6 - Paeds - Surgery-Acute Abdomen + Abdo Ex Flashcards by Vish Gossain | Brainscape

Q

Acute abdo - % of pain resolving undiagnosed? mustn’t delay diagnosis of what? why?

A

almost 50%

acute appendicitis as can perforate quickly in children

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Q

Intra-abdominal surgical conditions (Acute abdomen)

A

acute appendicitis
intestinal obstruction including intussusception
inguinal hernia
peritonitis
inflamed meckels
pancreatitis
trauma

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Q

Extra-abdo causes of acute abdo

A

URTI
Lower lobe pneumonia
Testicular torsion
hip + spine

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Q

Abdo Ex - inspect?

A

anaemia, jaundice, distension, bruising (umbilicus/flanks), dehydration

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Q

Abdo Ex - palpation?

A

shallow and deep, masses, tenderness, guarding, organomegaly, rebound tenderness, hernia, scrotum, LNs

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Q

Abdo Ex - percussion? auscultation?

A

ascites, bowel gas, tenderness, shifting dullness, fluid thrill, size of mass

bowel sounds, bruits

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Q

Abdo Ex - to complete exam?

A

DRE, pelvis, external genitalia, lower pulses, hernial orifices

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Q

Abdo Ex - Ix?

A

Urine dip, pregnancy test, bloods (U+E, FBC, LFT, glucose, calcium), G+S, ECG, O2, radiology

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CP2 (339 decks)

4 - PSY - Personality Disorders

4 - PSY - Alcohol and substance misuse

4 - PSY - Emergencies

5 - PSY - Child and Adolescent Psych

5 - PSY - Perinatal Psychiatry

5 - PSY - Intellectual Disability

1 - PSY - Hx, MSE + Management plan

1 - PSY - Psychopathology

1 - PSY - Psychosis and Schizophrenia

1 - PSY - Antipsychotics

2 - PSY - Depression

2 - PSY - Mania and Bipolar

2 - PSY - Antidepressants

2 - PSY - Mood stabilisers

2 - PSY - Self harm and Suicide

2 - PSY - Mental Capacity Act

3 - PSY - Anxiety Disorders

3 - PSY - Health Anxiety, Somatisation + Medically unexplained symptoms

3 - PSY - Eating disorder

3 - PSY - Psychotherapy

1 - Opth - Introduction and Anatomy - Outer Layer

1 - Opth - Introduction and Anatomy - Middle (uveal) layer)

1 - Opth - Introduction and Anatomy - Inner Layer

1 - Opth - Introduction and Anatomy - Eyelids and Conjunctiva

2 - Opth - Cataracts

3 - Opth - Glaucoma - Physiology + Assessment/screening

3 - Opth - Glaucoma - Primary Open Angle Glaucoma

3 - Opth - Glaucoma - Acute angle closure glaucoma

4 - Opth - Acute red eye - Blepharitis

4 - Opth - Acute red eye - Overview

4 - Opth - Acute red eye - Conjunctivitis and Subconjunctival Haemorrhage

4 - Opth - Acute red eye - Episcleritis and Scleritis

4 - Opth - Acute red eye - Keratitis

4 - Opth - Acute red eye - Anterior Uveitis

5 - Opth - Acute loss of vision - Hx + Examination

5 - Opth - Acute loss of vision - Retinal Vein Occlusion

5 - Opth - Acute loss of vision - Retinal Artery Occlusion

5 - Opth - Acute loss of vision - Anterior Ischaemic Optic Neuropathy (AION)

5 - Opth - Acute loss of vision - Posterior vitreous detachment (PVD) + Retinal detachment

5 - Opth - Acute loss of vision - Optic disc swelling, Optic atrophy, Vitreous haemorrhage, Macular haemorrhage, Causes of bilateral acute painless vision loss

6 - Opth - Retinal disease - AMD

6 - Opth - Retinal disease - Diabetic Retinopathy

7 - Opth - Pupillary reflexes - Constriction and Dilatation

7 - Opth - Pupillary reflexes - Dilated pupil

7 - Opth - Pupillary reflexes - Constricted pupil

7 - Opth - Pupillary reflexes - Pupil reflex abnormalities and Other pupil abnormalities

