Postmenopausal bleeding — structured oral station (12 minutes)

FRANZCOG oral-format station on postmenopausal bleeding: the 12-month definition and ~9% pooled cancer risk (Clarke 2018), the endometrial-thickness threshold (Karlsson, Smith-Bindman), the blind-versus-directed biopsy evidence (van Hanegem 2016), the source-by-source differential and the safety-net after recurrence (Ghoubara 2018), and the special populations (tamoxifen, granulosa cell tumour). Scored against the eight published RANZCOG oral domains.

Prompt

You are the gynaecology registrar in a one-stop clinic. A 68-year-old woman presents with recurrent postmenopausal bleeding; her first transvaginal ultrasound four months ago showed a 3 mm endometrium and she was reassured. The bleeding has now recurred. The examiner will test your definition and risk numbers, your source-by-source approach, your sampling-ladder reasoning on recurrence, the tamoxifen and hormone-therapy special contexts, and your handling of the safety-net after a previously reassuring workup. You may be shown a transvaginal-ultrasound image.

Station format

4 minutes reading, 12 minutes examination, 20 marks, global scoring. The eight published RANZCOG oral domains apply: history and examination; investigations and interpreting results; treatment and management; clinical knowledge; complex, urgent or unusual clinical presentations; rapport; respect; and communication skills. You are marked on how you behave, not only what you know. ^[1]

References6Show

[1]Clarke MA, Long BJ, Del Mar Morillo A, et al. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med, 2018.PMID 30083701
[2]Karlsson B, Granberg S, Wikland M, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study. Am J Obstet Gynecol, 1995.PMID 7755059
[3]Smith-Bindman R, Kerlikowske K, Feldstein VA, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA, 1998.PMID 9809732
[4]van Hanegem N, Prins MM, Bongers MY, et al. The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol, 2016.PMID 26748390
[5]Wolfman W, Leyland N, Heywood M, Singh SS, et al. Asymptomatic endometrial thickening. J Obstet Gynaecol Can, 2010.PMID 21176311
[6]Ghoubara A, Sundar S, Ewies AA Endometrial pathology in recurrent postmenopausal bleeding: observational study of 385 women. Climacteric, 2018.PMID 29741102

Postmenopausal bleeding — structured oral station (12 minutes)

Station format

References6Show

[1]Clarke MA, Long BJ, Del Mar Morillo A, et al. Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women: A Systematic Review and Meta-analysis. JAMA Intern Med, 2018.PMID 30083701
[2]Karlsson B, Granberg S, Wikland M, et al. Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study. Am J Obstet Gynecol, 1995.PMID 7755059
[3]Smith-Bindman R, Kerlikowske K, Feldstein VA, et al. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA, 1998.PMID 9809732
[4]van Hanegem N, Prins MM, Bongers MY, et al. The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol, 2016.PMID 26748390
[5]Wolfman W, Leyland N, Heywood M, Singh SS, et al. Asymptomatic endometrial thickening. J Obstet Gynaecol Can, 2010.PMID 21176311
[6]Ghoubara A, Sundar S, Ewies AA Endometrial pathology in recurrent postmenopausal bleeding: observational study of 385 women. Climacteric, 2018.PMID 29741102