Final osce station 2019

Day 1 Obstetrics
• Inlet—obstetrical conjugate
• True conjugate
• Diagnal conjugate
• Sacral promontary
• Plane of outlet
 Answer Key
• Manual removal of placenta
• Retained Placenta
• Complications:
• PPH
• Infection
• Side effects of anesthesia
• Risks of blood transfusion
• Recurrence
 Answer Key
• 1. Anencephalic Fetus
• 2. Postdate pregnancy, Polyhydramnios, IOL,
Abruption, Operative delivery, postpartum
depression, NPOL
• 3. Folic acid
 Station 4
• You are the final year student and doing round
in the ward you came across this patient who
had delivered 24 hours ago.
• Enumerate the steps of daily progress report
(DPR)
 Answer Key
• Introduction of case
• Complaints
• General physical examination
• Abdominal examination
• Lochia / Pelvic examination
• Legs
• Baby
Station 5
 Answer Key
• Leopards Maneour
• A. Fundal grip shows presntation
• B. Lateral grip shows location of spine and
limbs
• C. Pawlicks grip shows presentation and
engagement
• D. Pelvic grip shows presentation,
position/attitude, engagement
Station 6
 Answer key
• 1. Preterm labor, Polyhydramnios,
Malpresentation, Multiple pregnancy, PROM
• 2. Presence of loop of cord in vagina, Fetal
bradycardia
• 3.
• Duration of pregnancy
• Duration of cord prolapse
• Presence of cord pulsations/ FHR
• Immediate delivery or c section
Uses of these drugs
Station 7
Gynae Day 1
Answer Key each carries 1 mark
Station 2
 Answer Key
• Picture 1: Label : 1Cystocele(1)
•
• Picture 2 :
•
• Label 1: Cystocele ( 2 )
• Label 2: Rectum ( 1 )
• Label 3: Uterus ( 1 )
• Label 4: Bladder ( 2 )
• One or more pregnancies and vaginal births
• Giving birth to a large baby
• Increasing age
• Obesity
• Prior pelvic surgery
• Chronic constipation or frequent straining during bowel movements
• Family history of weakness in connective tissue
• Being Hispanic or white

