NEETPG D-DAY Live | Final OBGY Rapid Revision

0:03Good evening students. Good evening. Am

0:05I visible to all? Am I audible to all?

0:06Can all of you hear me? Can all of you

0:08see me?

0:18Yes. Okay. I think just a second. Yes.

0:21So, am I visible to all? Am I audible to

0:23all? Can all of you hear me? Can all of

0:24you see me? Yes, I think I can see. Just

0:26if somebody can use the chat box. Uh,

0:28yes. Yes. Perfect. Okay.

0:30So the

0:32audio video I think is all clear and can

0:34somebody please type in the chat box so

0:36that I know that the audio video is all

0:39working and

0:43yes very good. Hello. Yes. Okay. Clear.

0:45Perfect. Okay. Uh Adi705 is the audio

0:48video all clear? Can all of you hear me?

0:49Can all of you see me? Okay. So welcome

0:51all of you. Uh welcome to our D-day live

0:55marathon MCQ discussion for the upcoming

0:57FMGE examination.

0:59Feel free to get in touch with for our

1:01NETPG examination is for our NEITEP PG

1:042026 [snorts] examination. Feel free to

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1:07WhatsApp on this number. And very

1:09important announcement my dear students

1:11download the OG Guru app and please

1:15enroll in this OBGY rank booster for the

1:17upcoming NETPG 2026. just give 6 hours

1:21whichever source OB which you have

1:22studied from don't worry we are going to

1:24have three live sessions of 2 hours each

1:26we are going to discuss clinical MCQs uh

1:30image based and video based MCQ and most

1:32expected MCQ starting from 13th of

1:34August so 13th 14th 15th August three

1:38sessions 6 hours day one is already uh

1:41we are going to discuss the image and

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1:55needp examination as I said this stream

1:57is for NETP PG examination uh all other

2:00students are of course welcome to see it

2:01but this is for the needp okay is it

2:04clear to all of you and now let us

2:06discuss let us begin our discussion

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2:20day. Okay. So now let us begin our

2:22discussion with directly the tension the

2:26video based MCQ video based question.

2:29Okay. Now please understand the

2:31videobased question is just a new style

2:34of asking image based question. Please

2:36don't panic. Okay. Please don't panic

2:38when a video based question will come

2:39and when you will read the option you

2:41should be able to get the answer and I

2:43want all of you to answer. Please

2:45understand. Let this make a very uh

2:47interactive and participative uh uh

2:49stream and all of you answer right wrong

2:51does not matter if you make a mistake it

2:53is okay. Okay. So now first see the

2:56video. Okay. So when you see the video

2:57there is something a small needle is

2:59there and and and we are sucking in

3:02something. Yes. Yes. Yes. What are we

3:04sucking in? And this looks like what?

3:06This looks like a human egg. Of course.

3:08Yes. This is a egg or a usite. How do I

3:12know? We will see a polar body also. And

3:15this is this a holding tool. Yes, you

3:18can see a polar body over here also.

3:21Okay. There's a polar body. Okay. And

3:23and and then a needle is coming in and

3:26we are piercing it inside and we are

3:30releasing the sperm inside. Very good to

3:33go. Yeah. This is the polar body. Okay.

3:34Can all of you see this? That's a polar

3:36body. So this is the egg or the usite.

3:38The first structure what we had picked

3:40up was the was the sperm and now the

3:43sperm is put inside. So what is this

3:46procedure very quickly? Yes all of you.

3:49So this is intracytoplasmic

3:52sperm injection. Now look at the

3:54question. Now read the question. Okay.

3:55So very quickly. Okay. Sperm taken

3:57inside. One more time I'm showing you

3:59the video for those who are joining in

4:00late. Sperm taken in. Uite taken in. One

4:03egg one sperm to create one embryo. And

4:06then of course we do the we do the

4:09embryo transfer. Yes. Very good. Now

4:11what is the indication for this

4:13procedure is the MCQ. First question for

4:16the day. I want all of you to answer.

4:18Right wrong does not matter. Very good

4:20Alicia. Yes. Perfect. All of you. So

4:23what is the meaning of this procedure

4:24sir? Intracytoplasmic

4:26sperm injection. And we do this for

4:29advanced maternal age. No advanced

4:32maternal age of the poor oat both mean

4:34the same thing that might require donor

4:36egg or we might try to get IVF again and

4:39this is not necessary advanced paternal

4:41age because male can have very good

4:43sperm count unit at 4050 very good all

4:45of you I'll not be able to pick

4:46everybody name pneumonic zako ana alicia

4:50perfectly correct this is for severe

4:53oligothenospermia

4:55when the sperm count is not even less

4:57than 5 million see less than 5 million

4:59when the sperm count is somewhere where

5:01between less than 5 million per ml. We

5:04can even think of IVF. IVF may in one

5:07egg we put multiple sperm. Here when the

5:10sperm count is still very very very low

5:12like example 10 20 100 sperms like that

5:17when the sperm count is very very low we

5:20use this procedure. So like a severe

5:22oligo asano. Oligo means the count is

5:24less than means the motility is less.

5:26Yes or no? Thumbs up. So when the count

5:28is very low and the motility is also

5:31very low we can go for this which is XC

5:33ch. Now next again video based I'm

5:35starting with two three videos and again

5:36stay right throughout lots of images

5:38lots of video coming in ch now identify

5:40this what is this first of all is this a

5:42laparoscopy or is it a hyroscopy image

5:45anybody we'll discuss that also so this

5:47is we are seeing from above and we could

5:50see the uterus and what are we doing

5:53this yes anybody what are we doing this

5:57can you see the big bulky ovary

6:00big bulky ovary and what is it being

6:03done. Okay.

6:06Okay. Yes. One more time just I will

6:08play the video so that you can all of

6:10you can clear. Yes. This is a putrus.

6:12This is the pouch of douglas. This is

6:15the big ovary. And can you see the ovary

6:18is so big big big big big and we are

6:21drilling holes in the ovary. Yes. So

6:24this is the PCO drilling all of you

6:26correct. And now along with it now yes

6:29PM OS has the new name PC. Okay. So what

6:31is the indication of this procedure? So

6:35this is a PCO drilling polycystic ovary

6:38or now we know the PMO but what is the

6:41what is the uh this what is the answer

6:43anybody? What is the answer for this

6:48cho? What is the answer? Do I do it for

6:50acne and hyotism in PCOS patients? Do I

6:53do it as a firstline treatment for all

6:55infertile patients? Do we do it for

6:57infertility which is resistant to oral

7:00and ovulation induction or all lean

7:02PCOS? Anybody? What is the answer?

7:04Anybody? Anybody? Yes. Chello ch.

7:08Yes. If you do it for acne and hutism,

7:13we have to go to jail. Jail m it's a big

7:16crime. Is it clear? Similarly, if I do

7:18it as a firstline treatment of PCOS,

7:20both this we will have to go to jail.

7:22Jail come. It's a very big crime. Is it

7:25clear to all of you? So yes, please

7:27understand this. This is a surgery only

7:30for infertile patients and that also

7:33when when they are resistant to oral.

7:37Oral means what? The lezole or

7:41clomophen. We'll discuss that later on

7:42today only. And injectable ovulation.

7:45Injectable means which injections? Yes.

7:47Hmg injection or recombinant FSH

7:51injection. Okay. [snorts] So when the

7:54ovary is resistant to this ovulation

7:57method as a last resort, we can try

8:00doing this. So it is remember this that

8:02it is only for the infertile patient. Is

8:05this understood? So C is the answer and

8:08we don't do it for all PCOS patients.

8:10Crystal clear to all of you? Can I get

8:1210 thumbs up before we proceed further?

8:14So please remember this for PCOS we

8:16always try medical management first and

8:18as a last resort we go on to do this ch

8:21moving on. Case of twin pregnancy again

8:24a PQ. Okay. What will be the mode of

8:27delivery in this case? Now can anybody

8:30tell me this case means what case and

8:32how will we decide? Okay. So can you

8:34tell me the route of delivery decided by

8:37the position of which baby? Okay. And

8:41this is two plac and you can see one

8:43placenta another placenta. I can also

8:46see a dividing membrane. So this is a

8:49dorionic diamniotic twin. Remember this

8:52in mind. Is this understood to all of

8:54you? Yes or no? Yes. And please

8:57understand this. No. Okay. What is this?

9:00Yes. The first baby. The root of

9:02delivery decided by the position of the

9:04first baby. Now, who is the first baby?

9:06Please understand this. The one which is

9:08down. The one which I feel on PV is

9:11called the first baby. So here sir, we

9:14can see. Okay. This baby is first and

9:17this is coming by brereech and this is

9:21the second baby which is head or vertex

9:24and when the first baby is your breach.

9:27No Alicia wrong we will go for LSCs

9:31first baby breach. Is it clear to all of

9:33you? When the first baby is nonvertex

9:36okay so remember this. If the first baby

9:39is nonvertex,

9:41when the first baby is nonvertex

9:44directly don't think of anything go for

9:47LSCS non-vertex mother it could be

9:49bridge brow face oblique transfer. Now

9:52just one more thing all of you now tell

9:53me this both the picture ulta both can

9:56come in the exam now tell me over here

9:58what will you do and tell me in this

10:00picture so there are two different MCQ

10:02is okay so again separate placenta's

10:04cord yes now this my dear student this

10:08is the first fetus and this fetus is

10:11coming by vertex or head is coming out

10:15first or kefal and the second baby now

10:18this is the second is in breach So

10:21definitely in this case we can try. What

10:25is the answer for this? We will try for

10:28WD. WD is my short form for vaginal

10:31delivery. Is this understood to all of

10:34you? Yes, we will try for normal vaginal

10:36delivery. Is this clear to all of you?

10:38And please comment in the chat box.

10:39Suppose tough paper. Tough paper.

10:41Suppose now tell me this. Suppose you

10:43get this kind of a picture. There is

10:45this picture. First baby is also vertex.

10:50Second baby is also vertex. What will I

10:54do in this case? So with a case 3 MCQ is

10:57free. Okay. Can you tell me this

11:00picture? This one. What will I do?

11:05Can you tell me what will I do in this

11:07and identify what is this?

11:10Okay. So please understand this my dear

11:13student. This is a monocorionic

11:17monoamniotic

11:19twin. Very good. Why? Why? Why Zoka?

11:22Why? Yes, there is no membrane in

11:25between and MCMMA always goes for LSCS

11:30whatever may be the position. Why?

11:32Because very high risk moment you

11:33rupture the membrane very high risk of

11:35cord prolapse and during labor both the

11:37cords can get intertwed among themselves

11:39and therefore MCMA always goes for no

11:42wrong wrong no we don't do first normal.

11:45Okay clear MCMA always LCS is it clear

11:48to all of you? M C M A always L S CS

11:52only forget about the position of the

11:54baby. Yes, very good all of is it

11:55understood to all of you? So please read

11:57the question. Why? Because this is s

11:59mono there is no dividing membrane. So

12:02this is a MCMA clear. So with one thing

12:04all the things discussed. Now what is

12:07this? So this is a hysteros

12:10salpingography

12:11virgin ibq virgin virgin question m

12:15never ever asked those who have those

12:18who know me before are hearing me for

12:19before for the first time virgin MCQ

12:21never ever asked but will come in the

12:23future now my dear student here what are

12:25we seeing sir the tubes are fine that's

12:28not the question so tubes are seen all

12:31the way over here all the way over here

12:33and we can also see the we can also see

12:36the spill. So is this a bilateral coral

12:40block? No. Is this a bicornal uterus?

12:43No. In my image based session on 13th

12:45August, I want all of you to enroll 13th

12:47August 399 only. 134 15 6 hours lecture

12:50only in 399. All of you install the app

12:52and I'll see you. I'll show you all the

12:53bicorn sept also. And definitely this is

12:56not a normal HSG. What are we seeing?

12:59Yes sir. Normally sir when the uterus is

13:02opacified perfectly there are no filling

13:06defects uterus will be a proper round

13:08color that is our normal cavity that is

13:11normal but in this picture what are we

13:14seeing? Yes sir sir we are seeing

13:17multiple filling it is just patchy

13:20patchy patchy fillup is there we are

13:23seeing multiple filling defects

13:25suggestive of asherman syndrome asherman

13:29anybody why do we get so this is yes why

13:32not beta cornal block also cornal block

13:34will be what beta

13:36also tanny okay multiple filling defect

13:40but a cornal block will be what this

13:43suppose only The uterus is seen and you

13:47don't see the fallopian tube at all.

13:50That is called as a cornal block. Clear

13:54to all of you? Yes. Metan appearance.

13:55Very good. Okay. Clear. Over zelius.

13:58Very. Okay. So this will be your

14:00bilateral cornal block or a spasm. Okay.

14:03Bilateral cornal block only the triangle

14:06will be seen. Is this understood to all

14:08of you? Yes. Because of the adisions.

14:09And can anybody tell me what do we do

14:11the next step? What do we do as the next

14:12step to confirm the findings and to

14:14manage our patient again we're going to

14:16discuss now only stay right till the

14:18very end there's one more MCQ is there

14:19regarding this also okay so this very

14:22important ch now again a video based

14:24question again a video based question so

14:26lots of video based we're going to

14:27discuss okay yes yes okay now this is

14:32what so this is a uterus this is a ovary

14:36this is a tube and what is all this blue

14:37hair part this is again a ovary and what

14:39is this blue blue coming out. Blue,

14:42blue, blue coming out. Yes. Okay.

14:44Anybody? Anybody? So you can see this

14:46clearly. A blue color dye is coming out

14:50from the fimbral end. Isn't it? So what

14:53is this? What is this picture showing

14:56you? Everybody start jumping in the OT.

