Give answers to all tasks in English In the format if problem is from

Give answers to all tasks in English In the format if problem is from gynecology Symptoms, syndrome+diagnosis Main complaints Pain vaginal bleeding, discharge, menstrual disorder Type of physical examination If the problem is related to obstetrics Then in order Pregnancy labor partum Gravidity+parity Presentation, lie, position Complaints maternal and fetal Extragenital pathology of mother

Reading File

Running Command

cd /home/daytona/workspace/attachments/e04c9a60-5542-486d-a071-5ce345746bad/ && python3 -c " import pdfplumber with pdfplumber.open('Акуш. и гинек. Задачи ГИА 1.1.pdf') as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages[:5]): print(f'--- PAGE {i+1} ---') print(page.extract_text()) print() "

Running Command

cd /home/daytona/workspace/attachments/e04c9a60-5542-486d-a071-5ce345746bad/ && python3 -c " import pdfplumber with pdfplumber.open('Акуш. и гинек. Задачи ГИА 1.1.pdf') as pdf: for i, page in enumerate(pdf.pages[5:20]): print(f'--- PAGE {i+6} ---') print(page.extract_text()) print() "

Running Command

cd /home/daytona/workspace/attachments/e04c9a60-5542-486d-a071-5ce345746bad/ && python3 -c " import pdfplumber with pdfplumber.open('Акуш. и гинек. Задачи ГИА 1.1.pdf') as pdf: for i, page in enumerate(pdf.pages[20:50]): print(f'--- PAGE {i+21} ---') print(page.extract_text()) print() "

Running Command

cd /home/daytona/workspace/attachments/e04c9a60-5542-486d-a071-5ce345746bad/ && python3 -c " import pdfplumber with pdfplumber.open('Акуш. и гинек. Задачи ГИА 1.1.pdf') as pdf: for i, page in enumerate(pdf.pages[50:100]): print(f'--- PAGE {i+51} ---') print(page.extract_text()) print() "

Running Command

cd /home/daytona/workspace/attachments/e04c9a60-5542-486d-a071-5ce345746bad/ && python3 -c " import pdfplumber with pdfplumber.open('Акуш. и гинек. Задачи ГИА 1.1.pdf') as pdf: print(f'Total pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages[:3]): print(f'--- PAGE {i+1} ---') print(page.extract_text()[:500]) "

Now give tasks from 63 to 100 in same format and give a combined pdf

Running Command

cd /home/daytona/workspace/attachments/e04c9a60-5542-486d-a071-5ce345746bad/ && python3 -c " import pdfplumber with pdfplumber.open('Акуш. и гинек. Задачи ГИА 1.1.pdf') as pdf: for i, page in enumerate(pdf.pages[62:100]): print(f'=== TASK {i+63} (Page {i+63}) ===') print(page.extract_text()) print() " 2>&1 | head -500

Running Command

ls /home/daytona/workspace/ 2>/dev/null && ls /home/daytona/skills/pdf/ 2>/dev/null

Running Command

mkdir -p /home/daytona/workspace/obgyn_answers && python3 -c " from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, HRFlowable from reportlab.lib import colors from reportlab.lib.enums import TA_LEFT, TA_CENTER doc = SimpleDocTemplate( '/home/daytona/workspace/obgyn_answers/Tasks_63_100_Answers.pdf', pagesize=A4, rightMargin=2*cm, leftMargin=2*cm, topMargin=2*cm, bottomMargin=2*cm ) styles = getSampleStyleSheet() title_style = ParagraphStyle('Title', parent=styles['Title'], fontSize=16, spaceAfter=12, textColor=colors.HexColor('#1a237e')) task_style = ParagraphStyle('Task', parent=styles['Heading1'], fontSize=12, spaceAfter=6, textColor=colors.HexColor('#0d47a1'), spaceBefore=16) section_style = ParagraphStyle('Section', parent=styles['Heading2'], fontSize=10, spaceAfter=4, textColor=colors.HexColor('#1565c0'), spaceBefore=8) body_style = ParagraphStyle('Body', parent=styles['Normal'], fontSize=9.5, spaceAfter=3, leading=14) label_style = ParagraphStyle('Label', parent=styles['Normal'], fontSize=9.5, spaceAfter=2, textColor=colors.HexColor('#b71c1c'), fontName='Helvetica-Bold') story = [] story.append(Paragraph('OB/GYN State Examination - Tasks 63-100', title_style)) story.append(Paragraph('Structured Answers in English', ParagraphStyle('sub', parent=styles['Normal'], fontSize=11, textColor=colors.grey, alignment=TA_CENTER, spaceAfter=20))) story.append(HRFlowable(width='100%', thickness=2, color=colors.HexColor('#1a237e'))) story.append(Spacer(1, 12)) print('Template OK') doc.build(story) print('PDF test OK') "

Give answers from 1 to 100

Running Command

cd /home/daytona/workspace/attachments/e04c9a60-5542-486d-a071-5ce345746bad/ && python3 -c " import pdfplumber tasks = {} with pdfplumber.open('Акуш. и гинек. Задачи ГИА 1.1.pdf') as pdf: for i, page in enumerate(pdf.pages): tasks[i+1] = page.extract_text() # Save to file for reference import json with open('/home/daytona/workspace/obgyn_answers/all_tasks.json','w') as f: json.dump(tasks, f, ensure_ascii=False) print('Done, total pages:', len(tasks)) "

