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Osce O&G

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Osce O&G

  1. 1. Obstetrics & Gynaecology Past Year for OSCE Prepared by: LIM CHIN HWAN
  2. 2. Fetal Skull <ul><li>06/07 Q3 </li></ul><ul><li>a) List 4 sutures of fetal head coronal, sagittal, lambdoid, frontal b) List 2 fontanelles anterior & posterior c) 3 importants of fontanelles in Obs </li></ul><ul><ul><li>Ant fontanelle: allows moulding in labour & growth of the skull after birth </li></ul></ul><ul><ul><li>allow determination of the POSITION of the presenting part during vaginal examination ( vertex presentation, OA or OP position) </li></ul></ul>
  3. 3. <ul><li>00/01 Q8 </li></ul><ul><li>Engagement diameter (photo) </li></ul><ul><li>a) Fill in: </li></ul><ul><li>Suboccipito-bregmatic (9.5) </li></ul><ul><li>Mento-vertical (13) </li></ul><ul><li>Occipito-frontal (11.5) </li></ul><ul><li>Submenta-bregmatic (9.5) </li></ul><ul><li>b)Engagement diameter for face presentation: submento-bregmatic </li></ul><ul><li>c) The measurement: 9.5cm </li></ul><ul><li>d) 4 factors that cause face presentation: </li></ul><ul><li>Maternal cause: </li></ul><ul><ul><li>Multiparity </li></ul></ul><ul><ul><li>Lateral obliquity of the uterus </li></ul></ul><ul><ul><li>CPD/ flat pelvis </li></ul></ul><ul><ul><li>Fetal cause: </li></ul></ul><ul><ul><li>Congenital malformations: anencephaly, iniencephaly </li></ul></ul><ul><ul><li>Fetal thyroid enlargement, neck tumour </li></ul></ul><ul><ul><li>Musculoskeletal abnormalities: spasm/shortening of neck’s extensor muscles </li></ul></ul>
  4. 4. AREAS AND DIAMETERS OF SKULL VERTEX OCCIPUT SINCIPUT 11.5CM 14CM 10CM 9.5CM 9.5CM Mento-vertical Occipito-Frontal Suboccipito-bregmatic Submento-bregmatic Suboccipito-frontal SINCIPUT
  5. 5. Diameters of skull Diameters Definition cm Attitude Presentation Suboccipito-bregmatic Extend fr the nape of the neck to the centre of bregma 9.5 Complete flexion Vertex Suboccipito-frontal Extends fr the nape of neck to the anterior end of the fontanelle or centre of the sinciput 10 Incomplete flexion Vertex Occipito-frontal Extends fr the occipital eminence to the root of nose 11.5 Marked deflexion Vertex Mento-vertical Fr the midpoint of the chin to the highest point on the sagittal suture 14 Partial extension Brow Submento-vertical Fr the junction of the floor of mouth &neck to the highest point on the sagittal suture 11.5 Incomplete extension Face Submento-bregmatic Fr the junction of floor of the mouth &neck to the centre of the bregma 9.5 Complete extension Face
  6. 6. Menstrual cycle
  7. 7. <ul><li>04/05 Q4 </li></ul><ul><li>Picture: menstrual cycle chart </li></ul><ul><li>b) Name 1 clinical feature indicating ovulation </li></ul><ul><ul><li>Thickening of cervical mucus </li></ul></ul><ul><ul><li>Increased basal body temperature </li></ul></ul>B4 ovulation After ovulation Ovarian Follicular Luteal Endometrium Proliferative Secretory