8 - Opth - Eye movements

9 - Opth - Visual fields and Optic nerve

10 - Opth - Squints - Orthoptics + Types of Squint

10 - Opth - Squints - Concomitant Squints

10 - Opth - Squints - Incomitant Squints

11 - Opth - Orbital Disease - Typical Sx + Signs

11 - Opth - Orbital Disease - Orbital cellulitis + Vascular orbital disorders

11 - Opth - Orbital Disease - Orbital tumours

11 - Opth - Orbital Disease - Thyroid eye disease + Encephalocele + Idiopathic orbital inflammatory disease (IOID)

12 - Opth - Refractive Error - Normal focus, Types, Myopia

12 - Opth - Refractive Error - Hypermetropia, Astigmatism, Presbyopia

12 - Opth - Refractive error - Contact lenses

13 - Opth - Low vision and visual rehab - Visual impairment

13 - Opth - Trauma - Hx and Examination

13 - Opth - Trauma - Foreign Body + Corneal Abrasion

13 - Opth - Trauma - Penetration trauma + chemical injury

13 - Opth - Trauma - Blunt trauma

1 - ENT - Head and neck - Salivary gland anatomy

1 - ENT - Head and neck - Cancer and neck lumps - overview + HNSCC

1 - ENT - Head and neck - Salivary gland disease - Non-neoplastic salivary gland swelling

1 - ENT - Head and neck - Salivary gland disease - Benign and Intermediate salivary gland tumours

1 - ENT - Head and neck - Salivary gland disease - Malignant salivary gland tumours + metastases

1 - ENT - Head and Neck - Salivary gland disease - Dry mouth, surgery

1 - ENT - Head and Neck - Other throat complaints - Pharyngitis and Follicular Tonsilitis

1 - ENT - Head and Neck - Swallowing and Dysphagia

2 - ENT - Facial Nerve - Course, function and branches of FN CNVII

2 - ENT - Facial nerve palsy - Signs, Examination, Investigations and Management

2 - ENT - Facial nerve palsy - Causes + Bell's palsy

3 - ENT - Otology - Anatomy

3 - ENT - Otology - Pinna disease

3 - ENT - Otology - Conductive vs. Sensorineural deafness

3 - ENT - Otology - Conductive deafness - Otitis externa

3 - ENT - Otology - Conductive deafness - Otitis Media

3 - ENT - Otology - Conductive deafness - Cholesteatoma, Retraction pockets, Tympanosclerosis, Otosclerosis

3 - ENT - Otology - Conductive deafness - Chronic perforation (dry), Tumours, Trauma + Congenital

3 - ENT - Otology - Intracranial complications of temporal bone infection

3 - ENT - Otology - Sensorineural deafness - Presbyacusis, Acoustic Neuroma + Sudden sensorineural hearing loss

3 - ENT - Otology - Sensorineural deafness - Noise induced, Barotrauma + Perilymph fistula, Trauma, Ototoxicity, Herpes Zoster Oticus

3 - ENT - Otology - Other conditions of the ear

3 - ENT - Otology - Ear testing and otoscopy - Testing hearing

3 - ENT - Otology - Otoscopy

4 - ENT - Vertigo - dizziness, Nystagmus and Romberg's

4 - ENT - Vertigo - Central vertigo

4 - ENT - Vertigo - Peripheral vertigo

5 - ENT - Rhinology - Approach to the history

5 - ENT - Rhinology - Epistaxis

5 - ENT - Rhinology - Nasal obstruction

5 - ENT - Rhinology - Rhinosinusitis - RS, Acute RS

5 - ENT - Rhinology - Rhinosinusitis - Chronic RS and Complications of Infective RS

5 - ENT - Rhinology - Rhinosinusitis - Allergic and non-allergic RS

6 - ENT - Upper airway - Anatomy - Pharynx

6 - ENT - Upper airway - Obstruction - Causes + Signs

6 - ENT - Upper airway - Obstruction - Croup + Laryngomalacia

6 - ENT - Upper airway - Obstruction - Acute epiglottis + Laryngeal trauma

6 - ENT - Upper airway - Obstruction - Emergency airway management

6- Upper airway - OSA - OSA, Presentation, Aetiology

6 - ENT - Upper airway - OSA - Complications, Assessment, Management

6 - ENT - Upper airway - Voice - Speech production + Assessment

6 - ENT - Upper airway - Voice - Causes of voice change - Structural/neoplastic

6 - ENT - Upper airway - Voice - Causes of voice change - Inflammatory + Muscle Tension Imbalance (MTI)

