Professional examination OSCE for medical student

Olla peeps. It's been a year since I updated my blog. It's because I was coping with housemanship thingy as well as I forgotten my password to assess my blog. Just recently able to figure out the password. Haha..

So here, I just wanna share regarding my OSCE questions during my professional examination. Hope this can benefit anyone. Here you go...

LONG CASE: PP type 3 posterior

Causes uterine irritability

- braxton hicks contraction

- labour contraction

- uterine hyperstimulation by IOL

- abruptio placenta (usually hard uterus)

Methods use to detect fundus

- lateral grip

- fundal grip

- what else???

What can really determine uterus larger or smaller than date

- based on clinical fundal height more than 4 discrepancies not SFH

Possible causes of breech presentation for this patient

- Prematurity

- Placenta previa

- Congenital anomaly e.g. Neural tube defect (meningomyelocoele)

Other

- Polyhydramnios

- Multiple pregnancy

- Hydrocephalus

- Previous pregnancy with breech

- Abnormal uterus

Investigation to do

1. Full blood count- to check for anemia and maintain Hb > 10g/dL

2. GSH- if necessary, blood bank only hold pt’s GSH for 48hrs only

3. Fetal surveillance- CTG, US

When to transfuse blood

Women at or above 34 weeks gestation with haemoglobin less than 7 g/dL

Management: You’ve been called by a nurse informing that the pt develop bleeding. What are you going to do?

1. Attend pt immediately

2. Check amount of blood loss- might bleed a bit only

3. Put on CTG to monitor fetal heart activity and sign of labour (increase contraction)

4. Prepare patient for emergency lower segment caeseran section

  

SHORT CASES

1. Hand examination

- Present findings: pt has tenderness over distal radial side of wrist & +ve finkelstein test

- Dx: De quervain tenosynovitis

- Ddx: fracture of carpal bone

- Mx: rest, splinting, anti-inflammatory medication, injection of corticosteroid, surgical release of tendon sheath (rarely do)

- Cx steroid injection: tendon rupture, skin atrophy

2. Abdomen examination (obstetric)

- Calculate EDD and POA (at 40 w POA)

- Present your abdominal findings: scar, clinical FH 34w, SFH 35cm which is smaller than date

- Dx: Uterus smaller than date

- Causes: wrong date, oligohydramnios, congenital anomaly (renal agenesis)

- Questions u want to ask pt: ask whether she is sure of LNMP, does she has benefit of early dating scan, any hx gush of fluid (leaking liquor)

- Mx: to confirm date, to do VE in order to check any pooling of amniotic fluid, test fluid with litmus paper & nitralazine test and check bishop score. Give antibiotic to cover any infection.

- Bishop 4/10, what to do? – because cervix not yet favourable, IOL with prostin

3. History taking (psychiatry)

- Dx: OCD

- Ddx: GAD, panic disorder (pt has no symptoms to suggest MDD)

- Why panic disorder? – she has some symptoms of panic attack e.g. SOB, palpitation

- What organic cause could be for the symptoms? - hyperthyroidism

- What specific obsession she has: checking obsession

- How to mx? – give antidepressant such as SSRI, TCA and examples are fluoxetine, clomipramine

4. Examine motor & sensory of UL & LL

- Positive findings: reduced sensation over peripheral area

- What pt has? - Peripheral neuropathy

- Dx: peripheral neuropathy 2⁰ diabetes

- Ddx: peripheral neuropathy 2⁰ alcohol

These are simpler version of what I went through. Kindly read more about those topics and aim for distinction okayy?!

Best of luck all future doctors!!! ^^