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Clinical OSCE
for medical undergraduates
Obstetrics and Gynaecology
Yapa Wijeratne
Faculty of Medicine
University of Peradeniya
Q1
1. Identify A-G
2. Write the corresponding letters in
order of most effective method to
least effective method
A Female condom
B Levonorgestrel releasing intra uterine contraceptive
device (Mirena)
C Copper T-380 A intrauterine contraceptive device
D - Depot medroxy progesterone acetate injectable
suspension
E Norplant subdermal contraceptive implant system
F Combined oral contraceptive pill
G- Male condoms
E>B>F=D>C>G>A
% of women experiencing an
unintended pregnancy within the
first year of use
Method
Typical use1
Perfect use2
No method4
85
85
Withdrawal
27
Periodic abstinence
Calendar
Ovulation method
Sympto-thermal6
Post-ovulation
25
Condom - Female
9
3
2
1
21
15
0.3
0.3
0.8
0.6
0.1
0.1
0.05
0.05
0.5
0.5
0.15
0.10
Condom - Male
Combined pill and minipill
DMPA (Depo-Provera)
IUD (copper T)
Female sterilization
Male sterilization
6
5
3
3
Q2
A) 21 yrs old unmarried girl presents to your clinic after having
unprotected sex last night. What method/s that you can use in
this patient as post-coital contraceptive method/s.
B) A 35 yrs old healthy woman with two children aged 3 & 5 yrs
requests an emergency contraceptive after unplanned coitus 4 days
ago. Name a method that you would offer to this woman.
A.
1 Postinor2
take one tab immediately and the second tablet 12 hrs later
2 Combined oral contraceptive pill
Take 4 tablets immediately and repeat the same dose 12 hrs
later
B.
Copper T 380-A intrauterine contraceptive device
A copper-releasing IUD (Cu-IUD) can be used within 5 days
of unprotected intercourse as an emergency contraceptive.
However, when the time of ovulation can be estimated, the
Cu-IUD can be inserted beyond 5 days after intercourse, if
necessary, as long as the insertion does not occur more than
5 days after ovulation.
Q3
1. How long can it be used
2. List 2 advices you would
give after inserting this to
a patient
3. What should you do if a
woman gets pregnant
after placing it
1.
2.
10 years (6-8)
Expect some bleeding PV for a few days
Check for the presence of the threads (Specially during
menstruation period)
First 3-4 menstrual periods may be heavier than normal
Take paracetamol tablets if she develops lower abdominal pain.
Follow up In one month and thereafter annually
Prompt medical advice should be taken if
- the threads are not felt
- delayed menstrual period (Pregnancy?)
- Severe abdominal pain Prolonged or excessive bleeding
3. Cu-T Pregnant
Exclude ectopic
Counsel regarding risks
Miscarriage
Preterm delivery
Infection
Remove if threads +
Advise prompt return for Rx of complications (Bleeding,
pain, discharge, fever etc)
If threads Neg.
- US Scan - identify in utero
- counsel
- check at delivery
- check Post partum - X Ray
Timing of insertion
1st seven days of the cycle (Ideal during menstruation)
Removal of IUD
pregnancy
Perforation
Acute PID
Menopause one year after last period
Absolute contraindications
Pregnancy
Acute/Chronic PID
Abnormal uterine bleeding
Suspected/confirmed genital tract malignancy
Q4
1)
A - Levonorgestrel
B Male condom
C Combined oral contraceptive pills
2)
A-
Improves menorrhagia
Decrease dysmenorrhoea and pelvic pain in patients with endometriosis
Missed
pills
Q5
1. What is the
advice you would
give to the
patient when
prescribing this
2. List 3 Common
side effects
Advice
Q6
Mother giving breast milk to child,
looking far away
1. List 2 correct techniques when
breast feeding
2. List 2 maternal complications due to
incorrect technique of breast
feeding
Correct technique:
) Maternal complications:
a) Cracked nipples
b) Breast abcess
Q7
How do you prepare a patient for
LSCS
What are the complications of LSCS
Consent
Complications of LSCS
Anaesthetic Gastric acid aspiration
( Mendelsons synd)
Immediate- PPH, shock, damage to
bladder, ureters or colon
Early- Sepsis, Wound complications
(Haematoma, dehiscence)
Late- risk of scar rupture in future
pregnancies, incisional hernia, intestinal
obstruction due to adhesions
Q8
Give 4 risk factors from this antenatal record (Two slides)
Short stature
Previous death in-utero
Previous miscarriages
Blood pressure of 160/110
Proteinuria
Grand multi para
Q9
Plasters
14G IV cannula
Vacuum cup
A pair of gloves
Cuscos speculum
IV drip set
Vulsellum
IV metronidazole
10
Betadine
Plasters
14G IV cannula
Vacuum cup
A pair of gloves
Cuscos speculum
IV drip set
Vulsellum
IV metronidazole
10
Betadine
Q10
1. Identify/name
the instrument
2. Write 2 uses
1.
