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Give me 2 main uses of the following instruments

analyse_media

Quick answer

I read the list as: sponge-holding forceps, clamp, Doyen retractor, anterior vaginal wall retractor, posterior vaginal wall retractor, Cusco's speculum, needle holder, and episiotomy scissors.

Instrument	Two main uses
Sponge-holding forceps	1. Holding swabs to clean or paint the vagina/cervix with antiseptic. 2. Mopping blood and secretions from the operative field.
Artery clamp / haemostatic clamp	1. Clamping bleeding blood vessels for haemostasis. 2. Holding tissue or sutures temporarily during an operation.
Doyen retractor	1. Retracting the bladder during caesarean section. 2. Retracting soft tissues to expose the pelvic or abdominal operative field.
Anterior vaginal wall retractor	1. Retracting the anterior vaginal wall to expose the cervix. 2. Providing exposure during anterior colporrhaphy or other vaginal procedures.
Posterior vaginal wall retractor	1. Retracting the posterior vaginal wall for examination of the cervix and vagina. 2. Providing exposure during posterior colporrhaphy, perineal repair, or episiotomy repair.
Cusco's speculum	1. Visualising the vagina and cervix during pelvic examination. 2. Procedures such as Pap smear collection, IUCD insertion/removal, or cervical biopsy.
Needle holder	1. Holding and driving a curved needle through tissue while suturing. 2. Holding the needle securely while tying or removing sutures.
Episiotomy scissors	1. Making an episiotomy incision during childbirth. 2. Cutting perineal tissue or sutures during perineal repair.

The word written as “clamp” is not specific in the image, so I have taken it as an artery/haemostatic clamp.

Curette 2 main uses

Uterine curette - two main uses:

Endometrial curettage to obtain tissue for biopsy, such as in abnormal uterine bleeding or suspected endometrial pathology.
Evacuation of retained products of conception from the uterus after incomplete miscarriage or abortion.

Give me a long case for a 33 year old female with white discharge per vagina for last 4 months according to the ptsr record of ncism 2025 -2026 with ayurvedic treatment according to record format

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Quick answer

Long Case Record: Shweta Pradara (White Discharge per Vagina)

Note: This is a sample academic case-sheet in a commonly used NCISM-style PTSR format. Modify headings, dates, medicines, and investigation values according to your institution and the actual patient. White discharge should not be assumed to be physiological. Infection, pregnancy, cervical lesions, diabetes, and STI risk should be assessed before treatment.

1. Identification Data

Name: Ms. X
Age: 33 years
Sex: Female
Marital status: Married
Occupation: Homemaker
Religion: Hindu
Address: __________
OPD/IPD No.: __________
Date of admission: __________
Date of examination: __________
Informant: Patient herself
Reliability: Reliable

2. Chief Complaints

White discharge per vagina for 4 months
Itching over vulval region for 2 months
Mild lower abdominal discomfort for 1 month

3. History of Present Illness

The patient was apparently healthy 4 months ago, when she developed whitish vaginal discharge. The discharge was initially scanty, thin, non-foul smelling, and intermittent. Over the last 2 months, it has gradually increased in amount and occurs daily, causing frequent wetting of undergarments.

The discharge is white, thick, and at times curdy in nature. It is not blood stained and is not associated with a foul or fishy odour. The patient complains of associated itching around the vulva, more marked after micturition and at night. She has mild burning sensation during micturition occasionally but no increased frequency, urgency, or flank pain.

She also complains of dull aching lower abdominal pain, non-radiating, mild in intensity, and not related to meals. There is no history of fever, nausea, vomiting, genital ulcers, post-coital bleeding, dyspareunia, or irregular vaginal bleeding.

There is no history suggestive of diabetes mellitus, tuberculosis, hypertension, or previous sexually transmitted infection. No similar complaints in husband. She gives a history of using synthetic undergarments and occasionally using scented vaginal cleansing products.

No history of self-medication or prior definitive treatment for the present complaint.

