Full transcript
0:12Hi everyone. Uh good evening, good
0:14evening to all the dear dear students
0:18and although I have already done a
0:20recall in the mega recall session and I
0:24have also shared uh the answers in the
0:27form of very short shorts and reels. Um
0:31here I would be doing a quick recall of
0:34obs need PG 2025
0:38and um so don't worry it's not going to
0:41take up a lot of your time but yes
0:42you've been asking for it and we are
0:45here. Okay so uh let's look at the first
0:49question. So this was one of the image
0:52based questions um which we also covered
0:54in the marathon right and uh what is the
0:59image showing you right so this is an
1:01image of controlled cord traction uh it
1:06was not an image of MRP I am 100% sure
1:09so this was the image uh you know uh and
1:12this is controlled cord traction
1:14something that we do in AMTSL
1:18right the other name for this is What?
1:21Yes. It is modified brand Andrews
1:25method.
1:26Yes. So modified brand Andrew's method
1:30of controlled cord traction. Right.
1:32Where one hand is pulling the cord down,
1:35the other hand is giving a
1:38counterattraction to the uterus in the
1:40upward direction to prevent uterine
1:43inversion. Okay. Yes. Perfect. Let's
1:46look at the second question. Okay, so
1:50this was again an image based question
1:52and we covered it in marathon session as
1:56well, right? So the neatp marathon that
1:58we did. So what is this and these are
2:00all covered in your DVT, LR and
2:02obviously in your notes. Okay, so this
2:05is uh a method to deliver what? Yes,
2:09extended arms. So can you tell me what
2:11maneuver is this? Especially
2:14where you're holding the baby and you're
2:16rotating the baby first to one side and
2:18then to the other side. Yes, this is the
2:22loves maneuver which is what we do to
2:25deliver a breach baby with extended
2:28arms. The image was not of penards.
2:31Okay, penards is incorrect which is to
2:33deliver extended legs. Okay, the image
2:37was of lossets maneuver. Burns Marshall
2:41is for the delivery of after coming
2:43head. Okay. And so is MSV. This is also
2:47for the delivery of after coming head.
2:51Right. Okay. Let's look at the third
2:55image. Uh the third image was also uh
2:59covered by Dr. Sumeir, but I have tried
3:01to get the closest possible image to uh
3:05the one that you got in your exam. So
3:07this was an MRI image. Uh it was a 40 or
3:12maybe something like 32 year old female
3:14with abdominal pain, right? Uh as one of
3:18the complaints and uh this is the
3:21closest MRI image that I could get after
3:25talking to lots lots and lots of
3:28students. Right? So uh yes the answer is
3:32adenomiiosis. So remember we have said
3:35that although the investigation of
3:37choice for adenomiosis is ultrasound
3:40transvaginal ultrasound but the gold
3:43standard no it was not an image of
3:47fibroid okay so the gold standard uh is
3:52MRI you know typically when your
3:54diagnosis is doubtful then yes we do
3:57need an MRI and especially when there is
4:00a focal adomiiosis
4:03Yes, adenomiiosis
4:05is usually going to affect the entire
4:08myometrium. But sometimes there is an
4:11entity which is called as focal
4:12adenomiosis which I have also taught in
4:14the class that especially in focal
4:16adenomiosis you need an MRI to
4:18differentiate it from uh you know
4:21fibroid uterus right. So this is very
4:25typically an image of adenomiosis. I
4:28know that in your image along with this
4:31in the endometrium they had written ET
4:33also right but this as I said you will
4:36agree is the closest image to what you
4:38got in the exam right uh fibroid MRI
4:45sometimes yes we do an MRI guided hu if
4:49you have attended my classes then this
4:51is what we teach you MRI guided hu high
4:54inensity focused ultrasound which is
4:56done under MRI guidance
4:58Then sometimes when there are multiple
5:00fibroids pre-operatively you want to do
5:02a MRI but other than that you know MRI
5:05is not routinely required for fibroid
5:08uterus but yes it will be required a lot
5:11of times in adenomiiosis when the uh
5:14diagnosis is doubtful. So do you all
5:17agree that this is quite close to the
5:19image that you got in your real exam?
