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Clinical OSCE With Answers
Clinical OSCE With Answers
Clinical OSCE
A/L 2001 Batch
Dinusha Liyanapatabendi
Q7
1. Identify A-G
2. Write the corresponding letters in
order of most effective method to
least effective method
1. Identify A-G
2. Write the corresponding letters in order of most
effective method to least effective method
D
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
% of women experiencing an
unintended pregnancy within the
first year of use
Method
Typical use1
Perfect use2
No method4
85
85
Withdrawal
27
Periodic abstinence
Calendar
Ovulation method
Sympto-thermal6
Post-ovulation
25
9
3
2
1
Condom - Female
21
Condom - Male
15
0.3
0.3
0.8
0.6
0.1
0.1
0.05
0.05
0.5
0.5
0.15
0.10
Female sterilization
Male sterilization
3
3
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.
Q11
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
1.
2.
10 years (6-8)
3.
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
Q7
1)
A - Levonorgestrel
B Male condom
C Combined oral contraceptive pills
2)
A-
Improves menorrhagia
Decrease dysmenorrhoea and pelvic pain in patients with endometriosis
Missed pills
Sri Lanka Family Planning Association Guidelines
Missed one tablet
Take the missed pill as soon as you remember &
take the scheduled pill at the usual time
Missed consecutive two pills on two days
Take two pills on the third day and two on the
fourth day. From next day onwards take one pill
daily.
Till you get your next menstrual period use
condoms as a backup method OR abstain from sex.
Missed Pill
WHO Guidelines
1. What is the
advice you would
give to the
patient when
prescribing this
2. List 3 Common
side effects
Advice
Reliable (75%) post coital contraceptive method if it takes <72 hrs after
unprotected sex
1st tab should be taken immediately. 2 nd tab should be taken 12hrs after the
1st dose
Q9
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
Correct technique:
Maternal complications:
a) Cracked nipples
b) Breast abcess
Q 14
How do you prepare a patient for
LSCS
What are the complications of LSCS
Consent
Keep fasting
Complications of LSCS
Anaesthetic Aspiration ( Mendelsons
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
Q6
Give 4 risk factors from this antenatal record (Two slides)
Mrs. A
PAGE 1
Orange
+++
Short stature
Previous death in-utero
Previous miscarriages
Blood pressure of 160/110
Proteinuria
Grand multi para
Q8
Plasters
14G IV cannula
Vacuum cup
A pair of gloves
Cuscos speculum
IV drip set
Vulsellum
IV metronidazole
10
Betadine
Plasters
14G IV cannula
Vacuum cup
A pair of gloves
Cuscos speculum
IV drip set
Vulsellum
IV metronidazole
10
Betadine
Q4
94/95 batch
1. Identify/name
the instrument
2. Write 2 uses
1.
2.
In obtaining a Pap smear
In obtaining a high vaginal swab
To visualize the cervix & vaginal wall in
pelvic examination
Q18
1. What
do you
see
2. Write 2
causes
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
Hydralazine
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 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.
Mr. A
Write the
5-07-2006
names
of the 5
abnormalities
you see.
2.2 ml
10 million/ml
none
25%
30%
20%
+++
Normozoospermia
Oligozoospermia
Asthenozoospermia
Teratozoospermia
Oligoasthenoteratozoospermia
Azoospermia
Aspermia
No ejaculate.
Leukocytospermia
Normal values
Volume
2.0 ml or more
pH
7.2-7.8
Sperm concentration
Motility
Morphology
Vitality
1.
2.
Identify
List 3 prerequisites in using these instruments
3.
Wrigleys Forceps
Keillands Forceps
Simpsons Forceps
Ruptured membranes.
1.
1.
2.
Dressing Scissors
Artery Forceps
Needle Holder
Cutting needle
Complications of episiotomy
Immediate-
Vulval haematoma
Infection
Wound dehiscence
Remote
Dyspareunia
1. D&C :
Performed under GA
Olive pointed malleable graduated metallic uterine sound to confirm position &
length of cavity
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.
Gullipot
Artery forceps
Straight scissors
Curved mayos scissors
Kidney tray
CTG
What are the parameters that should
be observed in a CTG
Types of CTGs
If foetus is distresed what features
would you expect
Parameters observed in a
CTG
FHR
Any decelerations in HR
Basal heart rate variation
Frequency of uterine contractions
Strength of uterine contractions
Types of CTGs
1.
2.
3.
a.
b.
c.
d.
e.
2 days
1.
2.
Identify
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
1.
2.
5
4
6
7
Complications
Inter-menstrual bleeding
Pelvic inflammatory disease
Expulsion (1st 3 months)
Perforation
1. Identify
2. List an indication and a
contraindication
Advise to mother:
Risk factors
1.
2.
Maternal DNA
lost from
ovum
23x
Duplicati
on of
haploid
46xx sperm
Proliferation
of
monospermic
androgenetic
complete
HM
Maternal DNA
lost from
ovum
23x
46xy
Two paternal
genetic
contributions
Proliferation
of dispermic
androgenetic
complete
HM
23x
69xxx
Maternal and
two
paternal
genetic
contribution
69xxy
Proliferation
of triploid
partial HM
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
Missed abortion