Clinical OSCE With Answers

8/17/2019 Clinical OSCE With Answers

1/95

End of 4End of 4thth YearYear

Clinical OSCEClinical OSCEA/L 2001 BatchA/L 2001 Batch

Dinusha LiyanapatabendiDinusha Liyanapatabendi


2/95

Q7

1. Identify A!

2. "rite the corre#$ondin% letter# in

order of &o#t effecti'e &ethod tolea#t effecti'e &ethod


3/95

A


4/95

B


5/95

C


6/95

D E


7/95

F


8/95

G


9/95

A

D

B C

EF

G

1. Identify A!

2. "rite the corre#$ondin% letter# in order of &o#teffecti'e &ethod to lea#t effecti'e &ethod


10/95

( A ) *e&ale condo&

( B ) Le'onor%e#trel relea#in% intra +terine contrace$ti'e de'ice ,-irena

( C ) Co$$er 0 A intra+terine contrace$ti'e de'ice

( 3 3e$ot &edroy $ro%e#terone acetate in5ecta6le #+#$en#ion

( E ) or$lant #+6der&al contrace$ti'e i&$lant #y#te&

( * ) Co&6ined oral contrace$ti'e $ill

( ! -ale condo

E8B8*938C8!8A


11/95

% of women experiencing anunintended pregnancy within the

first year of use

Method Typical use1 Perfect use2

No method4 85 85

Withdrawal 27 4

Periodic abstinence

Calendar

Ovulation method

Sympto-thermal6

Post-ovulation

25

!

"

#

Condom - emale 21 5Condom - Male 15 2

Com!ined pill and minipill " #$

&MP' (&epo-Pro)era* #$

+,& (copper T* #$" #$

Mirena (./0 +,* #$1 #$1

./0 implants (/orplant* #$#5 #$#5

$emale sterili%ation &'5 &'5

(ale sterili%ation &'#5 &'#&

mergency contracepti)e pills3 Treatment initiated within 72 hours after unprotected

intercourse reduces the ris4 of pregnancy !y at least 75%$

2

3

3

4

56

1


12/95

A 21 yr# old +n&arried %irl $re#ent# to yo+r clinic after ha'in%+n$rotected #e la#t ni%ht. What method/s that you an use inthis patient as post!oita" ont#aepti$e method/s.

B A : yr# old healthy ;o&an ;ith t;o children a%ed < : yr#re=+e#t# an e&er%ency contrace$ti'e after +n$lanned coit+# 4 day#a%o. %ame a method that you &ou"d o''e# to this &oman.

1

2

4


13/95

A.1 ) >o#tinor2

ta?e one ta6 i&&ediately and the #econd ta6let 12 hr# later

2 ) Co&6ined oral contrace$ti'e $illa?e 4 ta6let# i&&ediately and re$eat the #a&e do#e 12 hr#later

B.

Co$$er 0A intra+terine contrace$ti'e de'ice

( A co$$errelea#in% I@3 ,C+I@3 can 6e +#ed ;ithin : day#of +n$rotected interco+r#e a# an e&er%ency contrace$ti'e.o;e'er ;hen the ti&e of o'+lation can 6e e#ti&ated theC+I@3 can 6e in#erted 6eyond : day# after interco+r#e ifnece##ary a# lon% a# the in#ertion doe# not occ+r &ore than: day# after o'+lation.


14/95

Q111. o; lon% can it 6e +#ed

2. Li#t 2 ad'ice# yo+ ;o+ld%i'e after in#ertin% thi# toa $atient

. "hat #ho+ld yo+ do if a;o&an %et# $re%nant

after $lacin% it


15/95

1. 10 year# ,

2.E$ect #o&e 6leedin% >D for a fe; day#

Chec? for the $re#ence of the thread# ,S$ecially d+rin%&en#tr+ation $eriod

*ir#t 4 &en#tr+al $eriod# &ay 6e hea'ier than nor&al

a?e $araceta&ol ta6let# if #he de'elo$# lo;er a6do&inal $ain.

*ollo; +$ ) In one &onth and thereafter ann+ally

>ro&$t &edical ad'ice #ho+ld 6e ta?en if the thread# are not felt

delayed &en#tr+al $eriod ,>re%nancy Se'ere a6do&inal $ain >rolon%ed or ece##i'e 6leedin%

. Fe&o'e the I@C3


16/95

( i&in% of in#ertion 1#t #e'en day# of the cycle ,Ideal d+rin% &en#tr+ation

( Fe&o'al of I@3

$re%nancy>erforationAc+te >I3-eno$a+#e ) one year after la#t $eriod

( A6#ol+te contraindication#

>re%nancyAc+te/Chronic >I3A6nor&al +terine 6leedin%S+#$ected/confir&ed %enital tract &ali%nancy

( "hat yo+ #ho+ld a#? in the GLF-> ) to r+le o+t $o##i6ility of $re%nancy-+co$+r+lent 'a%inal di#char%e >I3


17/95

Q7

1. a&e a6o'e ite and ;rite one noncontrace$ti'e 6enefitof each a6o'e %i'en &ethod#

2. 0 yr# old fe&ale ;ho i# on OC> ha# for%otten to ta?e her

la#t t;o $ill#. ;hat ad'i#e ;o+ld yo+ %i'e her

A

B C


18/95

1

A ! Le'onor%e#trel relea#in% intra +terine contrace$ti'e de'ice ,-irenaB ) -ale condo&C ) Co&6ined oral contrace$ti'e $ill#

2(A I&$ro'e# &enorrha%ia

3ecrea#e dy#&enorrhoea and $el'ic $ain in $atient# ;ith endo&etrio#i#

B >rotection a%ain#t S3>rotection fro& carcino&a of the C

C Felief of &en#tr+al $ro6leFe%+lariHe# $re'io+#ly irre%+lar cycle#3ecrea#e n+&6er of day# of 6leedin% and a&o+ntI&$ro'e# iron deficiency anae&iaFelie'e# and red+ce# $re&en#tr+al ten#ion

>rotection a%ain#t o'arian and endo&etrial cancer#3ecrea#e# incidence of 6eni%n 6rea#t cy#t# and fi6roadeno&a>re'ent ecto$ic $re%nancy


19/95

-i##ed $ill#Sri Lan?a *a&ily >lannin% A##ociation !+ideline#

( -i##ed one ta6let a?e the &i##ed $ill a# #oon a# yo+ re&e&6er <ta?e the #ched+led $ill at the +#+al ti&e

( -i##ed onseuti$e t&o pi""s on t;o day# a?e t;o $ill# on the third day and t;o on thefo+rth day. *ro& net day on;ard# ta?e one $illdaily.

ill yo+ %et yo+r net &en#tr+al $eriod +#econdo a# a 6ac?+$ &ethod OF a6#tain fro& #e.


20/95

-i##ed >illJ

"O !+ideline#


21/95

1. "hat i# thead'ice yo+ ;o+ld%i'e to the

$atient ;hen$re#cri6in% thi#

2. Li#t Co&&on#ide effect#


22/95

Ad'ice( >o#tinor contain# t;o ta6#. reat&ent nece##itate to ta?e 2 ta6#

( Felia6le ,7:K $o#t coital contrace$ti'e &ethod if it ta?e# 72 hr# after

+n$rotected #e

( 1#t ta6 #ho+ld 6e ta?en i&&ediately. 2nd ta6 #ho+ld 6e ta?en 12hr# after the1#t do#e

( If 'o&itin% occ+r# ;ithin 2hr# of inta?e ta?e another ta6.

( Can ca+#e irre%+larity to yo+r net &en#tr+al $eriod

( ot a &ethod of a6ortion

( o ad'er#e effect# to an already ei#tin% $re%nancy

( Ad'er#e effect# ) a+#ia Lo;er a6d $ain 6rea#t tenderne## Do&itin%

( Con#+lt a $hy#ician if yo+ &i##ed yo+r net $eriod

( Ad'i#e her a6o+t $ro$er +#e of #+ita6le contrace$ti'e &ethod


23/95

QM

-other %i'in% 6rea#t &il? to childloo?in% far a;ay

1. Li#t 2 correct techni=+e# ;hen6rea#t feedin%

2. Li#t 2 &aternal co&$lication# d+e to

incorrect techni=+e of 6rea#tfeedin%


24/95

( Correct techni=+eGa !ood e$o#+re of 6oth &other and 6a6y.

6 >o#t+re -other #ittin% co&forta6ly. he 6a6y i#held ;ith hi# head nec? and 6ody in one line#+$$orted 6y the &otherN# forear&.

