Prompt

You are the gynaecology registrar leading perioperative planning for the patient in the linked structured case. The examiner will test risk assessment, prescriptions, complications, communication and regional evidence.

Station format

4 minutes reading, 12 minutes examination, 20 marks, global scoring. Demonstrate history and examination; investigations; treatment and management; clinical knowledge; complex/urgent care; rapport; respect; and communication. [1]

Reveal examiner script and model responses

Opening — “Summarise your approach.”

Define the clinical objective and distinguish routine prevention/recovery from treatment of a complication.
State patient risk, procedure risk and the first safe prescription or pathway step.
Name who owns timing, review and escalation. [1]

Probe 1 — “What history and examination change your plan?”

High VTE risk: active cancer, age, obesity, open major pelvic surgery and expected reduced mobility.
Assess previous VTE/thrombophilia, oestrogen, mobility and additional comorbidity.
Assess bleeding, platelets, renal function and the drug-specific neuraxial timing plan.

[1][4]

Probe 2 — “Give me the exact perioperative orders.”

Correctly sized IPC applied before or at induction.
Confirm pump is connected and cycling; inspect skin.
Continue until mobile, including while pharmacological prophylaxis is temporarily unsafe.

[1][4]

Probe 3 — “What happens after surgery and at discharge?”

Use LMWH when haemostasis and epidural timing permit.
ENOXACAN II: enoxaparin 40 mg SC once daily after open abdominal or pelvic cancer surgery.
HIGHLOW neuraxial interval: at least 12 hours after low-dose LMWH and at least 24 hours after intermediate-dose LMWH; agree the plan with anaesthesia.
Four weeks of LMWH (ENOXACAN II 12.0 versus 4.8 percent VTE); gynaecology discharge packs often run 28 days.
At discharge prescribe, teach injection technique, document stop date and safety net.

[2][3][5][6]

Probe 4 — “The patient deteriorates. What now?”

Hold LMWH and resuscitate/control the bleeding source.
Continue IPC if safe.
Document reason, owner and planned reassessment time.
Restart pharmacological prophylaxis when haemostasis and neuraxial considerations permit.

[1][4]

Communication probe

Say: “I will explain the purpose, benefits and harms in plain language, check understanding and preferences, and tell you which symptoms need urgent review. If the plan changes, I will explain why and when we will reassess.” [1][2]

Evidence probe

Name the ANZ local guideline as the operational source and use the verified international evidence in this station.
Acknowledge uncertainty rather than inventing a version, threshold or PMID. [1][2][3][4]

Obstetrics & Gynaecology Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Obstetrics & Gynaecology fellowship atlas.

References6Show ledger

[1]American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232 Obstet Gynecol, 2021.PMID 34259490
[2]Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer N Engl J Med, 2002.PMID 11919306
[3]Lyman GH, Bohlke K, Khorana AA, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014 J Clin Oncol, 2015.PMID 25605844
[4]Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, 2008.PMID 18574271
[5]Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Chest, 2012.PMID 22315263
[6]Bistervels IM, Wiegers HMG, Áinle FN, et al. Onset of labor and use of analgesia in women using thromboprophylaxis with 2 doses of low-molecular-weight heparin: insights from the Highlow study J Thromb Haemost, 2023.PMID 36695396

Station format

Reveal examiner script and model responses

Opening — “Summarise your approach.”

Define the clinical objective and distinguish routine prevention/recovery from treatment of a complication.
State patient risk, procedure risk and the first safe prescription or pathway step.
Name who owns timing, review and escalation. [1]

Probe 1 — “What history and examination change your plan?”

High VTE risk: active cancer, age, obesity, open major pelvic surgery and expected reduced mobility.
Assess previous VTE/thrombophilia, oestrogen, mobility and additional comorbidity.
Assess bleeding, platelets, renal function and the drug-specific neuraxial timing plan.

[1][4]

Probe 2 — “Give me the exact perioperative orders.”

Correctly sized IPC applied before or at induction.
Confirm pump is connected and cycling; inspect skin.
Continue until mobile, including while pharmacological prophylaxis is temporarily unsafe.

[1][4]

Probe 3 — “What happens after surgery and at discharge?”

Use LMWH when haemostasis and epidural timing permit.
ENOXACAN II: enoxaparin 40 mg SC once daily after open abdominal or pelvic cancer surgery.
HIGHLOW neuraxial interval: at least 12 hours after low-dose LMWH and at least 24 hours after intermediate-dose LMWH; agree the plan with anaesthesia.
Four weeks of LMWH (ENOXACAN II 12.0 versus 4.8 percent VTE); gynaecology discharge packs often run 28 days.
At discharge prescribe, teach injection technique, document stop date and safety net.

[2][3][5][6]

Probe 4 — “The patient deteriorates. What now?”

Hold LMWH and resuscitate/control the bleeding source.
Continue IPC if safe.
Document reason, owner and planned reassessment time.
Restart pharmacological prophylaxis when haemostasis and neuraxial considerations permit.

[1][4]

Communication probe

Evidence probe

Name the ANZ local guideline as the operational source and use the verified international evidence in this station.
Acknowledge uncertainty rather than inventing a version, threshold or PMID. [1][2][3][4]

Obstetrics & Gynaecology Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Obstetrics & Gynaecology fellowship atlas.

References6Show ledger

[1]American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232 Obstet Gynecol, 2021.PMID 34259490
[2]Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer N Engl J Med, 2002.PMID 11919306
[3]Lyman GH, Bohlke K, Khorana AA, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014 J Clin Oncol, 2015.PMID 25605844
[4]Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, 2008.PMID 18574271
[5]Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Chest, 2012.PMID 22315263
[6]Bistervels IM, Wiegers HMG, Áinle FN, et al. Onset of labor and use of analgesia in women using thromboprophylaxis with 2 doses of low-molecular-weight heparin: insights from the Highlow study J Thromb Haemost, 2023.PMID 36695396

Perioperative VTE prophylaxis — structured oral station (12 minutes)

Station format

Opening — “Summarise your approach.”

Probe 1 — “What history and examination change your plan?”

Probe 2 — “Give me the exact perioperative orders.”

Probe 3 — “What happens after surgery and at discharge?”

Probe 4 — “The patient deteriorates. What now?”

Communication probe

Evidence probe

Perioperative VTE prophylaxis — structured oral station (12 minutes)

Station format

Opening — “Summarise your approach.”

Probe 1 — “What history and examination change your plan?”

Probe 2 — “Give me the exact perioperative orders.”

Probe 3 — “What happens after surgery and at discharge?”

Probe 4 — “The patient deteriorates. What now?”

Communication probe

Evidence probe