OSCE Preparation

Ob-Gyn
 Station No 1

o A 23 year old pt. refers to you d/t

infertility
Station No 1 History

o Diseases ? o No
o Surgery ? o Appendectomy
o Family dis ? o Mother w. graves dis
o Drugs ? o No
o Sensitivity ? o No
o Alcohol ? o No
o Smoking ? o 1-5 cigarettes/day
o Occupation ? o Advocate
Station No 1 History
o 1st mensturation ? o 14 y
o Menses ? Formula? o 28-30/3-5
o Pregnancies ? o G1P0A1 , AA
o Contraception ? o OCs for 5 years
o Dysmenorrhea ? o Yes (NSAIDs)
o Dypareunia ? o Yes
o When ?, How? o Always, deep pen.
o Glactorrhea ? o No
o PID/STD ? o No
Station No 1 Physical Exam
o General ? o NA
o BMI ? o 23
o Thyroid o NA
o Breast o Tanner 4, NA
o PV/PS ? o Normal size uterus,
o PR ? Tender, immobile, lt
enlarged ovary with
a cyst 3-4 cm.
Station No 1 What Next ?

o TVS ?
o Hormonal Panel ?
o When ? What ?
o SA ?
o HSG ?
o Endometrial biopsy ?
o Imaging ?
Station No 1 TVS
Station No 1 Hormonal
Panel
Day 3
E2 84 pmol/l

P 0.9 nmol/l

LH 2.2 IU/l

FSH 4.6 IU/l

Prolactin 220 mIU/l

TSH 0.9 mIU/l

17-OH-P 2.4 nmol/l

DHEAS 3.2 mmol/l

Testosterone 1.1 n/l

Station No 1 Sperm
Analysis
Volume 3.2 cc

PH 8.1

Viscosity Normal

Concentration 25 x 10^6

Progress motility at 1 hr 55%

Morphology (Kruger) 12%

WBC No
Station No 1 HSG

o Normal cervical canal

o Normal uterine cavity
o Rt. & lt. tubes: slow passage
and distribution
Station No 1 MRI
Station No 1 MRI
Station No 1 What Next ?

o Laparoscopy
Station No 1 Questions
o What is the reasonable o Endometriosis
diagnisis ?
o OC, danazol, GNRH-a,
o Name 3 Tx options ? lesion removal,
adhesiolysis, hysterectomy,
nerve ablation

o How is best to achieve o Ovulation induction/IVF

pregnancy ?

o What to do with endometrioma o Removed surgically

?
Questions and /or comments
Station No 3

o A 42 yo, mother to 2 children arrived

at 26 weeks of her 6th pregnancy d/t
vag. bleeding and suspected PROM
Station No 3 - History

o General: healthy, no operations, no tx,

no surgeries, no family history
o Smoker ( 10 py )
Station No 3 - History
o Previous pregnancy ? o G6P2, AA-1, SA-2
o LMP o Matching
o Previous deliveries ? o p/s X 2, Term
o Current pregnancy ? o Normal , CVS at 11
weeks, admission at
19 weeks d/t mild
vag. bleeding.
o 2nd level US -
normal
Station No 3 - Physical Exam

o Vitals o 120/70, 73, 370

o Abdomen o NA, FH 26
o Uterus o Soft , not tender
o ps/pv o NA
o Susp PROM ?
Station No 3 - What next ?

o NST
Station No 3 - What next ?

o TAS
o Oligohydramnions
o Breech
o Post. Placenta w. sub chorionic
hematoma
o FM +
o EFW : 734 gr
Station No 3 - What next ?

o Lab
o CBC : WBC 12,700 , Neut 70%
o Chem Normal
o Coagulation panel normal
o Blood type : O neg. titer 1:8
Station No 3 - Questions

o How do we prove PROM ?

o What are the bacterial agents for
amnionitis ?
o What about steroids ? AB ? Tocolytics ?
o When we are terminating the
pregnancy?
o How? Why ?
Questions and /or comments
Station No 4

o A 38 yo women arrives d/t irregular

non menstrual bleeding.
Station No 4 - History

o Diseases ? o No
o Surgery ? o No
o Drugs ? o No
o Alcohol/Smoking ? o No
o Coagulation ? o No
o Family Dis ? o No
Station No 4 - History

o Duration of o Several months

bleeding ?
o Any Pain ? o No
o Relief/Aggravate ? o Nothing
o LMP ? o Do not know
o Menses ? o Menometrorrhagia
o First Menses ? o 11 years
Station No 4 - Physical Exam

o Vitals Normal
o Abdomen NA
o PV/PS : NA
Station No 4 What Next

What is the D.D ?

Station No 4 D.D

o Anovulation (dysfunctional uterine

bleeding)
o Benign reproductive tract conditions
o Pregnancy
o Leiomyomata uteri
o Endometrial or endocervical polyps
o Adenomyosis
o Endometritis
o Pelvic inflammatory disease vaginal/cervical
infection
Station No 4 Questions ?

o Endometrial neoplasia
o Systemic diseases:
o Coagulation disorders (thrombocytopenia,
von Willebrands disease leukemia).
o Hypothyroidism
o Liver disease
o Iatrogenic causes
o Hormone therapy
o Contraceptive devices/injections
Station No 4 What Next ?

o Lab
b HCG
o Thyroid
o Endocrine
o Testosterone
o DHEAS
o 17 HP
o LH/FSH
o Coagulation
Station No 4 What Next ?

o TVS
o Endometrium o Thin , Irregular
o Myomatosis/polyps o Enlarged uterus,
o Anomaly several myomas,
intramural , sub-
mucous,
Station No 4 What Next ?

o Procedures
o PAP
o Pippelle
o D/C
Station No 4 Questions ?

o What is the D.D now ?

o What are the Tx options ?

o What is recomended for follow up ?

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