( Good attahment he areola co'ered 6y 6a6yN#&o+th ;ith the lo;er li$ e'erted and chee?# #ho+ld6e $+ffed o+t.

d Eye contact to 6e &aintained.e Each feed to 6e aro+nd 20 &in+te#.

( -aternal co&$lication#G

a Crac?ed ni$$le#6 Brea#t a6ce##


25/95

Q 14

( o; do yo+ $re$are a $atient forLSCS

( "hat are the co&$lication# of LSCS


26/95

( Con#ent

( Coordinati'e $art infor& anea#theti#t >O and theatre.

( ee$ fa#tin%

( In'e#ti%ation# !r$ < 3, Fe#er'e 1 +nit

( >re&edication -etachlo$ro&ide 10&% oral *a&otidine 20&% oral

( E&er%ency O2 ID Fanitidine :0&% ID -etachlo$ro&ide 10&% aCitrate 0.- 0&l. -other in left lateral $o#ition.

( Send @rinary cather ID anti6iotic# , -etronidaHole :00 &%Cef+roi&e 7:0 &% , 1 'ial each to theatre.


27/95

Co&$lication# of LSCS( Anae#thetic ) A#$iration , -endel#onN#

#ynd

( I&&ediate >> #hoc? da&a%e to 6ladder+reter# or colon

( Early Se$#i# "o+nd co&$lication#,ae&ato&a dehi#cence

( Late ri#? of #car r+$t+re in f+t+re

$re%nancie# inci#ional hernia inte#tinalo6#tr+ction d+e to adhe#ion#

Q


28/95

Q!i'e 4 ri#? factor# fro& thi# antenatal record ,;o #lide#

>A!E 1-r#. A


29/95

Orange

+++


30/95

( Short #tat+re

( >re'io+# death in+tero

( >re'io+# &i#carria%e#( Blood $re##+re of 10/110

( >rotein+ria

( !rand &+lti $ara


31/95

Q( )i* the items used in manua" #emo$a" o' p"aenta

1 >la#ter#

2 14! foley catheter

14! ID cann+la

4 Dac++& c+$

: A $air of %lo'e#

C+#coN# #$ec+l+&

7 ID dri$ #et

D+l#ell+&

M ID &etronidaHole

10 Betadine


32/95

1 >la#ter#

2 14! foley catheter

14! ID cann+la

4 Dac++& c+$

: A $air of %lo'e#

C+#coN# #$ec+l+&

7 ID dri$ #et

D+l#ell+&

M ID &etronidaHole

10 Betadine


33/95

Q4 M4/M: 6atch1. Identify/na&e

the in#tr+&ent2. "rite 2 +#e#


34/95

1. C+#coN# 6i'al'e #elf retainin% 'a%inal#$ec+l+&

2.

( In o6tainin% a >a$ #&ear( In o6tainin% a hi%h 'a%inal #;a6( o 'i#+aliHe the cer'i < 'a%inal ;all in

$el'ic ea&ination


35/95

Q1

1. "hatdo yo+#ee

2. "rite 2ca+#e#


36/95

1. Secondary arre#t

2. C>3

O> $o#itionInade=+ate +terine contraction#

-GC>3 ) E& LSCS

O> $o#itionInade=+ate +terine contraction#

Ecl+de o6#tr+ction

Increa#e oytocin inf+#ion rate

O6#er'e and if no $ro%re##ionE& LSCS


37/95

Q1M "rite a clinical condition ;here eachof the#e dr+%# are +#ed

ydralaHine

AB


38/95

C D

A B


39/95

A B

C D


40/95

OytocinA+%&entation of la6o+r.Acti'e - of rd #ta%e la6o+r < control >>.

*ollo;in% e'ac+ation of +ter+#.

-% #+l$hateA# ecla&$#ia $ro$hylai#.

ydralaHineIn >reecla&$#ia and ecla&$#ia.

Er%o&etrine>ro$hylai# a%ain#t ece## hea&orrha%e foll. deli'eryhera$e+tic In >>G atonic +terine 6leedin%.In atonic +terine 6leedin% foll. -i#carria%e e$+l#ion of .

&ole.


