Ospe Bank PDF

Department of Obstetrics & Gynaecology
Wah Medical College & Allied Hospital
Send up exam Ospe
Candidate Instruction
In a Para 0+5, in which there are all 2nd trimester miscarriages.
a. What is the procedure shown?
b. Name 2 routes of procedure?
c. Name the vaginally applied procedure?
d. In history what is suggestive of cervical incompetence?
e. Write appropriate investigation of cervical incompetence?
A primigravida at 34 weeks with B.P of 150/110mm, proteinuria

+++, and fits for 01 hour.
a. What is the diagnosis?
b. Specific investigations needed in this patient?
c. Outline the management?
Key
a. Eclampsia
b. Maternal
Blood c/p, platelet count liver Enzymes, Renal function tests,
coagulation pupil if needed fetal
c. CTG
 Anti convulsants
 Anti hypertensive
Plan for early delivery
G5 Para 2 + 2 presented at 32 weeks of gestation with

complaints of per-vaginal leaking for 4 hours. On vaginal
examination she is 3 cm dilated.
a. What is the diagnosis?
b. Name risk factors (any four)?
c. Pain settled down and she presented after 01 week with
rupture of membranes
d. How will you manage?
Key
a. Preterm labour
b. Maternal
 Previous history of preterm labour / PROM
 Rupture of membranes
 Infection
 Multiple pregnancy
 Poly hydramnios / APH
 Uterine anomaly
Fetal
 Congenital anomaly
 IUSR
 IUD
c. Admission
 Steroids
 Antibiotics
 Fetomatenal monitoring
 Delivery at 37 weeks if no fetometenal complications
Primigravida 30 year old

a. HIV + ve
b. Counseling
c. Answer the questions
Patient presented with heavy vaginal bleeding after delivery of a

4kg male baby 01 hour ago.
a. What is the most likely diagnosis?
b. What are other likely causes?
c. How will you manage retained placenta?
A 35 years old para 3 + 0 came to OPD with complaints of

Greenish Frothy discharge and itching for 02 weeks. Carefully
examine the slide and answer the Questions asked.

b. What is the causative agent of this disease?
c. Is it a sexually transmitted disease?
d. What is the diagnostic test for this condition?
e. How will you treat her?
Key
a. Trichomoniasis
b. Trichomonas virginal’s –a Flagellate protozoa
c. Yes
d. Wet slide
e. Flagyl
Tinidazole
Treat partner as well
a. What does this picture show?
b. What can be the signs of this pregnancy?
c. Describe three antenatal complications?
Key
a. Multiple pregnancy
b. Uterus large for dates
 Excessive vaniting
 Multiple fetal poles + fetal parts
 FHS at two places
c. PIH
 G. diabetes
 APH
 Anaemia
 PPH
a. Identify the instrument?
b. Describe the indication of its use?
c. What can be the complications of its use?
Key
a. Vacuum cup
b. Fetal distrus in 2nd stage to shorten 2nd stage for maternal
reasons
Occipitotransvise /post
c. Chignon
Sclap haematome
Intracrarrial hemorrhage
A 6th gravida age 38 years attends antenatal clinic at 30 weeks.

Her urine analysis show +3 sugar.
a. Provisional diagnosis?
b. Three important investigations?
c. What can be fetal complications of this condition?
Perform obstetrical examination of pregnant woman at 36

weeks. You are being observed by the examiner.
Key
Station /0
Introduction
Consent
Stand on Rt side of patient
Ensure privacy
Proper drapping
Abdominal examination
 Inspection
 Palpation
 Ascullate FH
Proper site
For one minute
Palpate pulse simultaneously.
Covering the patient and thanks
a. Identify?
b. What are prerequisites for application?
c. Complications / Dangers of wrong application?
Key
a. Obst forceps
b. CX fully dilated
 Bladder empty
 Proper indication
 Good uterine contractions
 VX below + 1station
c. Fetal injuries- intracranial, haemorrhage, face injuries,
Maternal, Perineal, cervical tears
a. Identify the instrument.

b. Indication for D&C
c. What are complications of D&C
Pelvic examination of a patient at term shows following

findings:-
Cervix is 2cms, os 1cm, consistency soft, position posterior,
station -13
a. What is the Bishop Score?

b. What are the methods used to improve Bishop Score?
A Patient with 06 weeks ammenorrhoea is complaining of pain

lower abdomen. Her pregnancy test is positive. Ultrasound
shows empty uterus with right adenexal mass.
b. What are risk factors for the condition?
c. What are the management options available?
Q. a. Name the X-ray taken in a 32Years old lady with primary

infertility?
b. What are the X-ray findings?
c. What are treatment options available to her?

Key
a. Hysterosalpingography
b. Normal uterus with bilateral tubal blockage.
c. IVF_ET, Tubal surgery, Adoption.

Interactive Station
A 28 Years old primigravida nurse by profession is 20
weeks pregnant. She is HIV positive. Answer the question
asked by examiner.
Examiner Instruction
28 Years old primigravida, 20 weeks pregnant is HIV positive.
1. What is the mode of transmission?
2. What is treatment during pregnancy?
3. What should be mode of delivery & Why?
4. How can we reduce the risk of transmission to baby?

Key
1. a. Vertical
b. Sexual contact
c. Blood & blood products
d. Infected syringes, pricks
2. Antiretroviral drugs
3. C.Section will reduced the transmission risk to fetus.
4. Antiretroviral, C.Section, No breast feeding.
A 32 Years old G4P3 is 36 weeks pregnant. She is otherwise healthy
with uneventful pregnancy and all normal deliveries but is Anti HCV
positive.
a. What precaution would you advise for prevention of transmission

to hospital staff?
b. What is risk of transmission to neonate?
c. Which contraception method would you advise to her?

Key
1. a. Clear documentation of HCV status

b. Double gloving
c. Avoid reneedingling, Pricks
d. Special disposal of wastes
e. Special sterilization of equipment
2. Less than 05%
3. Condom would best protect the transmission.

A 30 Years old G3P2 is 34weeks pregnant. She had previous normal
deliveries. This pregnancy is uneventful except that she is HBS Ag
positive.
1. What is the mode of transmission of Hepatitis B?
2. What advise would you give for the neonate?
3. What precaution the hospital staff should take to reduce the

risk of transmission to staff?
Key
1.
a. Vertical
b. Sexual
c. Infected needles, Pricks, blood & blood products.

2. Immunoglobins + Vaccination against Hep B
3. a. Clear documentation of HB status

b. Double gloving
c. Avoid reneedling, Pricks waste disposal precaution.
d. Follow special situation protocol.
A primigravida at 34 weeks pregnancy has prevented with B.P
150/110mm hg, and protein uria +++ and fits for 01 hour.
1. What is your diagnosis?

2. What special investigation will you perform?
3. Outline you management?
Key
1. Eclampsia
2. Maternal
Blood C/P, Platelet count, liver Enzymes, Renal function tests,
Coagulation profile if needed.
Fetal__
CTG
3. a. Anticonvulsants
b. Antihypertensives
c. Plan early delivery
d. Monitoring
G5 para 2 presented at 32 weeks gestation with complaints of P/V
leaking for 04 hours. On vaginal examination, OS is 03 cms dilated
membranes intact.
1. What is the diagnosis?

2. Name any 04 risk factors for this problem?
3. Pain settled down and she presented after 01 week with
rupture of membranes. How will you manage her?
Key
1. Preterm labour
2. Maternal__
a. Previous history of preterm labour
b. Rupture of membranes
c. Infections
d. Multiple pregnancy
e. Polyhydramnios
f. Uterine anomalies
Fetal___
a. Congenital
b. IUGR
c. IUD
3. Admission
a. Steroids
b. Antibiotics
c. Fetomaternal monitoring
d. Delivery at 37 weeks if no fetomaternal complications.
Examine the photograph + identify Anomaly

Key
1. Anencephaly
2. Gastroschesis
3. Spina Bifida
4. Cleft lip + Palate
5. Hydrocephalic
A 28 Years old para 02 has delivered a 04kg male baby 06 hours ago.
She has presented with heavy vaginal bleeding.
1. What is the most likely diagnosis?

2. What are the likely causes?
3. How will you manage retained placenta?
Key
1. PPH
2. Uterine atony
Retained placenta
Genital tract trauma
Coagulopathy
3. Maintain I/V line
Send Bl.gp + cross match, Blood C/P
Arrange blood
Shift her to OT
Manual removal of placenta .
1. Para 0+5 all 2nd trimester miscarriages. What procedure is shown?
2. Name 02 Routes of procedure?
3. Name commonly applied procedure and route?
4. In history what is suggestive of cervical incompetence?
5. What is the appropriate investigation of cervical incompetence
during pregnancy?
Key
1. Cervical cerclage.
2. Abdominal
Vaginal
3. McDonald’s stitch, Vaginal route
4. History of previous 2nd trimester miscarriages,
History of sudden rupture of membranes in previous pregnancy
(PPROM)
5. Ultrasonography
1. What is the specimen shown in photograph?
2. What is the penetrance of this condition?
3. Enumerate any three presenting symptoms?
4. Give management options?

Key
1. Fibroid uterus
2. 10_20%
3. Menorrhagia
Infertility
Pressure symptom
Pain (If complication occur)
4. Medical
GnRh analogues
Surgical
Myomectomy
Uterine atery Embolization
Hysterectomy
This picture is from a 25 Year old woman
1. Give diagnosis?
2. Suggest any laparoscopic procedure for this disease?
3. Give complications of this condition?
Key
1. Ovarian cyst
2. Laparoscopic enucleation
Laparoscopic ovarian cystectomy
3. a. Torsion
b. Haemorrhage
c. Infection
d. Rupture
1. How does this condition occur?
2. Give signs & symptoms?
3. What are treatment options?

Key
1. a. Complete procedentia
b. Mismanagement and prolong second stage of labour
c. Instrumental delivery
d. Chronic cough constination
2. a. Something coming out of vagina/ mass in vagina
b. Increase vaginal discharge
c. Difficulty in passing stools and uterine
3. a. Conservative Rx pessary
b. Vaginal hysterectomy with AP repair
1. What is this instrument?
2. Give five indications of its use?
3. Dangers of its inappropriate use?

