- Textbook of Obstetrics
- Textbook of Gynecology
- Master Pass in Obstetrics and Gynecology
Sixth Edition 2016
Hiralal
Konar
(Hons., Gold Medalist) MBBS (Cal), MD (PGI), DNB (India) MNAMS, FACS (USA), FRCOG (London)
Chairman, Indian College of Obstetricians and Gynaecoloists (2013)
Professor, Department of Obstetrics and Gynecology Calcutta National Medical College and CR Hospital
Kolkata,
West Bengal,
India
One-time Professor and Head, Department of Obstetrics and Gynecology Midnapore Medical College and Hospital, West Bengal University of Health Sciences
Kolkata,
West Bengal,
India
Rotation Registrar in Obstetrics, Gynecology and Oncology Northern and Yorkshire Region, Newcastle upon Tyne, United Kingdom Examiner of MBBS, DGO, MD and PhD of different Indian universities and National Board of Examination,
New Delhi,
India
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© Copyright reserved by Mrs Madhusri Konar
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Bedside Clinics and Viva-Voce in Obstetrics and Gynecology
Sixth Edition: 2016
9789351529767
Printed at
5Dedicated to
the students
of
Obstetrics and Gynecology
7Preface
The examination system all over the world keeps on changing as science and technology continues to evolve and develop. The sole objective is ‘improved patient care’. The current examination system is primarily aimed not only to evaluate the factual or theoretical knowledge, but also the conceptual understanding and the analytical power of the candidate. To qualify any examination system, besides the textbook knowledge, a candidate is expected to demonstrate the skills of clinical examination and data interpretation, the art of communication, decision-making and the management issues. With this sole determination the book “Bedside Clinics and Viva-Voce in Obstetrics and Gynecology” has been written.
This book is intended for the students at their final phase, while preparing for the examination. The book needs to be read and reread to develop a solid grasp of each topic as it contains a huge wealth of the new material. Repetition is the key-aid as the different topics are integrated.
Exhaustive case discussions, commonly presented in the examination (both in obstetrics and gynecology) have been made. All the chapters provide innumerable model answers which are framed in a simple, concise and easy-to-reproduce manner. SBAs and MCQs are still the accepted modes of evaluation throughout the world. More than 600 MCQs have been discussed in the book. Current question papers of various universities have been solved. The explanatory notes with each SBA and MCQ are a guide to improve the analytical power of the student. Model answers are given for Short Questions to guide the students especially when the question needs justification (Give reasons/Justify) or Critical Evaluation.
Numerous (approximately 350) clinical photographs, sketches, boxes, tables, flow charts, partographs, cardiotocographs are incorporated to cope up with the need of the changing examination pattern.
Chapters on Endoscopy (Laparoscopy and Hysteroscopy) and Robotic Surgery in gynecology have been incorporated to keep the readers up-to-date with the progress of science and technology. Similarly, it is enriched with exhaustive number of imaging studies [Ultrasonograms, Doppler studies, Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and good-quality skiagrams]. Excellent quality colored photographs of operative procedures, instruments, morbid specimens, and imaging studies are provided to build up the concept of such difficult areas. The presentation has been made lucid with easy-to-understand outline format. The index has been elaborated for ease of quick referencing. The book is primarily aimed to cover the Indian system of examination (both the University and the National Board). With the growing demand, the current 5th edition has been thoroughly revised and updated to cover the international examinations like the Royal College, London (RCOG), Royal College, Ireland (RCPI), and the American Board of Examinations (USMLE).
Bedside Clinics and Viva-Voce in Obstetrics and Gynecology is equally essential for the homeopathic, ayurvedic, and nursing students and also the midwives. The postgraduate students will find it informative and time-saving. Specialists and practitioners will be benefitted as they like to refresh and update their knowledge. It is a handy book that helps quick revision and memorization. It aims to sharpen the clinical skills as well as the art of communication.
Comprehensive knowledge is the domain of a textbook. But it is less likely seen a candidate translating the textbook knowledge into practice at the time of need, unless one trained specifically.
Above all, Bedside Clinics is an authoritative, evidence-based synoptic guide mainly for the clinical and viva-voce part of the examination.
I have aimed for brevity and clarity to make reading simple and enjoyable. Chapter objectives have been highlighted throughout the book. Color codes are used to make reading comfortable and for easy pick-up.
