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New cases in Pous 2064, HIV = 175, AIDS = 26, Death = 2. HIV rate is very high in Housewives than sex workers in Nepal ! ! ! HIV status in Nepal till 2005: Total Adult=70000, Adult Prevalence (15-49)=0.55%, Number of Women (15-49) LWHA=15,310 (22%), HIV Prevalence rate in IDUs=32.7%, HIV prevalence rate in sex worker=3.8%, HIV prevalence rate in client of SW=2.1%. The latest U.N. report shows that 65 million people have been infected with HIV since it was first identified 25 years ago. Twenty five million people have died of AIDS.

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KMC KATHMANDU MEDICAL COLLEGE Sinamangal, Kathmandu

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Thumbs up 5th Semester : viva questions (an exam experience) - 14-12-2006, 03:31 AM

Hi everybody, lets share viva questions and answers that you may have been asked during your practical exams/bed side learning/classes:

Lets begin with some questions (answers) :

Gyen/obs
What is excess weight gain during pregnancy?
• (>0.5kg weight gain/week and >2kg weight gain/month)
• It is early manifestation of pre-eclampsia

What is lochia and its composition?
• It is vaginal discharge for the first fortnight during puerperium (originates from uterine body, cervix and vagina)
• Types: lochia rubra (red,1-4 days), lochia serosa (pinkish yellow, 5-9 days), lochia alba( pale white,9-15 days)
• May extend to 3 weeks (if more may be abnormal, note the odour, amount, colour, duration
Why the cord-cutting scissor is round (curved) not pointed?
• To prevent slipping of curd while cutting
• To prevent injury to the surrounding structures(esp baby)

Uses of sponge holding forceps:
• Toileting the vulva, vagina, perineum prior to and following surgery
• Antiseptic painting
• To catch hold the membranes if threatens to tear during or after delivery
• To catch hold the cervix during suturing the cervical tear

What do you ask for menstrual history?
• LMP
• Age at menarche
• Duration
• Flow (amount)
• Cycle
• Dysmenorrhoea?
• Any history of clots, foul smell of menstrual blood

What are the advices you give on discharge:
For FTNVD
1. Normal diet,
2. Iron calcium for 45 days
3. Abstinence for at least 6 weeks
4. No heavy work at least for 3 months
5. Absolute breast feed for 6 months
6. Immunization of the child
7. ambulation
8. Maintainance of perineal hygiene
9. Antibiotics if indicated
10. F/U after 6 weeks or SOS

For LSCS
All of the above and
1. Next pregnancy after 3 years only
2. Next delivery should be planned and should be conductecd in a hospital.
3. F/U after one week or SOS

What are the criteria for normal labour?
1. full term
2. vertex presentation
3. spontaneous in onset
4. without undue prolongation
5. natural termination with minimal aids
6. no maternal and child complication
7. singleton pregnancy

Causes of PPH (any amount of bleeding from or into the genital tract after the delivery of child and during the puerperium, which adversely affects the maternal condition and is characterized clinically by increase in pulse and decrease in BP.)
4 T's
1. tone ( Atonic uterus-80%)
2. tissue (retained tissue)
3. trauma (during or after delivery)
4. thrombus ( coagulative disorder)
causes of APH (bleeding from or into the female genital tract after 28th week of pregnancy but before the birth of the baby, first and second stage of labour are thus included)
1. placental,70%(placenta praevia,35% abruption placentae,35%)
2. unexplained,25% (excluding placental and local lesions)
3. extraplacental causes,5% (cervical polyp,carcinoma cervix,varicose vein,local trauma)

ANC visit
If possible, according to WHO
1. In every 4 weeks upto 28 weeks
2. in every 2 weeks up to 36 weeks
3. every week till EDD

if not possible, at least 4 ANC visits in
1. in 16th week
2. in 24-28 weeks
3. in 32nd week
4. in 36th week



Please do read this also,
• Answers may not be exact, and if wrong/incomplete please suggest corrections
• Bold questions/answers/points are important
• Please go on adding
• While adding questions, please write the answers as far as possible (even if you don’t know the complete answer)
• Please add very commonly asked/interesting questions not theory type


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Re: viva questions - 14-12-2006, 04:43 AM

thanks for the sharing? keep it up?
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Re: viva questions - 14-12-2006, 09:41 PM

Wonderful final moment revision kit for the students.........

KEEP POSTING........

liVE WIIiIITH PASSION
sUSHANT-PAssioN


beE In toUch...
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Re: viva questions - 14-12-2006, 10:38 PM

mitra thanks timilai


better heart 4 better nepal
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Re: viva questions - 14-12-2006, 11:00 PM

PEDIATRICS VIVA QUESTION

Define PEM.
What are the causes of pallor?
What are the causes of Dehydration?
Causes of Cyanosis.