5:22Yes. Okay. So then let's look at the
5:26next question. There was a lady who is
5:2865 years old. She has come with
5:31postmenopausal
5:33bleeding right and they had uh shown you
5:36or with history of bleeding and they had
5:38shown you a hyerectomy specimen.
5:42Now uh very classically from the recall
5:44what I got was that there was a
5:46hyerectomy specimen where the
5:48endometrium looked uh you know uh
5:51fragile or necrotic or dirty looking
5:54indometrium uh and the adexi is also
5:57shown. So if you agree this is again uh
6:01very very close to the real image you
6:03got also ha class
6:07whenever you talk about postmenopausal
6:10bleeding what have I told you that you
6:12should always rule out endometrial
6:16cancer right so endoca rule out and yes
6:21this is actually a specimen for
6:24endometrial cancer right Okay, let's go
6:29on to the next one. The next question
6:32said, there is a 35 year old lady with
6:34very high FSH as well as LH values and
6:38very low AMH values. Right? So, AMH was
6:43around 0.05,
6:45right? FSH was I think as high as 50
6:48international units. Okay? And uh when
6:52we talk about high LH and FSH right and
6:58very low AMH values you all know we are
7:01talking about POI primary ovarian
7:04insufficiency. I have told you that this
7:07is the new name for premature menopause
7:10or premature ovarian failure. Right? So
7:14now we actually call it as POI primary
7:17ovarian insufficiency. Okay. So please
7:21remember the reason is because uh there
7:24is no negative feedback the gonadotropen
7:26levels begin to increase which is what
7:29you also see in menopause. Okay.
7:32So premature ovarian failure or
7:35premature
7:39menopause. Okay.
7:44Right. So this is the answer to this
7:47question. They all mean the same thing.
7:49Yes, a 35 year old lady. Okay, they are
7:52saying there was also history of
7:54secondary aminora. Fair enough. So there
7:57is a history of secondary aminoria. You
7:59all know the answer is not PCOS because
8:02in PCOS LH can be high FSH normal.
8:06Calman's may LH FSH low hypothyroidism
8:11typically will know not have a strong
8:14association but yes sometimes it can be
8:16associated with low levels of again LH
8:19and FSH okay let's look at the next
8:23question so number of arteries and veins
8:26in the umbl cord okay so again uh in
8:30your LR I did specify that some basics
8:33of placenta are always asked that's what
8:35we covered in live lapid revision as
8:37well. Right? So it could be this, it
8:39could be weight of the placenta, it
8:41could be ratios, it could be anything.
8:43So yes, it is two arteries and one vein.
8:47I hope you have not done a silly mistake
8:49on this one. And which vein is this? It
8:51is the left umbl vein. Do you remember
8:55how we remember it? The left one is left
8:57behind. Right? So it is going to be the
9:00left umbl vein and there are going to be
9:03two umblcal arteries right. Okay let's
9:07look at the next one. So there was a
9:10question where a lady has come to the
9:12doctor and she is showing lenia niagra
9:16engorged breast with mongomeary
9:18tubercles and on examination it was very
9:22clearly seen that the uterus is enlarged
9:25and the doctor finds bluish
9:28discoloration of vagina. I agree that
9:32linear niigra and engorged breasts or
9:34mongomeary tubercles can be presumptive
9:37signs but once she has come to the
9:39doctor we have done the examination it
9:42is no longer a presumptive diagnosis it
9:44is now a probable diagnosis because now
9:48the doctor has seen the changes both
9:51uterine enlargement and bluish
9:54discoloration of vagina which is the
9:57shadow sign okay they are considered ed
10:01as probable signs. So enlargement of the
10:04uterus, shadwig sign, they are both
10:06probable signs. So as in when a doctor
10:10has examined a pregnancy is now not a
10:13presumptive thing here. Now it is
10:15becoming a probable thing. As far as
10:18positive signs are concerned, I hope you
10:20remember you can see fetal parts on
10:25ultrasound, right? Or you could see
10:27fetal cardiac activity on ultrasound. Or
10:30in later pregnancy you can feel the
10:33fetal parts on a PA examination. Or you
10:36can even oscultate the fetal heart rate.
10:40But these two will happen later. Right?
