FAR EASTERN UNIVERSITY NICANOR REYES MEDICAL FOUNDATION

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

Regalado Avenue, West Fairview, Quezon City

Objective Structured Clinical Examination of Clinical Clerks

via Zoom Application

The clinical clerk will be given a maximum of 20 minutes to demonstrate the assigned
skill and answer relevant questions.

BREAST EXAMINATION

STEPS DESCRIPTION
Asepsis Wash hands
Introduce self
Get Consent Confirm patient details
Explain examination and need for chaperone
Check understanding
Ask patient to sit upright
Uncover the breast
General Inspection Not for asymmetry, swelling, masses, skin and nipple
changes
Arms at the side, look for:
Skin changes (erythema, puckering, peau d’ orange)
Nipple changes (retraction, discharge, scales)
Close Inspection Hands on hips, look for:
Masses
Arms over the head, look for:
asymmetry, masses, dimpling
Start with asymptomatic breast
Ensure hands are warm
Position patient in a 45-degree angle (hand behind their
head)
Palpation Use the flat of the fingers to compress the breast tissue
against the chest wall (clock face method/spiral method)
Examine the axillary tail
If there is nipple discharge, ask the patient to squeeze
the nipple
Examination of Position, size and shape, mobility, fluctuance
Breast Mass Consistency, skin changes
Axilla and other Patient in bed facing examiner
Lymph Nodes Support the arm with forearm
 Palpate axilla (medial, lateral, anterior, posterior)
Note for lymphadenopathy
Palpate other lymph nodes (cervical, supraclavicular,
infraclavicular, suprasternal)
Thank patient
Cover patient with blanket/Ask patient to dress
Completion
Wash hands
Summarize findings
 OBSTETRIC ABDOMINAL EXAMINATION

STEPS DESCRIPTION
Wash hands
Introduce self
Introduction
Confirm patient details
Ask if there is any pain
Describe the examination
Secure consent Get consent
Ask patient to void
Position patient in supine/expose abdomen
General Inspection Inspect for shape, fetal movements, scars, cutaneous
signs of pregnancy
Lightly palpate 9 quadrants and ask for any tenderness
Palpation Lightly palpate for the uterus
Measurement of fundic height
L1 – Fundal grip
Leopold’s L2 – Lumbar grip
Maneuver L3 – Pawlik’s Grip
L4 – Pelvic Grip
Get the FHT at the correct abdominal quadrant and
Fetal Heart Rate
interpret
Drape the patient
Completion of
Wash hands
examination Summarize findings
 PAPSMEAR

STEPS DESCRIPTION
Wash hands
Introduce self
Introduction Confirm patient details/Ask if pregnant
Explain examination and obtain consent
Explanation Describe the examination, understanding and detailed
explanation of the procedure, need for chaperone
Ask the patient verbal consent
Ask patient to empty bladder
Preparation of Gather instruments (Gloves/Lubricant)
Position patient in modified lithotomy with underwear
Instruments and removed
Patient Choose appropriate size of vaginal speculum
Warm vaginal speculum
Vulvar Inspection Wear gloves
Inspection of the vulva
(varicosities/ulcers/discharge/hairs/scars/lumps)
The speculum is then inserted by placing the transverse
diameter of the blades in the anteroposterior position
and guiding the blades through the introitus in a
downward motion with the tips pointing toward the
rectum. Once the blades are inserted, the speculum
should be turned so that the transverse axis of the
blades is in the transverse axis of the vagina. The blades
Insertion of Vaginal should be inserted to their full length and then opened
Speculum to inspect for the position of the cervix.
If the cervix cannot be visualized with repositioning of

the speculum, the physician should inspect for the

position of the cervix with his or her finger and then
reinsert the speculum accordingly. Once the blades are
inserted and the cervix is visualized, the speculum should
be opened and the introitus widened so that the cervix
can be adequately inspected and any indicated
specimens obtained.
Assess vagina for any irregularities. The vaginal
epithelium should be noted for erythema or lesions.
Assessment of Assess the cervix. It should be pink and without lesions.
cervix, vagina and In a nulliparous individual, the external os should be
fornices round. When a woman is parous, the external os takes
 on a slit-like appearance, and if there have been cervical
lacerations, healed stellate lacerations may be noted.
Fornices for any masses

Collect cells from the transformation zone of the cervix

Collect specimen Excess mucus is gently removed
for papsmear The endocervical canal is sampled with a Cytobrush,
which is placed into the canal and rotated.
A spatula is then used to collect ectocervical cells.
A single broom like sampling device can also be used by
inserting the long tip inside the endocervix and the
shorter brush samples the ectocervix. The brush is
rotated to collect both populations of cells in a single
step.
Withdraw the vaginal speculum
Completion of Re-cover the patient
examination Thank patient
Wash hands
Summarize findings/Documentation
Send specimen for histopathology
 BIMANUAL EXAMINATION OF GYNECOLOGIC PATIENT