Key
1. Laparoscope
2. Diagnostic for pelvic pain, infertility endometriosis, Operative,

Ectopic pregnancy
3. a. Trauma to abdominal and pelvic structure

b. Bleeding
c. Injury to bowls/bladder pelvic viscera
See the picture & answer the following questions.
1. Name the presentation?
2. Types?
3. Method of delivery of head?
4. Associated fetal complications?

Key
1. Breech presentation.
2. Extended, flexed, looking
3. Forcep, Burn’s Marshall, mauriceau- smellie, veit
manoeuvre
4. Fetal trauma, birth asphyxia traumatic intracranial
haemorrhage.
1. Name the graph?
2. What is it showing?
3. What is the duration of active phase?
4. What intervention has been shown in the process?

Key
1. Partogram
2. Normal progress of labour
3. Six hours
4. Artificial rupture of membrane + argumentation.

See the picture & answer the following questions.
1. Name the problem shown in picture?
2. What are the fetal risks?
3. What are the maternal risks?
4. How will you differentiate clinically it from placental abruption?

Key
1. Placenta praevia
2. Prematurity, prenatal mortality
3. Post partum haemorrhage, shock renal damage, maternal

mortality, and recurrence in next pregnancy.
4. FH = dates, soft, non tender malpresentation fetus asnarly alive.

1. Identify the presentation?
2. Fetomaternal complications?
3. Management at term?
Key
1. Shoulder presentation.
2. Cord prolapse, hand prolapse, obstructed labour, uterine rupture,

fetal death difficult cesarean section due to poorly formed lower
fegment.
3. ECV followed by stabilizing induction.

Cesarean section.
Maternity Book
1. What is the procedure shown?
2. Name the indication of this procedure?
3. What can be the complications of procedure?

Key
1. Hysteroscopy
2. DX Irregular vaginal bleeding.
Intermenstrual bleeding, menorrhagia
Post menopausal bleeding
Therapeutic
a. Endometrial resection
b. Endometrial Biopsy
c. Removal of polyps
d. Resection of septum, fibroids
3. a. Trauma --- Perforation
b. Infection
c. Haemorrhage
d. Fluid over load
e. Failed procedure
2. What are the indications of this procedure?
3. Which suture material should be used?
4. Name any complications?
5. What would be next step in management if this procedure

fails?
Key
1. B – Lynch suture
2. PPH
Uterine atony
3. Catgut / Vichyl / Absorbable
4. Ischemic necrosis, infection
5. Hysterectomy
1. What procedure is being done on this woman?
3. What is the magnification used?

Key
1. Colposcopy
2. a. Abnormal pap smear

b. LLETZ
c. Guided Biopsy of CX
3.
1. What are its uses?

2. Describe mode of action?
3. Give complications?
Key
1. Contraceptive purpose.
2. a. Induce an inflammatory response in the endometrium

which prevents in plantation.
b. cu bearing IUDS work by a toxic effort on sperm which
prevents fertilization.
3. a. Perforation
b. Damage to bladder
c. Haemorrhage
d. Infection
1. Identify the instrument?

2. Give its usage?
3. Complications?
Key
1. Hegar’s dilator
2. Cervical dilation
3. Perforation/ Truma
4. Infection
5. Damage to bladder
1. This is an ultrasound picture of a gynaecological condition?
i. Name the problem?
ii. What can be the presenting symptoms?
iii. What are treatment options available?

Key
i. Polycystic ovary
ii. Oligomenorrhea, weight gain, hirsintism, infectility.
iii. Weight reduction
Anti testosterone (cypoterone acetate)
Oral contraceptive pills, Ovulaton
Induction, Ovarian drilling
1. Diagnosis?
2. Treatment options?
3. Complications related to pregnancy?
Key
1. Fibroids uterus
2. Myomectomy/ Hystrectomy
3.
Miscarriage
Preterm labour
Pain
Malpresentation
Difficult labour (failure to progress)
Identify the problem and answer the questions asked by examiner?

Examiner Instruction
Shoulder dystocia
1. How will you manage this problem?
2. What can be the complications of this problem?

Key
Shoulder dystocia
1. a. call for help

b. Evaluate for episiotomy
c. Legs_ MCRoberts Manoeuvre
d. Suprapubic pressure
e. Enter_ Rotational manoeuvres
f. Romove the posterior am
g. Roll the patient to all fours
2. a. Maternal __ trauma
b. Fetal __ trauma
Palsy
Death
1. What is the pathology shown?
2. What can be the presenting symptoms?
3. What are management options available?

Key
1. Endometrial polyp
2. a. Manorrhagia
b. Intermenstrual bleeding Discharge
3. a. Curettage with polypectomy

b. hystroscopic resection
1. Identify the specimen?
2. From which embryonic layer does it anise?
3. How will you manage this problem?

Key
1. Desmoid cyst/mature cystic tuatara
2. All 03 germ layers.
3. Enucleation/oophorectomy.
1. This CTG is of a primigravida at term has come in advanced

labour on pelvic examination her os is 08 cm. cervix is fully
effaced with membranes abscent and vertex at zero station, clear
liquor drainage.
2. Interpret the CTG?
3. What will be you next step in management?

1. Identify the picture?

2. Indications?
3. Fetal complications?
Key
1. Vacuum cup
2.
 Fetal distress in 2nd stage to shorten 2nd stage for maternal
reasons
 Occipitotransverse position
3. Chignon
Sclap haematoma
Intracranial hemorrhage
A primigravida at term present with intra uterine fetal demise?
Please counsel her.

1. Identify the instrument.
2. Write its two diagnostic uses.
3. Write its two therapeutic uses.
Key
1. Cusco’s speculum
2. For routine examination to inspect cervix and vaginal wall to take
pap smear and HVS
Colposcopy
3. Insertion of IUCD
4. Cautery or cryosurgery of the cervix.
A 22 year old primigravida presented at 8 weeks gestation with

complaints of vaginal spotting and excessive vomiting for 3 days. Her
scan shows snow storm appearance.
Task:
2. What work up is needed before treatment?
3. How would you do her follow up?
Key
1. Molar pregnancy/ complete mole
2. Secrum BhCG, complete blood count, blood grouping and cross
matching, X-ray chest
3. Clinically and by urine/serum BhCG
Task:
Carefully examine the given photograph and answer the following
questions:
1. Identify the diagram?
2. What are the symptoms associated with this condition?
3. Name two options for surgical management of this disease?
Key
1. Fibroid uterus
2. Menstrual disturbances, enlargement of lower abdomen, pelvic
pressure or discomfort, urinary symptoms, constipation, pain
when complicated. Sub fertility.
3. Hysterectomy
Myomectomy
Task:
questions:
1. What procedure is being done?
2. What is the common clinical presentation of cervical cancer?
3. What is the disease extent in stage II?
Key
1. Colposcopy
2. Inter menstrual bleeding, post coital bleeding, post menopauasal
bleeding offensive blood stained vaginal discharge.
3. IIA: Tumor extending to the upper third of vagina
IIB: Tumor extending to the paramettium to the pelvis but not side
wall.
A 24 year old primigravida at 38 weeks gestation came in labour ward
in active phase of labour. Her aseline investigations were carried out
and it was found that she is rhesus negative. Husband’s blood group is
rhesus positive.
Task:
Carefully read the scenario and answer the following questions:
1. What further investigation would you like to carry out?
2. What are the features of hydrpos fetalis?
Key
1. indirect comb’s test
Kleihauer Bethke test
Antibody titer
2. Polyhydramnios
Enlarged fetal heart
Ascities and pericardial effusion
Hyperdynamic fetal circulation
Fetal subcutaneous edema
Abnormal CTG pattern (sinusoidal)
Task:
Carefully examine the instrument/photograph and answer the following
questions:
1. What are types of cups?
2. Give prerequisite for it?
3. What are the indications?
4. What are the contra-indications?
5. What you will do, if delivery fails after two attempts?
Key
1. Silicon and metallic cups
2. Cervix should be fully dilated
 Fully engagement of head.
 Good uterine contractions
3. Delay in second stage.
 Fetal distress in second stage
 Maternal conditions requiring short second stage.
4. Face presentation
 Gestation less than 34 weeks
 Active bleeding from a fetal blood sampling site
5. Do emergency c.section
Task:
questions:
1. What procedure is being performed? Regarding the procedure
define it.
2. What are possible indications?
3. What the types?
4. Give its complications?
5. Give advantages of midline procedure?
Key
1. Surgical incision of the perineum made to increase the diameter of
the vulval outlet during child birth.
2. Fetal distress, shoulder dystocia, an instrumental delivery.
3. Midline, mediolateral.
4. Severe hemorrhage,III, IV perineal tears,infection.
5. Less blood loss, easy wound healing, less pain.
Task:
questions:
Name the diameters of fetal skull.
Key
1. Suboccipito frontal diameter
2. Occipito frontal diameter
3. Submento-bregmatic diameter
4. Suboccipito-bregmatic diameter
5. Occipito mental diameter
Task:
questions:
1. Identify the device.
2. What is the use?
3. What are the causes of fetal distress in labour?
Key
1. Hand held Doppler USG/ sonic aid
2. Intermitten monitoring of FHR in labour
3. Poor placental perfusion
Hypovolemia (hemorrhage, dehydration)
Hypotension (shock, drugs, epidural)
Prolonged labour
Hypertonic uterine contractions
Cord compression
IUGR
Task:
questions:
2. Write its two diagnostic uses.
3. Write its two therapeutic uses.
Key
1. Casco’s speculum
2. For routine examination to inspect cervix and vaginal wall to take
pap smear and HVS Colposcopy
3. Insertion of IUCD Cautery or
cryosurqery of the cervix
A 35 years old P3 has heavy menstrual bleeding for last 6 months. Her
menstrual cycle was normal till then. She is pale, rest of the history and
examination in unremarkable. USG report is with the patient.
Task:
1. What is most likely diagnosis?
2. How will you investigate and manage this patient?
Key
1. DUB (dysfunctional uterine bleeding)
2. Investigations: CBC, BSR, Ultrasound for endomertrial thickness
Thyroid profile
Rule out pregnancy
Treatment; Correct anaemia
Medical management of DUB (any 3)
COC, tranexamic acid, danazol, progestogens, GnRh analogues,
mefenamic acid, if medical management falls then option for
surgery
A 23 years old P0A1 presentation in emergency in stste of shock with
H/o missed period, pain left iliac fossa and brownish spotting P/V
Task:

2. How would you confirm diagnosis? At bed side.
3. How would you manage?
4. What is the most common site of the condition?
Key
1. Ectopic pregnancy
2. Bed side pregnancy test USG for
interpreitoneal haemorrhage
3. Initial resuscitation …. Save 2 I/V lines, maintain airway,
oxygen inhalation Blood arrangement
Emergency laparotomy (Salpingectomy)
4. Ampullary region of the tube is the most commonest site of
ectopic pregnancy
A 24 years old woman married since 3 years, nulliparous, complains of
bothersome hirsutism and skipping periods. On examination she is 5
feet 2 inches tall and weights 160 lbs. her secondary sex characters are
normal. On USG uterus and ovaries are present with no pelvic
pathology.
Task:
2. What tests will you advice to confirm your diagnosis?
3. How will you treat her for this condition?
4. Patient is concerned about her fertility, how will you treat her?
Key
1. PCOs
2. Serum LH,FSH, Prolactin
3. Medical (metformin, Diana 35, COC, anti androgen)
Surgical (ovarian wedge resection, laparoscopic ovarian
drilling)
4. Ovulation induction with clomiphene citrate
A P4+1 presented through emergency 10 days after vaginal delivery
with heavy P/V bleeding and crampy lower abdominal pain. She looks
pale having pulse 110/min and BP 90/60 mmHg
Task:
1. What condition the lady is suffering from?
2. Define the underlying cause?
3. How will you manage her?
Key
1. Hypoyolemic shock due to Secondary PPH.
2. Fresh bleeding from the genital tract between 24 hrs & 6 wks
after delivery.
3. Management of heavy bleeding includes.
Double I/V line.
Draw sample for blood group & cross match, CBC and other
labs.
Set up srystalloid/ colloid infusion.
Uterotonic agents (Syntocinon, misoprostol, PGF2 alpha)
Evacuation of RPOCS.
A 32 years PG with weight of 98 kg at 40 weeks of pregnancy is being
delivered by duty resident. After delivery of head, there is significant
delay in delivery of shoulders.
Task:
2. What are the risk factors in this condition?
Key
1. Shoulder dystocia.
2. Large baby maternal obesity, D, mellitus, post maturity, prolonged
2nd stage of labour and assisted vaginal delivery.
A 30 years old G2P1A0 at 37 weeks of gestation presented in OPD with
USG showing breech presentation. She was offered the given
procedure?
Task:
Carefully read the scenario, examine the given photograph and
answer the following questions:
1. Name the procedure shown in the picture.
2. What are the contraindications of the procedure?
3. Predisposing factors for breech presentation?
Key
1. ECV
2. Plcenta previa, oligohydramnios, polyhydramnios, H/o APH,
previous C-section, multiple gestation.
3. CPD, pelvic tumor (fibroid,Ovarian tumor), placenta previa
multiple gestation.
A 65 years of postmenopausal nulliparous presented with lower
abdominal pain and distention. USG show bilateral ovarian with raised
CA 125
Task:
1. What is the most probable diagnosis?
2. What are the risk factors for disease in this patient?
3. What are other tumours markers for ovarian CA?
Key
1. Ovarian CA
2. Age of the patient Nulliparity
Bilateral ovarian masses Raised CA
125
3. Beta hCG, alpha fetoproteins
Task:
questions:
1. Identify the condition shown in the diagram.
2. What work up is needed before treatment?
3. If the beta-hCG remains persistently raised, what would you
suspect?
Key
1. Molar pregnancy/ complete mole
2. Serum beta hCG, complete blood count, blood grouping and
cross, x-ray chest
3. Choriocarcinoma, invasive mole
Task:
1. What is most likely clinical diagnosis?
2. Name organism causing it?
3. What are risk factors?
4. How will you confirm diagnosis?
5. How will you manage?
Key
1. Vaginal candidiasis
2. Candida albicans
3. Diabetes hypothyroidism Patient taking
OCPs, use of antibiotics
4. Confirmation of diagnosis is by microscopy and culture of
vaginal fluid
5. It is better to use topic rather than a systemic treatment
Single dose treatment 500 mg clotrimazole vaginal pessary is
adequate Fluconazole 150 mg oral
A 65 year old P4A0 presented with recurrent episodes of
postmenopausal bleeding. After evaluation her TAH and BSO was
done. Cut section showed
Task:
questions:
2. Risk factors for disease?
Key
1. Ca endometrium
2. a. Nulliparity, obesity, unopposed estrogen therapy
b. Impaired carbohydrate tolerance
c. Personal or family H/o ca breast, ovary, colon
A 38 years old G6P5A0 markedly obese lady is admitted in antenatal
ward for last 10 days for low lying placenta. She is habitual smoker.
Now she has developed pain and swelling of right calf.
Task:
1. What is likely your diagnosis?
2. What are risk factors for thromboembolic disease in this lady?
3. What are the risk factors specific to pregnancy?
Key
1. Thromboembolism
2. Maternal age, obesity, smoking, immobilization,
grandmultiparity
3. Multiple gestation, pre-eclampsia, C-section (especially,
emergency), damage to pelvic veins, sepsis
Task:
Carefully examine the given instrument/photograph and answer the
following questions:
1. Identify the instrumentals shown in given picture?
2. Name the procedure and the indications in which they are used?
Key
1. Picture1: Uterine curette
Picture 2: Hegar’s dilator
2. Dilatation and curettage
Indications:
Diagnostic: abnormal uterine bleeding, suspicion of
endometrial or cervical malignancy, infertility workup, diagnosis of
endometrial infection.
Therapeutic: abortion, heavy uterine bleeding, endometira
polyp, misplaced IUCD
A 25 year old lady presents with history of irregular periods and
inability to conceive for 5 years. Her pelvic ultrasound image is shown
in given picture.
Task:
Carefully examine the given ultrasound image, read scenario and
1. What is the likely diagnosis?
2. What are the clinical manifestations of this disease?
3. What investigations would help confirm the diagnosis?
4. What are the long term efforts of this disease?
Key
1. Polycystic ovarian disease
2. Oligomenorrheoa/ amenorrhoa, hirsutism, subfertility, obesity,
recurrent miscarriages, acanthosis nigricans
3. serum androgen levels (which may be marginally elevated) and
SHBG (which may be reduced) A blood test for
gonadotrophins (which may show elevated LH:FSH ration) TVS
(showing classical picture of PCOD)
4. Increased risk of developing diabetes, cardiovascular disease
Task:
Carefully examine the photograph and answer the following
questions:
1. What pathology is shown in the image?
2. What are the three types of fibroid within the body of uterus?
3. What are the management options?
Key
1. Fibroid is an oestrogen dependant benign tumour of smooth
muscies of uterus
2. Intramural, subserosal, submucosal
3. Surgical: Hysterectomy, myomectomy
Medical: GnRH analogues, danazol
Task:
question:
Label the diagram
Key
1. Posterior fontanelle
2. coronal
3. Bregma or anterior fontanelle
4. Sagital
5. Frontal eminence/ bone
A 25 year old G3P2A0 at 20 weeks of pregnancy presents in antenatal
clinic. She had history of previous 2 preterm deliveries at 32 and 30
weeks of pregnancy respectively.
Task:
1. Define preterm labour?

2. What is the risk of preterm delivery in this patient?
3. How she should be managed in this pregnancy?
Key
1. Incidence is 20% after two preterm deliveries.
2. Regular painful uterine contraction leading to cervical dilatation
and effacement before 37 complete weeks of pregnancy.
3. In view of significant risk for preterm. She should receive
consultant care in hospital. Screening for bacterial vaginosis and
other risk factors for PTL. Involve neonatologist.
Task:
questions:
1. Name the complication of the given picture.
2. The given complication mostly occurs in what type of
pregnancy?
3. Which type of vascular anamoly is present in this complication?
4. Describe the smaller fetus.
5. Describe the larger fetus.
Key
1. Twin – twin transfusion syndrome
2. Monochorionic twins
3. Arteriovenous
4. Anemia, grown retarded, oliguric, develops oligohydramnios
5. Polycythemic, polyuric, develops polyhydramnios, HTN, CCF,
become hydropic
Mrs. ABC para 3 presented six days after delivery with high grade
fever. She is breast feeding her neonate and both breasts are soft.
Task:
1. What is the most likely diagnosis? Define.
2. What are the possible causes?
3. What investigation will you do?
Key
1. Pueroeral pyrexia
A rise of temperature of 38 C (100.40F) or higher within first 10
days postpartum, exclusive of the first 24 hours
2. Genital tract infection, breast infection, chest infection, UTI,
local/ wound infection, venous thrombo embolism, pyrexia of
unknown origin
3. Complete blood count, sputum for culture MSU (for
urinalysis and for microscopy and c-section)
Swabs (wound, vagina and endocervix-blood culture) USG
pelvis
A 35 years old G4P3A0 admitted in labour room at 34 weeks gestation
with loss of fetal movements and mild vaginal bleeding. On
examination her BP is 140/90 mmHg. SFH is 37 cm, abdomen is tense
and tender and fetal heart sound not audible.
Task:
1. What is the most likely clinical diagnosis?
2. What are the necessary investigations required for definitive
management?
3. Write down the associated fetal and maternal risks.
Key
1. Placental abruption and fetal demise.
2. Pelvic USG, CBC, Blood GP and Rh Factor, clotting profile,
RFTs
3. Fetal: Fetal hypoxia, premature delivery
Maternal: Hypovolemic shock, clotting disorders, organ damage
Task:
Carefully examine the given graph and answer the following
questions:
1. Identify the trace.