•
• Pregnancy
• Difficult labor and delivery or trauma during
childbirth
• Delivery of a large baby
• Being overweight or obese
• Lower estrogen level after menopause
• Chronic constipation or straining with bowel
movements
• Chronic cough or bronchitis
• Repeated heavy lifting
 Counsel this thirty years old lady who is
diagnosed to have incomplete miscarriage
 Answer key
• Introduce yourself, put patient at ease( 1 mark)
• Explain what happened. Majority of cases cause of
miscarriage is fetal anomaly, nothing can be done to
prevent it and next pregnancy chances are good ( 2
marks)
• Need for evacuation to remove RPOCS( 1 mark)
• Preparation for next pregnancy wait for 3 months and
take folic acid 3 months prior to pregnancy ( 1 mark)
• Early antenatal booking and early follow up ( 1 mark)
• If you have any question to ask ( 1 mark)
Station 4
Answer Key
Station 5
 Answer Key
• Complete Mole/ Gestational Trophoblastic
disease ( 1 mark)
• Causes: teen aged or advance aged pregnancy,
Asian ethnicity, previous molar pregnancy ( 2
marks)
• Complications : Hemorrhage, need for
chemotherapy, Choriocarcinoma,
embolisation to distant organs ( 2 marks)
• Snow storm appearance ( 2 marks )
Station 6
 Answer
• Multiload (2 marks)
• Contraindications: (3 marks)
1. PID
2. Menorrhagia
3. Uterine or cervical cancer
4. Previous scar
• Complications: ( 2 marks)
• Expulsion, perforation, HMB, secondary
dysmenorrhea, ectopic pregnancy
Station 7
 Answer Key
1. Cusco's bivalve self retaining speculum
(2marks)
2. Tenaculum (2marks)
3. Endocervicalcytobrush (1mark)
4. Slide (1mark ) with spatula
5. Alcohol Fixative ( 1 mark)
Day 2 Obs
Ask five leading questions to determine the
severity of this patients condition who is 8
months pregnant and has blood
pressure160/100
 Answer Key
• Frontal Headache not relieved by simple
analgesia ( 1 mark)
• Visual disturbances/ flashing of lights( 2
marks)
• Epigastric pain( 1 mark)
• Swelling( 1 mark)
• Malaise( 1 mark)
• Nausea and vomiting ( 1 mark)
Station 2
 Answer Key
• Amniocentesis ( 1 mark)
• Indications: ( 2marks)
1. Antenatal diagnosis of chromosomal
anomalies
2. Fetal hemolytic disease ( billirubin detection
3. Antenatal diagnosis of neural tube
defect(increase AFP)
• Complications: ( 2marks)
• Miscarriage
• Leakage of amniotic fluid
• Fetal trauma
• Bleeding
• Infection
Alternative methods: ( 2 marks )
CVS, FBS, fetoscopy and embryoscopy
Station 3
 Answer Key
• Uterine inversion ( 1 mark)
• Predisposing factors: ( 4 marks)
• 1. Uterine atony
• 2. Mismanagement of third stage of labor
• Fundal attachment of placenta
• Short umbilical cord
• Manual removal of placenta
• Prevention: ( 2 marks)
• Active management of third stage of labor
• Removal of placenta by BA method
Station 4
 Answer Key
1. Bimanual uterine compression ( 2 marks)
2. PPH due to uterine atony ( 1 mark)
3. Next step ( 4 marks)
• Medical management
• Oxytocin
• Misoprostol
• Uterine temponade/ packing
• Catherization
• Surgical management
• B lynch suture
• Uterine artery/ ILA ligation
• STAH
 Answer Key
1.
Lie : Neglected transverse lie
Presentation: Elbow presentation
2. Diagnostic signs:
• Empty Pelvis
• Presence of elbow, shoulder on P/v
• Short fundal Ht than gestational age, upper
and lower poles both are empty
• Complications:
• 1. Ruptured uterus
• 2. Cord prolapse
• 3. IUD
• 4. Operative delivery
Station 6
 Answer
Answer
• 1-well flexed
• 2-partially extended
• Fully extended
• Suboccipito bregmatic—9.5cm
• Mento vertical 13.5--brow
• Submentobregmatic—9.5 cm
Day 2 gynae
• Day 14 ( 1 mark)
• Postcoital test : Day 12 – 13 in regular
menstrual cycle of 28days ( 1 mark)
• Progesterone level to detect ovulation – Day
21 in 28 day cycle ( 1 mark)
• Endometrial biopsy in day 21-23 in 28 day
cycle ( 1 mark)
• HSG after menses till 10th day ( 1mark )
• IUI washed sperms are injected in uterine
cavity at time of ovulation detected by
follicular growth by ultrasound.( 1 mark)
Station 2
 Answer Key
1.Stage 4 ( 2 marks )
2. Post coital bleeding, irregular pv bleeding, pain, increase vaginal discharge
( 1 mark)
3. Complications: ( 2 marks )
Hemorrhage
Infection/ vaginal discharge
Renal failure
Pelvic pain
Fistula
Thromboembolism
Metastasis to distant organs
Side effects of radiotherapy
Side effects of chemotherapy
4. Palliative treatment ( 2 marks )
Station 3
 Answer Key
• 1. Evacuation/ Diagnostic and curettage
(E n C/ D n C)
2. Indications :
• Miscarriages / Oblighted Ovum
• Heavy menstrual bleeding/ Irregular pv
bleeding
3. Complications:
Infection, Perforation, Side effects of
anesthesia,Pain.
Station 4
 Answer Key
• Dilators ( 1 mark)
• Indications: ( 3 marks )
To dilate cervix before curettage
To diagnose cervical incompetence
• Complications: ( 3 marks )
Perforation
Infection
Trauma to other organs
Bleeding
Station 5
• Uterovaginal Prolapse
Answer
( 1 mark)
Key
• In 2nd degree prolapse cervix lies at the level of introitus inside vagina while in 3 rd
degree cervix lies outside the vagina. ( 2 marks )
• Preoperative measures: ( 2 marks )
• Preop investigations
• Anesthesia fitness
• Vaginal packing to facilitate ulcer healing
• Consent
• NPO from midnight
• Preop medications
• Change OT dress in morning
• Shift to OT for surgery (Vaginal Hysterectomy)
• Predisposing factors: ( 2 marks )
• Menopause/ old age
• Chronic cough, constipation.
• Multiparity
• Difficult delivery
• Collagen deficiency/ family history
Station 6
 Answer Key
• ECV ( External cephalic Version) ( 1 mark)
• Indication : ( 1 mark )
Breech presentation or
Transverse lie
• Contraindications: ( 2 marks)
PROM, Multiple pregnancy, APH,
Oligohydramnios, previous C Section, Fetal
distress, Placenta Previa
• Precautions: (1.5 mark )
• Calculate gestational age should be more than 37 weeks
• There shouldn’t be any uterine anomaly
• Breech shouldn't be engaged
• Adequate liquor
• Exclude fetal distress before procedure by doing CTG

