Saturday, July 04, 2015

Obs & Gynae End Posting Exam

As usual, MCQ, OBA and OSPE questions were easy peasy!! - only if you have read about the topics before sitting for exam lol how we wish we have a brain like sponge >..<

PMP 1 (Obs) was about Rhesus Isommunization and PMP 2 (Gynae) was on Ectopic Pregnancy with Pelvic Inflammatory Disease.

LONG CASE with Prof. Roszaman

42 year old Malay housewife, G4 P3 (last childbirth 7 years ago) at 37 weeks 5 days POG with underlying Gestational Diabetes Mellitus and late onset Pregnancy Induced Hypertension, admitted for Bishop score and Induction of Labour.

On examination, she was a medium build lady, alert and comfortable. She did not look pale or jaundiced. Abdomen looked distended with presence of gravid uterus. There was linea nigra and striae gravidarum seen, but no surgical scar or dilated veins. Abdomen soft and non-tender, uterus was not irritable. SFH 34 cm which was smaller than date. There was a singleton fetus lying in longitudinal lie cephalic presentation, fetal back at maternal right side. Fetal movement was felt on palpation. No contraction felt. Head 3/5th palpable. Estimated fetal weight 2.6-2.8kg. Liquor was adequate.

Prof interrupted in between my history, and asked a lot of questions. Some of them that I can remember:

1. Differences between complications of GDM and DM complicating pregnancy
2. How to screen for Down Syndrome antenatally? Ever heard of triple tests?
3. Side effects of methyldopa and labetolol
4. How to investigate IUGR?
5. List problems in this patient
6. Investigations you want to do
7. Management plan
8. Methods of induction of labour (medical and mechanical)

SHORT CASE with Prof. Mokhtar

17 year old big build Malay lady, lying in supine position, looked in pain. Branula attached at dorsum of right hand. She was not pale. Abdomen distended with presence of gravid uterus. There was linea nigra seen, but no surgical scar. Umbilicus was flat, abdomen looked tense.  Abdomen was tender at suprapubic area. SFH at 40 cm. There was a singleton fetus lying in longitudinal lie cephalic presentation, fetal back at maternal right side. I could not appreciate the head engagement. Estimated fetal weight was 2.8-3.0 kg. Liquour was excessive. Fluid thrill was positive.

1. What is latent phase of labour?
2. Definition of prolonged phase of labour
3. Complications that you expect for this patient during delivery - Prof wanted to hear the answer cord prolapse

Now let's focus on FINAL PRO EXAM!!


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