osce exam shndi.ppt

OSCE EXAM
August 2008
Shendi University
Department of Obstetrics and
Gynaecology

Answer all 20 Questions
Time Allowed 80 minutes ( 4min for each
question)

what is the name of this maneuver?internal
podlic version
Mention one indication for it. Second twins
tranvervese
Mention two complications for this maneuver
Rupture uterus
Pph
Shock
Purpural sepsis

Brecch ECV
Contraidication
Aph multiple pregency c/s already
indicated major utrine anomly small cord
abnormal ctg
Factor increase success
Tocolytic multiparity adequet amount of
liquor

 a-What is the type of twins
 A monochoronic diamnotic
 B monochorinic mono amonotic
 C dichoronic diamontic
 b- Which one is associated most with complications?
………………………
 c- Mention three complications that can affect the fetus in twin
pregnancy
 Miscarrige
 Aniema iugr
 Preterm delivery aph
 Birth defect poly hydromis
 Ttts CORD entalgment
 Risk factor
 Ass conception increase maternal age genetic

Pinnard stethoscope
Other method
Us
Ctg
Sonicaid
Causes of fetal distress
Prolong labour
True knock of cord
Vasa previa
Placenta abroptio
Placental insuffecency

 Q (4)
 mention the name of this device?
 Short curve forceps (werigle )
 mention 5 prerequisites?
 Cephilic full diltation empty bladder empty rectum
anthesia epsiotomy engengment of head rupture
membrane effective contraction no pelvic contraction
 mention 3 complications
 Fetal (skull fracuture cephalohematoma asphaxia )
 Matrnal ( laceration pelvic injury pph infection fistula )

 What is the name of this tape? Merselene
stich
 What is the indication for its use?
 Cevical cerculage
 What are the prerequisites for its use?
 Ensure baby alive
 Ensure cardic activity
 Choronic villous sampling

Name each surgical incision and mention
one indication for its use
A-
B- C-

This lady presented two days after
spontaneous vaginal delivery with acute
unilateral tender swollen calf.
what two investigations that should be performed
to confirm the diagnosis? Venography duplex
us
What is the most serious complication? PE
Mention two drugs used in treatment. HEPRAIN
THROMBOLYSIS

 What is the percentage of this presentation
at term? 3.5 %
 What risks the lady may have?
OPRATIVE AND INSTRMENTAL
DELEVERY
 What is the best mode of delivery for this
presentation? c/s

 what is this called? SIMS SPECULUM
Mention 3 uses?
 D AND C
 Molar pregency and miscarge
 Draning of liquor
 Exploration
 Insertion of iucd
 Insert vaginal pack

 What is this? Utrerine sound
 What are its uses? To know length and
dirction of uterus
 Mention the complication?
 Distrubance of undiagnosed pregency
 Perfortion of uterus
 Acending infection

a. What is this? Bi valve speculum
b. Mention 2 Uses?
During clinical examination to expose the
cervix and vaginal wall
Allow insertion of uterine sound and iucd
HSG TAKING BIOPSY

 Name this flagellate? TRICHOMOUNS
VAGINALS
 Mention two symptoms caused by this
organism? Greenish vaginal discharge
icting .. Sorness … dysuria
Wet smear
Naats
Culture

 This lady presnted with pelviabdominal mass/
 A/ Mention 5 possible differential diagnoses
 Pregency .. Tubo ovarian abcess …. Ovarian cyst
…. Ovarian cancer …. Endomertial cancer
 B// If flanks were resonant with postmenopusal
bleeding and thick endometrium mention the
most likely cause? Endomertial carcinoma

This is a 30 years old Para 1+0 with a boy
5 years old
– what is this condition called?
– What could be the cause of this condition?
– What symptoms she may present with?
– B- If hormone levels were elevated what other
investigations should be arranged? Check tsh (
hypothyrdism ) hcg

 what is this condition called?. Turner
syndrome
 What is the karyotype? 45 xo
 Mention five characteristic features for
this condition
 Short stature wide sheld nipple
 Webbed neck stereck ovary rodomentry
uterus coratiction of aorta skeleatal
problem

This is a 16 years old girl with primary
amenorrhoea, periodic lower abdominal
pain and urinary symptoms in the last six
months.
What is this condition called? Inperforate
hymen
How could be her secondary sexual
characters?present normally
What is the treatment? Surgical curate and
documentation

