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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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 Posted: Mon Apr 30, 2007 10:41 am Post subject: result interpretation |
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Mr Fred Hall. 34 yrs. Ix for fertility with partner.
Semen analysis;
collected 22.3.07
2mls
pH 7.2
WBC < 1million/ml
count 30 million/ml, total 60 million
mobility 10%
normal forms 2%
live 50%
Mrs Katie Doll. 39 yrs. 6weeks postpartum. ovarian cyst noted during pregnancy.
US PELVIS
normaluterus with thin endometirum 3ms
left ovary seen and normal
right overy has several cysts the largest measuring 11x7x13cms. ground-glass appearance and streaming within which is more likely to be haemorrhagic. |
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Mon Apr 30, 2007 12:21 pm Post subject: |
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First case : Astheno-teratospermia
Second case : Complicated Ovarian cyst , I will advice for diagnostic laparoscopy to confirm the diagnosis and explore any associated pathology , then progress to cystectomy, The patient is conselled about the possibility of oopherectomy and progression to laparotomy.
HPE is required. |
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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Mon Apr 30, 2007 2:45 pm Post subject: |
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This is an OSCE question and I want full answers. We all know the problems. Explain yourself - fully. What do you want to know? What are you going to do and how?
Come on all you lot watching - have a go!! |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Mon Apr 30, 2007 4:25 pm Post subject: |
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| Abik wrote: | This is an OSCE question and I want full answers. We all know the problems. Explain yourself - fully. What do you want to know? What are you going to do and how?
Come on all you lot watching - have a go!! |
Long live Abi
She is quite right though - well done EMAK for getting involved but try and elaborate - short answers will not help you in the exam and the examiner does not necessarily need to push you - this should come spontaneously.
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Mon Apr 30, 2007 5:16 pm Post subject: |
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WoW! Abi! I feel sorry for the future candidates that will have you as an examiner! Brrrrrr
For Fred: Hx: Has he fathered any children, Smoke/Alcool, his occupation, is he on any medication (sulfasalazine, anabolic steroids can cause this picture), any recent flu, any previous surgery (inguinal hernia?), Hx/o mumps with orchitis, chemotherapy Tx.
Examination: Look for previous operations/varecocele
Investigation: Repeat semen analysis
Tx. Zinc and multivitamins have been shown to transiently improve the semen parameters but the evidence is poor. IUI or ICSI or Donor inseminetion (sorry Fred..). Therefore I would like to see Fred with his partner (what's happening with her investigations? very important) in my next routine available clinic appoitment |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Mon Apr 30, 2007 5:36 pm Post subject: |
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For Katie: Is she symptomatic ( Quite likely with such a big cyst and ground-glass appearance is linked with endometriomas isnt't it?). Is her periods returned? Is she breastfeeding? how was the cyst during pregnancy? Has it grown bigger? How was she before pregnany? Family Hx of ovarian Ca? (how's the baby, what's his/her name, oooh how sweet, etc... remember she is post partum).
I would like to see her in the clinic soon (she's probably anxious about the result) explain to her the USS findings, explore her symptoms, take a good Hx, examine her (feasibility for surgery laparoscopy/laparotomy) do a Ca-125 (could be elevated due to endometriosis but very high levels may be due to cancer), discuss the case in the MDT meeting with the result, consider further imaging (CT or MRI) or proceed to surgery. |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Mon Apr 30, 2007 7:23 pm Post subject: |
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What happened to the other forumers? Guys we need help! Wake up!
Rosemary Hunt 68: UDS studies
Bladder capacity 310 mls. Initial void 160 ml with a peak flow rate of 12 ml/sec. No unprovoked detrusor contractions noted. Severe incontinence noted on stress.
Caroline Hurler 24: Histopatholgy report:
Clin. infos. RPOCs
Result: Stella-Arias reaction. No chorinic villi seen. |
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mridulaben
Century Club
Joined: 08 Nov 2006
Posts: 137
Location: Brunei
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| Posted: Mon Apr 30, 2007 9:11 pm Post subject: |
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| wolverine wrote: | What happened to the other forumers? Guys we need help! Wake up!
Rosemary Hunt 68: UDS studies
Bladder capacity 310 mls. Initial void 160 ml with a peak flow rate of 12 ml/sec. No unprovoked detrusor contractions noted. Severe incontinence noted on stress.
