1. Neonatal jaundice. Term infant, jaundice at 310 at 12 hours of
life. 1) What are the DDX( 10 marks) 2) nter!ret "lood test results# $" 1%0, W&& 1%'00, (lt 2''000, )a"* +, D-T !ositi.e, /um -0 ndirect &oom"1s ne2ati.e, "lood 3lm sho4s s!heroc*tes. (10 marks) 3) What is *our mana2ement5 (1' marks) %) What 4ill "e the mana2ement in a lo40le.el countr* hos!ital5 (' marks) $aemol*tic . 6hesus incom!ata"ilit* . -)+ incom!ata"ilit* . other anti"od* (7ell, Du8* etc) . mem"rane (s!hero9eli!toc*tosis) . en:*me (;<(D, (7) . $" (al!ha Thal) 0 se!sis . ;)= . T+6&$ 0 he!atitis . T+6&$ . meta"olic (2alactossaemia) $" lo4 W&& lo4 !latelets normal N+T -)+ incom!ata"olit* since "a"* "lood 2rou! + N+T 6hesus since /um indirect &oom"s ne2ati.e /ost likel* s!heroc*tosis Mx: 0 neonatal resuscitation 0 call for hel!, senior sta8, haematolo2* 0 continue "reastfeedin2 0 !hotothera!* . decision de!ends on "iliru"in le.el and neonatal risk (refer to 6&$ online ta"le) 0 e>chan2e transfusion . cord "lood $" ?100 29@ . cord "iliru"in AB0 umol9@ . .isi"l* jaundiced ?12hrs of "irth . decision de!ends on "iliru"in le.el and neonatal risk (refer to 6&$ online ta"le) . reCuires tertiar* centre 0 treat underl*in2 cause if !ossi"le . e.2. se!sis D anti"iotics 0 monitor re2ularl* &all (E6=9NET= !ink 4arm s4eet transfer 1) (a! smear last 4k, results are out no4 4hich sho4s a &N3. E>!lain results and 2i.e ad.ice and 4hat1s 2oin2 to ha!!en (e>!lain col!osco!*). Cns# 4hat are the indications for a (-( smear in F&5 4hat is a cone "io!s* indicated5 ho4 does a cone "io!s* a8ect !re2nanc*5 2. @ad* comes in for results of her (-( test. 6esults sli! sho4s lo4 2rade intrae!ithelial lesion. E.idence of $(F chan2es to cells. Tell her of the results and the follo40u! of this dia2nosis. Talk a"out ha.in2 to ha.e col!osco!*, take a "io!s*. What are the common cancer causin2 .iruses in -ustralia. What .accinations are a.aila"le and 4hat su"0t*!es do the* !rotect a2ainst5 What is the cer.ical cancer screenin2 re2ime in -ustralia5 $i2h risk D $(F 1<, 1B (31, %') @o4 risk (2enital 4arts) D $(F <,11 ;ardasil D <, 11, 1<, 1B (at Gear H) =creenin2 (ro2ram# 0 2 *earl* from 1B*o +6 4ithin 2 *eas from 3rst intercourse (4hich e.er is later) 0 sto! at H0*o if last 2 (a! smears normal +6 total h*sterectom* . unless histor* of a"normal smears 3. @ad* comes in at 10 4eeks 2estation. Iirst "a"*. -d.ise on the "ookin2 .isit tests. -sked a"out ultrasound# 4ould *ou need another one other than the datin2 scan5 Ges, mor!holo2* scan at 1B 4eeks to look for fetal a"normalities and !lacenta !osition. %. @ad* comes in 4ith !eriod !ain. Take a histor*. Name 2 DDX# endometriosis, (D5 -denom*osis5 ... nter!ret a !icture# endometriosis. Will this a8ect fertilit*5 What is the mana2ement5 /ana2ement# 0 a2e 0 se.erit* of s*m!toms9a8ect on life 0 desire for children 0 comor"idities 0 nature of the !atholo2* 0 a"lation, diatherm* 0 resection of lesions 0 h*sterectom* and "ilateral sal!in2o0oo!horectom* Womens