4. Menstrual History

Menarche: 13 years
Menstrual cycle: Regular
Interval: 28-30 days
Duration: 4-5 days
Amount: Moderate
Colour: Bright red
Clots: Absent
Dysmenorrhoea: Mild, present on first day
LMP: __________
Menstrual flow: Normal
Intermenstrual bleeding: Absent
Post-coital bleeding: Absent

5. Obstetric History

Married life: 10 years
Gravida: 2
Para: 2
Living children: 2
Abortions: Nil

Pregnancy	Year	Outcome	Mode of delivery	Sex	Birth weight	Complications
G1	____	Full-term	Normal vaginal delivery	Female	2.8 kg	Nil
G2	____	Full-term	Normal vaginal delivery	Male	3.0 kg	Nil

Last childbirth: 4 years ago
Contraceptive history: Barrier method/none
History of IUCD use: Absent
History of infertility treatment: Absent

6. Past History

No history of diabetes mellitus, hypertension, thyroid disease, tuberculosis, asthma, or epilepsy.
No previous history of genital tuberculosis, pelvic inflammatory disease, or recurrent vulvovaginal candidiasis.
No previous surgery.
No known drug allergy.

7. Personal History

Appetite: Reduced
Diet: Mixed diet; frequent intake of sweets, bakery products, curd at night, spicy and oily food
Bowel: Constipation, once in 1-2 days
Micturition: 5-6 times/day; occasional burning
Sleep: Disturbed due to itching
Addiction: Nil
Hygiene: Uses synthetic/tight undergarments; changes undergarments once daily
Exercise: Inadequate

8. Family History

No family history of diabetes mellitus, hypertension, tuberculosis, malignancy, or similar genital complaints.

9. General Examination

Built: Moderate
Nourishment: Moderate
Consciousness: Conscious and cooperative
Pulse: 78/min, regular
Blood pressure: 112/70 mmHg
Respiratory rate: 18/min
Temperature: Afebrile
Pallor: Absent
Icterus: Absent
Cyanosis: Absent
Clubbing: Absent
Lymphadenopathy: Absent
Pedal oedema: Absent

10. Systemic Examination

Per Abdomen Examination

Abdomen soft and non-distended.
Mild tenderness present in hypogastrium.
No guarding or rigidity.
No palpable mass.
Liver and spleen not palpable.
Bowel sounds present.

Cardiovascular System

S1 and S2 heard normally. No murmur.

Respiratory System

Bilateral air entry equal. No added sounds.

Central Nervous System

Patient conscious, oriented, and neurologically normal.

11. Local and Gynaecological Examination

Inspection of External Genitalia

Vulva mildly congested.
Excoriation marks present due to scratching.
No genital ulcer, wart, swelling, or growth.
Whitish discharge seen at introitus.

Per Speculum Examination

Vagina mildly congested.
Moderate amount of thick, white, curdy, non-foul-smelling discharge present over vaginal walls.
Cervix healthy, no erosion, ulcer, growth, or contact bleeding.
Cervical os closed.
No foul-smelling discharge or cervical motion tenderness.

Per Vaginal Examination

Uterus anteverted, normal size, mobile, and non-tender.
Bilateral fornices free and non-tender.
No adnexal mass felt.
No cervical motion tenderness.

12. Ashtavidha Pariksha

Parameter	Findings
Nadi	Kapha-Vata predominance
Mutra	Prakrita, occasional burning
Mala	Constipated
Jihva	Mildly coated
Shabda	Prakrita
Sparsha	Anushna
Drik	Prakrita
Akriti	Madhyama

13. Dashavidha Pariksha

Parameter	Findings
Prakriti	Kapha-Vata
Vikriti	Kapha pradhana, Vata anubandha
Sara	Madhyama
Samhanana	Madhyama
Pramana	Madhyama
Satmya	Madhyama
Satva	Madhyama
Ahara Shakti	Madhyama
Vyayama Shakti	Avara
Vaya	Madhyama

14. Nidana Panchaka

Nidana

Excess intake of madhura, guru, snigdha, abhishyandi ahara
Excess curd, sweets, bakery products, and oily food
Inadequate genital hygiene
Tight synthetic undergarments
Constipation
Sedentary lifestyle
Suppression of natural urges, if present

Purvarupa

Mild itching around vulva
Feeling of vaginal wetness
Heaviness in lower abdomen

Rupa

Shweta srava per vagina
Kandu in yoni
Mild yonidaha
Kati shoola/adhodara discomfort
Klama due to disturbed sleep

Samprapti

Nidana sevana causes Kapha prakopa and impairment of Agni, leading to formation of Ama. Vitiated Kapha along with Vata reaches Artavavaha srotas/Yoni, causing excess picchila and shweta srava. Local irritation produces kandu and mild daha.

