4:31 PM

Addition - OSCE ONG q 1st group

salam, this is q  for 1st group


1. Eclampsia mx
2. Pic of Pprevia and malpresntation - most common cz of malpresentation : prematurity
3. Endometrial CA - 10 relevant q n ddx
4. Cervical CA - written q - cause, stage
5. Instrumental delivery- vacuum
6. Progesterone contaceptive

3:49 PM

OSCE Obs Gyne Questions

Salam to all,

Hope that everybody is in good condition as the exam is just around the corner hehe. Included here are questions from round that i got from Dr Khaled in Badiah(those are past year questions and ans for 6th year. He was the examiner for the past few years. Also i put questions from cd(bil rafedeen) in case anyone dont have it yet. bittawfeq salam

Some said these important for this exam…
  1.  canseling combine OCP
  2. Cervical CA
  3.  Incontinece
  4. DnC
  5. breech
  6. Post-abortive management(sgt2 imp)
  7. Infertility counseling
  8. Partogram

- Ovarian Dermoid cyst(question not known) : kluar dalam exam group sebelum kita

Past years questions in CD
1.       Pap smear :
      Indication , types , how to perform it.
2.       Ectopic pregnancy hx ( bleeding in 1st trimester )
3.       IUCD pic : what is this? Indication? Complications.
4.       Fibroids pic : what is this? Symptoms, complications during pregnancy.
5.       Placental abruption pic : what is this? Complications for fetus & mother, co conditions, treatment.
6.       Anencephaly pic : what is this? How to diagnose? Complications.
7.       CTG… read it …. What is your plan?
8.       HSG pic showing blocked tubes…. What do u see? Give another test to assess patency of tubes? What is your plan….

Block 2 :


Station 1:
Vaginal bleeding in the 3rd trimester "Ante-partum hemorrhage either placenta previa or abruptio placenta I can't remember" (Hx and management)


Station 2:
Vaginal bleeding in the 1st trimester (Hx and management).
كانت .inevitable abortion

Station 3:
Pregnant lady who has also fibroid in the lower part of the uterus (how to deliver and the type of the incision) and if she developed after the delivery DVT what is the cause and the management

Station 4:
Gestational diabetes (the tests and the management).

Station 5:
Instruments (what is the instrument and what is used for).



Station 6:
Lady presented with vaginal discharge (Hx, investigations and treatment).

Station 7:
Partogram with information on it (what is the problem and the management) 
كانتfailure to progress in the second stage  على ما اذكر و الـ management

Block 3 :

Case1: (Endometriosis)
The Dr gave  typical Hx of endometriosis.then he asked:
what is your diagnosis?
what investigations to confirm?
what is the most definitive diagnostic way?
what are the lines of treatment?

Case2: (Normal Labor, Induction of Labor)
1.what do you want to see in your examination?
2.when to decide doing cesarean?
-you should know when to do CTG, scalp PH sampling.
- you should know how frequent to do PV & repeat PH & CTG ,what is the next step in each case.

Case3:(Partogram)
you should know patterns of dysfnctional labor &management of labor.
 you should know how to read partogram & pickup needed information.

Case4: (Galactorrhea)
Presentation with excessive milk production + Inferitlity.
what this condition is called?
what is the m0ost likely diagnosis? Hyperprolactinemia.
what physical exmination to do? Visual field.
what investigations? Hormone profile(prolactin FSH,LH) +CT brain  for pituitary adenoma.

In a case of of infertility,.
 what is the key lab investigation? Progesterone level at day 21.
If hormonal profile &ovarian fxn were normal in a subfertile female, what is your next step? Hysterosalpingogram to check uterus and tubes.

Case5: (Ovarian mass)
when to suspect cancer?
what investigations?
what is your management?

Case 6:
Pregnant lady with Hx of 2 DVTs ,want to do Cesarean (indicated C\S)
when to start heparin as prophylaxis during pregnancy?
when to stop?
when to give after C\S? for how long.

Case7:OCP
tell me about OCPs.
the ptn was lactating &want to take OCP what you will tell her?