2.
. In obtaining a Pap smear
. In obtaining a high vaginal swab
. To visualize the cervix & vaginal wall in
pelvic examination
. Insertion /removal of IUCD
Q11
1. What
do you
see
2. Write 2
causes
1. Secondary arrest
2. CPD
OP position
Inadequate uterine contractions
Mx:
CPD Em LSCS
OP position
Inadequate uterine contractions
Exclude obstruction
Increase oxytocin infusion rate
Observe and if no progression
Em LSCS
Oxytocin
Augmentation of labour.
Active Mx of 3rd stage labour & control PPH.
Following evacuation of uterus.
Mg sulphate
As eclampsia prophylaxis.
Hydralazine
In Pre-eclampsia and eclampsia.
Ergometrine
Prophylaxis against excess heamorrhage foll. delivery
Therapeutic- In PPH: atonic uterine bleeding.
In atonic uterine bleeding foll. Miscarriage, expulsion of H.
mole.
Q 13
Counsel this 30 yrs old patient who is
diagnosed to have an incomplete
miscarriage
Q 14
Ask 5 leading questions to determine
the severity of this patients
condition who has a blood pressure of
160/100 mmHg
Q 15
Write the
names
of the 5
abnormalities
you see.
Normozoospermia
Oligozoospermia
Asthenozoospermia
Teratozoospermia
Oligoasthenoteratozoospermia
Azoospermia
Aspermia
No ejaculate.
Leukocytospermia
Normal values
Volume
2.0 ml or more
pH
7.2-7.8
Sperm concentration
Motility
Morphology
Vitality
Q16
What is the advise you would give
regarding obtaining a semen sample
for analysis
Q17
1.
2.
Identify
List 3 prerequisites in using these instruments
3.
Wrigleys Forceps
Ruptured membranes.
Q18
1.
1.
2.
Q19
Complications of episiotomy
Immediate-
Vulval haematoma
Infection
Wound dehiscence
Late
Dyspareunia
Q20
1. D&C :
.
.
.
.
.
.
.
.
.
.
Performed under GA
Placed in lithotomy position
Local antiseptic cleaning & draping
Empty bladder: using a metal catheter
Sims double bladed posterior vaginal speculum is
introduced
Anterior lip of cervix held by vulsellum
Olive pointed malleable graduated metallic uterine
sound to confirm position & length of cavity
Cervical canal dilated with Hegars graduated dilators
Uterine curette sharp end for benign lesions and
blunt end used for suspected malignant lesions
Curetted material preserved in 10% formal saline and
sent to histology lab with a short clinical history.
Q21
What are the instruments found in a
delivery set.
Q 22
Name following diameters
Q 23 Identify following
cervical cerclage techniques
A
Shirodkar technique
Q25
1
1.
2.
Identify
Name which one you would use in the following
procedures
To insert an IUCD
In vaginal hysterectomy
In D&C
In obtaining a pap smear
Repair of a cervical tear
Q26
Complications
Inter-menstrual bleeding
Pelvic inflammatory disease
Expulsion (1st 3 months)
Perforation
Q27
1. Identify
2. List an indication and a
contraindication
Q28
Advise to mother:
Q29
A) What is the
condition
B) What is the
diagnosis
C) Give 2 causes
Presentation
2. Passage of vesicular
grape like structures per
vaginum
1. Vaginal bleeding
3. Hyperemesis
4. Early onset PIH
Examination findings
5. Anaemia
6. F>D
Investigations
7. USS abd.
8. S. hCG
9. CXR
Management
10.Evacuation
11. Follow up (2 yrs)- hCG
assays
12.Contraception
13.Chemotherapy +/-
1.
2.
3.
a.
b.
c.
d.
e.
Q30
2 days
Note: