MCQ Y3B4 G.C 1. Embryologic development a. b. c. fertilization process lead to per vaginal bleeding d.

embryo begins to penetrate epithelial surface of the deciduasby 6th day after fertilization e. in normal pregnancy, hCG level doubles every 36-48 hours 2. Mid-trimester scan a. detect structural abnormalities b. estimate the accurate period of gestation if early scan was not done c. determine chorionicity in multiple pregnancy d. measure amniotic fluid e. diagnose placenta praveia 3. Regarding multiple gestation a. b. monochorionic - lambda sign c. presence of different sex fetus indicate dichorionicity d. the optimal gestation to perform US to determine chorionicity is at 9-10 weeks e. monochorionic twins has a high risk of TTTS 4. IUGR is suspected when a. oligohydramnios b. uterus is smaller than date c. serial US shows reduce growth velocity d. poor maternal weight gain e. reduce fetal activity 5. Iron supplement in pregnancy a. requirement is 60 mg elemental iron b. vitamin C enhance iron absorption c. contraindicated in Thalassemia trait d. haematinics is routinely given to all patient e. melena is a side effect 6. Perinatal mortality a. stillbirth is defined as death of baby within the first 1 hour of labour b. all stillbirths are subjected to confidential enquiry c. fresh stillbirth is mainly due to birth asphyxia d. a baby dies within one month of delivery I s classified into early neonatal death e. causes of macerated child birth are unknown in majority of cases 7. Features plotted in partogram a. fetal estimated weight b. fetal scalp pH c. moulding d. FHR e. color of liquor 8. These statement are true regarding puerperium

a. pre-existing bacterial vaginosis has high risk for sepsis b. high-fibre diet recommended c. exclusive breast feed is a method of contraception d. ovulation may start as early as 3 weeks after delivery e. apply antiseptic at perineum promote good healing 9. Mid-trimester miscarriage a. cervical incompetence is a common cause b. h/o 2 miscarriage at 20 week need to be investigated c. increase risk in patient with h/o D&C d. Hysterosalpingography is one of the ix e. progesterone is treatment of choice 11. Regarding PCOS a. acanthosis nigrican is a feature b. recurrent miscarriage c. US is sufficient to dx PCOS d. clomiphene is used for ovulation induction e. high serum testosterone level 12. Ectopic pregnancy should be suspected in woman with cc a. amenorrhea b. vaginal bleed c. acute pelvic pain d. acute nausea and vomiting e. syncopal attack 13. True regarding adenomyosis a. uterus contain encapsulated area of b. hyaline degeneration occurs when fibroid gradually outgrows its blood supply c. secondary spasmodic dysmenorrheal is a common sx d. GnRH analogue is a treatment of option e. myomectomy is treatment of choice 14. True regarding uterine fibroid a. submucosal type is a/w menorrhagia b. hyaline degeneration occurs when fibroid gradually outgrows its blood supply c. related to polychytemia d. a/w endometriosis e. leimyosarcoma transformation is rare 15. Regarding ovulation a. decrease in basal body temperature by 0.5C b. decrease in serum progesterone c. decrease in mid-luteal endometrial proliferation in histopatho examination d. mittelschmerz pain e. cervical mucus spinnbarkeit OBA Y3B4 G.C 1. 38 y/o G6P5, GDM. 2nd stage complicated with shoulder dystocia, Mc Roberts maneuver was done. baby weight 3.6 kg. 3rd stage was complicated with profused

vaginal bleeding. O/E, pale, tachycardic, BP 120/70, uterine palpable 22 week. What is the most suitable cause of bleeding? a. DIVC b. genital tract trauma c. uterine atony d. uterine rupture e. retained placenta 2. 36 y/o clerk in 2nd pregnancy at 33 week POA p/w PV bled and abdominal pain. Had previous C-sec. O/E, BP 160/100, PR 90 bpm, abdomen thick, difficult to assess. CTG fetal bradycardia a. bleeding placenta praevia b. bleeding vasa praevia c. abruption placenta d. premature labour e. uterine rupture 3. 36 y/o grandmultipara, Para 7, 12 week POA. Wt- 64kg, Ht- 159 cm, glycosuria- 3+ @ booking. Most appropriate ix? a. MOGTT b. fasting blood glucose on next morning c. BSP d. UFEME e. random blood glucose @ booking 4. A 34 y/o business woman, 1st pregnancy @ 33 week POA. Early scan revealed 2 fetus with chorionicity of T-sign. Upon lates follow-up, 1 fetus is small with reduced amniotic fluid and another fetus is large in size with increased amniotic fluid. What is the appropriate dx? a. growth fetal discordant b. IUGR c. TTTS d. TRAP (twin reversed arterial perfusion) e. twin with 1 fetal demise 5. 30 y/o G6P5, 41 week POA, BMI 30, admitted to labour room in APOL at 3pm. VE- well effaced cervix, os 3 co, station 0, EFW 3.5 kg. ARM done, light meconium but TG reactive. Cervical assessment at 7 pm - os 8 cm. Again, at 9 pm os still 8 cm, moulding 2+, CTG reactive, contraction 3:10:15s. What is the best thing should be done? a. prepare for EmLSCS b.. VE review by 2nd person c. augmentation with oxytocin d. prepare for ventouse e. review in 2 hours 6. 2o y/o sexually active c/o severe abdominal pain, vaginal discharge. O/E, T- 39C, vague tender mass at RIF, bimanual examination revealed right adnexa mass, positive cervical excitation test. On US, right cystic mass 3x5 cm, minimal fluid in POD. WBC high. Most probable dx? a. appendicular mass b. ectopic pregnancy c. tubo-ovarian abscess d. twisted ovarian cyst

