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Passing DNB Obstetrics and Gynecology
Sachin Nichite, Pragya Tripathi
SECTION 1: GENERAL THEORY
CHAPTER 1:
How to Prepare for Theory Examination
On starting Of Tenure
Importance of this Principle
Make Strategy
Tot—Things on Tip of Tongue
Seniors
Application of Theory in Practice
Four months before Examinations
Seven days before Examinations
One day before examination
Checklist before leaving for examination
During examination
CHAPTER 2:
How to Write DNB Note
SECTION 2: IMPORTANT SAMPLE QUESTIONS AND ANSWERS IN OBSTETRICS
CHAPTER 3:
Fetomaternal Medicine
INTRAUTERINE GROWTH RESTRICTION
Definition
Etiology
Idiopathic
Screening Options
Head Circumference
Abdominal circumference
Measurement Ratios
Sonographic estimate of fetal weight
FETAL MACROSOMIA
Definition
Various definitions
Grading (Boulet et al)
Causes
Complications
Estimation of fetal weight
Prevention of macrosomia
Management
Controversial
Plan of Management of Macrosomia
HYDROCEPHALUS
Definition
Etiology
Diagnosis
Management Options
Prenatal
Labor and delivery
Postnatal
SELECTIVE REDUCTION OR TERMINATION IN MULTIFETAL PREGNANCY
Definition
Selective Reduction
Selective Termination
Complications
Post Procedure
FETAL BLOOD SAMPLING (FBS)/CORDOCENTESIS/PERCUTANEOUS UMBILICAL CORD BLOOD SAMPLING (PUBS)
Indication
Diagnostic
Therapeutic
Post Procedure Monitoring
Complications and Risks
AMNIOCENTESIS
Indication
Complications
Precautions
FETAL COMPLICATIONS OF TWINS
General
Twin-to-Twin Transfusion Syndrome (TTTS)
Pathophysiology of TTTS
Brain Damage
ANTENATAL SCREENING FOR DOWN'S SYNDROME
Future Developments
Fetal Nasal Bones
Fetus Ductus Venosus
CHORIONIC VILLOUS SAMPLING
PRENATAL DIAGNOSIS OF NTD
FETAL THERAPY
Transplacental Pharmacotherapy
Invasive Therapy
Clinical Applications of Fetal Therapy
Fetal Drug Therapy
MANAGEMENT OF IUGR
CHAPTER 4:
Medical Disorders in Pregnancy
ACUTE RENAL FAILURE (ARF) IN PREGNANCY
Principles of Management
Correction of Precipitating Cause
HUS/TTP
ARF Associated with HUS / TTP
ARF due to Acute Renal Cortical Necrosis (ARCN) in Abruption, Amniotic Fluid Embolus and Sepsis
ARF due to Hemorrhage
ARF due to Sepsis
ARF due to AFLP
ARF due to Nephrotoxic Drugs
Monitoring and Optimizing Fluid Balance
Acute Renal Failure
Indications of RRT
Prevention
SICKLE-CELL DISEASE AND PREGNANCY
Effect of HbSS on Pregnancy
Pathophysiology
Major Complications
Sickle-Cell Crisis
Pathophysiology Explained by Virchow's Triad
Acute Chest Syndrome
Hematological Crisis
Management
Sickling Crisis
Prophylactic Transfusion Therapy
Intrapartum
Postpartum
Contraception- Low dose OC Pills not Contraindicated
OBSTETRIC CHOLESTASIS
Systemic Approach: Pruritus in Pregnancy
Causes of Pruritus in Pregnancy
With a Rash-pregnancy Specific Dermatoses
Pruritic Folliculitis
Prurigo
Pemphigoid Gestations or Herpes Gestations
With A Rash: Intercurrent Dermatological Disease
Eczema
Without a Rash: Pregnancy Specific Cause
Obstetric Cholestasis: Diagnosis of Exclusion
Changes in LFTs
Concluding a Diagnosis of OC (Obstetric Cholestasis)
Mechanism of Fetal Risk
Mechanism of Maternal Risk
Treatment
SAM-e (S-Adenosylmethionine)
Dexamethasone
Delivery
Postnatal Course in OC
HEART DISEASE IN PREGNANCY
Effect of Disease on Pregnancy
Fetal
Predictors of Cardiac Complications
NYHA Classification
Drugs to be Avoided
Drugs Relatively Safe
Preconception Counseling
Multidisciplinary Approach
Management
THROMBOCYTOPENIA IN PREGNANCY
Definition
Gestational Thrombocytopenia
Autoimmune Thrombocytopenia
Management
Prenatal
HYPOTHYROIDISM IN PREGNANCY
Maternal and Fetal Risk
Management
Increased Risk of Gestational Hypertension
Screening of Infants for Hypothyroidism
Management
Prepregnancy
Prenatal
Labor and Delivery
Postnatal
Contraception
HYPERTHYROIDISM IN PREGNANCY
Complications of Hyperthyroidism
Aplasia Cutis
Fetal Hypothyroidism (due to large doses)
Peripartum cardiomyopathy
Diagnosis of Exclusion
Diagnostic Criteria
Management
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) AND PREGNANCY
Effect of Pregnancy on Lupus
Effects of Lupus on Pregnancy
Management
Counseling Patient and Partner
CHAPTER 5:
Surgical Disorders in Pregnancy
ACUTE APPENDICITIS IN pregnancy
Risks in Pregnancy
Diagnosis
Rx- When Clinical Suspicion High – Surgery
CHAPTER 6:
Obstetric Emergency and Labor
OBSTRUCTED LABOR
Definition
