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Womens OSCE SEM 10 2010

1. Neonatal jaundice. Term infant, jaundice at 310 at 12 hours of


life.
1) What are the DDX( 10 marks)
2) nter!ret "lood test results# $" 1%0, W&& 1%'00, (lt
2''000, )a"* +, D-T !ositi.e, /um -0 ndirect &oom"1s
ne2ati.e, "lood 3lm sho4s s!heroc*tes. (10 marks)
3) What is *our mana2ement5 (1' marks)
%) What 4ill "e the mana2ement in a lo40le.el countr*
hos!ital5 (' marks)
$aemol*tic
. 6hesus incom!ata"ilit*
. -)+ incom!ata"ilit*
. other anti"od* (7ell, Du8* etc)
. mem"rane (s!hero9eli!toc*tosis)
. en:*me (;<(D, (7)
. $" (al!ha Thal)
0 se!sis
. ;)=
. T+6&$
0 he!atitis
. T+6&$
. meta"olic (2alactossaemia)
$" lo4
W&& lo4
!latelets normal
N+T -)+ incom!ata"olit* since "a"* "lood 2rou! +
N+T 6hesus since /um indirect &oom"s ne2ati.e
/ost likel* s!heroc*tosis
Mx:
0 neonatal resuscitation
0 call for hel!, senior sta8, haematolo2*
0 continue "reastfeedin2
0 !hotothera!*
. decision de!ends on "iliru"in le.el and neonatal risk (refer to
6&$ online ta"le)
0 e>chan2e transfusion
. cord "lood $" ?100 29@
. cord "iliru"in AB0 umol9@
. .isi"l* jaundiced ?12hrs of "irth
. decision de!ends on "iliru"in le.el and neonatal risk (refer to
6&$ online ta"le)
. reCuires tertiar* centre
0 treat underl*in2 cause if !ossi"le
. e.2. se!sis D anti"iotics
0 monitor re2ularl*
&all (E6=9NET=
!ink 4arm s4eet
transfer
1) (a! smear last 4k, results are out no4 4hich sho4s a
&N3. E>!lain results and 2i.e ad.ice and 4hat1s 2oin2 to
ha!!en (e>!lain col!osco!*). Cns# 4hat are the
indications for a (-( smear in F&5 4hat is a cone "io!s*
indicated5 ho4 does a cone "io!s* a8ect !re2nanc*5
2. @ad* comes in for results of her (-( test. 6esults sli! sho4s
lo4 2rade intrae!ithelial lesion. E.idence of $(F chan2es to
cells. Tell her of the results and the follo40u! of this dia2nosis.
Talk a"out ha.in2 to ha.e col!osco!*, take a "io!s*. What are
the common cancer causin2 .iruses in -ustralia. What
.accinations are a.aila"le and 4hat su"0t*!es do the* !rotect
a2ainst5 What is the cer.ical cancer screenin2 re2ime in
-ustralia5
$i2h risk D $(F 1<, 1B (31, %')
@o4 risk (2enital 4arts) D $(F <,11
;ardasil D <, 11, 1<, 1B (at Gear H)
=creenin2 (ro2ram#
0 2 *earl* from 1B*o +6 4ithin 2 *eas from 3rst intercourse
(4hich e.er is later)
0 sto! at H0*o if last 2 (a! smears normal +6 total h*sterectom*
. unless histor* of a"normal smears
3. @ad* comes in at 10 4eeks 2estation. Iirst "a"*. -d.ise on the
"ookin2 .isit tests. -sked a"out ultrasound# 4ould *ou need
another one other than the datin2 scan5 Ges, mor!holo2* scan
at 1B 4eeks to look for fetal a"normalities and !lacenta !osition.
%. @ad* comes in 4ith !eriod !ain. Take a histor*. Name 2 DDX#
endometriosis, (D5 -denom*osis5 ... nter!ret a !icture#
endometriosis. Will this a8ect fertilit*5 What is the
mana2ement5
/ana2ement#
0 a2e
0 se.erit* of s*m!toms9a8ect on life
0 desire for children
0 comor"idities
0 nature of the !atholo2*
0 a"lation, diatherm*
0 resection of lesions
0 h*sterectom* and "ilateral sal!in2o0oo!horectom*
Womens Health 2009 Sem 10
OSCEs
1. )leedin2 in earl* !re2nanc*. Take a histor*. /ost likel*
di8erentials and 4h*. -sked 4hat 3 in.esti2ations *ou1ll
like to do (Jh&;, !el.ic ultrasound, "lood 2rou! 4ith
anti"od* screen). ;i.en the results and asked to inter!ret
(Threatened miscarria2e and !atient is - ne2 4ith no
anti"odies detected). -sked to counsel !atient (tell her it1s
threatened miscarria2e, "ack to normal acti.ities, anti0D
!ro!h*la>is).
2. - talk0throu2h station. (atient is a !rimi2ra.ida, %0 4eeks
2estation, no si2ni3cant histor*, mem"ranes ha.e
ru!tured and she is in la"our. ;i.en !arto2ram to
inter!ret. Dela* in 3rst sta2e. Di8erentials5 (ne8ecti.e
uterine contractions, &(D, ma!resentation) /ana2ement5
(ut on s*ntocinon (after 4hich *ou !ut on &T;), look for
si2ns of o"structed la"our (haematuria, ketonuria,
tach*cardia, fe.er, etc.). ;i.en &T; K1, 4hich sho4s
incoordinate uterine contactions and reacti.e &T;. ;i.en
&T; K2, 4hich sho4s .aria"le decelerations. -sked for
cause5 (cord com!ression) What 4ould *ou do a"out it5
;i.en &T; K3, 4hich sho4s a !rolon2ed deceleration at
the end, at 4hich !oint the mid4ife calls *ou. -sked 4hat
*our di8erentials are5 (&ord occlusion, maternal
h*!o.olaemia, !lacental a"ru!tion) -sked for *our
mana2ement. (nstrumental deli.er* if !ossi"le,
emer2enc* caesarean)
3) (arto2ram L just the e>aminer and a !arto2ram
nter!ret !arto2ram L dia2nose failure to
!ro2ress
Dd> of failure to !ro2ress and mana2ement
of each common cause
2) 6u!ture of mem"rane, 2i.en a !arto2ram, !lease
inter!ret this !arto2ram (!icture of o"structed la"our),
then 2i.en 2 &T;s to inter!ret (.aria"le decelerations5
.aria"le decelerations then "ecomes !rolon2ed
deceleration)
'. @ad* comes in at %0 4eeks, is in la"our, 6+/ B hours a2o. Gou
are sho4n a !arto2ram and asked to inter!ret. =ho4s failure to
!ro2ress. $o4 4ould *ou mana2e this situation5 Then asked to
inter!ret &T;s. Iirst is normal, reacti.e !attern. =econd sho4s
.aria"le decelerations. -sked if there1s an*thin2 *ou need to do
a"out it. Third sho4s !rolon2ed decelerations. What are the
common causes5 What do *ou think is the cause here5 &ord
com!ression. $o4 do *ou mana2e this5 &han2e !osition, inMate
"ladder, sto! the s*ntocinon, tocol*tic5 &heck for cord !rola!se
on FE, if fail to res!ond, do emer2enc* &0section.
(o4er D inadeCuate9incoordinate uterine contraction
(assen2er D mal!resentation,
(assa2e D ce!halo!el.ic dis!ro!ortion
Management
1) &= if#
0 o"structed la"our
0 fetal distress
0 risk of ru!ture
2) -u2mentation (s*ntocinon) 4ith &&T;
/ana2ement of .aria"le decels
0 assess for com!le> .aria"le
0 check &T; !osition
0 consider fetal scal! electrode
6e.ersi"le causes
0 left lateral !osition
0 em!t* "ladder, 3ll "ladder
0 Muid "olus
0 consider o>*2en
0 FE for cord !rola!se
0 consider fetal scal! !$9lactate
0 treat underl*in2 cause
3. Neonatal !hotos. There 4asn1t enou2h time to 4rite in
this station, so 4rite fastN
a. /on2olian "lue s!ot. D>5 Di8erential5 N$>5
". Er*thema to>icum neonatorum. D>5 Dd>5 What >
*ou1ll do to con3rm D>5
c. Na!!* rash 4ith su!erim!osed candida infection.
D>5 T>5
d. Er"1s !als*. D>5 What can1t the "a"* do5 N$>5 />5
e. )lue"err* muOn s!ot. D>5 Dd>5 (-nd somethin2
a"out > or />, can1t remem"er)
%. 3 month histor* of amenorrhoea. Take a histor*. -t end,
asked 4hat *ou D> 4as5 (!rolactinoma) What "lood tests
*ou 4ant5 (Jh&;, (6@, I=$, @$, andro2ens) What ima2in2
*ou 4ant and 4hat does it sho45 (/6 "rain sho4in2
!ituitar* tumour)
'. (a! test. There 4as a !el.ic model and a P!atient1. Gou1re
asked to e>!lain the !a! test to the !atient (4ho1s ne.er
had one done "efore). Demonstrate the !a! test on the
!el.ic model. E>aminer asks 4hat ha!!ens if *ou can1t
3nd the cer.i> (1.4ithdra4 sli2htl* and re0insert. 2. Do
"imanual.)-fter that, the e>aminer 2i.es *ou the !a! test
results (ne2ati.e) and asks *ou to e>!lain it to the !atient.
-lso mention ne>t !a! test in 2 *ears.
2008 WH OSCES
1) (a! smear !rocedure L 4ith an actor and a .a2ina model
E>!lain to actor 4h* 4e do !a! smears
E>!lain 4hat an a"normal result means i.e.
it does not mean cancer
;et consent
(erform !a! smear on the model 4hilst
talkin2 it throu2h 4ith the actor
2) (ost Dates /> and &ounsellin2 L 4ith a female actor ( did shit
on this one)
Women is %1 4eeks
E>!lain to her the com!lications of !ost
dates and the mana2ement 4e 4ould
under2o
Tell her 4hat she needs to look out for
6isk Iactors#
0 male fetus
0 (ast !ost term !re2nanc*
0 !rimi2ra.ida
0 o"esit*
&om!lications#
0 meconium as!iration
0 still"irth
0 IDQ
0 mortalit* and mor"idit*
0 as!h*>ia
0 shoulder d*stocia
0 um"ilical cord com!ression
0 h*!o2l*caemia
0 o"structed la"our
0 (($
0 !el.ic trauma
0 &=
/ana2ement#
0 e>!ectant mana2ement 4ith increased sur.eillance
. &T;, Q== after %1 4eeks
. o8er !el.ic e>am Rstretch and s4ee!S
0 +@ (A%1 4eeks)
0 &= (A%1 4eeks)
Watch out for#
0 decreased fetal mo.ements
0 6+/
0 dischar2e
%) (el.ic mass and menorrha2ia L just the e>aminer
;i.e Dd> of !el.ic mass
6eco2nise a !icture of a 3"roid uterus (.er*
"lood* o".ious)
Discuss /> of /enorrha2ia
DD>#
0 3"roids
0 adenom*osis
0 cancer (endo, cer.ical, o.arian, "o4el, "aldder)
0 o.arian c*st
0 ;TD
0 ecto!ic !re2nanc*
0 !re2nanc*
') Neonatal !ictures L just *ou alone 4ith the !ictures and an
ans4er sheet, ha.e to reco2nise the !ictures and ans4er a fe4
short Cuestions
The* ha.e done this station e.er* *ear L "elo4 are the Cuestions
that kee! !o!!in2 u!, *ou 4on1t 2et asked all of them and of
course the* ma* thro4 in some ne4 ones
)lue"err* muOn s!ot (Dd>)
=e"orrhoeic Dermatitis9&radle ca! (/>)
Er"s !als* (cause and />)
$aeman2iomas (natural $>)
(ort 4ine stain (dd>)
/on2olian s!ot (Dd> (D "ruise))
=!ina "i3da neural tu"e lesion
(com!lications of s!ina "i3da)
+m!halitis (/>)
Na!!* 6ash (/>)
Er*thema To>icum Neonatorum
This sounded .er* dauntin2 to me 4hen 3rst heard that 4e had
to reco2nise neonatal dermatolo2* "ut its not, s!end a"out half
an hour 2oin2 throu2h this 4e"site#
htt!#99444.adh".2o.t.n:9ne4"orn9Teachin26esources9Dermatolo2
*9Dermatolo2*.htm
O&G osces 2007 sem 11
3) (ost !artum D3, "a"* is ok, mum no4 has a fe.er, take a
h> (4hich 4hen askin2 has no identi3a"le cause9 foci).
she comes in 3 4eeks later 4ith mastitis. ans4er
Cuestions on mastitis
DD>#
nfections#
0 se!sis
0 chorio
0 QT
0 4ound
0 mastitis
0 !neumonia
0 F site
0 !el.ic a"scess
DFT9(E
Dru2s
Throm!hle"itis
%) *oun2 4oman com!lains of !el.ic !ain, on histor* sounds
like an ecto!ic !re2nanc*. Tn# e>9 i> that *ou 4ant to do,
name the sur2ical !rocedure that is done in ecto!ic
!re2nanc*
osces 2006 sem 10
1) "ookin2 .isit tests L 4hat u 4ana do , 4h*
2) T4in !re2nanc* L tell mum a"out risks to mum9 fetus9 i>
3) /enorrha2ia .i.a
%) ncontinence in a !ostmeno!ausal 4oman (h>9 e>9 i>9 t>)
') neonatal !hotos (/on2olian s!ot9 er*thema to>icarum9
na!!* thrush9 "lue"err* muOn9 Er"1s !als*)
Women1s +=&E 200H
1 Written neonatal Cuestions on 1
st
2% hr jaundice and
mana2ement.
2 Woman in o"structed la"our. 6eco2nise !arto2ram,
.aria"le &T; and =e.ere decelerations9 cord
o"struction. Descri"e mana2ement.
3 (-( =mear# e>!lain to a 4oman a col!osco!* and
results &N , 4hat it means, $(F etc., mana2ement
o!tions.
% (uer!eral Ie.er. $istor*, discuss +9E, Di8erentials. />
' =udden -"do !ain in a nulli!ara 4ith missed !eriods.
$istor* , +9E , Di8erentials and />.
-s for m* *ear, 4e 2otU
Ior +V;U
1) &ounsel a 4omen 4ho 4ants to 2et !re2nant (i.e "efore
2ettin2 !re2nant0
folate etc, 4hile !re2nant .... . Gou must also e>!lain 4hat
ha!!ens if it
is a t4in !re2nanc* and ho4 the follo4 u!9mana2ement chan2es.
2)Ii"roid0 this station did not ha.e a !atient. +nl* 2 e>aminers.
3)&ounsel a 4omen 4ho cannot 2et !re2nant. 6emem"er to ask
a"out !artnerWs
occu!ation and medical $>
%)&anWt remem"er
Oa!"an Cance!
=et the scene.
-sk if the* 4ant someone in the room 4ith them.
&heck for !ri.ac*, room etc
The tests ha.e sho4n a dia2nosis of cancer of the o.aries.
t t*!icall* !resents at Cuite an ad.anced sta2e.
t1s a diOcult cancer to !ick u! earl*
kno4 this is some diOcult ne4s to take in. Do *ou need
some time to think a"out it5
There are num"er of thin2s 4e can do to hel! *ou throu2h
this diOcult time, includin2 sur2er*, radiothera!* or
chemothera!*.
n terms of the outlook, it1s hard to !ut a timeframe to it
"ecause it .aries from !erson to !erson.
Write it do4n L !ro.ide some 4ritten information L and
or2anise re.ie4 a!!ointment.
donWt 4ant to o.erload *ou 4ith too much information, do
*ou ha.e an* Cuestions for me ri2ht no45
#a$ smea!
1. $i /rs Xones /* name is Xiu:hi and 1m a 3nal *ear
medical student and 1.e "een asked to do a !a! smear
4ith *ou toda*. $a.e *ou had a !a!er smear "efore5
a% 4ill run throu2h 4hat 4e1re 2oin2 to do, "ut do
*ou ha.e an* !articular Cuestions or concerns
a"out the !rocedure5
&% s there an*thin2 in !articular that *ou 4ould like
checked5
2. Ex$la"n $!oce'(!e: 1ll run throu2h 4hat1s 2oin2 to
ha!!en
a% Iirst of all, 4ill 2et *ou to remo.e all *our
clothin2 "elo4 the 4aist and co.er *ourself 4ith
a sheet. 4ill !ut a !illo4 underneath the hi!s
and 2et *ou to !ut *our feet to2ether and let *our
knees fall to the side.