2. Comment on four features of this trace.
3. What are its indications of this teat?
Key
1. Normal reactive CTG
2. Baseline heart rate 130 bpm
Several accelerations
No deceleration
3. Admission CTG, High risk pregnancy, To detect fetal distress
A 20 year old unmarried girl presents to OPD with history of severe
pain in the pelvic region every month. The pain starts 2-3 days before
the onset of menstrual cycle and it gets worst during the days of menses.
The pain gradually disappears after 4-5 days.
Task:

2. What investigations are helpful?
3. What is the management?
Key
1. Endometriosis
2. color Doppler ultrasound scan, CA 125, sometimes laparoscopy
3. Danazol, progesterone, combined contraceptive pills, GnRH
analogues
Task:
questions:
1. Identify the picture?
2. Write other forms of hormonal contraception?
3. What are absolute contra indications of combined oral
contraceptive pills?
Key
1. Oral combined hormonal contraceptive pill
2. Combined oral contraceptive pills
a) Combined hormonal patches
b) Progesterone only pills
i. Progesterone only preparations
ii. Injectables
iii. Subdermal implants
3. Circulatory diseases
a) Ischemic heart disease
b) Cerebrovascular accident
c) Significant hypertension
d) Atrial or venous thrombosis
e) Any significant risk factor for cardiovascular disease
i. Acute or severe liver disease
ii. Estrogen dependant neoplasma particularly breast cancer
iii. Focal migraine
A 60 years old lady complains of loss of urine every time she coughs or
sneezes.
Task:

2. What procedure is shown in the picture?
3. What are the possible treatments?
Key
1. Stress incontinence
2. Cystometry
3. Physical examination, loss of bladderangle, presence of cystocele,
demonstration of loss of urine, cystometric examination
4. Urethropexy, anterior repair
Task:
questions:
1. Identify the procedure.

2. What steps can the surgeon take to minimize bowel injury during
its use? Enumerate.
Key
1. Laparoscopy
2.
a) Preoperative assessment of risk factors
b) Previous abdominal surgery
c) Previous abdominal sepsis
d) Vere’s needle check
e) High pressure pnemoperitonium
f) Use of grarded instruments
A 56 year old woman has come with a pelvic mass. Her CA 125 is
found to be 140 U/L.
Task:

2. What type of tumor is common in this age group?
3. What are the modes of treatment?
Key
1. Ovarian tumor
2. Epithelial ovarian tumor
3. Staging laparotomy (surgical) or chemotherapy
A 28 year old woman came with the history of whitish gray vaginal
discharge with fishy odour. She had preterm labor on previous
pregnancy.
Task:

2. What test would you perform to reach final diagnosis? (Any 3)
Key
1. Bacterial vaginosis
2.
a) Microscopy
b) Wet amount
c) Vaginal PH
d) Adding KOH
Task:
questions:
Identify the given instrument
1. What are the uses of this instrument and in which operation it is

used?
2. Name two complications which can occur with this instrument?
3. How can these complications be avoided?
Key
1. Hegar dilators
2.
a) Perforation with small dilator
b) Cervical incompetence with larger dilators
3. Assess direction of uterus and length of uterine cavity
before dilatation. Use dilators in correct order to avoid
stretching and tearing of cervix. Ideally do not dilate above
size 6 Hegar.
A P1A0 delivered one hour back counsel her for breast feeding.
Task:
1. What are the advantages of breast feeding to the mother and to the
baby?
2. What are the disadvantages of bottle feeding?
Key
1. Fetal advantages (any three)
a) Cheep
b) Readily available
c) Require no temp
d) Reduces gastroenteritis
2. Diarrhoea, low resistance, over weight babies, expensive
A 22 years old primigravida emergency at 36 weeks of gestation with
history of fits at home. On examination her BP is 160/120 mmHg.
Task:

2. What specific investigations will you order in this case?
3. What is the goal of management in this case?
Key
1. Eclampsia
2.
a) Urine for proteins
b) Blood for full blood count, clotting profile, liver function
test, urea and electrolytes, cross matching
3.
a) Stabilization of the patient
b) Control of fits
c) Control of blood pressure
d) Prompt delivery of the fetus and placenta
A primigravida at 14 weeks of gestation comes to OPD. Her blood
group is A-ve, husband’s blood group is B+ve.
Task:
1. What is the problem in this pregnancy?

2. What investigations will you do?
3. What is your plan of management?
Key
1. Rh incompatibility
2. Rh antibody titre every month after 16 weeks of pregnancy,
serial ultrasound scan
3. Prophylactic anti-D, if the baby is Rh positive give injection
of anti-D to mother after delivery
Task:
questions:

2. In which procedure it is used?
3. Name two different techniques of the procedure?
4. What complications are associated with the procedure? Enumerate.
Key
1. Episiotomy scissor
2. For cutting episiotomy
3. Midline, midiolateral
4.
a) Infection
b) Haematoma
c) Extension of episiotomy
d) Pain and dysperunia
Mrs. XY on examination at 36 weeks of gestation is found to have the
given condition in the picture.
Task:
Carefully examine the given photograph, read the scenario and
2. She wants to know the complications of this condition in second
stage and third stage of labour.
3. How can the complications in third stage be avoided?
Key
1. Twin pregnancy, one cephalic and one breech presentation
2.
a) Retained second twin
b) Abruptio placentae after delivery of first twin
c) Locked twin if first twin is breech
d) Uterine atony
e) PPH
3. Administration of oxytocin i/v or i/m with anterior shoulder
of second twin. Oxytocin infusion after delivery of placenta.
Availability of blood in labour.
Task:
questions:
1. What is the procedure being performed?
2. What are the complications of this procedure?
Key
1. Active management of 3rd stage of labour
2. Broken cord, retained placenta,inversion of uterus,
postpartum haemorrhage.
A gravida at 32 weeks of gestation gives history of fluid per vaginum
for the last 3 hours.
Task:

2. Name two medicines which might be used in the management.
3. Name predisposing factors in this condition.
Key
1. PROM
2. Steroid and abtibiotics
3. Vaginal infection, UTI, epidemiological factors.
A G2p1 who has been in labour for the last four hours, ruptures her
membranes, greenish colour liquor amnni is seen. Fetal heart rate is 170
bpm.
Task:

2. What further investigation should be done?
3. What is the appropriate treatment?
4. What are the risks to the fetus?
Key
1. Fetal distress
2. CTG, fetal blood sampling
3. Caesarean section,
4. Meconium inhalation
Task:
questions:
1. Name the complication of the given picture.
2. The given complication mostly occurs in what type of
pregnancy?
3. Which type of vascular anamoly is present in this
complication?
4. Describe the smaller fetus.
5. Describe the larger fetus.
Key
1. Twin – twin transfusion syndrome
2. Monochorionic twins
3. Arteriovenous
4. Anemia, grown retarded, oliguric, develops
oligohydramnios
5. Polycythemic, polyuric, develops polyhydramnios,
HTN, CCF, become hydropic
1. What is the pathology shown?

2. What can be the presenting symptoms?
3. What are management options available?
Key
1. Endometrial polyp
2. a. Manorrhagia
b. Intermenstrual bleeding Discharge
3. a. Curettage with polypectomy

b. hystroscopic resection
3. Which suture material should be used?
4. Name any complications?
5. What would be next step in management if this procedure
fails?
Key
1. B – Lynch suture
2. PPH
Uterine atony
3. Catgut / Vichyl / Absorbable
4. Ischemic necrosis, infection
5. Hysterectomy
Task:
questions:
1. Identify the organ?
2. Describe its functions?
3. Name the hormones it produces?
4. What are its abnormal forms? (Name any 3)
Key
1. Placenta
2. Exchange of nutrient and waste product between the mother and
fetus.
3. Hormones produced by the placenta are
a) Protein hormones
i. Human chorionic gonadotrophin
ii. Human placental lactogen
b) Steriod hormones
i. Estrogen ii. Testosterone
iii. Progesterone iv. Corticosteroid
4. Abnormal forms of placenta are
a) Placenta extrachorialis b) Bipartite placenta
c) Battle dore placenta d) Placental infarcts
e) Succenturiatre lobe of placenta e) Chorionic cysts
Interactive Station
A 32 year old G5P4A0 came in antenatal clinic at 34 weeks of gestation.
She had complain of weakness, lethargy, and having dyspnea while
performing normal household activities. She had report which was
shown below?
 Hb 8 gm/dl
 ESR 30
 MCV 60fl
 MCH 28pg
 MCHC 30 g/dl
Task:
Carefully read the scenario and answer the questions asked by the
examiner.
For Examiner:
The examiner will ask the following questions:
2. What are the important points you will ask in her history?
3. What investigation would you like to offer for anemia?
4. In this patient what can be the probable cause and how will you
manage her?
Key:
1. Moderate iron deficiency anemia
2. History
a) Mode of deliveries b) Chronic disease, worm
infestation
c) Eating habits d) Bleeding form any site
e) Haematemesis, haemoptysis, or malaria
f) Any evidence of haemoglobinopathies in family
3. Investigation
a) Serum ferritin/TIBC b) Transferrin receptor saturation
4. Probable cause (nutritional deficiency)
Management: after investigations:-
a) Counseling of the patient b) Initially blood transfusion
at least 2 then can b put on
oral or I.V iron
c) Blood transfusion with lasix d) Fetal surveillance (USG)
cover preferable pack cell to
make the Hb% at around 11gm
at the time of delivery
e) Regular antenatal check ups
i. Delivery spontaneously
ii. Post partum Hb and iron supplements
Interactive Station
A 36 year old P6A1 presented in emergency with complain heavy
vaginal bleeding after delivery of a male baby of weight 4 kg at home 2
hours back. On examination her pulse is 120bpm, BP 80/50mmHg,
temperature 98.6 F, and R/R 24/min. on abdominal examination uterus
is relaxed.
Task:
Read the scenario carefully and answer the questions asked by the
examiner.
For Examiner:
Please ask the following questions from the candidate:
2. What will be your immediate step?
3. How will you further manage this case?
4. What are the long term complications of such severe condition?
Key:
1. PPH due to uterine atony

