6th year Final Exam

2009
Obstetric and Gynecology

Oral Exam

Written by

Your colleagues

Class of 2003

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 6th year final Oral Exam 2009
Obstetric and Gynecology
e-Copy @ www.icareunit.com

In the exam there were 4 circuits, each one contains 2 station, 2 doctors in each one

Questions: I will post my answers briefly

Station 1: Dr. Ilais and another Dr. from PBH
the question was about APH as follows

define APH, hemorrhage after the age of viability

What is meant by (Age of viability) and what is it in our county: it is a medico-legal term and it
is 28 wks of gestation in Jordan, 24 wks according to WHO

what are the most common causes of APH? Placenta Previa (PP) and Abrubtio Placenta; AP
how can you differentiate clinically between them? here is a long story
By Hx and PE as follows

PP: recurrent painless unprovoked vaginal bleeding, commonly in early morning, abdomen
commonly soft and lax, Fundal height is normal, it may be associated with abnormal lie and
presentation, it may also interfere with engagement of the fetus . no effect on the baby

AP: vaginal bleeding associated with abdominal pain and tenderness, fundal height may be
large for gestational age specially in concealed Type, it may be associated with other disorders
like PET, the fetus may be distressed with acidosis and may die.
how do you manage a patient with Abrubtio placenta? here I did not answer because the was
no time, he was asking about immediate management and investigations>>>

Station 2 : Dr. Fayiz and another Dr. from PRH

a case, 16 year old female patient complaining of sever pain during menestruation that disable
her to go her school, what do you call this complain? dysmenorrhoea

what are the types of dysmenorrhea ? Primary and secondary

what is the different between these types? Primary is physiologic and secondary is associated
with organic disorder.

how do you approach this patient? Hx and PE

Hx of pain, and associated symptoms

what is the cause of pain in primary dysmenorrhea ? Prostaglandin release, myometrium

ischemia , and OVULATION (Dr. was looking for this) a

in this patient what type of dysmenorrhoea most likely she has? Primary

what investigation you will request? nothing, Why, it is physiologic

how do you manage her? relieve her symptoms, HOW? pain killer, anti-spasmodic drugs

what is the most effective drug in primary dysmenorrhoea? Combined oral contraceptive pills

Station 1: 35 year-old married P5 ask you about tubal ligation, Councel her

Station 2: Case Preeclampsia, Approach (Hx,, Investigations, when and how to deliver her,
management

A 34 wks pregnant woman presents with a sudden onset clear vaginal discharge. The
questions were how to approach her according to history, physical examination &
investigation. Then I was asked to give DDx

Notes: I’ve been asked to give 2 confirmatory tests, I mentioned the posterior fornix & I
couldn’t get the other. Although I mentioned the netralazine test, which the doctor mentioned
that it’s not used anymore. & I was asked what to do if you don’t see the leakage at the time
of speculum examination other than the U/S. It was a stupid station really but do your best

A 25 year Female presents with vaginal bleeding after intercourse. How do you approach her?

Notes: the case was about Cervical Ectropion. Don’t forget to ask about using combined
contraceptive through your history & Pap smear too. Also if you are asked about what kind of
patient we use brush type pap smear not the spatula one? The answer is Postmenopause
woman because the transformation zone goes inside due to estrogen deficincy. I was asked
too about the mechanism of ecropion formation

1st station :
hyperstimulation syndrome (cause,classification,inves,treatment)

Vaginal discharge (approach)

2nd station (al ta5be9)

define booking visit ?

after NVD low risk mother and every thing is fine
what u r going to tell her???
what do u know about breast feeding?!

APH (define, Hx, exam)

then what about the vaginal examination??
if no or contraindicated he asked me WHY?
and when to deliver this ptn

25 year old pt wants to yse coc .... what should u do to make sure that it will fit her ?
25 year old pt with bleeding? take hx , what will u do in exam , invistigation?
pt wid placenta previa , hx approach
ANC , what should u do in booking visit?

a pregnant lady in her 27th wk of gestation presented to the clinic with SOB her Hb is 7

take a proper Hx
what's you Dx
how to confirm IDA
how to differentiate between IDA and Thal by Hx
what's ur Mx
if she was in the 39th wk what's the Mx

a case of primary PPH

what's the cause
step by step you'll reach a cervical tear ... how to Mx

Q about HRT: definition, types, use of each type, symptoms of menopause how to Mx

first station :

1- puerperium
Definition - complication - if thhe lady came to u after 9 days after delivery complaining of red
vaginal bleeding what is ur dx inx tx and if she came at 20 days same question

2-25 yr old primigravida complaining of spoting vaginal bleeding ( threatened abortion )

hx dx inx

second station :

