Transcript pic trans

MiniOSCE Obs/Gyne C Group
6th year Hope Group
All the answers are suggested answers and are by no means at all
confirmed by any authority relating to the faculty or Obs/Gyne
Department.
Q1.
• A 23 year old female G2P1. P1 she had severe pre-eclampsia. Now she
is 20 weeks and there is no fetal heart for last 4 weeks
1. Name 2 serious complications because of the delay of her diagnosis
2. What is the best treatment option
3. What is the investigation you order to determine the cause of this
miscarriage
1. A. Disseminated intravascular coagulation (DIC)
B. Infection (Septic abortion)
2. Medical termination by misoprostol (cytotec)
3. Coagulation profile and antiphospholipid antibodies? (i.e Lupus
anticoagulant, beta-2-glycoprotein and anticardiolipin antibody)
Q2.
• 23 year old female G3P2 with history of 2 LSCS patient 33 weeks GA with
central placenta previa presented complaining of mild vaginal bleeding.
She is now stable, fetus is well and is receiving fluids
1. Mention 3 steps in her initial management
2. Mention two risks that you should counsel her about
Answer
1A. CBC and cross-match 2 units of blood
B. Dexamethasone (or betamethasone) administration
C. Plan for caesarean section
2A. Risks of prematurity
B. Possible risk of hysterectomy if bleeding is uncontrollable
Other suggested answers:
-Risks of uterine rupture if she goes into labor
Q3.
• A 30 year old female P2+0 presented complaining of chronic pelvic pain.
An initial ultrasound assessment and pelvic exam is normal
1. Mention two other problems you would like to ask about in the history
relating to her condition
2. Mention the best diagnostic investigation for this patient
3. Mention one complication for this investigation
Answers:
1. A. Secondary dysmenorrhea B. Dyspareunia, vaginal discharge
Other possible answers: details of her menstrual cycles, type of any
contraception method used, if her 2 previous pregnancies were
spontaneous or assisted …
2. Laparoscopy
3. Injury of surrounding organs during the procedure such as the ureters
Q4.
• A 65 year old female presented complaining
of vaginal bleeding. Her US findings are seen
below (Image of US with 15 mm thickened
endometrium that was written on the pic)
1. Name the most serious cause for her
condition
2. Name 2 investigations related to her
condition (other than ultrasound)
3. Name the most common cause for her
condition
Answers:
1. Endometrial cancer
2. A. Hysteroscopic guided endometrial biopsy (or just endometrial biopsy)
B. Pap smear
3. Atrophic changes (vaginitis or endometritis)
Q5.
1. Name the active ingredient in this device
2. Name the 2 most common side effects
after initial use you should tell the patient
about ?
3. If the patient comes complaining of
amenorrhea for 2 weeks, name 2 initial
tests that you would order
1. Copper
2. A. Breakthrough bleeding
B. ??
Suggestions were: Increased risk of PID, increased risk of ectopic pregnancy
if device fails, menorrhagia
3. A. Pregnancy test (beta-hCG level)
B. Ultrasound
Q6. 30 year old patient G2P1, 32 weeks pregnant, sure date, presented
complaining of a gush of fluid. Patient isn’t in labor. She was diagnosed
with premature preterm rupture of membranes (PPROM) and was
admitted.
1. Mention 2 indications for immediate delivery in this patient
2. Mention 2 medications that you will administer to her
1. A. Chorioamnionitis B. Fetal distress
Others: cord prolapse, placental abruption …
2. A. Betamethasone/dexamethasone B. Antibiotics
I think tocolytic is a wrong answer
Q7. A 27 year old pregnant female at 39 weeks presents where routine
ultrasound shows a fetus with a fetal weight greater than the 90th
percentile and AFI is 32. Her dates are sure.
1. Mention the most common cause of her current condition
2. Mention the best investigation to confirm the diagnosis
3. Mention 2 intrapartum fetal complications of her condition
1. Gestational Diabetes Mellitus
2. Oral glucose tolerance test (OGTT)
3. A. Cord prolapse
B. Shoulder dystocia and obstructed labor
Q8. A 20 year old female presented complaining of oligomenorrhea, hirsutism
and acne and has the following appearance on her ultrasound
1. Name the condition causing her symptoms
2. Mention 2 investigations that will confirm
this condition’s diagnosis
3. Mention one long term gyneacological
complication of this condition
4. Mention one long term non-gyneacological
complication of this condition
1. Polycystic ovarian syndrome (PCOS)
2. A. LH and FSH levels (LH:FSH ratio >3:1 expected)
B. Serum androgen levels (e.g. serum testosterone levels)
3. Endometrial cancer
4. Type II diabetes mellitus
Alternative answer: Metabolic syndrome
Q9.
