POST MENOPAUSAL BLEEDING:
68. post menopausal vaginal bleeding+ vaginal dryness and dysuria = ATROPIC VAGINITIS >>> Best
step in management =PIPELLE BIOPSY (HYSTEROSCOPIC BIOPSY)
69. Post menopausal + shifted from replacement HRT to continuous >>> irregular bleeding >>>
CAUSE: Change of medication:
70. PMB >>> USG-endometrial thickness 8mm >>> best step -HYSTEROSCOPY
71. If hymen intact-examine under GA
72. post menopausal bleed+discharge +obvious ulcer on cervix=single most appropriate investigation
=COLPOSCOPY
73. Intermenstrual bleed and discharge+previously treated for carcinoma in situ +recent smear
negative >>> Next best step in management =COLPOSCOPY
74. Check for mets from cervical Cancer=CT
75. Follow up for ovarian ca=CA125
VAGINAL DISCHARGE:
76. Gonococcal cervicitis uncomplicated =CIPROFLOXACIN And complicated=CEFTRIAXONE
77. PID=metronidazole+ doxycycline ×2 weeks
78. Chlamydia cervicitis=Azithromycin >> Doxycycline
79. Chlamydia UTI=single dose of Azithromycin 1gm stat to each partner
80. Vaginal discharge+fishy odour+no itch=BV
81. White curdy vaginal discharge+pruritis=candida= topical clotrimazole+single dose fluconazole
POST PARTUM HAEMORRAGE:
82. prolonged labour+ post delivery heavy bleed=UTERINE ATONY
83. forceps delivery+profuse bleeding=genital tears ( CERVICAL + VAGINAL + PRINEAL)
84. 10 days post delivery+heavy bleeding +univoluted uterus= retained placenta (2°PPH)
85. bleeding post abruption=DIC
ANTEPARTUM HAEMORRAGE:
86. 32 yr+ smoker ( 20cigg/ day) + 32 wks pregnant+ sudden onset of severe unprovoked abdominal
pain= PLACENTAL ABRUPTION
87. 36yr + prinmigravida+ 33 weeks+ painless bleeding+ Adb soft + fetus lying transverse= PLACENTA
PRAEVIA
88. 38 yrs+ para 4 + blood stained watery foul-smelling discharge= Speculum exa: cervix irregular and
ulcerated >>> Dx: CERVICAL CANCER
89. 22 yr+ 30 weeks gestation+ bright red cervical bleed + no pain+ abd non-tender + FHS audible+ 20
wk USG was unremarkable >>> General per speculum examination exclude other causes ( TVS is
the investigation of choice)
90. Failure to progress to labour >>> C/S >>> continuous pain over the scar + increasing blood stained
liquid= SCAR DEHISCENCE
Miscellaneous:
91. BEST time to unsenitize RH-ve women = WITHIN 72 hours
Additional Questions
Causes of Primary infertility
Congenital adrenal hyperplasia
Congenital abnormality of the genital tract
Turners syndrome
Testicular feminization syndrome
Post menopausal bleed + endometrial thickness = > 7 ( cut off is 5)= Hysteroscopy and
endometrial biopsy/ Pipelle’s endometrial sampling
COCP can be used along with Na- valproate
Hyperemeremesis Graviderum= 1 st line I/V fluid >>> 2 nd line antiemetic >>>if all fails >>>
Intractable vomiting >>> IV hydrocortisone
Asian primigravida >>>presents at 16 weeks >> most appropriate investigation for her is >>
OGTTm
Diabeteic mother >> Do fetal echo 22-24 weeks to see structural abnormality of hear ?? Sacral
agenesis VSD
Most common congenital abnormality = Sacral agenesis
Physiological change during pregnancy: tidal volume ↑ 700 ml + Red cell volume 1.64 litres+
Cardiac output 6.5 litre per minute+ ESR 4 fold increase