14:58Blue hair pani pani blue hair pani pani.

15:00Okay. So now identify the procedure. And

15:03the mistake students make is mistake

15:06student make is directly they see this

15:08methyline blue dye and they mark C

15:10hyroscopy methyline blue wrong clean

15:13bold clean bold is it clear why because

15:15sir this is not a hysteroscopy image sir

15:19this is a laparoscopy image we are

15:22seeing a uterus tube ovary and with

15:24hyroscopy we never use a mthyline blue

15:28dye yes sir the dye used is methyline

15:30blue and this is laproscopy be

15:33chromopertubation

15:36done with methyline blue dye is this

15:39understood to all of you and what one

15:42more thing we need to remember so this

15:44is the best so again the same picture

15:46see I'm showing you both so this is IBQ

15:48the previous one was a video yeah IBQ

15:52again this has never been asked in the

15:53exam surely coming so all of you look on

15:55the board so this is the uterus this is

15:58the ovary we are holding the fallopian

16:01tube and all This blue blue dye we call

16:04it as the spill of the dye. Spill of the

16:08dye. And therefore this is laproscopy

16:11chromopertubation

16:13gold standard. Gold standard or the best

16:18investigation for tubal patency. Is this

16:20understood to all of you? So do not make

16:23a mistake. Okay. Directly when you see

16:25blue blue colored eye yes it is

16:27methyline blue but don't mark it

16:29hyroscopy and methyline blue. Hyroscope

16:31is for the cavity of the uterus. Is this

16:33understood to all of you? Okay. So, so

16:36yes, the tubes are patent and this is

16:38laparoscopy chromopertubation. The best

16:41investigation for tubal patency. Moving

16:43on to the next thing. Again, a PQ. Okay.

16:46A picture is shown to you. This is a

16:50speculum. We are seeing a cervix and the

16:53whole cervix is like a bluish

16:56discoloration of the vagina and the

16:58cervix. Identify the sign. This is again

17:01a very famous one. Lots of images I'm

17:03showing you and many more images. 13th

17:05August 6:30 p.m. Do not miss out. Okay.

17:0913th August. 6:30 p.m. Yes. Okay. Yes.

17:13Very good. What is this sir? What is

17:16Hagar sign? On by manual examination

17:20approximation of the fingers. So with

17:22one MCQ we are discussing four MCQs.

17:24Okay. Oander sign is pulsations in the

17:28lateral fornics. Okay. So this is very

17:32good shadic sign. Another name is

17:35jacumer sign. Jacumer sign. Is this

17:39understood to all of you? Goodell is

17:41cervix will become very soft. Okay.

17:43Goodell sign may the cervix become soft

17:45like your lips. Cervix become soft like

17:48your lips. Okay. That is your goodell

17:50sign. So shadow sign or jacumer sign is

17:53the answer. Okay. Yeah. Thank you Zavo.

17:56Thank you. Yes. Okay. uh s sideway

17:58basically bluish discoloration of the

18:01cervix and the vagina. Okay, cervix

18:03maybe vagina they say bluish. Yeah,

18:05dusky dusky color dusky or bluish

18:08discoloration of the vagina. Ch. Next.

18:10Now what is this? What is this? It is

18:12cervix day. We showing different

18:13different types of cervix.

18:16Anybody? This is what this whole cervix

18:18is what in color? Anybody? Can you tell

18:21me this is whole picture is appearing?

18:24Which color my dear student? This again

18:26a cervix. This is anterior lip. This is

18:28posterior lip. And this is again a

18:30cervix. And the whole cervix is looking

18:33green in color. Isn't it? So sir, it is

18:36a cerv. It is a cervix of who? The

18:38cervix of sheh Hulk. Okay. It is a

18:41cervix of lady Hulk. Yes or no? Lady

18:44Hulka cervix. No. Yeah. That Thanos

18:47daughter. Thanos was green. Green.

18:49Thanos daughter. Gamora. Somebody told

18:50me Gamora cervix. Okay. So it is not

18:53Gamora cervix. It is not a lady Hulk

18:54cervix. Please understand this. What is

18:56this? Yes sir. This is not a hyroscopy.

18:59Hyroscopy you see the cavity. This is

19:02not a liquid base. I'll show you the

19:03picture today only of the pap and

19:05liquid. This is a colosscopy. Again my

19:08dear student. This is a virgin IBQ. I am

19:12expecting this in the upcoming 30th

19:14August need PJ examination. Why? Because

19:16this green filter word has come very

19:18good. The whole picture is green in

19:20color. So this is a green filter. Green

19:25filter which we use with calloscopy.

19:28Coloscopy plus green filter. The green

19:30filter word is not shown to you. So

19:32calloscopy first we do a yellow light

19:35and then we do a green filter. Can

19:38anybody tell me what is the purpose of

19:40this green filter? What is the

19:42[clears throat] purpose of this green

19:44filter? Anybody?

19:47The green filter purpose is what?

19:54The green filter purpose is very good to

19:58see the blood vessels MCQ because if

20:02there is cancer blood vessels there's a

20:04physics principle that with the green

20:07light the red RBCs are seen better okay

20:10very good okay yes is it clear so blood

20:13vessels are visible much better with the

20:15green color filter on culposcopy and

20:18therefore in culposcopy first We use a

20:20yellow light green filter just a green

20:21color light. Okay. So you can see the

20:23whole picture is green in color. This is

20:25the cervix and that is very important.

20:27MCQ clap if you have learned something

20:29neutral. Again identify this. They have

20:32given you it is a ultra sonography of

20:35the uterus. They will tell you

20:37[clears throat]

20:38they will tell you. They will also tell

20:40you that the lady has missed her

20:42periods. The levels are very high. And

20:44here what we can see my dear student

20:46this is the hole of the uterus and it is

20:50filled with what? Multiple fluid fil.

20:53Can you see all this? Very famous MCQ.

20:57Very famous MCQ. Multiple fluid fil

21:00grapes like vesicle. What is this sir?

21:04This is a snowstorm

21:07appearance. Snowstorm appearance

21:10suggestive of a complete vesicular mole.

21:13Please comment in the chat. Okay.

21:15Partial mole will also see the baby.

21:17Okay. And the beta hCG will be very very

21:21high and elevated. Can anybody tell me

21:24what is also the management of this

21:26condition if they ask you? So this is a

21:28complete vicular mole. It is not a

21:30partial mole. Okay, this is clear to all

21:33of you. Yes. Can anybody tell me the

21:34management? Yes. Very good. Very good.

21:37uh karuna Gupta the management of

21:39vasicular mole is suction evacuation

21:43whatever may be the weeks of gestation

21:46and after sucking out the pregnancy I

21:49have to monitor. Yes. So sir incomplete

21:52mole and partial mole what is the

21:55difference? Okay sir in complete

21:58everything is only corionic vi all

22:02grapes grapes grapes hydropic

22:03degeneration partial mole some fetal

22:06parts may be seen so when you see the

22:09baby and the snowstorm together okay

22:11that is your partial mole also tell me

22:14the carotype with one MCQ

22:17two more MCQs is what we are discussing

22:19anybody yes sir complete mole is 46 very

22:24common xx 46 xxx. Okay. And this is your

22:2969. Always triploidy. Always triploidy.

22:33Okay.

22:36Thank you. Thank you. Yes. Okay.

22:40Thank you. Okay. Yes. Is it clear? And

22:42then we have to monitor and suction

22:45evacuation should be done irrespective

22:47of weeks of gestation. Very good.

22:49Remember partial moon is always

22:50triploidy. Okay. Clear to all of you?

22:53Ch. Now identify this instrument and

22:56where is the instrument used? First tell

22:58me the use. Do I use it in tubal liation

23:01DNC? All of the above.

23:16Yes. Anybody? Anybody? Yes. So what is

23:19this for? What is this for? Okay.

23:21[snorts] Okay. Yes. So this anybody this

23:23is a again a virgin IBQ never ever been

23:27asked. So this is a green armage for

23:31sips. How I know remember when no but

23:34it's not for tuber. Okay when you see

23:36the a when you see the tip is triangle

23:39the tip is completely triangle. So what

23:42it is is please pay attention that all

23:44of you know all of you know okay sir we

23:49are going to do a cesarian section

23:52whenever this is the uterus and when we

23:55make a nick like this and cut open the

23:58uterus and get the baby out all this is

24:01going to bleed all this is going to

24:03bleed so till the time of course we are

24:04going to suture so till the time we

24:06suture it we will apply this instrument

24:10instrument like this. We will apply this

24:13instrument like this. Okay. Something

24:16like this. Okay. We will apply the

24:18instrument so that temporarily I can

24:21hold and then of course we are going to

24:25not inter. Okay. So is it clear to all

24:27of you? So we are going to hold it and

24:29then take the stitches afterwards and

24:31remove. So it is not for tubal liation.

24:34Tubal liation we use a bapcock forceps.

24:37Okay. Bapcock forceps which is

24:39traumatic. This is not for DNC. This is

24:42to uterus edges and angles in cesarian

24:46section surgery. One and only one use in

24:48whole of obstetics. Again a virgin MCQ.

24:51Okay. Never ever asked will come in the

24:53upcoming neat PG. You will remember me.

24:55Very good. So called a green army Taj

24:57for is it clear to all of you? Yes. Ch.

25:00Moving on. Yes.

25:03Yes. So please understand this. This is

25:06the air spatula.

25:10This is the air spatula. Wooden for the

25:13conventional papsmear.

25:16This part goes No. But all of the above

25:17is not dancer. Okay. All of them not.

25:19Okay. Only one. No. All of the above is

25:20not dancer. Only one. All of the above

25:21is not dancer. Utrine edges and angles

25:24in LSC surgery. Okay. Yes. So this part

25:27we rotate on the cervix. This goes in

25:29the poster forex and we prepare a glass

25:32slide and we do a conventional pap smear

25:35and [snorts] yeah this is what

25:39liquidbased cytologology. Yes this we

25:43call it as cytobrush or cyto broom. Okay

25:46cyto broom very similar to cytobrush

25:49only cyto broom is correct more

25:51technical word cytobrush almost similar

25:54and then what is done is that liquid we

25:56do dip dip dip. So this brush is rotated

25:58onto the cervix. Okay. And then we dip

26:02it in this liquid. Dip, dip, dip. And

26:04then the tip is broken off. Okay. The

26:06tip is broken up and then sent for

26:08testing. So this whole tip is sent with

26:11this bottle. Okay. So that is the

26:13liquidbased cytology. Now can anybody

26:16tell me what is the advantage of this

26:18liquid based cytologology? What is the

26:21advantage

26:22over the conventional papmear? When I do

26:25liquid based cytologology, what is why

26:27is it better than papsmere?

26:30Yes. One is we can get a clear picture.

26:33But anybody sure shot this MCQ is

26:35coming. Anybody? What is code testing?

26:40Anybody? What is testing? Chesure shot

26:42this needp MCQ you'll remember me on

26:4430th August. Okay.

26:47Okay. Core testing. So co- testing is

26:50doing a pap smear but along with the pap

26:54we also do hpv testing that is called as

26:59a co test and when we do the co- testing

27:03my dear students the co- testing can be

27:06also done every five yearly five years

27:09okay normal they tell you best screening

27:11test okay and normal pap is done every

27:14three yearly but is important because I

27:17can do hp PV testing uh we have to do I

27:21need a compulsory liquidbased

27:24cytologology conventional pap will not

27:26work when I do a core test it is liquid

27:29based cytologology plus your HPV testing

27:32is this understood to all of you yes

27:34after 30 years so pap but pap by liquid

27:37based cytology okay papme smear has to

27:38by liquid based cytologology compulsory

27:40that is quot so if they tell you in the

27:43exam what is quotest sir combination of

27:46liquid based cytology and HPV testing.

27:49This is your code test. If they tell you

27:50best screening test like like cost is

27:52not important. If they tell you best

27:54screening test, they tell you then I can

27:56do this HPV testing today. I can also do

27:58yes whether HPV is present or not. I can

28:00do HPV uh typing also. Okay. That which

28:03number the patient is affected with. Is

28:05this understood? Ch very important

28:10very very important. MCQ 19year-old

28:14unmarried girl comes to you with 45 days

28:17of armenoria wanting MTP

28:22what will I do?

28:32Okay. So point number one point number

28:35one up to 63 days up to 63 days we can

28:42go for the medical method what is the

28:46med up to 63 days or 9 weeks now just

28:50because please understand this just

28:52because the patient is unmarried you

28:56don't have to inform the police and MTP

28:58contract is wrong whoever is saying B is

29:00wrong okay yes no of course consider is

29:02needed. Alisha very wrong. Okay. Consent

29:04is of course required. You don't have to

29:06inform the police. Please understand

29:08this. Why? When do I? Because the

29:09patient is more than 18 years old. When

29:13do I have to inform the police? Sir,

29:15when the girl is less than 18. So if the

29:19patient is less than 18 years as per the

29:21POSCO, even if consensual act is

29:23considered as crime. So as per POSCO

29:26act, you need to inform the police. But

29:27MTP is not contraindicated. You can

29:29still go ahead and do if the patient is

29:32less than 18 years. Okay. Then

29:35definitely you have to inform the

29:37police. And then guardian consent is

29:39required. Consent of course required.

29:41What do we do? Whoever is saying a is

29:44wrong because why wrong I will tell you

29:48why. Now please understand this. The

29:50whole thing this is a combi kit. Okay.

