this publication in any way for free distribution,as a gift of Dhamma, is hereby granted and
no further permission need be obtained.
Reproduction in any way for commercial gain is strictly prohibited.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Q1
1. Identify A-G
2. Write the corresponding letters in
order of most effective method to
least effective method
3.
4.
5.
6.
7.
8.
9.
10. • A – Female condom
• B – Levonorgestrel releasing intra uterine contraceptive
device (Mirena®)
• C – Copper T-380 A intrauterine contraceptive device
• D - Depot medroxy progesterone acetate injectable
suspension
• E – Norplant subdermal contraceptive implant system
• F – Combined oral contraceptive pill
• G- Male condoms
E>B>F=D>C>G>A
11. % of women experiencing an
unintended pregnancy within the
first year of use
Method Typical use
1
Perfect use
2
No method
4
85 85
Withdrawal 27 4
Periodic abstinence
Calendar
Ovulation method
Sympto-thermal
6
Post-ovulation
25
9
3
2
1
Condom - Female 21 5
Condom - Male 15 2
Combined pill and minipill 8 0.3
DMPA (Depo-Provera) 3 0.3
IUD (copper T) 0.8 0.6
Mirena (LNG IUS) 0.1 0.1
LNG implants (Norplant) 0.05 0.05
Female sterilization 0.5 0.5
Male sterilization 0.15 0.10
Emergency contraceptive pills: Treatment initiated within 72 hours after unprotected
intercourse reduces the risk of pregnancy by at least 75%.
2
3
3
4
5
6
1
12. A) 21 yrs old unmarried girl presents to your clinic after having
unprotected sex last night. What method/s that you can use in
this patient as post-coital contraceptive method/s.
B) A 35 yrs old healthy woman with two children aged 3 & 5 yrs
requests an emergency contraceptive after unplanned coitus 4 days
ago. Name a method that you would offer to this woman.
Q2
13. A.
1 – Postinor2®
take one tab immediately and the second tablet 12 hrs later
2 – Combined oral contraceptive pill
Take 4 tablets immediately and repeat the same dose 12 hrs
later
B.
Copper T 380-A intrauterine contraceptive device
• A copper-releasing IUD (Cu-IUD) can be used within 5 days
of unprotected intercourse as an emergency contraceptive.
However, when the time of ovulation can be estimated, the
Cu-IUD can be inserted beyond 5 days after intercourse, if
necessary, as long as the insertion does not occur more than
5 days after ovulation.
14. Q3
1. How long can it be used
2. List 2 advices you would
give after inserting this to
a patient
3. What should you do if a
woman gets pregnant
after placing it
15. 1. 10 years (6-8)
2.
Expect some bleeding PV for a few days
Check for the presence of the threads (Specially during
menstruation period)
First 3-4 menstrual periods may be heavier than normal
Take paracetamol tablets if she develops lower abdominal pain.
Follow up – In one month and thereafter annually
Prompt medical advice should be taken if
- the threads are not felt
- delayed menstrual period (Pregnancy?)
- Severe abdominal pain Prolonged or excessive bleeding
16. 3. Cu-T Pregnant
• Exclude ectopic
• Counsel regarding risks
– Miscarriage
– Preterm delivery
– Infection
• Remove if threads +
• Advise prompt return for Rx of complications
(Bleeding, pain, discharge, fever etc)
If threads Neg.
- US Scan - identify in utero
- counsel
- check at delivery
- check Post partum - X’ Ray
17. • Timing of insertion
1st seven days of the cycle (Ideal during menstruation)
• Removal of IUD
pregnancy
Perforation
Acute PID
Menopause – one year after last period
• Absolute contraindications
Pregnancy
Acute/Chronic PID
Abnormal uterine bleeding
Suspected/confirmed genital tract malignancy
• What you should ask in the Hx:
LRMP – to rule out possibility of pregnancy
Mucopurulent vaginal discharge - ? PID
18. 1. Name above items and write one non-contraceptive
benefit of each above given methods
2. 30 yrs old female who is on OCP has forgotten to take
her last two pills. what advise would you give her?
