OSCE Content Flashcards
What are the key points of a menstrual history?
First day of last menstrual period
Number of days of bleeding and Flow (i.e. flooding, heavy, light)
Length and Regularity of cycle
Any abnormal bleeding: intermenstrual or post coital bleeding
Menarche (age at first period)
What are the key points of a contraceptive history?
Current method of contraception and duration of use
Previous methods of contraception
Any problems with contraception?
What are the key points of an obstetric history?
Gravidity, parity, pregnancy outcomes, birth weights and modes of delivery
What are the key points of a sexual health history?
Are you currently sexually active?
Do you have a regular partner? When was your last sexual health screen?
Are you using contraception at the moment? Have you used anything in the past?
Is there any chance you could be pregnant (e.g. missed pills)?
Do you have any vaginal symptoms (e.g. discharge, itching)?
Do you experience any problems during sex (e.g. dyspareunia)?
What are the key things to ask when establishing gynaecological PMH?
Have you had any gynaecological problems previously? Any problems which run in the family?
When was your last cervical smear? Are you up to date with your smears?
Any abnormal smears or treatment required?
What questions should you ask in a history of antepartum haemorrhage?
How much bleeding was there and when did is start?
Was it fresh red or old brown blood, or was it mixed with mucus?
Could the waters have broken (membranes ruptured?)
Was it provoked (post-coital) or not?
Is there any abdominal pain?
Are the fetal movements normal?
Are there any risk factors for abruption? e.g. smoking/drug use/trauma – domestic violence is an important cause.
How should you examine a patient with antepartum haemorrhage?
Pallor, distress, check capillary refill, are peripheries cool?
Is the abdomen tender?
Does the uterus feel ‘woody’ or ‘tense’ (placental abruption)?
Are there palpable contractions?
Check the lie and presentation of the fetus (USS can help)
CTG at 26 weeks gestation or above: (otherwise auscultate the fetal heart only)
Read the hand-held pregnancy notes: are there scan reports? This will be helpful in establishing whether there could be placenta praevia
How should you begin an obstetric abdominal examination?
Gain consent for examination
Explain the examination
Offer a chaperone
Offer raising head end at 15 degree and left lateral tilt
Expose the patient (xiphisternum to the top of the pubic hair line)
What are the key steps of an obstetric abdominal examination?
Inspection
distended abdomen in keeping with pregnancy, scars, striae
Palpation
Symphysio-fundal Height
Leopold’s Maneuver
Auscultation
using Pinnard / Doppler device
What are the 4 stages of palpation in an abdominal obstetric examination?
Fundal grip
Lateral grip
Pawlick’s grip
Pelvic grip
How could you establish the impact of HMB on a patient’s life?
How many pads or tampons do you use in a day? Do you need to wear both at the same time?
What colour is the blood? Have you noticed any clots or flooding (a sudden rush of heavy flow)?
Is there anything recently that’s prompted you to make an appointment today?
ICE – How is it affecting your life? Your job? Time off work? Is anything concerning you in particular?
What questions would you ask in a systems review for a patient with HMB?
Do you feel tired, short of breath or more short of breath on exertion? (screen for anaemia)
Have you been having any abdominal pain or bloating? (malignancy but also endometriosis/fibroids)
Have you had any bleeding problems in the past, or does this run in the family? (coagulopathy)
Any excessive tiredness, weight gain, dry hair/hair loss, feeling cold when others are not? (hypothyroidism)
Any fever, lethargy, weight loss, or night sweats? (malignancy)
What would you ask a patient in a history of dysmenorrhea?
When symptoms started in relation to menarche
Characteristics of the pain: SQITARS
Other sxs:
dyspareunia (endometriosis), urinary sxs, bowel habit (irritable bowel syndrome and lactose intolerance can mimic pain similar to dysmenorrhoea)
Menstrual history (length of menstrual cycle, regularity, duration, and the volume of flow)
Obstetric history, including plans for pregnancy
Drug history, including treatment(s) tried and the effect
What would you ask in an incontinence hx?
Presenting complaint:
How long has it been going on?
Does anything in particular make you pass urine?
Do you have a sudden urge to go to the toilet and not make it in time?
Other sxs:
- Going more frequently? Waking up in the night?
- Pain? Blood in urine?
- Hesitancy? – do you ever struggle to start urinating?
- Terminal dribbling? – after you’ve finished urinating do you find it difficult to stop the stream / it slows to a dribble?
- Splitting of stream?
- Cauda equina sxs
PMH:
- Children? Menopause? Pelvic surgery? Chronic cough? Constipation?
Drug Hx
- Diuretics, ACEi, antidepressants, antihistamines, alpha blockers
Social hx:
- Caffeine and alcohol intake, impact on MH and social life
How should you take a history of a current pregnancy?
1st trimester:
Preconceptual counselling and folic acid intake
Dating (see menstrual history), booking USS (timing and result), routine blood results, blood group, any antenatal screening offered
Any additional tests offered/advised
2nd trimester:
Second trimester screening for aneuploidy- in women who missed the cut off for NT screening. Result, if applicable?
Detailed USS? Result?
Any additional tests/problems?
3rd trimester
Any concerns by patient/midwife/doctors
Any additional testing undertaken (e.g. GTT, fetal growth scans etc)
