OBGY | Image Based Revision Session for NEETPG & FMGE || Dr. Deepti Bahl

0:50Ani everyone so a very good evening to

0:52all of you good evening and uh we are

0:56back with the image based session on

0:58YouTube and let's hope to make it

1:01absolutely High yielding right so my

1:04goal is to cover some important uh

1:06images but also you know to tell you the

1:09most important questions that can come

1:12around those images also you everyone

1:15who you know joins in my live session

1:18they should know by now that when we do

1:21a live session what are you supposed to

1:23do you are supposed to maintain a scorec

1:26card yes so is everyone ready with their

1:29sheet of paper paper okay so I want

1:32everyone to sort of Mark their uh answer

1:37not only in the chat box but also in

1:41their sheet of paper and then you're

1:42going to share me your marks right so

1:46everyone are you going to share your

1:47marks with me right post uh the session

1:51share the marks out of 20 so we will be

1:53covering 20 high yield mcqs and I have

1:57taken into consideration both my dear

1:59dear bachas the fmg bachas as well as

2:03the neat PG so we are going to cover

2:05topics which are important for both

2:07exams so everyone whether you are an fmg

2:11student preparing for the upcoming exams

2:13or neat PG exams irrespective of the

2:16exam whatever we will cover is going to

2:19be very very important for the exams

2:22right so uh we will do that also please

2:25don't worry the annotated PDF will be

2:28provided to you after the class okay uh

2:31on the dams daily official Channel we

2:34have posted the telegram link as well

2:37yes so everyone ready no abai the scores

2:41so just in case people who have joined

2:42in right now everyone has to maintain a

2:45sheet of paper as well as uh you are

2:48going to tell your answers in the chat

2:51box yes and in the end everybody is

2:54going to tell me their scores so

2:56everyone ready can we

2:58start all right right so let's look at

3:01the first question and you're all going

3:04to come at your answer here so what can

3:08be confirmed about the placenta being

3:10examined here right so look at this and

3:13tell me what can you tell about the

3:15placenta being examined here I'm just

3:18giving you a couple of seconds to

3:20comment your answer in the chat box yes

3:24don't guess your score just put the

3:27answer

3:28now yes so what is the answer is this

3:31placental image that is shown I'm going

3:33to just enlarge the image also for you

3:36right so for everyone I'm going to

3:38enlarge the image and I want you to tell

3:40me what is or what can be confirmed

3:44about the placenta shown here right so

3:47now I think everybody has seen the

3:50placental image and you've started to

3:52comment your answers so let's see what

3:55this is going to be so what are the

3:58options da otic monozygotic one Chon and

4:01two amnion or two chons and two amnion

4:05okay I knew some of you would get

4:07trapped in this but this is exactly why

4:10I wanted you to learn the concepts now

4:14I'm sure you know one of the concept

4:16that if you see four layers in the

4:19dividing membrane yes what is the type

4:22of placenta if you see four layers so

4:24one of the signs is that if you see four

4:28layers in the dividing membrane then we

4:30say this is a marker of dorion city

4:34right but the problem is that a lot of

4:36you will not be able to count four

4:38layers here is that right you could

4:41probably count only three layers am I

4:44right yes maybe some of you are thinking

4:47it as three less and that's where the

4:50confusion arises so that is why some of

4:53you are answering it as option number c

4:58that is a incorrect okay please

5:02understand here the coron is not outside

5:05the coron is in between the two amnon so

5:09can you now think and tell me if the

5:12coron enters between the dividing

5:14membrane right or between the two amnon

5:17what is it going to be yes so if the

5:21coron enters the region what is going to

5:25be the answer so coron enters the

5:28dividing membrane

5:30do you remember that this is what is the

5:32reason for Twin Peak sign do you all

5:36remember we see the Twin Peak sign on

5:39ultrasound and that is because the coron

5:42enters the dividing membrane so the two

5:44corons have actually fused so they look

5:47like one but it's a thick cor on there

5:49right so it's a thick coron there so

5:52this is actually a dionic placenta do

5:56you all understand that so this is a

5:58doron IC and obviously then this is

6:02diamniotic but why is it option A why is

6:07option A wrong why is option b wrong so

6:11please remember when it is dichorionic

6:15if you all remember do you understand

6:17that it could be dizygotic and it could

6:20be

6:21monozygotic yes so we cannot confirm

6:24that when you see this placenta is it

6:26going to be dizygotic or monozygotic

6:29because both can be

6:32dichorionic right so that is why beta G

6:35option A and option b are incorrect see

6:39this is the art you have to learn almost

6:41everyone would know the theory would

6:43know the content but are you able to

6:45apply the content or not is the key

6:47thing you know the signs you know the

6:49dividing membrane but still some of you

6:51could get confused right so that is why

6:55beta G the only thing that can be

6:58confirmed about this kind of placenta is

7:01that it is dichorionic and diamniotic so

7:05the answer is D Now quickly if you can

7:09tell me the following High yielding

7:11points and I'm going to write about it

7:14so I'm going to cover five high yielding

7:15points apart from the image itself so

7:18question number one each of you keep

7:20marking your score if I say what is the

7:23best sign of dorion City what would be

7:26the answer what is the best sign of

7:29dorion City then the answer is going to

7:33be in case you see two placentas so

7:38anytime in the McQ you see two placentas

7:42it has to be dichorionic this is the

7:44best sign the other good sign which

7:47could be the second best answer is if

7:50you see opposite sex twins on ultrasound

7:53but you know sex determination is not

7:56allowed in India right so for us the

7:58best answer would be if you see two

8:00separate placentas yes the next McQ is

8:03we know about the Lambda sign which is

8:06also called as Twin Peak sign am I right

8:10I want to know from you at what

8:13P okay at what P would you see the

8:16Lambda sign or the Twin Peak sign anyone

8:18at what P right so the answer is going

8:21to be 10 to 14 weeks okay what is the

8:25named sign that you see in mono coroni

8:28City so if it is monochorionic it is

8:32going to be T sign right sometimes also

8:35called as the inverted T sign so this is

8:37a marker of

8:40monochorionicity okay then next

8:42important question right the next

8:44important question I want to ask you is

8:47when I say this is dichorionic

8:48diamniotic in case this is monozygotic

8:51Twin at what time the cell division

8:54might have happened so if it is

8:57dcda and it is monocytic then the cell

9:01division would have happened in the

9:03first 72 hours or first 3 days right

9:09this is time when the cell division

9:11would happen and it would produce what

9:14it would produce a dichorionic and

9:17diamniotic placenta is that clear okay

9:20last question if it is

9:24monozygotic right so if the twins are

9:26monozygotic can you tell me what is the

9:29most common type of uh you know twin

9:34here so in monozygotic twins in general

9:37right what is the most common type of

9:39twin so that's the keyword if we ask you

9:42most common in

9:44monozygotic the answer is

9:47mcda okay the answer is monoionic and

9:53diamniotic but if we ask you in general

9:56which is the most common type of twin so

9:58in general the most common type of twin

10:01are Di zygotic and they would always be

10:05D chorionic and diamniotic right so di

10:09zygotic so in general the answer is dcda

10:13but here if we ask you about monozygotic

10:16it will be mcda ready so this was the

10:20first question of the day I hope you

10:22could get the catch in the question so

10:24I'm glad so many of you have answered

10:26correctly and I hope the ones who did it

10:28wrong would not do it wrong in the real

10:30exam okay are you finding this High

10:32healing should we move on to the next

10:34question and everyone who is joining in

10:38now you have to maintain your scorecard

10:41okay so let's go on to the next question

10:45of the

10:47day okay what is the iology of

10:51hydramnios in the condition depicted by

10:53the following V this thing right what is

10:56the iology of poly hros in the condition

11:00shown below okay tell me now what is the

11:05answer what is the answer so is it

11:08because of uh okay first you have to

11:10identify the image this is a very

11:12characteristic image and I'm sure you

11:14would not do it wrong the idea is not to

11:16do the image wrong but also not do any

11:19Associated question wrong right so yes

11:23this is an image of Anin seil okay and

11:27please remember it is is one of the most

11:30common neural tube defect okay so it is

11:34one of the most common neural tube

11:36defect so now we are asking you what is

11:39the cause of polyhydramnios in this

11:42condition tell me so is it reduced

11:45swelling uh swallowing is it increased

11:48maternal glucose is it increased

11:50production of urine or is it Association

11:53of tracho isop fasial fistula right what

11:55is the answer yes I think almost

11:59everyone has done it correct so you are

12:01right the answer is reduced fetal

12:05swallowing right so in anly please don't

12:08answer it as leakage of CSF okay so the

12:12main reason for polyhydramnios is not

12:15leakage of CSF it is reduced swallowing

12:19right okay now coming to very very

12:22important Association conditions yes so

12:24the sign we see here is called as Frog

12:28ice sign yes so this is the frog eye

12:31sign and it's characteristic to Anan and

12:36you should know that we also call it as

12:38what Mickey Mouse sign yes so we also

12:40call it as a Mickey Mouse sign are you

12:42ready for the next five high yielding

12:44points about it and I'm sure you're

12:46going to answer each one of them so the

12:49first question for you is how early can

12:53you diagnose anon sephy on ultrasound

12:56yes so how early can you diagnose Anin

13:00sey on

13:03ultrasound yes hydramnios is the other

13:06word for

13:07polyhydramnios right not for

13:10oligohydramnios okay so we should know

13:12even if you can't understand you have to

13:14know that in Anin sephi it is always

13:17polyhydramnios it's not oigo hydramnios

