2017 feb

4. Diabetic woman 22 yo wants to be pregnant, comes in for counseling, random blood glucose
6-8 • Hx (2-3 minutes) • No COCP, on condoms before • Pap done before • HBA1C normal •
Never in hospital before • No hypo attacks • Risk to baby • IUGR/ macrosomia •
Polyhydramnios • Miscarriage • Risk to mother • Worsening DM/ high risk pregnancy • PROM/
PPROM • Pre-eclampsia

. 32 yo with grey foul vaginal discharge with partner, no sex outside of relationship, diagnosed
with infection and on doxycycline and anti-fungal, doxycycline no change to discharge, not
pregnant – Bacterial Vaginosis? • Breif Hx • PEFE- no sheet of paper • Mx

14. 8 weeks pregnant, nausea & vomiting, positive pregnancy test, pelvic exam given in stem-
Hyperemesis Gravidarum • Hx • Order investigations • US • Urine for ketones • Ask what is
molar pregnancy • Mx

Gyane :

Vaginal D/C

Hyperemesis Gravidarum

diabetic prepreg counseling

. Vaginal discharge candida

2. Asking for elective CS

3. Placenta previa ( us given) explain and manage

2. Placenta Praevia- same karen notes.

Explain USG of PP Major

Management

1-pre eclampsia examination. Check BP, and other relevant exam

any evidence of underlying causes for hypertension in pregnancy should be sought, as well
as looking for evidence of endorgan involvement due to hypertension.

EXAMINATION: (LOOK, LISTEN, FEEL !!!!):

Pat. looks well, normal weight, no obvious peripheral oedema.

BP is indeed 175/110, P 72 and regular, afebrile, SaO2 98% on room air.

Uterus 6 cm above umbilicus (= c/w 24 – 26 weeks pregnancy = intrauterine growth restriction!!!),
non tender, foetal heart audible, foetal movements felt, normal presentation and position. Mild
hyperreflexia, but no clonus!

The initial assessment should include: • BP in both arms. • Identification of the apex beat
and heart rate. • Identification of an S4 or systolic flow murmur, indicating left ventricular
hypertrophy or coarctation of the aorta. • Feeling for radiofemoral delay by simultaneously
assessing the femoral and radial pulses. • Listening in the epigastrium for a systolic bruit,
indicative of renal artery stenosis

Assessing thyroid function can exclude either hyper or hypothyroidism as a cause of

elevated BP in pregnancy, and a normal calcium concentration corrected for serum albumin
can exclude hyperparathyroidism from a parathyroid adenoma as a cause.

Features of endocrine conditions would include purple striae and proximal muscle wasting
in Cushing’s disease, which may also be associated with depression and diabetes. Thyroid
disease is best assessed by thyroid function tests, but a thyroid examination should include
palpation and auscultation of the gland. A retinal examination is essential to identify
hypertensive changes

Hand--signs of shock, BP, pulse, , facial edema, rapid weight gain

Head--ophthalmoscope, ENT for infection
Neck--LNE, JVP
Chest--heart apex beat, simple auscultation; lung simple auscultation
Abdomen--fundus, fetal lie, presentation, etc (liver, spleen, kidneys can't be examined)
Vagina: inspection & speculum
legs: edema, varicose veins
Any suggestions? Many thanks in advance~~~ :)
 6 Comments
Neurological- ankle clonus and reflexes

Facial and putting pedal edema, Jaundice & Bruises ( Complications of PIH) Funds. Pulse,BP. Quick auscultation CVS
&Chest. Ankle and knee reflex. Fundal height measurement. (Size for gestation age, check for poly or oligo hydro)
No need for ent and pelvic exam. If Preeclampsia is likely (if BP >140/90) than. Ultrasound for fetal well being. Mx :
General advice adequate rest, lie on left lateral positin, low salt diet. Medication like labatolol, alphamethyldopa,
weeklyl regular followup for urine dipstick BP check, and check for progress in pregnancy.

Eyes fundoscopy ! Papiledema

And periorbital edema
Conclude with dipstick ! Looking for proteinuria !

30yrs old in third trimester presents with headache so all tests done,Showed protein
urea.Task is to do physical examination and management.

.47yrs old with 3 kids.youngest 17 yrs old.wants to have tubal ligation.Counsel the patient.

. 27 yrs old newly pregnant has alcohol consumption.her antenatal check up is due in 2
months so tell her how will u manage her before that and why?

