Important OSCE Exam Topics

By:

azem Gamal any Ramadan

PCO pathogenesis = Androgens

1.Stromal Hyperplasia 2.DM & obesity 3.Adrenal androgens
High Androgen
High LH <-- Incresed Eostrogen Low FSH
Hirsutism

Anovulation LH surge(NO) Multiple follicles Follicle Get older(larger & thinner) Cysts Progesterone (low) No secretory changes
Vagina No intermediate cells -ve spinnbarkeit No endometrial secretory chnages

Rotter dam (2 of three) = Not madame ^_^ its adam (man)

Ameno or oligo Androgenic cp or lab Adams criteria

CUPS 10 /10
C Cortex (10 follicles + 10 mm )
U Uterine hyperplasia e D&C P Pearly white e laprascope

Treatment

CP (Anovulation +Androgens) Abortion

Infertility Menstrual Changes Cause CP Male (Androgens) (Acne Hirsutism Seborrhea) Pathological

Cause:

Ovarian axis (local) FSH (HMG) Adrenal Androgens & Aromatase defect (Link) Diane Obesity &DM (Sys) Metformin

Complications

Local

Ovary axis (poly cystic) Drilling Uterus Endometrial carcinoma hystrectomy or D&C Tracts Bleeding COC Alertness,Body built ,colors & decubitus obesity & acnthosis Vital Data temp not cyclic (anovulation) Other Organs DM & IHD

Sys

Link

Endocrine Androgens (Acne Hirsutism Seborrhea) Diane & COC

Trichomonas
Cause
Trichomonas vaginalis STD

CP

Frothy & profuse Discharge Pain & post coital bleeding Straw berry vagina
Papanicalou culture Wet mount

Invs

Metronidazole

TTT

Candidal Dirty woman

Cause
Candida albicans (+ tropicalis &crusie) Abuse of Pills & Bad hygiene & Immunocomp Second MC

CP

Severly Itchy Malodorous & Curds Discharge Sever inflamm Bleeding upon removal of curds
PH <4.5(acidic) Hyphae (KOH) Sabaraud agar (gram +ve) Ketoconazole + local Mycostatin Avoid predispos Treat husband

Curds

Invs

TTT

Hyphae

Clue cells

Vaginosis Clean woman

Cause
Gardinella Vaginalis + Peptococci +Bacteroid Abuse of Pills & Douches & Immunocomp Most common

CP

Asymp Fishy & excessive Discharge No inflamm No Pus No itching

PH >4.5 alkaline Whiff test Clue cells Epithelium +Cocci (gram ve) Metronidazole + clindamycin + Ampicillin Avoid predispos Avoid sex (no partener ttt)

Invs

Thin Creamy

TTT

Wiff test

Clue cells

Endometriosis
Marylin Monroe
Cause Cancer Like Sampson (retrograde mensis) Metaplasia Hematogenous Spread Marylin Monroe Pain (cyclic) and all over (Dysuria-Dyspareunia) Infertility Menstrual symp

CP

Chocolate cyst

Complication

Frozen pelvis Infertility (assosciation) Hydronephrosis (fibrosis)

Remember Cancer like : Biopsy is must by laprascope Burnt powder - Chocolate cyst CA125 (follow Up) CT
Acc to CP Site & Parity desire No need to peg NSAIDS Nedd COCP continous followed by pregnancy or IVF Old hystrectomy Surgey Must ovarian chocolate cyst

Invs

TTT

Burnt Powder

Note

MC site Ovary

Grading Acc to Size Adhesions Depth

Stage Superficial implants <5 Stage II Deep implants 5-15

Site Intrauterine adenomyosis Extrauterine Ligamentary ovarian Extrapelvic

Stage III Dense adhesions 15-40

Umbilicus Nose

Stage IV Complete post sac obliteration > 40

Leiomyoma
Cause
Fibroblast origin & Smooth Ms origin 20 % of females 40 years aged 80%(77%) hystrectomy found Reproductive age (can be in post meno!!?)

CP All or none

Asymp Most common Pain all types ( Spasmodic ischemic ..etc) Menstrual symp all types (contact menorrhagia metrorrhagia) Infertility & recurrent abortion(sub mucous)

Pressure (obstrcuted labour Uropathy Rupture uterus Pelvic congestion (leucorrhea)) Pathological Traumatic (Red degeneration (pregnancy) ( Myxomatous degen (post menopausal) (calcification (woumb stone) & Vascular (torsion & telangiectasia) & Infalmmatory & Metabolic (polycythemia) & Malignant Complicatio (leiomyosarcoma & Pseudo meigs) ns Prolapse may lead to chronic inversion Radio US X ray CT IVP HYCOSY Lab CBC RFT Interventional Hysteroscope D&C (for endomerial hyperpalsia) laprascope

Invs

TTT

Acc to age & parity & site Surgical No No You should know No surgery small mass & large patient (old) & asymp No Myomectomy Numerous profuse (bleeding)- malignant post menopause You should know : anemia correction and minimal manipulation & bonnie hood Medical Red degenration mainly medical NSAIDS red needs rest - Danazole Anemia correction

