495958952-Techno-Obstetric-sminiOSCE.pdf

Obs. & Gyne.
Past Years Mini-
OSCEs – Part 1
Collected by : Ghada odeh
Re-arranged by :du’a alkhader
/group B1

ANC in pregnancy
• Questions on US findings
• Questions on Physical examination findings

US pic for a 40YO pt known to have SLE, she’s
14wks pregnant presented with mild
vaginal bleeding.
1. What is your Dx?
2. Give 2 signs & Symptoms in the physical exam?
3. Give 2 risk factors for this pt.
Question

1. Blighted Ovum.
2. SGA, Minor abdominal cramps.
3. SLE, 40YO.
Answers

Question
1. What’s the sign indicated by the arrow?
2. Mention the most common association with this
sign?
3. What’s the overall risk of the association (in 2nd Q.)
in the population?
4. Mention 3 clinical presentation for this fetus.
7

1. Nuchal Translucency.
2. Trisomy21 (Down syndrome).
3. 1:650 for all maternal ages.
4. IUGR, Mal-presentation,
Polyhydramnios.
Answers
Rememberthat with Down’s syndrome there’s
also absent nasal bone.

30 YO pregnant lady,
she’s lactating her baby,
came for ANC at GA of
12wks.
1. What is the most
accurate measure
for GA at this age?
2. If GA was according to the above measure 9,
what’s the most probable cause for this
discrepancy ?
3. Give other 3 uses for US at this GA?
Question

Answers
1. CRL (crown-rump length).
2. Wrong date due to BREAST FEEDING.
3. A. Fetal viability.
B. Number of fetuses.
C. Adnexal mass.
>> congenitalchromosomalabnormality, amount of liquor,
lie, intra-uterineor extra-uterine, presentationall are
wrong answers!

G6P5+0 pt, her blood group (A-) & took
anti-D in her previous pregnancies,
came to you
at clinic at 11 wks of gestation.
1. How to confirm the gestationalage?
2. Give 2 related blood tests that you
will do for this pt.
3. At 15 wks we did amniocentesisfor
this pt, how to manage the pt after
that?
4. Give one important complicationthe
baby is at risk of.
Question

1. By CRL on US.
2. Indirect Coomb’s test, CBC &
others.
3. Give her anti-D.
4. Hydrops fetalis/ Down
syndrome.
Answers

A primigravidus lady in here 36wks GA &
she’s sure about the date. On Exam; it
was 32 cm Fundal height, her blood
pressure is 150/100.
1. What do u call this?
>> small for gestational age.
2. Mention 2 causes for it.
>> PET, chromosomal abnormalities.
3. Mention 2 main investigationsin the
assessmentfor this case.
>> Urine analysis and KFT, US.
Question

25 YO female came for booking
visit & her Hb=11 mg/dl,
rubella IgG titer= -ve, other
readings all was normal.
1. What’s the abnormal result ?
>> Rubella IgG.
2. What do you expect this
womanto have during
pregnancy?
>> Infection & baby developcongenital
rubella.
Question

Question
1. What’s your Dx? Stria GRAVIDARUM.
2. Mention2 medical causes.
>> Cushing’s syndrome, liver failure.
3. Mention2 obstetriccauses.
>> Polyhydroamnius, multiple pregnancy.
4. Whats the pt’s concern about the tt?
>> Cosmetic issue.

 A: Shoulder presentation.
 B: Frank breech presentation.
 C: Cord presentation.
17
Question

1. What’s the presentation in C? Frank Breech.
2. What’s the dominator in A? Chin.
3. What’s the position in B? Occipito-posterior.
4. If the cervix was fully dilated in A; how to deliver the
baby? Vaginally.
5. Mention one fetal cause of the presentation in A?
Neck swelling or masses.
Question

1. What maneuver does indicate each pic?
2. What’s the presentation if you find by
the exam in pic A that it’s firm &
pallotable?
3. Give 2 types of management for this
lady?
Question

Answers
1. A- Fundal grip.
B- Lateral grip.
2. Breech presentation.
3. 1- ECV.
2- Elective CS.

