MK Obgy Osce Holy Grail

PREPARED BY MOSES KAZEVU JR
OBSTETRICS AND GYNECOLOGY OSCE

STATION 1: INSTRUMENTS
1. Identify the instruments shown at this station
Answer:
A- Sim’s speculum (Sim’s double bladed posterior vaginal speculum)
B- Cusco’s speculum (Cusco’s bivalve self-retaining vaginal speculum)
C- Uterine sound (Olive pointed malleable graduated metallic uterine sound)
D- Auvard’s speculum (Auvard’s self-retaining posterior vaginal speculum)
E- Uterine curette
F- Female metal catheter
2. Give one indication for each of the instruments

A- Sim’s speculum (Sim’s double bladed posterior vaginal speculum)
➢ Obstetric indications
o Inspect the cervix and vagina to detect any injury following
delivery
o Dilatation and evacuation procedures
➢ Gynecology indications
o Dilatation and curettage procedures
o Anterior colporrhaphy to retract the posterior vaginal wall
o Vaginal hysterectomy to retract the posterior vaginal wall
o To visualize the cervix and inspect the abnormalities in the
anterior vaginal wall like cystocele, VVF or Gartner’s cyst after
placing the patient in Sims’ position
o To collect the materials from the vaginal pool for cytology or
Gram stain and culture
B- Cusco’s speculum (Cusco’s bivalve self-retaining vaginal speculum)

➢ Obstetrics indications
o To visualize the cervix and vaginal fornices for any local causes
(polyp, ectopy) of APH.
o To inspect the cervix and prepare smear for cytology screening.
o To detect leakage of liquor from the cervical os in a case of
suspected PROM.
➢ Gynecological indications
o To have cervicovaginal swabs for Gram stain and culture
o To insert or to remove IUCD or to check the threads
o To perform minor operations like punch biopsy, surface
cauterization or snipping a small polyp
o To collect cervical smear for cytologic screening and vaginal

pool material
C- Uterine sound (Olive pointed malleable graduated metallic uterine sound)
➢ To confirm the position of the uterus
➢ To note the length of the uterocervical canal
➢ It acts as a first dilator of the cervical canal
➢ To sound the uterine cavity in a case of IUCD with missing threads
➢ To sound the uterine cavity to detect any foreign body.
➢ To differentiate a polyp from inversion
D- Auvard’s speculum (Auvard’s self-retaining posterior vaginal speculum)

➢ It is used as posterior vaginal wall retractor in operations like anterior
colporrhaphy, vaginal hysterectomy
E- Uterine curette
➢ Infertility
➢ Dysfunctional uterine bleeding
➢ TB endometritis
F- Female metal catheter

➢ To empty the bladder prior to major vaginal operations. Not only it
facilitates the operation but minimizes the injury to the bladder
➢ To confirm the diagnosis of Gartner’s cyst from cystocele
3. What are the complications of using instrument C? Recognizing uterine

• Uterine perforation and hemorrhage perforation
• Sudden loss of resistance
(sense of giving a way)
• Passage of the instrument
more than the length of the
uterine cavity
• Vaginal bleeding
Answer:
A- Foley’s catheter
B- Hawkin-Ambler dilator
C- Das’s/Hegar dilator
D- Multiple toothed vulsellum
E- Single toothed vulsellum

Answer:
A- Foley’s catheter
➢ Obstetric: Eclampsia, Retroverted gravid uterus, in management of atonic
PPH as a balloon tamponade
➢ Gynecological: Continuous drainage of bladder during vaginal/abdominal

hysterectomy, pelvic floor repair, repair of VVF, urinary retention due to
pelvic tumor/retro-overted gravid uterus and radical hysterectomy
B- Hawkin-Ambler dilator
➢ Obstetrics: Incomplete abortion, in medical termination of pregnancy by D
and E.
➢ Gynecological:
o To dilate the cervix to facilitate intrauterine introduction of
instruments (curette) or devices (IUCD) or hysteroscope or
radium
o To dilate the cervix to facilitate drainage of intrauterine
collection- pyometra, hematometra or lochiometra
o To confirm patency of cervical canal after amputation of the
cervix
o To dilate the urethra in urethral stricture
C- Das’s/Hegar dilator: same as above
D- Multiple toothed vulsellum
➢ Obstetric: To hold the anterior lip of the cervix during D and E procedures
➢ Gynecological:
o To hold the parous cervical lip in operations like D & C, anterior
colporrhaphy or vaginal hysterectomy. Its function is to make the
cervix steady by traction
o To remove a polyp by twisting as an alternative to Lane’s tissue
forceps
o To hold the fundus of the uterus and to give traction while the
clamps are placed in operation of total abdominal hysterectomy
for benign lesion
E- Single toothed vulsellum
➢ To hold the cervix after opening the vault of vagina and to give traction
while the remaining vault is being cut in total abdominal hysterectomy
➢ To hold the new cervical stump after amputation of the cervix and in
Fothergill’s operation
➢ To hold the cervical stump left after subtotal hysterectomy
➢ To hold the anterior lip of nulliparous cervix in operation of D + C (Allis’
tissue forceps preferred)
Answer:
A- Uterine dressing forceps
B- Sponge holding forceps
C- Ovum forceps
D- Allis Tissue forceps
E- Hysterosalpingography cannula

Answer:
A- Uterine dressing forceps
- Obstetrical indication
o To swab the uterine cavity following D and E operation with a small
gauze piece
- Gynecological indication
o To dilate the cervix in lochiometra or pyometra
o To plug the uterine cavity with gauze twigs in continued bleeding after
removal of polyp
B- Sponge holding forceps
- Obstetrical indication
o Toileting the vulva, vagina and perineum prior to and following
delivery
o Antiseptic painting of abdominal wall prior to C-section
o To catch hold the membranes if it threatens to tear during delivery of
the placenta
o To hold the cervix (2 pairs needed) for inspection in suspected cervical
tears.
o To catch hold the cervix during encirclage operation
- Gynecological indication
o Antiseptic dressing before any abdominal or vaginal operation
o To clean the vagina with gauze pieces before and after vaginal
operations
C- Ovum forceps
- To remove the product of conception in D and E after its separation
partially or completely.
- To remove molar tissue in hydatidiform mole
- To remove uterine polyp (small)
D- Allis tissue forceps
- Obstetrical indication:
o To catch hold the anterior lip of the cervix in D and E operation
o To hold the apex of the episiotomy wound during repair
o To catch hold of the margins of the peritoneum, rectus sheath, vaginal
mucosa during repair
o To catch hold of the torn ends of the sphincter ani externus prior to
suture in repair of complete perineal tear
o To catch hold the margins and angles of the uterine flaps in low section
C-section after the delivery of the baby as an alternative to Green-
Armtage hemostatic clamp
- Gynecological indication:
o To hold margins of the vaginal flaps in colporrhaphy operation
o To hold the peritoneum or rectus sheath during repair of the abdominal
wall
o To hold the margins of the vagina in the abdominal hysterectomy
o To hold the anterior lip of the cervix during D and C operation
o To catch torn ends of the sphincter ani externus in CPT repair
o To remove a small polyp
o To take out the tissue in wedge biopsy
STATION 4: CONTRACEPTIVE
Study the picture below and answer the following questions
1. Name the type of this intrauterine contraceptive device?