Causes
Fault in the Passage
Fault in the Passenger
Effects on Mother
Immediate
Remote
Effect on Fetus
Clinical Features
Prevention
Antenatal
Intranatal
Treatment
Preliminaries
Obstetric Management
PARTOGRAM
Definition
Indications of Partogram
MANAGEMENT OF MILD PREECLAMPSIA
MANAGEMENT OF SEVERE PREECLAMPSIA
Expectant Management
Indications of Delivery
Management During Labor
Intrapartum
Postpartum
Follow-up
Management of Eclampsia
Immediate Care
Recent
MANAGEMENT OF prelabor preterm rupture of membranes
Antenatal Tests/Monitoring in Expectant Mx
UNSTABLE LIE
Definition
Etiology
Management
Possible options—Antenatal
Intrapartum
Secondary postpartum hemorrhage
Definition (ACOG)
Causes
Management
ACUTE FETAL DISTRESS
Etiology
Diagnosis
Management
Hydramnios
Definition
Severity
Etiology
Pathogenesis
Complications (6 P's)
Maternal
Diagnosis
Management
PATHOPHYSIOLOGY OF PRETERM LABOR
Spontaneous Preterm Labor
PPROM
SHOULDER DYSTOCIA
Definition
Prediction
Mechanism
Complications
Management
Suprapubic Pressure (Hibbard/Resnick Maneuver)
McRoberts Maneuver
Woods Screw Maneuver
All Fours Maneuver (Gaskins)
Parallel Forceps
Cleidotomy
Zavanelli's Maneuver/Cephalic Replacement
MORBIDITY ADHERENT PLACENTA
Definition
Etiology
Diagnosis
Management
Placenta Accreta
Recent
CORD PROLAPSE
Definition
Etiology
Cord Prolapse
Diagnosis
Management
ANTENATAL MANAGEMENT OF MULTIPLE PREGNANCY
Intrapartum Management of Multiple Pregnancies
Recommendations
Induction or Stimulation of Labor
Vaginal birth after cesarean
Selection Criteria for VBAC (ACOG)
Intrapartum
ELECTRONIC FETAL MONITORING (EFM)
Indications of Continuous EFM
Interpretation of EFM (RCOG)
Guidelines for Methods of Intrapartum FHR Monitoring
Categories of FHR Features
Management of EFM
ARREST OF AFTERCOMING HEAD
At the Brim
In the Cavity
At the Outlet
Delivery through Incompletely Dilated Cervix
MANAGEMENT OF PROLONGED PREGNANCY
Prenatal
Prenatal (at 41 Weeks)
Active Management Options (Induction of Labor)
Expectant Management Options (Fetal Surveillance)
Prenatal (at 42 Weeks)
CERVICAL INCOMPETeNCE
Etiology and Diagnosis and Management
Etiology
Treatment Protocols
Preoperative Evaluation
Timing
Role of Tocolytic
Contraindications
Elective Cerclage
Urgent Cerclage
Emergency Cerclage
Abdominal Cerclage (Bensonf and Durfee)
Removal
Complications
Other Rare Procedures
Nonsurgical Procedures
PREVENTION OF RH-ISOIMMUNIzATION
Mid cerebral artery(MCA) Peak systolic velocity (PSV)
Amniocentesis (DOD 450)
Cordocentesis
Rh-Negative
Intrauterine Transfusions
SHOCK IN OBSTETRICS
Definition
Etiology
Stages of Shock
Hemodynamic Considerations in Pregnancy
Causes of Hemorrhage in Pregnancy
Management
Prenatal—Identification of “at risk” Patient
General Management (Order)
Protocol
Site of Management (Intensive Care Unit)
Specific Management
Recent Advances
Pelvic Vessel Embolism
Tamponade
SURGICAL MANAGEMENT OF PPH
Stepwise Uterine Devascularization
Under Suturing of the Placental Bed
Compression Sutures
Indication: Atonic PPH
Disadvantages
Hayman Suture
Cho Sutures
THE RETAINED PLACENTA
Etiology, Pathology and Management of Retained Placenta
Pathophysiology
Importance of Retroplacental Myometrium
Pathophysiological Mechanism
Management
Diagnosis
Treatment
Umbilical Vein Injection
Basis
MROP
CHAPTER 7:
Infections
RUBELLA IN PREGNANCY
Congenital Rubella – Triad of Gregg
Fetal Risks
Management Options
CHICKENPOX IN PREGNANCY
Clinical Features and Course
Prevention
Pregnant Women Giving History of Contact with Chickenpox or Shingles
Management Who Develops Chickenpox
Treatment
Indications of Hospitalization
Hospital Management
Management of Newborn
TUBERCULOSIS IN pregnancy
Clinical Presentation
Evaluation
Other Investigations
Management
Mother
GROUP B AND STREPTOCOCCUS
Spectrum of Maternal and Fetal GBS Infection
Neonatal Sepsis d/t GBS–2 Types
Late Onset Disease
Recommendations for Prevention (CDC 1996)
Antimicrobial Prophylaxis for Perinatal Prevention of Group and Streptococcus Disease
TOXOPLASMOSIS IN pregnancy
Organism – Toxoplasma Gondii
Pathophysiology
Clinical Presentation
Effect on Pregnancy
Diagnosis
Management
CHAPTER 8:
Neonatolo
AMBIGUOUS GENITALIA
Diagnosis
Treatment
NEONATAL RESUSCITATION
How you Manage Newborns with Meconium
CHAPTER 9:
Other
Prevention of Parent to child transmission (PPTCT) of HIV
National AIDS Control Organization (NACO) has Three Strategies for PPTCT