Running Command

mkdir -p /home/daytona/workspace/obgyn_answers && cat > /home/daytona/workspace/obgyn_answers/build_pdf.py << 'PYEOF' from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, HRFlowable, PageBreak from reportlab.lib import colors from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY doc = SimpleDocTemplate( '/home/daytona/workspace/obgyn_answers/OBGyn_Tasks_1_100_Answers.pdf', pagesize=A4, rightMargin=1.8*cm, leftMargin=1.8*cm, topMargin=2*cm, bottomMargin=2*cm ) styles = getSampleStyleSheet() title_style = ParagraphStyle('MyTitle', parent=styles['Title'], fontSize=15, spaceAfter=6, textColor=colors.HexColor('#1a237e'), alignment=TA_CENTER) sub_style = ParagraphStyle('MySub', parent=styles['Normal'], fontSize=10, spaceAfter=14, textColor=colors.grey, alignment=TA_CENTER) task_style = ParagraphStyle('MyTask', parent=styles['Heading1'], fontSize=11.5, spaceAfter=4, textColor=colors.HexColor('#0d47a1'), spaceBefore=14, fontName='Helvetica-Bold') section_style = ParagraphStyle('MySect', parent=styles['Heading2'], fontSize=10, spaceAfter=3, textColor=colors.HexColor('#6a1b9a'), spaceBefore=7, fontName='Helvetica-Bold') body_style = ParagraphStyle('MyBody', parent=styles['Normal'], fontSize=9.2, spaceAfter=2, leading=13.5, alignment=TA_JUSTIFY) label_style = ParagraphStyle('MyLbl', parent=styles['Normal'], fontSize=9.2, spaceAfter=1, textColor=colors.HexColor('#b71c1c'), fontName='Helvetica-Bold', leading=13) note_style = ParagraphStyle('MyNote', parent=styles['Normal'], fontSize=8.5, spaceAfter=2, textColor=colors.HexColor('#37474f'), leading=12) def H(txt): return Paragraph(txt, task_style) def S(txt): return Paragraph(txt, section_style) def B(txt): return Paragraph(txt, body_style) def L(txt): return Paragraph(txt, label_style) def N(txt): return Paragraph(txt, note_style) def sp(n=4): return Spacer(1, n) def hr(): return HRFlowable(width='100%', thickness=0.5, color=colors.HexColor('#90caf9'), spaceAfter=4, spaceBefore=4) story = [] # ── COVER ────────────────────────────────────────────────────────────────────── story.append(Spacer(1, 60)) story.append(Paragraph('OB/GYN State Examination', title_style)) story.append(Paragraph('Situational Tasks 1–100: Structured Answers', sub_style)) story.append(Paragraph('Department of Obstetrics and Gynecology · KSMU', sub_style)) story.append(HRFlowable(width='100%', thickness=2, color=colors.HexColor('#1a237e'))) story.append(Spacer(1, 10)) story.append(B('Format: Gynecology tasks → Syndrome + Diagnosis | Main complaints (pain, bleeding, discharge, menstrual disorder) | Physical examination. ' 'Obstetrics tasks → Pregnancy/Labor/Postpartum | Gravidity + Parity | Presentation, Lie, Position | Maternal & fetal complaints | Extragenital pathology.')) story.append(PageBreak()) # ============================================================================== # TASKS 1–100 # ============================================================================== # ── TASK 1 ──────────────────────────────────────────────────────────────────── story += [H('TASK 1 — GYNECOLOGY'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Uterine fibroids (leiomyoma uteri) with abnormal uterine bleeding (AUB-L) + secondary iron-deficiency anemia + secondary infertility.'), S('Main Complaints'), L('Pain:'), B('Cramping lower abdominal pain during menstruation (dysmenorrhea).'), L('Vaginal Bleeding:'), B('Heavy menstrual bleeding (menorrhagia) >7 days; soaking pads/tampons hourly; large clots; intermenstrual spotting (metrorrhagia). Pattern = menometrorrhagia.'), L('Menstrual Disorder:'), B('Irregular cycle; prolonged bleeding; pattern consistent with anovulatory or structural (fibroid-related) AUB. Resulting fatigue, weakness, dyspnea on exertion (anemia symptoms).'), S('Physical Examination'), B('General: Pallor, tachypnea during menses. BP 110/70, T 36.7 °C.'), B('Abdominal/Bimanual: Enlarged, irregular uterus; firm nodular contour consistent with fibroids.'), B('Investigations required: Pelvic ultrasound (transvaginal preferred) — confirms fibroid size/location. Hysterosonography or hysteroscopy to classify submucosal component. CBC (hemoglobin, ferritin). Hormonal panel (FSH, LH, estradiol, progesterone, TSH). Endometrial biopsy if indicated.'), B('Treatment: Medical — tranexamic acid, NSAIDs, progestins, LNG-IUD (Mirena), GnRH agonists (pre-op). Surgical — hysteroscopic myomectomy (submucosal), laparoscopic/open myomectomy, UAE, or hysterectomy if family complete and conservative measures fail. Treat anemia (iron supplementation ± transfusion).'), sp()] # ── TASK 2 ──────────────────────────────────────────────────────────────────── story += [H('TASK 2 — GYNECOLOGY'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Adenomyosis grade I (diffuse) + patient seeks contraception; no desire for further pregnancy.'), S('Main Complaints'), L('Pain:'), B('Dysmenorrhea associated with adenomyosis (implied by follow-up history).'), L('Menstrual Disorder:'), B('Adenomyosis grade I under gynecological observation; no current pharmacological treatment.'), S('Physical Examination'), B('General: Married, G2P2, no further pregnancy planned.'), B('Recommended contraception: Levonorgestrel-releasing IUD (LNG-IUD / Mirena 52 mg). This is the method of choice — it provides highly effective contraception AND is a first-line treatment for adenomyosis (reduces dysmenorrhea, decreases menstrual blood loss, may cause amenorrhea).'), B('Indications: Heavy or painful periods; adenomyosis; need for long-term (5-year) contraception; no desire for further pregnancy.'), B('Contraindications: Active pelvic infection; uterine anomaly distorting cavity; unexplained abnormal uterine bleeding; current or suspected pregnancy; cervical/endometrial malignancy.'), B('Advantages: Local hormone action (minimal systemic effects); treats adenomyosis; 5-year duration; reversible; reduces blood loss by up to 90%.'), B('Disadvantages: Irregular spotting in first 3–6 months; possible expulsion; insertion discomfort; does not protect against STIs.'), sp()] # ── TASK 3 ──────────────────────────────────────────────────────────────────── story += [H('TASK 3 — GYNECOLOGY'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Endometrial carcinoma (most likely) — postmenopausal bleeding in an obese woman with prior endometrial hyperplasia. Risk factors: age 72, BMI ~35 (96 kg/165 cm), nulliparous history (1 pregnancy), prior endometrial hyperplasia, menopause at 52 (late).'), S('Main Complaints'), L('Vaginal Bleeding:'), B('Moderate hemorrhagic vaginal discharge for 2 days — postmenopausal bleeding (>12 months after last menstruation). This is an endometrial cancer until proven otherwise.'), L('Pain:'), B('Not reported.'), L('Menstrual Disorder:'), B('Menopause since age 52 (20+ years ago); menarche age 11 (long estrogen exposure).'), S('Physical Examination'), B('General: BMI 35.3 (obese class II) — significant risk factor for endometrial cancer (excess estrogen from adipose aromatization).'), B('Speculum + bimanual: Assess for cervical lesions; uterine size/consistency; parametrial involvement.'), B('Investigations: Transvaginal ultrasound (endometrial thickness — >4 mm in postmenopause is significant). Endometrial biopsy (Pipelle or D&C) — mandatory. MRI pelvis for staging if malignancy confirmed. CA-125. Chest X-ray.'), B('Treatment: If endometrial carcinoma confirmed — Total abdominal hysterectomy + bilateral salpingo-oophorectomy (TAH-BSO) ± lymph node dissection. Adjuvant radiotherapy depending on stage/grade. If simple hyperplasia — progestin therapy with follow-up biopsy.'), sp()] # ── TASK 4 ──────────────────────────────────────────────────────────────────── story += [H('TASK 4 — GYNECOLOGY'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Uterine fibroids (leiomyoma uteri), multiple — with hypermenorrhagia and secondary iron-deficiency anemia. G7P2Ab5; prior IUD use 31–37 y.'), S('Main Complaints'), L('Pain:'), B('Dragging/pulling pains in lower abdomen for 6 months; tachycardia and weakness.'), L('Vaginal Bleeding:'), B('Progressively increasing menstrual blood loss over 2 years. Skin pallor (pale-rose) indicates significant anemia.'), L('Menstrual Disorder:'), B('Normal cycle until age 42, then increasing blood loss — consistent with fibroid growth at perimenopause.'), S('Physical Examination'), B('General: Pale-rose skin, BMI ~31.6 (86 kg/165 cm), tachycardia — signs of anemia.'), B('Bimanual: Enlarged, irregular nodular uterus; assess fibroid size, mobility, tenderness.'), B('Investigations: Pelvic US (fibroid mapping). CBC, ferritin, iron. Coagulation screen. Endometrial biopsy (rule out hyperplasia/carcinoma in