GYNAE & OBS SOLVED OSPE 9TH & 10TH SEMESTER

STATION NO: 01 (CA ENDOMETRIUM)

- SCENARIO:
 A 65-years old para 1+0 presented with irregular vaginal bleeding for last 01 year. She
underwent diagnostic D & C and histopathology report turns back as carcinoma of
endometrium.

1. Name three risk factors for this condition.

 Obesity, diabetes, nulliparity, late menopause > 52 years, hormone replacement therapy.

2. Write down stages of this condition.

 According to FIGO classification:
- Stage-I  Cancer confined to uterine body
- Stage-Ia  Less than 50% invasion
- Stage-Ib  More than 50 % invasion

3. What modality is used to stage the disease prior to surgery?

 Magnetic resonance imaging (MRI) is used for determining the extent of the disease i.e.
Stage.

4. What is the treatment options for this condition?

 Surgery (Total hysterectomy & bilateral salpingectomy)
 Radical hysterectomy with pelvic node dissection
 Debulking surgery for advanced cancer
 Postoperative radiotherapy
 Chemotherapy.

STATION NO: 02 (PARTOGRAM)

- SCENARIO:
 Mrs Razia wife of Aslam, gravida 2nd para 01 is in labour since 09:00 a.m.

1. What is your diagnosis according to this partogram?



2. What is the fetal heart rate at 11:00 am?



3. What was the dilatation of the cervix at 11:00 am, 2:00 pm & 5:00 pm?


4. How much is head palpable abdominal at admission & at 5:00 pm?


 STATION NO: 03 (HMB)
- SCENARIO:
 A 46-years old nulliparous patient attends gynae OPD with history of having prolonged
periods for 01 year. She is pale, her cycle is of 10 days duration & comes after every 30-40
days.

1. What is the differential diagnosis?

 Endometrial or cervical polyp
 Pelvic inflammatory disease
 Coagulation disorder
 Fibroids
 Thyroid disease.

2. Give at least 02 investigations to confirm the diagnosis.

 1) Full blood count, 2) Coagulation screen, 3) Pelvic ultrasound, 4) Endometrial biopsy.

3. Write at least 02 treatment options of this condition.

 1) Mefenamic acid & other NSAIDs, 2) Tranexamic acid, 3) Combined oral contraceptive
pills, 4) Endometrial ablation.

STATION NO: 04 (ANENCEPHALY)

- LOOK AT THE PICTURE AND ANSWER THE QUESTIONS

1. Name the condition shown in the picture.

 Anencephaly.

2. What type of anomaly is this?

 Neural tube defect.

3. What is the most probable cause for this anomaly?

 Failure of the neural tube to close due to lack of folic acid.

4. How this condition can be prevented?

 400 mcg folic acid should be given at least 03 months before conception and for 1st trimester
of pregnancy.

5. What is the recurrence rate of this condition?

 5-10% if parent or sibling has had NTD (neural tube defect).
 STATION NO: 05 (UTEROVAGINAL PROLAPSE)
- SCENARIO:
 A 65-year old para 07+0, presented with third degree utero-vaginal prolapse.

1. What could be the probable cause of prolapse in this case?

 Parity & age.

2. What is the operation of choice for her?

 Hysterectomy.

3. What other surgical options are available?

 1) Manchester (Fothergill) repair, 2) Sacrohysteropexy, 3) Sacrocolpoplexy

4. Write down at least 02 complications of vaginal surgery.

 1) Bleeding, 2) Pain, 3) Infection, 4) Hematoma formation.

STATION NO: 06 (PLACENTAL ABRUPTION)

- SCENARIO:
 A 28-years old gravida 06, para 05, came in emergency at 33 weeks of gestational
amenorrhea with complaint of pain in abdomen & moderate bleeding per since vagina 02
hours.

1. What is the most likely diagnosis?

 Placental abruption.

2. What are the causes of vaginal bleeding PV in this patient?

 1) Placenta previa, 2) Vasa previa, 3) Carcinoma of cervix.

3. What investigations will you ask to confirm the diagnosis?

 1) Ultrasound, 2) Biopsy, 3) Chest X-ray, 4) CT, 5) MRI.

4. How will you manage this patient?

 1) Cesarean section, 2) Vaginal delivery.

STATION NO: 07 (ORAL CONTRACEPTIVE PILLS)

- LOOK AT THE OBJECT & ANSWER THE QUESTIONS.

1. Identify the object which is shown in the picture.

 Combined oral contraceptive pills.

2. What are the contents used in this object?

 Combination of a synthetic estrogen & progesterone.
3. What is the mode of action of these pills?
 Inhibition of ovulation via negative feedback inhibition of estrogen & progesterone.

4. What is the failure rate of these pills?

 0.1-1 /100 women year.

5. Give at least 03 contraindications of these pills.

 1) Hypertension (160/100 mmHg), 2) Cerebrovascular accident, 3) Myocardial infarction,
4) Migraine with aura.

6. What is the duration for which it is effective?



STATION NO: 08 (VAGINAL LESION)

- SCENARIO:
 A 25-years old lady married to a driver working in Dubai, presented with the shown
painless vulval lesion.

1. Mention any 03 differential diagnosis according to this scenario.

 Vulval intraepithelial neoplasia (VIN)
 Vulval cancer
 Paget’s disease of vulva
 Litchen sclerosis.

2. Enlist investigations to be carried out in this lady to confirm the diagnosis.

 1) Biopsy, 2) Full blood count, 3) LFTs, 4) U & E, 5) MRI pelvis.

3. What treatment will you advise in this patient?

 VIN  Wide local excision, imiquimod cream, laser ablation.
 Vulval cancer  Surgery is wide local excision with 10 mm clear margin.
 Paget’s disease  Wide local excision, total vulvectomy.
 Litchen sclerosis  Potent high dose corticosteroids for 01 month.

STATION NO: 09 (IRON DEFICIENCY ANEMIA)

- SCENARIO:
 A 6th gravida, para 5+0 at 34 weeks of gestation presents in antenatal clinic with weakness,
palpitations & dyspnea. Her complete blood picture is in front of you. MCV= 69.

1. What type of anemia is shown in this report?

 Iron deficiency anemia.

2. What is the most likely cause of this anemia?

 1) Inadequate iron intake, 2) Poor absorption, 3) Increase blood loss, 4) Increasing iron
requirement in pregnancy.
3. How will you confirm your diagnosis?
 Serum ferritin level.