  8. 8. <ul><li>PYQ </li></ul><ul><li>Describe the events that take place: </li></ul><ul><li>Follicular phase </li></ul><ul><ul><li>FSH-RH  portal circulation  anterior pituitary  FSH </li></ul></ul><ul><ul><li>Recruitment &development of follicles in ovary </li></ul></ul><ul><ul><li>Only 1  dominant (just b4 ovulation: Graafian follicle) </li></ul></ul><ul><li>Proliferative phase </li></ul><ul><ul><li>Developing follicles secrete oestrogen: </li></ul></ul><ul><ul><li> endometrial glands &stroma to proliferate (↑ thickness) </li></ul></ul><ul><ul><li> -ve feedback on FSH for hypothalamus & pituitary </li></ul></ul><ul><ul><li> Convert cervical mucus to clear consistency (cervix receptive to sperm deposition in vagina) </li></ul></ul><ul><li>Ovulation </li></ul><ul><ul><li>Day 14: LH surge fr pitui gland (LH-RH fr hypothalamus) </li></ul></ul><ul><ul><li>Mature ovum extruded within 30-40hr </li></ul></ul><ul><ul><li>Ostium of Fallopian tube  migrate forward to proximal end of tube </li></ul></ul>
  9. 9. <ul><li>d) Luteal phase </li></ul><ul><ul><li>Remaining follicle excluding ovum  corpus haemorragicum </li></ul></ul><ul><ul><li>LH: corpus luteum formed  progesterone + some oestrogen </li></ul></ul><ul><li>e) Secretory phase </li></ul><ul><ul><li>Progesterone  glands of endometrium >tortous & secrete >nutrients in anticipation of fertilised ovum to be implanted </li></ul></ul><ul><ul><li>Corpus luteum lifespan 14d  spontaneous regression if no conception </li></ul></ul><ul><ul><li>Withdrawal of progesterone & oestrogen </li></ul></ul><ul><ul><li>Thus, endometrium unable to sustain itself  shed as menses </li></ul></ul><ul><ul><li>Low level of oes & proges  +ve feedback to hypothal to secrete GnRH again ( recruit a cohort of follicles for next cycle) </li></ul></ul>
  10. 10. Contraception <ul><li>06/07 Q4 </li></ul><ul><li>a) Name it. Condom b) List 5 advantages of it. </li></ul><ul><ul><li>Easily available </li></ul></ul><ul><ul><li>Inexpensive </li></ul></ul><ul><ul><li>No systemic side-effects </li></ul></ul><ul><ul><li>Easy to initiate or discontinue & there is immediate return to fertility </li></ul></ul><ul><ul><li>Protection against STDs or HIV infection </li></ul></ul><ul><li>c) List 2 disadvantages. </li></ul><ul><ul><li>Not as effective as other methods </li></ul></ul><ul><ul><li>May be difficult to use consistently and correctly </li></ul></ul><ul><ul><li>May require partner participation & hence interrupt sexual activity </li></ul></ul>
  11. 11. <ul><li>00/01 Q7 </li></ul><ul><li>Oral contraceptive pill </li></ul><ul><li>What is the function? </li></ul><ul><ul><li>Estrogen effect: </li></ul></ul><ul><ul><li>inhibits secretion of FSH via negative feedback on the anteror pituitary & thus suppress development of the ovarian follicle </li></ul></ul><ul><ul><li>Progestogenic effect: </li></ul></ul><ul><ul><li>inhibits secretion of LH & thus prevents ovulation </li></ul></ul><ul><ul><li>Cause changes in cervical mucus (production of thick viscid mucus decreasing its penetrability by spermatozoa) </li></ul></ul><ul><ul><li>With estrogen, causes changes in endometrium similar to those found during pregnancy, thus discouraging implantation </li></ul></ul><ul><li>2 chemical components </li></ul><ul><ul><li>Oestrogen & Progestogen </li></ul></ul><ul><li>3 complications </li></ul><ul><ul><li>Venous thromboembolism </li></ul></ul><ul><ul><li>Myocardial infarction </li></ul></ul><ul><ul><li>Breast cancer </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Headaches </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Weight gain </li></ul></ul>