• Complications: ( 1.5 mark )

• Cord prolapse
• Rupture of membranes
• Preterm labor
• Uterine rupture
• Abrution
Day3 obs
Station 1
 Answer Key
• 1. Kidney tray, two long clamps, sims
speculum, episiotomy scissors, needle holder
• 2. Extension of incision, vulval hematoma,
infection, wound dehiscence, dysparunia
Station 2
 Answer Key
• Removal of placenta by Brand Andrew method ( 1
mark)
• Active management of third stage of labor ( 2 marks )
• Precautions: ( 2 marks )
Give IV Oxtocin to facilitae uterine contraction
Place one hand over suprapubic area and push it
upward and hold umbilical cord with another hand and
pull it downwards to prevent uterine inversion.
• Complications: ( 2 marks )
• Uterine inversion, incomplete removal of placenta if
applied before placental detachment
Station 3
Answer
Station 4
Answer Key
Station 5
Answer Key
Station 6
Answer Key
Day 3 Gynae
Station 1
Station 2
Station 3
Answer Key
Station 4
Answer Key
Station 5
Answer Key
Station 6
• Pap
• All sexually active 18---64years
Day 4 Obs
Station 1
 Answer Key
• Cervical dilatation and Effacement
• Labor
• Bishops Score
Station 2
Answer Key
Station 3
Answer Key
Answer Key
Station 4
 Answer Key
• Failure to progress
• Fetal distress
Station 5
 Answer Key
• 1. Shoulder Dystocia
• 2. Biacromial diameter
• 3.Previous shoulder dystocia, Macrosomia,
Diabetes mellitus, Instrumental delivery
• 4. Macroberts Manevour, Rubins maneour ,
Wood screw , Reverse wood screw, delivery of
posterior arm, symphisiotomy, Zavellis
maneour,
Station 6
 Answer Key
• CTG ( Cardiotocograph)
• Fetal Heart Rate Activity
• Character of normal CTG
1. Baseline of fetal heart rate
2. Accelerations
3. Variability
4. Decelerations
Gynae Day 4
Station 1
Day 4 gynae Station 1
Station 2
 Answer Key
• Sequence of instruments used for inserting IUCD
2, 1,7,4,5

• Complications
Intermenstural bleeding
Menorrhagia
Pelvic inflammatory disease
Expulsion
Dysmenorrhea
Station 3
 Answer Key
• Cone Biopsy
• Indications
1. CIN
2. Cervical cancer stage 1a
▪ Complications
1. Haemorrhage
2. Infection
3. cervical incompetence
4. Preterm labor
5. Miscarriages
contraindications ...
Pregnancy
strong suspicion of invasive cancer.
Severe cervicitis or
a patient on anticoagulant therapy
Station 4
 Answer Key
• 1. Uterine Perforation
• 2. Posterior wall of uterus
• 3. Anteverted and anteflexed
• 4.Uterine sound
• 5. Cuscose Speculum
Station 5
 Answer Key
• 1. Bimanual pelvic examination
• 2. Lithotomy position
3.
▪ Pregnancy
• Abnormal uterine bleeding
• Routine gynecological examination
• pelvic pain
• secondary dysmenorrhea
• vaginal discharge
• before insertion of iucd
Station 6
A. Diagnose the disease shown in the picture
B. Stage the disease shown in picture
C. Name three risk factors that lead to this
disease.
• Uterine Cancer
• Stage IB
• Diabetes mellitus, PCOD, Estrogen intake,
Tamoxifen.