29:53In the exam you can get a picture like

29:56this also. It is a combi kit of one

29:59tablet and another four long tablets

30:03like this. Okay, anybody? What is given

30:06first? Clap if you feel happy. I'm going

30:08to give you a trick and the mantra mei

30:11pristone is given first. How to remember

30:14that my dear student because sir mi

30:18mayhe f and f comes in first. Is this

30:22understood? So first drug is to be given

30:24me which is 200

30:27mgram single tablet orally I will give

30:32it and after 48 hours we wait for 48

30:37hours and then I give miso prosttol

30:42again

30:44because sir miso may s and second is

30:48also as clap tootali so lifelong you

30:50will not forget so why option

30:53All of you why option number D is not

30:56the answer because sir miso is not given

30:58first. Okay clear option D out. Okay

31:01clear to all of you? Yes. Answer miso

31:04prosttol is PG1

31:06analog also MCQ and each tablet is 200

31:11micro g and we can see there are four

31:14tablets. So it is 800 microgram.

31:19800 micro. This can be given either

31:23vaginally or sublingual or even oral I

31:26can give it remember vaginal or

31:28sublingual. Lot of nausea vomiting can

31:30happen but this is it. So mey first and

31:33therefore why is first not the answer?

31:35Your units are interchange. It is wrong.

31:39Mey pristone is mig and misoprosttol is

31:43microgram after 48 hours. Is this

31:46understood to all of you? Clear to all

31:48of you? Day 1, day three. Okay. So we

31:51have to remember like that this is

31:52called day one on day one D1 I'm on day

31:55one we give and on day three day 1 day 3

31:58D1 D3 Mi first miso second crystal clear

32:02to all of you so yes all of you said the

32:03C is the correct answer is it clear very

32:07important sir simple okay 21 year old

32:10primida 23 weeks wants MTP okay

32:18cervical cancer already kuna please and

32:20see on the YouTube one hour video I have

32:23put regarding oncology and more cancers

32:25related question will be done on the

32:2614th of August in the app okay kuna is

32:28it clear to all of you 14th of August

32:30all clinical MCQs and 15th August expect

32:32MCQ definite cervical cancer and

32:34obstetric MCQs are going to be done lots

32:35of this okay 14th and 15th of August

32:37don't miss out okay yes so now please

32:40understand this okay clear to all of you

32:42now what all students feel sir MTP was

32:46allowed till 20 weeks of gestation and

32:50Now it has been increased to 24 weeks of

32:53gestation and therefore can be done with

32:56the opinion of two doctors. Yes or no?

33:00All of you wrong. Wrong. Clean bold. No.

33:03Why? Because please understand this.

33:06This is 23 weeks pregnant with OC pill

33:09failure. So she wants MTP for

33:13contraceptive

33:15failure. And please understand this.

33:19Okay, please understand this. Okay, this

33:2220 to 24 weeks increase is for which

33:26condition? Sir, if there is some anomaly

33:29in the baby, structural anomaly or some

33:32genetic problem in the baby or if it's

33:35some rape or sexual assault victim or of

33:37course special condition to save the

33:39life of the mother. All that is it clear

33:41to all of you? Please understand this.

33:43One of the most important message uh one

33:46of the most important point to keep in

33:48mind sir for failure of contraception.

33:55Failure of contraception

33:57MTP is still up to 20 weeks only. Clap

34:03if you have learned something new. Is it

34:05clear to all of you? Okay. Is it

34:08understood to all of you? Yes. Very

34:10good. Anantasud. Okay. Okay. uh 24 weeks

34:14is only for anomaly in the baby,

34:15structural problem in the baby or if

34:17mother's life is at risk. Okay, then of

34:19course we can do and some special

34:20circumstances like divorce during

34:22pregnancy or something of that sort.

34:24Okay, so please understand this is the

34:26most important take-home message. Okay,

34:28sir, for failure of contraception, it is

34:31still only up to 20 weeks and therefore

34:34I cannot do it on the opinion of two

34:37doctors. But yes, no hospital

34:40superintendent never gives and medical

34:42board is always after 24 weeks medical

34:46board is required. What is it my dear

34:48student? Yes. By the way, by the way

34:52suppose we do a scan and if some

34:54congenital anomaly is there in the baby

34:57which is not compatible with life then I

34:59can do can be done only because for that

35:02it is allowed till 24 weeks. Is this

35:05understood? Congenital anomaly in the

35:07fetus can be done up to 24 weeks. Is

35:11this understood? We are 23 weeks. Clap.

35:14Okay. So, please this kind of questions

35:17are going to come in your NETPG.

35:19Do not uh make a mistake because we

35:22don't want to miss out on the concepts.

35:24Okay. So, can be done? No, you cannot do

35:26it. If this if failure of contraception

35:29only up to 20 weeks. Okay. Is it clear?

35:31And of course consent of the lady is

35:33required. An opinion of two doctors is

35:34required

35:36more than 20 weeks less than 20 weeks

35:38only one doctor opinion. So we are 23

35:40weeks. This is MCQ is OCI pill failure.

35:42Contraceptive failure and therefore it

35:44cannot be done at 23 weeks. Okay. Clear?

35:47Because failure of contraception

35:49is only for the uh is only for the uh up

35:53to still up to 20 weeks only. Clear to

35:55all of you? Yes. And before we proceed

35:57further my dear student quickly take two

35:59seconds download the OG guru app and

36:0113th 14th 15th August whichever source

36:04OBGY you have studied from don't worry

36:06just give 6 hours 2 hours session each

36:11we are going to do three live sessions

36:12of 2 hours day one we are going to

36:14discuss all the image based video based

36:16question clinical MCQ and most expected

36:19you can see this much stream is giving

36:20you benefit how much more if you can get

36:22more this is your rank booster and

36:24definitely it going to improve your

36:26rank. We have been conducting the

36:27session but with almost 100% strike rate

36:30is what we are getting it many many

36:32questions from this 6 hours are going to

36:34appear in your 30th August it's only 399

36:36okay freedom here so quickly join it I'm

36:38going to see you live on 13th August at

36:406:30 p.m. is when we are going to see

36:42you on the 13th. Now moving on to the

36:46next very important MCQ

36:49again a longest question 25-year-old

36:52obese patient four years married for 4

36:55years she is having acne herutism

36:59infertility what is the treatment of

37:01choice for her anybody based on the

37:05based on the history what is your

37:08diagnosis what is your diagnosis based

37:10on the history yes sir we have got a

37:14patient friend who is now the new name

37:16PM OS poly

37:19endocrinology metabolical ovarian

37:22syndrome polyendocrine metabolic ovarian

37:23syndrome of course the old in your exam

37:26PCOS will still be there does not matter

37:28is it clear to all of you yes so PCS PM

37:31now anybody before I proceed further so

37:33there is irregular periods which suggest

37:35anovvulation and infertility and acne

37:38hyotism so the picture is suggestive of

37:41PCSP now before we proceed further can

37:43Can you quickly tell me what criteria we

37:46use for diagnosis of PCOS? What

37:49criteria?

37:51Anybody what criteria is used for

37:53diagnos PCOS?

37:56Okay. Yes sir. Rotordam criteria.

38:00Roterdam criteria is what we use. And in

38:03that totally there are three criterias

38:06any two out of three should be present.

38:09Criteria number one an ovulation.

38:13and ovulation. Criteria number two,

38:16hyperandrogenism.

38:18And third is the ultra sonography

38:22criteria. The famous necklace of pearl

38:25pattern, multiple small follicles

38:28arranged in the periphery of the ovary

38:31or ovarian volume more than 10 cc. Very

38:33good. Now can you please tell me as per

38:36the latest how many follicles? How many

38:39follicles? Yes, all these follicles are

38:41very very small and they are 2 to 9 mm

38:44in size. Multiple small follicles. Yes,

38:47but as per the latest this is again

38:49surely coming in the exam that when I

38:52use a 8 MHz probe, please remember

38:55follicle number per ovary. Yes, 12 12 or

38:59more than 12 follicle is slightly old.

39:03Better to go with the latest not 16

39:05beta. Okay. 20 or more than 20 follicle.

39:1020 or more than 20. Okay. It's called

39:12FNPO. Clap if you have learned something

39:14new. Follicle number per ovary. Okay.

39:17FNPO. Follical number per ovary to be

39:20calcul to be counted is 20 or more than

39:2220. That's the latest criteria. So go

39:24for that. Now please understand this.

39:26Okay. Sir, whenever we have a patient of

39:29PCOS, of course, lifestyle modification,

39:32diet, weight loss, very very important

39:36lifestyle changes again it is an

39:39important MCQ. Okay. What should be

39:41recommended to all patients? Okay. What

39:45should be recommended to all patients?

39:46Lifestyle changes. All that clear to all

39:48of you? Yes. Now, please understand

39:50this. Okay. That is one thing. Now

39:52whenever we have got a patient the

39:55further treatment will depend on if she

39:58is infertile planning pregnancy or she

40:03says doctor I'm not married I want only

40:06treatment for acne herutism and

40:10irregular periods okay you divide the

40:13patient very very important now if she

40:16is infertile the infertility is because

40:20of what sir infertility is because of an

40:24ovulation. So we have to go for

40:27ovulation

40:29induction

40:31and the number one drug of choice for

40:34this condition chomin wrong. Clomifin

40:37was the answer this isole. My dear

40:40student let is now the better response

40:45and therefore let the better answer

40:48glifin is later on. And still if the

40:52patient does not respond then we can go

40:53for recombinant FSH or HMG injection. Is

40:56this understood to all of you? So my

40:58dear student when you have this question

41:01please do not give OC pills not over

41:04here. She is please understand look at

41:06the question. The patient presents with

41:09infertility.

41:11So she wants ovulation induction.

41:14Clomifin is not preferred. I will go

41:16with letroozole. Of course, metformin

41:19will be added to tackle the problem of

41:22insulin resistance. Okay. Okay. No.

41:26Clomifin also very rare chance. Clomifin

41:28rare chance of OSS. That's not the

41:30correct answer. But we prefer is giving

41:32better results. Metformin is given

41:34because she's also obese. Okay. She is

41:36obese and obese patient has so obesity

41:39will be there. So there will be insulin

41:41resistance. So diet, weight loss,

41:43exercise and metformin will be added.

41:45Metformin can be added and therefore a

41:46is the answer. Clear to all of you? Is

41:48this understood to all of you? Lrosol

41:50and not clen. But now tell me the second

41:52answer. Now tell me this second MCQ.

41:55Again longest question. See long

41:57question students clean bold.

42:03I want all of you to answer. Okay please

42:05maximum student all of you try to answer

42:07right wrong does not matter. It's okay

42:08to be wrong over here then to be wrong

42:10in the exam. All of you answer ch. Okay

42:12we are coming to that. Coming to that.

42:14Okay.

42:16Why not OC? Because OCP will not make

42:18her conceive. Okay. She wants treatment

42:19for fertility. Okay. Now here. Okay. 20

42:22for a lady married for 3 years.

42:28Okay. Married for 3 years comes for now

42:30see look at the first line. She comes

42:32for treatment of herutism. Again obesity

42:36facial hair irregular period. So again

42:39my diagnosis is POS only and

42:42testosterone levels are elevated. And

42:44look at this LH to FSH ratio. Okay. FSH

42:47to LH ratio over here 9 is to 36 1 is to

42:524. So that is also suggestive. And here

42:56what do we give? Yes. Again those who do

42:58drilling drilling is drilling you will

43:01have to go to jail. Why? Because sir in

43:04a 24 year old young patient if you do

43:07drilling you have to go to jail. Clear?

43:09And let required during fertility. She

43:13[clears throat] does not want fertility.

43:15Now clear to all of you? Yes. So please

43:18understand this. Clap if you feel happy

43:20when I told you this management sir in a

43:23infertile patient we go for letros or

43:26chlomophen of course metformin can be

43:29added to both the patients and and and

43:33when we have a girl who wants only

43:35treatment for acneism and irregular

43:38periods. Clap if you feel happy

43:42answer PC o

43:46PC O just invert it OCP to tali clap

43:51nobody will teach you like this my

43:52guarantee that means sir here you prefer

43:54to give OC pills PC OCP that's the way

43:59to remember is it clear to all of you

44:01how will you remember my dear student

44:03sir we will remember PCO just they are

44:07made for each other OCP OCP MU OC pills

44:12PCO OC pills and and and in that one

44:16level further higher up yes sir any OC

44:20pills can be given any OC pills can be

44:23given but I prefer the one which has got

44:27the anti-androgenic

44:30property and therefore I prefer

44:33cyproteron.

44:35Cyproon is a progesterone with a

44:39anti-androgenic

44:41property and that is better because here

44:44she has got herutism acne and she wants

44:48treatment for that. So A is not

44:50completely wrong but B much better than

44:52A. Okay, B is much better than option A

44:56to make the paper tougher both B and A

44:59will be in the option. Is it clear to

45:00all of you? Yes. If only oipel is there

45:02you mark that but remember PCO oipil

45:05okay so B is better I repeat because

45:07cyproeron has got a anti-androgenic

45:09property okay is it clear to all of you

45:12yes moving on very important short shot

45:16primary ammenoria what is the definition

45:20so again primary ammenoria recent

45:23advances this is the MCQ the definition

45:28of primary ammenoria has changed and

45:32therefore we should know the new

45:34definition. Okay. So please understand

45:36this first the old and then the new

45:41old criteria.

45:43Sir old remember 14 years and 16 years.

45:48Why two definitions? Because sir second

45:52we look at the auxilary hair pubic hair

45:54breast development pubarchy minarchy. So

45:57secondary sexual characters SSC SSC is

46:02secondary sexual characters. So if I see

46:04a girl in the OPD and she is 14 years

46:07already and there is no secondary sexual

46:10characters then even at the age of 14.

46:14But if secondary sexual characters are

46:16present we can wait till 16 years. Now

46:19please understand this this has been

46:21changed by one one year. This 14 has now

46:25become 13 and 16 has now become 15. Is

46:30this clear to all of you? Absence of

46:33secondary sexual characters, presence of

46:35secondary sexual characters remain the

46:36same. So all of you look on the board.

