LAGI...soalan group C OnG 2010 pula..Mari TGK! ^_^

Salam semua. lagi soalan dr group C..2010 --all 3 groups b4 us have 6 stations

MiniOsce ..

1. partogram - primary dysfunctional labour
2. Endometrial cancer

Station OSCE..

3. Ectopic pregnancy
4. IUGR
5. Ovarian Ca
6. Caunseling before c/s

Seperti yang telah saya teliti dan kata-kata jui yang meramalkan selalunya(kalau ikut rotation 5th year)..
OnG ni tak ulang topik yang sama..

Saya melihat senarai soalan setiap group dan ternyata untuk topik2 selain cancer tidak pernah berulang topiknya..

Maka, wallahu a'lam kita cuba la tumpukan mana yang tak kluar lagi..
seperti abortion, incontinence, menorrhagia, amenorrhea, n macam2 lagi yang belum kuar

Endometrial cancer dah kuar dua kali di OSCE mahupun mini OSCE. setiap kali exam ada 2 soklan cancer..satu kluar betulis n sati keluar oral..so wallahu a'lam..sama-sama la pentingkan yang mana yang dirasakan penting..dan doa banyak2..

selamat study semua..salam

Addition - OSCE ONG q 1st group

salam, this is q  for 1st group

1. Eclampsia mx

2. Pic of Pprevia and malpresntation - most common cz of malpresentation : prematurity

3. Endometrial CA - 10 relevant q n ddx

4. Cervical CA - written q - cause, stage

5. Instrumental delivery- vacuum

6. Progesterone contaceptive

OSCE Obs Gyne Questions

Salam to all,

Hope that everybody is in good condition as the exam is just around the corner hehe. Included here are questions from round that i got from Dr Khaled in Badiah(those are past year questions and ans for 6th year. He was the examiner for the past few years. Also i put questions from cd(bil rafedeen) in case anyone dont have it yet. bittawfeq salam

Some said these important for this exam…

1.  canseling combine OCP
2. Cervical CA
3.  Incontinece
4. DnC
5. breech
6. Post-abortive management(sgt2 imp)
7. Infertility counseling
8. Partogram

- Ovarian Dermoid cyst(question not known) : kluar dalam exam group sebelum kita

Past years questions in CD

1.       Pap smear :
      Indication , types , how to perform it.
2.       Ectopic pregnancy hx ( bleeding in 1^st trimester )
3.       IUCD pic : what is this? Indication? Complications.
4.       Fibroids pic : what is this? Symptoms, complications during pregnancy.
5.       Placental abruption pic : what is this? Complications for fetus & mother, co conditions, treatment.
6.       Anencephaly pic : what is this? How to diagnose? Complications.
7.       CTG… read it …. What is your plan?
8.       HSG pic showing blocked tubes…. What do u see? Give another test to assess patency of tubes? What is your plan….

Block 2 :

Station 1:

Vaginal bleeding in the 3^rd trimester "Ante-partum hemorrhage either placenta previa or abruptio placenta I can't remember" (Hx and management)

Station 2:

Vaginal bleeding in the 1^st trimester (Hx and management).

كانت .inevitable abortion

Station 3:

Pregnant lady who has also fibroid in the lower part of the uterus (how to deliver and the type of the incision) and if she developed after the delivery DVT what is the cause and the management

Station 4:

Gestational diabetes (the tests and the management).

Station 5:

Instruments (what is the instrument and what is used for).

Station 6:

Lady presented with vaginal discharge (Hx, investigations and treatment).

Station 7:

Partogram with information on it (what is the problem and the management) 

كانتfailure to progress in the second stage  على ما اذكر و الـ management

Block 3 :

Case1: (Endometriosis)

The Dr gave  typical Hx of endometriosis.then he asked:

what is your diagnosis?

what investigations to confirm?

what is the most definitive diagnostic way?

what are the lines of treatment?

Case2: (Normal Labor, Induction of Labor)

1.what do you want to see in your examination?

2.when to decide doing cesarean?

-you should know when to do CTG, scalp PH sampling.

- you should know how frequent to do PV & repeat PH & CTG ,what is the next step in each case.

Case3:(Partogram)

you should know patterns of dysfnctional labor &management of labor.

 you should know how to read partogram & pickup needed information.