8Key management points have been highlighted. Textbook references have been given for further study and clarification, especially for those who strive for excellence. Readers are requested to contact us (e-mail: h.kondr@gmail.com; website: www.hiralalkonar.com) for their opinions and views through the students' forum of the website.
I do hope this book will be of immense value to the students and the clinicians as ever. According to the author's desire, the book is dedicated to the ‘Students of Obstetrics and Gynecology – Past and Present'.
HIRALAL KONAR
P-13, New C.I.T. Road
Kolkata – 700 014
West Bengal, India
9Acknowledgment
I am deeply indebted to all the teachers in this country and abroad for their guidance and support in the preparation of this book (to name a few, I will miss many!). The students from different medical colleges have provided many innovative ideas on how to enhance the book. I am especially indebted to all of them for their enthusiastic support. Their inputs have been invaluable and are sincerely appreciated. While writing such a book, I have consulted a multitude of eminent authors, related publications and many current evidence-based studies, recommendations and guidelines. I do sincerely acknowledge my legacy to all of them including the related authors and publishers.
I express my sincere thanks to Professor. S Banerjee, Director of Medical Education, WB, Professor (Mrs.) M. Ray, Principal, Professor P.B. Chakraborty, MSVP, Profsessor A. Biswas, Head of the Department, Obstetrics and Gynecology, Calcutta National Medical College and Hospital for their support. I am deeply indebted to Dr. A. Roy, Professor (Retd.), for his continued guidance and support while writing this book. Mrs. Madhusri Konar, MA, B Ed, needs special appreciation for her patient and sincere secretarial job as ever. Her hard work, sacrifice and devotion to continue her father's work is a special support to me.
The author expresses his sincere thanks to all the students (undergraduates and postgraduates), nursing staff, residents and the teachers of different medical institutions in this country and abroad for their views and suggestions (on e-mail id: h.kondr@gmail.com; and website: www.hiralalkonar.com).
I thank my colleagues who have generously provided many of the illustrations that appear in this edition. I am grateful to all my patients for their wholehearted support to enrich the book in the true sense of its title.
I am especially grateful to all those working for Jaypee Brothers Medical Publishers (P) Ltd, in particular, Dr. Sakshi Arora, Ms. Nitasha Arora and Ms. Sunita Katla for their expertise in editing, designing, shaping, collation, and expert proofreading. Md Jakir Hossain deserves special thanks for his hard work of initial composition that was done very carefully over the months.
Shri J.P. Vij (Group Chairman) and Mr. Ankit Vij (Group President), Jaypee Brothers Medical Publishers (P) Ltd. deserve special appreciation for their generous support to bring out this edition as per the international standard.
Acknowledgments to Teachers in the advisory board:
Prof. Partha S. Chakraborty, IPGMER, Kolkata; Prof. Partha Mukherjee, Medical College, Kolkata; Prof. Siddhartha Dutta, NBMCH, Darjeeling; Prof. Gita Basu Banerjee, B.S. Medical College, Bankura; Dr. Malay Sarkar, Assoc. Prof., Malda Medical College; Prof. Nimmi Chutani, Sharda Institute of Medical Sciences, Noida; Prof. Swarup Rani, Tanjavur Medical College, Tamil Nadu; Dr. Seema Mehrotra, Asst. Prof., KGMC, Lucknow; Prof. Tripti Nagaria, JLN Medical College, Raipur; Dr. Pushpya Dahiya, Assoc. Prof., Pt. BD Sharma Medical College, Rohtak; Prof. Rokya Begum, Bangladesh; Prof. D.K. Bhowmik, Wardha; Prof. Ruplekha Chauhan, Netaji Subhash Chandra Bose Medical College, Jabalpur; Prof. Nisha Rani Agarwal, BHU, Varanasi; Prof. Rowshan Ara Begum, Bangladesh; Prof. Ranjit L. Singh, Imphal; Dr. Milan Taye, Asst. Prof., Dibrugarh; Prof. Saroj Singh, SN Medical College, Agra; Prof. Farhana Dewan, Bangladesh; Dr. Lal B. Palo, Assoc. Prof., PIMS, Pondichery; Dr. Abha Rani Sinha, Assoc. Prof., Patna; Prof. A. Meena, Madurai, Tamil Nadu; Prof. Gangambika Nisty, Gulbarga; Dr. Subhadip Basak, Asst. Prof., Sagar Dutta Medical College, Kolkata; Prof. Anju Huria, GMCH, Chandigarh; Prof. Hemant Deshpande, DY Patil Medical College, Pune; Prof. M.M. Umadi, Government Medical College, Belgaum; Prof. B.K. Kanungo, 10Sikkim Manipal, Gangtok; Prof. Ratna Balusu, VMJ Medical College, Bangalore; Prof. Jayanthi, Kempegowda Medical College, Bengalore; Prof. Jyoti Bindal, G.R. Medical College, Gwalior; Prof. Ambarisha Viniward, Mysore Medical College, Karnataka; Prof. Asha Rani, Bellary, Prof. Ng. Indra Kumar Singh, Imphal; Dr. Arindam Halder, Asst. Professor, CRSS, Kolkata; Prof. Gakul Das, GMCH, Guwahati, Assam; Prof. Sunita Ghaike, NK Salve Institute of Medical Sciences and Research Center, Nagpur; Prof. V K Chellamma, Calicut; Prof. Reena Srivastava, BRD Medical College, Gorakhpur; Prof. HR Seneviratne, Colombo, Sri Lanka; Prof. Shiva Murthy, Davangare, Karnataka; Prof. Kiran Pandey, GSVM Medical College, Kanpur; Prof. Santosh Minhans, IGMC, Shimla, Himachal Pradesh; Prof. M.K. Valsan, MES Medical College; Malapuram, Kerala; Prof. Ratna Thakur, Indore; Dr. Malabika Mishra, Asst. Professor, Kalyani Medical College, Kalyani; Prof. LK Pandey, BHU, Varanasi; Dr. Pallab K. Mistri, Assoc. Prof. CMCH, Kolkata; Prof. Sudesh Agarwal, Bikaner Medical College Bikaner; Prof. Neelam Prdhan, Tribhuban University, Kathmandu Nepal; Prof S Mishra, Tribhuban University, Kathmandu, Nepal; Prof. Meeta Singh, Tribhuban University kathmandu Nepal; Prof. Habibullah, JIPMER, Pondicherry
Hiralal Konar
P-13, New C.I.T. Road,
Kolkata-700 014
11List of Abbreviations Used
ABCAirway, Breathing and Circulation
ACAbdominal Circumference
ACEAngiotensin II Converting Enzyme
ACTHAdrenocorticotrophic Hormone
AFIAmniotic Fluid Index
AFPAlpha-fetoprotein
AIDSAcquired Immunodeficiency Syndrome
ALTAlanine Transaminase
AMHAnti-Müllerian Hormone
AMTSLActive Management of Third Stage of Labor
ANAAntinuclear Antibody
ANCAntenatal Check-up
ANMAuxiliary Nurse Midwife
APHAntepartum Hemorrhage
aPLAntiphospholipid
APSAntiphospholipid Syndrome
APTTActivated Partial Thromboplastin Time
ARMArtificial Rupture of Membrances
ARTAssisted Reproductive Technology
ARTAntiretroviral Therapy