41/95

( Co+n#el thi# 0 yr# old $atient ;ho i#dia%no#ed to ha'e an inco&$lete

&i#carria%e


42/95

( Introd+ce yo+r#elf $+t the $atient at ea#e

( E$lain ;hat ha# ha$$ened , -o#t &i#carria%e# are

d+e to fetal ano&alie# there i# nothin% that #heco+ld ha'e done to $re'ent the &i#carria%e

( he need to +nder%o #+r%ery , E'ac+ation of

retained $rod+ct# +nder !A

( >re$aration for the net $re%nancy ) ;ait at lea#t &onth# d+rin% thi# $eriod ta?e folic acid

( Early antenatal clinic 6oo?in% and re%+lar follo; +$.

( A#? ;hether $atient ha# any =+e#tion# to a#?


43/95

( A#? : leadin% =+e#tion# to deter&inethe #e'erity of thi# $atient#

condition ;ho ha# a 6lood $re##+re of10/100 &&%


44/95

( *rontal eadache +nrelie'ed 6y #i&$leanal%e#ia.

( Di#+al di#t+r6ance fla#hin% li%ht# and

#$ot#( E$i%a#tric $ain( a+#ea/ Do&itin%

( S;ellin%( -alai#e


45/95

+#, A

5!-.!2--6

2,2 m"

1- mi""ion/m"

none25

3-

2-

000

"rite the

names

of the 5

abno#ma"ities

yo+ #ee.


46/95

Normozoospermia When all the spermatozoal parameters are normaltogether with normal seminal plasma ,WBCs andthere is no agglutination.

Oligozoospermia When sperm concentration is < 20 million/ml.

Asthenozoospermia ewer than !0" spermatozoa with #orwardprogression$categories $a% and $&% or #ewer than 2!"spermatozoa with categor' $a% mo(ement.

)eratozoospermia ewer than *0" spermatozoa with normalmorpholog'.

Oligoasthenoteratozoospermia +igni#ies distur&ance o# all the three (aria&les$com&ination o# onl' two pre#ies ma' also &e used%.

Azoospermia No spermatozoa in the e-aculate.

Aspermia No e-aculate.

euoc'tospermia more than 1 million white blood cells per ml of semen


47/95

Normal (alues

olume 2.0 ml or more

p1 .23.4

+perm concentration 20506 spermatozoa/ml or more

)otal sperm count 70506 spermatozoa or more

8otilit' !0" or more with #orward progression or2!" or more with rapid progressionwithin 60 min a#ter collection

8orpholog' *0" or more with normal morpholog'&

italit' !" or more li(e

White &lood cells ewer than 5506/ml

K


48/95

( #en#iti'ity of MK $oor #$ecificityre$eat #e&en #a&$le# $ro'ide#

%reater #$ecificity.

• At least two samples, preferably

taken at least two or three weeks apart, should be analyzed.


49/95

( "hat i# the ad'i#e yo+ ;o+ld %i'ere%ardin% o6tainin% a #e&en #a&$le

for analy#i#

hi t t i d t d t h ? f l f t


50/95

( hi# te#t i# cond+cted to chec? for &ale factor#+6fertility.

( S$eci&en #ho+ld 6e $rod+ced 6y &a#t+r6ation.

( A6#tinence fro& interco+r#e for day#.

( Condo #ho+ld not 6e +#ed for collection a# they contain

#$er&icide.

( Coit+# interr+$t+# i# not reco&&ended a# the fir#t $art ofthe e5ac+late contain# the hi%he#t concentration of #$er&.

( "ide &o+thed #terile $la#tic container ;ill 6e $ro'ided.

( Sa&$le #ho+ld 6e deli'ered to the la6 ;ithin 0 &in. ofcollection.

1 Identify


51/95

1. Identify

2. Li#t $rere=+i#ite# in +#in% the#e in#tr+&ent#

. !i'e indication# for the#e in#tr+&ent#


52/95

"ri%leyN# *orce$#


53/95

eillandN# *orce$#

Si&$#onN# *orce$#


54/95

Al;ay# $rior to a$$lyin% force$#1. A6d ea&ination ) ead en%a%ed

2. Confir& that the cer'i i# f+llydilated

. E&$ty the 6ladder

4. Chec? #tation of the $re#entin%$art:. >o#ition of the foetal #?+ll )

>o#ition of the #a%%ital #+t+re i it f l i f


55/95

>rere=+i#ite# for a$$lyin% force$#

( Dalid indication &+#t 6e $re#ent

( S+ita6le $re#entation 'erteface afterco&in% head of 6reech.