Answer: Levonorgestrel containing intrauterine contraceptive device/system
2. What is the mechanism of action?

Answer:
• Sterile inflammatory reaction in the endometrium. Lysosomal disintegration
from macrophages attached to the device liberate prostaglandins which are
toxic to spermatozoa. Macrophages also phagocytose the spermatozoa.
Endometrial inflammation decreases sperm transport and impedes ability of
sperm to fertilize the ovum.
• Progesterone released thickens cervical mucosa preventing sperm from
reaching the fallopian tube
• Thins endometrium
3. What are 2 indications of its use?

Answer:
• Contraception and family planning
• Menorrhagia (once pathological causes have been ruled out)
4. What hormone is contained in this device and what is the dosage/amount?

Answer:
• Levonorgestrel- 52mg
• 20 g/day is released
5. List 3 contraindications to the use of this form of contraception

Answer:
• Pregnancy
• History of salpingitis or pelvic inflammation or STIs in past 3 months
• Suspected gynecological/genital malignancy
• Undiagnosed vaginal bleeding
• History of ectopic pregnancy
• Abnormal uterine cavity
• Large or submucosal uterine fibroids
• Desired future pregnancy
• Significant immunosuppression
• Trophoblastic disease
6. Name 2 complications
Answer:
• Early:
➢ Cramp like pain
➢ Syncopal attack
➢ Partial or complete perforation
• Remote:
➢ Abnormal menstrual bleeding
➢ Increased risk of PID
➢ Spontaneous expulsion
➢ Uterine perforation
➢ Unexpected pregnancy
7. Name 3 non-contraceptive benefits for this method

Answer:
• Minimal systemic side effects
• Can be used to treat menorrhagia
• Can be used in hypertensive, breastfeeding women and epileptics
• Reversibility to fertility is prompt after removal
• Progesterone contained may be protective against endometrial carcinoma
ADDITIONAL INFORMATION
• Time of insertion:
➢ 2-3 days after the period is over
➢ Postabortal: immediately following TOP by suction D and E or following
spontaneous abortion
➢ Postpartum- can be done before patient is discharged but it is advised that
it should be inserted after 6 weeks when uterus is involuted to near normal
size
➢ Postplacental delivery- insertion immediately following delivery of the
placenta (expulsion rate is high)
STATION 5: PELVIC INFLAMMATORY DISEASE

A patient with chronic pelvic pain and infertility had a laparoscopy done and it
revealed the photo below:
1. What is the provisional diagnosis?

Answer: Infertility 20 Chronic Pelvic inflammatory disease
2. What is the commonest organism responsible for these lesions?

Answer:
- Neisseria gonorrhea
- Chlamydia trachomatis
3. What is the specific medical therapy for this condition?

Answer:
• Ceftriaxone 2g IV BD for 2-4 days + oral doxycycline 100mg BD for 14 days
STATION 6: INTRAUTERINE ADHESIONS

Study the image below and answer the following questions
1. Describe what the image above shows (left)

Answer: Intrauterine adhesion/uterine synechia
2. What is the name and cause of this condition?

Answer: Asherman’s syndrome caused by excessive curettage, TB or even
endometrial resection with diathermy loop.
Presentation: secondary amenorrhea, infertility
3. How to confirm the presence of this lesion

Answer: hysteroscopy
4. What is the treatment as shown on the image on the right?

Answer: adhesion lysis
STATION 7: CONIZATION
1. What is the name of this operation?

Answer: Cold knife cervical conization
2. What is the indication?

Answer: Diagnostic and therapeutic for pre-malignant cervical intraepithelial
lesions
3. What are the complications associated with this procedure?

Answer:
- Cervical incompetence
- Infection
4. What are the contraindications to this procedure?

Answer
- Pregnancy
- Severe cervicitis
STATION 8: SEPTATE UTERUS
1. What is the name of this uterine abnormality?

Answer: Septate uterus
2. What is the investigation used in this photo?

Answer: Hysteroscopy
3. Name 2 clinical presentation of this condition

Answer:
- Pain before or during menstrual bleeding
- Lower abdominal pain
4. Name 2 obstetrical complications

Answer
- Infertility
- Recurrent abortions
STATION 9: HYDROSALPINX
1. What is this procedure?

Answer: Hysterosalpingography (looks at the patency of the fallopian tubes and
the shape of the uterus)
2. What is your interpretation of this image?

Answer: Bilateral fluid filled dilatation of the fallopian tube (hydrosalpinx)
3. What is the name of the pathology shown in the photo?

Answer: hydrosalpinx
4. Name 2 alternative investigations

Answer:
- Hysteroscopy
- Laparoscopy
-
5. What treatment recommendation would you give to this patient?
Answer: Surgical intervention (salpingectomy)
6. What is the best treatment if this condition was bilateral?

Answer:
- IVF-in vitro fertilization
- Laparoscopy salpingostomy
STATION 10: COLPOSCOPY
1. What is the name of this investigation?

Answer: Colposcopy
2. What is the indication (name 2)?

Answer:
- Premalignant lesion of the cervix, vagina or vulva
- Malignant lesion of the cervix, vagina or vulva
- Evaluation of patients with postcoital vaginal bleeding
3. Name 2 abnormal findings by this examination?

Answer:
- Aceto-white lesion
- Ulcerative cervical lesion
4. Name 2 contraindications
Answer:
- Acute cervicitis
- Heavy bleeding
STATION 11: PAP SMEAR
1. What is the name of this test?

Answer: PAP smear
2. What is the indication?

Answer: cervical cancer screening
3. Name 2 precautions before test

Answer
- Ensure woman is not menstruating
- Avoid intercourse, douching or using any vaginal medicines or spermicidal
foams, creams or jellies 2 days before the PAP smear
4. Name 2 disadvantages for this test

Answer:
- Region affected may not be sufficiently collected or identified (inadequate
sample)
- Needs a specialist to interpret it
STATION 12: HYSTERECTOMY
1. What is the name of this operation?