Obstetrical Practice
Government of India Guidelines for PPTCT/ARV
NACO Guidelines for BF
SUPPRESSION OF LACTATION
Indications
Natural Methods
Hormonal Methods
Prolactin Inhibitors
FIBROiDS IN PREGNANCY
Effect of Pregnancy on Fibroid
Increase in Size
Torsion of Pedunculated Fibroid—Rare
Infection of the Fibroid
Management Options
Antepartum
Intrapartum
Postpartum
ABNORMALiTIES OF PLACENTA, CORD AND MEMBRANES
Placenta
Abnormal Shape or Implantation (Fig. 9.1)
Degenerative Lesions
Circulatory Disturbances
Hypertrophic Lesions of Villi/Hyperplacentosis
Microscopic Abnormalities
Tumors of Placenta
Membranes
Umbilical Cord
Length
Cord Coiling
Single Umbilical Artery
Four Vessel Cord
Abnormalities of Cord Insertion (Fig. 9.2)
Abnormalities Capable of in Impeding Blood Flow
ANATOMY OF FEMALE BREAST and PHYSIOLOGY OF LACTATION
Anatomy of Female Breast and Physiology of Lactation
Skin
Parenchyma
Alveolus
Stroma
Blood Supply
Physiology of Lactation
Four Phases
Mammogenesis
Lactogenesis
Galactokinesis
Galactopoiesis
Neuroendocrinology of Lactation
ESTIMATION OF GESTATION AGE and ITS IMPORTANCE
FETOMATERNAL Hemorrhage
Causes
Significance
Identification of Fetal RBCs in Maternal Circulation
Human chorionic gonadotropin (HCG)
Source
Biochemical Characteristics
Concentrations of hCG in Serum and Urine
Biological Functions
MANAGING SUBSTANCE ABUSE IN PREGNANCY
Antenatal Care
Intrapartum Care
Postnatal Care
MATERNAL MORTALITY
Maternal Mortality Rate
Causes (Direct)
Causes (Indirect)
Health Sector Action
Antenatal Care
Intranatal
Postnatal
Preventive Measures
Administrative Measures
Community Society and Family Action
Health Planner and Policy Markers Action
MAGNESIum SULfATE
Anticonvulsant Action
Tocolytic Action
Monitoring Magnesium Sulfate Therapy
Magnesium Sulfate Blood Levels
Magnesium Toxicity
Treatment of Magnesium Toxicity
Mild
Severe (Respiratory Paralysis)
Indication of Magnesium Sulfate
Neuroprotective—Effect of Magnesium
Magnesium Sulfate as Tocolytics
Side Effects
PERINATAL MORTALITY RATE
Definition (WHO)
Causes
Interventions for Reduction or Prevention of PMR
Prediction of Preeclampsia
Prediction of Preterm Labor
Predictors of Preterm Birth
Classification
Predictors of Preterm Birth
Primary Predictors
Risk Factors for Preterm Delivery
Secondary Predictors
Prostaglandins (PGs) IN OBSTETRICS
Various PG Preparations
Indications
Induction of Labor
Uses
Atonic PPH
weight GAIN IN pregnancy
Recommendation Based on Pregnancy Weight
Importance of Weight Checking
Total Weight Gain in Singleton Pregnancy in Healthy Woman
SECTION 3: SAMPLE QUESTIONS AND ANSWERS IN GYNECOLOGY
CHAPTER 10:
Reproductive Medicine
ASSESSMENT AND MANAGEMENT OF AZOOSPERMIA IN INFERTILE COUPLE
Causes of Azoospermia
Obstructive
Causes
Surgery
CBAVD
CFTR Protein
Other Respiratory Associated Conditions
Kartagener's Syndrome
Non-obstructive Causes
Miscellaneous
Evaluation
Azoospermia
Investigations
Management
Medical
Surgical
Provisional Diagnosis of NOA
Obstructive Azoospermia (Provisional)
INDUCTION OF OVULATION and MONITORING OF INDUCTION
Induction with Clomifene
Candidate for Clomifene
Induction with Gonadotropins
Indication of Gonadotropin Therapy
Contraindication of Gonadotropins
Induction with GnRH
Candidates for GnRH
Induction with Bromocriptine
CLOMIfeNE CITRATE
Pharmacology
Indications
Side Effects of Clomifene Citrate (CC)
Peripheral Antiestrogenic Effects
Congenital Anomalies No Evidence
INTRAUTERINE INSEMINATION
Indications
Sperm Preparation for IUI
Washing and Swim up
Density Gradient Centrifugation
Methods of Ovarian Hyperstimulation
Baseline D2/D3 Scan—Confirm Endometrial Shedding
Technique
Complications
Failure
ANATOMICAL UTERINE FACTORS IN INfERTILITY
Factors
Uterine Congenital Malformations
Investigations for Evaluation
Choice of Investigations
Pathology and Tubal Status Irrelevant
Congenital Uterine Malformations
In Utero Exposure of DES
Leiomyoma
Proposed Mechanism
Current Opinion
Management – must be individualized – depends upon
Asherman's Syndrome
Endometrial Polyp
DIAGNOSTIC AND THERAPEUTIC
Aspects of Tubal Patency Testing
Three Categories
Test Medium Flushed the Cervix
Laparoscopic Chromopertubation
HSG
Methylene Blue Test
Gas Hydrotubation (Rubins Test)
Phenolphthalein Test (Speck Test)
Use of USG
Radiolabeled Gas
Direct Cannulation of Fallopian Tubes
Tests Dependent on Particular Transport
