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OSCE STATION 1
HISTORY AND PHYSICAL
A 16 year old Gravida one, Para now one mother arrives at
emergency. She had undergone a Cesarean section seven days
earlier in this hospital. She does not know why she was operated on.
She reports that, for the past 48 hours, she has been feeling
lethargic, anorexic, feverish, and having stomach pains, foul and
brownish vaginal discharge, painful urination, and lower back pains.
OSCE STATION 1
OSCE STATION # 1
HISTORY AND PHYSICAL
A 16 year old Gravida one, Para now one mother arrives at emergency. She had undergone a
Cesarean section seven days earlier in this hospital. She does not know why she was operated
on. She reports that, for the past 48 hours, she has been feeling lethargic, anorexic, feverish, and
OSCE STATION 1
having stomach pains, foul and brownish vaginal discharge, painful urination, and lower back
pains.
On examination, the patient has a blood-pressure of 110/60 mm. Hg, a heart rate of 110 perminute, a 32 rpm respiration rate and an oral temperature of 39.2C. She has pale-colored
mucous membranes, good pulmonary ventilation, a painful uterine fundus two fingers below the
umbilicus, a hardened, painful and hyperemic operation site, and foul lochia.
The nurse obtained the patients clinical history, which revealed that the reason for the Cesarean
section was a cephalopelvic disproportion and acute fetal distress, under general anesthetic, with
abundant loss of blood (no blood transfusion); prior to the C-section, forceps were used
unsuccessfully. The patients clinical history also indicated that the patient had suffered a
premature rupture of membranes one day earlier, that she had been in labour for 20 hours, and
that she had pushed for two hours, before the attempted forceps.
Endometritis
OSCE STATION 1
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Prolonged labour
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Cesarean-section
_____
Which other pathologies should be considered?
Urinary infection
Pulmonary infection
_____
_____
General anesthetic
_____
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Blood
Urine
_____
_____
OSCE STATION 1
cefoxitin 2g IV 6 hourly
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_____
_____
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After 48 hours of penicillin, clindamycin and gentamicin, the patient still has fever,
what pathology should be discarded as a first option?
OSCE STATION 1
Pelvic abscess
_____
If pelvic abscess is ruled out both clinically and by pelvic ultra-sound, what
pathology should be used?
Septic pelvic thrombophlebitis
_____
_____
How soon after beginning the intravenous heparin does the fever begin to drop?
24-72 hours
TOTAL: ____ / 19
OSCE STATION 1
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