Case4: (Galactorrhea)

Presentation with excessive milk production + Inferitlity.

what this condition is called?

what is the m0ost likely diagnosis? Hyperprolactinemia.

what physical exmination to do? Visual field.

what investigations? Hormone profile(prolactin FSH,LH) +CT brain  for pituitary adenoma.

In a case of of infertility,.

 what is the key lab investigation? Progesterone level at day 21.

If hormonal profile &ovarian fxn were normal in a subfertile female, what is your next step? Hysterosalpingogram to check uterus and tubes.

Case5: (Ovarian mass)

when to suspect cancer?

what investigations?

what is your management?

Case 6:

Pregnant lady with Hx of 2 DVTs ,want to do Cesarean (indicated C\S)

when to start heparin as prophylaxis during pregnancy?

when to stop?

when to give after C\S? for how long.

Case7:OCP

tell me about OCPs.

the ptn was lactating &want to take OCP what you will tell her?

Questions past year from Dr Khaled Badi’ah Hospital

27yo pt, G3P2, both NVD, 3.5 kg, seen for routine natal visit at 38w, no significant hx

On exam : BP 120/70

Obs exam : Breech presentation

1.       Whats ur next step?
- pelvimetry/ultrasound

2.       U/S done shows breech, otherwise others is normal, pt ask you – how to deliver?

-          3 option : Breech Vaginal delivery/ECV then NVD/ c/s

3.       She decided Vaginal delivery and ECV, whats the success rate?

-          50%

4.       What are possible complication of ECV?

-          Failure of ECV

-          Cord compression

-          ROM

-          Placenta Abruptio

-          Ruptur uterus

-          Fetal distress

-          Feto Maternal silent hemorrhage

5.       ECV failed(which means the complication above happen),then what?

-do ELECTIVE c/s after 1 or 2 days waiting.

48yo, referred from private doc case of menorrhagia for further evaluation and treatment

(answer as in dr fayed jallad notes and in his lecture)

1.       What are the possible cause?

-organic cause

-non organic

2.       Step that should be taken?

-Hx : bleeding(analysis), previous treatment n drugs taken, prev biopsy/smear, thyroid/blood/liver disease

-PE : 

1.General  : anemia sign, breast,thyroid disease

2. Abdominal ; palpable mass

3. Pelvic : inspection, speculum, bimanual

Bimanual exam :

-uterus size(huge,bulky,normal), shape(resular/irregular)

-mobility : mobile/fix

-position : anterverted(cervix felt anterior)/retro (cervix felt posteriorly)– important to insert the sounds

-Investigation : (6) CBC, Coagulation, TFT,LFT,Cervical smear,endometrial smapling by DnC

3.       After investigation no organis cause identified, then whats the cause?

-DUB

4.       Treatment?(elaborate the answers)

1.       Medical

2.       Surgical

A pictures shows P.previa grade 3 and malpresentation(breech)

1.       What do u see the clinical problem in this pic?

-          PP and malpresentation

2.       Whats the  usual presentation?

-          Painless vaginal bleeding

3.       Give 4 complication

PPH, maternal morbidity and mortality, Fetal M& M, preterm delivery

4.       Mx?

1.       Admission

2.       2 large bore canula, draw blood for cbc(Hb), crossmatch, blood group, Prepare 4 unit blood

3.       Fetal maternal monitoring : ……..

4.       Dexametasone 2x 12h apart 12mg, Rhogam(anti D)

5.       When to deliver?

-wait at 37-38w to deliver by ELECTIVE C/S

If bleeding sever, fetal Distress, contaction indicate labour à EMERGENT C/S

38yo, G3P2, 2 NVD, 2 healthy boy, 32 w GA, singleton, came to ER c/o abd pain for the last 5h. She is medically fit(which mean uneventful pregnancy), take relevant hx…

1.       Analysis of pain – mild progressive colicky, for how long and the frequency?- every 5 min, lact 20sec each

2.       Bleeding? – no

3.       Passing liquor? – no

4.       Fetal movement – good

5.       Fever ? – no

6.       G1 symptoms/ urinary sx

7.       Feeling pressure down ?– IMPORTANT! DON’T FORGET!

8.       Passage of SHOW ?

9.       Trauma

IUCD questions…

1.       What the type IUCD u know? Copper and mirena

2.       What imp point in pt taking IUCD?

(7) allergy copper, PID hx, ectopic Hx, LMP(make sure she is not pregnant), Previous failure IUCD, systemic illness(if have infective endocarditis we cant give them IUD), sign of vaginal infection