Q4
19. 1)
A - Levonorgestrel releasing intra uterine contraceptive device (Mirena®)
B – Male condom
C – Combined oral contraceptive pills
2)
A- Improves menorrhagia
Decrease dysmenorrhoea and pelvic pain in patients with endometriosis
B- Protection against STD
Protection from carcinoma of the Cx
C- Relief of menstrual problems
Regularizes previously irregular cycles
Decrease number of days of bleeding and amount
Improves iron deficiency anaemia
Relieves and reduces premenstrual tension
Protection against ovarian and endometrial cancers
Decreases incidence of benign breast cysts and fibroadenoma
Prevent ectopic pregnancy
21. Q5
1. What is the
advice you would
give to the
patient when
prescribing this
2. List 3 Common
side effects
22. Advice
• Postinor contains two tabs. Treatment necessitate to take 2 tabs
• Reliable (75%) post coital contraceptive method if it takes <72 hrs
after unprotected sex
• 1st tab should be taken immediately. 2nd tab should be taken 12hrs
after the 1st dose
• If vomiting occurs within 2hrs of intake take another tab.
• Can cause irregularity to your next menstrual period
• Not a method of abortion
• No adverse effects to an already existing pregnancy
• Adverse effects – Nausia, Lower abd pain, breast tenderness,
Vomiting
• Consult a physician if you missed your next period
• Advise her about proper use of suitable contraceptive method
23. Q6
Mother giving breast milk to child,
looking far away
1. List 2 correct techniques when
breast feeding
2. List 2 maternal complications due to
incorrect technique of breast
feeding
24. • Correct technique:
a) Good exposure of both mother and baby.
b) Posture- Mother sitting comfortably. The baby
is held with his head ,neck and body in one line
supported by the mother’s forearm.
c) Good attachment- The areola covered by baby’s
mouth with the lower lip everted and cheeks
should be puffed out.
d) Eye contact to be maintained.
e) Each feed to be around 20 minutes.
• Maternal complications:
a) Cracked nipples
b) Breast abcess
25. Q 7
• How do you prepare a patient for
LSCS
• What are the complications of LSCS
26. • Consent
• Co-ordinative part- inform aneasthetist, PHO and theatre.
• Keep fasting 8 hours
• Investigations- Grp & DT( Reserve 1 unit)
• Pre-medication- Metachlopromide 10mg oral, Famotidine 20mg oral
• (Emergency- O2, IV Ranitidine 50mg, IV Metachlopromide 10mg, )
• Na Citrate 0.3M 30ml. Mother in left lateral position.
• Send Urinary cather, IV antibiotics ( Metronidazole 500 mg,
Cefuroxime 750 mg ( 1 vial each) to theatre.)
27. Complications of LSCS
• Anaesthetic – Gastric acid aspiration (
Mendelson’s synd)
• Immediate- PPH, shock, damage to
bladder, ureters or colon
• Early- Sepsis, Wound complications
(Haematoma, dehiscence)
• Late- risk of scar rupture in future
pregnancies, incisional hernia, intestinal
obstruction due to adhesions
28. Q8
Give 4 risk factors from this antenatal record (Two slides)
29.
30. • Short stature
• Previous death in-utero
• Previous miscarriages
• Blood pressure of 160/110
• Proteinuria
• Grand multi para
31. Q9
• Tick the items used in manual removal of placenta
1 Plasters
2 14G foley catheter
3 14G IV cannula
4 Vacuum cup
5 A pair of gloves
6 Cusco’s speculum
7 IV drip set
8 Vulsellum
9 IV metronidazole
10 Betadine
32. 1 Plasters
2 14G foley catheter
3 14G IV cannula
4 Vacuum cup
5 A pair of gloves
6 Cusco’s speculum
7 IV drip set
8 Vulsellum
9 IV metronidazole
10 Betadine
34. 1. Cusco’s bivalve self retaining vaginal
speculum
2.
