OSCE recalls 2011, 2013, 2016

Must cover list by dr. Mustafa

Gynae:

1-Infertility:  Male,  Female, Surrogacy.

2--Menstrual disorder: - Amenorrhoea:  XY-Female, MRKHS,Turner   Menorrhagia:Fibroid
 ,Dysmenorrhoea  , PMS, premature ovarian insufficiency ( file:///C:/Users/MH/Downloads/
ESHRE%20guideline_POI%202015_summary_01122015%20(1).pdf) 
3- Hyperprolactinaemia
4- Sterilization
5- Urogynae: OAB, USI, Urodynamics, Postpartum voiding disorder.
6- Contraception: Emergency, with Epilepsy, postpartum, after 45 years, for 12 years old,
for mentally handicaped female.
7- Endocrine: PCOs, Hirsutism, Precoceous puberty, 
8- Premenopausal ovarian cyst
9- Pelvic floor prolapse
10- Cx: CIN, Cervical screening, HPV- vaccination, HPV-triage
11- Recurrent miscarriage
12- Early pregnancy bleeding: Ectopic, threatened, Delayed
13- Vulval disorders: Lichen sclerosis, VIN
14- Oncology: Ca cx, Ca ovary, Endometrial hyperplasia ( Endometrial Hyperplasia,
Management of (Green-top Guideline No. 67) , PMB+Ca endomet (may be in obese pt)
15- Molar pregnancy
16- Chronic Pelvic Pain
17- HRT: Vasomotor, alternatives, bone protection, options available with DVT Hx.
18- Female sterilization ( Female Sterilisation (Consent Advice No. 3) )

Obstetrics

1- Obstetric Cholestasis
2- Chickenpox, Herpes, HIV, Malaria, Zika virus
3- VBAC: 1 Cs, 2 Cs : may request water birth, home birth.
4- Cs on maternal request
5- Pre-eclampsia
6- IUFD: + process of postmortem concent
7- Diabetes (esp gestational), Thyrotoxicosis, Epilepsy, SLE
8- Immune and non-immune hydrops fetalis
9- Obesity with pregnancy
10- Downs Syndrome screening
11- Multiple pregnancy problems: TTTs, Discordant Congenital malformation in MC/DC,
IUGR, Death of one twin
12- Reduced Fetal Movements
13- PPROM
14- GBS
15- Whooping cough vaccine.

Emergencies:

1- Ectopic pregnancy
2- Uterine perforation
3- Bowel injury
4- Bladder injury
5- Retained Placenta
6- Ruptured uterus
7- Acute inversion of the uterus
8- Eclampsia
9- Maternal Collapse
10- PP collapse
11- Shoulder Dystocia
12- APH
13- Retained second twin
14- Cord Prolapse

Skills
1- Hysterectomy: Abd, Vag
2- Caesarian section
3- Ventose
4- Forceps + pudendal block
5- FBS
6- CTG
7- Neonatal Resuscitation
8- IUCD
9- Novasure
10- Laparoscopy
11- Hysteroscopy
12- Speculum examination
13- Cervical smear
14- Breech delivery
15- Shoulder dystocia
16- Knot tying.
17- Cervical cerclage

Topics
1- Domestic violence
2- Child abuse
3- FGM
4- Breast feeding
5- Drug/Alcohol abuse
6- SIDS
7- Duty of Candour.

Bad news
1- Fetal congenital abnormalities: Spina bifida, ventriculomegaly, Clefts, Anencephally,
Renal agenesis, Dilated renal pelvis, CPCs , Abdominal wall defects(Ompha, Gastro), CDH
2- Cancer
3- IUFD/ miscarriage
4- HIV
5- XY female
6- Premature ovarian insufficiency ( avoid to use premature ovarian failure)

General:
1- Audit: in depth
2- Risk management
3- Critical appraisal : Leaflet, study, guideline, internet paper.
4- Teaching
5- Labour ward prioritization
6- Gynae Theatre list organisation
7- Fetal Skull
8- Female pelvis
9- Normal Labour
10- Elecrosurgery
11- Thromboprophylaxis: Obstetrics, Gynae
12- Premature delivery at margins of viability.
13- WHO Surgical Check list
14- Consent
The above topics may appear in different types of stations:
1- Role players (lay person terms).
2- Teaching ( must be medical terms): FY1, ST1, ST3, ....
3- VIVA : must be professional thinking, vocabulary, confidence ,discussion and organisation
at a level of postgraduate student.

We have covered many of those areas during our sessions.

Go through all those topics and put a mental image about how you will approach them in
your exam.

