OBJECTIVE STRUCTURED CLINICAL EXAMINATION OSCE Gynecology Dr Anas

OBJECTIVE STRUCTURED CLINICAL EXAMINATION “OSCE” (Gynecology) Dr. Anas Al Marzouki Associate Professor & Chairman Obstetrics & Gynecology King Abdulaziz University Hospital

OSCE Gynecology

This station is to test your skill in doing abdominal examination and building differential diagnosis § 38 years old, P 1 + 0 was referred to Gynecology clinic because of recurrent lower abdominal pain • Do systematic abdominal examination • What is the differential diagnosis

Grade Failure Border line Pass Marks 0 50% of Mark Full Mark 1. Introduce him/hers self & ask patient name 0. 5 2. Position patient properly for examination 0. 5 3. Describe systemic general examination (not to do) 0. 5 Inspection 4. Scars 0. 5 5. Hernia 0. 5 6. Hair distribution 0. 5 7. Movement of Abdomen 0. 5 Palpation 8. Ask about pain and start away from site of pain 0. 5 9. Superficial palpation : start away from pain 0. 5 10. Deep palpation 0. 5 11. Feel for renal angles 0. 5 Describe Mass 12. Site 0. 5 13. Size 0. 5 14. Surface 0. 5 15. Mobility 0. 5 16. Tenderness 0. 5 Differential Diagnosis 17. Ovarian mass 0. 5 18. Fibroid 0. 5 19. Pregnancy 0. 5 20. Bladder 0. 5

This Lady has been married for 10 years. Has had one child who is 8 years old. No pregnancy since then. She would like your advise and help § What other relevant informations you would like to know. § How would you investigate such case? § With the data you have been given, what is the most likely diagnosis?

What other relevant informations you would like to know. § Age. § Duration of trial for pregnancy (Use of contraception) § Mode of delivery § Relevant surgical history: i. e. pelvic surgery § The menstrual cycle: § Previous tests or investigations for the wife § Investigations for the husband results

Cause of infertility § Tubal: suggested if ch pelvic pain, pelvic surgery, infection. . etc § Ovulatory: oligomenorrhea, features of PCO (obesity, hirsutism) § Peritoneal: (i. e. endometriosis) dysmenorrhea § Male factor: semen test § Others: thyroid, hyperprolactinemia § Unexplained: no obvious cause

A 21 year old gravida 2 presented to the ER with lower abdominal pain of acute onset, with slight vaginal bleeding § How would you assess this case. § What is the differential diagnosis § What investigations would you like to order

How would you assess this case. § § § Important points in the history: Is she pregnant When was the LMP Is she using any contraception What was the outcome of the first pregnancy § Is there any history of pelvic surgery or infection Do not Know 6 weeks ago Not regularly Baby boy Appendectomy

§ Important points in the examination: Vital signs: Abdomen examination: Site of pain, tenderness, rigidity Pelvic Examination: Amount of bleeding: Condition of the cervix: Positive sign of cervical excitation:

What is the differential diagnosis § § § Ectopic. Intrauterine pregnancy Corpus luteum cyst Surgical pelvic conditions Cystitis The scenario of the case could take you to any of the aforementioned conditions

What investigations would you like to order? § § Pelvic U/S Pregnancy test (BHCG titre) COC: WBC and Hemoglobin Blood group (ABO) and Rh type

Interpretation of Investigations § HSG: § Hormonal profile for: l l § PCO. Secondary amenorrhea due to hyperprolactinemia Karyotype of Turner syndrome