46:3814year-old no menes but with breast

46:41development. H with breast development.

46:44So I can wait. I can wait. Okay. Wait

46:47till 15. Similarly sir 13year-old no

46:50menes with breast development. Both this

46:52we can wait. We can wait. And

46:5414year-old, no menes without breast

46:57development. This is the old answer old.

47:01What is the answer now? C. Yes. 13y old.

47:0613year-old. No menes without breast

47:09development. Is it clear to all of you?

47:12So A and B sir, we can wait. Wait till

47:14what all of you? We can wait till wait

47:19till 15 years. Okay. Okay, we can wait

47:22till 15 years and even after 15 years

47:24the menes are not starting then I will

47:28call this as

47:30then I will call this as

47:33a patient of primary amenoria. Clear to

47:37all of you? Clear to all of you? Yes.

47:40Okay. So

47:42yes okay is it understood to all of you?

47:45Yes.

47:47Moving on to the next MCQ. Second most

47:51common cause of primary amenoria

47:59in the exam generally students read the

48:01most common. Okay. But you second most

48:03common. So please understand this.

48:05Ovarian disgenesis or turner syndrome is

48:10the most common cause. Okay. Ovarian

48:13disenesis another name is Turner

48:15syndrome. Turner is the most common

48:17cause. Second pick. Anybody? Second

48:20pick.

48:25No, not thyroid. Okay. Answer is

48:29malarianesis

48:31or RMKH

48:33is the second most common cause and your

48:36number A here. That is the third most

48:39common cause of primary manora. So clap

48:42if you feel happy with one MCQ we are

48:45getting four MCQs. Correct. No but

48:47hypothyroid is not. Okay, clear to all

48:48of you? Yes, thyroid disorders can give

48:50rise to in fact menorasia. Please keep

48:53that in mind. Okay, clear to all of you?

48:54So, RMKH or malarian ogenesis is the

48:58second most common cause is the second

49:02most common cause for primary turner

49:04syndrome is number one. Is this

49:05understood to all of you? We'll discuss

49:07the carotyping also in some time. Now,

49:10cho very important clinical case.

49:13Clinical case. All of you.

49:34Yes. Anybody got the answer over here?

49:36Ch tell me over here. Okay. So now

49:38please understand this primary aminoria

49:41and USG absent uterus. So I am going to

49:45give all of you a very super hit mantra

49:48my dear student. Okay sir, whenever we

49:51have got a patient of primary aminoria

49:54along with absent uterus along with

49:57absent uterus there are only two

50:00possibilities in whole of gynecology.

50:03Sir either it will be RMK syndrome or it

50:08will be androgen insensitivity syndrome.

50:12Is this understood to all of you? is

50:14understood to all of you and very very

50:17important

50:19what is the carotype and how to

50:21differentiate please understand breast

50:23is breast is present in both the cases

50:27that is not a difference breast will be

50:30plus+ over here also plus+ over here

50:34also yes sir RM kH is malarianis

50:40so uterus fallopian tube will be absent

50:42but the gonard present is ovaries

50:46and androgen in sensitivity. The gonad

50:49present is testes. However, testes is in

50:52the inguinal region. Okay. Is it

50:54understood? Testes is present in the

50:56inguinal region because descent of test

50:58syndrome uterus will be present.

50:59Remember that in mind. Okay. RMKhis both

51:02uterus will be absent. Keep that in

51:03mind. Turner syndrome also. So when you

51:05have this MCQ automatically two options

51:09out. Saturnus syndrome the uterus is

51:12present. Calman syndrome also the uterus

51:15is present. Clear? So that is out

51:18because here it is absent uterus. Okay.

51:22What do we look at? Yes. Karaotyping if

51:26I will teach you also this is 46x

51:30and this is 46xy.

51:34But karaotyping will not be provided to

51:36you in the exam. We are supposed to look

51:38at the axillary and pubic hair. Can you

51:43tell me? Yes sir. Column number one.

51:47Column number one. Normal female like

51:50all girls like all female the ovaries

51:52will secrete testosterone and axillary

51:54and pubic hair will be present. But in

51:58column number two look at the hair. But

52:00look at the hair where not here. Okay.

52:02And look at the hair at exopic hair.

52:04Here the aapubic hair will be absent. To

52:07make the MCQ tough they can add the word

52:10sparse. They can add the word sparse.

52:12Okay. Clear to all of you? So here when

52:15the my dear student

52:17there is a MCQ which is telling you this

52:21one line this is your clincher. Okay sir

52:24absence of axillary and pubic hair. Is

52:29it clear to all of you? So when you have

52:32absence of a pubic hair what is your

52:35answer? Yes my dear student that is

52:38androgen insensitivity A is the answer.

52:42If they tell you present primary

52:44aminoria absent uterus with well a pubic

52:46hair that will be your RMK syndrome.

52:48Okay. And can anybody tell me what is

52:50this lump felt in the inguinal region?

52:53Yes sir. Lump in the inguinal region.

52:57This is the undescended

53:00testes. Okay, testes are in the inguinal

53:04area and you're supposed to remove this.

53:05Is it clear to all of you? So, androgen

53:07said the answer and lump in the in

53:08region is the unescended test which also

53:10very important. Ch. Now match the

53:12column. New style of asking question

53:15match the column. Clear to all of you

53:24anybody? So all of us know Turner

53:26syndrome is 45XO

53:291 A 1 A though option out two options

53:33out clear RM just now I told you absent

53:38uterus normal ovary but RMH is 2 C and

53:44you have the answer already 2 C androgen

53:49insensitivity is a boy actually

53:533B B 3B and clan center is 47xy

53:59that your pediatrician will teach you to

54:01option B. So I love this match the

54:03column kind because with one MCQ they're

54:05asking you four separate MCQ because you

54:06see four MCQs get asked to you in one

54:09four MCQs in in last one in in in one

54:12second 1 A 2 C 3 B 4 D clear to all of

54:16you clear to all of you. Now can anybody

54:19tell me how can just one more point how

54:22can RMK have their own babies? RMK can

54:25have their own babies. Can RMK have

54:28their own babies? Yes, sir. Absent

54:31uterus. Yes, uterus is absent but the

54:34ovary is perfectly normal. From that

54:37ovary we can get eggs. We can get

54:40estrogen being secret. That's why breast

54:42is well developed. And from that eggs we

54:44can take husband sperm. We can take IVF

54:47can be done and bka uterus or uterus on

54:50higher or surrogacy. Serrogacy can be

54:54offered to these patients who are having

54:58RMK. Why? Because sir surrogacy they can

55:02have their own biological okay movie had

55:04come me okay Sanon or if you have seen

55:07friend sitcom Phoebe Phoebe acts as a

55:09surrogate carrying triple triplets.

55:11Okay. Is it clear to all of you? Is it

55:12clear to all of you? Yes. So surrogacy

55:14is possible not ovelation induction.

55:16Yes, you will take the eggs out but

55:17uterus is absent absent uterus. So they

55:19will require surrogacy bka uterus or

55:22uterus on higher. Clear to all of you?

55:26Yes.

55:31Yes. Okay. So that is just very

55:33important by the way. Very important.

55:34Con movie they can ask you MCQ movie

55:37made on surrogacy. Okay. Mimi kiton.

55:40Okay. Yes. Now ch very important. Very

55:44important.

55:49Yes. Anybody? So again a longish

55:51question. Again a longish question.

55:53Students get clean board. Okay. Please

55:55pay attention. Yes. Okay. What is it

55:58that patient has come to you at 16 weeks

56:00for antiatal screening for down

56:02syndrome. She has missed her first

56:03trimester. That's why we could not do

56:05certain test. And and and

56:07which of the following would not? So

56:10please read the question. We are 16

56:13weeks pregnant. We are 16 weeks

56:15pregnant. Which of the following would

56:18not form a part of screening at this

56:21age? Okay. She wants to know the risk

56:24for fetal aniploid. M. Basically the

56:27question is about tisomi 21 screening

56:32test. Tisomi 21 screening test. Tell me

56:36what all test you know for tisomi 21

56:39screening sir we can use maternal serum.

56:42What are the test anybody? The test

56:44available are dual marker, triple

56:48marker, quadruple marker test. Is this

56:52clear to all of you and anybody? What

56:55are the components of these testing also

56:58we should know? Very important. Clean

57:00board. Okay. Majority students. No.

57:02Which of the following is not a part?

57:04Yes sir. So what is triple marker test?

57:08HCG, alpha, phto, protein, unconjugated,

57:13estriol,

57:16E3 sir here there is three because many

57:18students say no triple marker test

57:22triple marker test and when I add the

57:25fourth marker that becomes inhib

57:29that is your quadruple marker test okay

57:32SCG alpha fto protein unconjugated stri

57:35and the fourth marker that become the

57:36quad test Pap A is the answer sir. Pap A

57:40is only. So HCG is done. Sir HCG is a

57:43part of both. HCG is common to all

57:45double triple quadruple. So PAP A is the

57:48answer because sir PAP A is done in the

57:52first trimester

57:54when we do s 11 to 13 weeks we do the

57:58pap A and HCG. Clear to all of you? N.

58:01Okay. Yes. Very good. Okay. So pap A sir

58:04is a part of dual marker test. Very good

58:07Tanya inhib the dual marker test which

58:10is only done in the first yes HCG is

58:12also part of it. So sir HCG is in the

58:14both remember that HCG is T1 also T2

58:18also T1 first trimester T2 second. So

58:21HCG is also done in the first but it's

58:24done in the second clear cut at 16 weeks

58:26remember at 16 weeks what do I do? Yes

58:29sir. So sir triple mark per quadruple

58:32marker test are done between 16 to 18

58:35weeks of gestation. Clap if you have

58:36learned something new. Dual marker test

58:38is done between 11 to 13 weeks of

58:41gestation completely. We should know

58:43I'll tell you more about this MCQ in one

58:44because same question is there this one

58:46ch which is not true for antiatal

58:50screening for triomi which is not true

58:52for antiatal screening for tisomi. So

58:54this also we should know completely. So

58:56now tell me sir okay when I look at the

59:00if the baby has tricomi 21 tell me for

59:05this hcg

59:07alpha phto protein unconjugated estriol

59:12what is up what is down what is

59:15increasing what is decreasing anybody

59:18yes sir when we have tisomi if suppose

59:22the baby has tricom 21 suppose the baby

59:25has tricom 21 HCG will be higher than

59:30normal and other two will be lesser than

59:34normal. Okay, that is if it's a triple

59:38marker and if we add the quadruple

59:41marker which is inhib

59:44that is also higher than normal that is

59:48also so two up two up two down okay that

59:53is your quadruple marker test car report

59:57and suppose sir when I look at dual

1:00:00marker test dual marker test it is only

1:00:05HCG and PAP A pregnancy associated

1:00:09plasma protein A. Again we should know

1:00:12the arrow. See here hCG arrow is up. So

1:00:15here also hCG will be up but pap A will

1:00:18be lower than normal. Is this understood

1:00:20to all of you? This you should know by

1:00:22heart. Okay. So now we come back to

1:00:26this. Yes, look at the answer. Sir,

1:00:28alpha fto protein is going to go down.

1:00:30Correct? So question which is not true.

1:00:33Yes, alpha fto protein decrease. Yes, NT

1:00:36we'll discuss now. Nucal translucency

1:00:38it's ultra sonography that is also very

1:00:42important. And pap A is decreased. Very

1:00:45good. C is the answer. HCG is not going

1:00:48to be lesser than normal. Sir HCG is

1:00:52going to be higher than normal. Yes. Is

1:00:55this understood to all of you? Clap

1:00:57tootali if you're getting revived. So my

1:00:59dear student if this 2our session going

1:01:01to be so much beneficial to you imagine

1:01:03when you attend 6 hours class 13 14 15th

1:01:06of August do not miss out enroll today

1:01:09just 39 we're just taking very basic

1:01:11platform fee already many of the

1:01:12students have already enrolled and

1:01:14already are waiting and many more please

1:01:16join soon so that it's going to

1:01:17definitely rank booster course is going

1:01:19to start on 13 14 15 just 6 hours and

1:01:21it's going to tremendously boost up your

1:01:22objection crystal clear to all of you

1:01:25yes okay ch and scan bar we'll discuss

1:01:27when also more Again a new style. Now

1:01:30what the mistake students make is my

1:01:32dear student when the question comes

1:01:33they directly start marking from here 1

1:01:362 3 4. No all this is a part of the

1:01:40question only. Your whole damn question

1:01:43is still here. Okay. All this is a part

1:01:46of the question. Now select the correct

1:01:47answer from the code given below. Okay.

1:01:50Ventos. Ventoser is another name for

1:01:54vacuum.

1:01:56vacuum another name ventos

1:02:01okay clear to all of you vacuum so now

1:02:04what do I do it when do I do it please

1:02:07understand this can you tell me suppose

1:02:10sir if it's a face presentation

1:02:13suppose it is baby face okay baby face

1:02:16is there if I apply vacuum what will

1:02:19happen sir if I apply vacuum on the

1:02:21baby's face the baby's eyeballs will pop

1:02:24out so vacuum can never be applied on

1:02:26face and after coming head of the

1:02:28brereech sja. So that is why remember V

1:02:31for vacuum V for vortex. V for vacuum V

1:02:35for vortex tootal. Okay sir vacuum is

1:02:39only for vortex presentation

1:02:42forceps can be applied on breach and

1:02:44after coming out of the breach and and

1:02:45on after coming out of the breach and on

1:02:47our face. Okay. So vacuum is only for

1:02:49vortex vacuum. Second is yes maternal

1:02:53exhaustion we apply. Mater is exhausted

1:02:56and if there is fetal distress also we

1:02:58can apply. Is this understood to all of

1:03:00you? Now please understand if it is a

1:03:04prematurity

1:03:06prematurity my dear student absolute

1:03:10contraindication

1:03:12for vacuum. Why?

