Surgical procedures

2017 ◽  
Keyword(s):  
Hip Replacement ◽  
Reading Time ◽  
Clinical Skills ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Safety Communication ◽  
Safety Issues ◽  
Problem Solve ◽  
The Right ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with colleagues ● Applied clinical knowledge … Mrs. Ahmed is a 48- year- old lady undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy for heavy menstrual bleeding with a 20 week size fibroid. She is generally well and has undergone a left hip replacement five years ago. Your consultant has asked you to commence the surgery by opening the abdomen with a vertical subumbilical incision. She will shortly join you for the surgery. The Foundation Year 1 doctor will be assisting you in the interim. You will be presented with scenarios in the theatre. Your task is to problem solve and answer the queries of the F1 doctor. You have 10 minutes for this task (+ 2mins initial reading time). There is no role player for this scenario. This scenario checks the understanding of Monopolar diathermy and the ability to problem solve. It also assesses the understanding of safety issues surrounding electrocautery. First tell the candidate: The Theatre Assistant Practitioner (ODP) is newly qualified and normally works in the ENT theatres. You start the incision using a finger switch diathermy but it is not working What will you do? The candidate should first check if the machine is on Tell them that is was not on, but has now been switched on As soon as the machine is switched on, the machine starts beeping What should the ODP do next? If the candidate asks if there are any indications on the machine, say the sign of the returning electrodes is highlighted The candidate should check if the returning electrodes (pads) have been applied. They had not been. The ODP asks where he should apply the returning electrodes. The candidates should ask the electrode to be placed on the right buttock. The ODP asks if it is OK to put the returning electrode on the left buttock as the scrub nurse and trolley are on the right and it is convenient to apply on the left. The candidate should explain that as Mrs. Ahmed has had a hip replacement on the left, it is important to avoid applying the returning electrode near the metal implant and the scarring around it, for safety. The ODP asks that he has never seen a split returning electrode. Why is it split?

Management of delivery

2017 ◽  
Keyword(s):  
Reading Time ◽  
Clinical Skills ◽  
Breech Presentation ◽  
Antenatal Clinic ◽  
Information Gathering ◽  
Normal Vaginal Delivery ◽  
Clinical Impression ◽  
Safety Communication ◽  
Pregnancy And Delivery ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Rebecca Francis is a 34- year- old lady in her second pregnancy. She has had a normal vaginal delivery two years ago. Her pregnancy remained uneventful so far. At 36 weeks, her midwife detected that the baby was in breech presentation and has referred her to the antenatal clinic to discuss further management. You will then be given some information and asked questions by the examiner. You have 10 minutes for this task (+ 2mins initial reading time). Please read instruction to candidate and actor. After the consultation with the actor patient (or in the last two minutes), tell the candidate that Rebecca underwent an unsuccessful ECV and was booked for an elective caesarean at 39 weeks. You performed her caesarean and to your surprise, you delivered a cephalic baby by caesarean section. What should you have done to prevent this? What will you do next to prevent this kind of incidence? What will you explain to Rebecca? Record your overall clinical impression of the candidate for each domain (i.e. should this performance be pass, borderline, or a fail). You are Rebecca Francis, a 34- year- old mother of two- year- old Lucy. You had a straight forward pregnancy and delivery with Lucy. You are currently 36 weeks pregnant. You were seen by your midwife yesterday for a routine check and she found the baby to be in breech position. You were sent to the antenatal clinic and have had a scan confirming that the baby is in breech position. You were told that rest of the scan, including the baby’s measurements, fluid volume around the baby and the position of the placenta are normal. You are healthy. You do not smoke and have had no alcohol in pregnancy. Your pregnancy has progressed without any problems so far. The screening test for the baby showed low risk for Down’s syndrome. Temperament: You think you are mostly a calm, level- headed woman, but you do like to be organised and in control of things.

