CLINICAL MANAGEMENT SBA

1. Oxybutynin hydrochloride is a non-selective muscarinic receptor antagonist used to treat bladder interactivity. Which of the following diseases are aggravated by use of oxybutynin?

2. For overactive bladder a new drug called Mirabegron is used. Which is the single mechanism of action for this drug?

3. You are seeing the CTG of a primi 25 years of age, who is 6 cm dilated.The CTG shows baseline heart rate 155, no accelerations, baseline variability 8, variable decelerations for 120  mins. What is the type of CTG.

4. What is the speed of the CTG paper in UK?

5. In a partogram,what does the arrow indicate?(left arrow)

6. A 21 years old lady presents to the antenatal clinic with h/o 6 weeks amenorrhea & vaginal spotting.A transvaginal scan is done which showed the following—Gestational sac-20 mm, CRL-4 mm, no fetal cardiac activity seen. What does the picture indicate?

7. A 36 year old nulliparous woman & her partner are seen in fertility clinic for the 1st time. They have been unsuccessgully trying to conceive for the last 15 months. At the initial appointment you arrange a series of routine investigations, including semen analysis for the male partner. What advise should you give with regard to the collection of his semen?

8. What is your interpretation of the following urodynamic graph?

9. G2P1 with 1 previous normal delivery comes to labour suite at 39 weeks of pregnancy with SROM .she is 2 cm dilated.CTG is shown below- rest of t q as given

10. A primi at 41 weeks gestation is induced using dinoprostone pessary. A few hours later she starts getting contractions. Regarding the CTG, what is the most appropriate management?

11. A G5P5 with all normal deliveries. She developed postpartum hemorrhage after vaginal delivery.all pharmaceutical measures failed to control the bleeding. What is the 1st surgical step to stop the bleeding?

12. A 30 years old G2P1Ao with 39 weeks pregnancy. She has SROM of membranes at home 24 hrs ago. Came to labour room with abdominal pain x 4 hrs. She is febrile, Pulse rate 92/min, BP-100/70.
There I uterine tenderness & foul smelling lochia.cervix is 5 cm dilated.CTG shows baseline fetal heart rate 162/min, reduced variability. What is the best management option for this pt?

13. Amniotomy was done for a primi at 5 cm dilatation.2 hours later she is 5 cm & contracting 2 in 10.What is your further action?

14. A G6P5 is admitted with regular uterine activity at 6 cm with intact membranes. What is your plan of action?

15. A primi with a low risk pregnancy at 40 weeks in spontaneous labour.she has a history of leaking clear fluid vaginally for 2 hours.on exam her observations are normal.she is having regular painful contractions 3 in 10 mins & cervical dilatation is 4 cm.CTG was performed due to concerns about FHR on auscultation. The CTG shows a baseline fetal heart rate of 140-150 beats /min & no other non reassuring or abnormal features. What will be the next appropriate step?

16. How would classify a CTG with following features—baseline 120/min,variability 9 /min,decelerations with </= 60 beats drop from baseline ,lasting </= 60 seconds for over 90 minutes .

17. A 25 year old primi has had an uncomplicated pregnancy. She reports to labour room at 39 weeks gestation. She has clear fluid draining vaginally for past 2 hours & uterine contractions are strong,4 in 10 mins. The fetus is in cephalic presentation. Vaginal exam reveals an uneffaced cervix 5 cm dilated. The head is at -1 station, without any caput or moulding. Which of the following is the most appropriate method to monitor the fetus in labour? 

18. Which of the following statements is correct with reference to shoulder dystocia?

19. When uterine atony is the cause of PPH, which of the following measures should be instituted?

20. Regarding tubal factor infertility which of the following statements is incorrect?

21. A 55 year old woman with symptoms of stress urinary incontinence undergoes urodynamic study after a failed trial of life style modification & PFMT. What findings on the graph indicate a diagnosis of urodynamic SI?

22. The filling cystometry trace of a woman with c/o urinary urgency, frequency & nocturia is as below. She has no urge or stress urinary incontinence. What is the most likely diagnosis?

23. A 25 year old patient sustains a 4th degree perineal tear following delivery of her 1st baby. Your consultant has asked you to organise the operation theatre for the repair. From the list below which suture would you keep ready for suturing the anal mucosa?

24. You are reviewing a 21 year old primi in  1st stage of labour.she has dilated from 4 cm to 6 cm in 4 hours. At your initial assessment she is 6 cm dilated with intact membranes. A review after 2 hours & she is 6.5 cm dilated with membranes intact. What is the most appropriate management?

25. While in the labour suite you hear the emergency buzzer for shoulder dystocia. When you enter the room the midwife there confirm she is trying to deliver a primi 35 years old, when she diagnoses there is shoulder dystocia. What is the first manouvere you would do to relieve the dystocia?

26. While reviewing a CTG you notice there are variable decelarations. What is the cause of variable decelarations?

27. A 28 year old primi is induced at 39+2 weeks due to severe pre-eclampsia. She progressed well & became fully dilated but fetal head was not visible after 2 hous of pushing. A decision is made for assisted vaginal delivery & she is delivered after forceps application in the theatre. The episiotomy is extended &the tear involves approx. 60% of external anal sphincter. The internal anal sphincter & anal mucosa are intact. How would you classify this tear?

28. Urinary stress incontinence means involumtary leakage of urine. What is the underlying pathology in USI?

29. A 56 year old woman attends the gynecology clinic with urinary complaints. She says she passes urine on coughing. She also has urgency & has leakage while rushing to the toilet. What is your diagnosis from the history?

30. A 65 year old woman is seen by you in the clinic c/o frequency, urgency & urge leakage. She does not report hematuria. Her examination does not reveal any abnormality. What is the most relevant initial investigation to be done?

31. A 45 year ols woman has symptoms of OAB. She also reports a slow stream & a sensation of incomplete emptying of bladder.Urine dipstick & a clinical examination of the woman are normal.What is the next relevant investigation to be done

32. With regards to detrusor overactivity (DO) which of the following is true?

33. A 27 year old fit & healthy woman suffers from infertility. On enquiry she also has secondary amenorrhea.her last period was 5 months ago. What is the single most useful hormone measurement you would ask for?

34. A 32 year old woman with 60-90 day cycle & severe hirsutism. Which test will guide the DD between PCOS & an adrenal disorder?

35. A couple has been diagnosed with anovulatory infertility of 1 ½ years duration. The woman is 25 years old & has been diagnosed with PCOS. her BMI is 24. What treatment would you recommend at this point?

36. With regards to measurements of normal semen analysis, which of the following is correct?

37. How would you describe the following semen analysis report-volume>3ml,total sperm count-20 million,sperm conc-10 million/ml,pH>7.2,overall motility-15%,normal forms-1% .