1. Name the maneuvers in the images
2. Name 2 fetal complications of shoulder dystocia
1. A. McRoberts maneuver
B. Rubin I (suprapubic pressure)
C. All fours/Gaskin maneuver
2. A. Asphyxia B. Birth trauma (e.g. Erb-duchenne’s palsy)
Q10. A 20 year old primigravid presented
at term to the hospital in labor and her
partogram is shown below
(This isn’t identical to the partogram in the
exam but is very similar)
1. Is the fetus engaged at admission?
2. Comment on the progress of labor
3. What is the most common cause of her
condition
4. Mention one finding seen on vaginal
exam related to your diagnosis
5. What is your management for her
condition
1. No (descent of head was 4)
2. Prolonged active phase first stage of labor? versus arrest of the active
phase first stage of labor? (Arrest is probably the answer)
3. CPD (cephalopelvic disproportion)
4. Fetus station above 0 and non-fully dilated cervix
5. Delivery by emergency C/S
OSCE Hope Group C
Obs/Gyne
Station 1
• This is a 27 year old female P1 has been trying to conceive for 3 years now
and is unable to do so. Her husband is healthy. She is in good health and
her pelvic ultrasound is normal.
a. Mention two further initial investigations that you will do
Answer: Semen Analysis and assessment of tubal patency (using HSG or
laparoscopy)
b. Mention two advantages of laparoscopy over HSG
Answer: 1. Therapeutic interventions can be carried out 2. More sensitive
investigation
c. Mention two pathologies that can be treated with laparoscopy
Answer: 1. Adhesions by adhesolysis 2. Hydrosalpinx by salpingectomy
Station 1 (Continued)
d. Her is the male’s semen analysis
Count: 0.5 ml
Morphology: 50%
Motility: 35%
Volume: 3 ml
What is your interpretation?
Answer: Low sperm count, other values are normal
e. What is the finding in the semen analysis called?
Answer: Oligospermia
f. What is your management for this couple
Answer: In Vitro Fertilization (IVF)
g. What are complications of IVF?
Answer: Multiple gestations, OHSS (ovarian hyperstimulation syndrome)
Station 2
• This is a 25 year old who had 12 weeks of amenorrhea presents complaining of vaginal bleeding
and abdominal pain for few hours. On examination her uterus is 16 weeks in size and she reports
frequent nausea and vomiting
a. Mention two causes for her current presentation
Answer: Molar pregnancy or multiple gestations
b. Mention an investigation to confirm your diagnosis. What do you expect the result to be if the
patient has a molar pregnancy
Answer: beta-hCG. It would be very highly elevated if the patient has a complete mole
c. Mention 3 steps in the management of the patient
Answer: Suction evacuation followed by gentle sharp curettage, serial beta-hCG testing and
contraception
d. Mention the karyotype of the molar pregnancy in this patient
Answer: Possibly 46 XX if complete mole. 96 XXY if partial mole
*Other variants exist but answering those in my station granted me the required marks
Station 3
• This is a 40 year old patient with G3P2, P2 by lower segment cesarean
section who presented for elective cesarean at 38 weeks of GA. Counsel
her about the complications of her operation
-Mentioned a few intra-operative complications (Intraoperative bleeding,
risk of nearby organ injury and risk of fetal injury, hypotension in cases of
spinal anesthesia)
-Mentioned a few post-operative complications (can be found in the
lectures)
-What would you do to prevent DVT in this patient?
Answer: Early mobilization after surgery, administer LMWH*
*This is low risk according to the Caprini score where recommendation is to
go with mechanical prophylaxis rather than anticoagulating with LMWH.Uptodate. I am not sure what the answer the department wanted was.
Station 4
• This is a 24 year old female, 38 weeks pregnant presented complaining of
sudden gush of watery vaginal discharge with no abdominal pain.
1. Do an obstetric examination (findings included a transverse lie fetus
which was very easy to spot)
2. What would you do now?
Vaginal speculum examination to confirm ROM. If not confirmed go for HVS
(high vaginal swab)
3. The patient has confirmed ROM,what would you monitor in this patient?
-CTG for fetal wellbeing, maternal well being assessed through vital signs
4. A couple of other questions I can’t remember
Q1
• This CTG for Female pt. presented with abdominal
pain, 2cm dilation and ruptured membrane.
1) Give two abnormality in the CTG:
2) What’s the underlying pathology:
3) If the condition become worse what is the next
step:
1) Late deceleration, poor variability, tachycardia
2) Uteroplacental insufficiency , also umbilical
cord compression accepted !
3) Immediate delivery … fully we can use
instrument
… not fully go for C/S
Q2
• Lady with twins pregnancy presented with Hb.9g/dl.
1)What the most common type this condition:
2)What is the possible causes:
3)Two line of management:
1) Iron deficiency anemia
2) a-Increase the demand,
b-poor nutrition,
c- heamodilution
3) a- Oral iron supplementation
b- Diet
Q3
• According to the picture.
1)what’s the type of twins:
2)Two late pregnancy complication:
3)What’s the cause of the primary PPH:
1) Dichorionic Diamniotic twins
2) a- preterm labor
b- PROM
3) Uterine atony
Q4
• P2 deliver vaginally and after 10 days she presented
with excessive vaginal bleeding.