Answer: Abdominal hysterectomy
2. What are the types of this operation?

Answer:
➢ Total hysterectomy
➢ Sub-total hysterectomy
➢ Pan-hysterectomy
➢ Extended hysterectomy
➢ Radical hysterectomy
3. List 3 gynecological indications

Answer:
➢ Ovarian mass
➢ Symptomatic fibroids
➢ Cervical carcinoma
➢ Gas gangrene of the uterus
Answer:
➢ Hemorrhage
➢ Visceral injury (bladder, intestine, ureter)
➢ Urinary incontinence
STATION 13: PLACENTA ABRUPTION

1. What is the diagnosis?

Answer: placenta abruption (or abruptio placentae)
2. List 3 possible causes

Answer:
• Hypertension
• Maternal trauma
• Uterine anomaly (e.g. placenta over septate uterus or submucous fibroids)
• Preterm/ premature rupture of membranes (PPROM/PROM)
• Rapid decompression of an over-distended uterus (multiple gestation,
polyhydramnios)
• Folic acid deficiency
• Supine hypotension syndrome
• Bleeding diathesis/dyscracias
• Malnutrition, smoking and cocaine abuse
3. Mention 3 complications during pregnancy

Answer:
• Maternal
➢ Hypovolemia/hemorrhagic shock
➢ Premature labor
➢ DIC
➢ Heart failure
➢ Renal failure
➢ Sheehan syndrome
➢ Maternal mortality
• Fetal
➢ Fetal distress
➢ Fetal demise
4. Mention 2 complication during labor?

Answer:
• Hemorrhage during labor
• Increased cesarean delivery
• Birth injuries
5. How would you deliver the fetus, justify your reason for choosing this mode
of delivery?
Answer:
It depends on maternal and fetal status. If abruption limited, fetal heart trace
reassuring, electronic monitoring is available, fetus is alive and the prospect
of vaginal delivery is soon without any contraindications then delivery can be
by vaginal delivery otherwise it should be by C-section for patients that
continue to bleeding, >Grade 1 abruption and show features of maternal or
fetal jeopardy
STATION 14: LEOPOLD MANEUVERS
1. What is the name give to these four steps shown above?

Answer: Leopold maneuvers
2. What is the name of the maneuver at A and what does it look for?
Answer:
➢ Fundal grip
➢ Assesses the uterine fundus to determine its height and which fetal pole is
present cephalic or podalic i.e. it aims to determine the gestational age and
the fetal lie
3. What is the name of the maneuver at B and what does it look for?
Answer
➢ Umbilical grip
➢ It determines whether the fetus is in a longitudinal, transverse or oblique
situation and to determine the position of the back and small parts.
4. What is the name of the maneuver at C and what does it look for?
Answer:
➢ First pelvic grip or Pawlik’s grip
➢ It determines what fetal part is lying above the inlet or lower abdomen
5. What is the name of the maneuver at D and what does it look for?
Answer:
➢ Leopold’s second pelvic grip
➢ It determines the presenting part in the lower uterine pole
STATION 15: COUVELAIRE UTERUS

1. What is your diagnosis?

Answer: Couvelaire uterus (uteroplacental apoplexy)
2. Mention 5 ways in which this can present

Answer:
- Abdominal or back pain, uterine tenderness
- Vaginal bleeding
- Fetal distress
- Abnormal uterine contractions e.g. hypertonic, high frequency
- Fetal death
- Idiopathic premature labor
3. Mention 4 conditions that cause this

Answer:
- Placenta abruption
- Placenta previa
- Amniotic fluid embolism
- Coagulopathy
- Ruptured uterus from transverse lie and pre-eclampsia
STATION 16: NON-PNEUMATIC ANTISHOCK GARMENT
1. What is shown in the image above?

Answer: Non-pneumatic antishock garment
2. Define the most common obstetric indication for its use

Answer:
- This is blood loss >500ml after a vaginal delivery or >1000ml after a C-
section or >1500ml after cesarean hysterectomy.
- Fall in hemoglobin >10%
- Significant amount of blood loss after delivery that makes the patient
symptomatic or results in signs of hypovolemia
3. Mention any 2 conditions in Obs and gyn where it is also used

Answer:
➢ Antepartum hemorrhage
➢ Hemorrhagic/hypovolemic shock secondary to incomplete abortion
➢ Ruptured ectopic pregnancy in shock
4. Mention two complications of the indication it is mainly used for and how to
prevent
Answer
➢ Hypovolemic shock
➢ Adult respiratory distress syndrome
➢ Acute kidney injury
➢ Sheehan syndrome
STATION 17: CHORIOAMNIONITIS

A Primgravida came in at 32 weeks gestation with a history of draining. 2 days later
she develops a foul-smelling PV discharge
1. What drugs would you give on admission?
Answer: Ampicillin 2g IV QID, Gentamicin 80mg IV TDS and Metronidazole
500mg TDS until 48 hours afebrile then continue
2. What 3 features would be present?

Answer:
➢ Maternal fever >38oC
➢ Fetal tachycardia
➢ Maternal leukocytosis
➢ Uterine tenderness
➢ Hypotension
3. What is your management?

Answer:
➢ Admit
➢ Intravenous antibiotics:
- Ampicillin 2g IV QID, Gentamicin 80mg IV TDS and Metronidazole
500mg TDS until 48 hours afebrile then continue
➢ Deliver the infant via C-section to expedite delivery
➢ Admit neonate to NICU, treat hypoglycemia, hypothermia and cover
neonate on antibiotics
STATION 18: HYDATIDIFORM MOLE

Study the picture below and answer the subsequent questions
1. What is the most possible diagnosis?

Answer: Molar pregnancy (hydatidiform mole)
2. Identify A and B
Answer
A= Uterus
B= vesicles
3. Mention 2 risk factors associated with this condition

Answer:
• Maternal age extremes (<20 years and >35 years)
• Folate deficiency
• Prior molar pregnancy
• Race/geography: common in Philippines and Taiwan
• History of spontaneous abortion
• Blood group A woman impregnated by man with blood group O
• Use of combined oral contraceptive
4. Mention 2 symptoms?
Answer:
• Hyperemesis gravidarum
• Vaginal bleeding prior to 16 weeks and passage of vesicles (grape-like) tissue
from vagina
• Hyperthyroidism: insomnia, anxiety, heat intolerance, sweaty palms,
tachycardia
5. Two methods of investigations?