Ascending Test—Microsphere Migration
Desending Tests
Ovarian hyperstimulation syndrome (OHSS)
Classification of OHSS
Critical OHSS
Complications
Pathophysiology
Candidate Factors
Prevention
Conservation/Outpatient
History
History of Previous OHSS
UNEXPLAINED INFERTILITY
Role of Diagnostic Laparoscopy
Retrospective Studies of Laparoscopy
Endometriosis
Treatment
Superovulation + IUI
Advantages
COH + IUI
CHAPTER 11:
Contraception
VASECTOMY COMPLICATIONS AND ADVIsE ON DISCHARGE
Complications of Vasectomy
Immediate
Delayed
Postoperative Advice
INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD)
Timing of Insertion and Advice on Insertion, Indications of Removal
Timing of Insertion
Advice on Insertion
Indications of Removal
Who Criteria–Category 4
Complications
Increased Bleeding
Intermenstrual Bleeding
Pain
Expulsion
Abnormal Discharge
Perforation
Pregnancy
Missing Threads of IUCD
Infection
Ectopic Pregnancy
Newer IUCD
Gynefix
FEMALE STERILIZATION
Contraindications – no Permanent Contraindications
Cat – C
Cat – D
Cat – S
Complications
Intraoperative
Postoperative
Hematoma in Abdominal Wall
Failure
Methods of Tubal Ligation
Modified Pomeroy's
Irving's
Uchida
Kroener's
Mandlener's
Laparoscopic Tubal Updation
Methods
MISSING oral contraceptive (OC) PILLS
BREASTFEEDING AND CONTRACEPTION
Choices of Contraception
Non-hormonal Methods
When to Start
Breastfeeding and Emergency Contraception
Complications of female sterilization
Complications of Tubal Ligation
Depends on Several Factors
Operative Complications Include
Immediate Complications
Mortality Rate
Morbidity
Delayed Complication
Postoperative Complications
Long-term Complications
Complications after Laparoscopic Sterilization
Long-term Risk (real/suspected)
CONTRACEPTION FOR OVER 40
Combined Hormonal Contraception
Risks
Breast Cancer
Progestogen-only Pills (POPs)
Barrier Contraception
Cu-IUD
Sterilization
POSTCOITAL CONTRACEPTION
Definition
Uses
Mode of Action
Methods
Prescriptive Equivalents (ACOG)
Dedicated Products
COC
Mode of Action
Effectiveness
Risks
Effects
Follow-up
Levonorgestrel-only Pills
Dose
Use Beyond 72 Hours
Use More than Once in Cycle
Mechanism
Contraindication
Drug Interactions
IUCD
Future EC
TRANSCERVICAL STERILIZATION
Methods of Transcervical Sterilization
Disadvantages
Intratubal Chemical Methods
Disadvantages
Disadvantages
Intratubal Solid Plugs
Intratubal Devices
Available as a Part of Disposable System that Includes
Advantages
Disadvantages
Contraindication
CHAPTER 12:
Menstrual Disorders
EPIDEMIOLOGY and ETIOLOGY OF FIBROIDS
Epidemiology
Etiology Unclear
Management of Fibroid Uterus
Presentation of Leiomyoma
CHAPTER 13:
Urogynecology and Prolapse
Vault Prolapse
History and Examination
Prevention at Hysterectomy
Operations Described for Posthysterectomy Vault Prolapse
Conservative Management
Role of Iliococcygeus Suspension
Role of Vaginal Uterosacral Ligament Suspension
Laparoscopic Procedures
Colpocleisis
Sling Procedures (Postoperative Intravaginal Slingplasty) (Fig. 13.1)
Role of Total Mesh Reconstruction (Apogee and Prolift)
Vault Suspension to Anterior Abdominal Wall
MANAGEMENT OF GENITAL PROLAPSE
Conservative Surgeries of Prolapse
Fothergill's Operation/Manchester
Shirodkar's Modification of Fothergill's
Sling Operations
Virkud's Classification of Sling Operations
Purandare Sling
Shirodkar's Abdominal Sling
Khanna's Sling
Virkud's Composite Sling
Le Fort's Operation
Goodall and Power Modification of Le Fort
SUPPORTS OF BLADDER NECK and PHYSIOLOGY OF MICTURITION, MECHANISM MAINTAINING CONTINENCE
Nerve Supply of Bladder and Urethra (Innervation) (Fig. 13.6)
Physiology of Micturition
Storage of Urine
Voiding Phase
Chronological Events in Micturition
Mechanisms Maintaining Continence (Fig. 13.7)
NONSURGICAL MANAGEMENT OF PROLAPSE
Indications
Nonsurgical Management Methods
Conservative Management
Pelvic Muscle Exercises (Kegal Contractions)
Mechanical Devices—Pessaries
Initial Fitting
Primary Reason for Pessary Removal
Follow-up
Complication
VESICOVAGINAL FISTULA
Etiology and Types and Management
Clinical Features, Investigations and Prevention
Congenital
Acquired
Obstetric
Gynecological
Urological Surgery
Malignancies
Radiotherapy
Miscellaneous
Types (Fig. 13.9)
Classification According to Distance of Fistula from External Meatus
Clinical Features
Symptoms
Examination
Diagnosis and Investigation
