Women’s Health OSCE Stations

Women's Health OSCE Stations

Case 1 – Breast Mass

You are seeing Mrs. Thompson, a 56 year old woman, in your outpatient clinic today. She is worried about a left breast mass, and would like your reassurance that it isn’t cancer. Take a focused history of her complaint and perform a focused physical exam.

History

  • Onset of awareness of mass
  • Size of the mass and change in size
  • How mass was identified
  • Mastalgia
  • Associated discharge, including pus and blood (none)
  • Size/tenderness association with menstrual cycle
  • Nipple changes
  • Skin changes (on affected breast)
  • Systemic symptoms – weight loss, low energy, anorexia
  • Associated shortness of breath or chest pain
  • Changes in personality – suggestive of brain metastases
  • Bone pain – suggestive of bone metastases
  • Inquires about date of menopause
  • Pregnancy history
  • Breastfeeding history
  • History of chest radiation
  • Age of menarche
  • Alcohol history
  • Smoking history (quantity in pack-years)
  • Past and current use of hormone replacement and oral contraceptive pills
  • Family history of breast, ovarian, or colon cancer
  • Past history of breast masses
  • Past mammography results
  • Addresses patient’s concerns regarding the mass

Physical Examination

Inspection

  • Drapes patient appropriately
  • Inspects breast skin for discoloration, retraction, peau d’orange, or bruising
  • Comments on presence of asymmetry
  • Examines nipples, commenting on absence of discharge, irregularities, or retraction
  • Examines areolas (no abnormalities)

Palpation

  • Uses radial or strip method to palpate both breasts,
  • Comments on texture, size, firmness, and mobility of any palpated masses
  • Palpates axillary nodes bilaterally
  • Palpates infraclavicular and supraclavicular nodes
Case 2 – Vaginal Discharge

You are seeing Stacey Holland, a 23 year old female, for vaginal discharge. Please take a focused history for her complaint.

History

  • Onset and duration of vaginal discharge
  • Appearance of discharge
  • Association with menstruation
  • Presence of blood
  • Itching
  • Dyspareunia
  • Pain on defecation
  • Fever
  • Nausea/vomiting
  • Perineal/vaginal sores
  • Abdominal pain/discomfort
  • Rash or other lesions
  • Swollen joints
  • Vision changes
  • Dysuria
  • Hematuria
  • Increased frequency of urine
  • Last menstrual period
  • Menorrhagia
  • Dysmenorrhea
  • Regularity of menstruation
  • Past abdominal surgery
  • Pregnancy history
  • Current and past sexual history, including partners, method of intercourse, and contraception
  • Smoking and alcohol history
  • Medications – especially oral contraceptive pill
  • Allergies
  • Personal history of sexually transmitted infections and related investigations/treatment
  • Last Pap smear and result
Case 3 – Amenorrhea

You are seeing Cindy Albrecht, a 19 year old female, for amenorrhea. Please take a focused history for her complaint.

History

  • Distinguishes primary vs. secondary amenorrhea (patient has had previous menstrual periods)
  • Age of menarche
  • Onset of last menstrual period
  • Amount and changes in flow in recent menstrual periods
  • Length of menstrual period
  • Menorrhagia
  • Dysmenorrhea
  • Current use of birth control pills or other oral hormones
  • Presence of vaginal discharge/itching
  • Morning sickness
  • Abdominal pain/discomfort
  • Recent dieting
  • Recent fractures
  • Excessive exercise
  • Galactorrhea
  • Symptoms of hyperthyroidism (sweating, palpitations, heat intolerance)
  • Symptoms of hypothyroidism (feels slow, cold intolerance, constipation)
  • Symptoms of hypoestrogen state (hot flashes, night sweats, vaginal dryness)
  • Personal history of chronic disease
  • Pregnancy history
  • Current and past sexual history, including partners, method of intercourse, and contraception
  • Smoking and alcohol history
  • Family history of genetic abnormalities and infertility