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8/17/2019 Clinical OSCE With Answers
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End of 4End of 4thth YearYear
Clinical OSCEClinical OSCEA/L 2001 BatchA/L 2001 Batch
Dinusha LiyanapatabendiDinusha Liyanapatabendi
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Q7
1. Identify A!
2. "rite the corre#$ondin% letter# in
order of &o#t effecti'e ðod tolea#t effecti'e ðod
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A
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B
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C
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D E
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F
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G
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A
D
B C
EF
G
1. Identify A!
2. "rite the corre#$ondin% letter# in order of &o#teffecti'e ðod to lea#t effecti'e ðod
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( A ) *e&ale condo&
( B ) Le'onor%e#trel relea#in% intra +terine contrace$ti'e de'ice ,-irena
( C ) Co$$er 0 A intra+terine contrace$ti'e de'ice
( 3 3e$ot &edroy $ro%e#terone acetate in5ecta6le #+#$en#ion
( E ) or$lant #+6der&al contrace$ti'e i&$lant #y#te&
( * ) Co&6ined oral contrace$ti'e $ill
( ! -ale condo
E8B8*938C8!8A
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% of women experiencing anunintended pregnancy within the
first year of use
Method Typical use1 Perfect use2
No method4 85 85
Withdrawal 27 4
Periodic abstinence
Calendar
Ovulation method
Sympto-thermal6
Post-ovulation
25
!
"
#
Condom - emale 21 5Condom - Male 15 2
Com!ined pill and minipill " #$
&MP' (&epo-Pro)era* #$
+,& (copper T* #$" #$
Mirena (./0 +,* #$1 #$1
./0 implants (/orplant* #$#5 #$#5
$emale sterili%ation &'5 &'5
(ale sterili%ation &'#5 &'#&
mergency contracepti)e pills3 Treatment initiated within 72 hours after unprotected
intercourse reduces the ris4 of pregnancy !y at least 75%$
2
3
3
4
56
1
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A 21 yr# old +n&arried %irl $re#ent# to yo+r clinic after ha'in%+n$rotected #e la#t ni%ht. What method/s that you an use inthis patient as post!oita" ont#aepti$e method/s.
B A : yr# old healthy ;o&an ;ith t;o children a%ed < : yr#re=+e#t# an e&er%ency contrace$ti'e after +n$lanned coit+# 4 day#a%o. %ame a method that you &ou"d o''e# to this &oman.
1
2
4
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A.1 ) >o#tinor2
ta?e one ta6 i&&ediately and the #econd ta6let 12 hr# later
2 ) Co&6ined oral contrace$ti'e $illa?e 4 ta6let# i&&ediately and re$eat the #a&e do#e 12 hr#later
B.
Co$$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.
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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
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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
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( 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
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Q7
1. a&e a6o'e ite and ;rite one noncontrace$ti'e 6enefitof each a6o'e %i'en ðod#
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
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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
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-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?+$ ðod OF a6#tain fro& #e.
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-i##ed >illJ
"O !+ideline#
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1. "hat i# thead'ice yo+ ;o+ld%i'e to the
$atient ;hen$re#cri6in% thi#
2. Li#t Co&&on#ide effect#
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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 ðod 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 ðod 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 ðod
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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%
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( 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##
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Q 14
( o; do yo+ $re$are a $atient forLSCS
( "hat are the co&$lication# of LSCS
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( 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.
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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
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Q!i'e 4 ri#? factor# fro& thi# antenatal record ,;o #lide#
>A!E 1-r#. A
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Orange
+++
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( Short #tat+re
( >re'io+# death in+tero
( >re'io+# &i#carria%e#( Blood $re##+re of 10/110
( >rotein+ria
( !rand &+lti $ara
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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
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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
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Q4 M4/M: 6atch1. Identify/na&e
the in#tr+&ent2. "rite 2 +#e#
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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
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Q1
1. "hatdo yo+#ee
2. "rite 2ca+#e#
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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
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Q1M "rite a clinical condition ;here eachof the#e dr+%# are +#ed
ydralaHine
AB
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C D
A B
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A B
C D
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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.
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( Co+n#el thi# 0 yr# old $atient ;ho i#dia%no#ed to ha'e an inco&$lete
&i#carria%e
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( 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#?
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( A#? : leadin% =+e#tion# to deter&inethe #e'erity of thi# $atient#
condition ;ho ha# a 6lood $re##+re of10/100 &&%
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( *rontal eadache +nrelie'ed 6y #i&$leanal%e#ia.
( Di#+al di#t+r6ance fla#hin% li%ht# and
#$ot#( E$i%a#tric $ain( a+#ea/ Do&itin%
( S;ellin%( -alai#e
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+#, A
5!-.!2--6
2,2 m"
1- mi""ion/m"
none25
3-
2-
000
"rite the
names
of the 5
abno#ma"ities
yo+ #ee.