10:43Again if you remember in my marathon
10:45session the first slide itself I had
10:49shown you the probable signs and I said
10:52that it will be asked in the exam. So if
10:53you go back to neatp marathon this is
10:55the first slide that I started with
10:57right the shadvix especially the shadvix
11:00and the hagars both of which can be seen
11:03as early as 6 weeks. Yes the shadwick
11:06sign can also be called as the jquir
11:09sign. Okay, very nice. A birthday. Then
11:13there was a question that uh your
11:15patient is a post LSCS patient. She has
11:18a BMI of more than 35. What will you
11:21give for thromboprofile laxis? Now uh
11:25yes. So the as per the guidelines both
11:27American guidelines uh Royal College
11:30guidelines and Foxy guidelines if you
11:33are doing an emergency cesarian section
11:36and the BMI of the patient is more than
11:3935 then we should give her
11:42thromboprofilaxis
11:43for at least 10 days. If she has more
11:48risk factors then we can give it for a
11:50prolonged period of time which is 6
11:52weeks as well. And again there is a
11:54direct snapshot in the perpium topic
11:57when I'm teaching you about thrombosis
12:00of the pelvic veins or thromboplabitis.
12:02I've taught you that whenever it is
12:04pregnancy or pure perpurium and we have
12:08to give thromboprofile access or treat
12:11DVT deep vein thrombosis it will always
12:14be low molecular weight heperin warerin
12:19that is approved only for one condition
12:21in pregnancy otherwise warerin is a
12:24category X drug the only thing that it
12:27is approved for is yes prosthetic heart
12:31valves
12:32Okay. And please remember warerin there
12:36is a delay in the onset of action. Do
12:39you know that pharmacology? Yes. So
12:41there is a delay in the onset of action
12:42of warerin. So when you have to begin
12:45anti-coagulation perpurium is a very
12:47strongly thrombogenic state. So the
12:50preferred drug is low molecular weight
12:53heperin. Right? As I said the criteria
12:57is emergency cesarian and a BMI more
12:59than 35. then thromboprofile access will
13:02be done for at least 10 days. If she has
13:05additional risk factors like previous
13:07history of thrombosis or anything like
13:10that then we might have to do it for a
13:12prolonged span which is like 6 weeks.
13:15Okay, let's go on to the next question.
13:18A patient after vaginal delivery is
13:21having postpartum hemorrhage. She
13:24continues to bleed even after the
13:26medical management. What will you do
13:28next in the labor room? Now you got a
13:31very similar question in the FMG exam.
13:33But how is it different? In the FMG
13:36exam, they had asked about failed
13:38medical management and you are doing a
13:40cesarian section which means you are
13:43already in OT. The uterus is open. Here
13:47they have asked you failed medical
13:49management but the patient is still in
13:51the labor room. So what are you going to
13:54do? Yes, the answer has to be a balloon
13:58tamponard. So if you go back to the
14:00algorithms that I have taught, I've told
14:01you you give oxytocin and if the patient
14:06continues to bleed after oxytocin, what
14:08have I taught you? I have taught you
14:11then in the next step you will add more
14:14utroix
14:15and along with utroonics you have to now
14:18add balloon tamponard. Right? So the
14:23bakri balloon tamponard. Okay. No
14:26compression sutures. Okay. Belinch is a
14:29type of compression sutures. But
14:31compression sutures are not applied in
14:33labor room beta. The compression suture
14:36is a surgical management which you will
14:39do after balloon tamponard provided the
14:42vitals are stable. So after balloon
14:45tamponard if vitals are stable we do
14:48belch. If vitals are unstable, we will
14:52go on to stepwise devascularization.
14:55Okay. Yes. B Lynch beta G compression
14:58suture N. Maybe they had given
15:00compression suture in the language but
15:03they mean the same. The answer is still
15:05balloon tamponard. Okay.
15:08Let's look at the next one. So your
15:11patient is 9 weeks pregnant. She has
15:14history of toxopplasma 5 years back.
15:17Okay. Right. So toxopplasma kabua 5
15:20years back and now there is a positive
15:24IGG in the maternal serum and she's
15:26currently 9 weeks pregnant. Again
15:29whenever I teach infections I've taught
15:31you that you do not have to worry about
15:34IGG. IGG means a past infection not a
15:38currently active infection.