Different classifications of malnutrition like Waterlow's , Gomez, IAP, Welcome Trust , WHO. The Gomez classification given in Meharban singh is Wrong ....please refer IAP textbook or Parks community medicine.

What is a pre requisite to look for icterus? (adequate light, so when u are asked, take the patient near to window and then see )
Define Edema.
Causes of generalised edema
-hypoproteinemia due to :inadequate intake <kwashiorker>, maldigestion<panreatitis>, mal absorption<celiac disease, crohn's disease>,decreased synthesis <liver failure>, excess loss <nephrotic syndrome>
- volume overload : congestive heart failure ,renal failure

How do u differentiate edema due to fluid overload and that due to hypoproteinemia .
-in former jvp is raised but unaltered in the later

What are the ten points for successful breast feeding?


better heart 4 better nepal

Last edited by SUMAN-SAJAN : 14-12-2006 at 11:08 PM.
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Thumbs up Re: viva questions - 15-12-2006, 01:24 AM

today asked in surgery,
why u look upper bulbar conjunctiva for icterus?
bilirubin has high affinity for elastic tissue of sclera
white background is provided
upper part is generally unexposed to the environment
Define peritonitis,say some causes.

what are the factors that delay healing of ulcer,wound,sinus and fistula?

Last edited by SPRimal : 15-12-2006 at 01:40 AM.
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Re: viva questions - 15-12-2006, 05:55 AM

Surgery Viva questions
What is "periodicity of pain"?
Answer: no idea
What is the use of taking bronchial asthma as History of past illness in patient of Cholescystitis?
Answer:May be patient is suffering from basal plurisy of lung( differential for pain presented by patient)
What is the difference between floor and base?
Answer: Floor is what we see.
Base is what we palpate.
What is the difference between Edge and Margin of ulcer?
Answer: Margin is the outer lining of ulcer
Edge is lining between margin and healthy tissue. (*not sure)
Why is the edge of ulcer undermined in Tuberculosis?
Answer: Because the underlying subcutaneous tissue cannot cope-up with the fast growing epithelial surface.

Gynaecology/ Obstetrics
Why is the shape of cord cutting scissors round both externally and internally?
Answer: Internal: As cord contains Whartons jeely, it is slippery. In order to prevent it from slipping off it is round.
External: It is round and blunt. As Cord is cut at around 5 cms from baby's umblical region,
it might hurt baby's umblical and adjacent areas if it was straight or sharp.
Give orientation of Gynae ward ?
What do you see in delivery room?
What is the bed called that is used for delivery?
What is the most prominent sign you would look for assessing diarrhoea in babies ?
Answer: Ask for urine output.
What do you do in delivery room?/ Management of 1st,2nd or 3rd stage labour.
Answer: Management of labour in different stages.
What is Sims Traid?
Answer: Sims position, Sims speculum, Sims suture for repair of fistula.
What contraceptive you would prescribe a woman coming after 6 months of delivery?
Answer: May be IUCD. (because by 6 mths her uterus would have attained the pre-pregnant state, she can have longer duration of birth spacing).
*please give your opinions too.

## If I am wrong Please correct me.



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Re: viva questions - 16-12-2006, 10:28 PM

ujnas what i think is Margin is :what we feel (palpate)
Edge is : what we see

Better if u have mentioned the name of fistula in Sims triad: Vesico Vaginal fistula


better heart 4 better nepal
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Re: viva questions - 16-12-2006, 10:29 PM

sprimal! is there a relation between environment and looking for icterus in upper bulbar sclera ?
Do u mean to say sunlight causes degradation of bilirubin?


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Re: 5th Semester : viva questions (an exam experience) - 17-12-2006, 10:08 AM

Quote:
Originally Posted by SUMAN-SAJAN View Post
sprimal! is there a relation between environment and looking for icterus in upper bulbar sclera ?
I think he mean to say that, icterus should be examined in a natural light environment.

Quote:
Originally Posted by SUMAN-SAJAN View Post
Do u mean to say sunlight causes degradation of bilirubin?
Hey, phototherapy is done only in neonatal jaundice... as when bilirubin is exposed to light it undergoes photoisomerization to form “photobilirubin." The photobilirubin is formed photochemically from bilirubin near the surface of the skin and is then transported in plasma to the liver, where it is excreted in bile. The formation of photobilirubin appears to be a highly efficient process in which the photobilirubin is continuously removed from the skin by the plasma and is then excreted. read more in - Jaundice in Newborn 3,565KB size PDF file.

But don't forget to read Is sunlight an effective treatment for infants with jaundice?


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