1 Saudi Board exam 2015

Saudi Board 2015 Exam slides:

1-hystroscopic view of a septate uterus/ Bicornuate , mention 2 differential 2 diagnostic method and 2
future sequel
2-cartoon pic of twin-twin transfusion, mention the 4 sonographic criteria behind this complication?
3-Mention 4 hormones that are physiologically increased in pregnancy that can cause insulin resistance
4-karoytype analysis with turner syndrome 45x, mention4 reproductive consequences
5- Hirsitusim image of a face: mention 4 ovarian of this condition?
6-cartoon sagittal view of a rupture uterus with herniated pulping membrane through the rupture
uterus, 5 clinical signs of uterine rupture?
7-Picture of mastitis (Image red breast), mention 3 principals in treating this lactating mother?
8- 4 causes hot flushes other than estrogen deficiency?
9- Anorexia nervous image : mention 4 endocrine complications?
10- Image vacuum : mention 5 neonatal injuries?
11-an ultrasound pic of OHSS, 4 complications of OHSS?
12-a clinical scenario of severe PET, mention 5 maternal complications?
13. ECV INAGE : mention 5 complications of
14- Mention 4 factors that increase teratogenic potential?
15- Mention 10 risk fact for surgical infection in obstetrics and gynecology?
16-ultrasound pic of placenta accreta : what is diagnosis and 4 risk factors?
17-Gride a, b,c,d calculate from the gride the sensitivity, specificity , +&-ve predictive value?
18-Colopscopy pic with coarse mosaic pattern, punctuation and acetowhite changes, mention 3
abnormal colposcopic findings?
19-mention 5 ways to reduce DVT in the pre and post-operative period ?
20- Patient, 27 years with history of PE and anti-thrombin 3 deficiency: mention 4 obstetric
complications ?
21-mention 5 causes of negative progesterone challenge test?
22- Indomethacin administration at 33 week. Mention 4 fetal complication at this GA
23- Image of pelvic ultrasound showing ovarian mass: mention 4 feature of ovarian ca in this pelvic us.
24-mention 4 criteria for intrapartum birth asphyxia?
25-mention 3 theories of menorrhagia in fibroids?
26-mention 4 noninfectious causes of genital ulcers?
27-Mention 4 contraindications to pregnancy?
28. Mention 4 fetal consequences of Cholestasis in pregnancy
29. Ultrasound pic of 13 weeks partial molar pregnancy with fetus, mention 3 D\D?
30. Cartoon sagittal view of vesicovaginal fistula, MENTION 4 causes of this condition?
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Long cases over the 3 days:

1. PID with tub ovarian abscess : take focused history, how would u investigate
and Antibiotic regimen
2. ToT with mesh erosion : patient post TOT with dyspareunia and pv bleeding case
was about Vaginal erosion take focus history and how would u deal in such cases mention
post op complications of the procedure
3. Hyperthyroid: in pregnancy mention the features, impact on mother and fetus, name
of medications and safety of usage, when should we do surgery, side effects of drugs
4. Dictation: actually dictating a case like you are in the dictation
room. They brought 3 dictations over the 3 days :
Ovarian cancer staging and post-operative order
Endometrial cancer staging: 58yearold showed endometrial cancer by
biopsy: you ARE as a first surgeon dictate the clinical staging of uterine cancer? with
post-operative ORDERS
Patient with placenta accrete : Dictation for Caesarian
hysterectomy with post-operative order
5. Turner patient role player breaking bad news and advise about
her future plan and showing all the technique of breaking bad
news.
6. Twins IUFD with a patient role player breaking bad news This is a 35y
pg GA25w with an ultrasound report saying it was done by two senior sonograhpers, twin a
non vible fetus at 25w + amnotic fluid normal EFW 735 placenta posrerior..twin b non viable
fetus at 25w + amniotic fluid normal efw 755 placenta anterior.. Biometry both are normal
and structuraly normal.. Take a brief history from her? Explain to her the finding? How will
you further mange her? Shes aking about success rate failure and complication of induction
?Shes asking about her future fertility since she had history of infertility for 9years and this
is an ivf pregnancy?
7. Critical appraisal : needs the type of the study and discussing results and
interpretation and definition of RR and CI / NNT .Patient has odd ratio of 0.88 what does it
mean and NNT of 6 what does it mean. What does it mean if RR1.14? What is the best study
after RCT.
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8. Emergency contraception with patient role player discussing with

you the above then iucd perforation and management with
laparoscopy and complications then what you will do if you could
not find the IUCD in the abdomen intraoperative? Fatima is 23 yrs old
nurse she had un protective coitus 2 days ago & wants emergency contraception & types.
** Fatma tells you that : an iucd inserted 1day ago by her resident friend and now in
constant pain in her abdomen? What will you do next? Ok she brought u a tvs showing no
iucd in utero whats your next step?
Once you mention ultrasound she will give you the report: Her pelvic
us showed empty uterus

You have to mention doing abdominal xray to locate the iucd:

Patient will give you the xray to read: abdominl xray showed a migrated iucd.
how are you going to council her furtherly? Explain benefits risk and complications of
laproscopy and explain to her the details about the procedure? She was asking about if you
couldnt find it by laparoscopy what will you do next?

9. Maternal collapse : they brought 2 scenario of a patient

A : ***16-18 weeks who they would like to know CPR details and
defibrillation requirements and technique and what next for this
patient after. Are you doing to deliver her and why ? 29y pg GA16w you were
called and your junior staff was doing chest compressions what is you role as a senior? After failed
5cycles of chest compressions whats your next step? Are you going to deliver her in this stage And
explain why? If you encounter the same patient at 35 week are you going to deliver her and why?
After how many minutes will you deliver her? Where are you going to deliver her in the theater or
where? When and how to give AED defibrilator , steps., precaution s??? Does chest compressions
in pregnancy differ from non-pregnant? What are the rapid response team? What are signs of a
successful resuscitation? 2 reasons for not doing perimortum cs at 16 weeks
Discuss Causes of maternal collapse?
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B ** 35 weeks who they would like to know CPR details and

defibrillation requirements and technique then details of doing
caesarian section and instruments used. 35 wks with stab wound in haj
events brought to ER by ambulance un responsive what u will do?
U have to tell the steps starting from checking response , pulse , Respiration
Then code blue
For How long u will continue CPR
What is the difference between CPR in pregnant pt
& non pregnant ?
What u will do next after 5 cycles CPR?
When to initiate perimortum cesearian ?
Why u will tilt the pt 15 degree during CPR?
what instrument u will use in perimortum cs?
Where to perform post mortum cs ?
When to suture the wound ?
What is the defferential for maternal collapse ?
What is next after defebrilater?

10. Ectopic pregnancy over 3 days :

A **Acute management for rupture ectopic : 19y pg Lmp last 7 weeks has an
abdominal pain,. Take a focused hx? Elicit a Physical examination? She looks pale poor capillary
refill bp 90/40 and hr is 120bpm rt iliac fossa pain with rebound tenderness and +ve cx motion
tenderness, next step? Two large bore cannula start vigorous hydration with LR and withdrawal
blood mention all then call for TVS, hb is7 bhcg 2000 right adenxal mass 3*4 with flow and free fluid
pouch of douglas she didnt mention the amount, what is you DX? How are you gonna prepare her
for or? What type if surgery you will perform? Laproscopy or laprotomy? Why not laproscopy in this
case?why not salpingiostomy in this case? Does salpingectomy and salpingiostomy differ in follow
up post explain? What are the contraindications for methotrexate? Does salpingectomy will affect
future fertility? Is there a chance that ectopic will to recur again? Success rates?
Counselling Next preg risks?
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B ** Medical management of ectopic pregnancy : P2 presented to ER C/O

Lower abdominal pain
Please see this pt to reach adiagnosis &treatment care plan ?
After Hx & examination what investigations u will do?
Cbc normal
BHCG 4200
Uss ET 7mm
Rt adenexal mass 4x5 cm
What is ur diagnosis ?
What is the modalities of management ?
What is the dose of methotrexate ?
What is the prerquisits for methotrexate?
What is the CI of methotrexate?
What is the side effects of methotrexate?
How u will give methotrexate?
How u will counsil the pt regarding treatment with methotrexate?
After how long she can get pregnant post methotrexate?
Is medical management affect future fertility?
What sort of surgical management u know?

C ** Surgical management of ectopic pregnancy : Ectopic pregnancy

emergency surgical approach name of instruments used contraindications for medical use also take
a focus history

11. RH isoimmunization : Patient Role player to discuss with her

history and management in details of follow up ( MCA) has to be
mentioned. 25 y p2+o with a history of a jaundice in her last delivery it was said to her
by the neonatologist that is was due to rheaus disease. Explain to her what is it? Is there any
way to prevent it antenatal? If she got pregnant again will it get worse or better? If she got
pregnant again is there a way to prevent this from happening? Is there a certain people i
can go to whos specialized in such cases? How would be my next preg?
What could be the outcome.?
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12. Patient role player with IUFD : 2 scenarios :

A***26 weeks patient History and management in details leading to a diagnosis of

thrombophilia in pregnancy & mode of delivery.

B*** This pt presented with reduced fetal movement & uss showed IUFD at 37 wks.
Please counsel this pt ?
U r expected to discuss the cause of IUFD
Plan of current pregnancy

13. Obesity and its impact on obstetric patient : 2 scenario came

A***This is a 29 pg Ga 12 weeks with a BMI of 29, she is worried about the effect of her
weight on the pregnancy, define obesity, what problems she can encounter antepartum
intrapartum and postpartum? She ended with a caesarian section what do you advise her?
What test are you going to order in each trimester? Plan for next preg.

B*** P1 post bariatric surgery 1 year she came to the clinic pregnant 8 wks. ,
How u will approach this pt during antenatal care?
What is the definition of BMI
How bariatric surgery will affect pregnant lady ?

During ANC her BMI reach 35 what is ur care plan ?

What is the intra-partum care ?

What is the post partum care ?

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14. OHSS : nullipara presented to ER with abd pain & SOB

* How u will approarch this pt
After hx she had amenorrhea 5 wks , Received ART .Tachy cardia . Clinical ascitis
Investigations result Hb 10
WBC 17 ,K 3.9, creatinine 88 mmol
pelvic Us moderate to severe ascitis
Spiral CT: Pulmonary Embolism
*What is ur diagnosis?
*What is ur management
*What is the risk factors for OHSS
*What is the prognosis
*How to prevent
*What is the risk of death from OHSS

15. Family planning : Pt post partum 8 wks , lactating whants contraception

What are the contracptions suitable for this pt ?
What about cocp for this pt is it suitable & why?
What are the absolute contraindications for cocp?
What is the non contraceptive uses of ocp?
If pt came day 10 of period u will give ocp or no?
What points in the hx u have to know before giving ocp?
What are the prerquisits for IUCD?
What are the contraindications of ocp?

16. Role player of a women with advanced maternal age and

pregnancy and investigation for that and management ( they need
the new test in every trimester) then Follow up U r expected to discuss
the pregnancy risk & pregnancy care plan : 41yrs old P2 6 wks pregnant she had some
concerns , please answer her concerns?
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17. HRT
HRT & Menopause HRT 52y LMP 2y ago suffering from hot flashes interested in HRT but
worried from what she heard, take a focused hx if shes a suitable candidate? What are the positive
effect that HRTcan give her? What is the recommended dosage and duration for this patient? What
are complication of hrt? What are side effects of HRT? What are types of HRT that you know? She is
now taking HRT what annual investigation what will you order for her? Are HRT the first line of
treatment for osteoporosis?Followup

18. Chronic pelvic pain and endometriosis 25 y nulligravida, c/o

dysmenorrhea, take a focused history to reach your diagnosis? What p/e will you do on her?
Bimanual examination revealed an anteverted mobile uterus and small fixed nodule at the
pod? What is your diagnosis? How further you will treat her? She wants kids in the near
future? You did a laproscopy on her found gun shot lesions and a single nodule, what is your
next step? What are her chances of spontaneous fertility rate before and after this surgery?
She didnt get pregnat on her own what further are you going to offer her?
She had 3 cycles of controlled ovarian hyper stimulation +intrauterine insemination all have
failed whats your next step? What are the effect of endometriosis on pregnancy?