Samprapti Ghataka

Factor	Finding
Dosha	Kapha pradhana, Vata anubandha
Dushya	Rasa, Rakta, Artava
Agni	Mandagni
Ama	Present
Srotas	Artavavaha srotas, Rasavaha srotas
Srotodushti	Atipravritti, Sanga
Udbhava sthana	Amashaya
Adhisthana	Yoni
Vyaktasthana	Yoni and Artavavaha srotas
Rogamarga	Abhyantara

15. Investigations

Urine routine and microscopy
- Albumin: Nil
- Sugar: Nil
- Pus cells: 1-2/HPF
Complete blood count
- Hb: 11.2 g/dL
- TLC: 7,800/cumm
- Differential count: Within normal limits
Blood sugar, fasting: 92 mg/dL
Urine pregnancy test: Negative
Vaginal swab microscopy/KOH mount: Suggestive of candidal infection, if clinically indicated.
Pap smear: To be advised if due according to screening guidelines or if the cervix appears suspicious.
VDRL/HIV/HBsAg: Offer based on risk assessment, consent, and local protocol.

16. Diagnosis

Ayurvedic Diagnosis

Shweta Pradara
Kapha pradhana, Vata anubandha Shweta Pradara.

Modern Diagnosis

Vulvovaginal candidiasis with leucorrhoea, subject to confirmation by vaginal swab/KOH microscopy.

Differential Diagnosis

Physiological leucorrhoea
Bacterial vaginosis
Trichomoniasis
Cervicitis
Sexually transmitted infection
Diabetes-associated recurrent candidiasis
Cervical pathology

17. Chikitsa Siddhanta

Nidana parivarjana
Agni deepana and Ama pachana
Kapha-Vata shamana
Yonishodhana
Kandughna and Krimighna measures
Stambhana only after excluding active infection and according to clinical need
Improve personal and menstrual hygiene

18. Treatment Plan

A. Shamana Chikitsa

1. Triphala Guggulu

Dose: 500 mg to 1 g, twice daily after food with lukewarm water.
Purpose: Kapha-Meda hara, shothahara, shodhana support.

2. Chandraprabha Vati

Dose: 2 tablets twice daily after food with lukewarm water.
Purpose: Useful when urinary burning or associated genitourinary symptoms are present.

3. Pushyanuga Churna

Dose: 3 g twice daily with rice water or honey, after food.
Purpose: Traditionally used in Shweta Pradara.
Use with caution: Do not use merely to suppress discharge if there is untreated active infection.

4. Triphala Kashaya

Dose: 40-50 mL, twice daily before food, diluted with equal quantity of lukewarm water if needed.
Purpose: Deepana, pachana, shodhana, and Kapha shamana.

B. Local Treatment

Yoni Prakshalana with Triphala Kwatha

Once daily for 5-7 days, under supervision and with strict aseptic precautions.
Use only a properly prepared, cooled, filtered decoction.
Stop if burning, irritation, pain, or worsening discharge occurs.
Avoid internal douching in pregnancy and avoid repeated unsupervised vaginal procedures.

C. Management of Constipation

Triphala Churna

Dose: 3-5 g at bedtime with warm water, if constipation is present and suitable for the patient.