13:21okay so what we mean here is poly don't

13:24overthink in the mcqs baa all right so

13:27yes how early as early as 10 weeks so

13:34anany can be diagnosed as early as 10

13:38weeks on ultrasound so this makes it the

13:43anomaly which can be

13:46diagnosed okay so this is the anomaly

13:48which can be diagnosed earliest on

13:51ultrasound so when we ask this question

13:53other way around some of you go and

13:56answer it as Down syndrome so it's not

13:58Downs Downs is not diagnosed on

14:00ultrasound so when we ask you which

14:02anomaly is diagnosed earliest on

14:04ultrasound it has to be anony it's

14:06diagnosed at 10 weeks are you ready for

14:08the next

14:09question okay the next question for you

14:12is if a lady has previous history of a

14:15baby with Anan seil okay so if this

14:19woman has a previous history of

14:22Anan what is the dose of folic acid do

14:26you want to give to her what is the dose

14:28of folic CET do you want to give to her

14:30that's the next important point so I'm

14:33sure you will all answer it correctly

14:35the minimum requirement is 4 mgram right

14:39so the minimum requirement is 4 MGR and

14:42minimum requirement is you started 3

14:45months before to 3 months after

14:48conception see that is the minimum

14:50requirement okay so yes 4

14:53mg is the answer here is that clear to

14:57everyone okay per perfect very good in

15:00which other condition do you give 4 mgam

15:03right in which other condition do you

15:05give 4 migs so the other condition where

15:08we give it is

15:11anti-epileptics right so if the woman is

15:13on

15:14anti-epileptics then also she will

15:16receive a high dose okay quickly tell me

15:20can you tell me what would be the dose

15:22of folic acid for profy axis that we

15:26routinely give to all pregnant women so

15:28if if we are giving routinely to all

15:30pregnant women then the general answer

15:33for profy

15:37axis okay so General answer for profil

15:41axis for all pregnant women is how much

15:47yes so for all pregnant women the answer

15:50is 0.4 mg remember even in a diabetic

15:55pregnancy it will be 0.4 so don't get

15:57confused even for a diabetic it has to

16:00be 0.4 but if they say diabetic with

16:03neural tube defect then it becomes four

16:06okay next question can you tell me when

16:09it comes to an andle will it be

16:12associated with pre-term labor or

16:14postterm labor quickly so Anan SEI has

16:19polyhydramnios so will there be pre-term

16:21labor or postterm labor so yes please

16:25remember what is more common is

16:29postterm labor pre-term can also happen

16:32but if we have to pick one of the two

16:35then more common is postterm labor yes

16:38so because the brain matter is absent so

16:40HP AIS is not active and the fetal

16:43adrenal gland will not be active so

16:45estrogen production would go down right

16:48so postterm labor will be a better

16:50answer okay perfect very good and now I

16:54want to ask you not exactly related to

16:57an inly but maybe you can tell me

16:59because it's an important question which

17:01is in general the most specific anomaly

17:07okay which is in general the most

17:10specific anomaly in a diabetic pregnancy

17:13can you tell

17:14me and please remember when we say

17:17diabetic pregnancy the only diabetes in

17:20which you see anomalies are which type

17:22of Diabetes

17:24pregestational yes so then it will be

17:27seen only only in pregestational not in

17:31gestational and what is the most

17:33specific anomaly yes the most specific

17:36anomally will be codal regression

17:39syndrome which is also called as sacral

17:43a Genesis perfect okay so codal

17:46regression

17:48syndrome or sacral a Genesis some of you

17:52are saying cardiovascular or vssd no

17:56vssd is the most common anomaly not the

18:00most specific okay shoulder dystocia is

18:04not an anomaly B okay so the answer is

18:08uh sacral a Genesis again TGA is

18:11incorrect TGA is most specific within

18:15cardiovascular system not overall most

18:18specific so in general overall most

18:20specific is cordal regression or sacral

18:23a Genesis perfect are you ready for the

18:26next question yes so now we are bringing

18:30question number three and question

18:32number two was very easy for everyone so

18:34let's see how you will do in question

18:36number three so your patient is a

18:3938-year old woman she has presented for

18:42first trimester screening of downs at 12

18:44weeks the ultrasound image below is

18:47shown what is the next step in her

18:51evaluation right so what is the next

18:55step in her evaluation can you tell me

18:57the answer so now this is this

19:02is uh an applied McQ so the image that

19:05you see here if I enlarge for you is an

19:09image of nucle

19:11translucency and it seems increased yes

19:15so nucal translucency seems increased

19:19and we are asking you what are you going

19:20to do next okay so I have all answers

19:24except B so somebody is saying a

19:27somebody is saying uh B somebody is

19:29saying D I think and C as well so we

19:33have all the answers so which one is

19:36correct are you are you ready which one

19:38is

19:39correct okay so the answer is is is B oh

19:45sorry sorry sorry sorry the answer here

19:48is going to be a but you have to be very

19:52careful here okay in the option b I have

19:56given the answer as Cordo centesis in

20:00case they give you in the real exam the

20:04option as coric Willis sampling okay if

20:09they give you the answer as chonic

20:11Willis sampling then what the answer

20:13would be yes then the answer would

20:16change to chonic Willis sampling right

20:20so then konic Willis

20:23sampling is the a better answer than

20:26amnios synthesis but in this question

20:29since it's written as Cordo we are going

20:32to you know say it as a do you

20:35understand why CVS becomes better yes be

20:39very careful I knew some of you would

20:41read Cordo differently right so please

20:44remember the patient is in the first

20:48trimester are you all ready so we're

20:49going to do the points about it now so

20:52the patient is in the first trimester so

20:55if she's in the first trimester you are

20:58are not going to do amnio then right

21:01then the answer would become chonic

21:03Willers sampling that would be a better

21:05answer when in the options now yes I'm

21:09going to explain everything why is the

21:12answer not B okay so why is the answer

21:16not Cordo synesis because Cordo synesis

21:20is done even later than amniocentesis it

21:23is done Beyond 18 weeks and cordoes is

21:28much more risky than what it is much

21:31more risky than amnio so when we have to

21:34prefer you know carot typing we don't do

21:38Cordo we prefer doing

21:41amniocentesis can you tell me in which

21:43condition do you do Cordo RH

21:47incompatibility okay now why is the

21:50answer not quadruple test because I'm

21:53answering all your queries one by one

21:56why is the answer not quadruple test

21:58because if nucle translucency is

22:01increased right and how much of NT is

22:05considered increase that is the first

22:07highing point so please remember if NT

22:11is more than or equal to 3

22:14mm and we ask you next step then it has

22:18to be a diagnostic test so diagnostic

22:22test has to be preferred over

22:26ni okay

22:28noninvasive prenatal test why because ni

22:32is generally used for secondary

22:36screening nip is not a diagnostic test

22:40right so when n is raised our preference

22:43has to be diagnostic test and that is

22:46why nip is not the answer that is also

22:50why quadruple test is not an answer so

22:53ni as I said is used for secondary

22:57screening

22:59and quadruple test is used for primary

23:03screening in the second trimester okay

23:06so it is used for primary screening in

23:09second the only two answers which are

23:11diagnostic here are Cordo and amnio but

23:15out of the two obviously we will prefer

23:17amnio but we have to wait when can you

23:20do amnio synthesis can you tell

23:24me when can you do amnos synthesis so

23:27amn synesis can be done Beyond 15 weeks

23:32okay amnos synesis can be done Beyond

23:35anytime Beyond 15 weeks but remember it

23:38is most commonly done between 16 to 18

23:43weeks okay it is most commonly done

23:45between 16 to 18 weeks yes no problem

23:50you can wait for the diagnostic test and

23:52that is why I said had CVS been in the

23:56options chonic Willis sampling then the

24:00answer would definitely be uh you know

24:03CVS so I'm repeating again if NT is more

24:07than or equal to 3 mm and we are asking

24:10you next step it has to be diagnostic

24:13test and the most best answer is going

24:16to be chonic Willis sampling because

24:19that is something you can do in the

24:21first trimester itself right so next

24:25question when can you do CVS so chonic

24:29Willis sampling can be done any time

24:31Beyond 10 weeks most commonly it is

24:34going to be done between 11 to 13 weeks

24:38right so most commonly it will be done

24:40between 11 to 13 weeks okay

24:44nip when the patient is refusing a

24:47diagnostic test then yes you can do an

24:51nip but please

24:54remember as I said ni is a screening

24:58test so if you do nip and nip is

25:03positive then she has to definitely

25:06undergo diagnostic test right so then

25:10you can't avoid the diagnostic test so

25:12nip will be done only when you know um

25:15the patient is refusing a diagnostic

25:18test because it is invasive right then

25:21you do ni right currently okay can you

25:24or are you ready for next question as

25:27well when I say nip what is the other

25:30name yes it is cellfree

25:34fetal DNA testing cellfree fetal DNA

25:38testing who is going to tell me when can

25:41you do nip at what P can you do nip so

25:45remember nip can be done anytime okay

25:50nip can be done any time Beyond 10 weeks

25:55okay so it can be done any time Beyond

25:57beond 10 weeks quadruple test as I said

26:01gorab ENT is increased so you don't

26:05follow it up with a screening test okay

26:07quadruple test is a screening test that

26:10is something you do when the woman comes

26:12to you directly in the second

26:14trimester okay your next question is

26:17question number five when you talk about

26:20quad test when can you do it so remember

26:24quad test can be done anytime between

26:2815 to 22 weeks okay 15 to 22 weeks most

26:33commonly again 16 to 18 weeks so quad

26:37test most commonly between 16 to 18

26:40weeks now can you tell me in the

26:43components of quad test which two values

26:46are increased which two values are

26:49increased when you do a quad test so

26:52which two are increased so

26:55remember atcg

26:57[Music]