A female in the 1st stage of labor (4cm dilated &
membranes are ruptured) with this picture.
1. What’s your Dx? Transverse lie.
2. What’s the Main problem if this left untreated?
>> Uterine rupture.
3. What’s your management ? CS.
Question

1. What’s the problem in A?
Transverse lie.
2. If ROM in A, what’s the serous complication
that could happen?
Cord prolapse.
3. What’s the route of delivery in B? CS.
4. Incidenceof B?3-4% at term.
Question

1. What's the presentation in A?
2. Name a risk factor for this?
3. What’s the procedure in B?
4. When it should be done?
Question

1. Complete Breech (breech alone is wrong).
2. Placenta previa.
3. External Cephalic Version.
4. At term, or 37 weeks GA.
Answers

1. What’s the diameter in 1?
2. What’s the diameter in 5?
3. What’s the presentation in 1?
4. What’s the presentation in 5?
Question

Answers
1. Subocciptobregmatic (Don’t answer 9.5 cm).
2. Submentobregmatic(Don’t answer 9.5 cm).
3. Vertex cephalic presentation.
4. Face presentation.

1. What’s the presentation?
2. Cervix dilatation on picture?
3. Station?
4. How can you do induction for this lady?
5. Other indication of induction of labor ?
Question

Answers
1. Cephalic presentation.
2. No cervical dilatation.
3. -1 & above.
4. Per vaginal PG.
5. Post-Date.

Vaginal delivery(labor) and C/S

Question
1. What’s this stage of labor?
2. What’s the name of this procedure?
3. What’s the 1st step in this situation?
4. Mention 2 benefits regarding the previous
answer.

Answers
1. 3rd stage of labor (not stage 3).
2. Controlled cord traction.
3. Tocogens injection (Ergometrin,
Syntocinon).
4. Increases Uterine contractions,
Decreases postpartum bleeding.

1. What’s this stage?
2. What’s its duration?
3. What’s the 1st thing in its activemanagement?
4. When wouldyou start this management?
5. Mention2 complications of bad management?
Question

1. 3rd stage of labor.
2. Up to 30 minutes.
3. Administration of a uterotonic drug.
4. Delivery of the ant. Shoulder.
5. Uterine inversion, PPH.
Answers

This patient is a primi-gravida.
1. What are the stages of labor?
2. What’s the normal length of the stage in
picture A?
Question

Answers
1. A: Second stage of labor (not stage two).
B: First stage of labor (not stage one).
C: Third stage (not stage three).
2. 2 hrs max, 3 hrs in case of epidural.

Question
Pregnant lady in the 2nd stage of delivery.
1. What’s the best analgesia for her?
2. List 2 complications for it?
3. List 3 contraindications?
1. Epidural anesthesia.
2. Headache, Abscess.
3. Bleedingdisorder, Sepsis, Spinal Scoliosis.
Answers

About 3rd stage of labour
1) 3 signs of placental separation?
2) 2 lines of active management of this
stage?
Question
Answers
1) A- Globular uterus.
B- prolongation of the cord.
C- gush of blood.
2) A- Oxytocin.
B- Controlled cord traction (CCT).

Question
1. What’s the name of
this maneuver? McRoberts
Maneuver.
2. What’s it used for?
ShoulderDystocia.
3. Name one other maneuver you
can use if this fails.
Zavenelli, Woods', Rubin.

A pregnant lady presented in her
31 wk GA with abdominal
pain associated with cervical
dilatation 2-3 cm.
1. What’s your Dx?
>> Preterm labor.
2. What’s the most common
cause of this Dx?
>> Spontaneous in 70-80% .
3. What’s your management?
>> Admission, Prophylactic
antibiotics, Steroid, Tocolytics,
Monitoring of fetal wellbeing.
Question

Question
1. What is this procedure?
2. Mention 2 fetal elective indications.
3. Mention 2 intra-Op. complications.

Answers
1. Lower uterine segment Cesarean
Section.
2. Mal-presentation, Non-reassuring fetal
testing, Fetal anomaly, Multiple
pregnancy.
3. Organ injury (bladder, bowel, ureter),
Bleeding, uterine lacerations or atony.

Family planning and contraception

Name each one of these
hormones.
 Pink = Estradiol.
 Blue = LH.
 Green = Progesterone.
 Orange = FSH.
43
Question

Question
1. What’s the contraception method?
2. What’s its main component?
3. What’s the mechanism of action?
4. For how long is it effective?
5. Mention one side effect of it.
6. Mention side effect after removal of
this.
7. Mention one absolute
contraindication.

