MBBS OSCE · Obstetrics & Gynaecology
OSCE — Uterine Fibroids (Leiomyomas)
Eight-minute OSCE station on Uterine Fibroids (Leiomyomas): focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Uterine Fibroids (Leiomyomas).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Uterine fibroids (leiomyomas) are benign monoclonal smooth-muscle tumours of the myometrium — the commonest pelvic tumour in women (up to 70 to 80 percent by age 50; most asymptomatic). They are oestrogen- and progesterone-responsive (grow in reproductive years, shrink after menopause). Each fibroid is monoclonal, driven by MED12 mutations in about 70 percent. Risk factors: age, African ancestry (2 to 3x, earlier and more severe), family history, nulliparity, early menarche, obesity; protective: parity, OCP use, vitamin D sufficiency. The FIGO location classification (0 to 8) drives symptoms and treatment: submucosal (0 to 2) cause heavy menstrual bleeding and infertility; intramural (3 to 4
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Heavy menstrual bleeding with dysmenorrhoea and bulk symptoms in a reproductive- |
| Safety | Rapidly enlarging uterine mass or postmenopausal growth of a fibroid — suspect l |
| Safety | Submucosal fibroid with infertility or recurrent miscarriage — hysteroscopic res |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.