3.       When to insert? Any day provided not pregnant, preferably on 5^th day menses.

4.       Caunseling complication

-          Perforation, failure IUCD increase risk ectopi, PID, menorrhagia

-          Mild cramping pain and slight bleeding

-          Fainting(dizziness)

-          Risk od PID in 1^st few months

-          IUCD need to be f/up and check

-          Failure rate/perforation

-          Usual time perforation during insertion

-          If spill out – do u/cs à if not seen, do abdominal xray à seen radio opage

Primigravida, 36w GA, PROM since 24h + uterin e contraction

On exam : Obese, normal U/S

Vaginal Exam : 3cm dilated cervix + cord prolapsed, vertex presentation 3 cm above the ischial spine, FHR 100b/min(deceleration)

1.       Whats definitive tt? - EMERGENT C/S

2.       6 possible post op complication?

Thrombosis, resp infectn, endomeritis, bleeding, UTI etc

3.       How to decrease the complication?

-prophylaxis low molecular weight heparin and others(look in C/s notes)

4.       2^nd week after delivery, where will be the uterus?

-Pelvic Organ

5.       6 week post-del, lactationg, wish to use contraceptive, options?

-          Minipills, mirena, depopovera,implant

6.       What chances of this mom to deliver NVD the next time?

65 – 80%

Miss A, G4P3, all deliver by NVD, attend at 35w for 1^st time, no medical illness, normotensive

Abdominal exam – singleton,tranverse lie, fetus good

1.       Abdominal u/s perform, what to look for?

1.       Placental localization

2.       Amount of liquor

3.       Confirm GA + live fetus

4.       Congenital anomalies

5.       Uterine anomalies

2.       u/s done – single fetus, equal GA, tranverse lie, no gross anomalies, aFI 12, placenta ant reaching cervix

dx ? – Pprevia GRADE    2-3

3.       Whats ur plan?

1.       Admission – 2 large bore canula and…..

2.       Expectant Mx up to 37w then do c/s

3.       Dexametasone

4.       2 situation that may happen and what to do?

Bleeding and fetal distress – EMERGENT C/s

5.       At day of admission, 300ml blood clot , what to do?

-          EMERGENT C/s

48 old lady, 1 year amenorrhea, no hx of any surgey, LH 70 IU

1.       Dx? – menopause

2.       Name 2 long term complication

-osteoperosis

-cancer

3.       Tt?

-HRT, combine type

4.       Decline HRT, but present 1 year later with vaginal bleeding…what u think?

Endometrial cA

5.       4 additional factors cause this?

Estrogen tt, DM, Obes, PCOS, Nullipara, Estrogen secreting ovarian Ca

6.       2 investigation

-          Endometrial samping, U/S, hysteroscopy

Menorrhagia, 48yo, P6 +2, heavy period, take hx

1.       Analysis bleeding

2.       Prev investigation n tt

3.       Gyne hx

4.       Medical hx

5.       Drug

32 w uneventful preg, normal fetus, c/o watery vaginal discharge

Suggestive pROM

1.       How u establish dx?

-          Speculum exam-nitrazine test

2.       Exam?

-tempt 37 , Pulse 78, uterus equal to date, PROM confirm by speculu,, HVS taken

3.       Mention 3 assessment

-          u/s

-          CTG

-          Contraction/not

-          CBC + CRP

4.       Not contacting, fetus good, u/s normal, crp (-), what to do?

a.       Admit

b.      Prophylaxis Abs

c.       Dexa

d.      Fetal maternal monitoring

5.       5 days after admit, temp 37.5, pulse 110, uterus tender, tense, fetal ceplahic, good CTG

Mention 2 steps to do next?

-          Change to IV Ab

-          Deliver

6.       Boshop score 10, wthats next?

-syntocinon infusion

25yp G2P1, deliver by c/s, had cone Biopsy, admit at 7w, IVF pregnancy,mild vag bleed, nild abdominal pain, hemodinamically stable, BHCG 1500, vaginal u/s empty uterus, 2 cm cystic shadowing in adnexia

1.       After iv canula n cbc, next step?

2.       20h later clinically stable, BHCG 1000, serum progesterone 10ng, dx?

-          Medical

-          surgical

3.       Tt option?

Ectopic P

4.       Few days after receive methotrexate, look pale, pulse 120, bp 90/100,abd pain n tender, mx?

-          Recussitate, ivfluid

-          Laparotomy

5.       2 risk factors for this ectopic?

