Undergraduate: 481 GYN Obstetrics & Gynecology
Obstetrics and Gynecology is a branch of medicine which deals with the health care of women.It is concerned with the Physiological, Psychological and Pathological events of the reproductive and Menopausal Processes.
Aims and Objectives:
All undergraduate students must have three basic components knowledge, Clinical Skills, and Attitude in order to be a well motivated efficient future doctor.
The Course:
During one Academic year three cycles in Obstetrics and Gynecology are held on 12 weeks basis starting with Female Students followed by two Male Students cycle in addition one Summer Course of 8 weeks.
The Organization of the Course:
The integrated course will contain 40 Lectures for all Students. 12 Tutorials for each group, Skill Lab, Instruments, Beside the daily activities which include ward round with bed side teaching, Clinical attendance Operating Room, Labour Ward and Accident and Emergency sessions.
Programmes of the Department:
The most important objectives of the Department are to improve the general health status of pregnant women by providing adequate antenatal and post natal care, diagnose and treat women with gynaecological problems, and participate in the academic and clinical training of both under graduate and post graduates.
Under Graduate Programme:
Course 481 is given to medical students in their 4th year of the medical school. 11 hours of teaching, tutorials, and clinical exposure are given weekly. There are three of these cycles annually, two cycles for males and the third cycle for female students.
The course aims to impart in the students basic knowledge in the field of obstetrics & gynaecology. At the end of the course it is hoped they will be able to diagnosed and manage common obstetrical and gynaecological problems.
Pre-requisites:
Students spend 12 weeks in the department. This constitutes their entire obstetrics training. Due to the cycle system, every batch may do obstetrics straight after finishing Level 12 or after rotating through other cycles e.g. medicine, surgery, etc.
Students, however, have been given courses in medicine and surgery during or before Level 12 and, therefore, they should have the background in clinical practice. During these 12 weeks, it is impossible to cover all topics in details. Emphasis is put on graduating general physicians who have enough basic knowledge in obstetrics.
Weekly Academic Teaching:
1- Formal teaching During the first week of clinical teaching, clinical sessions are spent in demonstration of obstetric history taking and physical examination. During the following 10 weeks, bedside teaching and clinic attendance are conducted by teaching staff each week.
2- Attending the continuous medical education in the department weekly.
3- Final exam is conducted in the last week from each cycle.
Recommended Books:
1. Obstetrics - Illustrated Garrey/Govan - Hodge - Callender Churchill Livingstone Third Edition
2. Gynaecology - Illustrated A.D.T. Govan - Hodge - Callender Churchill Livingstone Third Edition
3. Obstetrics by Ten Teachers Stanley G. Clayton T.L.T. Lewis and G.D. Pinker Arnold 14th Edition I.
Exam Sample:
1- 31-year-old woman comes to the physician for follow-up after an abnormal Pap test and cervical biopsy. The patient's Pap test showed a high-grade squamous intraepithelial lesion (HGSIL). This was followed by colposcopy and biopsy of the cervix. The biopsy specimen also demonstrated HGSIL. The patient was counseled to undergo a loop electrosurgical excision procedure (LEEP). Which of the following represents the potential long-term complications from this procedure?
A. Abscess and chronic pelvic inflammatory disease
B. Cervical incompetence and cervical stenosis
C. Constipation and fecal incontinence
D. Hernia and intraperitoneal adhesions
E. Urinary incontinence and urinary retention
2- A 27-year-old woman, gravida 2, para 2, comes to the physician to have her staples removed after an elective repeat cesarean delivery. Her pregnancy course was uncomplicated. She states that she is doing well except that since the delivery she has noticed some episodes of sadness and tearfulness. She is eating and sleeping normally and has no strange thoughts or thoughts of hurting herself or others. Physical examination is within normal limits for a patient who is status post cesarean delivery. Which of the following is the most likely diagnosis?
A. Maternity blues
B. Postpartum depression
C. Postpartum mania
D. Postpartum psychosis
E. Poststerilization depression
3- A 22-year-old primigravid woman comes to the labor and delivery ward at term with regular, painful contractions. Her prenatal course was unremarkable. She has a past medical history significant for mitral valve prolapse with regurgitation demonstrated on echocardiography. She takes no medications and has no allergies to medications. Examination shows that her cervix is 4 centimeters dilated and the fetus is in vertex presentation. The fetal heart rate is reassuring. Which of the following is the most appropriate management of this patient?