15:42So what is the uh suggestion or advice
15:45that you will give to the patient? You
15:47advise to continue the pregnancy as
15:50there is no risk. Right? Please this is
15:53not an indication for MTP. There is no
15:57need to start treatment for
15:58toxopplasmosis.
16:00It is a past infection.
16:03We will not directly do a invasive
16:05procedure like amniotic fluid
16:07assessment. Especially when it is a past
16:10infection. Had it been a new infection
16:13for the patient. We can think of doing
16:15amniotic fluid assessment. Why is it
16:17done? To see whether the baby is also
16:20infected or not. But amniotic fluid
16:23assessment may be we do not do what? We
16:26do not do it at 9 weeks. It is something
16:28which is planned beyond 15 weeks. It
16:32doesn't matter what else they write.
16:34Right? The thing is they have very
16:36clearly given you IGG positive which
16:40means it is a past infection. Okay.
16:42They've also written five years back. So
16:45the problem is I've always taught you
16:47that you have to pick up the key words
16:49and you have to integrate them. Right?
16:52Also I've taught you to go with your
16:54first instincts. If you think too much
16:56you'll land up with overthinking and
16:58doing easy questions wrong. Okay? So it
17:02is not important. IGG means it is a past
17:05infection. Okay.
17:08Okay. A lady has come at 36 weeks with
17:12reduced fetal movements. An NST is done
17:16and it shows one acceleration in 20
17:18minutes. Exactly like this. I teach the
17:21case scenario when I do the classes with
17:23you, right? That a lady has come with
17:25reduced movements. You do NST. If the
17:28NST is showing one acceleration or zero
17:31acceleration in 20 minutes, what do you
17:33do? You have to extend it for another 20
17:37minutes. You cannot call it non-reactive
17:40before 40 minutes. So answer is continue
17:44the NST for up to 40 minutes. Yes, once
17:48you have reached 40 minutes, if there
17:51are less than two accelerations,
17:54it may be one, it may be zero. So if
17:57there are less than two accelerations in
17:5940 minutes then yes we call it as
18:03nonreactive
18:05or we call it as a positive NST and we
18:09will go ahead and do a biofysical
18:11profile for the patient but not in this
18:14patient. Okay. In this patient it is
18:16continue the NST for 40 minutes. Okay.
18:21Okay. Uh this is an image which was
18:25given to you. diagnosis was asked again
18:27directly from my class. Whenever I teach
18:29you amniotic fluid, I teach amniotic
18:32band syndrome. Okay. In the history they
18:35had given there is absent index finger
18:37and I know that there was a collage of
18:40images but one of the images was
18:43definitely this one. Do you all agree?
18:45So one of the images was definitely the
18:48one that I have shown here which is
18:50showing you constriction rings. Okay,
18:54these are constriction rings and absent
18:58index finger where we tell you that the
19:01distal fallances or fallenes may get
19:04amputated. Right? So the answer is
19:07amniotic band syndrome which is seen
19:10with severe oligo hydraos.
19:14Okay. Club foot can be a manifestation
19:17of this but or it can be a manifestation
19:20of any other syndrome. It is not the
19:22diagnosis by itself here. Arthroglyosis
19:26multiplex congenita is a condition where
19:28you see you know um problems only in the
19:32joints. You see joint contraures. So
19:35here it is not just joint problem. It is
19:39constriction rings typically the distal
19:41parts of the upper limbs and the lower
19:43limbs. Okay. So this is not B. Yes. In
19:48one hand index finger was gone. Exactly.
19:51images were of constriction rings. Yes,
19:53the answer is amniotic band syndrome.
19:56Let me ask someone if uh you have
19:59attended my class, can you tell me what
20:00is the other name for amniotic band
20:02syndrome? I have taught you. We also
20:05call it as streeters syndrome
20:09right syndrome. So amniotic band
20:12syndrome and streeters syndrome are
20:15same. Okay.
20:17Ch order of repair of episottomy.
20:23So it has to be first the mucosa. Sorry
20:26it has so not not C option. Okay. It has
20:29to be first the mucosa then it has to be
20:33the perennial muscles and then is it has
20:36to be the skin. Right? So mucosa muscle
20:40and skin. Epziottomy corresponds to a
20:44second degree perennial tar. And we have
20:47also taught you which muscles are cut.