Mention the types of illustrated
spontaneous miscarriage ?
Theratend
Invetabile
Missed
Incomplete

Doin retractor to retract uraanary bladder

 Classical scar
 Indication
 Post mortum
 Preterm < 34 wk
 Local infection in lower
 Fibroid or sever adhesion in lower
 Elective ceserain hysterectomy
 Disadvantage
 Not cosmetic
 Poor healing
 More bleeding
 No chance for VBAC
 GREAT RISK FOR UTREINE RUPTURE IN NEXT PRG

Auvard vaginal speculum:
- single blade with an attached weight.
- It keeps the vagina open leaving both hands free.
- usually it is used during vaginal surgery.

curved to side Straight
3 X 4 tooth
Straight single teeth
VOLSELLUM FORCEPS:
Used to hold and grasp the cervix

DOUBLE ENDED SHARP UTERINE CURETTE

OVUM FORCEPS: used for evacuation of the uterine cavity (removal of the
ovum.
VAGINAL EVACUATION OF THE PREGNANT UTERUS

 a.What is the normal foetal heart
rate?120 -160
b.A foetal scalp blood pH was found to be
7.1. What is the expected heart rate?
TACHY CARDIA > 180
 c.How frequent should you count the fetal
heart rate during an uncomplicated
labour? EVERY 15 MIN

Question -2:
A/Mention the name of the procedure this
doctor is performing on this pregnant lady.
BLOOD pressure monitoring
B/Mention two other abnormal findings that
are usually associated with an abnormal
reading. Headache dizziness
C/ Mention one complication of an
abnormal reading.cva and pre eclampcia

• This picture shows a newborn
weighing 5.1kg at birth.
What is your diagnosis?
Macrosomia large for
gestational age
• Mention two possible causes for
this condition. Infant of dm mother
• Obese mother
• Familial

 The picture shows part of the partogram of a
Para3+1 lady, demonstrating dilatation of the
cervix in cm.
 A.What is your diagnosis?arrest active phase
 B. Mention two possible causes for this
situation. Contracted pelvic fetal macrosomia
 C. What is your decision to treat this
condition. Agmentation of labour if no
effetient uterine contraction or C/S

 a. What does this picture show? Male
condom
 b. Mention two uses for this device sexual
intercourse
 Ballon in pph .
 C.Mention three diseases that can be
prevented by using this device. Hiv
syphllis gonnerhria

 A.Mention three situations when you need to
use this instrument.abstructed labour pre
oprative diagnosis of fistula
 B.Mention names of two of the types of this
instrument. Plastic or metal and silicon 2 way
and 3 way
 c.In a case of eclampsia what is the main aim
from using such instruments. Monitor input
and out put
 D.Mention the main risk from using this
instrument. Infection UTI

1
1. Describe what you see grape like
product
2. What is this condition called molar
pregency
3. What is the treatment suction and
evacuation and hysterectomy if
complete her family or risk for
choriocarcinoma
4. How would you follow this patient up
by B HCG till reach 20 iu and then for 6
month

A- Name the condition shown
B- What is the most likely complication?
C- How would this complication be
recognized clinically?
D- Is there any blood test that may be of use
with this complication?

1
1. Describe what you
see
2. What is this
condition called
3. What is the
treatment
4. How would you
follow this patient
up

1. What is this procedure called
2. What structures can you see
3. Three indications for the procedure
4. Three complications of this procedure

1. What operation is being performed
2. Mention three indications for this procedure
3. Mention three conditions that must be present before doing this
procedure
4. Mention three of the potential complications of this procedure

1.What is this ?
2. Write two symptoms the patient complains of.
3. What is the treatment?

1. What is this?
2. Mention two symptoms which bring the patient to you.
3. What investigation you would like to carry out?