4. What are the other investigations to confirm the diagnosis?

 1) FBC, 2) Serum iron level, 3) Total iron binding capacity (TIBC).

5. What is the most common cause of this in Pakistan?

 Poor nutrition (decrease intake of iron rich foods).

6. How will you manage this patient?

 Oral iron therapy.

STATION NO: 10 (OBSTETRIC CHOLESTASIS)

- SCENARIO:
 A 32-years old gravida 03 para 02, admitted with severe whole body itching with
gestational amenorrhea 34 weeks. Urine analysis shows bile salts + bile pigments. Liver
function test shows mildly elevated liver enzymes.

1. What is the most likely cause of this condition?

 Obstetric cholestasis (intrahepatic cholestasis of pregnancy).

2. At what gestational age would you like to deliver this lady?

 After 37 weeks of gestation (or when the fetal lung maturity is evident).

3. What maternal complications are you suspecting in this case? Write only 02.
 1) Spontaneous preterm birth, 2) Deficiency of vitamin K, 3) Increased risk of postpartum
hemorrhage.

4. What are the fetal complications on this condition?

 1) Fetal distress, 2) Fetal intracranial hemorrhage, 3) Fetal death.

5. What advise will you give to the woman after delivery?

 There is risk of recurrence in future pregnancy
 Avoid estrogen containing oral contraceptives.

STATION NO: 11 (TWIN PREGNANCY)

- SCENARIO:
 A 30-years old pregnant female para 3+0 has presented at 32 weeks of gestation, with
exaggerated signs & symptoms. On examination SFH is 36 cm.

1. What is the most likely diagnosis?

 Twin pregnancy.

2. What is the confirmatory test for this condition?


3. What are the complications of this condition?


4. What is the outcome of this condition?



5. What is the mode of delivery?



STATION NO: 12 (POSTPARTUM HEMORRHAGE)

- SCENARIO:
 A patient had persistent bleeding during the episiotomy repair after delivering the baby. The
placenta was examined by the attending physician & was noted to be complete. Uterus is
found to be atonic on examination

1. What is the most likely diagnosis?

 Postpartum hemorrhage.

2. What are the causes of this condition?

 1) Uterine atony, 2) Retained products of contraception, 3) Genital tract trauma, 4) Coagulation
disorders.

3. What is the management of this condition?



4. What are the complications of this condition?



STATION NO: 13 (DIABETES)

- SCENARIO:
 Antenatal care for diabetes.

1. How gestational diabetes is diagnosed?

 Fasting plasma glucose of 5.6 mmol/L or above.

2. What are the risk factors of gestational diabetes?

 Obesity
 Family history
 Previous baby >4.5kg

3. At what weeks screening is done?

 24-28 weeks
4. What investigations should be done in woman with previous gestational diabetes?
 Glucose tolerance test in 1st trimester
 Random blood glucose in 1st trimester.

STATION NO: 14 (FETAL GROWTH RESTRICTION)

- SCENARIO:
 On fetal growth restriction.

1. What are the findings of this condition?



2. What are the chances suggesting fetal growth restriction (FGR)?



STATION NO: 15 (FIBROIDS)

- SCENARIO:
 A 36-years old nulliparous has HMB since 01 year with a large abdominal swelling since
10 months. On examination swelling is firm, non-tender & mobile.

1. What is the most likely diagnosis?

 Uterine fibroids.

3. What are the investigations of this condition?



4. What is the treatment of this condition?



5. What are the effects on pregnancy or fertility?



STATION NO: 16 (CERVICAL CA)

- SCENARIO:
 A 53-years old multiparous complains of postmenopausal bleeding with atrophic uterus &
thickened cervical appendage which is friable & ulcerated.

1. What is the most likely diagnosis?

 Cervical carcinoma.

2. What are the investigations of this condition?

 Liquid based cytology
 Pap smear
 High risk HPV DNA testing
 Colposcopy

3. What are the risk factors of this condition?

 Persistent infection with HPV
 Multiple sexual partners
 Early age at first intercourse
 Immunosuppression

4. What is the treatment according to staging?

 CIN-I  follow up in 06 months with colposcopy & cytology
 CIN-II, III  ablative modalities, excisional modalities.

STATION NO: 17 (PLACENTAL ABRUTION)

- SCENARIO:
 A 30-years old gravida 09 para 6+2 came in emergency having 34 weeks of gestational
amenorrhea with complaints of pain in abdomen & moderate bleeding per vagina since 02
hours.

1. What is the cause of bleeding per vagina in this patient?

 Placental abruption.

2. What investigations will you ask to confirm the diagnosis?

 Inspection of placenta after 3rd stage of labour
 Ultrasound scan.

3. How will you manage this patient?

 Administer anti-D immunoglobulin if patient is Rh negative
 Start course of corticosteroids if gestation less than 36 weeks
 Vaginal delivery (if fetus died)
 C-section (fetus is alive / uncontrolled bleeding / DIC)
 Emergency cesarean hysterectomy.

STATION NO: 18 (CHLAMYDIA INFECTION)

- SCENARIO:
 A 19-years old lady presented with lower abdominal pain & vaginal discharge.
Endocervical swab report is positive for chlamydia trachomatis.

1. Name the most sensitive diagnostic test for this condition.

 Nucleic acid amplification technique (NAAT).

2. What are the clinical features of this condition?

 1) Asymptomatic, 2) Vaginal discharge with lower abdominal pain, 3) Post-coital bleeding.
3. Name the 03 long term complications of this condition.
 1) Pelvic inflammatory disease, 2) Peri-hepatitis Fitz Hugh Curtis syndrome,
3) Adult conjunctivitis

4. What are the treatment options of this condition?

 General advice:
- Avoid intercourse until treatment of both partners is complete
- Use of condoms to prevent reinfection & other STDs
- Contact tracing of partner.
 Antibiotic treatment:
- Doxycycline
- Azithromycin
- Erythromycin.

STATION NO: 19 (SEMEN ANALYSIS)

- READ THE SEMEN ANALYSIS REPORT OF MR. WAHID ALI. WRITE DOWN THE
ANSWER OF FOLLOWING QUESTIONS.

1. Identify the abnormality in the report of this patient.

 Oligozoospermia.

