2Hi everyone =D Welcome everyone =) This is a 425 OB/GYN slide show exam, most of the pictures here were the exact pictures showed in exam, some were almost the same. I’m ganna put (*) next to pictures that were the exact ones.The answers here were my answers in exam, so there is a chance to be wrong, so please tell others whenever there is a mistake and feel free to edit the slides.And for the next groups in 425, feel super free to add your slide show exam to this slides right after our exam with your beautiful names for years after us =)thanks a LOT guys.And BIG FAT good luck to you all.
11Qs: What is this condition? Name 4 causes. Which of them has highest dangerous complications. And why?Name 2 complications you would anticipate.
12Macrosomic babyDiabetic mother (GDM or pre-existing)Post dateFamily history of big babiesUndiagnosed DMObese mothers.Gaining a lot of weight during pregnency.
133.Diabetic mother, because it is associated with fetal poor health and delayed lung maturity and respiratory distress.4.Complications:Polycythemia, hypoglycemia, hyperbilirubinemia, delayed lung maturity, shoulder dystotia, prolonged labour and risk of fetal distress.
47Qs: What is the lie and presentation? Name two diagnostic signs. Name two complications.What is the management:Before delivery?During labour?
481.Transverse lie, shoulder presentation. 2.Signs: low fundal hight to date, feel the head on abdominal lateral sides, feel the back of the fetus running transverse lie, transverse lie by US.3.Complications: cord prolapse (Most common), cord compression, shoulder dystocia, prolonged labour, fetal distress, maternal exhaustion, fetal injury, bone fracture, maternal injury and obstructed labour.
54Qs What do you see? Give two DDx. What would you ask in Hx. (give 3) What would you order for investigation. (give 3)
55What do you see?Breast budding.Give 2 DDx.Complete precocious puberty.Incomplete precocious puberty
56What would you ask in Hx?Ask if she has any pubic or axillary hair?Ask if she had any vaginal bleeding or menses.Ask if she has been taking any medicationsAsk for any family Hx in this condition.
57What would you order for investigation? Check hormonal level of estrogen.Check her FSH, LH levels.Take radio-images of her brain to rule out any secretery tumors (sp: pituitary)Do an US for her ovaries to rule out any estrogen secreting tumors (ex: granulosal cells tumor)
67Qs What is it? Used for what? What are the indications for its job? Who uses it?Name to complication.
68What?An amniotic hook (or an amniohook)Used for what?For artificial rupture of membranes (or amniotomy)
69What are the indication? Used in induction of labor (to fasten baby birth due to any reason)Used to see muconium-stained amniotic fluid to confirm fetal distress (in an external fetal monitor)Used to put on fetal scalp heart monitor to confirm fetal distress in an external monitor.
70Who uses it?An obstetrician and a midwife.Name 3 complications:Bleeding.Injury to the baby’s presenting part.Infection.
72Pt presents with 6 week of amenorrhea and lower abdominal pain (look at picture)
73Qs What is the Dx? What possible other symptoms? Give 4 risk factors. How would you treat?
74What is the Dx?Ectopic pregnancy.What possible other symptoms?PV bleeding, lower abdominal pain and amenorrhea
75Give 4 risk factors.Previous Ectopic pregnancyTubal diseaseChronic PID and adhesions.Adhesions from endometriosisIUCDTubal ligation
76How would you manage?Medical: methotrexate if it fits the recommended criteria.Surgical: salpingostomy (if in ampulla and uncomplicated) salpingectomy if otherwise with checking the patency and health of the other tube.
84Qs What is your Dx? What symptoms would present (give 2) What hormones would be elevated?How would you treat?
85What is the Dx?Polycystic ovarian syndrome (PCOs)Symptoms:AcneHiristisumInfertilityIrregular menses
86What hormones would be elevated? (Give2) LHAndrogensInsulin
87How would you treat?Give combined OCPs (for hiristisum and prevention of endometrial cancer due to elevated unopposed estrogenOr give progestrone to prevent endometrial cancerGive metformin for insulin resistance.Remove ovary surgically if associated with neoplasm or unreasoning to medications.
102Qs What are 1 and 2? Name 4 indications for C/S. Name 4 complications for C/S.
103What are 1 and 2?1= vertical (longtudinal) section (classic)2= low transverse section.
104Name 4 indications.Placenta prevea.Preveious myomectomyPrevious C/SPrevious uterine ruptureConditions need to deliver baby as fast as possible with the cervix is unfavourable like:A-Severe pre-eclampsiaB-Eclampsia.C-Severe fetal distress.
105Name 4 complications:Heavy bleeding.risk of uterine rupture in a subsequent pregnancy.Higher risk for infections and puerperal sepses.Urine overflow incontinence (from anaesthetics)Risk of fetal injury (from cutting the uterus)Injury of other pelvic organ tissues.
107Missing picture =D In last Q (Q10), we had a case and a picture: The case was: postpartum patient, in day 4 with tender well contracted uterus.BUT unfortunately we don’t have the picture of it :$, It was a nurse chart :SIt was so easy , so no need to freak out =DIt clearly showed a temp of 38.5, HR: 120 and the word Heavy in the lochia column of the chart, and the Qs were as follows :
108Qs What do you see in the patient’s chart? What is the possible Dx? What investigations would you do?What general management would you do?
109What do you see in chart?Chart shows: fever, tachycardia and persisting heavy lochia (bleeding)
110What is the possible Dx?Secondary postpartum hemorrahge from retaind tissue and puerperal fever.What is most probably caused fever?Endometritis.
111What investigations would you do? (give3) US: to rule out retained placental tissue.CBC: for dropping Hb and leukocytosis.Culture of endometrial tissue and lochia to identify the causing organism. (not routinely done).
112General management? (give3) IV fluids (dehydration from fever).Antipyretics.Broad spectrum Abx.Analgesics.D&C to clear from retained tissue.