Management
Preoperative Care
Timing of Repair
Flap Splitting Repair (Fig. 13.11)
Latzko Procedure (Fig. 13.12)
Advantages
Martius Labial Fat Pad Graft (Fig. 13.13)
Abdominal Repair (Fig. 13.14)
Postoperative Care
Prevention
Primordial Prevention
Primary Prevention
Extra Information
INITIAL EVALUATION OF URINARY INCONTINENCE
History
Past Medical History
Physical Examination
Primary Testing
Post Void Residual (PVR) (Fig. 13.15)
Advanced Testing in UI
Urodynamic Studies
Urodynamic Classification of SUI
Imaging Tests
Nonsurgical Treatment of SUI
Includes
Surgery for SUI
Indications
Types of Procedures
Paravaginal Bladder Neck Suspension
Needle Suspension Procedures
Operations to Correct ISD
Selection of Procedure
Recommendation for Various Procedures
Laparoscopic Colposuspension
Marshall-Marchetti-Krantz (MMK)
Anterior Colporrhaphy
Transvaginal Taping (TVT)
Transobturator Tape (TOT)
Injection
Periurethral Injection (Fig. 13.18)
Steps of Burch
TVT
TOT
Postoperative Management in SUI
URETERIC INJURIES
Anatomy
Ureter (Abdominal Part)—Right
Ureter (Abdominal Part)—Left
Pelvic Part
Blood Supply
Applied Anatomy
Anatomical Locations of Injury
Sites
Types and Causes
Gyne Procedures Associated with Injuries
Prevention
Diagnosis
Intraoperative
Postoperative
Investigations
Management
Fistula Repair
MANAGEMENT OF THIRD/FOUrTH DEGRee PERINEAL TEARS
Risk Factors
Classification
RCOG Classification
Timing of Repair
Management
Suture Material
Postoperative Management
Prognosis
Future Deliveries
Surgical Technique for Chronic CPT or Perineal Laceration
Extra Information
Physiology of Defecation
Overactive Bladder Syndrome
Definition
Causes
Management
Comparison of Various Drugs
Other Drug Therapies
Nondrug Interventional Treatments
RECTOVAGINAL FISTULA (RVF)
Definition
Classification
Causes
Clinical Features/Presentation
Evaluation
Treatment
Timing of repair
Route of surgery and type of surgery
Physiology of Anal Continence
Mechanism of Anal Continence
SUPPORTS OF UTERUS (Figs 13.20 to 13.22)
Primary
Secondary
Pelvic Diaphragm
Parietal Fasciae
Visceral Fasciae
Delancey's Vaginal Vault Prolapse
CHAPTER 14:
Gyne-Oncology
DYSGERMINOMA OVARY
Pathology
Clinical Features
Treatment
POMB-ACE
ENDOMETRIAL HYPERPLASIA
Clinical Significance
Pathology
Features of Atypical Hyperplasia Associated with Undiagnosed Ca during Hysterectomy
Prognostic Implication
Management
HYDATIDIFORM MOLE
Modified WHO Classification
Pathogenesis
Complete Mole (Fig. 14.1)
Incomplete Mole (Fig. 14.2)
Difference between CHM and PHM
Clinical Features
Symptoms
Diagnosis
USG
Serum β hCG
Management of Gestational Trophoblastic Disease
Hydatidiform Mole
Hysterectomy
Evacuation
Role of Second Evacuation
Indications of Chemotherapy
Contraception
Barrier Method
Follow-up After Evacuation
Placental Site Trophoblastic Tumor (PSTT)
Molar Pregnancy with One Live Twin
Adnexal Mass
Differential Diagnosis (D/D)
Premenarchal
Reproductive age
Postmenopausal
Clinical Presentation
Diagnostic Modalities for Adnexal Mass
Nonoperative—no invasive
Nonoperative Invasive
Operative Noninvasive
Operative Invasive
Evaluation
Role of USG and CT Scan
CT Scan
MRI
Tumor Markers
Management
Reproductive Age Group and Postmenopausal
Role of Laparoscopy
Removal of uterus and contralateral ovary
Role of cyst fluid aspiration
CARCINOMA VULVA-EARLY (T1)
vulvar intraepithelial neoplasia (VIN)
Newer Classification (ISSVD, 2005)
VIN
Classification
Pathology and Pathogenesis
Clinical Features
Diagnosis
Treatment
Special Sites
Medical Therapy
Topical Treatment
Disadvantage of CO2 Laser
Cavitational Ultrasonic Surgical Ablation (CUSA)
VULVAL DYSTROPHIES
Classification of Epithelial Vulvar Diseases (ISSVD)
Lichen Sclerosis
Definition
Clinical Presentation
Age Group
Vulvar Hygiene Recommendations
Topical Estrogens
Retinoids
CHAPTER 15:
Infections
SYNDROMIC APPROACH
Pelvic Inflammatory Disease (PID) (NACO)
SYNDROMIC Management OF VAGINAL DISCHARGE (NACO)
SYNDROMIC Management GENITAL ULCER
Advantage
WHO Syndromic Management
CHANCROID
Clinical Features
Diagnosis
Treatment (CDC and WHO)
Follow-up
Management of Sex Partners
GRANuLOMA INGUINALE (DONOVANOSIS)
Calymmatobacterium Granulomatis (Closed Safety Pin Appearance)
Clinical Features
Extragenital Involvement
Pelvic Inflammatory Disease
Risk Factors
Protective Factors
Diagnosis
Clinical
Investigations
Treatment
Surgical Treatment
