OSCE

Question 1

Differentials for abdo and pelvic pain

Answer 1

ectopic pregnancy, ruptured ovarian cyst, endometriosis, pelvic inflammatory disease and ovarian torsion.

Question 2

Differentials for post coital vaginal bleeding

Answer 2

Causes include cervical ectropion, cervical cancer, gonorrhoea, chlamydia and vaginitis.

Question 3

Differentials for intermenstrual vaginal bleeding

Answer 3

Causes include contraception (e.g. Mirena coil), ovulation, miscarriage, gonorrhoea, chlamydia, uterine fibroids, perimenopause and malignancy (e.g. uterine cancer, cervical cancer, vaginal cancer).

Question 4

Differentials for abnormally heavy menstrual bleeding/ menorrhagia

Answer 4

endometriosis, contraception (e.g. copper coil), fibroids, hormonal changes (e.g. perimenopause), pelvic infection and malignancy (e.g. uterine cancer).

Question 5

Differentials for abnormally painful mestrual bleeding/ dysmenorrhea

Answer 5

Primary ((usually since first period): due to increased prostaglandin levels

Secondary: endometroisis, PID, uterine fibroids, ovarian cysts, polyps, cong uterine abnormalities, chronic pelvic pain, ectopic, pelvic adhesions

Question 6

Differentials for post menopausal bleeidng

Answer 6

vaginal atrophy, hormone replacement therapy and malignancy (e.g. uterine cancer, cervical cancer and vaginal cancer).

Question 7

Differentials for abnormal vaginal discharge

Answer 7

auses include vaginal candidiasis, bacterial vaginosis, chlamydia and gonorrhoea.
Candidiasis may present with thick, white or creamy lumpy discharge with associated vaginal itching and irritation.
Gonorrhoea and chlamydia may present with abnormal vaginal discharge.
Bacterial vaginosis typically presents with an offensive, fishy-smelling vaginal discharge, without any associated soreness or irritation.
Trichomonas vaginalis typically presents with yellow frothy discharge with associated vaginal itching and irritation.

Question 8

Differentials for dyspareunia

Answer 8

endometriosis, vaginal atrophy, gonorrhoea, chlamydia and pelvic inflammatory disease.

Question 9

Differentials for vulval skin changes and itching

Answer 9

vaginal atrophy, vaginal thrush, gonorrhoea and lichen sclerosus.

Question 10

PMH relevant to gynaecological presentations

Answer 10

Migraine with aura- estrogen containing meds are CI
Previous VTE- estrogen containing meds are CI
Breast ca - estrogen containing meds are CI
Bleeding disorders - if present with HMB

Question 11

Meds relevant to gyn presentations

Answer 11

TXA
Contraceptives
HRT
NSAIDS
GnRH analogues

Question 12

Key gynecological symptoms

Answer 12

Abdo and pelvic pain
Bleeding- post coital, intermenstrual, abnormally heavy menstrual, post menopausal
Abnormally painful menstrual bleeding
Abnormal vaginal discharge
Dyspareunia
Vulval skin changes and itching
Systemic symptoms