2. How many days of sexual abstinence is required before its collection?

 3-4 days.

3. What are the recent methods of fertilization under the circumstances when the wife is
normal?
 1) In-vitro fertilization (IVF), 2) Intracytoplasmic sperm injection (ICSI), 3) Intrauterine
insemination, 4) Donor insemination.

STATION NO: 20 (CTG)

- FOLLOWING IS THE ANTEPARTUM CARDIOTOCOGRAPHY (CTG) OF
MULTIPAROUS LADY AT 36 WEEKS GESTATION WITH HISTORY OF PREGNANCY
INDUCED HYPERTENSION.

1. What is the pattern of CTG?

 Normal.

2. What is the baseline fetal heart rate?

 130-140.

3. How many accelerations are present in CTG?

 03

4. What should be the next step in the management?

 Repeat NST weekly
 STATION NO: 21 (UTERINE BLEEDING)
- SCENARIO:
 A 45-years old para 03 having history of irregular vaginal bleeding for last 03 months. On
clinical examination, uterus is bulky in size. Ultrasound scan shows 11 mm size endometrial
thickness.

1. Give any 03 investigations for the diagnosis of this condition.

 1) Transvaginal ultrasound (TVUS), 2) MRI, 3) Hysteroscopy, 4) Endometrial biopsy.

5. Give 03 different types of conservative management of abnormal uterine bleeding.

 1) Combined oral contraceptive pills, 2) Progestins, 3) GnRH analogues, 4) Anti-fibrinolytic
agents, 5) NSAIDs.

6. Give different conservative surgical methods for treatment of abnormal uterine bleeding?
 1) Endometrial ablation, 2) D & C, 3) Hysteroscopy.

STATION NO: 22 (PARTOGRAM)

- MRS. ABG G2 PARA 1+0 IS IN LABOR SINCE 9:00AM. LOOK AT THE GIVEN
PARTOGRAM & ANSWER THE QUESTIONS.

1. What is the FHR at 5:00 pm?



2. What was the dilation of cervix at 11:00 am, 2:00 pm and 5.00 pm?


3. What was the station of presenting part at the time of admission & at 4.00 pm?

4. How many contractions/ minute were seen at 5:00 pm?



STATION NO: 23 (ORAL CONTRACEPTIVE PILLS)

- LOOK AT THE FOLLOWING MEDICINES & ANSWER THE QUESTIONS.

1. Identify the medicine shown in the picture.

 Oral contraceptive pills.

2. What are the indications for these medicines?

 1) Prevent pregnancy, 2) Heavy menstrual bleeding, 3) Polycystic ovarian syndrome,
4) Endometriosis, 5) Adenomyosis

3. What is the failure rate/100 women year?

 0.1-1.
4. Name 02 side effects associated with these medicines.
 1) Acne, 2) Breast tenderness, 3) Mood changes & depression, 4) Fluid retention.

5. These may increase the risk of which cancers?

 1) Breast cancer, 2) Cervical cancer.

STATION NO: 24 (DEFINITIONS)

- DEFINE THE FOLLOWING TERMS.

1. Full term normal delivery.

 The delivery at a gestational age of 37-42 weeks, as determined by the last menstrual period or
by ultrasonographic dating & evaluation.

2. Premature delivery.
 Delivery that occurs before 37 weeks of pregnancy.

3. Abortion.
 Termination of pregnancy before 20 weeks.

4. Stillbirth.
 A baby born with no signs of life.

5. Perinatal mortality.
 It refers to number of stillbirths & deaths in the first year of life (early neonatal mortality).

STATION NO: 25 (AMENORRHEA)

1. Define Amenorrhea.
 It is the absence of menstruation.

2. What are the causes of this condition?

 Anatomical disorders (genital tract abnormalities)
 Ovarian disorders (turners syndrome)
 Pituitary disorders (pituitary Adenoma)
 Hypothalamic disorders (space occupying lesion)

3. What are the clinical features of this condition?

 1) Absence of menstrual periods, 2) Weight gain, 3) Hair loss, 5) Hot flushes.

4. What is the treatment of this condition?

 Treatment of underlying cause
 Attain normal BMI
 In case of prolactinoma dopamine agonists or surgery
 Hormone replacement therapy for premature ovarian failure
 Specific treatment of endocrinopathies & tumor
 Relief of genital tract obstruction.
5. What are the investigations of this condition?
 1) Pregnancy test, 2) Blood test for LH, FSH & testosterone, 3) TSH, 4) Pelvic ultrasound.

STATION NO: 26 (INSTRUMENTS)

1. Identify the instrument & hold it correctly for application
 Obstetric forceps.

2. What are the 03 indications of this instrument?

 Prolong 2nd stage of labor
 Fetal distress
 Breech presentation
 Elective shortening of 2nd stage of labour due to any maternal medical disorder.

3. What are the prerequisites for its application?

 No CPD
 Cervix should be fully dilated
 Membrane rupture
 Head at 0 or below 0 station
 Bladder empty
 Pudendal perineal or epidural analgesia.

4. What are the maternal complications of this instrument?

 Genital tract trauma
 Perforation
 Infection
 Hemorrhage

5. What are the neonatal complications of this instrument?

 Trauma to genital tract
 Infection
 Fracture of skull

STATION NO: 27 (OVARIAN CANCER)

- SCENARIO:
 A 60-years old woman para 5+0, presented with abdominal mass for one year. On
abdominal examination, there is about 20/20cm mass extending from pelvis towards
abdomen. Fluid thrill & shifting dullness is positive.

1. What is the most likely diagnosis?

 Ovarian cancer.

2. What is the differential diagnosis?

 Ovarian carcinoma
 Endometriosis
 Endometrioma
 Uterine fibroid
 Ovarian torsion
 Ovarian cyst & abscess.

3. What investigation will you request in this condition?

 U/S
 CT scan
 Colonoscopy
 Tumor marker (Ca-125)

4. What surgery you will offer in this condition?

 Total abdominal hysterectomy
 Bilateral salpingo oophorectomy (BSO)
 Laparotomy

STATION NO: 28 (OVARIAN CANCER)

- SCENARIO:
 On ovarian cancer.