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Normozoospermia When all the spermatozoal parameters are normaltogether with normal seminal plasma ,WBCs andthere is no agglutination.
Oligozoospermia When sperm concentration is < 20 million/ml.
Asthenozoospermia ewer than !0" spermatozoa with #orwardprogression$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
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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
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( #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.
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( "hat i# the ad'i#e yo+ ;o+ld %i'ere%ardin% o6tainin% a #e&en #a&$le
for analy#i#
hi t t i d t d t h ? f l f t
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( hi# te#t i# cond+cted to chec? for &ale factor#+6fertility.
( S$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
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1. Identify
2. Li#t $rere=+i#ite# in +#in% the#e in#tr+&ent#
. !i'e indication# for the#e in#tr+&ent#
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"ri%leyN# *orce$#
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eillandN# *orce$#
Si&$#onN# *orce$#
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Al;ay# $rior to a$$lyin% force$#1. A6d ea&ination ) ead en%a%ed
2. Confir& that the cer'i i# f+llydilated
. E&$ty the 6ladder
4. Chec? #tation of the $re#entin%$art:. >o#ition of the foetal #?+ll )
>o#ition of the #a%%ital #+t+re i it f l i f
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>rere=+i#ite# for a$$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.
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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
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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
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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$anicolao+ #tain
,he %la## #lide i# fied in M:K alcohol for 0
&in+te# and air dried 6efore #endin% to thehi#tolo%y la6
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1. a&e : in#tr+&ent# in an e$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
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l l , l l
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Sterile to;el# ,;o Sterile #anitary to;el
3re##in% Sci##or# eedle older
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%
Artery *orce$# oothed Catch *orce$#
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Fo+nd 6ody needle
C+ttin% needle
Co&$lication# of e$i#ioto&y
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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#$are+nia
Ad'i# t & th r f ll in
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Ad'i#e to &other follo;in%e$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
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"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
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( >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.
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>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 $lannin% ðod.
( Ad'i#e the ;o&an to ;atch for #y&$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
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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%.
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( "hat are the in#tr+&ent# fo+nd in adeli'ery #et.
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Gu""ipotte#i"e sanita#y to&e"s
idney t#ay
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Cu#$ed mayos sisso#s
A#te#y 'o#eps
t#aiht sisso#s
idney t#ay
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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$ect
>ara&eter# o6#er'ed in a
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C!
( *F( Any deceleration# in F
( Ba#al heart rate 'ariation
( *re=+ency of +terine contraction#
( Stren%th of +terine contraction#
y$e# of C!#
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y$e# of C!#
* t h f t i
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*eat+re# ;hen foet+# i#di#tre##ed
( 3eceleration# in *F
(
( (
(
Ba#al 6ody te&$erat+re
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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
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O'+lation
0.:1 0* ,0.20.: 0C
2 day#
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1 3ay 14 of the cycle
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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
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in#ertion of an I@C3
2. !i'e $o##i6le co&$lication#
1
4
2
:
7
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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; +$d Aller%y to #ilicone or late
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*oetal &o'e&ent chart1. o; to ad'i#e &other to &aintain a
*oetal &o'e&ent chart
2. "hen do yo+ call it a6nor&al. Li#t ca+#e# for red+ced *-
4. Li#t non in'a#i'e te#t# to a##e##
foetal ;ell 6ein%
e#t #en#iti'e for fetal ;ell6ein% after 2 ;ee?#
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e#t #en#iti'e for fetal ;ell 6ein% after 2 ;ee?#
>hy#iolo%y of nor&al third tri&e#ter fetal &o'e&ent( *et+# #$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$$ler
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@SS a6d %i'en
,.-ole or &i##ed a6ortion
A "hat i# the conditionB "hat i# the dia%no#i#
C !i'e 2 ca+#e#
is* 'ato#s1. i#tory of $re'io+# !32. A%e Lo;e#t ri#? ) A%e 2: ) 2M year#
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46xx
23x
9roli#eration
o#
monospermic
androgenetic
complete
HM
:uplicati
on o#
haploid
sperm
8aternal :NA
lost #rom
o(um
46xy
23x
9roli#eration
o# dispermic
androgenetic
complete
HM
)wo paternal
genetic
contri&utions
8aternal :NA
lost #rom
o(um
69xxx
23x
9roli#eration
o# triploid
partial HM
8aternal and
two
paternal
geneticcontri&ution
69xxy
% % y ti&e# hi%her ) A%e le## than 1: yr# 4 ti&e# hi%her A%e 40 4: yr#
400 ti&e# hi%her ) o'er :0 yr#
(A6#ence of a foet+# ,In co&$lete &ole
(Sno; Stor&J a$$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