26:59and inhibin a please remember it has to

27:03be inhibin a okay so not B HCG and

27:08inhibin a are increased whereas Alpha

27:13feto protein and ue3 will be decreased

27:17yes so it has to be inhibin a is that

27:20clear to everyone no not inhibin B beta

27:23please be very careful it has to be

27:25inhibin a Okay so Alpha feto protein and

27:29ue3 are decreased okay clear everybody

27:34so this is important and last thing

27:36before I go on to the next question what

27:39is combined test let's see who can

27:41answer what is a combined test anybody

27:45what is a combined test so when we talk

27:47about combined

27:51test it is dual Test Plus NT right so

27:56one is a screen screening test and one

27:58is an N scan so dual Test Plus n is what

28:02is a combined test so combined test is

28:05also a test of first trimester the

28:08problem is you people go and answer when

28:10we say n is increased what will you do

28:13next you go and answer dual test is that

28:15correct or incorrect that is incorrect

28:19because if NT is increased you don't

28:22wait for a screening test as I said you

28:25have to go ahead with a diagnostic test

28:27and the single best answer is going to

28:30be konic vas sampling is that clear to

28:34everyone perfect integrated is when you

28:37do all the tests together first

28:40trimester as well as second trimester

28:42that's what is integrated okay ready

28:45everyone ready for the next

28:48one right let's see if you can do this

28:51one

28:52correct so now question number four

28:54commit your answers here your patient is

28:5828 years old and she is 28 weeks

29:02pregnant the fetal weight is below the

29:04third percentile you do an Amal artery

29:07Doppler for her and the following

29:09waveform is seen the NST is nonreactive

29:14what is the best course of action yes

29:19so commit your answers once you see it

29:22can you identify the graph I think

29:24that's easy the graph identification is

29:27not a problem it

29:30is R DF reversal of end diastolic flow

29:36okay I want to know what is the answer

29:39so yes let's see this number one are we

29:43going to expedite delivery right some of

29:47you did get confused and you started

29:50overthink yes what did what are you

29:52thinking you are thinking McQ May NST is

29:56nonre active so if NST is nonreactive I

30:01think we should expedite delivery did

30:03you think like that did you think like

30:06that that is why exactly I said even if

30:09you know everything but if you overthink

30:12in the exams if you overread you might

30:14do an error right please understand NST

30:18non-reactive is one of the first things

30:20to happen and this baby is definitely

30:23iugr with utr placental insufficiency

30:26yes so a is not correct because the p is

30:31only how much 28 weeks yes the period of

30:36gestation is only 28 weeks so what are

30:40the guidelines for reversal of end

30:43diastolic flow so high yield McQ Point

30:48number one hi everyone to everyone who

30:50is joining new okay High yielding Point

30:52number one in

30:54redf termination of pregnancy is done

30:57done if the p is beyond 32 weeks okay

31:03and the preferred mode is cesarian

31:06section so for redf the preferred mode

31:10is cesarian section okay what are you

31:13going to do if the pregnancy is less

31:16than 32 weeks so if the pregnancy is

31:19less than 32 weeks are we going to uh

31:22give steroid cover yes so we are going

31:26to give

31:27steroid cover I want to know from you

31:30what is the dose of

31:33dexamethasone can you tell me what is

31:35the dose of dexam methasone that we are

31:37going to give yes so we are going to

31:40give 6 mgram four doses 12 hours apart

31:47and it is an IM injection so we are

31:50definitely going to give steroids plus

31:53are we going to do a intensive

31:55monitoring yes

31:57so we are going to do daily

32:01monitoring okay so we are going to do

32:03daily monitoring with NST with

32:06biophysical profile

32:08okay with fetal movements right okay

32:13then are we also going to give mag Sal

32:16yes so very very important if p is less

32:21than 32 weeks you must add mag s which

32:25is given for

32:27neuroprotection right so which means the

32:30answer becomes what the answer becomes

32:33both B and C is that clear everyone so

32:36answer becomes both B and C okay Point

32:41number three when do you do the

32:44termination of pregnancy for absent end

32:47diastolic flow when do you do for

32:51aedf this is done at and Beyond 34 weeks

32:57okay at and Beyond 34 weeks and although

33:00vaginal delivery is not contraindicated

33:03but we generally prefer to do cesarian

33:06over vaginal but as I said vaginal

33:09delivery is not absolutely

33:11contraindicated okay fourth High

33:14yielding Point who is going to tell me

33:17what happens to SD ratio in the Amal

33:20artery in a normal pregnancy okay what

33:25happens to SD ratio in normal pregnancy

33:28as P increases can you tell me what will

33:33happen so as P increases the key word

33:37here is normal pregnancy what will

33:40happen then SD ratio will decrease okay

33:46so SD ratio will decrease but if okay if

33:52it is a uh you know pregnancy with uteru

33:56blast Central

33:58insufficiency okay in UPI what happens

34:02to SD ratio yes SD ratio will increase

34:07okay SD ratio will increase okay ready

34:10for the last point point number five for

34:13this question

34:15is uh when do you start fetal monitoring

34:19with NST with BPP right in a highrisk

34:23pregnancy so my question is in high risk

34:28pregnancy when do we start fetal

34:32monitoring what is the single best

34:35answer when should we start fetal

34:39monitoring in a high-risk pregnancy come

34:41on tell

34:43me yes so in a highrisk pregnancy the

34:47monitoring has to begin at 302 weeks why

34:52because at 32 weeks the baby will be

34:56neurologically mature so the tests that

34:59you do become more reliable right what

35:02will happen at less than 32 weeks at

35:04less than 32 weeks the baby is not

35:07neurologically matured so a lot of tests

35:10that you do may come out abnormal and

35:13they are not very reliable is that clear

35:16to

35:17everyone perfect okay how many of you

35:20got this one correct and then we move on

35:22to question number five are you all

35:23maintaining your score so far anybody

35:26has scored 5x five has anyone scored 5x5

35:30so

35:31far okay let's move on to the next

35:35question of the day a lady presents with

35:37history of bleeding at 12 weeks yes and

35:42the following tissue was expelled with

35:44blood okay and an ultrasound was done

35:48right so we have given you the

35:49ultrasound image what all will be

35:52characteristic of this type of pregnancy

35:56except so all the following are

35:58characteristic of this type of pregnancy

36:00except so what is the

36:03finding okay the finding is very simple

36:06everybody can pick up the finding so if

36:08you realize the problem is usually not

36:11the images the problem is if they make

36:14it into an application question okay so

36:17now tell me we all understand that this

36:22is snow storm appearance which is also

36:26called

36:27as honey kumb appearance and I want you

36:30to tell me what is it characteristic of

36:33yes it is a characteristic of complete

36:37mole yes now with respect to complete

36:40mole you have to say which is not

36:43correct the question has an accept so

36:45what is the answer is deployed kot type

36:48yes so please remember high yield Point

36:52number one the most common karot

36:55type incomplete mole is 46 XX this is

37:01what you see in 80 to 90% of patients

37:05okay do you see theal tin syst yes very

37:08very important complete moles will be

37:11associated with

37:13bilateral

37:15thaline cyst who is going to tell me

37:18what is the reason for the thaline cyst

37:20very high atcg levels so we all remember

37:25that

37:28complete mole has very high HCG levels

37:33sometimes it can be more than 10 the

37:35power of 5 and then what is going to

37:38happen the alpha subunit of HCG is

37:41absolutely identical to Alpha of FSH LH

37:46and TSH so because it resembles FSH and

37:50LH it stimulates the ovaries perfect

37:53very good point number three do you see

37:56focal vus edema no that is what is the

38:01answer here please remember focal villis

38:04edema is actually a feature

38:08of partial mole not of complete mole

38:12what do you get in complete mole in

38:14complete mole it has to be a complete

38:18hydropic degeneration of the

38:22placenta right so it is a complete

38:25hydropic degeneration of placenta in a

38:29complete mole not focal okay and is

38:33option number D correct yes what is the

38:36risk of

38:38conversion okay so risk of conversion to

38:42gtn in complete mole what is the answer

38:46so for complete mole the risk of

38:47conversion is 15 to 20% yes 15 to 20% we

38:55move on to point number five if it is a

38:58partial mole what is the most common

39:01karot type okay so here it is going to

39:05be 69 XX y right so it is triploid and

39:11remember partial moles are

39:15dispermic okay whereas complete moles

39:18are going to be

39:20monospermic right so they are

39:23monospermic and 46x X is that clear to

39:28everyone perfect and what is the risk of

39:31conversion to gtn in a partial mole so

39:35in a partial mole the risk is only

39:38around 3 to 5% okay so these are the

39:42five most high yielding points and if

39:45they ask you a very simple question they

39:47show you the image and they ask you

39:49treatment of choice what would be the

39:51answer so I'm just going to write it

39:53with a different color right so when it

39:55is uh a complete mole what is the

39:59treatment of choice suction and

40:02evacuation yes so suction and evacuation

40:06okay so I think this one was easy for

40:09everyone are you ready for the next one

40:12okay ready ready ready so ready steady

40:16go the following fetal position is seen

40:19in which type of maternal pelvis right

40:23so it is seen in which type of maternal

40:25pelvis so if anyone has attended my

40:28class you know what position is this so

40:31you look at the Triangular

40:35Fontanel and this triangular Fontanel is

40:39close to sacrum right so it is oxy

40:44posterior and because it is my left it

40:47will be patient's right so what is the

40:51position the position is Right oxy

40:55posterior

40:56yes the position is right oxpo posterior

41:00now once you know it is right oxpo

41:03posterior yes which is going to be the

41:06pelvis now we know it is not gynecoid we

41:09all know it is not platti piloid so as

41:11usual we will be able to rule out two

41:13options and we will always get confused

41:15with two like some of you are answering

41:17B some of you are answering it as C so

41:20what is the correct answer the answer is

41:24B okay please

41:28remember most common cause of op and in

41:33op the most common position is r o okay

41:38so in op the most common position is ROP

41:42and the most common cause of oxto

41:46posterior in general is Android okay in

41:51general it is Android but if I write a

41:55prefix in front of it so if we ask you

41:58persistent op or which is also called as

42:04direct op so persistent op and direct op

42:08are same so if in case in the exam and

42:11these are famous mcqs for fmg also and

42:15neat PG also so if you write a prefix in

42:17front of it then yes you will change the