1. What operation is being performed
2. What is the purpose of this operation
3. What are the disadvantages of this operation

This is a laparoscopy slide:
 Describe what you see
 Mention 2 possible theories behind this disease
 Mention 2 medications to treat this condation

1. What is the name of this condition
2. 3 more symptoms that this patient might present with
3. How would you investigate this patient
4. What treatment modalities are available

1. What is the dignosis
2. Mention 3 symptoms this patient present with?
amenorrhoea, periodic lower abdominal pain and
urinary symptoms

1. What is this intra uterine copper device
2. What is the mechanism of action prevent implantation
And inhibit sperm transport
1. Three absolute contraindication to the use of this device
active PID current pregency copper allergy Wilson dx
unexplained vaginal bleeding
2. Three complications associated with its use
Explation perforation bleeding in first 3month PID ectopic
pregency

 This woman had a blood pressure of 150/110 and +++ protienuria
1. What obvious sign is evident pitting ll edema
2. What other symptoms might she have headache dizziness epigastric pain
3. What signs you specifically look for on examination abd pain hyper reflexia
papllioedema
4. What investigation would you do on this patient cbc rft lft bleeding profile s
uric acid
5. Mention 3 Antihypertensive medications that can be used during pregnancy
methyldopa – labetalolol – nifedipine – hydralazine

1.Describe this. Recected uterus with multiple polyp(fibroid) and
tube and ovary
2. Write down three complications which may arise from
this bleeding infection injury to bladder and ureter and
vaginal vault prolapse

This patient had the above X-ray
of the pelvis followed by a
laparotomy removing this
tumour.
Teratoma 1. What is this tumour
called?
Embroynic germ cell in ovary 2.
From where does it originate?
3. Describe the gross pathology you
see well differntated cells and hair
withtooth
4. What do you think the patient
complained of?abd pain or
asymptomatic

This patient has secondary
infertility and normal menstrual
cycles. She has undergone this investigation
HSG1. What is the name of the investigation?
2. Write down the result. normal
3. Mention one complication which can arise from this procedure.
ACENDING INFECTION –PAIN – FALSE NEGTIVE
RESULT
AFTER THE 5TH DAY ?? 4. At what time of the cycle you perform
this procedure?

A women complained of severe vulval pain and
retention of urine. Inspection of her vulva revealed
what you see in the upper photograph. Speculum
examination revealed what you see in the upper lip
of the cervix (lower photo)
TRICHOMONS 1. What is your diagnosis?
NO 2. Would you catheterize this women?
3. What relevant investigation you carry out for her?
WET SMEAR
METRONIDAZOAL 4. What treatment you prescribe
for her?

A 20yr old was admitted to L&D at 42wks in
labour at 3cm dilated cervix
LATE DECELRATION 1. What is the diagnosis
2. What other investigations can you do to confirm
diagnosis FETAL SCLAP PT
3. What are the steps you will take in the
management of this patient

cord prolapse 1. What is the diagnosis
2. What are the
predisposing factors? abnormal lie or presentation
Multiple pregency .. Poly hydromis … prematurity .. High
head .. Long cord
3. What is the most
fetal distress dangerous complication?
4. How will you manage this condition? While prepare to
C/S ..knee chest position full bladder with warm saline
tocolytic hand in vagina pushing the presenting part…..
AND DO EMERGENCY C/S

This procedure was performed on a patient
in labour with fetal distress.
vevtose delivery 1. What is this procedure?
2nd stage 2. What stage of labour is this patient
in?
3.Mention 3 contraindications?face presentation
breech presentation
Fetal premature
Active bleeding Fetal distress

This woman has had a previous classical caesarean section
 1) Mention 3 indications for this operation
 Post mortum
 Preterm < 34 wk
 Local infection in lower
 Fibroid or sever adhesion in lower
 Elective ceserain hysterectomy
 2) Mention 3 disadvantages of a classical caesarean section
 Not cosmetic
 Poor healing
 More bleeding
 No chance for VBAC
 GREAT RISK FOR UTREINE RUPTURE IN NEXT PRG
3) How should this woman be delivered in her current
pregnancy elective c/s

 Slide no. 2
1. What is the name of this condition hirsutism
2. Mention three more symptoms that this patient might
present with. Acne sebrea virilization
Testosterone DHEAS OGTT US 3. How would you
investigate this patient ?
4. What treatment modalities are available ?
COCP
DEPROPROVERIA
LASER WAXING SHEVERING
Spironolactone finasteride gnrh analog

 Slide no. 4
1. Describe what you see milk discharge from both nipple .
Galactorrhea 2. What is this condition called ?
3. What gynecological condition may she have presented with ?hyper
prolictinemia
4. What investigation would you perform? Prolactin level
5. Name one drug that can be used for the treatment
Promocriptine
Capargolin

 Slide no. 3
1. What investigation is being performed ?trans abd us
2. In a pregnant woman, what parameters would you look for in
the first trimester ?gestation san CRL CARDIC ACTIVITY
number of pregency exclude ectopic congental anomly
3. What must be placed on the maternal abdomen for the correct
functioning of the probe?gel ??

