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1. A 26 year old lady with twin pregnancy presented at 33 weeks of gestation, with intra-uterine death of one foetus at the time of admission and was taken up for emergency caesarean under subarachnoid block. On examination she was drowsy, pulse 120 per minute, blood pressure 170/96 mm Hg, had pedal and sacral oedema. Hand held record investigations showed haemoglobin of 11.2gm %, platelet count 2,10,000/mm3, blood urea 24 mg %, serum creatinine 0.8 mg %, serum bilirubin 3.0 mg%, ALT 184 units per litre, AST 158 units per litre.immediate category 1cesarean did &Both the babies delivered were still born and the intraoperative course was uneventful. In the postoperative period renal function deteriorated with blood urea of 36 mg % and serum creatinine 1.8mg %. There was evidence of haemolysis on peripheral blood smear and LDH was raised to 1110 units per litre. Coagulation profile wasderanged with PT 12 secs and PTT 23 secs more than the control values and platelets count fell to 75,000/mm3. Urine is blood stained .
What’s your diagnosis ?
2. Mrs.Rebecca , is in her first pregnancy now she is 9 weeks pregnant .has presented with excessive nausea and vomiting.
What’s her diagnosis ?
3. Which one of the following blood-gas values is consistent with meta- bolic acidosis?
PaCO HCO – pH 23
4. An infant is born and at 5 minutes it has a vigorous cry, a heart rate of 105, movement of all four extremities, grimacing with stimulation, and has bluish hands and feet. What is the Apgar score of this infant?
5. Ms. Babitha, primigravida, now 38 weeks pregnant, has come to labour room with history of leaking in active labour. She has a history of multiple fibroids in lower segment. On examination she is 4 cm dilated ,baby’s nose, mouth and malar process are felt .
What is the length of engaging diameter in this presentation ?
6. Mr.Stuart is here with semen analysis report .its is as follows
* volume = 3 ml
* total sperm count =49 million
* sperm concentration = 20 million/ml
* pH >7.2
* overall motility = 20%
* Progressive motility -10%
* normal forms =4%
* vitality =65%
What’s the diagnosis ?
7. Mrs. Rosy, 28-year-old woman with 3 years of secondary subfertility .she is a smoker, alcoholic . She has been treated for PID twice at the age of 16 .She has had a child with a previous partner and a recent hysterosalpingogram s image is enclosed
What is correct regarding cause for tubal factor infertility?
8. Ms. x is Primiparous who has undergone cesarean at full dilatation for failed forceps delivery .her BMI at booking was 40kg/m2.
She has history of anemia .
Today is her postop day 11, she has come with uneasiness and fever ,her wound image and Meows charts enclosed
Abdomen -soft, non tender
Minimal vaginal bleeding
9. Mrs. Tina , 24 year old Primigravida at 30 weeks presented with continuous pain abdomen with vaginal bleeding , around 250ml.
She is a smoker who smokes 20cigartees per day .
She has repeated episodes of spotting in this pregnancy
She is quite and scared
Bp-100/70mm of Hg
Bruises present over back and legs and on her abdomen as well
She has a black left eye and bruise shown in image.
P/A- uterus, 30weeks, tense and hard
Speculum examination – os-2cm dilated dark brownish bleeding +
What is the most important cause of abruption you suspect in this woman ?
10. 63-year-old Mrs. Briganza had undergone vaginal hysterectomy for prolapse she is readmitted after 10days with a vault haematoma .she subsequently develops severe sepsis,
An arterial blood gas was performed, which showed the following:
* pH 7.15 (7.35–7.45)
* pO2 10.1 kPa (10–13)
* pCO2 4.6 kPa (4.5–6.0)
* BE 17 mmol/L (22–28).
What is the most appropriate definition of her clinical condition?
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