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prime gravid mother at 34 weeks as admitted in maternity ward with severe abdominal pain. BP is 180/110mmHg. Uterus is hard, FHR 174 bpm. Urine dipstick + + + + for protein. Platelet count: 140 x 10 / L a) Discuss the differential diagnosis (10 Marks) b) What is the most li kely diagnosis diagnosis (10 Marks) c) How would you manage the diagnosis in b) above (20Marks). A
2. Write short notes. a) Components of routine active management of 3rd stage of labour (20 marks) b) Advantage of breastfeeding (20 marks) c) Possible benefits when using prenatal steroids (20 marks) 3. Write short notes on the following: a) Oxytocin (5 marks) b) MgSO 4 in the management of pre-eclampsia. ( 10 marks) c) Goals of treatment for eclampsia. (10marks). 4. Explain the following events occurring during pregnancy. a) Cardiovascular changes. (5 marks). b) Maternal weight increased in around 12.5 kg (5 marks). c) Increased iron demands (10 marks) d) How do explain the presence of anaemia in around 6% of pregnancies if erythropoiesis erythropoiesis i s increased? e) Coagulating cascade in activated state. (5 marks). 5.
prime gravid mother at 34 weeks as admitted in maternity ward in coma. BP is 120/90mmHg, urine dipstick + + + + for protein a) Discuss the differential diagnosis (15 marks) b) What is the most li kely diagnosis diagnosis (5 marks) c) How would you manage the diagnosis in b) above (5 marks)
6.
30 year old G3 P2+0 all spontaneous vaginal deliveries, presents at ANC with suspected twin pregnancy at 38 complete weeks of amenorrhea. a) How would you ascertain that this woman is actually 38 weeks? (10 marks) b) Assuming she had twins, describe how would you deliver the second twin? (10 marks) c) List the possible complication the above lady is exposed. (5 marks)
A
A
7. Write short notes on the following: a) Obstetric complications complications of of malaria malaria (3marks) b) Treatment of malaria malaria in pregnancy (4marks) c) Pathophysiology Pathophysiology of cerebral malaria in pregnancy.(5 pregnancy.(5 marks) 8. a) List uterotonic drugs commonly used in health facilities in Uganda (5 marks) b) Which one is recommended for active management of 3 rd stage of labour (1mark) c) Discuss the principles principles of eclampsia in Ibanda Hospital Hospital (19 marks) -1-
9.
You
are the director of Health Services in Euginia district with limited resources. are invited to give an inaugural lecture on the prevention of obstructed labour. Describe how you would do this in Euginia (10Marks)
You
10. You are the medical officer in Kabuyanda District. The Head teacher of a nearby secondary school asks you to examine female students for pregnancy. Discuss the diagnosis of pregnancy with her before you undertake this activity, informing her of what you need to carry out the activity. Include the historical historical perspective perspective (10 Marks) 11. A 35 year old Para 8+2 had a postpartum haemorrhage which Doctor Waswa¶s team managed successfully. He then talked to the students about the management of Post Partum haemorrhage. haemorrhage. Discuss Discuss the issues Dr. Waswa talked talked about about (15Marks) 12. A young Prime Gravida has been told that she needs a Caesarean section to deliver her baby, but she is reluctant. Discuss with her the indications and possible possible complications of Caesarean section and the post operative management and advice on discharge (15Marks) 13. A prime gravid mother at 34 weeks as admitted in maternity ward with severe abdominal pain. BP is 170/110mmHg. Uterus is hard, FHR 174 bpm. Urine dipstick + + + + for protein. Platelet count: 140 x 10 9 /L a) What is the most li kely diagnosis diagnosis (5 Marks) b) How would you manage the diagnosis in a) above? (15Marks) c) Discuss the prevention prevention of the diagnosis diagnosis in a) above. above. (5 Marks) 14. A 24 years old G3 P2+0 with 41+3 weeks presents to maternity maternity ward today complaining of lower abdominal pain, backache, fever and vaginal discharge. a) List the differential diagnosis diagnosis in this mother. (4 marks) b) What history will you take to get the possible diagnosis? c) What will be the clinical findings of the differential diagnosis? d) What investigations will be done to differentiate the differential diagnosis? e) If the mother was found to have a breech presentation at 7 cm dilatation with ruptured membranes, having havin g 3 contractions in 10 minutes minutes lasting lasti ng 46 seconds, FHR 155/ minutes, and BP 170/ 130mmhg. i) Plot a partogram. ii) How should she be managed? 15. List 5 causes of post menopausal bleeding. 16. Write short notes on the following. a) Mechanism of anaemia in Malaria. (10 mks). b) Ministry of Health Malaria i n pregnancy control Strategy. Strategy. (10 mks). c) List 10 complications of malaria in pregnancy. (5 mks). d) Malarial infection prevention. (5marks)