42:20answer to

42:22anthropoid okay then the answer is going

42:25to be anthropoid

42:26okay perfect please don't confuse you

42:30know uh these two they are very very

42:32important next important point with

42:35respect to op can you tell me when we

42:39talk about oxpo posterior what findings

42:43on PA exam help you in making a

42:48diagnosis right so what findings on a PA

42:51exam help you make the diagnosis so

42:53these

42:54are infra umal

42:58flattening yes so there will be infra

43:02umal

43:04flattening where would the limbs be so

43:07please remember fetal limbs are towards

43:13midline where is the back more towards

43:17the flanks yes so back is going to be

43:21towards the

43:24flanks where is the fetal heart

43:27yes again towards

43:30flanks and the anterior shoulder away

43:34from midline right anterior shoulder

43:37away from midline so these are the

43:40findings on a PA exam are you ready for

43:43Point number four okay so Point number

43:46four can you tell me the engaging

43:48diameter in op who is going to tell me

43:52engaging diameter in oxpo posterior so

43:56remember when we say engaging diameter

43:59the head is deflexed usually in op and

44:04if it is deflexed the engaging diameter

44:06is going to

44:08be

44:10oxy frontal okay oxy frontal and if that

44:15is not in the answers or options you

44:18will Mark sub Oxo frontal yes so then

44:22you will Mark sub Oyo front Al so but if

44:27oxpo frontal is in the options that is

44:30what you're going to Mark no B sub Oyo

44:33bregmatic is what you see in vertex when

44:37the head is well flexed here please

44:40remember the head is deflexed so it is

44:43oxy frontal is that clear perfect Point

44:48number five please remember that there

44:52is slow progress of Labor

44:56okay there is slow progress of Labor in

45:00op and when they ask you what is the

45:03management of slow progress of Labor in

45:06op what are you going to answer then we

45:09are going to answer weight and watch

45:13right so for slow progress of Labor we

45:15are going to Mark weight and watch so

45:18everybody good with me I'm trying to

45:19give you the more High most high

45:21yielding Five Points around it as well

45:24do you find it useful yes so I'm trying

45:28so that you can revise the topic itself

45:30here with me especially the must knows

45:33right we can't cover everything but we

45:35must know the must knows yes okay are

45:38you ready for the next question

45:41everyone okay so I have if you realize

45:44what have I done I have alternated the

45:48difficulty level yes so one question

45:51gives you a boost that yay I could get

45:53it right and one question tells you oh I

45:56should read more right this is what we

45:58need in the exam a balance of confidence

46:02but not

46:03overconfidence right so that is why I've

46:05just alternated one very easy with one

46:08little tricky question not very tricky

46:11the difficulty level is moderate of

46:13today's test okay so what deceleration

46:17can you all see here so if you see the

46:22deceleration starts at the peak of the

46:26contraction yes it is not starting with

46:29the onset it is starting with the peak

46:32of the contraction

46:34so then after that there is a gradual

46:38fall and a gradual pickup yes and

46:44the deceleration is persisting even

46:48after the contraction so please remember

46:52if you see features where there

46:54is delay in the

47:00onset because there will be onset which

47:03is at the peak of

47:06contraction so if you see it at the peak

47:08of the contraction there is a delay in

47:10the onset it is a gradual fall and a

47:14gradual pickup and the deceleration will

47:19persist after the contraction for some

47:22time so if it is persisting after the

47:25contraction it cannot be variable beta G

47:29right so these are features of late

47:33deceleration do you all get it don't do

47:36this wrong Bap partti okay so this is

47:39going to be late deceleration Now

47:41quickly tell me if it is late

47:43deceleration what is the cause yes it is

47:49uteroplacental

47:51insufficiency yes so I think a lot of

47:53you have got it right some of you have

47:55got it wrong WR but no problem we can

47:57always get better what are other

47:59important things I want you to know so

48:01Point number

48:02one head compression is seen with or

48:06will cause which kind of

48:08deceleration so with head compression

48:11you will see early deceleration right so

48:14then it will be

48:17early with cord compression what will

48:20you see yes with cord compression you

48:23will see variable

48:26deceleration which one will you see with

48:28severe fetal

48:31anemia so with severe fetal anemia it is

48:34going to be sinusoidal pattern okay in

48:40general which is the which is the one

48:43which has the worst outcome so out of

48:47these the worst outcome is seen with

48:51sinusoidal followed by which one the uh

48:55late

48:56decelerations right so the worst outcome

48:59is with sinusoidal followed by late

49:02decelerations but please remember the

49:05most common type of

49:08deceleration in general during labor

49:11which one so most common type of

49:14deceleration during labor is actually

49:17variable deceleration okay it is

49:20variable deceleration and lastly can you

49:23tell me if there is a ooh

49:27hydramnios yes if there is oigo

49:31hydramnios which deceleration are you

49:34likely to see in labor okay so if there

49:37is oigo hydramnios which deceleration

49:41are you likely to see yes so please

49:45remember oligohydramnios will show you

49:48variable deceleration do you know the

49:50reason why because because why because

49:54there is C comp compression in oigo

49:57right so it will produce variable

49:59decelerations okay so moving on to the

50:03next question are you ready for the next

50:05one yes okay let's look at this so

50:11incorrect about the procedure shown

50:14below can you all see the procedure I'm

50:16sure you can all identify what procedure

50:18is this so this is nothing but yes a

50:23cervical circlar

50:27and we have to say what statement is

50:29incorrect also which type of cirage is

50:32this yes this is

50:35McDonald's which we also call as Pur

50:39string right so it is a Pur string

50:41future now let's see what statement is

50:44incorrect okay some of you are giving me

50:48the answers let's check if you're right

50:50or wrong now can they do it if the

50:53cervix is fully dilated it yes this is

50:58true so some of you have marked answer a

51:00so no a is true you can do it and this

51:03is what is called as examination based

51:08Circle arge okay so this is examination

51:13based circlage and it is also called as

51:17so I'm also covering High yielding

51:18points so when it is fully dilated and

51:21you put a circlar it is also called as

51:24res cir Lage right so it is also called

51:28as rescue cirage okay perfect let's go

51:33on

51:34to can it be used for prevention of

51:37pre-term Labor yes but you have to tell

51:41me about option C this is the high point

51:44number two when do you do it for

51:46pre-term labor so when your patient has

51:49history of pre-term

51:52Labor and along with that she has short

51:58cix so she has a previous history and

52:02now she has a short cix can you tell me

52:05what is the cut off of short cervix yes

52:08so less than 25 mm right so if she has a

52:13history of pre-term Labor and a short

52:15cervix I will put a circlage for her

52:18please remember whenever you put a

52:21cirage we will also add progesterone

52:24right so

52:26cirage plus progesterone will be be

52:29therapy for her for prevention

52:32okay okay so ultrasound indicated

52:36circlage is when women have history of

52:41abortion but it is not three abortions

52:45right so please remember there is

52:47history of abortion but not three so if

52:50there is history of abortion in second

52:53trimester okay which

52:56is okay if there is history in the

52:59second trimester which is

53:03painless okay which is painless so

53:06mid-trimester painless abortion and if

53:10she has again what short cervix then

53:14this is called as ultrasound indicated

53:18circlage right so then this is

53:20ultrasound indicated circlage point

53:23number four high yielding point can you

53:26tell me what is history indicated

53:30circlage so what is history indicated

53:32circl if she has more than or equal to

53:36three

53:38abortions in second

53:41trimester which are

53:43painless right then you don't even need

53:46to do an ultrasound you can directly put

53:49a circlage in the next pregnancy and

53:51this is what is called as history

53:54indicated circlage so which means the

53:57option is our answer is B very very

54:01important because we had to answer the

54:03incorrect statement so please remember

54:06ruptured membrane so high yield Point

54:10number

54:11five okay is absolute contraindications

54:16for circlage and the most important one

54:20is ruptured membranes okay so the most

54:23important one is ruptured membrane but

54:26apart from that gross congenital anomaly

54:30which is incompatible with life like

54:34analy third important contraindication

54:38is current pelvic infection so these are

54:43the absolute contraindications to put a

54:46circlar yes what is the ideal

54:48time the ideal time is around 12 to 14

54:53weeks if you have to mark mark one

54:55answer it should be 14 weeks okay then

54:59it should be 14 weeks good to go

55:01everyone ready for the next question

55:04okay so we are covering one image based

55:07question but we are covering five more

55:09High yielding points about it keep track

55:11of your score we are reaching on to

55:14question number nine so now the question

55:17is what is not true about the device

55:20shown

55:23below so what is this

55:26device yes this is a MVA

55:31syringe okay it is an MVA syringe now

55:35once we know this what is not true let's

55:38look at this can you all Comm at your

55:41answers what are the answers yes so

55:45let's look at this it is a method of

55:47second trimester abortion yes so I said

55:51I am alternating one medium difficulty

55:54with one easy question right so the

55:57answer is a it is not a method of second

56:00trimester abortion so the first high

56:03heing point about it is that it is a

56:05method of first trimester abortion and

56:10it can be done therefore up to 12 weeks

56:14okay so it can be done up to 12 weeks I

56:17knew some of you would go with option b

56:21because you're so stuck with the value

56:24okay sometimes please understand the

56:26value may not match but some other

56:29option is more obviously wrong so that

56:31is what is McQ skill yes it can be 660

56:36that is the single best answer but I

56:38always teach in my class that if 660 is

56:41not there 600 is what is the usual

56:44pressure we generate so yes 660 is a

56:47better answer but 600 is not incorrect

56:51buta okay more incorrect statement here

56:54is is a it is obviously wrong and it's a

56:57big no okay does not need electricity

57:02that is correct okay so that is a true

57:05statement that is how this is different

57:06from suction and evacuation so suction

57:10evacuation needs electricity and it is a

57:1360 ml syringe that is also true okay now

57:18quickly tell

57:20me which other is the surgical method

57:23for first trimester of abortion so

