SOL@Playground : ONG

Bismillah

Alhamdulillah, selesai sudah rotation ONG selama 8 minggu. Selasa dan Rabu lepas, waktu untuk menguji kefahaman saya tentang ilmu perbidanan dan sakit puan ini melalui mid-term exam yang dibahagikan kepada mini-OSCE station dan OSCE station pada hari berikutnya. Sekadar untuk makluman, soalan-soalan exam buat rakan-rakan yang lain yang belum (cik ashiato dan cik jui) ataupun telah mengikuti rotation ini (korang-korang yang lainlah)

Mini OSCE Station
6 Slides

(Sorry, couldn't remember how the exact question is, I just stated the main idea what the examiners wanted from the questions given)

Slide 1 : A picture of intrauterine twins (With 2 chorionicities and 2 amnionicities, normal lie and presentation)

Name the type of the twins
Dichorionic Diamniotic

2. What is the presentation?
Cephalic/cephalic

3. With that type of presentation, what do you expect the mode of delivery will be?
Normal Vaginal Delivery

4. If the woman with this type of pregnancy presents to your clinic with abdominal pain at 34
weeks of GA, name 3 differential diagnosis?

(Here, you should state any related complication and risk of multiple pregnancy (hyperplacentosis, large uterus, etc) that will manifest as abdominal pain)

Eg: Preterm Labour Pain
Placental Abruption
Pre-Eclampsia

5. Complications during labour and delivery (cudn't remember the exact question)

Preterm Labour
Post Partum Hemorrhage
(Others, you can find them yourself)

Slide 2 : Rh isoimmunization
The question is quite long.
Main idea: Woman with G1P0, blood type O negative and her husband- B positive, came to your clinic with vaginal bleeding.

1. How do you manage this case regarding Rh Isoimmunization

ADMISSION !

Indirect Coomb's Test ( to check whether the mother has already sensitized or not, here we
don't need to do Blood grouping- because we already knew her blood group from the
question)

Amniocentesis and Kleihuer-Berke Test (Quantitative measurement of how much the fetal
blood has leaked into the mother circulation)

Give Anti-D within 72 hours (All the doses from British/American School recommendation,
you can read them yourself)

2. At 34 weeks of GA (maybe....) , you found out her indirect Coombs test was positive. What is
your next step?

Of course she needs admission
(Now, put in your mind, the mother has already sensitized.
Here, again we have to do amniocentesis to determine the severity . Management is based
on the Liley's Chart and Whitefield's Chart ( severity is determined by the level of
unconjugated bilirubin found in the blood à indicates hemolysis)

Based on the Liley's and Whitefield's Chart (a modified Liley's Chart), management is directly
proportional to the gestational age and the severity of hemolysis (before or after 34 weeks of
GA, Zone I, II, or III) whether to repeat the amniocentesis, to give intra-uterine transfusion
or to terminate the pregnancy (deliver immediately). )

3. (Here the doctor showed another slide with a stillbirth fetus)
What do you call this?
Immune hydrops/ Hydrops fetalis (a complication of failure to treat an Rh
isomummuized case)

Slide 3 :
A picture of laparoscope showing a mass in the fallopian tube, and collection of blood in the Pouch of Douglas.
Q- Main Idea: Woman with ….. ( cudn't remember the gravidity and parity), presents to the ER with abdominal pain and history of 4 weeks of amenorrhea.

1. What do you suspect ?
Ectopic Pregnancy

2. What are other symptoms she may have ?
(You should state other symptoms of ectopic pregnancy and early pregnancy)
Eg: vaginal bleeding, shoulder tip pain and symptoms of pregnancy (nausea,
vomiting, etc)

3. Before doing laporoscopy, what are investigations you need to do ?

(Here, remember to do pregnancy test - level of beta HCG, and serial level of beta HCG
reading after 48 hours- usually in normal pregnancy, beta HCG level will be doubling after
each 48 hours in early pregnancy, but never in ectopic pregnancy.