Questions past year from Dr Khaled Badi’ah Hospital

27yo pt, G3P2, both NVD, 3.5 kg, seen for routine natal visit at 38w, no significant hx
On exam : BP 120/70
Obs exam : Breech presentation

1.       Whats ur next step?
- pelvimetry/ultrasound

2.       U/S done shows breech, otherwise others is normal, pt ask you – how to deliver?
-          3 option : Breech Vaginal delivery/ECV then NVD/ c/s

3.       She decided Vaginal delivery and ECV, whats the success rate?
-          50%

4.       What are possible complication of ECV?
-          Failure of ECV
-          Cord compression
-          ROM
-          Placenta Abruptio
-          Ruptur uterus
-          Fetal distress
-          Feto Maternal silent hemorrhage

5.       ECV failed(which means the complication above happen),then what?
-do ELECTIVE c/s after 1 or 2 days waiting.

48yo, referred from private doc case of menorrhagia for further evaluation and treatment
(answer as in dr fayed jallad notes and in his lecture)

1.       What are the possible cause?
-organic cause
-non organic
2.       Step that should be taken?
-Hx : bleeding(analysis), previous treatment n drugs taken, prev biopsy/smear, thyroid/blood/liver disease
-PE : 
1.General  : anemia sign, breast,thyroid disease
2. Abdominal ; palpable mass
3. Pelvic : inspection, speculum, bimanual

Bimanual exam :
-uterus size(huge,bulky,normal), shape(resular/irregular)
-mobility : mobile/fix
-position : anterverted(cervix felt anterior)/retro (cervix felt posteriorly)– important to insert the sounds

-Investigation : (6) CBC, Coagulation, TFT,LFT,Cervical smear,endometrial smapling by DnC

3.       After investigation no organis cause identified, then whats the cause?
-DUB

4.       Treatment?(elaborate the answers)
1.       Medical
2.       Surgical

A pictures shows P.previa grade 3 and malpresentation(breech)

1.       What do u see the clinical problem in this pic?
-          PP and malpresentation
2.       Whats the  usual presentation?
-          Painless vaginal bleeding
3.       Give 4 complication
PPH, maternal morbidity and mortality, Fetal M& M, preterm delivery

4.       Mx?
1.       Admission
2.       2 large bore canula, draw blood for cbc(Hb), crossmatch, blood group, Prepare 4 unit blood
3.       Fetal maternal monitoring : ……..
4.       Dexametasone 2x 12h apart 12mg, Rhogam(anti D)

5.       When to deliver?
-wait at 37-38w to deliver by ELECTIVE C/S
If bleeding sever, fetal Distress, contaction indicate labour à EMERGENT C/S

38yo, G3P2, 2 NVD, 2 healthy boy, 32 w GA, singleton, came to ER c/o abd pain for the last 5h. She is medically fit(which mean uneventful pregnancy), take relevant hx…

1.       Analysis of pain – mild progressive colicky, for how long and the frequency?- every 5 min, lact 20sec each
2.       Bleeding? – no
3.       Passing liquor? – no
4.       Fetal movement – good
5.       Fever ? – no
6.       G1 symptoms/ urinary sx
7.       Feeling pressure down ?– IMPORTANT! DON’T FORGET!
8.       Passage of SHOW ?
9.       Trauma

IUCD questions…

1.       What the type IUCD u know? Copper and mirena
2.       What imp point in pt taking IUCD?
(7) allergy copper, PID hx, ectopic Hx, LMP(make sure she is not pregnant), Previous failure IUCD, systemic illness(if have infective endocarditis we cant give them IUD), sign of vaginal infection

3.       When to insert? Any day provided not pregnant, preferably on 5th day menses.

4.       Caunseling complication

-          Perforation, failure IUCD increase risk ectopi, PID, menorrhagia
-          Mild cramping pain and slight bleeding
-          Fainting(dizziness)
-          Risk od PID in 1st few months
-          IUCD need to be f/up and check
-          Failure rate/perforation
-          Usual time perforation during insertion
-          If spill out – do u/cs à if not seen, do abdominal xray à seen radio opage

Primigravida, 36w GA, PROM since 24h + uterin e contraction
On exam : Obese, normal U/S
Vaginal Exam : 3cm dilated cervix + cord prolapsed, vertex presentation 3 cm above the ischial spine, FHR 100b/min(deceleration)