57:25another alternative for first trimester

57:28abortion and I am talking about surgical

57:31method apart from MVA there is suction

57:35and

57:37evacuation so remember suction

57:39evacuation can also be done up till up

57:42to what time up to 12 weeks the pressure

57:46is again similar 600 mm of mercury okay

57:51DNC no no no now please remember B as I

57:55have told this in class also

57:58DNC was a very old method of first

58:02trimester abortion it is not used now

58:05now the only two methods for surgical

58:08abortion in the first trimester are

58:10suction evacuation and MBA DNC was an

58:14older first trimester method but it is

58:18not approved now now it is not in the

58:22MTP act okay

58:25so let's move on to high yielding Point

58:28number three medical abortion as per the

58:31government of India guidelines can be

58:34done up to what time can you tell me

58:38medical abortion as per the MTP act can

58:41be done up to what P so up to 9 weeks so

58:47it is now approved up to 9 weeks yes

58:51okay Point number four can you tell me

58:55the drug dose for Mii

58:58priston as well as the root and after 48

59:02hours we are going to give tab

59:06misoprostol so can you tell me the dose

59:09and root okay can you tell me the dose

59:12and

59:13root yes so correct so myy Prestone will

59:18be 200 mg yes and it is oral okay okay

59:25so it is oral dose what about

59:27misoprostol so now there is a single

59:30answer which is

59:32800 microgram okay 800 microgram it can

59:37be given sublingual or Buckle or oral or

59:43vaginal yes any root but the dose

59:46remains as 800 buta you are confusing

59:50MTP can be done up to so these are two

59:52different questions when I say medical

59:55abortion can be done up to we mean MMA

59:59methods medical methods of outp portion

1:00:02abortion they are done up to 9 weeks

1:00:06please don't confuse this if they give

1:00:09you a statement like MTP can be done up

1:00:13to okay so yes MTP as per the government

1:00:17guidelines now can be done up to 24

1:00:21weeks okay can be done up to 24 weeks I

1:00:25hope I have made it clear I don't want

1:00:27you to do this mistake okay now please

1:00:30remember okay please remember up to 20

1:00:34weeks we need opinion

1:00:38of one rmp registered medical

1:00:42practitioner and from 20 to 24 weeks we

1:00:45need opinion of two rmps two registered

1:00:50medical practitioners yes also please

1:00:53remember only and only female consent is

1:00:59required okay so female consent is

1:01:02required please remember spouse consent

1:01:06is not mandatory okay so spouse uh

1:01:09consent is not mandatory so these are

1:01:12again very important questions whether

1:01:14we talk about our fmg upcoming exam or

1:01:17we talk about npg exam some topics will

1:01:21remain common your board is common okay

1:01:23the national board is common let's move

1:01:26on to the questions from Gynecology now

1:01:29are you all ready anybody who scored 10

1:01:31out of 10 so far so we have 10 more

1:01:34questions to go anybody who has scored

1:01:3610 out of 10 can let me know okay now

1:01:40which is not a contraindication to use

1:01:43the contraceptive method shown below

1:01:47right so what contraceptive method is

1:01:48this

1:01:50B yes so this is my Rena so maybe some

1:01:55of you can do what some of you can mark

1:02:00your comments or your answer in the

1:02:03comments spouse consent is not mandatory

1:02:07even for female sterilization okay even

1:02:10for tubal liation or female

1:02:12sterilization spouse consent is not

1:02:15mandatory okay perfect 8 by1 is good

1:02:19let's keep it going so which is no so

1:02:23now listen again there is always going

1:02:26to be confusion between two options I

1:02:28think everyone knows about option D so

1:02:33if there is

1:02:34a uterine anomaly which is distorting

1:02:37the cavity then you are not supposed to

1:02:40use intrauterine devices so everybody

1:02:43can rule out

1:02:44B everyone can rule out pelvic infection

1:02:48so we are now confused between A and B

1:02:52yes so please remember this has to be a

1:02:56current pelvic

1:02:59infection did you read the keyword in

1:03:01the McQ which is not a contraindication

1:03:04so a is not the answer buta answer is

1:03:09heavy mences due to coagulation disorder

1:03:13acute liver disease or active liver

1:03:17disease is an absolute contraindication

1:03:21for hormonal anything which is releasing

1:03:24a hormone whether it is a pill or a Mya

1:03:27so which hormone does Mya release LNG

1:03:31Leo nor gestal right and it releases at

1:03:36the rate of 20 microgram per day that is

1:03:39why it is called as

1:03:42lg20 yes that is why it is called as

1:03:46lng2 but please remember the total

1:03:50amount of LG so this is high healed

1:03:53Point number number one you should know

1:03:55the release rate you should know the

1:03:56total the total amount of LNG in this is

1:04:0052 mg yes I'm coming to the explanation

1:04:04now why is it answer B Because please

1:04:10understand when you talk about Mya it

1:04:14reduces menstrual blood flow do you all

1:04:17know this or no this is a

1:04:20noncontraceptive benefit of Mya unlike

1:04:23copper tea which increases blood loss so

1:04:27in a coagulation disorder copper tea

1:04:30will definitely be

1:04:32contraindicated but not marinaa Mya will

1:04:35be our Preferred Choice because it will

1:04:39decrease menstrual blood flow and help

1:04:42in these patients who have coagulation

1:04:45disorders is that understandable to

1:04:47everyone yes so that is why B is

1:04:50actually an indication to give Mya now

1:04:53this is why why you should know the

1:04:56other

1:04:57noncontraceptive uses of

1:05:00Mya okay so non-contraceptive uses of

1:05:04Mya can we use it in endometrial

1:05:08hyperplasia yes okay so we can use it in

1:05:12women with endometrial hyperplasia

1:05:15remember it will also decrease dis

1:05:19manoria okay it will decrease dis

1:05:21manoria can we use it in end

1:05:25endometriosis yes we can use it in

1:05:27endometriosis because it reduces the

1:05:29pain okay why liver disease because if

1:05:33it is act liver disease it is liver

1:05:36which metabolizes the hormones right so

1:05:39when there is accute liver disease or

1:05:41active liver disease you don't want to

1:05:43give hormonal therapy of any type okay

1:05:47yes very correct it has to be

1:05:49endometrial

1:05:51hyperplasia without at tpia okay okay

1:05:54because with atpa you should do a

1:05:58hysterctomy okay so it has to be without

1:06:01AIA without

1:06:05okay all right perfect now please

1:06:09remember when we talk about Mya what

1:06:12else is a contraindication breast cancer

1:06:16please remember best cancer is

1:06:20contraindication for Mya but can we give

1:06:24te yes we can give coppery right but Mya

1:06:29will be

1:06:30contraindicated yes okay High heeld

1:06:33Point number five okay what are other

1:06:38absolute contraindications so we have

1:06:40almost covered everything so heavy bleed

1:06:43you know um pelvic infection undiagnosed

1:06:46bleeding but this is not undiagnosed

1:06:48bleeding okay so please remember altered

1:06:51shape of the cavity and SU suspected

1:06:57pregnancy okay suspected pregnancy is

1:07:00also a contra indication for all

1:07:03intrauterine devices another area which

1:07:06you might do incorrect what is the main

1:07:09mechanism of action of a myira so please

1:07:12remember when we ask you the main

1:07:16mechanism of action even for Mya as well

1:07:19as for coperti the answer is inhibition

1:07:23of of IM

1:07:26fertilization and

1:07:29implantation okay so inhibition of

1:07:32fertilization and implantation please

1:07:35remember ovulation is not suppressed you

1:07:40know completely so some Cycles will be

1:07:44ovulatory so do not Mark inhibition of

1:07:46ovulation in fact most Cycles are

1:07:49ovulatory only some Cycles will be an

1:07:52ovulatory is that clear here so the

1:07:54answer is not inhibition of ovulation

1:07:57yes that is why I am talking about it so

1:08:00even with Mya please remember most

1:08:03Cycles are ovulatory only some Cycles

1:08:07are anovulatory so that is not the main

1:08:09mechanism of action good to go let's

1:08:13move on to question number 11 okay that

1:08:17is again an important one and it is

1:08:19important for both exam the upcoming fmg

1:08:22exams in January as well as neat PG in

1:08:26March you have done a pelvic ultrasound

1:08:29and Doppler for a 50-year-old lady and

1:08:32it shows the following image what is not

1:08:36true regarding this abnormality can you

1:08:39all pick up the abnormality what is it

1:08:42were you able to diagnose okay let me

1:08:44try and help you this is a growth in the

1:08:49cavity of the uterus okay so this is a

1:08:52growth in the cavity of the U uterus and

1:08:54what do you see

1:08:56here this is the vessel going into the

1:09:01growth right what sign is this what sign

1:09:05is this yes so it is feeder vessel

1:09:12sign okay so it is a feeder vessel sign

1:09:16which is characteristic to what it is

1:09:18characteristic to

1:09:20endometrial pop right so it is

1:09:24characteristic to endometrial polyp and

1:09:25we have to say which statement is not

1:09:28true so let's quickly see this is it a

1:09:31common cause of abnormal uterine

1:09:34bleeding yes okay this is a true

1:09:38statement I want to know from you can it

1:09:40cause postmenopausal bleeding yes so

1:09:44please remember Point number one polyps

1:09:48are common in

1:09:50perimenopausal and postmenopausal women

1:09:55and it is an important cause of

1:10:00postmenopausal bleeding okay so it is an

1:10:02important cause of postmenopausal

1:10:04bleeding right second thing does stoxen

1:10:09increase the risk yes so second High

1:10:12yielding Point tamoxifen I'm sure you

1:10:16all know increases risk of endometrial

1:10:20cancer but does it also increase risk of

1:10:23polyps yes it's a significant risk

1:10:26factor so it also increases risks of Pop

1:10:30right remember the drug and therefore if

1:10:33this woman on tamoxifen comes with

1:10:35abnormal bleeding do an endometrial

1:10:39sampling right so if a woman with

1:10:41tamoxifen comes with abnormal bleeding

1:10:43do a sampling okay Point let's look at

1:10:47option number D ocp use is protective is

1:10:50it

1:10:51true yes o ocp use is definitely

1:10:55protective so Mo MOA is mechanism of

1:10:59action butu okay mechanism of action so

1:11:02please remember ocps decrease the risk

1:11:06of endometrial cancer they also are

1:11:09protective

1:11:12for

1:11:14FIP okay which other cancer do they risk

1:11:17decrease ovarian cancer which one can

1:11:21they increase cervical cancer caner and

1:11:25hepatic

1:11:26adoma right so very very important

1:11:29points you should know this okay so

1:11:31which means the answer is a because the

1:11:35diagnostic modality is not going to be

1:11:39papsmear what is the investigation of

1:11:43choice for a polyp anybody it is going

1:11:46to be

1:11:48hysteroscopy right so whenever you see a

1:11:50focal lesion okay so whenever you see a

1:11:54focal leion the best way to confirm it

1:11:57is through a hysteroscope what is the

1:12:00treatment of choice yes it is going to

1:12:03be

1:12:05hysteroscopic

1:12:07polypectomy yes so it is going to be

1:12:09hysteroscopic polypectomy okay somebody

1:12:13is asking will the PDF be available yes