10 may 2017
20 weeks gestation lady requesting to have elective c/section . Pros and cons discuss..

atrophic vaginitis, heavy bleeding lady requesting for hysterectomy,

Prom
Transverse lie

Lichen sclerosis picture was given. 77 yo lady with 2 year history of itching. typical karen
5. PROM typical karen exactly the same scenario
6. Transverse lie typical karens case same scenario as well

21 april
11- amenorrhea for 12.months
Hx mx
5p
Exclude ddx
She was preparing for the marathon
Dx amenorrhea due to excessive exercise
Mx bloods and decrease the exercise
Fb menstrual complain: pass global score 7
7- young woman with vaginal bleeding and amenorrhea for 8 wks
Hand book case
Dx incomplete abortion
Started with resuscitating the pat then hx and exam and management
Fb vaginal bleeding : pass

20/4/2017 recalls ( from a friend)

1.In rural hospital, mom Victoria gave birth a premature baby( <34 week, I forgot the exact
gestational age) with birth weight 1.9 kg , now the baby got respiratory distress. ( the role player
was very anxious, about to cry, husband was outside, no problem of support, wanna go to
tertiary hospital with her baby)Task : counselling mother .
. A young lady Bronwyn came with per vaginal bleeding for
from yesterday, she used 4 pads, not fully soaked , no clot, no tissue, no grape like structure, last
period 8 weeks ago, blood group rh positive, Task : Hx , Pe from examiner: ( scanty bleeding, no
cervical excitation, no Dane all mass tenderness, uterus 8 weeks in size) Diagnosis n
management ( dipstick negative for nitrite, urine positive for pregnancy,
5. Young lady came with ultrasound report. ( ultrasound pic given: looks like cyst) report says 1.5
cm firm lobulated nontender mobile mass. No lymphnodes involved, no positive family history of
breast cancer. Task: tell patient the report n further counselling n management. ( patient doesn't
want any surgical procedure, happy with the lump, agree to do self breast examination every
month, agree to go for biopsy).
6. Post purtam young lady Claudia Now came for 6 weeks checkup, Task : Hx, pe from
examiner, management. ( patient was euphoric, said everything normal, without asking direct
question didn't reveal that she got dyspareunia.. she told without prompting that shetook ocp
before pregnancy now want contraception, didn't like pop, wanted to get pregnant in 2 years. In
examination: atrophic changes.).

. Concealed abruptio placenta Task: Hx, examination findings ( funds higher than date, no feral
heart rate). Management. ( tissue n water were there. Patient was crying) it was her 3rd
pregnancy).

OBs+Gynae
1.27 yrs old lady coming with severe tummy pain since last night in 3rd pregnancy
a. focused H/O (FHS-absent)
b. b.PEFE
c. Dx

2. 27yrs old coming with PV bleeding

a. H/O (not completely soaked 3 pads, 8 wks amenorrhoea, home preg test +)
b. B.PEFE (PV bleeding)
c. C. Dx

d. 11. A young lady presents with lower abdominal pain and vaginal bleeding after 8w
amenorrhea. ( incomplete abortion in handbook)
Task: 1. Take history 2. Ask examination specifically from examiner 3. Tel patient the
most likely cause and other possibilities
e. 12. A young lady who had LMP 12 months ago and is doing a vigorous exercise is here
to discuss the issue...
Task: 1. Take history for 6 min
2. Tel her the likely cause of amenorrhe
1. secondary dysmenorrhea - in that station examiner and patient was ok.. she is
having painful periods since 12 months and before that she didn't have pain. She is
married but don't have kids yet. 5 days of periods she have pain. And she said don't
have relief and nothing makes it better that's y she came here. I said don't worry I am
here to help u.. she won't smoke or drink alcohol. And asked examination findings
from examiner she was telling wat I asked and in bimanual exam she said uterus is
retroverted and mild tenderness in adnexa- that r positive findings for that case and I
said it's secondary dysmenorrhea due to endometriosis I know that case but didn't
explain well I said it's secondary because u have pain only since last year if it was
from ur first period we call it as primary dysmenorrhea and said will give u painkillers
and refer u to the specialist.. she asked me wat specialist will do I said they will do
hysteroscopy for u that means they will send a tube with camera and see ur womb
for any changes and in history asked about flow she said not too much so didn't told
about danazol..that's it thanked both of them and came out.. it was my 1 st case so
little things I did..