2. Call for help, initiate resuscitation, and check air way, start 100%
oxygen, save 2 wide bore I/V lines, take blood for CBC, clothing profile
and cross matching of 4 unit of blood.
3. Start I/V fluid, once blood available start blood, start uterine
massage, pelvic examination to rule out any retained products of
conception and to rule out any local cause of bleeding like cervical tear
etc, if no RPOCs or tear than bimanual compression of uterus,
intravenous uterotonics. Insert 800 ugm (4 Pessaries) of Misoprostol
rectally, PGF2 alpha injection intramyometrially. If still bleeding,
hydrostatic balloon vaginally inflated with 300-400ml water. If still
bleeding shift to theatre do laparotomy……uterine artery ligation, apply
B lynch, if still bleeding……Internal iliac ligation……still
bleeding……hysterectomy.
4. Sheehan’s syndrome.
Interactive Station
Task:
Carefully examine the given photograph and answer the questions asked
by the examiner.
For Examiner:
Please ask the following questions:
2. It is used to?
3. In which procedure it is used for?
4. In gynaecological surgery, name 2 speclums which are used?
Key:
1. Sim s speculum
2. Toretract posterior vaginal wall
3. Diagnostic dilatation nn curettage
4. Sim’s and Cusco’s speculum
Task:
Carefully read and answer the following questions:
1. Give three common presentations of patient with cervical
carcinoma?
2. What is most common type of cervical carcinoma?
3. What is stage 3 of cervical carcinoma?
4. What do you mean by Wertheim s hysterectomy?
For Examiner:
Key:
1.
a) Asymmptomatic
b) --Postcoital bleeding
c) --intermenstrual bleeding
d) --post menopausal bleeding
e) --blood stained vaginal discharge
2. Squamous cell carcinoma
3. Carcinoma involving lower third of vagina and/or extending to
pelvic side walls
4. Removal of cervix, upper third of vagina, uterus and parametrial
tissue + pelvic lymph nodes including obturator, internal and external
iliac lymph nodes
A 42 year old woman presented in gynae OPD with complains of
irregular vaginal bleeding for 6 months. She had USG report with bulky
uterus and 10mm endometrium. She was advised to have D n C?
Task:
1. What do you mean by D n C?
2. Give 4 indications for D n C?
3. Give 3 complications of D n C?
4. Outline steps of D n C?
For Examiner:
Key:
1. Dilatation and curettage(it is dilatation of cervix to allow passage
of instrument into uterine cavity and curettage means removal of
endometrium)
2. Abnormal uterine bleeding, endometrial polyp, suspected
endometrial and cervical malignancies, abortion
3.
a) …..Trauma
b) ….haemorhage
c) ….infection
4.
a) ….informed consent
b) ….anaesthesia
c) ….lithotomy postion
d) ….emptying urinary bladder
e) ….cleaning and drapping
f) ….bimanual examination under anaesthesia
g0 ….retract posterior vaginal wall with sim s speculum. Hold
cervical lip (anterior) with vulsellum. Introduction of uterine sound for
length of uterine cavity, then introduce currete for endometrial tissue
(take curettage from all sides of uterine cavity)
h) ….clean the area
i) ….watch postoperatively
Task:
1. What is etiology of polycystic ovaries disease?
2. Give 3 clinical features of polycystic ovaries disease?
3. What is ultrasound criteria for diagnosis?
4. Outline steps of treatment?
For Examiner:
Key:
1. Not completely clear but family history is positive.
2.
a) Oligomenorrhoea/amenorrhoea
b) Subfertility
c) Hirsustism
d) Obesity
e) Recurrent miscarriage
3. 8 or more subcapsular follicular cysts, <10mm in diameter and
stroma
4.
a) COCP and syslical progesterone….to regulate menses
b) ….Metformin….those with hyperinsulinemia
c) ….Clomephene….induce induction
d) ….Lifestyle advice
e) ….Weight reduction
A 21 year old female, p0+0, complains of painful menstruation since her
menarche, now presented with dysparunia,
Task:
2. What might you find on examination?
3. What investigation would you help to confirm diagnosis?
4. What treatment options should be discussed?
For Examiner:
Key:
1. Endometriosis
2.
a) Tenderness
b) Reduced mobility of uterus
c) Adenexal mass
d) Palpable endometrial nodules
3. Endocervical/high vaginal swabs
a) USG to exclude endometriosis
b) Diagnostic laparoscopy
4. Analgesia
a) COCP
b) Mirena
c) GnRH analogue
d) Surgical(laser or diathermy by laparoscopy)
Task:
questions:
1. Which is the diagnosis?
2. What is the etiology of this delivery?
3. What is the mode of delivery?
4. Can it happen in next pregnancy?
For Examiner:
Key:
1. Hydrocephalus
2. Congenital causes, infections and folic acid deficiency.
3. Depending upon degree of hydrocephalus. It could be normal
vaginal delivery(NVD), after drainage of cerebrospinal fluid or it could
be lower segment caesarean section.
4. Yes. Recurrent risk is present.
Task:
questions:
1. Which measurements are taken?
2. This measurement is used for what? Give 2 indications.
3. What is prediction its accuracy?
For Examiner:
Key:
1. CRL measurement of fetus