19. Pathya-Apathya

Pathya

Light, freshly prepared warm food
Green gram soup, old shali rice, vegetables, bitter vegetables
Adequate warm water intake
Cotton, loose-fitting undergarments
Change undergarments whenever damp
Keep genital area dry and clean
Use plain water for washing external genitalia
Regular bowel habits, walking, and adequate sleep

Apathya

Curd, especially at night
Excess sweets, bakery foods, refined carbohydrates
Deep-fried, oily, spicy, and heavy food
Excessive use of scented soaps, vaginal washes, deodorants, and powders
Tight synthetic clothing
Sexual intercourse until itching/discharge has settled, especially if infection is suspected
Self-medication and repeated vaginal douching

20. Follow-up Plan

Review after 7 days for itching, burning, amount/character of discharge, and any adverse effects.
Review after 14 days with vaginal swab reports, if performed.
Continue or modify treatment according to findings.
If discharge is foul smelling, green/yellow, blood stained, associated with fever, pelvic pain, ulcers, post-coital bleeding, pregnancy, or persistent symptoms, refer for gynaecological evaluation and appropriate antimicrobial treatment.
Evaluate for diabetes or STI when symptoms are recurrent, severe, or treatment-resistant.

21. Prognosis

Sadhya, provided underlying infection and associated causes are identified and managed, hygiene is maintained, and dietary/lifestyle advice is followed.

Give me a long case for a 33 year old female with white discharge per vagina for last 4 months according to the ptsr record of ncism 2025 -2026 with ayurvedic treatment according to record format

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NCISM PTSR 2025 2026 record format Prasuti Tantra Stri Roga case record white discharge per vagina

Finding Sources

Searching PubMed

vaginal discharge AND vaginitis

Long Case Record: Shweta Pradara / White Discharge Per Vagina

This is a fictional academic model for a PTSR clinical record. Use the exact headings and prescription style required by your college hospital. White vaginal discharge must be assessed with per-speculum examination and appropriate tests to distinguish physiological leucorrhoea, candidiasis, bacterial vaginosis, cervicitis, and STI. The NCISM curriculum specifically expects history, general examination, per-abdomen, per-speculum, per-vaginal examination, investigations, and a management plan in the prescribed journal proforma. NCISM PTSR curriculum

Prasuti Tantra and Stri Roga Case Record

OPD No.

Date

Name

Mrs. X

Age

33 years

Sex

Female

Address

Marital status

Married, for 10 years

Occupation

Housewife

Religion

Informant

Patient herself, reliable.

Chief Complaints

White discharge per vagina for 4 months.
Mild low-backache for 2 months.
Feeling of weakness/fatigue for 1 month.

History of Present Illness

The patient was apparently well 4 months ago, after which she noticed a gradual onset of white vaginal discharge. The discharge is thin to moderately thick, whitish, non-foul smelling, non-blood stained, and moderate in quantity. It does not soak her clothes but causes a feeling of dampness.

There is no associated itching over vulva, burning micturition, dyspareunia, lower abdominal pain, fever, genital ulcer, post-coital bleeding, or intermenstrual bleeding. The patient does not give a history of greenish/frothy discharge, curdy white discharge, or offensive/fishy odour.

She complains of mild low-backache and generalized weakness. Her appetite is irregular and she frequently consumes bakery items, excess sweets, curd at night, fried food, and cold beverages. Bowel habit is irregular, with occasional constipation. Sleep is moderately disturbed due to household work and stress.

No history suggestive of diabetes mellitus, tuberculosis, thyroid disorder, or long-term steroid/antibiotic use.

Menstrual History

Menarche: 13 years
Cycle: Regular, every 28-30 days
Duration: 4-5 days
Flow: Moderate
Dysmenorrhoea: Mild, first day only
LMP: __________
Menstrual blood: No clots, no foul smell
Intermenstrual bleeding: Absent
Post-coital bleeding: Absent

Obstetric History

G2 P2 L2 A0

Pregnancy	Year	Mode of delivery	Sex of child	Birth weight	Outcome
G1	2017	Full-term normal vaginal delivery	Female	2.8 kg	Alive and healthy
G2	2020	Full-term normal vaginal delivery	Male	3.0 kg	Alive and healthy

No history of abortion, ectopic pregnancy, stillbirth, postpartum haemorrhage, or puerperal sepsis.
Last childbirth: 6 years ago.
No history of episiotomy-related chronic symptoms.

Contraceptive History

Uses barrier contraception occasionally.
No history of IUCD insertion.
No oral contraceptive pill use at present.