1:12:16it is going to be shared annotated PDF

1:12:18on the dams Delhi telegram channel the

1:12:21link has been posted before we will post

1:12:23it again under the comment section will

1:12:25the video Stay on YouTube yes I have no

1:12:27intention of removing it it is for you

1:12:30okay let's go on to question number 12

1:12:33everyone

1:12:34ready okay let's look at this so your

1:12:38patient is a 38-year old woman with

1:12:41Progressive dis minoria and

1:12:44infertility right she is coming to us

1:12:47with this image on ultrasound what is

1:12:51the management for her right so what is

1:12:54the management for her so what is this

1:12:57image what is this image this is

1:13:01a

1:13:03endometrioma which is also called as

1:13:07a chocolate cyst right so this is an

1:13:11endometrioma or a chocolate cyst now

1:13:14please remember as far as chocolate cyst

1:13:18are concerned Point number one they do

1:13:21not respond to medical

1:13:26management okay so they do not respond

1:13:29to medical management which means ocps

1:13:34and GNR Agonist is out we are not going

1:13:37to give ocp we are not going to give GNR

1:13:39Agonist also because the woman has

1:13:43infertility right and she wants to

1:13:45conceive so if she wants to conceive you

1:13:48cannot give her ocps or GNR ages because

1:13:52they they are going to not let ovulation

1:13:56happen so now which means we have again

1:13:59two options the problem of two are we

1:14:02going to do a cystectomy or are we going

1:14:04to take her up for IVF now please

1:14:09remember women who have

1:14:12endometriomas which is a cyst in the

1:14:14ovary right what kind of endometriosis

1:14:17is this so remember this is severe

1:14:22endometriosis

1:14:24okay so this is severe endometriosis and

1:14:28if it is severe

1:14:30endometriosis treatment for infertility

1:14:34you are all

1:14:36forgetting that she has infertility that

1:14:40was the key word so in severe

1:14:42endometriosis the treatment for

1:14:44infertility is

1:14:47IVF also because presence of ovarian

1:14:52endometriomas reduces the ovarian

1:14:54reserve right so we directly take them

1:14:57up for IVF now are we going to do aect

1:15:01to me before doing an IVF the answer is

1:15:04no okay so please

1:15:07remember routine cystectomy before

1:15:12IVF is not done can you think of the

1:15:16reason why why not because when you

1:15:18operate you damage the surrounding

1:15:21ovarian tissue and you reduce the

1:15:24ovarian reserve further so we will not

1:15:27do a routine cystectomy before IVF

1:15:31unless she has severe pain or she has a

1:15:35ruptured cyst right or the cyst is not

1:15:39allowing us to reach the follicles and

1:15:42do a ovam pickup okay so please remember

1:15:47if we are planning IVF routine

1:15:49cystectomy is not done okay yes that's

1:15:53the key thing you will do a cystectomy

1:15:56only if there are severe symptoms like

1:15:59severe pain or it is big and it does not

1:16:03allow you to reach the follicles or

1:16:05maybe it under goes rupture is that

1:16:08clear I hope I have clarified your

1:16:10doubts it's an important question now in

1:16:13general important Point number four this

1:16:16is not related to infertility this is a

1:16:20general thing that I'm asking for

1:16:22endometriosis so my question is in end

1:16:26so dis manoria is pain during Menses

1:16:30okay and that comes from the uterus

1:16:32right we are not talking about severe

1:16:35pelvic pain if it is an ovarian

1:16:37endometrioma she would rather have

1:16:39severe pelvic pain and that too as I

1:16:42said we will operate only if it is

1:16:45severe or if it is not allowing you

1:16:48access to reach the follicles and do a

1:16:51ovam pickup okay so

1:16:55otherwise which means when fertility is

1:16:59not a

1:17:03concern okay so when the fertility is

1:17:06not a complaint then in general we say

1:17:10treatment of choice for chocolate cyst

1:17:13is

1:17:14cystectomy but even in that case you

1:17:17have to be careful you will do a syct me

1:17:21only if it is is either bigger than 5 cm

1:17:26or it is

1:17:29symptomatic okay so either it is big in

1:17:32size or it is symptomatic right so this

1:17:36is when the question is not on

1:17:38infertility and a general question on

1:17:42endometrioma why will it inhibit the

1:17:44fetal growth no it doesn't Okay in fact

1:17:47it doesn't even affect the IVF outcome

1:17:50okay so not everything is to be operated

1:17:53upon and removed okay lastly can you

1:17:56tell me what is the appearance of the

1:17:59image called it is called as ground

1:18:03glass appearance and can you tell me

1:18:07what is investigation of choice for

1:18:12endometriosis the investigation of

1:18:14choice for endometriosis is

1:18:18laparoscopy right so very few places we

1:18:21tell you it is lap but yes ioc for

1:18:23endometriosis is

1:18:25laproscopy okay perfect chances of

1:18:29malignancy then in this case you don't

1:18:31see any malignant features okay please

1:18:34remember this is a very characteristic

1:18:37image of endometrioma with no signs of

1:18:39malignancy if you have doubt about

1:18:42malignancy then obviously you go and

1:18:44remove it okay chello ready for the next

1:18:48one all right question number 13 what is

1:18:51the primary go goal of the procedure

1:18:54depicted below can you tell me what is

1:18:56this

1:18:58procedure yes so this is what procedure

1:19:03laparoscopic ovarian

1:19:07drilling okay so laproscopic

1:19:10ovarian Drilling and in which condition

1:19:15do we do it we all know we do it in PCOS

1:19:19right so we do lap ovarian drilling for

1:19:22poly cystic ovarian syndrome but now you

1:19:25have to tell me something else you have

1:19:28to tell me why are you doing it we all

1:19:30know we do it in PCOS right so that is

1:19:33something everyone will answer but we

1:19:35want to know why what is the goal of

1:19:38this

1:19:39therapy so let's

1:19:41see okay is it done as a treatment

1:19:46for reducing the follicles absolutely no

1:19:51why would we want to destroy the

1:19:52follicles because women with PCOS

1:19:55already have infertility we are not

1:19:58going to destroy their follicles right

1:20:00so now is it done to reduce

1:20:04heroism no it is not the treatment for

1:20:08heroism okay are we going to induce a

1:20:11surgical menopause again no these women

1:20:14have infertility why would we do

1:20:16menopause okay so the only and only

1:20:19reason why we do lap ovarian Drilling is

1:20:23for resumption of ovulation in PCOS so

1:20:28please remember it is second line

1:20:32treatment of

1:20:36infertility okay it is second line

1:20:38treatment of infertility in

1:20:41PCOS high yield Point number two can you

1:20:44tell me what is drug of choice for

1:20:47ovulation induction in

1:20:50PCOS I'm sure you're all going to give

1:20:52me the answer answer it is

1:20:54LOL okay although Chine is also first

1:20:58line it is not be drug of choice drug of

1:21:01choice is letrozol yes okay perfect

1:21:05third can you tell me what is drug of

1:21:08choice for her pism in

1:21:12PCOS what is the drug of choice for her

1:21:15pism in PCOS then it is going to be

1:21:19combined oral contraceptive pills please

1:21:22please don't go and Mark spironolactone

1:21:25the answer is not

1:21:26spironolactone okay then can you tell me

1:21:30which

1:21:31drug is not given okay which drug is not

1:21:36given if woman wants to conceive in

1:21:41PCOS okay so if a woman wants to

1:21:44conceive which drug will not be given

1:21:48okay the question is

1:21:49not so the single best answer answer

1:21:52will be

1:21:55spironolactone and the second best

1:21:58answer is going to be oral contraceptive

1:22:01pills so drug which we will not give if

1:22:04she wants to conceive is definitely

1:22:07spironolactone it impairs development of

1:22:10the male baby right the second best

1:22:12answer will be combined oral

1:22:14contraceptive pills is that clear to

1:22:17everyone okay let's move on to last

1:22:21Point uh when you talk about polycystic

1:22:24ovarian syndrome always and always if

1:22:27you see it in an obese woman no matter

1:22:30what her complaint is what is the first

1:22:34advice it is weight loss and that is

1:22:39done alone you don't combine it with

1:22:41ocps so initial advice is only weight

1:22:44loss you see if that works or not and

1:22:47then we might put her on oral

1:22:49contraceptive pills yes is that clear

1:22:53lastly please

1:22:55remember okay please remember cloro

1:22:59megali okay or

1:23:03virilization right so cloro megali or

1:23:07virilization are never seen in PCOS okay

1:23:12they are never seen in PCOS yes so when

1:23:15you say weight loss it has to be done by

1:23:19changing her lifestyle right so it has

1:23:22to be about diet it has to be about

1:23:25exercising so yes changing lifestyle to

1:23:28advice weight loss okay perfect good to

1:23:31go

1:23:33everyone okay so this is the next one

1:23:36and I am sure that this is the easy one

1:23:39for you so a woman presents with

1:23:42infertility yes and the following is her

1:23:45hsg finding what is your interpretation

1:23:49come on that's easy again very important

1:23:51for both the upcoming exams which ones

1:23:54fmg upcoming January session as well as

1:23:58neat PG upcoming March session yes so

1:24:02what is the finding it's simple this is

1:24:07a bilateral Hydro salings yes okay don't

1:24:12confuse this with normal in normal you

1:24:15see a spill but the tubes are not

1:24:17supposed to be dilated so this is not a

1:24:20spill this is dilated tube and this is

1:24:24not uterus delfus please there is a

1:24:28single uterus here which has a normal

1:24:31Contour right so it's not a delfus okay

1:24:36now coming to important High healing

1:24:39Five Points yes Point number one in

1:24:44which phase of the cycle do you do hsg

1:24:47in which phase of the menstrual cycle do

1:24:51you do hsg so this is done in the post

1:24:55menstrual phase okay post menstrual

1:24:59phase most commonly around day 10 of the

1:25:03cycle Point number two can you tell me

1:25:07if you see a bilateral block okay if you

1:25:12see a bilateral block what is going to

1:25:16be the next step okay if you see a

1:25:20bilateral block what do is going to be

1:25:22the next step so the answer is going to

1:25:24be Diagnostic

1:25:27laproscopy and Chromo

1:25:32perturbation right so Diagnostic

1:25:34laproscopy and

1:25:37chromopertubation

1:25:39perfect okay now can you tell me what D

1:25:44do you use in Chromo perturbation so

1:25:47this is a con some students get confused

1:25:50so you have to tell me the D which we

1:25:52use in hsg and the Dy which we use in

1:25:57Chromo

1:25:58perturbation what is the

1:26:01answer tell me so yes in hsg the D we

1:26:08use is a

1:26:10iodinated Dy right so the Dy we use here

1:26:14is iodinated dy and it is usually a

1:26:18water soluble D and what D do we use in

1:26:21chrom pertubation yes so we will see

1:26:25methylene blue in Chromo perturbation

1:26:29perfect who is going to tell me absolute

1:26:33contraindication so remember suspected

1:26:36pregnancy is an absolute

1:26:39contraindication current pelvic

1:26:42infection is an absolute

1:26:45contraindication active bleeding is also

1:26:49a

1:26:50contraindication D Aller

1:26:53is also a contraindication and apart

1:26:55from that untreated genital

