This document provides information on various clinical OSCE questions and answers related to obstetrics and gynecology. It includes questions on family planning methods, emergency contraception, IUD insertion and complications, management of miscarriage, interpreting semen analysis results, use of forceps during delivery, techniques for obtaining pap smears and more. The document provides answers to 21 multiple part questions on these obstetrics and gynecology topics in a clinical exam format.

1. Final year.clinical OSCE-Obstetrics & Gynaecology.for medical
undergraduates. with answers
1. 1. Obstetrics and Gynaecology Yapa Wijeratne Faculty of Medicine University of Peradeniya
2. 2. Q1 1. Identify A-G 2. Write the corresponding letters in order of most effective method to
least effective method
3. 3. • A – Female condom • B – Levonorgestrel releasing intra uterine contraceptive device
(Mirena®) • C – Copper T-380 A intrauterine contraceptive device • D - Depot medroxy
progesterone acetate injectable suspension • E – Norplant subdermal contraceptive implant
system • F – Combined oral contraceptive pill • G- Male condoms E>B>F=D>C>G>A
4. 4. % of women experiencing an unintended pregnancy within the first year of use Method
Typical use 1 Perfect use 2 No method 4 85 85 Withdrawal 27 4 Periodic abstinence
Calendar Ovulation method Sympto-thermal 6 Post-ovulation 25 9 3 2 1 Condom - Female
21 5 Condom - Male 15 2 Combined pill and minipill 8 0.3 DMPA (Depo-Provera) 3 0.3 IUD
(copper T) 0.8 0.6 Mirena (LNG IUS) 0.1 0.1 LNG implants (Norplant) 0.05 0.05 Female
sterilization 0.5 0.5 Male sterilization 0.15 0.10 Emergency contraceptive pills: Treatment
initiated within 72 hours after unprotected intercourse reduces the risk of pregnancy by at
least 75%. 2 3 3 4 5 6 1
5. 5. A) 21 yrs old unmarried girl presents to your clinic after having unprotected sex last night.
What method/s that you can use in this patient as post-coital contraceptive method/s. B) A
35 yrs old healthy woman with two children aged 3 & 5 yrs requests an emergency
contraceptive after unplanned coitus 4 days ago. Name a method that you would offer to this
woman. Q2
6. 6. A. 1 – Postinor2® take one tab immediately and the second tablet 12 hrs later 2 –
Combined oral contraceptive pill Take 4 tablets immediately and repeat the same dose 12
hrs later B. Copper T 380-A intrauterine contraceptive device • A copper-releasing IUD (Cu-
IUD) can be used within 5 days of unprotected intercourse as an emergency contraceptive.
However, when the time of ovulation can be estimated, the Cu-IUD can be inserted beyond 5
days after intercourse, if necessary, as long as the insertion does not occur more than 5
days after ovulation.
7. 7. Q3 1. How long can it be used 2. List 2 advices you would give after inserting this to a
patient 3. What should you do if a woman gets pregnant after placing it
8. 8. 1. 10 years (6-8) 2. Expect some bleeding PV for a few days Check for the presence of
the threads (Specially during menstruation period) First 3-4 menstrual periods may be
heavier than normal Take paracetamol tablets if she develops lower abdominal pain. Follow
up – In one month and thereafter annually Prompt medical advice should be taken if - the
threads are not felt - delayed menstrual period (Pregnancy?) - Severe abdominal pain
Prolonged or excessive bleeding
9. 9. If threads Neg. - US Scan - identify in utero - counsel - check at delivery - check Post
partum - X’ Ray3. Cu-T Pregnant • Exclude ectopic • Counsel regarding risks – Miscarriage
– Preterm delivery – Infection • Remove if threads + • Advise prompt return for Rx of
complications (Bleeding, pain, discharge, fever etc)
10. 10. • Timing of insertion 1st seven days of the cycle (Ideal during menstruation) • Removal of
IUD pregnancy Perforation Acute PID Menopause – one year after last period • Absolute
contraindications Pregnancy Acute/Chronic PID Abnormal uterine bleeding
Suspected/confirmed genital tract malignancy • What you should ask in the Hx: LRMP – to
rule out possibility of pregnancy Mucopurulent vaginal discharge - ? PID
11. 11. 1. Name above items and write one non-contraceptive benefit of each above given
methods 2. 30 yrs old female who is on OCP has forgotten to take her last two pills. what
advise would you give her? Q4
12. 12. 1) A - Levonorgestrel releasing intra uterine contraceptive device (Mirena®) B – Male