e. ruptured ovarian cyst 7. 29 y/o G2P1, 10 week POG, k/c/o DM on medication, p/w vaginal spotting, severe nausea and vomiting for few weeks. She didnt notice passing product of conception. Vital signs stable, not pale, afebrile. Uterus at 14 week. Adnexal mass palpable. Dx? a. ectopic pregnancy b. multiple pregnancy with threatened miscarriage c. molar pregnancy d. missed miscarriage e. pregnancy with ovarian cyst 8. A 40 y/o p/w 6 months of per vaginal bleeding. PE- pale, Hb-8.7g/dL, US- posterior fibroid of 3x3 cm, endometrial thickness- 22.3 mm. Most appropriate ix? a. colposcopy b. hysteroscopy with diagnostic curettage c. curettage d. pap smear e. pipelle sampling as outpatient 9. 60 y/o, post-menopause, p/w superficial dyspareunia, vaginal soreness, vaginal bleeding. O/E- vagina looked pale and thin. Most likely cause of bleeding? a. atrophic vaginitis b. cervical malignancy c. endometrial carcinoma d. endometrial hyperplasia e. endometrial polyp 10. 23 y/o, social escort, Para 1, presented to Emergency Dept with c/o severe abdominal pain. Pain a/w per vaginal spotting. She had h/o recurrent foul smelling per vaginal discharge and irregular bleeding. O/E, she appeared pale, BP- 90/50 mmHg, PR110 bpm, T- 39C. On abdominal examination, there was generalized tenderness with guarding. Most probable dx? a. pelvic abscess b. ruptured follicular cyst c. ruptured appendicitis d. ruptured ectopic pregnancy e. torsion ovarian cyst

PMP Y3B4 G.C (Date of examination: 30/07/2012) PMP 1 A 37 y/o G2P1 presented to antenatal screening with a c/o regular contraction 1 day pta. Her LMP was on 12/12/2011. She had h/o Caesarian section 6 years ago due to fetal distress. On antenatal check up at periphery clinic 2 weeks ago, she was told to have uterus larger than date and she was then referred to tertiary centre, however, she defaulted the follow-up? 1. 2. 3. Calculate her EDD and POA? List her problems Future hx regarding her clinical presentation

4. 5.

Physical signs you would like to elicit Ix and reasons

24 hours later, her contraction resolved, but she complained of passing warm fluid which soaked 1 sarong. 6. 7. Provisional dx Complications regarding this event

PMP 2 A 36 y/o, Indian lady, G1P0, LMP was on 30/1/2012. Her pre-pregnancy BMI was 34. Dating was done at 14 week and blood pressure was 110/70 mmHg, urine protein was negative, and FBC was taken. [The result was RBC, Hb, MCV, MCH, MCHC, PCV were Low; Plt and WBC were Normal. Blood Group: A-] 1. 2. 3. 4. 5. Other blood ix during booking Risk factors for GDM in this patient Interpret the FBC result Other ix for above condition Drug for Rh-isoimmunization and when to administer

At 39 week, patient p/w lethargy and palpitation. O/E, she was tachycardic and her Hb was 6.5. She was planned for blood transfusion. 6. Complications of blood transfusion

PMP3 Madam Sharifah is a 35 y/o Para 2, who was referred by her GP complaining of painful menstruation for 1 year. The pain started prior to her menses and it continued throughout the days of the flow and only resolved by the end of menstruation. She has two children aged 8 and 4 years after which she never conceived. There was no h/o using any contraception. 1. Other relevant hx 2. Physical signs you would like to elicit 3. Ddx 4. Concerning her dysmenorrheal. how are you going to investigate? What do you expect to find? 5. Concerning her subfertility, how can we assess her ovulation? 6. Name 2 methods to assess her tubal patency