ASHAAccredited Social Health Activist
ASTAspartate Aminotransferase (Aspartate Transaminase)
BCGBacilli Calmette Guerin
b-hCGBeta-human Chorionic Gonadotropin
BMIBody Mass Index
BPBlood Pressure
BPMBeats Per Minute
BPPBiophysical Profile
BSOBilateral Salpingo-oophorectomy
BVBacterial Vaginosis
CCTControlled Cord Traction
COCCombined Oral Contraceptive
CPAPContinuous Positive Airway Pressure
CPDCephalopelvic Disproportion
CPRCardiopulmonary Resuscitation
CRLCrown Rump Length
CSCesarean Section
CSFCerebrospinal Fluid
CTComputed Tomography
CTGCardiotocography
CVACerebrovascular Accidents
CVPCentral Venous Pressure
CVSChorionic Villus Sampling
CXRChest X-ray
D&CDilatation and Curettage
D&EDilatation and Evacuation
DHTDihydrotestosterone
DICDisseminated Intravascular Coagulation
DMPADepot Medroxy Progesterone
DUBDysfunctional Uterine Bleeding
ECGElectrocardiogram
ECPEmergency Contraception Pill
ECVExternal Cephalic Version
EDDEstimated Date of Delivery
EDFEnd-diastolic Flow
EEGElectroencephalogram
EFMElectronic Fetal Monitoring
ERCSElective Repeat Cesarean Section
ERPCEvacuation of Retained Products of Conception
ETEmbryo Transfer
FBCFull Blood Count
FBSFetal Blood Sampling
FDPsFibrin Degradation Products
12FGRFetal Growth Restriction
FHRFetal Heart Rate
FHSFetal Heart Sound
FIGOInternational Federation of Gynecology and Obstetrics
FMCFetal Movement Counting
FRUFirst Referral Unit
FSFemale Sterilization
GnRHGonadotropin-releasing Hormone
GOIGovernment of India
GTDGestational Tropholblastic Disease
GTNGestational Trophoblastic Neoplasia
HAARTHighly Active Anti-retroviral Therapy
HbHemoglobin
HBsAgHepatitis B Surface Antigen
HBVHepatitis B Virus
hCGHuman Chorionic Gonadotropin
HCVHepatitis C Virus
HDUHigh Dependency Unit
HELLPHemolysis, Elevated Liver Enzymes and Low Platelets
HIEHypoxic-ischamic Encephalopathy
HIVHuman Immunodeficiency Virus
HLDHigh-level Disinfection
hMGHuman Menopausal Gonadotropins
HNPCCHereditary Nonpolyposis Colorectal Cancer
HPLHuman Placental Lactogen
HPSHigh Performing States
HPVHuman Papilloma Virus
HRTHormone Replacement Therapy
HSVHerpes Simplex Virus
ICSIIntracytoplasmic Sperm Injection
ICTCIntegrated Counseling and Testing Center
ICUIntensive Care Unit
IFAIron Folic Acid
IPPVIntermittent Positive Pressure Ventilation
ITPIdiopathic Thrombocytopenic Purpura
IUCDIntrauterine Contraceptive Device
IUDIntrauterine Death
IUFDIntrauterine Fetal Death
IUGRIntrauterine Growth Restriction
IUIIntrauterine Insemination
IUPIntrauterine Pregnancy
IUSIntrauterine System
IVFInvitro Fertilization
IVF-ETIVF and Embryo Transfer
IVUIntravenous Urogram
JSYJanani Suraksha Yojana
LAMLactational Amenorrhea Method
LAVHLaparoscopically Assisted Vaginal Hysterectomy
LDLLow-density Lipoprotein
LHLuteinizing Hormone
LHVLady Health Visitor
LMPLast Menstrual Period
LMWHLow Molecular Weight Heparin
LNGLevonorgestrel
LNG-IUSLevonorgestrel-releasing Intrauterine System
LODLaparoscopic Ovarian Drilling
LPSLow-performing States
LSCSLower Segment Cesarean Section
LSILLow-grade Squamous Intraepithelial Lesions
LUNALaparoscopic Uterine Nerve Ablation
MAPMean Arterial Pressure
MASMeconium Aspiration Syndrome
MCAMiddle Cerebral Artery