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17. A 26 year old G5 P4+0 came in with twin pregnancy at 38 weeks of amenorrhea. The first twin was cephalic presentation and the lie and presentation of the second twin was not ascertained. She was in active labour with intact membranes. membranes. a) Briefly discuss how you deliver the first baby. (5 mks). b) Discuss how you would deliver the 2 nd twin. (15 mks). c) List 5 indications indications of caesarean sections in twin pregnancy. pregnancy. (5 mks). 18. A Gravida 5 presents with high fever at the start of labour. She has difficulty in breathing and has body pains. Her haemoglobin is 4.5g/dl and random blood sugar is 2mmol/l. a) What is the most likely diagnosis? (10 marks) b) Which one test would you recommend for her? (10 marks) c) List the principles of treatment (10 marks) 19. Write short notes. a) Transverse Lie. (5 Marks) b) Shoulder Shoulder Dystocia. (5 Marks) c) Vacuum Extraction. Extractio n. (10 Marks) d) Patient preparation for emergency C/S (5 Marks) 20. A 25 year old patient at 32 weeks of amenorrhea was brought to maternity ward of MRRH. These are the clinical findings on the physical examination: examination: Pale xxx, dehydrated, PR: 120/min; BP 90/60 mmHg; delay i n the capillary refilling time; bleeding by mouth. Abd: Fundal height 36 cm, tenderness, and uterus hard, no foetal heart heard. Vaginally: scanty blood coming through the canal, reddish area around the cervix was noticed. a) Which is the most likely li kely Diagnosis? (8 marks) b) Discuss the differentials diagnosis. (7 marks) c) Discuss the management for this patient. (10 marks) d) Possible complication in this case (5 marks) 21. G8 P7+0, 40 year-old lady with uterine ruptured has been seen on labour ward; she has also signs of shock. a) Discuss the general management. (10 marks) b) Discuss the specific management. management. (10 marks) c) Explain principles of postoperative care in this case. (5 marks) 22. A 25 year old university student presents presents to the gynaecological gynaecological emergency ward with severe abdominal pain. Discuss the differential diagnosis and management of this patient. 23. a) Describe how you would manage manage a G8 P6+0 at 38 w eeks of amenorrhoea who comes in labour. b) What problems can arise in this mother during first stage of labour? c) What treatments and advice will you give this mother-baby pair on discharge? d) This mother requested you to advice on family planning. Discuss.
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24. A 16 year old patient was brought with pelvi c peritonitis and shock. a) Which is the most likely li kely diagnosis? diagnosis? b) Discuss your management. management. 25. A 19 year-old PG at 37 weeks, present to you on the ward with convulsions, fever, headache and vomiting a) List and explain 2 most likely causes of her symptoms (4 marks). b) List and explain 3 important investigations you would do to ruled one of the above differential diagnosis (6 marks) c) Briefly describe the pathogenesis is of convulsions in one of the differential diagnosis diagnosis in (a) above (5 marks) d) Briefly but precisely describe the management of this mother (10 marks) 26. Write short notes on the following. a) Uterine causes of infertility (8 marks) b) Ovarian causes of female infertility. (10 marks) c) Superfecundity. Superfecundity. (5 marks) d) Superfetation. (5 marks). 27. In relation with HIV/AIDS a) Outline the 4 strategies for prevention prevention of HIV in Uganda 4 Marks b) Discuss antiretroviral combination regimens for PMTCT including the criteria for each regimen 5 Marks c) What is Post Exposure Prophylaxis 3 Marks d) Write down two basic regimens for PEP 2 Marks e) Discuss ART in pregnancy. 5 Marks f) ARVs in Pregnancy 5 marks g) MTCT strategies 3marks 28. A 35year old Nulliparous woman presents to you in Gynae clinic c/o failure to menstruate all her life & failure to conceive for 15 years. She has been married and divorced twice due to her failure to conceive; she gives a history of deep Dyspareunia but has normal secondary sexual characteristics. a) List 3 most likely causes of her amenorrhea and infertility (5mks) b) Briefly explain how you would would manage this lady (15mks) c) List and explain 3 specific investigations you would do to elucidate the causes of her primary amenorrhoea (5mks) 29. You are called to the admission room at KIUTH because a 34 year-old G5 P4+0 has been referred from Kabwohe HC IV. She is examined examin ed and found in labour with signs and symptoms of labour with an over distended abdomen. a) What is the most probable probable diagnosis diagnosis 2 Marks b) List 4 signs of shock 4 Marks c) How will you manage this patient 15 Marks d) What are your differentials 4 Marks