perimenopausal patient). Hysteroscopy if submucosal fibroid suspected.'), B('Indications for surgical treatment: (1) Symptomatic fibroids with anemia resistant to medical management; (2) Rapid growth; (3) Uterine size >12 weeks; (4) Submucosal location causing AUB; (5) Infertility from fibroid; (6) Pressure symptoms on bladder/rectum. Surgery options: Myomectomy (if wishes to preserve uterus) or hysterectomy (family complete, G7P2).'), sp()] # ── TASK 5 ──────────────────────────────────────────────────────────────────── story += [H('TASK 5 — GYNECOLOGY'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Primary hypogonadism / primary amenorrhea with oligomenorrhea — likely hypogonadotropic hypogonadism or constitutional delay. Underdeveloped secondary sexual characteristics. Possible Turner syndrome or hypothalamic-pituitary dysfunction.'), S('Main Complaints'), L('Menstrual Disorder:'), B('Oligomenorrhea (scanty and infrequent menstruation) since menarche — primary menstrual dysfunction. Virgin; first consultation.'), L('Pain:'), B('Not reported.'), L('Vaginal Bleeding/Discharge:'), B('Scanty periods only.'), S('Physical Examination'), B('General: BMI 16.6 (45 kg/165 cm) — underweight; underdeveloped secondary sexual characteristics (breast development, pubic/axillary hair, body shape).'), B('Note: Patient is a virgin — external inspection only; rectal exam permissible if needed.'), B('Investigations: Hormonal panel: FSH, LH, estradiol, prolactin, TSH, free T4, cortisol, DHEAS, testosterone. Karyotype (exclude Turner 45,X0). Pelvic US (uterine/ovarian morphology). Bone age X-ray. MRI pituitary if prolactin elevated.'), B('Functional diagnostic tests: (1) Basal body temperature (BBT) chart — daily rectal temperature measurement immediately on waking before rising; record for ≥3 cycles. Monophasic flat curve (no rise in luteal phase) = anovulation; Biphasic curve (temp rise ≥0.3–0.5 °C after ovulation, lasting 12–14 days) = ovulation present. (2) Cervical mucus score (Billings). (3) Urinary LH surge kits.'), B('Treatment: Correct underweight (nutritional support). Cyclic hormone replacement (estrogen-progestin) to induce withdrawal bleeds and secondary sexual development. Treat underlying cause if found.'), sp()] # ── TASK 6 ──────────────────────────────────────────────────────────────────── story += [H('TASK 6 — GYNECOLOGY'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Cervical carcinoma (cancer of the cervix uteri) — "cauliflower" exophytic growth with contact bleeding on colposcopy. G4P3Ab1.'), S('Main Complaints'), L('Pain:'), B('None reported (early stage may be asymptomatic).'), L('Vaginal Bleeding:'), B('Contact bleeding (drop hemorrhage on touch) — hallmark of cervical carcinoma.'), L('Discharge:'), B('May have watery/blood-stained discharge (not stated but typical).'), S('Physical Examination'), B('Speculum: Cauliflower-like exophytic lesion on cervix; contact bleeding.'), B('Bimanual/rectovaginal: Assess parametrial involvement, uterine mobility, adnexal masses.'), B('Investigations: Cervical biopsy (punch biopsy from lesion) — histological confirmation mandatory. Colposcopy with directed biopsy. PAP smear. HPV genotyping. MRI pelvis (staging — parametrium, lymph nodes). CT chest/abdomen/pelvis. Cystoscopy/proctoscopy if advanced stage. CBC, biochemistry, renal function.'), B('Treatment: Stage-dependent. Early stage (IA–IB1): Radical hysterectomy (Wertheim) + pelvic lymph node dissection, or radiotherapy. Advanced (IIB+): Concurrent chemoradiotherapy (cisplatin-based). All patients: HPV vaccination counseling for contacts.'), sp()] # ── TASK 7 ──────────────────────────────────────────────────────────────────── story += [H('TASK 7 — GYNECOLOGY'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Ruptured ovarian cyst (most likely ruptured follicular/corpus luteum cyst) — blood in pouch of Douglas (culdocentesis positive). Differential: ectopic pregnancy must be excluded.'), S('Main Complaints'), L('Pain:'), B('Sharp right iliac fossa pain during physical exertion at mid-cycle (ovulation timing). Radiating character possible.'), L('Vaginal Bleeding:'), B('None reported externally; internal bleeding evidenced by hemoperitoneum.'), S('Physical Examination'), B('General: Pale-rose skin, BP 110/70, HR 78 — hemodynamically stable at present.'), B('Abdominal: Tenderness RIF; peritoneal signs may be present.'), B('Gynecological causes of blood in Douglas pouch: (1) Ruptured ectopic pregnancy; (2) Ruptured ovarian cyst (follicular, corpus luteum, endometrioma); (3) Ovarian apoplexy; (4) Ruptured tubo-ovarian abscess; (5) Uterine perforation; (6) Pelvic inflammatory disease with peritonitis.'), B('Next step: β-hCG (blood) — rule out ectopic. Transvaginal ultrasound (free fluid, adnexal mass). CBC. Type and crossmatch. If hemodynamically unstable or hCG positive → emergency diagnostic laparoscopy.'), B('Culdocentesis technique: Patient in lithotomy; speculum placed; posterior lip of cervix grasped with tenaculum; 18G needle inserted through posterior vaginal fornix (pouch of Douglas) at midline; aspiration — non-clotting blood = hemoperitoneum; clear fluid = physiological; purulent fluid = abscess.'), sp()] # ── TASK 8 ──────────────────────────────────────────────────────────────────── story += [H('TASK 8 — GYNECOLOGY'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Primary infertility (female factor to be investigated) — unable to conceive after 2 years of unprotected regular intercourse with no previous pregnancies. Normal menstrual history.'), S('Main Complaints'), L('Menstrual Disorder:'), B('None — regular cycles (28-day, 3–5 days, 80–100 mL). Menarche age 12. No prior pregnancies.'), L('Pain/Bleeding/Discharge:'), B('Not reported.'), S('Physical Examination'), B('General + bimanual: Assess uterine size, mobility, adnexal tenderness, cervical lesions.'), B('Causes of female infertility: (1) Ovulatory disorders (PCOS, hypothalamic amenorrhea, hyperprolactinemia, thyroid disease, POI); (2) Tubal factor (PID sequelae, endometriosis, prior surgery); (3) Uterine/cervical factor (fibroids, polyps, adhesions, cervical stenosis); (4) Endometriosis; (5) Unexplained infertility.'), B('Investigations: Day 2–3 FSH, LH, estradiol, AMH (ovarian reserve). Progesterone day 21 (confirm ovulation). Prolactin, TSH. Transvaginal US (follicular tracking, uterine/ovarian pathology). HSG (hysterosalpingography) — tubal patency. Hysteroscopy if uterine anomaly suspected. Semen analysis of partner (already done? — ask). Laparoscopy + chromopertubation if tubal pathology suspected.'), B('Management: Depends on cause found. Ovulation induction (clomiphene, gonadotropins), tubal surgery, IVF as indicated.'), sp()] # ── TASK 9 ──────────────────────────────────────────────────────────────────── story += [H('TASK 9 — GYNECOLOGY (Early Pregnancy Complication)'), hr(), S('Syndrome + Diagnosis'), B('Diagnosis: Ectopic pregnancy (right-sided tubal) — ruptured or about to rupture. 7–8 weeks amenorrhea + right iliac fossa pain + low hemoglobin (106 g/L).'), S('Main Complaints'), L('Pain:'), B('Severe right iliac fossa pain radiating to lower back — characteristic of tubal ectopic rupture/distension.'), L('Vaginal Bleeding:'), B('Amenorrhea 7–8 weeks (missed periods); possible dark spotting.'), L('Menstrual Disorder:'), B('Sudden amenorrhea after regular periods = sign of pregnancy.'), S('Physical Examination'), B('Vitals: Hb 106 g/L (mild anemia from bleeding), HR 92 (tachycardia — internal bleeding), BP 120/70 (currently compensated), T 36.9 °C, WBC 9.3×10⁹ (mild leukocytosis — stress response).'), B('Abdominal: Tenderness RIF; cervical excitation sign on bimanual.'), B('Investigations: Serum β-hCG (expected positive; level indicates size/viability). Transvaginal ultrasound — empty uterus + adnexal mass + free fluid in Douglas. CBC, coagulation, blood group + crossmatch. Culdocentesis if US unavailable.'), B('Treatment: Surgical (most likely given pain + anemia): Emergency laparoscopy — salpingotomy (if unruptured, wishes future fertility) or salpingectomy (ruptured). Medical: Methotrexate IM only if unruptured, hCG <5000, tube intact, no fetal cardiac activity, patient reliable. IV access, fluid resuscitation, consent for surgery.'), sp()] # ── TASK 10 ─────────────────────────────────────────────────────────────────── story += [H('TASK 10 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 16 weeks gestation. Labor: Not in labor. Postpartum: Not applicable.'), S('Gravidity + Parity'), B('Gravidity: Not specified (likely G1 or multigravida — Filipino woman, age 41). Parity: Not specified.'), S('Presentation, Lie, Position'), B('Uterus size 22 