6 - ENT - Upper airway - Voice - Causes of voice change - Neuromuscular - RLN Palsy/paresis

1 - Derm - Introduction + Examination - S+F

1 - Derm - Introduction + Examination - Terminology

1 - Derm - Introduction + Examination -Derm Hx and Describing

1 - Derm - Introduction + Examination - Signs + Colour abnormalities

2 - Derm - Skin + Systemic disease - Major mechanisms

2 - Derm - Skin + Systemic disease - Diabetes and the skin

2 - Derm - Skin + Systemic disease - Cutaneous manifestations of malignancy

2 - Derm - Skin + Systemic disease - Thyroid disease, SLE, Erythema nodosum

2 - Derm - Skin + Systemic disease - Cutaneous small vessel vasculitis

2 - Derm - Skin + Systemic disease - Dermatitis herpetiformis, Generalised pruritis, RA

2 - Derm - Skin + Systemic disease - Drug eruptions 1

2 - Derm - Skin + Systemic disease - Drug eruption - Erythema multiforme

3 - Derm - Benign and Malignant Melanocytic Lesions - Moles (naevi)

3 - Derm - Benign and Malignant Melanocytic lesions - Melanoma 1

3 - Derm - Benign and Malignant Melanocytic lesions - Melanoma 2

3 - Derm - Benign and Malignant Melanocytic lesions - Melanoma 3

4 - Derm - Non-melanoma skin cancers + Benign skin tumours

4 - Derm - Non-melanoma skin cancers + Benign skin tumours - BCC mgmt

4 - Derm - Non-melanoma skin cancers + Benign skin tumours - SCC

4 - Derm - Non-melanoma skin cancers + Benign skin tumours - Pre-malignant cutaneous tumours

4 - Derm - Non-melanoma skin cancers + Benign skin tumours - Benign lesions

5 - Derm - Leg ulceration - Venous ulceration

5 - Derm - Leg ulceration - Arterial ulceration

5 - Leg ulceration - Diabetic, Vasculitic and other leg ulcers

6 - Derm - Eczema - Intro

6 - Derm - Eczema - Atopic eczema

6 - Derm - Eczema - Topical steroids

6 - Derm - Eczema - Seborrheic eczema (dermatitis) + other eczema'a

6 - Derm - Eczema - Exogenous eczema

7 - Derm - Psoriasis - Intro + Plaque psoriasis

7 - Derm - Psoriasis - Guttate, Flexural + Pustular Psoriasis

7 - Derm - Psoriasis - Erythrodermic psoriasis and Psoriatic arthritis

7 - Derm - Psoriasis - MGMT of psoriasis

8 - Derm - Bacterial infections - Common pathogenic organisms 1

8 - Derm - Bacterial infections - Common pathogenic organisms 2

8 - Derm - Bacterial infections - Primary staph/strep infections - Hair follicle infections + Impetigo

8 - Derm - Bacterial infections - Primary staph/strep infections - Cellulitis, Erysipelas, Ecthyma

8 - Derm - Bacterial infections - Staph + Strep toxic reactions

9 - Derm - Viral infections - HPV

9 - Derm - Viral infections - HSV

9- Derm - Viral infections - VZV

9 - Derm - Viral infections - Pox viruses, Hand foot and mouth disease, Pityriasis rosea

10 - Derm - Fungal infections - Antifungals

10 - Derm - Fungal infections - Dermatophyte infection

10 - Derm - Fungal infections - Candidiasis + Pityrosporum

10 - derm - Fungal infections - Infestations

11 - Derm - Acne - Background

11 - Derm - Acne - Lesions of acne + Acne variants + Acne rosea

11 - Derm - Acne - Mgmt of Acne

1 - Paeds - Resp - Asthma - Background, Hx + Ex

1 - Paeds - Resp - Asthma - Ix, DDx, Acute Exacerbation, Stages

1 - Paeds - Resp - Asthma - Mgmt

1 - Paeds - Resp - Asthma - BTS guidelines, Assessing Asthma Control, Parental Advice