1:03:14Because sir pre-term babies are anyway

1:03:18more prone to intravententricular

1:03:20hemorrhage and if I apply vacuum it will

1:03:24lead to more intra ventricular

1:03:26hemorrhage. Is this understood to all of

1:03:29you? No time 6 cm wrong right wrong.

1:03:32Okay no minimum seven minimum seven but

1:03:35practically we wait for full dilation

1:03:37only. Wait for full dilation only. Clear

1:03:39to all of you? So all of you look on the

1:03:41board. All of you look on the board. The

1:03:43question is what is the indication as

1:03:47well as prerequisite? So delay in the

1:03:49second stage of labor. Yes.

1:03:52Nonreassuring fetal heart rate. Yes.

1:03:55That is fetal distress. Yes. We can

1:03:57apply vacuum. Forceps is better. But

1:03:59yes. And and and vertex presentation of

1:04:03course. Yes. Three is wrong.

1:04:04Gestationally less than uh less than 34

1:04:08weeks is a absolute contra indication.

1:04:11So very good. 1 2 4. Yes, heart disease

1:04:13also. Very good. Heart disease to cut

1:04:15short. Second stage. Okay. Heart disease

1:04:17patient also we go. So basically three

1:04:20should not be there. Three out. Three

1:04:23out here. 1 2 4. Very very important.

1:04:27MCQ 1 2 4.

1:04:30Yes. Clap if you feel happy. Clear?

1:04:32Okay. Yes. Ch. Now tell me this again a

1:04:36longest. It's a simple question.

1:04:38Sometimes reading the last line will

1:04:41better. Okay, such a long question.

1:04:43Primig gravida with certain LMP comes to

1:04:46attend antinatal. She wants to undergo

1:04:48first trimester screening for an

1:04:50employee combined screening. Combine

1:04:52means what I tell you. So the sonologist

1:04:53wants to do a a scan for nucal

1:04:56translucency. When is to be done? Sja.

1:04:59Yes. So such a long question again

1:05:01popular question nothing great. Okay.

1:05:04Simple MCQ. Okay. When is the NT scan to

1:05:08be done? 11 to 13 weeks of gestation. 8

1:05:13to 10 weeks is very early and 18 to 20

1:05:16weeks we do a anomaly

1:05:20scan. One more MCQ. So the MCQ is okay.

1:05:24NT scan cup and all of you know NT scan

1:05:29is done in the first trimester. Okay.

1:05:31And remember what do we mean this

1:05:32combined screening. Okay. Combined

1:05:34screening means what anybody very

1:05:36difficult. What is combined screening?

1:05:37So remember when they ask you combined

1:05:40screening, combined screening means

1:05:42what? Combined screening means with the

1:05:44help of maternal serum also mother's

1:05:47blood is taken and we do a dual marker

1:05:52test and along with it we do ultra

1:05:55sonography which is the NT scan.

1:05:58Nowadays we call it as NBNT scan nasal

1:06:01bone should be present and all of us

1:06:03know yes up to 3 to 3.5 mm is considered

1:06:09normal normal entity more than this ent

1:06:13more than 3.5 mm we consider it as

1:06:16increased entr

1:06:21so basically this the question is okay

1:06:23at what gestational window can the

1:06:26anti-ucal translucency be reliably

1:06:27measured So sometimes don't panic for

1:06:29the long questions. Okay. So all these

1:06:31long clinical MCQs is going to discuss

1:06:33also on the 14th of August. Uh in the

1:06:37app also we are going to discuss clear

1:06:38to all of you. Yes. So NT scan is a very

1:06:41important all these are extremely

1:06:43important MCQ you will remember me on

1:06:44the day of the exam. Okay. Yes. Up to 3

1:06:46to 3.5 mm is considered normal.

1:06:50Okay. Is it clear to all of you? That is

1:06:52considered normal. Okay. Yes. Moving on

1:06:55to the next MCQ.

1:06:57What is this? A picture again a IBQ.

1:07:05Identify what is the total content and

1:07:10what is the quantity of it. So sir this

1:07:14is your completely white. It is not

1:07:17copper. It is myina.

1:07:21It is myina and the myina contains LNG

1:07:26is also called as LNG IUD and we call it

1:07:31as LNG 20. Why? Because s 20 micro g per

1:07:37day. Okay. Is this clear? 20 microgram

1:07:41per day. Yeah. Total quantity is asked

1:07:45it is not 20 mg. Wrong. Clear. Wrong.

1:07:50Wrong. Wrong. Yes. Option A. So this

1:07:53device contains LNG 52 mg tootal. Okay.

1:07:59Total is 52. We call it LG20 because 20

1:08:02microgram per day is released. Totally

1:08:05it is having total 52 mg. So please read

1:08:09the question correctly before answering.

1:08:11Okay. And can anybody tell me what is

1:08:13the use of this? Where do we use it?

1:08:14Other than birth control.

1:08:19Other than birth control

1:08:22any idea?

1:08:26Yes. So it can be used in menorasia

1:08:28dismenoria. Why we use it in man? What

1:08:31does it do? Sir, we can use it in heavy

1:08:33menstrual bleeding. Menoria dismenora

1:08:36because it decreases the blood flow.

1:08:38Menstrual become menis becomes scanty

1:08:40scanty scanty and because of continuous

1:08:42progesterone it induces a manora in the

1:08:46patient. very important concept it

1:08:49causes progesterone induced ammenora

1:08:53basically what it is it it does not

1:08:55allow the lining to grow only the

1:08:57endometrium does not grow only correct

1:08:59so it's like only if the beard is

1:09:01growing if the beard is growing then I

1:09:03have to shave if the beard is not

1:09:05growing only tiger shuff what will I

1:09:07shave okay tiger shuff when he came many

1:09:09years back he did not have any beard now

1:09:11he now his beard has started growing

1:09:12okay so the this myina it prevents the

1:09:15endometrum from growing. Yes. So the

1:09:18endometrium remains very very thin. Is

1:09:20it clear to all of you? The endometrium

1:09:22remains very very very thin. And

1:09:25therefore if the endometrium is not

1:09:27going to grow, it is not going to shed.

1:09:29Sjabachal

1:09:31clearly to all of you. Yes. So

1:09:33continuous progesterone progesterone

1:09:35induced manora and therefore we can use

1:09:36it in menorasia dismenoria adenoma also

1:09:39we can try. Yes. [snorts] Septum in the

1:09:42uterus.

1:09:45Patient comes with the septum in the

1:09:48uterus. Which of the following is the

1:09:50management of this condition?

1:09:53Okay. So please understand this. You

1:09:56should know septum laparoscopy no role

1:10:00because laparoscopy will see the uterus

1:10:04from outside. Laparoscopy picture

1:10:07already I showed you. So laparoscopy

1:10:10will look at the tube, ovary, pouch of

1:10:13douglas, all that. Okay, we can do

1:10:17chromopertubation. All that is our

1:10:19laparoscopy.

1:10:21Laparoscopy can never detect septum

1:10:24because where is the septum? Yes sir,

1:10:27the septum is within the cavity of the

1:10:31uterus. It is projecting in the cavity.

1:10:34This is the septum like this. Septate

1:10:38uterus and septate uterus my dear

1:10:41student will require hysteroscopy.

1:10:45Is this understood to all of you?

1:10:49Recently also some student sent me a

1:10:50photograph. Some of the tests he had

1:10:51conducted I some of the portland it was

1:10:53wrong. The laparoscopic mount is wrong.

1:10:55Okay. We have to go through hyroscopy

1:10:57and with hyroscopy we go and we can

1:10:59start cutting. We cut the septum with

1:11:02this. We cut cut cut cut cut cut cut cut

1:11:03cut cut cut cut cut cut cut cut cut cut

1:11:03cut cut cut cut cut cut cut cut cut cut

1:11:03cut cut cut cut cut cut cut cut cut cut

1:11:03cut cut cut cut cut cut cut cut cut cut

1:11:03cut cut cut cut cut cut cut cut cut cut

1:11:03cut cut cut cut cut cut cut cut cut cut

1:11:03cut cut cut cut cut cut cut cut cut cut

1:11:03cut cut cut cut cut the septum. That is

1:11:05called as hyroscopic septal resection.

1:11:08Yeah. Septolastep. Okay. So laparoscopy

1:11:12laparotomy hyroscopic septtolasty. Yeah.

1:11:16Septum resection. Yeah. Septal

1:11:18resection. Is this understood to all of

1:11:20you? We can either go with the scissors

1:11:22or we can use electricity current also

1:11:25cold scissors or uh this. Okay. Electric

1:11:28current. Is this understood to all of

1:11:30you? Clear? So hyroscopy require very

1:11:33very simple if you know the concepts.

1:11:35Okay. So what is it? Please keep in mind

1:11:37the hyroscopy my dear student is to

1:11:40visualize the cavity. Any problem with

1:11:44the cavity that hyroscopy can detect

1:11:48clear to all of you? Laparoscopy is to

1:11:50see the outer surface pelvis. Suppose

1:11:53there are adhesions between the pouch of

1:11:55Douglas ovaries. Chocolate cyst.

1:11:57Anybody? Chocolate cyst is seen in which

1:12:00condition? Endometriosis.

1:12:03And what else do we see in

1:12:05endometriosis? Anybody? Fruit salad.

1:12:08Fruit salad means what? Sir, we will see

1:12:11blueberry lesions, blue lesions, red

1:12:15raspberry, purple raspberry, strawberry,

1:12:19red red lesions. Okay. And what are

1:12:22those black black lesions called as?

1:12:24Golia. Yes. Gunshot or matchstick burnt

1:12:28spots. Is it clear to all of you? So it

1:12:32is a very colorful picture chocolate

1:12:34cyst all that that requires laparoscopy

1:12:37isn't it? So now you know hyroscopy is

1:12:40for what other indication?

1:12:43Septum I told you sir along with septum

1:12:46sir suppose there are intrauterrine

1:12:49adhesions ashermanman syndrome or there

1:12:54is endometrial polip or submucosal

1:12:58fibroid all this will cause infertility.

1:13:02So it is also very important for

1:13:06infertile patient to evaluate the

1:13:09cavity. It is not for tubal patency.

1:13:11Keep that in mind. Anybody for tubal

1:13:13patency what do we do? Tubal patency we

1:13:16have to go and do a we have to go and do

1:13:18a laparoscopy. Clear to all of you? Is

1:13:21it clear? So all these can be managed

1:13:23and therefore all of you look on the

1:13:25board. Yes sir. Asherman syndrome

1:13:28hyroscopy

1:13:29endometrial polip hyroscopy and all this

1:13:33fibroid polip will also cause

1:13:35infertility. So infertility evaluation

1:13:38to see the cavity of the uterus.

1:13:41Question is except endometriosis.

1:13:45Yes sir. Endometry I just now told you

1:13:47will require laproscopy tokoal. It's a

1:13:50terrace view by seeing from above.

1:13:52Hyoscopy my inside view inside the

1:13:54classroom view. Is this understood to

1:13:56all of you? Can I get 10 thumbs up? So

1:13:59endometriosis requires seeing from

1:14:01above. Laparoscopy is required for

1:14:04endometriosis.

1:14:09Okay. Endometriosis may you can get big

1:14:11ovaries, chocolates, kissing ovaries be.

1:14:13Okay. Clear to all of you? Yes. So all

1:14:17this is the indication for hyroscopic

1:14:20septum adhesions asherman syndrome

1:14:23fibroid. Okay. Submucosal

1:14:26fibroid and of course your polip.

1:14:31Okay polip and of course a infertile

1:14:33patient to evaluate the cavity. Clear to

1:14:35all of you. Cho. Moving on. Very again

1:14:38simple question made into bigger

1:14:40question.

1:14:57Yes. Yes. Yes. Cha.

1:15:02Yes. Grace white discharge. And when I

1:15:06add KO, we get a fishy odor. What is

1:15:09this test? VIF test. VIF test my dear

1:15:13student if you don't know. Okay. VIF

1:15:14test. And also what do we get? Presence

1:15:17of clue cells. So this is what what is

1:15:21the diagnosis?

1:15:23So the diagnosis is bacterial vaginosis

1:15:27partner treatment not required.

1:15:29Imbalance between the good and the bad.

1:15:32Okay. Fluonazole is for fungal.

1:15:35Metronidazol

1:15:36is the drug of choice for tricommonosis

1:15:39as well as this. Okay. So very simple it

1:15:41is your bacterial vaginosis. Okay. Which

1:15:44criteria we use? Anybody whose criteria

1:15:46we use? So sir whiff test presence of

1:15:49clue cells. Okay. Clue cells on the wet

1:15:51mount. This one saline wet mount

1:15:53epithelial state loaded with the cocoa

1:15:56basili is your clue. Yes. M cells

1:15:58criteria. M cells criteria.

1:16:00Metronidazol. Okay,

1:16:05crystal clear to all of you. So simple

1:16:07MCQ again can be made into so all

1:16:09clinical cases we are discussing. Can

1:16:11you see long long questions because that

1:16:12is how we keep a practice of reading

1:16:14long questions. Okay. Again yes somebody

1:16:17was asking me sir can you teach me the

1:16:19levels of FSH? I'm teaching you now.

1:16:21Okay. Yes. Shall you tell me the answer?