Health 2009 Sem 10 OSCEs 1. )leedin2 in earl* !re2nanc*. Take a histor*. /ost likel* di8erentials and 4h*. -sked 4hat 3 in.esti2ations *ou1ll like to do (Jh&;, !el.ic ultrasound, "lood 2rou! 4ith anti"od* screen). ;i.en the results and asked to inter!ret (Threatened miscarria2e and !atient is - ne2 4ith no anti"odies detected). -sked to counsel !atient (tell her it1s threatened miscarria2e, "ack to normal acti.ities, anti0D !ro!h*la>is). 2. - talk0throu2h station. (atient is a !rimi2ra.ida, %0 4eeks 2estation, no si2ni3cant histor*, mem"ranes ha.e ru!tured and she is in la"our. ;i.en !arto2ram to inter!ret. Dela* in 3rst sta2e. Di8erentials5 (ne8ecti.e uterine contractions, &(D, ma!resentation) /ana2ement5 (ut on s*ntocinon (after 4hich *ou !ut on &T;), look for si2ns of o"structed la"our (haematuria, ketonuria, tach*cardia, fe.er, etc.). ;i.en &T; K1, 4hich sho4s incoordinate uterine contactions and reacti.e &T;. ;i.en &T; K2, 4hich sho4s .aria"le decelerations. -sked for cause5 (cord com!ression) What 4ould *ou do a"out it5 ;i.en &T; K3, 4hich sho4s a !rolon2ed deceleration at the end, at 4hich !oint the mid4ife calls *ou. -sked 4hat *our di8erentials are5 (&ord occlusion, maternal h*!o.olaemia, !lacental a"ru!tion) -sked for *our mana2ement. (nstrumental deli.er* if !ossi"le, emer2enc* caesarean) 3) (arto2ram L just the e>aminer and a !arto2ram nter!ret !arto2ram L dia2nose failure to !ro2ress Dd> of failure to !ro2ress and mana2ement of each common cause 2) 6u!ture of mem"rane, 2i.en a !arto2ram, !lease inter!ret this !arto2ram (!icture of o"structed la"our), then 2i.en 2 &T;s to inter!ret (.aria"le decelerations5 .aria"le decelerations then "ecomes !rolon2ed deceleration) '. @ad* comes in at %0 4eeks, is in la"our, 6+/ B hours a2o. Gou are sho4n a !arto2ram and asked to inter!ret. =ho4s failure to !ro2ress. $o4 4ould *ou mana2e this situation5 Then asked to inter!ret &T;s. Iirst is normal, reacti.e !attern. =econd sho4s .aria"le decelerations. -sked if there1s an*thin2 *ou need to do a"out it. Third sho4s !rolon2ed decelerations. What are the common causes5 What do *ou think is the cause here5 &ord com!ression. $o4 do *ou mana2e this5 &han2e !osition, inMate "ladder, sto! the s*ntocinon, tocol*tic5 &heck for cord !rola!se on FE, if fail to res!ond, do emer2enc* &0section. (o4er D inadeCuate9incoordinate uterine contraction (assen2er D mal!resentation, (assa2e D ce!halo!el.ic dis!ro!ortion Management 1) &= if# 0 o"structed la"our 0 fetal distress 0 risk of ru!ture 2) -u2mentation (s*ntocinon) 4ith &&T; /ana2ement of .aria"le decels 0 assess for com!le> .aria"le 0 check &T; !osition 0 consider fetal scal! electrode 6e.ersi"le causes 0 left lateral !osition 0 em!t* "ladder, 3ll "ladder 0 Muid "olus 0 consider o>*2en 0 FE for cord !rola!se 0 consider fetal scal! !$9lactate 0 treat underl*in2 cause 3. Neonatal !hotos. There 4asn1t enou2h time to 4rite in this station, so 4rite fastN a. /on2olian "lue s!ot. D>5 Di8erential5 N$>5 ". Er*thema to>icum neonatorum. D>5 Dd>5 What > *ou1ll do to con3rm D>5 c. Na!!