Management of Sexual Partners
Follow-up
PID in HIV Positive Cases
OC Pills in PID
BACTERIAL VAGINOSIS
Risk Factors
Etiology
Organisms
Diagnosis
Gynecological Complications Associated with BV
Obstetrical Associated Problems
Postpartum Endometritis
Treatment
ChlAMYDIAL INFECTION IN gynecology
Pathogenesis
Diagnosis
Screening Guidelines (American College of Preventive Medicine)
Specimen Collection Guidelines
Treatment
GENITAL TUBERCULOSIS
Pathology
Endometrial TB—50–80% Cases
Clinical Presentation
Diagnosis
CBC - with ESR
X-ray Chest
MT - Controversial
Seen Only in 50–60% Cases
PCR
BACTEC 460
Treatment
DOTS Strategy
Category I (Genital TB)
Relapse/failure (Category II)
LYMPHOGRANULOMA VENEREUM (LGV)
Clinical Trachomatis L1, L2, L3
Clinical Features
Sis
POST EXPOSURE PROPHYLAXIS OF HIV
Exposure Code (EC)
HIV Status Code
SYPHILIS
Causative Organism – Treponema pallidum
Diagnosis
Treatment (CDC and WHO Recommendations)
Latent Syphilis
Tertiary Syphilis
Follow-up
Management of Case Partners
VAGINAL DISCHARGE
Common Causes
Management
Clinical and Sexual "history"
Examination
Lab Investigations
HVS (from Lateral Vaginal Walls)
Endocervical Swabs
Treatment
CHAPTER 16:
Other
VESTIBULITIS
Definition
International Society for the Study of Vulvovaginal Diseases (ISSVD) Classification of Vulval Pain
Symptoms and Signs
Diagnosis of Vulvodynia
Diagnosis
Etiopathogenesis
Treatment
Dysesthetic Vulvodynia
Vulvar Vestibulitis Syndrome
Conservative Management
Topical
Local Injection
Surgical Management
Vestibulectomy
MEASURES TO REDUCE BLOOD LOSS DURING MYOMECTOMY
Preoperative
Intraoperative
Surgical
Medical
GnRH Analogs
Good Surgical Technology
Bonney's Clamp
Elastic Rubber Tourniquet
Local Vasopressin
NEWER ROUTES OF HormoNE replacement therapy (HRT)
Transdermal Patches
Advantages
Advantages
Disadvantages
Vaginal Preparations
Advantages
Disadvantages
Estradiol Implants
Advantages
Disadvantages
Percutaneous Estrogen
Advantages
Disadvantage
PREVENTING LAPAROSCOPIC ENTRY RELATED COMPLICATIONS
Closed Laparoscopic Entry
Primary Trochar Entry
Hasson (Open) Entry Technique
Alternative Entry Devices
Laparoscopy after Previous Abdominal Surgery
Secondary Ports
Obese Patients (Morbid) or Very Thin
HYSTEROSCOPY IN GYNECOLOGY
Indications
Operative
Timing
Patient Preparation and Communication about/Counseling Consent
Equipment and Technique
Positioning Modified Dorsal Lithotomy
Uterine Distention
Media
NS
Dextran
Imaging
Flexible
Rigid
Complications
Anesthesia
Allergy
Impaired
Neurologic
Perforation
Bleeding
CHOCOLATE CYST OF OVARY
APPROACH TO DYSPAREUNIA
EARLY DIAGNOSIS OF ECTOPIC PREGNANCY
Laboratory Assessment
Urinary Human Chorionic Gonadotropin (hCG)
hCG Measurements
Doubling Time
Serum Progesterone
Disadvantages
Other Endocrinologic Markers
Ultrasonography
Transvaginal USG Superior to TAS
Ultrasound Findings
Placental Markers
Doppler Ultrasonography
Suspected Ectopic Pregnancy
Dilatation and Curettage (D and C)
Indication
Culdocentesis
Laparoscopy
Differential Diagnosis for Ectopic Pregnancy
Abortion
Salpingitis
Twisted Ovarian
Rupture of Chocolate Cyst
Dysmenorrhea
Retroverted Gravid Uterus
Acute Appendicitis
Renal Colic
HIRSUTISM
Definition
Pathophysiology
Within hair follicle
Causes
Evaluation of Hirsutism
Hirsutism—Management
Medical Management of Hirsutism
Hormonal Suppression
Medroxyprogesterone Acetate
LAPAROSCOPICALLY ASSISTED VAGINAL HYSTERECTOMY (LAVH)
Indications
Principle
Staging System for Laparoscopic Hysterectomies
Stages
Advantages
Disadvantages
Determination of Route of Hysterectomy
Abdominal versus Vaginal Hysterectomy
Advantage of Vaginal Over Abdominal
Disadvantage Compared to Abdominal
LYMPhATIC DRAINAGE OF PELVIS
Inguinal Glands
External Iliac Gland
Sacral Groups
Lumbar Group
Lymphatic Drainage of Uterus (Fig. 16.3)
Intrinsic Plexus
Extrinsic Drainage
Lymphatics of the Cervix (Fig. 16.4)
Lymphatics of Tubes and Ovary
Lymphatics of Vagina (Fig. 16.5)
Lymphatics of Vulva (Fig. 16.6)
POSTOPERATIVE ADHESIONS
Steps to Reduce Adhesion Formation
Pharmacological Agents
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Physical Barriers
Solid Mechanical Barriers
Interceed (Oxidized Regenerated Cellulose)
Seprafilm (Hyaluronic acid/carboxymethylcellulose)
Intergel
Spray Gel—Two Water based Solutions of Synthetic Polyethylene Glycol
Macromolecular Solutions
Hydroflotation
PROGESTERONE IN GYNECOLOGY
