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3. Pt 2cm ….fetal distress….Pt refusing surgery at any cost ,…… what next
[Counseling by another consultant …..legal court order urgent,,, next of kin……. Accept
women wishes…..]
5. Every year a hospital accept 12 new trainee as a part of the training program. What is
the best method to evaluate the new trainee before they engage into the hospital? [Q.99 Sep
2016].
6. Rude trainee …difficult to work with ..college supervisor informed …what type of
assesement tool/method to deal with the situation.
8. Severe HMB resistant to medical Rtt in a 32 yrs with learning disabilities, brought by
relatives enquiring about hysterectomy
[legal order, proceed in best interest, take parental consent, proceed without consent as
gestures enough].
[Clinical case task , Mini cex, OSCE, OSAT, Ability to BBN, to assess skills,…]
EMQ: Options: failure to inform, Battery, implied consent, wriitten consent, Bolam……
12. Obese lady with bmi 39 have neccrtizing facitis ..was sueing that why not informed
about this complication before hysterectomy [& was not on consent] …was told that any
doctor of reasonale responsitiliry will not told such arisk as it is rare.
13. Pt obese with 3.9 kg baby 2with gdm had forceps delivery with shoulder dystocia
+erb’s. and the erbs palsy not corrected by physiotherapy ..was sueing that why was not
told abt risk of erbs palsy ..was not mention in the written consent foe instrumental delivery
14. Consent for sterilization ..mention about risk of ectopic and risk of failure ….what type
of legal act [Or: Consented for tubal sterilization, special hospital concent signed including
failure Rate 2/ 200]
16. Pt with PMB was referred to either quick one stop or general gynae clinic. Time was
compared from referral to ?investigation.
EMQ: Consent [options: remove this from that, leave, cancel, call, take biopsy,…]
Compare to Q21-22 March 2015, Q42-44 March 2016, Q 145-146 march 2017
18. Consented for laparotomy+ removal of appendix. You were called as a 6cm ov cyst
was found instead.
19. Age???, Consented for TAH [for HMB?]± laparotomy. A Rt ovarian cyst suggestive for
dermoid was found imbedded in dense adhesions to pelvic sidewall. ? PH of removed Lt ovary
for dermoid.
21. Type of Stitch for anorectal mucosa after 4th degree tear.
[antior labial branch of ilioinguinal nerve.. ant labial of pudendal, lateral cutansous n of
thigh.....lateral branch of femoral ilio hypogastric,post cutaneous of the thigh, ant cervical….].
25. Wound [surgical site] Infection rate after Em LSCS [?2nd stage]: [5, 10, 15, 20%,….]
26. Site of lidocaine inj for paracervical block [at what o’clock?]
Pictures with different combinations like (1 , 3 & 9) (2, 6 o'clock & 1) (2 3 5 o'clock & 7) (4
11 o'clock & 1) (4 o’clock & 8) (2 & 10).
28. Question about support to prevent prolapse after surgery & another one asking for
definitive Rtt for PHVP [Q.27-28 Sept 2016]
29. EMQ: The most major consequence to notify about if pt refused Rtt. [same Q53-54
sept 2016]
30. Asking for most relevant investigation for a scenario suggestive of bladder [?ureter]
injury: complicated CS with extension to broad lig,….
[options included CT urogram, cystography MRI & some other urology invests].
31. Uretreic injury: what is the most common type requiring theraputic treatment.
32. Missed aborion , CRL 35 mm , has intramural fibroid 3 cm (+ other risk cant
remember), opted for MVA , what risk factor in her hx make this procedure unacceptable.
33. Trainee atend c/s with consultant and found consultant doing blunt disection what is
one advantage of this procedure
EMQ: Next step [TAH for fibroid uterus, you are assisted by ST2]
34. Next step skin incision. [ relevant options include: packing bowel, visualization of
adnexa , uterus and pouch of doughlas,…]
36. You found bladder adherent to uterus [?or ant vaginal wall]. Next step? [dissect away
or call consultant/urologist,…]
37. previous history of tah with left salphingooophorectomy 5 years before …..now right
complex mass need right oophorectomy ….post op laparoscopy 7 day ,,,pain localized right
side than generalized pain …bowel sound present …rigidity..guarding ….high grade fever.
38. Typical description of AFE,,,,fast delivery …..DIC, cardiac arrest
40. Afrocaribbean sickler with chest pain not responsive to anti-acids & antibiotics, now
severe, O2 89%.
43. Pt with hyperemesis in early preg and her TFT , high T4 , undetectable TSH
[give carbamizole, PTU, PTU then carbimazol, propranolol, potassium iodide, iv fluids with
oral iodine, do nothing,..]
44. Patient with hyperemesis TSH upper normal limit and t4 lower normal limit given,
cause was asked
46. Anomaly scan showing truncus arteriosus. What is the most likely associated
chromosomal defect?
