Tiêu đề GYNE Straddle Injury July 2025 (FOR DISTRIBUTION).pdf ✅

20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 1 University of the Philippines-Manila, College of Medicine Philippine General Hospital Department of Obstetrics and Gynecology ORAL SIMULATION EXAM JULY 2025 EXAMINER’S COPY (Straddle Injury in a Pediatric patient) Name of Examinee: Name of Examiner: A 7-year-old female presents to the pediatric emergency room with right vulvar swelling and pain following a fall at a playground approximately 2 hours prior. According to the mother, the child fell straddling a horizontal metal bar. There is no reported loss of consciousness, nausea, vomiting, abdominal pain, hematuria, or rectal bleeding. She voided once since the injury but complained of pain during micturition. The child has no significant past medical history, is up to date on immunizations, and is not on any medications. There is no known bleeding diathesis in the family. Vital signs are as follows: T: 36.9°C HR: 98 bpm BP: 100/60 mmHg RR: 18 SpO2: 99% on room air
20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 2 QUESTION ANSWER/ POINT POINTS SCORE How will you approach with the physical examination of this patient? (2.0 points ● Obtain informed consent from the caregiver and, when possible, assent from the child. ● Explain the purpose and steps of the exam in age-appropriate language. ● Ensure a chaperone is present, ideally a female clinician or nurse trained in pediatric care. ● Conduct the exam in a private, calm, child-friendly environment. Avoid unnecessary personnel in the room. ● The child should be in a supine frog-leg position or knee-chest position, depending on comfort and examiner preference. ● Use gentle inspection with adequate lighting, and avoid the use of speculums unless absolutely necessary (typically not indicated in prepubertal patients). ● Document findings meticulously with appropriate diagrams or photographs if part of forensic documentation (only with proper consent and institutional protocol). 0.25 0.25 0.25 0.25 0.5 0.25 0.25 She was brought in via a wheelchair and in moderate discomfort. Abdomen is soft and non-tender. Perineal examination reveals a slightly tense, fluctuant, ecchymotic swelling localized to the right labia majora, measuring approximately 4x6 cm.. Minimal blood clots are seen at the introitus, but no active bleeding is observed. Further examination of the external genitalia and rectal exam are deferred due to patient discomfort.

20th OBGYN ORAL EXAM REVIEW ORAL SIMULATION 4 Describe how you will proceed with managing this case. (2.5 points) ● Admit the patient, establish IV access, prepare blood products ● Secure consent for surgery ● Inform the anesthesia and pediatric services ● Surgical evacuation of the hematoma, ligation of bleeders ● Diagnostic cystourethroscopy to assess for urethral or bladder injury ● Diagnostic vaginoscopy to evaluate for occult vaginal trauma, which cannot be excluded on external exam alone ● Drain insertion 0.25 0.25 0.25 0.5 0.5 0.5 0.25 Patient underwent examination under anesthesia, diagnostic cystourethroscopy, vaginoscopy, evacuation of hematoma, ligation of bleeders and Penrose drain insertion under IV sedation. QUESTION ANSWER/ POINT POINT S SCORE How will you manage the patient post- operatively? (1.5 points) ● Analgesia: acetaminophen ± NSAIDs ● Antibiotic prophylaxis: may be given perioperatively to reduce infection risk, particularly if a drain is placed ● Perineal care: hygiene instruction, warm sitz baths ● Monitor urine output and voiding ● Drain management: daily monitoring, removal when output is minimal ● Provide child life or psychosocial support as appropriate 0.25 0.25 0.25 0.25 0.25 0.25