* rash 4ith su!erim!osed candida infection. D>5 T>5 d. Er"1s !als*. D>5 What can1t the "a"* do5 N$>5 />5 e. )lue"err* muOn s!ot. D>5 Dd>5 (-nd somethin2 a"out > or />, can1t remem"er) %. 3 month histor* of amenorrhoea. Take a histor*. -t end, asked 4hat *ou D> 4as5 (!rolactinoma) What "lood tests *ou 4ant5 (Jh&;, (6@, I=$, @$, andro2ens) What ima2in2 *ou 4ant and 4hat does it sho45 (/6 "rain sho4in2 !ituitar* tumour) '. (a! test. There 4as a !el.ic model and a P!atient1. Gou1re asked to e>!lain the !a! test to the !atient (4ho1s ne.er had one done "efore). Demonstrate the !a! test on the !el.ic model. E>aminer asks 4hat ha!!ens if *ou can1t 3nd the cer.i> (1.4ithdra4 sli2htl* and re0insert. 2. Do "imanual.)-fter that, the e>aminer 2i.es *ou the !a! test results (ne2ati.e) and asks *ou to e>!lain it to the !atient. -lso mention ne>t !a! test in 2 *ears. 2008 WH OSCES 1) (a! smear !rocedure L 4ith an actor and a .a2ina model E>!lain to actor 4h* 4e do !a! smears E>!lain 4hat an a"normal result means i.e. it does not mean cancer ;et consent (erform !a! smear on the model 4hilst talkin2 it throu2h 4ith the actor 2) (ost Dates /> and &ounsellin2 L 4ith a female actor ( did shit on this one) Women is %1 4eeks E>!lain to her the com!lications of !ost dates and the mana2ement 4e 4ould under2o Tell her 4hat she needs to look out for 6isk Iactors# 0 male fetus 0 (ast !ost term !re2nanc* 0 !rimi2ra.ida 0 o"esit* &om!lications# 0 meconium as!iration 0 still"irth 0 IDQ 0 mortalit* and mor"idit* 0 as!h*>ia 0 shoulder d*stocia 0 um"ilical cord com!ression 0 h*!o2l*caemia 0 o"structed la"our 0 (($ 0 !el.ic trauma 0 &= /ana2ement# 0 e>!ectant mana2ement 4ith increased sur.eillance . &T;, Q== after %1 4eeks . o8er !el.ic e>am Rstretch and s4ee!S 0 +@ (A%1 4eeks) 0 &= (A%1 4eeks) Watch out for# 0 decreased fetal mo.ements 0 6+/ 0 dischar2e %) (el.ic mass and menorrha2ia L just the e>aminer ;i.e Dd> of !el.ic mass 6eco2nise a !icture of a 3"roid uterus (.er* "lood* o".ious) Discuss /> of /enorrha2ia DD># 0 3"roids 0 adenom*osis 0 cancer (endo, cer.ical, o.arian, "o4el, "aldder) 0 o.arian c*st 0 ;TD 0 ecto!ic !re2nanc* 0 !re2nanc* ') Neonatal !ictures L just *ou alone 4ith the !ictures and an ans4er sheet, ha.e to reco2nise the !ictures and ans4er a fe4 short Cuestions The* ha.e done this station e.er* *ear L "elo4 are the Cuestions that kee! !o!!in2 u!, *ou 4on1t 2et asked all of them and of course the* ma* thro4 in some ne4 ones )lue"err* muOn s!ot (Dd>) =e"orrhoeic Dermatitis9&radle ca! (/>) Er"s !als* (cause and />) $aeman2iomas (natural $>) (ort 4ine stain (dd>) /on2olian s!ot (Dd> (D "ruise)) =!ina "i3da neural tu"e lesion (com!lications of s!ina "i3da) +m!halitis (/>) Na!!* 6ash (/>) Er*thema To>icum Neonatorum This sounded .er* dauntin2 to me 4hen 3rst heard that 4e had to reco2nise neonatal dermatolo2* "ut its not, s!end a"out half an hour 2oin2 throu2h this 4e"site# htt!