Past History

No history of diabetes mellitus, hypertension, thyroid disease, tuberculosis, or sexually transmitted infection.
No previous pelvic surgery.
No known drug allergy.
No significant medical or surgical history.

Personal History

Appetite: Irregular
Diet: Mixed
Bowel: Occasionally constipated
Micturition: Normal
Sleep: Disturbed occasionally
Addiction: Nil
Hygiene: Uses cloth/pads during menstruation, changes regularly; occasionally uses scented soap for genital washing.

Family History

No significant family history of diabetes mellitus, tuberculosis, malignancy, or similar complaints.

Ashtavidha Pariksha

Parameter	Findings
Nadi	76/min, regular, Kapha-Pitta predominance
Mutra	Normal
Mala	Occasionally constipated
Jihva	Mildly coated
Shabda	Normal
Sparsha	Normal temperature
Drik	Normal
Akruti	Madhyama

Dashavidha Pariksha

Parameter	Findings
Prakriti	Kapha-Pitta
Vikriti	Kapha predominance with Pitta anubandha
Sara	Madhyama
Samhanana	Madhyama
Pramana	Madhyama
Satmya	Madhyama
Satva	Madhyama
Ahara Shakti	Madhyama
Vyayama Shakti	Madhyama
Vaya	Madhyama

General Examination

Built: Moderately built
Nourishment: Moderately nourished
Consciousness: Conscious and oriented
Pallor: Mild pallor present
Icterus: Absent
Cyanosis: Absent
Clubbing: Absent
Lymphadenopathy: Absent
Pedal oedema: Absent

Vitals

Pulse: 76/min, regular
Blood pressure: 110/70 mmHg
Respiratory rate: 16/min
Temperature: Afebrile

Systemic Examination

Cardiovascular System

S1 and S2 heard normally. No murmur.

Respiratory System

Bilateral air entry present. No added sounds.

Per Abdomen Examination

Abdomen soft and non-tender.
No guarding, rigidity, or palpable mass.
Liver and spleen not palpable.
No suprapubic tenderness.

Local Examination

Inspection of External Genitalia

Normal development of external genitalia.
No vulval erythema, oedema, excoriation, ulcer, wart, or lesion.
No visible foul discharge at introitus.

Per Speculum Examination

Vagina: Healthy vaginal mucosa, no congestion or ulceration.
Discharge: Moderate amount of thin, white, non-foul-smelling discharge present in vagina.
Cervix: Healthy, no erosion, ulcer, growth, contact bleeding, or mucopurulent discharge.
External os: Multiparous.
No retained foreign body seen.

Per Vaginal Examination

Uterus: Anteverted, normal size, mobile, non-tender.
Bilateral fornices: Free and non-tender.
Cervical motion tenderness: Absent.
No adnexal mass felt.

Investigations

Investigation	Result
Haemoglobin	10.4 g/dL
Total leucocyte count	Within normal limits
Differential leucocyte count	Within normal limits
ESR	Mildly raised / as per report
Urine routine and microscopy	Normal
Urine pregnancy test	Negative
Random blood sugar	Normal
Vaginal pH	4.2
Saline wet mount	No clue cells, no motile Trichomonas
KOH mount	No budding yeast cells/pseudohyphae
VDRL/HIV testing	To be advised with consent if STI risk is present
Pap smear	To be advised if due for screening or if cervical lesion is suspected

Interpretation: No clinical or microscopic evidence of candidiasis, bacterial vaginosis, trichomoniasis, or cervicitis in this model case. Per-speculum examination helps differentiate vaginitis from cervicitis; curdy white discharge suggests candidiasis, frothy green discharge suggests trichomoniasis, and adherent discharge may suggest bacterial vaginosis.
Park's Textbook of Preventive and Social Medicine, p. 3571-3580.

Diagnosis

Modern Diagnosis

Physiological leucorrhoea / non-infective vaginal discharge, with mild anaemia.

