OB&G-AIM4PG

A 22 years old women who is trying to conceive since 2 years came to your office. She also give a history of excessive cramping pain during periods. So you adviced to get her an ultrasound scan of pelvis. But the report came out to be normal. She ask you to give her some tablet for painful menstruation. You can advice any of the following except? A) Mefenamic Acid B) Paracetamol C) Buscopan D) OCPs AIM4PG.COM EXPLANATION Ans D. OC pills Option: D) As there is no pelvic pathology on ultrasound, it is primary Dysmenorrhoea. OC pills can be used for management of primary Dysmenorrhoea but here the patient is trying to conceive since 2 years, so OC pills cannot be considered. Option: A) Mefenamic acid is a NSAID 250-500mg QID provide relief in 80-90% cases Option: B) Paracetamol is an analgesics, can be given at a dose of 500mg tid. Option: C. Buscopan (hyoscine) is an antispasmodic can be used for primary dysmenorrhoea. For more notes www.aim4pg.com/study-group Daily lecture www.youtube.com/aim4pgmed

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KETOGENIC-KETO DIET CHART https://youtu.be/7iUf0ib2Vlg More Lectures will be uploaded every week Also notes will be provided Currently all notes are posted in @AIM4PGNOTES Group Join Notes Group @aim4pgnotes

MANAGEMENT OF DIABETIC KETOACIDOSIS https://youtu.be/O9Enw3fzUt4 More Lectures will be uploaded every week Also notes will be provided Currently all notes are posted in @AIM4PGNOTES Group Join Notes Group @aim4pgnotes

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A 45-year-old woman complains of pain in her left breast of 2 weeks' duration. On examination she has a tender string-like band with overlying prominent veins as shown in the Image. What is the most likely diagnosis? A. Zuska's disease B. Mondor's disease C. Hidradenitis suppurativa D. Tuberculosis of the breast DETAILED EXPLANATION Answer is (B) Mondor’s disease is a variant of thrombophlebitis that involves the superficial veins of the anterior chest wall and breast. Frequently involved veins include the lateral thoracic vein, the thoracoepigastric vein, and, less commonly, the superficial epigastric vein. Typically, a woman presents with acute pain in the lateral aspect of the breast or the anterior chest wall. A tender, firm cord is found to follow the distribution of one of the major superficial veins. For more notes join telegram group https://t.me/aim4pg

BRONCHIECTASIS https://youtu.be/Fmp08De_BcM More Lectures will be uploaded every week Also notes will be provided Currently all notes are posted in @AIM4PGNOTES Group Join Notes Group @aim4pgnotes

Low Birth-weight baby was born in Primary Healthcare Center, he was thin, hypoxic and body temperature was also low. Doctors suggested mother for providing Kangaroo Mother care to the newborn. All are the components of Kangaroo Mother care except: A. Skin to skin positioning of a baby on Mother's chest B. Adequate Nutrition through Breast feeding C. Ambulatory Care as a result of earlier discharge from Hospital D. Approach the cause of Prematurity of Baby DETAILED EXPLANATION Kangaroo Mother Care include : • Skin-to-skin positioning of a baby on the mother's chest; • Adequate nutrition through breast-feeding. • Ambulatory care as a result of earlier discharge from hospital; and • Support for the mother and her family in caring for the baby Ans. D. Approach the cause of Prematurity of Baby For more notes join www.aim4pg.com/pdf www.aim4pg.com/study-group Join notes Group @aim4pgnotes

A 69-year-old diabetic presents with right-sided weakness. The weakness is equal in the right face, arm, and leg. Sensation, speech, and comprehension are intact. Select the site of lesion? A. Posterior cerebral artery B. Proximal Middle cerebral artery C. Anterior cerebral artery D. Penetrating branch of middle cerebral artery DETAILED EXPLANATION • OPTION D : Penetrating branch of the middle cerebral artery occlusion is presented with , the syndrome of pure motor hemiplegia. • The infarct involves only the posterior limb of the internal capsule, impairing motor fibers to the face, arm, and leg. • Occlusion of a penetrating artery causes a lacunar infarct For more notes & MCQ join www.aim4pg.com/quiz www.aim4pg.com/study-group

THORACOCENTESIS https://youtu.be/Az2cYrvKFCU More Lectures will be uploaded every week Also notes will be provided Currently all notes are posted in @AIM4PGNOTES Group Join Notes Group @aim4pgnotes .

What's your diagnosis? A young lady presents to the gynaecology OPD with complaints of primary infertility, excessive weight gain and hirsutism. Laparoscopy shows the following finding. What is the most likely diagnosis? A. Turner's syndrome B. Pituitary adenoma C. PCOS D. Bilateral dysgerminoma https://www.instagram.com/p/CcI95rfvJh_/?igshid=YmMyMTA2M2Y=

Q. 16yr old female presents with primary amenorrhea with b/l inguinal hernia. She has normal sexual development with no pubic hair. USG shows no Uterus and ovaries with a blind vagina. Diagnosis is:- A. STAR syndrome B. Mullerian agenesis C. Turner's syndrome D. Androgen insensitivity syndrome Ans. D In these patients testis are intra abdominal which can present in the form of bilateral inguinal hernia and since the entire testosterone is converted to estrogen hence these patients are tall.