1- cervical erosion
definition - causes - tx

2- missed abortion 10 weeks management

dr zuhair ammari : pph definition, causes, management

dr haifa galabi : infertility, define, causes, investigations, about tubal factors how to
diagnose,why is hysteroscopy useful in assessing tubal factors, is DnC helpful and why?
complications of hystroscope, wt do u see in laparoscope, how to diagnose premature ovarian
failure

dr.fayez and a doctor from PBH : everything about anemia in pregnancy

dr.nael obedat and dr.m7mood alkhateb

everything about ectopic pregnancy and postmenopausal bleeding

dr.fayez and a dr.nahar :Threatened abortion & Rh iso.

dr.nael obedat and dr.m7mood alkhateb: endometriosis & infertility

station 1 dr. 3esam la6ayfeh

case 30 wk gestation came with abdominal pain how do u approach
Hx, then he asked about differential, then he concentrates on PTL
what r the possible causes of PTL in the Hx: multiple pregnancy, polyhydraminos, previous PTL,
previous abortions, medical disorder HTN....
P/E if large what is the cause other than multiple and poly? fibroid
what next? pelvic exam inspection speculum and PV
dr. 3esam asked if it's necessary to do PV, and can't it be enough to assess the cervical changes
with the speculum,,, i answered sure u have to do the PV, he doesn't seem much convinced...

dr. mn wazarat l se7ah

what do u know about CTG
definition, normal parameters , causes of all types of decelerations
if it happened to have a pregnant with late deceleration and liquor became meconium stained
what next? C/S

station 2 dr. faheem zayed

what do u know about cervical smear
he asked me v. much everything in cervical smear lecture

dr. mn bade3ah
fibroid what r the 3 locations and associated presentations
investigations
complications in pregnancy
what is the medical treatment and when to use it?
what is an invasive non surgical Rx for fibroid? uterine a embolization

salam the exam was 2 stations

first dr.na2el 3bedat and dr from PBH

approach to 41 wks pregnancy>> hx, examination,what to do what u found on us, and then
every thing about induction of labor
breech presentation almost every thing
ECV also almost every thing

station 2 dr.fayez aljallad and dr from mafraq i think!!

approach to 60 year female 10 years postmenopause with vagainal bleeding
it was atrophic endometritis (after taking hx,, examination,, us and bx)
what is ur treatment? HRT
what type? COCP, cuz she still has her uterus
what COCP? monophasic
what do u call this type of COCP? non bleeding

note: dn't answer in preterm labor the nit. test as an investigation cuz dr.na2el kan m3aseb
mn altollab elle jawabo heik

my stations were

1. placenta abruption

2. ectopic pregnancy

3. contraception

the exam was nice ... and it really is all about luck ... wish u the best of it ..

Menorrhagia in 18 year old

Dr:Nael Obaidat:
Pregnant at 31 weeks,you discovered that presentation is breech,what you will do???
Asked many Qs about ECV

Foreign examiner + Dr. Zuheir Ammareen

A 24 year-old lady, G2P1, GA=8 wks, known case of bronchial asthma, on B2 agonists. Her first
son was SGA (2 kg), and she's afraid that this pregnancy will be the same. Counsel her
regarding her asthma & pregnancy. What's the cause of SGA due to asthma (hypoxia). Would
you tell her to continue her medications normally? What would be the effect of labor on her
asthma (exacerbate it or not?)

2nd station:
Dr Haifa + Dr. from PBH
What's the definition of ectopic pregnancy. What are the risk factors. What are the
commonest sites. How you treat it (surgically & medically). Compare between the 3 surgical
procedures!!
What's menorrhagia? What's the differential diagnosis? What's endometriosis? How they
present usually? What's adenomyosis? What's fibroids? The commonest site of fibroids to
cause menorrhagia? How do you treat fibroids medically?

Dr Na2el + Dr Francees

Pregnant 32 weeks, presented with abdominal pain...how would u approach her? it was acute
onset, generalized and continuous....everything else was pretty much negative!

i asked questions in the history, told him the exam, investigation and treatment based on that
it's abruption!

bel akher be7kele 6ayeb msh momken tkoon ACUTE POLYHYDRAMINOS? m3 el 3elm eno ma
7akale enu bel exam LGA aw bel US fe polyhydraminos....anyway kan be7awel eikhabe el
diagnosis! lol

Dr Francis sa2latni 3an el management of 3rd stage of labor..how would u give the oxytocin?
how long it takes to start its action? give it WITh or AFTER delivery of teh anterior shoulder?

Second Station: Dr jallad + Dr unknown:

dysmenorrhea....went smooth till Dr jallad start asking about 7year-old female with vaginal
discharge? ddx: F.B, infections but NOT candida...tx: antibiotic + estrogen

1) dr.layla : about HELLP syndrome (all things from presentation till treatment)
options of treatment for 31 wks with HELLP syndromes .

2) external : vaginal discharge ( history+exam+investi+treatment ) .

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