• In obtaining a Pap smear
• In obtaining a high vaginal swab
• To visualize the cervix & vaginal wall in
pelvic examination
• Insertion /removal of IUCD
36. 1. Secondary arrest
2. CPD
OP position
Inadequate uterine contractions
Mx:
CPD – Em LSCS
OP position
Inadequate uterine contractions
Exclude obstruction
Increase oxytocin infusion rate
Observe and if no progression
Em LSCS
37. Q12 Write a clinical condition where
each of these drugs are used
38.
39.
40. Oxytocin
Augmentation of labour.
Active Mx of 3rd stage labour & control PPH.
Following evacuation of uterus.
Mg sulphate
As eclampsia prophylaxis.
Hydralazine
In Pre-eclampsia and eclampsia.
Ergometrine
Prophylaxis against excess heamorrhage foll. delivery
Therapeutic- In PPH: atonic uterine bleeding.
In atonic uterine bleeding foll. Miscarriage, expulsion of H.
mole.
41. • Q 13
• Counsel this 30 yrs old patient who is
diagnosed to have an incomplete
miscarriage
42. • Introduce yourself, put the patient at ease
• Explain what has happened ( Most miscarriages
are due to fetal anomalies, there is nothing that
she could have done to prevent the miscarriage )
• The need to undergo surgery ( Evacuation of
retained products under GA)
• Preparation for the next pregnancy – wait at least
3 months, during this period take folic acid
• Early antenatal clinic booking and regular follow
up.
• Ask whether patient has any questions to ask
43. • Q 14
• Ask 5 leading questions to determine
the severity of this patients
condition who has a blood pressure of
160/100 mmHg
46. Normozoospermia When all the spermatozoal parameters are normal
together with normal seminal plasma ,WBCs and
there is no agglutination.
Oligozoospermia When sperm concentration is < 20 million/ml.
Asthenozoospermia Fewer than 50% spermatozoa with forward
progression(categories (a) and (b) or fewer than 25%
spermatozoa with category (a) movement.
Teratozoospermia Fewer than 30% spermatozoa with normal
morphology.
Oligoasthenoteratozoospermia Signifies disturbance of all the three variables
(combination of only two prefixes may also be used).
Azoospermia No spermatozoa in the ejaculate.
Aspermia No ejaculate.
Leukocytospermia more than 1 million white blood cells per ml of semen
47. Normal values
Volume 2.0 ml or more
pH 7.2-7.8
Sperm concentration 20x106 spermatozoa/ml or more
Total sperm count 40x106 spermatozoa or more
Motility 50% or more with forward progression or
25% or more with rapid progression
within 60 min after collection
Morphology 30% or more with normal morphologyb
Vitality 75% or more live
White blood cells Fewer than 1x106/ml
48. • sensitivity of 89%, poor specificity
repeat semen samples provides
greater specificity.
• At least two samples, preferably
taken at least two or three weeks
apart, should be analyzed.
• Newly formation of sperm to transport
& to present in ejaculate, it takes ~74
days. Therefore ideally it has to be
repeated ~2-3 months later.
49. • Q16
• What is the advise you would give
regarding obtaining a semen sample
for analysis
50. • This test is conducted to check for male factor
subfertility.
• Specimen should be produced by masturbation.
• Abstinence from intercourse for 3-4 days.
• Condoms should not be used for collection as they contain
spermicide.
• Coitus interruptus is not recommended as the first part of
the ejaculate contains the highest concentration of sperm.
• Wide mouthed sterile plastic container will be provided.
• Sample should be delivered to the lab within 30 min. of
collection.
51. 1. Identify
2. List 3 prerequisites in using these instruments
3. Give 3 indications for these instruments
Q17
54. Always prior to applying forceps
1. Abd examination – Head engaged?
2. Confirm that the cervix is fully
dilated
3. Empty the bladder
4. Check station of the presenting
part
5. Position of the foetal skull –
Position of the saggital suture &
posterior fontanelle
55. Prerequisites for applying forceps
• Valid indication must be present
• Suitable presentation- vertex,face, aftercoming head of breech.