LONG CASES OBSTETRICS & GYNAECOLOGY GROUP C (Y3B4) CASES QUESTIONS

Partially treated pneumonia and urinary tract infection in pregnancy G1P0,30 yrs, malay, refered from kk beserahfor high bp

? y/o female G5P2+2 at 28w POA LMP? EDD? POA? Complaint of PV bleeding 3/7 PTA o Bleeding after break fasting o Red bright blood o Wet her panty o Assc with pain after PV bleedintermittent ,lower abd pain o No clots or tissue o No trauma o No fainting spell o No shoulder tip pain Bring to HTAA to lower risk Reassess & examine Comorbidity-obesity BMI=34.7 No speculum done US done pt mention something about radang uri..what the hell was that??.. Ill think it was abruption placenta.. Pt admitted for close observation Tro out pregnancy pt was normotensive,no glycosuria, no proteinuria,Hb normal O/E Pt alert,conscious.Vital signs normal. Abdomenfetal part hard to felt because thick abdomenif u cannot appreaciate fetal part due to fat mention straight away to the doctor..dr not gonna finalized u..dr will bring u again to the pt for examnation 29 y/o, G2P1 at 34 weeks of POA k/c/o established DM for 11 years on insulin, p/w reduced fetal movements for 1/7 pta. Voluntary sub-fertility for 3 years and involuntary sub-fertility for 3 years. Poor diabetic control, however, no complication e.g. retinopathy, neuropathy, nephropathy, skin infection etc. But claim comply to

dr. ziana a) causes of chronic cough b) investigations c) management dr Muna - define PIH - sign n symptom of PIH - important sign to elicit in phy.exam - management - bishop score - read CTG Dr Ayu DDx Provisional-points against & points favor Ixbla2..bla2..tq

Dr.Raja 1. How was the blood sugar profile for each follow-up and how was the insulin dose? Why it was increased or decreased? Dr. wants a detailed profile and control. 2. How should be investigated? Regarding her control? I forgot to ask about HbA1c!!!! (BIG

insulin and follow-up. Also had regular eye follow-up. Strong family history of DM. No h/o intrauterine death, SGA or macrosomic baby. PE- uterus correspond to date, no multiple poles felt, fluid thrill negative. Not to forget CNS, funduscopy, and other systems endmetrial plyp/hyperplasia 48years, G10, businesswoman, NKMI, came with lethargy, 2 wk PTA associated with menorrhagia for 2 months. -menorrhagia, need pampers (3/day), blood clot, with minimal pain (2/10), during menses but prolonged up to 21 days. The second episode, still same, but prolonged up to 12 days and associated with lethargy Obs, 1 child died due to lung infection after 3 days delivery Gynea, had 4-5 flow, 45 days cycle(abnormal) PMH, spine injury due to blunt trauma (kick by husband 9 years ago) FH, not significant but father died due to illness like colon related cancer. SH, divorced 1 year ago. 26 y/o,gravida 1,36 w poa , d4 of admission,admitted for leaking liquor 1 day prior to admission(soaked 1 sarong). h/o of leaking liquor during 27w poa,warded 5-6 days ,given tocolytic n dexa h/o hyperem,warded one month currently stable, minimal leaking liquor, AFI normal,no signs n symptoms of chorioamnitis

mistake!!!). Dr. was disappointed, he was expecting the regular HbA1c value. 3. Complications of DM? How should be detected during physical examination and how should be investigated?

Dr.Muna 1) What is normal cycle of menstruation?? 21-35 2) What your ddx? 3) How to manage the patient?? 4) How many pints should we transfuse t the patient if the Hb 5.8g/dl? 5) What other examination should be carried out? Speculum 6) Investigation? 7) What device use to take endometrial biopsy?

prof hamizah -ddx -characteristics of liquor -if soaked 1 sarong,how much liquor lost ?500ml,if 1 pad ?-100ml. -normal volume of liquor - 500-700ml kot,maximum? normal AFI? -pt had LL and soaked 1 sarong (500ml) n still have ll,why AFI is still normal? -how liquor is produced - def ,ddx of hyperem n management in ward -investigations for LL -signs n symptoms of chorioamnitis, management for chorio -list of bacteria that can cause chorio,how to detect? after HVS ,what to do? which bacteria can be cultured,n if not,what to do -management in ward,name of tocolytic agents what to see in pad chart?how many times review pt per day -if pt has s/s of labour now,need to tocolyse or not?-no need if pt has completed dexa -meaning of PPROM

CONTRACTION PAIN WITH 1 EPISODE OF PV BLEED 1 DAY PTA 29, G3 P1+1 at 38weeks 5 days POA, short stature 145cm, admitted due to contraction pain 1 day pta. Antenally unevenful, 4 scan done at 28 to 32 weeks to rule out iugr due to uterus smaller than date. However, results scan normal. 1 history of miscarriage at 8 weeks POA last year.D&C done. On examination, uterus smaller than date.