weeks at 16 weeks GA — discrepancy (uterus larger than dates). No fetal parts palpable normally.'), S('Maternal Complaints'), L('Vaginal Bleeding:'), B('Mild vaginal bleeding at 16 weeks.'), L('Pain:'), B('Headache, vertigo.'), B('Other: BP 150/90 (hypertension). β-hCG 110,000 mIU/mL (markedly elevated for 16 weeks — normal <50,000). Ultrasound: "snowstorm" pattern = pathognomonic for hydatidiform mole.'), S('Extragenital Pathology'), B('Hypertension at 16 weeks (pre-eclampsia-like features are a recognized complication of GTD).'), S('Diagnosis'), B('Complete hydatidiform mole (gestational trophoblastic disease). Features: (1) Uterus large for dates; (2) Snowstorm US pattern; (3) Markedly elevated β-hCG; (4) Early hypertension; (5) Vaginal bleeding; (6) No fetal parts.'), B('Medical management: Suction curettage (evacuation) under general anesthesia + oxytocin infusion after cervix dilated. Rh-immunoglobulin if Rh negative. Weekly β-hCG monitoring until negative × 3 consecutive weeks, then monthly × 6–12 months. Reliable contraception (OCP preferred) for 6–12 months.'), B('Surgical management: Hysterectomy if: no desire for future fertility, age >40, or malignant transformation. Chemotherapy (methotrexate, actinomycin-D) if β-hCG plateaus or rises — diagnosis of gestational trophoblastic neoplasia.'), sp()] # ── TASK 11 ─────────────────────────────────────────────────────────────────── story += [H('TASK 11 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 36 weeks. Labor: Not in active labor (being assessed). Postpartum: No.'), S('Gravidity + Parity'), B('Age 37 — gravidity/parity not specified; advanced maternal age.'), S('Presentation, Lie, Position'), B('Not specified in this scenario (focus is on maternal condition).'), S('Maternal Complaints'), L('Pain:'), B('Severe headache; epigastric pain (liver capsule distension).'), L('Other:'), B('Visual disturbances (scotomata/blurred vision — cerebral involvement). BP 160/110 mmHg — severe range hypertension.'), S('Fetal Complaints'), B('Labs: Hb 74 g/L (hemolytic anemia), WBC 8.6×10⁹, Platelets 92,000/mL (<100,000 = thrombocytopenia), elevated liver enzymes, proteinuria 0.09 mg/L.'), S('Diagnosis'), B('HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) — severe variant of pre-eclampsia at 36 weeks.'), S('Extragenital Pathology'), B('Hypertension (BP 160/110) + HELLP = life-threatening obstetric emergency.'), B('Investigations: Full CBC with smear (schistocytes = microangiopathic hemolysis), LFTs, coagulation (PT/APTT/fibrinogen), serum LDH, uric acid, creatinine, urine protein:creatinine ratio, CTG, Doppler USS.'), B('Delivery plan: Delivery is the definitive treatment. At 36 weeks — immediate delivery. Route: Cesarean section preferred given severe HELLP, thrombocytopenia, and maternal condition (vaginal delivery can be attempted if cervix favorable and rapid progress expected). Pre-delivery: IV MgSO₄ (seizure prophylaxis), IV antihypertensives (labetalol, hydralazine, or nifedipine), dexamethasone (platelets + fetal lung maturity), blood products if platelets <50,000.'), sp()] # ── TASK 12 ─────────────────────────────────────────────────────────────────── story += [H('TASK 12 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Term. Labor: Active — 6 hours of contractions; cervix 5 cm dilated (active phase). Postpartum: No.'), S('Gravidity + Parity'), B('Primigravida (G1P0).'), S('Presentation, Lie, Position'), B('Lie: Longitudinal. Presentation: Cephalic (vertex). Position: Right Occiput Posterior (ROP) — sagittal suture in oblique diameter, posterior fontanel (occiput) at right sacroiliac joint. Station: -2 (occiput 2 cm above ischial spines).'), S('Maternal Complaints'), L('Pain:'), B('Contractions 30–40 sec every 5 min for 6 hours.'), B('Membranes: Ruptured spontaneously during VE.'), S('Fetal Complaints'), B('Head: Movable above pelvic brim (not yet engaged prior to VE). Fontanel assessment confirms ROP.'), S('Answers'), B('1. Fetal relationship with pelvis: Head NOT yet engaged (2 cm above ischial spines = station -2). The occiput is posterior (ROP position). This means the engaging diameter is the occipito-frontal diameter (11.5 cm) — larger than the suboccipito-bregmatic (9.5 cm) of OA position.'), B('2. Factors associated with OP position: Android/anthropoid pelvis; flat pelvis; poorly flexed head; premature rupture of membranes; occipital dolicocephaly; uterine anomalies; contracted inlet.'), B('3. Engaging diameter in OP position: Occipito-frontal diameter = 11.5 cm (large oblique diameter, as head is deflexed). Compare: Suboccipito-bregmatic 9.5 cm (OA); Fronto-occipital 11.5 cm (OP — deflexed); Mento-occipital 13.5 cm (brow).'), sp()] # ── TASK 13 ─────────────────────────────────────────────────────────────────── story += [H('TASK 13 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Term (40 weeks). Labor: Not in labor (presenting for assessment). Postpartum: No.'), S('Gravidity + Parity'), B('Primigravida G1P0, age 28.'), S('Presentation, Lie, Position'), B('Not specified in this task.'), S('Maternal Complaints'), L('No symptoms'), B('Previously uncomplicated pregnancy — asymptomatic presentation now.'), B('Findings: BP 150/100 mmHg; proteinuria 2+ (significant); generalized edema.'), S('Fetal Complaints'), B('Not specified.'), S('Diagnosis'), B('Pre-eclampsia (hypertension ≥140/90 + proteinuria ≥1+ at term in a primigravida).'), S('Extragenital Pathology'), B('Gestational hypertension with proteinuria = pre-eclampsia. No prior hypertension mentioned.'), B('Plan of investigations: Full CBC (platelets), LFTs, uric acid, creatinine, 24-hour urine protein (or spot protein:creatinine ratio), coagulation screen, fundoscopy, CTG, obstetric Doppler USS (fetal wellbeing + umbilical artery).'), B('Management: At term with pre-eclampsia → delivery is indicated. Admit. IV MgSO₄ (seizure prophylaxis — loading dose 4–6 g over 20 min, maintenance 1–2 g/hr). Antihypertensives if BP ≥160/110 (IV labetalol, hydralazine, oral nifedipine). Continuous fetal monitoring. Cervical assessment (Bishop score) — if favorable, oxytocin induction; if not favorable, ripen cervix (PGE2) then induce. Cesarean if obstetric indication.'), sp()] # ── TASK 14 ─────────────────────────────────────────────────────────────────── story += [H('TASK 14 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Early (2 missed periods ≈ 8 weeks). Labor/Postpartum: Not applicable.'), S('Gravidity + Parity'), B('Not specified. Pregnancy confirmed on examination.'), S('Presentation, Lie, Position'), B('Too early for Leopold maneuvers (8 weeks).'), S('Maternal Complaints'), B('Breast changes, morning nausea/fatigue, amenorrhea × 2 months. Urine glucose negative (despite diabetes).'), S('Extragenital Pathology'), B('Pre-existing Type 1 Diabetes Mellitus — taking 30 units insulin daily. Negative glucosuria due to elevated renal glucose threshold in pregnancy (or good control).'), B('Q1 — Metabolic changes in diabetic pregnancy: (1) Placental hormones (hPL, progesterone, cortisol, glucagon) cause insulin resistance — especially in 2nd/3rd trimester; (2) Early pregnancy has increased insulin sensitivity (hypoglycemia risk); (3) Accelerated starvation ketogenesis (fasting ketosis develops faster); (4) Increased glucose utilization by fetoplacental unit; (5) Renal glucose threshold lowered (glycosuria common even with normal glucose).'), B('Q2 — Blood glucose changes: 1st trimester: hypoglycemia risk (increased insulin sensitivity, nausea reducing intake). 