#99444.adh".2o.t.n:9ne4"orn9Teachin26esources9Dermatolo2 *9Dermatolo2*.htm O&G osces 2007 sem 11 3) (ost !artum D3, "a"* is ok, mum no4 has a fe.er, take a h> (4hich 4hen askin2 has no identi3a"le cause9 foci). she comes in 3 4eeks later 4ith mastitis. ans4er Cuestions on mastitis DD># nfections# 0 se!sis 0 chorio 0 QT 0 4ound 0 mastitis 0 !neumonia 0 F site 0 !el.ic a"scess DFT9(E Dru2s Throm!hle"itis %) *oun2 4oman com!lains of !el.ic !ain, on histor* sounds like an ecto!ic !re2nanc*. Tn# e>9 i> that *ou 4ant to do, name the sur2ical !rocedure that is done in ecto!ic !re2nanc* osces 2006 sem 10 1) "ookin2 .isit tests L 4hat u 4ana do , 4h* 2) T4in !re2nanc* L tell mum a"out risks to mum9 fetus9 i> 3) /enorrha2ia .i.a %) ncontinence in a !ostmeno!ausal 4oman (h>9 e>9 i>9 t>) ') neonatal !hotos (/on2olian s!ot9 er*thema to>icarum9 na!!* thrush9 "lue"err* muOn9 Er"1s !als*) Women1s +=&E 200H 1 Written neonatal Cuestions on 1 st 2% hr jaundice and mana2ement. 2 Woman in o"structed la"our. 6eco2nise !arto2ram, .aria"le &T; and =e.ere decelerations9 cord o"struction. Descri"e mana2ement. 3 (-( =mear# e>!lain to a 4oman a col!osco!* and results &N , 4hat it means, $(F etc., mana2ement o!tions. % (uer!eral Ie.er. $istor*, discuss +9E, Di8erentials. /> ' =udden -"do !ain in a nulli!ara 4ith missed !eriods. $istor* , +9E , Di8erentials and />. -s for m* *ear, 4e 2otU Ior +V;U 1) &ounsel a 4omen 4ho 4ants to 2et !re2nant (i.e "efore 2ettin2 !re2nant0 folate etc, 4hile !re2nant .... . Gou must also e>!lain 4hat ha!!ens if it is a t4in !re2nanc* and ho4 the follo4 u!9mana2ement chan2es. 2)Ii"roid0 this station did not ha.e a !atient. +nl* 2 e>aminers. 3)&ounsel a 4omen 4ho cannot 2et !re2nant. 6emem"er to ask a"out !artnerWs occu!ation and medical $> %)&anWt remem"er Oa!"an Cance! =et the scene. -sk if the* 4ant someone in the room 4ith them. &heck for !ri.ac*, room etc The tests ha.e sho4n a dia2nosis of cancer of the o.aries. t t*!icall* !resents at Cuite an ad.anced sta2e. t1s a diOcult cancer to !ick u! earl* kno4 this is some diOcult ne4s to take in. Do *ou need some time to think a"out it5 There are num"er of thin2s 4e can do to hel! *ou throu2h this diOcult time, includin2 sur2er*, radiothera!* or chemothera!*. n terms of the outlook, it1s hard to !ut a timeframe to it "ecause it .aries from !erson to !erson. Write it do4n L !ro.ide some 4ritten information L and or2anise re.ie4 a!!ointment. donWt 4ant to o.erload *ou 4ith too much information, do *ou ha.e an* Cuestions for me ri2ht no45 #a$ smea! 1. $i /rs Xones /* name is Xiu:hi and 1m a 3nal *ear medical student and 1.e "een asked to do a !a! smear 4ith *ou toda*. $a.e *ou had a !a!er smear "efore5 a% 4ill run throu2h 4hat 4e1re 2oin2 to do, "ut do *ou ha.e an* !articular Cuestions or concerns a"out the !rocedure5 &% s there an*thin2 in !articular that *ou 4ould like checked5 2. Ex$la"n $!oce'(!e: 1ll run throu2h 4hat1s 2oin2 to ha!!en a% Iirst of all, 4ill 2et *ou to remo.e all *our clothin2 "elo4 the 4aist and co.er *ourself 4ith a sheet. 