Practical Exam June 2016

Centre- St Stephens -
Medicine
Bronchiactasis, Fever with  HSM

Paediatrics
Preterm new born, PUO

Surgery
Adhesion with intestinal obstruction following laparotomy with bile leak

(Courtesy - Dr. Athish)


Medicine 
Bronchial asthma
Acute liver hepatitis
liver abscess
Pediatric empyema thoracis
Neonatal sepsis
Lipoma

(Courtesy - Dr.Shiv)


Liver abscess
Lipoma
Enteric fever
LRTI
PEM
Newborn

Table viva
X ray - Pacemaker

ECG-  SVT

Dicussion 
blocks,sick sinus syndrome

Paediatrics 
X ray bilateral pneumothorax
MMR vaccine,ET tube, bone marrow needle,neonatal resuscitation

PSM
Health policies, legislation, nutrition - dal,rice,bread,statistics-  median,mode, latest vaccines,mortality rate, incidence, attack-  secondary attack, sensitivity, specificity, vector methods,
 1 hour viva covering PSM and entire Park

Family medicine 
Ethics , Maintenance of records, CME, emergency medicine

(Courtesy - Dr. Mayuri)

Paraplegia
Cirrhosis
Normal newborn
Thalassesmia
Abdominal mass undescended testis
(Courtesy - Dr. Aryan)

MGIMS Wardha

Transverse myelitis
CLD
Hemiplegia
RHD with MS
Enteric fever
Newborn
Ca breast
Intra abdominal malignancy

PSM
Legislative act,Morbidity and mortality index,census,CME credit hours,core statistics,composition of hospital ethics,Objective of health policy

(Courtesy - Dr. Somesh)

Hemiplegia
RHD with MS
CML
RA
Plural effusion

Surgery
Thyroid carcinoma
Diabetic foot
Traumatic foot with peripheral neuropathy

Paediatrics
Thalassemia
Hepatosplenomegaly
Comprehensive myelopathy

(Courtesy - Dr. Rajat)

Anaemia
Stroke
Ca breast
Newborn
Hepatosplenomegaly

Viva
Contraceptives
NRH programme
Sterile insertion of copper T
Testing efficiency of condoms  on large scale
Census
(Courtesy - Dr. Vaishnavi)

Releasing soon our new book "Common Problems in Geriatric Women"

Dear friends,
      We Sukarmayogi Publishers,Sankeshwar,Belgaum are soon releasing our next book  "Common Problems in Geriatric Women" by Authors Dr. Subhash Nikumbh and Dr.Smruti Nikumbh-Haval.
         The book discuss the various problems a lady face in her geriatric age.The format is suitable for for both common public and medical practitioners.
          The cost of book with postage is 200/- and can be purchased at rural cme with rs.150/-.Looking forward for your warm response. Good day.

Feedback from readers on Integrated Handbook of Family Medicine volume 3

1)Nice book-Dr. Bijoy,Delhi.
2) Its a great compilation of important topics to deal with. Certainly beneficial in academic and practice.Thank you mam for your efforts. Keep inspiring us.-Dr. Smita,Kerala.
3)Nice book and great efforts.- Dr. Niyati.
4)Its a fantastic book written by you mam.-Dr. Vrun,Delhi.
5)Can't thank you enough for writing such an amazing series- Dr. Sukrit ,Delhi.
6)Nicely written book.-Dr. Gauri, Mumbai.
7) Great efforts. - Dr. Boobina,Vellore.
8)Books made study of family medicine exams much easy.Very helpful.Will try to contribute i n revised editions of book.- Dr.Paul.
9)Books really helped me in clearing my theory exam.Worth reading. - Dr. Afzal.
10)I have seen your books mam.It's very useful. I didnot want to xerox so I ordered.Your efforts we should be greatful not by xeroxing.-Dr. Tejaswini,Karnataka

Exam cases practical April 2016

1. Wardha- GDM,Pleural effusion,Bell's palsy,CVA with hemiparesis,MS,diabetic foot,pregnancy with anaemia,haemolytic anaemia,Nephrotic syndrome,CLD,Megaloblastic anemia(Courtesy - Dr.Monica,Delhi)