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Q. A 44-year-old female has a history of endometriosis resulting in chronic pelvic pain. She presents to you 6 months after her total abdominal hysterectomy and bilateral salpingooophorectomy. She reports continued pelvic pain. Which of the following would be your most appropriate recommendation for medical management? A. GnRH B. Oral estrogen C. Oral progestins D. GnRH antaagonists E. Tamoxifen Ans. C There are a number of effective medical therapies for pain due to endometriosis. These include GnRH agonists, danazol, progestins, and oral contraceptives. Surgical menopause requires the use of GnRH agonists or antagonists in order to suppress of ovarian function. Unopposed estrogen would be contraindicated in this patient because of its stimulatory effect on any remaining endometriosis. Tamoxifen has not demonstrated efficacy in the treatment of endometriosis. Progestins are effective at improving endometriosis symptoms due to their atrophic effect.

Q. A 58yr old female G6P4Ab2 diabetic weighs 122.6kg has her first episode of vaginal bleeding in 5 years. Her physician performs an outpatient operative hysterectomy and dilatation and curettage (D&C). Which of the following is indication for such procedure & likely diagnosis? A. Endometrial cancer because of her high parity B. Endometrial cancer because of her obesity C. Cervical cancer because of her age D. Cervical cancer because of her obesity E. Cervical cancer because of her diabetes Ans. B Obesity, advanced age, and hepatic disease are associated with an increased risk of endometrial adenocarcinoma. While postmenopausal bleeding is most commonly caused by atrophic changes in the genital tract, cancer must be considered. Cervical cytology and examination of endometrial histology are absolutely indicated. The risk of endometrial cancer is increased approximately threefold in diabetic women, and obese women have a three- to fourfold increased risk. High parity is a risk factor for cervical cancer; low parity is a risk factor for ovarian and endometrial cancer. Postmenopausal bleeding is a sign of ovarian cancer only if the malignancy secretes estrogen to stimulate the endometrium. An office endometrial biopsy has a sensitivity of about 90%. If postmenopausal bleeding persists, a D&C with hysteroscopy should be done. A D&C alone samples about 50% of the endometrium. For this reason, many gynecologists are performing a hysteroscopy and directed endometrial biopsy in addition to a D&C.

Q. A patient with persistent headache following a postpartum hemorrhage is diagnosed with sheehan syndrome. If patient were consistently amenorrhic and infertile, what treatment would you recommend to assist this patient to conceive? A. Gnrh pump B. Clomiphene citrate C. Dopamine agonist D. In vitro fertilization E. LH & FSH Ans. E Sheehan syndrome describes damage to the pituitary gland classically resulting from hypotension following a postpartum hemorrhage. The clinical picture is variable due to the fact that the damage may involve one or more of the various cellular subtypes in the pituitary gland that secrete either adrenocorticotropic hormone (ACTH), GH, prolactin, TSH, or LH/FSH. An amenorrheic patient with a history of Sheehan’s syndrome would not be expected to have functional pituitary gonadotropes so a GnRH pump or clomiphene citrate would not be useful because they both rely on a functional pituitary gland. Replacement of gonadotropins (LH and FSH) would be the best treatment.

Q. A 26yr old female with recurrent pregnancy loss undergoes a laparoscopy and a hysteroscopy. She is found to have a Mullerian anomaly with a heart shaped Uterus that has 2 uterine horns with a common cervix. Name the uterine anomaly. A. Didelphys B. Unicornuate C. Septate D. Bicornuate E. Mullerian agenesis (mayer- rokitanskykuster-hauser syndrome) Ans. D Müllerian anomalies result from either the lack of proper fusion or resorption of the paramesonephric (Müllerian) ducts during organogenesis. Vertical abnormalities occur when the invaginating urogenital sinus—extending in a cranial direction from the introitus—and the Müllerian structures—extending caudally—fail to canalize appropriately. Longitudinal defects occur when the two paramesonephric ducts either do not fuse appropriately or following fusion the intervening tissue is not reabsorbed completely. A didelphic uterus represents lack of fusion, and the patient has a duplicated cervix and each cervix is connected to a separate uterine horn. Aunicornuate uterus results from aplasia of one of the paramesonephric ducts so that only one cervix connecting to a single uterine horn is found. A bicornuate uterus results from failure of the paramesonephric ducts to fuse cranially resulting in a single cervix but two separate uterine horns. A septate uterus occurs when fusion is completed but reabsorption of the intervening tissue is incomplete.