2. For measuring
a) Gestational age
b) Calculating EDD
3. Early CRL is accurate by prediction of ± 5 days
Interactive Station
Task:
Carefully examine the provided instrument and answer the
1. What is the name of this instrument?
2. What are the indications for the use of this instrument? Tell any
four?
3. What are the prerequisites for its use? Tell any four.
For Examiner:
Key:
1. Forceps
2. Indications
a) Delay in the second stage of labour
b) Fetal distress in the second stage of labour
c) Maternal conditions requiring the short second stage of labour
d) Face presentation
e) Bleeding from fetal blood sampling site
f) After coming head of the breech
g) Delivery before 34 weeks of gestation
3. Prerequisite
a) Full dilation of the cervix
b) Fetal membrance should be ruptured
c) Presentation vertex, face or after coming head of the breech
d) Position of the presenting part should be known
e) Head should be engaged at zero station or below
f) Cephlopelvic disproportion should be ruled out
g) Bladder should be emptied
Interactive Station
Task:
questions:
For Examiner:
The examiner will ask the following questions:-
1. Identify?
2. What is mechanism of action?
3. Give three contraindications?
4. Give three common side effects?
Key:
1. Combined oral contraceptive pills.
2. Acts both centrally and periphery
a) ….inhibition of ovulation as estrogen and progestogen suppress
both LH and FSH
b) ….Causes endometrium atrophic and prevent implantation
c) ….alter cervical mucous to prevent sperm ascending into uterine
cavity
3.
a) ….breast feeding <6 weeks postpartum
b) ….smoking
c) ….hypertension
d) ….migraine
4. depressed mood
a) ….headache
b) ….breakthrough bleeding
c) ….nausea, vomiting
e) ….breast pain
f) ….fluid retention
A patient G6P4+1 presented with history of 39 weeks gestation with
mild labour pains for 6 hours and sudden gush of watery discharge for 5
minutes. On examination, fundal height term with longitudinal lie, fetal
head 5/5 palpable through the vagina.
Task:
Carefully examine the Scenario and answer the following questions:
How will you manage the case?
For Examiner:
Key:
a) Call for help and explain the situation to the patient and relatives.
b) Auscultate for fetal heart sound to ensure fetal viability
c) If fetus dead then wait for vaginal delivery
d) If baby alive, immediately do pelvic examination if cervix fully
dilated, immediate instrumental delivery. Other wise
e) Replace the cord within the vagina to keep warm and relieve cord
compression while preparing for the caesarean section by
i. Knee elbow/left laterals with Trendelenberg position.
ii. Maternal elevation of the presenting part
iii. Manually push the fetal part high
iv. Or catheterize and fill the bladder with 500ml of normal saline
then clamp catheter
f) Save I/V line take blood for routine investigation, cross matching
and arrangement of blood.
Task:
questions:
1. Identify the diagram what is showing
2. What do you mean by condition shown in figure?
3. What are the risks in condition shown in figure? (Give any three)
4. At what gestational age, it can be done?
For Examiner:
Key:
1. Amniocentesis
2. It means aspiration of the amniotic fluid, and this is in use for the
evaluation of fetal condition
3.
a) Pregnancy loss (1%)
b) Leakage of amniotic fluid
c) Fetal trauma
4. 16 weeks of gestation
Task:
Carefully and answer the following questions:
1. Define normal menstrual cycle?
2. What are different phases of normal menstrual cycle?
3. Name hormone which play important role in proliferative phase?
4. What is best predictor of imminent ovulation?
For Examiner:
Key:
1. It is presence of normal vaginal bleeding. This depends on changes
occurring within ovaries and fluctuation in ovarian hormones,
controlled by pituitary and hypothalamus.
2. Endometrial (proliferative, secretory phase)
Ovarian (follicular, Iuteal phase)
3. Estrogen induces growth of glands and stroma
4. LH surge
A P4 + 1, 35 years old presented with smelling vaginal discharge,
Task:
Read the scenario and answer the given questions:
2. How will you investigate?
3. What is treatment of this condition?
4. Enlist the two important causes of vaginal discharge with itching?
For Examiner:
Key:
1. Bacterial vaginosis
2. H/O odour, test – amine test, ph test
Wet smear – clue cells
Gram staining
3. Metronidazole
Clindamycin (orally) or vaginally
4.
a) Trichomoniasis
b) Candidiasis
A 19 year old second year medical student came with H/O irregular
periods since menarche and hirsutism for the last one and half years.
Her BMI is 34.
Task:
2. What investigations would be helpful to confirm clinical
diagnosis?
3. What treatment options are available for this young girl?
4. What are the long term implications of PCOS?
For Examiner:
Key:
1. PCOS
2. Serum androgen, SHBG, LH & FSH levels, fasting insulin level
and pelvic ultrasound.
3. Counselling, weight reduction, cyclical progesterone or COC to
regulate the periods. For hirsutism – cyproterene acerate, surgical (laser
& electrolysis)
4. Role of metformin
Subfertility or infertility, risk of diabetes and coronary heart
disease.
Task:
Carefully examine the given photograph and answer the given
questions:
1. Identify the picture.
2. What are the different types of uterine polyps?
3. What are the clinical features of the shown pathology?
4. What is the treatment option in young patient?
For Examiner:
Key:
1. Fibroid
2.
a) Fibroid polyp c) Cervical polyp
b) Endometrial polyp d) Placental polyp
3. Irregular p/v bleeding
Intermenstrual bleeding
Post coital bleeding, vaginal discharge
4. Polypectomy
Mrs. Ali P3 + 1 is being monitored by serial ßHCG after evacuation of a
molar pregnancy. At 5 months serum ßHCG revel, which initially
showed a fall, starts rising again.
Task:
Carefully read the given scenario and answer the given questions:
1. What may be the causes of this rising titre?
2. What investigations can help you to reach a diagnosis?
3. What are risks of invasive mole?
4. What is the treatment of a case of invasive mole?
For Examiner:
Key:
1. The causes of rising titre can be persistent trophoblastic disease i.e
(choriocarcinoma, invasive mole) or new pregnancy.
2. Pelvic USG – to see molar tissue in uterus, theca luteal cyst.
Doppler USG – can show invasive mole invading uterine wall.
 Investigations for ectopic focci of trophoblastic tissue eg chest X-
ray chest, C.T scan/MRI of brain / vertebral colonies.
3. It can be life threatening due to sudden intra peritoneal
haemorrhage & by virtue of metastasis to brain, liver & lungs.
4.
a) Chemotherapy
b) In case of intra peritoneal haemorrhage – Laparotomy followed by
focal resection or hysterectomy.
Task:
Carefully examine the picture and answer the given questions:
Examine the given picture carefully and label the structures marked as
1-10 in the given picture.
For Examiner:
Key:
a) Bladder f) Ovary
b) Fundus of uterus g) Pouch of douglus
c) Round ligament h) Fallopian tube
d) Body of the uterus i) abdominal aorta
e) Ovarian ligament j) sigmoid colon
Task:
See the device or its picture and answer the given questions:
1. Identify the device.
2. Give its role in the management of menorrhagia.
3. How it acts as a contraceptive device.
4. Give the advantages and disadvantages of this system.
For Examiner:
Key:
1. Levonorgestrel intrauterine system.
2. Highly effective in the management of menorrhagia 95% reduction
in MBL after one year use of LNG-IUS has been found. Effective
alternative to surgical treatment of menorrhagia.
3. This device prevents pregnancy primarily by a local hormonal
effect on cervical mucus and E/M.
4. Advantages – highly effective, protects against PID. Disadvantages
– persistent spotting and irregular bleeding in first few months of use,
acne, breast tenderness.
Interactive Station
Task:
questions:
2. What are its different parts?
3. Give indications for its usage?
4. How this is used?
5. What are its advantages over sim’s speculum?
For Examiner:
Key:
1. Casco’s speculum
2. Two Blades & a screw lock
3. To examine the cervix and vaginal walls.
To take pap smear, to take HVS.
Insertion of IUCD
4.
a) Consent from the patient
b) Hands should be gloved.
c) Speculum should sterilized
d) Before application it should be checked (its screw lock)
e) Lubricant should be used
f) Insert gently to avoid pain
g) Blades are opened up after inserting the speculum inside the
vagina
h) Before taking out speculum blades should be approximated.
5. Its used doesn’t require assistant.
Self retaining
Interactive Station
36 years old known diabetic was delivered by caesarean section at 36
weeks. Baby was shift to the nursery immediately. The baby died on 2nd
day.
Task:
1. How will you label this death?
2. What could be the possible causes of it?
3. What is prenatal death & what is PNMR?
4. Enlist any four common causes of PND?
5. What measures should be taken to bring down PNMR in Pakistan?
For Examiner:
Key:
1. Early neonatal death (first week neonatal death)
2. Prematurity, RDS, fetal comolications due to maternal diabetes
(macrosomia, polyhydramnios, growth retardation, metabolic
derangement, CMF)
3. Prenatal death is IUD + first week neonatal death.
PNMR = IUD + first week neonatal × 1000
Total No. of births
4.
a) Congenital malformation. e) Infection
b) Uteroplacental insufficiency f) Prematurity
c) Obstructed labour g) Rh incompatibility
d) Birth trauma
5.
a) Improvement in A/N care
b) Picking up & timing referral of high risk cases (HDP, APH,
Malpresentation, preg. with medical disorders, multiple gestation)
c) Presence of skilled birth attendant at the time of delivery.
d) Ensuring aseptic conditions at the time of delivery.
e) Atraumatic delivery.
f) Proper & adequate pediatric cover & nursery.
Interactive Station
A G2P1 + 0 has com in OPD at 14 weeks of pregnancy. She is a
diagnosed case of ß thalasemia minor, in last pregnancy. She is worried
about the outcome of her current and future pregnancies.
Task:
Carefully read the scenario and answer the given questions:
How will you counsel her?
For Examiner:
Key:
1. Introduction.
2. Sympathetic approach
3. Couple should be involved
4. Detail history of last pregnancy relevant to ß thalasemia, any
investigations done to detect child’s status delivered previously.
5. Screening of husband for it.
6. Likelihood of transmission if only mother is carrier or both
parents.
7. Obst. Management same expect for avoiding iron, blood
transfusion may be required.
8. Counselling for future depends on husband status.
Interactive Station
Task:
questions:
1. Identify the given instrument?
2. What are the indications of its use?
3. What are pre-requisites for its used?
4. Describe the method of its application?
For Examiner:
Key:
1. Outlet Forceps
2.
a) Maternal:- Maternal cardiac, respiratory disease when exertion to
be avoided.
b) Fetal:- Fetal distress, after coming head of breech.
c) Prolonged 2nd stage.
3.
a) CX. Should be fully dilated.
b) Position & station of the presenting part should be confirmed.
c) Bladder should be empty.
d) No element of CPD.
e) Episiotomy should be given
4.
a) Check the forceps pair before application.
b) Left handed blade applied first
c) Insertion of forceps downwards & inwards guided by obstetrician’s
hand.
d) Same procedure followed for other blade.
e) Blades must lock easily, should not be forced to lock.
f) Proper direction of pull.
g) Use of undue force must be avoided.
h) After delivering the head, take out the forceps & complete rest of
the delivery.
Task:
Carefully answer the following questions:
1. What is antenatal care?
2. At what gestational age booking visit is recommended?
3. What are the objectives of booking visit?
4. What baseline investigations should be performed at booking visit?
For Examiner:
Key:
1. Antenatal care is the clinical assessment of mother & fetus during
pregnancy for purpose of obtaining the best possible outcome for both
the mother & the child.
2. Booking visit is recommended at 8-14 weeks
3. Objectives are to obtain comprehensive history, establish
gestational age, & identify maternal & fetal risks, & perform baseline
investigation & formulate a management plan.
4. CBC (Hb & full blood count), blood group (ABO & Rh factor),
BSR, C/E urine, HbSAG & Anti HCV, ultrasound for dating, viability,
no of fetus, location of pregnancy and any pelvic pathology or
abnormality.
A G5P4 presents with labour pains at 35 weeks of gestation. Previously
she had normal vaginal deliveries. Lie and presentation of the baby are
shown in the given picture.
Task:
Read the scenario examine the picture and answer the following
questions:
1. What is the lie and presentation of the baby?
2. What are probable causes of this malpresentation?
3. What investigations are required?
4. What are risks of labour in this patient?
5. How will you mange this patient?
For Examiner:
Key:
1. Lie with shoulder presentation
2. Multiparity, prematurity,
Polyhydramnios
Fibroids in lower uterine segment
Placenta previa
3.
a) Baseline investigations, CTG
b) USG for assessing fetal growth & well being, confirmation of lie,
detection of
c) Any uterine anomalies or pathology, placental localization.
4.
a) Early rupture of memberane causing
Prolapse of cord, hand, limbs
Leading to fetal distress or IUD.
b) Obstructed labour, ruptured uterus
5. Emergency C-section & BTL
A P3 + 0 delivered spontaneously in your unit and discharged on the 1st
post delivery day.
Task:
Read the scenario and answer the following questions:
1. When will you advice her to come for postnatal check up.
2. What enquires should be made during her visit to postnatal clinic?
3. Name two issues that must be discussed during her postnatal visit
to the hospital.
For Examiner:
Key:
1. After six weeks of delivery
2.
a) Enquires regarding any problem or concern with which woman
may present.
b) General health status.
c) Diet, medicines & rest
d) Whether lochiae have ceased or not.
e) Bladder & bowel function
f) Infant feeding problem
3. Vaccination of the baby and options regarding contraception.
Task:
Carefully answer the following questions:
2. What investigations should be done?
3. How will you mange the case?
For Examiner:
Key:
1. Pre-eclampsia
2. Urine C/E, LFTs, RFTS, coagulation studies, USG, 24 hours
urinary protein.
3.
a) Antihypertensive agent
b) Prophylaxis of fits (MgSo4)
c) Obst. Management
If condition remains stable continue pregnancy- maternal & fetal
surveillance.
If start deteriorating then assess bishop score and deliver after dexa
cover, vaginally / abdominally guided by fetomaternal condition.
Task:
Carefully examine the given graph and answer the following
questions:
1. Identify it?
2. Explain it?
3. Define reactive CTG?
4. Define deceleration?
For Examiner:
Key:
1. Cardiotochograph
2. Patient name, time and date
a) Showing baseline FHR 130-140bpm
b) Beat to beat variability + ve, no deceleration
c) Showing accelerations
3. Baseline FHR 110-160 bpm
Beat to beat variability 5-7
2 accelerations in 20 minutes.
No deceleration
4. FHR 15 bpm less from baseline & remain so for 15 seconds or
more.
Task:
Carefully examine the given photograph/instrument and answer the
2. Name one operation it can be used in?
3. Why is this instrument specific for this operation?
4. What injuries can be caused by this?
For Examiner:
Key:
1. Doyen abdominal retractor
2. Lower segment caesarean section
3. Cephalic curve for delivery of fetal head
4. Bladder injury
A 27 years old gravida 2 seen by the doctor at 37 weeks of gestation
with the presentation (shown in the picture)
Task:
questions:
1. What four factors may be responsible for this presentation?
2. What single investigation is needed for diagnosis?
3. What delivery options will you discuss with the woman?
For Examiner:
Key:
1.
a) Polyhydramnios
b) Placenta previa
c) Uterine anomaly
d) Uterine and ovarian masses
e) preterm labour
2. Ultrasound scan
3. Caesarean section and breech deliver
A grand multiparous patient who has been in labour for 12 hours
presents with the situation as shown in the picture, in labour room.
Task:
2. What is the treatment?
a) If baby is alive
b) If baby is dead
3. Name three complications which can occur during the procedure
for the treatment of this situation.
For Examiner:
Key:
1. Cephalic
2.
a) Lower segment caesarean section
b) Lower segment caesarean section
3.
a) Extension of uterine incision
b) Haemorrhage
c) Injury to bladder
d) Injury to alive baby
Interactive Station
A G5p2+2 presents at 32 weeks gestation with labour pains for 4 hours.
On examination cervix is 3 cm dilated.
Task:
2. What are the risk factors of this conditions? Name any four.
3. If her pain settles after tocolysis and she has ruptured of
membranes without labour pains after one week, how will you manage
her?
For Examiner:
Key:
1. Preterm labour
2. Rupture membranes, preterm delivery, neonaltal death, retained
placenta
3. Deliver
Mrs. XY on examination at 36 weeks of gestation is found to have the
following condition (see picture)
Task:
2. She wants to know the complications of this condition in second
stage and third stage of labour.
3. How can the complications in third stage be avoided?
For Examiner:
Key:
1. Twin pregnancy, one cephalic and breech presentation
2.
a) Retained second twin
b) Abruptio placentae after delivery of first twin
c) Locked twin if first twin is breech
d) Uterine atony
e) PPH
3. Administration of oxytocin i/v or i/m with anterior shoulder of
second twin. Oxytocin infusion after delivery of placenta. Availability
of blood in labour
Task:
1. Identify instrument?
2. What is its use?
3. Enumerate the anatomical features of the structure for which this
instrument is used
For Examiner:
Key:
1. Umbilical cord scissors
2. Use to cut the cord
3.
a) Umbilical cord has three vessels
b) It is surrounded by Wharton’s jelly
c) It has one umbilical vein and two umbilical arteries
Interactive Station
Task:
A G2P1 with history of lack of fetal movements presents in emergency.
On ultrasound scan intra uterine death is diagnosed. Counsel and
discuss management with patient.
For Examiner:
Key:
a) Explain problems
b) Discuss probable causes
c) Discuss time of delivery
d) Explain mode of delivery
e) Provide complications
Interactive Station
Task:
A 38 years old primigravida comes to antenatal clinic. She has concerns
about congenital abnormalities your task is to explain two useful tests to
patient to exclude Down’s syndrome.
For Examiner:
Key:
a) Chromosomal abnormality 21 trisomy
b) Fetal nuchal translucency by scan and trisomy 80%
c) Amniocentesis/ chorionic villus biopsy
d) Procedure/ complications
e) Accuracy of tests
A 21 years old girl has been referred to OPD with primary
amenorrhoea. She has a short height and breast development is not
adequate.
Task:
1. What is the name of this condition?
2. What is the chromosomal abnormality?
3. What advice will you offer her about her future fertility?
For Examiner:
Key:
1. Turner syndrome
2. 45 XO
3. She will be infertile but with embryo donation she may able to
achieve fertility, if laparoscopy shows adequate size of uterus.
A 55 years old woman had a hysterectomy for menorrhagia. Her
hysterectomy specimen picture is given.
Task:
1. Identify the specimen
2. Enumerate 4 risk factors for this condition
3. Enumerate any 4 presenting symptoms.
For Examiner:
Key:
1. Endometrial carcinoma
2.
a) Age – postmenopausal mostly 65-75 years
b) Excessive endogenous estrogen
c) Nulliparity
d) Unapposed estrogen therapy
e) Diabetes mellitus
3.
a) Postmenopausal bleeding
b) Postmenopausal vaginal discharge/ pyometra
c) Menstrual irregularity
d) Symptoms due to distant metastasis
Interactive Station
A 17 years old unmarried girl presents to emergency department with 7
weeks of amenorrhoea vaginal bleeding 3 days, temperature of 39.50C
and a dirty foul smelly discharge.
Task:
2. What are the investigations you will perform? Enumerate five.
3. Which three organisms may be isolated from this patient?
For Examiner:
Key:
1. Septic incomplete abortion
2. Full blood count, blood culture, group and save serum, high
vaginal swab, endocervical swab, urine culture and sensitivity.
3. Chlamydia trachomatis, E-coli, neisseria gonorrhoea,
streptococcus, clostribium, welchii.
Task:
2. Name three procedures that it is used in?
3. Complications that can occur with its use?
For Examiner:
Key:
1. Insufflation canula
2.
a) D & I
b) HSG
c) Laparoscopy
3. Injury, infection
Task:
questions:
1. Identify the two uterine anomalies?
2. Name four symptoms these might produce?
3. What is treatment of the condition in picture ‘b’?
For Examiner:
Key:
1.
a) Uterus bicornis unicollis
b) Uterus subsaptus
2.
a) Menstrual irregularities
b) Infertility
c) Repeated abortions
d) Preterm labour
3. Hysterectomy resection of septum
Task:
questions:
1. Identify the device given?
2. What are the indications? Give two.
3. What are the complications? Give two.
For Examiner:
Key:
1. Mirena – intrauterine device
2.
a) Contraception
b) Menorrhagia
3.
a) Irregular bleeding
b) Amenorrhoea
Interactive Station
Task:
Carefully read the scenario and perform the task:
A 65 years old lady presents with 3rd Degree utero vaginal prolapse. She
is booked for vaginal hysterectomy take informed consent.
For Examiner:
Key:
a) Explain diagnosis
b) Possible options of treatment
c) Explain operation and anaesthesia
d) Discuss complications
e) Ask patient for any concerns
Interactive Station
Task:
Demonstrate clinic pelivmetry on dummy/pelvis
For Examiner:
Key:
a) Pelvic inlet for its AP diameter. Diagonal conjugate is by
measuring from lower end of pubis to the sacral promonotory using tip
of second finger and the point where base of index finger meets the
pubis.
b) The obstetric conjugate is by substracting 1.5 to 2cm from
diagonal conjugate.
c) Middle finger often can not reach sacral promontory thus obstetric
conjugate is considered adequate. If diagonal conjugate is greater than
or equal to 11.5 cm it is adequate, Anterior surface of sacrum palpated
to assess curvature
d) Mid cavity: if parallel or convergent side walls, Ischial spines
prominent or not, Length of sacrospinous ligament should be 3 finger
breadth
e) Pelvic out let: Placing fist between 2 ischial tuberosities. 8.5 cm is
considered adequate transverse diameter.
A 20 year old nullipara married for 4 months attended genitourinary
clinic, endocervical swab was taken which showed gram positive
diploccoci.
Task:
2. What symptoms she may present with?
3. What other organisms you should screen for?
4. How will you manage her?
For Examiner:
Key:
1. Neissaria Gonorrhea
2. Vaginal discharge, lower abdominal pain, dysuria
3. Chlamydia Trachomatis, Trichomonas Vaginalis
4. Antibiotics, contact tracing
A 47 year old lady P1+0 presented with complain of rapidly enlarging
abdominal mass, dysponea, indigestion and weight loss for last 6
months. Menstrual cycle is irregular. On examination 20 weeks size
abdominal mass. Looking at this picture regarding this lady;
Task:
2. What type of procedure has been performed?
3. Is this procedure sufficient for treatment?
4. What subsequent treatment she may require?
For Examiner:
Key:
1. Ovarian carcinoma
2. TAH+BSO
3. Staging laparotomy is essential
4. Chemotherapy
Task:
questions:
1. Identify the object.
2. For what purpose it is used?
3. What is the difference between the two and why?
For Examiner:
Key:
1.
a) Aylesbury spatula
b) Ayres spatula
2. To take pap smear
3. As squamocolumnar junction recedes inside the cervical canal so
the one prong of Aylesbury spatula pointed and is better in this age
group to take smear than Ayres spatula.
Mrs. XYZ, 34 yrs old, G6P4+1, previous all normal deliveries, presented
in emergency at 37 week gestation with antepartum haemorrhage. On
examination, pluse: 120/min BP: 90/60mmHg, abdomen is tense and
tender, fetal heart sounds are not audible.
Task:
1. What is most probable diagnosis?
2. What is the differential diagnosis?
3. What investigations you will advise?
4. What will be mode of delivery?
5. What are most likely complications?
For Examiner:
Key:
1. Abruptio placenta
2. Placenta praevia/vasa praevia
3. CBC with platelets, clotting profile, blood group, renal function
tests, C/E urine ultrasound
4. Normal vaginal delivery, in case of massive haemorrhage
caesarean section
5. Hypovolaemic shock, acute tubal necrosis, DIC etc.
30 years old, G5P4+0 previous 1 LSCS, presented in emergency at 38
week gestation in labour. On examination, pulse: 92/min, BP: 110/70.
Examination reveals brow presentation. Moderate pains are palpable.
CTG is reassuring.
Task:
1. What investigations you will advise?
2. How will you treat the patient?
3. What is most life threatening risk to the patient?
4. How will you prevent this complication?
For Examiner:
Key:
1. CBC, BSL, CUE, HBsAg, AntiHCV, blood group ultrasound to
look for anomalies 1.5
2. Arrange blood, counseling regarding maternal and fetal condition,
call to anaesthetist and pediatrician, emergency LSCS by senior
obstetrician
3. Uterine rupture
4. By elective LSCS before start of labour pains
A 26 year old patient who presents with very scanty periods for 12
months. She has history of evacuation for incomplete miscarriage 12
months back. Her hysteroscopy reveals in the above picture.
Task:
questions:
2. What other investigations can help in diagnosis if hysteroscopy not
available?
3. What is treatment?
4. What complications can occur if she gets pregnant?
For Examiner:
Key:
1. Ashermen’s syndrome
2. Hysterosalpingography
3. Hysteroscopic division of adhesions followed by intrauterine
device insertion, contraceptive pills
4. Spontaneous miscarriage, preterm labour, placenta acreta
Interactive Station
20 years old lady has come in OPD for emergency postcoital
contraception
Task:
1. What two important questions will you ask her?
2. What two options are available for her?
3. What instructions will you give her about the tablets?
4. What further advise you must give her?
For Examiner:
Key:
1. Timing of sexual intercourse, date of last menstrual period
2. Levonorgestrel 0.75mg 2tab stat, intrauterine copper device
3. Use should be with in 72 hours of exposure, if there is vomiting,
she should take two more tablets.
4. If she fails to menstruate at her expected date, she should contact
doctor.
Interactive Station
Task:
A 30 year old primigravida presented in antenatal clinic with diagnosis
of rubella 1 week back. Report reveals 1gm positive & 1gG negative.
She is very apprehensive. How you will counsel her?
For Examiner:
Key:
a) Introduction
b) Eye to eye contact, sympathetic approach
c) Offer termination
d) About 80% risk of congenital rubella syndrome
e) Otherwise only symptomatic treatment
f) Encourage questions.
Interactive Station
Task:
questions:
1. Identify the object given in picture?
2. What is the principle idea of its use?
3. What is the most important point in its use which determines the
fetal outcome?
For Examiner:
Key:
1. Vacuum extractor
2. Creation of negative pressure to allow traction on cup which is
ultimately transmitted to: fetal scalp
3. Positioning of cup on the fetal head. Maximun flexion if placed 3
cm in front of posterior fontanel
Task:
questions:
2. What is the basic defect during embryogenesis?
3. What is the etiology?
4. How to diagnosis in antenatal period?
5. How much is the chance of recurrence?
For Examiner:
Key:
1. Anencephaly
2. Defect of Formation of neural tube
3. Multifactorial
4. High resolution ultrasound in first trimester
5. 5-10% if one sibling effected
Task:
1. What is the lie of fetus?

