1995

All questions are to be answered

1

A female 30 years old had an IUD applied one year ago Presented to the hospital with severe lower right abdominal pain. What are

a- The possible causes?

b-Methods of investigation?

c-Treatment?

2

Write a short account on the following:

a-Types and treatment of Neonatal Asphyxia.

b-Management of Cervical dystocia.

c-Causes of Habitual Abortion.

d-Causes of Arrest Of breech Presentation On The Pelvic Outlet.

3

A 49 years old multipara presented to the hospital complaining of progressive enlargement of her abdomen. What are:

a-The possible underlying causes?

b- The methods for diagnosis?

c- The possible lines of treatment?

4

Write short notes on:

a-Management of Uterine Perforation during D&C operation

b-Treatment of second degree Uterine Prolapse in a young patient

c-diagnosis of Female Genital Tuberculosis.

d-What is Douglas Pouch; enumerate the masses felt at This site

1996

1

A Primigravida 24 years old comes to the hospital in labour. She has antenatal sonogram that shows breech presentation and the presence of uterine septum. Just on admission the buttocks of the fetus are spontaneously delivered.

How are you going to assist the delivery of:

a-The shoulders if they are:

   i-Flexed

   ii- Extended  

   iii- Nuchal position

b-The aftercoming head (the most recommended 2 methods).

After delivery of the fetus the placenta can’t be delivered by routine methods. How are you going to manage this retained placenta?

c-Mention the most common causes of:

     1-Breech presentation

     2-Placental retention in this particular case.

2

Write short notes on the following:

a-Compare and contrast the four main types.(configurations) Table is recommended.

b- Diagnosis and management of complete penned immediately after labour.

c- Indication and methods of pregnancy termination in pregnancy induced hypertension (P.E.T)

d- Causes and diagnosis of incompetent cervix.

e- Criteria of intrapartum fetal distress.

3

A 22 years old patient, married since 3 years comes to the outpatient Clinic with a history of inability to conceive. Since 2 years she started to complain of severe central lower abdominal pain that occurs during menstruation and 2 days after its end pelvic ultrasound and empty cavity. The right ovary shows a unilocular cystic mass 5 cm in diameter. The left ovary is normal.

a-what is the most probable diagnosis-explain why?

b-what are the investigations required reaching final diagnosis

c-what is your plan of treatment

4

Write short notes on:

A-development of 2ry female sexual characters at puberty

B-lymphatic drainage of the Vulva

C-diagnosis and treatment of gonoccocal infections of 1ry sites

D-screening methods for carcinoma of cervix

E-Long acting hormonal contraception

1997

All questions are to be answered:

1

A multipara having an intrauterine contraceptive device inserted 3 months ago. She is complaining of inability to feel the threads.

a-what are the possibilities.

b-what are the investigations you want to do reach diagnosis? c-what is your plan of treatment?

2

Give short notes on:

a-Investigation of tubal factor in case of infertility.

b- Monilial vulvovaginitis.

c- Classify ovarian germ cell tumours.

d-Complication of D&C operation.

3

A fifth gravida at 36 weeks pregnancy is transferred to the hospital in a state of shock after falling on her abdomen, On examination the abdomen is extremely tender and the fetal heart sounds are not heard. Vaginal examination shows: moderate vaginal bleeding and closed cervix.

a- What is the probable diagnosis? Explain why?

b-What are the investigations you want to do to corf’rm your diagnosis?

c-How can you manage this case?

4

Give short notes on:

a-The conditions that must be present to allow using the forceps.

b-Causes of polyhydramnios

c-Apgar score.

d-The diameters of the inlet in normal gynaecoid pelvis.

1998

PAPER 1:.Obstetrics

All questions are to be answered:

I

A 35 years old primigravida woman comes to the hospital in labour at 40 weeks gestation. She has never had antenatal care she gives a history polyuria and polydepsia in the second  half of pregnancy and of non perception of fetal movements since 10 days. Her body weight is 85 kg. And P/P is 120/80.

