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Home / Station 11: First-trimester pain and bleeding

NAC OSCE preparation

Station 11: First-trimester pain and bleeding

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

First-trimester pain and bleeding

11 minutes

Discipline: Obstetrics & Gynecology
Station type: Focused history + urgent plan
Setting: Emergency department

Your task

Take a focused history. Summarize differential, investigations and immediate management.

Information available at entry

HR 108/minBP 102/66 mm HgRR 18/minSpO₂ 99%T 37.0°C

Coach prompt: Recognize ectopic pregnancy and prioritize hemodynamic safety.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 11 of 30

Standardized-patient profile

NameMs. Priya Singh

Age30

Pronounsshe/her

RolePatient

Demeanour: Anxious and intermittently lightheaded.

Opening statement: “I'm about seven weeks pregnant and started bleeding. I have sharp pain on the left.”

History and standardized-patient responses

Pregnancy/symptoms

Candidate explores	Standardized-patient response
Gestation	LMP seven weeks ago; home test positive.
Pain	Sharp left pelvic pain increasing over six hours; 8/10.
Bleeding	Moderate bleeding, about one pad every two hours.
Associated	Lightheaded with mild left shoulder-tip pain.
Location	No ultrasound yet.

Risk/background

Candidate explores	Standardized-patient response
Ectopic risk	Previous chlamydia; no prior ectopic, IUD, fertility treatment or tubal surgery.
Obstetric history	One prior term birth.
Blood group	Believes she is Rh-negative.
Medication/allergy	Prenatal vitamin; no allergies.

Physical findings

Mild pallor and left-lower-quadrant tenderness with guarding.
With consent/chaperone, pelvic examination shows blood and left adnexal tenderness; os closed.
No generalized peritonitis yet.

Examiner prompts

Leading diagnosis?

Ectopic pregnancy until proven otherwise.

Urgent tests?

Serial vitals, quantitative beta-hCG, CBC, blood group/antibody screen and urgent transvaginal ultrasound.

If unstable?

Immediate resuscitation, blood products as needed and urgent gynecologic surgery without waiting for complete testing.

Differential diagnosis

Ectopic pregnancy
Threatened/incomplete miscarriage
Ovarian torsion
Hemorrhagic corpus luteum
PID
Non-gynecologic abdominal disease

Investigations

Serial observations
Quantitative beta-hCG
CBC and type/screen/antibody testing
Transvaginal ultrasound
Renal/liver tests when treatment decisions require them

Management

Resuscitate and activate emergency gynecology if unstable
IV access, analgesia, NPO and reassessment
Medical or surgical definitive management based on stability and findings
Anti-D when indicated
Follow until pregnancy location/resolution is confirmed

Communication behaviours

Acknowledge uncertainty and fear
Do not assume whether pregnancy is desired
Explain warning symptoms clearly

Critical safety actions

Do not discharge without safe follow-up
Treat instability as ruptured ectopic until proven otherwise
Shoulder-tip pain/syncope suggest intraperitoneal bleeding

Model closing summary

This seven-week pregnant patient has unilateral pelvic pain, bleeding, lightheadedness and shoulder-tip pain with no confirmed intrauterine pregnancy, making ectopic pregnancy most likely. I would monitor her, obtain IV access, CBC, beta-hCG and blood group/antibody testing, arrange urgent transvaginal ultrasound and gynecology review, and resuscitate with immediate operative escalation if she becomes unstable.

Common pitfalls

Calling it miscarriage before locating pregnancy
Delayed ultrasound/consultation
Ignoring Rh status
Intimate exam without consent/chaperone

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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