1 - Paeds - Resp - Chest Infections - Bronchiolitis

1 - Paeds - Resp - Chest infections - Pneumonia

1 - Paeds - Resp - Chest infections - Pertussis

1 - Paeds - Resp - Chest infections - TB

1 - Paeds - Resp - Cystic Fibrosis

1 - Paeds - Resp - CF mgmt

1 - Paeds - Resp - ENT - Epiglottitis

1 - Paeds - ENT - AOM + Tonsillitis

1 - Paeds - Resp - URTI

1 - Paeds - Resp - The Febrile Child

1 - Paeds - Resp - Croup

1 - Paeds - Resp - DDx Upper Airway Obstruction

2 - Paeds - CVS - Cardiac Failure

2 - Paeds - CVS - Heart murmurs

2 - Paeds - CVS - Atrial Septal Defect (ASD)

2 - Paeds - CVS - Ventricular Septal Defect

2 - Paeds - CVS - Persistent DA

2 - Paeds - CVS - Aortic Stenosis + Pulmonary Stenosis

2 - Paeds - CVS - Atrioventricular Septal Defect

2 - Paeds - CVS - Coarctation of Aorta

2 - Paeds - CVS - Duct-dependent Lesions

2 - Paeds - CVS - Supraventricular Tachycardia

2 - Paeds - CVS - Tetralogy of Fallot

2 - Paeds - CVS - Transposition of the Great Arteries

2 - Paeds - CVS - Cardiac Disease and Syndromes + Hypoplastic LH Syndrome

2 - Paeds - CVS - Myocarditis and Subacute Bacterial Endocarditis

3 - Paeds - Gastro - Nutrition

3 - Paeds - Gastro - Failure to Thrive

3 - Paeds - Gastro - Malnutrition

3 - Paeds - Gastro - Constipation

3 - Paeds - Gastro - Encopresis and Hirschsprung's

3 - Paeds - Gastro - Gastroenteritis

3 - Paeds - Gastro - GORD

3 - Paeds - Gastro - Jaundice

3 - Paeds - Gastro - Biliary Atresia

3 - Paeds - Gastro - Viral Hepatitis

3 - Paeds - Gastro - Coeliac

3 - Paeds - Gastro - Food allergy/Intolerance

3 - Paeds - Gastro - Malabsorption + Parasitic Infections

3 - Paeds - Gastro - Recurrent/Functional Abdo pain + CMPI + Toddler Diarrhoea

3 - Paeds - Gastro - IBD

3 - Paeds - Gastro - Gastritis + Mesenteric Adenitis

4 - Paeds - Community Paeds + Psych - Autism

4 - Paeds - Community Paeds + Psych - Aspergers Syndrome

4 - Paeds - Community Paeds + Psych - Developmental Milestones

4 - Paeds - Community Paeds + Psych - Neurological Ex

4 - Paeds - Community Paeds + Psych - Speech + Language, Social + Emotional + Behavioural Development

4 - Paeds - Community Paeds + Psych - ADHD

4 - Paeds - Community Paeds + Psych - Enuresis

4 - Paeds - Community Paeds + Psych - Specific LDs

4 - Paeds - Community Paeds + Psych - Stammer + Speech impediment

5 - Paeds - Safeguarding - Abuse/Neglect

5 - Paeds - Safeguarding - CAMHS - Anorexia/Bulimia Nervosa

5 - Paeds - Safeguarding - CAMHS - Effects of Chronic Disease

5 - Paeds - Safeguarding - CAMHS - School refusal

5 - Paeds - Safeguarding - CAMHS - Tantrums, Aggressive behaviour + Conduct disorder

5 - Paeds - Safeguarding - CAMHS - Depression

5 - Paeds - Safeguarding - CAMHS - Psychosis + Self harm + Recreational Illicit drugs

5 - Paeds - Safeguarding - CAMHS - Chronic fatigue syndrome + Sleep disorders

6 - Paeds - Surgery-Acute Abdomen + Abdo Ex

6 - Paeds - Surgery - Shock

1 - O+G - Hx + Ex - Gynae Hx

1 - O+G - Hx + Ex - Gynae Ex

1 - O+G - Hx + Ex - Obstetric Hx

1 - O+G - Hx + Ex - Obstetric Ex

1 - O+G - Hx + Ex - Postnatal Hx, Ex, Ix, MGMT

2 - Obs - Antenatal Care - Aims of care + Pre Conceptual care and counselling

2 - Obs - Antenatal Care - The Booking Visit

2 - Obs - Antenatal Care - The Booking Visit 2

2 - Obs - Antenatal Care - Later Pregnancy Screening + Continuing Antenatal care

2 - Obs - Antenatal Care - Minor Conditions of Pregnancy

2 - Gynae - Menstrual Cycle and its disorders - Physiology

2 - Gynae - Menstrual Cycle and its disorders - Menorrhagia

2 - Gynae - Menstrual Cycle and its disorders - Irregular Menstrual and Intermenstrual bleeding