2nd–3rd trimester: increasing insulin resistance → hyperglycemia worsens → insulin dose increases 50–100%. Postpartum: rapid fall in insulin resistance → reduce dose immediately.'), B('Q3 — Difficulty regulating insulin dose: Continuously changing insulin requirements throughout pregnancy; unpredictable carbohydrate intake due to nausea; rapid glucose changes with exercise; risk of nocturnal hypoglycemia; impaired hypoglycemia awareness in pregnancy; fetoplacental glucose consumption variable.'), sp()] # ── TASK 15 ─────────────────────────────────────────────────────────────────── story += [H('TASK 15 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Calculation required. Labor: Admitted for delivery. Postpartum: No.'), S('Gravidity + Parity'), B('Primipara (P0), age 26.'), S('Presentation, Lie, Position'), B('Not specified in this task.'), S('Maternal Complaints'), B('Admitted to maternity home 25 April 2019. LMP: 18 July 2018. First fetal movement: 12 December 2018. AC = 101 cm; FH = 35 cm.'), S('Calculations'), B('1. Gestational age: By LMP (Naegele): LMP 18 July 2018 → EDD = 18 July + 9 months + 7 days = 25 April 2019. GA on 25 April 2019 = 40 weeks (term). By first movement (primipara): 12 Dec + 20 weeks = ~30 April 2019 ≈ 40 weeks. Consistent.'), B('EDD (Naegele rule): LMP 18/07/2018 − 3 months + 7 days = 25 April 2019. Patient presented exactly on EDD!'), B('2. Estimated fetal weight (Jordania formula): EFW = AC × FH = 101 × 35 = 3,535 g (≈3.5 kg).'), B('3. Stages of labor: Stage 1 (Dilation): Onset of regular contractions → full cervical dilation (10 cm). Latent phase: 0–6 cm (nullip ≤20 h). Active phase: 6–10 cm (≥0.5 cm/hr). Stage 2 (Expulsion): Full dilation → delivery of baby (nullip ≤3 h without epidural, ≤4 h with). Stage 3 (Placental): Delivery of baby → delivery of placenta (≤30 min). Stage 4 (Recovery): First 2 hours postpartum.'), sp()] # ── TASK 16 ─────────────────────────────────────────────────────────────────── story += [H('TASK 16 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 38 weeks. Labor: Active — ruptured membranes, contractions since 1 am (~8 hours), now at 7–8 cm dilation. Postpartum: No.'), S('Gravidity + Parity'), B('Primigravida G1P0, age 24.'), S('Presentation, Lie, Position'), B('Lie: Longitudinal. Presentation: Cephalic. Position: Not specified. Station: Head in mid-cavity (middle pelvis).'), S('Maternal Complaints'), L('Pain:'), B('Regular contractions since 1 am.'), L('Discharge:'), B('Amniotic fluid leak since 1 am — PROM (premature rupture of membranes at onset of labor = simultaneous rupture).'), S('Fetal Complaints'), B('FHR: 140–142 bpm — normal (reassuring, 110–160 range).'), S('Diagnosis'), B('Diagnosis: G1P0, 38 weeks. Active phase of labor (Stage 1, active phase). Spontaneous rupture of membranes. Head in mid-cavity. FHR normal.'), B('Delivery plan: Continue monitoring labor. CTG continuously. Assess cervical progress hourly. Maintain partogram. Position changes (upright/lateral). IV access. Adequate hydration. Analgesia (epidural if requested). Expect delivery within 2–4 hours at current rate. Prepare for normal vaginal delivery. Episiotomy only if indicated (fetal distress, rigid perineum, operative delivery).'), B('Types of episiotomy: (1) Mediolateral (45° from midline, right — most common in Europe/Russia) — lower risk of 3rd/4th degree tears; (2) Median/midline (directly posterior — easier repair, but higher risk of extension to sphincter); (3) Lateral (rarely used — risk of Bartholin duct injury); (4) J-shaped (starts median then curves laterally).'), sp()] # ── TASK 17 ─────────────────────────────────────────────────────────────────── story += [H('TASK 17 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 40 weeks. Labor: Active — contractions 5–6 min apart × 25–30 sec; membranes absent (ruptured). Cervix 5–6 cm.'), S('Gravidity + Parity'), B('Age 20, gravidity/parity not specified (primigravida implied by context).'), S('Presentation, Lie, Position'), B('Lie: Longitudinal. Presentation: Cephalic (vertex). Position: Left Occiput Anterior (LOA) — sagittal suture in right oblique diameter; small fontanel (occiput) left anterior near symphysis. Conducting point: Small (posterior) fontanel.'), S('Maternal Complaints'), L('Pain:'), B('Regular contractions.'), L('Discharge:'), B('Amniotic fluid (membranes ruptured). FHR 138–140 bpm (normal).'), S('Diagnosis'), B('Diagnosis: 40 weeks gestation. Active phase Stage 1. LOA position, ruptured membranes. FHR normal.'), B('Biomechanism of labor (LOA — anterior occiput): (1) Flexion — chin to chest; conducting point = small fontanel; (2) Internal rotation — occiput rotates from LOA → OA (direct anterior) as head descends to mid-pelvis; (3) Extension — head passes under symphysis with suboccipital region as pivot (fixation point = suboccipital fossa); (4) External rotation (restitution) — occiput returns to original oblique direction; (5) Expulsion of shoulders and body.'), B('Engaging diameter: Suboccipito-bregmatic = 9.5 cm (well-flexed vertex). Fixation point: Suboccipital fossa (nape of neck) against inferior symphysis pubis.'), sp()] # ── TASK 18 ─────────────────────────────────────────────────────────────────── story += [H('TASK 18 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 37 weeks. Labor: Not in labor. Postpartum: No.'), S('Gravidity + Parity'), B('Age 23. First movement at 18 weeks → primigravida (first movement = 18–20 weeks in primigravida; 16–18 weeks in multigravida). Therefore G1P0.'), S('Presentation, Lie, Position'), B('Lie: Not documented (not stated). Presentation: Cephalic. Cervix: Central, external os admits 1 finger.'), S('Maternal Complaints'), B('No complaints. Routine antenatal visit. Mucosal discharge (normal).'), S('Answers'), B('1. External examination type: Leopold-Levitsky maneuvers (4 maneuvers): (1) First maneuver — fundal grip: identify presenting part at fundus (head = hard, round, ballotable; breech = soft, irregular); (2) Second maneuver — lateral grip: identify fetal back (firm, smooth) and small parts (irregular); (3) Third maneuver — Pawlick grip: assess presenting part above symphysis (engaged or free); (4) Fourth maneuver — pelvic grip: confirm engagement and flexion of presenting part.'), B('2. Primigravida or multigravida? Primigravida — first fetal movement at 18 weeks (primigravidas feel movement 18–20 weeks; multigravidas 16–18 weeks).'), B('3. Bishop Score: A pre-labor cervical scoring system assessing readiness for induction. Parameters (each scored 0–3): Dilation (cm); Effacement (%); Station (−3 to +2); Cervical consistency (firm=0, medium=1, soft=2); Cervical position (posterior=0, mid=1, anterior=2). Total ≤5 = unfavorable (cervix needs ripening); 6–8 = moderate; ≥9 = favorable (induction likely to succeed).'), sp()] # ── TASK 19 ─────────────────────────────────────────────────────────────────── story += [H('TASK 19 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 38 weeks. Labor: Not in labor. Postpartum: No.'), S('Gravidity + Parity'), B('Age 22, G?P?'), S('Presentation, Lie, Position'), B('Lie: Longitudinal. Presentation: Breech (soft, ballotable presenting part above inlet; hard round part [head] in fundus to right side). Position: Not fully defined (head in right fundus). Cervix: Closed. Presenting part not clearly palpated on VE.'), S('Maternal Complaints'), B('No complaints. Routine visit at 38 weeks.'), S('Diagnosis'), B('Diagnosis: 38 weeks gestation, longitudinal lie, breech presentation.'), B('Classification of breech presentations: (1) Frank breech (extended legs — both hips flexed, knees extended; most common 65%); (2) Complete breech (flexed legs — both hips and knees flexed, feet beside buttocks; 25%); (3) Footling/incomplete breech (one or both feet presenting; 10%); (4) Knee presentation (rare — knees presenting).'), B('Variants of delivery: (1) External cephalic version (ECV) at 36–37 weeks — preferred initial step if no contraindications; (2) Planned cesarean section — safest for fetus (recommended if ECV fails/contraindicated); (3) Vaginal breech delivery — only in selected cases (frank breech, adequate pelvis, EFW 2500–3800 g, experienced operator, second/subsequent birth); (4) Emergency cesarean if complications arise in labor.'), sp()] # ── TASK 20 ─────────────────────────────────────────────────────────────────── story += [H('TASK 20 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 39 weeks. Labor: Not in labor (cervix closed). Postpartum: No.'), S('Gravidity + Parity'), B('Age 20, nullipara (P0).'), S('Presentation, Lie, Position'), B('Lie: Longitudinal. Presentation: Face presentation — nose and lips palpable on VE (mentum presenting, not vertex). Head: Cephalic (but hyperextended = face). Station: Not stated.'), B('EFW: AC 99 × FH 38 = 3,762 g (Jordania). Cervix: 1.5 cm, soft, 2 cm dilated (partially ripened), central. FHR 136–138 bpm (normal).'), S('Maternal Complaints'), B('No complaints at this visit (routine).'), S('Diagnosis'), B('Diagnosis: 39 weeks, G?P0, longitudinal lie, face presentation (mentopresentation).'), B('Delivery plan: Face presentation — conduct depends on chin (mentum) position. Mento-anterior (chin toward symphysis): vaginal delivery possible — head delivers by flexion under symphysis. Mento-posterior (chin toward sacrum): vaginal delivery impossible (further extension blocked) → cesarean section mandatory. Assess chin position with US/VE. Continuous CTG in labor. If mento-anterior and adequate pelvis — trial of labor; if no progress or mento-posterior → CS.'), B('Complications of conservative management: Prolonged labor; obstructed labor; facial edema/trauma; cord prolapse; fetal distress; mento-posterior arrest requiring emergency CS.'), sp()] print("Tasks 1-20 written") PYEOF python3 /home/daytona/workspace/obgyn_answers/build_pdf.py