Check notes If any Plan & when is next appnt
If not for routine appnt to discuss for TVT, But has ?? voiding problem also as flow rate is less than 15ml/s
if any medical problems or asctd morbidities, needs fitness for surgery
Very poor try!!!!Just 2 weeks only
Caroline Hurler 24: Histopatholgy report:
Clin. infos. RPOCs
Result: Stella-Arias reaction. No chorinic villi seen. |
Ectopic
Get case notes or in computer to contact her
To be seen urgently if not admitted again
ask her GP to contact her
call back, see her symptoms & vitals
beta HCG
TVS
Consider Laparoscopy after discussion
FBC& grp, save |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Tue May 01, 2007 9:26 am Post subject: |
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Great questions guys and very exam-comparable.
I suggest you all set and answer as many of these as you can - you will kick yourself if you get one in the exam!
The Aria-Stella reaction on biopsy / D&C is a classic as is a decidual reaction on Pipelle in a woman who has been sterilised or had a TCRE (came up last exam in fact and we covered this on OSCE Gold this weekend).
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Tue May 01, 2007 3:52 pm Post subject: |
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Nick please elaborate!! (or someone else) we weren't all free to come to the OSCE Gold course  |
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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Tue May 01, 2007 3:56 pm Post subject: |
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| wolverine wrote: |
Rosemary Hunt 68: UDS studies
Bladder capacity 310 mls. Initial void 160 ml with a peak flow rate of 12 ml/sec. No unprovoked detrusor contractions noted. Severe incontinence noted on stress.
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Great question and good answer from mridulaben.
She can be seen routinely - nothing urgent.
Void and rate suggest voiding dysfunction but not always the case. Re-check history for any suggestion of vioding problems. Hesitancy, dribbling, re-voiding. Could also check residual with USS prior to return to clinic. Was she incredibly nervous on the day (I had this with a patient who said she was too shy to pee!!)
Any signs of neurology? TVT/TOT risky with this picture but may be worth it from her point of view. Best to see her when there is a consultant handy for discussion. |
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Abik
Century Club
Joined: 15 Jan 2007
Posts: 243
Location: Poole
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| Posted: Tue May 01, 2007 4:01 pm Post subject: |
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| Miss KT, 42 yrs old. Cervical biopsy = invasion. Lletz = CIN 3 to the margins, no invasion |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Tue May 01, 2007 4:42 pm Post subject: |
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| Abik wrote: | | Nick please elaborate!! (or someone else) we weren't all free to come to the OSCE Gold course |
Have a go first of all ... click here to see the questions from the recent exams.
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 |
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wolverine
Century Club
Joined: 16 Jan 2007
Posts: 394
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| Posted: Tue May 01, 2007 5:07 pm Post subject: |
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| Abik wrote: | She can be seen routinely - nothing urgent.
Void and rate suggest voiding dysfunction but not always the case. Re-check history for any suggestion of vioding problems. Hesitancy, dribbling, re-voiding. Could also check residual with USS prior to return to clinic. Was she incredibly nervous on the day (I had this with a patient who said she was too shy to pee!!)
Any signs of neurology? TVT/TOT risky with this picture but may be worth it from her point of view. Best to see her when there is a consultant handy for discussion. |
Very good answer Abi! It does suggest voiding disfunction probably due to detrusor insuficiency as the volume is >150 mls (only just) and the rate <15 mls/sec. Difficult managment. PFE and ring/tampons would be more appropriate (conservative) as any surgery could worsen her voiding problem or give rise to detrusor instability. TVT/TOT with clear documentation of the above risks if really desparate. Also neurological causes should be excluded as you said. (would you consider urogyn instead of oncology at the end?) |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Tue May 01, 2007 5:16 pm Post subject: |
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| Abik wrote: | | Miss KT, 42 yrs old. Cervical biopsy = invasion. Lletz = CIN 3 to the margins, no invasion |
Invasion has not been excluded then. Bring her back urgently and repeat the Excision probably a loop or knife cone. If complete this time (CIN3 or even microinvasion) treatment could be completed or proceed to a simple hysterectemy. If Ia2 and above will need radical hysterectomy. Cervical biopsy is generally rubbish for high grade lesions as it overestimates and has high false positives for invasion. |
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