Tutorial 21 March 2013

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Tonight we discussed the technique for dealing with a laboratory results station. You have a 15 minute preparatory station. The station is about administrative actions. You will briefly mention the relevant clinical matters, but don't get side-tracked into detailed discussions. Keep a careful eye on the time.  It is very easy to talk too much to start with and run out of time for the last few results.

Laboratory results.

Your consultant is on annual leave.

Her secretary has asked you to look through the following results and decide what action should be taken in relation to each.

+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.

Then we had a roleplay about PMB.

 

A 55 year old woman is referred by her General Practitioner.

Candidate’s Instructions.

You are an SpR in the “one-stop” PMB clinic. You are about to see a woman with bleeding some years since her menopause.

Your task is to take an appropriate history and advise her about the investigations you feel are appropriate.

Referral letter from the General Practitioner.

Manor Lodge,

High Street,

Bestown.

BE5 S00

Re: Mrs. Mary Smith,

5b High Street,

Bestown.

BE5 SO1

Dear Doctor,

Please see Mrs. Smith who has had bleeding.

Yours sincerely,

James Fewords,

General Practitioner.

 And, finally, a viva about urinary tract infection in pregnancy.

The questions the examiner asked were:

1.         What is the definition of ASB?

2.         What is its prevalence of ASB in the pregnant and the non-pregnant?

3.         Why do we screen for ASB in pregnancy?

4.         How do we screen for ASB in pregnancy?

5.         Which antibiotics are contraindicated in the management of UTI in pregnancy?

6.         How would you decide the antibiotic to use in a case of severe pyelonephritis?

7.         What would be your management of a woman who has recurrent ASB after apparently effective antibiotic treatment?