1:27:00tuberculosis okay if it's treated you

1:27:02can do it but untreated genital TB would

1:27:05be a

1:27:07contraindication okay last

1:27:09question can you tell me what will you

1:27:12answer if they ask you ioc for tubal

1:27:17patency and what will you answer if they

1:27:20say best for tubal

1:27:25evaluation okay so when they ask you ioc

1:27:28for tubal patency it is

1:27:32hsg but if they ask you best for tubal

1:27:35evaluation then it is

1:27:38laproscopy okay then it is going to be

1:27:42laparoscopy yes so those are the five

1:27:44high yielding points about this one are

1:27:47you ready for next one everybody okay

1:27:49are you keeping your

1:27:51score let's look at this one the

1:27:54histologic structure shows here a single

1:27:57papilla lined by tumor cells containing

1:28:00a central vessel right so which ovarian

1:28:04tumor so in which ovarian tumor do you

1:28:08see this do you know what it is what is

1:28:11this this is the new way of asking they

1:28:14describe the hystopathological

1:28:16findings right so what is this this is

1:28:21tell me what

1:28:23yes so these are descriptions of Shiller

1:28:27dual bodies yes so Shiller dual bodies

1:28:32and therefore what would be the tumor

1:28:36yes it has to be the yok sac tumor what

1:28:40else do you call it we also call it

1:28:44endodermal sinus

1:28:47tumor right endodermal sinus tumor okay

1:28:51let's talk about other characteristic

1:28:53hystopathological findings as high

1:28:56yielding points and you have to quickly

1:28:57give me the answers the first one is

1:29:01where do you see call exner

1:29:05bodies very good so this is going to be

1:29:09granulosa cell perfect okay where do you

1:29:12see rinky

1:29:15crystals certainly leading but the

1:29:19single best answer is leading cell tumor

1:29:22okay where do you see Signet ring

1:29:26cells yes this is going to be

1:29:31kenberg okay this is going to be kenberg

1:29:35where do you see Ward sell Nest where do

1:29:39you see balad cell Nest right so this is

1:29:42going to

1:29:44be brenners okay that is going to be

1:29:47brers Rocky tansy

1:29:50protuberant

1:29:52so Rocky tansky protuberance is what we

1:29:55see in a

1:29:57dermoid okay is what we see in a dermoid

1:30:01perfect so those were the most important

1:30:04five now can you tell me all the options

1:30:07here so dis germinoma yok saac immature

1:30:11corio carcinoma can you tell me all

1:30:14these options belongs to which category

1:30:17of ovarian tumors which category of

1:30:20ovarian tumors

1:30:22yes so very very important they are all

1:30:25examples

1:30:27of germ cell tumors right so there are

1:30:31all examples of germ cell tumors and in

1:30:35general which is the most common it is a

1:30:39mature cystic

1:30:42teratoma which is nothing but the other

1:30:44name for dermoid right so they are all

1:30:47germ cell tumors and they are um you

1:30:50know the most common germ cell tumor is

1:30:53a mature cystic teratoma which is

1:30:55nothing but the other name for dermoid

1:30:58perfect are you ready for the next one

1:31:01everyone okay a lady is undergoing

1:31:05infertility treatment and she now

1:31:07presents with abdominal pain and nausea

1:31:10ultrasound evaluation is done what is

1:31:13the diagnosis I'm sure this is an easy

1:31:16one as well so I kept the last four easy

1:31:20to give you a

1:31:22right to boost your scores and to make

1:31:24you feel happy at the end of the session

1:31:26that's the purpose right so yes the

1:31:29answer here is going to

1:31:32be ovarian

1:31:34hyperstimulation syndrome yes okay

1:31:37someone before I go on to this one

1:31:39someone is asking about mes so please

1:31:42remember classically me syndrome is seen

1:31:46with a fibroma which is a benign ovarian

1:31:49tumor along with a citis and along on

1:31:52with plural effusion okay but now we say

1:31:56Meek syndrome is also seen with

1:31:59briners also with granulosa cell tumors

1:32:03and also with Thoma so with all these

1:32:08four it is Ms but the single answer is

1:32:11fib broma and uh anything apart from

1:32:15this will be pseudo means okay perfect

1:32:19so this is ohss let's come on

1:32:22to the key uh you know High yielding

1:32:25things can you tell

1:32:27me which infertility treatment drug okay

1:32:32increases risk

1:32:34maximally which drug has the highest

1:32:38risk right so this is going to be

1:32:41injection

1:32:43HMG okay human menopausal

1:32:47gonadotropin okay but if we ask you

1:32:52what is the cause of the

1:32:55syndrome right so if I'm asking you

1:32:59cause of syndrome then it is injection

1:33:04HCG okay HCG HCG causes the syndrome the

1:33:09risk is increased by HMG okay perfect

1:33:14third can you tell

1:33:16me which is the mediator here right so

1:33:21the med mediator is

1:33:23vegf vascular endothelial growth factor

1:33:28right all right do you understand that

1:33:31women with PCOS are going to be at high

1:33:36risk of

1:33:38ohss right so women with PCOS are at

1:33:41high risk remember High amh

1:33:46values especially if they are more than

1:33:503.3

1:33:52also increase risk of

1:33:57ohss okay and I'm

1:34:01sure you all know that in

1:34:03PCOS amh levels will they be high or

1:34:06will they be low so in PCOS the amh

1:34:09levels are going to be high yes so

1:34:13remember these important points about

1:34:15ovarian hypers stimulation syndrome okay

1:34:19wasn't a very difficult one but yes it

1:34:21is an important one for your upcoming

1:34:24exams both fmg and neat

1:34:27PG that brings us to question number 17

1:34:31and I am sure you would do even this one

1:34:33correct so this is a photograph of an

1:34:36air dried sample of cervical mucus right

1:34:40it will show high effects of which

1:34:44hormone can you tell me what is the

1:34:46finding here yes so very right the

1:34:49finding IS F in of cervical mucus so if

1:34:55it is ferning which hormone is it going

1:34:57to

1:34:58be yes the answer is again C very

1:35:02correct excellent good going right so

1:35:05ferning please remember is seen number

1:35:08one at high levels of estrogen and high

1:35:12levels of NAC okay that's Point number

1:35:16one second what is the kind of cervical

1:35:19mucus that you see under under

1:35:21progesterone so under progesterone it is

1:35:24going to

1:35:26be thick and

1:35:28scanty okay but either ways if it is

1:35:32physiological it will not be foul

1:35:34smelling so it can be thin it can be

1:35:37thick but it will not be foul smelling

1:35:40okay can you tell me under the effect of

1:35:43estrogen which cells would you see okay

1:35:47which cells would you see in vaginal

1:35:50cytology

1:35:52which ones yes so we will see

1:35:56superficial cells right which are mature

1:36:00cells and they stain pink right so that

1:36:04is under the effect of

1:36:06estrogen fourth High yielding point

1:36:08please remember under the pro effect of

1:36:11progesterone like in pregnancy like in

1:36:15post ovulatory phase which is the

1:36:18secretory phase which cells will

1:36:22predominate which cells will

1:36:25predominate yes I'm trying to revise

1:36:28most high yielding points for you that

1:36:30are also possible or probable mcqs right

1:36:34so yes this is going to be

1:36:37intermediate perfect lastly can you tell

1:36:40me which sign of puberty okay listen to

1:36:45me carefully I'm asking you which sign

1:36:48of puberty in females

1:36:52is not brought by not okay is not

1:36:56brought by

1:36:58estrogen so which sign of puberty in

1:37:01females is not brought by estrogen what

1:37:05is the

1:37:06answer yes so it is appearance of pubic

1:37:10and axillary hair so remember pubic and

1:37:14axillary hair are under the effect of

1:37:18androgens and especially which androgen

1:37:21DT dihydro

1:37:24testosterone yes perfect good to go okay

1:37:29I am sure this is not going to be

1:37:31difficult as well but important because

1:37:34it has been a pyq so let's do this which

1:37:38color hormone out of this is responsible

1:37:42for

1:37:43ovulation okay so is it the purple one

1:37:47is it the orange one is it the green one

1:37:49or is it the blue blue one so let's

1:37:52quickly do this the purple one here is

1:37:55going to be the one with the biggest

1:37:57Peak right in the middle of the

1:38:00cycle is LH right a smaller Peak at the

1:38:05time of ovulation is going to be FSH so

1:38:10that is the green one okay then two

1:38:14peaks one before ovulation right so this

1:38:17is speak number one and this is speak

1:38:19number two so two peaks one before one

1:38:23after so this hormone is

1:38:27estrogen and a single Peak after

1:38:31ovulation so this hormone is

1:38:35progesterone right now once you know the

1:38:37hormones can you tell me which is the

1:38:39most important one for ovulation always

1:38:42the single best answer is LH so we are

1:38:46going to go with the purple color right

1:38:49okay quickly just not many points but

1:38:53quickly tell me this one time gap

1:38:55between LH surge and

1:38:59ovulation is yes

1:39:0236 hours perfect okay time gap between

1:39:07LH Peak and

1:39:10ovulation that is going to be 12 hours

1:39:14again perfect can you tell me which

1:39:17hormone brings about a let search

1:39:22which hormone brings about AET surge so

1:39:26this has to be estrogen and it has to be

1:39:30high amount right so it has to be

1:39:33estrogen it has to be high amounts of

1:39:35estrogen okay Point number four please

1:39:39remember LH hormone maintains Corpus

1:39:43litium so not only does it form Corpus

1:39:47litium but it also maintains Corpus

1:39:50litium but if I ask you which hormone

1:39:53maintains corus litium of

1:39:56pregnancy then the answer will change to

1:40:00HCG right and last highing point about

1:40:04LH is that please

1:40:08remember uh LH brings about the Lal

1:40:11phase and it is the Lal phase which is

1:40:15going to be

1:40:17constant so this is going to be 14 days

1:40:21which is also the lifespan of copper

1:40:25lithium right so the lual phase is fixed

1:40:28at 14 days and that is also the lifespan

1:40:30of corus

1:40:32lithium okay so five high yielding

1:40:35points from question number 18 are you

1:40:37ready for last second last yes second

1:40:40last question of the day okay management

1:40:43of fibroid which is numbered as one can

1:40:47you see one now yes can you can you tell

1:40:51me we are asking you this is the fibroid

1:40:55okay that we are trying to show you we

1:40:56are saying fibroid number one and we are

1:41:00saying this lady has fibroid number one

1:41:04and she has heavy

1:41:07bleeding what are you going to do for

1:41:09her so now I have already brought these

1:41:13numbers are nothing but please remember

1:41:17the fot types of fibroid I've brought

1:41:21this image so that you can revise from

1:41:24the image itself so this is the number

1:41:27corresponds to the Figo stage so zero is

1:41:30Figo stage zero one is Figo stage one

1:41:34two is two and so on so please remember

1:41:380 1 and two are

1:41:42submucosal okay three and four are

1:41:48intramural okay three and four are

1:41:53intramural 5 six 7 are

1:41:58subserosal please focus on number seven

1:42:02this is the pedunculated

1:42:05subserosal yes so this is pedunculated

1:42:10subserosal and type zero is pedunculated

1:42:16submucosal right so this is pedunculated

1:42:19submucosal okay okay so that is why I

