Chapter 5 Specialist level practice OSCE questions
MRANZCOG OSCE E
E2
Encounter 3
The patient presents a week later for the results of her investigations.
Investigation results
E3
Encounter 1
You are the obstetric registrar on call for a tertiary level labour ward. A midwife calls you for a Mrs CK, who has been pushing for 2 hours in second stage, and now has an abnormal CTG. Please manage.
Encounter 2
With the third pull of the forceps the head of the baby is delivered, but the shoulders are stuck. How do you proceed?
Encounter 3
Following delivery of the baby, Mrs CK has had a post-partum haemorrhage, which is being managed with oxytocics, as well as IV resuscitation with whole blood. Half an hour later the bleeding has been controlled and the midwife calls you back to the labour ward: “Mrs CK is distressed with fever, chills, and chest discomfort with wheezing!” Please advise on your management.
E4
Encounter 3
A diagnostic laparoscopy is performed and the patient is discovered to have severe endometriosis with a 4 cm left endometrioma. The anatomy is distorted with both ovaries adherent in the POD with bowel overlying, the fimbrial ends of both tubes are not present within the adhesions. The tubes are patent, the hysteroscopy is normal.
E5
Encounter 1
You have been asked to do the elective caesarean section list at a tertiary hospital for a colleague who is ill. The first case is a 32-year-old woman, Mrs M, gravida 4 para 3, with a suspected placenta percreta.
The patient, Mrs M, is in the theatre reception area. Please take a brief history from her.
Encounter 2
For which investigations would you like to see the results? What should have been done prior to delivery?
Encounter 3
Encounter 4
You proceed to surgery. To attempt to decrease blood loss you decide to ligate the internal iliac arteries. Describe how you would go about this.
E6
Encounter 1
Mrs B, a fit and sprightly 80-year-old woman, is referred to you by her GP after he has tried unsuccessfully to treat her vulval itch.
Encounter 4
The vulval biopsy shows squamous cell carcinoma of the vulva (SCC). The other investigations are normal. There is no evidence of groin node enlargement on the CT scan.
E7
Encounter 2
The patient returns 4 weeks later for the test results. She still has not had a period.
MRANZCOG OSCE F
F1
Encounter 1
A 28-year-old woman, Mrs K, is referred to you with a history of right iliac fossa pain for 6 months. A pelvic ultrasound scan has shown a 14 cm solid mass arising from the right ovary.
Encounter 4
Mrs K cancelled her follow-up visit to discuss her results, as she had an important meeting to attend interstate. On her return, she was driving back from the airport when she developed acute abdominal pain. Her husband drove her to the Emergency Department and you have been asked to attend.
Encounter 5
At laparotomy, a ruptured haemorrhagic right ovarian mass was removed. The mass appeared to be predominantly blood clot. The left tube, ovary and the uterus looked normal. The abdomen was irrigated with warm saline thoroughly to remove the blood. All peritoneal surfaces were inspected, as well as the bowel, liver, spleen and stomach. Lymph nodes were checked (none enlarged). The incision was closed.
Final histology: Granulosa cell tumour
Had the patient not had an emergency operation for an acute abdomen, and had you known that the initial blood results had shown a raised Inhibin B (2492 pg/mL), what would have been the appropriate surgical management for this woman, who wishes to preserve her fertility if possible?
F2
Encounter 2
The patient returns 4 weeks later for the test results. She still has not had a period.
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