1.       Whats definitive tt? - EMERGENT C/S
2.       6 possible post op complication?
Thrombosis, resp infectn, endomeritis, bleeding, UTI etc
3.       How to decrease the complication?
-prophylaxis low molecular weight heparin and others(look in C/s notes)

4.       2nd week after delivery, where will be the uterus?
-Pelvic Organ

5.       6 week post-del, lactationg, wish to use contraceptive, options?
-          Minipills, mirena, depopovera,implant

6.       What chances of this mom to deliver NVD the next time?
65 – 80%

Miss A, G4P3, all deliver by NVD, attend at 35w for 1st time, no medical illness, normotensive
Abdominal exam – singleton,tranverse lie, fetus good

1.       Abdominal u/s perform, what to look for?
1.       Placental localization
2.       Amount of liquor
3.       Confirm GA + live fetus
4.       Congenital anomalies
5.       Uterine anomalies

2.       u/s done – single fetus, equal GA, tranverse lie, no gross anomalies, aFI 12, placenta ant reaching cervix
dx ? – Pprevia GRADE    2-3

3.       Whats ur plan?
1.       Admission – 2 large bore canula and…..
2.       Expectant Mx up to 37w then do c/s
3.       Dexametasone

4.       2 situation that may happen and what to do?
Bleeding and fetal distress – EMERGENT C/s

5.       At day of admission, 300ml blood clot , what to do?
-          EMERGENT C/s



48 old lady, 1 year amenorrhea, no hx of any surgey, LH 70 IU

1.       Dx? – menopause
2.       Name 2 long term complication
-osteoperosis
-cancer

3.       Tt?
-HRT, combine type

4.       Decline HRT, but present 1 year later with vaginal bleeding…what u think?
Endometrial cA
5.       4 additional factors cause this?
Estrogen tt, DM, Obes, PCOS, Nullipara, Estrogen secreting ovarian Ca

6.       2 investigation
-          Endometrial samping, U/S, hysteroscopy

Menorrhagia, 48yo, P6 +2, heavy period, take hx

1.       Analysis bleeding
2.       Prev investigation n tt
3.       Gyne hx
4.       Medical hx
5.       Drug

32 w uneventful preg, normal fetus, c/o watery vaginal discharge
Suggestive pROM

1.       How u establish dx?
-          Speculum exam-nitrazine test

2.       Exam?
-tempt 37 , Pulse 78, uterus equal to date, PROM confirm by speculu,, HVS taken

3.       Mention 3 assessment
-          u/s
-          CTG
-          Contraction/not
-          CBC + CRP

4.       Not contacting, fetus good, u/s normal, crp (-), what to do?
a.       Admit
b.      Prophylaxis Abs
c.       Dexa
d.      Fetal maternal monitoring

5.       5 days after admit, temp 37.5, pulse 110, uterus tender, tense, fetal ceplahic, good CTG
Mention 2 steps to do next?
-          Change to IV Ab
-          Deliver

6.       Boshop score 10, wthats next?
-syntocinon infusion

25yp G2P1, deliver by c/s, had cone Biopsy, admit at 7w, IVF pregnancy,mild vag bleed, nild abdominal pain, hemodinamically stable, BHCG 1500, vaginal u/s empty uterus, 2 cm cystic shadowing in adnexia

1.       After iv canula n cbc, next step?
2.       20h later clinically stable, BHCG 1000, serum progesterone 10ng, dx?
-          Medical
-          surgical
3.       Tt option?
Ectopic P
4.       Few days after receive methotrexate, look pale, pulse 120, bp 90/100,abd pain n tender, mx?
-          Recussitate, ivfluid
-          Laparotomy
5.       2 risk factors for this ectopic?
-          IVF preg
-          C/S

35yo, 1st NVD, 10 days ago, presented now as heavy vaginal bleeding after 24h

1.       Dx? Secondary PPH

2.       Ather possible cause?
-          Blood disorder
-          ChorioCarcinoma – the do BHCG immediately.

3.       u/s : RPOC. Outline the mx of this case
1.       admit – 2 large bore, iv line, blood crossmatch….
2.       AB in 12 h
3.       DnC

4.       describe how u do it?(as in skill lab)

5.       Complication
-          Perforation
-          Bleeding


wallahu a'lam. Rabbana Yusahhil...