20:50Okay. So I told you arthrogyosis is
20:54joint contraures. You don't see
20:57amputations there and you don't see
20:59constriction rings. Okay. Arthogriosis
21:03congenital multiplex is joint
21:05contraures. B. Okay. Multiple joints are
21:08involved there. Okay.
21:10Ch. This was the next question. Again
21:14exactly the case scenario like we do in
21:16class. Your patient is uh 5 cm dilated
21:21there is vertex and she develops a chord
21:24prolapse. Uh the question very clearly
21:27mentioned that there are chord
21:29pulsations are present. What is the
21:32management? So if you go to my class
21:35notes or if you go to my live rapid
21:37revision notes, you will see exactly the
21:40same order in which you see the things
21:43here. So what are you supposed to do?
21:45You are supposed to do a butck lift.
21:47Push the head up which means push the
21:50you supposed to put your hand inside and
21:52with your fingers you're supposed to
21:54push the presenting part upwards so that
21:57it does not compress the cord. This is
22:00the first and the most important thing
22:02to be done. Okay, you push up the
22:05presenting part and for the same reason
22:08you also do a retrograde filling of the
22:11bladder because once the bladder is full
22:14it is going to push the presenting part
22:17up and the cord will no longer be
22:20compressed. So exactly in the same order
22:22I also shared the images of the nodes
22:24itself directly. Right? So this is the
22:28answer. Butter lift push up the
22:31presenting part or push up the head and
22:34do a retrograde filling of the bladder.
22:37And at the same time while you're doing
22:38all this you have to shift her to OT for
22:41an emergency cesarian section. Okay
22:46let's look at the next. Again almost
22:49everything if you see has been covered
22:51in your revision resources. So whether
22:54it is DVT or live rapid revision it
22:57covered each and every MCQ of obsen gyne
23:01hydroone nephrosis is stage 3b right so
23:06specially I tell you that it reaches the
23:08ura I also told you that it can also
23:10reach the pelvic side walls. So if it
23:14reaches the pelvic side walls it is
23:16again considered as 3B and once there is
23:19involvement of urer eventually it can
23:22cause involvement of the kidneys as
23:24well. So you will see hydrononepherosis
23:27and uh another related MCQ is what is
23:30the most common cause of death in CA
23:32cervix. So most common cause of death in
23:35cancer cervix yes is uremia. The reason
23:39for uremia is renal failure because the
23:42back pressure changes continuously are
23:46affecting the kidneys and as a result
23:48the kidneys eventually fail. Okay. So
23:51this is going to be stage 3b. Okay. All
23:56right. Let's look at the next one. A 46
24:00year old woman with irregular bleeding.
24:03Right. And endometrial thickness is
24:06given as 16 mm. Right? What is the next
24:10step? Always I have taught in my class
24:13that if your patient is beyond 45 years
24:16of age and she has abnormal bleeding
24:20especially in the form of minor regia or
24:24irregular bleeding
24:27we must do a endomtrial biopsy. I have
24:31also told you that they will ask what
24:33devices you need. So any set is very f
24:36fond of asking what device will you use
24:39for this endometrial biopsy. So like you
24:42can use a pipelia
24:45we also use a carman scanula right
24:50exactly what we are doing is endometrial
24:52aspiration cytologology EAC but
24:55practically we call it as an endometrial
24:58biopsy. Papsmear can also should also be
25:01done. If she has not undergone any kind
25:03of screening so far, we will also do the
25:06papsmear. But papsmear right now is not
25:09the most relevant next step. The most
25:12relevant next step is endomtrial
25:15sampling. Right. Very good. Ch. About
25:20there was a question which you all have
25:23been fighting it out for. A 65year-old
25:26postmenopausal woman has come. Okay. Her
25:29BP is 170 by 100. But she has come to
25:32you with blood stain discharge and you
25:35all are telling me I should send her to
25:37a cardiologist.