2.Baptist Bangalore - COPD,CVA,Normal neonate,15 month old child with failure to thrive,chronic osteomyelitis(Courtesy - Dr. Meghana,Pune)

3. CMC Vellore- ALD with cirrhosis and portal hypertension,stroke in young with hemiplegia,normal newborn,CHD with recurrent respiratory infection,testicular mass with inguinal hernia (Courtesy - Dr. Vinod,Bangalore)

Feedback on handbook of family medicine from users post theory/results

1.Books are absolutely helpful.I wrote many questions based on your book. - Dr. Hari.
2.Books are very helpful. -Dr. Impana.
3.Books were helpful especially when you have to read a lot in such a less time. -Dr. Mrinalini.
4.Thank you for your books.They made my preparation efforts very easy.-Dr. Pawar.
5.Books are really helpful at every step of exam.-Dr. Rajat.
6.Books made study of family medicine exams much easy.Very helpful.Will try to contribute i n revised editions of book.- Dr.Paul.
7.Books really helped me in clearing my theory exam.Worth reading. - Dr. Afzal.

Team of contributors Integrated handbook of family medicine volume 3

Contributors

Nutrition Section

                           Dr Sarika Ganesh Satav _{BAMS, MSc (dietetics)}

Certified International Diabetes Educator by Project Hope and International Diabetes Federation (IDF) USA

Clinical Nutritionist

Head of the Department (Nutrition and Dietetics)

Noble Hospital, Pune

Maharashtra

Physiotherapy Section

Dr. Mudmala Vijaya Ram Reddy, _{MPT-Ortho & Sports medicine, MIAP}

Consultant Physiotherapist

Bangalore, Karnataka

Obstretics Section

Dr.Aayesha Fathima _{D.N.B. (OBG)}

Department of Obstetrics and Gynaecology,

MES Medical College. Perinthalmanna, Kerala

Dr.Niyati Srivastava-Kumar _{D.N.B. (Obstetrics and Gynaecology)}

Gynaecology Section

 Gauri Utturkar _MBBS

Drug Safety Physician-Pharmacovigilance 

Mumbai –India

Dr.Sagar Shashikant Bhavsar _{M.B.B.S., D.N.B.(OBGY)}

Consultant OBGY at Yashfeen Hospitals Ltd, Navsari, Gujrat

Consultant Obstetrics and Gynaecology,

Special interest in infertility, Vaginal reconstructive surgeries and laparascopy

                                     Dr.Supriya Pritam Malvade - Haval  _D.G.O.

Consultant Rukmini Multispeciality Hospital,

Sankeshwar,Dist-Belgaum,Karnataka

Dermatology Section

Dr Pranita Tejab Wankhede _{MD Dermatology and Venereology}

                                     Consultant Dermatologist, Skin city, Pune

                                                             Maharashtra

Dr. Manasi Thawani   _{M.D. Dermatology, Venereology & Leprosy}

                                         Consultant Dermatologist, Skin City, Pune

                                                               Maharashtra

Gauri Utturkar _MBBS

Drug Safety Physician-Pharmacovigilance 

Mumbai –India

Dr. Aparna Gaikwad-Kapadnis _{DNB (Dermatology, Venereology & Leprology)}

Lecturer, Department of Dermatology & Venereology, K.E.M. Hospital, Pune

Consultant Dermatologist, Ratna Hospital, Pune,

Maharashtra

         Dr. Vikarm Lahoria _{M.D. Dermatology, Venereology & Leprosy}

                                              

               Seth G.S.Medical College and KEM Hospital, Mumbai, Maharashtra

                                            Special Topics Section

Dr.Waseem Ahmed.N _{M.B.B.S.,PG Dip Family medicine(CMC Vellore),P.G.Diploma Geriatric Medicine}
Family physician 
Special interest in Diabetes ,Geriatrics 
Chennai,Tamilnadu

Dr. Bobeena Chandy _{M.D.D.N.B. (P.M.R.)}

Assistant Professor

Department of Physical Medicine & Rehabilitation

Christian Medical College, Vellore

Tamil Nadu, India

sneak peek 2 handbook family medicine volume 3

                               ENDOMETRIOSIS

Gauri Utturkar

Endometriosis is defined as the presence of normal endometrial tissue implanted abnormally in location other than the uterine cavity. This tissue is composed of endometrial gland surrounded by endometrial stroma.