9:27 AM

OSCE O&G kumpulan D

InsyaAllah lagi 2 minggu, pelajar tahun 6 akan sekali lagi diuji fizikal & mentalnya dlm OSCE. Ini soalan2 OSCE O&G kumpulan D. Moga bermanfaat buat semua sahabat.

1) Q :counseling for the baby of gestational diabetic mother
Ans : fetal assessment of GDM baby as written in the Ru2ia lecture notes

2) Q : patient with history of gush of fluid (PROM)
a -what is your DDx?
b -what investigation should we use to diagnose PROM ?
c - if the patient does not have labour pain after 12 hours (not sure) what is your management plan?

3) Q : findings of patient with endometriosis
a - what is your dx?
b - what is the common site of endometriosis lesion
c - what is the diagnostic procedure?
d - what is the treatment ?

4) Q : patient with postmenopausal bleeding
a - what is your DDx?
b - what investigation will you order for the patient?
c - what is the medication?
d - what are the 2 side effects of progesterone?

InsyaAllah bittaufeq

Jelaskan matlamat...Tuluskan niat~

8:01 PM

lelaki tanpa hati

Suatu hari ada seorang pemuda yang merasakan dirinya terpisah antara kewajipan & realiti, antara iman & ilmunya dan antara ucapan lisan & penghayatan dari hatinya. Lantas dia menulis surat kepada Imam Hassan al-Banna bertanyakan penawar bagi hatinya & kemudian dibalas pula oleh ulama tersebut. Apa yang menarik adalah huraian suratnya seakan-akan menerangkan apa yang pernah, sedang atau akan tersirat di hati kita.

Dalam kita sentiasa mencari cara menjadikan hari semalam lebih baik dari hari ini, mendekatkan diri lebih rapat kepada Allah swt, melatih jiwa lebih taat menuruti iman dan mengawasinya dari setiap helah kemungkaran kita akan menemui keadaan di mana hati kita seakan-akan tidak turut serta dalam usaha fizikal kita mengejar semua ini. Kitab yang ditatap mata dan nasihat yang mencelah masuk ke telinga seolah-olah tidak sampai ke hati untuk menghidup suburkannya. Di sini, saya ingin berkongsi surat pemuda & jawapan Imam Hassan al-Banna.

Yang terhormat ustaz Hassan al-Banna,

Assalamualaikum wbth,
Apakah anda pernah mendengar tentang lelaki tanpa hati? Maaf, jika hati yang dimaksudkan adalah salah satu anggota tubuh dari daging yang berwarna merah, yang menarik dan melepaskan darahnya, tentu saja lelaki itu memilikinya. Yang dengannya dia dapat hidup & menjalani kehidupannya.
Akan tetapi hati yang bersemangat, kuat & hidup, sayang sekali dia tidak memilikinya.

Dia mengetahui kebaikan meskipun kecil, dia juga mengetahui keburukan meski pun samar-samar.

Seringkali dia benar2 merasai & memahami perilaku seseorang dari wajahnya & dapat memberi respon terhadap hal itu. Akan tetapi, dia tidak memiliki hati. Jika bertemu dengan teman lamanya yang sudah lama tidak bersua, dia bersalam lalu menggenggam tangannya kuat, bahkan memeluknya. Namun hatinya, tetap beku, sama sekali tidak terpengaruh.
Dia memberi nasihat kepada orang lain, " Jadilah kalian begini & jadilah kalian begitu", serta menyebutkan pelbagai dalil & bukti, namun hatimya semakin keras & tidak terpengaruh.

Dia tersenyum kala mendengar berita gembira. Dia juga mengerutkan dahi saat menerima berita duka. Akan tetapi, kegembiraan & kesedihannya hanyalah reaksi semula jadi semata, sedangkan hatinya tetap diam & tidak bergoncang.

Dia menyatakan cinta & benci kepada seseorang. Tetapi ketika melihat hatinya, ia tetap diam tanpa memberi penjelasan.

Dia berdiri menunaikan solat & berusaha khusyuk, membaca al-Quran & berusaha menumpukan perhatiannya. Ketika menunaikan solat, dia membaca bacaan solat dengan nadanya sehingga orang-orang pun berkata, " Dia itu khusyuk nampaknya." Akan tetapi ketika meraba hatinya, dia mendapatinya tuli & tidak khusyuk, walaupun memahami apa yang dibaca.

