SOAL PESERTA

OSCE T3
09 FEBRUARI 2011
RAHASIA
KOORDINATOR T3

Program Pendidikan Dokter Spesialis I

Obstetri-Ginekologi
FKUI-RSCM, Jakarta

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Case No 1.
You are the resident on-duty at Gynecology Outpatient Clinic.
A 40-year old woman was referred by a general practitioner to your
Outpatient Clinic due to abnormal paps smear result.

Case No. 2.
You are the resident-on-duty at Gynecology Outpatient Clinic.
Ms. A., 32-years old, came with chief complaint of recurrent
menstrual pain.
She had undergone laparoscopic cystectomy 3 (three) years ago and
adenomyosis resection 2 (two) years ago, continued with hormonal
therapy for 3 (three) months.
On physical examination, you discovered an enlarged uterus.
From ultrasound examination, there was a mass with no distinct
border at the posterior corpus sized 3 cm x 3 cm x 3 cm.
Patient stated that she is very upset and disturbed by the pain, and oral
pain killer could only help for a very short period.
She demands an explanation from you whether the recurrence of the
disease could be due to incomplete procedure of previous operation
or inadequate hormonal therapy.

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Case No. 3.
You are the on-duty resident at infertility clinic.
A 29-year old woman with primary infertility for 3 (three) years,
came to you with US examination result.
From the US an intramural myoma sized 3 cm x 3 cm x 2 cm was
detected.
Patient and her husband had undergone basic infertility work up.
HSG result showed both tubes were non-patent, while sperm analysis
result was normal.
Patient want to have an explanation about the next step for her
infertility management.

Case No. 4
Knowledge ( Menstrual Disorder )
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You are the resident on-duty at Gynecology Outpatient Clinic

A 25-year-old nulligravid patient came to you and complains of bleeding
between her periods and heavy menses since 10 days ago. Her menstrual
cycle was irregular since 2 years ago and ranged between 40 until 75
days. No contraception is used. The patients has married for 2 years, has
no history of systemic disease, do not take any medications and
unfortunately, secondhand smoker.
Clinical Data
From the physical examination, you found :
Body weight : 66 kg, Heigh t: 155 cm
Galactorrhea No mass was palpable in the abdomen
Gynecological examination:
Inspeculo : within normal limit
Uterus and both adnexae were normal.
Questions :
1. What is
patient?
a)
b)
c)
d)
e)

the possible cause of the abnormal uterine bleeding in this

Anovulation
Hypothyroidism
Hyperthyroidsm
Hyperprolactinemia
None of the above is true

2. Regarding anovulatory dysfunctional uterine bleeding, statements

below are true, EXCEPT :
a) Anovulatory dysfunctional uterine bleeding results from a
disturbance of the normal hypothalamic-pituitary-ovarian
b) Estrogen breakthrough bleeding occurs with chronic and
unopposed estrogenic endometrial stimulation
c) Polycystic ovary syndrome is one of the cause of estrogen
breakthrough bleeding
d) When ovulation does not occur, no progesterone is produced
to stabilize the endometrium; thus, proliferative endometrium
persists
e) 10% of dysfunctional uterine bleeding cases result from
anovulation
3. What is the essential test that you should perform to this patient
a) Thyroid hormones
b) Pregnancy test
c) Blood glucose
d) Prolactin
e) FSH

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4. What other tests might be needed to find the etiology of the menstrual
bleeding?
a) Coagulation test
b) Thyroid function test
c) Complete blood count
d) All of the above are true
e) None of the above are true
5. What modality can be used to evaluate the uterine cavity of patients
with abnormal uterine bleeding?
a) Office Hysteroscopy
b) Endometrial biopsy
c) Saline infusion sonography
d) Transvaginal ultrasonography
e) All of the above are true
6. What are the risk factors that should be considered before performing
endometrial biopsy?
a) Obese
b) More than 35 years old
c) Hypertension
d) Diabetes Mellitus
e) All of the above are true
7. All of those statements are true, EXCEPT:
a) Transvaginal ultrasound may not always distinguish
submucosal fibroids, polyps or adenomyosis
b) Saline infusion sonography is very useful in pre-, peri- and
postmenopausal women
c) Saline infusion sonography is not superior to transvaginal
ultrasound
d) Saline infusion sonography is not a first line diagnostic
modality
e) Diagnostic hysteroscopy is easily performed in the office
setting
8. In the abnormal uterine bleeding patient with infertility problem, what
management should not be advised ?
a. Stop the bleeding with oral prescriptions
b. Ovulation induction
c. Oral Contraceptives
d. Body weight reduction
e. Smoking environment avoidance

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Case No 5.
You are the resident on-duty at Central Operating Theatre.
Today ou are scheduled to perform a surgery for a 40-years old
woman, P4, due to cystic ovarian neoplasm sized 20x10x10 cm,
multilocular with internal echo that shift during postural alteration.
Solid part was not found.
No blood flow increase on Doppler examination.
CA 125 : 100. BMI 23.
History of losing body weight was denied.
The patient had already prepared for a salpingo-oophorectomy.
Using a laparotomy surgery set, please explain step-by-step of
laparotomy salpingo-oophorectomy procedure you are going to
perform to the patient.

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Case No 6.
You are the resident-on-duty at gynecology polyclinic.
Today you received a referral letter as stated below:
Dear Colleagues Ob/Gyn
At Dr. Cipto Mangunkusumo Hospital
Please perform further evaluation and management for
Mrs. Aminah, 65-years old, P5,
with chief complaint of vaginal bulging since 1 (one)
year ago.
Yours sincerely,
Sri Handayani, Am.Keb

Soal untuk Peserta OSCE Tahap T3 MOHG 030211 - Hal. 7

POPQ
Aa
Ba
+2
+2
GH
PB
4
2
Ap
Bp
0
0

C
+3
TVL
8
D
+1

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