1. OSCE
Gynecology

2. 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

3. 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

4. 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?

5. 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

6. 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

7. A 21 year old 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

8. How would you assess this case.
Important points in the history:
Do not Know
Is she pregnant
6 weeks ago
When was the LMP
Not regularly
Is she using any contraception
What was the outcome of the first pregnancy
Baby boy
Is there any history of pelvic surgery or infection
Appendectomy

9. 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:

10. 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

11. What investigations would you like to order?
Pelvic U/S
Pregnancy test (BHCG titre)
COC: WBC and Hemoglobin
Blood group (ABO) and Rh type

12. Interpretation of Investigations
HSG:
Hormonal profile for:
PCO.
Secondary amenorrhea due to hyperprolactinemia
Karyotype of Turner syndrome