Ini adalah gambaran sebenar yang terjadi pada hati lelaki itu. Saya tidak melebih-lebihkan atau menguranginya. Menurut anda, apakah anda dapat mengatakan bahawa hatinya sama seperti kebiasaan hati orang-orang lain?

Saya dianugerahi akal tetapi hati saya hilang. Saya merasakan akal fikiran saya cerdas berfikir, bekerja, hidup & menunjukkan kewujudannya. Akan tetapi, ketika saya ingin menghayati semua itu pada hati saya, sama sekali saya tidak menjumpainya. Saat ini, anda telah mendengar tentang seseorang lelaki yang tidak memiliki hati.

Dia adalah seorang yang membuat perjanjian(baiah) dengan anda & anda teah mengambil janji setia darinya. Apakah anda rela jika seorang tentera anda hidup tanpa hati? Apakah anda dapat membantu menghidupkan hatinya agar bergerak dan merasai apa yang diucapkan oleh lisannya?

Inilah penyakit salah seorang tentera anda yang akan membuat anda sedih jika mengetahuinya. Oleh sebab itu, saya tidak akan menyebutkan namanya, hinggalah saya maklumkan anda bahawa dia telah sembuh.

Waalaikumussalam wbth


InsyaAllah saya akan tuliskan jawapan yang dibalas oleh Imam Hassan al-Banna. Sementara itu, saya alu-alukan sebarang pendapat pembaca tentang surat lelaki ini, baik dari huraian keadaan hatinya yang 'hilang' itu atau cadangan ubat untuk menyembuhkan hatinya.

p/s-surat ini dipetik dari Nazhrat fi at-Tarbiyyah wa as-Suluk, h.107, 108.

Jelaskan matlamat...Tuluskan niat~


10:23 AM

Kisah anak Pak Imam

Bismillah

Utusan emel daripada seorang sahabat. Kisah menarik untuk perkongsian. Minta izin untuk menyalin tampal di sini, untuk manfaat bersama. Baca sehingga habis cerita, ambillah pengajaran.


Assalamualaikum wth,

Dear brother and sisters, please read this..

For there is no time to waste.....


Every Friday afternoon, after the Jumma services at the Central Mosque (and shortly after Al-Usrah program), theImam and his eleven year old son would go out into their town and hand out "PATH TO PARADISE" and other Islamic literature.


This particular and fortunate Friday afternoon, as the time came for the Imam and his son to go to the streets with their booklets, it was very cold outside, as well as pouring rain.


The boy bundled up in his warmest and driest clothes and said, 'OK, dad, I'm ready!'

His 'Mu'allim' dad asked, 'Ready for what?'

'Dad, it's time we gather our tracts together and go out.'

Dad responds, 'Son, it's very cold outside and it's pouring rain.'

The boy gives his dad a surprised look, asking, 'But Dad, aren't people still going to Hell, even though it's raining?'

Dad answers, 'Son, I am not going out in this weather.'

Despondently, the boy asks, 'Dad, can I go? Please?'

His father hesitated for a moment then said, 'Son, you can go. Here are the booklets. Be careful son.'

'Thanks, Dad!'

And with that, he was off and out into the rain. This eleven year old boy walked the streets of the town going door to door and handing everybody he met in the street a pamphlet or a booklet.


After two hours of walking in the rain, he was soaking, bone-chilled wet and down to his VERY LAST BOOKLET. He stopped on a corner and looked for someone to hand a booklet to, but the streets were totally deserted.

Then he turned toward the first home he saw and started up the sidewalk to the front door and rang the door bell. He rang the bell, but nobody answered..


He rang it again and again, but still no one answered. He waited but still no answer.


Finally, this eleven year old da'wah-expert turned to leave, but something stopped him.

Again, he turned to the door and rang the bell and knocked loudly on the door with his fist. He waited, something holding him there on the front porch!


He rang again and this time the door slowly opened.


Standing in the doorway was a very sad-looking elderly lady. She softly asked, 'What can I do for you, son?' With radiant eyes and a smile that lit up her world, this little boy said, 'Ma'am, I'm sorry if I disturbed you, but I just want to tell you that "ALLAH REALLY LOVES AND CARES FOR YOU" and I came to give you my very last booklet which will tell you all about God, the real purpose of creation, and how to achieve His pleasure.'