25:40Why do you think I cannot give her a
25:42tablet for high blood pressure? So you
25:45know she's come to a doctor and you
25:47think that I will not take care of
25:49anything and just simply send her off to
25:52a cardiologist. Please remember 65 years
25:55of age post menopausal bleeding there is
25:58a very high risk of malignancy
26:01right so I will definitely definitely do
26:04a pelvic examination this was what was
26:07in your option we will definitely do a
26:10pelvic examination and send a papsmearia
26:14where say as age increases you are
26:17likely to have slightly blood pressure
26:19on the higher side right so if required.
26:23We will see what she needs an
26:25evaluation. But as of now, I'm not just
26:27going to not do anything about the
26:29vaginal bleeding and just send her off
26:32to a cardiologist. Okay? Uh no, that is
26:35not the most relevant next step for her.
26:38Okay? And especially only for high blood
26:41pressure, I really don't need to send
26:43her to a cardiologist. Okay? So please
26:47remember this. Okay?
26:49Hypertension I hope you know is
26:52hypertension, diabetes, obesity.
26:55Do you know this that uh these are risk
26:58factors for endometrial cancer? What do
27:00you call it? Corpus cancer syndrome. So
27:04not only will I do a pelvic exam and
27:07papsmear I will also try and do an
27:10ultrasound to look for endometrial
27:11thickness do an endometrial sampling as
27:14well. Okay. So please remember this.
27:17They are risk factors. Okay.
27:21Ch. Then there was a question where we
27:25have asked you sequence of maneuvers in
27:28shoulder dystocia. I don't think the
27:30options were difficult because there was
27:32only one option just shuru macroberts or
27:36end zava. Right? So please remember
27:39macroberts has to come first. Zava has
27:43to come last. Right? So they had jumbled
27:47up these four maneuvers. What were the
27:49four maneuvers? Macroberts, Gaskkin,
27:53Rubines and Zavanellies, right? So the
27:56key thing is Macroberts is the first
27:59maneuver. Zava Nelly's is the last
28:02maneuver right or Gaskin
28:07it doesn't really matter as far as this
28:09MCQ is concerned. Right? Again something
28:12that I have predicted even when we were
28:15doing the mock paper needp mock you
28:18remember I had given a question on
28:20shoulder dystocia and specially I asked
28:23you yes that's okay you can put rubine
28:26here and gaskin here it it's okay the
28:29answer will still remain the same
28:31because as I said there was only one one
28:34option where Mac Roberts was first and
28:37Zavanellis was last okay so Please
28:41remember this
28:45question.
28:47I confused you about the finer details.
28:51You remember this delivery of posterior
28:54arm or rub. Do you all remember that
28:57question? So that was from your last
29:00neat PG mock that we did. Right? So we I
29:04knew that they are going to give you
29:07these topics. They don't are not going
29:09to ask you something out of an
29:11encyclopedia.
29:12They will ask you basics but they will
29:14twist options. They will make the
29:17options very close. And that is why you
29:19have to have a very good content and
29:22application of your content. Right? So
29:25uh yes. So this was the answer for the
29:28shoulder dystocia question. Okay. Ch.
29:32Then there was history of prolapse and
29:35which ligament is damaged or which
29:38ligament is the best support was asked
29:42right. So the answer is macken rod which
29:45I hope you also know is called as
29:48transverse cervical ligament.
29:53It is also called as
29:57cardinal ligament. Right? So they are
30:00names of the same ligament and uh
30:03especially especially when I teach I
30:06tell you this that you know if they have
30:08to confuse you with this ligament they
30:10will ask you other names in the option.
30:13So you have to know that they are names
30:14of the same ligament. Round ligament is
30:18not a main support. It is a support but
30:21not a main support. Yes it is
30:23responsible for anti-version and anti-
30:25flexion. Broad ligament is not a support
30:29at all. It is a false name. It's not a
30:32ligament. Sacrospinus is not the
30:35ligament for uterine support. Okay.
30:38Sacross spinus importance pudendal nerve
30:42block. When you're giving a pudendal
30:43nerve block, you have to pierce the
30:46sacrospinus ligament. That's what they
30:48will ask you. They will ask you if
30:50you're giving a pudendal nerve block,
30:52which ligament will you pierce? Then the
30:55answer is sacrospinus.