1. Implanon.
2. Etonogestrel (Progestin).
3. Continuous release of hormones
& so endometrial atrophy.
4. Up to 3-5 years.
5. Break-through bleeding,
Acne, …
6. Amenorrhea.
7. Pregnancy.
Answers

1. Which type of contraception?
2. What’s its components?
3. Adviseher how to use it.
4. If the lady uses OCP & she forgot to
take the pill last night, & she notices
that there are 4 pills in packet, what to
do?
Question

Answers
1. Patch.
2. Progesterone& estrogen.
3. One patch per week for 3
weeks, & a week off.
4. Take the pervious pill,
Discharge the old packet,
start the new packet, &
emergency contraception
(condoms,…etc).

Answers
1. Cu-releasing & Mirena.
2. Break-through bleeding.
3. Congenital uterine anomaly & active PID.
4. After 6 weeks.
1. What’s A & B?
2. What’s the major
withdrawal to use B?
3. Mention 2 absolute
contraindications?
4. When A can be first
used after delivery?
48
Question

1) Mention 2 side effects?
2) Mention 2 methods contain the
same active ingredient?
3) How to express the failure rate?
Question

1) A- Break through bleeding.
B- Acne.
2) A- Implants.
B- Injections.
3) Pearl index.
Answers

1. What’s this medication?
2. Mentionthe activecomponents (2 points).
3. What’s the content of the brown pills?
4. What’s the effect on the menstrual cycle (3
points).
5. Mentionanother 2 indicationfor it’s use.
Question

Answers
1. Combined Oral Contraceptive
Pills.
2. A. estrogen.
B. progesterone.
3. Placebo.
4. A. reduce amount of bleeding.
B. reduce pain / dysmenorrhea.
C. regulate cycles.
(don’t write it will inhibit ovulation,it’s wrong)
5. Endometriosis,
Hyperandrogenism.

1. What’s the compositionof
each type?
2. Mention2 conditionswhere
A can be used in advance to
B?
3. Mention2 advantages of B
over A.
Question

1. A: progesterone only.
B: synthetic estrogen &
progesterone derivatives
(ethinylestradiol &
levonorgestrel).
2. Breastfeeding, DM & CVS
diseases.
3. Reduce functional ovarian
cysts, Reduce ovarian &
endometrial CA, Reduce PID.
Answers

1. What's the name of this device (no abbreviations)?
2. Give 2 absolute contraindications?
3. On follow-up; the pt was found to be 10wks
pregnant, what's your next step?
4. What’s the pearl index for it?
5. What’s the main mechanism of action?
6. What’s the best time to introduce it?
Question

1. Copper Intrauterine Contraceptive
Device.
2. Suspected or known pregnancy, uterine
anomalies, active PID, copper allergy.
3. Remove the device.
4. 1-2%.
5. Interfere with fertilization unless it’s
used as emergency contraception; it
prevents the implantation.
6. During menstruation (5th day of the
cycle).
Answers

1. What do we call this? Mirena (levonorgestral).
2. What’s the active ingredient? Progesterone.
3. Give 2 mechanisms of action.
>> Endometrial thinning / Increase cervical mucous to
prevent sperm passage / Inhibit ovulation.
4. What is it used for?
>> Contraception, Treatment of menorrhagia.
Question

1. What’sthe condition? IUCDPerforation
2. What do expect to see on speculum exam?
>> Loss of the thread from the vagina.
3. When do expect this problem to happen?
>> Usually it happensduringinsertion.
Question

Pic of Twins at 12 wks of GA.
1. What is your Dx?
2. What’s the most commontype?
3. Mention2 risk factors?
4. Mention2 maternal complicationat this
age?
Question

1. Twins.
2. Dichorionic Diamniotic.
3. Increase maternal age & Multi-parity,
Family history.
4. Miscarriage, Hyperemesis gravidarum.

Lambda signs in dichorionic diamniotic
Monochorionic Monoamniotic Vs. Monochorionic Diamniotic

A 36 wks pregnant lady came to labor with
the following pic.
1. What’s your Dx (& what type)?
2. What’s the presentation of these twins?
3. How you would deliver her?
4. What’s the main maternal postpartum complication?
Question

Answers
1. Diamniotic Dichorionic Twins.
2. CephalicCephalic.
3. Vaginally.
4. Primary PPH.

