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OSCE > GOSH > Flashcards

GOSH Flashcards

1
Q

Male genitalia exam

A

Intro - consent, chaperone
Hx - pain, swelling, discharge, skin changes
Expose
Inspection
Palpation - retract foreskin, open meatus, replace foreskin, testicles, epididymis, raise testes + cremaster reflex, palpate spermatic cord
Finish - abdo exam, PR, US of testicles, swabs
Urology review

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2
Q

Speculum/ smear/ swabs/ bimanual exam

A

Intro - consent, chaperone
Hx - pain, bleeding, discharge, skin changes
Expose
Inspection
Palpate inguinal nodes + labia for cysts/ abscesses
VVS swab
Speculum
Smear
Swabs - HV + ECS
Remove, check, change gloves
Insert fingers - feels vaginal walls, cervix, fornices, uterus + adnexa
Finish - discuss findings, offer bloods, receiving results + follow up

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3
Q

Pregnant abdo exam

A

Intro - consent + chaperone
Empty bladder?
Inspect - generally, pulse, head + neck, oedema
Abdo inspect - distension, movements, scars, skin changes
Palpation - fundal height, lie, presentation, engagement, liquor volume
Auscultate fetal heart with doppler
Finish

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4
Q

What to cover on booking appointment?

A 
Lifestyle - smoking, alcohol, folic acid, Vit D 
BMI, BP, urine dip 
MOSCC
Explain scans + screening 
Assess risk of pre-eclampsia, VTE + GDM
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5
Q

What % of pregnancies have bleeding after 24 weeks + what % of this is undiagnosed?

A

3-5% pregnancies experience APH

40% undiagnosed

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6
Q

Why is Rubella tested even when people have had the MMR vaccine?

A

Vaccine doesn’t fully protect 1 in 20 women

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7
Q

When is the next scan if you have a low lying placenta?

A

32 weeks

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8
Q

What is the rate of DS in pregnancies?

A

1 in 1000

1 in 300 over 30

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9
Q

How many pregnancies miscarry?

A

1 in 5

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10
Q

What is the management for the 3rd miscarriage?

A

Cytogenic analysis of baby
Pelvic USS
Screening for blood disorders + hormones

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11
Q

What are the risks + success rates of miscarriage management?

A

Expectant - follow up in 7 days. Risk of prolonged bleeding, infection + pain

Medical - 85% success, risks of bleeding, pain + infection. Follow up in 7 days

Surgical - bleeding + infection risk

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12
Q

What to say in safety netting of a miscarriage?

A

Any signs of infection come back
Vaginal loss is normal but if excessive come back
No need to delay further pregnancy attempts but have time to grieve
Psychological support for feelings of grief, loss, shock, depression + guilt

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13
Q

What is the management of ectopics?

A

Expectant - bloods every 48 hrs until repeated fall, then weekly

Medical - methotrexate IM if hCG is 1500-5000
Take hCG on day 4 + 7
Further methotrexate if fall is <15%
Need reliable contraception for 3 months

Surgery if >5000 or pain or fetal heart beat

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14
Q

What are the chances of a successful normal pregnancy after tube removal?

A

7 in 10

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15
Q

What are the pros + cons of epidural?

A

Pros: 95% effective, good for CS
Cons: dizziness, headache, patchy block
Increases length of 2nd stage + rates of operative delivery

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16
Q

What is the risk of prolonged pregnancy?

A

Stillbirth risk increased from 3 in 3000 at 42 weeks to 6 in 3000 at 43 weeks

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17
Q

What are the complications of an induction?

A 
Failure
Uterine hyperstimulation 
Uterine rupture 
Intrauterine infection 
Prolapsed cord 
Amniotic fluid embolism
18
Q

What % of pregnancies have a rupture before 37 weeks?

A

2%

19
Q

What are the complications of PPROM?

A

Operative delivery
Preterm delivery (+ premature baby risks)
Infection
Cord prolapse
Placental abruption
Oligohydraminos + underdevelopment of lungs

20
Q

How common is placenta praevia?

A

1 in 200

21
Q

What should you ask about to assess VTE risk?

A 
ABCD VSP 
Age >35
BMI >30
Conditions (medical)
Disability + immobility

VTE past
Smoking
Parity/ pre-eclampsia

22
Q

How common is pre-eclampsia + how many go on to get HELLP, eclampsia + recurrence?

A

1 in 14 pregnancies = pre-eclampsia
1 in 100 go on to have eclampsia
1 in 5 severe pre-eclampsia get HELLP
1 in 10 chance of recurrence

23
Q

What is the management of chorioamnionitis?

A

Cefuroxime + metronidazole

24
Q

What does existing HTN increase you risk of in pregnancy?

A

Pre-eclampsia
IUGR
Placental abruption
SAH

25
Q

How common are twins?

A

Twins = 1 in 90

26
Q

What is the average gestation of delivery in twins + triplets?

A 
Twins = 37 weeks 
Triplets = 31 weeks
27
Q

What are the risks of multiples (to babies)?

A

Congenital abnormalities, cerebral palsy, mortality in neonatal period

28
Q

What % of babies are born by CS?

A

20%

29
Q

What % of mothers go on to have a VBAC after CS?

A

60%

30
Q

What is the failure rate of male + female sterilisation?

A

1 in 2000 male

1 in 200 female

31
Q

What are the causes of irregular bleeding/ amenorrhoea?

A 
5Ps + TE
Pregnancy 
Prolactinoma 
Post pill/ injection 
Premature ovarian failure 
PCOS

Thyroid problems
Extremes - weight, exercise + stress

32
Q

How common is endometriosis?

A

1 in 10

33
Q

How common is PID?

A

1 in 50 women

34
Q

How common is urge incontinence?

A

1 in 5 women >40

35
Q

How common is stress incontinence?

A

1 in 5 women >40

36
Q

What advice can be given for incontinence?

A

Avoid caffiene + fizzy drinks + alcohol

Lose weight

37
Q

How common are normal, mild + moderate changes on smears?

A 
Normal = 9 in 10 
Mild = 1 in 20
Moderate = 1 in 100
38
Q

How common is difficulty conceiving + what are the rates of conception?

A

1 in 7 have difficulty
85% conceive within 1 year
95% conceive within 2 years

39
Q

How common is it to not find a cause for subfertility?

A

30%

40
Q

What to counsel for IUD/S?

A 
E + 5Ps:
Expulsion 5% 
Pregnancy 1 in 10 ectopic 
Perforation 1 in 1000
PID 
Periods heavier or irregular 
Progestogenic SE 1 in 10 with IUS
41
Q

What do you need to ask a 13-15 y/o having sex?

A

Partner - age
Where they met + where they have sex
Do parents know?

OSCE (9 decks)

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