Don't forget to do U/S ( empty uterus-no gestational sac and if you are fortunate you can
see an extrauterine sac)

4. What are procedures that may be done in laporoscopy ?
Salpingotomy
Salpingectomy
Or, if we are sure the mother is hemodynamically stable,the fetus size is less than 3 cm (or
2 cm) in the fallopian tube, and no fetal heart is detected, we can inject methotrexate to kill
the ectopion (owh, am I using the word 'kill' here…?)

Slide 4 :
A Picture of contraceptive pills.
A Woman with P4 has this type of contraception after she deliver 3 month ago and is now lactating her newborn baby. She complain of irregular bouts of vaginal bleeding.

1. What type of contraception shown in the picture?
Progestogen-only pills (the picture was not so clear, but you can guess it,
because this type of contraception is safe in lactating mother)

2. Give 2 mechanisms of action this contraception can help in preventing
pregnancy

Thickening of the cervical mucus
Thinning and atrophying the endometrium

3. Name other method of this type of contraception that are available
Injectable
Subdermal implant
Hormone-releasing intrauterine system

4. Name other complications associate with this contraception use

Weight gain
Acne
Breast tenderness
Functional ovarian cyst
(Others, refer to your book)

Slide 5 :
A 45YO woman, P5 came to your clinic complaining of prolong and heavy bleeding

1. What clinical term for this condition?
Menorrhagia

2. What investigation you need to do on her?
CBC
Pap Smear
U/S
Hysteroscopy with endometrial biopsy

3. If all investigations turn normal, what do you suspect she may have?
Dysfunctional Uterine Bleeding

4. What kind of treatment you can offer before you decide to do surgery?
Medical treatment with hormonal and non hormonal drugs

a. Non-hormonal – anti fibrinolytic and anti-prostaglandin (NSAIDs)
b. Hormonal - Combined oral Contraceptive Pills
c. Levonogestrel releasing intrauterine device (Mirena)

5. If all the treatment above fail to improve her condition, what is the definite treatment?
Hysterectomy

Slide 6 :
(Now, it's your turn to find out the answer)

A pregnant woman at her 24 weeks of GA (ye kut..), with this result of CBC

HB : 8 g/dL

Sorry, cudn't remember other blood indices results. But, it was so obvious she is having Iron Deficiency Anemia

1. What is your diagnosis?
Iron Deficiency Anemia

2. What are other investigation to confirm your diagnosis?
3. What would you like to take in the history regarding her problem?
4. What are your initial treatment on her ?

OSCE Exam on the next day….

Station 1 :
A Genital Prolapse case in 53YO woman.
Remember to analyze the lump/ prolapse first, then ask about associated symptoms, and risk factors. Dr Faiz Jallad's wordà Genital prolapse is caused by childbirths, aggravated by increase intrabdominal pressure and, accelerated by menopause.

Station 2 :
Physical Exam without patient. You should tell every step you want to do to the examiner.

Case 1 : A 28YO woman, P2, delivered her baby by spontaneous vaginal delivery 14 days ago. She came to your clinic suspected of having puerperal sepsis.
What you may find from abdominal and pelvic examination?

Case 2 : A 24YO woman G2P1, 34 weeks of GA, diagnosed as a case of major placenta previa. What are your clinical findings from the physical examination?

Station 3 :
All about antenatal care

A 30YO woman G3P2, came to your clinic on her regular antenatal care. She is now at her 20 weeks of gestational age.

How do you confirm the gestational age?
How do you assess the gestational age on the basis of regular antenatal care?
Where do you expect her fundal height will be at this week of gestation?
What is the most accurate parameter to confirm the gestational age according to this case.

" ONG…
The highest medical specialty, because it deals with woman, the highest rank in society " – Dr Basel Obeidat, Head of Department, ONG, KAUH

P/s- Dr. Muui.. if you have time to read this, please check the answers (I got some questions wrong already.. (only some..? or many…?).. huhu )…
All the best, friends! Need your cooperation too in sharing the examination questions here.. Thank you

Wallahua'lam