4ill !ut a !illo4 underneath the hi!s and 2et *ou to !ut *our feet to2ether and let *our knees fall to the side. &% Then 4ill "e insertin2 a s!eculum (5e>!lain s!eculum) into *our .a2ina and usin2 a "rush to collect some cells from *our cer.i> L 4hich is the neck of the uterus94om", 4hich 1ll !ut onto a slide and send to a la". c% This ma* "e a "it uncomforta"le "ut it shouldn1t "e !ainful, and the more rela>ed *ou are, the easier it 4ill "e. f an* time *ou feel uncomforta"le let me kno4 and if *ou 4ant to sto!, just raise *our hand and 1ll sto!. '% Do *ou understand 4hat1s 2oin2 to ha!!en and are *ou still ha!!* to 2o ahead5 )% #!e$a!e the $at"ent *o! the exam"nat"on a% +8er to use the toilet L !ri.ate area to chan2e L 2o4n V sheetL mirror under !illo4 L to4el on the "ed and check li2ht &% @a"el slide c% Wash hands L 2lo.es , !ut a 2lo.e on the li2ht '% &ollect kidne* dish, s!eculum (check if clean, check scre4, !re.ent clatterin2) L 4arm 4ater , lu"e +% #!oce'(!e a% &on3rm !atient is read* to !roceed 4ith e>amination &% -sk them to "ut !illo49to4el under the hi!s c% R)rin2 *our heels to *our "ottom and rela> *our knees9 let *our knees fall to the sideS '% R(ull "ack the sheet 4hen *ou1re read*S e% &heck tem!erature of s!eculum a2ainst !atient1s u!!er thi2h *% E>ternal ins!ection g% nsert s!eculum i. $old s!eculum in *our dominant hand and !art la"ia 4ith non0dominant hand ii. 6est the s!eculum on the fourchette. iii. RTake a dee! "reath in and then outS L insert as she "reathes out. i.. -n2le s!eculum at %' de2rees to the "ed .. R1m just o!enin2 the entrance to the .a2inaS L o!en s!eculum .i. @ocate cer.i> L ins!ect the cer.i> L o8er the mirrorNN .ii. Ti2hten scre4s .iii. Take sam!le L insert "rush L 3rml* rotate throu2h 3<0 i>. Transfer the sam!le of cells to the 2lass slide >. =!ra* the slide 4ith 3>ati.e immediatel* "efore remo.in2 the s!eculum h% 6emo.e the s!eculum i. (lace the thum" on the le.el to kee! the "ills stead* ii. With *our free hand, undo the to! scre4 iii. ;entl* o!en the "ills a little and 4ithdra4 sli2htl* until *ou can see that *ou ha.e cleared the cer.i> i.. =lo4l* release L allo4 to close L o"ser.e until the 4alls close o.er L remo.e once it is full* closed .. RWe1.e 3nished L *ou can 2et chan2ed no4S "% (lace s!eculum on a tra* for cleanin2 and !lace dis!osa"les in the contaminated 4aste "in ,% Wash hands -% Iill out the reCuest form and !ut into the slide "o> thin2 .% Com$lete the $!oce'(!e a% )imanual if reCuired 6% /"sc(ss"on 0"th the $at"ent a% Discuss *our 3ndin2s Rfrom 4hat can see L e.er*thin2 looks normalS &% E>!lain 4hen the results 4ill "e a.aila"le L c% $o4 these 4ill "e communicated to the !atient '% Wa!n a&o(t s$ott"ng an' c!am$"ng e% RThank *ou for comin2 in to ha.e *our !a! smear toda*. *% /"sc(ss the $a$ !eg"st!1 an' enco(!age g% Encoura2e the !atient to attend for other health checks.