G2P1, 32 wks pregnant, her previous pregnancy
ended at 35 wks., comes with regular
contractions.
1) What’s your provisionalDx.?
2) 2 risk factors in this case?
3) 2 medications that are given in this situation?
Question

1) Preterm Labour.
2) Multiple gestation (twins), & previous
preterm labour.
3) Dexamethazone, & tocolytics.
Answers

1. Identifythis US.
2. What’s the incidenceof these conditions.
3. What complications are associatedwiththis
condition?
4. What conditionsare at increased incidence
of this?
Question

1. Multiple gestations: triplet, twin.
2. Hellin’s rule (1:80 n-1):
1. triplet 1:6400.
2. twin 1:80.
3. Fetal: miscarriage, preterm, IUGR, fetal
abnormalities, fetal death.
Maternal: HTN, GDM, anemia, APH,
Amniotic fluid embolism, PPH,
hyperemesis gravidarum …(more of
every thing!).
4. Artificial ovulation, ART, previous Hx.,
family Hx.
Answers

1. What type of twins is this?
2. Name the sign marked by an arrow?
3. What’s the common cause of mortality in this
case?
4. Mention one factor that cause this condition.
5. When can you specifically determine type of
twins?
Question

1. Dichorionic Diamniotic.
2. Lamba sign.
3. Prematurity.
4. IVF.
5. Late in 1st trimester.
Answers

Bleeding in pregnancy
early :abortion and ectopic pregnancy
late :Antepartum haemorrhage(PP and
AP)

Question
A: Threatened
abortion.
B: Inevitable
abortion.
C: Incomplete
abortion.
D: Missed
abortion

These females presentedto you with vaginal
bleeding at GA of 10wks,& you diagnosed
them as following:
 A: Threatened abortion.
 B: Inevitable abortion.
 C: Incompleteabortion.
Question

Young lady had 3 recurrent miscarriages, all lab
results are normal.
1. What’s your Dx.?
2. Give a predictive indicator (prognostic factor)?
3. Other 2 investigations?
4. Management?
Question
1. Unexplained infertility.
2. Age of the patient.
3. HSG, Laparoscopy.
4. Supportive, Progesterone & Beta-HCG.
This Q. was bonus! No body answers it completely, or even knows what’s the point
from question!
Answers

12 wks GA, sure for date, singleton, with
2h mild vaginal bleeding, general
condition is good with normal vital
Signs.
1) What’s the most likely Dx.?
2) 2 gynecologic findings that support the
Dx.?
3) How to confirm your Dx.?
4) How do you expect the outcome of the
pregnancy will be?
Question

1) Threatened Abortion.
2) A- Closed cervix.
B- Correct uterus size for age.
3) +ve fetal heart beat on US (important tosay
+ve fetal heart).
4) Good outcome, >90% of cases complete
the pregnancy normally.
Answers

G2P0+1 came to the clinic at 12wks GA,
complaining of mild vaginal spotting.
on US the fetus was consistent with 10wKs
& no fetal heart beat.
1. What's the Dx?
2. Mention one drug used in the medical
management?
3. Mention 2 complications of the surgical
management?
Question

1. Missed abortion, or early fetal demise.
2. Misoprostol.
3. Asherman's syndrome, cervical
incompetence …etc.
Answers

30 YO pt G5P2+2, 10wks GA. Her 1st
delivery was at 36th week, 2nd
delivery was at 32th week, the 3rd
pregnancy ended with
miscarriage, & the 4th pregnancy
was miscarriage at 21th week of
gestation.
1. What’s the Dx?
2. What’s the most probable cause?
3. How you can confirm your Dx?
4. What’s the tt in next pregnancy,
& when you should perform it?
Question

Answers
1. Secondary recurrent
miscarriage.
2. Cervical incompetence.
3. By trans-vaginal US.
4. Cervical cerculage at 14week
of gestation.

28 YO lady, 10 wks GA, presented to ER with
heavy vaginal bleeding & passage of
some conceptusmaterial.
>> Incomplete Miscarriage.
2. Give ONE lab (investigation)can be done
to confirm your Dx?
>> US.
3. Give 3 main principles for treatment.
1. Resuscitation of the pt (ABC, IV Fluids, …).
2. D&C.
3. Contraception to optimize the next
pregnancy.
82
Question

A multi-para pregnant woman 12 GA,
blood group B-, her husband’s
blood group is B+, diagnosed to
have threatened abortion, initial
investigations were done to her,
& here are the results:
Hb 12 gm/dl, platelets 120, Blood
glucose 6.5mmol/L.
1. What you want to do for her? (2
things).
2. What’s the great complication
May it happen to this pt?
3. How do you think this women will
present during the antenatal
period?
Question

Answers
1. Anti-D, Progesterone & hCG,
Husband genotype,
Antibodies screening every
4 weeks (indirect coombs
test).
2. Hydrops fetalis.
3. Fetal anemia, Fetal
generalized edema, fetal
ascites, IUFD (not sure!).

Question
1. What is your Dx.?
2. Mention 2 modalities of treatment?
3. Mention one complicationfor each modality?
This TVUS was done for 6-wks pregnant lady who
presented with abdominalpain & vaginal
spotting with b-HCG of 3500, & she was stable.

Answers
1. Ectopicpregnancy.
2. - Medical (methotrexate).
- Surgical(laparoscopy with salpingectomy/
salpingostomy).
3. Medical: Liver toxicity,Nausea,Vomiting.
Surgical:Adhesions.

This US is for a P6 lady, last one by CS, came with
4wks of amenorrhea & vaginalbleeding with
positive pregnancy test.
1. What’s your primary Dx?
2. Give 2 investigations/procedures to confirm Dx.
3. Give 2 risk factors in this pt.
Question

1. Ectopic pregnancy.
2. Serial β-hCG, laparoscopy. (Diagnosed by B-hCG
>1500 mU & -ve VaginalUS).
3. IUCD, previous CS.
Answers

A 28 YO, 13wks GA, presented with vaginal
bleeding, she's stable.
1. Mention 3 DDx?
>> Ectopic pregnancy, missed miscarriage, blighted ovum.
2. Mention 2 tests you want to order?
>> Serum B-hCG, Serum Progesterone.
Question

A lady complaining of amenorrhea for 4
wks was using mini pills, presented to ER
with severe lower abdominal pain.
2. What’s the risk
factor she has?
3. Where is it located?
4. Mention other
locations?
Question

Answers
1. Ectopic pregnancy.
2. Mini pills.
3. Fallopian tube.
4. Abdomen, cervix, ovary (any one is correct).

A Woman P1 +1 (a previous CS), with
IUCD in situbefore pregnancy,
presented complainingfrom
lower abdominal pain followed
by vaginal bleeding, her urine
pregnancy test was positive.
1. What’s the most possible Dx.?
2. What most important
investigations you want to do for
her? (2 things).
3. Name 2 predisposing factors for
her condition.
Question

Answers
1. Ectopic Pregnancy.
2. Trans-vaginal US, Serial B-
hCG.
3. IUCD, Previous CS.

Antepartum Hemorrhage(PP and AP)

35 YO pregnant lady, G6p5,
had previously 2 C/S.
1. What's your Dx.?
2. Mention2 risk factors in
this pt.
3. What’s the classical
presentationfor it?
4. Mention 1 major
complication?
Question

Answers
1. Placenta previa (there was no mark on totalis).
2. A. previous CS.
B. grand multipara.
3. Painless vaginal bleeding (painless has ½ the
mark).
4. PPH, Malpresentation.

Transverse lie at 32 weeks GA.
2. Mention 2 risk factors.
3. What’s the most commoncause of perinatal
mortality?
4. Mention2 complications.
Question

1. Placenta Previa with Transverse lie.
2. Placenta Previa & Tumor.
3. Prematurity.
4. Obstructed labor, Cord prolapse.
Answers

1. Name 2 abnormalities
in the picture.
2. How do you deliver
her?
3. What’s the main
maternal
complication?
4. What’s the main fetal
complication?
Question

1. Low-laying placenta (placenta previa
totalis), Breech presentation.
2. By Elective CS.
3. Hypovolemic shock.
4. Prematurity.
Answers

35 YO pregnant, known to have
polyhydromnios,comes chiefly complaining
of vaginal leakage followedby vaginal
bleeding & abdominal pain.
1. What’s the cause of
her bleeding?
2. 2 risk factors for her
bleeding?
3. 2 complications on
her?
Question

1. Placental Abruption.
2. A- Polyhydramnios.
B- Multi-parity.
C- Age.
3. PPH, DIC.
Answers

40 YO, G4P3, 38wks GA, known to have poly-
hydramnios came due to passageof watery
vaginal discharge. Followed by vaginal
bleeding & abdominal pain.
1. What's the cause of the vaginal bleeding?
>> Placental abruption.
2. Give 2 risk factors for the bleeding?
>> Old age, PROM, Polhydramnios, Multiparity.
3. What's the main complication after
delivery?
>> Primary Postpartum Hemorrhage (PPH alone is
wrong).
Question

38 YO pregnant lady with HTN & Hx of
abruption placenta in the last
pregnancy presented with heavy
vaginal bleeding in the 3rd
trimester.
1. Mention 2 risk factors in this pt.
>> Previous abruption, HTN.
2. Mention 2 maternal complications
other than blood loss.
>> DIC, renal damage.
3. What’s the main fetal
complication?
>> Fetal distress or IUFD.
Question

Question
A P6 pregnant lady delivered by vaginal delivery at
36wks after presentation with vaginal bleeding
& abdominalpain. The picture is of
her placenta after delivery.
2. What’s the complication may occur after delivery?
3. Give 2 risk factors & 2 causes.
4. What are the fetal complications?