-          IVF preg

-          C/S

35yo, 1^st NVD, 10 days ago, presented now as heavy vaginal bleeding after 24h

1.       Dx? Secondary PPH

2.       Ather possible cause?

-          Blood disorder

-          ChorioCarcinoma – the do BHCG immediately.

3.       u/s : RPOC. Outline the mx of this case

1.       admit – 2 large bore, iv line, blood crossmatch….

2.       AB in 12 h

3.       DnC

4.       describe how u do it?(as in skill lab)

5.       Complication

-          Perforation

-          Bleeding

wallahu a'lam. Rabbana Yusahhil...

OSCE O&G kumpulan D

InsyaAllah lagi 2 minggu, pelajar tahun 6 akan sekali lagi diuji fizikal & mentalnya dlm OSCE. Ini soalan2 OSCE O&G kumpulan D. Moga bermanfaat buat semua sahabat.

1) Q :counseling for the baby of gestational diabetic mother
Ans : fetal assessment of GDM baby as written in the Ru2ia lecture notes

2) Q : patient with history of gush of fluid (PROM)
a -what is your DDx?
b -what investigation should we use to diagnose PROM ?
c - if the patient does not have labour pain after 12 hours (not sure) what is your management plan?

3) Q : findings of patient with endometriosis
a - what is your dx?
b - what is the common site of endometriosis lesion
c - what is the diagnostic procedure?
d - what is the treatment ?

4) Q : patient with postmenopausal bleeding
a - what is your DDx?
b - what investigation will you order for the patient?
c - what is the medication?
d - what are the 2 side effects of progesterone?

InsyaAllah bittaufeq

Jelaskan matlamat...Tuluskan niat~

Persenyawaan in-vitro: Harapan dalam ujian

Sudah 4 minggu rotation Obstetrik & Ginekologi berlalu. Fatrah 2 minggu di Hospital Badi3ah & 2 minggu di Hospital Ameer Rasyeed (Army) pergi macam angin lalu. Pantas! 4 minggu lagi, OSCE & mini OSCE pertama untuk tahun terakhir akan datang menguji sebelum bersedia menyarung ‘scrub’ & memegang ‘scalpel’ pula untuk rotation seterusnya.

Hari terakhir rotation luar KAUH berakhir di Ameer Rasyeed. Puas. Setakat ni, normal labor, caesarean section, posterior colporraphy, abdominal hysterectomy dan berkali-kali D&C dah tengok. Tinggal transvaginal hysterectomy, myomectomy & anterior colporraphy je yang belum berpeluang tengok untuk melengkapkan – that’s-enough-for-you-checklist bak kata Dr. Basil Obaidat.

Paling puas lagi, bila berpeluang melihat prosedur persenyawaan in-vitro (in-vitro fertilization atau singkatnya IVF)dilakukan. Di hospital ketenteraan ini, kos untuk menjalakan IVF sekitar JD1300; lebih kurang RM6500 satu jumlah yang saya kira ‘mampu’ untuk insan-insan yang memerlukan. Purata ‘pesakit’ yang datang untuk membuat proses – retrieval (proses pengambilan telur dari ovary wanita) kira-kira 10 orang sehari.

Patient akan diberikan local anesthesia dan diletakkan dalam posisi lithotomy. Kemudiannya, setelah prosedur antiseptic dilakukan pada external &internal genitalia, pakar akan mengukur terlebih dahulu ketebalan dinding rahim (endometrium) dengan menggunakan transvaginal ultrasound (TVUS) Ukuran <8>8.5 is excellent. Pengukuran ketebalan dinding rahim tidak berakhir disitu. Ia kemudiannya diklassifikasikan sama ada A atau B. Contoh 12A atau 12B. Kualiti 12A pastinya lebih baik dan insyaAllah akan memberikan keputusan yang mempunyai success rate yang paling tinggi. A atau B dimaknakan sebagai lapisan dinding rahim yang mempunyai 3 lapisan untuk A dan kurang dari itu untuk B.