1:42:22got this image so that you can revise

1:42:24from here itself it is an important

1:42:26question again for both exams Bas fmg

1:42:29and neat PG don't

1:42:32think so important go staging you better

1:42:35know it okay now if it is now we know a

1:42:40submucosal fibroid causing heavy

1:42:42bleeding then what is the treatment of

1:42:44choice for sub mucosal fibroid

1:42:48presenting to us with heavy bleeding

1:42:51Bing so hmb is heavy menstrual bleeding

1:42:54what is the answer the answer is yes we

1:42:59are going to do a

1:43:01hysteroscopic myomectomy so the answer

1:43:04is D perfect I think everyone answered

1:43:06it correctly quickly tell me Point

1:43:08number two can you tell me which

1:43:11submucosal cannot be removed

1:43:14hysteroscopically okay so which

1:43:17submucosal cannot be removed

1:43:20hysteroscopic Al then what is the answer

1:43:23then what is the answer so if this is

1:43:25what we ask you then it has to be type

1:43:29two type zero and one okay so type zero

1:43:34and one will be removed by hysteroscopic

1:43:37myomy but not type two okay third which

1:43:42of the fibroids is most likely to

1:43:44undergo

1:43:46torsion so torsion is most commonly seen

1:43:49with type seven which are subserosal and

1:43:54pedunculated is that clear to everyone

1:43:57okay fourth red degeneration is seen in

1:44:01which trimester of pregnancy so this is

1:44:05seen in second trimester okay it is seen

1:44:09in the second trimester of pregnancy and

1:44:13what is the management of red

1:44:17degeneration can you tell me what is the

1:44:19management of red

1:44:21degeneration yes the answer is

1:44:25conservative okay the answer is

1:44:28conservative now please remember

1:44:31asymptomatic fibroids no

1:44:35treatment okay so asymptomatic fibroid

1:44:39no treatment irrespective of size and

1:44:43the only exception to this rule is sub

1:44:48mucosal fibroid and and

1:44:51infertility that is an exception because

1:44:55in this case even if it is asymptomatic

1:44:58you will do a what yes you will still do

1:45:04a myo Mech to me right so you will still

1:45:08do a myomectomy is that clear okay that

1:45:12brings us to the last question of the

1:45:14day and I hope it's an easy one and you

1:45:17give me a great score at the end of the

1:45:19session so which is not true about the

1:45:23condition shown in the 16-year-old girl

1:45:25with primary a minoria right what is the

1:45:28finding yes so this is imperforate Hyman

1:45:32I think the image is not difficult at

1:45:35all right so this is

1:45:38imperforate

1:45:40Hyman okay now let us see what statement

1:45:44is not true is breast development

1:45:46present yes so please remember this will

1:45:50cause primary amoria with secondary

1:45:53sexual characters can it present with

1:45:57acute urinary retention yes yes yes

1:46:01option C is correct so what happens is

1:46:05if they have a big

1:46:08hematos which can be seen in women with

1:46:11imperforate himman a collection in

1:46:13vagina it compresses the bladder outflow

1:46:16tract and this can cause acute urinary

1:46:20retention so this is uh the acute

1:46:24presentation of imperforate Hyman okay

1:46:27does it have a good reproductive outcome

1:46:30yes so once you treat it right these

1:46:33girls have no problem in conception and

1:46:36in their pregnancy so what is the

1:46:38treatment of

1:46:40choice it is a

1:46:43cruciate incision okay it's usually a

1:46:46cruciate incision sometimes we can give

1:46:49a oval incision as well but the single

1:46:52best answer is cruciate okay so the

1:46:55answer is B there is no need to do a

1:47:00gonadectomy right where do you do

1:47:02gonadectomy is the third question

1:47:05gonadectomy is typically done in swies

1:47:09and in Androgen in Sensitivity Syndrome

1:47:13please remember routinely in Turners no

1:47:17gonadectomy no gonadectomy in m Aran a

1:47:21Genesis these are common mistakes don't

1:47:24make these mistakes okay it is not

1:47:27required in imperforate Hyman so what is

1:47:31the kot type so an imperforate Hyman

1:47:37okay again as I said no

1:47:43gonadectomy right and please remember

1:47:46they have a normal karot type which is

1:47:4946 XX so they will have a normal ovary

1:47:54and all hormonal levels are going to be

1:47:58normal right so all hormones are going

1:48:02to be normal can you tell me which other

1:48:06condition they are at high risk of which

1:48:09other condition are they high risk of so

1:48:11remember they are at increased risk of

1:48:16what they usually have no other problem

1:48:18but they are still at increased risk of

1:48:20of

1:48:23endometriosis okay

1:48:25Endo

1:48:27metriosis okay last doubt and then I'm

1:48:30going to ask for your scores I said the

1:48:32treatment of choice is cruciate incision

1:48:35but when do do it so generally please

1:48:38remember this will be done after puberty

1:48:43we want the tissues to be well

1:48:45estrogenized and then we actually treat

1:48:48this condition or we will treat if she

1:48:51comes to us in emergency but otherwise

1:48:54generally we say after puberty is when

1:48:58we would want to treat the condition

1:49:00when the structures and tissues are well

1:49:04estrogenized and you have to remove the

1:49:07excess Hyman tissue do you understand

1:49:09that so please remember we have to

1:49:12remove the excess Hyman tissue it's not

1:49:15left there so it's not simple indd a lot

1:49:19of people people confus and think it is

1:49:21incision and drainage no it's not just a

1:49:25simple incision and drainage it is a

1:49:28cruciate incision and you have to remove

1:49:31the excess tissue otherwise the the

1:49:34drainage is not going to be complete and

1:49:37it will reform right so with this we

1:49:41come to an end for today's high healed

1:49:43obsin gy image based sessions I've

1:49:46covered 20 different topics not just

1:49:50images and in 20 topics we have covered

1:49:53five high yielding questions at least

1:49:56apart from one that is given so

1:49:58basically we have covered

1:50:01nearly there were 20 mcqs and we have

1:50:05covered at least six High yielding

1:50:08points one is the McQ and I did five

1:50:11other right so almost 12 potential

1:50:15probable things that can be asked in the

1:50:18exam so now let's wind this session off

1:50:22with your scores so I think 15 16 17

1:50:26excellent anyone who has scored 18 19 20

1:50:3113 is very good 14 is very good okay I'm

1:50:34happy with each one of you you have all

1:50:36done well but I must say there is scope

1:50:40of

1:50:41improvement yes do you all agree nine

1:50:44buckup beta you can definitely do better

1:50:48all right so okay very very good so

1:50:50Joseph has got 19 out of 20 it's

1:50:54excellent 20 out of 20 a a huge clap for

1:50:58Shan subramanyam Shan please inbox me uh

1:51:03I will send you a gift from my side you

1:51:06are the winner of today's session so

1:51:08shravan if you're listening to me please

1:51:10send me an inbox send me your contact

1:51:12number and I'm going to send you a gift

1:51:15of acknowledgement of Praise anybody

1:51:18who's got 19 I will also send you a

1:51:21appraisal and a gift from my side so

1:51:24anyone with score 19 but you have to

1:51:26give me evidence so send a snapshot yes

1:51:30okay the best time for endometrial

1:51:32biopsy is premenstrual Phase okay

1:51:36premenstrual around Day 26 all right

1:51:42man I'm sure you will improve right see

1:51:45the purpose of solving questions is not

1:51:48to get demotivated the purpose is to

1:51:52understand our lacune okay so you have

1:51:55to see mcqs in the right Spirit if you

1:51:58see them as something that is going to

1:52:00demotivate you then you know there is a

1:52:03problem you have to see them as these

1:52:06mcqs are going to tell me what I lack

1:52:09and where I need to spend my time and

1:52:11energy and once you identify that

1:52:14believe me you will definitely improve

1:52:16your score right so I'm going to

1:52:21uh leave you now with all the best

1:52:23wishes we'll keep coming Live on YouTube

1:52:25sessions and after DVT we will soon be

1:52:29coming up with special series for my all

1:52:32my fmg Bas a special fmg revision series

1:52:36on YouTube after we do DVT and DFX So

1:52:40currently DFX is going on which is the

1:52:43special revision session for the

1:52:44upcoming fmg exam in in January and DVT

1:52:49is going to start which is a special

1:52:51revision session for upcoming exam of

1:52:54neat PG in March right so I am sure that

1:52:58each one of you are going to work hard

1:53:00you're going to give your best and we as

1:53:03teachers are going to send you lots of

1:53:06good wishes we are going to stay with

1:53:08you we are not going anywhere we'll keep

1:53:10bringing more sessions

1:53:13fmg we are going to bring special

1:53:15revision sessions on YouTube for you and

1:53:18we will definitely do something for neat

1:53:20PG also after DVT right so take care

1:53:24everyone the only staging that you need

1:53:27to know is cervical cancer okay recently

1:53:30they're not asking questions on directly

1:53:32on staging but you should know cervical

1:53:35cancer don't worry about others all

1:53:37right okay absolute contraindications

1:53:40for IUD because gorov is asking so I

1:53:42will write them here gor just for you

1:53:45okay so absolute contraindication of

1:53:48intrauterine device so first undiagnosed

1:53:54bleeding okay undiagnosed bleeding

1:53:59second uh a uterine cavity which is

1:54:02distorted it may be distorted by

1:54:04anything it may be distorted by Marian

1:54:08anomalies it may be distorted by a

1:54:10fibroid so whatever may be the

1:54:14cause but if the cavity is distorted

1:54:17don't put an intrauterine device then

1:54:19current pelvic

1:54:22infection okay current pelvic infection

1:54:25suppose they say there is a mucco purin

1:54:27discharge from the cervix also if there

1:54:30has been a septic abortion so please

1:54:33remember within 3 months of septic

1:54:38abortion okay so within 3 months of

1:54:41septic abortion apart from that as I

1:54:44said please remember Wilson's disease is

1:54:48an absolute contraindication for copper

1:54:52tea but not for Mya that is Wilson's

1:54:55Disease and as I said breast cancer is

1:54:59an absolute contraindication for marinaa

1:55:03not for coppery apart from that uh dis

1:55:07manoria and heavy bleeding in the Menses

1:55:10are relative contraindications for

1:55:12copper tea not for Mya history of

1:55:17ectopic is not an absolute

1:55:20contraindication right so all the best

1:55:22everyone I'm going to leave you

1:55:24obviously suspected pregnancy that's

1:55:26obvious okay if there is a suspected

1:55:29pregnancy we are never going to put an

1:55:31intrauterine device right so with this

1:55:35note uh I'm going to wish you good luck

1:55:38and I'm very happy that I could do this

1:55:40session for you I hope you find it

1:55:42useful and do write in the comment

1:55:44section about the session and you know

1:55:47what all would you want from us and

1:55:48we'll bring it to you I repeat the PDF

1:55:51will be shared in the telegram Channel

1:55:53which is the official telegram channel

1:55:55of dams but it is going to take some

1:55:57time they're going to extract the

1:55:58annotated PDF and then they will share

1:56:01it with you take care good night loads

1:56:03of love and loads of good wishes