Answer:
• Ultrasound: snowstorm appearance (complete mole), absent fetal heart or fetal
parts and honeycomb appearance of the placenta (partial mole)
• Serum beta hCG: elevated usually >100,000 mIU/ml
• Biopsy for histopathology: definitive diagnosis
• Chest X-ray for lung metastasis
6. How would you advise if she wants contraceptives?

Answer: She should be on oral contraceptive pills for a year at least to prevent
confusion from recurrent disease and normal pregnancy.
7. What are the complications?

Answer:
1. Recurrence/persistence of trophoblastic tissue
2. Malignant transformation and metastasis
STATION 19: EPISIOTOMY

Study the imaging the below and answer the questions below
1. What is this procedure shown in the picture?

Answer: Mediolateral episiotomy
2. Name 3 indication for this procedure

Answer
• Poor progress which may be due to a rigid perineum
• Complex delivery: breech, instrumentation, dystocia
• If perineum appears to be tearing or there are previously poorly healed scars
• Previous perineal surgery (perineal reconstructive surgery)
• Fetal distress during active phase
3. Describe the procedure and what is the right time to do this procedure?
Answer:
• This is done just prior to crowning (bulging thinned perineum) when the head
is 3-4cm
• Anesthesia (lidocaine) is prepared and injected in perineum
• 2 fingers are placed to protect the baby’s head
• For right mediolateral episiotomy: cut with scissors 3cm from fourchette
laterally to avoid anal sphincter. Ideally cut at peak of contraction
• Suture after labor
4. What are the types of this procedure that can be done including advantages and
disadvantages of each?
Answer:
➢ Midline (median) incision episiotomy

- Advantage: easy to repair, less pain during postpartum period, less blood
loss
- Disadvantage: increased extension of incision into or through anal muscles
➢ Mediolateral incision episiotomy
- Advantage: less extension of the incision into or through anal muscles
- Disadvantage: more blood loss, difficult to repair and more perineal
discomfort post-partum
5. Name 2 possible complications

Answer:
• Wound dehiscence
• Infection
• Extension of incision to involve the rectum
• Vulval hematoma
• Dyspareunia
• Scarring
• Injury to the anal sphincter causing incontinence
• Rectal vaginal fistula (Rare)
STATION 20: PARTOGRAPH

A primip with no risk factors in labor at term. Examine the partogram and answer
the questions below.
1. Based on the partogram, what was the diagnosis at t=4 hours, and what two
things on the partogram support that? (3 marks)
Answer:
Diagnosis: Poor progress in first stage
Support:
➢ Little cervical dilation
➢ Little descent
2. What actions were taken at t=4 hours? (3 marks)

Answer:
• Artificial rupture of membranes
• Augmentation with IV syntocinon
• Analgesia (Pethidine)
3. What dose of oxytocin (in mU/min) was she commenced on? (1 mark)
Answer: 15 dpm of 5U/L= 5 mU/min
4. What drugs are indicated by X at 4 hours?

Answer: Pethidine and antiemetic
5. What abnormalities are shown on the partogram at t=10 hours?

Answer:
• Fetal distress- decreased fetal heart rate and meconium
• Moulding- Obstructed labor
6. How should she be safely delivered?

Answer: Caesarean
STATION 21: PARTOGRAPH

A primip with no risk factors in labor at term. Examine the partogram and answer
the questions below.
1. Based on the partogram, what action was taken by the clinic midwife after 4 hours
in labor (t=4 hours) and why? (1 mark)
Answer: Artificial rupture of membranes (ARM) for delay in first stage
2. Why was she referred to UTH at t=6 hours? (0.5 marks)

Answer: poor contractions after ARM
3. On arrival at UTH at t=7 hours, the findings were essentially unchanged. What
actions were taken? (2 marks)
Answer:
• Augmentation with IV syntocinon
• Analgesia (Pethidine)
4. What does of oxytocin (in mU/min) was she commenced on? (1 mark)
Answer: 15dpm of 5U/l= 5mU/min
5. How would you describe the contractions at t=9 hours? (1 mark)

Answer: Strong, 3 contractions in 10 minutes
6. She was fully dilated at t=12 hours. Two hours later, she had still not delivered.
What 3 reasons can be surmised from the partogram? (3 marks)
Answer:
Ketonuria 2+- exhaustion
Poor contractions
Right occipital posterior
7. How could she be safely delivered? (1.5 marks)

Answer: Vacuum, forceps
STATION 22: DRUGS

In hypertensive disorders of pregnancy:
1. Name three antihypertensive dugs that can be safely used in pregnancy and their
mode of action
Answer:
• Methyldopa (central acting Alpha 2 agonist): it is an alpha 2 agonist that is
converted to alpha-methylnorepinephrine centrally to diminish adrenergic
outflow from the CNS
• Hydralazine (vasodilator): Releases nitric oxide from the endothelial. Nitric
oxide stimulates guanylyl cyclase to convert GTP to cGMP, cGMP activates
protein kinase G that phosphorylates myosin light chain kinase rendering it
inactive and so it cannot phosphorylate myosin light chans and this causes
relaxation of vascular smooth muscle in arteries and arterioles, vasodilation
and reduced peripheral resistance and blood pressure.
• Labetalol (mixed alpha 1 and beta 1 & 2 blocker): it blocks alpha 1 receptors
on blood vessels causes vasodilation (reducing peripheral resistance) well as
beta 1 receptors on the heart (reducing cardiac output, heart rate and force of
contraction) resulting in a decrease in blood pressure.
• Nifedipine (calcium channel blocker): Blocks calcium channels on the blood
vessels causes reduction in peripheral resistance and venous return and
ultimately blood pressure
2. What pharmacologic agent can be used to prevent convulsions in eclampsia?

Answer: Magnesium sulfate
3. What drugs can be used to reverse the side effects of in the event of toxicity of
the drug in ‘b’?
Answer: Calcium gluconate
STATION 23: AMTSL

1. In the active management of the third stage of labor?
A. What is the drug of choice?
Answer: Oxytocin (syntocinon)
B. The natural equivalent of drug acts on what two parts of the body?
Answer:
• The fundus of the uterus to cause uterine contractions
• The myoepithelial cells of the breast to cause ejection of milk
STATION 24: OVULATION

1. A woman has anovulation
A. What pharmacologic agent can be used to induce ovulation?
Answer: Clomiphene citrate
B. What is the mode of action of the drug?

Answer: Clomiphene is very similar in structure to estrogen and so
clomiphene fits into the estrogen receptors at the level of the pituitary. The
pituitary does not interpret clomiphene as estrogen and rather as low estrogen
state, therefore producing high levels of gonadotropins.