2. What is the presenting part?
3. What are the predisposing factors?
4. What are the risk factors associated with this presentation?
For Examiner:
Key:
1. Transverse lie
2. Shoulder presentation
3. Multiple pregnancies, multiparity, polyhydramnios, placenta
praevia
4. Cord prolapse, hand prolapsed, premature rupture of membranes,
Obstructed labour
A 21 years old primigavida at 34 wks gestation presented in emergency
with h/o tonic clonic fits. Her blood pressure is 180/120 of hg.
Task:
2. What emergency measures will you take?
For Examiner:
Key:
1. Eclampsia
2.
a) Call for help
b) Take care of airway, breathing and circulation
c) Pass folleys to monitor output.
d) Control of fits with MgSo4.
e) Control of Bp with i/v hydralzine.
f) Plan of delivery preferably vaginal. C/Section is reserved for
fetal distress and if vaginal delivery is contraindicated.
Task:
questions:
1. Identify the picture and mention types?
2. Indications of the procedure?
3. Identifications of procedure?
For Examiner:
Key:
1. Episiotomy, midline and mediolateral
2. To enlarge the diameter of vulval outlet in primigravida and in
instrumental vaginal delivery.
3. Haemorrhage, infection, dysparunia
Task:
Carefully read and define the following terms:
1. Maternal mortality ratio