1. Placental abruption.
2. PPH.
3. Risk factors: Multi-parity,
HTN. Causes: Trauma, PET.
4. IUGR, Fetal distress &
death.
Answers

A G6P5 lady delivered a 4kg baby with
forcipes & lost 800 ml blood.
1. What’s your Dx? Primary PPH
2. Mention 2 possible causes.
1. Trauma.
2. Utrine atony.
3. Mention 2 possible risks from the Hx.
1. Large baby (risk of uterine atony).
2. Multiparity (risk of uterine atony & trauma).
3. Instrumental delivery (risk of trauma).
Question

Question
Grand multi-para had prolonged
labor 10 days ago & had CS, now
came to your clinic with severe
vaginal bleeding.
1. What is your Dx?
2. What is the cause?
3. Name the 2 most important investigationsto
be done?
4. Name 2 risk factors for the conditionabove.
110

1. Secondary post-partum hemorrhage .
2. Endometritis
3. Speculum exam: High Vaginal Swab, US,
CBC.
4. Prolonged labor, CS.
111
Answers

A pregnant female (twin pregnancy) presented
with a BP 160/90 & was induced by Oxytocin,
then
she was delivered. Presented then with vaginal
bleeding within (I couldn’t remember the
duration
but for sure < 24 hour), on inspection there are
no
laceration, blood is clotting.
With palpation the uteruswas above the
umbilicus.
1. What’syour Dx? Primary PPH.
2. What’sthe cause for the above? Uterine
Atony.
3. What’sthe cause for the above? Multiple
Gestation.
Question

Question
1. Name the instruments.
2. Mention 2 procedures that can be done by them
or (some) of them.
3. What is (D) used for?
4. Give 2 immediate& one late complications.
5. Mention 2 intra-operationsteps you should do.

Answers
1. A. Uterine curette.
B. Tenaculum.
C. Cervical dilator (Higar’s).
D. Uterine sound.
E. Sim’s speculum.
2. Dilatation& curettage,Evacuation&
curettage,Insertionof an IUCD. (note that if
there’s no cervical dilator, don’tanswer D&C).
3. Uterine depth & position.
4. Immediate:perforation,bleeding.
Late: Adhesions,Infection.
5. Emptying bladder, Bimanualexamination.
115

Answers
1. Kielland Forceps.
2. Rotation & traction.
3. Sliding Lock, shoulder.
4. Fixation, so blades can’t open beyond handle
closure limit.
1. What’s the name of this
instrument?
2. What’s the main use of it?
3. What are the parts
indicated by A & B?
4. What’s the functionof A?
116
Question

Question
1. What’s the name of the
instrument?
2. What’s its main use?
3. Mention another
instrument of the same
use.
4. What are the parts
indicated by A & B.

Answers
1. Tractional forceps.
2. Assisted (instrumental) vaginal
delivery.
3. Vacuum tractor.
4. A. Shank. B. Blade.

Question
1. What’s the name of this instrument?
>> Simpsons Forceps.
2. Name A & B parts.
>> A: Cephalic Curve, B: Shank.
3. What’s it used for?
>> Traction of the fetus.
4. Name other instrument can be used for
the same purpose.
>> Vacuum Extractor.

Question
1. What’s the name of this instrument?
>> Amnion-hook.
2. Why it’s used?
>> ArtificialRupture of membrane.
3. What’s the most important complication?
>> Cord prolapse.
4. Name 2 steps you would do to identify this
complication.
>> PV, Fetal CTG.

Question
1. Name the test?
2. What’s the benefit from this test?
3. Name A, B, & C.

Answers
1. Pap smear.
2. Screening test to early detect precancerous
cervical lesions.
3. A. Bivalve speculum.
B. Spatula.
C. Posteriorlip of the cervix (to take the
biopsy from Transformationzone).