Answer:
1. A- Doyen’s retractor
2. B-Kocher’s forceps
3. C- Needle holder
4. D-Punch biopsy forceps
5. E-Episiotomy scissors
6. F- Towel clip

Answer:
1. A-Scalpel
2. B-Handle and blade
3. C-Pessary ring
4. D- Manual vacuum aspiration (MVA) synringe
5. E-Plastic suction cannula (Karman’s type)
6. F- Ventouse cup

1. A- Cord-clamp (disposable)
2. B-Pinard’s stethoscope
3. C-Doppler fetal monitor device
4. D-Cervical dilators
STATION 28: MVA

Miss Felicity Mumba is a 6th year medical student whose LMP was 8 weeks ago.
She was seen by the PAC nurse who made a diagnosis of incomplete abortion. You
repeat the VE and find that the uterus is anterverted and is 8 weeks in size and the
os open. Please explain how you will perform an MVA
Answer:
• Greet the patient and introduce yourself
• Explain the procedure to the patient and gain consent
• Check MVA syringe and charge it (Establish a vacuum)
• Put on apron, wash hands/scrub and don gloves
• Insert speculum and check the vagina and cervix for tissue fragments
• Applies antiseptic solution to the cervix
• Put tenaculum on cervix
• Paracervical block
• Identify appropriate cannula
• Inserts cannula gently into uterine cavity
• Attach prepared syringe to the cannula
• Evacuates uterus by rotating and moving cannula back and forth within
uterine cavity
• Withdraw cannula and remove forceps
• Inspects cervix for bleeding
• Performs bimanual examination to check size and firmness of uterus
• Continue talking to patient during procedure

• Cover the client and reassure the patient
• Clean patient, wash hands after
• Thank the patient and ask them to cover up

1. Identify the instruments shown at this station and list 1 indication for each
A- Allis tissue forceps: used to grasp tough structure like rectus sheath and it is
used in Low segment cesarean section and hysterectomy
B- Artery forceps: clump bleeders (straight end- stay suture, Curved end-
hemostat)
C- Ayre’s spatula: used in pap smear
D- Cervical brush: used in pap smear
E- Pipelle: used to take endometrial sample
F- Umbilical cord scissors: cutting the umbilical cord
STATION 30: SUPINE HYPOTENSIVE SYNDROME

1. What is the name of this syndrome? (2 marks)

Answer: Supine hypotensive syndrome (inferior vena cava syndrome)
2. How does it occur? (4 marks)

Answer: Due to compression of the inferior vena cava by a gravid uterus when
a pregnant woman is in a supine position leading to decreased venous return
centrally.
3. What are the clinical features of this associated syndrome? (3 marks)

Answer:
• Fetal: Fetal hypoxia (Reduce fetal heart rate on CTG),
• Maternal: dizziness, pallor and hypotension
4. What should be done to avoid it? (4 marks)

Answer: Advise the patient to avoiding lying on her back for prolonged
periods and lie on the left lateral position during the later periods of pregnancy
STATION 31: FIBROIDS

A. What do you see in the pictures? (2 marks)

Answer: Uterine tumors (fibroids/leiomyoma)
B. Describe the location of the tumor that you see (4 marks)

Answer:
• Intramural/intramural: fibroid within the uterine wall.
• Subserosal/subperitoneal: fibroids are just below the serosa/peritoneum
• Pedunculated subserosal: fibroids are just below the serosa/peritoneum
• Submucous: fibroids are just below the endometrium
C. Name one complication for each of the mentioned location of the tumors (4
marks)
Answer:
• Intramural/intramural: Postpartum hemorrhage.
• Subserosal/subperitoneal: bladder compression and abdominal distension
• Pedunculated subserosal: acute abdominal pain (torsion)
• Submucous: anemia from menorrhagia, metrorrhagia, infertility
D. What is the commonest presentation?

Answer: Dysmenorrhea and menorrhagia
STATION 32: CARCINOMA OF THE CERVIX

Study the image below and answer the following questions. This is a case of cancer
cervix
1. What is the staging of this patient?

Answer: 4A (involvement of the adjacent organs e.g. bladder and rectum)
2. What is the commonest clinical presentation?

Answer:
• Contact bleeding,
• Foul smelling vaginal discharge,
• Intermenstrual bleeding,
• Prolonged bleeding,
• Post-menopausal bleeding.
Answer:
• Anemia
• Metastasis to the lungs
• Hemorrhagic shock
• Hydronephrosis
• Sepsis
4. What is the best line of treatment (in one word)

Answer: Chemoradiotherapy
STATION 33: GALACTORRHEA
1. What does this photo show?

Answer: Whitish nipple discharge (most likely Galactorrhea)
2. What is the responsible hormone?

Answer: Prolactin
3. Name 3 possible causes

Answer:
- Pituitary tumors (adenomas)

- Drugs: methyldopa, opioids, antipsychotics, antidepressants (serotonin reuptake
inhibitors)
- Hypothyroidism
4. Name 2 drugs used to treat this case?

Answer:
- Bromocriptine
- Cabergoline
5. How would you treat it?

Answer:
- Treatment is dependent on the cause
- Investigations: CT/MRI of the head, TSH, Prolactin levels,
mammogram/ultrasound
- Stop or change any drugs that may be causing galactorrhea
- Hypothyroidism: give thyroxine
- Pituitary adenoma: surgery
STATION 34: TURNER’S SYNDROME

1. A 19-year-old girl presents with 1-year amenorrhea. She is 141cm.
A. What is the most likely diagnosis?

Answer: Turner’s syndrome
B. What hormone test would you request?

Answer:
FSH and LH: increased
Estrogen: decreased
C. What does her uterus look like?

Answer: It appears small
D. What do her gonads look like?

Answer: Gonads are streaks (fibrous tissue follicles)
E. Name 2 other associated anomalies

Answer:
➢ Coarctation of the aorta
➢ Partial anomalous venous drainage
➢ Aortic valve stenosis
➢ Hypoplastic left heart syndrome
➢ Scoliosis
➢ Hypothyroidism
➢ Diabetes mellitus
- Turner’s syndrome also known as 45X or 45XO is a genetic condition in which
a female is partly or completely missing an X-chromosomes
- Features: short stature, low set ears, webbed neck, widely spaced breasts, shield
chest
- Management: estrogen therapy is important for growth and development of
secondary sexual characteristics
STATION 35: ENDOMETRIOSIS
1. Identify the lesion shown in the image above

Answer: Endometriotic lesion
2. What is the commonest clinical presentation?