condom C – Combined oral contraceptive pills 2) A- Improves menorrhagia Decrease

2. dysmenorrhoea and pelvic pain in patients with endometriosis B- Protection against STD
Protection from carcinoma of the Cx C- Relief of menstrual problems Regularizes previously
irregular cycles Decrease number of days of bleeding and amount Improves iron deficiency
anaemia Relieves and reduces premenstrual tension Protection against ovarian and
endometrial cancers Decreases incidence of benign breast cysts and fibroadenoma Prevent
ectopic pregnancy
13. 13. Missed pills
14. 14. Q5 1. What is the advice you would give to the patient when prescribing this 2. List 3
Common side effects
15. 15. Advice • Postinor contains two tabs. Treatment necessitate to take 2 tabs • Reliable
(75%) post coital contraceptive method if it takes <72 hrs after unprotected sex • 1st tab
should be taken immediately. 2nd tab should be taken 12hrs after the 1st dose • If vomiting
occurs within 2hrs of intake take another tab. • Can cause irregularity to your next menstrual
period • Not a method of abortion • No adverse effects to an already existing pregnancy •
Adverse effects – Nausia, Lower abd pain, breast tenderness, Vomiting • Consult a physician
if you missed your next period • Advise her about proper use of suitable contraceptive
method
16. 16. Q6 Mother giving breast milk to child, looking far away 1. List 2 correct techniques when
breast feeding 2. List 2 maternal complications due to incorrect technique of breast feeding
17. 17. • Correct technique: a) Good exposure of both mother and baby. b) Posture- Mother
sitting comfortably. The baby is held with his head ,neck and body in one line supported by
the mother’s forearm. c) Good attachment- The areola covered by baby’s mouth with the
lower lip everted and cheeks should be puffed out. d) Eye contact to be maintained. e) Each
feed to be around 20 minutes. • Maternal complications: a) Cracked nipples b) Breast abcess
18. 18. Q 7 • How do you prepare a patient for LSCS • What are the complications of LSCS
19. 19. • Consent • Co-ordinative part- inform aneasthetist, PHO and theatre. • Keep fasting 8
hours • Investigations- Grp & DT( Reserve 1 unit) • Pre-medication- Metachlopromide 10mg
oral, Famotidine 20mg oral • (Emergency- O2, IV Ranitidine 50mg, IV Metachlopromide
10mg, ) • Na Citrate 0.3M 30ml. Mother in left lateral position. • Send Urinary cather, IV
antibiotics ( Metronidazole 500 mg, Cefuroxime 750 mg ( 1 vial each) to theatre.)
20. 20. Complications of LSCS • Anaesthetic – Gastric acid aspiration ( Mendelson’s synd) •
Immediate- PPH, shock, damage to bladder, ureters or colon • Early- Sepsis, Wound
complications (Haematoma, dehiscence) • Late- risk of scar rupture in future pregnancies,
incisional hernia, intestinal obstruction due to adhesions
21. 21. Q8 Give 4 risk factors from this antenatal record (Two slides)
22. 22. • Short stature • Previous death in-utero • Previous miscarriages • Blood pressure of
160/110 • Proteinuria • Grand multi para
23. 23. Q9 • Tick the items used in manual removal of placenta 1 Plasters 2 14G foley catheter 3
14G IV cannula 4 Vacuum cup 5 A pair of gloves 6 Cusco’s speculum 7 IV drip set 8
Vulsellum 9 IV metronidazole 10 Betadine
24. 24. 1 Plasters 2 14G foley catheter 3 14G IV cannula 4 Vacuum cup 5 A pair of gloves 6
Cusco’s speculum 7 IV drip set 8 Vulsellum 9 IV metronidazole 10 Betadine
25. 25. Q10 1. Identify/name the instrument 2. Write 2 uses
26. 26. 1. Cusco’s bivalve self retaining vaginal speculum 2. • In obtaining a Pap smear • In
obtaining a high vaginal swab • To visualize the cervix & vaginal wall in pelvic examination •
Insertion /removal of IUCD
27. 27. Q11 1. What do you see 2. Write 2 causes
28. 28. 1. Secondary arrest 2. CPD OP position Inadequate uterine contractions Mx: CPD – Em
LSCS OP position Inadequate uterine contractions Exclude obstruction Increase oxytocin
infusion rate Observe and if no progression Em LSCS
29. 29. Q12 Write a clinical condition where each of these drugs are used
30. 30. Oxytocin Augmentation of labour. Active Mx of 3rd stage labour & control PPH. Following
evacuation of uterus. Mg sulphate As eclampsia prophylaxis. Hydralazine In Pre-eclampsia

3. and eclampsia. Ergometrine Prophylaxis against excess heamorrhage foll. delivery
Therapeutic- In PPH: atonic uterine bleeding. In atonic uterine bleeding foll. Miscarriage,
expulsion of H. mole.