1. What is A,B,C?
2. Give alternative to A? & What’s it used
for?
3. A pap smear was done for a pt, showing
(HSIL), what’s the next step?
124
Question

Answers
1. A. Conventional pap smear.
B. Colposcopy.
C. Cold knife conization .
2. Liquid based pap smear, used to
screen for cervical CA (to detect the
pre-cancerous lesion CIN).
3. Immediate referral to colposcopy,
take punch biopsy +/- endocervical
curettage.
125

Question
1. What is A , B?
2. List 2 procedures in which A is
used ?
3. List 2 conditionsin which B is
used?
1. A. Uterine sound. B. Mirena.
2. A. D&C. B. IUCD insertion.
3. A. DUB. B. Contraception.
A
B
Answers

Question
1. Name these instrument?
A: Plastic vacuum, B: metallic vacuum, C: Rotational
Forceps.
2. Give one specific complicationof it.
>> Cephalohematoma.
3. In which presentationwe can use it?
>> Breach presentation.
Note: Vacuum,we just use it in cephalic vertex, but the forceps can be
used in any cephalic presentation.

Infertility case.
1) What we call this test?
2) Alternative procedure?
3) 2 causes of infertility can be diagnosed in
this procedure?
Question

1) Laparoscopy with methylene blue dye
test (Dye test for tubal patency).
2) HSG (Hysterosalpingogram).
3) Endometriosis, PID, PCOS, …
Answers

1. Mention the name of this technique.
>> ICSI.
2. What’s the MAIN absolute indication
to do it?
>> Severe Male infertility.
3. What’s the most important evidence
that it will be successful?
>> Division of the cells.
Question

A couplenever ever had baby for
many yrs (since marriage), with
data for Semen Analysis & level
Of LH = 300.
1. What’s the Dx? Primary
Infertility.
2. Does the level of LH ensure that
there is Ovulation?NO.
3. What’s your Management? IVF.
Question

Medical disorders of pregnancy

A 6wks GA pregnant female came with +ve family
Hx. of DM.
1. What’s the best test for screening?
2. When shouldthis screening test be performed?
3. What possible fetal complicationsthat may
happen?
1. 50 g Challenge test
2. 24-28 weeks of Gestation (we can do screening test now in the 1st
visit because this pt has risk factor for GDM).
3. Macrosomia, congenital anomalies.
Question
Answers

A pregnant female, GA 30wks,came with poly-
hydromnios,her previous ANC records
were uneventful.Her mother have DM &
on oral hypoglycemic agent.
>> Gestational diabetes (GDM).
2. What test you will order?
>> OGTT.
3. What complicationmay occur secondary to
this problem?
>> Macrosomia, shoulder dystocia.
Question

29 YO female, known case of insulin-
dependent DM, normotensive,
planning to get pregnant.
1) 2 clinical baseline assessments?
2) 2 baseline investigations?
Question
Answers
1) Ophthalmic examination & Neurological
assessment.
2) HbA1c & urine analysis (or KFT).

A pregnant diabetic lady with HbA1c: (7.5).
2-hours post-prandial: (10.5).
>> Poorly controlled diabetes.
2. If it continues like this, what would
happen to the baby?
1. Macrosomia.
2. Fetal hydrops.
3. Shoulder dyctocia.
Question

A woman with DM & she’s on oral
hypoglycemic agents, her HBA1c is > 8%
she wants to get pregnant.
1. What’s your interpretation of this woman?
>> Poorly controlled or uncontrolled diabetes.
2. What’s the main 2 congenital anomalies for her fetus?
1. CNS anomalies.
2. CVS anomalies.
3. Mention 2 advices for this woman?
1. Shift to insulin.
2. Take folic acid.
Question

A pregnant lady known to have
chronic DM, presented at
32wks GA to the ANC.
1. Give 3 investigations you do
for her other than glucose?
>> CBC, Urine dipstick, urine analysis.
2. Give 2 signs for bad control?
>> IUFD, polyhydraminos.
Question

35 YO female 20 wks of gestation, came to
antenatal care unit complaining
from severe headache with blurred vision.
1. What’s your primary suspicion Dx?
>> Severe PET.
2. Mention 2 immediate testes to
confirm this Dx.
1. Measuring the blood pressure.
2. Urine dipstick for proteinuria.
3. Mention 2 complications the pt is at
risk of.
1. Eclampsia.
2. Others(placentaabruption, DIC).
Question

A 36 YO P1 was delivered at 34 wks
because the mother complained
of eclampsia.
Pt is 32 wks now presented with BP
of 140/90 & 500 proteinuria.
1. What’ s your Dx?
>> Mild Pre-eclampsia.
2. Give 2 symptoms of the severe
case?
>> SOB, RUQ Pain.
3. Give 2 risk factors for this pt.
>> Age > 35, Previous eclampsia Hx.
4. Give 2 signs in the physical exam?
>> Face Swelling, Increased BP.
Question

