INSTRUCTIONS FOR CANDIDATES

Q. 1 Identify the instrument?

Q. 2 In which indication this is used?
Q.3 Describe the steps of procedure?
Q.4 Screening protocol?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1

Identify the instrument?

Q. 2

In which Indication this is used?

Answer:

Papsmear ---------------------------------------------------------- Mark 1

(what is papsmear) 1 mark of discrimination

Q.3

Describe the steps of procedure?

Answer:
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Q.4

OPD Procedure, without anesthesia --------------------------- Mark

Informed consent ------------------------------------------------ Mark
Lithotomy Position----------------------------------------------- Mark
Localised the Cervix with Cuscos Speculum---------------- Mark
Visualized transformation zone--------------------------------- Mark
Take Smear in clock wise and anti-clock wise at 1800------ Mark
Spread on slide --------------------------------------------------- Mark
Fixed with fixative (90% Alcohol)----------------------------- Mark
Screening Protocol?

Answer:
3 yearly in sexually active women
from 20 60 years of age------------------------------------------ Mark 1

Q. 1 Identify the instruments?

Q. 2 In which procedures these are used?
Q.3 What are the indications of these procedures? (list any four)
Q.4 What are the complications of these procedures?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1

Identify the instruments?

Answer:

Hegars Dilator------------------------------------------Currette --------------------------------------------------Valsellum------------------------------------------------Sims Speculum -----------------------------------------

Q. 2

In which procedures these are used?

Answer:

* D & C -----------------------------------------------* D & E ------------------------------------------------

Q.3

What are the indications of these procedures? (list any four)

Answer:

Diagnostic and therapeutic.

i.
ii.
iii.
iv.
v.
vi.
vii.

Q.4

Menstrual irregularities --------------------Post Menopausal Bleeding-----------------Incomplete abortion ------------------------Missed abortion -----------------------------Entometrial hyperplasia -------------------Entometrial polyp --------------------------Misplaced IUCD ---------------------------

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What are the complications of these procedures?

Answer:
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iii.
iv.

Haemorrhage --------------------------------Perforation -----------------------------------Cervical tear / false passage ---------------Sepsis ------------------------------------------

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INSTRUCTIONS FOR CANDIDATES

Read the investigation slips carefully?
Q.1 Name the report ?
Q.2 What is your diagnosis?
Q.3 Name other investigations to confirm diagnosis?
Q.4 What are the complications of your diagnosis?
Q.5 What are treatment options?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1
Answer:

Name the report ?

Complete Blood Count (CBC) ----------------------

Marks 1

Q. 2
Answer:

What is your diagnosis ?

i. Iron Deficiency Anemia ----------------------------- Mark
ii. Thalasemia ------------------------------------------- Mark

Q.3
Answer:

Name other investigations to confirm diagnosis ?

* Serum Ferritin -------------------------------------* TIBC ------------------------------------------------* Peripheral film ------------------------------------* Stool D/R -------------------------------------------

Q.4

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What are the complications of your diagnosis ?

Answer:

Q.5

Miscarriage ------------------------------------Preterm Labor ---------------------------------IUGR -------------------------------------------PPH ---------------------------------------------Infections --------------------------------------Cardiac failure ---------------------------------

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What are the treatment options ?

Answer:

Oral Iron --------------------------------------Parental Iron ---------------------------------Blood -----------------------------------------

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Specialty

OBSTETRICS & GYNAECOLOGY

INSTRUCTIONS FOR CANDIDATES

30 years old Mrs. Hameeda, gravida 3, para 2 +0, presents in OutPatient-Department with the history of 26 weeks pregnancy for
routine antenatal check-up. The weight of her last baby was 4 kg. Her
mother is diabetic and her BMI is 31 kg/m2.
Q.1
Q.2
Q.3

Identify the risk factors for gestational diabetes in her history?

Name any four screening test for diabetes in pregnancy?
What test will you perform to confirm the gestational diabetes?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1
Answer:

Identify the risk factors for gestational diabetes in her history?

a. Age 30 Years -------------------------------------b. Family history of diabetes-----------------------c. History of good size baby -----------------------d. BMI >31 kg / m2-----------------------------------

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Q. 2
Answer:

Name any four screening test for diabetes in pregnancy?

