"Don't get upset seeing the huge size of this document...

You have to prepare all the mentioned imp topics for covering ur vivas and OSCE.....just go through the tips mentioned,at the end of your prep....It'll help alot"

The Protocol Two long cases(one of gynae and one of obs) are allotted.There are 4 examiners(2 internal and 2 external) for two long cases and two table vivas...Table viva may or may not be related to long case.....two units combination which will be decided by them...Then there is OSCE and TOCS in the same way as in ward test....The questions are more or less the same with slight change....

2.Important Topics

Imp. Topics of Gyne 4 Viva. . . . . . . * D & C * Infertility * Amenorrhoea * Abortion * U.V Prolapse * Molar pregnancy * Fibroid Uterus * DD & Managment of lowr abdominal mass * Abn. Uterine bleedng * P.C.O * Vaginal Discharge * Urinary tract fistula * P.I.D * OCPs , IUCD * Dysmenorhea * Cervical CA * Endometrial CA * Hystrectmy * Menopause * Endometriosis * Ectopic pregnancy

Imp Topics 4 Obs Viva ._._._._._._. D.M in Pregnancy Eclampsia, PreEclampsia, HTN APH, PPH Amemia work up PPROM Active managment of 3rd stage of labour C section Anemia in Preg

 Placenta previa, abruptio IUGR & Causes of IUD Rh. incompatability Polyhydramnios Forceps delivery Breech Twins Pregnancy Induction of labour Mech. of normal labour & in Occipito Post. position antenatl care External cephalic version Episiotomy Preterm Labour Purperal pyrexia Maternal mortality Obstructd labour

3.Some Tips From Sir Nadeem(answers to some Q included)

Tip 1.Sites whr u wl find the cause of puerperal pyrexia.

Tip 2. Principles of managment of eclampsia..(Resusitation, Control the fit, Antihypertensiues, Tests to knw the efect ofdisease, Induction after stabilizatin, Post delivery care antihypertensives) * cause of death in eclampsia1.Intra cranial haemorhage 2.Pulmonary edema.

Tip 3.Four major causes of vaginal discharge &their distiguishd featres in a glance 1.Candidial disharge curd like NON SMELY causing pruritus vulvae.Rx clotrimazole pesary.2.Trichomoniasis yelowish green

FOUL SMELY pruritus vulvae.Rx.Metrnonidazol tablts 3.Bacterial vaginosis milk like FOUL SMELY NOT causing pruritus valvae.Rx metronidazole oral tablet4.Chlamydial discharge mucoprulent discharge.Rx doxycycline capsules.

Tip 4.Effects of DIABETES ON PREGNANCY And EFECTS OF PREGNANCY ON DIABETES(Diffcult control ,Nephropathty,Retinopathy etc)

Tip 5.Ten imp investigtins of infertile couple 1.Semen analysis 2.Pelvic USG 3.Day 21 progesteron(>30) 4.Folical tracing by USG 5.Basal body temp 6.Fern test(3,4,5 &6 for ovulatn detectin) 7.Hsg(hysterosalpingography) 8.Laproscopy 9.Hystero salpingn contrast sonograpy(7,8 &9 for tubal patency) 10.Post coital tst(for cervicl factor)

Tip 6. Some facts abt APH.Definatin Bleeding frm the genital tract aftr 24 wks of gestatin til the delivery of the baby. NEVER DO PV Until the placenta previa hasbn ruldout by USG. 3 maternal complicatins of abruptio placetae 1DIC 2.Renal failure 3.PPH Fetal complctns r 1.Fetal distres 2.Fetal death 3 Matrnal comp of p previa 1.Haemorhage 2. Pph 3.Anemia Fetal compl is premaure delivery. P previa type 1 &2 anterior vaginal delivry, in 3&4 C/s

Tip 7. Gynecological oncology Major symptoms of comon gyne malignanies. CA CERVIX-intermenstral and post coital bleding. CA ENDOMETRIUM-post menopausal bleding. CA OVARY-vague symptoms,GIT Upset,abdominal distension. CHORIOCARCINOMA-iregular vag bleding. Averge age of presntatin of gyn malgnancies. CA CERVix,45-50 yrs. Ca endometrum-60 yrs.Epithelial ovarian tumors 60 yrs.Germ cel tumor-30yrs

Tip 8. PPH (Defn,criteria,types,causes,management)

Tip 9. Contraception... NON CONTRACEPTIV BENeFITS of COCP's r difrent from NON CONTRCEPTIVE USES. Benefits which woman enjoys while taking pills r 1.Rgular and painles menstral bleeding 2.Decrease in the incidence of ovarian cyst 3.Fibrid 4.Bening breast disease 5.CA endomdtrium 6.Ovarian ca(3,4,5,6 r actually drawbacks) USES are.. 1.DUB 2.Endometriosis 3.PCO 4.TURNER's syndrome 5.Hirsutism cOCP's should b avoided during breastfeeding for that progestron only pils can b usd