1. Write down symptoms of malignant ovarian cancer?

 Pelvic pain
 Back pain
 Vaginal discharge
 Bloating
 Changes in bowel habits

2. Which tumor marker is raised in epithelial ovarian cancer?

 CA- 125
 CA 19-9

3. What is treatment of stage-I ovarian cancer?

 Hysterectomy with bilateral salpingo-oophorectomy.

STATION NO: 29 (FIBROIDS)

- FIGURE OF FIBROIDS.

1. Write any four symptoms of this pathology.

 Firm mass arising from uterus
 Menstrual disturbances
 Urinary frequency
 Subfertility
2. What is the pathology in this figure?
 Uterine fibroids (leiomyoma).

3. What is the surgical treatment of this pathology?

 Myomectomy
 Hysterectomy
 Uterine artery embolization

4. What are complications of uterine artery embolization?

 Bleeding
 Infection
 Hematoma
 Infertility

STATION NO: 30 (MATERNAL COLLAPSE)

- SCENARIO:
 Maternal collapse of 30 minutes emergency.

1. Write down 04 differential diagnosis of maternal collapse.

 Hemorrhage due to uterine rupture, postpartum hemorrhage, ectopic pregnancy
 Amniotic fluid embolism
 Sepsis
 Eclampsia

2. Outline the initial management of obstetric emergency.

 Management of obstetric emergencies follows the guidelines of ABCDE
 Airway
 Breathing & ventilation
 Circulation
 Disability (neurological status)
 Exposure & environment control
 Always summon the help of senior obstetrician.

STATION NO: 31 (DOWN SYNDROME)

1. Name three invasive tests for down’s syndrome.
 Amniocentesis
 Chorionic villus sampling (CVS)
 Cordocentesis (Percutaneous umbilical blood sampling)

2. What tumor markers are shown on ultrasound in early down’s syndrome scan?
 Screening between 10-14 weeks  beta-hCG, PAPP-A
 Screening between 14-20 weeks  beta-hCG, inhibin-A, unconjugated estriol
3. At what gestational age the procedure is performed?
 Amniocentesis  15-40 weeks
 CVS  11-40 weeks
 Cordocentesis  20-40 weeks.

STATION NO: 32 (IUDs)

1. Write down the side effects of copper bearing IUDs?
 Increased menstrual blood loss
 Increased dysmenorrhea
 IUD expulsion

2. Write down 04 mechanisms of COCP.

 Inhibition of ovulation via negative feedback inhibition of estrogen & progesterone
 Endometrial hyperplasia making endometrium non-receptive to embryo
 Thickens cervical mucus impairing sperm transport & penetration
 Affect tubal motility & transport.

3. According to WHO which categories are contraindications?

 Absolute contraindications:
- Breast feeding < 06 weeks postpartum
- Smoking >15 cigarettes per day & age >35
- Multiple risk factors for cardiovascular disease
- Hypertension (systolic >160 or diastolic >100 mmHg)

 Relative contraindications:
- Multiple risk factors for arterial disease
- Hypertension (systolic blood pressure 140–159)
- Hyperlipidemias
- Diabetes mellitus with vascular disease.

STATION NO: 33 (CTG)

1. Is it reactive CTG?

2. How many accelerations are seen in this CTG?

3. How many decelerations are seen in this CTG?

4. Define acceleration & deceleration.

 Acceleration:
- Transient rise in FHR by at least 50 bpm over the baseline lasting for 15 seconds
 Deceleration:
- Transient reductions in FHR by at least bpm over the baseline lasting for 15 seconds
 STATION NO: 34 (MOLAR PREGNANCY)
- SCENARIO:
 Passage of grape like tissues per vagina.

1. What is the most likely diagnosis?

 Hydatidiform mole (molar pregnancy).

2. What are the risk factors of this condition?

 Previous history of molar pregnancy
 Maternal age extremes
 Maternal blood group A

3. Outline the management of this patient.

 Suction D & C (method of choice)
 Hysterectomy
 Barrier contraception should be used until serum beta-hCG is normal.

4. Which investigation is used to diagnose this condition?

 Serum beta-hCG
 Full blood count
 Coagulation profile
 LFTs.

STATION NO: 35 (BISHOP SCORE)

- SCENARIO:
 Cervical dilation 08 cm, baby at 03 station.

1. What is the cause of this condition?



2. What is the diagnosis according to this scenario?

 Unripe cervix (unfavorable cervix).

3. What is the management of this condition?

 Amniotomy
 Prostaglandins (PGE-2) (preferred agents for cervical ripening)
 Oxytocin infusion
 Membrane sweeping

4. What is the mode of delivery?


 STATION NO: 36 (PCO)
- SCENARIO:
 A 30-years old presents with primary subfertility. Her BMI is 35 kg/m². Semen analysis is
normal. Hysterosalpingography reveals patent tubes. She is having hirsutism & infrequent
periods.

1. What is the likely cause of subfertility in her case?

 Polycystic ovarian syndrome (PCOS).

2. Give 02 diagnostic noninvasive tests for further confirmation of the likely cause?
 Ultrasound
 Hysterosalpingography

3. What are the treatment options for her? Write 04.

 Lifestyle modification (Low calorie diet)
 Weight reduction
 Combined oral contraceptives for hirsutism & irregular periods
 Cyclical oral progesterone
 Clomiphene citrate first line drug for ovulation induction with normal tubal patency.

STATION NO: 37 (SEMEN ANALYSIS)

1. Define Asthenozoospermia.
 Sperm motility less than the reference value.

2. Define Aspermia.
 No ejaculate.

3. What is the normal volume of semen?
 1.5 ml.

4. What is the normal concentration of semen?
 15 million/ml.

5. What is the liquification time?
 20-30 minutes after collection.

6. What is the normal amount of WBCs in it?
 Fewer than 01 million/cc or 01 million/ml.
 STATION NO: 38 (CA ENDOMETRIUM)
- SCENARIO:
 A 65-years old para 1+0 presented with irregular vaginal bleeding for last 01 year. She
underwent diagnostic D & C & histopathology report turns back as carcinoma of
endometrium.

1. What is the most common form of carcinoma endometrium?

 Endometrioid (Adenocarcinoma).