Q.3

What test will you perform to confirm the gestational diabetes?

a. Fasting Blood Sugar-------------------------------b. Time Random Blood Sugar ----------------------c. Urine for Glucose Estimation --------------------d. Glucose Challenge Test---------------------------e. HbA1C -----------------------------------------------

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Answer:
* Oral Glucose Tolerance Test (OGTT) -----------

Marks 2

INSTRUCTIONS FOR CANDIDATES

Mrs. Fareeda 28 years old, married since 5 years, primigravida
conceived on ovulation induction (Clomiphene Citrate) presented in
OPD with history of 12 weeks gestational amenorrhea and excessive
nausea vomiting her ultrasound shows twin pregnancy.
Q.1
Q.2
Q.3

What is the predisposing factor in her history for twin pregnancy?

Name any six maternal complications of the twin pregnancy?
What are the fetal / neonatal complications of twin pregnancy?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1

What is the predisposing factor in her history for twin pregnancy?

Answer:

Clomiphene Citrate-----------------------------------

Q. 2
Answer:

Name any six maternal complications of the twin pregnancy?

Q.3

What are the fetal / neonatal complications of twin pregnancy?

a. Hyperemesis gravidarum -------------------------b. Miscarriage -----------------------------------------c. Anemia ---------------------------------------------d. Pregnancy induced hypertension ----------------e. Diabetes mellitus -----------------------------------f. Pre Term Labor ------------------------------------g. Malpresentation / Malposition -------------------h. Increased risk of operative delivery -------------i. Polyhydramnios ------------------------------------j. Antepartum Haemorrhage -------------------------k. Post Partum Haemorrhage -------------------------

Marks 2

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Answer:
a. Miscarriage -------------------------------------------------b. Congenital abnormalities ---------------------------------c. Twin Twin Transfusion Syndrome --------------------d. Twin Reversed Arterial Perfusion Syndrome --------e. Locked Twins ----------------------------------------------f. Prematurity ---------------------------------------------------

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INSTRUCTIONS FOR CANDIDATES

Answer the following questions regarding maternal mortality.
Q.1
Q.2
Q.3

Define maternal death?

What are the three most common cause of maternal mortality in
Pakistan?
What are the three delays of maternal mortality?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1

Define maternal death?

Answer:

According to WHO, Maternal Death is defined as death of a woman while

pregnant, or within 42 days of termination of pregnancy, inspective of the
duration and the site of pregnancy, from any case related to or aggravated
by the pregnancy or its management, but not from accidental or incidental
causes. ----------------------------------------------------------- Marks 2

Q. 2

What are the three most common causes of maternal mortality in

Pakistan?

Answer:

a. Haemorrhage -------------------------------------------------- Mark 1

b. Hypertensive disorder ---------------------------------------- Mark 1
c. Sepsis ----------------------------------------------------------- Mark 1

Q.3

What are the three delays of maternal mortality?

Answer:

The three delays are defined as : ---------------------------1. First delay in decision to seek care.
2. Second delay in reaching to appropriate care facility.
3. Third delay in receiving quality care at the facility.

Marks 3

INSTRUCTIONS FOR CANDIDATES

A 60 years old, obese lady para 1+0 presents in out patient department
with the history of postmenopausal bleeding since 1 month. She is
known diabetic and hypertensive. Her ultrasound shows endometrial
thickness of 1cm.
Q.1
Q.2
Q.3
Q.4

What is your provisional diagnosis?

What are the other causes of postmenopausal bleeding?
What tests are required to confirm the diagnosis?
What are the different treatment options?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1
Answer:

What is your provisional diagnosis?

i. Endometrial carcinoma --------------------------------------- Marks 1

Q. 2
Answer:

What are the other causes of postmenopausal bleeding?

a. Atrophic vaginitis --------------------------------------------b. Ca Cervix ----------------------------------------------------c. Endometrial hyperplasia ------------------------------------d. Endometrial polyp ------------------------------------------e. Entometroitis ------------------------------------------------d. Drugs (HRT & Tamoxifin) ---------------------------------

Q.3

What tests are required to confirm the diagnosis?

Answer:

a. Trans Vaginal Ultrasound ---------------------------------b. Papsmear ---------------------------------------------------c.

i. Piplle Biopsy ---------------------------------------ii. D & C ----------------------------------------------iii. Hysteroscopic guided biopsy -------------------

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Q. 4
Answer:

What are the treatment options ?

