Tuesday 4 October 2011

Tutorial 3rd. October 2011.

Tonight we started with a discussion of some laboratory and other results. The usual instruction would be that the consultant is away and the secretary asks you, the SpR, to deal with some results that have come in. You have to decide on the degree of urgency and what action should be taken.
Laboratory results.

+ve MSSU at booking. No symptoms.

GTT at 34 weeks. Peak level 11.5.

FBC with ­ MCV at booking.

Thrombocytopenia at booking. 50,000.

Hydatidiform mole after evacuation of suspected miscarriage.

Histology after ERPC for incomplete miscarriage: no trophoblastic tissue.

Endometrial cancer: hysteroscopy: thickened endometrium. Histology: Anaplastic malignancy.

Endometrial cancer: MR scan: reaching serosa and upper endocervical canal.

Consultant does lap drainage of normal looking ovarian cyst. Malignant cells. Nulliparous. Wants children.

HVS: trichomonas.

Clue cells on smear. 12/52 pregnant.

Antenatal discharge: endocervical swab: chlamydia

Actinomyces on smear.

Herpes in pregnancy

Severe dyskaryosis on cervical smear at booking.

Primary infertility: FSH & LH ­ at 25 on day 3 of cycle.

Primary infertility. FSH 3, LH 12 on day 3 of cycle.

Treated with cabergoline for ­ prolactin and pituitary adenoma. +ve beta HCG.

3 cm. ovarian cyst. ­ Ca 125.

“Miscarriage” ERPC. Histology report: Decidual reaction. No trophoblastic tissue seen.

We then had a roleplay. You are the Spr in clinic. The consultant is off sick and you have been told to run the clinic.  

The scenario is one of breaking bad news.
Age 60. Follow-up after hysteroscopy for PMB.
Histology shows poorly differentiated adenocarcinoma.
Unstable diabetes.

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