A 23 YO pregnant lady of 32 GA
came to your clinic with BP of
154/96 & Protein +1 & mild
headache.
1. What’ s your Dx?
>> Mild Pre-eclampsia.
2. Mention 3 Blood
investigations.
>> CBC, KFT, LFT.
3. What abnormal findings
you will find in the above
Tests?
>> High PCV(hemoconcentration), high
BUN & Cr, elevated liver enzymes.
Question

Answers
A primi-gravid 26 YO female with
35wks GA, came to the ER with
tonic clonic movement, her BP
was 170/110.
1. What’s the Dx?
2. Mention 3 modalities of tt.
1. Eclampsia.
2. Blood pressure stabilization,
Control convulsions with MgSO4,
Immediate delivery.
Question

30 week pregnant lady, on ANC; it’s found
that her BP is 150/90, on urine collection
protein = 400mg/24h.
2. Give 2 specific investigations you would
order?
3. Give 2 fetal complications?
Question

Answers
1. PET (preeclampsia).
2. LFT, KFT, CBC & PLT count, Uric acid
level.
3. IUGR, IUFD, prematurity.

25 YO primi-gravida, come with headache &
blurred vision,BP 160/110 & proteinurea
+4 by dipstick.Her bookingBP was 110/70.
1. What's the Dx?
2. What are the main 3 lab tests to order?
3. What’s your management? (2 points).
1. SEVERE pre-eclampsia(wrong without severe).
2. CBC, KFT, LFT.
3. Stabilize the pt, then Induce labor.
Question
Answers

28 wks pregnant came to the clinic with the
following lab results; Hb: 8, MCV: 75,
Hct 23, …
1. What's the most probable cause ?
2. Give 2 other tests to confirm the Dx.?
3. What's your first line treatment?
Question
1. Iron deficiency anemia.
2. Serum ferritin, Total Iron Binding Capacity
(Blood film is wrong).
3. ORAL iron supplementation (iron alone is
wrong).
Answers

A Pregnant lady with (A-) blood group & Rh. &
other lab tests were shown, all were
normal.
1. Which of the previous tests needs further
investigation?
>> The blood Rh.
2. What would you do?
1. Indirect coombs.
2. Husband blood group.
3. What complicationof the baby would occur if
not managed well?
>> Hydrops fetalis, Fetal anemia.
Question

There was a table with antiphospholipid,
anticardiolipin antibodies, Protein C &
Factor V leiden values,
antiphosopholipid & anticardiolepin
values were elevated.
1. What is the Dx.? Antiphospholipid
Synd.
2. Mention 3 obstetricalcomplications.
>> Recurrentmiscarriages,Earlyonset PET,
IUGR, IUFD, venous& arterial
thrombosis.
3. What is the best tt during pregnancy?
1. LMWH.
2. Low doseaspirin.
Question

Lab results for pregnant with
anemia.
1. What’s your Dx.?
>> Macrocytic Norchromic Anemia.
2. Mention2 causes.
>> Vit.B12 deficiency, Folate deficiency.
3. Mention2 risk factors.
>> Anti-convulsions drugs, Vegetarian.
Question

28 YO multi-para,vegetarian, 24 wks GA,
presented with SOB & fatigue. Her
Hb=9mg/dl.
1. What are the most 2 possible types of
anemia she could have?
>> IDA, Vit.B12 deficiency anemia.
2. Give 3 lab investigations to confirm
your Dx with their results.
1. Serum feritin (decreased in IDA).
2. Vit.B12 level (decreased).
3. TIBC (increased in IDA).
151
Question

Question
A female pt presents for antenatal testing at
10wks,on investigationshe has the all
results normal except a platelet count of
75,000.
1. What is the abnormal result?
Thrombocytopenia
2. What’s the Dx?
Idiopathic Thrombocytopenic Purpura (ITP)
3. Name two lines of treatment.
Steroid, IVIG.

A pregnant lady during her routine antenatal visits,her
lab tests were as following:
- HB 12 g/dl. - Urine bacteria >100 000.
- BP. 115/78 - Glucose100 mg/dl
>> Asymptomatic bacteriuria.
2. What’s the tt?
>> Oral antibiotics.
3. What are the complicationsthat may develop due
to this Dx?
>> Pyelonephritis, acute cystitis, PTL, Miscarriage.
Question

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