TEALE FENNING

himanshu · Joined: 28 Jan 2008 Posts: 9

hello everybody
i have written down osce circuits as i remebred them , hope they might be of some help to u

Station 1 [ with examiner]
woman with sickle cell disease , what important points u would like to know from history what imp inv u would like to know?

She comes with abdo pain and fever, what is ur differential diagnosis, what will be ur management

She was found to have UTI which was treated , now at 38/40 spontaneous labour , what will be intrapartum and postpartum care?

Station 2 [with examiner]

U r doing a hysterectomy with SHO, found that bladder is opened, what will be ur immediate actions?

What u will do to complete procedure?
What will be ur postop instructions?
What u will tell to the patient?

Station 3 [ prep station]

2 long cases , identify various risk management issues
one was prev lscs in labour who had scar rupture
other was 31/40 preterm labour

station 4 [role player]
young girl , has endometrioma
laparoscopy, adhesiolysis , bleeding ends with pfannenstiel laparotomy
not happy with managemet
explain her the op findings, answer her queries

station 5 [role player]

young girl, ovarian cyst accident, laparoscopic cystectomy, histopath- moderately differentiated adenocarcinoma
explain the report
anser her queries and discuss further management

station6 [role player]
consent for TAH BSO suffering from deep dyspareunia, endometrioma

explain consent, risks
discuss queries

station 7 [role player]
37 yrs old, first preg, uncomplicated
20/40 scan – growth liq normal, bladder thick walled, left hydronephrosis and bilateral hydroureter
explain scan findings
discuss management

station 8 [ examiner]

a letter from consultant to GP
identify where information is ambiguous , where there is breach of code of conduct,
where there is irrelevant information
what is advantage and importance of written documentation
and few more similar kind of questions

station 9 [ prep station with role player]

primip, prolonged labour , difficult instrumental delivery, complaining if urinary incontinence and reduced bladder sensation [ after delivery went in retention, 1.75 lit urine drained]
history
explain symptoms and further managemt

[ I think it was in line with retention, overflow incontinence, SUI or fistula]

station 10 [ examiner]
various instruments kept needed for vag hyst
including blade
step by step use of instruments with their advantages [ and why u do it in this way?]

EMAK · Century Club Joined: 26 Nov 2006 Posts: 570

himanshu · Joined: 28 Jan 2008 Posts: 9

hi
he started saying ur doing a vag hyst
how do u proceed
like paint , drape, catheter, eua etc etc
then do u infiltrate? if yes then why? if no then why? what r advantages
which blade do u use for incising cervix? why?
How do u reflect and dissect bladder ? why?
which instrument u will use to clamp? why?
like this he took me through whole vaginal hysterectomy
with justification of use of each instrument and step with their advantages

jilly · Joined: 16 Jan 2008 Posts: 15

Tuesday OSCE as far as I can remember - not in the right order!

1. Abdominal hysterectomy for 49yr P3, 3 prev cs, for menorrhagia, 14 week size uterus

which skin incision and why, going through instruments - how would you prepare pt, which cleaning sol and why, which scalpel blade, which clamp, what do you do if bladder very stuck, how do you identify ureters, would you close the peritoneum, which clamps and why

2. Pt counselling - P1 prev cs for breech at term, now 20 weeks with anomaly scan showing dextrocardia, absent pulm art and VSD. Explain findings and make a plan

3. Role player - 26yr P0 in colposcopy for f/u - had cone biopsy showing CIN3 and invasion - margins clear and no lymphvascular involvement

4. Case note review - prep station
2 obs cases , A - em cs at 5cm for undiagnosed breech at term and suboptimal CTG, baby with poor apgars and HIE, B - term failed instrumental of OP baby, 4hr second stage, em cs and 3L PPH

5. Role player - given theatre notes for 44yr planned lap subtotal hysterectomy for menorrhagia but converted to open due to bleeding from bladder base, had 2 blood units. You are seeing her the next morning and she is upset that she had an open procedure

6. Letter from consultant to GP re patient who had right ectopic - laparoscopy then laparotomy and salpingectomy. Had to criticise letter and give reasons for patients being given copies of letters

7. Role player - 69yr P0 with prolapse for vaginal hysterectomy - take a history and complete consent form

8. Role player with prep station - letters from GP and consultant - P2 with stress incontinence who had TVT and then difficulty emptying bladder and irritative symptoms. Had to see for f/u and make a plan for her.

9. Examiner viva - P0 at 8 weeks with prev DVT and factor V leiden and mother with DVT - how would you manage her pregnancy? What plans would you make for delivery, post del she has a vulval haematoma and epidural - how would you manage her anticoagulation PN?

10. Examiner viva - you are doing a laparotomy for 8cm ovarian cyst in young woman with ca125 of 8. You cause a small bowel injury. What is your immediate management and what would you tell the patient?

docsubhi · Joined: 03 Sep 2007 Posts: 12 Location: london

Thanks for the questions Jilly and himanshu
The OSCE seemed to be tricky!
Good luck with results

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 886

Jilly and Himanshu,

thanks a lot for the questions. most of the questions look standard.

the breach of conduct one seems interesting. how did you go about it? do you remember the exact wordings of it?

we have our fingers crossed for you results and are sure you all will make it.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region

himanshu · Joined: 28 Jan 2008 Posts: 9

hi raj
thanks for ur wishes
i have passed the osce
thanks again

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 886

hi himanshu,

congrats!!! well done. am happy for you.

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SpR O&G Wessex Region