Clinical Management

1. Ms. X primigravida, IVF pregnancy with BMI of 35Kg/m 2. She was known case of type 2 Diabetes mellitus. She had a vacuum delivery followed by which shoulder dystocia, baby was delivered with internal maneuvers, baby’s birth weight 44475gm.
Baby has an abnormality shown in image.
Identify the nerve root affected?

2. 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 ?

3. The position of fetal presentation has a large impact on the success of the second stage of labor. The diagram depicts which position of the fetus in the female pelvis?

4. Engagement is best defined as which of the following?

5. Mrs. Rosy, A 30-year-old woman presents with abdominal pain, a high fever and has been feeling generally unwell for 10 days since her caesarean section. On examination,
Image is enclosed

a red, warm and swollen area is noted on her abdominal wall around the scar. She reports that the area of redness has rapidly increased in size. Blisters have developed around the margins. What is the likely diagnosis?

6. 40 year year old girls present with nausea and vomiting, and heavy vaginal bleeding she has undergone dilatation and evacuation for complete molar pregnancy 8weeks back. She give history of weight loss she has been sent for scan suggestive of mass in uterus.
Which tumour marker is appropriate, which helps diagnose This particular tumour?

7. Friend mentions to you she just had a positive pregnancy test and wonders if you can tell her when she is likely due. The LMP was June 30. Her expected date of confinement (EDC) is approximately which of the following?

8. Ms.Rachel, 34 year old has come at 24 weeks. Her BMI is 32kg/m2. This is her first pregnancy. She undergoes an oral glucose tolerance test. The results are shown below:
fasting plasma glucose 5.9 mmol/l 2-hour plasma glucose 7.0 mmol/l
What does this result show?

9. A healthy 28-year-old, P0+2, has a 7-hour history of sudden-onset severe right-sided lower abdominal pain; her LMP was 6 weeks ago; periods are normally infrequent and irregular: 3–4/35–56 days. She and her partner have a past history of subfertility and are currently receiving clomiphene citrate 100mg for ovulation induction for anovulatory oligomenorrhea. Her first pregnancy was an early miscarriage; the second was a left tubal pregnancy.
On examination: she looks pale and distressed; the abdomen is very tender in the lower half on the right side with rebound peritonism; no masses. Vaginal examination: normal sized uterus, no masses and cervical excitation tenderness is elicited.
Observations are as follows:
Pulse rate (bpm) 110
Temperature (ºC) 36.0
Blood pressure (mmHg) 120/50
Urine analysis has not passed urine
Respiratory rate (breaths/min) 14
O2 saturation on air (%) 96
What is the most appropriate investigation. Of choice is

10. Ms. sweetie, 30-year-old woman has been coming with recurrent vulval itching and curvy white vagina discharge ,she has been treated couple of times for this . Examination image is enclosed

What’s diagnosis ?

11. A 15-year-old girl attends the outpatient clinic with her stepmother, who has not adopted her. Her father, who has only recently re-married, could not attend the appointment. The patient is due to have a laparoscopic cystectomy for an 8 cm dermoid cyst in a week. The consultant has deemed the patient to have capacity and has explained the procedure, risks and benefit, and alternatives to her and her parents on a previous clinic visit. Both the father and stepmother support the patient’s decision to proceed with surgery.
What is the most appropriate means of completing the consent form?

12. A 15-year-old girl attends sexual health clinic requesting termination of pregnancy. She is 7 weeks pregnant. Her boyfriend is also 15-years-old and studies in the same school. She has not informed anyone of this pregnancy. What is your most likely immediate action?

13. The sutures are shown in image used extensively in surgical procedures, particularly to ligate vessels. What are the key features of polyglactin sutures?

14. A 30 year old woman presents with following features

She was noted to have a high prolactin and normal electrolytes. She is otherwise fit and well. What is the likely cause of the high prolactin?

15. Iatrogenic injury to the ureter is a potentially devastating complication of modern surgery. The ureters are most often injured in gynecologic, colorectal, and vascular pelvic surgery. When performing surgery, the position of important structures should be well known to avoid injury.
What is the ureter’s relationship to the arteries in its course through the pelvis?

16. Mrs. Saida. Is primiparous fully dilated and pushing for 2 hours, she is not on any analgesia she agrees for operative delivery with pudendal block. After going home she complains of pain buttocks and vulval pain which is increased while sitting. Identify nerve root affected?