( F+le o+t ce$halo$el'ic di#$ro$otion.

( En%a%ed >re#entin% $art. >o#ition of the fetal head #ho+ld 6e ?no;n.

( Cer'i #ho+ld 6e f+lly dilated.

( Bladder e&$tied $refera6ly 6y catheri#ation.

( F+$t+red &e&6rane#.

( A6do&inally head #ho+ld not 6e $al$a6le. If &ore than 1/:th $al$a6lea6andon 'a%inal deli'ery.


56/95

Indication# for force$# deli'ery ( 3elay in $ro%re##ion of #econd #ta%e of la6o+r

( -aternal eha+#tion

( -edical $ro6le ;hich re=+ire a'oidance of

ece##i'e &aternal effort

( *etal di#tre## in the #econd #ta%e

( 3eli'ery of the after co&in% head of a 6reech$re#entation

1 a&e the re=+ired in#tr+&ent# in o#de# o' use ;hen o6tainin% a


57/95

1. a&e the re=+ired in#tr+&ent# in o#de# o' use ;hen o6tainin% a$a$ #&ear

2. "hat i# the fiati'e and the #tain +#ed

A B C

D E GF


58/95

1. * C+#coN# 6i'al'e #elf retainin% 'a%inal#$ec+l+&

! AyreN# ;ooden #$at+laB Cyto6r+#h/ Endocer'ical 6r+#hA !la## #lide#

2. *iati'e ) M:K Alcohol

Stain >a$anicolao+ #tain

,he %la## #lide i# fied in M:K alcohol for 0

&in+te# and air dried 6efore #endin% to thehi#tolo%y la6


59/95

1. a&e : in#tr+&ent# in an e$i#ioto&y

#et.

2. Li#t co&$lication# of an e$i#ioto&y

. "hat are the ad'i#e %i'en to &otherafter re$airin% an e$i#ioto&y


60/95

l l , l l


61/95

Sterile to;el# ,;o Sterile #anitary to;el

3re##in% Sci##or# eedle older


62/95

%

Artery *orce$# oothed Catch *orce$#


63/95

Fo+nd 6ody needle

C+ttin% needle

Co&$lication# of e$i#ioto&y


64/95

Co&$lication# of e$i#ioto&y

) I&&ediate( Eten#ion of the inci#ion

Early

( D+l'al hae&ato&a( Infection( "o+nd dehi#cence

) Fe&ote( 3y#$are+nia

Ad'i# t & th r f ll in


65/95

Ad'i#e to &other follo;in%e$i#ioto&y

( ee$ the area dry and clean.

( 3o not +#e anti#e$tic# #oa$ i#

#+fficient.( Can ;ear a #anitary $ad to ?ee$ area

dry.

"h i d i


66/95

"hat in#tr+&ent# are +#ed inthe follo;in% $roced+re# in

o#de# o' use

1. 3ilatation < C+retta%e

2. Fe$air of a cer'ical tear

1. 3


67/95

( >erfor&ed +nder !A

( >laced in lithoto&y $o#ition

( Local anti#e$tic cleanin% < dra$in%

( SiN do+6le 6laded $o#terior 'a%inal #$ec+l+& i# introd+ced

( Anterior li$ of cer'i held 6y '+l#ell+&

( Oli'e $ointed &allea6le %rad+ated &etallic +terine #o+nd to confir& $o#ition <len%th of ca'ity

( Cer'ical canal dilated ;ith e%arN# %rad+ated dilator#

( @terine c+rette ) #har$ end for 6eni%n le#ion# and 6l+nt end +#ed for #+#$ected&ali%nant le#ion#

( C+retted &aterial $re#er'ed in 10K for&al #aline and #ent to hi#tolo%y la6 ;ith a#hort clinical hi#tory.


68/95

>o#t $roced+re careG

( !i'e $araceta&ol :00 &% 6y &o+th a# needed.

( Oytocin 10 @ %i'en foll. EF>C ( Offer other health #er'ice# if $o##i6le incl+din% tetan+#

$ro$hylai# co+n#ellin% or a fa&ily $lannin% &ethod.

( Ad'i#e the ;o&an to ;atch for #y&$to and #i%n# re=+irin%i&&ediate attentionG

$rolon%ed cra&$in% ,&ore than a fe; day# $rolon%ed 6leedin% ,&ore than 2 ;ee?#

6leedin% &ore than nor&al &en#tr+al 6leedin% #e'ere or increa#ed $ain fe'er chill# or &alai#e faintin%.