Ethical and legal issues

2017 ◽  
Keyword(s):  
Reading Time ◽  
Clinical Skills ◽  
Family Doctor ◽  
Information Gathering ◽  
Termination Of Pregnancy ◽  
Legal Issues ◽  
Safety Communication ◽  
Competitive Swimming ◽  
Ethical And Legal Issues ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients ● Information gathering ● Applied clinical knowledge … You are working alongside your consultant in the termination of pregnancy clinic and have just seen 15- year- old Chantelle Briar who has come with her friend requesting a termination of pregnancy. She insists she has a surgical termination of pregnancy as she does not want to have any pain during the procedure. Please take the appropriate consent for the procedure. You have 10 minutes for this task. (+ 2mins initial reading time). This station assesses the candidate’s ability to consent and their understanding of the important principles of Gillick/ Fraser competence and the issues surrounding Jehovah’s witness. Please do not interrupt them. You are Chantelle Briar, 15- year- old and attending the clinic requesting termination of pregnancy. You are in the High school and are preparing for your GCSEs. You like the school and have good friends. You are training for competitive swimming and have lot of plans for your future career. You have recently been going out with one of your classmates who recently moved to your school. You have used condoms during sex but do not understand how you got pregnant. Your friend suggested you take a pregnancy test after you felt sick in your last swimming lesson and it was positive. You are shocked and worried as your parents are not aware that you are sexually active. You have not informed any of your family members or teachers or GP regarding the pregnancy. You googled for the termination services and got an appointment at the clinic. Your boyfriend is aware and is supportive; he has not informed his parents either. You wish to have surgical termination so that it is all done quickly and with no pain. Your friend has accompanied you to the clinic and has been very supportive throughout. When you are seen by the doctor you insist that it is all kept confidential and that you would not wish either your parents or your family doctor know about it. You would want the procedure to be done as soon as possible and the first thing in the morning so you could go home by the end of the day.

Gynaecological problems

2017 ◽  
Keyword(s):  
Reading Time ◽  
Clinical Skills ◽  
Management Plan ◽  
Safety Communication ◽  
Speculum Examination ◽  
Menstrual History ◽  
History Of ◽  
Abdominal Examination ◽  
Initial Reading ◽  
High Bmi

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are in the gynaecology clinic and your next patient is Rachel Sawyer a 38- year- old woman suffering from heavy and irregular periods. She has a BMI of 42 and has been diagnosed with PCOS in the past. Your task is … ● To take a focussed history ● Explain what examination and investigations need to be performed to Rachel ● Make a management plan … You have 10 minutes for this task (+ 2mins initial reading time). Please read instructions to candidate and actor. Allow the candidate to conduct the interview undisturbed unless they are straying off the track of the question (in which case you can show them their instructions again). This patient has heavy and irregular periods. The history of presenting complaint should cover: … ● The extent, duration, and inconvenience caused by the bleeding ● Establish the menstrual history from menarche ● Last menstrual period and present menstrual cycle ● Past gynaecological history, including PCOS ● No medical, surgical, family history ● No allergies ● Normal and regular smears ● Nulliparous ● Wants to preserve fertility … Once the candidate has taken a relevant history, they are expected to explain that they will need to perform a speculum examination and bimanual examination to Rachel. They should explain that this is to rule out any obvious abnormality in the vagina/ cervix and to assess the uterus and adnexa. Abdominal examination— unremarkable: … ● Speculum examination— cervix satisfactory ● Bimanual examination— uterus bulky, retroverted, mobile, no adnexal masses Investigations ● Endometrial sampling— either at this consultation or accept another appointment- This is to assess the endometrium as, although 38, Rachel has risk factors of High BMI, PCOS, and nulliparity ● TVS- as Rachel has a high BMI, the sensitivity of an internal examination is reduced, TVS, not TAS will be useful due to high BMI.