Note

MC symptom bleeding MC presentation Asymp

Note
Cervical type
Four % Faster Failure of Myomectomy Why Narrow space & richest in blood X corporeal ..may be parasitic & pedunculated

Sub mucous Small but early bleeding

MC site Corporeal (95%) MSM (Mural then serous then Mucous)

Sub serous Mainly large & late presentation

Cervical & ligamentous Affect Ureters Early symptoms Rapid growing

MC complication Hyaline degenration

Pregnancy Bleeding

Early Before 28th week

Any Time

Late After 28th week

General causes

Gynecologic

Vesicular Mole

Miscarriage

Ectopic Pregnancy

DIC

Genital Tracts TVIDM

APH

IPH

PPH

Open OS Painful

Iatrogenic opening (Abortion)

Closed OS No Pain

Amniotic embolism

Placenta (abruption)

Vasa Previa

Placenta (previa)

Continouation or Beginning

Placnta Accreta

In Evitable

Septic

Threatened

Missed

Bleeding tendency (hepatic failure)

Painful Sudden

Rupture of fetal vessels 80% mortality

Painless Recurrent

Uterine Atony Uterine Rupture

Resuscitate & terminate

Resuscitate (+ AB + Antiserum + ATN) & terminate

Excessive Discharge Excessive bleeding E coli commonest

Conservative Resusc Rest (No sex) Pain (valium) Pad No Prog (masking effect) No PV

Dead fetus

PIH Primae Dangerous triad

DM Multigravida Large baby & exhausted placental bed

Placenta Retained parts

Evacuation

Mainly termination Vaginal better Mainly conservative

Viable fetus
Hgic Shock (tachycardia ) Septic Shock (bradycardia)

Regressing Pregnancy Brun juice

Complication Maternal Pressure above amniotic Below bleeding Sides Shocks Complication Fetal presentation

Continuing pregnancy Complete separation of conceptus Occur e any type vaginal fresh blood

Early

Ectopic

Vesicular

MC cause Infections (PID)

MC cause Chromosomal

Peripheral Pain Early presentation <8 weeks

Central Pain Early preganacy Symp

Tubal 95 % Extra tubal (ovarian) cervical !!! Severe bleeding

Complete Paternal Diploid Incomplete Mixed Triploid Missed abortion like

Empty Uterus Tubal fetal sac & parts

Filled uterus (complete Snow Storm + No fetal parts)

Ovarian theca lutein cyst spontaneous remission

Mainly medical Methotrexate Weekly dose + monitoring Surgical if medical contraindicated

Mainly Surgical Evacuation Medical Methotrexate e indication only Single dose

Complications Abnormal Sites ovarian (Spiegelberg) in ovary & ovary tissue in & tube intact & in ligament

Complications Abnormal Site (invasive Mole)

Abortion

Spontaneous 20 %

Recurrent > 3 times consec 1%

Iatrogenic

50% chromosomal 50% idiopathic Fetal

Mainly Maternal causes

1st trim

1st trim

2nd trim

2nd trim

Complications

Fetal abnormalities

IUGR IUFD Preterm labour Cong malformation Pre eclampsia Placenta Previa Poly hydraminos Pyelo nephritis

Maternal

labor
1st PROM 2nd Prolonged 3rd Post partum Hge

Clinical types of

Palcenta previa

Minor Lateralis Marginalis Major Partial Complete central Revealed Concealed Mixed Recurrent & induced Complete & incomplete DD of abortion Metropathia hemorrhagica (ameno then bleeding) Membranous dysmenorrhea Note both ve pragnacy test Un disturbed Acute Chronic Mole complete & incomplete Invasive Malignant (metastatic & Non)

Accidental hge

Rare abortion

Ectopic

Vesicular

Termination Types

Vaginal better in accidental Hge (due to DIC)

Vaginal indication X ceserian No distress Fit for induction No assosc obstetric condition (No obstruction) ..

Ceserian better e previa D&C (better in abortion) Suction (better in septic abortion & Vesicular mole) (due to soft uterus)

Diagnosis
US HCG Progesterone

CBC RH

Bleeding in woman

Either

Local genital
Child FB Young Pregnancy complications Old Endometrial cancer till proved otherwise

MC atrophic vaginitis

General Hormonal
DUB (not due to local or general) D Dys hormonal U uterine prostaglandins B Bills

Hormonal
Unopposed oestrogen (Anovular) Schroeder Threshold

Un sufficient progesterone (ovular)

Follicular phase Functional (regular) Mid cyclic Poly menorrhea (inc No.) Luteal phase Irregular Halban

Types
Oligo No. Hypo amount

Poly No Menorrh amount

Metro Regularity

DUB
Ovular Schroeder Continuous Ovary Growth & func Amenorrhea then bleeding Painless Profuse bleeding Anovular Halban Early Degeneration Amenorrhea then bleeding Painful Mild bleeding