Diagnostic
Progesterone Challenge Test
Therapeutic
Only Progesterone
Combined Preparations
SALINE SONOHYSTEROGRAPHY
Indications
Basis/Therapy
Technique
Preparation
Polyps
Abnormalities of Uterus Cavity
Conclusion of Examination
Future
Algorithm of Care After Procedure
Value in Clinical Practice
Limitations
SURGICAL MANAGEMENT OF ECTOPIC PREGNANCY
CONSERVATIVE SURGERY
Radical Surgery
Linear Salpingostomy (Fig. 16.7)
Laparoscopy Linear Salpingostomy
Segmental Resection (Figs 16.8A and B)
Radical and Salpingectomy
UTERINE ARTERY EMBOLIzATION
For Fibroids
Contraindications
Preoperative Assessment
Technique
Postoperative
Results
Complications
SECTION 4: THINGS ON THE TIP OF TONGUE
CHAPTER 17:
Things on the Tip of Tongue
SEXUAL DEVELOPMENT
MEASUREMENT OF STRUCTURES
RELATIONSHIP OF CERVIX AND UTERINE LENGTH
EPITHELIAL LINING
VAGINAL PH
USG APPEARANCE OF ENDOMETRIUM ON TVS
PAIN IN FIBROID (MY PET DOG)
DEGENERATION IN FIBROID (AVOID RED HOT FATTY MEAT OF CHICKEN)
INDICATIONS OF GNRH AGONIST
RISK FACTORS FOR ENDOMETRIAL CANCER (FAMILY HAS OLD AUNTI)
RATE OF PROGRESSION OF CERVICAL INTRAEPITHELIAL NEOPLASMA (CIN)
STAGING PROCEDURE RECOMMENDED BY FIGO FOR CARCINOMA CERVIX
OVARIAN TUMORS MOST COMMONS
CAUSES OF PELVIC CALCIFICATION
PATHOLOGICAL FEATURES
PREGNANCY FAILURE RATES
INCREASED DURING PREGNANCY
DECREASED DURING PREGNANCY
ANC VISITS (WHO)
TIME OF RUPTURE OF ECTOPIC
AMNIOTIC FLUID VOLUME
DISORDERS MOST COMMON IN MULTIPARA
DISORDERS COMMON IN NULLIPARA
NAEGELE'S PELVIS – SINGLE ALA (TO REMEMBER ‘NALA')
LIFESPAN OF MOST IUCDS – 3 YEARS, EXCEPT
DAILY REQUIREMENT
CALORIE CONTENT OF VARIOUS FOODS
PRETERM BABY
IUGR
RISKS FACTORS FOR NEURAL TUBE DEFECTS (NTDs)
CONDITIONS ASSOCIATED WITH OLIGOHYDRAMNIOS
VOMITING IN PREGNANCY
ANEMIA
BPP
BIRTH DEFECT IN DIABETIC INFANT
ABNORMAL LABOR DUE TO ARREST OF PROTRACTION DISORDER (ACOG)
OXYTOCIN REGIMEN FOR STIMULATION OF LABOR (ACOG)
JAUNDICE IN PREGNANCY
SELECTION CRITERIA FOR VBAC (ACOG)
RISK FACTORS FOR ABRUPTION PLACENTA
CAUSES OF MATERNAL MORTALITY
OBSTETRIC CAUSES OF COAGULOPATHY
COMPLICATIONS OF TWIN PREGNANCY
RISK FACTORS FOR PLACENTA PREVIA
FACTORS CAUSING LARGE FETUS
SIDE EFFECTS OF OC PILLS
FACTORS INFLUENCING RATE OF DIZYGOTIC TWINNING
COMPLICATIONS OF HYDATIDIFORM MOLE
COMPLICATIONS OF TL
COMPLICATIONS OF ABRUPTION
INDICATIONS OF ELECTRONIC FETAL MONITOR (EFM)
COMPLICATIONS OF PREECLAMPSIA
NEW YORK HEART ASSOCIATION (NYHA) CLASSIFICATION
COMPLICATIONS OF ECLAMPSIA
D/D OF 1ST TRIMESTER PAIN OR BLEEDING
COMPLICATIONS OF PLACENTA PREVIA
CONGENITAL RUBELLA (TRIAD OF GREGG)
COMPLICATIONS OF SEVERE ANEMIA
BREATHLESSNESS IN PREGNANCY
COMPLICATIONS OF POST-TERM
ETIOLOGY OF BREECH
PREDISPOSING FACTORS OF SHOULDER DYSTOCIA
DIAGNOSTIC CRITERIA FOR PERIPARTUM CARDIOMYOPATHY
COMPLICATIONS OF LSCS
LSCS IN BREECH
CORD PROLAPSE
NON-ORAL HORMONAL CONTRACEPTIVES
SCREENING OF GESTATIONAL DM ON RISK ASSESSMENT
INDICATIONS OF EPISIOTOMY
STRUCTURES CUT IN EPISIOTOMY
CAUSES OF PLACENTA ACCRETA
INDICATIONS OF HYSTEROSCOPY
CAUSE OF IUGR
SUTURE MATERIAL
ENDOMETRIAL HYPERPLASIA AND PROGRESSION TO CARCINOMA
RISK FACTORS FOR ECTOPIC
PRINCIPLES OF MICROSURGERY
TENDERNESS ON TRANSVERSE CERVICAL MOVEMENTS
BRACHES OF INTERNAL ILIAC ARTERY
PREDISPOSING FACTORS FOR INVERSION
PREDISPOSING FACTORS FOR OBSTRUCTIVE SEPSIS
CAUSES OF ANOVULATION
USG CHARACTERISTICS OF MALIGNANT OVARIAN
REVERSIBLE CAUSES INCONTINENCE (DIAPERS)
ICMR CATEGORIES OF ANEMIA
ENHANCES OF FE ABSORPTION-PROTEIN
FACTORS DECREASING ABSORPTION
D/D OF PELVIC MASS IN REPRODUCTIVE AGE
EVENTS FOLLOWING FERTILIZATION
NORMAL SEMEN ANALYSIS
MALE INFERTILITY
COMPLICATION OF DM IN PREGNANCY
CONVULSION IN PREGNANCY
ACUTE PELVIC PAIN
VULVAL ULCER
TANNER STAGING
DRUGS CONTRAINDICATED IN LACTATION
SERUM MARKERS IN OVARIAN CANCER
FEMALE PRECOCIOUS PUBERTY
COMPLICATIONS OF EPISIOTOMY
CAUSES OF GALACTORRHEA
INDICATIONS FOR HOSPITALIZATION WITH PID
POSTMENOPAUSAL BLEEDING
BISHOP SCORING
HIRSUTISM
PRURITUS VULVAE
APGAR
TIMING IN TWINS
RISK FACTORS FOR PREECLAMPSIA
RUPTURE UTERUS
RISK FACTORS FOR PROM
INDICATION OF LAPAROSCOPY
CHORIOAMNIONITIS
Contraindications of tocolysis (β agonists)
CRITERIA FOR TTTS
DIC PROFILE
HELLP SYNDROME
TIMING OF hCG
ADVANTAGES OR BENEFICIAL EFFECTS OF OC PILLS
MEASURES TO REDUCE OHSS
INDICATIONS OF CONTINUOUS EFM
PRINCIPLES OF MICROSURGERY
PREMATURE OVARIAN FAILURE
DYSPAREUNIA
POSTOPERATIVE FEVER
