ObG

Question 1

Ectopic pregnancy

Answer 1

Presents with h/o amennorhea, abdominal pain, bleeding p.v.
First confirm pregnancy by UPT. If positive UPT:
Do TVS to confirm intrauterine preg. If uterus is empty and pt is unstable do emergency laparotomy. If uterus is empty and pt is stable check Bhcg levels. If >1400- ectopic pregnancy is confirmed. If <1400 ectopic is unlikely and hence wait and observe. Maybe the intrauterine pregnancy is too small to be seen on TVS.

Question 2

Ruptured uterus

Answer 2

H/o C/S
Present with:
Severe abdominal pain, profuse bleeding p.v, CTG shows distressed foetus.
Treat with emergency laparotomy to deliver the foetus.

Question 3

Abruptio placenta

Placenta previa

Answer 3

Both are bleeding p.v in the 3rd trimester.
Abruptio placenta
Presents with severe abdominal pain and bleeding p.v.
Do CTG. If foetus distressed deliver by C/s. If foetus not distressed then do TVS to rule out placenta previa.

Placenta previa:
Painless bleeding p.v.
Do TVS. Never do speculum/E.

Question 4

Chorioamnionitis

Answer 4

H/o PROM preceding ascending infection.
Presents with foul smelling vaginal discharge (amniotic fluid), SFH small for date d/t PROM. Abdominal pain.
Maternal tachycardia f/b fever.
Fetal tachycardia.

Question 5

Pelvic inflammatory disease

Answer 5

IUS is the m/c risk factor along with multiple partners.
Presents with:
AUB, lower abdominal pain, dyspareunia, fever, vaginal discharge.
M/c d/t Chlamydia- treat with Doxycycline
N gonorrhoea- Treat with Ceftriaxone.
Complications:
Tubo ovarian abscess- diagnose by USG
Ectopic pregnancy

Question 6

Vaginal infections

Answer 6

M/c post course of broad spectrum antibiotics.

Trichomonas vaginalis- Yellow- greenish vaginal discharge, itching. Treat with metronidazole.
Gardnerella vaginalis- Greyish white vaginal discharge. Fishy odour. No itching. Positive Whiff test (Add 10% KOH to discharge- fishy odour). Treat with metronidazole.
Candidiasis- Cottage cheese like vaginal discharge (thick curdy white). Treat with clotrimazole.

Question 7

Atrophic vagintis

Answer 7

Genito urinary syndrome of menopause.
Vaginal dryness, itching and dyspareunia.
Urinary incontinence, dysuria, increased frequency.
Treat with topical oestrogen creams.

Question 8

HELLP Syndrome

Acute fatty liver of pregnancy

Answer 8

Complication of preeclampsia. 
Do LFT first. 
Hemolysis- dark coloured urine
Elevated liver enzymes.
Low platelets. 
RUQ pain and tenderness +N,V.
Deliver the baby. 

Acute fatty liver of pregnancy is HELLP without the H with hypoglycaemia.

Question 9

Endometrial CA

Answer 9

Presents with post menopausal bleeding which could either be d/t atrophic vaginitis or endometrial CA.
Do TVS and see endometrial thickness. If <4cm- not endometrial CA. If >4cm, likely CA so do hysteroscopy with biopsy.
If biopsy shows no atypic then give Mirena.

Question 10

Endometriosis

Answer 10

Endometrium present ectopically ( outside the uterus).
Presents with:
Dyspareunia, dyschezia, dysmenorrhea, AUB, dysuria, cyclic pelvic pain, sub fertility.

Gold standard for diagnosing: Laparoscopy.
Give NSAIDs for the pain which is the most appropriate action. If fertility is not of concern, give COCP or POP. If fertility to be saved then do laparoscopy which the the most definitive test.