With that, he handed her his last booklet and turned to leave..

She called to him as he departed. 'Thank you, son! And God Bless You!'



Well, the following Friday afternoon after Jumat service (during which period they hold a weekly program, Al-Usrah) the Imam was giving some lectures. As he concludes the lectures, he asked,

'Does anybody have questions or want to say anything?'

Slowly, in the back row among the ladies, an elderly voice was heard over the speaker. As the voice went on, a hint of glorious gaiety and contentment was plainly evident in it even though it wasn't to be seen,

'No one in this gathering knows me. I've never been here before. You see, before last Friday I was not a Muslim, and thought I could be. My husband passed away some time ago, leaving me totally alone in this world. Last Friday, being a particularly cold and rainy day, it was evenmore so in my heart that I came to the end of the line where I no longer had any hope or will to live.

So I took a rope and a chair and ascended the stairway into the attic of my home. I fastened the rope securely to a rafter in the roof then stood on the chair and fastened the other end ofto leap off, when suddenly the loud ringing of my doorbell downstairs startled me. I thought, I'll wait a minute, and whoever it is will go away……

I waited and waited, but the ringing doorbell seemed to get louder and more insistent, and then the person ringing also started knocking loudly............

I thought to myself again, 'Who on earth could this be? Nobody ever rings my bell or comes to see me.' I loosened the rope from my neck and started for the front door, all the while the bell rang louder and louder.

When I opened the door and looked I could hardly believe my eyes, for there on my front porch was the most radiant and angelic little boy I had ever seen in my life. His SMILE, oh, I could never describe it to you! The words that came from his mouth caused my heart that had long
been dead TO LEAP TO LIFE as he exclaimed with a cherub-like voice,


'Ma'am, I just came to tell you that ALLAH REALLY LOVES AND CARES FOR YOU!'


Then he gave me this booklet, "Path To Paradise" that I now hold in my hand.

As the little angel disappeared back out into the cold and rain, I closed my door and read slowly every word of this book. Then I went up to my attic to get my rope and chair. I wouldn't be needing them anymore.

You see? I am now a Happy Vicegerent of the One True God. Since the address of your congregation was stamped on the back of this booklet, I have come here to personally say THANK YOU to God's little angel who came just in the nick of time and by so doing, spared my soul from a eternity in Hell.'



There was not a dry eye in the mosque. And as shouts of TAKBIR!!! ALLAH AKBAR!!! rented the air, even among the ladies.

Imam-Dad descended from the pulpit to the front row where the little angel was seated....

He took his son in his arms and sobbed uncontrollably.


Probably no jama'at has had a more glorious moment, and probably this universe has never seen a Papa that was more filled with love and honor for his son....... Except for One. This very one...



Blessed are your eyes for reading this message.

Don't let this message die, read it again and pass it to others. Heaven is for HIS people!

Remember, Allah's message CAN make the difference in the life of someone you know.
Please share this wonderful message.



Spread HIS Word, help HIM and you'll see HIS hand in everything you do...


Moral of the story.....?

Tanya diri, soal hati

(Kene ketuk, ouchh... bangunla weiii, bangun! )



Wallahua'lam

8:52 PM

Di hari lahirmu

Bismillah

Doa yang pernah dikirim oleh seorang sahabat ketika sambutan hari jadi saya 3 tahun lalu. Dan saya kirimkan buat mereka yang tersayang di sisi saya yang telah, sedang dan bakal meraikan hari gembira mereka...

Buatmu, sahabat


Ya Allah ,

Berilah ketenangan buat sahabatku ini,

Mudahkannya dalam urusannya,

Benamkanlah kalam-kalamMU utuh dalam nuraninya,

Tampilkan addhiya’ diwajahnya,

Kembalikan semangat jhad dalam dirinya,

Kuatkan bara juang pada minda, jasad dan qalbunya,

Lembutkan lidahnya memuji kebesaranMU,

Lantangkan lidahnya menegakkan agamaMU,

Semaikan pada jiwanya bahawa mukmin itu khalifah,

Muliakan dirinya dengan ilmu,

Matikannya dalam roh syuhada

Ameeen…

Selamat hari lahir, sahabat