1:16:2436 year old patient had uh 11 weeks

1:16:28pregnant had an incomplete abortion. And

1:16:30so she underwent a check curage and

1:16:32after that she's continuing with a

1:16:34manora. Manora is not coming only. So

1:16:36it's a case of secondary manora. Okay

1:16:39manora she's still having a minora and

1:16:41the FSH came out to be five. What is the

1:16:44most probable diagnosis? Anybody

1:16:48clinical case?

1:16:55Okay. What is this? Anybody? So now

1:16:58three MCQs will be discussed in the next

1:17:001 minute. Okay. Please understand that

1:17:03this five this five if it is there this

1:17:07five if I make it into 50 will the

1:17:11answer change or answer remain same? Yes

1:17:13answer. And if this five I make it into

1:17:16five 0.5 will the answer change? Yes.

1:17:20All answers will change. So all of you

1:17:22please pay attention here. Master

1:17:23servant relationship. Pituitary my dear

1:17:26student is the master and ovary is the

1:17:29servant. Clear? Pituitary secretes FSH.

1:17:33So now you only tell me you only tell me

1:17:36sir suppose suppose the ovarian function

1:17:39is going down down down what will happen

1:17:43to the FSH? So referral will keep on

1:17:46rising rising rising rising. Because if

1:17:49the ovary is not functioning properly,

1:17:53P2 will secrete more FSH, more FSH, more

1:17:55FSH. So when you get high FSH, it is

1:17:59your ovarian failure or ovarian reserve

1:18:02has gone. Okay, ovarian diminish. Is it

1:18:05clear to all of you? And and and suppose

1:18:08it is a fault with the pituitary gland

1:18:10only. Suppose pituitary gland has gone

1:18:13damaged, then FSH will not be secreted.

1:18:16FSH will be very very low. Is it clear

1:18:18to all of you? So now remember my dear

1:18:21student FSH

1:18:25remember 5 to 10 is considered normal 5

1:18:28to 10. Okay, clear 5 to 10 normal. Some

1:18:31even say 3 to 10. But remember that is

1:18:33in that range. They'll give you 6 7 8.

1:18:35When they want to make you tell you FSH

1:18:39very low, they will not tell you 2.5. In

1:18:42the exam they will tell you.5,

1:18:452, 3. Okay, basically less than one they

1:18:49will give you PQ. Is it clear to all of

1:18:52you? FSH less than one point is very

1:18:54very low. And when the FSS they want to

1:18:57tell you very high they will again not

1:18:59tell you 14 15 they will tell you 20 30

1:19:0340 more than 40 is seen in menopause

1:19:07when the FSH is more than 40 50 you get

1:19:10menopause that means there is menopause

1:19:12is clear to all of you and therefore

1:19:14here my dear student if this was ovarian

1:19:19failure because she's 36 years old

1:19:22premature what would have been FSH

1:19:25very very high. If this five if this

1:19:29five becomes 50 then it is first option.

1:19:33It is not any of the pituitary failure

1:19:37pituitary gland is only gone. FSH very

1:19:40very low example 0.5

1:19:45and here this is five this five FSH is

1:19:50normal FSH and that is because of intra

1:19:54why so because if it's a intrautrine

1:19:56adisions you can see we just now told

1:19:59you ashman syndrome intrautrine addision

1:20:03pituitary gland is also normal ovary is

1:20:06also normal that is functioning properly

1:20:08so sir pit Pitutary normal ovary means

1:20:10ovary is functioning normally. So

1:20:13therefore pituitary will remain normal.

1:20:14Is it clear to all of you? Clap

1:20:18so very important. See 1 MCQ how can

1:20:19become just one digit one digit a digit

1:20:24answer

1:20:26rank. So if you don't read this clear so

1:20:29if the FSH instead of this five becomes

1:20:3150 option A is the answer. If it becomes

1:20:340.5 option C answer and intrauterine sin

1:20:37sir FSH is normal why normal because sir

1:20:41the it is a problem with the uterus and

1:20:43also history of check curage given

1:20:47history of check but I can also be given

1:20:48just to confuse you clear to all of you

1:20:50so please keep this is a fivestar slide

1:20:52please keep this in mind okay whenever

1:20:53like it's a example shan syndrome what

1:20:56is shihan syndrome pituitary necrosis

1:20:59FSH will be very low okay clear to all

1:21:02of you example I'm giving you Shian

1:21:04syndrome.

1:21:07Okay. Shihan syndrome may FSH will be

1:21:10very because it's a postpartum pitutary

1:21:12necros. So you'll get.3 basically

1:21:13pituitary failure. Okay. Or if it's a

1:21:16pituitary pituitary failure. Pituitary

1:21:20failure may FSH will be no. Okay. FSH

1:21:23very very high. Either it is your

1:21:25ovarian failure. Ovarian failure or

1:21:28basically menopause. To talally clap. Is

1:21:30this understood to all of you? Ch. Now

1:21:33whenever I have a nully paras patient

1:21:36with prolapse, what do I do? How many of

1:21:40you want to do hyerectomy? How many want

1:21:42to do hyerectomy in a 27 year old nully

1:21:45paras patient they have to go to jail?

1:21:47Okay. Yes. Vaginal hyerectomy is the

1:21:50best surgery for patients of prolapse.

1:21:52But for old patient postmenopause,

1:21:55pmenopause family complete in that we do

1:21:58this clear to all of you. Now very very

1:22:01common mistake. So tell me the answer.

1:22:05Very common mistake. Students tell me

1:22:07fathergill operation. Wrong. Can you

1:22:11tell me when the patient is nully paris?

1:22:14You will always avoid fathergill

1:22:19surgery. Why? Fatherill surgery you will

1:22:22always avoid. Why? Because what happens

1:22:25in fathergill operation? All of you tell

1:22:27me this. Ch. One more. MCQ is sir.

1:22:31fathergill repair associated with all

1:22:33I'm coming to that MCQ in a minute

1:22:35discuss all of the following

1:22:37complication except so can anybody tell

1:22:40me what do we do in fathergill operation

1:22:43sir we are doing cervical amputation

1:22:48this is the uterus this is the cervix so

1:22:51in fathergill we are doing cervical

1:22:54amputation

1:22:56sir when I do a cervical amputation

1:23:00It is going to cause yes either cervix

1:23:04becomes too tight cervical stenosis and

1:23:06mainly it can give rise to cervical

1:23:10incompetence

1:23:12and repeated abortion in the second

1:23:14trimester or cervix can become too

1:23:17tight. Cervical stenosis can happen.

1:23:20Infertility can happen. All these are

1:23:23the complication of fathergill surgery.

1:23:26So sir fathergill surgery can cause

1:23:29pre-term labor, cervical dystocia. It is

1:23:32all except except pa all except

1:23:39okay all except first trimester. Yes.

1:23:44Why? Because sir whenever there is

1:23:46cervical incompetence

1:23:49always there is a painless painless

1:23:52abortion but mainly always in the second

1:23:56trimester T2 second trimester never T1

1:23:59clear to all of you? Is it clear to all

1:24:01of you? So it is going to give rise to

1:24:05abortions in the second trimester and

1:24:08patient can also develop infertility. So

1:24:11infertility, pre-term labor, cervical

1:24:14dystocia, all these complications and

1:24:17therefore please understand this. We do

1:24:20not do this fathergill. Leford is again

1:24:22only for postmenopausal lady. What do we

1:24:24do is we do a sling surgery.

1:24:28Sing is king. All of you repeat after

1:24:30me. Akshai Kumar movie had come. See it

1:24:32after your exam. Sing is king. Sing is

1:24:36king. Yes. Akshai Kumar Katrina. Singh

1:24:38is king. Many students told me. Shall we

1:24:40remember his voice in the exam? Sing is

1:24:42king and of course Singh is king and you

1:24:46will also remember sling is king. Sling

1:24:50is king. M sling is the best. Sling

1:24:53surgery. Sling is king. Another name for

1:24:57sling surgery is cervicoexi.

1:25:01How the surgery is done we'll discuss

1:25:03some other day. But this is the answer

1:25:04done through the abdominal road. It's

1:25:06called sling surgery or cervopexy. Both

1:25:08mean the same thing. When you take a So

1:25:10here you do not amputate the cervix. In

1:25:12sling surgery in sling surgery we are

1:25:15going to fix a merceline tape. Okay. We

1:25:19fix a merceline tape or a me or a tape

1:25:22is taken and we fix it to the cervix.

1:25:26We fix it to the cervix with the

1:25:28stitches and then these two ends of the

1:25:30tape are lifted up so that and you fix

1:25:33it to the body. So that is the sling

1:25:35surgery. So basically you do not

1:25:38amputate the cervix here. Your cervical

1:25:40amputation is not done. Clap if you have

1:25:42learned something new took. Okay. So

1:25:43sling is king or sling surgery is the

1:25:46best to be done in a young unmarried

1:25:48girl always or nully paras patients

1:25:50because a father girl will cause lot of

1:25:52complication. Again very important.

1:25:54Okay. Clear to all of you? Yes.

1:25:57Similarly,

1:25:59previous year question ultra sonography

1:26:02again by the history only but just this

1:26:05image if you see see this will tell you

1:26:07the ultra sonography of the uterus

1:26:08ultrasonography focus somewhere over

1:26:11here what is the shape what is the shape

1:26:15it is looking like if you just see this

1:26:18see here and here and here what shape is

1:26:23this letter what is this letter.

1:26:27Which is this letter? Yes sir. This is Y

1:26:31shape. Y. And why is it Y shape? Why is

1:26:35it Y shape? Yes sir. Because it is

1:26:39getting opened up. There is a pressure.

1:26:43Okay. So when the cervix is closed, it

1:26:46is T shape. T T T T T T T T T T T T T T

1:26:48T T T T T T T letter T T T T T T T T T T

1:26:49T T T T T T T T T T T T T T T T T T T T

1:26:49T T T T T T T T T T T T T T T T T T T T

1:26:49T T T T T T T T T T T T T T T T T T T T

1:26:49T T T T T T T T T T T is normal. And if

1:26:51all of you look over here, if my hands

1:26:53are closed and if it opens up from

1:26:55above, what happens is you get Y shape.

1:27:01This is called as funneling. Funneling

1:27:04of the cervix is about to open up. That

1:27:07is the cervical incompetence.

1:27:12Very very and again they told you see

1:27:14second trimester abortion. Okay.

1:27:16Previous they can also tell you painless

1:27:17to become easy. Yeah. Losses in the

1:27:19second trimester. Okay. So this is not

1:27:22abruption or a pre-term or PL. This is

1:27:24cervical incompetence. Okay. Clear to

1:27:28all of you. Cervix is showing very

1:27:30important. Why? Why is funneling?

1:27:34Okay. Funneling. Clear to all of you. So

1:27:37please keep all these points in mind. 31

1:27:40year old 31 weeks 28 to 31 weeks patient

1:27:44suddenly complains of headache blurring

1:27:45of vision oligura no convulsion to BP

1:27:49180 110 diagnosis okay so this my dear

1:27:54student is impending eclamsia

1:27:58impending eclamsia why because there are

1:28:02some dangerous signs and symptoms

1:28:06all of you remember O B easy h

1:28:12guru ha

1:28:14to O easy h. Okay. Ob easy henna means

1:28:18what? Sir O is oligura. Clap. B is

1:28:23blurring of vision. E is epigastric

1:28:27pain.

1:28:29H is headache

1:28:32and N is nausea and vomiting. Cluster of

1:28:37the symptoms. Cluster of the symptoms is

1:28:39very dangerous. It indicates impending

1:28:42eclamsia. Look at our patient. They've

1:28:44given you headache, blurring of vision.

1:28:47No convulsion. So it is not eclamsia. It

1:28:49is not eclamsia. If somebody says sir

1:28:51eclamsia, no sir, this is impending

1:28:55eclamsia. Now what do you do? Anybody?

1:28:58Impending clamsia. What do you do?

1:29:00Please understand. Sir, we are only 31

1:29:03weeks. Can I wait? Wait wait wait wait

1:29:04wait wait never impending please

1:29:09understand this Hindi picture stupid

1:29:11dialogue

1:29:17all that we don't do it's always save

1:29:20the mother first because mother

1:29:23so doctor never gives such an option

1:29:25okay so whenever we have impending

1:29:28eclamsia that is the last day of the

1:29:31pregnancy the pregnancy has to be

1:29:34terminated. We have to do the delivery

1:29:37and most importantly keep in mind the

1:29:40delivery will be done irrespective

1:29:45of weeks of gestation. Is this

1:29:48understood to all of you? So let this be

1:29:51will induce the labor. So let this

1:29:53patient be 24 weeks, 28 weeks, 32 weeks,

1:29:5836 weeks. The answer will not change.

1:30:00Let this MCQ be anything. 3128 this okay

1:30:05so but but but before I induce the labor

1:30:09of course I will give magnesium sulfate

1:30:12profileactically to prevent conversion

1:30:15very important because it is impending

1:30:16and then we go for induction of labor is

1:30:19this understood to all of you can I get

1:30:2110 thumbs up so labalol and wait and

1:30:24watch you have to go to jail okay if you

1:30:26wait and watch you have to go to jail

1:30:28mother it's a crime similarly labal yes

1:30:31but then ls 34 3 4 weeks. No, we'll not

1:30:33wait for 3 weeks. So remember this my

1:30:35dear student. Okay. Whenever it is

1:30:38impending acclamia,

1:30:40never never www ww never wait and watch.