STEPS DESCRIPTION
Wash hands
Introduce self
Introduction
Confirm patient details/Ask if pregnant
Explain examination and get consent
Describe the examination, understanding and detailed
explanation of the procedure, need for chaperone
Explanation Ask the patient verbal consent
Ask patient to empty bladder
Preparation of Gather instruments (Gloves/Lubricant)
Instruments and Position patient in modified lithotomy with underwear
Patient removed
Wear gloves
Vulvar inspection Inspection of vulva
(varicosities/ulcers/discharge/hairs/scars/lumps)
Lubricate gloved finger
Separate labia using thumb and smallest finger of the
Vaginal right hand then insert gently the middle and index into
Examination the vagina
Enter the vagina with palm facing laterally and then
rotate 90 degrees so that the palm faces upwards
Assess vagina for any irregularities
Assessment of
Cervix: position, consistency, os (open or closed), cervical
Cervix, Vagina
excitation
Fornices
Fornices: any masses
Assessment of the Place left hand above symphysis pubis, right hand in the
Uterus posterior fornix
Push up internal right hand on the cervix
Left hand push down the abdomen towards the internal
fingers of the right hand (take note of the uterine size,
shape, position, surface and tenderness)
Place internal fingers into left lateral fornix and external
Assessment of the fingers to left iliac fossa
Adnexa Press external hand downwards while internal fingers
press upwards and laterally
Feel for any mass, size and shape
Repeat on the other side
Withdraw the fingers-inspect glove for blood or
Completion of discharge
Re-cover patient
examination Thank patient
Wash hands
Summarize findings/Documentation
 DILATATION AND CURETTAGE

STEPS DESCRIPTION
Greet patient
Introduction
Obtain consent
Explanation Describe the detailed explanation of the procedure
Check instruments if complete
Induction of anesthesia
Preparation of
Position patient in dorsal lithotomy position with
Instruments and
underwear removed
Patient Asepsis and antisepsis under anesthesia
Bladder catheterization
Vulvar inspection
Vaginal examination
Internal
Assessment of Cervix, Vagina Fornices
examination
Assessment of the Uterus
Assessment of the Adnexa
The posterior vaginal retractor is applied by placing the
transverse diameter of the blade in the anteroposterior
position and guiding the blades through the introitus in a
downward motion with the tips pointing toward the
Visualization of the
rectum. Once the blade is inserted, the retractor should
Cervix
be turned so that the transverse axis of the blade is in
the transverse axis of the vagina. The blade should be
inserted to its full length so that the tip is positioned
below the cervix.
Using tenaculum forceps, grasp the anterior lip of the
cervix.
Dilatation Insert the lubricated Hegar’s dilator into the cervical
canal starting from the smallest numbered rod and
progressing gradually to larger numbers.
Measurement of Gently Insert the hysterometer until its tip reaches the
Uterine Depth uterine fundus to measure the uterine depth. State the
findings.
In a clockwise manner, perform blunt curettage followed
Curettage by sharp curettage in the uterine cavity until gritty
sensation is felt.
Repeat hysterometry (optional)
Remove all instruments
Clean the vaginal vault with povidone iodine
Completion of Thank patient
Wash hands
examination Summarize findings/Documentation: Note the character
of the specimen obtained (amount, color, consistency)
and send to the laboratory for histopathologic
examination
 NORMAL SPONTANEOUS DELIVERY WITH DELIVERY OF PLACENTA

STEPS DESCRIPTION
Obtain consent
Introduction
Describe detailed explanation of the procedure
Check instruments if complete
Preparation of
Position patient in dorsal lithotomy position
Instruments and
Asepsis and antisepsis under anesthesia
Patient Prep and drape the patient
the head is visible to a diameter of 3-4 cms during
contraction. Two fingers are slipped between the
perineum and the presenting part.
Episiotomy Right mediolateral episiotomy:
Begin the incision at the posterior fourchette and direct
it toward towards the right at a 45-60 degree angle away
from the anus
Median episiotomy:
Begin the incision at the posterior fourchette and direct
it toward towards the perineal body
Delivery of the Deliver the head by Ritgen’s Maneuver: using a draped
Head towel pressing on the perineum, exert forward pressure
on the fetal chin just in front of the coccyx while the
other hand presses superiorly against the occiput and
held against the symphysis pubis
Immediate and thorough drying of the baby
A clean and dry cloth is used to thoroughly dry the baby,
wiping the face, eyes, head, front and back, arms and
legs.
Essential Newborn Early skin to skin contact
Care The baby is placed in prone position on the mother’s
abdomen
The waiting pediatrician continues the essential
newborn care.
After the pulsations have stopped, umbilical cord is
clamped 2cms and 5 cms away from
the baby’s abdomen
and cut in between clamps
Placenta is delivered
using Modified Crede’s Maneuver by doing fundal
Delivery of the pressure with gentle traction of the umbilical cord.
placenta When the placenta is seen at the introitus, Brandt
Andrews Maneuver is done by placing pressure over the
symphysis pubis until the placenta is delivered.
Examine the placenta for completeness
Assessment and Assess the degree of laceration.
Repair of Laceration Inspect the vagina and cervix for any laceration.
 Proceed with episiorraphy.
Evacuation of blood clots
Completion of Rectal examination
examination Advise patient
Wash hands
Documentation