2 - Gynae - Menstrual Cycle and its disorders - Amenorrhea + Oligomenorrhea

2 - Gynae - Menstrual Cycle and its disorders - Postcoital bleeding + Dysmenorrhea

2 - Gynae - Menstrual Cycle and its disorders - Precocious puberty + Ambiguous development and Intersex

2 - Gynae - Menstrual Cycle and its disorders - Premenstrual Syndrome

3 - Gynae - The Uterus and its abnormalities - Anatomy and Physiology of the Uterus

3 - Gynae - The Uterus and its abnormalities - Fibroids

3 - Gynae - The Uterus and its abnormalities - Adenomyosis

3 - Gynae - The Uterus and its abnormalities - Other Benign Conditions of the Uterus

3 - Gynae - The Uterus and its abnormalities - Endometrial Ca

4 - Gynae - The Cervix and its disorders - Anatomy and Fx of Cervix

4 - Gynae - The Cervix and its disorders - Benign Conditions of the Cervix

4 - Gynae - The Cervix and its disorders - Premalignant disease of the Cervix (CIN)

4 - Gynae - The Cervix and its disorders - Carcinoma of the Cervix

5 - Gynae - The Ovary and its disorders - Anatomy and Function

5 - Gynae - The Ovary and its disorders - Ovarian Sx + Disorders of Ovarian Funciton

5 - Gynae - The Ovary and its disorders - Ovarian Tumours

5 - Gynae - The Ovary and its disorders - Ovarian Cancer

5 - Gynae - The Ovary and its disorders - Palliative Care

6 - Gynae - Disorders of the Vulva and Vagina - Anatomy + Vulval Sx

6 - Gynae - Disorders of the Vulva and Vagina - Miscellaneous Benign Disorders

6 - Gynae - Disorders of the Vulva and Vagina - Premalignant Disease of the Vulva: VIN

6 - Gynae - Disorders of the Vulva and Vagina - Carcinoma of the Vulva

6 - Gynae - Disorders of the Vulva and Vagina - Malignancy of the Vagina

7 - Gynae - Prolapse of the Uterus and Vagina - Anatomy and Physiology of Pelvic Supports

7 - Gynae - Prolapse of the Uterus and Vagina - Prolapse

8 - Gynae - Disorders of the Urinary Tract - Anatomy and Fx of Female Lower Urinary Tract

8 - Gynae - Disorders of the Urinary Tract - Ix of UT

8 - Gynae - Disorders of the Urinary Tract - Urinary Stress Incontinence

8 - Gynae - Disorders of the Urinary Tract - Overactive Bladder

8 - Gynae - Disorders of the Urinary Tract - Other Urinary Disorders

9 - Gynae - Endometriosis + Chronic Pelvic Pain - Endometriosis

9 - Gynae - Endometriosis + Chronic Pelvic Pain - Endometriosis MGMT + fertility

9 - Gynae - Endometriosis + Chronic Pelvic Pain - CPP

10 - Gynae - Genital Tract Infections - Infections of Vulva and Vagina

10 - Gynae - Genital Tract Infections - STIs of Vulva and Vagina

10 - Gynae - Genital Tract Infection - Infections of Uterus and Pelvis - Endometritis and Chronic PID

10 - Gynae - Genital Tract Infection - Infections of Uterus and Pelvis - Acute Pelvic infection and PID

10 - Gynae - Genital Tract Infection - Infections of Uterus and Pelvis - Vaginal Discharge

3 - Obs - Screening tests - Methods of Prenatal testing for Congenital Abnormalities