 Slide no. 7
Cervical fibroid 1. What is your diagnosis ?
2. Mention 3 presenting symptoms that this patient might present with???
Abstructed labor pressurse symptoms discharge??.
3. Mention 3 drugs that can be used to treat this condition cocp NSAIDS
danazol.

 Slide no.6
1) What is your diagnosis ?anenceply
2) Is this abnormality compatible with life ? No
3) What would you advice the mother to take before her next pregnancy
and during the first three month of the next pregnancy ??folic acid

This is a 7 year old girl
1. What stage is her pubic hair ?
2. Comment on her height.
3. What is your diagnosis?
4. Mention three investigations you
may do for her.
5. All investigations are normal.
Would you suggest a useful
treatment for her.

View 1
Stage 4
Tall for her age
precocious puberty
X-ray skull , X-ray hands ,Pelvic ultrasound
, CT scan for pelvis, CTscan for brain
Medroxyprogesterone acetate (depoprovera)

1. What is this ?
2. What causes it?
3. What other examination
you carry out in this
patient?
4. What is your
management?
5. What is your advice for
the consort?

View2
Vulvar warts (condylomata acuminata)
Human papilloma virus 16,18
Colposcopy, cervical smear
Surgical excision, cautary or laser surgery and
follow up of the patient with smears
Clinical examination of his genitalia and use
of condom during sexual intercourse

1. What is this?
2. Mention two symptoms the
patient has.
3. What investigation you carry
out in this patient
4. What is your treatment?

View 3
Bartholin cyst
a) Pain b) fever
Bacterial culture and sensitivity and screening
for gonococcus and chlamydia
a) Marsupialization b) wide spectrum
antibiotic

1. What is this investigation called?
3. Describe two phenotypic features you can see in this
patient?
4. Mention one complaint for this patient.

View 4
Karyotyping
47XXY , Klinefelter syndrome
a) Gynaecomastia b) small testicles c) tall d)
azoospermia
Infertility

This investigation is done for a 26 weeks pregnant patient
2. Mention two complaints
for this patient.
3. How do you treat her?

View 5
trichomonas vaginalis
prutitus vulvae , vaginal discharge
Metronidazole for her and her consort

This is the face and breasts of an
unmarried 19 year old student
1. Describe what you see?
2. Describe one other
symptom this girl may be
having?
3. Mention three useful
investigations for this
patient
4. What drug treatment you
prescribe for her?

View 6
Facial and periareolar hirsutism
oligomenorrhoea or amenorrhoea
LH/FSH ratio, serum tetosterone, pelvic
ultrasound for the ovaries
Cyproterone acetate

This is pelvic ultrasound for an
infertile woman on medication
2. What Causes this?
3. Mention one initial
complaint this woman
might have given.
4. What other problems this
woman may be having?
5. What is the main line of
treatment ?

View 7
Ovarian hyperstimulation
Induction of ovulation and use of human
chorionic gonadotrophin (hCG)
Abdominal fullness and pain
Haemoconcentration
Fluid replacement and infusion of plasma
proteins

An infertile woman has this investigation carried out for her
1. What is the name of this
investigation?
2. Mention one complication
which can result from this
procedure.
3. Describe what you see?
4. Write down two problems
this woman can have
during pregnancy

View 8
Hystosalpingogram HSG
a) allergy to the dye b) pelvic infection
a bicornate or subseptate uterus, patent
fallopian tubes
a) midtrimeter abortions and preterm labour b)
malpresentations.

The upper photographs are for a woman
and her vulva. The lower photograph is
for the same women after she has
undergone a laparotomy for an ovarian
tumour.
1. Describe what you see in the upper photographs?
2. Give one name for this malady.
3. What is the nature of the tumour removed and
what is it called?