1:30:46You have to do the delivery irrespective

1:30:48of weeks of gestation. But do not forget

1:30:50to give magnesium sulfate and of course

1:30:51labalol also. So magnesium sulfate very

1:30:54good. Lebital very good. But then

1:30:55delivery at 37 weeks again wrong because

1:30:58we are only 31. What is the answer? So

1:31:01maxel will be given leol to control the

1:31:03blood pressure and immediately induction

1:31:06of labor will be done. Is this

1:31:07understood? You have to do the delivery

1:31:09because delivery is the definitive

1:31:12treatment. If they ask you

1:31:16what is the definitive treatment for

1:31:18this patient? Delivery. Yes steroids can

1:31:20be given but uh uh there might not be

1:31:23time for the steroid to act. So you can

1:31:25give steroid of course magnesium sulfate

1:31:27plus anti-hypertensive also you give

1:31:30anti-hypertensive you give but then

1:31:31proceed for the delivery is this

1:31:33understood to all of you very important

1:31:35MCQ tell me this patient is having

1:31:40seizures pre-chart regimen 4 g IV max

1:31:45and then 10 g I am and then what do you

1:31:48check is also in the question paper only

1:31:50resident is checking the knee jerks

1:31:51respirator urine out simple MCQ made all

1:31:54this long. All this does not matter.

1:31:57This is all time pass. All this is does

1:32:00not this time waste. Directly your

1:32:02answer question starts from here in

1:32:04prechart regime. Therapeutic level of

1:32:06magnesium to be achieved 4 to7 mill

1:32:10equivalents per liter. Samaja because 4

1:32:12to 7 conversion stop 12 very high. Kneel

1:32:17become abolish. This is very high. Okay.

1:32:19All this is very high. 4 to 7 is the

1:32:21simple answer. All this is extra time

1:32:24waste just to make you read the question

1:32:26wasting your time. So sometimes reading

1:32:28the last part will become better init

1:32:31regime therapeutic range of magnesium

1:32:32sulfate

1:32:34chart regime therapeutic range is 4 to7

1:32:37mquins per liter and what is the

1:32:39antidote antidote yeah calcium gluconate

1:32:42okay so before we proceed further one

1:32:44more time please get in touch with me on

1:32:46phone and WhatsApp on this number

1:32:48download the og guru app and just in 399

1:32:50100% rank booster whichever source objiv

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1:32:56neatp PG five to seven marks more my

1:32:58dear students the difference between a

1:32:59rank of four 4,000 and 40,000 okay if

1:33:03with your current knowledge you are

1:33:04getting 10 11 12 MCQs just 6 hours 13th

1:33:0714th 15th of August 399 rupees 13 14th

1:33:1115th August your score in OBJ will jump

1:33:13up to 18 19 20 3 hours three sessions 2

1:33:16hours we're going to discuss clinical

1:33:18MCQs image based video based and

1:33:20expected MCQ surely all these questions

1:33:21are going to come in the nepg all

1:33:23recordings will be available till NE

1:33:24needp so don't worry

1:33:26All recordings available. Don't worry

1:33:29about that. Available till August end.

1:33:32Okay. Till August exam your recordings

1:33:35will be available. So if case in case

1:33:37you miss your live classes, don't worry.

1:33:39All recordings are going to be

1:33:40available. Don't worry about that. And

1:33:42do not forget to quickly subscribe to

1:33:44the YouTube channel. Share this video

1:33:46with all your friends and colleagues.

1:33:47And yeah,

1:33:49so we have got a patient. They will give

1:33:52you a cyclical abdominal pain. Urinary

1:33:56retention primary amenoria given to you.

1:33:59What is this cryptomenoria?

1:34:03Crypto means hidden. Crypto means

1:34:06hidden. Okay. Is this clear to all of

1:34:09you? Crypto means hidden. Okay. So

1:34:11please uh share this video with your

1:34:13friends and colleagues and do do not

1:34:14forget to subscribe to the YouTube

1:34:15channel. Please subscribe to the YouTube

1:34:16channel. Okay. Yes. My dear student,

1:34:19this is your imperate highman. Is this

1:34:23understood to all of you? bluish

1:34:25purplish hyman because sir the blood

1:34:29will start coming out but the blood is

1:34:32not coming out clear to all of you. So

1:34:35the blood is coming out but the because

1:34:38of imperforate himman the blood cannot

1:34:40the blood gets collected inside which is

1:34:42called as hematol

1:34:45and then blood gets collected inside the

1:34:48uterus hematra

1:34:51and what do we see when we look at the

1:34:54patient tense bulging him highman bluish

1:34:58purplish bulging him highman is seen

1:35:01which is the answer over here imper for

1:35:05himman and we have to make a cruciate

1:35:07incision. Okay, a cut is made you make a

1:35:11cut cruciate incision.

1:35:14Jello tell me this also 35 weeks

1:35:16patient. So whenever we have bleeding in

1:35:19the third trimester G2 P1 L1 painless

1:35:24bleeding

1:35:26uterus relaxed clue head floating BP

1:35:31normal. What is it my dear student? So

1:35:35whenever sir we have got a bleeding in

1:35:38the third trimester

1:35:40keep two things in mind sir it could

1:35:43either be a placenta privia or it could

1:35:48be abruption.

1:35:50How to differentiate between the two?

1:35:52Anybody? How to differentiate?

1:35:55Placenta pia sir is a painless bleeding.

1:36:00Abbruption is always painful. Keep that

1:36:03in mind. And very important sir, here

1:36:06the uterus is relaxed.

1:36:09Abbruption the uterus is tonically

1:36:12contracted. The tone is increased.

1:36:15Increased tone, tenderness and tonically

1:36:18contracted uterus. Is this understood to

1:36:21all of you? Tonically contracted uterus.

1:36:25Keep that in mind. So that is very

1:36:27important. And in placenta privia you

1:36:29can wait and watch. Abbruption never

1:36:31wait and watch. And again placenta

1:36:33prevents the head from coming down. So

1:36:34head is floating. Okay? Because all of

1:36:37you look on the board when there's

1:36:39placenta pia over here the baby head the

1:36:42head will not enter the pelvis. So head

1:36:45is unengaged. So this is not abruption

1:36:47because uterus is relaxed and it's a

1:36:50painless bleeding. This is not a

1:36:51clamshia. This is very simple MCQ

1:36:54placenta pia. But now what will I do?

1:36:58Chello tell me what will I do?

1:37:03Yes. Fundalite can be more in abruption.

1:37:04Very good. Okay. Yes.

1:37:0733 weeks lady admitted with episode of

1:37:10bleeding. Hemoglobin. Okay. BP normal

1:37:12uterus relaxed f. Next line of

1:37:14management is okay. How many want to

1:37:18induce labor? Anybody? How many want to

1:37:20induce labor? How many 1 2 3 4 5 4 7?

1:37:35Okay. Clear to all of you? Yes. So

1:37:38please understand this. Whenever it is

1:37:40placenta privia, whenever it is placenta

1:37:44privia, if you induce labor, you'll have

1:37:47to go to jail. Please understand this

1:37:49because if you make the uterus further

1:37:51contract there's going to be torrential

1:37:52bleeding baby cannot perforate through

1:37:54the placenta and come out fata placenta

1:37:57nicla hero clear so or heroin so baby

1:38:00cannot perforate to the placenta come so

1:38:02placenta pia we will always have to do

1:38:05the delivery by lscs but but but many

1:38:08student directly make the diagno again

1:38:10same thing so this is painless bleeding

1:38:13uterus relax so this is again pp

1:38:16placenta pia and directly Student will

1:38:18say this is in section wrong. Please

1:38:21understand this. Yes, this is placenta

1:38:23privia but we are only 33 weeks and

1:38:29along with it so never induce induction

1:38:31of labor you have to go to jail. Okay.

1:38:33Jail. Similarly forep delivery not

1:38:36possible. Clear to all of you? Yes sir.

1:38:38Look at the condition what we can do.

1:38:42Sir MJ what is MJ? Not Michael Jackson.

1:38:47Mafi and Johnson regimen. So when the

1:38:50mother is stable, if the mother is

1:38:54stable, there is no fetal distress

1:39:00and sir the pregnancy is less than 37

1:39:05weeks. Please understand we are waiting

1:39:07for the fetal lung maturity. We are not

1:39:09waiting for the placenta to go up.

1:39:12So all of you please pay attention.

1:39:14Okay, here sir what we will do is we

1:39:18will look at the question paper sir the

1:39:21mother is stable fetal heart rate 140

1:39:25per 150 is again normal and we are only

1:39:2833 weeks we can wait and watch but then

1:39:32wait and watch wait and watch wait and

1:39:33watch wait and watch till only 37 weeks

1:39:38then don't wait further once you reach

1:39:4037 weeks then we can go and do cesarian

1:39:43section Is it clear? If mother baby is

1:39:45okay, mother's stable, baby stable, then

1:39:47I'll try to wait, wait, wait, wait till

1:39:4937 weeks. But then don't wait further.

1:39:51Don't wait till 39, 40 weeks. There's no

1:39:53point waiting further. Okay? So wait and

1:39:55watch in a macafei and Johnson. This is

1:39:58wait and watch in placenta privia. We

1:40:01are waiting for the fetal lung maturity.

1:40:07Okay, that is the purpose why we are

1:40:09waiting. Clear? But mother should be

1:40:10stable. There should be no fetal

1:40:12distress. Crystal clear all of you? Ch

1:40:14again a very important

1:40:17balloon. This is for eronic pph balloon

1:40:22tamponard

1:40:25bakri. Please understand this bakri

1:40:28balloon tampon foreign

1:40:31all of you bakri stylish. How will all

1:40:34of you say bakri balloon? Bakri this

1:40:36slightly this jaw this angle of jaw

1:40:38should go down. Repeat after me. Back

1:40:40balloon. Okay. There's a balloon

1:40:41tamponard we give for a tonic pph

1:40:44specifically when the medical management

1:40:46fails. Okay. When all the medical

1:40:48management is over and then I have to go

1:40:51for surgical management

1:40:54beach we can try this balloon. Is it

1:40:57clear to all of you? And what is the

1:41:00capacity of this balloon is also an MCQ

1:41:04500 ml. Very good. That's an MCQ. Clear

1:41:07to all of you. One more video or video.

1:41:13Okay. What is being shown over here?

1:41:15What is being shown like a pitchkari I

1:41:17am I did this suction creation and I

1:41:20pull this. What is this instrument? What

1:41:23is this instrument? We are going in and

1:41:26we are sucking out it done for what MTP

1:41:29in the first trimester. Okay. So what is

1:41:32this instrument? Yes sir. This is the

1:41:37MVA syringe

1:41:39and this is the carman canula. Isn't it

1:41:44carman canula clear? When do we use it?

1:41:48It is for MTP in the first trimester up

1:41:52to 12 weeks. Okay. This is only possible

1:41:56up to 12 weeks.

1:42:01Question is s. Yes. What is the

1:42:05question? What is the capacity of this

1:42:07device and the vacuum? This m the MVA

1:42:11syringe. Okay. Manual vacuum aspiration

1:42:15syringe. So please understand this. The

1:42:17capacity is 60 ml. Okay. So 50 wrong,

1:42:23100 wrong, 60 ml. But the vacuum created

1:42:27600 mm of mercury. Very important MCQ.

1:42:31Okay. So 60 ml and 600 ml of mercury.

1:42:36That is your answer to this video. So

1:42:38please don't panic. Don't panic. Video

1:42:40based is just like asking you image.

1:42:43Video based is an extension of image

1:42:44based question. Many more videos we're

1:42:46going to discuss on 13th of August. Come

1:42:48there at 6:30 p.m. Clear to all of you?

1:42:50So video is just like image. Don't

1:42:52panic. Okay. Ch again very simple

1:42:55diagnosis. After delivery of the

1:42:58placenta there is heavy bleeding

1:43:01and the uterus is large and flabby. So

1:43:06what is it? It is a tonic PP.

1:43:11What all we will do? Sir, immediately

1:43:13start massaging the uterus. Of course,

1:43:15for management of PPH, okay, we will

1:43:17massage. Call for extra help. Do not

1:43:20forget to give tranexymic acid also.

1:43:23Okay, triexmic acid also will all of the

1:43:26following are used except oxytocin

1:43:30is the first drug of choice. Clear? We

1:43:33can also give methylerometrin.

1:43:36Misoprosttol

1:43:38of course is used PG1 and when it is a

1:43:44PPH refractory we can also give carbo

1:43:48which is PGF2

1:43:50alpha PGF2 alpha intramuscular

1:43:54injection. What is the absolute

1:43:56contraindication? So bronchial ama

1:43:58patient. Okay. Mey pristone. Yes very

1:44:01simple sir. Mei we just told you it is

1:44:03for MTP. It is nothing to do with PPH.

1:44:06So meipy crystal is used for MTP. Clear?

1:44:08This is youric PPH ABC. All of the

1:44:11following drugs are used except crystal

1:44:13clear to all of you.

1:44:16Diagnosis. What is your diagnosis?

1:44:23Okay. So shock 2 months a minora with

1:44:28pain and BP 90 by 60. Okay. And

1:44:34hemoglobin 6 up positive. What is your

1:44:38diagnosis? What is your diagnosis? Okay.

1:44:40So this is your

1:44:44this is your shock. Okay. Shock in early

1:44:47pregnancy. Please keep in mind shock in

1:44:51early pregnancy is ruptured ectopic

1:44:55unless proven otherwise. Okay, it is

1:44:58ruptured ectopic unless proven

1:45:00otherwise. Is this understood to all of

1:45:02you? Please keep this in mind. What will

1:45:05I do? Okay, ruptured ectopic. Okay, so

1:45:07please understand this. Okay, your

1:45:09diagnosis of this is ruptured ectopic

1:45:11pregnancy. Why ruptured? Because patient

1:45:14is in shock. You can clearly see BP

1:45:16hemoglobin definitive treatment. Please

1:45:18understand this mthotrix is only for

1:45:21unruptured.