3 - Obs - Screening tests - Chromosomal Abnormalities

3 - Obs - Screening tests - Structural Abnormalities

3 - Obs - Screening tests - Polyhydramnios

4 - Obs - Infections in Pregnancy - Importance in Preg

4 - Obs - Infections in pregnancy - HIV

4 - Obs - Infections in Pregnancy - Infections

5 - Obs - Hypertensive Disorders in Pregnancy - Classification

5 - Obs - Hypertensive Disorders in Pregnancy - Pre-existing HTN in Pregnancy

5 - Obs - Hypertensive Disorders in Pregnancy - Pre-eclampsia

5 - Obs - Hypertensive Disorders in Pregnancy - Pre-eclampsia 2

6 - Obs - Other Medical Disorders in Pregnancy - Thrombophilia in Pregnancy

6 - Obs - Other Medical Disorders in Pregnancy - Anaemia in pregnancy

6 - Obs - Other Medical Disorders in Pregnancy - Mental Illness + Recreational Drug use in pregnancy

6 - Obs - Other Medical Disorders in Pregnancy - Cardiac Disease in pregnancy + Resp

6 - Obs - Other Medical Disorders in Pregnancy - Epilepsy + Thyroid disease in pregnancy

6 - Obs - Other Medical Disorders in Pregnancy - Renal and Liver disease in pregnancy

6 - Obs - Other Medical Disorders in Pregnancy - VTE disease + Obesity in pregnancy

6 - Obs - Other Medical Disorders in Pregnancy - DM + GDM in pregnancy

7 - Obs - Red Blood Cell Isoimmunisation

7 - Obs - Red Blood Cell Isoimmunisation 2

8 - Obs - Preterm Delivery - Background, Complx + Aetiology

8 - Obs - Preterm Delivery - Prediction, Prevention + Clinical features

8 - Obs - Preterm Delivery - Ix + MGMT

8 - Obs - Preterm Delivery - Preterm Prelabour ROM

9 - Obs - APH - Background + Less common causes of APH

9 - Obs - APH - Placenta Praevia

9 - Obs - APH - Placental Abruption

10 - Obs - Fetal Growth, Compromise and Surveillance - Fetal Growth and Terminology

10 - Obs - Fetal Growth, Compromise and Surveillance - Fetal Surveillance

10 - Obs - Fetal Growth, Compromise and Surveillance - Methods of Surveillance

10 - Obs - Fetal Growth, Compromise and Surveillance - The SFD and IUGR Fetus

10 - Obs - Fetal Growth, Compromise and Surveillance - Prolonged Pregnancy

11 - Obs - Abnormal Lie and Breech Presentation - Abnormal (transverse and oblique) lie

11 - Obs - Abnormal Lie and Breech Presentation - Breech Presentation

12 - Obs - Multiple Pregnancy

12 - Obs - Multiple Pregnancy - Complications

12 - Obs - Multiple Pregnancy - Antepartum MGMT

12 - Obs - Multiple Pregnancy - Intrapartum MGMT

13 - Obs - Labour - Normal Labour

13 - Obs - Labour - Slow progress

13 - Obs - Labour - Occipito-Posterior position

13 - Obs - Labour - Fetal monitoring in labour

13 - Obs - Labour - Analgesia in Labour

13 - Obs - Labour - Induction of Labour

13 - Obs - Labour - Vaginal Delivery after previous C-section (VBAC)

13 - Obs - Labour - Prelabour Term ROM

14 - Obs - Instrumental and Operative Delivery - C/S

14 - Obs - Instrumental + Operative Delivery - Forceps + Ventouse

15 - Obs - Obs Emergencies - Shoulder dystocia

15 - Obs - Obs Emergencies - Cord Prolapse

15 - Obs - Obs Emergencies - Amniotic Fluid Embolism

15 - Obs - Obs Emergencies - Uterine Rupture

15 - Obs - Obs Emergencies - Other emergencies

16 - Obs - The Puerperium - Physiological changes + General postnatal care

16 - Obs - The Puerperium - Lactation

16 - Obs - The Puerperium - PPH

16 - Obs - The Puerperium - Other puerperium problems

11 - Gynae - Contraception - Natural Contraception, Male and Female Sterilisation

11 - Gynae - Contraception - Special Pt groups

11 - Gynae - Contraception - Combined Methods

11 - Gynae - Contraception - POP

11 - Gynae - Contraception - Long-acting Reversible Contraceptives (LARCs)

11 - Gynae - Contraception - Emergency Contraception + Intrauterine Contraceptive Devices