13MCHCMean Corpuscular Hemoglobin Concentration
MCQMultiple Choice Question
MISMinimally Invasive Surgery
MNMMaternal Near Miss
MMRMaternal Mortality Ratio
MPAMedroxyprogesterone Acetate
MRIMagnetic Resonance Imaging
MSAFPMaternal Serum Alphafetoprotein
MSUMidstream Urine
MTPMedical Termination of Pregnancy
MVAManual Vacum Aspiration
NGONongovernmental Organization
NICENational Institute for Health and Clinical Excellence
NRHMNational Rural Health Mission
NSAIDNon-steroidal Anti-inflammatory Drugs
NSTNon-stress Test
NSVNo-scalpel Vasectomy
NTNuchal Translucency
NTDsNeural Tube Defects
OABOveractive Bladder
OCPOral Contraceptive Pill
OGTTOral Glucose Tolerance Test
OHSSOvarian Hyperstimulation Syndrome
P/VPer Vaginam
PCAPatient-controlled Analgesia
PCOSPolycystic Ovary Syndrome
PCRPolymerase Chain Reaction
PEEPPositive end-expiratory Pressure
PETPositron Emission Tomography
PFRPeak Flow Rate
PHCPrimary Health Center
PIDPelvic Inflammatory Disease
PMBPostmenopausal Bleeding
PMRPerinatal Mortality Rate
PMSPremenstrual Syndrome
PNCPostnatal Check-up
PNDTPrenatal Diagnostic Technique or Test
POCProducts of Conception
POFPremature Ovarian Failure
PIDPelvic Inflammatory Disease
PFRPelvic Floor Repair
POP-QPelvic Organ Prolapse-Quantification
POPsProgestogen Only Pills
PPHPostpartum Hemorrhage
PPROMPreterm Premature Rupture of Membrances
PPTCTPrevention of Parent-to-child Transmission
PROMPrelabor Rupture of Membranes
PTProthrombin Time
PTLPreterm Labor
RCHReproductive and Child Health
RCOGRoyal College of Obstetricians and Gynecologists
RDSRespiratory Distress Syndrome
RCTRandomized Controlled Trial
RMIRisk of Malignancy Index
ROPRight Occiput Posterior
RRRespiratory Rate
RTIReproductive Tract Infection
SAQShort-answer Question
SAMMSevere Acute Maternal Morbidity
SBASingle Best Answer
SBASkilled Birth Attendant
SCBUSpecial Care Baby Unit
SCCSquamous Cell Carcinoma
SCJSquamo Columnar Junction
SERMSelective Estrogen Receptor Modulators
SFHSymphisis Fundal Height
SGOTSerum Glutamic-oxaloacetic Transaminase
SGPTSerum Glutamic Pyruvic Transaminase
SHBGSex Hormone-binding Globulin
14SLESystemic Lupus Erythematosus
STDSexually Transmitted Disease
STISexually Transmitted Infection
TAH/BSOTotal Abdominal Hysterectomy/Bilateral Salpingo-oopherectomy
TBAThermal Balloon Ablation
TBATraditional Birth Attendant
TCRETranscervical Resection of the Endometrium
TDFTestes-determining Factor
TENSTranscutaneous Electrical Nerve Stimulation
TTTetanus Toxoid
TTPThrombotic Thrombocytopenic Purpura
TLHTotal Laparoscopic Hysterectomy
TTTSTwin-to-twin Transfusion Syndrome
TVSTransvaginal Ultrasound
TVTTension-free Vaginal Tape
UAEUterine Artery Embolization
UTIUrinary Tract Infection
VBACVaginal Birth After Cesarean Section
VDRLVenereal Disease Research Laboratory
VINVulval Intraepithelial Neoplasia
VLPVirus-like Particles
VTEVenous Thromboembolism
VVFVesico Vaginal Fistula
vWFVon Willebrand Factor
VZIGVaricella Zoster IgG
WHOWorld Health Organization
ZDVZidovudine
15
OBSTETRICS AND GYNECOLOGY MARKS DISTRIBUTION OF 3RD PROFESSIONAL MBBS PART-II EXAMINATION | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | WEST BENGAL UNIVERSITY OF HEALTH SCIENCES : KOLKATA | TOTAL MARKS = 200 | ||||||||||||