Stress incontinence- hx,Pete and mx... she was cooperative- 3 normal

deliveries..18 hrs delivery.. normal size kids..only when coughing, straining she is
having and not on medications.. findings normal.. I draw a diagram and said
ligaments around uterus got weak as u have normal deliveries long term deliveries..
don't worry I know it's must be distressing for u.. it's manageable condition.. refer to
specialist they will give u vaginal pessaries.. will teach u pelvic flour exercises which
helps u..if u feel more hard it's getting more worse then specialist will fix it with sx..
will give u reading material and she was happy..thanked both of them and came..

12. Preeclampsia case I didn't even know it's that but I asked baby kicking and
medical illnesses.. where she lives and all.. she came with upper tummy pain gave
painkiller for her..36 wks pregnant no delivery features.. examination no negative
findings.. I missed fundoscopy.. but told her will admit u specialist will assess u ..we
will do usd and ctg for baby I will come and see u every 2 hrly will call ur husband if u
want..once everything is fine u can go home..thanked and came..do it In handbook
that's wat I felt should know examination findings properly.. but did next station well.

7- 67 y/o lady comes with vaginal bleeding . Her LMP was 15 years
ago and she has been treated 10 years with mixed estrogen and
progestron . She has 2children. Her pap smear has been NL all the
time .the last one is 18 months ago.
Task:
1-take consent for examining her.
2- examine her (manikin) and give the results to the examiner.
3- explain the most probable diagnosis and other possible ones to
the patient

9-A 24y/o lady comes 10 days after vaginal delivery with c/o
Bleeding to GP.
Task:
1-take further history
2- ask about physical findings from the examiner
3- explian the most probable diagnosis for the patient

14- a 25 y/o lady comes on combined OCP,with 4 times vaginal

candidiasis in the last 3 months . The last time has been proved by
culture as severe monoliasis infection and has treated by nystatin
cream 100 mg for 5 days but immediately aftef stopping the
medication it has recurred.
Task:
1- take detailed history from the patient
2- ask the requested physical findings and investigations from the
examiner
3- talk about the measures that you want to do with the patient
Woman 57 yr or so come with stress incontinence symptoms. Task Pelvic exam, explain
diagnosis. With reasons. Cough test urine leaking.

52 yr old woman with lump( didnt say where) . task history, PEFE, DDx. On history she got vaginal
lump and did hysterectomy 10 yrs ago. On examination Vault prolapse.

22 yrs old 30 wk GA, watery discharge. Rural hospital. Task history, PEFE, investigation and
management.
35 year old primi with high BP, headache, tummy pain, - pre eclampsia

March 2017

O&G

4. Fundus larger than dates

5. S’ Amenorrhoea
Amenorrhea for 12 weeks. her husband concerned she is athletes, do a lot of exercise. had
curettage I think 6 years back for unwanted pregnancy. I asked everything weight 67 kg, no
OCP, no blurred vision, headache and milk discharge, no Polycystic ovarian symptoms, no
hypothyroidism, no medication such as antipsychotic. I explained it could be either to previous
termination or over exercise I need to run further investigation as you are very concerned and
we will see you a gain
PE

6. Right lower abdominal pain Exam ? ectopic ( She looks really pale. I start examination with
vital sign the examiner very nice I said I need watch. he said pulse normal I start the Bp then he
give me all the vital signs. I quickly check the face then Jvp , then abdomen and ask patient
where is the pain? pointed to me I did full examination then i said the patient has week pt
positive. I want to do vaginal examination I need the patient consent and I need cheparone for
examination then the examiner give me all the examination cervical excitation positive
retroverted, bulky uterus no fluid in pouch. I said I need USD. Pending. I turn to the patient and
said most probably you have a condition we called it an ectopic pregnancy I already informed
the obstetrician. we need USD to confirm it. it's a pregnancy but not in the womb it's outside. Tx
will be decided by specialist. you will be in safe hand. forgot to do appendicitis exam.