Setelah ukuran endometrium diambil, langkah seterusnya ialah dengan menyedut telur dari ovary. Bi-valve speculum akan diletakkan pada vagina bagi memudahkan view, kemudian satu alat khas seperti tiub halus-panjang berukuran lebih kurang 40+ cm dimasukkan under TVUS-guidance. Hasil suction dimasukkan dalam lebih kurang 5 tube (vials) dan kemudiannya di hantar ke lab. Jumlah telur yang ada dalam setiap vial bergantung kepada respond pesakit ke atas ubat yang diberikan. Secara purata, jumlah telur adalah 5-7, sesetengah pesakit kurang/lebih dari itu. Selepas prosedur retrieval ini, patient akan melalui sprosedur seterusnya iaitu transfer (memindahkan telur yang telah disenyawakan dengan sperma di dalam lab ke dalam rahim)

Kata doctor, success rate untuk IVF bergantung kepada beberapa faktor seperti kualiti telur, ketebalan endometrium dan wanita itu sendiri. Walaupun serba sedikit detail tentang prosedur tentang IVF ini saya coretkan, perkara yang lebih ingin saya kongsikan adalah wajah ibu-ibu yang setia menanti di bilik menunggu, wajah ibu-ibu apabila dianggil ‘misi’ untuk masuk ke bilik doctor, wajah-wajah ibu di bilik pemulihan (recovery room). Setiap satu penuh dengan harapan. Sesetengahnya bermuka gusar, tidak kurang juga yang ceria tatkala dipanggil nama oleh doctor untuk menjalankan prosedur. Ada juga yang berselawat dan berzikir dengan kuat dari awal nama dipanggil, ketika prosedur sampailah di bilik pemulihan. Tidak berhenti. Ada juga yang seolah terkejut dan macam-macam reaksi lagi. Rata-rata wanita yang ada berumur dalam lingkungan akhir 30-an. Namun ada juga yang berumur semuda 25 tahun.

Apabila saya cuba meletakkan diri saya di kasut mereka, pastinya tekanan psikologi yang mereka rasa memuncak terutamanya apabila berada di hospital. Mana tidaknya, bilik untuk prosedur IVF ini bersebelahan sahaja dengan delivery room & wad ibu bersalin. Raungan dan jeritan kesakitan ibu yang melahirkan anak saban hari mampu didengar. Tangisan bayi yang keluar dari alam rahim ke alam dunia, pastinya menambahkan lagi sayu dan harap. Dari mata kasar, mereka insan tabah.

Tapi bila saya teringat pada seorang pesakit wanita yang saya jumpa di klinik dua hari sebelumnya, bakal-bakal ibu IVF insan yang lebih bertuah. Wanita yang berusia 25 tahun ini baru sahaja melangsungkan perkahwinannya kira-kira setahun yang lepas. Dia datang ke klinik untuk follow-up masalah haid & usaha untuk hamil. Beberapa ujian telah dilakukan termasuklah karyotyping dijalankan untuk mencari punca haid yang kurang teratur dan hampir tiada tanpa bantuan ubat. Keputusan ujian – positif. Dia perempuan sejati yang punya karyotype 46XX. Namun, hasil keputusan ujian hormon FSH mendukacitakan. Paras pada ujian awal sekita 20.8 menunjukkan peningkatan ke paras 38.1 di ujian kedua. Progressive increase! Paras FSH yang tinggi menunjukkan, ovary tidak berfungsi menghasilkan telur yang kebiasaannya akan respond terhadap FSH untuk proses kematangan. Kata doctor, wanita ini di-diagnose dengan premature ovarian failure (POF) yang secara akalnya tidak akan memungkinkan dia untuk hamil apatah lagi untuk menimang anak sendiri.

Pada usia 25 tahun, baru setahun mendirikan rumahtangga dan dengan permintaan suami dan dirinya sendiri untuk hamil, di-diagnose dengan POF boleh diibarat seperti mendapat hukuman gantung sampai mati. Apabila diterangkan doctor tentang keputusan ujian dan diagnosis, wajahnya berubah. Apabila ditanya tentang suami, dia jadi lebih gusar, kecewa dan macam-macam lagi mimik muka yang saya sendiri pun tak mampu untuk mentafsir. Kaedah kaunseling yang saya kira agak, ‘simple’ dan mudah buat hati rasa, “Ish..apekah..”

Ujian itu tarbiyah. Bukan mudah. Sukar yang sangat. Namun meyakini dan menghadapinya dengan tabah menjadikan manusia itu hamba yang sedar. Sedar bahawa setiap hamba itu layak diuji dan hasil kesabaran, ketabahan dan redha, balasannya hanya Allah.

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