23 year old Indian lady G1P0 at 34 weeks came to the hospital due to contraction pain 3 days prior to the admission. - Associated symptoms of frequency, dysuria, abnormal vaginal discharge and itchiness. - USOD, dx of GDM at 32 weeks with diet control, hx of hospitalization at 28 weeks due to premature contraction with associated vaginal candidiasis (given dexamethasone) and hx of UTI - No leaking liquor or show, FM good - Examination- no significant finding - ** Hx: ask if patient comply with the diet control? The fetal conditions? ** dont forget to do CVS, Respiratory, Breast, Thyroid examinations

Dr Dahlia 1.What is commonly done here for infectious screening disease? 2.Is Hep B commonly done?No, only for health care worker. 3.What was the ve finding at antenatal screening?I supposed to ask because pt had pv bleed with clots after ve done. 4.What investigation to be done? 5.What cause ut smaller than date? 6.Components of bishop score? 7.What you want to do next?IOL 8.Let say os 3cm, effacement 0.5cm, what will you do next?ARM with pitocin infusion - What are the normal MOGTT results? How we diagnosed the patient as GDM? - DDx - What will you do if you are the one who first sees the patient? (investigation, a bit of mx) - Did the patient is given dexamethasone? What is BSP? What is the best time to take BSP if the patient is given dexamethasone? Why? - If the patient is in labor, who else should be involved?- Pediatrician - MAAF, ADA LAGI SOALAN TAPI TERLUPA.

SHORT CASES OBSTETRICS & GYNAECOLOGY GROUP C (Y3B4)

CASES breech presentation (ada LSCS)

QUESTIONS prof murad a) causes of breech presentation b) how to investigate and management of breech presentation c) gynae causes for LSCS

Case 20+ primid pt at 34weeks POA Question Examine her abdomen Straight away introduction,permission,position,exposure.. (Dont waste time 10 min only) All normal EXCEPT: SFH was 28w uterus smaller than date(bear in mind dr gonna ask the causeshahaha) kacang je nihh.. What else u want to do??mistakenly terbuat percussion..(aduhh silap la plak ..x pernah orng buat kat obs case)..dr wat muke pelik.after examine cover the pt back & say TQ..this one dr puji thats y aku pass kot..rase lega..fuhh Straight away suruh present..OK

Dr Kamarul Bahyah Causes of Uterus<date- Dr mention dxPPROM-->whats the meaning? What to do if pt come to u at low risk?? reassess the ptconfirm PPROMadmit ptmonitor vitals sgns 4 chorio What else u want to do in warddr mean IxCTG..etc What else??? aku dah abes ideadr bagi clue to prevent Infxowhhh bagi antibiotic..hahah What antibiotic?? hantampenicilin,EESnaseb bek dr dgr erythromycinbetol kot From what study/research do we give EES?? soalan Distinc nehhrugi x dpt jawabdr bagitaugo back & read further..ha3 If the uterus at xiphisternum..how many weeks?? Ans 40wsalah..go back & read Dr. Muna 1. Causes of uterus larger than date? - the patient has triplet 2. What is the complication of triplet? - Dr. wants to hear preterm delivery 3. What are the complications of preterm delivery during the delivery (intrapartum)? - Ans: RDS, NEC, IVH dr ziana -by examination, how to recognize polyhydromnios?? -what can cause uterus larger than date but liquor and baby weight is normal? *obese, short stature and lax uterus What is gravida? What is Para? What is lie? (demonstrate how you get the lie) What are the patients problems? Ddx (must match the findings)

POA=26 weeks. On examination, SFH = 40 cm. Uterus larger than date. Fetal parts difficult to felt, but fluid thrill negative.

xsure case ape..mybe normal tp uterus lax 36, G6 P4+1 @38wk POA. examine her abdomen -look like larger than date -1 scar -Fetal part pyh nk palpate..tp doctor mcm xpuas hati.. -3/5, not engage. - 30+ year old Malay lady, G5 P4, given LMP - Calculate the EDD and POA (about 38 weeks) - Examination- Uterus smaller than dates Liquor- adequate, fetal lie- oblique 32 y/0,G2P1,at 38W poa,smaller than date, cant appreciate the lie and presentation.

dr suhaiza -causes of smaller than date