View 9
enlaged clitoris, temporal recession of hair,
facial hirsutism, periareolar and chest
hirsutism
viralism
Androgen secreting tumour, Androblastoma
(arrynoblastoma) Sertoli leading tumor

Question -3
A. What is the name of this instrument?
Wegith measure device
B. What do we use it for? Measure wt of
nenate
C. What is the normal range?2.5 -3.5

Question -6
A. Mention three uses for this drug.
Episiotomy scar instrumental delvery take
cervical biopsy
B. What is the maximum dose of this drug.??
C. Mention two side effects.??
D. Can we use this drug intravenously?no

Question -9
A. What is this instrument?metal catheter
B. What is it used for?bladder empty
C. Mention two complications for that
procedure. Infection injury of ureathra

Instrument used in D&C
Curator
Used in case of :-
D&C
Evacuation of molar
pregnancy
Used in curettage in
case of 2ry infertility

Uterine sound :
Indication :
1/ measure the length
of uterine cavity
before D&C
2/ identification of the
uterine direction

Cervical dilator:
Hegars dilator:
Indication : dilatation
of the cervical canal
Come in different size
but there is no
difference in the
length
Cervical dilator:
Used in dilatation of
the cervix

Instrument used during C.S
Towel clips :used in
capture the covering
towel
Artery forceps :used
during cutting &
ligation of artery
Scissor : used in
cutting of the tissue

 Dissection forceps :
Used to hold the tissue
while is cutting
 Scalpel with knife :
used to incision of the
skin
 Needle holder : used
to catch the needle
while it used
 Suturing :used to close
the wound
1/Absorbable suture
2/non Absorbable suture

Retractor
Type :-
Doey's retractor
Used in retracte of
abdominal wall during
operation .
Duane's bladder
retractor
Used to retract the
urinary bladder
during operation

Green armitage :
Used in :
Stop bleeding during oparation
To fix the edge of sectioned tissue
Used in C.S

Speculum
Type
1/ Sims
Indication :
 Visualize the cervix
 Retract of the posterior
vaginal wall in D&C
2/ cuscus :
Indication :
 Visualize the cervix
 Use in routine examination
 Used when the PV is
contraindicated

Forceps :
Type :
Ovum forceps used in
evacuation
Volsellum used to fix
the anterior lips of
cervix during D&C
Curve clamp use to fix
the rough tissue
Popcorn forceps use
to fix soft tissue
Ellis forceps

 Kocher's forceps :
Used in Artificial Rupture of
Membrane (ARM)
 Drew-Smythe catheter
Is introduced between the
membranes and uterine wall
to the point above the
presenting part
Complication :
 Less efficient in inducing
labour
 Trauma
 Separation of the posteriorly
situated placenta
 infection

Forceps used in forceps
delivery:
1/ long curve forceps
2/Mid curve forceps
3/short curve forceps
Indication :
 Prolonged 2nd stage
 Maternal indication :
Maternal distress
Maternal disease
 Fetal indication :
Fetal distress
Cord prolapse
Preterm delivery
After coming of head in breech
presentation
 During C.S

Complication :-
Complication of
anesthesia
Laceration
Bone injuries
Pelvic nerve injuries
PPH due to
laceration of artery
Puerperal infection
Fracture of skull &
ICH
Birth injury &
Long curve :
Kiellands forceps
Barton forceps
Mid curve :
Neville-Simpson-Barnes
Milne-Murrays
Short curve :
Wrigley's forceps

Def :-
Extracting the fetal
head by means of a
vacuum cup
applied to the scalp
.
Parts of ventouse :
 Metal suction cup
 Metal handle
 Pressure gauge
 Vacuum bottle
 Vacuum pump
Indications for use:

Contraindication :-
 Face presentation
 Breech presentation
 Fetal distress
 Prematurity
Complications :
 Necrosis of scalp
 Cephaloheamatoma
 Sub_aponeurotic
haematoma
 Intracranial haemorrhage

Uerinary catheter :
Foley's catheter :
used in
Evacuation of UB
In case of urethral
stricure
Use for long time
In & out catheter :
used in
Evacuation of UB
Use for one time

Combined contraceptive pills:
Divided into :
1/oral contraceptive pills
2/combined contraceptive patch
3/subdermal combined
contraceptive
Progesterone pills :
Used in case of if the combined
contraceptive pills is
contraindicated like :
1/ lactation
2/ peripheral vascular disease
3/ other causes
Contraception

Question -10
What is this instrument used for?suction
Mention two complications that can arise
from using this instrument.

osce exam shndi.ppt

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