doctorate) instructions to site organizers قسم النساء... · 1- what is the type of...

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OSCE Mock Exam .. ../…./ 2015

Obstetrics & Gynaecology

Postgraduate Exam (Master \ Doctorate)

Instructions to Site Organizers

-There are 3 examiners in each station.

- Mobiles should be closed during Exam.

-The Exam is 6 Stations .Each one is 12 minutes.

Logistics Description Station

Table and 5 chairs

Bed, sheets, curtains,

cleaning gel and 4 chairs

Table and 4 chairs

Table and 4 chairs

Table and 4 chairs

Bed, sheets ,

curtains,cleaning gel and

4 chairs

Role player (Female)

Real patient

Partogram

Pathological specimen (endometrial

carcinoma)

Model of uterus, speculum ,slide

and cytobrush

Real patient

1-History taking

2-Examination

3-Investigations

4-Jar

5-Procedure

6-Examination

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OSCE station 1

History Taking

Instructions to Students

This is an 12-minute station.

The patient you are going to see is an infertile patient.

You are asked to take a focused history trying to answer these questions to the

examiner:

1- What is the type of infertility?

2- The menstrual history of the patient.

3- What are the investigations done and their results?

4- What is the aim of laparoscopy in this case?

You will also be asked to answer:

5- Any further questions raised by the patient.

6- Any further questions raised by the examiner.

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OSCE station 1

History Taking

Instructions to Role player

(Copy to Examiner)

Personal data:

Your name is Hoda Ali

You are 26 years old

You are married since 5 years

Your problem:

You have never been pregnant before and this is causing social problems to you

Your menstrual cycles started at the age of 13 years. They are irregular and

recur every 6 or 7 weeks and sometimes longer.

You had had some pills to regulate them before marriage.

There are some thick hairs on your face which you remove every week.

You were obese but lost weight over the last 2 years.

You have had these investigations:

Your husband's semen analysis is normal

You have had a dye test to test your tubes which was normal.

You have had an ultrasound scan which revealed large number of small follicles

in your ovaries but no mature follicle during folliculometry & a hormone test in

the blood confirmed this (day 21 serum progesterone 2 ngm%) .

You have had tablets to help your ovulation (called clomid) for 5 days each cycle

but have not been so effective. Also, you have had some expensive injections to

help you to ovulate but with no response.

You are referred to the hospital to have an operation called laparoscopy .

Role player will ask the student these questions at the end of the interview:

1-Am I going to get pregnant after this operation to the ovaries?

2-What should I do if I do not get pregnant after this operation?

The examiner will ask the student about the underlying cause of infertility and to

mention 5 DD of hirsutism.

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OSCE station 1

History Taking

Instructions to Examiner

Ask students to take a focused history trying to answer these questions :

1- What is the type of infertility?

2- The menstrual history of the patient.

3- What are the investigations done and their results?

4- What is the aim of laparoscopy in this case?

Students will be asked to answer:

5- Any further questions raised by the patient.

6- Any further questions raised by the examiner.

-Gentle handling with the patient 2 marks

-Diagnose the type of infertility: primary infertility 5 years 2 marks.

-Diagnose the type of menstrual disorder (Oligomenorrhea) 2 marks.

-Asks for semen analysis 2 marks

-Asks for HSG and know that it is normal 2 marks

-Asks for serum progesterone or folliculometry 2 marks

-Asks about the aim of laparoscopy 2 marks

-Answer the patient's question that 70-80% will

get pregnant within one year of LOD 2 marks

-Answer the patient's question that she might need

IVF/ICSI, if failed to get pregnant after LOD by one year 2 marks

-Answer the examiner's question that this is a PCOS. 2 marks.

-Mention 5 causes of hirsutism (adrenal tumor ,adrenal hyperplasia , iatrogenic,

drugs e.g danazole ,ovarian tumors & familial ) . 5 marks

5

OSCE station 1

History Taking

Marking Sheet

Student's name

Student's number

-Gentle handling with the patient 2 marks

-Diagnose the type of infertility 2 marks.

-Diagnose the type of menstrual disorder 2 marks.

-Asks for semen analysis 2 marks

-Asks for HSG and know that it is normal 2 marks

-Asks for serum progesterone or folliculometry 2 marks

-Asks about the aim of laparoscopy 2 marks

-Answer the patient's question that 70-80% will

get pregnant within one year of LOD 2 marks

-Answer the patient's question that she might need

IVF/ICSI, if failed to get pregnant after LOD by one year 2 marks

-Answer the examiner's question that this is a PCOS. 2 marks.

