Gynecology – Menstrual and Hormonal Disorders
1. Endometriosis
- Key Areas:
- Relevant history for diagnosing endometriosis
- Appropriate initial investigations for endometriosis
- Non-pharmacological actions for opioid therapy management
- Common Errors:
- Misinterpreting clinical information, focusing on other diagnoses like STIs
- Asking history already provided or irrelevant questions
- Listing lifestyle changes instead of non-pharmacological decision-making processes for opioid prescribing
2. Female Elite Athlete with Menstrual Issues
- Key Areas:
- Pharmacological management of menstrual difficulties
- Identifying adverse effects of anabolic steroid use
- Immediate investigation for significant family cardiac history (electrocardiogram)
- Common Errors:
- Inappropriate treatments such as ‘Implanon’ or ‘Kyleena intrauterine device’
- Listing adverse effects of corticosteroids instead of anabolic steroids
- Prioritizing irrelevant screenings over necessary cardiac investigation
3. PCOS in a 17-Year-Old Girl
- Key Areas:
- Required diagnosis identification
- Understanding of long-term risks associated with PCOS
- Medication strategies for menstrual regulation
- Strengths:
- Correct diagnosis from the provided information and identification of long-term PCOS complications
- Improvements Needed:
- Consideration of contraindications in prescribing medication for menstrual regulation
4. Management of Heavy and Painful Periods
- Key Topics Discussed:
- Initial investigations
- Differential diagnosis
- Pharmacological management
- Candidate Performance:
- Insufficient knowledge on managing common gynecological conditions
- Improvement Areas:
- Enhance understanding of diagnostic and management strategies for menstrual disorders
5. Dysmenorrhea and Menorrhagia Management
- Medical Heading: Gynecology
- Key Topics:
- Investigation strategy for abnormal menstruation
- Management of cervical screening results
- Contraindications for specific contraceptives
- Candidate Performance:
- Failure to recognize the serious complication of using combined oral contraceptive pill in a patient with absolute contraindications
- Improvement Areas:
- Recognize contraindications for contraceptive use, especially in smokers
- Apply current guidelines to manage abnormal cervical screening results effectively
6. Heavy Menstrual Bleeding and Sexual Assault
- Insight:
- The complexity of managing gynecological symptoms and the critical importance of understanding and responding to sexual assault in a clinical setting
- Strengths:
- Identifying the need for sensitive and appropriate immediate management following assault
- Improvements:
- Improve knowledge of mandatory reporting obligations and patient support mechanisms
7. Heavy Vaginal Bleeding in an Adult Female
- Key Topics Discussed:
- Risk factors for serious underlying disorders
- Appropriate investigations
- Immediate management for re-presenting heavy bleeding
- Candidate Performance:
- Repetition of provided history instead of focusing on new, relevant information
- Improvement Areas:
- Prioritize investigation and management plans based on the evolving nature of symptoms, with a focus on urgent care for heavy bleeding
Gynecology – Screening and Preventive Care
1. Solid Organ Transplantation Requesting Cervical Cancer Screening
- Key Areas:
- Explanation of rationale behind the changes to the cervical screening program in 2017
- Identifying factors in the patient’s history supporting cervical screening and self-collected samples
- Understanding the importance of immunosuppression, early sexual debut, and patient preferences
- Common Errors:
- Describing the current screening program instead of the rationale for changes
- Incorrectly stating that cervical screening is not required post-HPV vaccination
- Misidentifying factors in history relevant for self-collected samples (e.g., personal history of STIs, family history of cervical cancer)
2. Management of Heavy Periods and Abnormal Cervical Screening
- Key Topics Discussed:
- Initial investigations for heavy periods
- Pharmacological management
- Interpretation of cervical screening results
- Candidate Performance:
- Gaps in managing heavy periods and interpreting cervical screening results
- Improvement Areas:
- Improve pharmacological management strategies for heavy periods
- Understanding of cervical screening guidelines
3. Follow-Up of Abnormal Pap Smear
- Key Topics:
- Management of an overdue follow-up for an abnormal Pap smear result
- Candidate Performance:
- Struggle with practice management and follow-up protocols
- Improvement Areas:
- Adherence to cervical screening guidelines
- Implementation of follow-up systems in practice
Gynecology – Pain and Infections
1. Acute Abdominal and Pelvic Pain Management
- Key Topics Discussed:
- Differential diagnoses
- Initial investigations
- Non-pharmacological management of dyspareunia
- Candidate Performance:
- Differential diagnoses not aligned with clinical features
- Improvement Areas:
- Provide specific, relevant differential diagnoses and initial investigations
- Understand non-pharmacological management options for dyspareunia
2. Skin Lesion and Vulval Lump in a Young Female
- Key Topics Discussed:
- Differential diagnoses
- Informed consent for a vaginal examination
- Candidate Performance:
- Lack of knowledge on differential diagnoses
- Overlooking patient rights in informed consent
- Improvement Areas:
- Improve knowledge on differential diagnoses
- Emphasize patient consent and rights
3. Acute Abdominal Pain and Pelvic Pain
- Key Topics Discussed:
- Differential diagnoses
- Immediate investigations
- Candidate Performance:
- Lack of specific and relevant differential diagnoses
- Improvement Areas:
- Focused history taking and understanding of pregnancy-related gynecological emergencies
Gynecology – Menopause and Post-Menopausal Issues
1. Post-Menopausal Bleeding
- Key Topics:
- Identification and management of post-menopausal bleeding
- Candidate Performance:
- Inability to recognize post-menopausal status
- Inappropriate investigation and management strategies
- Improvement Areas:
- Enhance understanding of guidelines for managing post-menopausal bleeding
- Focus on targeted investigations
2. Menopausal Symptoms and Breast Cancer Risk
- Key Topics Discussed:
- Investigations
- Pharmacological management of menopausal symptoms
- Addressing concerns about breast cancer
- Candidate Performance:
- Lack of knowledge on managing menopausal symptoms
- Addressing familial cancer concerns
- Improvement Areas:
- Increase knowledge on menopause management
- Incorporate patient history and concerns into management plans
Gynecology – Pregnancy and Postpartum Issues
1. Post-Partum Mastitis and Breast Lump Investigation
- Key Topics Discussed:
- Targeted history for mastitis
- Pharmacological management
- Initial investigations for a breast lump
- Candidate Performance:
- Lacked specificity in history taking
- Errors in articulating diagnostic value elements
- Improvement Areas:
- Focus on case-specific, relevant history taking and diagnostic approaches