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30. Ectopic pregnancy a) Describe the predisposing factors, clinical presentation differential diagnosis and management of a patient who presented with features suggestive of a ruptured Ectopic Ectopic pregnancy. pregnancy. 15 Marks b) Outline the criteria for medical management of an Ectopic Ectopic pregnancy pregnancy using Methotrexate. Methotrexate. 7 Marks c) What are the side effects of this drug 3 Marks 31. 46 years old Para 8+0 presented to the gynaecological outpatient clinic with complaints complain ts of abdominal abdominal pain and per vaginal disch arge for 2 months. months. Pap smear was done and showed severe dysplasia. Visual inspection with acetic acid showed oyster coloured lesion at 6 o¶clock position. Visual inspection with Lugol¶s iodine iodine showed mustard yellow patch at 5-6 o¶clock position. Colposcopy showed mosaics and coarse punctuations at the same area. Colposcopy was used to guide biopsy and histopathology results showed koilocytosis in all layers of the cervical epithelium a) What is the diagnosis? (2 Marks) b) Describe the different treatment methods for the above disease (10 Marks) c) How would you reduce the incidence of the adverse effects of the above condition in the population (10 Marks) d) Describe the mechanism of action of lugol¶s iodine in the identification of the above lesion (10 Marks) e) List the host factors that may lead the progression of the above diseases (8 Marks) 32. A 23 year old patient, primegravida, admitted at 34 wks of amenorrhea, c/o; epigastric epigastric pain. O/E: Membrane mucosa: pale +, jaundice +++. Cardiorespiratory: Cardiorespiratory: BP: 160/116 mmHg, Pulse: 86bpm , crepitations in both pulmonary bases. Abdomen: right upper quadrant tenderness. CNS: fully conscious. 30 minutes later the patient undergoes to generalized tonic-clonic convulsions. There is also easy bleeding at the puncture sites. a) Discuss the most li kely diagnosis diagnosis and the differential. differential. ( 5 marks) b) Discuss the pathophysiology to the signs and symptoms in the patient. (10 marks) c) Discuss the management for this patient. (10 marks). 33. Write short notes on the following. a) Post operative operative management of a patient in gynaecological gynaecological ward. ( 12 marks) b) Dilatation and curettage (8 marks) c) Cusco¶s vaginal speculum. (5 marks) d) Post operative management of 30 years old patient with T AH + BSO. (10 marks) 34. A 40 year old patient P9 + 2, referral from Kabuyanda after delivering a 4.9 kg baby with vaginal bleeding, shortness of breath, chest pain and sweating. O/E: Pale +++. Pulse: 125/ Min. B.P: 90/50. bdomen: Uterus is bulky, 3cm above the umbilicus, with multiples irregular mass. Abdomen: -5-
Vaginal Examination: Heavy Heavy bleeding, umbilical cord is still in vagina. Extensive varicosities in the lower limbs a) Discuss the diagnosis (2 marks). b) Discuss the management. (10 marks) c) Identify the risk factors contributing to the differential diagnoses. (8 marks) d) Discuss prevention of postpartum haemorrhage. (5 marks) 35. A 24 year old woman P2 + 0 present to gynaecology clinic 3 months after delivery at Kabuyanda HC IV, complaining of leaking of urine, which appeared two days after delivery. a) Which is the most probably diagnosis. (2 marks) b) Discuss the risk factors for this disease. (3 marks) c) Discuss the management (5 marks) d) Postoperative Postoperative care. ( 5Mrks) e) Prevention (10 marks). 36. Describe the different strategies you can use to reduce the incidence of cervical cancer in the community(20marks) Marking
guide to examiner: The student should state the risk factor for cervical cancer as HPV [1 mark] The student should state at least three risk factors for HPV acquisition as ± Multiple sexual partners partners,, early age of onset of sexual in ter tercourse, course, high risk husbands, smoking, immunosupression etc [3 marks] The student should be able to describe primary prevention as- Avoidance of risky sexual behaviors by increasing community awareness through different community awareness programs [2marks]. The student should be to describe vaccination against HPV as - a primary prevention strategy, he/she she be able to discuss the vaccines [4marks]. The student should be able to state, define and describe secondary cervical cancer prevention prevent ion as - detection and treatment of precance precancerous rous cervical cervi cal lesions[4ma l esions[4marks]rks]The student should be able to state the different screening methods as-HPV D NA detection, Cytology both the conventional Pap smear and liquid based cytology, VI A and VILI [3marks] The student should be able to describe the different methods of treatment of cervical precancerous lesions as - Cryotherapy, LEEP, and cervical cone biopsy [3marks].
