Postmenopausal bleeding — structured oral station (12 minutes)

FRANZCOG oral-format station on postmenopausal bleeding: candidate states the 9% pooled cancer risk, defends the transvaginal-ultrasound endometrial-thickness threshold with the Karlsson and Smith-Bindman numbers, runs the Pipelle-versus-sonohysterography-versus-hysteroscopy sampling ladder, applies the RCOG GTG 67 split of hyperplasia, and counsels on tamoxifen-related bleeding. Scored against the eight published RANZCOG oral domains.

Prompt

You are the gynaecology registrar in the one-stop postmenopausal-bleeding clinic. A 64-year-old woman, whose last menstrual period was 3 years ago, reports two episodes of light brownish vaginal bleeding; she takes tamoxifen for breast cancer. The examiner will ask you to define the presentation, justify your imaging and threshold, defend your sampling ladder, apply the RCOG Green-top 67 management of hyperplasia, and counsel on the tamoxifen-related aspects. 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 to every station: history and examination; investigations and interpreting results; treatment and management; clinical knowledge; complex, urgent or unusual clinical presentations; rapport with patient, support person or colleague; respect; 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]Dijkhuizen FP, Mol BW, Brölmann HA, et al. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer, 2000.PMID 11042572
[5]Wolfman W, Leyland N, Heywood M, Singh SS, et al. Asymptomatic endometrial thickening. J Obstet Gynaecol Can, 2010.PMID 21176311
[6]Trimble CL, Kauderer J, Zaino R, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia. Cancer, 2006.PMID 16400639

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]Dijkhuizen FP, Mol BW, Brölmann HA, et al. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer, 2000.PMID 11042572
[5]Wolfman W, Leyland N, Heywood M, Singh SS, et al. Asymptomatic endometrial thickening. J Obstet Gynaecol Can, 2010.PMID 21176311
[6]Trimble CL, Kauderer J, Zaino R, et al. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia. Cancer, 2006.PMID 16400639