Keep pushing hard ,I am sure you will do it

All the best

Mustafa

May 2016 osce, Day 1



1. Prep. Station: Gyne  risk Mng. You are given the case note of a pt  who underwent vaginal
hysterectomy, & reoperated on second day. The scenario involved the consultant being called in
the middle of first surgery during pedicel ligation or something like that

A. Identify –vie points

B. Identify +vet points.

C. Lessons learned

D. Steps to reduce chance of litigation/claim.



2. Interactive viva. A case scenario with abruptio placentae.

A. 2 consultants are doing CS. After delivering the baby --> Atonia + bleeding.. What steps to do
till blood arrive.

B. The pt now lost 2.8 L. What blood products & what amount you are going to give.

C. The pt is A rh +ve, with low titles of anti-K & c at booking. How this is going to affect your
Mng?

D. After rescucitation, the results came: Hb-82%, Plt-87,000. , Fibrinogen 0.9 , PT & PTT – can’t
remember exactly but very high. According to these results, what are & what are not you going
to give.



3. Role play: Obese lady, came to A & E c/o SOB & chest pain/cough. She had CS 3 wks ago.

-Marks for relevant history, plan of Mng (& how to explain to her )& answer her Q.



4. Role play. 40 yrs + menorrhagia. US-NAD apart from ET of 19mm.

-Marks for Relevant history, plan of Mng & answering Her Q.



5. Role play. Referred with a GP letter, c/o persistent abd.pain for 6m. US showed bilateral
endometriotic cysts.

-Marks for relevant history, loan of Mng & answering her Q. 

-She was frightened by the word endometriotic cyst, & kept asking about how is she going to
conceive.



6. Viva: You are given your maternity unit dashboard, plus the RCOG dashboard. The examiner
was silent as a fly on the wall, just expecting you to answer.

A. Explain the dashboard.

B. What are the trends.

C. What are your recommendations.



7. Role play. Post menopause lady with vaginal dryness & dysprunia. Hot flushes in the past
( but now no). Reluctant for HRT.



8. Interactive Viva: 52 yrs, GP letter: Complex ovarian mass, Ca-125: 80.

A. Points in history you want to know & why.

B. Further invest & why.

C. Plan of Mng 

D. Now the pt is in front of you, What are you going to say?



9. Role play: 14 yrs old, came alone to A&E, c/o  Amenorrhea for 3m,nausea & vomiting. PT +ve
(She doesn’t know). Deal with her. (no more info given

-N.B she was very reluctant & hesitant to give info. Only after reassurance & asking many times
then she tells: unconsensual sex, 40 yrs old man, father away (or dead?), mother away most of
the time. She couldn't tell whether or not to continue or terminate,…..



10. Role play: Poor discharge letter by a junior Doctor. The case was forceps delivery +
sphincter tear (that what she wrote). She wrote antibiotics (amoxiclav) +laxatives (lac tulle &
some other sachets ) + paracetamol. In future plan, she wrote that the incidence of recurrence
is 20-40 % so next delivery should be by CS. Next appointment after 12 wks with specialist
nurse

May 2016 day 2

1. Risk management. File with multiple pages given. Starts with GP letter and consultant
correspondence. Patient had menorrhagia which was difficult to manage. Decision to do lap
hysterectomy.  History of previous CS . Then anaesthetic record given and operation report. OP
report not detailed. Mentioned used bipolar diathermy as preferred method not available. No
details of adhesions or ureter being traced given.

Then inpatient entry was adequately dated and timed and designation written.
Patient was discharged on day 2 after removal of IDC. No details about trial of void.

Patient represents after 2 weeks with continous leakage of urine and fever.
Seen by FY2 and admitted and treated as UTI. PS not done. 
Then seen by ST4 but briefly. Made a note that patient needs PS and USS but he will do after
return from OT.
Saw patient 4 hour later. Found to have VVF. Discussed with urologist. Urologist advices IDC for
conservative management.
Then entry by consultant. 

Task: good and bad points

What should have been done
What should be done to avoid litigation.

2. Maternity dashboard.
There was a dashboard, asked to comment on its trends, reasons of what you see and what can
be done to correct.

3. 40 year old referred by GP with 18 months of ammenorrhea, and hot flushes and vaginal
dryness. Referred for management. Did two FSH both elevated.

4. Discharge letter by SHO, patient had 3b tear after ventouse. Says can have vaginal delivery .
Medicines prescribed were paracetamol and lactulose in correct doses.
Advises follow up in 3 weeks with midwife.
Teaching station.

