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

Failure Borderline Pass Grade Failure Border line Pass Marks 50% of Mark Full Mark 1. Introduce him/hers self & ask patient name 0.5 2. Position patient properly for examination 3. Describe systemic general examination (not to do) Inspection 4. Scars 5. Hernia 6.Hair distribution 7. Movement of Abdomen Palpation 8. Ask about pain and start away from site of pain 9. Superficial palpation : start away from pain 10. Deep palpation 11. Feel for renal angles Describe Mass 12. Site 13. Size 14. Surface 15. Mobility 16. Tenderness Differential Diagnosis 17. Ovarian mass 18. Fibroid 19. Pregnancy 20. Bladder Failure Borderline Pass

This Lady has been married for 10 years 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