• Rule out cephalopelvic dispropotion.
• Engaged Presenting part. Position of the fetal head should be
known.
• Cervix should be fully dilated.
• Bladder emptied- preferably by catherisation.
• Ruptured membranes.
• Abdominally head should not be palpable. If more than 1/5th
palpable abandon vaginal delivery.
56. Indications for forceps delivery
1. Delay in progression of second stage of labour
2. Maternal exhaustion
3. Medical problems which require avoidance of
excessive maternal effort
4. Fetal distress in the second stage
5. Delivery of the after coming head of a breech
presentation
57. 1. Name the required instruments in order of use
when obtaining a pap smear
2. What is the fixative and the stain used
Q18
58. 1. F - Cusco’s bivalve self retaining vaginal
speculum
G - Ayre’s wooden spatula
B - Cytobrush/ Endocervical brush
A - Glass slides
2. Fixative – 95% Alcohol
Stain- Papanicolaou stain
(The glass slide is fixed in 95% alcohol for 30
minutes and air dried before sending to the
histology lab)
59. 1. Name 5 instruments in an episiotomy
set.
2. List 3 complications of an episiotomy
3. What are the advise given to mother
after repairing an episiotomy
Q19
60.
61.
62.
63.
64. Complications of episiotomy
– Immediate-
• Extension of the incision
- Early
• Vulval haematoma
• Infection
• Wound dehiscence
– Late
• Dyspareunia
65. Advise to mother following
episiotomy
• Keep the area dry and clean.
• Do not pull out the sutures, they are
absorbable (~3wk)
• Do not clean with hot water.
• Do not use antiseptics, soap is sufficient.
• Drink plenty of water, eat more
vegetables, fruits to avoid constipation
• Can wear a sanitary pad to keep area dry.
66. What instruments are used in
the following procedures in
order of use
1. Dilatation & Curettage
2. Repair of a cervical tear
Q20
67. 1. D&C :
• Performed under GA
• Placed in lithotomy position
• Local antiseptic cleaning & draping
• Empty bladder: using a metal catheter
• Sims’ double bladed posterior vaginal speculum is
introduced
• Anterior lip of cervix held by vulsellum
• Olive pointed malleable graduated metallic uterine
sound to confirm position & length of cavity
• Cervical canal dilated with Hegar’s graduated dilators
• Uterine curette – sharp end for benign lesions and
blunt end used for suspected malignant lesions
• Curetted material preserved in 10% formal saline and
sent to histology lab with a short clinical history.
68. Post procedure care:
• Give paracetamol 500 mg by mouth as needed.
• Oxytocin 10 U given foll. ERPC
• Offer other health services, if possible, including tetanus
prophylaxis, counselling or a family planning method.
• Advise the woman to watch for symptoms and signs requiring
immediate attention:
- prolonged cramping (more than a few days);
- prolonged bleeding (more than 2 weeks);
- bleeding more than normal menstrual bleeding;
- severe or increased pain;
- fever, chills or malaise;
- fainting.
69. Repair of a cervical tear
• Anaesthesia is not required for most cervical tears. For
tears that are high and extensive, give pethidine IM
• Good light source and patient is placed in lithotomy position.
• Sims’ speculum is introduced
• Gently grasp the cervix with Green armytage forceps. Apply
the forceps on both sides of the tear and gently pull in
various directions to see the entire cervix. There may be
several tears.
• Close the cervical tears with continuous chromic catgut (or
polyglycolic) suture starting at the apex (upper edge of
tear), which is often the source of bleeding.
77. Q 24 Identify following patterns of
abnormal progress in labor
78.