Ayurvedic Diagnosis

Shweta Pradara
(Kapha-pradhana Yonivyapad, with Pitta anubandha)

Nidana Panchaka

Nidana

Excessive intake of Madhura, Guru, Snigdha, Abhishyandi ahara
Excess curd, bakery products, fried food, cold food and drinks
Improper genital hygiene / use of irritant scented products
Constipation and irregular dietary habits
Stress and inadequate sleep

Purvarupa

Yoni kleda
Mild kati shoola / katishoola
Daurbalya
Increased vaginal wetness

Rupa

Shweta srava from yoni
Kleda in yoni
Mild katishoola
Daurbalya

Samprapti

Nidana sevana leads to Kapha prakopa and impairment of Agni, producing ama and increased kleda. The vitiated Kapha, with Pitta association, localizes in Artavavaha srotas/Yoni, causing excessive whitish discharge, described clinically as Shweta Pradara.

Samprapti Ghataka

Component	Finding
Dosha	Kapha pradhana, Pitta anubandha
Dushya	Rasa, Rakta, Artava
Agni	Mandagni
Ama	Present
Srotas	Artavavaha srotas
Srotodushti	Atipravritti and kleda vriddhi
Udbhava sthana	Amashaya
Adhisthana	Yoni / Garbhashaya
Vyadhi marga	Abhyantara

Chikitsa Siddhanta

Kapha-Pitta shamana
Kledahara
Yoni shodhana and yoni prakshalana
Deepana-pachana
Raktaprasadana
Pathya ahara-vihara
Correction of mild anaemia and constipation

Chikitsa Yojana

1. Internal Medication

Illustrative academic prescription only. Actual prescription should be issued by the supervising clinician after confirming diagnosis, excluding pregnancy and infection, and checking formulation availability and contraindications.

Medicine	Dose	Anupana	Frequency	Duration
Pushyanuga Churna	3 g	Madhu or tandulodaka	Twice daily after food	14 days
Lodhrasava	15 mL	Equal quantity of water	Twice daily after food	14 days
Arogyavardhini / alternative only if indicated by physician	As per institutional protocol	As advised	As advised	Do not prescribe routinely without supervision
Iron-rich diet / Ayurvedic haematinic as per physician	As advised	As advised	Daily	Based on Hb and physician advice

Note: If investigations show candidiasis, bacterial vaginosis, trichomoniasis, cervicitis, or STI, disease-specific modern treatment should not be delayed or replaced by Ayurvedic medicines.

2. Local Treatment

Yoni Prakshalana

Panchavalkala Kwatha, lukewarm and properly filtered.
Local vaginal cleansing only as directed by the treating physician.
Frequency: Once daily for 5-7 days.

Avoid vigorous douching, unsterile preparations, or intravaginal application during menstruation, pregnancy, pelvic infection, or when there is pain/bleeding.

3. Constipation Management

Warm water in the morning.
Adequate dietary fibre and vegetables.
Triphala only if advised by the treating physician.

Pathya-Apathya

Pathya

Freshly prepared, light, warm food
Green leafy vegetables, fruits, whole grains
Adequate oral fluids
Buttermilk only if tolerated and advised
Regular bowel habits
Cotton, loose-fitting undergarments
Change sanitary pads/underwear frequently
Wash external genitalia with clean water and keep it dry
Adequate sleep and stress management

Apathya

Excessive sweets, bakery products, deep-fried food
Excess curd, especially at night
Cold drinks and refrigerated food
Excessively spicy, sour, oily, and junk food
Tight synthetic undergarments
Scented vaginal washes, deodorants, and unnecessary douching
Suppression of natural urges
Unprotected intercourse if STI risk is present

Follow-Up Advice

Follow up after 7 days and again after 14 days.
Assess quantity/character of discharge, itching, odour, pain, dysuria, and treatment adherence.
Repeat haemoglobin assessment and manage anaemia.
Refer promptly for gynaecology evaluation if there is foul smell, itching, curdy/frothy discharge, fever, pelvic pain, lower abdominal pain, post-coital bleeding, abnormal bleeding, genital ulcer, or pregnancy.
If discharge persists despite normal initial tests, repeat evaluation and consider cervical screening, STI testing, diabetes screening, and specialist review.

Prognosis

Sadhya, provided infection, cervical pathology, and STI have been excluded; hygiene and dietary advice are followed; and follow-up is maintained.

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