gynecology examination question

I apologize first for any grammar or spelling mistake, need to rely on my short term memory, so as time goes by my memory fades off fast. Need to do everthing quick so mistakes are inevitable, anyway hope this could be of some help.

Note: answer only provided to those questions whose answer are beyond comprehension. In simple language, weird answer for weird question.

1. A women with Stage 3b cervical carcinoma, came in with bilateral leg swelling and abdominal pain.
a. what is stage 3b

b. what causes her bilateral leg swelling and abdominal pain
pelvic nerve compression, lymph node involvement, severe tumour till it compress inferior vena cava, pelvic bone metastasize.

c. now discuss your management plan
bad prognosis tumour
discuss to family member years of survival
need to plan for palliative care, radiotherapy, chemotherapy, and surgery.
give her morphine

d. what complication develop from the treatment given in question c. .
complications of morphine
complications of chemotherapy
complications of surgery
complication of radiotherapy

2. A women having done anterior copoherography for her cyctocele with vaginal hysterectomy. 6 hours later having breathing difficulty and raise pulse rate.
a. 2 diagnosis as to what cause her breathing difficulty and raise pulse rate.
Respiratory causes: lung collapse, aspiration, pulmonary embolism
CVS causes: heart failure

b. 4 investigation for the above condition and their value of ding so.
Chest x-ray
Spiral CT
ECG
ABG, blood oxygen level.

Now 8 hours later while pulling out catather see urine leaking from the vagina
c. what causes the vagina leaking, reasons
vesico-vagino fistula
utero-urethra fistula
neurogenic bladder (this answer is acceptable, cause women can’t differentiate source of urine, so be creative)

d. how to treat the above problem.

4. women came in with preterm premature rupture of membrane, at 24 weeks of gestation. Examination review nothing except, uterus at 32 cm, fluid thrill positive. Had 2 previous miscarriage before
a. what investigation need to be done, explain reasons
ultrasound
MGTT
Rhesus and blood group
high vaginal swap

for normal delivery to progress, need intrauterine blood transfusion, deliver by cesarian section at 32 weeks of gestation
b. diagnosis:
rhesus incompatabilty
blood grp incompatabilty
isoimunization

c. further management plan for the mother after delivery
Tell the mother the problem.
Advice on contraception
Future pregnancy needs intensive management.
Note: giving anti-rhesus immunoglobulin is not indicated, previous miscarriage had sensitize mother.

4. A 47 years old women having diagnose with uterine fibroid, she weight 97 kg, presented with sever emenorrhagia for 6 months.
a. how to manage her
b. she now insists on having surgery, what 2 option did she have, and reason out.(reason base on trigger)
Now she presented with unilateral leg swelling, which is painful.
c. diagnosis
d. what is her risk factor
e. treatment

5. 19 year old, factory operator, came in for emergency contraception.
A. 2 important history to elicited
Menstrual cycle and period of amenorrhea
Multiple sexual partner
Previous medical problem
B. 2 methods of emergency contraception, precautions
Yuzpe’s method
IUCD
5 weeks later, she develop severe abdominal pain with per vaginal bleeding, she is fainting.
C. diagnosis
Ruptured ectopic pregnancy.
Acute dysmenorrheal
Miscarriage
Twisted ovarian cyst (any cause of gynecological acute abdomen)
D. treatment plan for the above question

A contribution by the former president of ASS.