30:57Okay. Chello. Then there was a clinical
31:01vignette. Again something that I have
31:03been putting in your CBTs and your mock
31:06test papers and always asking you to
31:08differentiate it from abruption. So the
31:11key words here were a patient of
31:13previous cesarian. She is in active
31:16labor. But the other keywords given to
31:20you were fetal bradic cardia and
31:24maternal tachicardia.
31:26So these are signs of impending rupture.
31:31Right? So these are signs of impending
31:34rupture. If you go to the topic of
31:36previous cesarian and back to basics,
31:39you know I have very clearly written
31:40what is the first sign or symptom of
31:44rupture uterus or impending rupture. It
31:46is nonreassuring
31:49fetal heart rate. It is also the most
31:53reliable sign. It is also the first
31:55sign. So because we are anticipating an
31:59impending rupture, what is the step? I
32:01have written there that the management
32:03is going to be an emergency cesarian
32:08at the time of cesarian you realize that
32:11it is already a scar dehissence but that
32:14is an intraoperative finding right so
32:17the answer here is going to be the
32:19management is emergency cesarian section
32:22okay let's look at the next one the next
32:25question is a woman who has a 28 day and
32:30a regular cycle on day 21 to 25 or day 1
32:36to 24 whatever they had given it doesn't
32:38matter 24 yeah 25 right what is the
32:42correct status of her hormones again go
32:46to your DBT go to your classes go to LRR
32:49do you remember a diagram that I have
32:51made you draw anybody remembers I and
32:55I've specially taught you that you have
32:57to see these diagrams and you have to
32:59know what is the interpretation of these
33:02diagrams, right? Do you remember this
33:05diagram? And if you have attended my
33:08class, you will know how I teach. Yes,
33:13tell me. So, I have taught you that
33:15there are two hormones which show you a
33:18peak. Okay. In the second half, what are
33:24the two hormones? There is estrogen and
33:27progesterone.
33:29Corpus lutium not only secretes
33:31progesterone, it also secretes estrogen.
33:34But the most important thing or class,
33:38what happens to LH and FSH levels? Yes.
33:43What happens to LH and FSH levels
33:48uh in the lutial phase? So you have to
33:51know that lutal phase may you see the
33:54lowest levels of LH and FSH. As far as
33:58the recall I have there was only one
34:00option with where both LH and FSH were
34:04low and that is the answer right so
34:07let's look at this so as I said LH and
34:10FSH have to be low low LH low FSH and
34:15progesterone has to be high you
34:18mandatory here for the hormonal profile
34:21in this second half right so there was
34:24only one option just
34:27LH FSH.
34:35You know you were wondering why ma'am is
34:37teaching us the graph because I knew
34:39they will ask you and they will confuse
34:42you in basics by making the options
34:45close. Right? So remember it is not
34:49about weird things. It is not about
34:51encyclopedias. It is about basics,
34:55concepts and application of concepts.
34:58That is what we all have to target.
35:00Whether it is FMG exam or needp or in
35:04set, they're all going on the same
35:06lines. Okay. So the answer here is B. As
35:09per the recall that I have got from
35:11these students, high estrogen and high
35:15progesterone whereas low LH and low FSH.
35:19Okay, is that clear to understand?
35:26So I think I've got exactly correct
35:28recall because I've asked a lot of
35:31students for the recall. Some of you you
35:33know you want to sometimes keep thinking
35:36about it and people will twist. Believe
35:39me if you see recalls from the YouTube a
35:43lot of times people are twisting options
35:46just to prove themsel right. Okay. So um
35:50uh please ensure that we have the
35:53correct recalls because
35:56but any which ways you know these
35:58recalls are more for students who are
36:00going to appear next year in the exams
36:02because they should know what is right.
36:04Okay
36:06estrogen
36:08I just told you corpus lutium is going
36:12to secrete estrogen as well. So the
36:14three most important things are number
36:17one there has to be high progesterone
36:21that is the important part in the second
36:23half low LH and low FSH in case there
36:27were two options with low LH and FSH you
36:30have to go with one with high
36:33progesterone okay very very important
36:37okay high progesterone and low LH and
36:40FSH
36:44You will have to go with one which has
36:46these findings. Okay.
36:49Next. A 20-year-old woman with irregular
36:53cycles conceived with IVF. She has 2
36:57months of aminoria
36:59and LMP is not known. What is the best
37:03parameter to know the gestational age?