Answer:
• Lower abdominal and pelvic pain
• Dysmenorrhea
• Deep Dyspareunia
• Subfertility
3. What is the commonest site of this lesion?

Answer: Ovary
4. What investigations would you order?

Answer:
• Laparoscopy (gold standard)
• Transvaginal ultrasound (ground glass appearance)
- The second most common site is the culdesac, there may be scarring of the
uterosacral ligament in the culdesac causing uterosacral ligament nodularity
(uterus becomes tender fixed and retroverted with uterosacral nodularity)
- Common site:
o Ovary- chocolate cyst/endometriomas
o Uterine ligaments- pelvic pain
o Pouch of Douglas-pain with defecation
o Bladder wall- pain with urination, hematuria
o Bowel serosa- abdominal pain and adhesions
o Fallopian tube mucosa- scarring (increased risk for infertility and ectopic
tubal pregnancy)
- Management:
 Medical
o Pregnancy
o Analgesics NSAIDs (Mefenamic acid 250-500mg PO TDS)
o Continuous Depo-provera (medroxyprogesterone acetate) or OCPs
o Danazol: androgen derivative that suppresses FSH/LH thus inducing
menopause and endometrial gland atrophy even in endometriotic lesions
o GnRH agonist e.g. leuprolide

 Surgical
o Conservative (preserves fertility): laparoscopic surgery with diathermy,
laser vaporization and adhesion lysis or excision.
o Definitive (failed medical therapy): Total abdominal hysterectomy and
bilateral salpingo-oophorectomy
STATION 36: LABOR

1. What does this picture show? (2 marks)

Answer: Crowning
2. At what stage of events does this occur? (2 marks)

Answer: second stage of labor
3. Describe the tasks of the obstetrician at this stage (6 marks)

Answer:
• The patient is encouraged for the bearing down efforts during uterine
contractions. This facilitates descent of the head
• When the scalp is visible about 5 cm in diameter, flexion of the head is
maintained during contraction. This is achieved by pushing the occiput
downwards and backwards by using thumb and index fingers of the left hand
while pressing the perineum by the right palm with a sterile vulval pad. If the
patient passes stool, it should be cleaned and the region is washed with
antiseptic lotion
• The process is repeated during subsequent contractions until the sub-occiput
is placed under the symphysis pubis.
STATION 37: CLINICAL SCENARIOS

1. A 39-year-old is admitted to CO2 at 24 weeks in her first pregnancy. She was
admitted with a blood pressure of 145/90 and 1+ proteinuria. She has received no
treatment since admission. Blood tests performed on admission reveal the
following results:
Hemoglobin: 13.1 g/dl
Platelet 152 x 109/L
Creatinine 120 micrmols/l
ALT 45IU/L
Alk phosphatase 210 IU/L
Bilirubin 9 micromols/L
Albumin 25g/L
Uric acid 0.59 mmol/L
The midwife reports that the 24 hour urine protein is 6.2g
A. What are the differential diagnosis and why? (4 marks)

Answer:
1. Severe Pre-eclampsia
➢ Gestation >20 weeks
➢ Systolic blood pressure >140mmHg and proteinuria 1+
➢ High level of hemoglobin (hemoconcentration)
➢ High levels of uric acid
➢ High level of creatinine
➢ Elevated liver enzymes (hepatic involvement)
2. Chronic hypertension with superimposed pre-eclampsia

➢ Lack of booking pressure
B. What other history would you obtain? (5 marks)

Answer:
➢ Previous history of hypertension
➢ Family history of hypertension

➢ Family history of twins
➢ Exaggerated symptoms of pregnancy e.g. hyperemesis gravidarum
➢ Symptoms pertaining to UTI
C. What other investigations would you arrange? (6 marks)

Answer:
a. Imaging: ultrasound for fetal viability, estimated fetal weight and amniotic
fluid indices
b. Serial blood tests
➢ Full blood count: Hemoglobin, platelets
➢ Live function test: Serum albumin, bilirubin and prothrombin time
➢ Renal function tests: serum urea, electrolytes and creatinine
c. Urinalysis
D. What complications may arise? (5 marks)

Answer:
a. Maternal
➢ Eclampsia
➢ HELLP syndrome
➢ Preterm labor
➢ Abruptio placenta
➢ DIC
➢ Pulmonary edema
➢ Renal failure
➢ Maternal death
➢ High risk of surgical intervention
b. Fetal
➢ Intrauterine growth restriction
➢ Intrauterine fetal death
➢ Prematurity
2. Mrs. A. B is a 23-year-old married woman in her first pregnancy. She booked at

18 weeks gestation and her blood results at booking were:
Full blood count
Hb- 8.3g/dl
Hct- 0.252
MCV 68.4 fl
MCH 21.5 pg
WBC 9.0 x 109/L
Platelets 202 x 109/L
Other results
HIV positive
CD4 count 200
RPR negative
Hepatitis B negative
Hepatitis C positive
A. What abnormality does the full blood count show? (1 mark)

Answer: Low Hemoglobin, Low hematocrit, Low mean cell volume, Low
mean corpuscular hemoglobin consistent with microcytic hypochromic
anemia (iron deficiency anemia)
B. What other tests should be done in light of the full blood count? (1 mark)
Answer:
• Stool microscopy/culture/sensitivity for ova and parasites
• Urine microscopy/culture/sensitivity
• Iron studies
C. What should be the treatment? (2 marks)

Answer:
• Hematinics: ferrous sulphate 200mg TDS and folic acid 5mg OD
• Antihelminths
• Nutrition good in iron rich foods (leafy vegetables and animal meat and
animal products)
• Intermittent prophylaxis treatment- malaria
D. How should she be managed antenatally in light of the HIV status? (2 marks)
Answer: Initiate ARVs
E. Her CD4 count at 36 weeks is reported at 1000, what should be the preferred
mode of delivery (1 mark)?
Answer: Vaginally
F. How can the mother be counselled to prevent PMTCT postnatally? (2 marks)

Answer:
• Exclusive breastfeeding of the infant for 6 months if she cannot manage to
feed child formula milk
• Continued ARV treatment
• Routine check up for viral load and CD4 count
• Place child on prophylaxis for the time of exposure
• Test the child regularly
G. How should the hepatitis C be treated? (1 mark)

