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These Are Not Recalls-If You Know What I Mean

This document contains descriptions of 15 clinical scenarios or "stations" presented to a medical student or resident in training. The stations cover a range of specialties including gynecology, obstetrics, maternal medicine, and more. For each station, brief clinical details are provided about a patient case, and the examiner asks probing questions to test the examinee's clinical reasoning and management planning skills. Feedback is also provided on a previous student's performance of an episiotomy procedure.

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Fareesha Khan
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66 views3 pages

These Are Not Recalls-If You Know What I Mean

This document contains descriptions of 15 clinical scenarios or "stations" presented to a medical student or resident in training. The stations cover a range of specialties including gynecology, obstetrics, maternal medicine, and more. For each station, brief clinical details are provided about a patient case, and the examiner asks probing questions to test the examinee's clinical reasoning and management planning skills. Feedback is also provided on a previous student's performance of an episiotomy procedure.

Uploaded by

Fareesha Khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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These are not recalls-if you know what I mean.

1. SPT: 39 yrs, came to ER, difficulty to pass urine. Initial exam showing 24 wks sized
pelvic mass. Not scanned yet.
 Task: Targeted H, explain possible causes, propose a mng plan.
 D/D to consider: Fibroid, adenomyosis, malignancy. [?papable bladder?]
 Some points in H: HMB, no fertility concerns. Remember red flags [wt loss,…].
 Plan: relief symptoms, further exam, tests [FBC, UG, PT,…] & imagings [TVS, Abd
US, possible MRI]. Surgery is a possibility.

2. SD. Gyne list prio.


 3 cases-NOT the “repeat station”. Always asked “is I the suitable surgery for
her?”
 1st: a lady planned for laparoscopic cystectomy. 62 yrs, normal BMI, indication
was a 6cm “simple” ovarian cyst. [why cystectomy rather than oophorectomy,
as she post meno]. What further info you want to know. When you tell
anything, e.g scan, net Q will be “why?”. Also asked “calculate her RMI, what is
the importance/significance”. Her Ca-125 was low by the way. US features
weren’t suspicious. RMI for me was <200. Anyhow, I suggested BSO as more
suitable.
 2nd: a pt planned for hysterescopic resection of a sub mucous fibroid. She had a
high BMI, previously failed endometrial ablation. She is anemic [Hb 9.5 g/dl]. He
asked “what are the risks here?”. “Any medications to give before surgery?”
[may be iron tabs if surgery is planned a head, ?GnRH? don’t know]. Also asked
“what are the risks of hysteroscopy?”
 3rd: planned for TLH. 42yrs old. High BMI. Can’t remember the indication but not
cancer. “is it the suitable route? Why?”. “keep or remove ovaries?”. She
completed her family.

3. SD: loabour ward prio.


 Difficult one. NOT the “repeat station”.
 9 cases 🙈 . Not the typical “what task for whom”. Mostly “what are you going
to do”.
 Cases I remember:
o Pt after CS, lost 2.5 L now, atonia. [communicate, resuscitate, monitor &
investigate,..]
o 2PS, planned for EL SC, came in labour.
o FGR came for IOL.
o Pathological CTG in 2nd stage. [how advanced in 2nd stage?, position,
caput, moulding, epidural,....].
o Another case very similar to the one above. She was on epidural & head
at +1,…

4. SPT with lay. 44yrs. Combined test showing high risk of Down’s. [low for T.13 & 18].
 Some points in her H: Unplanned but welcomed. No folic, P2 [NVD].
 Reluctant to needle test . Thinks it will cause miscarriage. Looks more keen to
continue the pregnancy and asked about the outlooks and those things.
Otherwise it was a straight forward station. Looks more of a “communication”
sort of things.

5. SPT. Maternal medicine. Grave’s disease.


 Diagnosed 6 months ago. Now 8 wks pregnant. Targeted H & mng plan.
Unplanned [only condoms] but very welcomed.
 Also newly discovered HTN. Taking PTU for grave’s.
 New station but anyway, template applies.

6. SD. Infertility with huge fibroids.


 Same as “repeat station”. [MRI & things, summarize, what further tests-if any &
why, what do you suggest,..]. Still an odd one.

7. SPT. Peri-menopause woman with typical symptoms of hut flushes, night sweats &
V.dryness.
 Same as “repeat station”.

8. SPT. Referred with stage 2 vault prolapse [VH 3 yrs back].


 She will reveal distressing stress incontinence symptoms when asked. She is
sexually active. I think exam is justifiable [POP elsewhere].
 So options of life style, PFMT, pessaries & surgery [likely colposupension?].

9. SPT with lay: 62 yrs with long-standing itch, biopsy showing VIN-3.
 Similar to recall. This time there was LS as well. Remember colposcopy.

10. SPT. Talipes.


 Same as “repeat station”.

11. SD: Incontinence after hysterectomy.


 Same as “repeat station”.

12. SD about PP.


 The woman has 1PS [breech]. Now 20 wk scan showing placenta covering the
os.
 What further plan & tests? [MRI will be handled when you mention it-likely
accrete, asked about accreta spectrum].
 Also asked about the bundle care, then surgical mng, precautions if jehovah’s.
are you going to admit her [now or at some point?].

13. SPT: OHSS after egg retrieval


 Same as “repeat station”. She was in pain [lay examiner was there]. She was
reluctant to admission.

14. Teaching [feedback]:


 Your ST1 did an episiotomy. He didn’t identify the apex, issues with protocols [?
Suture type? Things were written in a paper?]. knot tying was there somewhere.
Then the typical thing of asking to sign the summative osat. This time when you
apologies for the summative, he will show you the formative . No way to
escape.
15.

Thanks to all who shared


4-11-19

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