-Mention 5 causes of hirsutism. 5 marks

Total /25 marks.

Examiner's name Examiner's signature

Comments ……………………………………………….

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OSCE station 2

Clinical Examination



This is a real pregnant patient

Your consultant wants you to perform the obstetric examination and to

mention the value & the findings of each test:

1- The fundal level

2- The fundal grip

3- The umbilical grip

4- The first pelvic grip

5- The second pelvic grip.

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OSCE station 2



-This is an 12-minute station.

-This is a real pregnant patient

-You should observe the student during obstetric examination .The

student should approach the patient gently greats him and introduce

himself asking politely for the permission to examine the patient. He

should state that the reason for the examination is according to the

consultant's orders. His hands must be warm and clean.

…………………………………………………..5 marks

-Ask him about the value and the findings of each grip .

-Grant half the mark for each correct technique and the other half for the

value of test and each correct result.

1- The fundal level . 4 marks

2- The fundal grip. 4 marks

3- The umbilical grip. 4 marks

4- The first pelvic grip. 4 marks

5- The second pelvic grip. 4 marks

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OSCE station 2


Marking Sheet

Student's name

Student's number

Gentle handling with the patient 5 marks

Grant half the mark for each correct technique and the other half for the value

& each correct result:

Fundal level: correct technique and value & result 4 marks

Fundal grip: correct technique and value & result 4 marks

Umbilical grip: correct technique and value & result 4 marks

First pelvic grip: correct technique and value & result 4 marks

Second pelvic grip: correct technique and value & result 4 marks

Total /25 marks


Comments :

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OSCE station 3

Data Interpretation



Look at this partogram and answer the following questions:

1- The pattern of cervical dilatation 4 marks

2- Descent of the fetal head 4 marks

3- FHR changes 4 marks

4- Amniotic fluid and moulding 4 marks

5- Uterine contractions 4 marks

6- Mention 5 causes of macrosomia 5 marks

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OSCE station 3

Data Interpretation

Instructions to Examiners

Please ask the student to read the partogram straight away,

if he/she can not find the answer, direct him/her to the graph and deduct one

mark.

1-The pattern of cervical dilatation: Know that this is an obstructed labor

as no dilatation between 4 and 7 hours 4 marks

2-Descent of the fetal head: know that there is no descent over the whole 7

hours and this is called failure of descent 4 marks

3-FHR changes: bradycardia (FHR<100) for one hour 4 marks

4-Amniotic fluid and moulding: there is meconium staining of the AF in the

last one hour and there is moulding (+3) at delivery 4 marks

5-Uterine contractions: 3-4/10 minutes without syntocinon 4 marks

6- Causes of macrosomia 5 marks

One mark for each of:

DM and prediabetics,

Obesity,

Postterm pregnancy,

Previous delivery of a macrosomic baby,

Excessive weight gain during pregnancy.

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OSCE station 3

Data Interpretation

Marking Sheet

Student's name

Student's number

1-The pattern of cervical dilatation 4 marks

2-Descent of the fetal head 4 marks

3-FHR changes 4 marks

4-Amniotic fluid and moulding 4 marks

5-Uterine contractions 4 marks

6-Mention causes of macrosomia 5 marks

Total /25 marks


Comments :

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OSCE station 4

Pathological Specimen



Look at this jar and answer the following questions:

1- The anatomical structures seen in the specimen 4 marks

2- The pathological findings seen 4 marks

3- The type of operation done 1 mark

4- The clinical presentation in this pathology 4 marks

5- 2 important investigations to diagnose this pathology 4 marks

6- The lines of treatment of this condition (in general) 8 marks

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OSCE station 4



Please ask the student to see the jar straight away,

if he/she can not find the answer, direct him/her to the site and

deduct one mark.

1-The anatomical structures seen in the specimen 4 marks

Uterus ,tubes & ovaries

2-The pathological findings seen 4 marks

Necrotic mass in the uterine cavity mostly endometrial carcinoma

3-The type of operation done 1 marks

TAH &BSO

4-The clinical presentation in this pathology 4 marks

Vaginal bleeding , purulent vaginal discharge & pain

5-Two important investigations to diagnose this pathology :Endometrial

biopsy & MRI. 4 marks

6- The lines of treatment of this condition :According to stage ,TAH & BSO

& pelvic lymphadenectomy ,post operative radiotherapy ( types and

techniques). 8 marks

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OSCE station 4


Marking Sheet

Student's name

Student's number

1-The anatomical structures seen in the specimen 4 marks

2-The pathological findings seen 4 marks

3-The type of operation done 1 marks

4-The clinical presentation in this pathology 4 marks

5-2 important investigations to diagnose this pathology 4 marks

6-The lines of treatment of this condition (in general) 8 marks

Total /25 marks


Comments :………………………..

