OSCE Surgery (1st rotation)

Maaf terlambat pula merespons untuk soalan Surgery. (Khas untuk Puan Zayyani yang bakal menduduki peperiksaan OSCE yang terakhir inshallah. Kami yang lain ini masih berbaki satu lagi rotation..:))

Setakat yangboleh direcall dan direfresh, soalannya adalah seperti berikut.

Station 1
Patient complaining of scrotal swelling.
a) Take a focus history. (history suggestive epididymo-orchiditis)
b) What are the differential diagnosis?
c) What are the investigations you want to do
d) Name 2 predisposing/risk factors for this condition (UTI, STD)

Station 2
Lower limb examination in patient with intermittent claudication


Station 3
Post-Op Management.
a) Take a brief history
b) Physical exam
c) Management, counselling, nutrition.
d) From history and PE, patient has paralytic ileus. Give 2 investigations


Bittaufiq Wannajah.
Selamat bercuti dan berelektif untuk Zay. Doakan kami yang masih 'berusaha' ni..:)

lelaki tanpa hati 2

Buat semua yang ternanti, inilah surat yang dibalas as-syahid Imam Hassan Al-Banna kepada pemuda tanpa hati.

Waalaikumussalam warahmatullahi wabarakatuh,

Saya telah membaca suratmu dan sangat terpengaruh dengan kejujuran bahasamu, keindahan keberanianmu, halusnya kesedaranmu dan HIDUPNYA hatimu.

Saudaraku, kamu bukan orang yang hatinya mati seperti yang kamu sangka. Akan tetapi, kamu adalah seorang pemuda yang perasaannya tajam, jiwanya bersih dan nuraninya lembut. Seandainya tidak bersifat demikian, tentulah kamu engkari perasaanmu. Akan tetapi besarnya semangat & jauhnya tujuan(matlamat hidup) membuatmu menganggap kecil urusanmu yang besar & engkau mengharapkan tambahan untuknya. Tidak ada masalah dalam hal itu & memang itu yang sepatutnya berlaku.

Saya merasakan apa yang kamu rasakan, saya berjalan sebagaimana kamu berjalan & saya akan berusaha untuk memberikan beberapa nasihat. Jika nasihat-nasihat ini bermanfaat bagimu & dengan melaksanakannyakamu lihat dapat menghapuskan dahaga serta mengubati sakitmu, maka alhamdulillah atas taufikNya. Namun jika tidak demikian, maka saya senang untuk bertemu denganmu agar kita saling bekerjasama untuk mengenal pasti penyakitmu & menentukan ubatnya.

Berteman dengan orang-orang yang khusyuk yang selalu merenung, bergaul dengan orang yang selalu berfikir & menyendiri, dekat dengan orang yang bertaqwa & soleh yang dari mereka terpancar hikmah & dari wajah mereka terpancar cahaya, & dari hati mereka bertambah makrifat-dan jumlah mereka adalah sedikit- adalah ubat yang mujarab. Berusahalah berteman dengan orang-orang seperti mereka, selalu bersama mereka, kembali kepada mereka & kamu sambungkan rohmu dengan roh mereka, jiwamu dengan jiwa mereka serta kamu habiskan kebanyakan waktu kosongmu bersama mereka. Hati-hatilah dengan orang yang mengaku-ngaku. Carilah orang yang keadaannya membuatmu bangkit bersemangat, perbuatannya membawamu berbuat baik & jika kamu melihatnya maka kamu mengingat Allah.

Berteman dengan orang-orang seperti ini adalah salah satu ubat yang mujarab kerana watak manusia sering mencuri, sehinggalah hati terpengaruh dengan hati yang lain dan jiwa pun mengambil contoh dari jiwa yang lain. Oleh kerana itu, berusahalah untuk menemukan jiwa-jiwa yang soleh sebagai teman.

Saudaraku, berfikir, berzikir di waktu-waktu yang suci, menyendiri, bermunajat serta merenung alam yang indah dan menakjubkan, menggali rahsia keindahan & keagungan alam, meneliti dengan hati & berzikir dengan lisan tentang tanda keagungan yang menakjubkan serta hikmah yang agung ini, termasuk hal yang memberi kehidupan kepada hati dan menyinari kalbu dengan keimanan & keyakinan. Allah swt berfirman;
"Sesungguhnya dalam penciptaan langit & buni, dan silih bergantinya malam & siang terdapat tanda-tanda bagi orang-orang yang berakal." (Ali-Imran : 190)

Saudaraku, seterusnya berfikir tentang masyarakat, melihat pelbagai penderitaan, kebahagiaan, kesulitan serta keamanan, menjenguk orang sakit, menggembirakan orang yang ditimpa bencana & mengetahui sebab kesengsaraan yang berbentuk pembangkangan, kekafiran, kezaliman, pelanggaran, sikap mementingkan diri, egois, terpedaya oleh hal-hal yang semu, semua ini merupakan cantuman bagi rantaian hati yang menyatukan cerai berainya & menghidupkannya dari kematian. Maka berusahalah agar kewujudanmu menjadi penghibur bagi orang-orang yang sengsara & tertimpa bencana. Tidak ada perkara yang pengaruhnya lebih kuat terhadap perasaan daripada berbuat baik kepada orang yang sangat memerlukan, membantu orang yang teraniaya atau berkongsi rasa dengan orang yang susah atau sedih.

Saudaraku, hati ada di tangan Allah. Dia mengubahnya sesuai dengan kehendakNya. Oleh kerana itu, bersungguh-sungguhlah dalam berdoa, agar Dia memberikan kehidupan kepada hatimu, membuka dadamu dengan iman & melimpahkan keyakinan kepadamu sebagai anugerah serta nikmat dariNya. Berdoalah di waktu-waktu mustajab & waktu sahur kerana doa pada watu sahur adalah ibarat anak panah yang meluncur tidak terhenti sehingga sampai ke Arasy. Saya tidak meragui keikhlasanmu dalam mencapai tujuan & kejujuran dalam pengakuanmu.

Allah swt berfirman;
" Sesungguhnya Allah hanya menerima (korban) dari orang-orang yang bertaqwa." (AL-Maidah : 27)

Saudaramu, Hassan Al-Banna.

Semoga kita semua berjaya mencari hati yang hilang dan menyatu padukan amalan anggota badan kita dengan hati yang hidup supaya setiap zikir yang dituturkan dihadiri oleh hati yang sedar akan keagungan Allah Taala.

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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

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