When the cervix is 9 cm dilated. A partially collapsed head is spontaneously delivered after repeated forceful trials. Immediately after the delivery of a complete placenta, massive bleeding occurs while the uterus is well contracted.

Answer the following questions:

1

Name two sure methods for prenatal diagnosis of intrauterine fetal death

2

What is the cause of IUFD in this case? Explain why sudden death occurred and mention the investigation which can be used to confirm the diagnosis of the

3

What are the possible causes of shoulder dystocia in the case?

4

What are the possible causes of postpartum bleeding in this case? Name the methods, which can be used to confirm the diagnosis?

5

Outline the management of this bleeding.

Answer the following questions briefly:

II

1

Name 5 uterine signs of Pregnancy in the 1st Trimester.

2

Name the routine laboratory tests to be done at the first antenatal visit.

3

Give the methods, dosages and contraindications of ERGOMETRIN use in the 3rd stage of labour.

4

Out line the treatment of HYPEREMESIS GRAVIDARUM.

5

Enumerate the cardiac diseases, which contraindicate pregnancy and necessitate termination.

6

What are the effects of oligohydramnios on the fetus?

PAPER 2:.Gynecology

III

A 37 years old multiparous woman comes to the hospital complaining of severe irregular uterine bleeding, pelvic examination reveals bulky uterus. (Symmetrically enlarged) and a 10 cm solid right ovarian tumor. Fractional dilatation and curettage reveals endometrial hyperplasia

Answer the following questions:

a)What is the significance of endometrial hyperplasia? Name the pathological varieties.

b) What are the ovarian tumors that may cause this hyperplasia And why?

c) Name 2 preoperative methods for diagnosis of ovarian malignancy in this case?

d)Name the intro-operative criteria of ovarian malignancy in such a case and mention 2 intraoperative investigations for diagnosis of malignancy.

e)Outline the treatment of this case if the ovarian tumor proves to be:

     a-Benign

     b-Malignant stage I

IV

Answer The Following Question Briefly:

1

Enumerate the anatomical Structures between 2 Layers of the Broad Ligament.

2

Classify Functional Hypothalamic Amenorrhea.

3

Name 5 methods of pain control in Primary (Spasmodic) dysmenorrhea.

4

Enumerate the causes of cervical in infertility.

5

Name the operations to be used in the following types of Prolapse.

a) Rectocele.

b) Cystorectocele.

c)First degree uterine Prolapse.

d)Second degree uterine Prolapse.

e)Postmenopausal procedentia.

6

Name the predisposing causes of monilial vulvovaginitis.

7

Enumerate the causative organisms of the acute pelvic inflammatory disease (PID) and mention one effective antibiotic combination for treatment.

8

Mention the available methods for Emergency Contraception.

9

Define stage I cancer cervix.

10

Outline the (surgical and medical) treatment of tubal pregnancy.

1998

1

HISTORY

A 64 years old Para 2-1-0-2 complains of increased abdominal girth and diffuse lower abdominal pain discomfort for 6 weeks. She has noted fullness in the upper abdomen, and in the last 2 weeks has developed mild shortness of breath.

She has no gynecological or urinary symptoms, and although her appetite is poor. she has gained 8kg in body weight in the last 3 months, she is menopausal since age 50, and her post and family history are unremarkable.

PHYSICAL EXAMINATION

She is pale, normal-appearing female with mild shortness of breath, with a blood pressure 110/70 mm hg, pulse 88/mm and respiration 28/ min.

ENT examination is normal, there is no cervical. supraclavicular, axillary or inguinal lymphadenopathy. Examination of the lungs discloses diminished breath sounds and dullness in the left lung field. Examination of the heart and breasts is normal. The abdomen is distended. With prominent fluid wave and shifting dullness. There is a diffuse nodular mass felt in the epigastrium. The liver and spleen are not palpable. On pelvic examination, the external genitalia and vagina are atrophic, the cervix is small, flush with the vaginal vault, and has no lesion. On bimanual and rectovaginal examination there is a 10cm, irregular, nodular mass fixed to the right pelvic sidewall and extending accross the midline. There is nodularity filling the cul-de-sac. The uterus is not palpable

LABORATORY DATA

Hemoglobin 10gm/dl, hemoatocnit value 30%

urine analysis normal, total protein 6.5 gm/dl, albumin 3.1 gm/dl.