2. Maternal mortality rate
3. Still birth
4. Perinatal death
5. Live birth
For Examiner:
Key:
1. Number of maternal deaths during a given time per 100000 live
births during the same time period.
2. Number of maternal deaths in a given period per 100000 women of
reproductive age during the same time period.
3. Still birth is a baby born with no sign of life
4. Prenatal death is a stillbirth>24th weeks gestation or death within 7
days of birth
5. Live birth is any baby that shows signs of life irrespective of
gestation.
Task:
Carefully observe the given photograph and answer the following
questions:
1. Identify the measurement that has been shown?
2. What is the indication of its use?
For Examiner:
Key:
1. Head circumference
2. To assess the gestational age
Interactive Station
A 22 years old primigravida is in 2nd stage of labour for the last 1 hour.
her CTG is reactive.
Task:
Discuss with examiner about diagnosis and further management.
For Examiner:
Key:
a) Diagnosis is deep transverse arrest.
b) Reassessment of uterine contraction if irregular than
syntocinon augmentation for spontaneous rotation to occur.
c) Ventous extractor can be applied
d) If failed then emergency C/Section
Interactive Station
A 25 year old primigravida presented in labour room with complain of
labour pains for the last 8 hours. On examination she is 6 cm dilated.
Liquor is clear on ARM.
Task:
Carefully examine the given photograph and answer questions
asked by the examiner:
1. Identify the given trace? 0.5

2. How do you interpret it? 2.5
3. Is it a normal or abnormal? 1
4. Discuss the management of given scenario? 1
For Examiner:
Key:
1. CTG
2. Baseline heart, beat to beat variation
a. Fetal scalp blood sampling for PH.
b. If normal than vigilant fetomaternal monitoring and continous
fetal heart rate monitoring.
c. If <7.2 than process for emergency C/Section
Interactive Station
Task:
questions:
1. What procedure is being carried out?
2. What are the indications?
3. What are the risk factors involved?
For Examiner:
Key:
1. Amniocentesis
2.
a) Prenatal diagnosis for
b) Anueploides (Trisomy21,18,13)
c) Genetic disorder, viral infections and biochemical tests
3. Miscarriages, infection
Task:
questions:
1. Identify the given picture?
2. How patients present with this problem?
3. What should be the idea treatment in this case as this pt is at 45
years of age and p4?
For Examiner:
Key:
1. Multiple fibroids.
2. Menorrhagia, subfertility, abdominal mass, pressure symptoms like
urinary retention.
3. Abdominal hysterectomy
A 35 years old presented with 4 recurrent 2nd trimester miscarriages.
She has this report with her.
Task:
1. What is this investigation?
3. What would be the cause of recurrent miscarriages in this case/
For Examiner:
Key:
1. Hysterosalpingogram
2. Uterine didelphys
3. Cervical incompetency
A 26 years old P1 presented with painful swelling over the vulva.
Task:
Carefully examine the given photograph, read the scenario and
1. Identify the problem?
2. How will you manage?
For Examiner:
Key:
1. Bartholin abscess
2.
a) Analgesics and antibiotics
b) Incision drainage/marsuplization
A 46 years old p6, delivered vaginaly know asthmatic, weighing 90 kg
presented with feeling of something coming out of vagina. She also
complains of poor urinary stream and incomplete emptying of her
bladder. She admits no urinary incontinence or symptoms.
Task:
2. What risk factors does she have for the development of prolapsed?
For Examiner:
Key:
1. Anterior vaginal wall prolapse
2. Multiparity, obesity, chronic asthma causing excessive intra
abdominal pressure.
Interactive Station
A 35 years old nulliparous presented with endometrial histopathology
report showing well defined endometroid adenocarcinoma figo grade 1.
She is a known case of polycystic ovarian syndrome with heavy
menstrual bleeding following spells of amenorrhoea.
Task:
How will you counsel her regarding further management?
For Examiner:
Key:
a) Greeting and introduction
b) Breaking the bad news in the presence of relatives
c) Sympathetic approach
d) Discussion regarding management like earlier stage of disease
requiring staging laprotomy (TAH,BSO, peritoneal fluid
washings and infracolic omentectomy)
e) Follow up every 6 monthly with complete examination and
pelvic USG
Task:
1. Write down the name of the structures cut down while performing
mediolateral episiotomy incision?
2. Name the sutures commonly use for repair of episiotomy?
3. What is the recommended rate of pain at episiotomy by WHO?
4. What can be common causes of pain at episiotomy site?
For Examiner:
Key:
1. Structures cut down are:
a) Skin subcutaneous tissue.
b) Bulbocavernosus muscle.
c) Transverse perineal muscle
d) Vaginal wall.
2.
a) Catgut
b) Vicryl
3. 10%
4. Excessive tension on sutured tissues. Hematoma at episiotomy site.

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Department of Obstetrics & Gynaecology

Wah Medical College & Allied Hospital

Send up exam Ospe

A primigravida at 34 weeks with B.P of 150/110mm, proteinuria

G5 Para 2 + 2 presented at 32 weeks of gestation with

Primigravida 30 year old

Patient presented with heavy vaginal bleeding after delivery of a

A 35 years old para 3 + 0 came to OPD with complaints of

a. What is the most likely diagnosis?

A 6th gravida age 38 years attends antenatal clinic at 30 weeks.

Perform obstetrical examination of pregnant woman at 36

a. Identify the instrument.

Pelvic examination of a patient at term shows following

a. What is the Bishop Score?

A Patient with 06 weeks ammenorrhoea is complaining of pain

Q. a. Name the X-ray taken in a 32Years old lady with primary

b. What are the X-ray findings?

c. What are treatment options available to her?

b. Normal uterus with bilateral tubal blockage.

c. IVF_ET, Tubal surgery, Adoption.

A 28 Years old primigravida nurse by profession is 20

weeks pregnant. She is HIV positive. Answer the question

28 Years old primigravida, 20 weeks pregnant is HIV positive.

1. What is the mode of transmission?

2. What is treatment during pregnancy?

3. What should be mode of delivery & Why?

4. How can we reduce the risk of transmission to baby?

a. What precaution would you advise for prevention of transmission

b. What is risk of transmission to neonate?

c. Which contraception method would you advise to her?

1. a. Clear documentation of HCV status

2. Less than 05%

3. Condom would best protect the transmission.

1. What is the mode of transmission of Hepatitis B?

2. What advise would you give for the neonate?

3. What precaution the hospital staff should take to reduce the

c. Infected needles, Pricks, blood & blood products.

3. a. Clear documentation of HB status

1. What is your diagnosis?

1. What is the diagnosis?

Examine the photograph + identify Anomaly

1. What is the most likely diagnosis?

2. What is the penetrance of this condition?

3. Enumerate any three presenting symptoms?

4. Give management options?

1. How does this condition occur?

2. Give signs & symptoms?

3. What are treatment options?

2. Give five indications of its use?

3. Dangers of its inappropriate use?

2. Diagnostic for pelvic pain, infertility endometriosis, Operative,

3. a. Trauma to abdominal and pelvic structure

1. Name the presentation?

3. Method of delivery of head?

4. Associated fetal complications?

3. What is the duration of active phase?

4. What intervention has been shown in the process?

2. Normal progress of labour

4. Artificial rupture of membrane + argumentation.

1. Name the problem shown in picture?

2. What are the fetal risks?

3. What are the maternal risks?

4. How will you differentiate clinically it from placental abruption?