  12. 12. <ul><li>04/05 Q3 </li></ul><ul><li>Picture: Prostin </li></ul><ul><li>What is this use for? </li></ul><ul><ul><li>Given as vaginal gel  cervical ripening & induction of labour </li></ul></ul><ul><ul><li>Given by extra-amniotic route  late (2 nd trimester) therapeutic abortion </li></ul></ul><ul><li>Describe the mech of action </li></ul><ul><ul><li>Stimulate gravid uterus to contract </li></ul></ul><ul><ul><li>Ripening of cervix (soften the consistency of collagen fibers of cervix) </li></ul></ul><ul><li>In which part of vagina you would insert this? </li></ul><ul><ul><li>Upper one third </li></ul></ul><ul><li>Name 2 possible complications. </li></ul><ul><ul><li>Uterine pain </li></ul></ul><ul><ul><li>Nausea and vomiting </li></ul></ul><ul><ul><li>Hypertonicity of uterus </li></ul></ul><ul><ul><li>Uterine rupture </li></ul></ul><ul><ul><li>Prematurity </li></ul></ul><ul><ul><li>Transient ↓ BP </li></ul></ul><ul><ul><li>Bronchospasm </li></ul></ul><ul><ul><li>Headache, flushes, anxiety </li></ul></ul>
  13. 13. <ul><li>01/02 Q5 </li></ul><ul><li>Name it (2) </li></ul><ul><ul><li>Cusco’s speculum (bivalve) </li></ul></ul><ul><li>2 findings on VE that must be present if instrument can be used (4) </li></ul><ul><ul><li>Bleeding </li></ul></ul><ul><ul><li>Mass </li></ul></ul><ul><li>2 complications (4) </li></ul><ul><ul><li>Contact bleeding </li></ul></ul><ul><ul><li>Causing pain </li></ul></ul><ul><ul><li>Entrapment of cervix during removal </li></ul></ul>
  14. 14. <ul><li>05/06 Q4 </li></ul><ul><li>Diagnosis (2) Molar pregnancy </li></ul><ul><li>2 diagnostic investigations (4) </li></ul><ul><ul><li>U/S: vesicular sonograhic @ “snow-storm” pattern </li></ul></ul><ul><ul><li>with no fetal part seen </li></ul></ul><ul><ul><li>Beta-hCG level elevated </li></ul></ul><ul><li>2 complications (2) </li></ul><ul><ul><li>Choriocarcinoma </li></ul></ul><ul><ul><li>Invasive mole </li></ul></ul><ul><ul><li>Pre-eclampsia </li></ul></ul><ul><ul><li>Hyperemesis gravidarum </li></ul></ul><ul><li>Possible karyotype (2) </li></ul><ul><ul><li>46 XX </li></ul></ul><ul><ul><li>69 XXX </li></ul></ul>
  15. 15. <ul><li>05/06 Q8 </li></ul><ul><li>Patient parity 9, urine leakage, pad test positive </li></ul><ul><li>Dx (2) Stress incontinence </li></ul><ul><li>4 causes (8) </li></ul><ul><ul><li>Pelvic wall weakness with UV prolapse </li></ul></ul><ul><ul><li>Pelvic floor weakness with cystocele </li></ul></ul><ul><ul><li>Raised intra-abdominal pressure eg chronic cough, constipation, obesity etc. </li></ul></ul><ul><ul><li>menopause/ multiparity  weakness of urethral weakness </li></ul></ul>
  16. 16. <ul><li>01/02 Q6 </li></ul><ul><li>28 year old female newly-wed, dysuria, increase frequency. Urine culture: mixed growth </li></ul><ul><li>Diagnosis: UTI </li></ul><ul><li>Interpret + reasons </li></ul><ul><ul><li>Not mid stream urine, contaminated </li></ul></ul><ul><ul><li>Low culture proportion </li></ul></ul><ul><li>Commonest pathogen </li></ul><ul><ul><li>Escherichia coli </li></ul></ul>