BUN, creatinine, SGOT, SGPT, alkaline phosphatase, and electrolytes are normal.

Chest X-ray revealed a left pleural effusion,

Thoracocentesis is performed. Cytology of pleural effusion indicates that malignant cells are percent. Abdominal film reveals a ground-gloss appearance in the penitoneum and absence of bowel in the middle of the abdomen. IVP and cystoscopy are normal. Barium enema shows displacement of the rectosigmoid by a pelvic mass, sigmoidoscopy to 15 cm shows no abnormalities. An abdominal paracentesis is performed, removing 6000 ml of straw-colored ascetic fluid in half an hour by gravity drainage. Cytology examination reveals malignant cells.

* Is there any danger of rapid removal of ascites?

* What is the most probable diagnosis?

* Is there any differential diagnosis?

* How do you stage this disease? Mention the accepted classification.

* Discuss the treatment of this patient.

2

Discuss the diagnosis & treatment of cephalopelvic disproportion.

3

Write notes on:

Value of Amniocentesis.

Diagnosis and treatment of Eclamptic Fits.

Genital Chlamydial Infection (bacteriology, pathology diagnosis andtraetment

Causes, diagnosis and treatment of Retained Placenta.

Indications, contraindications & complications of Intro Uterine Contraceptive Devices.

ALL QUESTIONS ARE TO BE ANSWERED

1

Give an account on the diagnosis and treatment of Gestational Trophoblostic Disease.

2

Write short notes on:

a)Anatomy & function of Pelvic Floor Muscles.

b)Immunological factors in Infertility, abortion & contraception

c)Cesarean Hysterectomy.

d) Etiology & complication of Multifoetal Pregnancy.

e)Pathology of Vulvar Ulcers.

COMMENTARY

A 31-year-old P1+1, married woman was referred to the fertility clinic 18 month organization definition of subfertility would after a right salpingectotny for a tubal ectapic pregnancy.

1

which of the following statement are correct?

A) The world health organization definition of subfertilty would consider this situation as secondary infertility.

B) The most likely cause for delay in conception is tubal disease.

C) Tubal disease is the commonest cause of secondary subfertility.

D) All tubal pregnancies are a consequence of pelvic inflammatory disease.

E) This woman has a low chance of delivering a term baby in the future.

The patient had one child; a 2.86kg male was delivered normally at 37 week’s gestation following spontaneous conception. She suffered from insulin dependent diabetes and myxoedema (for the later she took 100 ug thyroxin dailv).

She has been diagnosed by insulin-dependent diabetes at the age of 12 and her control was though to be good on a twice-daily regimen of soluble (12 units) and Isophane (12 units) Insulin.

2

What would be your advice if this patient consulted you?

a) To advice sterilization as she has a serious maternal disease.

b)To advice against pregnancy due to maternal ingestion of thyroxin.

c)To advice her to commence ingestion of 400 mg folic acid doily.

d)To advice her to avoid pregnancy and to use the progesterone-only contraceptive pill.

e)To advice her to optimize her diabetic control.

On examination, the patient had a background retinopathy but there was no evidence of diabetic neuropathy or nephropathy. She was a non- smoker and her menstrual period was 6 weeks previously. There was no overt history of any pelvic inflammatory disease and the pelvis was noted to have been normal at the time of laporotomy. A pregnancy test was positive.

3

How would you manage the early stages of this pregnancy?

When seen in a subsequent consultation she had experienced 8 week’s amenorrhea and an ultrasound scan confirmed a singleton viable intrauterine pregnancy with a crown-rump length of 18mm, consistent with the gestational age. The blood pressure was 110/70mmHg.