31. 31. • Q 13 • Counsel this 30 yrs old patient who is diagnosed to have an incomplete
miscarriage
32. 32. • Introduce yourself, put the patient at ease • Explain what has happened ( Most
miscarriages are due to fetal anomalies, there is nothing that she could have done to prevent
the miscarriage ) • The need to undergo surgery ( Evacuation of retained products under GA)
• Preparation for the next pregnancy – wait at least 3 months, during this period take folic
acid • Early antenatal clinic booking and regular follow up. • Ask whether patient has any
questions to ask
33. 33. • Q 14 • Ask 5 leading questions to determine the severity of this patients condition who
has a blood pressure of 160/100 mmHg
34. 34. 1. Frontal Headache- unrelieved by simple analgesia. 2. Visual disturbance- flashing
lights and spots 3. Epigastric pain 4. Nausea/ Vomiting 5. Swelling 6. Malaise
35. 35. Q 15 Write the names of the 5 abnormalities you see.
36. 36. Normozoospermia When all the spermatozoal parameters are normal together with
normal seminal plasma ,WBCs and there is no agglutination. Oligozoospermia When sperm
concentration is < 20 million/ml. Asthenozoospermia Fewer than 50% spermatozoa with
forward progression(categories (a) and (b) or fewer than 25% spermatozoa with category (a)
movement. Teratozoospermia Fewer than 30% spermatozoa with normal morphology.
Oligoasthenoteratozoospermia Signifies disturbance of all the three variables (combination of
only two prefixes may also be used). Azoospermia No spermatozoa in the ejaculate.
Aspermia No ejaculate. Leukocytospermia more than 1 million white blood cells per ml of
semen
37. 37. Normal values Volume 2.0 ml or more pH 7.2-7.8 Sperm concentration 20x106
spermatozoa/ml or more Total sperm count 40x106 spermatozoa or more Motility 50% or
more with forward progression or 25% or more with rapid progression within 60 min after
collection Morphology 30% or more with normal morphologyb Vitality 75% or more live White
blood cells Fewer than 1x106/ml
38. 38. • sensitivity of 89%, poor specificity repeat semen samples provides greater specificity. •
At least two samples, preferably taken at least two or three weeks apart, should be analyzed.
• Newly formation of sperm to transport & to present in ejaculate, it takes ~74 days.
Therefore ideally it has to be repeated ~2-3 months later.
39. 39. • Q16 • What is the advise you would give regarding obtaining a semen sample for
analysis
40. 40. • This test is conducted to check for male factor subfertility. • Specimen should be
produced by masturbation. • Abstinence from intercourse for 3-4 days. • Condoms should not
be used for collection as they contain spermicide. • Coitus interruptus is not recommended
as the first part of the ejaculate contains the highest concentration of sperm. • Wide mouthed
sterile plastic container will be provided. • Sample should be delivered to the lab within 30
min. of collection.
41. 41. 1. Identify 2. List 3 prerequisites in using these instruments 3. Give 3 indications for these
instruments Q17
42. 42. Wrigley’s Forceps
43. 43. Always prior to applying forceps 1. Abd examination – Head engaged? 2. Confirm that
the cervix is fully dilated 3. Empty the bladder 4. Check station of the presenting part 5.