1:45:23Unruptured when the patient has to be

1:45:25stable. Okay. Ruptured ectopic. Please

1:45:28understand.

1:45:30Okay. This is the whole tube. Okay. This

1:45:32is one side fallopian tube. This whole

1:45:34tube is stone. This whole tube is stone

1:45:37and it is bleeding bleeding bleeding

1:45:38bleeding bleeding. Of course immediately

1:45:40what we do? Two widebore IV line. two

1:45:43wide bore IV line IV fluids cross match

1:45:47and shift to patient to OT until the

1:45:50time please understand this you have to

1:45:52quickly enter the abdomen till the time

1:45:54I remove this tube the bleeding is not

1:45:57going to stop please understand ruptured

1:46:00ectopic pregnancy you many students have

1:46:02this misconception wrong you save the

1:46:04tube wrong please understand that

1:46:06salpingotomy salpingotomy all that is

1:46:09kura dust bin salpingtomy me is the gold

1:46:14standard surgery. Please don't feel sad

1:46:17that oh we are cutting off patients one

1:46:19tube another tube is enough to cause

1:46:21population explosion. So scalpingtomy is

1:46:24the gold standard surgery for ruptured

1:46:27ectopic pregnant because till that time

1:46:28you clamp the tube and get it out the

1:46:30bleeding will not stop. So please don't

1:46:32do laparoscopy and spingotomy

1:46:35dbin laprotomy salpingotomy laprotomy

1:46:39and salpingtomy has to be done tube is

1:46:43gone no problem other tube is there with

1:46:45this tube patient can conceive two three

1:46:46times okay okay is it clear to all of

1:46:50you okay So

1:47:04okay soctomy is the gold standard

1:47:06surgery. Okay. What happened? Yes. Now

1:47:08tell me this. Yes. Okay. Is it clear to

1:47:10all of you? Uh most specific anomaly in

1:47:13the baby of the diabetic mother.

1:47:37Yes. Can anybody tell me very very

1:47:40simple MCQ? Please don't make a mistake.

1:47:43Okay. Please don't make a mistake. Okay.

1:47:45The most specific. Okay. So, so, so

1:47:47please understand. Okay. The most VSD is

1:47:51the most common anomaly. Most common.

1:47:54Okay. VS is the most common. When the

1:47:56mother is having diabetes, the specific

1:47:59anomaly is sacralis

1:48:03also called as cordal regression

1:48:05syndrome. Is this understood to all of

1:48:08you? So this is the most specific

1:48:10anomaly in the baby of the diabetic

1:48:13mother. Crystal clear to all of you? The

1:48:15most common is VHS. Okay. What are all

1:48:18the other things? And can you tell me

1:48:19this? If I ask you this anomaly, okay,

1:48:23very important MCQ. The anomaly is it

1:48:27seen in overt diabetes,

1:48:30gestational diabetes or both of the

1:48:33above?

1:48:36Anybody? Anomaly in the baby will be

1:48:38seen in which condition?

1:48:40Anomaly will be seen in which condition?

1:48:56Anybody?

1:49:03Anybody?

1:49:11Yes, please understand this very

1:49:14important MCQ. When does GDM develop?

1:49:18Sir GDM develops only at 24 to 28 weeks

1:49:23of gestation and therefore anomaly will

1:49:26never be seen in gestational diabetes.

1:49:28Is it clear? Anomaly is only always in

1:49:31over diabetes patients. Hindu wrong.

1:49:33Okay. Very important MCQ clear to all of

1:49:36you. Keep this in mind sir. This is

1:49:39anomaly. Diabetes only when it is overt

1:49:42diabetes. Overt preconumption that also

1:49:45uncontrolled

1:49:47uncontrolled overt diabetes

1:49:51then only the baby can develop anomaly

1:49:54the MCQ is specific anomaly it is sacral

1:49:56genenesis ch now [clears throat] one

1:49:58more one more video video based question

1:50:03identify this what is it

1:50:10yes yes yes we are holding the baby by

1:50:13the lower limb and rotating up up up up

1:50:16up up up up up up up up up up up up up

1:50:16up up up up up up up up up up up up up

1:50:16up up up up up up up up up up up up up

1:50:16up up up up up up up up up up up up up

1:50:16up up up up up up up up up up up up up

1:50:16up up up up up up up up up up up up up

1:50:16up into the maternal abdomen and what is

1:50:20this delivery? Okay, what is this

1:50:23maneuver done? One more time we will

1:50:25see. So all of you can see. All of you

1:50:28can see. Okay sir. The head the brereech

1:50:32the head is inside. We are holding the

1:50:35baby by the lower limbs. The brereech is

1:50:39already out and we are doing we are

1:50:42doing the delivery of the after coming

1:50:46head. After coming head is it understood

1:50:50to all of you? Yes. So this is what?

1:50:55Yes. after coming head

1:50:58and this is your burns marshall very

1:51:01good this was in the recent and the FMG

1:51:03exam the IBQ okay very likely to be

1:51:06coming in the upcoming NEPG examination

1:51:08clear to all of you so please understand

1:51:09this this is not a Mac Roberts maneuver

1:51:13Robert's maneuver is done for shoulder

1:51:15dystocia please comment in the chat box

1:51:18when do we do ridgun maneuver so this is

1:51:21the Burns Marshall maneuver the Burns

1:51:24Marshall maneuver is done. You hold the

1:51:28baby by the lower limb and and and this

1:51:31is the vag you hold baby is like this

1:51:34like this and we are holding it up up up

1:51:36up up up up up up up up up up up up up

1:51:36up up up up up up up up up up up up up

1:51:36up up up up up up up up up up up up up

1:51:36up up up up up up up up up up up up up

1:51:36up up up up up up up up up up up up up

1:51:36up up up up up up up up up up up up up

1:51:36up up up and you rotate it on the

1:51:37maternal abdomen and this head will pop

1:51:40out that is the burns marshall man clear

1:51:42to all of you and one more trick I'll

1:51:44give you why is it not Morice anybody

1:51:46Morice

1:52:05Okay. Morris smelly. Okay. Please

1:52:08understand this. Moric smelly weight is

1:52:10MS. The trick is MS. Okay. So in MS you

1:52:16do MS. MS you do MS

1:52:19more. The left hand goes inside. We give

1:52:23Melar flexion.

1:52:25Melar flexion plus shoulder traction.

1:52:30Melar flexion plus shoulder traction.

1:52:33That is your Moricy smelly wheat. Okay.

1:52:36Say sir in MS you do MS. Okay. MS. MS do

1:52:44MS. MS do MS Morris is smelly. MS you do

1:52:49Melar flexion and shoulder traction toko

1:52:53tali. Okay. So two hand goes inside the

1:52:55vagina we on the finger on the mealar

1:52:58and right hand shoulder traction. Left

1:53:00hand will do melar flexion shoulder

1:53:01traction. Is this understood to all of

1:53:02you? Yes. Ridzen maneuver is done in

1:53:05head delivery vertex to prevent maternal

1:53:07tears. Okay. Very very important. Again

1:53:12match the column match the column style

1:53:14of asking question.

1:53:17We have already disc I love the mag.

1:53:19Okay. Asher man syndrome cho you want to

1:53:22do hyroscopy or laparoscopy.

1:53:25Okay. Yes sir. Already told to you sir.

1:53:28Asher man syndrome is intrautrine

1:53:31adions. No point doing laparoscopy. I

1:53:36have to do a hysteroscopy.

1:53:38Isn't it? So sir Asherman syndrome I

1:53:41will do hysteroscopy. 2 A 2 A 2 A to do

1:53:46though option out

1:53:49it is not 2 B it is not 2 C clear two

1:53:53options out now endometriosis I drawn

1:53:57and shown to you fruit salad chocolate

1:53:59sys endometriosis laproscopy is the

1:54:02preferred investigation so 1B 1 B 1 B to

1:54:07be the option the option now anybody

1:54:10first of all torsion which is the most

1:54:13common ovarian tumor to undergo torsion.

1:54:15Anybody? Torsion. Dermmoid cyst.

1:54:19Remember dermmoid cyst is the most

1:54:22common ovarian tumor to undergo torsion.

1:54:24Now what happens in torsion? Acute

1:54:26they'll tell you patient has ovarian

1:54:28mass. Okay. And severe pain and

1:54:31vomiting. And what happens in torsion my

1:54:33dear students? There is a pedicle. There

1:54:36is a pedicle and there is a ovarian

1:54:39mass. And when there is tortion it gets

1:54:44twisted. What happens to the blood

1:54:47supply? The blood supply gets occluded

1:54:50and therefore color Doppler. Yes, you

1:54:53will see absent flow dangerous. Okay.

1:54:56Blood supply because whenever you twist

1:54:58whenever you twist something the blood

1:55:00supply will get occluded and therefore

1:55:02for torsion color doppler is the

1:55:05investigation of choice. Very important.

1:55:06MCQ clap. Okay. So ovarian torsion we do

1:55:09color doppler 3 C very good it is not 3D

1:55:133 C and adinommyiosis

1:55:16adinomiiosis what do we do normal ultra

1:55:20sonography 4D very good see so these are

1:55:23the conditions these are the

1:55:24investigations these are your

1:55:25pathologies

1:55:27which conditions which investigation

1:55:29tell me in adinomiosis what will I see

1:55:32when ID okay so derma most common

1:55:34ovarant tumor most common ovarian tumor

1:55:36to undergo torsion

1:55:40Okay. And when there is tortion there is

1:55:42going to be a congestion necrosis absent

1:55:44flow. So you require color doppler and

1:55:46adinomiiosis. What do we do my dear

1:55:49student? In adinommyiosis

1:55:52we are going to get okay multiple

1:55:56glands. This is the uterus. Cystic

1:55:59spaces. What is it called as venian

1:56:02blind? Okay. Venian blind appearance.

1:56:06Cystic spaces. Remember this gland

1:56:09cystic spaces in the myometrium. Salt

1:56:13and pepper appearance. Very important.

1:56:15Yes. Endometrial glands within the

1:56:18myometrium. Adinomomas. Remember two

1:56:19MCQs. Venation blind and salt and pepper

1:56:21appearance. Keep that in mind. Urus will

1:56:23be enlarged. Bulky uterus. Okay. Is it

1:56:25clear? So these are very very important

1:56:27MCQs and match the column style surely

1:56:29coming in the exam. And my dear students

1:56:31all this you can read Aram say as per

1:56:34the student. So much love we are getting

1:56:35from the student sir. Each and every

1:56:37question OBGY cakewalk because of your

1:56:40lectures. Okay. OBGY cakewalk. All your

1:56:43MCQ videos helped me a lot. So many

1:56:45questions directly from your MCQ

1:56:47discussion videos. Please read. Okay.

1:56:49Same format as the MCQ videos. Even I

1:56:52could answer each and every question

1:56:54from your from the NETP. These are all

1:56:56the previous year needp students and got

1:56:58all answers correct in OBGY. You can

1:57:01read all this. Okay. entire notes

1:57:03revision just two times. Is it clear?

1:57:04All 22 questions were from the s lecture

1:57:07note. Okay. So yeah my dear student and

1:57:10these are beautiful colored handwritten

1:57:11notes just you can revise the notes

1:57:14exactly in 2 hours is my guarantee. No

1:57:16need to change the show that is fine but

1:57:18completely corrected notes and this my

1:57:20dear student lifechanging thing do not

1:57:22miss it. it. This OBGY will be your game

1:57:25changer because out of 180 MCQs, you

1:57:28know, 20 MCQs are going to come in OBGY.

1:57:3120 MCQs are going to come in OBGY. I

1:57:34will be seeing you live on 13th of

1:57:36August. Download the OG Guru app and get

1:57:40in touch with me on phone and WhatsApp

1:57:42and only in 399 rupees. Use this coupon

1:57:45code. We are going to have 6 hours

1:57:47session. 6 hour session. 2 hours. All

1:57:49recordings will available. Don't worry.

1:57:51image based video based question

1:57:53clinical cases most expected MCQ okay so

1:57:55I hope all of you had a great time today

1:57:58do not stress and do not panic subscribe

1:58:02to the YouTube channel follow me on

1:58:03Insta before the exam I'll also give you

1:58:05the list of the important topics which

1:58:07are likely to be coming on the YouTube

1:58:09and just how to attempt the questions

1:58:10all that we're going to discuss don't

1:58:12waste time stay absolutely focused this

1:58:14PDF will be available on the telegram so

1:58:16join the telegram this whole PDF I'm

1:58:19going to upload on the telegram also

1:58:20share this video with all your friends

1:58:22and colleague. I hope all of you had a

1:58:24great time today. Thank you very much

1:58:25for coming in. That's our time. So this

1:58:272our session marathon 2 hours so many

1:58:30MCQs are going to come in the NETPG and

1:58:32six more hours you attend 13th, 14th,

1:58:3515th August. All recordings will be

1:58:37available till NEITPG and whichever

1:58:38source you have studied don't worry.

1:58:40Okay. So I'm going to see you it's in

1:58:41the OGU app. So 13, 14, 15th August. And

1:58:44best of luck stay calm, stay focused,

1:58:47read the whole question correctly. Okay.

1:58:50Very good. Very good. Great. Okay.

1:58:51Great. Great. Okay. Yes. Thank you very

1:58:53Okay. Same thing. Okay. So, don't panic

1:58:55and just stay focused and calm and you

1:58:57will do very well in the upcoming exams.

1:58:59Yes. Wishing you all the best and best

1:59:01of luck for the upcoming exam. Okay. And

1:59:03subscribe to the YouTube channel. Put in

1:59:05your comments in the chat box also.

1:59:06Bye-bye. Best of luck. Thank you very

1:59:08much.

1:59:11And see you live on 13th August.