Developing professionalism

2017 ◽  
Keyword(s):  
Communication Skills ◽  
Reading Time ◽  
Clinical Skills ◽  
Antenatal Clinic ◽  
Induction Of Labour ◽  
Safety Communication ◽  
Assessment Task ◽  
Foetal Growth ◽  
Normal Ultrasound ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are in the antenatal clinic and are about to see Kelly Morgan, a 23- year- old nulliparous patient. She is 37 + 3 and this is her first pregnancy. She has been classified as low risk, and has been under midwifery care until now. Her community midwife has sent her to the clinic because she has been requesting induction of labour because she is exhausted and ‘unable to cope’. There have been no concerns about foetal growth or movements, her blood pressure and urinalysis are normal, and she has no medical co- morbidities. She had a normal ultrasound scan at 36 weeks. The clinic is running over an hour late as your consultant is off sick. You have been told by the clinic staff that she has already been complaining about the delay. The hospital has a very definite policy against induction of labour for non- obstetric reasons. Your task is to explore Kelly’s concerns and to explain to her that her request for IOL is not something that is usually done in this context. You have 10 minutes for this task (+ 2mins initial reading time). This clinical assessment task assesses the candidate’s ability to professionally deal with an angry patient. This needs robust communication skills to defuse the situation at the same time exploring the patient’s concerns and making a safe plan. Please do not interrupt or prompt the candidate. Please mark each domain as pass, borderline, or fail. At this station, you are very angry and upset. You are Kelly Morgan, a 23- year- old admin assistant. This is your first pregnancy, and you have found it difficult from the very beginning. You had morning sickness until 18 weeks, and ever since 30 weeks you have felt absolutely exhausted. You have no energy, your back hurts and you just want this baby delivered. Your midwives keep telling you that this is all normal, and that it’s better to wait for natural labour, but you don’t care if you end up with a caesarean section. You are fed up with being fobbed off by people who don’t know what they are talking about.

Subfertility

2017 ◽  
Keyword(s):  
Normal Forms ◽  
Clinical Skills ◽  
Semen Analysis ◽  
Hormone Replacement ◽  
Treatment Options ◽  
Visual Disturbance ◽  
Oocyte Donation ◽  
Safety Communication ◽  
Consultation Skills ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are a ST4 doctor working in an infertility clinic. A couple who were referred to the clinic by their GP have returned for review. She has had oligomenorrhoea for the past year. She does not report headaches, visual disturbance, galactorrhoea or hyperandrogenism, she has been trying to conceive for two years. Her partner had an orchidopexy at the age of two. The assessor will ask you some questions and then give you the results of their investigations. You will be asked to explain the results and next steps to the patient. You have 10 minutes for this task (+ 2mins initial reading time). Please check that candidate and actor have read instructions. Ask the candidate what investigations they would like to organize for this patient and her partner. Give them the results of investigations (if asked for): Pregnancy test— ve LH 45, FSH 40, E2 120 (day two of cycle) PRL— 200 TSH— 1.2 Testosterone— 0.8 USS— NAD HSG— Patent tubes Rubella immune Chlamydia swabs— ve Smear— ve Semen analysis— 10m/ ml, 32% motility, 3% normal forms Ask them if they want to arrange any further investigations. Expect candidate to ask to repeat gonadotrophins more than a month after initial measurement in order to confirm the diagnosis of Premature Ovarian Insufficiency (POI). They should also repeat the semen analysis. Tell them that repeat gonadotrophins were again elevated— FSH 35, LH 20, E2 120. Repeat semen analysis was 15m/ ml, 34% motile, with 4% normal forms. Ask the candidate to explain these results to the patient and explain next steps, including further investigation and treatment options. They should then recommend that further investigations are arranged including karyotype, an auto-immune screen, lupus anticoagulant and vitamin B12 levels to try and identify a cause for the POI. Treatment options should include the role of hormone replacement therapy and oocyte donation with IVF. Observe consultation skills including the candidate’s ability to break bad news. Record your overall clinical impression of the candidate for each domain (i.e. pass, borderline, or fail).