Position of the foetal skull – Position of the saggital suture & posterior fontanelle
44. 44. Prerequisites for applying forceps • Valid indication must be present • Suitable
presentation- vertex,face, aftercoming head of breech. • Rule out cephalopelvic dispropotion.
• Engaged Presenting part. Position of the fetal head should be known. • Cervix should be
fully dilated. • Bladder emptied- preferably by catherisation. • Ruptured membranes. •

4. Abdominally head should not be palpable. If more than 1/5th palpable abandon vaginal
delivery.
45. 45. Indications for forceps delivery 1. Delay in progression of second stage of labour 2.
Maternal exhaustion 3. Medical problems which require avoidance of excessive maternal
effort 4. Fetal distress in the second stage 5. Delivery of the after coming head of a breech
presentation
46. 46. 1. Name the required instruments in order of use when obtaining a pap smear 2. What is
the fixative and the stain used Q18
47. 47. 1. F - Cusco’s bivalve self retaining vaginal speculum G - Ayre’s wooden spatula B -
Cytobrush/ Endocervical brush A - Glass slides 2. Fixative – 95% Alcohol Stain-
Papanicolaou stain (The glass slide is fixed in 95% alcohol for 30 minutes and air dried
before sending to the histology lab)
48. 48. 1. Name 5 instruments in an episiotomy set. 2. List 3 complications of an episiotomy 3.
What are the advise given to mother after repairing an episiotomy Q19
49. 49. Complications of episiotomy – Immediate- • Extension of the incision - Early • Vulval
haematoma • Infection • Wound dehiscence – Late • Dyspareunia
50. 50. Advise to mother following episiotomy • Keep the area dry and clean. • Do not pull out
the sutures, they are absorbable (~3wk) • Do not clean with hot water. • Do not use
antiseptics, soap is sufficient. • Drink plenty of water, eat more vegetables, fruits to avoid
constipation • Can wear a sanitary pad to keep area dry.
51. 51. What instruments are used in the following procedures in order of use 1. Dilatation &
Curettage 2. Repair of a cervical tear Q20
52. 52. 1. D&C : • Performed under GA • Placed in lithotomy position • Local antiseptic cleaning
& draping • Empty bladder: using a metal catheter • Sims’ double bladed posterior vaginal
speculum is introduced • Anterior lip of cervix held by vulsellum • Olive pointed malleable
graduated metallic uterine sound to confirm position & length of cavity • Cervical canal
dilated with Hegar’s graduated dilators • Uterine curette – sharp end for benign lesions and
blunt end used for suspected malignant lesions • Curetted material preserved in 10% formal
saline and sent to histology lab with a short clinical history.
53. 53. Post procedure care: • Give paracetamol 500 mg by mouth as needed. • Oxytocin 10 U
given foll. ERPC • Offer other health services, if possible, including tetanus prophylaxis,
counselling or a family planning method. • Advise the woman to watch for symptoms and
signs requiring immediate attention: - prolonged cramping (more than a few days); -
prolonged bleeding (more than 2 weeks); - bleeding more than normal menstrual bleeding; -
severe or increased pain; - fever, chills or malaise; - fainting.
54. 54. Repair of a cervical tear • Anaesthesia is not required for most cervical tears. For tears
that are high and extensive, give pethidine IM • Good light source and patient is placed in
lithotomy position. • Sims’ speculum is introduced • Gently grasp the cervix with Green
armytage forceps. Apply the forceps on both sides of the tear and gently pull in various
directions to see the entire cervix. There may be several tears. • Close the cervical tears with
continuous chromic catgut (or polyglycolic) suture starting at the apex (upper edge of tear),
which is often the source of bleeding.
55. 55. Q21 • What are the instruments found in a delivery set.