4

Which of the following statements concerning insulin-dependent diabetes and pregnancy are correct?

a)There is an increased risk of Down’s syndrome.

b) Maternal serum screening for Down’s syndrome is invalid.

c)The incidence of neural tube defects is increased.

d)Optimizing pre-conception glucose levels can significantly reduce the risk of structural abnormalities?

e)There is an increased risk of spontaneous miscarriage.

5

How would you manage her antenatal care?

6

Which of the following statements about pregnant insulin dependent diabetics are correct) (Compared with the general pregnant population?)

a) They have regular risk of developing pre-eclampsia.

b) They have a regular risk of preterm delivery.

c) They have no greater risk of post-caesarean section febrile morbidity.

d) They have no greater risk of shoulder dystocia.

7

The patient was seen in the joint antenatal/diabetes clinic at 11 weeks gestation. The blood. Pressure was 110/70 mmhg and the body mass index was 26. dipstick testing of urine revealed 2+ glucose and no proteinuria The serum fructosamine level was 1.9 umol/lit. The free thyroxin concentration was 11.7 pmol/1it and the level of thyroid stimulating hormone (TSH) was 2.3 mug/l the insulin regimen was changed to a three times a day postprandial soluble insulin (10 units) with the addition of Isophane insulin (16 units) with the evening dose.

At 21 weeks gestation the free thyroxin concentration was 10 pmol/l and the TSH level was 4.3 micrograms/lit.

Thyroxin replacement therapy was thus increased to 150 micrograms daily.

The retinopathy remained unchanged.

What are the complications of aiming for good sugar control.

The pregnancy progressed satisfactorily unit 32 weeks gestation when the patent was admitted to hospital with hypertension (160/90 mmHg) and 2+ h proteinuria. Thyroid function test result had remained raised, urine culture  was negative and significant proteinuria was confirmed (1.1 gm per 24 hours). The hemoglobin concentration was 12.1 g/dl and the platelet count was 141000/cc. A diagnosis of pre-eclampsia was made and the decision to deliver the baby was taken. dexamethasone 12 mg intramuscularly was administered after an insulin infusion load commenced and the dose was repeated 12 hours later. The pediatricians were notified of the impending delivery.

8

How would you decide the mode of delivery in this case

9

How would you manage the labour?

10

What would you advise this woman about Thyroxin use during the puerperium?

2000

1

A 32 years old Woman presents with a 5 years history of infertility dysmenorrhea and deep dyspareunia. Her husband's seminogram is within normal.

a-what is The most probable diagnosis?

b-How can you proceed to investigate this patient?

c-Is there any place for laser therapy for this patient?

d-What are the lines of treatment to assist this couple to reproduce?

2

A 25 years old multiparous women presents with amenorrhea of 3 months, excessive vomiting and mild serosanguinous vaginal discharge

a-What is the most probable diagnosis?

b-What is the differential diagnosis?

c-What are the investigations to confirm your diagnosis?

d-describe in details the management of the problem of this patient.

e-What are the complications of this patient?

3

Write short notes on the following:

Complicotions of accidental haemorrhage.

4

describe the Eclamptic fits and its complication.

5

The neonate of diabetic mother.

6

Complications of episiotomy.

7

Secondary postpartum haemorrhage

8

Vulvovaginitis of children.

9

Benign cystic teratoma (dermoid cyst) of the ovary.

10

Side effects of the combined oral contraceptive pills.

11

Complete perineal tear.

12

Hyperprolactinemia

2003

Answer the following questions:
Write short notes on:

1

Diagnosis and treatment of atonic postpartum haemorrhage.

2

Diagnosis and outlines of treatment of polycystic ovarian disease.

3

Diagnosis and treatment of eclamptic fits.

4

Types and treatment of precocious puberty.

5

Causes, diagnosis and outlines of treatment of intrauterine fetal death.

6

Diagnosis and outlines of treatment of endometrial carcinoma.

7

Diagnosis and treatment of puerperal Sepsis

8

Diagnosis and treatment of monilial and trichomonial vaginitis.