Teaching appraisal and assessment

2017 ◽  
Keyword(s):  
Patient Safety ◽  
Clinical Skills ◽  
Shoulder Dystocia ◽  
Clinical Knowledge ◽  
Doctor Who ◽  
Forceps Delivery ◽  
Safety Communication ◽  
Active Involvement ◽  
Practical Management ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient Safety ● Communication with colleagues ● Applied clinical knowledge … You are teaching practical management of shoulder dystocia to your ST1 doctor who has just started obstetrics. He/ she has witnessed a shoulder dystocia after a forceps delivery last week and is very stressed about facing one. You have a pelvis and baby model and today you are teaching the shoulder dystocia scenario. You have 10 minutes for this task (+ 2mins initial reading time). This station assesses the candidate’s ability to teach a practical skill. This will also assess their knowledge of managing shoulder dystocia. Please observe the teaching and do not interrupt. You are a ST1 doctor who has just completed the foundation training. This is your second week on the delivery suite. You have seen one shoulder dystocia after forceps delivery recently. You found the experience stressful and are now worried about facing such a scenario. Your Registrar has kindly agreed to teach you the practical management of Shoulder dystocia using the pelvis and baby model. Please do not prompt and follow the instructions of the candidate (registrar). Patient safety … ● Avoid dangerous manoeuvres fundal pressure and excessive lateral and downward traction ● Explain advanced techniques and advice the importance of using them only if experienced— Zavanelli’s manoeuvre and symphysiotomy ● Explains the importance of documentation… Communication with colleagues … ● Explains the objectives of the station ● Allows active involvement of the team/ trainee ● Promotes team working ● Makes the trainee demonstrate while talking through the steps and allows trainee to talk through while demonstrating ● Finally gives opportunity to the trainee to independently talk through and demonstrate the whole scenario… Applied clinical knowledge … ● Has knowledge of all the manoeuvres ● Demonstrates and talks through the steps ● Recognize the problem ● Call for help ● Mc Roberts manoeuvre ● Suprapubic pressure ● Consider episiotomy ● Posterior arm delivery or internal rotatory manoeuvres ● Turn into all fours ● Emphasize subsequent management ● If unsuccessful consider repeating the manoeuvres ● If experienced, consider advanced manoeuvres ● Complete delivery.

scholarly journals Magnetic Resonance Appearance of Pulmonary Type of Primary Small Cell Carcinoma of the Ovary: A Case Report and Literature Review

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Xuechao Du ◽  
Pengtao Sun ◽  
Yuan Zhao ◽  
Yuchang Yan ◽  
Zhenyu Pan
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Cell Carcinoma ◽  
Small Cell Carcinoma ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Small Cell ◽  
Imaging Features ◽  
The Right ◽  
Carcinoma Of The Ovary

: The pulmonary type of primary small cell carcinoma of the ovary (SCCOPT) is a rare aggressive malignancy with a poor prognosis, usually occurring in postmenopausal women. Few literatures have emphasized on the magnetic resonance (MR) imaging features. In this paper, we analyze its MR imaging findings in combination with pathological manifestations. We report a case of a 51-year-old woman who presented with abdominal pain and distension. Several tumor markers were elevated. MR scan of the pelvis was performed. It revealed a heterogeneous lobulated mass with solid and cystic components originating from the right adnexa. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histology showed a tumor comprising areas of classical small-cell carcinoma, and SCCOPT was diagnosed based on histopathology and immunohistochemistry. SCCOPT is a rare aggressive malignancy with certain characteristic imaging features. The solid component exhibits slightly higher signal on T2-weighted imaging with fat suppression, restricted diffusion on diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps, and honeycomb-like persistent enhancement. More data are needed to better understand its specific imaging manifestations.

Sentinel node detection in a patient with recurrent endometrial cancer initially treated by hysterectomy and radiotherapy

2004 ◽  
Vol 14 (4) ◽  
pp. 673-676 ◽  
Author(s):  
P. Van Dam ◽  
H. Sonnemans ◽  
P.-J. Van Dam ◽  
D. Smet ◽  
L. Verkinderen ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Sentinel Node ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Pelvic Lymphadenectomy ◽  
Sentinel Node Detection ◽  
Lymph Node Sampling ◽  
Sentinel Node Identification ◽  
Grade Ii ◽  
The Right

This is the first article reporting sentinel node identification in a patient with endometrial cancer recurring in the vagina. A 79-year-old woman presented with a midvaginal recurrence of a stage IB, grade II endometroid carcinoma that had been treated 3 years earlier by a total abdominal hysterectomy, bilateral salpingoophorectomy, and pelvic lymph node sampling, followed by adjuvant brachytherapy to the vaginal vault. A staging examination under anesthetic was performed. Preoperatively, 60-MBq technetium-labeled nannocolloid was injected in the mucosa at 3, 6, 9, and 12 o'clock just adjacent to the tumor recurrence. Three sentinel nodes were detected, respectively, in the left obturator fossa (two) and the right external iliac region, using a laparoscopic probe (Navigator) and removed for pathological assessment. As they proved to be negative, the patient underwent a total vaginectomy, parametrectomy with pelvic lymphadenectomy. The tumor was completely removed, and all lymph nodes proved to be negative. The accuracy of sentinel node identification in patients with recurrent gynecological tumors needs further evaluation. This unique case shows that sentinel node detection is possible after previous radiotherapy and surgery and hopes to stimulate further research in this field.