Running Command

cat >> /home/daytona/workspace/obgyn_answers/build_pdf.py << 'PYEOF' # ── TASK 21 ─────────────────────────────────────────────────────────────────── story += [H('TASK 21 — OBSTETRICS (Postpartum)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Postpartum: Day 3 after normal vaginal delivery, NB weight 3.5 kg.'), S('Gravidity + Parity'), B('Age 22, primipara (P1).'), S('Presentation, Lie, Position'), B('Not applicable (postpartum).'), S('Maternal Complaints'), B('Findings: Fundus 10 cm above pubis (normal day 3 — uterus involutes ~1 cm/day; at day 3 should be ~9–10 cm above pubis ✓). Uterus hard (well-contracted ✓). T 36.6 °C (normal). Lochia red (lochia rubra ✓ for day 3). Perineum intact/satisfactory. Breastfeeding normally. Breasts soft.'), S('Diagnosis'), B('Diagnosis: Normal early puerperium, day 3 post-vaginal delivery. No pathology.'), B('Classification of lochia: (1) Lochia rubra (red) — days 1–4: blood, decidua, vernix; (2) Lochia serosa (pink-brown, watery) — days 4–10: serum, leukocytes, old blood; (3) Lochia alba (yellowish-white) — days 10–6 weeks: leukocytes, mucus, epithelial cells.'), B('Colostrum vs. Mature milk: Colostrum (days 1–3): yellow, thick, high IgA, protein, fat-soluble vitamins, lower fat and lactose; Transitional milk (days 4–14): increasing lactose and fat, decreasing immunoglobulins; Mature milk (>2 weeks): white, watery foremilk → creamy hindmilk; higher fat, lactose, water; lower protein and IgA.'), sp()] # ── TASK 22 ─────────────────────────────────────────────────────────────────── story += [H('TASK 22 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Approximately 7–8 weeks (uterus enlarged 7–8 weeks on VE, amenorrhea 9 weeks). Labor/Postpartum: No.'), S('Gravidity + Parity'), B('Age 18, G1P0 (likely).'), S('Presentation, Lie, Position'), B('Too early for Leopold maneuvers.'), S('Maternal Complaints'), L('Menstrual Disorder:'), B('Amenorrhea 9 weeks.'), L('Nausea/Vomiting:'), B('Morning sickness — normal early pregnancy.'), B('VE: Uterus soft, enlarged to 7–8 weeks (consistent with pregnancy). Hegar sign (softening of isthmus) likely present.'), S('Diagnosis'), B('Diagnosis: Uterine pregnancy, approximately 7–8 weeks gestation.'), B('Investigations to confirm: (1) Urine β-hCG (positive); (2) Serum β-hCG (quantitative); (3) Transvaginal ultrasound — confirm intrauterine pregnancy, gestational sac, yolk sac, fetal pole, cardiac activity; (4) CBC, blood group, Rh factor.'), B('Classification of pregnancy symptoms: (1) Presumptive signs (subjective): amenorrhea, nausea/vomiting, breast tenderness, urinary frequency, fatigue, quickening; (2) Probable signs (objective — examiner finds): uterine enlargement, Hegar sign (isthmus softening), Chadwick sign (cervical/vaginal cyanosis), Goodell sign (cervical softening), ballottement, positive urine hCG; (3) Positive signs (definitive): fetal cardiac activity on Doppler/USS, fetal parts palpable, fetal movement felt by examiner, fetus seen on ultrasound.'), sp()] # ── TASK 23 ─────────────────────────────────────────────────────────────────── story += [H('TASK 23 — OBSTETRICS (3rd Stage Labor)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Labor: Total 9 hours, just delivered baby (3 kg boy). Now in 3rd stage of labor — placenta not yet delivered, 5 minutes post-delivery.'), S('Gravidity + Parity'), B('Age 22, primipara (P0→P1 now), weight 70 kg.'), S('Presentation, Lie, Position'), B('Baby delivered. Uterus palpable at umbilicus level (left of midline — sign of placental separation).'), S('Maternal Complaints'), B('Vitals: BP 110/70, HR 78 — hemodynamically stable. Uterus palpated left side of abdomen = Schroeder sign (positive — placenta separating).'), S('Diagnosis'), B('Diagnosis: 3rd stage of labor — placenta in process of separation. Uterus left-deviated (Schroeder sign) = placenta has separated and lying in lower segment.'), B('Physiological blood loss: 0.5% of body weight = 0.5% × 70 = 350 mL. Maximum acceptable: 1% body weight = 700 mL (or traditionally 500 mL for vaginal delivery). Blood loss >1000 mL = major PPH.'), B('Signs of placental separation: (1) Schroeder — uterus rises and deviates to right (fundus rises, becomes globular); (2) Alfled — cord lengthens at vulva; (3) Küstner — cord does not retract when suprapubic pressure applied (= separated); (4) Strassmann — cord transmission sign absent.'), B('Types of placental delivery (afterbirth): (1) Schultze mechanism (80%): placenta separates centrally, delivers fetal surface first (shiny), blood behind placenta; (2) Duncan mechanism (20%): separates from edge, slides out sideways, maternal surface first (rough), blood trickles alongside; (3) Managed active 3rd stage: Oxytocin 10 IU IM at delivery of anterior shoulder + controlled cord traction + uterine massage.'), sp()] # ── TASK 24 ─────────────────────────────────────────────────────────────────── story += [H('TASK 24 — OBSTETRICS (Pelvimetry)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Not specified (pregnant woman). Pelvimetry assessment.'), S('Gravidity + Parity'), B('Not specified.'), S('Presentation, Lie, Position'), B('Pelvis assessment.'), S('Pelvic Measurements'), B('Dist. interspinarum: 26 cm (normal ≥25 cm ✓). Dist. intercristarum: 28 cm (normal ≥28 cm ✓). Dist. intertrochanterica: 32 cm (normal ≥31 cm ✓). Conjugata externa (Baudelocque): 20.5 cm (normal ≥20 cm ✓). Wrist circumference (Soloviev index): 14 cm (normal ≤14 cm ✓ — thin bones).'), S('Answers'), B('1. Normal pelvis? YES — all measurements within normal range. Gynecoid pelvis, normal.'), B('2. Conjugata vera (true conjugate): Method 1 (from Baudelocque): C. vera = C. externa − 9 = 20.5 − 9 = 11.5 cm (normal ≥11 cm ✓). Method 2 (from Soloviev index): If wrist ≤14 cm → subtract 8 from externa: 20.5 − 9 = 11.5 cm. (If wrist ≥15 cm → subtract 10).'), B('3. Four methods to determine true conjugate: (1) From conjugata externa: C.vera = C.ext − 9 cm; (2) From conjugata diagonalis: C.vera = C.diag − 1.5 cm (if Soloviev ≤14) or − 2 cm (if Soloviev >14); (3) From lateral conjugate (with correction); (4) X-ray pelvimetry (pelvic radiograph — most accurate, now replaced by MRI); (5) MRI pelvimetry; (6) Ultrasound measurement.'), sp()] # ── TASK 25 ─────────────────────────────────────────────────────────────────── story += [H('TASK 25 — OBSTETRICS (Pelvimetry — Contracted)'), hr(), S('Pelvic Measurements'), B('Dist. interspinarum: 26 cm ✓. Dist. intercristarum: 29 cm ✓. Dist. intertrochanterica: 31 cm ✓. Conjugata externa: 18 cm (↓ — normal ≥20 cm). Wrist circumference: 14 cm. Conjugata diagonalis: 11 cm.'), S('Answers'), B('1. Conjugata vera: From C.diagonalis: C.vera = C.diag − 1.5 cm = 11 − 1.5 = 9.5 cm. Confirmation from externa: 18 − 9 = 9 cm (≈ consistent). True conjugate = 9.5 cm.'), B('2. Type of pelvis and degree of narrowing: Uniformly narrowed pelvis (flat/simple flat) — C.vera = 9.5 cm. Degree I narrowing: C.vera 9.0–10.9 cm (mild). Degree II: 7.5–8.9 cm. Degree III: 6.0–7.4 cm. Degree IV: <6 cm.'), B('3. Four types of pelvis (Caldwell-Moloy): (1) Gynecoid — round inlet, widest transverse diameter near center (most common, 50%; favorable for delivery); (2) Android — heart-shaped inlet, narrow anterior segment, convergent sidewalls (30% of women; poor prognosis); (3) Anthropoid — oval inlet elongated AP, wide posterior sagittal (25%; OP position common); (4) Platypelloid — flat oval inlet, reduced AP, wide transverse (rare, 3%; transverse arrest).'), sp()] # ── TASK 26 ─────────────────────────────────────────────────────────────────── story += [H('TASK 26 — OBSTETRICS (EDD Calculation)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Primigravida. LMP: Feb 18 – Feb 22. Cycle 28 days. First fetal movement: May 31.'), S('Answers'), B('1. Methods to calculate EDD (8 variants): (1) Naegele rule (LMP): LMP + 9 months + 7 days; (2) First fetal movement (primigravida + 20 weeks; multigravida + 22 weeks); (3) First antenatal visit (uterine size assessment); (4) Ultrasound biometry (crown-rump length in 1st trimester most accurate); (5) Bartholomew rule (uterine fundal height at defined weeks); (6) Ahlfeld sign (fetal movements begin); (7) Quickening + 20 weeks (primipara) or +22 weeks (multipara); (8) X-ray/MRI skeletal maturity (historical).'), B('2. EDD calculation: LMP Feb 18. Naegele: Feb 18 − 3 months + 7 days = Nov 18 + 7 = November 25. By first movement: May 31 + 20 weeks (primigravida) = Oct 19. Average ≈ late November 2019. Primary EDD by Naegele = 25 November 2019.'), B('3. Methods used to determine EDD: Naegele rule (most common); ultrasound (most accurate); fundal height measurement; first fetal movement; Bartholomew rule; clinical uterine size at first visit.'), sp()] # ── TASK 27 ─────────────────────────────────────────────────────────────────── story += [H('TASK 27 — OBSTETRICS (Fetal Weight + Blood Loss)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 38 weeks. Patient weight 80 kg. FH = 35 cm. AC = 102 cm.'), S('Gravidity + Parity'), B('G2P?, age 32.'), S('Answers'), B('1. Estimated fetal weight: Jordania formula: EFW = AC × FH = 102 × 35 = 3,570 g (≈3.6 kg). Johnson formula: EFW = (FH − n) × 155 where n=11 if head not engaged, n=12 if engaged = (35−11) × 155 = 24 × 155 = 3,720 g. Rankin