Obs & gyn

4.Thalassemia
Thal is the usual case, preg lady coming with blood report hb91, mcv65, iron studies r normal.
Hx , explain Ix,dx& further tests required
5. Transvers lie
6. LSIL
Pap smear came as LSIL+ hpv , all risk factors r positive- explain the dx and further mx( 24 yrs
and last pap 2 yrs bck was N.
.35 year old lady come back for paps test. HSIL with HPV +.
Task h/o, explain condition and causes, mx and implication of management.
(no safe sex previously, current stable partner, no family history, want to get pregnant in one
year, ocp taking, no family history of cancer, no features of cancer, please check latest guideline
for HSIL, patient very interested about colposcopy,)
Threatened abortion -Lady with painless vaginal bleed after 8 weeks of amenorrhea Task : Hx,
PEFE, Invx with examiner Dx to patient Bleeding since yesterday pads not fully soaked. No
tummy pain. lmp 8 weeks ago periods have always been regular uses condoms.Pelvic
examination mild bleed no prune colour or vesicles, is is closed, CMT negative, uterus enlarged
to that week. UPT positive Uss shows intrauterine pregnancy
6. LGA - Lady says she is 20 weeks pregnant. You examine her and the final height is 30cm, rest
is normal. She had just returned after travelling overseas with her partner
Task: hx, Mx
No anc checks done ever. No blood investigation, no Uss scans, no folic acid, doesn't know blood
group, no hx of fibroids, no polyuria polydipsia, no raw meets,no infections
8/3/2017

1- anemia in pregnant lady(fith pregnancy)

2- bleeding after 8 weeks of amenorrhea
3- vaginal bleeding not pregnant stable relationship, perform relevant PE (when you come to
pelvic exam examiner gives you findings of fibroid.. )
GYN AND OBS
4.Hyperemesis gravidarum
5.Repeated vulval cancer
6.OCP request 15 years old

6.77 yr lady with vaginal itching- photos shows some white discharge.
7.Infertility with recurrent miscarriages.
6)recurrent miscariage

patient wanting to conceive for past 3/4 years but not successful .. (when outside I thought of
infertility )

Task
history
tell diagnosis and order investigations

positive findings
3 consecutive miscarriages at around 6 to 8 weeks of pregnancy.... not investigated so far ,, no
genetic testing done so far...no known risk factor .
10)post menopausal lady with vulval itching

Task
history
interpret the picture shown by examiner to the examiner
diagnosis and management

positive findings
1) vulval itching for years,, took HRT for it no response , had topical estrogen creams and
pessaries but no response ..
2)picture of lichenosclerosis.
13- Breast feeding.. book case
14-Pre eclampsia
15-Postmenopausal symptoms hot flushes and irregular periods. 47 year old female with
complaints of hot flushes.. her bp breast n pelvic assessment were normal..no physical ex
findings.. task is take history for 6 mins.. explain further inv n management plan to the pt.
positive history are irregular peroids for 1 yr which is becoming lighter n hot flushes.. no
positive findings regarding contraindication for hrt..
JM :A useful regimen, especially for irregular bleeding in the perimenopausal phase, is the
combined sequential pill which can be continued for several years if necessary. Sufficient
oestrogen should be given to control symptoms and prevent osteoporosis.
16-Infertility
Obgyn
8.Women with Nausea and vomiting
?Threatened abortion vs Multiple pregnancy vs hyperemesis gravidarum
Stem says 11 weeks
On Pe 2cm over umbilicus ?? Could indicate multiple preg
vomiting and bleeding since yesterday, HX,PEFE,what investigations you will do further.blood O
+ve
no ketones on dipstick

9.Preg with murmur counseling

27 year old lady,10 weeks pregnant,had some strep infection when 10 years old,last gp heard
murmers,recently moved to your area,so came for antenatal check up.on PE you get diastolic
murmer on mitral area.
HX,PEFE,MX
Obgyn

Women with Nausea and vomiting

?Threatened abortion vs Multiple pregnancy vs hyperemesis gravidarum
Stem says 11 weeks
On Pe 2cm over umbilicus ?? Could indicate multiple preg

Preg with murmur counseling (Karen's)

Sti counseling young female Multiple sexual partners

Hx Ix and why
Advice patient

Gynae and obs.

1. SLE want to pregnant. No flare up in last six months.
History.
PEFE.
Management.
2. Primary infertility.
17 years old female has not started menstruation.
History. Nothing positive.
D/ D and further investigations
So explained all D/D of primary infertility and investigations.
3. Vaginal discharge.
Yellowish green. Nothing else positive.
History.
PEFE.
Most Likely diagnosis and other D/D S
Told trichomonasis and other other D/Ds as candiasis, chlamydia and Gonorrhea.
6. Post delivery discharge review fir for dicharge or nt

31.03.17

1. Secondary amennorhoea 32 year old with bmi 17 , on pills for 15 years diagnosis wid
reasonAccording to the given note ,we can think about post pill amennorrhoea or eating disorders, strenous
exercises,emotional stress(hypothalmic causes), but before come to the conclusion we should consider and exclude
the other causes for 2ry amenorrhoea -metabolic/ovarion /uterine/pitutory/other iatrogenic causes and its also very
important to discuss regarding the possilblity of pregnancy,After taking the focused hx we can narrow the list of dd,
. Specifically, measurement of bone density with dual X-ray absorptiometry may
reveal important clinical information that is useful for treatment and counseling.21

. Post delivery discharge review fir for dicharge or nt

Postnatal Discharge Advice Doctors Appointment – If you haven’t already been given a 6
week check-up appointment please call and make one soon after you leave hospital. If you
would like a Pap smear smear at this time, please tell my receptionist when you make this
appointment and it will be arranged. Length of stay – As a general rule, if you had a vaginal
delivery you will go home on Day 5 after birth, Day 6 if you had your baby by Caesarean
Section. If all is well you may choose to leave earlier. You must have a medical reason to
stay longer. Child Health nurse – It is advisable to phone your clinic within the first week of
arriving home to make an appointment. The phone number is in your purple book.
Immunisation – Hepatitis B immunisation is now offered to all babies on Day 3 in hospital.
Your child health nurse will discuss subsequent immunisation. Your baby’s first triple
antigen and polio immunisation is due when your baby is 2 months old. Uterine bleeding –
May continue for 6 weeks post delivery. It sometimes increases following breast feeding or
exercise and may vary in colour from dark red to pale pink or brown. This should not be
excessive, offensive in odour or consist of large clots. Perineal sutures- Keep area as clean
and dry as you can. The sutures will usually fall out between weeks 4-6. If you are concerned
about the wound make an appointment to see Dr Harris. Caesarean wound – Keep clean
and dry. Continue anti-inflammatory medications +/- Panadol as long as you need. Firm
binding over the area often helps discomfort. Watch for areas of redness, heat or swelling
suggesting infection, if this occurs please call and make an appointment with Dr Harris.
Mastitis – If an area of your breast becomes red, flushed and or very tender and you have
flu like symptoms (hot/cold or feel unwell) continue breastfeeding but seek medical advice
immediately. Breast feeding difficulties – Contact Joy, Lactation Consultant on 9447 0111 –
Glengarry patients. SJOGH patients contact hospital Lactation Consultant Emotional changes
– Bringing baby home from hospital creates lots of new experiences and many parents find
it takes time to adapt to their new role. If you feel you are having difficulty coping or
adjusting to the demands placed on you or you are feeling depressed it is important to
speak to your GP, Obstetrician or Child Health nurse. Activity and Exercise – After childbirth,
all women should make pelvic floor exercises part of their daily routine. Normal daily
activity or walking can be resumed immediately but no vigorous exercise programs or sports
should be commenced for 6 weeks to allow you body to get back to normal. If you want to
swim as part of a regular exercise program avoid public pools and swim only in the ocean
until 6 weeks. Driving – After having a Caesarean Section it is advisable to avoid driving long
distances for up to 6 weeks. It is OK to drive short distances when you feel ready. SIDS
Prevention strategies – ™Lay baby on back to sleep ™Do not smoke near baby ™Make cot
up at bottom so baby can’t wriggle down and cover head ™No doonas, bumpers or soft toys
in cot ™ Breast feed if possible Food Fibre and water – Eat a well balanced diet including
plenty of fresh fruit and vegetables. Aim to drink 8 glasses of water a day. This will help to
keep you feeling good and your bowels regular. Tampons– You can start wearing tampons
with your first period if you feel comfortable. The first period can occur as early as 6 weeks
(but often later if breast feeding) and any stitches you have had should have healed by then.
Sexual activity – Unless advised against it, sex can be resumed when your loss has stopped
or when you feel ready and comfortable. Some couples find a water based lubricant makes
sex more comfortable. To prevent an unplanned pregnancy, use a reliable method of
contraception. Contraception – Contraception will be discussed at your 6-week check up if
not already decided on. If sexual activity is resumed prior to this some form of
contraception is recommended, as some women may already be fertile. Condoms can be
used as soon as sexual activity is resumed other options to be considered are the pill, the
mini-pill, a diaphragm, Depo Provera or an IUCD. Natural family planning is difficult to use
until periods return to normal.

10 May 18, 2017

37 yr old female heavy period bleeding wants to hv hysterectomy task: further hx, investigation u
do, counsel pt regarding hysterectomy.
8. Young female comes in ED with bruise on eye. All invx comes out to b normal task: hx,
immediate management
9. 22yr old female comes at 20 weeks pregnancy having shared care. All reports normal till now
wants to discuss c sec. Task: relevant hx, risk n benefits of c sec, further management

Young female BMI 17 comes e 12 months amenorrhea. Did home UPT neg. exercise a lot,
athletic task: take hx, most likely diagnosis n DDx n cause
11. Hypertensive pt not taking medicine task: hx, counsel regarding medications

5. 67 yr old female with brownish colour discharge 2 days back. ( I think pap n mammography ws
given in stem that ws normal) task: take relevant hx, ask PEFE, tell diagnosis to pt

37 yr old female heavy period bleeding wants to hv hysterectomy task: further hx, investigation u
do, counsel pt regarding hysterectomy.

22yr old female comes at 20 weeks pregnancy having shared care. All reports normal till now
wants to discuss c sec. Task: relevant hx, risk n benefits of c sec, further management
10. Young female BMI 17 comes e 12 months amenorrhea. Did home UPT neg. exercise a lot,
athletic task: take hx, most likely diagnosis n DDx n cause

24 aril

7 vaginal fluid loss

Rural Gp.34 weeks pregnant with pre term rupture of membrane.clear fluid.no
pain,bleeding,trauma,fever,discharge etc.antenatal history normal.single baby,no pre-eclampsia
symptoms,sweet drink test normal,blood group positive.baby kicking well.on examination fundal
height according to gestation,fhr present..speculum no cord prolapse.told all investigation swabs
to rule out infection,fibronectin test,esr cry,group b strep.needs to be admitted in hospital with
consultant obs,pediatrician and incubator plus cesarean facilities.prolong pregnancy and steroids
for the baby's lungs.support empathy etc

4 lump
Post menopausal with lump.examination n tell pt diagnosis.on history lump in private part.no
other menopausal symptoms.no hrt.no incontinence or constipation cough etc.on asking tells
about hysterectomy few months ago.obs history not significant.examiner was standing beside me
while doing per speculum on dummy.on cough impulse patient pretends to cough.after asking
examiner tells no cervix.asked vault healthy? Lump is vault prolapse.finished examination with
per vaginal biannual.explained patient diagnosis.advised ammo,pay.examiner told management
is not the task
Passed
5 health review
Post menopausal with urine incontinence.Gp,task history,diagnosis management.simple case
stress incontinence.differentiate between stress and urge incontinence,other postmenopausal
complaint,cough constipation,hrt pap mammo etc.investigation management simple as in books
Passed
6 health review
Two weeks baby check at Gp.greeted mom.asked her
health,breastfeeding,mood,coping,support.name of baby John.concern about baby.mom told
John is fine just came for check up.examiner observed carefully while I examined doll.running
commentary to mom.all perfect in john.in the end reassure mom,offer help in dressing,keep
umbilical stump Clean,don't put anything on umbilical cord.immunisation advise
breastfeeding.thanks

20 april

Station no 5
Lady with recently delivered the baby(no exact time frame) come to talk to you..
just assessing as post partum assessment
Found two issues..i.e 1-dyspareunia & 2-contraception
Explain as her concerns
AMC's feedback- health review- pass

station no 11
Pregnant lady with vaginal bleeding...
Dx-threatened abortion + reassured
AMC's feedback- vaginal bleeding-pass
tation no 20
Pregnant lady with sudden abdominal pain
Dx-abruptio placenta (concealed)
AMC's feedback-abdominal pain-pass
Recall 25/08/17
O&G
1) Cervical shock – book case
2) Vaginal discharge 3 months 32 woman – grey and foul smelling. Has been on antifungal and
antibacterial before. No prior investigations done.
3) POG 8/52 having pallor and anemia but iron studies normal. (Probable thallasemia)
Counsel patient suggest further management (Sr Electrophoresis and check husband)

28 August 27, 2017 retest

- Obstetric
Antenatal check up