(Depends on stage)
1. TAH + BSO -----------------------------------------------2. Radiotherapy ---------------------------------------------3. Chemotherapy ---------------------------------------------

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INSTRUCTIONS FOR CANDIDATES

An 18 years old, para 2+0 came in emergency with the history of
gestational amenorrhea 28 weeks and labor pains. She had her 1 st
delivery at 34 weeks and 2nd at 32 weeks, both babies are alive and
healthy.
O/E, she had palpable contractions. Cervical OS was 4 cm dilated,
membranes were bulging and show was positive.
Q.1
Q.2
Q.3

What is your diagnosis?

What are common causes / risk factors (name any eight)?
What are the fetal complications?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1
Answer:
Q. 2
Answer:

What is your diagnosis?

Preterm Labor ------------------------------------------ Mark 1
What are common causes / risk factors (name any eight)?
a. Prior Preterm Labor --------------------------------b. Uterine anomaly ------------------------------------c. Uterine over distention (multiple pregnancy,
Polyhydramnios, fibroid) --------------------d. Anmeia ----------------------------------------------e. Reproductive tract infection ----------------------f. Cervical incompetence ----------------------------g. APH -------------------------------------------------h. Low BMI -------------------------------------------i. Iatrogenic -------------------------------------------j. Substance abused -----------------------------------

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Q.3

What are the fetal complications (name any four)?

Answer:

a. Hypothermia ----------------------------------------b. Hypoglycemia --------------------------------------c. RDS --------------------------------------------------d. Sepsis ------------------------------------------------e. Increased perinatal mortality ---------------------f. Necrotizing enterocolitis --------------------------g. Bleeding tendency ---------------------------------h. Jaundice ---------------------------------------------

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INSTRUCTIONS FOR CANDIDATES

Q.

Perform obstetrical examination.

INSTRUCTIONS FOR EXAMINER

KEY:
Q.

Perform obstetrical examination.

Answer:
Presentation Skills ---------------------------------------------- Mark 1
1. Inspection
a. Umblicus -----------------------------------------------b. Pigmentation ------------------------------------------c. Scars ----------------------------------------------------i. Striae Gravidarum ---------------------------ii. Surgical Scars --------------------------------d. Prominent Veins --------------------------------------e. Movement with Respiration -------------------------

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2. Palpation
a. SFH ----------------------------------------------------b. Fundal Palpation -------------------------------------c. Lateral Palpation -------------------------------------d. Pelvic Grip -------------------------------------------e. Pawliks Grip ----------------------------------------f. Amount of Liquor -----------------------------------g. Estimated Fetal Weight -----------------------------

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3. Auscaltation ---------------------------------------------------

Mark 2

INSTRUCTIONS FOR CANDIDATES

Q.1
Q.2
Q.3

Identify the specimen?

What are complications associated with this condition? (list any five)
What are the treatment options?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1
Answer:

Identify the specimen?

Ovarian Cyst ------------------------------------------

Q. 2

What are complications association with this condition?

Mark 1

(list any five)

Answer:
a. Torsion ---------------------------------------------b. Rupture ---------------------------------------------c. Haemorrhage --------------------------------------d. Infection --------------------------------------------e. Degeneration ---------------------------------------f. Malignant transformation --------------------------

Q.3

What are the treatment options?

Answer:

a. Conservative ----------------------------------------b. Ultrasound guided aspiration --------------------c. Laparoscopic aspiration --------------------------d. Cystectomy -----------------------------------------e. TAH + BSO------------------------------------------

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INSTRUCTIONS FOR CANDIDATES

Read the investigation slips carefully.
Q.1
Q.2
Q.3
Q.4
Q.5

Name the report?

What is your diagnosis?
Name other investigations to confirm the diagnosis?
What are the complications of your diagnosis?
What are the treatment options?

INSTRUCTIONS FOR EXAMINER

KEY:
Q. 1
Answer:

Name the report?

Complete Blood Count (CBC) Report------------------------ Marks 1

Q. 2
Answer:

What is your diagnosis?

Iron Deficiency Anemia ---------------------------------------

Q.3

Name other investigations to confirm the diagnosis?

Answer:

* Serum Ferritin -----------------------------------------------* TIBC ----- ----------------------------------------------------

Q. 4
Answer:

What are the complications of your diagnosis?

Q. 4
Answer:

Miscarriage --------------------------------------------Preterm Labor -----------------------------------------IUGR ---------------------------------------------------PPH -----------------------------------------------------Infections ----------------------------------------------Cardiac failure -----------------------------------------

Mark 2
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What are the treatment options?

Oral Iron ------------------------------------------------ Mark 1

Parental Iron -------------------------------------------- Mark 1
Blood Transfusion ------------------------------------ Mark 1