formula: EFW = (AC × FH) / 1000 × some constant.'), B('2. Methods to determine fetal weight (3 methods): (1) Ultrasound biometry (BPD, HC, AC, FL — Hadlock formula; most accurate); (2) External measurement — Jordania formula: EFW = AC × FH; (3) Clinical — Johnson formula: EFW (g) = (FH in cm − 11/12) × 155.'), B('3. Estimated blood loss in labor: 0.5% × body weight = 0.005 × 80 = 400 mL (physiological). Maximum acceptable: 1% × 80 = 800 mL. PPH threshold: >500 mL vaginal delivery; >1000 mL cesarean.'), sp()] # ── TASK 28 ─────────────────────────────────────────────────────────────────── story += [H('TASK 28 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Calculation required. Labor: Active — admitted Feb 21, contractions 10–15 min × 20–25 sec, cervix 3–4 cm. Total labor 12 hours. Postpartum: No.'), S('Gravidity + Parity'), B('Primigravida. LMP June 14.'), S('Presentation, Lie, Position'), B('Presentation: Cephalic. Position: Left Occiput Anterior (LOA) — posterior fontanel near symphysis, anterior fontanel not palpable (well flexed). Station: 0 (engaged). Sagittal suture: Not specified in this task.'), S('Answers'), B('1. Gestational age: LMP June 14, admitted Feb 21. Months: June→July (1), July→Aug (2), Aug→Sep (3), Sep→Oct (4), Oct→Nov (5), Nov→Dec (6), Dec→Jan (7), Jan→Feb (8) = 8 months + 7 days. 8 months × ~4.3 weeks = 34.4 + ~1 = ~35–36 weeks. More precisely: June 14 to Feb 21 = 8 months 7 days = ~36 weeks.'), B('2. Diagnosis: G1P0, 36 weeks gestation. Active phase Stage 1 of labor. Cephalic presentation, LOA position, station 0. Contractions every 10–15 min (early active phase). Cervix 3–4 cm dilated, effaced, central. Total labor 12 hours (within normal for primigravida — latent phase included).'), B('3. Classification of delivery by gestational age: (1) Post-term (≥42 weeks); (2) Term (37–41+6 weeks); (3) Late preterm (34–36+6 weeks); (4) Moderate preterm (32–33+6 weeks); (5) Very preterm (28–31+6 weeks); (6) Extremely preterm (<28 weeks).'), sp()] # ── TASK 29 ─────────────────────────────────────────────────────────────────── story += [H('TASK 29 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 39 weeks. Labor: Active — contractions 5–6 min × 30–35 sec; cervix 4 cm, fully effaced; membranes absent (ruptured). Postpartum: No.'), S('Gravidity + Parity'), B('Age 26, G1P0 — first pregnancy.'), S('Presentation, Lie, Position'), B('Cervix absent (fully effaced) — presentation not specifically detailed in question.'), S('Answers'), B('1. Stage of labor: Cervix 4 cm, fully effaced, membranes ruptured, contractions 5–6 min: Stage 1, Active Phase (active phase begins at 6 cm per current WHO guidelines; by traditional criteria 4 cm = entry into active phase).'), B('2. Diagnosis: G1P0, 39 weeks. Stage 1 active phase of labor. Spontaneous rupture of membranes. Contractions regular every 5–6 min.'), B('3. Classification of rupture of membranes: (1) Timely (spontaneous) — occurs at full cervical dilation; (2) Early (premature rupture during labor) — occurs before full dilation but after onset of labor; (3) Antenatal/PROM — rupture before onset of labor at ≥37 weeks; (4) PPROM — preterm premature rupture of membranes (<37 weeks before labor onset); (5) High rupture — rupture above os, slow leak; (6) Artificial (amniotomy) — deliberately performed by clinician.'), sp()] # ── TASK 30 ─────────────────────────────────────────────────────────────────── story += [H('TASK 30 — OBSTETRICS (CTG Interpretation)'), hr(), S('Method Name'), B('Cardiotocography (CTG) — fetal heart rate monitoring (external or internal electronic fetal monitoring).'), S('Conclusion'), B('Without seeing the actual CTG strip, standard interpretation parameters are: Baseline FHR (normal 110–160 bpm); Variability (normal 5–25 bpm); Accelerations (normal: ≥2 accelerations of ≥15 bpm for ≥15 sec in 20 min = reactive); Decelerations (early = vagal, benign; variable = cord compression; late = uteroplacental insufficiency). A reactive NST is reassuring.'), B('Normal fetal heart rate: 110–160 beats per minute (average 130–140 bpm at term).'), sp()] # ── TASK 31 ─────────────────────────────────────────────────────────────────── story += [H('TASK 31 — OBSTETRICS (Ultrasound / Doppler)'), hr(), S('Method Name'), B('Obstetric Ultrasound (likely Doppler velocimetry of umbilical artery, or biophysical profile). The specific image from the task is not visible in text form, but based on context it may depict fetal biometry or Doppler waveforms.'), S('Why We Use This Method'), B('Obstetric ultrasound is used for: (1) Confirm pregnancy and gestational age; (2) Fetal number and viability; (3) Fetal biometry and growth; (4) Placental localization; (5) Amniotic fluid assessment; (6) Fetal anatomy scan; (7) Doppler assessment (umbilical artery, MCA, ductus venosus) for fetal wellbeing; (8) Cervical length; (9) Presentation and position.'), S('Conclusion'), B('Specific conclusion depends on the image provided. If Doppler waveform: assess S/D ratio, pulsatility index, resistance index of umbilical artery (normal RI <0.7 at term). If biometry: measure BPD, HC, AC, FL — compare to gestational age standards.'), sp()] # ── TASK 32 ─────────────────────────────────────────────────────────────────── story += [H('TASK 32 — OBSTETRICS (Postpartum)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Postpartum day 2. Normal spontaneous delivery. Now with fever and lower abdominal pain.'), S('Gravidity + Parity'), B('Age 27, G1P1.'), S('Presentation, Lie, Position'), B('Not applicable (postpartum).'), S('Maternal Complaints'), L('Pain:'), B('Lower abdominal pain (uterine tenderness).'), L('Discharge:'), B('Foul-smelling lochia — key sign of endometritis.'), B('Vitals: T 38.4 °C (fever), HR 100 (tachycardia), BP 110/70. Breasts soft (not mastitis). Lower abdominal tenderness.'), S('Diagnosis'), B('Diagnosis: Postpartum endometritis (postpartum uterine infection) — puerperal fever, foul lochia, uterine tenderness on day 2 postpartum.'), S('Extragenital Pathology'), B('None identified.'), B('Investigations: CBC (leukocytosis with left shift expected). Endometrial/cervical swab for culture and sensitivity. Blood cultures if sepsis suspected. Pelvic USS (retained placental tissue? uterine dehiscence?). Urine culture. CRP/ESR.'), B('Management: Broad-spectrum IV antibiotics: Ampicillin + Gentamicin + Metronidazole (triple regimen) OR Clindamycin + Gentamicin (standard). Switch to oral when afebrile >24 h. Continue breastfeeding (unless antibiotic contraindicated). Uterotonic agents (oxytocin, methylergometrine). If retained products on USS → D&C. If abscess → surgical drainage.'), sp()] # ── TASK 33 ─────────────────────────────────────────────────────────────────── story += [H('TASK 33 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Term (40 weeks). Labor: Onset of labor.'), S('Gravidity + Parity'), B('Age 20, primigravida.'), S('Presentation, Lie, Position'), B('EFW: 3.5 kg. Pelvimetry: 22–24–27–15 cm. Wrist index 14 cm.'), S('Pelvic Analysis'), B('Dist. interspinarum: 22 cm (↓ — normal 25–26 cm). Dist. intercristarum: 24 cm (↓ — normal 28–29 cm). Dist. intertrochanterica: 27 cm (↓ — normal 30–31 cm). Conjugata externa: 15 cm (↓↓ — normal 20–21 cm).'), B('C.vera: 15 − 9 = 6 cm (or from externa). This represents a critically narrow pelvis — degree IV narrowing (C.vera <6.5 cm = absolute indication for CS).'), S('Diagnosis'), B('Diagnosis: G1P0, 40 weeks, term, onset of labor. Uniformly narrowed pelvis, degree III–IV (C.vera ≈6 cm). EFW 3.5 kg. Absolute cephalopelvic disproportion.'), B('Management: CBC, coagulation, blood group, urinalysis, CTG, USS for presentation/position.'), B('Delivery mode: Emergency/planned Cesarean section — absolute indication. C.vera <7.5 cm is absolute indication for CS regardless of fetal size.'), sp()] # ── TASK 34 ─────────────────────────────────────────────────────────────────── story += [H('TASK 34 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 37 weeks. Labor/Postpartum: No.'), S('Gravidity + Parity'), B('Age 20, primigravida (G1P0).'), S('Presentation, Lie, Position'), B('Fetal heart sound present (viable).'), S('Maternal Complaints'), L('Pain:'), B('Convulsions at home (seizure episode) → now comatose.'), B('Vitals: BP 170/120 mmHg (severe hypertension), generalized edema, oliguria, proteinuria 0.3 g.'), S('Diagnosis'), B('Diagnosis: Eclampsia — convulsions + severe hypertension (170/120) + edema + proteinuria in a primigravida at 37 weeks. This is a life-threatening obstetric emergency.'), S('Extragenital Pathology'), B('Severe pre-eclampsia/eclampsia — gestational hypertensive disease.'), B('Investigations: ABC, GCS. CBC, LFTs, creatinine, uric acid, coagulation (DIC screen), blood glucose, electrolytes. Urine protein. CTG (fetal wellbeing). USS (biophysical profile, Doppler). CT head if seizures atypical or status.'), B('Treatment: (1) Airway/breathing/circulation — left lateral, O₂, IV access × 2; (2) MgSO₄ (anticonvulsant): loading 4–6 g IV over 15–20 min, maintenance 1–2 g/hr (monitor reflexes, RR, urine output); Calcium gluconate 1 g IV (MgSO₄ antidote); (3) Antihypertensives: IV labetalol (20 mg bolus) or hydralazine 5 mg IV to keep BP <160/110; (4) Deliver: After stabilization, plan urgent delivery — CS at 37 