Answer: Management is largely supportive however ribavirin and
recombinant interferon alpha can be given
3. Mr. and Mrs. Banda, both in their late 20s have been trying to conceive for nearly
3 years. Mr. Banda had not fathered any children and Mrs. Banda had never been
pregnant before. Mrs. Banda’s cycles were irregular (24-40) days long with
scanty periods. All the investigations you had ordered over the clinic visit show
that the semen analysis, hysterosalpingogram and pelvic ultrasound were normal.
Mrs. Banda’s hormone profile results are as follows:
FSH 5IU/ml (1-10 IU/ml)
LH 12 (0.61-16.3 IU/L)
Prolactin 205ng/ml (Non-pregnant: 2-29ng/mL)
TSH 3.2 mU/L (0.4-4.2 mU/L)
Day 21 progesterone 4.3 nmol/L (6-80nmol/L)
Next period started day 29

A. What abnormality/ies do the results show? (2 marks)
Answer:
• Raised prolactin (hyperprolactinemia)
• Low day 21 progesterone (lack of evidence of ovulation)
B. What other tests should be done now? (1 mark)

Answer:
• Visual field
• Skull X-ray (lateral) or CT scan to view pituitary fossa
C. What should be the treatment (2 marks)

Answer:
• Bromocriptine to treat hyperprolactinemia
• Proceed to clomiphene citrate to induce ovulation
D. Mrs. Banda subsequently falls pregnant and presents to antenatal clinic at 28

weeks and although asymptomatic has the following hematology results:
Hb- 8.0g/dl
MCV- 66fl
MCHC-23
Platelets 210
WBC- 10
What do the results indicate? (1 mark)

Answer: Microcytic hypochromic anemia (iron deficiency anemia)
E. What is the treatment?

Answer: Ferrous sulphate 200mg PO TDS and folic acid 5mg PO OD
F. Mrs. Banda cannot tolerate oral treatment, how then should she be treated? (1
mark)
Answer: Total parenteral iron e.g. iron dextran or iron sucrose
G. An Hb when she goes in labor at 38 weeks gestation was 9.9g/dl. What should
be the management? (2 marks)
Answer:
• Group and save
• Active management of the third stage of labor
STATION 38: DRUG

1. Drug A: Magnesium sulphate
A. What is the mechanism of action of this drug?
Answer: Cerebral vasodilation and membrane stabilizer hence preventing
seizures. It also acts as competitive calcium antagonist
B. Mention 2 indicates for its use

Answer:
• Hypertensive disorders of pregnancy: Severe pre-eclampsia and eclampsia
• Tocolysis of the uterus
C. State 3 ways of detecting possible toxicity of this drug during administration

Answer:
• Reduce urine output <30ml/hr
• Reduce respiratory rate <12b/min
• Diminished/absent deep tendon reflexes e.g. knee jerk
D. You find a patient is exhibiting these features while on treatment. What would
be your action?
Answer: Stop the magnesium sulphate infusion
E. The condition of this patient does not improve regardless of your intervention
above. What drug can you administer to such a patient?
Answer: Calcium gluconate 1g in 10 minutes
2. Drug B: oxytocin
A. Mention 2 major indications of this drug:
Answer:
• Induction and augmentation of labor
• Postpartum hemorrhage management
• Active management of third stage of labor
B. List 2 other alternative drugs you can use and mention the indication for its
use
Answer:
• Ergometrine, methergine- Postpartum hemorrhage management
• Misoprostol (Cytotec)-induction of labor
C. Name 3 condition in which these alternative drugs are contraindicated

Answer:
• Vascular disease
• Severe cardiac disease
• Severe hypertension, eclampsia
D. Give 2 reasons why they are contraindicated

Answer:
• Causes sustained contractions
• Alpha receptor activity is increased causes increase in peripheral resistance
E. What are the possible complications that may arise from the use of drug B
(mention 2)
Answer:
• Uterine rupture
• Overstimulation of uterus
• Fetal distress
3. Drug C: Depo-provera
A. Mention the indication of this drug
Answer: contraceptive/family planning (Medroxyprogesterone acetate)
B. What is the mechanism of action of this drug?

Answer: Thickening of cervical mucus, alteration of endometrial epithelium
and tubal motility, prevention of ovulation
C. List the advantages and disadvantages of this drug

Answer:
• Advantages
➢ Long acting
➢ Good compliance
➢ Does not interfere with sex
• Disadvantages
➢ Delayed return of fertility
➢ Abnormal uterine bleeding

➢ No protection against STIs
➢ Weight gain
STATION 39: CONTRACEPTION

Mrs R Musonda is a 30-year-old who has 3 kids. She is not very sure whether she
wants more children and she opts for a long term contraceptive. After counseling
she settles for implants and you have been called to insert Jadelle. How would you
go about it.
Answer:
• Greet patient and introduce yourself
• Explain the procedure to the patient
• Ask about allergies to antiseptic solution and local anesthesia
• Checks to be sure that the arm is clean
• Determine insertion area by measuring 8cm above elbow fold
• Determine that instruments are present
• Wash hands with soap and puts on sterile gloves
• Apply antiseptic to incisional area
• Prepare 1% lignocaine and injects it under the skin
• Makes a shallow 2mm incision just under the skin
• Insert trocar and plunger through incision with bevel facing up
• Slowly and smoothly advance trocar and plunger towards the mark
• Remove plunger
• Load first rod into trocar
• Reinsert plunger and push rod towards tip of trocar
• Hold plunger firmly and slide trocar till it reaches plunger handle
• Redirect trocar about 15 degrees and advance to reinsert second rod
• Palpate incision to make sure that both rods are 5mm clear of incision
• Remove trocar from incision
• Place all instruments into 0.5 chlorine
• Wash hands
• Instruct client regarding wound care
• Asks if the patient has any questions
• Thank the patient
2. My name is Miss Jane Mwansa and I am unmarried. I had sex with my boyfriend
last night and only discovered afterwards that the condom had burst. I really do
not want to fall pregnant is there anything that you can give me to prevent a
pregnancy? I am not on any family planning method I have heard that there is
emergency contraception which I can take to prevent this from happening. Please
help me with information about this method and how I can access and use it, and
any other information that may be useful to me.
Answer:
• Defines emergency contraception (3 marks)
• Describes the various types, mode of action, timing of uptake and risk of
failure (9 marks)
• Inquires about last menstrual period (2 marks)
• Mentions TOP as option after this ordeal in event of pregnancy (2 marks)
STATION 40: MIXED

1. Study the image below and answer the following questions
A. What is this graph used for? (2 marks)

Answer: This is the partograph used to monitor the fetal and maternal well
being during the progression of labor from the active phase of labor
B. Name 3 main components of this graph? (6 marks)

Answer:
1. Demographics
2. Fetal condition: heart rate, liquor, moulding, progression of labor (descent,
contraction and cervical dilation)
3. Maternal condition: Blood pressure, pulse, respiratory rate, temperature
and urinalysis
C. What was the indication for cesarean section as suggested by this graph? (2
marks)
Answer: Prolonged active phase of labor with poor descent, poor cervical
dilatation and fetal distress
2. Study the picture and answer the following questions
A. Identify the instrument above

Answer: Karman’s syringe with cannula in situ (manual vacuum aspirator)
B. What are the indications of this instrument?

