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