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OSCE station 5

Procedure



You are asked to perform routine gynecological examination and to

take a cervical smear.

You will be asked to show to the examiner how you perform these procedures (

1- Inspection of external genitalia 5 marks

2- Speculum examination 5 marks

3- How to take a cervical smear? 5 marks

4- How to manage screen positive women? 5 marks

5- Bimanual examination. 5 marks

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OSCE station 5

Procedure


Please ask the student to perform routine gynecological examination and to take

a cervical smear.

If, he/she can not perform, direct him/her to the model and deduct one mark.


Mons veneris ,labia majora,labia minora,clitoris (mass or

ulcer),discharge,perineum ,urethra &vaginal introitus

2-Speculum examination 5 marks

correct handling by right hand(1mark), separation of the labiae by left hand

(1mark), edge wise insertion and rotation half way to expose the cervix

3-How to take a cervical smear? 5 marks

(insertion of the cytobruch/spatula on ext os , rotation 360 degrees, spread

into glass


-Screen positive women with mild dyskaryosis should

have a repeat smear in 6 months

-Moderate and severe dyskaryosis should be referred to colposcopy

(conization , Leep.)


Size and position of uterus -Uterine or adnexal mass

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OSCE station 5

Procedure

Marking Sheet

Student's name

Student's number


2-Speculum examination 5 marks

3-How to take a cervical smear? 5 marks



Total /25 marks


Comments ………………………….

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OSCE station 6

Clinical Gynecological Examination



This is a Real patient

She is a ~55-year-old (post menopause 5 years) who has noticed

recently distension & enlargement of her abdomen.

Your consultant wants you to perform appropriate abdominal

inspection and palpation to mention the findings .

You will be presenting the findings to the examiner while you are

doing the examination

Then you should :

o Mention 3 important investigations that should be

performed for such condition?

o What is the possible diagnosis?

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OSCE station 6

Clinical Gynecological Examination


This is an 10 minute station.

This is a Real patient

She is a ~55-year-old (post menopause 5 years) who has noticed

recently distension & enlargement of her abdomen.

PLEASE EXAMINE THE ABDOMEN OF THE PATIENT

BEFORE THE FIRST STUDENT COMES IN AND CHECK THE

CLINICAL SIGNS IN ORDER TO MARK THE STUDENTS’

PERFORMANCE

The Examiner is expected to be observing the student who should:

1- Approach the patient gently greats him and introduce himself asking

politely for the permission to examine the patient. He should state that the

reason for the examination is according to the consultant's orders.

…………………………………………………………….(2 marks)

2- Watch the abdomen while the patient taking his normal breathing and

while coughing; looking at it tangentially from the right side and from

caudally. (2marks)

3- Inspection : positive signs. ( 4 marks)

4- Superficial and deep palpation in the classic method. (2marks)

5- Palpation for the abnormal mass & define its characters (site,

size,surface,consistency,mobility & tenderness) . (6 marks)

6- 3 Important investigations that should be performed for such condition

-Pelviabdominal Ultrasound (to define uterine or ovarian mass and its

characters). (2 marks)

-Serum CA125 (tumor marker for ovarian tumor). (2 marks)

-MRI on the abdomen and pelvis (to confirm diagnosis and detect any

metastasis). (2 marks).

7- What is the possible diagnosis?...cystic ovarian tumor. (3 marks)

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OSCE station 6

OSCE …./…/2015

Clinical Gynecological Examination Marking Sheet

Student's name

Student's number

1- Approach the patient gently. (2 marks)

2- Watch the abdomen while the patient taking his normal breathing and while

coughing; looking at it tangentially from the right side and from caudally.

(2marks)

3- Inspection : positive signs. ( 4 marks)

4- Superficial and deep palpation in the classic method. (2marks)

5- Palpation for the abnormal mass & define its characters (site,

size,surface,consistency,mobility & tenderness) . (6 marks)

6- 3 Important investigations that should be performed for such condition

-Pelviabdominal Ultrasound (to define uterine or ovarian mass and its

characters). (2 marks)

-Serum CA125 (tumor marker for ovarian tumor). (2 marks)

-MRI on the abdomen and pelvis (to confirm diagnosis and detect any

metastasis). (2 marks).

7- What is the possible diagnosis?...cystic ovarian tumor. (3 marks)

Total /25 marks

Examiner's name : Examiner's signature

Comments: …………

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