Signs and symptoms

About one third of women with endometriosis remain asymptomatic. Common symptoms are

• Dysmenorrhea
• Heavy or irregular bleeding
• Pelvic pain/ tenderness
• Lower abdominal or back pain
• Dyspareunia
• Dyschezia (pain on defecation) - Often with cycles of diarrhea and constipation
• Bloating, nausea and vomiting
• Inguinal pain
• Pain on micturition
• Pain during exercise
• Infertility

Diagnosis

Laparoscopy

The following sites are the most commonly involved

• Ovaries
• Posterior cul-de-sac
• Broad ligament
• Uterosacral ligament
• Rectosigmoid colon
• Bladder
• Distal ureter

Histology

Combination of endometrial glands and stroma in biopsy specimens obtained from sites outside the uterine cavity.

CA-125 assay

Usually raised more than 35 U/ml.Not of diagnostic value but useful for follow up post treatment.

Complete blood count (CBC)

Cervical Gram stain and culture,urinalysis and urine culture if indicated

Ultrasonography

Endometriosis can be assessed by either transvaginal or endorectal ultrasonography

Magnetic resonance imaging (MRI) if needed.

Management

Asymptomatic minimal endometriosis may be observed over 6-8 months. All symptomatic cases need active treatment.

Hormonal therapy

Combination oral contraceptive pills (COCPs) 

Act by ovarian suppression and continuous progestin administration. Initially a regimen of continuous or cyclic COCPs should be administered for 3 months. This treatment is continued for 6-12 months.

Progestational agents as Medroxyprogesterone, Norethindrone-act by decidualization and atrophy of the endometrium.

Gonadotropin-releasing hormone analogues as Goserelin, Leuprolide- produce hypogonadotrophic state by down regulation of the pituitary gland and cause endometriotic tissue atrophy.Danazol work by suppression of both the hypothalamic & ovarian axis by inhibiting the midcycle follicle-stimulating hormone (FSH) and luteinizing hormone (LH) surge,preventing steroidogenesis in the corpus luteum. Not preferred now as it has a higher incidence of adverse effects.

Aromatase Inhibitors Letrozole work by blocking the aromatase activity in extraovarian sites that suppress the conversion of androstenedione and testosterone to estrogen. This results in suppression of endometriosis at a local level.

Minimally invasive surgery

Primarily for management in young women.

Done through laparoscopy, destruction of endometriotic implants by diathermy.

Cauterization or laser. Excision of cysts (chocolate cysts) can be done.

Surgical therapy

Conservative surgery

The aim is to destroy visible endometriotic implants and lyse peritubal and periovarian adhesions that cause the symptom of pain. The laparoscopic approach is the method of choice for treating endometriosis conservatively.

Semiconservative Surgery

It is preferred in women who have completed their family are too young to undergo surgical menopause or but have severe symptoms.This involve hysterectomy and cytoreduction of pelvic endometriosis.

Radical surgery

Radical surgery involve total hysterectomy with bilateral oophorectomy (TAH-BSO) and cytoreduction of visible endometriosis. Adhesiolysis is performed to restore mobility and normal intrapelvic anatomy.

Pain management can include the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotic analgesics.

Complications

• Infertility/subfertility
• Chronic pelvic pain and subsequent disability
• Anatomic disruption of involved organ systems (e.g. adhesions, ruptured cyst)

Further reading

D.C.Dutta, Hiralal Konar,Textbook of gynaecology,5th edition,2004,New Central Book Agency(P) Ltd.,Kolkata.