F $ i f i l t


69/95

Fe$air of a cer'ical tear

( Anae#the#ia i# not re=+ired for &o#t cer'ical tear#. *ortear# that are hi%h and eten#i'e %i'e $ethidine I-

( !ood li%ht #o+rce and $atient i# $laced in lithoto&y $o#ition.

( SiN #$ec+l+& i# introd+ced

( !ently %ra#$ the cer'i ;ith !reen ar&yta%e force$#. A$$lythe force$# on 6oth #ide# of the tear and %ently $+ll in'ario+# direction# to #ee the entire cer'i. here &ay 6e#e'eral tear#.

( Clo#e the cer'ical tear# ;ith contin+o+# chro&ic cat%+t ,or$oly%lycolic #+t+re #tartin% at the a$e ,+$$er ed%e oftear ;hich i# often the #o+rce of 6leedin%.


70/95

( "hat are the in#tr+&ent# fo+nd in adeli'ery #et.


71/95

Gu""ipotte#i"e sanita#y to&e"s

idney t#ay


72/95

Cu#$ed mayos sisso#s

A#te#y 'o#eps

t#aiht sisso#s

idney t#ay


73/95

C!( "hat are the $ara&eter# that #ho+ld6e o6#er'ed in a C!

( y$e# of C!N#( If foet+# i# di#tre#ed ;hat feat+re#

;o+ld yo+ e$ect

>ara&eter# o6#er'ed in a


74/95

C!

( *F( Any deceleration# in F

( Ba#al heart rate 'ariation

( *re=+ency of +terine contraction#

( Stren%th of +terine contraction#

y$e# of C!#


75/95

y$e# of C!#

* t h f t i


76/95

*eat+re# ;hen foet+# i#di#tre##ed

( 3eceleration# in *F

(

( (

(

Ba#al 6ody te&$erat+re


77/95

Ba#al 6ody te&$erat+re

chart ,BBC

1. "hat i# the day of o'+lation

2. "hat ad'i#e yo+ %i'e on +#in% thi#

. On ;hich day accordin% to the chart ;o+ld yo+ do the

follo;in%

a. >o#t Coital e#t6. >ro%e#terone le'el# to detect o'+lationc. Endo&etrial 6io$#yd. S!e. I@I


78/95

O'+lation

0.:1 0* ,0.20.: 0C

2 day#


79/95

1 3ay 14 of the cycle


80/95

1. 3ay 14 of the cycle.

2. here i# a 6i$ha#ic $attern of 'ariation in o'+latory cycle.

( Be%in recordin% te&$. on the fir#t day of the $eriod day 1 onthe chart.

( -ea#+re the oral te&$. +#in% a clinical ther&o&eter.

( -ar? the date in the col+&n and #hade the area on the day of&en#e#.

( a?e the oral te&$ daily on ;a?in% 6efore %ettin% o+t of 6ed.

, do not ;a#h &o+th

( 3ay# ;hen interco+r#e ta?e# $lace #ho+ld 6e noted ;ith anarro;.

l d l


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a. >o#t Coital e#t day 121 in a re%+lar2 day cycle.

6. >ro%e#terone le'el# to detect o'+lation )3ay 21 in a 2 day cycle.c. Endo&etrial 6io$#y 3ay 212 in a 2

day cycle.

d. S! *ir#t 10 day# of the cycle.e. I@I ;a#hed #$er are $laced in the

+terine ca'ity at the ti&e of o'+lation.O'+lation detected 6y follic+lar %ro;th

&onitorin% 6y @SS.

1 2


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1 2

1. Identify

2. a&e ;hich one yo+ ;o+ld +#e in the follo;in%$roced+re#

( o in#ert an I@C3( In 'a%inal hy#terecto&y

( In 3


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( C+#coN# 6i'al'e #elf retainin% 'a%inal#$ec+l+&

a In#ertin% an I@C36 O6tainin% a $a$ #&ear

( SiN do+6le 6laded $o#terior 'a%inal#$ec+l+&

a Da%inal hy#terecto&y6 3ilatation and c+retta%ec Fe$air of a cer'ical tear

1. "hat are the in#tr+&ent# needed for thein#ertion of an I@C3


84/95

in#ertion of an I@C3

2. !i'e $o##i6le co&$lication#

1

4

2

:

7


85/95


86/95

Co&$lication#

( Inter&en#tr+al 6leedin%

( >el'ic infla&&atory di#ea#e( E$+l#ion ,1#t &onth#

( >erforation


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1. Identify

2. Li#t an indication and a

contraindication

a&e of in#tr+&ent ) Fin% $e##ary


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Indication# for +#e of 'a%inal $e##ary

a >rola$#e of +ter+#6 +rinary incontinencec cy#toceled rectocele

Contraindication#a Acti'e infection# of the $el'i# or 'a%ina #+ch a#

'a%initi#

6 >el'ic infla&&atory di#ea#ec >atient# ;ho are nonco&$liant or +nli?ely to

follo; +$d Aller%y to #ilicone or late


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*oetal &o'e&ent chart1. o; to ad'i#e &other to &aintain a

*oetal &o'e&ent chart

2. "hen do yo+ call it a6nor&al. Li#t ca+#e# for red+ced *-

4. Li#t non in'a#i'e te#t# to a##e##

foetal ;ell 6ein%

e#t #en#iti'e for fetal ;ell6ein% after 2 ;ee?#


90/95

e#t #en#iti'e for fetal ;ell 6ein% after 2 ;ee?#

>hy#iolo%y of nor&al third tri&e#ter fetal &o'e&ent( *et+# #$end# 10K of it# ti&e &a?in% %ro## &o'e&ent#

) Acti'e fetal $eriod# la#t 40 &in+te#) Inacti'e fetal $eriod# la#t 20 &in+te# ,7: &in+te#

( *etal acti'ity $ea?# ;ith &aternal y$o%lycae&ia) @#+ally occ+r# 6et;een M $& and 1 a&

) Acti'ity not increa#ed after &eal# or %l+co#e load

Ad'i#e to &otherG

R >atient #elf &onitor# ?ic? co+nt# daily at ho&eR Co+nt $erfor&ed at #a&e ti&e e'ery day

R Lie on left #ide in co&forta6le locationR Co+nt fetal &o'e&ent# to a co+nt of 1012 in 12 ho+r#R If $ercei'ed &o'e&ent# are 10/12hr# #ee? &edical

ad'i#e

Ca+#e# of red+ced foetal &o'e&ent#G


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( or&al #lee$ $ha#e( >hy#iolo%ical

( Fed+ced &aternal $erce$tion( Sedati'e dr+%# %i'en to &other( >olyhydra&nion/oli%o( Intra+terine a#$hyia

onin'a#i'e te#t# to a##e## foetal ;ell 6ein%G( C!( @SS foetal %ro;th < Li=+or. 6io$hy#ical $rofile

( @&6ilical artery 3o$$ler


92/95

@SS a6d %i'en

,.-ole or &i##ed a6ortion

A "hat i# the conditionB "hat i# the dia%no#i#

C !i'e 2 ca+#e#

is* 'ato#s1. i#tory of $re'io+# !32. A%e Lo;e#t ri#? ) A%e 2: ) 2M year#


93/95

46xx

23x

9roli#eration

o#

monospermic

androgenetic

complete

HM

:uplicati

on o#

haploid

sperm

8aternal :NA

lost #rom

o(um

46xy

23x

9roli#eration

o# dispermic

androgenetic

complete

HM

)wo paternal

genetic

contri&utions

8aternal :NA

lost #rom

o(um

69xxx

23x

9roli#eration

o# triploid

partial HM

8aternal and

two

paternal

geneticcontri&ution

69xxy

% % y ti&e# hi%her ) A%e le## than 1: yr# 4 ti&e# hi%her A%e 40 4: yr#

400 ti&e# hi%her ) o'er :0 yr#

(A6#ence of a foet+# ,In co&$lete &ole

(Sno; Stor&J a$$earance

#esentation1. Da%inal 6leedin%


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2. >a##a%e of 'e#ic+lar%ra$e li?e #tr+ct+re# $er'a%in+&

. y$ere&e#i#4. Early on#et >I

E7amination 'indins

1. Anae&ia

2. *83

8n$estiations

1. @SS a6d.

2. S. hC!

. CF

+anaement

1. E'ac+ation

2. *ollo; +$ ,2 yr# hC!a##ay#

. Contrace$tion

T


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-i##ed a6ortion

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