UTERINE SIZE MORE THAN EXPECTED
PRURITUS IN PREGNANCY
COMPLICATIONS OF VASECTOMY
OBSTRUCTED LABOR
NERVE SUPPLY OF BLADDER
INDICATIONS OF SURGERY IN SYMPTOMATIC FIBROID
COMPLICATIONS OF WERTHEIM'S
NATURAL METHODS OF CONTRACEPTION
COMPLICATIONS OF SHOULDER DYSTOCIA
CORD PROLAPSE
COMPLICATIONS IN PREGNANCY OF ADVANCED MATURITY AGE
INTERPRETATION OF EFM
BASELINE VARIABILITY DECELERATION ACCELERATION
FETAL BLOOD SAMPLE (FBS)
LYMPHATIC DRAINAGE OF UTERUS
Vaginal
Vulva
LIVER FUNCTION TEST (LFT) CHANGES DURING PREGNANCY
URODYNAMIC DATA IN NORMAL FEMALE
PROGESTERONE IN GYNECOLOGY
CAUSES OF MENORRHAGIA IN FIBROIDS
COMPLICATIONS/PROBLEMS IN PRETERM INFANT
THYROID FUNCTION IN PREGNANCY
ANEMIA
DRUGS CONTRAINDICATED IN BREASTFEEDING
RISK FACTORS FOR PROLAPSE
FUNDAL HEIGHT LESS THAN PERIOD OF AMENORRHEA
USG DIFFERENTIATION OF CHRONICITY
INDICATION OF LSCS IN TWINS
FACTORS INCREASING VERTICAL TRANSMISSION OF HIV
ANTI-TUBERCULOSIS: CONTRAINDICATED IN PREGNANCY
POLYMENORRHEA
METRORRHAGIA
OLIGOMENORRHAGIA
HYPOMENORRHEA
CTG DECELERATION
SINUSOIDAL PATTERN
FAILED FORCEPS
ACUTE FETAL DISTRESS
SITES OF URETERIC INJURIES
PREVENTION OF OHSS
INDICATIONS OF IUI
AIH
AIDS
RISK FACTORS FOR MACROSOMIA
SECTION 5: PRACTICALS—AN ART, NOT A NIGHTMARE
CHAPTER 18:
About Practical Examinations
CHAPTER 19:
How to Prepare for Practicals
DURING TENURE
Your Routine Work is the Best Place to Get Practical Knowledge in your Blood
In OPD
In Wards
In Emergency Duties
Example
Learn the Rationality of Investigation
Learn to Write Complete Prescription of Drug you are Prescribing to Patient
Operation Theater
Case Presentations
Contraception
In OPD
CHAPTER 20:
Case Presentation
PAST HISTORY
FAMILY HISTORY
PERSONAL HISTORY
SOCIOECONOMIC HISTORY
DIETARY HISTORY
GENERAL EXAMINATION
Cardiovascular System (CVS) Examination
Auscultation
Respiratory System
Per Abdomen Examination
Palpation
Obstetrical Examination
Auscultation
Local Examination
Diagnosis
COMMON QUESTIONS ASKED
CHAPTER 21:
Ward Rounds
CHAPTER 22:
Mechanism of Normal Labor—How to Answer in Examination
Definition
How to Present Answer in Examination
CHAPTER 23:
Mechanism of Abnormal Labor—How to Answer in Examination
CHAPTER 24:
Answering Some Common Clinical Questions
SECTION 6: APPENDIX
CHAPTER 25:
Topicwise Questions
GYNECOLOGY
Anatomy
Normal Histology
Physiology
Puberty
Menopause
Uterine Malformations
Vulva
Vagina
Sexually Transmitted Diseases (STD)
Tuberculosis (TB)
Injuries to Genital Tract Disease of Urinary System
Fistulas and Stress Urinary Incontinence (SUI)
Infertility
Physiology
Female Infertility
Ovulation Induction
Artificial Reproductive Techniques
Male Infertility
Miscellaneous
Gestational Trophoblastic Disease (GTD)
Disorders of Menstruation
Dysfunctional Uterine Bleeding (DUB)
Hormone Therapy in Gynecology
Prolapse
Fibroid
Disorders of Ovary/Ca
Uterine Ca
Ca Cervix
Pelvic Inflammatory Disease (PID)
Chronic Pelvic Pain
Endometriosis
Breast
Endoscopy
Imaging Modalities
Others
OBSTETRICS
Anatomy
Implantation/Embryogenesis/Placenta
Fetal Growth/Development
Maternal Physiology
Parturition
Counseling
ANC
Abortion
Ectopic Gestation
Genetics
Prenatal Diagnosis (PND) and Fetal Therapy
CHORIONIC VILLUS SAMPLING
Drugs
Antepartum Assessment
USG and Doppler
Normal Labor and Delivery
Intrapartum Assessment
Anesthesia
Abnormal Labor
Disorders of Amniotic Fluid
Induction of Labor
Instrumental Delivery
Breech
Cesarean Section (CS)
Abnormalities of Placenta/UC/Membranes
Newborn
Disease and Injuries to Fetus
Puerperium
Puerperal Infection
Contraception
Sterilization
Hypertension (HTN)
OBSTETRICAL HEMORRHAGE
Antepartum
Postpartum
Preterm Delivery (PTD)
Post-term
Fetal Growth Disorders
Multifetal Gestation
Heart Disease
Pulmonary Disorders Thromboembolic Disorders
Renal and Urinary Tract Disorders
Gastrointestinal (GI) Disorders
Hepatic/Biliary/Pancreatic Disorders
Hematological Disorders
Diabetes
Endocrine Disorders
Connective Tissue Disorders
Psychiatric Disorders
Dermatological Disorders
Neoplastic Diseases
Others
CHAPTER 26:
Sample Cases for Presentation and Discussion
LONG CASES
Obstetrics—Normal Term Pregnancy
Gynecology
SHORT CASES
Obstetrics
Gynecology
CHAPTER 27:
Books and Journals Which Candidate Must Read/Refer
OBSTETRICS
GYNECOLOGY
LIST OF BOOKS—MUST REFER
List of Journals—Indian
LIST OF JOURNALS—FOREIGN
INDEX
TOC
Index
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