weeks. Corticosteroids if time permits; (5) ICU monitoring postpartum.'), sp()] # ── TASK 35 ─────────────────────────────────────────────────────────────────── story += [H('TASK 35 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 37 weeks. Labor: Not in labor. Postpartum: No.'), S('Gravidity + Parity'), B('G5P4 (5th pregnancy, 4 previous normal deliveries), age not specified.'), S('Presentation, Lie, Position'), B('Lie: Not specified. Presentation: Cephalic, but head is high above pelvic brim (not engaged despite multiparity at 37 weeks — highly suspicious). Uterus: Soft, non-tender.'), S('Maternal Complaints'), L('Vaginal Bleeding:'), B('Painless vaginal bleeding after intercourse at 37 weeks. No abdominal pain. Fetal movements felt.'), B('Vitals: HR 100 (mild tachycardia), BP 120/70. FHR 150/min (normal).'), S('Diagnosis'), B('Diagnosis: Placenta previa (most likely) — painless bleeding, high unengaged head, soft non-tender uterus in a Grand multipara (G5P4). Grand multiparity is a risk factor for placenta previa.'), S('Extragenital Pathology'), B('Grand multiparity (G5P4) — itself a risk factor for placenta previa, uterine atony, postpartum hemorrhage.'), B('Investigations: DO NOT perform vaginal examination until placenta previa excluded. Urgent transvaginal/transabdominal USS to locate placenta. CTG (fetal wellbeing). CBC, coagulation, crossmatch. Blood group + Rh factor. Maternal vitals continuously.'), B('Management: If confirmed placenta previa at 37 weeks with bleeding: admit, IV access, blood products available. If bleeding controlled and minor previa → expectant, corticosteroids already given (37 weeks — may defer). Planned CS at 37–38 weeks for major (central/partial) previa — DO NOT attempt vaginal delivery. If massive bleeding → emergency CS regardless of GA.'), sp()] # ── TASK 36 ─────────────────────────────────────────────────────────────────── story += [H('TASK 36 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: Term. Labor: 10 hours, Stage 2 (fully dilated) for 3 hours — arrested 2nd stage.'), S('Gravidity + Parity'), B('Age 20, primigravida.'), S('Presentation, Lie, Position'), B('Presentation: Cephalic. Station: -3 (head not descending despite full dilation). No descent in 3 hours. Poor application of presenting part.'), S('Maternal Complaints'), L('Pain:'), B('Strong contractions (4 in 10 min × 50 sec) — adequate.'), B('Other: Urinary retention ×2 hours (bladder distension — obstructed). FHR 148/min (reassuring).'), S('Diagnosis'), B('Diagnosis: Obstructed labor / Cephalopelvic disproportion — 2nd stage arrest. Head at -3 station despite full dilation and adequate contractions × 3 hours. Urinary retention from bladder compression.'), S('Extragenital Pathology'), B('None stated.'), B('Investigations: Assessment of Vasten sign (positive if head above symphysis on pressing = disproportion). Pelvimetry. USS fetal position. CBC, coagulation. Catheterize bladder.'), B('Management: Catheterization of bladder immediately. Assess Vasten sign — if positive: emergency Cesarean section. If head at 0/+1 station and near delivery: consider trial of instrumental delivery (vacuum/forceps) only if prerequisites met. Given head at −3 = CS is mandatory. Start IV fluids, prepare for CS, consent, theater alert.'), sp()] # ── TASK 37 ─────────────────────────────────────────────────────────────────── story += [H('TASK 37 — OBSTETRICS (3rd Stage)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Labor: 3rd stage — 30 min after delivery of baby, placenta has NOT separated, NO bleeding.'), S('Gravidity + Parity'), B('Age 30, multiparous.'), S('Diagnosis'), B('Diagnosis: Retained placenta — placenta in situ 30 minutes after delivery without separation or bleeding. (Distinguish from placenta accreta spectrum — accreta implies invasion; retained = mechanical retention without invasion until proven otherwise.)'), S('Extragenital Pathology'), B('Multiparity — risk for placental adhesion disorders.'), B('Investigations: Assess signs of separation (Schroeder, Alfled, Küstner). Check bladder distension (distended bladder prevents descent). Vitals. CBC, coagulation. USS if available (retained products, accreta).'), B('Management: (1) Catheterize bladder; (2) Attempt controlled cord traction with uterine support (Brandt-Andrews maneuver) after ensuring separation signs; (3) If no separation: Oxytocin 10 IU IV bolus + controlled cord traction; (4) If still retained after 30 min and signs of separation present → Brandt-Andrews or Crede maneuver; (5) If no signs of separation at 30 min → Manual removal of placenta under general/spinal anesthesia; (6) IV antibiotics prophylactically; (7) Oxytocin infusion post-removal; (8) Examine placenta for completeness.'), sp()] # ── TASK 38 ─────────────────────────────────────────────────────────────────── story += [H('TASK 38 — OBSTETRICS (Postpartum)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Postpartum day 5. Pain in left breast + fever.'), S('Gravidity + Parity'), B('Age 22, P1.'), S('Maternal Complaints'), L('Pain:'), B('Left breast pain.'), B('Vitals: T 38.2 °C. Left breast: engorged, swollen, tender on palpation.'), S('Diagnosis'), B('Diagnosis: Puerperal mastitis (postpartum mastitis) — left breast, non-infective or early infective stage (day 5). If localized fluctuant mass: breast abscess.'), S('Extragenital Pathology'), B('None stated.'), B('Investigations: Breast USS (abscess vs. mastitis). Breast milk culture (identify organism — usually Staph aureus). CBC. Blood culture if systemically unwell.'), B('Management: Continue breastfeeding / pumping from affected breast (key — prevents progression). Warm compresses + massage. Adequate fluid intake + rest. Antibiotics: Flucloxacillin 500 mg QID × 10–14 days (covers Staph aureus) or Cephalexin / Clindamycin (penicillin allergy). If no improvement in 48 h → USS to exclude abscess. Abscess: Incision and drainage or USS-guided aspiration + antibiotics; may need to temporarily suspend breastfeeding from affected side.'), sp()] # ── TASK 39 ─────────────────────────────────────────────────────────────────── story += [H('TASK 39 — OBSTETRICS'), hr(), S('Pregnancy / Labor / Postpartum'), B('Pregnancy: 37 weeks. Labor: Not in labor. Postpartum: No.'), S('Gravidity + Parity'), B('Age 19, primigravida (G1P0).'), S('Presentation, Lie, Position'), B('Uterus hypertonic + tender (boardlike uterus — characteristic of abruption). FHR 90/min (fetal bradycardia — distress).'), S('Maternal Complaints'), L('Pain:'), B('Lower abdominal pain (severe, constant — not colicky like labor).'), L('Vaginal Bleeding:'), B('Vaginal bleeding at 37 weeks.'), B('Vitals: HR 100 (maternal tachycardia), BP 100/60 (hypotension — hemorrhagic shock). Weakness, dizziness.'), S('Diagnosis'), B('Diagnosis: Placental abruption (abruptio placentae) — painful bleeding, hypertonic uterus, fetal bradycardia, maternal shock at 37 weeks.'), S('Extragenital Pathology'), B('Hemodynamic compromise (hemorrhagic shock class II).'), B('Investigations: Large bore IV × 2. CBC, coagulation (DIC screen — fibrinogen, PT, APTT, FDP). Crossmatch 4 units. CTG (confirm fetal distress). Kleihauer-Betke if Rh negative. USS (retroplacental clot — may be normal in severe abruption).'), B('Management: Emergency Cesarean section — maternal shock + fetal bradycardia = immediate delivery. IV crystalloid/colloid resuscitation. Blood transfusion. Treat DIC if present (FFP, cryoprecipitate, platelets). Neonatologist attendance at delivery. ICU postoperatively.'), sp()] # ── TASK 40 ─────────────────────────────────────────────────────────────────── story += [H('TASK 40 — OBSTETRICS (Placenta Accreta)'), hr(), S('Pregnancy / Labor / Postpartum'), B('Labor: 3rd stage. Manual removal attempted — placenta firmly adherent, cannot be separated. No bleeding (dry accreta).'), S('Gravidity + Parity'), B('Age 30, multiparous.'), S('Diagnosis'), B('Diagnosis: Placenta accreta (accreta vera) — abnormal placental implantation without decidua basalis; villi attach directly to myometrium. Manual removal impossible. No bleeding (typical of true accreta — no separation plane).'), B('Spectrum: Accreta (superficial, 75%); Increta (into myometrium, 15%); Percreta (through myometrium into serosa/bladder, 10%).'), S('Extragenital Pathology'), B('Multiparity — risk factor for accreta.'), B('Investigations: USS (intraoperative — placental lakes, absent retroplacental clear zone). Coagulation (DIC risk). CBC, crossmatch emergency.'), B('Management: Hysterectomy is definitive treatment for placenta accreta when manual removal fails (bleeding or no bleeding). Steps: Stop attempting manual removal. Call senior obstetrician + anesthetist + blood bank. IV access × 2, crossmatch. Decision: (1) If hemostasis maintained and wishes future fertility → leave placenta in situ + methotrexate protocol (conservative management — rare, high complication rate); (2) Total/subtotal hysterectomy — standard of care. Blood products + ICU postoperatively.'), sp()] print("Tasks 21-40 written") PYEOF python3 /home/daytona/workspace/obgyn_answers/build_pdf.py

Running Command

rm -f /home/daytona/workspace/obgyn_answers/build_pdf.py && ls /home/daytona/workspace/obgyn_answers/

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