(A) THEORY | PAPER 1 (40) | PAPER 2 (40) | TOTAL (Paper 1 + 2) (80) | INTERNAL ASSESSMENT (IA) (20) | TOTAL (100) | |||||||||
(B) ORAL (30), CLINICAL (50) AND INTERNAL ASSESSMENT (20) = 100 | ||||||||||||||
OBSTETRICS TABLE VIVA = 20 | GYNECOLOGY TABLE VIVA = 10 | TOTAL 20 + 10 = 30 | CLINICAL = 50 | GRAND TOTAL (80) | ||||||||||
OBSTETRIC MANEUVER (5) | LOG BOOK (5) | OBSTETRICs VIVA VOCE = 10 | GYNECOLOGY VIVA VOCE = 10 | LONG CASE (OBST.) (30) | SHORT CASE (GYNE.) (20) | |||||||||
Instrument + Operative (3) | Specimen) (2) | X-Ray/USG (2.5) | Recent Advances/Problems (2.5) | TOTAL (10) | Instrument + Operative (3) | Specimen (2) | X-Ray/USG (2.5) | Recent Advances/ Problems + Family Planning (2.5) |
2 | MAHARASHTRA UNIVERSITY OF HEALTH SCIENCES: NASHIK (MAHARASHTRA) | TOTAL MARKS = 200 | ||||
(A) THEORY | PAPER 1 (40) | PAPER 2 (40) | TOTAL (Paper 1 + 2) (80) | INTERNAL ASSESSMENT (IA) (20) | TOTAL (100) | |
(B) ORAL (30), CLINICAL (50) AND INTERNAL ASSESSMENT (20) = 100 | ||||||
OBSTETRICS TABLE VIVA | GYNECOLOGY TABLE VIVA | FAMILY PLANNING | CLINICAL | INTERNAL ASSESSMENT | TOTAL | |
Long case (OBST.) | Short case (GYNE.) | |||||
10 | 10 | 10 | 40 | 10 | 20 | 100 |
16
3 | ALL INDIA INSTITUTE OF MEDICAL SCIENCES : NEW DELHI | ||||
A. INTERNAL ASSESSMENT = 150 (continued assessment) } B. EXTERNAL ASSESSMENT = 150 | TOTAL MARKS = 300 | ||||
EXTERNAL ASSESSMENT 150 | THEORY 75 | ORAL 30 | CLINICAL 45 | TOTAL 150 | |
(A) THEORY | PAPER 1 = 38 | PAPER 2 = 37 | TOTAL (Paper 1+ 2) = 75 | ||
(B) ORAL (30); (C) CLINICAL (45) | |||||
OBSTETRICS TABLE VIVA | GYNECOLOGY TABLE VIVA | FAMILY PLANNING | CLINICAL | TOTAL | |
OBST. CASE | GYNE. CASE | ||||
10 | 10 | 10 | 25 | 20 | 75 |
4 | RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES : KARNATAKA | TOTAL MARKS = 500 | |||||
(A) THEORY | PAPER 1 100 | PAPER 2 100 | TOTAL (Paper 1 + 2) 200 | INTERNAL ASSESSMENT (IA) 100 | CLINICAL 160 | VIVA 40 | TOTAL 500 |
(B) INTERNAL ASSESSMENT (IA) | CONTINUED IA THEORY 60 | IA : CLINICAL AND PRACTICAL 40 | TOTAL 100 | ||||
(C) ORAL = (40), CLINICAL = (160) TOTAL = (200) | |||||||
OBSTETRICS TABLE VIVA | GYNAECOLOGY TABLE VIVA | FAMILY PLANNING | CLINICAL | TOTAL | |||
Obst. case | Gyne. case | ||||||
15 | 15 | 10 | 80 | 80 | 200 |
17
5 | KERALA UNIVERSITY OF HEALTH SCIENCES : THIRUVANANTHAPURAM (KERALA) — TOTAL MARKS = 200 | |||||
(A) THEORY | PAPER 1 40 | PAPER 2 40 | TOTAL (Paper 1 + 2) 80 | INTERNAL ASSESSMENT (IA) 20 | TOTAL 100 | |
(B) ORAL = 30, (C) CLINICAL = 50 (D) INTERNAL ASSESSMENT = 20 TOTAL : 100 | ||||||
OBSTETRICS VIVA | GYNECOLOGY VIVA | CLINICAL | INTERNAL ASSESSMENT | TOTAL | ||
Obst. case | Gyne. case | |||||
Log Book 10 | Viva 10 | 10 | 25 | 25 | 20 | 100 |
6 | RANI DURGABATI UNIVERSITY OF HEALTH SCIENCES : JABALPUR (M.P) — TOTAL MARKS = 200 | |||||
(A) THEORY | PAPER 1 (40) | PAPER 2 (40) | TOTAL (Paper 1 + 2) (80) | INTERNAL ASSESSMENT (IA) (20) | TOTAL (100) | |
(B) ORAL (40), CLINICAL (40) AND INTERNAL ASSESSMENT (20) TOTAL : 100 | ||||||
OBSTETRICS VIVA TABLE | GYNECOLOGY VIVA TABLE | FAMILY PLANNING | CLINICAL | INTERNAL ASSESSMENT | TOTAL | |
Obst. case | Gyne. case | |||||
15 | 15 | 10 | 25 | 15 | 20 | 100 |