Hi Paul
Kindly give me roughly idea about the most important common questions involved in the exam ? Thanks
2) You have been called to review a healthy 34 year old woman in the theatre recovery. She had an em
Posted by Jinan H.
Risk factor is prolonged labour
Assess the patient
Detailed history about operation & Hb level prior to operation , amount of blood loss & placenta history of blood disorder
Assessthe patient level of consciousnesses, pallor ,breathlessness, urine output . Spo2 ,BP,PR,RR & start charting
Ask for help multidisciplinary : consultant obstetrician , anesthetiser, ICU, haematologist , blood banking , & nurse & follow local guideline
Start 2nd line send for CBC , LFT , coagulation profile & U&E & ask for 4 units blood , give colloid while awaiting blood arrival .
Assess uterine contractility & start drip containing 40 unit oxytocin
Give misoprostole rectally if no contraindications
Give hemabate intramyometrail
If no response return her to theatre & explore the patient
Blynche suture for uterus
If no response discuss uterine artery embolistation , ,internal iliac artery ligation & hysterectomy
Involve the patients family in the decision if the patient unconscious
Documentation & incident report
3) A 32 year old woman with renal transplant secondary to SLE requests reliable contraception. Discu
Posted by Jinan H.
Involve the patient in the decision
Long acting reversible & birth wishes of the patint
Hormonal choices:
SLE risk factor for DVT
Therefor combined pill is risk out benefit
Progesterone pill is safe alternative : different options pill, injections , IUD contains progestron
Second generation pill is preferable to 3rd generation as the last associated with more DVT than second one
IUD is safe alternative but carry risk of heavy bleeding
Barrier method is an option
Long acting non reversible
Vasectomy
Tubal ligation
3) A 32 year old woman with renal transplant secondary to SLE requests reliable contraception. Discu
Posted by Jinan H.
History
Enquire about activity of the disease & medications used for transplant that may interfere. with contraception history of DVT or family history of DVT , history of breast CA . Is she in stable relation ?
The patient wishes for fertility & wether want reversible or non reversible contraception
Involve the patient in the decision
Long acting reversible
Hormonal choices:
SLE risk factor for DVT
Therefor combined pill is risk out benefit
Progesterone pill is safe alternative : different options pill, injections , IUD contains progestron
Second generation pill is preferable to 3rd generation as the last associated with more DVT than second one
IUD is safe alternative but carry risk of heavy bleeding
Barrier method is an option
Long acting non reversible
Vasectomy
Tubal ligation
4) A 48 year old woman with a 6 months history of vague abdominal discomfort has been referred to th
Posted by Jinan H.
History
Menstrual detailed: regularity , amenorrhea , dysmenorrhea, dysparunia, history of menorrhagia
Loss of appetite & weight
GI symptoms : constipation alternate with diarrhoea ,indigestion& bloating , epigatric pain & vomiting
Pressure symptoms , pain
History of infertility , medication , smoking
Investigations
CBC, LFT, U&E E
Pelvic US : detailed Us : consistency of mass & wether related to ovary or to uterus . Presence of solid area any changes
CT scan to assess the mass
CA 125 raise in epithelial ovarian tumour but it is non specific & other tumour marker may considered
Assessment of malignancy risk index
If 250 high malignancy index may consider laparotomy referral to cancer Center
4) A 48 year old woman with a 6 months history of vague abdominal discomfort has been referred to th
Posted by Jinan H.
History Menstrual detailed: regularity , amenorrhea , dysmenorrhea, dysparunia, history of menorrhagia Loss of appetite & weight GI symptoms : constipation alternate with diarrhoea ,indigestion& bloating , epigatric pain & vomiting Pressure symptoms , pain History of infertility , medication , smoking
Examination
Abdominal exam : mass or tenderness
Pelvic exam feeling of mass size mobility
Supraclavicular lymph node
Review Pap smear
Investigations CBC, LFT, U&E E Pelvic US : detailed Us : consistency of mass & wether related to ovary or to uterus . Presence of solid area any changes CT scan to assess the mass CA 125 raise in epithelial ovarian tumour but it is non specific & other tumour marker may considered Assessment of malignancy risk index If 250 high malignancy index may consider laparotomy referral to cancer Center