Tip 10. INSTRUMENTL VAGINAL DELIVRY. INDICATIoNS Ov OUTLET FORCPS. 1.Prolongd 2nd stage of labor 2.maternl exhauxtion 3.mothr nt able to push 4.wen pushing is nt requird 5.fetal distres 6.high head at doing c s. OBSTRUCTD LABOR IS NOT AN INDICATION RATHER A CONTRAINDICATION. PRE REQUISTs BEFORE APLICATIoN Ov OUTLET FORCPS OR VACUM 1.F-Fuly dilatd cervix 2.O-OutLt adequte no cpd 3.R-ruptrd membrans 4.C-contractins present 5.E-Engagmnt n episiotomy 6.P-presentation (cephaic),postion(ocipito ant) 7.S-Surounding structurs empty (rectum and bladar) COMPLICATIONS OF FORCPS 1.FETAL Facial nerve paralsis n intra cranial haemorhage 2.MATERNL Injury to surounding structre n perinal tears. CONTRAINDICATNS OV VACUM XTRACTOR. 1.fac presentatn 2.brech 3.if fetal blood sample takn 4.suspctd thrombocytopenia

5.pretrm fetus (metalic cup nt usd)

Tip 11. One word answer to managment of imp gynaecological diseases. MOLAR PREGNANCY -Suction curettage (irrespective to gestational age) MISSED ABORTION-BEFORE 12 WEEKS (D AND C) AFTER 12WKS (EXPULSION WT PGD2Alpa or PGE2 OR SYNTOCINON infusion) INCOMPLETE ABORTION- E AND C BARTHOLINE CYST-Marsupialization ADENOMYOSIS-hysterectomy. ECTOPIC PREGNANCY-Laparatomy with salpingectomy or salpingostomy

Tip 12.CAUSES OF DIC IN GYNE N OBSTETRICS (v.v imp) 1.Mised abortion 2.amniotic fluid embolsm 3.iud 4.abruptio placentae 5.molar pregnancy 6.preeclampsia 7.intrauterine infection.

Tip.13 A+B=C Dnt get upset this is nt a mathematical questin.any obstetrical comliplication(A) Associatd wt breech(B) Mode of delivery is C/S(C) Complications r 1.previvos one c/s 2.p previa any type 3.maternal hypertensin 4.DM 5.WT of fetus>3.75 kg<2.5kg 6.extended attitute of fetal head 7.oligo or polyhydramnios 8.twin which is breech 9.IUGR 10.RH Incomptbily afectd baby etc. FEW MANEUVERS IN BREECH DELIVERY PINARD MANOUVER- For extended legs LOVSET MANOUVER for extended arms. MARACEUIA SMELI VIET MAOUVER, BURN'S MARSHAL TECHNIQUE.PIPERS FORCEPS,Pinnard

Tip14.EFFECTS OF SMOKING IN OBSTETRICS. 1.preterm labor 2.preterm rupture of membranes 3.placenta previa and abruption 4.IUGR 5.Respiratory infection after c/s.NICOTINE IS NT TERATOGENIC. INCIDNCE OF PRECLAMPSIA IS DECREASD IN SMOKERS. EFFECTS OF SMOKING IN GYNECOLOGY 1.CIN And CA Cervix r more comon 2.increase incidence of ECTOPIC PREGNANCY 3.EARLY MENOPAUSE LEADING TO OSTEOPROSIS. 4.UV PROLAPSE due to chronic cough and vault proplase.

Tip 15. MATERNL MORTALITY RATE.. Death of a woman during prgnncy,labour or within 42 days aftr delivry by any cause dirctly relatd to prgnncy or its cmplications pr 100,000 live births. Majr direct causes r 1.hemorhag 2.infection 3.eclmpsia 4.obstructd labr 5.unsafe abrtions. MMR In pakistan is275/1ooooo births. PERINATAL MORTALITY RATE. No of deaths of fetus after 24 wks(IUD)+Stil births+death of babies in 1st week of life(early neonatal death) per 1000 live births. Major causes in pakistan r 1.prematurity 2.asphyxia 3.sepsis 4.congenital malfrmatin. PNMR is around 70.

Tip16. D&C Is one of d most comonly performd gynaecolgical procedure. In tabel viva every studnt wil b askd about it.u must prepare indications,procedure,instruments &complicatins in a good and presentable way. Indications r 1.irregular vaginal bleeding aftr d age of 40 yrs 2.iregular vaginal bleeding before 40 yrs if medical management failed 3.postmenopausal bleeding 4.diagnosis of endometrial tuberculosis. D&C is nt always performd under GA, It can b performd undr para cervical block. IN OBSTETRICS CAESAREAN SECTION Is one of the comonly performed procedure, u wl b askd about it in viva.u must prepare the indicatins, instruments,procedure n complicatins. When askd about complicatins always start with anesthesia than operative than early,late and delayd (read D&C and C/S)

Tip 17. Few imp points related to gyne n obs. 1.largest diametr of pelvic inlet is transverse dia n outlet is anteriopost diamtr 2.Women presentd with secondary amenorhea, always rule out pregnncy 3.triplets should b deliverd by c/s. 4.brow presentation (presenting diametr is mentovertical 13.5 cm) is an abolute indication of c/s. 5.support of uterus is cardinal ligament n uterosacral ligament. Round ligament keep the uterus in antevertd position 6.RH antibodies r nt natural like ABO bt only producd in RH -VE Woman when fetomatrnal hemorhage occours 7.always reduce weight before any treatment 4 PCO 8.oral hypoglycemic agents r contraindicatd in pregnancy, Insulin cannt cros placenta 9.TERM Is defind as 37 to 42 completd weeks of gestation. 10.complications of ovarian cyst r haemorhage, torsion, infection n rupture

Good Luck