Gynaecological oncology

2017 ◽  
Keyword(s):  
Social Life ◽  
Clinical Skills ◽  
After School ◽  
Cervical Smear ◽  
Safety Communication ◽  
Part Time ◽  
Level 3 ◽  
Early Cervical Cancer ◽  
The Moment ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … Your consultant has asked you to speak to Agnieska Polanski aged 38 whose smear result has shown ‘severe dyskaryosis’, HPV positive. Your task is to: … ● break the news to Agnieska about the abnormal smear ● discuss the next stage of management (i.e. colposcopy and biopsy) ● answer any questions … You do not need to take a history. You have 10 minutes for this task (+ 2mins initial reading time). Please read the instructions for candidates and actors. This station is designed to test the candidate’s ability to break bad news in a sensitive and professional way. This case involves a patient who has a severely abnormal cervical smear result (with the possibility of early cervical cancer). The candidate explains the implications of such a smear and discusses the next step in management. Record your overall clinical impression of the candidate for each domain (e.g. should this performance be pass, borderline, or a fail. You are Agnieska Polanski, aged 38 years, and you have come to an outpatient gynaecology clinic (called a colposcopy clinic) to discuss your recent cervical smear result. You have a feeling that the smear might be abnormal because the secretary refused to discuss it with you on the phone and you received a very prompt appointment to see the doctor. You love children and work part time in a local nursery and after school club whilst you are studying for a NVQ level 3 childcare qualification. Your social life is great at the moment— you live with a very supportive and loving partner Lee and are planning to get married next year. Your partner and you have planned to have children and you will probably come off the pill just before your wedding (because at your age you don’t want to leave it too long but you don’t want to look huge in your wedding dress).

Sexual and reproductive health

2017 ◽  
Keyword(s):  
Failure Rate ◽  
Clinical Skills ◽  
General Rule ◽  
Uterine Perforation ◽  
General Anaesthetic ◽  
Surgical Trauma ◽  
Safety Communication ◽  
Contraceptive Implant ◽  
Effective Contraception ◽  
Initial Reading

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are an ST4 doctor conducting a post operative ward round. Your next patient is Danielle Wilson, a 26- year- old mother of three who has undergone a left salpingectomy for ectopic pregnancy. Having explained the operation to her, she asks why you couldn’t have just sterilized her at the same time as she never wants to be pregnant again and is struggling with her health and her young children. Her notes show that she has had 2 previous terminations and takes carbamazepine and levetiracetam for epilepsy and fluoxetine for anxiety. There is nothing else of note. Explain to Danielle why she was not sterilized at the time of salpingectomy. Then make a safe and effective contraception plan which is acceptable to her. You have 10 minutes for this task (+ 2mins initial reading time). Ask the candidate and actor to read their instructions. Then ask the candidate to start their discussion with the patient. Allow the candidate to conduct the discussion undisturbed unless they are straying off the track of the question (in which case you can show them their instructions again). Rationale for not sterilising should cover… ● General inadvisability of performing procedure at a time of reproductive stress (e.g. delivery, termination of pregnancy [TOP], miscarriage, salpingectomy) ● Sterilization under age 30 associated with higher incidence of regret— this should be conveyed as a general rule of thumb rather than as a personal judgement ● Reversal not funded by NHS ● Higher failure rate when performed when pregnant ● Possible complications of sterilization— general anaesthetic, surgical trauma or if hysteroscopic day case procedure, uterine perforation, interval to confirmation of success, need for ongoing contraceptive method ● Lifetime failure rate of sterilisation 1:200 which is comparable to that of an IUS and higher than the failure rate of the contraceptive implant ● Vasectomy safer

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