5. Structured viva.
35 weeks posterior placenta previa with minor APH. Mother RH neg and fetus RH pos. How will
you manage? Her Hb is 99.
Then she has a planned CS what precautions will you take.
Then she bleeds intraop 2.5L how will you manage
Then shows Hb 88, fib 0.8, plt 64 and PT/APTT given a no with control. How will u manage.

6. 18 year old 17 weeks pregnant, comes with back pain. Take history and manage. This was
station of Domestic violence.

7. Station of Chronic pelvic pain. 28 year female referred by GP with US showing simple ovarian
cyst and ET 10mm. On history she had CPP for 2 years, past history of STD, normal laparoscopy,
family history of endometriosis with superficial and deep dyspareunia.

8. Structured viva. Us scan showing complex ovarian cyst in 48 year old with internal echoes
suggestive of blood , patient has heavy menstrual bleeding and CA 125 40.
Don't really know what they wanted in this station.

9. Role player: 38 weeks pregnant with left limb DVT, no risk factors.

10. Counsel patient for TVT

May 2013 day 1

1-CTG interpretation: the patient is primigravida, 39 wks, oxytocin started,

epiduralised, became fully at 11 50 pm, delivered at 1: 08am. baby had apgar of 0 at 1
minute and 1 at 5 minutes, acidosis, imaging for baby suggestive of brain insult.
placenta normal, no cord problems.

look at ctg and assess quality of ctg

interpret ctg

what do you think are causes why things went wrong

what needs to be done 

2- role player with patient from somalia with FGM, coming with dysmenorrhea and
urinary problems, take history , explain condition, how to treat, answer her questions

3-role player with recently joining obgyn trainee who wrote a poor GP letter and
stopped  valproic acid ttt for a woman with controlled epilepsy on his own, this lady
also hadn't seen her neurologist for a long time, she gave her folic acid though and
arrange a follow up to the antenatal clinic , what was incorrect and how to teach
trainee what are the wrong things she did and how to deal with such patients

4-role player patient is obese, smokes, has previous c/section and preterm delivery at
31 wks to an iugr baby, now presenting for antenatal couselling because she has a new
partner and wants to get pregnant, what are risks to her and her baby, how you will
manage, do u need to change her meds (steroids inhaled and oral, omeprazole,
montelucast, bricanyl and ipratropium.)

5- cochrane explained to a midwife interested in research. definition, aim, interpret a
cochrane paper, answer questions of midwife.

6- appraisal of audit done about ovarian cyst in premenopausal women and the actual
rcog guidelines provided in the preparatory station. what are the changes u would do
to protocol( it contained wrong info), what is the evidence, how will ensure u make
the changes

7- prep station about cardiac disease in pregnancy (aortic stenosis) there is a case
report provided abouts successful epidural done and management of patient with AS.
also provided notes about normal changes of pregnancy, then u will be asked about
symptoms of cardiac dis in pregnancy, antenatal management and intrapartum care

8- role player 37 yr old lady coming to enquire about options to preserve her fertility

9-viva patient underwent colposcopy and treatment of CIN in the states, her doctor
said that she will need a suture when she becomes pregnant. she is not pregnant in
first trimester what other info you will ask about in history, you are then given report
of her procedure and ttt done ( CIN2 USING single loop electrosugery, 9 mm depth,
done two years ago, normal follow up so for), what exam to offer, what inv to do, will
u do a cerclage and what is ur management of pregnancy 

10- role player patient is a pregnat teacher 13 weeks and had documented parvovirus
infection, explain dx, inv, management of her pregnancy

OSCE May 2011


 

1. Set of notes and discuss with role player with BMI 52 events of delivery (undiagnosed breech
in labour, difficult breech delivery and baby in NICU). (D2 Shoulder dystocia)

2. Teach junior trainee palmer's point entry laparoscopy (D2 Hysteroscopy)

3. Design subheadings for leaflet on endometriosis  ( D2 Blood transfusion)

4. Discuss with role player VBAC after 2 CS 

5. Viva- Infertility and PCOS ( Day2 Hirsutism)

6- Viva- Obesity and pregnancy  

7- Discuss with role player contraception for 12yr old daughter with learning difficulties, stroke
and epilepsy! (D2 with menorrhagia)

8- Viva- Risk of thromboembolism in pregnancy and management of 25yr old smoker with
severe varicose veins 

9- Management of amenorrhoea and hyperprolactinaemia and prescribe and write out
medication ( D2 PID)

10- Breaking bad news- MCDA twins on anomaly, one normal twin and one twin with large
enencephalocele ( D2 DCDA no anomalies