2. Which gene mutation occurs in type-2 carcinoma endometrium?

 HER-2/nu
 P-53

3. What are the clinical features of this condition?
 Postmenopausal bleeding
 Intermenstrual bleeding
 Heavy periods
 Vaginal discharge
 Anemia

4. What are the differential diagnosis of this condition?

 Atopic vaginitis
 Endometrial hyperplasia
 Endometrial polyp
 Cervical carcinoma

STATION NO: 39 (ENDOMETRIOSIS)

- SCENARIO:
 Mrs. Azra 30 years married since 04 years, nulliparous having cyclical menorrhagia &
worsening dysmenorrhea since menarche. On examination she is having retroverted fix
uterus & both fornices are tender. On U/S uterus is normal sized both ovaries are enlarged
& cystic with thick fluid.

1. What is the provisional diagnosis?

 Endometriosis.

2. Give investigations which can help to reach the diagnosis.

 Laparoscopy (gold Standard).

3. Give the treatment modality of this condition.

 Family is not complete so medical treatment + laparoscopy.
- Medical treatment: NSAIDS, COCP, GnRH agonists
- Laparoscopy: Diathermy, Laser vaporization, Excision
4. What are the clinical features of this condition?
 Dysmenorrhea
 Menorrhagia
 Dyspareunia
 Low back pain
 Infertility

5. What is the surgical treatment of this condition?

 Laser
 Diathermy
 Excision of endometriotic tissue

6. What are the common sites of this condition?

 Ovary
 Pelvic walls
 Pouch of Douglas
 Uterosacral ligaments

STATION NO: 40 (PUERPERAL FEVER)

1. Define this condition.
 It is defined as a temperature of 38⁰ C (100.4 F) or higher on any two of the first 10 days
postpartum, exclusive of the first 24 hours.

2. What are the causes of this condition?

 Genital causes:
- Endometritis
- Retained placental tissue
 Non-genital:
- Pneumonia
- Deep vein thrombosis
- Pyelonephritis

3. What are the complications of this condition?

 Septicemia
 Septic shock
 DIC
 Pulmonary embolization
 STATION NO: 41 (ABORTION)
1. Define recurrent miscarriage.
 It is defined as three or more consecutive pregnancy losses.

2. What are the complications of septic miscarriage?

 Endotoxic shock
 Acute renal failure
 Diffuse peritonitis

3. What are the signs of missed miscarriage?

 Amenorrhea
 Brownish vaginal discharge
 No bleeding
 No cramping
 No cervical dilation
 No heart activity

4. What is the investigation of choice of miscarriage?

 CBC
 Blood grouping
 Urine D/R
 U/S
 Cervicovaginal swab

5. What are the risk factors of miscarriage?

 Smoking
 Obesity
 Increased maternal age
 Balanced chromosomal translocations
 Anti-phospholipid syndrome

6. What are the causes of miscarriage/abortion?

 Chromosomal abnormalities
 Maternal age >35 years
 Cocaine use
 Abnormal uterus
 Infection.

7. What are the treatment of missed miscarriage?

 Medical management: Misoprostol (PG-E analogue)
 Surgical management: Dilatation & Evacuation.
 STATION NO: 42 (POSTPARTUM HEMORRHAGE)
1. Define postpartum hemorrhage.
 Excess blood loss after delivery.

2. What are the types of this condition?

 Primary: Excess blood loss after delivery in the first 24 hours
 Secondary: Excess blood loss after delivery up to 06 weeks.

3. What is the immediate step of management in this condition?

 Stop the bleeding by massaging the uterus by causing it to contract or by bimanual examination.

4. What are the risk factors of this condition?

 Prolonged 3rd stage of labour
 Multiple deliveries
 Episiotomy
 Pregnancy induced hypertension

5. What is the surgical management of PPH?

 Uterine artery embolization
 Iliac artery ligation
 Uterine balloon Insertion
 Hysterectomy

STATION NO: 43 (DEFINITIONS)

- DEFINE THE FOLLOWING TERMS

1. Puerperium.
 It refers to the 06-week period following completion of 3rd stage of labour & lasts until the
reproductive organs have returned to their pre-pregnant state.

2. Gravida.
 Total number of pregnancy (regardless whether they were carried to term) & includes current
pregnancy.

3. Parity.
 It is the number of live births at any gestation or stillbirths after 24 weeks of gestation.

4. Expected date of delivery (EDD).

 It is the term used to describe the estimated delivery date for a pregnant woman.

5. Naegeles rule.
 It involves adding 09 calendar months & 07 days to the first day of the last menstrual period.
 Alternatively count back three calendar months from the last menstrual period, then add 01 year
& 07 days. E.g. LMP= 10 september 2017 then EDD = 17 June 2018.
6. Maternal mortality.
 It is defined as by WHO as death of a woman while pregnant or within 42 days of a termination
of pregnancy irrespective of the site and duration of pregnancy from any cause related to
pregnancy.

STATION NO: 44 (C-SECTION)

1. Define C-section.
 Surgical procedure performed to deliver a baby via the transabdominal route.

2. What are the indication of lower segment C-section?

 Previous C-section
 Fetal distress
 Placenta previa

3. What are the indication of classical C-section?

 Preterm delivery with poorly formed lower segment
 Anterior placenta previa with abnormally vascular lower uterine segment
 Elective cesarean hysterectomy.

4. What is the preferred incision of classical C-section?

 Pfannensteil s incision.

5. What are the complications of C-section?

 Intraoperative:
- Uterine lacerations
- Hemorrhage
 Post-operative:
- Endometritis
- UTI
 Long term effects:
- Uterine rupture
- Venous thromboembolism

STATION NO: 45 (FORCEPS DELIVERY)

1. What are the types of forceps delivery?
 Low  cavity forceps e.g. Wrigley s
 Mid  cavity forceps e.g. Kjelland s
 Mid  cavity non rotational forceps: Simpson s

2. What are the pre-requisites of forceps delivery?

 Head engaged
 Fully dilated cervix
 Ruptured membrane
 Suitable presentation & position
 Bladder must be empty
3. What are the indications of forceps delivery?
 Prolonged 2nd stage of labour
 Face presentation
 Delivery before 34 weeks of gestation
 Large fetus

4. What are the contraindications of forceps delivery?

 Head not fully engaged
 Cervix not fully dilated
 Inexperienced operator

5. What are the complications of forceps delivery?

 Facial nerve palsy
 Laceration to genital tract
 Anal sphincter trauma
 Skull fracture

STATION NO: 46 (ECTOPIC PREGNANCY)

- SCENARIO:
 A lady came with 08 weeks gestational amenorrhea with lower abdominal pain & fainting
episodes.