37:07So the answer is going to be crown rump
37:10length. So again covered everywhere DVT
37:13LR and obviously your notes that CRL I'm
37:18use then I have written three things for
37:21you. I have written number one patient
37:23has irregular cycles. Number two LMP is
37:27not known. Number three patient has
37:30conceived on OCPS.
37:34In these three conditions, we cannot use
37:37LMP and therefore we will use crown rump
37:41length. Not just that, if you remember,
37:43I've taught you what is the ideal time
37:45to measure crown rump length? 7 to 9
37:49weeks, right? 7 to 9 weeks is the ideal
37:53time to measure crown rump length. Okay.
37:56Ch loading dose of magulf. Again people
38:01who are teaching superficially
38:04then you might have done this incorrect.
38:07Okay but please remember they have asked
38:10loading dose of magal as per the
38:12prchard's regime and the answer is not 4
38:16g it is not 10 g it is 14 g. You have to
38:22know this 4 g is given IV and along with
38:26this this 10 g is given IM. The total
38:30dose of magulf as per the prchard's
38:33regime is 14 g. Exactly same way we have
38:38written in dbt. Loading dose is 4 g iv
38:43plus 10 gim. So a total of 14 g. Okay,
38:49that is the answer. So it's not four and
38:51it is not 10. Okay, so this is as per
38:55the prchard's regime. Okay. Then there
39:00was a question on ovarian tumor. Again
39:03directly we have done this when we have
39:06done this in your marathon as well. So
39:09if you remember in the neatp marathon I
39:11just did images for you and out of I
39:15think five or six images except for the
39:17MRI one all the images are from the
39:20marathon session. Right? So this is a
39:23ovarian tumor. What were the hints? If
39:26you go to the marathon you will see that
39:27I had written the hints on the basis of
39:29which you will mark the answer. The
39:31hints were raised CA 125 asitis and
39:37papillary excrete senses. Right? So when
39:40you have the papillary excretences you
39:44have raised CA125
39:46and the cancer has already spread
39:48causing aitis. This is a typical cirrus
39:52cyst adenoc carcinoma right? Yes, it can
39:56be multiloculated. It is a complex mass.
40:00Okay, because it is a malignancy. It's a
40:02complex mass. There will be solid areas.
40:05There may be cystic areas. Okay, so
40:08please remember the answer is cirrus
40:11cyst adenoc carcinoma. Yes, it is not an
40:14endodermal sinus tumor. Endodermal sinus
40:17tumor is same as yolk sack tumor and yes
40:21tumor marker alpha protein. Okay. In
40:25every CBT and the mock test, right, we
40:29gave this as a MCQ
40:33may we gave you the tumor markers. We
40:36gave you these key words tumor cona
40:39keyword used right that brings us to the
40:43last question again directly from DVT
40:47verbaten there is a line there. So what
40:50is the reason for aminora? Because of
40:53high prolactin very similar to why we
40:57see lactational aminora.
41:00So the reason for aminora is negative
41:04feedback of prolactin on gnr.
41:08So it inhibits g&rh. As a result there
41:11will be low pulses of LH and FSH. So no
41:16the reason is not increased A2. In fact,
41:19it will be decreased. Okay. Pulsatile
41:23release of FSH or LH come. And as I
41:26said, LH FSH levels are going to be low
41:29because there is a negative feedback on
41:32G NR. So that is the answer for these 25
41:36questions. I hope I haven't missed any
41:39MCQ. Right? So do let me know how you
41:42have performed. I hope OBGY was a
41:45scoring subject for you. We've tried our
41:48best to give you u whatever best we can
41:52whether it is in the form of revision
41:54courses or it is your back to basic
41:57videos or it is your CBTs and mock test
42:00papers. So I wish each one of you all
42:03the best. May you come out with flying
42:05colors and you do well and most
42:08importantly you get the branch of your
42:10choice. So take care everyone. All the
42:13best to each and every student for your
42:15results. Whether it is our FMG students
42:19or whether it is our NETPG students,
42:23both of you are waiting for results. So,
42:26God bless you and I will pray that you
42:28are blessed with success and the branch
42:31of your choice. Okay. So, take care
42:33everyone. All the best. Keep keep doing
42:35great work.