OSCE 5, 6, 7

Question 1

What OCP would you recommend to an 18-yo, nulliparous pt?

Answer 1

2nd gen combined pill (low-dose estrogen, 20-35 mg)

Question 2

Name 4 contraindications to the pill.

Answer 2

Hx of thrombosis, stroke, MI; pregnancy; thrombophilia; Hx of severe esttrogen- or preg-induced disease

Question 3

Name 3 non-contraceptive benefits to the pill.

Answer 3

reduced menstrual blood loss; regularization of periods; reduced risk of ovarian, endometrial ca

Question 4

List for pieces of key advice for a healthy, young woman starting OCPs.

Answer 4

1. signs of DVT
2. what to do if miss pill
3. how to take pill
4. breakthrough bleeding
5. seek alt. contraceptive or pre-preg counseling before stopping

Question 5

What would you advise a pt to do if she misses her OCP one day? Two days?

Answer 5

take double dose next day; take double dose next 2 days; use alt. form of contraception until you finish pack

Question 6

What would you tell a pt. starting OCPs about breakthrough bleeding?

Answer 6

normal in first 2 or 3 mos., should normalize after. If not, may need to switch formulation.

Question 7

You suspect a pt has PCOS, name 4 tests you would run.

Answer 7

follicular phase LH or LH:FSH
US of ovaries
BMI, OGTT
Rubella and chix pox status

Question 8

What tx would you arrange for a pt w/ PCOS who wants to conceive? (2)

Answer 8

clomiphene; wt. loss, metformin if appropriate

Question 9

What counseling would you give to a pt w/ PCOS who wants to conceive?

Answer 9

pre-preg counseling; side fx of clomiphene

Question 10

What are the side fx of clomiphene?

Answer 10

multiple gestation, ovarian hyperstimulation syndrome, ovarian cysts and theoretical risk of ovarian cancer.

Question 11

What follow up investigation would you arrange for a PCOS pt that you have put on clomiphene?

Answer 11

Luteal phase progesterone once regular menstrual cycles are achieved.

Question 12

What type of drug is clomiphene?

Answer 12

SERM

Question 13

How does clomiphene induce ovulation?

Answer 13

prevents negative feedback of estrogen on gonadotropin release

Question 14

Define postmenopausal bleeding.

Answer 14

genital tract bleeding 12 mos after menopause

Question 15

List 4 issues to cover in history-taking for postmenopausal bleeding.

Answer 15

• onset and number of occurrences
• assoc’ed Sx: discharge
• obvious explanation: trauma, anticoagulants
• cancer risk: Hx, tamoxifen use

Question 16

What will you look for on pelvic exam in the case of postmenopausal bleeding (3)?

Answer 16

• lesion on vagina, cervix
• vaginal atrophy
• pelvic masses
• foreign object

Question 17

What further investigations will be necessary in the case of postmenopausal bleeding? (3)

Answer 17

Pap smear (colposcopy, biopsy if nec)
US for endometrial thickness, tumors
hysteroscopy and endometrial biopsy (Pipelle)

Question 18

If pt w/ postmenopausal bleeding has totally normal workup, what can you say about the risk of malignancy?

Answer 18

<10%; serious conditions are treatable if not curable