79. 1 2
1. Identify
2. Name which one you would use in the following
procedures
• To insert an IUCD
• In vaginal hysterectomy
• In D&C
• In obtaining a pap smear
• Repair of a cervical tear
Q25
80. • Cusco’s bivalve self retaining vaginal
speculum
a) Inserting an IUCD
b) Obtaining a pap smear
• Sims’ double bladed posterior vaginal
speculum
a) Vaginal hysterectomy
b) Dilatation and curettage
c) Repair of a cervical tear
85. Name of instrument – Ring pessary
Indications for use of vaginal pessary
a) Prolapse of uterus
b) urinary incontinence
c) cystocele
d) rectocele
Contraindications
a) Active infections of the pelvis or vagina, such as
vaginitis
b) Pelvic inflammatory disease
c) Patients who are noncompliant or unlikely to
follow up
d) Allergy to silicone or latex
86. Foetal movement chart
1. How to advise mother to maintain a
Foetal movement chart
2. When do you call it abnormal
3. List 3 causes for reduced FM
4. List 3 non invasive tests to assess
foetal well being
Q28
87. Test sensitive for fetal well-being after 28 weeks
Physiology of normal third trimester fetal movement
• Fetus spends 10% of its time making gross movements
– Active fetal periods last 40 minutes
– Inactive fetal periods last 20 minutes (<75 minutes)
• Fetal activity peaks with maternal Hypoglycaemia
– Usually occurs between 9 pm and 1 am
– Activity not increased after meals or glucose load
Advise to mother:
» Patient self monitors kick counts daily at home
» Count performed at same time every day
» Lie on left side in comfortable location
» Count fetal movements to a count of 10-12 in 12 hours
» If perceived movements are <10/12hrs seek medical
advise
88. Causes of reduced foetal movements:
• Normal sleep phase
• Physiological
• Reduced maternal perception
• Sedative drugs given to mother
• Polyhydramnion/oligo
• Intrauterine asphyxia
Non-invasive tests to assess foetal well being:
• CTG
• USS- foetal growth & Liquor., biophysical profile,
• Umbilical artery Doppler
89. Q29
A) What is the
condition
B) What is the
diagnosis
C) Give 2 causes
91. Presentation
1. Vaginal bleeding
2. Passage of vesicular
grape like structures per
vaginum
3. Hyperemesis
4. Early onset PIH
Examination findings
1. Anaemia
2. F>D
Investigations
1. USS abd.
2. S. hCG
3. CXR
Management
1. Evacuation
2. Follow up (2 yrs)- hCG
assays
3. Contraception
4. Chemotherapy +/-
•Absence of a foetus (In complete mole)
•“Snow Storm” appearance
92. Basal body temperature
chart (BBTC)
1. What is the day of ovulation
2. What advise you give on using this
3. On which day according to the chart would you do
the following
a. Post Coital Test
b. Progesterone levels to detect ovulation
c. Endometrial biopsy
d. HSG
e. IUI
Q30
95. 1. Day 14 of the cycle.
2. There is a biphasic pattern of variation in ovulatory cycle.
• Begin recording temp. on the first day of the period- day 1
on the chart.
• Measure the oral temp. using a clinical thermometer.
• Mark the date in the column and shade the area on the day
of menses.
• Take the oral temp daily on waking before getting out of
bed. ( do not wash mouth)
• Days when intercourse takes place should be noted with an
arrow.
96. a. Post Coital Test- day 12-13 in a regular
28 day cycle.
b. Progesterone levels to detect ovulation –
Day 21 in a 28 day cycle.
c. Endometrial biopsy- Day 21-23 in a 28
day cycle.
d. HSG- First 10 days of the cycle.
e. IUI- washed sperms are placed in the
uterine cavity at the time of ovulation.
Ovulation detected by follicular growth
monitoring by USS.
97. Note:
• These questions were given in the
past OSCEs in various medical
faculties.
• Original slides were modified in good
faith to provide updated & user
friendly presentation.
• Every effort is made to ensure
accuracy of the material. But the
practices can be slightly different.