1)what’s the Dx:
2)What’s the underlying cause:
3)How you confirm the Dx:
4)Two specific line of management rather than
stabilization:
1) Secondary PPH
2) Retain product of conception
3) US
4) a- D/C
b- antibiotics
Q5
• This picture in 40 yo lady after doing hysterectomy for
sever menorrhagia .
1)what’s the cause:
2)Two other investigation before doing hysterectomy:
3)Do we remove the ovary routinely in such case:
1) Fibroid
2) a- Endometrial biopsy
b- pap smear
3) No need.
Q6
• 35 years old female medically free complaining from
amenorrhea for 2 years.
1)what’s the cause:
2)What’s the most serious complication of this
condition:
3)How you will treat her condition:
1) Premature ovarian failure
2) Osteoporosis
3) a- HRT
b- Ca and vitamin D
Q7
• This was found during the laparoscopy investigating
infertile female.
1)what’s the most likely Dx.:
2)Other investigation that can be done during this:
3)One symptom the pt. may come complains of:
4)Two medical management:
1) Endometriosis
2) Methyline blue dye test for tubal
patency
3) Secondary dysmenorrhea and any
thing …
4) a- continuous combined OCP
b- GnRH analoge
Q8
• Female pt. complains of white thick vaginal
discharge, itching and erethema with this result of
the wet mount test.
1)what’s the cause:
2)How to confirm it:
3)How to treat:
4)Two risk factor:
1) Candida albican
2) Culture
3) Local antifungal
4) a- DM
b steroid use ….
Q9
• Young pt. presented with vaginal bleeding at 7 week
amenorrhea with BhCG =1400 and by trans vaginal US
the uterus is empty.
1) what’s your DDx.:
After 3 days she still stable with BhCG of 2100 and
empty uterus.
2) How to treat:
1) a- early pregnancy
b- ectopic pregnancy
2) Methotrexat or surgery
Q10
• Rh –ve lady married to Rh +ve male come at 14
weeks gestation with vagianal bleeding that has
bees stopped.
1)Two specific thing in the
management:
2)Fetal complication in the next
pregnancy if not treated well now:
1) a- Anti D
b- Indirect coombs test
2) a- fetal hydrobs
b- fetal anemia
c- IUFD
‫مالحظه‪:‬‬
‫مش هذا هو النص الحرفي بس هذا هو المضمون !!! ‪OSCE‬بالنسبه السئلة ال‬
‫‪station #3‬يعني االسئله ما كانت هالقد واضحه ومفهومه وخاصه‬
Station #1
• 45 years old female, p5, completed her family doing
pap-smear for her abnormal vaginal bleeding 3
weeks ago and comes now to the clinic with this
report …
Conventional pap-smear
Adequate
HSIL “high grade sequamous intraepithelial lesion”
* Then the doctor start to ask the following questions
…
1) What do we mean by adequacy? The smear contain
two type of cell (sequamous and columnar).
2) Other type for pap-smear? Liquid based pap-smear
3) What’s the cause for this lesion? HPV (16-18)
4) What’s the next step in this patient? Immediate
colposcopy+biopsy with or without ECC.
5) On colposcopy we see mosacim and punctuation what
stage of disease this? CIN III and more.
6) How we prevent this condition? By HPV vaccine
(bivalent and quadrevalent) given at age 12-29 years 3
doses IM injection.
7) How to manage? By excision or total abdominal
hysterectomy since she complete her family.
Station #2
• 35 primigravida come to the ANC at GA 12 weeks with
BP of 151/95 with nothing remarkable.
1) what’s your Dx.? Chronic HTN
2) What to do other than the routine investigation?
Order internal consultation (my doctor just want me to
say this)
3) At 32 GA BP=150/90 and protein +1 what’s your Dx.?
Chronic HTN superimposed with PET.
4) What to do? Stabilize the pt, give steroid, PET profile,
24 hrs urine collection.
5) How to treat this pt during pregnancy? Methyl dopa
6) At 36 weeks GA BP=150/95 ,with symptom what’s your
Dx? Sever PET
7) What to do? Stabilization, anti HTN, MgSo4
prophylaxis, immediate delivery.
Station #3
• P1 lactating come to your clinic asking for mini pillis …
1) Tell the pt how to use: given every 28 days without free
period
2) Side effect: vaginal spotting, functional ovarian cyst,
acne, hirsutism, breast tenderness.
3) Tell the pt about pregnancy after stopping the pillis: she
can get pregnant immediately after stopping the pillis
without having period of amenorrhea.
4) What do we afraid of if she get pregnant while she is
using the pillis: ectopic pregnancy
5) Tell the pt about missing pillis: same as missing
compined pillis BUT with 3 hrs instead of 12 hrs
6) Failure rate: 2-3%
Station #4
• Examination station … as usual
1) what’s your comment after the examination?
Singleton
Breech
Longitudinal
Back to the left
Not engaged
2) When we do ECV? At term >37 weeks
3) what’s the complication of ECV? Preterm labor, PROM,
cord compression, failure.
4) If Fetal distress on CTG what to do? Emergent C/S