47. Screening results: NT 0.23 ?PAPPA low HCG normal. What advice?
48. RH-D neg Pt undergoing medical TOP at 8 wks, asking for the need of anti-D.
51. A woman with H/O hodgkins lymphoma, was given bleomycin+ neck/mediastinum
radiotherapy 4 yrs back.. What test In future pregnancy?.
52. Risk of postpartum psychosis for a pregnant woman with bipolar disorders.
53. HAART started at 22week to prevent vertical transmission. At delivery; zero viral load
,healthy. When to stop it post delivery.
54. Husband infected with ZIKV. Mother should use effective & barrier CC for how long
before trying for a pregnancy ?
[6,8,12,16,24 weeks]
55. Previous LSCS. Low lying placenta at ?29wks. What next step to rule out Accreta?
60. Which one is considered a major risk factor for SGA in this scenario?
[donor insemination .iui, natural conception , age was ok .....may be have fibroid . compare to
Q131 sept 2016].
62. Which of the following is more associated with a male fetus? [Q.137 Sept.2016]
63. Which of the following drugs increases the risk for GD?
64. The most useful dignositic tool for accreta in 2cs with anterior low placenta
65. Twins MCDA , twin 1 liqour 1 cm i think , twin2 liqour 9 cm. Bladder visible for both.
what is the diagnosis
66. Mother with chicken box st 39 wks what is the complication to the neonate?
68. Treatment [?initial live saving Rtt] for TTP at 24 wks wit Plt count of 45,000
69. SBA about CMV: pt was at 20week with CMV signs of infection [echogenic
bowel,..].....her booking blood and 20week blood were taken , asking how it will be
confirmed that it is first trimester infection [fourfolds rise IgM/IgG seoarate or both as
options, low avidity, high avidity,…..]
EMQ: NVP [tretment in community sitting with thiamine & vitamins, treatment in
community sitting e cyclazine, Inpatient treatment e iv Ns, inpatient treatment with e
dextrose & thiamin, oral prednisilon, parenteral feeding….]
72. EMQ: Genetic counselling: thallasemia, Duchene, marfan,…… [Q.160-165 March 2016]
73. Second pregnancy, anti d was normal but rose to 20 at 36week, delivered at 37 week.
77. 24 week exact. TOP for severe pre eclampsia with coagulopathy not responding to
medical Rtt.
80. lasts 6 hours and worse on climbing stair, A/W photophobia and phonophobia
EMQ: AED [Low ris of congenital anomalies , High risk , limited evidence, Risk of CA similar to
back ground risk , Neurodevelopmental delay , Slight increase risk of developmental dely,
NTD, clefts, hypospadias,…]
91. Pt on lamtorigin, stabe on this drug ask about effect if the baby
92. pt was on lamotrigine not stable , change to topiremate ask about risk
93. patient came in latent phase of labour was on paracetamol. She requested for more
analgesia.. she does not want effect of vomiting [? Vomiting phobia] . What is your choice of
drug
96. Tightinings at 33 wks. Previous pregnancy ended in PTL at ?33 wks. What are the
chance of PTL in this pregnancy with +ve [or -ve] FFN test
99. FGM: Severely depressed (on Rtt) due to irregular labia (asymmetry), asked for
labioplasty. Age?? [agree surgery, psychsexual counselling, deny, report,….]
101. Low risk pregnancy contracting every 15 min for the past 12 hours . Os is 2 cm dilated
and well effaced. What is your next step
[advice to go home and come back, come back nxt morning for IOL, rupture membrane,….]
102. 30year p1 with SROM, a case of preclampsia + placental abruption at 24 week… now
presented with bleeding heavily 500ml clots removed vaginally .…..cervix 5 cm with bulging
membranes ……vitals and labs not mentioned. what next
103. Another scenario/version of above question: 24 wks woman referred d/t BP 150/110
proteinurea +, labetalol started after admission.she has h/o abnormal combined test multiple
anomalies diagnosed on amniocentesis ,TOP advised by consultant but pt refused . Now next
day after admission to control BP , she develop no >160/110 , protein ++++, pain abdomen &
o/e :tender abdomen .shifted to labour room PV os 5m, cx effaced and she was also
multiparous . And fhs 100 what to do
104. PG with fast progress ..now 9 cm…before early deceleration ..now ctg with deep
variable deceleration some early with shouldering some late …..variability good ..last fbs was
7.23 1 hours before , asking for next step.….no option of conservative ..it was like start synto
fbs….caesarean no fbs option.
105. CTG trace picture showing tachycardia with occasional deceleration. Mother pulse
high but temperature normal what initial action u will do
106. Spinal cord injury at t4 140/90 maternal Brady ….now anxious tremors …dx [Q.100
Sept 2016]
108. Pt on epidural received top up in 30 min before ..now fully, no urge…Head +3 DOA,
persistent brady 90. Next step?
109. Post partum with S&S of pulmonary embolism. No sign of DVT. CXR showed features
of atelectasis. Next step?
110. Pt with heptatis B sAg + , core antibody + , refused to come for follow up what to do to
minmize vertical transmission during labour?