&% Then 4ill "e insertin2 a s!eculum (5e>!lain
s!eculum) into *our .a2ina and usin2 a "rush to
collect some cells from *our cer.i> L 4hich is the
neck of the uterus94om", 4hich 1ll !ut onto a
slide and send to a la".
c% This ma* "e a "it uncomforta"le "ut it shouldn1t
"e !ainful, and the more rela>ed *ou are, the
easier it 4ill "e. f an* time *ou feel
uncomforta"le let me kno4 and if *ou 4ant to
sto!, just raise *our hand and 1ll sto!.
'% Do *ou understand 4hat1s 2oin2 to ha!!en and
are *ou still ha!!* to 2o ahead5
)% #!e$a!e the $at"ent *o! the exam"nat"on
a% +8er to use the toilet L !ri.ate area to chan2e L
2o4n V sheetL mirror under !illo4 L to4el on the
"ed and check li2ht
&% @a"el slide
c% Wash hands L 2lo.es , !ut a 2lo.e on the li2ht
'% &ollect kidne* dish, s!eculum (check if clean,
check scre4, !re.ent clatterin2) L 4arm 4ater ,
lu"e
+% #!oce'(!e
a% &on3rm !atient is read* to !roceed 4ith
e>amination
&% -sk them to "ut !illo49to4el under the hi!s
c% R)rin2 *our heels to *our "ottom and rela> *our
knees9 let *our knees fall to the sideS
'% R(ull "ack the sheet 4hen *ou1re read*S
e% &heck tem!erature of s!eculum a2ainst !atient1s
u!!er thi2h
*% E>ternal ins!ection
g% nsert s!eculum
i. $old s!eculum in *our dominant hand and
!art la"ia 4ith non0dominant hand
ii. 6est the s!eculum on the fourchette.
iii. RTake a dee! "reath in and then outS L
insert as she "reathes out.
i.. -n2le s!eculum at %' de2rees to the "ed
.. R1m just o!enin2 the entrance to the
.a2inaS L o!en s!eculum
.i. @ocate cer.i> L ins!ect the cer.i> L o8er
the mirrorNN
.ii. Ti2hten scre4s
.iii. Take sam!le L insert "rush L 3rml* rotate
throu2h 3<0
i>. Transfer the sam!le of cells to the 2lass
slide
>. =!ra* the slide 4ith 3>ati.e immediatel*
"efore remo.in2 the s!eculum
h% 6emo.e the s!eculum
i. (lace the thum" on the le.el to kee! the
"ills stead*
ii. With *our free hand, undo the to! scre4
iii. ;entl* o!en the "ills a little and 4ithdra4
sli2htl* until *ou can see that *ou ha.e
cleared the cer.i>
i.. =lo4l* release L allo4 to close L o"ser.e
until the 4alls close o.er L remo.e once it
is full* closed
.. RWe1.e 3nished L *ou can 2et chan2ed
no4S
"% (lace s!eculum on a tra* for cleanin2 and !lace
dis!osa"les in the contaminated 4aste "in
,% Wash hands
-% Iill out the reCuest form and !ut into the slide "o>
thin2
.% Com$lete the $!oce'(!e
a% )imanual if reCuired
6% /"sc(ss"on 0"th the $at"ent
a% Discuss *our 3ndin2s Rfrom 4hat can see L
e.er*thin2 looks normalS
&% E>!lain 4hen the results 4ill "e a.aila"le L
c% $o4 these 4ill "e communicated to the !atient
'% Wa!n a&o(t s$ott"ng an' c!am$"ng
e% RThank *ou for comin2 in to ha.e *our !a! smear
toda*.
*% /"sc(ss the $a$ !eg"st!1 an' enco(!age
g% Encoura2e the !atient to attend for other health
checks.