1. What is the most likely diagnosis?

 Ruptured ectopic pregnancy.

2. What are the differential diagnosis?

 Acute appendicitis
 Diverticulitis
 Threatened abortion
 Molar pregnancy

3. What are the investigations of this condition?

 Urine beta-hCG to confirm pregnancy
 Serum beta-hCG for quantification
 Transvaginal ultrasound (TVUS)

4. What are the risk factors of this condition?

 Previous PID
 Previous ectopic pregnancy
 Intrauterine device in place
 Previous tubal surgery

5. What is the treatment in case of emergency?

 Laparotomy.
6. What is Beta-HCG follow up?


7. What is the Beta-HCG discriminatory zone?

 Beta-hCG level of >2000 IU/L.

STATION NO: 47 (ECTOPIC PREGNANCY)

- SCENARIO:
 A 28-years old para 1+2 with gestational amenorrhea of two months has presented in
emergency with lower abdominal pain, hypovolemia, shoulder tip pain & collapse.

1. What is the most likely diagnosis?

 Ruptured ectopic pregnancy.

2. What is the most common site of this pregnancy?

 Ampulla of the fallopian tubes
 Ovary
 Cervix
 Abdominal

3. What are the symptoms of ruptured ectopic pregnancy?

 Severe lower abdominal pain classicaly unilateral
 Internal bleeding & hypovolemia
 Abdominal guarding & rigidity
 Shoulder tip pain & collapse

4. Write down the medical management.

 Methotrexate is the agent of choice for medical management

5. Write down the surgical management.

 Unstable (ruptured) = laparotomy & salpingectomy
 Stable (unruptured) = laparotomy & salpingectomy (treatment of choice), salpingotomy (if
patient has only 1 fallopian tube)

6. What is the follow up of beta-hCG?

 Follow up continues until beta-HCG levels are non-detectable usually 7 weeks
But it can take 35-109 days
 STATION NO: 48 (CONTRACEPTION)
1. Identify the object shown in the picture.
 Depo-vera injectable Progestogens.

2. What are the contents of this object?

 Medroxy-progestrone acetate (DMPA) 150 mg.

3. What is the mode of action of this object?

 Inhibition of ovulation.

4. What is the failure rate of this object?

 0.1-2/ 100 women.

5. Give any 03 contraindications of this object.

 Family history of breast cancer
 Diabetes
 Porphyria
 Hypertension

STATION NO: 49 (INSTRUMENTS)

1. Name the instruments in front of you.
 Cusco’s speculum
 Cervical spatula
 Cotton tip applicator

2. For which process these instruments are used?

 During Pap smear.

3. What are the indications of these instruments?

 Bleeding per vagina
 Cervical dysplasia
 Malignant and premalignant conditions of the cervix
 Annually after age of 21 years.

4. How will you confirm CIN?

 Minor cytologic abnormalities = High-risk HPV DNA test
 High grade cytologic abnormalities = Colposcopy

5. If CIN lesion is confirmed then what is the management?

 Wartheim hysterectomy
 STATION NO: 50 (AMNIOCENTESIS)
1. At what gestational age it is done?
 From 15 weeks onward.

2. How much fluid is taken in sample?

 15-20 ml.

3. What are the indications of this process?

 Thalassemia
 Aneuploidy
 Cytomegalovirus (CMV) + toxoplasmosis

4. What are the complications of this process?

 Miscarriage
 Neonatal talipes
 Respiratory difficulty

STATION NO: 51 (INSTRUMENTS)

1. Identify the instrument in front of you.
 Sim’s speculum.

2. Write down the uses of this instrument.

 Routine per speculum examination in OPD
 For taking biopsy
 Dilatation & curettage
 Vaginal hysterectomy

3. Identify the other instrument in front of you.

 Volsellum forceps.

4. Write down the uses of this instrument.

 Dilatation & curettage
 Cervical biopsy
 Vaginal hysterectomy
 Post colpotomy.
 STATION NO: 52 (INSTRUMENTS)
1. Identify the instrument shown in the picture.
 Hegars cervical dilator.

2. Write down the uses of this instrument.

 Dilatation & curettage (D & C)
 Amputation of cervix
 Spasmodic dysmenorrhea

3. What are the complications of this instrument?

 Sepsis
 Hemorrhage
 Perforation
 Cervical tear.

4. Identify the other instrument shown in the picture.

 Uterine sound.

5. Write down the uses of this instrument.

 Ascertain size & direction of uterus
 Ascertain position of abnormal uterine contents e.g. tumor or polyp
 Correct retroverted uterus.

STATION NO: 53 (INSTRUMENTS)

1. Identify the instrument shown in the picture.
 Uterine curettage.

2. Write down the uses of this instrument.

 Missed abortion
 Incomplete abortion
 Postmenopausal bleeding
 Suspect endometrial carcinoma.

3. Identify the other instrument shown in the picture.

 Suction cannula (curette)

4. Write down the uses of this instrument.

 Dilation & curettage (D & C)
 Missed abortion
 Hydatidiform mole
 Endometrial biopsy.
 STATION NO: 54 (OLIGOHYDRAMNIOS & POLYHYDRAMNIOS)
1. Define oligohydramnios.
 It is defined as amniotic fluid index < 05th percentile or AFI < 05 cm for gestation or decreased
amount of amniotic fluid < 05th percentile.

2. What are the causes of oligohydramnios?

 Renal agenesis
 Multi cystic kidneys
 Placental insufficiency
 Posterior urethral valves
 Preterm prelabour rupture of membranes (PPROM).

3. What are the complications of this condition?

 Related to cause:
- Preterm delivery due to PPROM
- Intrauterine growth restriction (IUGR)
 Related to reduced volume:
- Lung hyperplasia if occurs < 24 weeks
- Limb abnormalities e.g. talipes (club foot) if occurs < 24 weeks.

4. Define polyhydramnios.
 It is defined as amniotic fluid index > 95th percentile or AFI > 25 cm.

5. What are the causes of polyhydramnios?

 Maternal causes  Diabetes
 Fetal causes  Fetal hydrops, duodenal atresia
 Placental causes  Chorioangioma.

6. What are the complications of polyhydramnios?

 Preterm delivery
 Malpresentation
 Maternal discomfort.

STATION NO: 55 (PRE-ECLAMPSIA)

- SCENARIO:
 A lady has a BP of 140/90 mmHg & protein 300 mg.

1. What is the most likely diagnosis?

 Preeclampsia.

2. What are the risk factors of this condition?

 First pregnancy
 Multiparous with previous history of preeclampsia
 Diabetes
 Age 40 years or more
 BMI of 35 or more.
3. What are the investigations of this condition?
 Urine analysis by dipstick
 24hrs urine collection
 Full blood count (platelets & hematocrit)
 Liver function tests.

4. What are the complications of this condition?

 Eclampsia
 HELLP syndrome
 Cerebral hemorrhage
 Disseminated intravascular coagulation (DIC)
 Renal failure.

5. What is the management of this condition?

 No evidence of maternal or fetal jeopardy:
- Monitor BP > 4 times a day
- Monitor CBC, LFT
- Oral Labetalol
 Evidence of maternal or fetal jeopardy:
- Prompt delivery
- IV MgSO4
- IV labetalol

6. What is the drug of choice of this condition?

 Magnesium sulphate (MgSO4).

STATION NO: 56 (ECLAMPSIA)

1. Define Eclampsia.
 Grand mal convulsions occurring in a woman with established preeclampsia in the absence of
any other neurologic or metabolic cause.

2. What are the investigations of this condition?

 Urine analysis for urinary proteins
 Full blood count
 Clotting studies
 Liver function test.

3. What is the management of this condition?

 Call for help senior obstetrician & anesthetist
 Maintain airway breathing & circulation
 Maintain I/V line
 I/V labetalol
 Magnesium sulphate (anticonvulsant drug of choice)
 Fluid balance
 Delivery (definitive cure).
 STATION NO: 57 (DOWN SYNDROME)
- SCENARIO:
 A married couple with past history of Down’s syndrome baby. CVS done in current
pregnancy.

1. At what gestational age we do chorionic villus sampling?

 11 weeks onwards.

2. What is the route of this?

 Route-1  U/S guided trans-abdominal, myometrium.
 Route-2  U/S guided trans-cervical if retroverted uterus, low-lying placenta

3. What are the complications of this?

 Cleft lip & palate
 Digital amputation abnormalities
 Chorion villus contamination with maternal cells
 Increased risk of HIV & hepatitis-B.

4. What are the indications of this?

 For karyotyping
 For DNA analysis if parents are carriers of thalassemia or cystic fibrosis.

STATION NO: 58 (ADENOMYOSIS)

1. What are the clinical features of this condition?

 Severe secondary dysmenorrhea
 Increased menstrual blood loss

2. What are the diagnostic tests of this condition?

 Ultrasound (best initial test)
 MRI (investigation of choice).

3. What is the definitive treatment of this condition?

 Hysterectomy.

STATION NO: 59 (PLACENTA PREVIA)

- IDENTIFY THE FIGURE.

1. What is the diagnosis according to this figure?

 Placenta previa.

2. Give 02 presenting complaints of this condition.

 Painless bright red vaginal bleeding during 3rd trimester
 Premature contractions
 Post coital bleeding.
3. Give 02 clinical findings of this condition.
 No uterine tenderness, uterus is soft & relaxed
 Low lying placenta on ultrasound.

4. What is the specific investigation for confirmation of diagnosis?

 Ultrasound.

5. Give 02 risk factors of this condition.

 Multiple gestation
 Previous caesarian section
 Uterine structure anomaly.

STATION NO: 60 (CHICKEN POX)

- SCENARIO:
 Scenario on chicken pox.

1. What are the maternal risks of this condition?

 Pneumonia
 Hepatitis
 Encephalitis
 Induction of labour.

2. What are the fetal risks of this condition?

 Skin scarring (zig zag skin lesions)
 Limb hypoplasia
 Eye lesions (microphthalmia, chorioretinitis, cataract)
 Neurological abnormalities (microcephaly, mental retardation).

3. What are the neonatal risks of this condition?

 Severe pneumonia
 Fulminant hepatitis.

4. What is the treatment of this condition?

 In pregnancy oral acyclovir is given, if delivery is during high viremic period then I/V acyclovir
is given.
 STATION NO: 61 (MENSTRUAL CYCLE)
1. Describe the changes in endometrium during the cycle.
 Ovarian changes:
- Follicular phase
- Ovulation
- Luteal phase
 Changes in endometrium:
- Menstrual phase
- Proliferative phase
- Secretory phase.

2. Ovulation occurs in which day of the cycle?

 Day 14.

3. What are the hormones responsible?

 Follicular phase  Estrogen
 Ovulation  Leutinizing hormone
 Luteal phase  Progesterone.

STATION NO: 62
- SCENARIO:
 A pregnant lady having pinkish rashes, sore throat, lymphadenitis.

1. What is the differential diagnosis?



2. What fetal anomalies occur in this condition?



3. How to prevent this condition?



STATION NO: 63
- SCENARIO:
 A 60-years old lady para 7+0 came with history of something coming out of vagina.

1. What is the most likely diagnosis?



2. What are the causes of this condition?


3. What are the treatment options?


STATION NO: 64 (OCP)

- LOOK AT THE OBJECT & ANSWER THE QUESTIONS.

1. Identify the object shown in the picture.

 Oral contraceptive pills.

2. What are the indications of these pills?

 Prevent pregnancy
 Heavy menstrual bleeding
 Polycystic ovarian syndrome
 Endometriosis
 Adenomyosis.

3. Give 02 side effects of these pills.

 Estrogenic effect  Cholelithiasis, venous & arterial thrombosis
 Progesterogenic effect  Weight gain, depression, acne, mood changes, breast tenderness.

STATION NO: 65 (PMB)

1. What are the causes of this condition?
 Atrophic vaginitis
 Endometrial polyps
 Endometrial hyperplasia
 Endometrial carcinoma
 Cervical carcinoma.

2. What are the investigations of this condition?

 Ultrasound scan
 Cervical cytology
 Saline infusion sonography
 Hysteroscopy.

3. What is the treatment of this condition?

 Treatment depends upon the cause:
 Atrophic vaginitis  Topical estrogen cream
 Endometrial polyps  Removal
 Endometrial hyperplasia  Progestogens
 Endometrial carcinoma  Total abdominal hysterectomy + BSO.
4. What are the differential diagnosis?
 Atrophic vaginitis
 Endometrial polyps
 Endometrial hyperplasia
 Endometrial carcinoma
 Cervical carcinoma.

STATION NO: 66 (STRESS INCONTINENCE)

1. What are the risk factors of this condition?
 Multiple vaginal deliveries
 Injury to perineal region (e.g. forceps delivery)
 Increasing age
 Post-menopause.

2. What are the clinical features of this condition?

 Leakage of urine during coughing, sneezing, running
 Urgency
 Frequency
 Urge incontinence.

3. What are the investigations of this condition?

 Pelvic examination
 Urodynamic studies.

4. What is the treatment of this condition?

 Conservative:
- Pelvic floor exercises (mainstay)
- Balanced fluid intake
- Reduce caffeine
 Surgical:
- Mid-uretheral tape procedure
- Colposuspection
- Peri-uretheral injection bulking agents.

STATION NO: 67 (PCO)

- ULTRASOUND SCAN OF POLYCYSTIC OVARIAN SYNDROME.

1. What is the diagnosis according to this ultrasound?

 Polycystic ovary syndrome.

2. What are the clinical features of this condition?


3. What is the treatment of this condition?


STATION NO: 68 (CONGENITAL CATARACT)

1. Identify the abnormality shown in the picture.
 Congenital cataract.

2. What are the cause of this condition?

 Rubella (most common cause)
 Measles.

3. How to prevent this condition?



STATION NO: 69 (CTG)

- SCENARIO:
 CTG showing late deceleration.

1. Describe this condition.

 CTG showing late deceleration (having 15 sec time lag).

2. Is it normal or abnormal CTG?

 Abnormal.

3. What is the cause of this condition?

 Utero-placental insufficiency (acidosis).

4. What is the management of this condition?



STATION NO: 70

- SCENARIO:
 Specimen of uterus with cervicitis, ruptured tubes & ovarian abscess was shown.

1. Identify the specimen shown in the picture.



2. What are the indications of this surgery?



3. What is the causative organism?


 4. What are the complications of this condition?


STATION NO: 71 (THALASSEMIA)

- SCENARIO:
 If both mother & father are having thalassemia minor.

1. What is the percentage of children having thalassemia?



2. A lady comes to you with her blood reports with thalassemia minor, she is pregnant &
gestational age 10 weeks. How will you counsel her?


STATION NO: 72 (TURNER SYNDROME)

- SCENARIO:
 A 14-years old girl presents with primary amenorrhea & short stature.

1. What is the most likely diagnosis?

 Turner syndrome.

2. What are the clinical features of this condition?

 Primary amenorrhea
 Primary infertility
 Webbed neck
 Wide carrying angle
 Short stature

3. What is the treatment of this condition?

 1st phase  HRT for induction of puberty
 2nd phase  Donor egg for pregnancy

STATION NO: 73 (DOPPLER ARTERY SCAN)

1. What is this investigation called?
 Doppler artery scan.

2. What are the interpretations of middle cerebral artery doppler?

 Decreased pulsatility of middle cerebral artery showing fetal hypoxia
 High diastolic velocities suggesting growth restricted fetus

3. What is cerebro-placental ratio?

 It is the ratio of pulsatility index of middle cerebral artery & uterine artery.
4. What is the normal ratio?
 > 1:1.

STATION NO: 74 (BREECH PRESENTATION)

1. What are the types of presentation?
 Cephalic (most common)
 Breech (buttocks present first)
 Compound (more than one anatomic part is presenting).

2. What are the types of breech presentation?

 Extended breech
 Flexed breech
 Footling breech.

3. What are the causes of this?

 Maternal  Fibroids, uterine abnormalities, oligohydramnios
 Fetal  Multiple gestations, anencephaly, hydrocephalus.

4. How vaginal delivery is done in this case?

 Delivery of buttocks
 Delivery of legs & lower body
 Delivery of shoulders
 Delivery of head.

5. What are the maneuver used in this?

 Pinards maneuver if legs are extended
 Loveset’s maneuver if arms are stretched above chest
 Mariceau-Smellie-Veit (MSV) maneuver for delivery of head.

STATION NO: 75 (FIBROIDS)

1. What are the causes of this condition?
 Genetic factors (translocation, trisomy)
 Hormones (estrogen & progesterone)
 Growth factors (tumor growth factor beta, basic fibroblast growth factor).

2. What are the clinical features of this condition?

 Asymptomatic
 Firm mass arising from uterus
 Menstrual disturbances
 Urinary frequency.
3. What are the differential diagnosis of this condition?
 Pregnancy
 Ovarian tumor
 Leiomyosarcoma
 Adenomyosis.

4. What are the investigations of this condition?

 Ultrasound
 MRI
 Laparoscopy
 Saline hysterography.

5. What is the treatment of this condition?

 Medical:
- GnRH analogues
- Mirena
 Surgical:
- Hysterectomy
- Myomectomy

6. What are the complications of this condition?

 Malpresentation
 Infection
 Torsion
 Degeneration.

7. What type of degeneration occurs?

 Hyaline degeneration
 Red degeneration
 Cystic degeneration.

STATION NO: 76 (LABOUR)

1. What is the anterio-posterior diameter of pelvic outlet?

 13.5 cm.

2. What is the transverse diameter of pelvic outlet?

 11 cm.

3. What are the types of pelvis?

 Gynaecoid (most common)
 Android
 Anthropoid
 Platypelloid.
4. What are the pelvic diameters?


5. What is the largest fetal head diameters?

 Occipito-mental.

6. What is mal-presentation?


STATION NO: 77 (LABOUR)

1. What are the indications of induction of labor?
 Post-term pregnancy (prolonged pregnancy)
 Pre-labour rupture of membranes (PROM).

2. What is mechanism of labour?

 It refers to a series of changes in position & attitude that the fetus undergoes during its passage
through the birth canal.

3. What are the steps of labour?

 Engagement
 Descent
 Flexion
 Internal rotation
 Extension
 Restitution
 External rotation
 Expulsion.

4. What is restitution?
 Slight the rotation of the occiput through one-eighth of a circle.

STATION NO: 78 (BISHOP SCORE)

1. What is the dilatation of cervix?


2. What is the consistency of cervix?



3. What is the length of cervix?



4. What is the position of cervix?



5. What is the station of presenting part?

