Hematology – Diagnostic and Management Approaches
1. Investigation of Raised Hemoglobin and Mean Cell Volume
- Key Topics Discussed:
- Differential diagnoses for hematologic abnormalities
- Relevant examination findings
- Further investigative steps
- Candidate Performance:
- Gaps in interpreting hematologic results
- Difficulty connecting results with potential differential diagnoses
- Improvement Areas:
- Improve hematologic knowledge, specifically the implications of abnormal blood results
- Tailor further investigations to these findings
2. Deterioration in Health with Hematological Signs
- Key Topics:
- Differential diagnoses for systemic symptoms
- Management of gout secondary to hematological conditions
- Candidate Performance:
- Not recognizing signs of hematological malignancy
- Inappropriate gout management
- Improvement Areas:
- Early recognition and management of hematological conditions and their complications
3. Chronic Hematological Condition
- Topic Discussed:
- New symptoms in a patient with a previously stable chronic hematological condition, requiring further investigation
- Candidates Did Well On:
- Identifying additional necessary information for diagnosis
- Improvement Areas:
- Recognizing the potential rapid progression of chronic conditions
- Providing specific, targeted answers rather than vague or general responses
4. Macrocytic Anemia
- Topic Discussed:
- Investigation and management of macrocytic anemia with low B12 levels, indicating potential pernicious anemia
- Candidates Did Well On:
- Identifying possible underlying causes based on history
- Improvement Areas:
- Progressing with investigations to confirm pernicious anemia
- Recognizing outdated tests like the Schilling test and avoiding inappropriate initial investigations
Hematology – Thrombosis and Vascular Conditions
1. Postpartum Thrombophlebitis
- Key Topics:
- Diagnosis of thrombophlebitis
- Impact of medical history on management
- Candidate Performance:
- Misidentification of superficial thrombophlebitis
- Inadequate use of case information
- Improvement Areas:
- Recognition of clinical signs
- Tailored management considering past history
2. Upper-limb Venous Thromboembolism
- Specifics:
- Failure to specify the investigation site
- Adaptation of initial management to the patient’s medication history, especially concerning anticoagulation
- Improvement Areas:
- Specify investigations clearly
- Adjust management plans based on comprehensive patient history, including medication use and risk factors
3. Deep Venous Thrombosis in an Elderly Resident
- Medical Heading: Geriatrics, Vascular Medicine
- Key Topics:
- Examination for DVT confirmation
- Initial investigations
- Urgent management considerations in an elderly patient with a complex medical history
- Candidate Performance:
- Some candidates failed to focus on specific examination and investigation for DVT
- Offering generalized management plans
- Urgent referral for anticoagulation management was often overlooked
- Improvement Areas:
- Prioritize urgent and specific management for suspected DVT, considering patient history
- Tailor investigation requests explicitly and recognize the need for immediate specialist input