A. Administer intravenous antibiotics throughout labor.
B. Administer intravenous antibiotics 30 minutes prior to the delivery.
C. Administer intravenous antibiotics after the cord is clamped.
D. Administer intravenous antibiotics six hours after the delivery.
E. Antibiotic prophylaxis is not necessary
4- 26-year-old primigravid woman at 42 weeks' gestation comes to the labor and delivery ward for induction of labor. The prenatal course was significant for a positive group B Streptococcus culture performed at 35 weeks. Antenatal testing over the past 2 weeks has been unremarkable. The patient is started on lactated Ringer's IV solution. Sterile vaginal examination shows that the patient's cervix is long, thick, and closed. Prostaglandin (PGE2) gel is placed into the vagina, and electronic fetal heart rate monitoring is continued. In approximately 60 minutes, the fetal heart rate falls to the 90s, as the tocodynamometer shows the uterus to be contracting every 1 minute with essentially no rest in between contractions. Which of the following was most likely the cause of the uterine hyperstimulation?
A. Infection
B. IV fluids
C. Postdates pregnancy
D. Prostaglandin (PGE2) gel
E. Vaginal examination
5- A 16-year-old female comes to the physician because of an increased vaginal discharge. She developed this symptom 2 days ago. She also complains of dysuria. She is sexually active with one partner and uses condoms intermittently. Examination reveals some erythema of the cervix but is otherwise unremarkable. A urine culture is sent which comes back negative. Sexually transmitted disease testing is performed and the patient is found to have gonorrhea. While treating this patient's gonorrhea infection, treatment must also be given for which of the following?
A. Bacterial vaginosis
B. Chlamydia
C. Herpes
D. Syphilis
E. Trichomoniasis
6- A 16-year-old nulligravid woman comes to the emergency department because of heavy vaginal bleeding. She states that she normally has heavy periods every month but missed a period last month and this period has been unusually heavy with the passage of large clots. She has no medical problems, has no history of bleeding difficulties, and takes no medications. Her temperature is 37 C (98.6 F), blood pressure is 110/70 mm Hg, pulse is 96/minute and respirations are 12/minute. Pelvic examination shows a moderate amount of blood in the vagina, a closed cervix, and a normal uterus and adnexae. Hematocrit is 30%. Urine hCG is negative. Which of the following is the most appropriate management?
A. Expectant management
B. Hysteroscopy
C. Oral contraceptive pills
D. Laparoscopy
E. Laparotomy
7- A 34-year-old woman comes the physician because of lower abdominal cramping. The cramping started 2 days ago. Examination is unremarkable except for a pelvic examination that reveals a 10-week sized uterus. Urine hCG is positive, and pelvic ultrasound reveals a 10-week intrauterine pregnancy with a fetal heart rate of 160. The patient states that she is not sure whether to keep the pregnancy. Which of the following is the most appropriate next step in management?
A. Counsel the patient or refer to an appropriate counselor
B. Notify the patient's parents
C. Notify the patient's partner
D. Schedule a termination of pregnancy
E. Tell the patient that she is likely to have a miscarriage
8- A 29-year-old woman comes to the physician for follow-up of a right breast lump. The patient first noticed the lump 4 months ago. It was aspirated at that time, and cytology was negative, but the cyst recurred about 1 month later. The cyst was re-aspirated 2 months ago and, again, the cytology was negative. The lump has recurred. Examination reveals a mass at 10 o'clock, approximately 4 cm from the areola. Ultrasound demonstrates a cystic lesion. Which of the following is the most appropriate next step in management?
A. Mammography in 1 year
B. Ultrasound in 1 year
C. Tamoxifen therapy
D. Open biopsy
E. Mastectomy
9- A 27-year-old primigravid woman at 39 weeks' gestation comes to the labor and delivery ward with a gush of fluid and regular contractions. Examination shows that she is grossly ruptured, contracting every 2 minutes, and that her cervix is dilated to 4 cm. The fetal heart rate tracing is in the 140s and reactive. She is admitted to labor and delivery, and over the following 4 hours she progresses to 9 cm dilation. Over the past hour, the fetal heart rate has increased from a baseline of 140 to a baseline of 160. Furthermore, moderate to severe variable decelerations are seen with each contraction. The fetal heart rate does not respond to scalp stimulation. The decision is made to proceed with cesarean delivery. Which of the following is the reason for the cesarean delivery and the preoperative diagnosis?
A. Fetal acidemia
B. Fetal distress
C. Fetal hypoxic encephalopathy
D. Low neonatal APGAR scores
E. Non-reassuring fetal heart rate tracing
10- A 29-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the labor and delivery ward with frequent painful contractions. Her prenatal course was significant for a urine culture that showed 100,000 colony-forming units/milliliter of Group-B streptococci and asthma, for which she uses an albuterol inhaler. Examination shows that she is contracting every 2 minutes and her cervix is 5 centimeters dilated and 100% effaced. Which of the following medications should this patient be treated with during labor and delivery?
A. Betamethasone
B. Folic acid
C. Magnesium sulfate
D. Oxytocin
E. Penicillin