Download OSCI Examination

OBJECTIVE STRUCTURED
CLINICAL EXAMINATION
“OSCE”
(Gynecology)
Dr. Anas Al Marzouki
Associate Professor & Chairman
Obstetrics & Gynecology
King Abdulaziz University Hospital
OSCE
Gynecology
This station is to test your skill in
doing abdominal examination and
building differential diagnosis
 38 years old, P1 + 0 was referred to
Gynecology clinic because of recurrent
lower abdominal pain
• Do systematic abdominal examination
• What is the differential diagnosis
Grade
Failure
Border line
Pass
Marks
0
50% of Mark
Full Mark
1. Introduce him/hers self & ask patient name
0.5
2. Position patient properly for examination
0.5
3. Describe systemic general examination (not to do)
0.5
Inspection
4. Scars
0.5
5. Hernia
0.5
6.Hair distribution
0.5
7. Movement of Abdomen
0.5
Palpation
8. Ask about pain and start away from site of pain
0.5
9. Superficial palpation : start away from pain
0.5
10. Deep palpation
0.5
11. Feel for renal angles
0.5
Describe Mass
12. Site
0.5
13. Size
0.5
14. Surface
0.5
15. Mobility
0.5
16. Tenderness
0.5
Differential Diagnosis
17. Ovarian mass
0.5
18. Fibroid
0.5
19. Pregnancy
0.5
20. Bladder
0.5
This Lady has been married for 10
years. Has had one child who is 8
years old. No pregnancy since then.
She would like your advise and help
 What other relevant informations you would
like to know.
 How would you investigate such case?
 With the data you have been given, what is
the most likely diagnosis?
What other relevant informations
you would like to know.
 Age.
 Duration of trial for pregnancy (Use of
contraception)
 Mode of delivery
 Relevant surgical history: i.e. pelvic surgery
 The menstrual cycle:
 Previous tests or investigations for the wife
 Investigations for the husband and results
Cause of infertility
 Tubal: suggested if ch pelvic pain, pelvic surgery, infection ..etc
 Ovulatory: oligomenorrhea, features of PCO (obesity, hirsutism)
 Peritoneal: (i.e. endometriosis) dysmenorrhea
 Male factor: semen test
 Others: thyroid, hyperprolactinemia
 Unexplained: no obvious cause
A 21 year old gravida 2 presented to the
ER with lower abdominal pain of acute
onset, with slight vaginal bleeding
 How would you assess this case.
 What is the differential diagnosis
 What investigations would you like to order
How would you assess this case.





Important points in the history:
Is she pregnant
When was the LMP
Is she using any contraception
What was the outcome of the first
pregnancy
 Is there any history of pelvic surgery
or infection
Do not Know
6 weeks ago
Not regularly
Baby boy
Appendectomy
 Important points in the examination:
Vital signs:
Abdomen examination: Site of pain, tenderness, rigidity
Pelvic Examination:
Amount of bleeding:
Condition of the cervix:
Positive sign of cervical excitation:
What is the differential diagnosis





Ectopic.
Intrauterine pregnancy
Corpus luteum cyst
Surgical pelvic conditions
Cystitis
The scenario of the case could take you to any of the
aforementioned conditions
What investigations would you like to
order?




Pelvic U/S
Pregnancy test (BHCG titre)
COC: WBC and Hemoglobin
Blood group (ABO) and Rh type
Interpretation of Investigations
 HSG:
 Hormonal profile for:



PCO.
Secondary amenorrhea due to
hyperprolactinemia
Karyotype of Turner syndrome