[ immungluni to mother, immunglu to baby vaccin , oral lamu? To mother and imun to
baby,…]
111. Twins , Ist delivered , 2nd breech , os remain fully for ?30m , breech engaged
113. A baby was delivered with one eye in the center of the head, holonecephaly +
omphacole, asking about most likely syndrome.
114. Flu vaccine protective for how many months for the baby as passive immunity?
115. Hepatitis b virus vaccine immunity last for how many days for baby after birth
117. From the following, which one is an indication for Routine testing of blood sugar of
the neonate? [Q.130 Sept 2016].
119. EMQ: refer letter from a GP with results of HIV & 1 st TM screening: [Q.32 Sept 2015]
EMQ: Breech [IOL at 39 wks, ECV, CS,…..]
120. Para3, all VD, now breech at 38wks, presented with 3rd episode of RFM. US & CTG are
normal. She is keen for VD.
121. Breech second twin ..engaged ,,membrane intact ,,,,ctg normal ,,multi ..wat next.
122. 28plus 3 days admitted three days before and received steroid …now 3cm dilated
bulging membranes …..irregular mild contraction a..Para 3
123. 31week threatened preterm labor ……tvs done 1cm long cervix…… what next
128. 50 yrs old, Complaining of virilizing symptoms that were rapidly progressing over the
last 6m. [Q.74 Sept 2016].
129. 56 year + hot flushes…..what will be advise on starting HRT [ that it will not increase
the risk of : unsheduled bleeding at 6 month…. Bleeding for 1 month………????????????
131. PMB, on scan ET 2mm with small amount of fluid ,,what next ???
132. PM have hysteroscopy and polyps removed… histology polyp showed simple
endometrial hyperplasia. Next step?
133. Primary amenorrhea with uterus not found ,…..external genitals and secondary
normal..karyotyping xx…..vagina short 1 cm ….what dx
134. 19 year BMI 26 secondary amenorrhea 8 month… took cop before …stopped already
…us and physical findings normal……. Mildly increase total and free testosterone. increased
lh/fsh ratio. Dx?
[LOD, IVF, HIgh dose gonadotropin, 3 more cycle of clomiphene, increase dose of metformin]
137. First line by NICE for HMB , most effective with good profile. [What is best for quailtly
of life for HMB: merena or progesteron ?]
138. PM with flushes, asking for HRT, she is a smoker & obese. Best option?
139. a pt had two episodes of PMB ....on ultrasound the endometrial thickness was 3mm.
Next step?
EMQ: what next step [Hystrescopy and biobsy, Out pt biobsy , Out biobsy after 6 months ,
Out pt biobsy after 3 months, TVS, do nothing….]
145. Question about incidence of neonatal herpes if VD after 1ry herpes. [GA:?]
148. Suitable contraception for a woman who also has patent foramen ovale & heavy
periods.
149. Pt in depo inj came with breakthrough bleeding. Wht to offer [COC, northisterone
luteal phace, change inj time,….]
150. What type of contraception is suitable for epileptics on enzyme inducer? [Q.70 Sept
2016].
152. Recurrent herpes, last episode 1wk ago, now asymptomatic, GA?, worried about risk
to baby. What advice.
EMQ: What likely finding to be expected on exam [ compare to Q.172-173 march 2016].
Options included multiple tender nodules in posterior forcheete …..multiple punched out
lesion, pinful blisters/?vesicles, vaginal hyperemia with whitish plaques on Vulva,….
153. 47 year old Vulval soreness and itching……. Initial sexual intercourse panfl despite of
lubricants …some occasional post coital bleeding no vagina discharge was noticed.
EMQ: Ovarian cyst in PM. Options: Follow up in…month, refer to cancer center, cystectomy,
oophorectomy, TAH,…..
156. Cyst found 4.5cm simple with complain of lower abdominal pain many days ….other
ovary can’t visualize due to gas intestine CA-125 was 16. What next .?
157. Another cyst was 10mm …ca 125 35…..follow up ….other ovary was not visualized
158. Another cyst was also simple..ca 125 was not mentioned.
159. Another cystic septated mass with no ovarian tissue around 6.5 cm ..ca 125 was 35
161. 52 year old lady Cin 3 removed completely. Histo CGIN seen extending in deeply
excised tissue. After 6 month both smear and hpv negative.
163. Treated cin 1….test of cure still low grade ..hpv negative
164. Pt diagnosed with moderate diskaryosis but she didn't came follow up , after 1 yrs
smear showed severe diskaryosis , sent for colopscopy which show acetowhite change.
treated by LLETZ [see & treat], next step
Urogynecology
166. A scenario was given with a picture [bladder tumor on cystoscopey], asking for next
step [? Refer to urology].
167. Another scenario with symptoms like recurrent UTI but neg cultures, on cystoscope
glomerulation. Diagnosis? [? BPS]
168. First line treatment for OAB with failed conservative Rtt.
EMQ: BPS [many options including diet, drugs, MDT, botox, UD studies, neuromodulation,
essentially all options in algorithm]
173. failed drug treatment ..referred to MDT, had instillation therapy ,presented with OAB
symptoms……what next .