37. A 40 year old prime gravida, previously Normotensive is admitted with at 16 weeks of amenorrhea wi th complaints of on and off off per virginal bleeding and history of passage of vesicles in blood. Her blood pressure was 180/110mmhg The fundal height was 28/40. Ultrasound showed a snow storm appearance. a) State the diagnosis precisely?[3marks] b) How did you reach the diagnosi diagnosis s from the information informati on above? [3marks] [3mark s] c) What are your differential diagnoses? [2marks] d) How will you confirm the diagnosis? [5marks] e) Discuss how you will manage the above patient [7 marks] Examiners¶ marking guide a) The student should be able to state the precise precise diagnosis asas - hydatidiform mole [3marks] -6-
b) The student should be able to get out the key factors pointing to hydatidiform mole as-hypertension in pregnancy before 20 weeks of amenorrhea, fundal height greater than weeks of amenorrhea, u/s snow storm appearance. [3marks] c) The student should be able to state causes of bleeding in early pregnancy asmolar pregnancy, ectopic pregnancy, abortions, abortions, and local causes. [2marks] d) The student should be able to mention mention making investigations investigations as - taking a biopsy for histopathology and to state the histopathological features of a hydatidiform mole. [5marks] e) The student should able to mention investigations investigati ons such as - blood grouping grouping and cross matching, consent, suction curettage, and follow up plus indications for chemotherapy[In follow should mention monitoring of HCG levels, metastases, doing x-rays, ultrasound, contraceptives ,when to conceive etc] (7marks) 38. Describe the development of the internal female genital tract. 39. Skilled birth attendant a) Describe a skilled attendant at birth. b) What are the skills this person should have? c) What are the advantages of delivering with a skilled attendant? 40. Discuss the prevention of PPH. 41. Discuss the prophylaxis to VVF. 42.
Abortion
a) Describe the components of Post Abortion Care (P AC) 10 Marks Marks b) Abortion is one of the leading causes of maternal mortality and morbidity in developing countries where it is largely illegal. Do you think legalizing safe abortion is beneficial? beneficial? 10 Marks c) Describe the investigations you would carry out following treat ment of a spontaneous mid trimester abortion 5 Marks d) Describe in detail indications, procedure, and care of MV A set 15 Marks 43. One of the causes of Gynaecological emergencies is delay to seek appropriate Gynaecological consultation. a) What are the causes of possible delays and at what levels level s 05 Marks b) Describe measures measures you would institute institute (as a Distr ict Health officer) to avoid unnecessary gynaecological gynaecological emergencies emergencies 15 Marks 44. A 30 year old G3 P2+0 all spontaneous vaginal deliveries, presents at ANC with suspected twin pregnancy at 38 complete weeks of amenorrhea. a) How would you ascertain that this woman is actually 38 weeks? (10 marks) b) Assuming she had twins, describe how would you deliver the second twin? (10 marks). c) List the possible complication the the above lady i s exposed. (5 mark).
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45. A forty year old nulliparous woman presents to you in MRRH, c/o failure to conceive for the last 10 years she has been married and suffering from heavy menses and abdominal abdominal mass. a) What the primary diagnosis in this patient? (2 marks). b) List at least 6 differential differential diagnoses. diagnoses. (3 marks). m arks). c) Explain 4 important investigations you would carry out to confirm the diagnosis. (10 marks). d) Briefly outline how you would treat the above patient. (10 marks). 46. A 40 year old woman presents in Gynaecology clinic c/o lower abdominal pain for 6 years, failure to conceive for 10 years and has noticed an abdominal abdominal mass over the last 3 years. a) List 5 possible differential diagnosis in this woman. (5 marks) b) List 10 causes of the above woman¶s woman¶s failure f ailure to conceive at the utero-tubal level. (10 marks) c) Briefly explain 4 main investigations you would do to properly manage the woman¶s problems in b) above. (5 marks) d) If the above woman¶s problem was bilateral tubal occlusion, how would you treat this condition? condition? (Assume that the woman¶s husband is normal). (5 marks). 47. Write short notes on the following: a) 3rd generation COC¶s (5 marks) b) Norplant II (5 marks) c) Cu T380A (5 marks) d) Advantages of doing vasectomy over epididymectomy (5 marks) e) The NUVA ring. (5 marks) f) Emergency contraception (10 marks) g) Implanon ( 7 marks ) h) Advantages of female condom over male condom. (5 marks) i) Male condom. (5 marks)
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