56. 56. Q 22 Name following diameters
57. 57. Q 23 Identify following cervical cerclage techniques A B
58. 58. Identify following cervical cerclage techniques McDonald technique Shirodkar technique
Shirodkar -> I -> Internal Os
59. 59. Q 24 Identify following patterns of abnormal progress in labor
60. 60. 1 2 1. Identify 2. Name which one you would use in the following procedures • To insert
an IUCD • In vaginal hysterectomy • In D&C • In obtaining a pap smear • Repair of a cervical
tear Q25

5. 61. 61. • Cusco’s bivalve self retaining vaginal speculum a) Inserting an IUCD b) Obtaining a pap
smear • Sims’ double bladed posterior vaginal speculum a) Vaginal hysterectomy b)
Dilatation and curettage c) Repair of a cervical tear
62. 62. Q26
63. 63. Complications • Inter-menstrual bleeding • Pelvic inflammatory disease • Expulsion (1st 3
months) • Perforation
64. 64. 1. Identify 2. List an indication and a contraindication Q27
65. 65. Name of instrument – Ring pessary Indications for use of vaginal pessary a) Prolapse of
uterus b) urinary incontinence c) cystocele d) rectocele Contraindications a) Active infections
of the pelvis or vagina, such as vaginitis b) Pelvic inflammatory disease c) Patients who are
noncompliant or unlikely to follow up d) Allergy to silicone or latex
66. 66. Foetal movement chart 1. How to advise mother to maintain a Foetal movement chart 2.
When do you call it abnormal 3. List 3 causes for reduced FM 4. List 3 non invasive tests to
assess foetal well being Q28
67. 67. Test sensitive for fetal well-being after 28 weeks Physiology of normal third trimester fetal
movement • Fetus spends 10% of its time making gross movements – Active fetal periods
last 40 minutes – Inactive fetal periods last 20 minutes (<75 minutes) • Fetal activity peaks
with maternal Hypoglycaemia – Usually occurs between 9 pm and 1 am – Activity not
increased after meals or glucose load Advise to mother: » Patient self monitors kick counts
daily at home » Count performed at same time every day » Lie on left side in comfortable
location » Count fetal movements to a count of 10-12 in 12 hours » If perceived movements
are <10/12hrs seek medical advise
68. 68. Causes of reduced foetal movements: • Normal sleep phase • Physiological • Reduced
maternal perception • Sedative drugs given to mother • Polyhydramnion/oligo • Intrauterine
asphyxia Non-invasive tests to assess foetal well being: • CTG • USS- foetal growth &
Liquor., biophysical profile, • Umbilical artery Doppler
69. 69. Q29 A) What is the condition B) What is the diagnosis C) Give 2 causes
70. 70. USS abd given H.Mole
71. 71. Presentation 1. Vaginal bleeding 2. Passage of vesicular grape like structures per
vaginum 3. Hyperemesis 4. Early onset PIH Examination findings 1. Anaemia 2. F>D
Investigations 1. USS abd. 2. S. hCG 3. CXR Management 1. Evacuation 2. Follow up (2
yrs)- hCG assays 3. Contraception 4. Chemotherapy +/- •Absence of a foetus (In complete
mole) •“Snow Storm” appearance
72. 72. Basal body temperature chart (BBTC) 1. What is the day of ovulation 2. What advise you
give on using this 3. On which day according to the chart would you do the following a. Post
Coital Test b. Progesterone levels to detect ovulation c. Endometrial biopsy d. HSG e. IUI
Q30
73. 73. Ovulation 0.5-1 0 F (0.2-0.5 0 C) 2 days
74. 74. 1. Day 14 of the cycle. 2. There is a biphasic pattern of variation in ovulatory cycle. •
Begin recording temp. on the first day of the period- day 1 on the chart. • Measure the oral
temp. using a clinical thermometer. • Mark the date in the column and shade the area on the
day of menses. • Take the oral temp daily on waking before getting out of bed. ( do not wash
mouth) • Days when intercourse takes place should be noted with an arrow.
75. 75. a. Post Coital Test- day 12-13 in a regular 28 day cycle. b. Progesterone levels to detect
ovulation – Day 21 in a 28 day cycle. c. Endometrial biopsy- Day 21-23 in a 28 day cycle. d.
HSG- First 10 days of the cycle. e. IUI- washed sperms are placed in the uterine cavity at the
time of ovulation. Ovulation detected by follicular growth monitoring by USS.
76. 76. Note: • These questions were given in the past OSCEs in various medical faculties. •
Original slides were modified in good faith to provide updated & user friendly presentation. •
Every effort is made to ensure accuracy of the material. But the practices can be slightly
different.