  17. 17. Anaemia in pregnancy <ul><li>What is the contributary factors (4) </li></ul><ul><ul><li>Malnutrition dt poverty @ food taboo </li></ul></ul><ul><ul><li>Multiparity @ lack of birth spacing </li></ul></ul><ul><ul><li>Menorrhagia </li></ul></ul><ul><ul><li>Worm infestation </li></ul></ul><ul><ul><li>Thalassemia minor </li></ul></ul><ul><li>Effect on fetus (3) </li></ul><ul><ul><li>Low birth weight </li></ul></ul><ul><ul><li>Prematurity </li></ul></ul><ul><ul><li>Still birth @ IUGR </li></ul></ul><ul><ul><li>Fetal anaemia </li></ul></ul><ul><li>Dietary advice? (3) </li></ul><ul><ul><li>No taboo </li></ul></ul><ul><ul><li>Good nutrition </li></ul></ul><ul><ul><li>Hematinics: Iron tablet, folic acid, vit B12 and vit C suppliment </li></ul></ul><ul><ul><li>Avoid taking hematinics together with coffee, milk or calsium tablet </li></ul></ul>
  18. 18. 33y.o female commercial sex worker with vulva warts. Pap smear: dysplasia, invasive CA, HPV infection. <ul><li>2 classical symptoms of cervical CA </li></ul><ul><ul><li>Intermenstrual, postmenopausal, post coital bleeding @irregular vagina bleeding </li></ul></ul><ul><ul><li>PV discharge ± blood-stained (infected) </li></ul></ul><ul><li>2 other investigations </li></ul><ul><ul><li>Punch biopsy (90% SCC, 10% adenoCA) </li></ul></ul><ul><ul><li>Colposcopy: CIN </li></ul></ul><ul><ul><li>CT scan: staging </li></ul></ul><ul><li>Risk factors </li></ul><ul><ul><li>Multiple sexual partners </li></ul></ul><ul><ul><li>Sexual partner with multiple sexual partner </li></ul></ul><ul><ul><li>Early age of 1 st coitus </li></ul></ul><ul><ul><li>Lower socio-economic status </li></ul></ul><ul><ul><li>Human papilloma virus (HPV) </li></ul></ul>
  19. 19. G2P1 at 36 wk of gestation; sudden pv bleed, emergency LSCS done. Dr unable to remove the placenta  hysterectomy to secure haemostasis. a) Dx: Placenta accreta <ul><li>Physical signs b4 c/s </li></ul><ul><ul><li>Shock: pallor, sweating, drowsy, cold clammy skin </li></ul></ul><ul><ul><li>Tachycardia: >160bpm </li></ul></ul><ul><ul><li>Hypotension: SBP<100 </li></ul></ul><ul><ul><li>Decreased CVP </li></ul></ul><ul><li>Causes of APH </li></ul><ul><ul><li>Placenta praevia </li></ul></ul><ul><ul><li>Abruptio placentae </li></ul></ul><ul><ul><li>Local causes: cervical growth/ polyp/ laceration/ CA </li></ul></ul><ul><ul><li>Indeterminate causes </li></ul></ul><ul><li>Why can’t remove the placenta? </li></ul><ul><ul><li>Placenta adhere to myometrium dt defect in decidua formation </li></ul></ul>
  20. 20. Rubella in pregnancy. Serology: haemaglutination Ab < 1/10 <ul><li>Clinical Feature of congenital rubella syndrome </li></ul><ul><li>Investigation </li></ul><ul><ul><li>Compare serum Ab levels 10 days apart </li></ul></ul><ul><ul><li>IgM Ab 4-5 weeks fr incubation period @date of contact </li></ul></ul>Transient Developmental Permanent <ul><li>IUGR </li></ul><ul><li>Thrombocytopenic purpura </li></ul><ul><li>Hepatosplenomegaly </li></ul><ul><li>Hemolytic anemia </li></ul><ul><li>Jaundice </li></ul><ul><li>Bone lesions </li></ul><ul><li>Meningoencephalitis </li></ul><ul><li>Sesorineural deafness </li></ul><ul><li>Mental retardation </li></ul><ul><li>IDDM </li></ul><ul><li>Delayed onset adolescence/ adulthood </li></ul><ul><li>Rubelliform rash </li></ul><ul><li>Persistent diarrhoea </li></ul><ul><li>Pneumonitis </li></ul><ul><li>Heart defects: patent ductus, VSD, pulm v/v stenosis </li></ul><ul><li>Eye defects: retinopathy, cataract, microopthalmia, glaucoma, severe myopia </li></ul><ul><li>CNS defects: microcephaly, psychomotor retardation </li></ul>

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