Answer:
• Evacuation of retrained products of conception
• Incomplete abortion
• Missed abortion
• Septic abortion
• Molar pregnancy
C. What are complications associated with its use?

Answer:
• Uterine perforation
• Infection
• Asherman syndrome (subfertility)
D. What is PAC?
Answer: PAC= post abortal care
• Counsel the patient
• Explain the cause and how they can be prevented
• Tell patient when to return, if bleeding does not stop or in case of signs of
infection such as fever and abnormal discharge
• Give antibiotics and analgesia
• Family planning
• Avoid coitus for 2 weeks
• Avoid conceiving for at least 6 months- advise to choose a contraceptive
method
3. Study the picture below and answer the following question.
A. Identify the image above

Answer: Copper T intrauterine device
B. What are the uses?

Answer: Used as a type of non-hormonal long acting reversible contraceptive

(LARC) and as an emergency contraceptive
C. What are the complications of the use of this device?

Answer:
• Expulsion of IUD
• Can act as nidus for infection
• Perforation
• Failure leading to pregnancy
• Ectopic pregnancy
D. What are the side effects of use of this device?

Answer:
• Bleeding (HMB or IMB)
• Pain
• Allergic reaction
UNSUNG HEROES
1. Mwansa Zimba an 18 year old primigravida at 36 weeks gestation is referred
from her local clinic (Kanyama) at 0800 hours because of floods being
experienced there. She is 5cm dilated, membranes are intact, the descent is 4/5
and she is having 3 contractions in 10 minutes lasting for 20 seconds.
The fetal heart rate is 130/min, regular. Her Blood pressure is 110/70mmHg and
pulse is 80/min. Her temperature is 36.5oC. She has passed 200mls of clear urine
and there is no protein, acetone or glucose in the urine.
4 hours later Mwansa is re-examined. She is noted to be having 3 contractions in

10 minutes, now lasting for 40 seconds. The descent is still 4/5, FHHR is
132/min. Vaginal examination shows her to be 8cm dilated with intact
membranes. Her BP is 110/80mmHg, pulse is 82/min, temperature is 36.5oC and
has passed another 200ml of clear urine still negative for proteins, acetone and
glucose.
A. Plot the findings on partograph (1 mark for each entry-34)

B. What is your impression on the progress of labor? If there is a problem what
is it?
C. What are you going to do at this stage?
D. She delivers a 3.0 Kg female baby with an A/Score of 8, 9. The nurse does
not carry out ‘Active management of the third stage’. What is this and what
are the steps?
Answer:
2. Twins
A. What condition is being demonstrated here? (1 mark)

B. What anatomical diagnosis is given to this condition (1 mark)
C. What complications would be associated with this condition during pregnancy
(3 marks)
3. You are called to the labor ward 15 minutes after a P3 G4 has had a normal
delivery. She is bleeding excessively.
A. What is the first thing you do when you enter the room?
B. What two relevant questions do you ask the midwife?
C. What do you then do? Name 5 courses of action
D. What is the most likely cause?
E. You are unable to stop the bleeding. What measures do you take while
awaiting senior help.
WORTHY MENTIONS
• Uterine prolapse
o First degree: descent within the vagina
o Second degree: descent to the introitus
o Third degree: outside the introitus (Procedentia)
Hirsutism (abundant facial hair) and ultrasound showing multiple cystic dilation
• Post-dates pregnancy: pregnancy between 40-42 weeks
• Post term pregnancy: pregnancy 42 weeks or more

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PREPARED BY MOSES KAZEVU JR

OBSTETRICS AND GYNECOLOGY OSCE

2. Give one indication for each of the instruments

B- Cusco’s speculum (Cusco’s bivalve self-retaining vaginal speculum)

o To collect cervical smear for cytologic screening and vaginal

D- Auvard’s speculum (Auvard’s self-retaining posterior vaginal speculum)

F- Female metal catheter

3. What are the complications of using instrument C? Recognizing uterine

2. Give one indication for each of the instruments

➢ Gynecological: Continuous drainage of bladder during vaginal/abdominal

2. Give one indication for each of the instruments

1. Name the type of this intrauterine contraceptive device?

2. What is the mechanism of action?

3. What are 2 indications of its use?

4. What hormone is contained in this device and what is the dosage/amount?

5. List 3 contraindications to the use of this form of contraception

7. Name 3 non-contraceptive benefits for this method

STATION 5: PELVIC INFLAMMATORY DISEASE

1. What is the provisional diagnosis?

Answer: Infertility 20 Chronic Pelvic inflammatory disease

2. What is the commonest organism responsible for these lesions?

3. What is the specific medical therapy for this condition?

STATION 6: INTRAUTERINE ADHESIONS

1. Describe what the image above shows (left)

2. What is the name and cause of this condition?

3. How to confirm the presence of this lesion

4. What is the treatment as shown on the image on the right?

1. What is the name of this operation?

2. What is the indication?

3. What are the complications associated with this procedure?

4. What are the contraindications to this procedure?

STATION 8: SEPTATE UTERUS

1. What is the name of this uterine abnormality?

2. What is the investigation used in this photo?

3. Name 2 clinical presentation of this condition

4. Name 2 obstetrical complications

1. What is this procedure?

2. What is your interpretation of this image?

3. What is the name of the pathology shown in the photo?

4. Name 2 alternative investigations

6. What is the best treatment if this condition was bilateral?

STATION 10: COLPOSCOPY

1. What is the name of this investigation?

2. What is the indication (name 2)?

3. Name 2 abnormal findings by this examination?

STATION 11: PAP SMEAR

1. What is the name of this test?

2. What is the indication?

3. Name 2 precautions before test

4. Name 2 disadvantages for this test

STATION 12: HYSTERECTOMY

1. What is the name of this operation?

2. What are the types of this operation?

3. List 3 gynecological indications

STATION 13: PLACENTA ABRUPTION

1. What is the diagnosis?

2. List 3 possible causes

3. Mention 3 complications during pregnancy

4. Mention 2 complication during labor?